common behavioral disorder

1. Common Behavioral
Disorders
Presented by:
Aruna Shastri
M.Sc. Nursing 1st 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??

34. THANK YOU.................