Behavioural problems

Sandeep Kaur Bhikhan MSc. Child health nursing

1. PRESENTED BY: SANDEEP KAUR M.Sc. 1 st year BEHAVIORAL PROBLEMS

2. INTRODUCTION Normal children are healthy, happy and well adjusted. This adjustment is developed by providing basic emotional needs along with physical and physiological needs for their mental well being. The emotional needs are considered as emotional food for healthy behaviour. They should have opportunity for development of independence, trust, confidence and self respect.

3. CONTI... These all needs required to be satisfied to ensure optimum behavioural development. Major behavioural problems are the significant deviation from socially accepted normal behaviour. These problems are mainly due to failure in adjustment to external environment and presence of internal conflict. Acc. To the United nation’s development on the RIGHT OF THE CHILD, every child has the right to affection, love and understanding.

4. What promotes mental well being in children Lots of friends Regular holidays Being able to ask your problems. Having supportive parents/teachers. Good relationship with family and peers. No substance abuse Healthy eating Enjoying different hobbies.etc.

5. ecology of behaviour problems Children show a wide variety of behaviour disorders. Most of these problems are minor and do not cause permanent disturbances. Nevertheless, these cause considerable anxiety to parents. Management of these minor behaviour deviations requires an understanding of the stresses which lead to these problems.

6. behaviour Behaviour means the way in which one acts or conducts oneself, especially towards others. A behaviour is considered to be maladaptive when it is inappropriate, when it interferes with adaptive functioning, or when others misunderstand it in terms of cultural inappropriateness.

7. definition The term ‘behaviour problem’ is used to designate a deviation in behaviour from one expected or approved by the group. It is defined as 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 the behaviour problems.

8. prevalence of behavioural disorders Overall 1.2 to 3% children suffers from Behavioural problems or disorders. 10% are school aged children. 80% have features into adolescents. 65% enter adulthood with that features. Boys have 4 times more risk than girls. Urban children are more prone as compared to rural children.

9. Causes of behavioural problems Faulty parental attitude. Inadequate family environment. Mentally and physically sick or handicapped conditions. Influence of social relationship. Influence of mass media. Influence of social change.

10. Types of behavioural disorders or problems Behaviour disorders can be classified as: HABIT DISORDERS SPEECH DISORDERS EATING DISORDERS SLEEP DISORDERS PERSONALITY DISORDERS SEXUAL PROBLEMS ANXIETY DISORDERS

11. 1. Habit disorders Thumb sucking Nail biting Tics Enuresis Encopresis Stealing Telling lie

12. 2. Speech disorders Stammering /stuttering Cluttering Delayed speech Dyslalia

13. 3. Eating disorders Pica Anorexia nervosa Bulimia nervosa

14. 4. Sleep disorders Sleep walking(Somnambulism) Sleep talking( somniloquy ) Night mares and night terrors

15. 5. Personality disorder Juvenile delinquency Temper tantrums Shyness

16. 6. SEXUAL DISORDERS MASTURBATION

17. 6.Anxiety disorders School phobia or school refusal Truancy Repeated failure Absenteeism

18. Enuresis or bed wetting

19. introduction The word enuresis is derived from the greek word “ enourein ” means ‘to void urine’. It can occurs either during the day or at night.

20. definition Enuresis is a disorder of involuntary micturition in children who are beyond the age when normal bladder control should have been acquired. It is common during 4 years to 12 years age PREVALENCE IN INDIA -12.6% in Indian children is present -Prevalence at age 5 years is 7% for males And 3% for females. -At age 10 years 35 for males and 2% for females

21. types

22. Sign and symptoms Wetting during the day. Frequency, urgency, or burning on urination. Straining, dribbling, or other unusual symptoms with urination. Cloudy or pinkish urine. Soiling, being unable to control bowel movements constipation

23. management The home conditions, socioeconomic status and habits of the family should be found out. Child parent relations should be explored. Analysis of the time of bed-wetting frequency and relation to sleep should be done. Restriction of fluid intake in the evening and helping the child in developing the habit of passing urine before going to bed. Toilet training should be given to the child to increase the capacity of the bladder.

24. ENCOPRESIS

25. NAIL BITING

26. Nail biting is bad oral habit especially in schoolage children beyond 4 years of age(5 to 7 years). - It is a sign of tension and self punishment to cope with the hostile feeling toward parents. - It may continue up to adolescence. - The child may bite all 10 finger nails or any specific one. -The bite may includes the cuticle or skin margins of nail bed or surrounding tissue.

27. MANAGEMENT

28. Thumb sucking

29. Thumb sucking is a habit disorder due to feeling of insecurity and tension reducing activities Babies have a natural urge to suck. This urge usually decreases after 6 months of age. But many babies continue to suck their thumbs to soothe themselves.

30. Cont... Thumb sucking can become a habit in babies and young children who use it to comfort themselves when they feel hungry, afraid, restless, quiet, sleepy, or bored. It is normally in early infancy. It may interfere with the normal alignment of the teeth.

31. CAUSES MANAGEMENT -Emotional insecurity. - Positive reinforcement( -Feeling of isolation praise the child and provide -Boredom small awards). -Stress - Identify the real issue and provide comfort. - Do not scold the child. - Offer gentle reminders.

32. BREATH HOLDING SPELL

33. -Breath holding spells are brief periods of children stop breathing up to 1 minute. These spells often cause a child to pass out. - Breath holding spells usually occurs when young child is angry, frustrated, in pain, or afraid. - It is most common in toddlers. And more common in 2 months old and up to 2 years old. - It occurs between 6 month to 6 years of age

34. TYPES CYANOTIC SPELLS: they are often provoked by an upsetting situation, in an anger or in frustration. The child cries loudly and then cry gradually becomes noiseless as child open the mouth and holds the breath in expiration for about 20-30 sec. The child turns blue and then child may again start breathing or may proceed to lose consciousness 2. PALLID SPELLS: They are usually seen following a painful or fearful experience. The child becomes pale and often loses consciousness within a single gasp or cry.

35. CAUSES SIGN & SYMPTOMS Fear Pain Traumatic event Being startled or confronted Genetic conditions Iron deficiency anaemia Family history of breath holding spell. Blue or pale skin Crying then no breathing Fainting or loss of alertness. Jerky movements Normal breathing starts again after a brief period of unconsciousness. The child’s colour improves with the first breath. They occurs several times a day

36. management No treatment usually needed. Iron drops or pills if the child has an iron deficiency. During a spell, make sure the child is in safe place where he or she will nor fall or be hurt Place a cold cloth on the child’s forehead during a spell to help shorten the episode After the spell, try to be calm.

37. Cont.... Avoid giving too much attention to the child, as this can reinforce the behaviours that led to the spell. Avoid situations that cause a child’s temper tantrums. This can help reduce the number of spells. Ignore breath holding spells that do not cause the child to faint. Ignore the spell in the same way ignore temper tantrums.

38. TIC DISORDER

39. Tic disorder are characterized by persistent presence of tics, which are abrupt, repetitive, involuntary movements and sounds that are purposeless. Tics are sudden non-rhythmic behaviours that are either motor or vocal for example knee bends, lip smacking, tongue thrusting, grimacing, eye blinking, throat clearing and so on. Tics are seen in transient tic disorder, chronic vocal or motor tic disorder and tourette’s disorder.

40. Conti... The age of onset of tic disorder is 2-15 years. In 75% cases of tourette’s disorder, symptoms appear by the age of 11 years. Transient tic disorder occurs in approximately 4-24% of school children. Tourette’s disorder is 3-4 times more common in males than females.

41. Types of tic disorder 1.Simple 2. complex Simple motor tics: these are simple brief meaningless movements like eye blinking, facial grimacing, head jerks. These lasts for less than 1 sec. Simple phonic tics: these are meaningless sounds or noises like throat clearing, coughing, sniffing, barking or hissing Complex motor tics: these tics involve slower, longer and more purposeful movements like sustained looks, facial gestures, biting, banging, whirling or twisting around or obscene gestures. Complex phonic tics: includes syllables, words, phrases and statements like “shut up” or “yes, you’ve done it.

42. causes Emotional factors Biological, chemical and environmental factors. Due to structural and functional disability in brain Abnormal neurotransmitters When changes occurs in basal ganglia and interior cingulate cortex .

43. management Educating the patient and family about the course of disorder in a reassuming member. Completion of necessary diagnostic tests including self reports by child and parents. Comprehensive assessment including the child’s cognitive abilities, perceptions, motor skills, behaviour and adaptive functioning. Cognitive behaviour therapy: the patient is asked to deliberately perform tic movement for specified period of time interspersed with brief periods of rest.

44. PICA

45. The term PICA derived from latin word “magpie” refers to eating of substances other than food. E.g. Earth, dust, clay, sand, flakes of paint, plaster from wall, fabrics, ice etc.. PICA is characterized by an appetite for substances largely non-nutritive(such as clay or chalk) and the habit must persist for more than one month, at an age when eating such objects is considered developmentally inappropriate.

46. Cont.. PICA as a manifestation of inclination for mouthing and tasting in the absence of any associated problem may be taken as normal until two years of age. This pattern of eating should last for at least 1 month to be diagnosed as PICA

47. types Amylophagia : consumption of starch. Coprophagy : consumption of animal feces . Geophagy : consumption of soil, clay or chalk. Hyalophagia : consumption of glass Pagophagia : pathological consumption of ice Trichophagia : consumption of hair or wool Urophagia : consumption of urine.

48. CAUSES Associated with mental retardation Iron deficiency and vitamin deficiency Mineral deficiency Maternal deprivation Family issues Parental neglect Poverty Malnutrition with worm infestation

49. Clinical manifestation Children are often anaemic. Mineral and vitamin deficiencies. Intestinal and parasitic infestation are generally associated. Behavioural problems- children pull out their head hair and swallow them( trichotillomania ). Lots of hair collect in the stomach which is palpable as a big lump in the upper abdomen, particularly after meals. The preverted appetite in such children.

50. management P rovide the treatment of worm infestation and vitamin, mineral deficiency. Psychotherapy where PICA is associated with psychosomatic disorder. Proper supervision of the parents over the child.

51. ANOREXIA NERVOSA

52. definition ANOREXIA NERVOSA is characterized by voluntary refusal to eat, significant weight loss, an intense fear of becoming overweight and a pronounced disturbance of body image. T he individual with anorexia nervosa may restrict food intake or engage in binge eating followed by self-induced vomiting or misuse of laxatives or diuretics. Incidence of anorexia nervosa is seen in about 5% of adolescent females and 5-10% of all males. The disorder starts by the age of 10-19 years.

53. CAUSES Biological theory suggests that anorexic individuals suffers a disturbance in levels of neurotransmitters in brain. Psychodynamic theory suggests that deficits in ego development may predispose young children to anorexia. Family system theory suggests that anorexia nervosa is caused by intra familial conflicts and dysfunctional family.

54. Clinical features Extreme weight loss. Intense or irrational fear of weight gain. Distorted body image, weight or shape. Other physical manifestations like amenorrhea for up to 3 months, hypothermia, muscle wasting, cardiac dysrhythmias , dry skin, brittle nails and cold intolerance .

55. management Nutritional counselling by a dietician regarding healthy eating habits and balanced diet. Individual therapy to correct distortions and deficits in psychological thinking. Family therapy to correct disturbed patterns of interaction in family In certain cases, antidepressants and selective serotonin reuptake inhibitor(SSRIs) prove to be effective.( Citalopram ) Enhance self esteem and self worth of the individual so that he/she learns to like self, learns to trust and develop an identity beyond their thin body

56. BULIMIA NERVOSA

57. definition BULIMIA NERVOSA is a disorder of binge eating, where the individual consumes the large amount of food with lack of control followed by various compensatory behaviours(like self induced vomiting) to control weight. Incidence of bulimia nervosa is higher than anorexia nervosa. Bulimia occurs in about 1-1.5% females with lower rates in males. The disorder is seen in age group of 15-30 years.

58. causes Family history of depression Substance abuse Eating disorders Sports career in which require low body weight

59. Clinical features Intense fear of getting fat. Binge eating stops when abdominal discomfort occurs. After binge eating adolescents feel out of control, depressed, guilt and anxious. Self induced vomiting and misuse of laxatives and diuretics is also seen , due to which the person loses the ability to experience hunger. Fasting or excessive exercise to prevent weight gain.

60. management Behaviour modification is used to control the binge eating. Cognitive therapy: it helps the individual a sense of self, understanding of conflicts, developing realistic perceptions of one’s body and enhancing self esteem and self concept. Dietary counselling may be helpful. Selective serotonin reuptake inhibitor(SSRIs) drugs have been effective in reducing binge eating.

61. SOMNAMBULISM

62. This is a common sleep disorder. This is also called sleep walking. In this condition, children are aware of the environment during the episode but are indifferent to it. When these children once awake they will forget everything about episode. Now a days in India several families are suffering fro somnambulism It occurs about 5-8% of children.

63. management Locking the doors and windows of the room in which the child is sleeping. Removing all dangerous objects and correction of superstitions. Provide small doses of diazepam in advanced cases.

64. Sleep talking ( somililoquy )

65. - This is a sleep disorder, in which child talks during sleep. - These children talk irregularly and give the gaps same like conversations. - Parents when observe they feels that child is talking with somebody. - Child gives good facial expression also.

66. CAUSES Children who are having incomplete talk during the day time by the influence of parents. Stress and anxiety. Children who are having the conflicts with siblings and school mates. Children who sleep after the listening of story , any TV serials. Children who have more feeling of home sickness.

67. management Always sleep with these children and assure them they are with them. Satisfy the child’s need. Resolve the child’s conflicts if persists with any other children. Don’t show any movie and story video before sleep. Give comfortable environment for sleep. Make good relationship between child and older sibling. Provide tension free environment to child.

68. Night mares and Night terrors

69. Night mares In this disorder, child awakens due to a frightening bad dream and child conscious about surroundings. Night mares associated with dreams. MANAGEMENT Child should have light diet in dinner and pleasant scene and stories at bed time. comforted the child and reassured him physically and verbally. Sitting at the bed side until the child feel secure and is ready to go back to sleep .

70. NIGHT TERRORS In this disorder, child awakens during sleep, sits up with screaming and terrified to recognize the surrounding and after sometime child sleeps again at his/her bed. The terror may last 12-20 minutes . MANAGEMENT Assure the child that there is nothing wrong. Parent must stay calm. Assure child’s safety. Night terrors gradually decrease in frequency and intensity and usually resolves by adolescent.

71. TEETH GRINDING (BRUXISM)

72. management Reduce the tension of the child by improving environmental conditions. Do not allow the child to watch horror and thriller movies before bed time. Provide a proper food and make a happy bed time for child. Discuss the children feelings properly before bed time and give the solutions.

73. MASTURBATION

74. masturbation Masturbation is the stimulation and manipulation of one’s own genitals in order to experience erotic feelings and possibly leads to orgasm. Masturbation is common in both sexes in the pre-school years and in early adolescence. The child experience pleasurable sensation which leads to repetition of the behaviour. The child may obtain pleasure by genital stimulation, rubbing of thighs against each other, or by rhythmic swaying movement.

75. causes Conflict of feelings of child against parents. In the toddler this activity is increased in intensity and in frequency. Preschool children behave sexually with parents and other adults by rubbing their bodies against them and by seeking close intimate body contact.

76. Cont… The male children due to the visibility and structure of genitalia, they learn that rubbing of this part of the body is pleasurable, and they engage in masturbation. At the time of bathing and diaper changing, parents often handle their infants genitals. These pleasing sensations are registered by the infants.

77. management The parents should know that masturbation is not harmful to the child but the child is curious about his sexuality. Parents should not scold or show negative attitude towards their behaviour, it can lead to resentful anger towards frustrating parents. Just ignore this behaviour of the infant. Advice the child that masturbation is not acceptable in public. It should be conveyed in a non threatening manner.

78. Cont.. Parents should react calmly when their children explore and manipulate their own body with enjoyment. The child should be taught the proper names. For the parts of the body including genitals. Provide sufficient emotional satisfaction to the child, they should not feel solace.

79. SPEEECH PROBLEMS STUTTERING AND STAMMERING CLUTTERING DELAYED SPEECH DYSLALIA

80. LANGUAGE DEVELOPMENT OF CHILD AGE OF CHILD MILESTONES 1 month - Turns head to sound 3 months - Cooing sound 6 months - Monosyllables word( ma, la, pa) 9 months - Bisyllables words(mama, baba , papa) 10 months - Does not make any response name.

81. CONT... 12 months(1 year) - Two to five words with meaning. 15 months - Does not respond to or understand “no, no” , “bye, bye” etc. 18 months - Ten words with meaning, does not have vocabulary up to 10 words. 24 months - Simple sentence, does not use 2 word phrases.

82. Cont... 30 months - Has speech that is not intelligible to any family member. 36 months - Telling a story. 42 months - Fails to produce final consonent (i.e. “ da ” for dog) After 4 years - Is noticeably dysfluent (stutter) After 7 years - Has any speech sound error. At any age - Has noticeable hypernasality , has monotone voice, inappropriate pitch.

83. SLUTTERING AND STAMMERING Stammering is also known as sluttering . It is a speech disorder in which the flow is disrupted by involuntary repetitions and prolongation of sounds, words or syllables. Also there is involuntary silent pause or blocks. Sluttering and stammering is a fluency disorders begin between the age of 2-5 years probably due to inability to adjust with environment and emotional stress.

84. CAUSES Developmental factors: if the child has cleft lip, cleft palate or tongue tie, the speech is affected. There may be central nervous system impairment which may affect the speech. Neurogenic Sluttering : A stroke or brain injury may affect the signals between brain, speech nerves and muscles, that lead to sluttering Psychological factors: stress and embarrassment.

85. Cont... Other causes are: Due to physical weakness or fatigue. Most common in children who cannot cope their self with emotional and environmental stress. Due to neurotic attitude of mother. More common in left handed children who are forced by the parents to use right hand. It can occur due to conflict between parents and child expectations

86. Sign and symptoms Interruption in the flow of speech. Prolongation and repetition of words. Child may have hesitation. Problems in starting a word or phrase. Speech may come out in spurts. Trembling lips and jaws when trying to talk. Interjection like ‘ uhm ’ used more frequently before attempting to utter certain sounds.

87. management Behaviour modification and relaxation therapy to resolve the conflict and emotional stress, thus to improve the confidence in the child. The child should be reassured and helped in breath control exercise and speech therapy. Parents need counselling to rationalize their expectations of child’s achievement according to the potentiality. These children have normal or high IQ level, so they need encouragement and guidance. Stammer suppressor, psychotherapy and drug therapy

88. CLUTTERING Cluttering is characterized by unclear and hurried speech in which words tumble over each other. There are awkward movements of hands, feet and body. These children have erratic and poorly organized personality and behaviour pattern. They need psychotherapy.

89. DELAYED SPEECH Delayed speech beyond 3 to 3.5 years can be considered as organic causes like mental retardation , infantile autism, hearing defects or severe emotional problems.

90. dyslalia Dyslalia is the most common disorder of difficulty in articulation. It can be caused by abnormality of teeth, jaw or palate or due to emotional deprivation Treatment of the structural and speech therapy should be done adequately.

91. Cont.. In absence of structural problems , the responsible emotional disorders or factors should be ruled out. The child needs counselling. The parents should be informed about the modification of family environment and correction of deprivation

92. Juvenile delinquency Juvenile delinquency is an antisocial behaviour, in which a child or adolescent purposefully and repeatedly does illegal activities.

93. Cont.. A juvenile is a person under age of 18 years. The children act 1960 in India defines a delinquent as “ a child who has committed an offence such as theft, sexual assault, murder, burglary or inflicting injuries, running away from home etc. Teachers call them incorrigible and beyond correction. The psychiatrist and psychologist call them ‘emotionally disturbed’ while judiciary has one term for the ‘DELINQUENTS’

94. THE CHILDREN ACT 1960 The children act 1960 in India develops for the care maintenance, welfare, education and rehabilitation of the deliquent children. It covers the neglected and destitute socially handicapped. The state shall in particular direct its policy towards securing the childhood and youth.

95. JUVENILE JUSTICE ACT 1986 The new act, provides a comprehensive scheme for care, protection, treatment, development and rehabilitation of deliquent juveniles. Features of this act: It provides a uniform legal framework for juvenile justice in the country, so as to ensure that no child under any circumstances is put in jail or police lock up. It envisages specialized approach towards prevention and treatment of juvenile delinquency in keeping with the developmental needs of children.

96. Cont.. It establishes norms and standards for administration of juvenile justice in terms of investigation, care, treatment and rehabilitation. It lays down appropriate linkage and co-ordination between the formal system of juvenile justice and voluntary organizations By the year 1992, there were 609 institutions under Juvenile Justice Act, out of these 269 were observation homes, 249 juvenile homes, 40 special homes and 51 after care institutions

97. Presentation of Antisocial problems in children The common forms of presentation of Juvenile delinquency are: 1.Constant disobedience 2. Truancy from school 3.Sexual assault. 4. Destructiveness 5. Gambling 6. Cruelty

98. Cont.. 7. Running away from school. 8. Fights 9. Ungovernable behaviour 10. Mixing with antisocial gang. 11. Murder 12.Lying 13.Stealing 14.Fire setting 15. Drug and alcohol intake with dependence

99. Contributing factors are Rapid urbanization and industrialization. Social change and changing life style. Influence of mass media. Lack of educational opportunities and recreational facilities

100. Cont.. Unsatisfactory conditions at school. Poor economy. Unhealthy student teacher relationship Lack of discipline.

101. Diagnostic procedure Interview: interview the delinquent as well as his parents. Interview should preferably consist of a structural procedure to avoid omitting or failure to elicit essential data. Mental status examination: it is to obtain information about the present mental state and abnormalities they may prevail.

102. Cont... Neurological examination EEG: It is helpful to rule out any organic cause of the problem Psychological test or personality test : like Rorshach’s tests

103. Prevention juvenile delinquency PRIMARY PREVENTION: In this remove all the factors which directly or indirectly causes delinquency. SECONDARY PREVENTION: It includes prompt diagnosis and treatment of delinquency. TERTIARY PREVENTION: Rehabilitation of delinquents .

104. Cont... Effective family planning so that children are wanted, is useful Emotional and financial security should be at home. Close contact of children with parents. Tender loving care Fulfilment of basic needs. Healthy teacher taught relationship Facilities for sports Exercise and recreation.

105. MANAGEMENT It includes following therapies: Preventive therapy.( already discussed) Corrective therapy. Drug therapy.

106. corrective therapy It includes: 1. Protective therapy: which not only extends to custodial care, but also to probation and parole. 2. Punitive therapy: with an idea to serve as deterrent.

107. Cont.. 3.Reformative therapy: it is to bring about certain changes in the personality and behaviour of the delinquent. 4. Rehabilitative therapy: which is very essential to assist the delinquent in his progress and give him a new way of living.

108. Drug therapy Drugs are useful in case of aggressive behaviour. Tranquilizers: to reduce stress or tension. Chlorpromazine: 25-50mg orally TDS. Haloperidol: 1.5-10 mg orally TDS.

109. SCHOOL PHOBIA

110. School phobia It is refusal to go to school or to stay in school, without any attempts to conceal. School phobia is an emotional disorder of the children who are afraid to leave the parents, especially mothers. School phobia is also called school refusal. It is a symptom of crisis situation of developmental stages and ‘cry for help’, which needs special attention.

111. PREVALENCE OF SCHOOL PHOBIA School refusal  was seen in 3.6% of  children . 77.8% of the  children had a psychiatric diagnosis, most common being depression (26.7%), followed by anxiety  (17.7%). Both sexes are equally affected. The incidence peak during three periods of school life: Age 5 and 6 Age 11 and 12 Age 14 to 16.

112. causes Individual factors: withdrawl . Separation anxiety. Family factors. Factors specific to school. Psychiatric disorders like depression, phobic anxiety or other psychiatric conditions.

113. Sign and symptoms High level of anxiety. Headache Nausea Abdominal pain and palpitations. The symptoms are usually school day linked.

114. management Habit formation for regular school attendance. Play session and other recreational activities at school. Improvement of school environment. Family counselling to resolve the anxiety related to maternal separation.

115. SHYNESS

116. SHYNESS leading to complete withdrawl is considered as a behaviour problem. CAUSES OF SHYNESS: Genetic inheritance. Environmental causes like lack of exposure, cultural norms and society etc.

117. management Assess the cause of shyness. Talk to the child. Provide exposure to the child by arrange small get-to-gather with peer group. Do not pay attention to the child’s mistakes. Do not compare the child with other child

118. Cont.. Do not criticize the child. Reward the child whenever he performs well or takes on initiative. Encourage the child to develop his potentials and talents. Help the child to gain self confidence. Do not force the child to socialize, as this may aggravate shyness.

119. Nursing responsibilities in behavioural disorders Nurse play a vital role for prevention, early identification and management of behavioural disorders in children. Assessment of specific problem of the child by appropriate history and detection of the responsible factors. Informing the parents and making them aware about the causes of behavioural problems of the particular child.

120. Cont... Assisting the Parents, teachers and family members for necessary modification of environment at home, school and community. Encouraging the child for behaviour modification, as needed. Promoting healthy emotional development of the child by adequate physical, psychological and social support. Creating awareness about psychological disturbances which may lead to behavioural problems during developmental stages.

121. Cont.. Providing counselling services for children and their parents to solve the problems, whenever necessary and for tender loving care for children. Participating in the management of the problem child, as a member of health team along with paediatrician, psychologist and social worker. Organize child guidance clinic. Referring the children with behavioural problems for necessary management and support to better health care facilities, child guidance clinic and support agencies

122. RESEARCH ARTICLE A study on family factors in association with behaviour problems amongst children of 6-18 age groups by Sandip S Jogdand et al in July-Dec. 2014. This cross-sectional study focussed on the family factors associated with behaviour problems amongst children of 6-18 years of age. AIM AND OBJECTIVE To study the family factors associated with behaviour problems amongst children of 6-18 Years age group.

123. Cont.. MATERIAL AND METHODS   A total 600 children in the age group of 6-18 years were enrolled for study from adopted urban slum area. The children were selected by simple random sampling method from the list of family survey registers of field workers. Their socio-demographic data and information regarding behaviour was recorded. Socio-demographic data pertaining to socioeconomic classification, type of family, parent educational status, parent habits and addictions etc., was collected .

124. RESULT In this study out of 600 children, there were 71 (11.83%) children with either one or both real parents absent. Out of these children 56 (78.87%) children exhibited one or more than one behaviour problem. There is an association between behaviour problems and absence of parents. Out of 600 children, 238 (39.67%) children were from families having a history of alcoholism in parents or caretakers. Amongst these children, 134 (56.30%) children exhibited one or more than one behaviour problems

125. REFERENCES Ghai OP, “ Essential Paediatrics”.CBC Publishers, ed. 7 th. Dutta Parul , “Paediatrics nursing” jaypee publishers, ed. Second Sudhakar A, “ Essentials of Paediatrics nursing” Jaypee publishers, ed. 1 st . http://www.ijabmr.org/