Common Behavior Disorders in Children

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Dr. C.S.N.Vittal Common Behavioural Disorders in Children


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.

Classification of Individuals with Emotional or Behavioral Disorders:

Classification of Individuals with Emotional or Behavioral Disorders

What can affect Behaviour in a child?:

What can affect Behaviour in a child? Heredity Environment Learning Conditioning Positive reinforcements

Categories of Behaviour Disorders:-:

Categories of Behaviour Disorders:- Habit Disorders (Tension releasing disorders) Finger (thumb) sucking Nail biting Tics Teeth grinding (Bruxism) Emotional Disorders Breath holding spasms Temper tantrums Eating Disorders Pica

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Repetitive Behaviours Repetitive Behaviours Repetitive Behaviours Repetitive Behaviours Repetitive Behaviours

Head Banging:

Rhythmic hitting of the head against a solid surface often the crib mattress. In 5-20% of children during infancy & toddler years Benign & self-limiting Head Banging

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Head banging Can result in callus formation, abrasions, contusions Treatment: Assurance – significant injury unlikely Teach parents to ignore as concern and punishment can reinforce it. Padding

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Finger Sucking Nail Biting

Finger (Thumb) sucking & Nail Biting:

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

Finger (Thumb) sucking & Nail Biting:

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

Finger (Thumb) sucking & Nail Biting:

Finger (Thumb) sucking & Nail Biting Adverse Effects Paronychia and digital abnormalities

Finger (Thumb) sucking & Nail Biting Management:

Reassure parents that it’s transient. Improve parental attention / nurturing. Teach parent to ignore; and give more attention to positive aspects of child’s behavior. Provide child praise / reward for substitute behaviors. Bitter salves, thumb splints, gloves may be used to reduce thumb sucking. Finger (Thumb) sucking & Nail Biting Management Most give up by 2 yrs If continued beyond 4 yrs – number of squelae If resumed at 7 – 8 yrs : sign of Stress

Finger (Thumb) sucking & Nail Biting:

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

Finger (Thumb) sucking & Nail Biting:

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

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Temper Tantrums

Temper Tantrums:

Temper Tantrums In 18 months to 3 yr olds due to development of sense of autonomy. Child displays defiance, negativism / oppositionalism by having temper tantrums. Normal part of child development. Gets reinforced when parents respond to it by punitive anger. Child wrongly learns that temper tantrums are a reasonable response to frustration.

Temper Tantrums Precipitating factors:

Hunger Fatigue Lack of sleep Innate personality of child Ineffective parental skills Over pampering Dysfunctional family / Family violence School aversion Temper Tantrums Precipitating factors

Temper Tantrums – Management:

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

Temper Tantrums – Management:

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

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Evening Colic

Evening Colic:

Evening Colic Intermittent episodes of abdominal pain and severe crying in normal infants Begins at 1-2 wks age and persists till 3-4 mo. Crying usually in late afternoon or evening Definition : “ Infant cries for > 3 hrs per day for > 3 days per week for > 3 weeks ”

Evening Colic Attack:

Evening Colic Attack Begins suddenly with a loud cry Crying continuous – lasts for several hours – mostly in the late afternoon or evenings Face becomes red and legs drawn up on the abdomen Abdomen becomes tense Attack terminates after exhaustion or after passage of flatus or feces

Evening Colic Causes:

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

Evening Colic Management:

Evening Colic Management During Episode Hold the child erect or prone Avoid drugs No much role to antispasmodics, carminatives, simethicone, suppositories or enemas Counseling - Coping with the parents Reassure the parents that infant is not sick They need to soothe more with repetitive sound and stimulate less with decrease in picking up and feeding with every cry

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Disorder Eating Disorder Pica


Pica Repeated or chronic ingestion of non-nutritive substances. Examples: mud, paint, clay, plaster, charcoal, soil. Normal in infants and toddlers. Passing phase. Even Lord Krishna Did it !!!


Pica Geophagia Eating of mud, soil, clay, chalk, etc. Pagophagia Consumption of ice Hyalophagia Consumption of glass Amylophagia Consumption of starch Xylophagia Consumption of wood Trichophagia Consumption of hair Urophagia Consumption of urine Coprophagia Consumption of feces


Pica after 2nd yr of life needs investigation Predisposing factors : Parental neglect Poor supervision Mental retardation Lack of affection Psychological neglect, (orphans) Family disorganization Lower socioeconomic class Autism Pica


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

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Breath Holding Spasms

Breath Holding Spasms:

Breath Holding Spasms Simple breath-holding spell Cyanotic breath-holding spells Pallid breath-holding spells Complicated breath-holding spells Frustration Injury Anger Anemia Precipitating Factors:

Breath Holding Spasms Management – General::

No treatment is usually needed Iron supplements to children with iron deficiency Breath Holding Spasms Management – General: During a spell : Make sure your child is in a safe place where he or she will not fall or be hurt. Place a cold cloth on your child's forehead during a spell to help shorten the episode. After the spell, try to be calm. Avoid giving too much attention to the child, as this can reinforce the behaviors that led to the event. Avoid situations that cause a child's temper tantrums.

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Emotional Disorders Emotional Disorders School Phobia

School Phobia:

School Phobia Approximately 1 to 5% of school-aged children have school refusal  Most common in 5- and 6-year olds and in 10- and 11-year olds School refusal differs from truancy (refusal is because of fear or anxiety about school)

School Phobia:

What can parents do? Have a physician examine the child to determine if he or she has a legitimate illness. Listen to the child talk about school to detect any clues as to why he or she does not want to go. Talk to the child's teacher, school psychologist, and/or school counselor to share concerns. Together determine a possible cause or causes Develop an appropriate plan of action School Phobia

School Phobia:

The goal is to have the child return to school and attend class daily However, if the school phobia is extreme, a therapist or psychiatrist's assistance may be necessary. School Phobia

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Disorders Speech Disorders Stammering

Stuttering / Stammering:

Defect speech Stumbling and spasmodic repetition of some syllables with pauses Difficulty in pronouncing consonants Caused by spasm of lingual and palatal muscles Stuttering / Stammering

Stuttering / Stammering:

Usually begins between 2 – 5 yrs Reminding and ridiculing aggravate Child loses self confidence and become more hesitant They can often sing or recite poems without stuttering Stuttering / Stammering

Stuttering / Stammering Management:

Parents should be reassured They should not show undue concern and accept his speech without pressurizing him to repeat Children should be given emotional support Older children with secondary stuttering should be referred to speech therapist Stuttering / Stammering Management

… sudden, repetitive, nonrhythmic motor movement or vocalization involving discrete muscle groups:

… sudden, repetitive, nonrhythmic motor movement or vocalization involving discrete muscle groups Tics 12 to 20% children, peak age 5 -7 yr. Motor Tics or Phonetic Tics More common in boys t han in girls Increase when stressed, anxious, fatigued, or bored Can occur in any body part Decrease when focused

Tics : Common types:

Simple Tics: Grimacing Yawning Grunting Sighing Blinking Wrinkling Scratching nose Head jerking Throat clearing Tics : Common types Complex Tics: Jumping Spinning Touching objects or people Echopraxia: Repeating other’s actions Copropraxia : Obscene gestures Palilalia: Repeating one’s own words   Echolalia: Repeating what someone else said   Coprolalia: Obscene, inappropriate words

Tic Disorders:

Tic Disorders both multiple motor and one or more vocal tics should have been present at some time during the illness, although not necessarily concurrently; the tics should occur many times a day nearly every day or intermittently throughout a period of more than 1 year; and during this period there should never be a tic-free period of more than 3 consecutive months; the onset should be before age 18 years; the disturbance should not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition Tourette’s Chronic Transient ( Gilles de la Tourette syndrome)

Tics : Management. :

Medication to help control the symptoms and Habit reversal training (HRT): a behavioral therapy The child and adolescent psychiatrist can also advise the family about how to provide emotional support and the appropriate educational environment for the youngster. Tics : Management.

Tics : Formulations in the Management contd.. :

haloperidol , pimozide, clonidine, nifedipine are use in low doses. risperidone, olazapine mecamylamine, tetrabenazine, Benzodiazepines baclofen, botulinum toxin   Tics : Formulations in the Management contd..


Title Subtitle Behavioural Disorders Behavioural Disorders

Oppositional defiant disorder (ODD):

Oppositional defiant disorder (ODD) Easily angered, annoyed or irritated Frequent   temper tantrums Argues frequently with adults, particularly the most familiar adults in their lives, such as parents Refuses to obey rules Seems to deliberately try to annoy or aggravate others Low self-esteem Low frustration threshold Seeks to blame others for any misfortunes or misdeeds.

Conduct Disorders:

Conduct Disorders Frequent refusal to obey parents or other authority figures Repeated truancy Tendency to use drugs, including cigarettes and alcohol, at a very early age Lack of empathy for others A ggressive to animals and other people or showing sadistic behaviours including bullying and physical or sexual abuse Keenness to start physical fights & Using weapons Frequent lying Criminal behaviour such as stealing, deliberately lighting fires, breaking into houses and vandalism A tendency to run away from home Suicidal tendencies – rarely.

Attention Deficit hyperactivity disorder (ADHD):

Attention Deficit hyperactivity disorder (ADHD) Inattention  – difficulty concentrating, forgetting instructions, moving from one task to another without completing anything. Impulsivity  – talking over the top of others, having a ‘short fuse’, being accident-prone. Overactivity  – constant restlessness and fidgeting. Around two to five per cent of children are thought to have attention deficit hyperactivity disorder (ADHD), with boys outnumbering girls by three to one.

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C.S.N.Vittal a T h n Q

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