The Difficult Child

Abstract

One of the more common problems confronting the consultant is that of the uncooperative or difficult pediatric inpatient, whose non-compliance threatens recovery and whose behavior disturbs the ward and its staff. The differential diagnosis of such “problem” cases includes various organic states, inadequate education and preparation by staff, anxious or depressive responses to illness and hospitalization, pre-existing psychopathology, the influence of problematic parental styles, maladaptive adolescent attempts to cope with dependency and helplessness, and mature decisions to refuse treatment. The multifaceted assessment and management of such cases are discussed.