behavioral disorder

common behavioral disorder

1. Common Behavioral Disorders Presented by: Aruna Shastri M.Sc. Nursing 1 st year Roll no. 826

2. Behavior: The way in which one acts or conducts oneself, towards others or The way in which an animal/ person behaves in response to a particular situation or stimulus.

3. Behavioural disorders are conditions in which an individual experiences alterations in thinking and emotions that result in challenging behaviours . Behavioral disorders:

4. Heredity Temperament Environment Learning Conditioning Positive reinforcements Parenting Factors influencing behavior of a child:

5. Harming or threatening themselves, other people or pets Damaging or destroying property Lying or stealing Not doing well in school, skipping school Early smoking, drinking or drug use Early sexual activity Frequent tantrums and arguments Consistent hostility towards authority figures Warning signs:

6. Habit disorders Learning disabilities Sleep disorders Eating disorders Conduct disorders ADHD Autism Common disorders in children:

7. Behavioral problems: Infancy: Resistance to feeding Impaired appetite Abdominal colic Stranger anxiety

8. Childhood Problems: Temper tantrums Breath-holding spells Thumb sucking Nail biting Enuresis/ bed wetting Encopresis Geophagia or Pica Tics Speech problems

9. Adolescence problems: Masturbation Juvenile delinquency Anorexia nervosa Bulimia nervosa Substance abuse Schizophrenia Depression

10. INFANCY & YOUNG CHILD

11. Benign & self-limiting Begin between 6 – 10 months Eg . Body rocking Head banging Repetitive behavior:

12. Padding hard surface Reassuring parents Parents should ignore the behavior No punishment Repetitive behavior: Management:

13. Breath Holding Spells: Provocative event- starts crying Cyanotic or pale Sometimes, loss of consciousness, or even seizure can occur. It is child’s attempt to control environment, parents /caregivers. Rare before 6 months , peak at 2 years and abate by 5 years

14. Management: History For repeated cyanosis, do echocardiogram Reassure parents. Iron supplement ( 3 mg/kg/day) Child guidance clinic reference.

15. Thumb sucking and Nail Biting

16. Thumb Sucking and Nail Biting Repetitive ritual to cope with stress situations- infants and toddler Reinforced by attention from parents. Predisposing factors: Developmental delay Neglect Most give up by 2 years If resumed at 7 – 8 years : sign of Stress

17. Adverse effects of Thumb Sucking: Malocclusion Mastication difficulty Speech difficulty Lisping Paronychia and digital abnormalities

18. Management: Reassure parents that it’s transient. Improve parental attention / nurturing. Teach parent to ignore; and give more attention to positive aspects of child’s behaviour. Provide child praise / reward for substitute behaviours. Bitter salves, thumb splints, gloves may be used to reduce thumb sucking.

19. Enuresis: Involuntary passage of urine into bed in children who are beyond the age when voluntary bladder control should normally have been acquired. It is urinary incontinence beyond the age of 4 years for daytime and 6 years for night time.

20. Enuresis: The inappropriate voiding of urine At least twice a week At least 3 consecutive months or child suffers significant distress because of it. Prevalence-7% in Boys Age of 5 years 3% in Girls

21. Enuresis classification: Enuresis Primary Secondary Nocturnal Diurnal

22. Enuresis classification: Primary - Child has never been dry at night Secondary - Child begins bedwetting after remaining continent for 6 months or more. Nocturnal- Involuntary voiding occurs only during sleep at night Diurnal- Occurs during daytime also while child is awake

23. Enuresis etiology: Genetic -PNE Risk-40% if one parent had in childhood 70% if both parents had Physiological factors- ADH at night Delayed maturation of urethral sphincter control Increased bladder irritability -UTI and severe constipation with full rectum impinging on bladder

24. Polyuria -DM or DI can present as secondary enuresis. Organic causes- Spina anomalies(neurological bladder dysfunction),ectopic ureter Psychological factors- Secondary enuresis precipitated by acute stressful condition Micturition deferral- Waiting till the last minute to void is a common cause

25. Investigations: Full medical history Genital and Neurological examination Tests for DM, DI, CRF Examination of urine Evidence of UTI- further evaluated with Ultrasonography Voiding cystourethrogram and Urodynamic studies (for bladder capacity =300 to 350ml normal)

26. Management: Children below 6 years-high spontaneous cure rate Non pharmacological therapy Motivational therapy Child assume active responsible role

27. Contd … Void before going to bed Change wet clothes and bedding Restrict fluids caffeinated like cola coffee and tea in evening Positive reinforcements should be given (praise, star chart)

28. Management: Alarm therapy Elicit a conditioned response of awakening to the sensation of a full bladder. Ordinary alarm clocks can be used to wake up the child prior to usual time of Bedwetting.

29. Pharmacotherapy Imipramine - Alter the arousal-sleep mechanism 1-2.5mg/kg/day Relapse rate is high Adverse effect- cardiac conduction disturbance Oxybutynin - anticholinergic drug:-reduces uninhibited bladder contractions useful in children with urge incontinence 10-20 mg/day

30. Desmopressin(DDAVP) 10 mcg orally or intranasally Drug of Choice – staying out for the night Reduce the volume of urine produced at night Relapse rate is high Rare adverse effects- Water intoxication, Hyponatremia

31. Nursing considerations: Help parent to understand and the problem its management and tell them to give love. Supportive management and encouragement for patience. Encourage communication with child Decrease fluid intake after 5pm Parents should be taught to observe for side effects of any medications. Remind child to empty bladder 2 hourly

32. Children do not always display their reactions to events immediately although they may emerge later. It is important to realize that all children go through periods of behavioural and/or emotional difficulty. It is also important to recognize that all children are individuals, therefore there is no universal formula for resolving all emotional or behavioural problems. Conclusion:

33. QUERIES??

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