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
1. 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