Question: A 4-year-old is consistently defiant of his parent's instructions and is getting into trouble in preschool. The adults see this as his simply being a difficult child. What issues might they consider? (What they don't realize is that he is having trouble with attention, lack of structure and inability to make transitions.)
Answer: When we're considering some problems that preschoolers are having in school with behavior or with defiance, we should think of these in terms of biological problems or psychological and environmental problems. Biologically, the child may have trouble with vision or with hearing, interfering with processing information. They may be neurologically slow at processing information; they may have trouble with attention or distractibility; they may have difficulty with anxiety or mood. Some kids have trouble with transition. Some kids have trouble with short fuses. All of these are the way kids are built.
And it's very important for parents to understand and know their child and know the child's limitations. An additional area is what's going on psychologically and environmentally; what's happening at home? Have there been any stresses at home in terms of birth of siblings, death, job losses, changes in homes or the environment in homes? So when we think about those stresses 4-year-olds are exquisitely sensitive to parental stress. If we look at both of those things, the parents need to take stock about what the child's capabilities are look at their own expectations.
See how the child is meeting them or not meeting them. I think it's always wise to get an outside opinion -- a relative, a friend, the pediatrician -- or they could even go to a child psychologist or psychiatrist to get some advice about how to assess these issues and then figure out what they can do to address them in a way that's helpful for the child and helps to restructure the child's response to school and to other situations that require attention.