BEHAVIOURAL DISORDER BSC 3RD.pptx

1. 1

2. DEFINITION
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 as behavioural
problems.
2

3. CAUSES
1. Faulty Parental Attitude
2. Inadequate Family Environment
3. Influence of Social Relationships
3

4. CAUSES
4. Mentally And Physically Sick or
Handicapped Conditions
5. Influence of Mass Media
6. Influence of social changes
4

5. TYPES OF BEHAVIOURAL DISORDER
Personality disorder
•Temper tantrums
•Juvenile delinquency
•Shyness
Problems of habit
•Thumb sucking
•Nail biting
•Tics
•Breath holding spells
•Stealing and telling lie.
5

6. Problems of Toilet Training
•Enuresis
•Encopresis
Problems of Speech
•Stuttering
•Cluttering
Problems at School
•School Phobia
6
TYPES OF BEHAVIOURAL DISORDER

7. Sleep Disorders
•Somnambulism
•Sleep talking
•Bruxism
Eating Disorders
•Pica
•Anorexia Nervosa
•Bulimia Nervosa
7
TYPES OF BEHAVIOURAL DISORDER

8. EATING DISORDER

9. PICA (GEOPHAGIA)
9

10. •Pica is an eating disorder.
•Defined as the persistent ingestion of non-nutritive
substances for a period of at least 1 month at an
age at which this behavior is developmentally
inappropriate (e.g, >18-24 months).
10
PICA (GEOPHAGIA)

11. The substances may include
•Plaster
•Charcoal
•Clay
•Wool
•Ashes
•Paint
•Pencils
• Chalk
•Burnt matches
•Pebbles, etc 11
PICA (GEOPHAGIA)

12. Causes
According to psychological theories….
Parental neglect
Poor attention of the caregiver
Inadequate love and affection
Mental retardation
Children of poor socio economic status family.
12

13. According to nutritional theories……
•Pica develops due to deficiencies of such substances
as iron and zinc which produces craving for
substances like ice or dirt.
13
PICA (GEOPHAGIA)

14. Clinical Features
•Anaemia
•Intestinal parasitosis
•Lead poisoning
•Vitamins and mineral deficiency,
•Mild constipation to life threatening haemorrhage
14

15. Diagnosis
•A complete medical history and physical examination.
•Blood investigations for possible anemia
•Imaging studies used to identify ingested materials and
aid in the management of gastrointestinal (GI) tract
complications of pica such as…
•Abdominal radiography
•Upper and lower GI barium examinations
•Upper GI endoscopy
15

16. Treatment
•Treatment of the deficiencies.
•Training in discrimination between edible and non-
edible items
•Self-protection devices that prohibit placement of
objects in the mouth
•Parental counselling
•Behaviour modification
• Psychotherapy 16

17. BULIMIA NERVOSA
17

18. Definition
Bulimia nervosa is characterised by episodes of binge
eating where the individual consumes large amount of
food with lack of control followed by various
compensatory behaviours ( self inducing vomiting) to
control weight.
18

19. Mable_Maria 19

20. Incidence & Etiology
• Occurs more in female than male.
• Occurs in age group of 15-30 years with peak incidence at about
18-19 years of age.
• Society’s emphasis on appearance and thinness.
• Family disturbances or conflict.
• Sport person.
• Sexual abuse.
• Eating disorder.
• Struggle for control or self identity.
20

21. Clinical Features
•Intense fear of getting fat and
very sensitive to weight gain.
•Binge eating stops when
abdominal discomforts occurs.
21

22. Clinical Features
•After eating the adolescents feel
out of control, depressed, guilty and
anxious.
•Self inducing vomiting and misuse
of laxatives and diuretics is also
seen.
•Fasting or excessive exercise to
prevent weight gain. Mable_Maria 22

23. •Cognitive therapy to helps in developing a sense of
self, understanding of conflicts, developing realistic
perception of one’s body and enhancing self esteem
and self concept.
Management

24. Management
•Behavioural modification is used to control binge eating
and then inducing vomiting.
•Selective serotonin reuptake inhibitors drugs (SSRIs) to
reduces the urge to binge.
•Dietary counselling.
24

25. ANOREXIA NERVOSA

26. ANOREXIA NERVOSA
•Anorexia nervosa is characterized by
voluntary refusal to eat, significant
weight loss, an intense fear of
becoming over weight.
•They may restrict food intake or
engage in binge eating followed by self
inducing vomiting or misuse of
laxatives or diuretics.

27. ETIOLOGY
The exact cause is unknown.
•Biological
•Conflict family.
•Dysfunctional family.

28. RISK FACTOR
•Accepting society’s attitude about
thinness.
•Experiencing childhood anxiety.
•Feeling increased concern or attention
to weight and shape.
•Having negative self image.

29. CLINICAL FEATURES
• Extreme weight loss
• Intense fear of gaining weight.
• Distorted body image, weight or shape.
• Amenorrhea for up to 3 months.
• Muscle wasting
• Hypotension
• Dry skin
• Cold intolerance etc.

31. MANAGEMENT
1. Nutritional Counselling.
2. Therapy to correct distortion and deficits in psychological
thinking.
3. Family therapy to correct disturbed patterns of
interaction in family.
4. In certain cases, Antidepressants prove to be effective.

32. 5. 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.
MANAGEMENT

33. SPEECH DISORDER

34. 34

35. Definition
Stuttering or stammering is a speech disorder in which
the flow of speech is disrupted by involuntary repetition
and prolongation of sounds, words or syllables.

36. Types
1. Developmental- Cleft lip, cleft palate or tongue tie.
2. Acquired – A stroke or brain injury affects the signal
between brain.
3. Psychogenic – Stress and embarrassment may make
stammering worse in people who stutter.
36

37. Risk factor
•It is evident in children who cannot cope with the
environmental and emotional stresses.
•It is commonly found in boys with fear, anxiety.
• Family history.
37

38. Signs and Symptoms
38

39. •Problems in starting a word or phrase.
•Hesitation before certain sound has to be uttered.
•Repetitions of sound, word or syllable.
•Speech may come out in spurts.
•Trembling lips and jaws.
•Interjection like “uhm” used more frequently.
Signs and Symptoms

40. Management
•Parents should not put undue
pressure on the child regarding
fluency of speech.
•Give the child sufficient time to
express himself.
•Never criticize the child for his
speech.
40

41. • Encourage the child to speak clearly by
teaching him songs and rhymes.
• Breath control exercises and speech
therapy.
• Fluency Shaping Therapy and Stuttering
Modification Therapy
Management

42. PERSONALITY
DISORDER

43. 43

44. DEFINITION
Temper tantrums is a sudden outburst of violent
display of anger, frustration and bad temper as
physical aggression or resistance such as rigid body,
biting, kicking, throwing objects, hitting, crying, rolling
on floor, screaming loudly, banging limbs, etc.
44

45. • Temper tantrums are most common in children ages 1 to 4
years. But anyone can have a tantrum—even an adult.
• The activity is directed to environment and not to any
person or thing.
• It is usually found in boys, single child and pampered child.
45

46. ETIOLOGY
•Parental Factors
•Not meeting demands
•Interruption of play
•Stranger anxiety, criticism
•Imitation
46

47. CLINICAL FEATURES
•Screaming,
•Biting,
•Hammering,
•Stamping feet, thrashing arms,
•Kicking, throwing objects,
•Rolling on the floor
47

48. MANAGEMENT
•Educate the parents that temper tantrum are child's way
of releasing frustration, so they should ignore them.
•Parents should be a good role model for the child.
•During an attack, the child should be protected from
injuring himself and the others.
48

49. •Parents should show the child that he is loved even
through his behaviour is disapproved.
•Deviating his attention from the immediate cause and
changing the environment can reduce the tantrum.
•Some temper tantrums result from the child’s frustration
at failing to master a task. These can be managed by
distracting the child and permitting success in more
manageable activity. 49
MANAGEMENT

50. JUVENILE DELIQUENCY

51. JUVENILE DELIQUENCY
•Juvenile delinquency is an antisocial behaviour, in which a
child or adolescents purposefully and repeatedly does
illegal activities.

52. •The children Act 1960, in India defines a Deliquent as
“a child who has committed an offence such as theft,
sexual assault, murder, burglary or inflicting injuries,
running away from home etc.
JUVENILE DELIQUENCY

53. ETIOLOGY
1. Genetics
2. Sex – No. of boys compare to girls is very large.
3. Age – Onset of puberty.
4. Family background – Poor family, criminal history etc.
5. Personality – Superior intelligence as well as
borderline mental retardation.

54. Management of Juvenile delinquency
1. Preventive therapy –
• Remove all factors which directly or indirectly cause
delinquency.
• Effective family planning.
• Method of bring-up child should be taught at prenatal stage.
• Close contact with children with parents.
• The energy of children should be channelized to prevent
delinquency.

55. 2. Corrective therapy-
•Protective therapy - Custodial care
•Punitive therapy - With an idea to serve as a deterrent.
•Reformative therapy - Changes in personality and
behaviour.
•Rehabilitative therapy.
Management of Juvenile delinquency

56. Juvenile detention centre/ Rehabilitation
centre

57. 3. Drug therapy
•Use in aggressive behaviour.
•Tranquillizers, chlorpromazine, haloperidol.
Management of Juvenile delinquency

58. SHYNESS

59. SHYNESS
Shyness leading to complete withdrawal is
considered as a behavioural problem.

60. CAUSES
•Genetic inheritance.
•Environmental causes like lack of exposure, cultural
norms, society etc.

61. MANAGEMENT
•Find out the causes of shyness.
•Talk to child.
•Provide exposure to the child.
•Don’t compare the child with other children.

62. MANAGEMENT
•Help the child to gain confidences.
•Don't pay attention to the child’s
mistakes.
•Reward whenever he performs well or takes on initiative.
•Don’t force child to socialize, as this may aggravate
shyness.

63. HABITS
DISORDER

64. THUMB SUCKING
Thumb sucking is define as non-nutritive
sucking of fingers or thumb.

65. CAUSES
 Parental causes
• Over protection
• Neglect by parents.
• Strictness of parents.
• Disharmony between parents.
Due to teachers
• Excessive strictness
• Excessive punitive attitude of teachers.

66. Due to siblings and friends
• Excessive competition
• Separation from close friends or siblings.
Other causes
• Loneliness and boredom.
• Tiredness
• Frustration and anxiety
• Separation from parents.
CAUSES

67. PROBLEMS CAUSED BY THUMB SUCKING
•If thumb sucking continuous up to 5 years or above, it
indicates presence of an emotional damage.
•Dental problems like malalignment of teeth or
sometimes malformation of upper palate.
•Speech problems like mispronouncing.

69. Management
Usually thumb sucking can be managed at home
by parents setting rules and providing distraction.

71. Do’s
•Divert the child's attention.
•Offer praise and rewards to child for not sucking thumb.
•Distracts the child's when he gets bored.

72. •Put non toxic bitter tasting substance on thumb.
Do’s

73. •Put gloves or wrap the thumb with a cloth or bandage
•If the child is sucking thumb due to anxiety or distress,
talk to the child and manage it.
Do’s

74. Don’ts
Do not scold the child.
Do not tie the child's thumb or fingers.
Do not nag, scold or beat the child.
Do not leave the child wet or hungry.

75. NAIL BITING

76. •Onychophagia or nail biting is a common oral compulsive
habit in children and adults.
•It is just a way of coping with stress of comforting self.
NAIL BITING

77. CAUSES
•Out of curiosity or boredom.
•To relieve stress or anxiety.
•Because of habit.
•Lack of confidence
•Nervousness.
•Feeling shy.
•Tiredness etc.

78. MANAGEMENT
•Application of bitter tasting nail
polish.
•Keep nails clean and short.
•Talk to child about the anxiety or
any worries and manage it.
•Do not punish or pressurize the
child.

79. • Reassure the child with love and affection.
• Help the child to become aware of this bad
habit.
• Divert the child’s attention with play or
other things.
• In case all these fail, Behaviour therapy is
beneficial.
MANAGEMENT

80. TICS

81. TICS
Tic is an abnormal involuntary movement which
occurs suddenly, repetitively, rapidly and is
purposeless in nature.
81

82. Types
Motor Tics- characterized by repetitive motor
movements.
- Simple motor tics
- Complex motor tics
Vocal Tics- characterized by repetitive
vocalisations.
- Simple vocal tics
- Complex vocal tics
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83. MOTOR TICS
Mable_Maria 83

84. Simple motor tics- Eye blinking, facial grimacing,
head jerks or shoulder shrugs etc.
Mable_Maria 84

85. Complex motor tics- Biting, banging, twisting
around or obscene gestures.
Mable_Maria 85

86. VOCAL TICS
1. Simple voice tics- Coughing, throat clearing,
sniffing, hissing etc.
2. Complex voice tics- Includes syllabus, words
like SHUT UP, YES I KNOW.
Mable_Maria 86

87. Treatment
• Parents and the family should be educated and
counselled about course of disorder and
spontaneous resolving of disorder
• Relaxation exercises have proven efficacy.
• Cognitive Behaviour therapy may be used.
• Awareness training.
87

88. Pharmacotherapy
• Antipsychotics drugs- Haloperidol is the
drug of choice.
• In severe cases, pimozide or clonidine can be
used.
• Benzodiazepines to reduce anxiety.
Mable_Maria 88

89. PROBLEMS OF
TOILET
TRAINING
Mable_Maria 89

90. ENURESIS
• Enuresis or Bed wetting is a disorder of involuntary
micturation in children who are beyond the age, control is
not acquired.
• Bladder control is normally acquired by the age of 2.5 -3
years.
• If it is not acquired beyond 4-5 years of age, it is abnormal.
• When bed wetting occurs repeatedly, it is called as
ENURESIS.

91. TYPES
1. Primary enuresis: It refers to the condition in which
children have never been successfully trained to
control urination. There may be delay in maturation
of sphincter control.
2. Secondary enuresis: It refers to the condition in
which children have been successfully trained, but
revert to bed wetting in response to some stress. It
may be due to parent child maladjustment.

92. 1. NOCTURNAL- During night.
2. DIURNAL- During day time.
3. MIXED – Both.
TYPES ON BASIS OF TIME OF ENURESIS

93. CAUSES
1. Inappropriate toilet training.
2. Neurological developmental delay.
3. Genetics.
4. Emotional factors.
5. Organic cause- Anatomical defect, UTI etc.
Mable_Maria 93

94. MANAGEMENT
• Reassure the child and parents.
• Try to build the child's self-confidence.
• Parents should be explained about the factors
related to bed wetting.
• Parents should be asked not to scold, threat or
punish the child.
• The child should not be given any liquids like tea or
milk after 5 pm in the evening.

95. • The child should be habitually made to pass urine before
going to bed.
• The parents should arouse the child after 2-3 hours of
sleep and persuade him to walk unaided to the toilet, to
empty bladder.
• The child is trained to hold urine for longer time. This may
be done by making the child drink large quantity of water
during day and persuading him to delay emptying bladder
as long as possible.
MANAGEMENT

96. • Bed wetting alarms
• Medications: In very resistant cases Tricyclic
Antidepressants like amitriptyline, imipramine and
nortriptyline are given orally, at night for 2 months.
Desmopressin, which is a synthetic replacement for
antidiuretic hormone (ADH) is also given as it
reduces urine production during sleep.
MANAGEMENT

97. ECOPRESIS
Encopresis also known as paradoxical diarrhoea is
involuntary faecal soiling in children who are past
the age of toilet training.

98. CAUSES
• Rarely cause by any congenital defect.
• In majority of cases it develop as a result of chronic
constipation. The problem begins with painful passage of
hard stool. Over the time child becomes reluctant to pass
stool or holds stool to avoid pain. This "holding in" of stool
becomes a habit. As more and more stool collects in child's
colon, the colon goes on stretching and finally the child
loses the natural urge to pass stool. Eventually, the partly
formed soft stool from high up in the intestine, leaks
around the large collection of hard stool at the bottom of
rectum and then leaks out of the anus. As time passes,
more and more stool leaks and then the child starts passing
entire stool in his or her underwear.

99. MANAGEMENT
• Empty the colon of stool.
• Establish regular, soft and painless bowel
movement.
• Promote regular bowel habits.
• Behavior therapy for modification of child's
behavior.

100. A combination of medical and
behavior therapy, works best in
evacuation of hard stool from the
colon.

101. Evacuation can be accomplished in the following manner:
1. Enema
2. Suppositories or laxatives.
3. Establish regular toilet routine.
4. Behavioral techniques to develop regular toilets
habits.
MANAGEMENT