“He is too rough with his little sister; it’s started to concern us. This is a new behavior that started about six months ago. Shouldn’t he know better at five years of age?

Ralph’s parents have come to my office for a parent guidance session focused on their older child’s recent behavioral issues. While Ralph has adjusted to kindergarten without any issues, he is often dysregulated when he returns home after school. Too often, his upset focuses on his two-year-old little sister, Grace.

Grace is delighted to see Ralph after school, but she is also a typical two-year-old. She likes to play with his toys. She might grab something out of his hands. Ralph is enraged that she doesn’t understand the concept of taking turns. He grabs his toy back, or pushes Grace away from his prized possessions. He doesn’t recognize how much bigger and stronger he is. Grace invariably ends up in tears. Despite repeated time-outs and explanations why he needs to be more gentle, Ralph’s behavior has not improved.“What else can we do?” his parents wondered.

Before delving into the potential psychological meaning of Ralph’s conduct, I first learn about Ralph’s sleeping and eating habits. Fatigue, hunger and thirst are the most common, and easily treated reasons, for pediatric dysregulated behavior.

What time is Ralph going to sleep? Most children his age need 10-13 hours of sleep per night. If Ralph is sleep........

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