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A STUDY TO “ASSESS THE KNOWLEDGE AND ATTITUDE ON

BEHAVIOURAL PROBLEMS OF PRESCHOOL CHILDREN
AMONG PARENTS” IN SELECTED AREAS OF
MADHUGIRI WITH A VIEW TO DEVELOP
INFORMATION BOOKLET.

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DESSERTATION

MRS.B.K. MUNILALITHA.
CHILD HEALTH NURSING

MADHUGIRI SRI RAGHAVENDRA INSTITUTE

OF
NURSING SCIENCES
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RAJIV GANDHI UNIVERSITY OF HEALTH SCINCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

1. NAME OF THE CANDIDATE MRS. B.K. MUNILALITHA

AND ADDRESS 1 Year M.Sc., Nursing
Madhugiri Sri.Raghavendra Institute of
Nursing Sciences, Shankar Matt Road,
Raghavendra Colony,
Madhugiri- 572132, Tumkur district.

2. NAME OF THE INSTITUTION Madhugiri Sri.Raghavendra Institute Of

Nursing Sciences,

3. COURSE OF STUDY AND 1st Year M.Sc., NURSING

SUBJECTS Child Health Nursing

4. DATE OF ADMISSION TO 10-06-2009.

COURSE

5. TITLE OF THE TOPIC A Study to “Assess the knowledge and

attitude on behavioral problems of pre
school children among parents” in selected
areas of Madhugiri with a view to develop
information booklet.
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6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION :
“Believe that problems do have answers that they can be overcome and
that you can be solve them.”
- Nightingale nursing times.

Normal children are healthy, happy and well adjusted. This adjustment is
developed by providing basic emotional needs along with physical and
physiological needs for their mental well being. The emotional needs are
considered as emotional food for healthy behavior. The children are dependent on
their parents, so parents are responsible for fulfillment of the emotional needs.
Every child should have tender loving care and sense of security about protection
from parents and family members. They should have opportunity for development
of independence, trust, confidence and self respect. There should be adequate
social and emotional interaction with discipline. The child should get scope for
self expression and recreation. Parent should be aware of about achievements of
their children and express acceptance of positive attitude with in the social
normsf.1

The preschool years extending from approximately 3 to 5 years of age .2

Common behavioral problems of childhood are tempertantrum breath holding
spell, thumb sucking, nail biting, enuresis, encopresis, pica, tics, and stuttering or
stammering, delayed speech and attention deficit disorder. 1

The causes for all behavioral problems in preschool childrens are due to
parents negligence poor supervision or poor attention , family conflict and
maladjustment eg, too strict parents, rejection, sibling rivalry, unconscious anger
and defiance in the child, insecurity, conflict or hostility, aggression, neurotic
attitudes of the mothers.4
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The study was conducted on relationship between the occurrence and

intensity of nail biting in Department of Psychology. A sample of children were
selected . The study resulted in a conclusion that the most consistent trait
associated with nail biting was oral aggression. 20

Temper tantrums will be managed by alerting parents about the beginning

of tempertantrum when the child loses control. Parent should provide alternate
activity at that time. The child protected from self injury. Breath holding spells
will be managed by giving assurance to the parents about harmless effects of the
attack and should be tolerant , calm and kind. Thumb sucking managed with
praising and encouraging child for breaking the habits are very useful .1 Nail biting
is managed by keeping Childs hands busy with creative activities or play,
punishment to be avoided. Enuresis will be reduced by encouraging and rewarding
the child for dry nights. Pica will be managed with psychotherapy.4

6.1. NEED FOR STUDY :

As children move in to the preschool years (ages 2 ½ to 5 ½ ), cries

of “ No and I will do it myself”, are frequently heard. Children this age may be
easily frustrated when faced with limits. They will cry, throw tantrums and even
lash out a parent, caregiver or friend. However some preschoolers show even more
extreme and difficult behaviors, often defying adults and deliberately hurting other
people. Some may be so disruptive that they are banned from preschool .5 Major
behavioral problems are the significant deviations from socially accepted normal
behavior. These problems are mainly due to failure and adjustment to external
environment and presence of internal conflict. Behavioral problems always special
attention.1
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Identifying and helping these children is a vital task. Current research

suggests that, without help these children may go on to have serious problems with
aggression. Indeed researchers are finding that intervening at this time in life can
be highly effective in helping children develop better coping skills.5

A study was conducted on tools (DSM-IV ) to help with behavioral

problems of preschool children in Chicago. A sample of 79 children were selected.
The study resulted in a conclusion that using a modified version of
the DSM –IV ( Diagnostic and statistical Manual of mental disorders- fourth
edition ) criteria and discovered that over 70% met the DSM -4 TH definition for
disruptive behavioral problems. 5

These behavioral problems in children will be managed by adequate

guidance to parents regarding how to tackle with problems and psychotherapy for
the preschool children in extreme condition.4 In many communities the parents are
more anxious towards their preschool children behavioral problems. In this
Madhugiri area the parents are illiterates and also less attention seeking towards
their preschool children behavioral problems.

Now a days in many communities the parents are more anxious towards
their preschool children behavioral problems due to less attention or negligence or
ignorance. So the researcher felt that to study the knowledge attitudes on
behavioral problems of preschool children’s among parents
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6.2 . REVIEW OF LITERATURE :

6.2.1: A study was conducted to determine the prevalence of child behavior

problems reported by parents in “Child Development and Neurology unit”. A
sample size of total 4003 children aged 2-9 years were identified during a
population based survey of 2231 house holds. The study resulted in a conclusion
that the prevalence and nature of reported behavior impairments in rural
Bangladesh have implications for public health planning and delivery of health
services. 6

6.2.2: A study was conducted to analyze the clinical symptoms of tic disorders
(TG) and sleep habits in children in chair and Department of Developmental
Neurology. A sample size of 84 children with treatment group (TC), control group
included 156healthy children work selected by cluster sampling. The study
resulted in a conclusion that Quote frequently treatment group are connected with
other behavioral symptoms, in particular Attention Deficit Hyperactivity disorder
and obsessive compulsive disorder. Sleep habits are different in treatment group
(TG) than in control group.7

6.2.3: A study was conducted on prevalence of tic disorders among primary

school children in Department of child Neurology and Psychiatry. A sample size
of 2347 primary school children were selected. The study resulted in conclusion
that a total 68 children (56 boys, 12 girls) aged 6-11 years were identified with tic
disorders. The prevalence was 4.4% in boys and 1.1% in girls with no detectable
trends at the age 6-11 years. Situation related takes were noted in 37 cases. A
significant correlation was found between the presence of tick disorders and
impaired school performance.8

6.2.4: A study was conducted to determine prospectively the duration of non-

nutritive sucking behaviors of children between 1 and 8 years of age and the effect
of persistent habits on selected occlusal characteristics in the late deciduous
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dentition in college of Dentistry. A sample size of 797 children were selected by

observation method. The study resulted in a conclusion that to intercept the
development of cross bites and functional shifts, the developing occlusion should
be observed in the deciduous dentition in children with prolonged digit or pacifier
habits. 9

6.2.5: A study was conducted on the attitudes of Saudi Mothers towards the digit
sucking habit in their children and their attempts to stop this fixation in
Department of preventive Dental sciences. A sample size of 50 Saudi Mothers
were selected. The study resulted in a conclusion that no mother accepted the
habit in their children after the age of 4 years. The majority of mothers had notices
the adverse effect of the digit sucking. The results shown that 48 mothers did not
like to see the habit at any age. Most mothers (86%) tried to stop their children
digit sucking. 66% of the present sample and noticed the adverse effect of this
fixation on their child’s occlusion, and this was given as the main reason for their
attempts to stop the habbit.10

6.2.6: A study was conducted about how will private practice Pediatricians can
identify emotional or behavioral problems among pre-school childrens (No.3876)
in Department of Child Psychiatry and Pediatrics. A sample size of 1 of 68
pediatricians who rendered on opinion about the presence of emotional
behavioural problems were selected. The study resulted in a conclusion that a
substantial number of pre-school children with behavioral problems in primary
care are not being identified or treated. 11

6.2.7: A study was conducted on assessments of developmental status, attachment,

and behaviour problems of Romanian orphans adopted in Ontario. A sample size
of 56 Romanian orphans were selected. The study resulted in conclusion that
children who had more institution experience, those who were developmentally
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less competent, and those who were insecurely attached had more parent reported
behavior problems12.

6.2.8: A study was focused to investigate the prevalence of co-Morbid psychiatric

disorders in a clinical sample of children with nail biting who present at a child
and adolescent mental healthcare out patient clinic and the prevalence of
psychiatric disorders in their parents in Director of Research Center for psychiatry
and behavioral sciences. A sample size of 450 referred children were selected.
The study resulted in a conclusion that nail biting present in a significant
proportion of referrals to a mental health care clinic setting..13

6.2.9: A study was focused to investigate whether difference in tantrum behaviors

of health verses disruptive disorder preschoolers. It involved care givers of 279
preschool children completed the preschool age psychiatric assessment, to
determine pre schoolers diagnostic classification and to measurement tantrum
behavior. The study resulted in a conclusion that disruptive pre-schoolers
displayed violence during tantrum significantly more greater than the depressed
and healthy groups. 14

6.2.10: A study was conducted to explore behavioral and emotional problems in

toddlers with pervasive developmental disorders (PDDS), those with delay without
a PD, and their families in centre for Developmental psychiatry and psychology.
A sample size of 123 children aged 20-51 months were selected. The study
resulted in a conclusion that the need for early support and intervention for
mothers fathers and families in this context was also evidenced. As research has
shown that behavioral and emotional problems persists in to adolescence and
young adult hood, understanding of these issued in very young children and their
parents has important implications for intervention and long term out comes. 15

6.2.11: A study was conducted to examine the prevalence of features of attention

deficit Hyperactivity disorder in a special school. The study also explores the
reliability of the conners teachers rating scale in this population in department of
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child guidance clinic. A simple size of 84 children between the age of 5 and 18
years were selected. The study resulted in a conclusion that attention deficit hyper
activity disorder may be under diagnosed in children with in attention disorder.
The conners teachers rating scale was found to be internally reliable and had a
normal distribution with our results. Overall 55.9% of participants had markedly
elevated the scores for at least one of the target subscales, which were the
‘Hyperactivity’, In attention and the “ADHD Index” subscales of the corners
teachers rating scales. 16

6.2.12: A study was conducted to examine the empirical evidence on the impact of
bed wetting and its treatment on a Childs self esteem and behavior in Department
of General practice and Primary health care. A sample of children aged 5 to 16
years old with primary nocturnal Enuresis using measures of self esteem or
behavior were selected. The study resulted in a conclusion that fifteen empirical
studies matched the inclusion criteria. There is empirical evidence for increased
behavioral problems in bedwetting children.17

6.2.13: A study was conducted on teeth grinding in preschoolers has been linked
to with drawn behaviors. A sample of 1,956 pre-scholars, whose parents completed
a questionnaire were selected. The study resulted in a conclusion that 36.8% of the
pre-scholars ground their teeth one or more times per week and 6.7% of them, four
or more times per week. As the study suggests, it will benefit parents to keep a
close eye on their children’s sleep patterns and their social behavior. 18

6.2.14: The study was conducted on exploration the relationship between mothers
and father’s discipline, as well as their disagreement on discipline, with
externalizing behaviors of preschool children in the home and class room in
department of psychology. A sample of parents and teachers of 39 preschool
children participated in the study. The study resulted in a conclusion that multiple
regression analyses indicated that maternal authoritarian discipline and paternal
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permissiveness were related to externalizing behaviors in the home and classroom.

These findings indicate a different relationship between parent discipline, and the
development of externalizing behaviors in preschool children.19

STATEMENT OF THE PROBLEM

A Study to “Assess the knowledge and attitude on behavioral problems of

preschool children among parents” in selected areas of Madhugiri with a view to
develop information booklet.

6.3 OBJECTIVES
6.3.1 To assess the knowledge on behavioral problems of preschool children
among parents.
6.3.2 To assess the attitude on behavioral problems of preschool children among
parents.
6.3.3 To create awareness on behavioral problems of preschool children among
parents.
6.3.4.To associate the knowledge and attitude of parents with selected variables.

6.4. VARIABLES UNDER STUDY:

Age of the parents, No. of children, Education of parents, occupation,
socio-economic status, type of family and exposure to mass media.

6.5. OPERATIONAL DEFINITIONS:

ASSESS : To evaluate the level of knowledge of parents regarding

behavioral problems of preschool children.

KNOWLEDGE : The level of understanding of parents regarding behavioral

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problems of preschool children.

ATTITUDE : It is feeling of a parents regarding behavioral problems of

preschool children.

PARENTS :The parents who have 3-5 year age group children.

BEHAVIORAL :Behavioral problems refers tempertantrum

PROBLEMS :breath holding spell, thumb sucking, nail biting, enuresis,

encopresis, pica, tics and stuttering or stammering, delayed
speech and attention deficit hyper activity disorder.

PRESCHOOLER :The children’s of 3-5 years age group

INFORMATION :It refers a book that contain scientific information

BOOK LET regarding behavioral problems of preschool children.

6.6. ASSUMPTIONS:

6.6.1 Parents may have little knowledge on behavioral problems of preschool

children.
6.6.2. Information booklet will enhance knowledge of parents regarding
management of behavioral problems of preschool children.
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7. MATERIALS AND METHODS:

7.1 Source of Data

 Research approach : Descriptive approach
 Research design : Survey method
 Setting of the study : Community setting Madhugiri
 Population : Parents
 Sampling Technique : Simple random sampling
 Sample size : 100 Parents
 Sampling criteria
* Inclusion criteria
Parents of preschool children’s
Parents who are living in Madhugiri
Parents who can understand Kannada and English
* Exclusion Criteria
Parent who are not willing to participate in study
The parents who cannot read and write Kannada or English.
7.2 METHOD OF DATA COLLECTION

 Tools of data collection:

Part A : Demographic Proforma.
Part B : Structured questionnaire of knowledge and attitude.

 Data analysis and Interpretation.

Data analysis will be through descriptive and inferential statistics.

 Duration of the study – 6weeks.

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 Does the study requires investigation or intervention on patients or

other persons or animals described briefly.
- No -
 Has ethical clearance has been obtained from your institution.
Yes, ethical clearance will be obtained from
- The research committee of Madhugiri Sri Raghavendra
Institute of Nursing Sciences, Madhugiri
- The authorities of selected communities, Madhugiri
- The informed consent from the candidates willing to
participate in the study.

8. LIST OF REFERENCES.

1 Parul Datta “A Text Book of pediatric Nursing”, second edition, published by

Jaypee, Page No.
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2. Wong’s “A text book of Essentials of Pediatric Nursing”, 7 th Edition, Published

by Marilyn J. Hocken berry, Page No. 417.

3. Op. Ghai, Piyush Gupta, VK. Paul “ A text book of Pediatrics”, 6 th Edition,
published by CBS publishers Page No. 57.

4. Suraj Gupte “The short Text of Pediatrics”, 9 th Millennium Edition, Published

by Jaypee, Page No. 400-405.

5. Keenank, Wakschlag LS, “Journal of Abnormal child Psychology” 2000, 28(1):

33-46.

6. Naila Z Khan et al “ Behaviour problems in young children in Rural

Bangladesh”, December 2007.

7. Mlodzikowska – Albrecht J et al “The symptomatology of tic disorders and

concomitant sleep habits in children” poland, 2007, 1; 212-4.

8. lanzi G, Zambrino CA , et al “Prevalence of tic disorders among primary

school students” city of pavia, Italy,2004 Jan 89 (1): 45-7.

9. Bishara SE, Et al “Changes in the prevalence of non nutritive sucking patterns

in the first 8 years of life” Lowa City, USA, 2006 Jul:130(1):31-6.

10. Al – Jobair A, AL – Amran SE, “Attitudes of SaudiArabianMothers towards

thedigit-sucking habit in children”- SaudiArabia, 2004 Sept, 14 (5):347-54.

11. John V.Lavigne Phd Et al “Behavioural andemotional problems among

preschool children in Pediatric primary care”, Chicago March 1993, 649-655.

12. Karla Krekewich, “Determinants of behavioral problems in Romanian children

Adopted in Ontar”, Canada, 1997 17-31.
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13. Ahmed Ghanizadeh “Association of nail biting and psyctriatric disorders in

children and their parents in a psychiatrically referred sample of children”,
Iran, June 2, 2008.

14. www.Eric.Ed. Gov.com.

15. Herrings, Et.al “Behavioral and Emotional problems in toddlers with

pervasive developmental disorders and developmental delay; associations with
parental mental health and family functioning”, Austrilia, 2006, Dec (50), 875-
82.

16. Buckely S, Et al “The prevalence of features of attention deficit hyper activity

disorder in a special school”, Irland, 2008 Feb; (52); 156-162.

17. Redsell SA, Collierj, “Bedwetting behavior and self esteem”, Leicester, UK,
2001 Mar. 27(2); 149-62.

18. Dr.Jeseph, “Healthyliving teeth Grinding and Behaviour problems in

Preschoolers”, 2009 May (15).

19. Martha carlton, Et al “The relationship between mother’s and father’s

decipline, as well as their dis agreement on discipline with externalizing
behaviour of preschool children in the home and class room, Mid Western
Community 2008 .

20. Gilleard, Et al “Nail biting and oral aggression in a Turkish, student

population”, Turky, 1988, Jun; 61; 197-201.

9. SIGNATURE OF THE CANDIDATE ……………………………

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10. REMARKS OF THE GUIDE.

11. NAME AND DESIGNATION OF GUIDE

11.1. SIGNATURE ……………………………………………………..

11.2. H.O.D. OF THE DEPERTMENT.

11.3. SIGNATURE .

12. REMARKS OF THE CHAIRMAN/PRINCIPAL.

12.1 SIGNATURE: ……………………………………………………