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Definition
A young person is said to have a
behaviour disorder
when he or she demonstrates behaviour
that is noticeably di...
Classification of Individuals with
Emotional or Behavioral Disorders
What can affect Behaviour in a child?

• Heredity
• Environment
• Learning Conditioning
• Positive reinforcements
Categories of Behaviour Disorders:• Habit Disorders
(Tension releasing disorders)
–
–
–
–

Finger (thumb) sucking
Nail bit...
Repetitive Behaviours
Repetitive Behaviours
Repetitive Behaviours
Repetitive Behaviours
Repetitive Behaviours
Head Banging
Rhythmic hitting of the head against a solid surface often the crib mattress.
– In 5-20% of children during i...
Head banging
– Can result in callus
formation, abrasions, contusi
ons
Treatment:
– Assurance – significant injury
unlikely...
Nail Biting

Finger Sucking
Finger (Thumb) sucking & Nail Biting
• Sensory solace for child
(“internal stroking”) to
cope with stressful
situation in ...
Finger (Thumb) sucking & Nail Biting
• Adverse Effects
– Malocclusion – open bite

– Mastication difficulty
– Speech diffi...
Finger (Thumb) sucking & Nail Biting
• Adverse Effects
– Paronychia and digital
abnormalities
Finger (Thumb) sucking & Nail Biting
Management
• Reassure parents that it’s
transient.
•

Most give up
by 2 yrs

•

If co...
Finger (Thumb) sucking & Nail Biting
• Treatment Options:
SOLUTION TYPE

HOW IT WORKS

EXAMPLES

Behvioural

Depends on ch...
Finger (Thumb) sucking & Nail Biting
•

Finger guards / Thumb guards , etc.:
Temper Tantrums
Temper Tantrums
• In 18 months to 3 yr olds due to
development of sense of autonomy.
• Child displays defiance, negativism...
Temper Tantrums
Precipitating factors

•
•
•
•
•
•
•

Hunger
Fatigue
Lack of sleep
Innate personality of child
Ineffective...
Temper Tantrums –
Management

• In general, parents advised to:
 Set a good example to child
 Pay attention to child
 S...
Temper Tantrums –
Management

• During temper tantrum:
 Parents to ignore child and
once child is calm, tell child
that s...
Evening Colic
Evening Colic
• Intermittent episodes of abdominal pain and
severe crying in normal infants
• Begins at 1-2 wks age and pe...
Evening Colic
Attack

• Begins suddenly with a loud cry
• Crying continuous – lasts for
several hours – mostly in the late...
Evening Colic
Causes

•
•
•

More likely if the child is over active and
parents are over anxious
Not known
Could be a man...
Evening Colic
Management

During Episode
– Hold the child erect or prone
– Avoid drugs
– No much role to
antispasmodics, c...
Eating

Disorder
Disorder

Pica
Pica
Repeated or chronic
ingestion of
non-nutritive substances.
– Examples:
mud, paint, clay, plaster, char
coal, soil.

•...
Pica
Geophagia

Eating of mud, soil, clay, chalk, etc.

Pagophagia

Consumption of ice

Hyalophagia

Consumption of glass
...
Pica
Pica after 2nd yr of life needs investigation
• Predisposing factors :
 Parental neglect
 Poor supervision
 Mental...
Pica
• Screening indicated for:
 Iron deficiency anemia
 Worm infestations
 Lead poisoning
 Family dysfunction
• Treat...
Breath Holding Spasms
Breath Holding Spasms
1.
2.
3.
4.

Simple breath-holding spell
Cyanotic breath-holding spells
Pallid breath-holding spells...
Breath Holding Spasms
Management – General:
• No treatment is usually needed
• Iron supplements to children with iron defi...
Emotional
Disorders

School Phobia
School Phobia
• Approximately 1 to 5% of school-aged children have
school refusal

•

Most common in 5- and 6-year olds an...
School Phobia
What can parents do?
1. Have a physician examine the child to determine
if he or she has a legitimate illnes...
School Phobia

• The goal is to have the child return to
school and attend class daily
• However, if the school phobia is
...
Speech

Disorders

Stammering
Stuttering / Stammering
• Defect speech
• Stumbling and spasmodic repetition of
some syllables with pauses
• Difficulty in...
Stuttering / Stammering
• Usually begins between 2 – 5 yrs
• Reminding and ridiculing
aggravate
• Child loses self confide...
Stuttering / Stammering
Management

• Parents should be reassured
• They should not show undue concern and accept
his spee...
… sudden, repetitive, nonrhythmic motor movement or
vocalization involving discrete muscle groups
12 to 20% children,
peak...
Tics : Common types
Simple Tics:
• Grimacing
• Yawning
• Grunting
• Sighing
• Blinking
• Wrinkling
• Scratching nose
• Hea...
•

Tic Disorders
Transient

•

•

Chronic
•
•

Tourette‟s
(Gilles de la Tourette syndrome)

both multiple motor and one or...
Tics : Management.
• Medication to help control the symptoms and
• Habit reversal training (HRT): a behavioral therapy
• T...
Tics :
Formulations in the Management contd..
•
•
•
•
•
•
•
•
•
•
•

haloperidol,
pimozide,
clonidine,
nifedipine are use ...
Title
Subtitle

Behavioural Disorders
Oppositional defiant disorder (ODD)
• Easily angered, annoyed or irritated
• Frequent temper tantrums
• Argues frequently ...
Conduct Disorders
•
•
•
•
•

•
•
•
•
•

Frequent refusal to obey parents or other authority figures
Repeated truancy
Tende...
Attention Deficit hyperactivity disorder
(ADHD) Around two to five per cent of children are thought to have
attention defi...
•C.S.N.Vittal
Common Behavior Disorders in Children
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Common Behavior Disorders in Children

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Common Behavior Disorders in Children

  1. 1. Definition A young person is said to have a behaviour disorder when he or she demonstrates behaviour that is noticeably different from that expected in the school or community. A child who is not doing what adults want him to do at a particular time.
  2. 2. Classification of Individuals with Emotional or Behavioral Disorders
  3. 3. What can affect Behaviour in a child? • Heredity • Environment • Learning Conditioning • Positive reinforcements
  4. 4. Categories of Behaviour Disorders:• Habit Disorders (Tension releasing disorders) – – – – Finger (thumb) sucking Nail biting Tics Teeth grinding (Bruxism) • Emotional Disorders – Breath holding spasms – Temper tantrums • Eating Disorders – Pica
  5. 5. Repetitive Behaviours Repetitive Behaviours Repetitive Behaviours Repetitive Behaviours Repetitive Behaviours
  6. 6. Head Banging Rhythmic hitting of the head against a solid surface often the crib mattress. – In 5-20% of children during infancy & toddler years – Benign & self-limiting
  7. 7. Head banging – Can result in callus formation, abrasions, contusi ons Treatment: – Assurance – significant injury unlikely – Teach parents to ignore as concern and punishment can reinforce it. – Padding
  8. 8. Nail Biting Finger Sucking
  9. 9. Finger (Thumb) sucking & Nail Biting • Sensory solace for child (“internal stroking”) to cope with stressful situation in infants and toddlers. • Reinforced by attention from parents. • Predisposing factors:  Developmental delay  Neglect
  10. 10. Finger (Thumb) sucking & Nail Biting • Adverse Effects – Malocclusion – open bite – Mastication difficulty – Speech difficulty ( D and T ) – Lisping
  11. 11. Finger (Thumb) sucking & Nail Biting • Adverse Effects – Paronychia and digital abnormalities
  12. 12. Finger (Thumb) sucking & Nail Biting Management • Reassure parents that it’s transient. • Most give up by 2 yrs • If continued beyond 4 yrs – number of squelae • If resumed at 7 – 8 yrs : sign of Stress • Improve parental attention / nurturing. • Teach parent to ignore; and give more attention to positive aspects of child’s behavior. • Provide child praise / reward for substitute behaviors. • Bitter salves, thumb splints, gloves may be used to reduce thumb sucking.
  13. 13. Finger (Thumb) sucking & Nail Biting • Treatment Options: SOLUTION TYPE HOW IT WORKS EXAMPLES Behvioural Depends on child‟s Rewards & willingness to stop punishments, stories Child loses control when sleeping or in subconscious state Aversive Use of pain or discomfort to discourage the habit Creates more stress and pain to child / can even worsen… Mechanical Mechanical Bandages around impediments to the elbows, socks over process the fingers, fabric gloves, etc Restrict movements, can be removed, not hygienic T Guards Remove the pleasure associated by eliminating suction Can not remove, hygienic, do not restrict movement, 95% success rate Applying foul tasting liquids Thumb guards, finger guards HOW IT FAILS
  14. 14. Finger (Thumb) sucking & Nail Biting • Finger guards / Thumb guards , etc.:
  15. 15. Temper Tantrums
  16. 16. Temper Tantrums • In 18 months to 3 yr olds due to development of sense of autonomy. • Child displays defiance, negativism / oppositionalism by having temper tantrums. • Normal part of child development. • Gets reinforced when parents respond to it by punitive anger. • Child wrongly learns that temper tantrums are a reasonable response to frustration.
  17. 17. Temper Tantrums Precipitating factors • • • • • • • Hunger Fatigue Lack of sleep Innate personality of child Ineffective parental skills Over pampering Dysfunctional family / Family violence • School aversion
  18. 18. Temper Tantrums – Management • In general, parents advised to:  Set a good example to child  Pay attention to child  Spend quality time  Have open communication with child  Have consistency in behavior
  19. 19. Temper Tantrums – Management • During temper tantrum:  Parents to ignore child and once child is calm, tell child that such behavior is not acceptable  Verbal reprimand should not be abusive  Never beat or threaten child  Impose “Time Out” - if temper tantrum is disruptive, out of control and occurring in public place.
  20. 20. Evening Colic
  21. 21. Evening Colic • Intermittent episodes of abdominal pain and severe crying in normal infants • Begins at 1-2 wks age and persists till 3-4 mo. • Crying usually in late afternoon or evening • Definition: “ Infant cries for > 3 hrs per day for > 3 days per week for > 3 weeks ”
  22. 22. Evening Colic Attack • Begins suddenly with a loud cry • Crying continuous – lasts for several hours – mostly in the late afternoon or evenings • Face becomes red and legs drawn up on the abdomen • Abdomen becomes tense • Attack terminates after exhaustion or after passage of flatus or feces
  23. 23. Evening Colic Causes • • • More likely if the child is over active and parents are over anxious Not known Could be a manifestation of …
  24. 24. Evening Colic Management During Episode – Hold the child erect or prone – Avoid drugs – No much role to antispasmodics, carminatives, simethicone, sup positories or enemas Counseling - Coping with the parents – Reassure the parents that infant is not sick – They need to soothe more with repetitive sound and stimulate less with decrease in picking up and feeding with every cry
  25. 25. Eating Disorder Disorder Pica
  26. 26. Pica Repeated or chronic ingestion of non-nutritive substances. – Examples: mud, paint, clay, plaster, char coal, soil. • Normal in infants and toddlers. • Passing phase. Even Lord Krishna Did it !!!
  27. 27. Pica Geophagia Eating of mud, soil, clay, chalk, etc. Pagophagia Consumption of ice Hyalophagia Consumption of glass Amylophagia Consumption of starch Xylophagia Consumption of wood Trichophagia Consumption of hair Urophagia Consumption of urine Coprophagia Consumption of feces
  28. 28. Pica Pica after 2nd yr of life needs investigation • Predisposing factors :  Parental neglect  Poor supervision  Mental retardation  Lack of affection Psychological neglect, (orphans)  Family disorganization  Lower socioeconomic class  Autism
  29. 29. Pica • Screening indicated for:  Iron deficiency anemia  Worm infestations  Lead poisoning  Family dysfunction • Treat cause accordingly. • Usually remits in childhood but can continue into adolescence
  30. 30. Breath Holding Spasms
  31. 31. Breath Holding Spasms 1. 2. 3. 4. Simple breath-holding spell Cyanotic breath-holding spells Pallid breath-holding spells Complicated breath-holding spells Precipitating Factors: • • • • Frustration Injury Anger Anemia
  32. 32. Breath Holding Spasms Management – General: • No treatment is usually needed • Iron supplements to children with iron deficiency During a spell : • Make sure your child is in a safe place where he or she will not fall or be hurt. • Place a cold cloth on your child's forehead during a spell to help shorten the episode. • After the spell, try to be calm. • Avoid giving too much attention to the child, as this can reinforce the behaviors that led to the event. • Avoid situations that cause a child's temper tantrums.
  33. 33. Emotional Disorders School Phobia
  34. 34. School Phobia • Approximately 1 to 5% of school-aged children have school refusal • Most common in 5- and 6-year olds and in 10- and 11year olds • School refusal differs from truancy (refusal is because of fear or anxiety about school)
  35. 35. School Phobia What can parents do? 1. Have a physician examine the child to determine if he or she has a legitimate illness. 2. Listen to the child talk about school to detect any clues as to why he or she does not want to go. 3. Talk to the child's teacher, school psychologist, and/or school counselor to share concerns. 4. Together determine a possible cause or causes 5. Develop an appropriate plan of action
  36. 36. School Phobia • The goal is to have the child return to school and attend class daily • However, if the school phobia is extreme, a therapist or psychiatrist's assistance may be necessary.
  37. 37. Speech Disorders Stammering
  38. 38. Stuttering / Stammering • Defect speech • Stumbling and spasmodic repetition of some syllables with pauses • Difficulty in pronouncing consonants • Caused by spasm of lingual and palatal muscles
  39. 39. Stuttering / Stammering • Usually begins between 2 – 5 yrs • Reminding and ridiculing aggravate • Child loses self confidence and become more hesitant • They can often sing or recite poems without stuttering
  40. 40. Stuttering / Stammering Management • Parents should be reassured • They should not show undue concern and accept his speech without pressurizing him to repeat • Children should be given emotional support • Older children with secondary stuttering should be referred to speech therapist
  41. 41. … sudden, repetitive, nonrhythmic motor movement or vocalization involving discrete muscle groups 12 to 20% children, peak age 5 -7 yr. Motor Tics or Phonetic Tics Can occur in any body part Decrease when focused Tics More common in boys than in girls Increase when stressed, anxious, fatigued, or bored
  42. 42. Tics : Common types Simple Tics: • Grimacing • Yawning • Grunting • Sighing • Blinking • Wrinkling • Scratching nose • Head jerking • Throat clearing Complex Tics: • Jumping • Spinning • Touching objects or people • Echopraxia: Repeating other‟s actions • Copropraxia: Obscene gestures • Palilalia: Repeating one‟s own words • Echolalia: Repeating what someone else said • Coprolalia: Obscene, inappropriate words
  43. 43. • Tic Disorders Transient • • Chronic • • Tourette‟s (Gilles de la Tourette syndrome) both multiple motor and one or more vocal tics should have been present at some time during the illness, although not necessarily concurrently; the tics should occur many times a day nearly every day or intermittently throughout a period of more than 1 year; and during this period there should never be a tic-free period of more than 3 consecutive months; the onset should be before age 18 years; the disturbance should not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition
  44. 44. Tics : Management. • Medication to help control the symptoms and • Habit reversal training (HRT): a behavioral therapy • The child and adolescent psychiatrist can also advise the family about how to provide emotional support and the appropriate educational environment for the youngster.
  45. 45. Tics : Formulations in the Management contd.. • • • • • • • • • • • haloperidol, pimozide, clonidine, nifedipine are use in low doses. risperidone, olazapine mecamylamine, tetrabenazine, Benzodiazepines baclofen, botulinum toxin
  46. 46. Title Subtitle Behavioural Disorders
  47. 47. Oppositional defiant disorder (ODD) • Easily angered, annoyed or irritated • Frequent temper tantrums • Argues frequently with adults, particularly the most familiar adults in their lives, such as parents • Refuses to obey rules • Seems to deliberately try to annoy or aggravate others • Low self-esteem • Low frustration threshold • Seeks to blame others for any misfortunes or misdeeds.
  48. 48. Conduct Disorders • • • • • • • • • • Frequent refusal to obey parents or other authority figures Repeated truancy Tendency to use drugs, including cigarettes and alcohol, at a very early age Lack of empathy for others Aggressive to animals and other people or showing sadistic behaviours including bullying and physical or sexual abuse Keenness to start physical fights & Using weapons Frequent lying Criminal behaviour such as stealing, deliberately lighting fires, breaking into houses and vandalism A tendency to run away from home Suicidal tendencies – rarely.
  49. 49. Attention Deficit hyperactivity disorder (ADHD) Around two to five per cent of children are thought to have attention deficit hyperactivity disorder (ADHD), with boys outnumbering girls by three to one. 1. Inattention – difficulty concentrating, forgetting instructions, moving from one task to another without completing anything. 2. Impulsivity – talking over the top of others, having a „short fuse‟, being accident-prone. 3. Overactivity – constant restlessness and fidgeting. LOGO
  50. 50. •C.S.N.Vittal

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