Management of

Behavioral and
social problem in
children.
Rahul Dhaker,
Asst. Professor, RCN Bhilwara 1
 Introduction
• This range of disorders may be caused by a
number of factors such as-
– parenting style which is inconsistent or
contradictory,
– family or marital problems,
– child abuse or neglect,
– overindulgence,
– injury or chronic illness,
– separation or bereavement (Grief).
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Cont…. Introduction

• The child's problems are often multi-factorial

and the way in which they are expressed may be
influenced by a range of factors including-
– developmental stage,
– temperament (Personality/disposition),
– Coping,
– adaptive abilities of family and the nature and
– duration of stress.
• In general, chronic stressors are more difficult
to deal with than isolated stressful events.

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Cont…. Introduction

• All young children can be naughty, disobedient

and impulsive from time to time, which is
perfectly normal.
• However, some children have extremely difficult
and challenging behaviors that are outside the
norm for their age.

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Cont…. Introduction

• When children cannot adjust to a complex

environment around them, they become unable to
behave in the socially acceptable way resulting in
exhibition of peculiar (Abnormal) behaviors and
this is called as Behavioral Problems.

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Psychiatric disorders: an overview
• Classification of psychiatric disorders in
children debatable.
• Adjustment reaction
• Behavior problems
• Speech symptoms
• Childhood neurosis
• Childhood psychosis
• Organic brain syndrome
• Mental retardation.
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 Categorization of common
behavioral problems:-
• Habit problem • Scholastic problem

• Eating problem • Sexual problem

• Sleep problem • Personality problem

• Speech problem • Antisocial problem

• Adjustment Problem
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 Habit problem
Tension-reducing habit disorders

Repetitive
Thumb sucking Tics
vocalisations

Nail biting Hair pulling Breath holding

Manipulating
Air swallowing Head banging
parts of the body

Hitting or biting
Body rocking
themselves
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 Eating problem
• Pica
• Food fads
• Food refuse/ overeating
• Vomiting
• Aerophobia
• Anorexia

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 Sleep problem
• Night terrors

• Nightmares

• Insomnia

• Sleep – talking

• Hypersomnia

• Narcolepsy

• Cataplexy
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 Speech problem
• Stammering

• Stuttering

• Mutism

• Articulation disorder
• Phonation

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 Scholastic problem
• Reading • Truancy
• Writing or • School phobia
mathematical
• Aggressiveness
disability
• Repeated failure

• Absenteeism

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 Sexual problem
• Masturbation

• Homosexuality

• Incest

• Precocious sexuality
• Hypersexuality

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 Personality problem
• Shyness

• Timidity

• Fear

• Anger
• jealousy

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 Antisocial problem
• Juvenile delinquency in the form of -

• Stealing

• Lying

• Destructiveness

• Cruelty

• Gang activities etc.

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 Adjustment Problem
• Temper Tantrum

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Categorization of behavior problems in
relation to age group

• Infancy

• Childhood

• Adolescent

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 Infancy

• Feeding problem

• Abdominal colic

• Stranger anxiety

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 Childhood
• Temper tantrum • Speech problem-
• Breath holding spell • Stuttering or
• Thumb sucking stammering
• Nail biting • Cluttering
• Enuresis or bed wetting • delayed speech
• Encopresis • Dyslaia
• Pica • Speech disorder
• Tics or habit spasm • School phobia
• Attention deficit disorder
(ADD) or ADHA
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 Adolescent
• Masturbation

• Juvenile delinquency

• Substance abuse

• Anorexia nervosa

• Bulimia nervosa

• Hysteria

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 Risk factors in children’s
behavioral disorders
• Children who show the sign of behavior disorders are
facing some problem or the other which they cannot
express.
• The frustration arising out of these problem thus erupts in
form of behavioral disorders.

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Cont…Risk factors in children’s behavioral disorders

• Gender - boys are much more likely than girls to suffer from
behavioral disorders. It is unclear if the cause is genetic or linked
to socialization experiences.
• Gestation and birth – difficult pregnancies, premature birth and
low birth weight may contribute in some cases to the child’s
problem behavior later in life.
• Temperament/ Personality – children who are difficult to
manage, temperamental or aggressive from an early age are more
likely to develop behavioral disorders later in life.

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Cont…Risk factors in children’s behavioral disorders

• Family life –
– behavioral disorders are more likely in dysfunctional families.

– For example, a child is at increased risk in families where

domestic violence, poverty, poor parenting skills or substance
abuse are a problem.
– Divorce or separation of parents.

– Improper behavior of parents towards child and others.

– Getting scolded by parents regularly.

• Learning difficulties
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Cont…Risk factors in children’s behavioral disorders

• Intellectual disabilities
• Brain development
• Poor nutrition and faulty eating habits
• Sexual abuse

• When children have to face any or some of the above

mentioned circumstances, their mental health gets
affected.
• The repercussions of these circumstances give rise to
the various symptoms of behavioral problems in
them.
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 Signs And Symptoms of Abnormal
Behavior
• Children are cute when naughty. A few tantrums,
arguments, and yelling once in a while is not
abnormal.
• But if such behavior becomes a daily occurrence,
then it is a cause for concern.
• Here are some signs that indicate that child’s
behavior is abnormal. 25
Cont…Signs And Symptoms Of Abnormal Behavior

• Child seems to have difficulty managing his

emotions. He has frequent emotional outbursts
and minor things bother him.
• It is not normal if eight-year-old girl or boy
becomes impulsive. They may display destructive
behavior like hitting, throwing things, screaming,
etc.

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Cont…Signs And Symptoms Of Abnormal Behavior

• little boy maybe lying more often than parents

realized. Stealing or taking things that do not
belong to them becomes a habit.
• child’s behavior is affecting his performance at
school. For example, kid may be getting into
fights, going late to class or missing classes.
• Unable to focus on one thing, gets restless,
extremely lazy or disoriented.
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Cont…Signs And Symptoms Of Abnormal Behavior

• Child starts questioning your instructions and

does not respond to discipline. He may defy rules
just to challenge you.
• It is not normal for children to harm themselves
or even think about self-harm. So, if they are
harming themselves physically and having
suicidal tendencies, Parent should be worried.

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Assessment Methods
• In order to treat the child with behavioral
disorders, first he/she must be assessed of what
his/her problem.
• This is done by –
– Direct methods

– Indirect methods

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 Direct methods
• Naturalistic observation

• Analog observation

• Participant observation

• Self observation

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 Naturalistic observation
• It is a systematic monitoring of representative
sample of a child’s behavior in the environment
where the behavior has been identified as being
problematic.
• For Example
– Observation in classroom

– Observing interaction with peers on playground.

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 Analog observation
• This involves the observation of a child’s behavior
in settings, which are designed to increase the
chance of occurrence of a specific behavior.
• For example
– Parent –child interaction in a structured setting in
which specific interaction is giving( having a parent
request the child to clean up playroom).

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 Participant observation
• This involves the observation by person who is
normally a part of child’s everyday environment
such as
– Parent
– Teacher
– Child(sibling)
– Who observed and even records selected behavior of a
child.

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 Self observation
• A child is request to observe his/her own behavior
and then record its occurrence.
• This obviously required a motivational subject
who as the ability to discriminate between the
presence or absence of specific target behavior

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 Indirect methods
• Indirect assessment procedure collect information
about relevant behavior that are obtained at a time
and place different than where the acute
problematic behavior occur.
– Clinical interview
– Use of rating scales
– Checklist
– Self reported instrument.
– For example – Child behavior checklist ( CBCL)

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BEHAVIORAL PROBLEMS OF
CHILDHOOD

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 Temper tantrum
• Temper tantrum is a sudden outburst or violent display
anger, frustration and bad temper as physical aggression
or resistance such as
– rigid body,
– biting,
– kicking,
– throwing objects,
– hitting,
– crying,
– rolling on floor,
– screaming loudly,
– banging limbs etc. 37
 Information about Temper tantrums
• Temper Tantrums or "acting-out" behaviors are natural
during early childhood. It is normal for children to want to
be independent as they learn they are separate people from
their parents.
• This desire for control often shows up as saying "no" often
and having tantrums. Tantrums are worsened by the fact that
the child may not have the vocabulary to express his or her
feelings.
• Tantrums usually begin in children 12 to 18 months old.
They get worse between age 2 to 3, then decrease until age
4. After age 4, they rarely occur. Being tired, hungry, or sick,
can make tantrums worse or more frequent.
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 Causes of Temper Tantrum
• Emotional insecurity
• Lack of sleep
• Fatigue
• Limitation
• Frustration
• Unmet needs
• Attention seeking

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 Management
• Professional help from child guidance clinic.
• Parent should be made aware about the beginning of
temper tantrum and when the child loses control.
• Parent should provide alternate activity at that time.
Nobody should make fun and tease the child about
the unacceptable behavior.
• Parent should explain the child that the angry feeling
is normal but controlling anger is an important
aspect of growing up.

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 Cont…Management
• The child should be protected from self injury or
from doing injury to others.
• The child's tension can be released by energetic
exercise and physical activities.
• Parents must be firm and consistent in behavior.

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 How to Avoid a Temper Tantrum
• The temper tantrum is probably one of the most
challenging parts of parenting.
• When child is flailing on the ground, it’s hard not to feel
powerless, overwhelmed, and fearful of what other people
might be thinking of you and your child.
• SPEND QUALITY TIME TOGETHER
• SET CLEAR EXPECTATIONS
• Healthy FOOD AND DRINK
• GIVE CHOICES
• REINFORCE POSITIVE BEHAVIOURS
• STAY CALM
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43
Breath holding spell

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 Introduction
• Breath Holding Spells is an involuntary reflex that
is common in children up to about 6 years old.
• When a child is afraid, scared, angry and
frustrated their body will freeze up causing them
to stop breathing and possible lose consciousness
for a short period of time, they can turn grey,
purple or blue in colour.

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