Children and youth with

behavior disorders
ECOLOGY OF BEHAVIOUR PROBLEMS
• Children show a wide variety of behavior disorders. Most of these
problems are minor and do not cause permanent disturbances.
Nevertheless, these cause considerable anxiety to parents.
Management of these minor behaviour deviations requires an
understanding of the stresses which lead to these problems.
• Behaviour means the way in which one acts or conducts oneself,
especially towards others.
• A behaviour is considered to be maladaptive when it is inappropriate,
when it interferes with adaptive functioning, or when others
misunderstand it in terms of cultural inappropriateness.
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.
PREVALENCE OF BEHAVIOURAL DISORDERS

• Overall 1.2 to 3% children suffers from Behavioural problems or

disorders.
• 10% are school aged children.
• 80% have features into adolescents.
• 65% enter adulthood with that features.
• Boys have 4 times more risk than girls.
• Urban children are more prone as compared to rural children.
CAUSES OF BEHAVIOURAL
PROBLEMS
• Faulty parental attitude.
• Inadequate family environment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137648/

• 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
6. SEXUAL PROBLEMS
7. ANXIETY DISORDERS
 Subtypes
1. HABIT 2. SPEECH 3. EATING 4. SLEEP 5. PERSONALITY 6. SEXUAL 7.ANXIETY
DISORDERS DISORDERS DISORDERS DISORDERS DISORDER DISORDERS DISORDERS

• Thumb • Stammering / • Pica • Sleep walking • Juvenile • Masturbation • School

sucking stuttering • Anorexia (Somnambuli delinquency phobia or
• Nail biting • Cluttering nervosa sm) • Temper school
• Tics • Delayed • Bulimia • Sleep talking tantrums refusal
• Enuresis speech nervosa (somniloquy) • Shyness • Truancy
• Encopresis • Dyslalia • Night mares • Repeated
• Stealing and night failure
• Telling lie terrors • Absenteeism
 ENURESIS OR BED WETTING
• The word enuresis is derived from the greek word “enourein” means ‘to void urine’. It can
occurs either during the day or at night.
• Enuresis is a disorder of involuntary micturition in children who are beyond the age when
normal bladder control should have been acquired.
• It is common during 4 years to 12 years age

• PREVALENCE IN INDIA
• -12.6%in Indian children is present
• -Prevalence at age 5 years is 7%for males And 3%for females.
• -At age 10 years 35 for males and 2%for females

• TYPES
• Nocturnal enuresis- Enuresis that occurs during sleep
• Diurnal enuresis- Enuresis that occurs during day time or when the child awake
• Monosymptomatic or uncomplicated enuresis- Enuresis without lower urinary tract
symptoms other than nocturia and no history of bladder dysfunction
CAUSES habits of the family should be found out.
• Overactive bladder • Child parent relations should be explored. Analysis of
the time of bed-wetting frequency and relation to sleep
• Emotional atmosphere should be done.
• Organic causes like anatomical defect of urinary • Restriction of fluid intake in the evening and helping
tract, UTI, neurological deficit the child in developing the habit of passing urine before
• Feeling of shame and guilt going to bed.
• Faulty or defects in toilet training • Toilet training should be given to the child to increase
the capacity of the bladder.
SIGN AND SYMPTOMS
• Wetting during the day.
• Frequency, urgency, or burning on urination.
• Straining, dribbling, or other unusual symptoms with
urination.
• Cloudy or pinkish urine.
• Soiling, being unable to control bowel movements
constipation

MANAGEMENT
• The home conditions, socioeconomic status and
 ENCOPRESIS
• ENCOPRESIS refers to passage of faeces into inappropriate place at
any age when bowel control should have been established
• Encopresis indicates a more serious emotional disturbances than
enuresis and is less common(around 1% in school children)

CAUSES SIGN & SYMPTOMS DIAGNOSTIC MANAGEMENT

EVALUATION

-Anatomic abnormality -Withhold defecation - History of bowel -Establish regular

- Emotional disturbances -Distended abdomen elimination. bowel habits(e.g.
-Improper toilet training -Diarrhoea related to - Physical make the child to sit in
-Stress in school activity irritation of GI tract examination. toilet for at least 10
-Overprotection - Tensed feeling -Detail about pattern minutes a day.
- Fear related to toilet - Aggressiveness of current toilet -Reassurance and help
-Poor parent child practice from psychologist for
bonding counselling of child
and parents.
 NAIL BITING
Nail biting is bad oral habit especially in
school age children beyond 4 years of
age(5 to 7 years).
- 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
-Persistent nail biting may be indicative of
emotional problem.
- Psychosomatic
• Sign and symptom
- Rotation
- Alteration of incisal edge or incisor
- Inflammation of nail bud.
• Management
o The child’s hand to be kept busy with
creative activities or play
o Punishment to be avoided.
o The child should be praised for well kept
hand by breaking the habit to maintain
self confidence.
o Application of nail polish, light cotton
mitten as reminder
o Increase calcium intake
Thumb sucking
• Thumb sucking is a habit disorder due to CAUSES
feeling of insecurity and tension reducing
-Emotional insecurity.
activities
• Babies have a natural urge to suck. This urge
-Feeling of isolation
usually decreases after 6 months of age. But -Boredom
many babies continue to suck their thumbs to -Stress
soothe themselves.
MANAGEMENT
• Thumb sucking can become a habit in babies
and young children who use it to comfort - Positive reinforcement(praise the child and
themselves when they feel hungry, afraid, provide small awards).
restless, quiet, sleepy, or bored. - Identify the real issue and provide comfort.
• It is normally in early infancy. - Do not scold the child.
• It may interfere with the normal alignment of - Offer gentle reminders.
the teeth.
 CAUSES SIGN & SYMPTOMS MANAGEMENT

Breath holding spells-Fear Blue or pale skin

- Crying then no • No treatment usually
-Pain breathing needed.
Breath holding spells are brief periods of children stop - Traumatic event - Fainting or loss of • Iron drops or pills if
breathing up to 1 minute. -Being startled or alertness. the child has an iron
confronted - Jerky movements deficiency.
These spells often cause a child to pass out. - Genetic conditions - Normal breathing • During a spell, make
- Breath holding spells usually occurs when young child - Iron deficiency starts again after a brief sure the child is in
is angry, frustrated, in pain, or afraid. anaemia period of safe place where he
- Family history of unconsciousness. or she will nor fall or
- It is most common in toddlers. And more common in breath holding spell. - The child’s colour be hurt
2 months old and up to 2 years old. improves with the first • Place a cold cloth on
- It occurs between 6 month to 6 years of age. breath. the child’s forehead
-They occurs several during a spell to help
TYPES times a day shorten the episode
1. CYANOTIC SPELLS: they are often provoked by an • After the spell, try to
upsetting situation, in an anger or in frustration. be calm.
The child cries loudly and then cry gradually
becomes 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 breathing or may not.
2. PALLID SPELLS: They are usually seen following a
painful or fearful experience. The child becomes
pale and often loses consciousness within a
single gasp or cry.
 TIC DISORDER
• Tic disorder are characterized by persistent presence of tics, 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.
• 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 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
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
• 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, behaviour and adaptive functioning.
• Cognitive behaviour therapy: the patient is asked to deliberately
perform tic movement for specified period of time interspersed
with brief periods of rest.
2. complex
a) 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.
b) Complex phonic tics: includes syllables, words, phrases and
statements like “shut up” or “yes, you’ve done it.

PICA
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. 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
TYPES
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.
CAUSES
• 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.

ANOREXIA NERVOSA
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.
CAUSES
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

Bulimia Nervosa
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.
CAUSES
• 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
Somnambulism
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.
CAUSES
• 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. This is a common
problem of children during sleep. In this
problem child grinds teeth during sleep. It
occurs among school going children.
CAUSES
• Due to disturbances of dreams
• Due to tension and aggression
• Meningitis and encephalitis
• 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.
 MANAGEMENT
MASTURBATION
• The parents should know that
• Masturbation is the stimulation and manipulation of one’s own genitals masturbation is not harmful to the child
in order to experience erotic feelings and possibly leads to orgasm. but the child is curious about his
• Masturbation is common in both sexes in the preschool years and in sexuality.
early adolescence. • Parents should not scold or show
• The child experience pleasurable sensation which leads to repetition of negative attitude towards their
the behaviour. behaviour, it can lead to resentful anger
• The child may obtain pleasure by genital stimulation, rubbing of thighs towards frustrating parents.
against each other, or by rhythmic swaying movement. • Just ignore this behaviour of the infant.
CAUSES • Advice the child that masturbation is not
• Conflict of feelings of child against parents. acceptable in public. It should be
• In the toddler this activity is increased in intensity and in frequency.
conveyed in a non threatening manner.
Parents should react calmly when their
• Preschool children behave sexually with parents and other adults by children explore and manipulate their
rubbing their bodies against them and by seeking close intimate body own body with enjoyment.
contact.
• The child should be taught the proper
• 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 names. For the parts of the body
engage in masturbation. including genitals.
• At the time of bathing and diaper changing, parents often handle their • Provide sufficient emotional satisfaction
infants genitals. These pleasing sensations are registered by the infants. to the child, they should not feel solace.
SLUTTERING AND STAMMERING SIGN AND SYMPTOMS
• Interruption in the flow of speech.
• Stammering is also known as sluttering. It is a speech disorder in which the flow • Prolongation and repetition of words.
is disrupted by involuntary repetitions and prolongation of sounds, words or
syllables. Also there is involuntary silent pause or blocks. • Child may have hesitation.
• Sluttering and stammering is a fluency disorders begin between the age of 2-5 • Problems in starting a word or phrase.
years probably due to inability to adjust with environment and emotional stress.
• Speech may come out in spurts.
CAUSES
• Trembling lips and jaws when trying to talk.
• Developmental factors: if the child has cleft lip, cleft palate or tongue tie, the
• Interjection like ‘uhm’ used more frequently before
speech is affected. There may be central nervous system impairment which may
attempting to utter certain sounds.
affect the speech.
• Neurogenic Sluttering: A stroke or brain injury may affect the signals between MANAGEMENT
brain, speech nerves and muscles, that lead to sluttering • Behaviour modification and relaxation therapy to
• Psychological factors: stress and embarrassment. resolve the conflict and emotional stress, thus to
improve the confidence in the child.
Other causes are:
• The child should be reassured and helped in breath
o Due to physical weakness or fatigue. control exercise and speech therapy.
o Most common in children who cannot cope their self with emotional and • Parents need counselling to rationalize their
environmental stress. expectations of child’s achievement according to the
potentiality.
o Due to neurotic attitude of mother.
• These children have normal or high IQ level, so they
o More common in left handed children who are forced by the parents to use right need encouragement and guidance.
hand.
• Stammer suppressor, psychotherapy and drug
o It can occur due to conflict between parents and child expectations 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.
• 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.
• 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. 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 IN CHILDREN

The common forms of 7. Running away from school.

presentation of Juvenile 8. Fights
delinquency are: 9. Ungovernable behaviour
1.Constant disobedience 10. Mixing with antisocial gang.
2. Truancy from school 11. Murder
3.Sexual assault. 12.Lying
4. Destructiveness 13.Stealing
14.Fire setting
5. Gambling
15. Drug and alcohol intake with dependence
6. Cruelty

CONTRIBUTING FACTORS ARE
• Rapid urbanization and industrialization.
• Social change and changing life style.
Effective family planning so that children are wanted, is useful
• Emotional and financial security should be at home.
• Close contact of children with parents.

• Influence of mass media. • Tender loving care

• Lack of educational opportunities and recreational facilities • Fulfilment of basic needs.
• Unsatisfactory conditions at school. • Healthy teacher taught relationship
• Poor economy. • Facilities for sports
• Unhealthy student teacher relationship
• Exercise and recreation.
• Lack of discipline.
MANAGEMENT : It includes following therapies:
DIAGNOSTIC PROCEDURE
• Interview: interview the delinquent as well as his parents. Preventive therapy.( already discussed)
Interview should preferably consist of a structural procedure Corrective therapy.
to avoid omitting or failure to elicit essential data.
Drug therapy.
• Mental status examination: it is to obtain information about
the present mental state and abnormalities they may prevail. CORRECTIVE THERAPY1- It includes:
Neurological examination
1. Protective therapy: which not only extends to custodial care, but also to probation and
• EEG: It is helpful to rule out any organic cause of the problem parole.
• Psychological test or personality test : like Rorshach’s tests 2. Punitive therapy: with an idea to serve as deterrent.
3.Reformative therapy: it is to bring about certain changes in the personality and
PREVENTION JUVENILE DELINQUENCY behaviour of the delinquent.
• PRIMARY PREVENTION: In this remove all the factors which 4. Rehabilitative therapy: which is very essential to assist the delinquent in his progress
directly or indirectly causes delinquency. and give him a new way of living.
• SECONDARY PREVENTION: It includes prompt diagnosis and
DRUG THERAPY
treatment of delinquency.
• TERTIARY PREVENTION: Rehabilitation of delinquents. Drugs are useful in case of aggressive behaviour.
• Tranquilizers: to reduce stress or tension.
 SCHOOL PHOBIA
CAUSES
• Individual factors: withdrawl.
• It is refusal to go to school or to stay in school, without • Separation anxiety.
any attempts to conceal.
• Family factors.
• School phobia is an emotional disorder of the children
• Factors specific to school.
who are afraid to leave the parents, especially mothers.
• Psychiatric disorders like depression, phobic anxiety or
• School phobia is also called school refusal.
other psychiatric conditions.
• It is a symptom of crisis situation of developmental
SIGN AND SYMPTOMS
stages and ‘cry for help’, which needs special attention.
• High level of anxiety.
PREVALENCE OF SCHOOL
• Headache
PHOBIA
• Nausea
• School refusal was seen in 3.6% of children. 77.8% of the
children had a psychiatric diagnosis, most common being • Abdominal pain and palpitations.
depression (26.7%), followed by anxiety (17.7%).
• The symptoms are usually school day linked.
• Both sexes are equally affected.
MANAGEMENT
The incidence peak during three periods of school life:
• Habit formation for regular school attendance.
- Age 5 and 6
• Play session and other recreational activities at school.
- Age 11 and 12
• Improvement of school environment.
- Age 14 to 16.
• Family counselling to resolve the anxiety related to
maternal separation.
 SHYNESS
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
• 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.
 Attention Deficit Hyperactivity Disorder Indicators
• Primary feature is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with
functioning or development
• Present before age 12 and manifests in two or more settings
• Three subtypes within the disorder is less known
• Predominantly Inattentive
• Predominantly Hyperactive/Impulsive
• Combined
Inattention (six or more) Hyperactivity and impulsivity (six or more)
1. Fails to give close attention to details 1. Often fidgets with or taps hands or feet
2. Difficulty maintaining attention 2. Leaves seat in situations when being seated is expected
3. Does not seem to listen when spoken to directly 3. Runs/climbs in situations where it is inappropriate
4. Does not follow through on instructions 4. Unable to play or engage in leisure activities quietly
5. Difficulty organizing tasks or activities 5. Is often “on the go,” acting as if “driven by a motor
6. Often avoids tasks requiring sustained attention 6. Often talks excessively
7. Loses things necessary for completing tasks or 7. Blurts out answer before a question has been
activities completed
8. Easily distracted by extraneous stimuli 8. Difficulty waiting his or her turn
9. Often forgetful in daily activities 9. Interrupts or intrudes on others
 Conduct Disorder Indicators
Pattern of behavior in which the basic
rights of others or societal norms and
rules are violated
Behaviors must fall into three out of four
categories
1. Aggression to people/animals
2. Destruction of property
3. Deceitfulness or theft
4. Serious violation of rules
Three subtypes
1. Childhood onset (prior to age 10)
2. Adolescent subtype (no symptoms
prior to age 10)
3. Unspecified (not enough
information to determine onset)
Specifier code added if symptoms reflect
limited prosocial emotions.
Lack of remorse, empathy, concern
about performance, or affect
Higher risk for abuse (child with CD and
others)
Oppositional Defiant Disorder Indicators
• Angry/irritable mood
• Argumentative/defiant behavior
• Vindictiveness
• Rates range from 1 percent to 11
percent, with an average prevalence of
3.3 percent
• More prevalent in families where child
care is disrupted by a succession of
different caregivers or in families in
which harsh, inconsistent, or neglectful
child-rearing practices are used
Intermittent Explosive Disorder
• Recurrent behavioral outbursts representing
a failure to control aggressive impulses
manifested by either of the following:
• Verbal aggression or physical aggression that
does not result in destruction of property or
physical injury
• Three outbursts within a 12 month period
involving destruction of property and/or
physical injury to animals or people
• Outbursts are grossly out of proportion to
the provocation or precipitating stressor and
are not premeditated
• Must be at least 6 years of age or
developmental level
 Causes
1. Biological factors:
• Genetics
• Abnormalities in the neurological and
biochemical development of the child
• Injuries to the central nervous system
2. Psychoanalytical factors
Traumatic childhood experiences
3. Behavioral factors
• Lack of adaptive behaviors
• Exposure to maladaptive behaviors
• Exposure to poor environmental stresses
that lead to maladaptive behaviors
4. Phenomenological
• Improper use of defense mechanisms
• Failure to learn about oneself
5. Sociological/Ecological
• Destructive family life
• Poor living conditions
• Rejection by peers
• Expectations of the child that cause a lot
of stress on the child
• Labeling of the child
• Culture