This document discusses various behavioral disorders in children including habit disorders, emotional disorders, eating disorders, repetitive behaviors, temper tantrums, school phobia, speech disorders, tics, oppositional defiant disorder, conduct disorders, and attention deficit hyperactivity disorder. It describes the characteristics and potential causes and management strategies for each disorder.

2. 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.

3. Classification of Individuals with
Emotional or Behavioral Disorders

4. What can affect Behaviour in a child?
• Heredity
• Environment
• Learning Conditioning
• Positive reinforcements

5. 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

6. Repetitive Behaviours
Repetitive Behaviours
Repetitive Behaviours
Repetitive Behaviours
Repetitive Behaviours

7. 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
Head Banging

8. 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

9. Nail Biting
Finger Sucking

10. 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

11. Finger (Thumb) sucking & Nail Biting
• Adverse Effects
– Malocclusion – open bite
– Mastication difficulty
– Speech difficulty ( D and T )
– Lisping

12. Finger (Thumb) sucking & Nail Biting
• Adverse Effects
– Paronychia and digital
abnormalities

13. • Reassure parents that it’s
transient.
• 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.
Finger (Thumb) sucking & Nail Biting
Management
• Most give up
by 2 yrs
• If continued
beyond 4 yrs –
number of
squelae
• If resumed at
7 – 8 yrs : sign
of Stress

14. Finger (Thumb) sucking & Nail Biting
• Treatment Options:
SOLUTION TYPE HOW IT WORKS EXAMPLES HOW IT FAILS
Behvioural Depends on child‟s
willingness to stop
Rewards &
punishments,
stories
Child loses control
when sleeping or
in subconscious
state
Aversive Use of pain or
discomfort to
discourage the
habit
Applying foul
tasting liquids
Creates more
stress and pain to
child / can even
worsen…
Mechanical Mechanical
impediments to the
process
Bandages around
elbows, socks over
the fingers, fabric
gloves, etc
Restrict
movements, can
be removed, not
hygienic
T Guards Remove the
pleasure
associated by
eliminating suction
Thumb guards,
finger guards
Can not remove,
hygienic, do not
restrict movement,
95% success rate

15. Finger (Thumb) sucking & Nail Biting
• Finger guards / Thumb guards , etc.:

16. Temper Tantrums

17. 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.

18. • Hunger
• Fatigue
• Lack of sleep
• Innate personality of child
• Ineffective parental skills
• Over pampering
• Dysfunctional family / Family
violence
• School aversion
Temper Tantrums
Precipitating factors

19. 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

20. 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.

21. Evening Colic

22. 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 ”

23. 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

24. Evening Colic
Causes • More likely if the child is over active and
parents are over anxious
• Not known
• Could be a manifestation of …

25. 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

26. Eating
DDisiosrodredrer
Pica

27. 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 !!!

28. 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

29. 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
Pica

30. • Screening indicated for:
 Iron deficiency anemia
 Worm infestations
 Lead poisoning
 Family dysfunction
• Treat cause accordingly.
• Usually remits in childhood but can
continue into adolescence
Pica

31. Breath Holding Spasms

32. Breath Holding Spasms
1. Simple breath-holding spell
2. Cyanotic breath-holding spells
3. Pallid breath-holding spells
4. Complicated breath-holding spells
Precipitating Factors:
• Frustration
• Injury
• Anger
• Anemia

33. 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.

34. Emotional
Disorders
School Phobia

35. 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 11-
year olds
• School refusal differs from truancy
(refusal is because of fear or anxiety about school)

36. 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
School Phobia

37. • 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.
School Phobia

38. Speech
Disorders
Stammering

39. • Defect speech
• Stumbling and spasmodic repetition of
some syllables with pauses
• Difficulty in pronouncing consonants
• Caused by spasm of lingual and palatal
muscles
Stuttering / Stammering

40. • 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
Stuttering / Stammering

41. 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

42. … sudden, repetitive, nonrhythmic motor movement or
vocalization involving discrete muscle groups
Tics
12 to 20% children,
peak age 5 -7 yr.
Motor Tics
or
Phonetic Tics
More common in boys
than in girls
Increase when stressed,
anxious, fatigued, or bored
Can occur in
any body part
Decrease when focused

43. Simple Tics:
• Grimacing
• Yawning
• Grunting
• Sighing
• Blinking
• Wrinkling
• Scratching nose
• Head jerking
• Throat clearing
Tics : Common types
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

44. Tic Disorders
• 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
Tourette‟s
Chronic
Transient
(Gilles de la Tourette syndrome)

45. • 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.
Tics : Management.

46. Tics :
Formulations in the Management contd..
• haloperidol,
• pimozide,
• clonidine,
• nifedipine are use in low doses.
• risperidone,
• olazapine
• mecamylamine,
• tetrabenazine,
• Benzodiazepines
• baclofen,
• botulinum toxin

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48. 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.

49. 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.

50. LOGO
Attention Deficit hyperactivity disorder
(ADHD)
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.
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.

51. •C.S.N.Vittal