Common behavioural problem and management for school child
- 1. COMMON BEHAVIORAL PROBLEM AND ITS MANAGEMENT FOR SCHOOL CHILD PRESENTED BY: R.SIVABARATHY M.SC (N) 1STYEAR CON JIPMER
- 2. •These problems are related to: Inappropriate behavior and feelings Unsatisfactory inter personal relationship School learning problem Unhappiness Physical symptoms Fears related to school
- 3. AGE SEVERITY EFFECT OF DEVELOPMENT FREQUENCY Criteria to label a child to be having a problem
- 4. Ways to identify a problem in the child: •If that behavior inhibits his ability to work in classroom or interest with peers •If he is constantly talking and disrupting other classmates and is not focusing on the work.
- 5. Definition: •Behavior problems are viewed as discrepancy between the child’s behavior and demands placed on him by his parents, teachers and colleagues.
- 6. Types: HABIT DISORDER SPEECH DISORDER EATING DISORDER SLEEP DISORDER PERSONALITY DISORDER
- 7. HABIT DISORDER: THUMB SUCKING NAIL BITING TICS ENURESIS ENCOPRESIS STEALING TELLING LIE
- 8. Eating disorder: •PICA •Anorexia nervosa •Bulimia nervosa Sleep disorders: • Somnambulism • Somniloquy • Night mares/ night terrors Personality disorder • Juvenile delinquency • Temper tantrum • shyness Speech disorder: • Stammering / stuttering • Phonation and articulation problems
- 10. Thumb sucking: •Thumb sucking is defined as non nutritive sucking of fingers or thumb. •Age of occurence: thumb sucking is common in oral stage as the babies have a natural urge to suck.
- 11. • Causes: Parental causes: Over protection by parents Neglect by parents Strictness of parents Disharmony between parents Due to teachers: Excessive strictness Excessive punitive attitude of teachers Due to siblings and friends: Excessive competition Separation from close friend or sibling
- 12. Other causes: •Lonelineness and boredom •Tiredness •Frustration and anxiety •Separation from parents
- 13. Problems caused by thumb sucking: • Thumb sucking in children younger than 4 is not a problem, but if it continues up to 5 years or above it indicates presence of an emotional problem. • Prolonged thumb sucking may lead to dental problem like misaligned teeth or sometimes malformation of the upper palate of mouth. • May also develop speech problem like misprouncingT and alphabet D, lipsing and thrusting out the tongue child talking.
- 15. Management: •Usually thumb sucking can be managed at home and includes parents setting rules and providing distractions. •Many experts recommend ignoring thumb sucking in children as most children stop it on their own.
- 16. Do’s • Divert and distract the child attention • The hand and fingers of the child should be busy • Offer prize and reward to the child for not thumb sucking • Put gloves on child’s hands or wrap the thumb with a cloth or bandage • A non toxin bitter tasting substance can be applied on child’s thumb so that he may not suck it • Take help of elder children for explanation to younger siblings Don’t • Do not scold the child or punish him or forcefully remove thumb from the mouth • Do not tie the child’s thumb and fingers • Do not nag, scold or beat the child • Do not leave the child repeatedly cold, wet or hungry
- 17. Nail biting: •Onychophagia or nail biting is a common oral compulsive habit in children and adults. It is just a way of coping with stress or comforting self.
- 18. Causes: • Out of curiosity or boredom • To relieve stress or anxiety • Because of habit • Because of nervousness • Lack of confidence • Feeling shy • Fear or jitteriness due to horror scene or family environment • Feeling of insecurity • Tiredness • Constant nagging
- 19. Management: • Application of a clear, bitter tasting nail polishes to the nail, the bitter flavor discourages nail biting. • keep the fingernails of child neatly trimmed to cut down on the temptation to bite. • Keep the child hands clean to cut down on ingestion of germs. • Reassure the child with love and affection. • Don’t pressurize the child to stop biting nails, as their adds to their stress. • Don’t lag or punish the child.
- 20. Tic disorders: • Characterized by persistent pressure of tics, which are abrupt, repetitive, involuntary movements and sounds that are purposeless.Tics are sudden non – rhythmic behaviors that are either motor or vocal.
- 21. Types: Simple : using only a few muscles or simple words. Simple motor tics: these are simple brief meaningless movements like eye blinking, facial grimacing, head jerk or shoulder shrugs, they usually last than one second. Simple phonic tics: these are meaningless sounds or noise like throat clearing, coughing, sniffing barking or hissing.
- 23. •Complex: using many muscles groups or full words and sentences. •Complex motor tics: these tics involve slower, longer and more purposeful movements like sustained looks, facial gestures, biting, banging ,whirling or twisting around or obscene gestures. •Complex phonic tics: these tics include syllabus, words, phrases and statements like “shut up” or “yes, you’ve done it” .The child’s speech may be abnormal with unusual rhythms, tones and accent.
- 25. Onset: • The age of onset of tic disorder is 2 -15 years. In 75% cases of Tourette’s disorder, the symptom appear by the age of 11 years. • Transient tic disorder occurs in approximately 4-24% of school children.Tourette’s disorder is 3-4 times more common in males than females.
- 26. Causes: • There appear to be both functional and structural abnormalities in brains of people with tic disorders. • It is believed that abnormal neurotransmitters contribute to this disorders.(basal ganglia and anterior cingulate cortex)
- 27. Management: • A holistic approach is recommended for the treatment of tic disorder. • Collaborative work • Educating the patient and family about the course of disorder in a reassuring manner. • Completion of necessary diagnostic test • Comprehension assessment including the child’s cognitive abilities, perception, motor skills, behaviour and adaptive functioning. • Cognitive behavior therapy • Medications: typical neuroleptics, alpha adrenergic receptor agonist , atypical antipsychotics .
- 28. Prevention: •There are few preventive strategies for tic disorders.There is some evidence that maternal emotional stress during pregnancy and severe nausea and vomiting during first trimester of pregnancy may affect tic severity. •Attempting to minimize prenatal stress may possibly serve a limited preventive function. •We have to give stress free environment to child.
- 30. Enuresis: •Enuresis or bed wetting is a disorder of involuntary micturition in children who are beyond the age, when normal bladder control is acquired. Bladder control is normally acquired by the age of 2 – 31/2 years. •If it is not acquired beyond 4-5 years of age, it is abnormal.When bed wetting occurs repeatdly, it is called as enuresis.
- 31. Types: • Primary : It refers to the condition in which children have never been successfully trained to control urination.There may be delay in maturation of sphincter control. • Secondary: It refers to the condition in which children have been successfully trained, but revert to bed wetting in response to some stress.it may be due to parent child maladjustment.
- 32. •Another classification : Nocturnal enuresis: it means bed wetting during night Diurnal enuresis: it means bed wetting during day time Mixed enuresis: it includes a combination of both nocturnal and diurnal type.
- 33. Causes: •Inappropriate toilet training •Neurological developmental delay •Genetics •Emotional factors •Organic factors
- 34. Management: • Reassure the child and parents • Try to build the child’s self confidence • Should not give any liquids like tea or milk after 5 pm in the evening. • Should be habitually made to pass urine before going to bed • Should arouse the child after 2-3 hours of sleep and persuade him to walk unaided to the toilet.to empty bladder. • Bed wetting alarms • Medications: in very resistant cases tricyclic antidepressants like amitriptyline, imipramine and nortriptyline are given orally at night for 2 months.
- 37. Encopresis: • Encopresis also known as paradoxical diarrhea is involuntary fecal soiling in children who are past the age of toilet training. • Incidence: as each child achieves bowel control at his or her own rate. Physicians do not consider stool soiling to be a medical condition unless the child is at least 4 years old.
- 38. Causes: • Constipation • In most children the problem begins with painful passage of hard constipated stool • Over the time, child become reluctant to pass stool or holds stools to avoid pain.This holding in of stool become a habit.
- 39. Management: Empty the colon Establish regular, soft and painless bowel movement Promote regular bowel habits Behavior therapy for modification of child’s behavior
- 40. Management: • Administer the enema or series of enemas, as it creates pressure within the rectum and gives the child an urge to pass stool • Suppositories and laxatives can also be used to promote bowel evacuation. • Establish a regular toilet routine. • Behavioral technique • Training: children may respond to teaching about appropriate use of muscles and other physical response during defecation. • This may help them to learn how to recognize the urge to defecate. • Children are taught how to use their abdominal, pelvic and anal sphincter muscles which they have so often used to retain stool.
- 42. Stammering/stuttering: •Is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongation of sounds, words or syllables.Also there are involuntary silent pauses or blocks.
- 44. Risk factors: •Family history •Age when stutter starts •Duration since stuttering •Sex of the child
- 45. Clinical features: •Problem in starting a word or phrase •Hesitation before certain sound has to be uttered •Repetition of a sound, word or syllabus •Speech may come out in spurts •Trembling lips and jaws/ when trying to talk •Interjections like “uhm” used more frequently before attempting to utter certain sounds.
- 46. Management: • Aim at teaching the child skills, strategies and behavior that help in oral communication.This include fluency shaping therapy and stuttering modification therapy. • Parents should not put undue pressure on the child, regarding fluency of speech during preschool age. • Give the child sufficient time to express himself • Never criticize the child for his/her speech • Encourage the child to speak clearly by teaching him/her songs and nursery rhymes. • Make the child feel that parents are interested in his talks.
- 47. Eating disorders
- 48. PICA • Is characterized by an appetite for substances largely non nutritive and the habit must persist for more than one month, at an age when earing such objects is considered developmentally inappropriate. • Pica is eating of non edible substances such as chalk, clay, coal, mud etc.,
- 50. Causes: •Due to acquired taste or neurological mechanism like iron deficiency or chemical imbalance •May linked to mental disability •Stressors such as maternal deprivation, family issues, parental neglect, pregnancy, poverty and a disorganized family structure are strongly linked to pica.
- 51. Management: • Presentation of attention, food or toys not contingent on pica being attempted. • Discrimination training between edible and non edible items • Detect nutritional deficiencies and treat them. Eg) anemia, hypocalcemia, etc • Make meal time pleasant • Meet the emotional needs of child • Don’t leave the child alone • Keep the child busy, as boredom may give him time for eating non edible substances.
- 53. Anorexia nervosa: •Is characterized by voluntary refusal to eat, significant weight loss, an intense fear of becoming over weight and a pronounced disturbance of body image. •Incidence: is seen in about 5% of adolescent females and 5 – 10% of all males.The disorder starts by the age of 10 - 19 years.
- 54. Etiology: •Biological theory •Psychodynamic theory •Family system theory
- 55. C/F : • Extreme weight loss • Intense or irrational fear of weight gain • Distorted body image, weight or shape • Other physical manifestation like, • Amenorrhea for up to 3 months • Hypothermia • Muscle wasting • Cardiac dysrhythmias • Hypotension • Dry skin • Brittle nails • Cold intolerance
- 56. Management: •Nutritional counselling •Individual therapy to correct distortions and deficits in psychological thinking •Family therapy to correct disturbed patterns of interactions in family •In certain cases, antidepressants and selective serotonin reuptake inhibitor prove to be effective •Enhance self esteem and self worth of the individual so that he/she learns to like self, learns to trust and develop an identity beyond their thin body.
- 57. Bulimia nervosa: • Is a disorder of binge eating, where the individual consumes large amount of food with lack of control followed by various compensatory behaviors (like self induced vomiting) to control weight. • Incidence: is higher than anorexia nervosa, about 1-1.5% females with lower rates in males. • This disorder is seen in age group of 15 – 30 years.
- 58. C/F: • Intense fear of getting fat and are very sensitive to weight gain because they lack impulse control • Binge eating stops when abdominal discomfort occurs • After binge eating the adolescents feel out of control, depressed, guilty and anxious • Self induced vomiting and misuse of laxatives and diuretics is also seen, due to which the person loses the ability to experience hunger and satiety • Fasting or excessive exercise as compensatory behaviors to prevent weight gain.
- 59. Management: • Behavior modification • Cognitive therapy may required • Dietary counselling • Selective serotonin reuptake inhibitor drugs have been effective in reducing the urge to binge and in treating depression.
- 60. SLEEP DISORDERS
- 61. • Sleep disorders are common during the preschool years. These problems resolve and diminish as the child gets older. • Most of the sleep problems are related to irregular sleep habits or anxiety about going to bed and sleeping • In school age children, sleep walking (somnambulism) and sleep talking (somniloquy) occur in about 15% children, mainly boys. • The sleep walking event is usually not recommended in the morning. • Somniloquy can occur at any age and its prevalence rate is 7- 8%. It does not indicate a health concern or need for intervention.
- 62. Management: • Establish a bedtime routine • Establish a wake up time • Avoid giving stimulants such as sugar or caffeine to the child near bedtime • Make the bedroom cozy and inviting • Avoid disturbances in sleep like television • Maintain silence in and near bedroom • Be with the child while he falls asleep • Provide pleasant activity like story telling prior to sleep
- 65. Temper tantrums: •Temper tantrum is a behavior problem, where children assert their independence by violently objecting to discipline through the display of anger at uncontrollable level.
- 66. Causes: •Emotional insecurity •Lack of sleep and fatigue •Imitation of adults •Frustration •Unmet needs •Attention seeking
- 67. Management: •Educate the parents that temper tantrums are child’s way of releasing frustration so they should ignore them •Parents should talk to the child to find out the cause of frustration •Provide adequate rest and sleep to the child •Parents should show the child that he is loved even though his behavior is disapproved •Parents should be good role model for the child •Parents should not be over protective for the child though they should provide security and support to the child.
- 69. Shyness: • Shyness leading to complete withdrawal is consider as a behavior problem. • Causes: • Genetic inheritance • Environmental causes like lack of exposure, cultural norms, society etc.,
- 70. Management: • Assess the causes of shyness • Talk to the child • Provide exposure to the child by arranging small get to gather with peer group • Do not pay attention on the child’s mistakes • Do not criticize the child • Reward the child whenever he performs well or takes on initiative • Encourage the child
- 71. JUVENILE DELINQUENCY: • Antisocial behavior is the most taxing and troublesome, affecting not only the family but also various levels of society. • Parents refer to these children as bad boys who need to go to the house of correction • Teachers call them incorrigble and beyond correction. • The psychiatrist and psychologist call them emotionally disturbed while judiciary has one term for them – denlinquents.
- 72. Definition: • In which a child or adolescents purposefully and repeatedly does illegal activities. • The children act, 1960 in India defines a delinquent as a child who has committed on offence such as theft, sexual assault, murder, burglary or inflicting injuries, running away from home, etc.,
- 73. Presentation of antisocial problems in children: • Constant disobedience • Lying • Stealing • Fire setting • Destructiveness • Cruelty • Truancy from school • Running away from home • Sexual problem • Drug and alcohol intake with dependence • gambling
- 74. EEG studies and personality testing genetics Body build sex age intelligence Family background Etiology:
- 75. Measure and diagnosis of delinquency: •For confirming the diagnosis •For understanding the dynamics of problems •For planning the management and treatment of delinquents •For judicial reasons and helping the court •For reasons of prognosis
- 76. •The diagnostic findings procedure: •Interview •Mental status examination •Neurological examination •EEG •Psychological test
- 78. Protective therapy Punitive therapy Reformative therapy Rehabilitative therapy Corrective therapy:
- 79. Drug: •Tranquilizers in adequate dose need to be given •Chlorpromazine given orally in dose of 25 – 50 mg three times a day is the best. •Haloperidol can be given orally in dose of 1.5 – 10 mg three times a day •Injectable route for uncontrolled aggression