Of all the questions I receive from parents, by far the most frequent questions refer to the normalcy of their children's behaviors.

Parents want to know if the things their children can and cannot do, the way they behave, and the difficulties they face are normal. Generally speaking, there is a very broad range of what is “normal.”

There is a normal curve for most behaviors and those of us that do developmental analyses know what we should and should not see, on the average, in a child at any given age. For example, a child at 15 months of age should have lost most of her neonatal reflexes, she should be walking, and she should be forming at least a few words.

But there is variability in when these skills develop. A child who exhibits a behavior earlier than the average child is not necessarily exceptional. Likewise, a child who is later than average in exhibiting a certain behavior is not necessarily dysfunctional. For example, one child might talk at 13 months and another might not talk until 22 months and yet both could be seen as “normal.”

Other issues in childhood have equally evasive meanings. For example, I am often questioned by parents who wonder if their children are normal because they appear more aggressive than other children, or because they seem to have disturbed sleep patterns. This is especially true for parents who have more than one child, with the child in question being the youngest, because the younger child is so visibly different from older siblings.

However, in children of any age, there are three specific behaviors that are almost never normal. I always ask about these three behaviors when I am analyzing a child. These three behaviors are called the “terrible triad.”

Their presence in a child, especially when the child exhibits all three behaviors together, is almost always a troubling sign. The first of these three behaviors is bed-wetting. All children, of course, wet the bed and how long it takes to train children to master nighttime bladder control varies. However, once the child has fully mastered both day and nighttime bladder control, a relapse several months, or especially several years, later is a troubling symptom.

Even though there are many reasons why a child might begin to wet the bed after mastering the skill, those reasons include trauma such as sexual abuse. I absolutely never draw any such conclusion based on a single piece of evidence, but it is something I would definitely investigate until I am satisfied that something else is causing this relapse.

The second symptom of the terrible triad is fire setting. Again, both children and adults have some level of fascination with fire. Curious children may occasionally seek to experiment with fire or matches, but an obsession with fire and an apparent need to burn things is highly abnormal. This need to destroy is indicative of unresolved internal conflict.

The final symptom of the triad is cruelty to animals. It is not unusual for children to hurt animals by accident, but any harm to animals that is deliberate and cruel is abnormal. Children normally have compassion for animals and the absence of such compassion is a sign of a problem.

I have always found significant disturbances in children who torture or kill pets, neighborhood animals, or wild animals that are caught for the purpose of torturing. Like fire setting, this is representative of a need to destroy and it also is a sign of serious emotional distress.

Many years ago when I was first beginning my practice, I worked with a child who delighted in killing frogs. He repetedly would find frogs and then throw them into trees or into the ground to kill them. His parents were not sure if that was a problem. In his case, it most definitely was a problem.

Many teenagers and young adults who rape, assault, or kill began their careers by torturing and/or killing animals. I recognize I am making a sweeping generalization, but if there is no resolution to the internal conflict that drives this behavior, he or she will eventually graduate to harming people.

Because every child is different, I am very careful in my developmental analyses and I look for a normal progression in development as much as I look for certain behaviors at a certain time. I also consider the wide variety of backgrounds and cultures that could contribute to behaviors that I see. However, a parent, teacher or other concerned adult who sees any or all of the terrible triad should pursue clinical intervention for the child.

These behaviors are not normal and the child should be referred to a psychologist for evaluation.

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