This document provides an overview of behavioral disorders in children. It begins with an introduction stating that normal children are well-adjusted when their emotional, physical and psychological needs are met. It then defines behavioral problems as significant deviations from socially accepted norms. The main causes and various types of behavioral disorders are discussed, including habit disorders, speech disorders, eating disorders, sleep disorders, personality disorders, and anxiety disorders. Specific behavioral disorders like enuresis, encopresis, nail biting, thumb sucking, pica, anorexia nervosa, bulimia nervosa, somnambulism, sleep talking, nightmares, stuttering, and school phobia are then defined and their causes, signs/symptoms

1. PRESENTATION
ON
BEHAVIOURAL
DISORDERS
PRESENTED BY: AIN, NALAGARH
NILEKHA THAKUR
PARUL BHATIA
POOJA
PUSHPLATA
RINKU

2. INTRODUCTION
Normal children are happy, healthy and well
adjusted. This adjustment is developed by
providing basic emotional needs along with
physical and psychological needs for their mental
well -being. The emotional needs are considered
as emotional food for healthy environment. Major
behavioural problems are significant deviation
from socially accepted normal behaviour.

3. DEFINITION
Behavioural problems include disorders that
represents significant deviation from the normal
behaviour. The root of the problem usually is
traceable to the home or school environment

4. CAUSES OF BEHAVIOURAL
PROBLEMS
HABIT
DISORDER
SPEECH
DISORDER
EATING
DISORDER
SLEEP
DISORDER
PERSONALITY
DISORDER
SEXUAL
DISORDER
ANXIETY
DISORDER

6. HABIT
DISORDERS
ENURESIS
NAIL BITING

7. 1. ENURESIS
 The word derived from the Greek word
“enourein” means “to void urine”. It can
either during the day or at night.
 Enuresis is a disorders of involuntary
micturition in children who are beyond the
age when normal bladder control should
have been required.
 It is common during 4 years to 1 years
age.

8. TYPES OF ENURESIS
NOCTURNAL
ENURESIS
DIURNAL
ENURESIS
MONOSYMPTOMATIC
OR UNCOMPLICATED
ENURESIS

9. CAUSES
 Faulty or defects in toilet training
 Overactive bladder
 Feeling of shame and guilt
 Emotional atmosphere
 Organic causes like UTI

10. SIGN AND SYMPTOMS:
 Wetting during the day
 Frequency urgency, or burning
urination.
 Straining, dribbling, or other
unusual symptoms with urination
 Cloudy or pinkish urine

11. MANAGEMENT
 The home condition, socioeconomic status and
habits of the family should be found out.
 Child parent relations should be explored.
 Analysis of the time of bed wetting frequency
and relation to sleep should be done.
 Restriction of flid intake in the evening and
helping the child in developing the habit of
passing urine before going to the bed.

12. 2. ENCOPRESIS
Encopresis refers to passage
of feaces into inappropriate
place at any age when bowel
control should have been
established.

13. CAUSES:
 Anatomic abnormality
 Emotional disturbances
 Improper toilet training
 Stress in school activity
 Overprotection
 Fear related to toilet
 Poor parent child bonding.

14. SIGN AND SYMPTOMS:
 Withhold defecation
 Distended abdomen
 Diarrhoea related to irritation of
GI tract
 Tensed feeling
 Aggressiveness

15. DIAGNOSTIC
EVALUATION:
 History of bowel elimination
 Physical examination
 Detail about pattern of current
toilet practice
MANAGEMENT
-Establish regular bowel
habits
-Reassurance and help from
psychologist for counselling
of child and parents.

16. 3. NAIL BITING
Nail biting is bad oral
habit especially in
school-age children
beyond 4 years of age(5
to 7 years)

17.  Persistent nail biting may be incidicative of emotional problem.
 Psychosomatic
 Sign and symptoms
 Rotation
 Alteration of incisal edge or incisor
 Inflammation of nail bud
 Management
 The child’s hand to be kept busy with creative activities or play.
 Punishment to be avoided.
 The child should be praised for well kept hand by breaking the
habit to maintain self -confidence.
ETIOLOGY

18. 4. THUMB
SUCKING
It is due to feeling of
insecurity and tension
reducing activities.

19. CAUSES
 Emotional
insecurity.
 Feeling of isolation
 Boredom
 Stress
MANAGEMENT
 Positive reinforcement
 Identify the real issue and provide
comfort.
 Do not scold the child
 Offer gentle reminders

20. EATING
DISORDERS

21. 1.PICA
PICA is characterized by an appetite for
substance largely non- nutritive and the
habit must persist for more than one
month, at an age when eating such objects
is considered developmentally
inappropriate.

22. CAUSES
 Associated with mental retardation.
 Iron deficiency and vitamin deficiency
 Mineral deficiency
 Maternal deprivation
 Family issues
 Parental neglect
 Poverty

23. SIGN AND SYMPTOMS
 Children are often anaemic
 Minera and vitamin deficiencies
 Intestinal and parasitic infestation are generally
associated

24. MANAGEMENT
Psychotherapy
Proper supervision

25. 2. ANOREXIA NERVOSA
It is a characterized by voluntary refusal
to eat, significant weight loss, a
pronounced disturbance of body image.

26. CAUSES
 Neurotransmitter
disturbances
 Deficit ego development
 Familial conflicts.
CLINICAL FEATURES
 Extreme wight loss
 Intense or irrational fear of
weight gain
 Distorted body image
 Hypothermia
 Cardiac dysrhythmia
 Cold intolerance

27. MANAGEMENT
 Nutritional counselling by a dietician regarding
healthy eating habits and balanced diet
 Individual therapy
 Family therapy
 Enhancement of self esteem

28. 3. BULIMIA NERVOSA
It is a disorder of binge eating, where the
individual consume the large amount of
food with lack of control followed by the
various compensatory behaviours.

29. CAUSES:
 Family history of
depression
 Substance abuse
 Eating disorders
 Sports career in
which body weight
should low.
SIGN AND SYMPTOMS
 Intense fear of getting fat
 Binge eating stops when
abdominal discomforts
 occurs
 Self -induced vomiting.
 Fasting or excessive exercise.

30. MANAGEMENT
 Behaviour modification
 Cognitive therapy
 Dietary counselling
 SSRIs drugs

31. SLEEP
DISORDERS

32. 1.Somnambulism
This is a common sleep disorder. It is also
called sleep walking. In this condition,
children are aware of the environment
during the episode but are indifferent to it.

33. MANAGEMENT:
 Locking the doors and windows of the
room in which the child is sleeping.
 Removing all the dangerous objects
and corrections of superstitions.
 Provide small doses of diazepam in
advanced cases.

34. 2. Sleep talking(smililoquy)
It is sleep-disorder, in which child talks
during sleep.
These children talk irregularly and give the
gaps same like conversations.
Parents when observe they feels that child is
talking with somebody.

35. CAUSES:
 Children who are having
incomplete talk during the day
time by the influence of
parents.
 Stress and anxiety
 Childrens who are having the
conflicts with siblings and
school mates.
 Children who have more
feeling of the home sickness.
MANAGEMNET:
 Always sleep with these children
and assure them they are with
them.
 Satisfy the child’s need
 Resolve the child’s conflicts
 Don’t show any movie or story
video before sleep
 Give comfortable environment for
sleep

36. 3. NIGHT MARES AND NIGHT
TERRORS
In this disorders, child awakens due to
frightening bad dream and child conscious
about surroundings, night mares associated
with dreams.

37. MANAGEMENT
 Child should have light diet in dinner and pleasant
scene and stories at bed time.
 Comforted the child and reassured him physically
and verbally
Sitting at the bed side until the child feel secure and
is ready to go back to sleep

38. SPEECH
DISORDERS

39. 1.SLUTTERING AND STAMMERING
Stammering is also known as sluttering.
It is a speech disorder in which the flow is
disrupted by involuntary repetitions and
prolongation of sounds, words and
syllables. Also there is involuntary silent
pause or blocks.

40. CAUSES:
 Developmental
factors
 Neurogenic
factors
 Psychological
factors
SIGN AND SYMPTOMS:
 Interruption in the flow of speech
 Prolongation and repetition of words
 Child may have hesitation
 Problems in starting a word or phrase
 Speech may come out in spurts
 Trembling lips and jaws when trying to
talk.
 Interjection of ‘uhm’ used more frequently
before attempting to utter

41. MANAGEMENT:
 Behaviour modification and relaxation therapy to resolve
conflict and emotional stress.
 Child should be reassured and helped in breath control
exercise and speech therapy.
 Parents need counselling to rationalize their expectations
of child’s achievement according to the potentiality.
 These children have normal or high IQ level, so they need
encouragement and guidance.

42. 2. DYSLALIA
DYSLALIA is the most
common disorder of difficulty
in articulation

43. ANXIETY DISORDERS

44. School phobia
It is a refusal to go to school or to stay in school
without any attempts to conceal.
It is a emotional disorders o the children who are afraid
to leave the parents especially mothers.
School phobia is also called school refusal

45. CAUSES:
 Individual factors: withdrawl
 Separation anxiety
 Family factors
 Factors specific to school

46. SIGN AND SYMPTOMS
 High level of anxiety
 Headache
 Nausea
 Abdominal pain and palpitations

47. MANAGEMENT:
 Habit formation for regular school
attendance
 Play session and other recreational
activities
 Improvement of school environment
 Family counselling

48. NURSING
RESPONSIBILITY

49.  Nurse play a vital role for
prevention, early identification and
management of behavioural disorders
in children.
 Assessment of specific problems of
the child by appropriate history and
detection of the responsible factors.
 Informing the parents and making
them aware about the causes of
behavioural

50.  Problems of particular child.
 Assisting the parents, teachers
and family members for
necessary modification of
environment at home school
community.
 Encouraging the child for
behaviour modification as
needed.

51.  Promoting healthy emotional
development of child by
adequate physical, psychological
and social support.
 Creating awareness about
psychological disturbances which
may lead to behavioural
problems during developmental
stages.