DISORDERS

DEFINITION

 The term ‘behaviour problem’ is used to designate a

deviation in behaviour from one expected or
approved by the group.
 It is defined as 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 behaviours and
this is called the behaviour problems.
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.
CAUSES OF BEHAVIOURAL PROBLEMS

• Faulty parental attitude.

• Inadequate family environment.
• Mentally and physically sick or handicapped
conditions.
• Influence of social relationship.
• Influence of mass media.
• Influence of social change.
 TYPES OF BEHAVIOURAL
DISORDERS OR
PROBLEMS

Behaviour disorders can be classified as:

1. HABIT DISORDERS
2. SPEECH DISORDERS
3. EATING DISORDERS
4. SLEEP DISORDERS
5. PERSONALITY DISORDERS
 1. HABIT DISORDERS
 Thumb sucking Telling lie
 Nail biting  Bruxism
 Tics  Breath Holding
 Enuresis Spell
 Encopresis
 Stealing
 2. SPEECH
DISORDERS
 Stammering /stuttering
 Cluttering

 Phonation &
Articulation Problems
 Delayed speech

 Dyslalia
 3. EATING DISORDERS

 Pica

 Anorexia nervosa
 Bulimia nervosa
 4. SLEEP
DISORDERS

 Sleep walking(Somnambulism)
 Sleep talking(somniloquy)

 Night mares and night terrors

5. PERSONALITY DISORDER

 Juveniledelinquency
 Temper tantrums

 Shyness
 Definition
Thumb Sucking is defined as non-nutritive
sucking of fingers or thumb.
AGE OF OCCURRENCE:-
It is common in oral stage (0-1yr) as the babies
have a natural urge to suck. This usually
decreases after the age of 6months. Many
babies continue to suck their thumb to soothe
themselves. Most children stop thumb sucking
between 3-6years of age.
 CAUSES MANAGEMENT
-Emotional insecurity. -Positive reinforcement(
-Feeling of isolation praise the child and provide
-Boredom small awards).
-Stress -Identify the real issue and
provide comfort.
- Do not scold the child.
- Offer gentle reminders.
 NAIL
BITING
 Nail biting/ Onychophagia is a common oral
compulsive habit in children and adults.
 It is a bad oral habit especially in school age
children beyond 4 years of age.
-It is a sign of tension and self punishment to cope
with the hostile feeling toward parents.
-It may continue up to adolescence.
-The child may bite all 10 finger nails or any specific
one.
-The bite may includes the cuticle or skin margins of
nail bed or surrounding tissue.
 Etiology:-
 Out of Curiosity/ Boredom
 To relieve stress or anxiety.
 Because of Habit.
 Because of Nervousness.
 Lack of Confidence.
 Feeling Shy.
 Fear due to horror
scenes or family
environment.
 Feeling of Insecurity
 Tiredness
 Constant Nagging
 Parents need reassurance and
assistance to accept the situation and
help the child to overcome the problem

MANAGEMENT Application of a clear bitter tasting

nail polish to the nails , the bitter
flavour discourages nail biting.

Address the child anxieties and make the

child speak about his worries.

Don't pressurize the children to stop

biting, nails as this adds to stress

Reassured the child with love and

affection.
 Cont.
 Discuss with a child about unacceptable habits and how
to break them .
• Help the child become aware of this bad habit.
• Suggest a substitute activity like car riding or holding a
smooth stone in free hand while reading or writing and
then make the child practice alternative habit daily.
• Incase all these simpler measures fail then behavior
therapy is beneficial .
• Habit reversal training with seeks to unlearn habit of nail
biting and possibly replace it with more constructive
habit, has shown its effectiveness. In addition to habit
reversal training, stimulus control therapy is used to both
identify and then eliminate the stimulus that triggers
biting urges
TIC / HABIT SPASM
DISORDER
 Tic disorder are characterized by persistent presence
of tics, which are abrupt, repetitive, involuntary
movements and sounds that are purposeless.
 Tics are characterized as abnormal involuntary
movement which are abrupt, repetitive, involuntary
movements and sounds that are purposeless.
 Tics are sudden non-rhythmic behaviours that are
either motor or vocal for example knee bends, lip
smacking, tongue thrusting, grimacing, eye blinking,
throat clearing and so on.
 Tics are seen in transient tic disorder, chronic vocal or
motor tic disorder and tourette’s disorder.
CONT...
The age of onset of tic disorder is 2-15 years.
In 75% cases of tourette’s disorder,
symptoms 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.
 TYPES OF TIC DISORDER
1.Simple
a) Simple motor tics: these a) Complex motor tics: these tics
are simple brief
meaningless movements
like eye blinking, facial
grimacing, head jerks.
These lasts for less than 1
sec.
b) Simple phonic tics: these
are meaningless sounds or
noises like throat clearing,
coughing, sniffing, barking
or hissing
2. complex
involve slower, longer and
more purposeful movements
like sustained looks, facial
gestures, biting, banging,
whirling or twisting around or
obscene gestures.
b) Complex phonic tics: Includes
syllables, words, phrases and
statements like “shut up” or
“yes, you’ve done it.
 CAUSES
• Emotional factors
• Biological, chemical and environmental
factors.
• Due to structural and functional disability in
brain
• Abnormal neurotransmitters
• When changes occurs in basal ganglia and
interior cingulate cortex.
 MANAGEMENT
 A Holistic approach is recommended for the
treatment of tic disorder. A multi- disciplinary team
should work together with the affected child’s
parents and teachers, to make a comprehensive
treatment plan.
Treatment should include the following:-
 Educating the patient and family about the course
of disorder in a reassuming member.
 Completion of necessary diagnostic tests
including self reports by child and parents.
 Comprehensive assessment including the
child’s cognitive abilities, perceptions,
motor skills, behavior and adaptive
functioning.
 Cognitive behavior therapy: The patient is asked
to deliberately perform tic movement for
specified period of time interspersed with brief
periods of rest.
 Contingency Management:- It is based on
positive reinforcement, usually administered by
parents. Children's are praised and rewarded for
not performing tics and for replacing them with
alternative behavior.
• Habit Reversal is most commonly used technique,
which when combined with relaxation exercises,
awareness training and contingency management.
• Medications:
Medicines are the main treatment for motor and
vocal tics. Medications Prescribed include:
a) Typical Neuroleptics(Antipsychotics) like
Haloperidol, Pimozide and Tetrabenzine.
b) Alpha-adrenergic receptor agonist including
Clonidine and Guanfacine.
c) Atypical Antipsychotics like Resperidone and
Clozapine.
ENURESIS OR BED WETTING
 INTRODUCTION
The word enuresis is derived from the greek
word “enourein” means ‘to void urine’. It can
occurs either during the day or at night.
 DEFINITION
 Enuresis is a disorder of involuntary micturition in
children who are beyond the age when normal
bladder control should have been acquired.
 Bladder control is normally acquired by the age of
2.5-3yrs.
 If it is not acquired beyond 4-5yrs of age, it is
abnormal
 When bed wetting occurs repeatedly, it is called as
Enuresis.
 Types of Enuresis
Enuresis maybe of the following types:-
• Primary / Persistent Enuresis:- It refers to the
condition in which there delayed maturation of
neurological control of urinary bladder.
• Secondary / Regressive Enuresis:- It refers to the
condition in which the children have been
successfully trained but revert to bedwetting In
response to some stress. It may be due to parent child
maladjustment.
 TYPES

• Enuresis that
Nocturnal occurs during
enuresis sleep
• Enuresis that occurs
Diurnal Enuresis during day time or
when the child awake

• It includes a combination of
Mixed Enuresis both nocturnal and diurnal
type.
 CAUSES OF ENURESIS
 Inappropriate toilet training:- The age at which toilet
training is started as an important impact on child. If
toilet training is started very early it produces stress on the
child.
 Neurological developmental delay:- This is the most
common cause of bedwetting. There is delayed
development in the ability to stay dry. bedwetting may be
due to delay in nervous system ability to process feeling
of a full bladder.
 Genetic:- Bed wetting has a strong genetic
component. children whose parents were not waiting belt
have only 15% incidence of bedwetting. When one or
both parents where bedwetter the rate jump
to 44% to 77% respectively. genetic research shows that
bedwetting is associated with jeans on chromosome 13q
and 12 q.
 Emotional factors:- Emotional and psychological
disturbance due to death in family sexual abuse, extreme
bullying, punishment for scolding, jealousy feeling your
sibling rivalry and feeling of being rejected create
internal tension in the child which may lead to
secondary enuresis.
Organic causes:- enuresis may occur due to
Anatomical defect of urinary tract and bladder, Diabetes
Insipidus, urinary tract infection etc.
 MANAGEMENT
For management of bedwetting it is essential to assess the
home condition of the child his or her socioeconomic status
and family conditions. Assess the child parent
relationship. Child relationship with play means, teachers
and siblings is also evaluated.
1) Reassure the child and parents.
2) Try to built the child self confidence
3) Parents should be explained about the factors related
to bedwetting
4) Parents should be ask not to scold thread or punish the
child. Parents are advised not to Nag, criticize or
reprimand the child for bedwetting.
5) The child should not be given any liquid like tea or milk
after 5:00 p.m. in the evening.
6) The child should be habit really made to pass urine
before going to bed.
7) The parents should arouse the child after 2 to 3 hours
of sleep and persuade him to walk unaided to the
toilet to empty bladder.
8) The child is trained to hold urine for longer time. This
may be done by making the child drinking large
quantity of water during day and persuade him to
Delay empty bladder as long as possible.
9) Bedwetting alarms: provisions frequently suggest
bedwetting alarms which produce a loud tone on
sensing moisture. this helps the child to wake at
sensation of full bladder.
10) Assessment of exact causes very essential through
history and physical and clinical examination.
11) Organic causes should be managed with specific
treatment.
12) Parents should encourage and reward the child for dry
Nights.
13) Punishment and criticism may lead to embarrassment
and frustration of child so it should be avoided.
14) Medications: in very resistant cases tricyclic
antidepressant like amitriptyline , imipramine and
nortriptyline are given orally at night for two
months. Desmopressin which is a synthetic
replacement for antidiuretic hormone is also given as it
produces urine production during sleep.
ENCOPRESIS
DEFINITION
-Encopresis indicates a
ENCOPRESIS refers to more serious emotional
passage of feaces into disturbances than
inappropriate place at enuresis and is less
any age when bowel common(around 1% in
control should have school children)
been established
 CAUSES
SIGN &
-Anatomic abnormality
SYMPTOMS
- Emotional disturbances
-Withhold defecation
-Improper toilet training
-Distended abdomen
-Stress in school activity -Diarrhoea related to
-Overprotection irritation of GI tract
- Fear related to toilet - Tensed feeling
-Poor parent child - Aggressiveness.
bonding
DIAGNOSTIC MANAGEMENT
EVALUATION -Establish regular
- History of bowel bowel habits(e.g.
elimination. make the child to sit in
- Physical toilet for at least 10
examination. minutes a day.
-Detail about pattern -Reassurance and help
of current toilet from psychologist for
practice counselling of child
and parents.
-Breath holding spells are brief periods of
children stop breathing up to 1 minute.
These spells often cause a child to pass out.
-Breath holding spells usually occurs when
young child is angry, frustrated, in pain, or
afraid.
-It is most common in toddlers. And more
common in 2 months old and up to 2 years
old.
-It occurs between 6 month to 6 years of
age
 TYPES
1. CYANOTIC 2. PALLID SPELLS:
SPELLS: they are often They are usually seen
provoked by an upsetting following a painful or
situation, in an anger or fearful experience. The
in frustration. The child child becomes pale and
cries loudly and then cry often loses consciousness
gradually becomes within a single gasp or cry.
noiseless as child open
the mouth and holds the
breath in expiration for
about 20-30 sec. The
child turns blue and then
child may again start
CAUS SIGN & SYMPTOMS
ES
-Fear -Blue or pale skin
-Pain -Crying then no breathing
-Traumatic event -Fainting or loss of
-Being startled or alertness.
confronted -Jerky movements
- Genetic conditions -Normal breathing starts
- Iron deficiency anaemia again after a brief period of
-Family history of breath unconsciousness.
holding spell. -The child’s colour
improves with the first
breath.
-They occurs several times
a day
 MANAGEMENT

 No treatment usually needed.

 Iron drops or pills if the child has an
iron deficiency.
 During a spell, make sure the child is in safe
place where he or she will nor fall or be hurt
 Place a cold cloth on the child’s
forehead during a spell to help
shorten the episode
 After the spell, try to be calm.
CONT....
 Avoid giving too much attention to the child, as
this can reinforce the behaviours that led to the
spell.
 Avoid situations that cause a child’s temper
tantrums. This can help reduce the number of
spells.
 Ignore breath holding spells that do not cause the
child to faint.
 Ignore the spell in the same way ignore temper
tantrums.
• The term PICA derived from latin word
“magpie” refers to eating of substances
other than food. E.g. Earth, dust, clay, sand,
flakes of paint, plaster from wall, fabrics, ice
etc..
• PICA is characterized by an appetite for
substances largely non-nutritive(such as clay
or chalk) and the habit must persist for more
than one month, at an age when eating such
objects is considered developmentally
inappropriate.
CONT..

• PICA as a manifestation of inclination for

mouthing and tasting in the absence of any
associated problem may be taken as normal
until two years of age.
• This pattern of eating should last for at least 1
month to be diagnosed as PICA
 TYPE
S
1. Amylophagia: consumption of starch.
2. Coprophagy: consumption of animal feces.
3. Geophagy: consumption of soil, clay or
chalk.
4. Hyalophagia: consumption of glass
5. Pagophagia: pathological consumption of
ice
6. Trichophagia: consumption of hair or wool
7. Urophagia: consumption of urine.
 CAUSE
S
• Associated with mental retardation
• Iron deficiency and vitamin deficiency
• Mineral deficiency
• Maternal deprivation
• Family issues
• Parental neglect
• Poverty
• Malnutrition with worm infestation
 CLINICAL MANIFESTATION
1. Children are often anaemic.
2. Mineral and vitamin deficiencies.
3. Intestinal and parasitic infestation are generally
associated.
4. Behavioural problems- children pull out their head
hair and swallow them(trichotillomania).
5. Lots of hair collect in the stomach which is
palpable as a big lump in the upper abdomen,
particularly after meals.
6. The preverted appetite in such children.
 MANAGEMENT

1. Provide the treatment of worm infestation

and vitamin, mineral deficiency.
2. Psychotherapy where PICA is associated
with psychosomatic disorder.
3. Proper supervision of the parents over the
child.
 DEFINITION
• ANOREXIA NERVOSA is characterized by
voluntary refusal to eat, significant weight loss, an
intense fear of becoming overweight and a
pronounced disturbance of body image.
• The individual with anorexia nervosa may restrict
food intake or engage in binge eating followed by
self-induced vomiting or misuse of laxatives or
diuretics.
• Incidence of anorexia nervosa is seen in about 5%
of adolescent females and 5-10% of all males. The
disorder starts by the age of 10-19 years.
 CAUSE
S
1. Biological theory suggests that anorexic
individuals suffers a disturbance in levels of
neurotransmitters in brain.
2. Psychodynamic theory suggests that deficits
in ego development may predispose young
children to anorexia.
3. Family system theory suggests that anorexia
nervosa is caused by intra familial conflicts
and dysfunctional family.
 CLINICAL FEATURES
• Extreme weight loss.
• Intense or irrational fear of weight gain.
• Distorted body image, weight or shape.
• Other physical manifestations like
amenorrhea for up to 3 months, hypothermia,
muscle wasting, cardiac dysrhythmias, dry
skin, brittle nails and cold intolerance.
 MANAGEMENT
 Nutritional counselling by a dietician regarding healthy
eating habits and balanced diet.
 Individual therapy to correct distortions and deficits in
psychological thinking.
 Family therapy to correct disturbed patterns of interaction
in family
 In certain cases, antidepressants and selective serotonin
reuptake inhibitor(SSRIs) prove to be effective.(
Citalopram)
 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
 DEFINITION
• BULIMIA NERVOSA is a disorder of binge
eating, where the individual consumes the large
amount of food with lack of control followed by
various compensatory behaviours(like self induced
vomiting) to control weight.
• Incidence of bulimia nervosa is higher than
anorexia nervosa.
• Bulimia occurs in about 1-1.5% females with
lower rates in males.
• The disorder is seen in age group of 15-30 years.
 CAUSE
S
•Family history of depression
•Substance abuse
•Eating disorders
•Sports career in which
require low body weight
 CLINICAL FEATURES
• Intense fear of getting fat.
• Binge eating stops when abdominal discomfort
occurs.
• After binge eating adolescents feel out of control,
depressed, guilt 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.
• Fasting or excessive exercise to prevent weight
gain.
 MANAGEMENT
• Behaviour modification is used to control the binge
eating.
• Cognitive therapy: it helps the individual a sense of
self, understanding of conflicts, developing
realistic perceptions of one’s body and enhancing
self esteem and self concept.
• Dietary counselling may be helpful.
• Selective serotonin reuptake inhibitor(SSRIs)
drugs have been effective in reducing binge eating.
This is a common sleep disorder.
This is also called sleep walking.

In this condition, children are aware of the

environment during the episode but are
indifferent to it.
When these children once awake they will
forget everything about episode.
Now a days in India several families are
suffering fro somnambulism
It occurs about 5-8% of children.
 MANAGEMENT
 Locking the doors and windows of the room
in which the child is sleeping.
 Removing all dangerous objects and
correction of superstitions.
 Provide small doses of diazepam in advanced
cases.
 Sleep
talking
(somililoquy)
-This is a sleep disorder, in which child
talks during sleep.
-These children talk irregularly and give
the gaps same like conversations.
-Parents when observe they feels that
child is talking with somebody.
- Child gives good facial expression also.
 CAUSE
S
• Children who are having incomplete talk
during the day time by the influence of parents.
• Stress and anxiety.
• Children who are having the conflicts with
siblings and school mates.
• Children who sleep after the listening of story ,
any TV serials.
• Children who have more feeling of home
sickness.
 MANAGEMENT
• Always sleep with these children and assure them
they are with them.
• Satisfy the child’s need.
• Resolve the child’s conflicts if persists with any
other children.
• Don’t show any movie and story video before sleep.
• Give comfortable environment for sleep.
• Make good relationship between child and older
sibling.
• Provide tension free environment to child.
Night mares
and Night
terrors
 NIGHT MARES
• In this disorder, child awakens due to a frightening
bad dream and child conscious about surroundings.
Night mares associated with dreams.
MANAGEMENT
• Child should have light diet in dinner and pleasant
scene and stories at bed time.
• comforted the child and reassured him physically
and verbally.
• Sitting at the bed side until the child feel secure and
is ready to go back to sleep.
 NIGHT TERRORS
• In this disorder, child awakens during sleep, sits up
with screaming and terrified to recognize the
surrounding and after sometime child sleeps again at
his/her bed.
• The terror may last 12-20 minutes.
MANAGEMENT
• Assure the child that there is nothing wrong.
• Parent must stay calm.
• Assure child’s safety.
• Night terrors gradually decrease in frequency and
intensity and usually resolves by adolescent.
TEETH GRINDING
• It is involuntary activity.
CAUSES
• Due to disturbances of
This is a common dreams
problem of children
during sleep. In this • Due to tension and
problem child grinds aggression
teeth during sleep. It • Meningitis and
occurs among school encephalitis
going children. • Mental retarted
children may have
grinding
 MANAGEMENT
• Reduce the tension of the child by improving
environmental conditions.
• Do not allow the child to watch horror and
thriller movies before bed time.
• Provide a proper food and make a happy bed
time for child.
• Discuss the children feelings properly before bed
time and give the solutions.
 MASTURBATION
• Masturbation is the stimulation and manipulation
of one’s own genitals in order to experience erotic
feelings and possibly leads to orgasm.
• Masturbation is common in both sexes in the pre-
school years and in early adolescence.
• The child experience pleasurable sensation which
leads to repetition of the behaviour.
• The child may obtain pleasure by genital
stimulation, rubbing of thighs against each other,
or by rhythmic swaying movement.
 CAUSE
S

• Conflict of feelings of child against parents.

• In the toddler this activity is increased in intensity
and in frequency.
• Preschool children behave sexually with parents
and other adults by rubbing their bodies against
them and by seeking close intimate body contact.
CONT…

• The male children due to the visibility and

structure of genitalia, they learn that rubbing of
this part of the body is pleasurable, and they
engage in masturbation.
•At the time of bathing and diaper changing,
parents often handle their infants genitals.
These pleasing sensations are
registered by the infants.
 MANAGEMENT
• The parents should know that masturbation is not
harmful to the child but the child is curious about
his sexuality.
• Parents should not scold or show negative attitude
towards their behaviour, it can lead to resentful
anger towards frustrating parents.
• Just ignore this behaviour of the infant.
• Advice the child that masturbation is not
acceptable in public. It should be conveyed in a
non threatening manner.
CONT..
• Parents should react calmly when their children
explore and manipulate their own body with
enjoyment.
• The child should be taught the proper names. For
the parts of the body including genitals.
• Provide sufficient emotional satisfaction to the
child, they should
not feel solace.
 SPEEECH PROBLEMS
STUTTERING AND
STAMMERING
CLUTTERING
 DELAYED SPEECH
 DYSLALIA
 LANGUAGE DEVELOPMENT OF
CHILD
AGE OF CHILD MILESTONES
1 month - Turns head to sound
3 months - Cooing sound
6 months - Monosyllables word( ma, la,
pa)
9 months - Bisyllables words(mama,
baba, papa)
10 months - Does not make any response
name.
CONT...
12 months(1 year) - Two to five words with
meaning.
15 months - Does not respond to or
understand “no, no” ,
“bye, bye” etc.
18 months - Ten words with meaning,
does not have vocabulary
up to 10 words.
24 months - Simple sentence, does
not use 2 word phrases.
CONT..
.
30 months - Has speech that is not intelligible
to any family member.
36 months - Telling a story.
42 months - Fails to produce final consonent
(i.e. “da” for dog)
After 4 years - Is noticeably dysfluent(stutter)
After 7 years - Has any speech sound error.
At any age - Has noticeable hypernasality, has
monotone voice, inappropriate
pitch.
SLUTTERING AND STAMMERING
 Stammering is also known as sluttering. It is a
speech disorder in which the flow is disrupted by
involuntary repetitions and prolongation of sounds,
words or syllables. Also there is involuntary silent
pause or blocks.
 Sluttering and stammering is a fluency disorders
begin between the age of 2-5 years probably due to
inability to adjust with environment and emotional
stress.
 CAUSE
S
Developmental factors: if the child has cleft
lip, cleft palate or tongue tie, the speech is
affected. There may be central nervous system
impairment which may affect the speech.
Neurogenic Sluttering: A stroke or brain
injury may affect the signals between brain,
speech nerves and muscles, that lead to
sluttering
 Psychological factors: stress and
embarrassment.
CONT..
.
Other causes are:
o Due to physical weakness or fatigue.
o Most common in children who cannot cope
their self with emotional and environmental
stress.
o Due to neurotic attitude of mother.
o More common in left handed children who are
forced by the parents to use right hand.
o It can occur due to conflict between parents and
child expectations
 SIGN AND SYMPTOMS
 Interruption in the flow of speech.
 Prolongation and repetition of words.
 Child may have hesitation.
 Problems in starting a word or phrase.
 Speech may come out in spurts.
 Trembling lips and jaws when trying to talk.
 Interjection like ‘uhm’ used more frequently
before attempting to utter certain sounds.
 MANAGEMENT
 Behaviour modification and relaxation therapy to
resolve the conflict and emotional stress, thus to
improve the confidence in the child.
 The child should be reassured and helped in breath
control exercise and speech therapy.
 Parents need counselling to rationalize their
expectations of child’s achievement according to the
potentiality.
 These children have normal or high IQ level, so they
need encouragement and guidance.
 Stammer suppressor, psychotherapy and drug
therapy
 CLUTTERING
 Cluttering is characterized by unclear and hurried
speech in which words tumble over each other.
There are awkward movements of hands, feet and
body.
 These children have erratic and poorly organized
personality and behaviour pattern.
 They need psychotherapy.
 DELAYED SPEECH
 Delayed speech beyond 3 to 3.5 years can be
considered as organic causes like mental
retardation , infantile autism, hearing defects or
severe emotional problems.
 DYSLALIA

 Dyslalia is the most common disorder

of difficulty in articulation.
 It can be caused by abnormality of teeth,
jaw or palate or due to emotional
deprivation
 Treatment of the structural and
speech therapy should be
done adequately.
CONT..

 In absence of structural problems , the responsible

emotional disorders or factors should be ruled out.
 The child needs counselling.
 The parents should be informed about the
modification of family environment and correction
of deprivation
 JUVENILE DELINQUENCY

 Juvenile delinquency is an antisocial

behaviour, in which a child or adolescent
purposefully and repeatedly does illegal
activities.
CONT..
 A juvenile is a person under age of 18 years.
 The children act 1960 in India defines a delinquent
as “ a child who has committed an offence such as
theft, sexual assault, murder, burglary or inflicting
injuries, running away from home etc.
 Teachers call them incorrigible and beyond
correction. The psychiatrist and psychologist call
them ‘emotionally disturbed’ while judiciary has
one term for the ‘DELINQUENTS’
 THE CHILDREN ACT 1960
 The children act 1960 in India develops
for the care maintenance, welfare,
education and rehabilitation of the
deliquent children.
It covers the neglected and destitute
socially handicapped.
The state shall in particular direct its
policy towards securing the childhood and
youth.
 JUVENILE JUSTICE ACT 1986
 The new act, provides a comprehensive scheme for
care, protection, treatment, development and
rehabilitation of deliquent juveniles.
 Features of this act:
• It provides a uniform legal framework for juvenile
justice in the country, so as to ensure that no child
under any circumstances is put in jail or police lock
up.
• It envisages specialized approach towards prevention
and treatment of juvenile delinquency in keeping
with the developmental needs of children.
CONT..
• It establishes norms and standards for administration
of juvenile justice in terms of investigation, care,
treatment and rehabilitation.
• It lays down appropriate linkage and co-ordination
between the formal system of juvenile justice and
voluntary organizations
• By the year 1992, there were 609 institutions under
Juvenile Justice Act, out of these 269 were
observation homes, 249 juvenile homes, 40 special
homes and 51 after care institutions
 PRESENTATION OF
ANTISOCIAL PROBLEMS
The common forms IN ofCHILDREN
presentation of Juvenile
delinquency are:
1.Constant disobedience
2.Truancy from school
3.Sexual assault.
4. Destructiveness
5. Gambling
6. Cruelty
CONT..
7.Running away from school.
8.Fights
9.Ungovernable behaviour
10. Mixing with antisocial gang.
11. Murder
12.Lying
13.Stealing
14.Fire setting
15. Drug and alcohol intake with dependence
 CONTRIBUTING FACTORS ARE

 Rapid urbanization and industrialization.

 Social change and changing life style.
 Influence of mass media.
 Lack of educational opportunities and
recreational facilities
CON
T..
 Unsatisfactory conditions at school.
 Poor economy.
 Unhealthy student teacher relationship
 Lack of discipline.
 DIAGNOSTIC PROCEDURE
 Interview: interview the delinquent as well as
his parents. Interview should preferably consist
of a structural procedure to avoid omitting or
failure to elicit essential data.
 Mental status examination: it is to obtain
information about the present mental state and
abnormalities they may prevail.
CONT
...
 Neurological examination
 EEG: It is helpful to rule out any organic
cause of the problem
 Psychological test or personality test : like
Rorshach’s tests
PREVENTION JUVENILE DELINQUENCY
PRIMARY PREVENTION: In this remove all
the factors which directly or indirectly causes
delinquency.
 SECONDARY PREVENTION: It includes
prompt diagnosis and treatment of
delinquency.
TERTIARY PREVENTION: Rehabilitation of
delinquents.
CONT..
.
• Effective family planning so that children are
wanted, is useful
• Emotional and financial security should be at home.
• Close contact of children with parents.
• Tender loving care
• Fulfilment of basic needs.
• Healthy teacher taught relationship
• Facilities for sports
• Exercise and recreation.
 MANAGEMENT
It includes following therapies:
Preventive therapy.( already
discussed)
Corrective therapy.
Drug therapy.
 CORRECTIVE THERAPY
It includes:
1. Protective therapy: which not only extends
to custodial care, but also to probation and
parole.
2. Punitive therapy: with an idea to serve as
deterrent.
CONT..
3.Reformative therapy: it is to bring about
certain changes in the personality and
behaviour of the delinquent.
4. Rehabilitative therapy: which is very
essential to assist the delinquent in his
progress and give him a new way of
living.
 DRUG
THERAPY
Drugs are useful in case of aggressive
behaviour.
• Tranquilizers: to reduce stress or tension.
• Chlorpromazine: 25-50mg orally TDS.
• Haloperidol: 1.5-10 mg orally TDS.
 SCHOOL PHOBIA
 It is refusal to go to school or to stay in school,
without any attempts to conceal.
 School phobia is an emotional disorder of the
children who are afraid to leave the parents,
especially mothers.
 School phobia is also called school refusal.
 It is a symptom of crisis situation of developmental
stages and ‘cry for help’, which needs special
attention.
 PREVALENCE OF SCHOOL
PHOBIA
 School refusal was seen in 3.6% of children. 77.8%
of the children had a psychiatric diagnosis, most
common being depression (26.7%), followed by
anxiety (17.7%).
 Both sexes are equally affected.
 The incidence peak during three periods of school
life:
- Age 5 and 6
- Age 11 and 12
- Age 14 to 16.
 CAUSE
S
 Individual factors: withdrawl.
 Separation anxiety.
 Family factors.
 Factors specific to school.
 Psychiatric disorders like depression, phobic anxiety
or other psychiatric conditions.
 SIGN AND SYMPTOMS
 High level of anxiety.
 Headache
 Nausea
 Abdominal pain and palpitations.
 The symptoms are usually school day linked.
 MANAGEMENT
 Habitformation for regular school attendance.
 Play session and other recreational activities at
school.
 Improvement of school environment.
 Family counselling to resolve the anxiety related to
maternal separation.
SHYNESS leading to complete withdrawl is
considered as a behaviour problem.

CAUSES OF SHYNESS:
• Genetic inheritance.
• Environmental causes like lack of exposure,
cultural norms and society etc.
 MANAGEMENT

• Assess the cause of shyness.

• Talk to the child.
• Provide exposure to the child by arrange small
get-to-gather with peer group.
• Do not pay attention to the child’s mistakes.
• Do not compare the child with other child
CONT..

• Do not criticize the child.

• Reward the child whenever he performs well
or takes on initiative.
• Encourage the child to develop his potentials
and talents.
• Help the child to gain self confidence.
• Do not force the child to socialize, as this may
aggravate shyness.
 RESPONSIBILITIES IN
BEHAVIOURAL
 Nurse play a vital role for prevention, early
identification andDISORDERS
management of behavioural
disorders in children.
 Assessment of specific problem of the child by
appropriate history and detection of the responsible
factors.
 Informing the parents and making them aware about
the causes of behavioural problems of the particular
child.
CONT..
.
 Assisting the Parents, teachers and family members
for necessary modification of environment at home,
school and community.
 Encouraging the child for behaviour modification,
as needed.
 Promoting healthy emotional development of the
child by adequate physical, psychological and social
support.
 Creating awareness about psychological disturbances
which may lead to behavioural problems during
developmental stages.
CONT..
 Providing counselling services for children and their
parents to solve the problems, whenever necessary
and for tender loving care for children.
 Participating in the management of the problem
child, as a member of health team along with
paediatrician, psychologist and social worker.
Organize child guidance clinic.
 Referring the children with behavioural problems for
necessary management and support to better health
care facilities, child guidance clinic and support
agencies
 RESEARCH ARTICLE
A study on family factors in association with
behaviour problems amongst children of 6-18 age
groups by Sandip S Jogdand et al in July-Dec.
2014. This cross-sectional study focussed on the
family factors associated with behaviour
problems amongst children of 6-18 years of age.
AIM AND OBJECTIVE
To study the family factors associated with
behaviour problems amongst children of 6-18
Years age group.
CONT..
MATERIAL AND METHODS
A total 600 children in the age group of 6-18 years
were enrolled for study from adopted urban slum
area. The children were selected by simple
random sampling method from the list of family
survey registers of field workers. Their socio-
demographic data and information regarding
behaviour was recorded. Socio-demographic data
pertaining to socioeconomic classification, type
of family, parent educational status, parent habits
and addictions etc., was collected.
RESULT
In this study out of 600 children, there were 71
(11.83%) children with either one or both real
parents absent. Out of these children 56 (78.87%)
children exhibited one or more than one
behaviour problem. There is an association
between behaviour problems and absence of
parents. Out of 600 children, 238 (39.67%)
children were from families having a history of
alcoholism in parents or caretakers. Amongst
these children, 134 (56.30%) children exhibited
one or more than one behaviour problems
 REFERENCE
S
 Ghai OP, “ Essential Paediatrics”.CBC
Publishers, ed. 7th.
 Dutta Parul, “Paediatrics nursing” jaypee
publishers, ed. Second
 Sudhakar A, “ Essentials of Paediatrics
nursing” Jaypee publishers, ed. 1st.
 http://www.ijabmr.org/