Common disorder

COMMON BEHAVIOURAL

DISORDERS AND THEIR

MANAGEMENT

Presented By:

Navjyot Singh

M.Sc.(Nsg) 1st Year

INTRODUCTION

Disruptive behaviors should be

considered from both a developmental

and a bio-psychosocial framework.

A child who is not doing what adults

want him to do at a particular time is

considered as behavioral disorder.

DEFINITION

A person is said to have a behavior

disorder when he or she

demonstrates behavior that is

noticeably different from that

expected in the school or community.

COMMON BEHAVIORAL DISORDERS

Repetitive Behaviors

Finger (thumb) sucking & Nail biting

Temper Tantrums

Evening Colic

Stranger Reaction / Anxiety

Pica

Breath holding spasms

Stuttering / Stammering

REPETITIVE BEHAVIORS

Benign & self-limiting

Begin between 6 – 10 years

Example- Body rocking, Head banging

Head banging

In 5-20% of children during infancy & toddler years

Can result in callus formation, abrasions, contusions

MANAGEMENT

Assurance

Teach parents to ignore – as

concern and punishment can

reinforce it.

Padding

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.

Most give up by 2 years.

Predisposing factors:

• Developmental delay

• Neglect

ADVERSE EFFECTS

Malocclusion – open bite

Mastication difficulty

Speech difficulty (D and T)

Lisping

Paronychia and digital abnormalities

MANAGEMENT

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.

TEMPER TANTRUMS

In 18 months to 3 year 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

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

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.

EVENING COLIC

Intermittent episodes of abdominal pain

and severe crying in normal infants

Begins at 1-2 weeks age and persists till

3-4 months.

Crying usually in late afternoon or

evening

CAUSENot known

More likely if the child is over active and

parents are over anxious

Could be a manifestation of

-hunger,

-aerophagia,

-immaturity of intestine,

-overfeeding,

MANAGEMENT

During Episode

Hold the child erect or prone

Avoid drugs

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.

STRANGER REACTION

By 6-7 months age infant can differentiate

from primary care givers and others

At this age they develop fear of others.

This may last for a few months to peak

around 13-15 months

It might be an indication for later

development of behavioral problem as

separation anxiety.

MANAGEMENT

Teach relaxation technique such as slowly

exposing them to stranger,

Initially from a distance

Asking them to greet and slowly advance

Reassure the parents that the behavior

gradually declines

But if persists, refer to child psychiatrist

PICA

Repeated or chronic ingestion of

non-nutritive substances.

It’s an eating disorder.

Normal in infants and toddlers.

Examples: mud, paint, clay, plaster,

charcoal, soil.

PREDISPOSING FACTORS

Parental neglect

Poor supervision

Mental retardation

Lack of affection Psychological neglect,

orphans)

Family disorganization

Lower socioeconomic class

Autism

MANAGEMENT

Screening for:

Iron deficiency anemia

Worm infestations

Lead poisoning

Family dysfunction

Treat accordingly to cause.

BREATH HOLDING SPASMS

Behavioral problem in infants and toddlers.

Child cries and then holds breath until limp.

Cyanosis may occur.

Sometimes, loss of consciousness or even

seizure can occur.

It is child’s attempt to control environment:

parents/caregivers.

Benign condition: no risk of epilepsy

developing in later life.

MANAGEMENT

Referral to Child Guidance Clinic.

Referral to Child Psychologist

– If BHS accompanied with head

banging or highly aggressive behavior.

STUTTERING /STAMMERING

Defect speech

Stumbling and spasmodic repetition of some

syllables with pauses

Difficulty in pronouncing consonants

Caused by spasm of lingual and palatal muscles

Usually begins between 2 – 5 years

Reminding and ridiculing aggravate

Child loses self-confidence and become more

hesitant

They can often sing or recite poems without

stuttering

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