Behavioral disorders

Behavioral disorders in pediatric population

1. SEMINAR ON BEHAVIORAL PEDIATRICS.

2. INDEX INTRODUCTION. DEFINITION CAUSES OF BEHAVIOURAL DISORDERS TYPES OF BEHAVIOURAL DISORDERS ASSESSMENT OF COMMON BEHAVIORAL DISORDERS. DESCRIPTION OF BEHAVIOURAL DISORDERS CONCLUSION

3. INTRODUCTION Behavioral disorders include many tension reducing activities that appear during childhood at various levels of development. Some of these habits develop from adults through imitation where as other as purposeful movement.

4. DEFINITION When children cannot adjust to a complex environment around them, they become unable to behave in the socially acceptable way resulting in exhibition of peculiar behaviours and this is called as behavioural problems.

5. CAUSES OF BEHAVIORAL DISORDERS Faulty Parental Attitude Inadequate Family Environment Mentally and Physically Sick or Handicapped Conditions

6. Influence of Social Relationship. Influence of Mass Media. Influence of Social Change.

7. TYPES OF BEHAVIORAL PROBLEMS IN CHILDREN Behavioural disorder results due to deprivation in any one of the area mentioned below :- 1. Emotional Deprivation. 2. Physical Deprivation. 3. Social Deprivation 4. Other forms.

8. 1. EMOTIONAL DEPRIVATION It occurs when a child is criticized, neglected, ignored or abused by primary caregiver. Behavioral problems resulting from emotional deprivation are :- Tempertantrum Breath holding spells Jealousy Insomnia Nightmares/ night terrors Somnolence

9. Contd. Masturbation or Homosexuality Bruxism

10. 2. PHYSICAL DEPRIVATION A physically deprived child has profound effects on developing brain. Behavioural disorders coming under this are :- Enuresis (Bed wetting) Encopresis Tics Nail Biting Pica Thumb Sucking

11. Attention Deficit Hyperactive Disorder

12. SOCIAL DEPRIVATION It is the reduction of culturally normal interaction between individual and society, It includes :- Juvenile Deliquency School Phobia Stealing Repeated Failures Lying Agerssiveness /Destructiveness

13. Other forms Sibling Rivalry Speech Disorder

14. ASSESSMENT OF COMMON BEHAVIORAL PROBLEMS Assess whether child is happy or difficult to manage. Child’s response to new situation. Excessive demand of attention. Problems of toilet and bladder. Habit of nail biting, thumb sucking, pica etc...

15. DISORDERS CAUSED BY EMOTIONAL DEPRIVATION. 1. TEMPERTANTRUM. Temper tantrum is a sudden outburst or violent display anger, frustration and bad temper as physical aggression or resistance such as rigid body, biting, kicking, throwing objects, hitting, crying, rolling on floor, screaming loudly, banging limbs, etc.

16. SYMPTOMS Loud cry Shouting Kicking Biting Head Banging Screaming Throwing and breaking objects Inflicting self injury.

17. Management Support the child and protect from self harm. Take away the child from immediate cause in a calm and quiet way. Wash the face and hands of child and change clothes. Educate the child about acceptable behaviour and give toys and emphasize on play therapy.

18. 2. BREATH HOLDING SPELLS. These are brief periods for which young children stop breathing for 1 minute. These spells often causes a child to lose consciousness. It is of 2 types: Cyanotic Spell Pallid Spell

19. Cyanotic Spell :- It is caused by a change in child’s usual breathing pattern, usually in response to feeling angry or frustrated. Pallid Spell :- It is caused by slowing of child’s heart rate usually in response to pain.

20. SIGN AND SYMPTOMS Fainting Stiff body Too fast or too hard breath Long pause before child takes another breath Red or blue purple lips Intense/single or no cry at all

21. MANAGEMENT During the episode, make the child lay down in floor and prevent his/her arms or legs from hitting any sharp object. After the episode, child starts breathing immediately after 1 min. But if the child does not breathes then call emergency. Give plenty of rest.

22. 3. JEALOUSY Jealousy is a normal response to actual, supposed or threatened loss of affection. e.g. During the birth of an additional family member lots of new feelings are generated in older child.

23. SYMPTOMS Aggressive nature Roughly handling of new baby Children may act naughty to get attention Gets detached and may become over affectionate

24. MANAGEMENT Never punish the child for his feeling of jealousy. Teach the child to deal effectively with his emotions. Parents should treat child equally and avoid comparison. Professional help can be taken in complicated cases.

25. SLEEP DISORDERS, 4. SOMNILOQUY It is a sleep disorder that refers to talking aloud while asleep. It can be quite loud ranging from simple mumbling sounds to loud shouts.

26. SYMPTOMS Talking irregularly and giving gaps like normal conversation. Child gives good facial expression in sleep also.

27. MANAGEMENT Sleep alongwith the child and assure that parents are with him/her. Satisfy the child’s needs. Resolve conflicts with other children. Try to make good relationship with child. Do not show movie or tell story before sleeping.

28. 6. SOMNABULISM It is a phenomenon of combined sleep and wakefulness. In this sleep walking occurs at a state of low consciousness and child performs activities that are usually performed in full consciousness.

29. SYMPTOMS Activities like: Sitting up in the bed. Walking to the bathroom and cleaning it. Initiating hazardous activities like cooking, driving and grabbing hallucinated objects. Homicide

30. MANAGEMENT Lock the doors and windows of the room in which child is sleeping. Remove all dangerous and hazardous objects, Give small dose of Diazepam in advance cases. Consult physician in uncontrollable cases.

31. 7. NIGHTMARES AND NIGHT TERRORS NIGHTMARES:- In this the child gets awakened due to a frightening bad dream but the child is conscious about the surrounding. NIGHT TERRORS:- In this the child gets awakened during sleep and sits up screaming and terrified to recognize the surroundings and after sometimes sleeps again.

32. SYMPTOMS Child suddenly awakes during sleep periods. Child gets frightened and may not be fully alert. Child describes frightening dreams in detail He seeks and responds to comfort given by parents. May resist return to bed because of fear of recurrence.

33. Management Give reassurance to the child by holding him. Speak in very soothing tone that there is nothing wrong. Discuss the dream images with the child and work together to change the outcome Have the child to go to bed in same time everyday. Avoid scary books or movies before sleeping

34. 8. INSOMNIA It is a sleep disturbance in which children have trouble falling asleep or staying asleep at night.

35. SYMPTOMS Difficulty falling asleep or staying asleep or waking up too early in morning. Being sleepy during the day. Irritability Mood swings Decreased attention span

36. MANAGEMENT Provide a comfortable sleep environment. Set bedtime to obtain usual timing of sleep. Provide deep breathing, positive mental imaginery while lying in bed and other relaxation technique.

37. 9. MASTURBATION AND HOMOSEXUALITY Masturbation:- It is the stimulation and manipulation of one’s own genitals in order to achieve orgasm. Homosexuality:- It is the sexual attraction between the members of same sex or gender.

38. MANAGEMENT Parents should not scold or show negative attitude towards child’s behaviour. Advice and educate the child in a non threatening way about acceptable behaviour in public. As intellectual development progress incidence of masturbation declines in preschoolers.

39. BRUXISM It is excessive grinding or clenching of teeth while sleeping which is not related to normal function of eating or talking.

40. SYMPTOMS Excessive teeth wear. Tooth fractures Hypersensitive teeth Grinding or tapping noise during sleep Cheek/lip Biting Tenderness, pain or muscle fatigue Headache particularly in temples

41. MANAGEMENT Repairing of damaged teeth. Dental restoration like crown filling.

42. DISORDERS CAUSED BY PHYSICAL DEPRIVATION ENURESIS Enuresis refers to bed wetting after the age of 5 years. It is common pediatric problem in which repeated involuntary urination takes place at an age in which voluntary bladder control should have established. It is of 2 types :-

43. PRIMARY ENURESIS :- In this child is never dry at night and occurs as a result of rigid bladder training by parents who are over anxious. SECONDARY ENURESIS :- It is characterized by initial control of bladder that later gets disrupted by stressful environment.

44. SYMPTOMS Repeated voiding of urine into bed or clothes. Soiling themselves.

45. MANAGEMENT Do not give excess fluid to child after 6-7 pm Make the child void before going to bed Do not give strict bladder and bowel training Wake up the child once or twice at night to void Reward the child for dry nights

46. 2. ENCOPRESIS It is repeated voluntary or involuntary passage of feces of normal or near normal consistency in places not appropriate for that purpose.

47. CAUSES Subconscious anger Child with emotional problem Psychosocial stress like entering new school

48. MANAGEMENT Do not give too strict toilet training. Educate parents that toilet training is a developmental process which happens in time. Provide minerals and vitamins if deficiency occurs. Give family counselling about the problem.

49. 3. TICS A tic is a nonvoluntary body movement or vocal sound made repeatedly or suddenly. They appear to be a manifestation of discharge of tension. It is of following types :- SIMPLE TICS- It involves only few muscles or sounds that are not words. E.g. Nose wrinkling, facial griemace , jerking the neck and shrugging the shoulders.

50. COMPLEX TICS- It involves multiple group or muscles or complete words or sentences. Eg . Making same motions with hands repeatedly, Touching or smelling an object repeatedly and holding body in unusual position. SENSORY TICS- In this repeated unwanted or uncomfortable sensation arise. E.g. Repeated feeling of blinking the eyes.

51. PHANTOM TICS- It is the least common type. In this out of body variation takes place and the person feels a sensation in other people or object, E.g. The person experience relief by touching or scratching the object involved.

52. MANAGEMENT Tics should be ignored by caregivers while working with these children Allow the child to discuss concerns related to school and family. Refer child for medical evaluation if tic does not decrease,

53. 5. NAIL BITING Nail Biting is a common habit of childhood. It is usually an overt evidence of anxiety in older children. Sometimes thumb suckers change to nail biters as they grow older.

54. SYMPTOMS Biting nails of all the fingers. The cuticle, skin margins, and surrounding tissue of the nail gets affected. Nail cutting is painful and the child may use this as a form of self punishment.

55. MANAGEMENT Assess the psychological environment of the child. Do not scold or punish the child for it. Use a bitter substance applied for nails. Keep child’s hand soft by applying lotion or warm oil.

56. 6. PICA It is eating substances other than food. E.g. Clay, sand, plaster from walls. It is frequent in first year of life but may be seen in grown ups as well.

57. SYMPTOMS Lack of appetite. Lots of hair collection in stomach. Intestinal and parasitic infection. Minerals and vitamin deficiencies.

58. MANAGEMENT Provide treatment of worm infestations. Provide psychotherapy. Proper supervision of parents is necessary.

59. 7. THUMB SUCKING Sucking is the infant’s chief pleasure through which they get love, affection and satisfaction. Infants do thumb sucking if they lack oral satisfaction.

60. CAUSES OF THUMB SUCKING Infants deprived of sucking and breast feeding Manifestation of feeling of insecurity Lack of bonding between parent and child Sign of boredom, stress and isolation

61. MANAGEMENT Parents should not show anxiety till the child is 4 years old. Always praise and encourage the child which helps to give up thumb sucking. Mother should fulfill the need for sucking by allowing for breastfeed.

62. 8. ATTENTION DEFICIT HYPERACTIVITY DISORDER It is a condition that affects the behaviour of children which is marked by persistent inattention, hyperactivity and impulsivity.

63. SYMPTOMS Hyperactivity Impulsivity Disorganization Inattention Distraction Difficulty in making and keeping friends.

64. MANAGEMENT Parents can create small manageable goals for their child like sitting in chair for 10 min and giving rewards for its completion. Sleeping for extra half hour helps in dealing with restlessness Start practicing good health habits Make sure that child gets plenty of opportunities to play.

65. DISORDERS CAUSED BY SOCIAL DEPRIVATION 1. JUVENILE DELIQUENCY Juvenile Deliquency is defined as an individual under the age of 16 who fails to abide the laws.

66. CHARACTERISTICS OF JUVENILE DELEQUENCY The behaviour is marked by violation of law, persistent mischieviousness , antisocial behaviour, disobedience etc.

67. INTERVENTIONS Delequent court seeks to provide protection and safety of public and of the minor who has come in contact with court. Special facilities like juvenile correction homes are there which provides safety and supervision of delequent child. Family should act as role models and support tgeir child always.

68. CONCLUSION Behaviour disorders include many tension reducing activities that appear during childhood at various levels of development. In this education to parents is a part of this process which help parents to guide their children

69. 2. SCHOOL PHOBIA DEFINITION: School phobia is also known as school refusal or school avoidance. Children who resist going to school or who demonstrate extreme refusal to attend school for a sustained period of time are said to have school phobia. They demonstrate signs like leg pain, headache, nausea, vomitting etc.

70. MANAGEMENT Treatment depends upon the cause. Examine the relationship of child and teacher with the peer group. Reward the children for going to school in daily basis. Professional child consultation is needed in severe problem.

71. OTHERS 1. SPEECH PROBLEMS. i ) STUTTERING OR STAMMERING It is fluency disorder beginning between 3-5 years probably due to inability to adjust with stress. It is characterized by interruptions in the flow of speech, hesistations , spasmodic repetitions etc.

72. ii) CLUTTERING Cluttering is characterized by unclear and hurried speech in which words trumble over each other. These are awkward movement of hand feet and body. These children therapy.

73. iii) Dyslalia It is the disorder of difficulty in articulation which is caused by abnormalities in jaw and palate

74. MANAGEMENT Speech disorders are managed by: Behaviour modification and relaxation therapy. Reassure the child and help in breath control exercise. Speech therapy

75. COMMON POINTS OF MANAGING BEHAVIOUR DISORDERS. 1. DISCIPLINE THE CHILD 2. BEHAVIOUR MODIFICATION 3. STRATEGY OF IGNORING