Common Behavior Disorders in Children

1. 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.

2. Classification of Individuals with Emotional or Behavioral Disorders

3. What can affect Behaviour in a child? • Heredity • Environment • Learning Conditioning •

Positive reinforcements

4. 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

5. Repetitive Behaviours Repetitive Behaviours Repetitive Behaviours Repetitive Behaviours

Repetitive Behaviours

6. Head Banging 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

7. 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

8. Nail Biting Finger Sucking

9. Finger (Thumb) sucking & Neglect Developmental delay Nail Biting • Sensory solace for
child (“internal stroking”) to cope with stressful situation in infants and toddlers. • Reinforced by
attention from parents. • Predisposing factors:

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

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

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

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

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

15. Temper Tantrums

16. 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.

17. Temper Tantrums Precipitating factors • • • • • • • Hunger Fatigue Lack of sleep Innate

personality of child Ineffective parental skills Over pampering Dysfunctional family / Family
violence • School aversion

18.  Have consistency in behavior Have open communication with child  Spend quality time
 Pay attention to child  Set a good example to child Temper Tantrums – Management • In
general, parents advised to:

19.  Impose “Time Out” - if temper tantrum is disruptive, out of control and occurring in public
place. Never beat or threaten child  Verbal reprimand should not be abusive  Parents to
ignore child and once child is calm, tell child that such behavior is not acceptable Temper
Tantrums – Management • During temper tantrum:

20. Evening Colic

21. 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 ”

22. 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

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

25. Eating Disorder Disorder Pica

26. 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 !!!

27. 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

28.  Autism Lower socioeconomic class  Family disorganization  Lack of affection

Psychological neglect, (orphans)  Mental retardation  Poor supervision  Parental neglect
Pica Pica after 2nd yr of life needs investigation • Predisposing factors :

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

30. Breath Holding Spasms

31. Breath Holding Spasms 1. 2. 3. 4. Simple breath-holding spell Cyanotic breath-holding spells

Pallid breath-holding spells Complicated breath-holding spells Precipitating Factors: • • • •
Frustration Injury Anger Anemia

32. 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.

33. Emotional Disorders School Phobia

34. 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 11year olds • School refusal differs from truancy
(refusal is because of fear or anxiety about school)
35. School Phobia 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

36. School Phobia • 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.

37. Speech Disorders Stammering

38. 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

39. Stuttering / Stammering • 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

40. 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

41. … sudden, repetitive, nonrhythmic motor movement or vocalization involving discrete

muscle groups 12 to 20% children, peak age 5 -7 yr. Motor Tics or Phonetic Tics Can occur in
any body part Decrease when focused Tics More common in boys than in girls Increase when
stressed, anxious, fatigued, or bored

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

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

45. Tics : Formulations in the Management contd.. • • • • • • • • • • • haloperidol, pimozide,

clonidine, nifedipine are use in low doses. risperidone, olazapine mecamylamine, tetrabenazine,
Benzodiazepines baclofen, botulinum toxin

46. Title Subtitle Behavioural Disorders

47. 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.

48. 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.

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

50. •C.S.N.Vittal