Behavioural problems can occur in children of all ages. Very often they start in early life. Toddlers and young children may refuse to do as they are asked by adults, in spite of being asked many times. They can be rude, swear and have tantrums. Hitting and kicking of other people is common. So is breaking or spoiling things that matter to others.

Some children have serious behavioural problems. The signs of this to look out for are:

• if the child continues to behave badly for several months or longer, is repeatedly being disobedient, cheeky and aggressive
• if their behaviour is out of the ordinary, and seriously breaks the rules accepted in their family and community, this is much more than ordinary childish mischief or adolescent rebelliousness.

This sort of behaviour can affect a child's development, and can interfere with their ability to lead a normal life. When behaviour is this much of a problem, it is called a conduct disorder.

Children with a conduct disorder may get involved in more violent physical fights, and may steal or lie, without any sign of remorse or guilt when they are found out. They refuse to follow rules and may start to break the law. They may start to stay out all night and truant from school during the day. Teenagers with conduct disorder may also take risks with their health and safety by taking illegal drugs or having unprotected sexual intercourse.

This kind of behaviour puts a huge strain on the family. Children who behave like this will often find it difficult to make friends. Even though they might be quite bright, they don't do well at school and are often near the bottom of the class. On the inside, the young person may be feeling that they are worthless and that they just can't do anything right. It is common for them to blame others for their difficulties if they do not know how to change for the better.

What causes oppositional defiant disorder/conduct disorder?

A child is more likely to develop an oppositional defiant disorder/conduct disorder if they:

• have a difficult temperament;
• have learning or reading difficulties - these make it difficult for them to understand and take part in lessons. It is then easy for them to get bored, feel stupid and misbehave;
• are depressed;
• have been bullied or abused;
• are `hyperactive' - this causes difficulties with self-control, paying attention and following rules (see Factsheet 5 on ADHD and hyperkinetic disorder).

Parents themselves can sometimes unknowingly make things worse by giving too little attention to good behaviour, always being too quick to criticise, or by being too flexible about the rules and not supervising their children adequately. This often happens if a parent is depressed, exhausted or overwhelmed.

Aggressive behaviour is a normal reaction in young children. It emerges most often when children feel the need to protect their safety, happiness, individual position within the family or group, their inability to verbalize frustration or as a learned response i.e. a parent or leader gives into the child's demands in order to stop the undesired behaviour. By 7-9 years of age children are fairly well controlled, so if the the child still engages in frequent, Often children who strike out physically cannot or do not know how to control their tempers.

Acknowledge the child's feelings. Even if the behaviour is unacceptable, the child's feelings are real, so do not minimize the frustrations or concerns of the child. One approach might be "I know that in this situation you feel like hitting, but hitting is not acceptable, why you don’t tell me how you feel".

There are no real statistics as to the number of children who act relatively silly at various ages. Also, there are no estimates as to what percentage of time a child must act foolishly before the behaviour is considered a problem, making it very difficult to determine whether constant clowning should be considered a problem or a sign of general immaturity. Therefore, the concern about clowning/silliness becomes a combination of the amount of the child's behaviour and the parent's and leader's attitude and tolerance about it. Children who feel negatively about themselves try acting like clowns to obtain attention from others. Negative attention is better than no attention at all. Peer influence is very powerful. Peers very often encourage or even provoke a child to act foolishly. Positive or very negative reactions from peers, respected adults, or parents can reinforce clowning in the child who is lonely and desperate for attention. Silliness is very common in young children and absolutely contagious when friends act silly. For some children silliness can continue as a habit if they are not taught appropriate humour. These children may believe that the only way to get the attention that they crave, is to be laughed at. Similarly, they may feel that the only way to be humorous is to be a clown. There is no question that a constant clowner can be very disruptive to a program.

Symptoms usually do not occur until blood flow becomes restricted or blocked. See the specific condition for more details on symptoms:

• Abdominal aortic aneurysm
• Coronary artery disease
• Kidney disease
• Mesenteric artery ischemia
• Peripheral artery disease
• Renal artery stenosis
• Hypertension
• Stroke (cerebrovascular disease)
• Thoracic aortic aneurysm

A health care provider will perform a physical exam and listen to the heart and lungs with a stethoscope. Atherosclerosis can create a whooshing or blowing sound ("bruit") over an artery.

Tests that may be used to diagnose atherosclerosis or its complications include:

• Ankle/brachial index (ABI)
• Aortic arteriography (aortic angiography)
• Arteriography
• Cardiac stress testing
• Coronary artery angiography)
• CT scan
• Doppler study
• Extremity arteriography
• Intravascular ultrasound (IVUS)
• Magnetic resonance arteriography (MRA)
• Mesenteric arteriography
• Pulmonary angiography
• Renal arteriography

To help prevent atherosclerosis or its complications (such as heart disease and stroke), make the following lifestyle changes:

• Avoid fatty foods. Eat well-balanced meals that are low in fat and cholesterol. Include several daily servings of fruits and vegetables. Adding fish to your diet at least twice a week may be helpful. However, do not eat fried fish.
• Do not drink more than one or two alcoholic drinks a day.
• Exercise regularly for 30 minutes a day if you are not overweight, and for 60 - 90 minutes a day if you are overweight.

Get your blood pressure checked every 1 - 2 years, especially if high blood pressure runs in your family. Have your blood pressure checked more often if you have high blood pressure, heart disease, or you have had a stroke. Talk to your doctor about how often you should have yours checked.

Specific recommendations depend on your age and blood pressure readings.

• Everyone should keep their blood pressure below 140/90 mmHg
• If you have diabetes, kidney disease, or have had a stroke or heart attack, your blood pressure should probably be less than 130/80 mm/Hg. Ask your doctor what your blood pressure should be.

Have your cholesterol checked and treated if it is high.

See: High cholesterol and triglycerides

• Adults should have their cholesterol checked every 5 years. If you are being treated for high cholesterol or a family history of cholesterol problems, you will need to have it checked more often.
• All adults should keep their LDL ("bad") cholesterol levels below 130-160 mg/dL.
• If you have diabetes, heart disease, or hardening of the arteries somewhere else in your body, your LDL cholesterol should be lower than 100 mg/dL.

A number of surgeries are performed to help prevent the complications of atherosclerosis. Some of these are:

• Angioplasty and stent - heart - discharge
• Angioplasty and stent placement - peripheral arteries
• Coronary artery bypass surgery