behavioral problem in children
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The document discusses various behavioral problems in children including feeding problems, habit disorders, speech problems, sleep problems, educational difficulties, adjustment problems, emotional problems, antisocial problems, and sexual problems. It provides definitions and descriptions of common issues such as temper tantrums, breath holding spells, thumb sucking, nail biting, bedwetting, encopresis, pica, tics, speech disorders, and sleep disorders. Causes, clinical features, and management strategies are described for each problem. Behavioral issues in adolescents like masturbation, delinquency, substance abuse, anorexia nervosa, and bulimia nervosa are also mentioned.
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behavioral problem in children
- 1. BEHAVIORAL PROBLEM NAOREM MONIKA DEVI LECTURER M.SC. NURSING IN PEDIATRIC
- 2. DEFINITION Behaviour problems are viewed as discrepancy between the child’s behaviour and demands placed on him by his parents, teacher and colleagues.
- 3. CONCEPT A condition exhibiting one or more of the following characteristics over a long period of time and to marked degree that adversely affects a child’s educational performance. An inability to learn An inability to build or maintain satisfactory interpersonal relationship Inappropriate types of behaviour A general pervasive mood of unhappiness or depression. A tendency to develop physical symptoms or fear associated with personal or school problems
- 4. PRINCIPLES Negative consequences sometimes change behaviour, but they do not change attitude Only positive reinforcement strategies produce long term attitudinal change Negative consequences do not improve the behaviour of impulsive of their misbehaviour Cognitive control of behaviour can be learned through the use of appropriate positive reinforcement systems.
- 5. COMMON BEHAVIOR DISORDER 1. FEEDING PROBLEMS Food refusal Over-eating Vomiting Impaired appetite Anorexia nervosa
- 6. 2. HABIT DISORDERS Thump sucking Nail biting Enuresis Encopresis TICS Breath holding spell Bruxism(teeth grunting) Rolling and head banging Trichotillomania
- 7. 3. SPEECH PROBLEMS Unclear speech Delayed speech Dyslalia, stammering or shuttering
- 8. 4. SLEEP PROBLEMS SLEEP WALKING(SOMNAMBULISM) SLEEP TALKING(SOMNOLOQUY) NIGHT TERRORS NIGHTMARES INSOMNIA HYPERSOMNIA NARCOLEPSY CATAPLEXY
- 9. 5. EDUCATIONAL DIFFICULTIES SCHOOL PHOBIA TRUENCY REPEATED FAILURE HYPERACTIVE ATTENTION DEFICIT DISORDERS 6.ADJUSTMENT PROBLEM DISOBEDIENCE TEMPER TANTRUM
- 11. 8. ANTISOCIAL PROBLEM Delinquency Destructive attitude Kleptomania(compulsive stealing) Substance abuse Social phobia Drug addicts
- 12. 10. SEXUAL PROBLEM Masturbation Precocious sexuality Homosexuality Hypersexuality Sexual assault
- 13. FOR INFANCY 1. IMPAIRED APPETITE OR RESISTANCE TO FEEDING -Develop at the time of weaning Causes - Dislike of taste - Separation anxiety from mother - Force feeding - Abdominal colic - Painful ulcer in mouth - Sore throat - Indigestion of food
- 14. clinical feature crying and weight loss Irritation Frequent feeding Drooling of saliva Refrains from eating favourite food
- 15. Treatment Change the food item frequently Rescheduling the feeding time Problem like mouth ulcer, sore throat nasal congestion to be treated accordingly Adequate gap between the meals should be present to digest it properly Provide zinc level to increase appetite like chicken, pumpkin seed and cashew nuts If not able to manage at home, consult doctor
- 16. 2. ABDOMINAL COLIC/EVENING COLIC Abdominal colic is an important cause of crying in the children. Some infants may cry continuously for variable period. This problem improve after 3 to 4 months and crying mostly in evening
- 17. Causes Unknown Clinical features Irritation and crying continuously Management Extra support to the mother or parents Placed the baby in upright position Improved psychological bonding between parents and the child Small and frequent diet should be provided
- 18. 3. STRANGER ANXIETY Stranger anxiety is a form of distress that children experience when expose to people unfamiliar to them Causes Separation from the mother of parents Clinical features Crying due to feeling of insecurity Fear Anxiety
- 19. Management Play therapy should be given In the absent of the parents, loving concern of the stranger is very important Advice the parents not to leave as much as possible
- 20. BEHAVIOUR PROBLEMS OF CHILDHOOD 1.Tamper tantrum 2.Breath holding spell 3.Thumb sucking 4.Nail biting 5.Enuresis or bed weting 6.Encopresis 7.Pica or geophagia
- 23. TAMPER TANTRUM Tamper tantrum is a behaviour problem where children assert their independence by violently objecting to discipline through the display of anger at uncontrollable level. It is mostly seen in toddlers. Causes Emotional insecurity Lack of sleep and fatigue Pamper children Attention seeking Unmet needs
- 24. Clinical features Rigid body Biting Kicking Hitting Throwing objects Rolling over the floor Banging limbs
- 25. Management Take help form professional guidance Parent should not punish instead talk nicely and give positive enforcement Avoid making fun of the child and avoid teasing
- 26. BREATH HOLDING SPELL Breath holding spell are brief periods when young children stop breathing for upto 1 minute, often cause a child to pass out(loss of consciousness) Causes Frustration Angry In pain Afraid
- 27. Types a) Cyanotic spell Caused by change in breathing pattern in response to angry or frustration It is the most common type b) Pallid spell Slowing of heart rate in response to pain
- 28. Clinical features Bluish or pale skin Crying then no breathing Fainting Jerky movement Heart rate decrease
- 29. Management Repeated attack of spell need to be evaluated Psychotherapy Attention should be given to the child Over protection should be avoided
- 30. THUMB SUCKING It is a habit disorder due to feeling of insecurity and tension reducing activities Causes Feeling of insecurity Poor breastfeeding Tired or bored Frustration
- 31. Clinical features Malocclusion and misalignment of teeth Difficulty in swallowing Deformities of thumb Speech difficulties Management Guidance from parents and family members Encourage for breaking the habit Keep the hands busy Feeding should be provide adequately Punish to be avoided
- 32. NAIL BITING It is bad oral habit especially in school age children beyond 4 years of age. It is a sign of tension and self punishment to cope with the hostile feeling towards parents or teachers Causes Feeling of insecurity Conflict Fear Watching frightening or violent scene
- 33. Management Identify the cause of nail biting Keep the hand busy Punishment should be avoided Assistance to accept the situation
- 34. ENURESIS(BED WETTING) It is the repetitive involuntary passage of urine at inappropriate place especially at bed during night time beyond the age of 4-5 years Causes Small bladder capacity Improve toilet training Deep sleeping with inability to receive the signal
- 35. Management Restrict fluid intake before sleeping Advice to void urine before sleeping Avoid punishing them
- 36. ENCORPRESIS It is the passage of faeces into inappropriate places after the age of 5 years, when the bowel control is normally achieved. Causes Emotional disturbances, abnormal digestive tract Unconscious anger Stress and anxiety Over aggressive toilet training
- 37. TYPES Primary or continuous encopresis: it is identified by age 4 if fecal continence is not achieved Secondary or discontinuous encopresis: if it occurs after 4 years, after achieving continence.
- 38. Diurnal relationship During daytime , it seldom occurs at school, but most often occurs on the way home from school The behavior occurs indoors
- 39. Management Proper toilet training Dietary changes Behavioural therapy Regular schedule time for toilet Parental support Avoid punishment Educate the child to void in proper place Psychologist should counsel both mother and child
- 40. PICA OR GEOGRAPHAGIA it is eating disorder which is characterised by eating of substances other then food like earth, clay, sand, plastics, fabrics etc. Causes Acquired taste from the item Mineral and vitamin deficiency Poor socio economic family Intestinal parasitosis Parental neglect Malnourish child
- 41. Symptoms Intoxication Physical & mental impairment Lead poisoning Dental injury Nutritional deficiency Intestinal obstruction
- 42. Management Teach what to eat what not to eat Explain the differences between the food and non food items Psychotherapy Increase communication with the child Offer tasty and nutritious food Provision of proper food
- 43. TICS OR HABIT SPASM Tics are sudden abnormal involuntary movements It is repetitive, purposeless, rapid sterotype movements of straited muscles, mainly of the face and neck they often occur in school children for discharge of tension in maladjusted emotionally disturbed child.
- 44. TYPES Motor tics: blinking, grimacing, shrugging shoulder, tongue protrusion, facial gesture, etc Vocal tics: throat learning, coughing, barking, sniffing, etc.
- 45. MANAGEMENT Behavioral therapy Drug therapy: haloperidol drug group Parental counseling
- 46. SPEECH PROBLEM It is a common disorder among the children. Causes Hearing defect Cleft lips and palate Cerebral palsy Dental malocclusion Facial paralysis Emotional deprivation
- 47. Types of speech disorder 1) Stuttering or stammering It is a speech disorder characterized by interruption in the flow of speech, spasmodic repetitions and prolongation of sound specially in the initial consonants Causes Inability to adjust with the environment Fear and anxiety Timid personality
- 48. Clinical features Interruption in flow of speech Hesitation Spasmodic repetition Prolongation of sounds specially of initial consonants
- 49. Management Behaviour modification Relaxation therapy Encourage to increase self confidence Speech therapy psychotherapy
- 50. 2) Cluttering It is characterised by unclear and hurried speech Causes Genetic factors Neurophysiological factor Symptoms Movement of hand body and fingers along with the speech Psychotherapy Relaxation therapy
- 51. Management Behavioral therapy psychotherapy
- 52. 3) Delay speech It is a speech disorder which delay speech ( beyond 3-3.5 years) Causes Mental retardation Infantile autism Hearing defect Severe emotional problem Management Hearing should be tested Spend more time communicating with the child Increased bonding with the child
- 53. 4) Dyslalia It is the most common disorder of difficulty in articulation which is caused by abnormalities of teeth jaw or palate or due to emotional deprivation. Causes Abnormalities of teeth Emotional deprivation Abnormalities of jaw or palate Symptoms Delay language development Difficulty in repeating sound
- 54. Management Speech therapy Rule out the factors responsible for the disorder Counselling of the child Use clear and simple words
- 55. SLEEP DISORDER Change in the negatively affect health due to anxiety, tension and over activity Causes Anxiety Tension Overeactivity Types of sleep disorder 1)Narcolepsy Overwhelming daytime drowsiness
- 56. 2)Sleep walking (somnabulesm) The act of wake up and walking around while sleeping 3) Obstructive sleep apnea Intermittent airflow blockage during sleep 4) Insomnia Persistent problems falling or staying asleep 5)Night mares Awaken from a frightening bad dream and is conscious of surrounding
- 57. 6) Night terror awaken during sleep and sit up with screaming and terrified to recognized the surrounding and sleep after sometime 7) Sleep talking Talking during sleep without aware of it 8) Bruxism (teeth grinding) Involuntary habitual grinding of teeth during sleep
- 58. Clinical feature Difficulty in falling or staying asleep Daytime fatigue Depression Anxiety Strong urge to nap during daytime Diagnostic measure Polysonography
- 59. Treatment Establish a regular bedtime routine and wake up time Do not give the child any food or drinks with caffeine Provide a warm bath or warm milk to drink before going to sleep
- 60. SCHOOL PHOBIA School phobia is an emotional disorder of the children who are afraid to leave parents, prefer to stay at home and refuse to go to school
- 61. Causes Anxiety about maternal separation Overprotection Dominant mother Disinterested father Intellectual disability of child uncongenial school environment
- 62. Symptoms Recurrent physical complain of: Abdominal pain Headaches, which subside if the child stay at home Fear of examination
- 63. Management Habit formation for regular school attendance Play session Assessment of health status Family counseling
- 64. BEHAVIORAL PROBLEM AMONG ADOLESCENCE Masturbation Juvenile delinquency Substance abuse Anorexia nervosa Bulimia nervosa
- 65. ANOREXIA NERVOSA Anorexia Nervosa is a eating disorder found as a refusal of food to maintain normal body weight by reducing food intake, especially fats and carbohydrates. The core psychopathological feature is the dread of fatness, weight phobia and a drive for thinness.
- 66. ETIOLOGY • Genetic causes • A disturbance in hypothalamic function. • Social Factors • Individual psychological factors • Causes within family • Diseases of liver, kidney, heart or diabetes.
- 67. Clinical features Extreme weight loss Intense or irrational fear of weight loss Distorted body image, weight or shape Other physical symptoms like amenorrhea for upto 3 months, hypothermia, muscle wasting, dry skin, etc
- 68. DIAGNOSIS Complete physical examination including lab tests to rule out metabolic and CNS abnormalities; malabsorption syndrome etc. Complete blood testing- haemoglobin levels, platelet counts, cholesterol level, total protein, sodium, potassium, chloride and BUN.
- 69. MANAGEMENT Pharmacotherapy Neuroleptics Appetite stimulants Antidepressants Psychological Therapies Individual psychotherapy Behavioural therapy Cognitive behaviour therapy Family therapy
- 70. BULIMIA NERVOSA Bulimia nervosa is characterized by episodes of binge eating followed by feelings of guilt, humiliation, depression and self condemnation.
- 71. ETIOLOGY • More common in first degree, biological relatives of people with bulimia. • Society’s emphasis on appearance and thinness. • Family disturbances or conflict. • Learned maladaptive behaviour. • Struggle for control or self identity.
- 72. Clinical features Fear of getting fat Eating stop when abdominal discomfort occurs After binge eating the adolescent become more depressed, guilt, anxious Self induce vomiting Miss use of laxative and diuretics Fasting or excessive exercise
- 73. MANAGEMENT • Psychotherapy Behavior modification Dietary counseling Cognitive therapy Hospitalization in complicated cases.
- 74. JUVENILE DELINQUENCY Juvenile delinquency involves wrong doing by a child or a young person who is under an age specified by the law of the place concerned. • A juvenile delinquent is a person who is below 16 years of age (18 years in case of a girl) who indulges in antisocial activity.
- 75. Causes • Social Causes • Psychological causes • Economic Causes • Physical Poor economic Lack of discipline Influence by mass media Rapid urbanization and industrialization
- 76. Activities done Lying Theft Burglary Truancy from school Run away from home Habitual disobedience Mixing with anti social gang Destructive attitude Murder Sexual assault
- 77. Diagnostic measures Interview Mental status examination Neurological examination
- 78. Management • Reform of Juvenile Delinquents • drug therapy: transquilizers, chlorpromazine(25- 50mg) • Reformatory Institutions • Psychological Techniques – Play Therapy – Finger Painting – Psychodrama Healthy parent child relationship Healthy teacher child relationship Fulfillment of basic needs Refer to child guidance clinic
- 79. Prevention Primary prevention Secondary prevention Tertiary prevention
- 80. SUBSTANCE ABUSE It is periodic or chronic intoxication by repeated intake of habit forming agents.
- 81. Factors leading to substance abuse Social nonconformity Low self esteem Depressive feeling Frustration Impulsive and impatience Low achievement motivation
- 82. Childhood trauma Repeated school failure Stronger influence of friends than parents Company of friends taking drugs Misuse of substances in the family
- 83. Clinical features Personality changes Behavioral changes Social changes Social group
- 84. Prevention Recreation and entertainment Education regarding drug abuse Metal health program Periodical psychiatric guidance facilities Strict implementation of drug control measure Group health education Mass media communication Psychotherapy and rehabilitation
- 85. MANAGEMENT OF BEHAVIOR DISORDER 1. FAMILY THERAPY Involvement of family on planning and counseling
- 86. 2. Group therapy Formal therapy: