Deals with behavioral disorders, family factors influencing the behavior of children ( risk factors and protective factors) and psycho social management.

1. FAMILY FACTORS IN
BEHAVIORAL
DISORDERS
Nafeesath Sabida SM
Mphil Scholar
NIMHANS, Bengaluru
Date: 29/7/2017

2. INTRODUCTION
• Behavioral disorders, also known as
disruptive behavioral disorders, are the most common
reasons that parents are told to take their kids for
mental health assessments and treatment.
• The term “disorder” is used cautiously in this age
group, with some skepticism about its validity
(Campbell, 2002).

3. Behaviour Problems/Disorders Related
to Daily Physiological Activities
• Feeding/Eating Problems
• eating too little
• eating too much
• eating in an abnormal or strange manner.
• Pica is an example of abnormal eating, where the child persists
in eating non-nutritive substances such as paint, hair or cloth.

4. • Sleep Problems
• difficulty sleeping (bedtime resistance, sleep-time anxiety and
sleeplessness),
• Daytime sleepiness
• snoring or gasping during sleep
• sleepwalking
• nightmares
• bedwetting

5. Disruptive Behaviour Problems and
Disorders
• Temper Tantrums and Conduct Problems
• common worry in parents
• when children start to hold their breath or hit themselves.

6. • Oppositional Defiant and Conduct Disorder
• Oppositional defiant disorder is defined as a pattern of
prolonged negativistic, hostile and defiant behaviour occurring
“more frequently” than is “typically observed” in individuals of
comparable age and developmental level. (Rey J M, Walter G)
• Conduct disorder is manifested by prolonged antisocial
behaviour which violates the basic rights of others or societal
norms, characterised by aggression to people andanimals,
destruction of property, deceitfulness or theft andserious
violations of familial, communal or societal rules (DSM-IV).

7. • Attention Deficit Hyperactivity Disorder (ADHD)
• ADHD, the most common emotional, cognitive and behavioural
disorder paediatricians, family physicians and psychiatrists treat
in children, is characterised by inattention, hyperactivity and
impulsivity.

8. • Substance Abuse
• The incidence of drug abuse among children and adolescents is
higher than the general population.
• Heroin, Opium, Alcohol, Cannabis and Propoxyphene are the
five most common drugs being abused by children in India.
• A survey shows that of all alcohol, cannabis and opium users
21%, 3% and 0.1% are below the age of eighteen.(childline)

9. Pervasive Developmental Disorders
and Disorders of Social Behaviour
• Autism & Pervasive Developmental Disorders
• Sleep problems and aggression

10. Behaviour Problems Related to
Emotional Disorders
• Affective Disorders
• withdrawal
• school refusal
• sleep problems
• separation anxiety
• anger
• irritability

11. • Anxiety and Obsessive-Compulsive Spectrum Disorders
• school refusal
• Somatic complaints
• repeated health and reassurance seeking behaviour.

12. • Selective Mutism
• more likely to occur in girls
• begins after a stressful life event (Angelou M)
• social anxiety

13. • Dissociative and Conversion States
• Dissociative states refer to the manifestation of psychological
distress as disruption to consciousness, memory, identity or
perception.
• Conversion states refer to unexplained symptoms, deficits or
loss of function of motor or sensory function.
• particular stress factors

14. Family factors
• INFANCY MIDDLE CHILDHOOD & EARLY CHILDHOOD
• Risk factors
• Parental drug/alcohol use
• Cold and unresponsive mother behavior depression
• Marital conflict
• Negative events anxiety
• Cold and unresponsive mother behavior substance
Parental drug/alcohol use abuse
• Family dysfunction schizophrenia
• Disturbed family environment conduct disorders
• Parental loss

15. • INFANCY MIDDLE CHILDHOOD & EARLY CHILDHOOD
• Protective Factors
• Reliable support and discipline from
• caregivers
• Responsiveness
• Protection from harm and fear
• Opportunities to resolve conflict
• Adequate socioeconomic resources for the family

16. • MIDDLE CHILDHOOD
• Risk factors
• Parental depression
• Poor parenting
• rejection
• lack of parental warmth depression
• Child abuse/maltreatment
• Loss
• Marital conflict or divorce
• Family dysfunction

17. • Parents with anxiety disorder or anxious childrearing
practices
• Parental overcontrol and intrusiveness
• Parents model, prompt, and reinforce threat appraisals
and avoidant behavior
• Marital conflict; poor marital adjustments anxiety
• Negative life events

18. • Permissive parenting
• Parent-child conflict
• Low parental warmth
• Parental hostility
• Harsh discipline
• Child abuse/maltreatment substance
• Substance use among parents or siblings abuse
• Parental favorable attitudes
• Inadequate supervision and monitoring
• Low parental aspirations for child
• Lack of or inconsistent discipline
• Family dysfunction schizophrenia

19. • MIDDLE CHILDHOOD
• Protective Factors
• Consistent discipline
• Language-based rather than physically based discipline
• Extended family support

20. • ADOLESCENCE
• Risk factors
• Parental depression
• Parent-child conflict
• Poor parenting
• Negative family environment depression
• Child abuse/maltreatment
• Single-parent family
• Divorce

21. • Parent with anxiety
• Parental/marital conflict
• Family conflict anxiety
• Parental drug/alcohol use
• Parental unemployment
• Substance use among parents
• Lack of adult supervision substance abuse
• Poor attachment with parents

22. • Family dysfunction
• Family member with schizophrenia schizophrenia
• Poor parental supervision
• Parental depression conduct disorder
• Sexual abuse

23. • ADOLESCENCE
• Protective Factors
• Family provides structure, limits, rules and monitoring
• Supportive relationships with family members
• Clear expectations for behavior and values

24. Psycho social management
• Behaviour Problems/Disorders Related to Daily
Physiological Activities
• Feeding/Eating Problems
• self-monitoring and record keeping;
• habit breaking
• stimulus control
• modification of eating style
• reinforcement of desirable behaviours
• impulse/ self control.

25. • Sleep Problems
• pre-sleep routine,
• graduated or modified extinction by resisting reacting to
the child’s cries or demands and scheduled

26. • Disruptive Behaviour Problems and Disorders
• Temper Tantrums and Conduct Problems
• positive parent-child interaction
• A balance of positive incentives to increase desirable
behaviour
• Oppositional Defiant and Conduct Disorder
• individual therapy (cognitivebehavioural,psychodynamic
and social skills training),
• family therapy (including parent management training)

27. • Attention Deficit Hyperactivity Disorder (ADHD)
• Parent management training
• Substance Abuse
• Prevention based
• Educating the parents
• PMT

28. • Pervasive Developmental Disorders and Disorders of
Social Behaviour
• Autism & Pervasive Developmental Disorders
• The intervention of choice is early and remedial special
education targeting behaviour and communication
• Educating parents about use of early stimulation space

29. • Behaviour Problems Related to Emotional Disorders
• Affective Disorders
• Cognitive-behavioural therapy (CBT)
• Nondirective supportive psychotherapy
• Systemic behavioural family therapy
• Anxiety and Obsessive-Compulsive Spectrum Disorders
• behavior therapy (exposure to the feared situation and
prevention of response by performing a ritual to reduce
anxiety)

30. • Selective Mutism
• Individual behaviour therapy
• family and school involvement

31. CONCLUSION
• Behavioral problems in children may be associated with a
disorder or may not.
• Family factors have high influence on children’s
behavioral issues.
• Bio psycho social management of the behavioural issue
with the support and co-operation from the family
members can bring change in the behavioral issues of the
child.

32. REFERENCES
• Ung, K. E. K. (2001). Behavioural disorders in childhood: a Singapore
perspective. ANNALS-ACADEMY OF MEDICINE SINGAPORE, 30(2), 155-163.
• Gardner, F., & Shaw, D. S. (2009). Behavioral problems of infancy and preschool
children (0–5). Rutter's Child and Adolescent Psychiatry, Fifth Edition, 882-893.
• Rey J M, Walter G. Oppositional defiant disorder. In: Hendren R L, editor. Disruptive
Behavior Disorders in Children and Adolescents. Review of Psychiatry 18.
Washington, DC: American Psychiatric Press, 1999:99-132
• http://dhss.alaska.gov/dbh/Documents/Prevention/programs/spfsig/pdfs/IOM_Matrix
_8%205x11_FINAL.pdf