Common behavioral-problems

COMMON BEHAVIOURAL
PROBLEMS
1
IAP UG Teaching slides 2015‐2016

COMMON BEHAVIORAL PROBLEMS
• Anorexia
Nervosa,Bulimia
• Pica
• Bed wetting (Enuresis)
• Thumb sucking
• Breath holding spells
• Temper tantrums
• Tics
• Bruxism
• Encopresis
2

Anorexia Nervosa
It’s a eating disorder.
Characterized by - body weight of <85% of expected weight for age and
height. intense fear of becoming of fat even when they are under weight
amenorrhea in post menarche age
Common between 15-19 years old.
2types - they lose weight by excessive dietary restrictions and by
increased physical activity
or
Resort to vomiting,diuretics or laxatives.
TREATMENT _ Psychotherapy and family therapy - nurturing environment
Nutritional rehabilitation - monitored feeds , sometimes tube feeds are
necessary too
May require antidepressants.

Bulimia
It is characterized by - recurrent episodes of binge eating , i.e eating
more than a normal person eats at a particular time.
Recurrent inappropriate compensatory behaviour to prevent weight
gain by vomiting ,enemas,misuse of laxatives
Atleast twice a week for a period of 3mnths
More common in girls - 10-19yrs
Management includes - psychotherapy and antidepressants -
fluoxetine
Active follow up to ensure adherence to therapy

Food Fussiness
Common problem in young children
excessive control on what a child should eat by parents
Management - examine for nutritional deficiencies , assess
growth patterns
Behavioural strategies - regular meal timings, pleasant
atmosphere,
Offer variety and small regular meals
Interesting presentation - shapes etc
Praise good behaviour like when they finish their portion
Do not give sugar foods or junk as praise

PICA
• Definition:
Persistent ingestion of non‐nutritive substances for
at least 1 month in a manner that is inappropriate
for the developmental level.
• Examples: mud, paint, clay, plaster, charcoal.
6

PICA(CONT..)
Predisposing factors :
• Lack of parental nurturing
• Mental retardation
• Psychological neglect (orphans)
• Family disorganization
• Lower socioeconomic class
• Autism
7

PICA (CONT)
• Screening indicated for:
• Iron deficiency anemia
• Worm infestations
• Lead poisoning
• Family dysfunction
• Treat cause accordingly
• Usually remits in childhood but can continue into
adolescence.
8

ENURESIS
• Evacuation of bladder at a wrong place and time at
least twice a month after 5 yrs of age
• Prevalence:
‐5‐10 yr olds: 2‐3%
‐adolescence: 0.5‐1%
9

TYPES OF ENURESIS
• Primary nocturnal enuresis: child has never been dry
at night (90% of cases).
• Secondary nocturnal enuresis: child has been
continent for ≥ 6 months and then begins to wet bed
during sleep.
• Diurnal enuresis: child passes urine in clothes during
day and while awake.
10

PRIMARY NOCTURNAL ENURESIS‐CAUSES
• Marked familial pattern.
• 68% concordance rate in monozygotic twins.
• 38% concordance rate in dizygotic twins.
• Maturational delay is the most common cause
• Hypo secretion of arginine vasopressin (AVP)
hormone may be possible etiology.
11

SECONDARY NOCTURNAL ENURESIS‐CAUSES
• Psychosocial Stress: Family quarrels/Academic stress
• Urinary Tract Infection.
• Juvenile Diabetes Mellitus.
• Management of secondary nocturnal enuresis
depends on cause.
12

MANAGEMENT OF PRIMARY NOCTURNAL ENURESIS
• Detailed clinical / developmental history
• Family history
• Rule out urinary tract infection.
• Rule out occult spina bifida / abnormalities of urinary
tract
• X‐ray lumbosacral spine
• USG abdomen
• Rule out Diabetes Mellitus
13

e
BEHAVIOR THERAPY FOR PRIMARY NOCTURNAL
ENURESIS
• Adequate fluid intake during the day as 40% in th
morning,40% in the afternoon and 20% in the
evening
• Caffeinated drinks to be avoided in the evening
• Reassurance and emotional support to the child
14

BEHAVIOUR THERAPY FOR PRIMARY NOCTURNAL
ENURESIS
• Encourage child to keep a dry night diary and void
urine before bed
• Dry nights to be credited with praise
• Never humiliate or punish the child
• Alarm therapy
15

PHARMACOTHERAPY FOR PRIMARY NOCTURNAL
ENURESIS
• If behavior therapy fails or if parents want
prompt response:
•Imipramine (2.5 mg/kg/24 hrs at bed time) for
few weeks and taper
•Desmopressin acetate (DDAVP) orally or intra
nasally at bed time
16

THUMB SUCKING
• A habit disorder.
• Sensory solace for child (“internal stroking”).
• Normal in infants and toddlers.
• Reinforced by attention from parents.
• Predisposing factors:
• Developmental delay
• Neglect
17

MANAGEMENT OF THUMB SUCKING
• Reassure parents that it’s transient.
• Improve parental attention/nurturing.
• Teach parent to ignore; and give more attention to
positive behavior.
• Provide child praise for substitute behaviors.
• Bitter salves may be used reduce thumb sucking.
• Chronic thumb sucking in older children may affect
alignment of teeth.
18

BREATH HOLDING SPELLS
• Behavioral problem in infants and toddlers.
• Typically initiated by a provocative event
• Child cries and then holds breath until limp.
• Cyanosis may occur.
• Sometimes, loss of consciousness, or even seizure
can occur.
• Reverts back to normal on their own within several
seconds
• Rare before 6months of age; peak at 2yrs and abate
by 5yrs of age
19

PALLID SPELLS CYANOTIC SPELLS
• Triggered by sudden
fright or pain
• Triggered by
frustration or anger
• Child may gasp/ give
brief cry
• Cries vigorously
• Becomes pale, limp • Following cry  Turns
blue
• Brief episode, less
than one minute
• May become
unconscious, less than
one minute
• Regains
consciousness,
recognise people
• Regains
consciousness, gasps.
Returns to n17ormal

G
DIFFERENCE BETWEEN SEIZURE AND BREATH HOLDIN
SPELLS
21

TREATMENT OF BREATH HOLDING SPELLS
• Elicit clinical sequence of events from parents.
• Parents reassured, told to ignore behavior.
• Parents should remain calm during the event
• Iron supplementation for children with iron
deficiency anemia
22

TEMPER TANTRUMS
• In 18 months to 3 yr olds due to development of
sense of autonomy.
• Child displays defiance / oppositionalism by having
temper tantrums.
• Normal part of child development.
• Gets reinforced when parents respond to it by
punitive anger.
23

PRECIPITATING FACTORS FOR TEMPER TANTRUMS
• Hunger
• Fatigue
• Lack of sleep
• Innate personality of child
• Ineffective parental skills
• Over pampering
• Dysfunctional family / Family violence
• School aversion
24

TEMPER TANTRUM‐MANAGEMENT
• In general, parents advised to:
• Set a good example to child
• Spend quality time
• Have open communication with child
• Have consistency in behavior
• During temper tantrum:
• Parents to ignore child, leave child alone
• Once child is calm, tell child calmly that such
behavior is not acceptable
• Never beat or threaten child
25

TEMPER TANTRUM‐MANAGEMENT
• Praise / reward child for good behavior.
• “Time Out” as disciplinary method if temper
tantrum is disruptive and , out of control
• Refer to Child Guidance Clinic if temper tantrums
persist.
26

TICS
Definition: Repetitive movements of muscle groups of
face, neck, hands, shoulders, trunk.
Examples:
• Lip smacking
• Grimacing
• Tongue thrusting
• Eye blinking
• Throat clearing
27

TICS
• Tension relieving habit disorder.
• Mostly transient.
• Persistent tics need psychotherapeutic intervention.
• Causes of persistent tics:
• Academic under achievement
• Low self esteem
• Neuropsychologic dysfunction
28

BRUXISM
• A habit disorder.
• Begins in first 5 yrs of life.
• Associated with daytime anxiety.
• May lead to problems with dental occlusion.
29

MANAGEMENT OF BRUXISM
• Help child find ways to reduce anxiety:
Parent reads relaxing stories at bedtime
Emotional support
• Persistent bruxism leads to muscular or temperomandibular
joint pain.
• Dental referral necessary.
30

ENCOPRESIS
• Passage of faeces at inappropriate places after 4
yrs of age.
• Usually associated with constipation and overflow.
• Subtypes:
–Primary: persisting from infancy onward
–Secondary: appears after successful toilet training
• Can be
A)Retentive(with constipation and overflow
incontinence)
B)Nonretentive (without constipation and overflow
incontinence)
31

PREDISPOSING FACTORS FOR ENCOPRESIS
• Primary subtype:
– Developmental delay
• Secondary subtype:
– Psychosocial stressors
– Conduct disorder
32

CLINICAL FEATURES
• Offensive odour leads to:
– Ridicule by schoolmates / teachers
– Punitive measures / scolding from parents /
teachers
– Poor school attendance and performance
• Abdominal pain, impaired appetite
• UTI
33

MANAGEMENT
• Clearance of impacted faeces using enemas.
• Short term use of mineral oil / laxatives to prevent
constipation.
• Behavior therapy: Regular postprandial toilet habits
• High fiber diet / improve water intake.
• Individual or group psychotherapy sessions.
• Family support: encourage child, rewards for
compliance, avoid power struggles.
34

MUNCHAUSEN BY PROXY
 Its a disorder in which care giver deliberately makes up a history
of illness in her child and /or harms the child to create illness.
 Most common victims are young infants or preverbal children.
 Confirmation of the diagnosis needs careful history and reviewing
of the past hospital records.
 Monitoring the child by hidden cameras may be needed.
 Once confirmed – then offending care giver needs to be
confronted.
 Child should be separated and provided psychotherapy.

Disruptive behaviour Disorders
2 categories - 1.Oppositional Defiant Disorder
2.Conduct Disorder
consistent disruptive defiant behaviour towards authorities
aggressive behaviour affecting the environment
they lead to JD

JUVENILE DELINQUENCY
 Children who come in conflict with justice
system are JDs
 It refers to person less then 18yrs of age
who commit a crime or display any
behaviour which is not permitted under law
such as drugs, alcohol etc
 Family and parenting help in reducing this
rate
 Foster care

Thank You
38

Common behavioral-problems

More Related Content

What's hot

Similar to Common behavioral-problems

Recently uploaded

Common behavioral-problems