My cousin has a child who definitely has a severe problem. She is only 7 years old but seems to enjoy pain or punishment. She asks that her mother do things to her to make her angry, and she is cruel to other children and to her younger sister. Her speech and communication skills are slow. The school has already requested she leave. The parents are just now beginning to admit there is a problem. How would you suggest they proceed?

I’m glad her parents acknowledge there is a problem. It sounds like several things are going on with this child. Your question brings up quite a few issues that need to be investigated by professionals. She should be seen by her pediatrician to address the developmental delays. If she has had regular checkups, her parents may have already discussed these concerns with her doctor. The pediatrician may refer her to a pediatric neurologist for evaluation. She may need to be assessed by a speech pathologist. Other medical concerns should also be addressed.

You mention that she seems to want pain and punishment and that she is cruel to other children. I would recommend that the family see a family therapist. Sometimes children act out when there are other problems in the family. She may be reacting to parental instability such as depression or marital strife. Sometimes when children are in emotional pain, they hurt themselves physically. Physical pain often seems more manageable to children than emotional pain. A good family therapist will try to sort out what is happening with the family and with the child and make recommendations. You are obviously an alert, concerned cousin and your support can be very helpful.

Eve Kahn, LPC
Family and Personal Counseling Center
314-427-3832

Caring people frequently find themselves not knowing how best to intervene on behalf of troubled youth. Here are some examples of comments that might be helpful in a face-to-face or phone conversation with your cousin.

• Compliment some aspect of parenting. For example, "I’m impressed with how calm you remain when the kids are yelling."
• State your concern for the parent. "It must be frustrating for you to be asked again and again to find alternate schools for your daughter. I hope you have some professionals helping to find a school well suited to promoting her success."
• Share some "outsider" observations of the child along with your concern for the child. For example, "You seem to understand her so easily (compliment), but much as I try, I can’t understand her speech…it occurs to me that she might be frustrated by the same thing. Maybe that’s why she tries to get you to act mean to her, to give her opportunities to be angry and let out her frustration. Is there anything I might do to help things get easier for you?" This form of engagement is likely to breed a response that is both self-disclosing and appreciative on the other’s part.

If your cousin is open to helpful ideas, suggest a comprehensive developmental assessment. Referrals sources include the pediatrician, school district and early childhood/special education services, Cardinal Glennon Hospital and St. John’s Mercy Child Development Center. The young girl’s behavior will likely change when her communication frustrations are alleviated and her family is supported in paying lots of attention to her when she is behaving in pro-social ways.

Marla Liberman, Ph.D.
Hawthorn Children’s psychiatric Hospital
St. Louis, MO

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