1. Presented By:
Navjyot Singh
M.Sc.(Nsg) 1st Year

2. INTRODUCTION
Disruptive behaviors should be considered from
both a developmental and a bio-psychosocial
framework.
A child who is not doing what adults want him to
do at a particular time is considered as behavioral
disorder.

3. DEFINITION
A person is said to have a behavior
disorder when he or she demonstrates
behavior that is noticeably different from
that expected in the school or
community.

4. COMMON BEHAVIORAL
DISORDERS
 Repetitive Behaviors
 Finger (thumb) sucking & Nail biting
 Temper Tantrums
 Evening Colic
 Stranger Reaction / Anxiety
 Pica
 Breath holding spasms
 Stuttering / Stammering

5. REPETITIVE BEHAVIORS
 Benign & self-limiting
 Begin between 6 – 10 years
Example- Body rocking, Head banging
 Head banging
 In 5-20% of children during infancy & toddler years
 Can result in callus formation, abrasions, contusions

6. MANAGEMENT
Assurance
Teach parents to ignore – as concern
and punishment can reinforce it.
Padding

7. FINGER (THUMB)
SUCKING & NAIL BITING

8.  Sensory solace for child (“internal stroking”) to cope with stressful
situation in infants and toddlers.
 Reinforced by attention from parents.
 Most give up by 2 years.
 Predisposing factors:
• Developmental delay
• Neglect

9. ADVERSE EFFECTS
 Malocclusion – open bite
 Mastication difficulty
 Speech difficulty (D and T)
 Lisping
 Paronychia and digital abnormalities

10. 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.

11. TEMPER TANTRUMS

12.  In 18 months to 3 year 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

13. 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

14.  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.

15. EVENING COLIC

16. Intermittent episodes of abdominal pain and
severe crying in normal infants
Begins at 1-2 weeks age and persists till 3-4
months.
Crying usually in late afternoon or evening

17. CAUSE
 Not known
 More likely if the child is over active and parents are over
anxious
 Could be a manifestation of
-hunger,
-aerophagia,
-immaturity of intestine,
-overfeeding,

18. MANAGEMENT
 During Episode
 Hold the child erect or prone
 Avoid drugs
 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.

19. STRANGER REACTION

20.  By 6-7 months age infant can differentiate from primary
care givers and others
 At this age they develop fear of others.
 This may last for a few months to peak around 13-15 months
 It might be an indication for later development of
behavioral problem as separation anxiety.

21. MANAGEMENT
 Teach relaxation technique such as slowly exposing them
to stranger,
 Initially from a distance
 Asking them to greet and slowly advance
 Reassure the parents that the behavior gradually declines
 But if persists, refer to child psychiatrist

22. PICA

23. Repeated or chronic ingestion of non-nutritive
substances.
It’s an eating disorder.
Normal in infants and toddlers.
Examples: mud, paint, clay, plaster, charcoal, soil.

24. PREDISPOSING FACTORS
 Parental neglect
 Poor supervision
 Mental retardation
 Lack of affection Psychological neglect, orphans)
 Family disorganization
 Lower socioeconomic class
 Autism

25. MANAGEMENT
 Screening for:
 Iron deficiency anemia
 Worm infestations
 Lead poisoning
 Family dysfunction
 Treat accordingly to cause.

26. BREATH HOLDING
SPASMS

27.  Behavioral problem in infants and toddlers.
 Child cries and then holds breath until limp.
 Cyanosis may occur.
 Sometimes, loss of consciousness or even seizure can occur.
 It is child’s attempt to control environment:
parents/caregivers.
 Benign condition: no risk of epilepsy developing in later life.

28. MANAGEMENT
 Referral to Child Guidance Clinic.
 Referral to Child Psychologist
– If BHS accompanied with head banging or highly
aggressive behavior.

29. STUTTERING /
STAMMERING

30.  Defect speech
 Stumbling and spasmodic repetition of some syllables with pauses
 Difficulty in pronouncing consonants
 Caused by spasm of lingual and palatal muscles
 Usually begins between 2 – 5 years
 Reminding and ridiculing aggravate
 Child loses self-confidence and become more hesitant
 They can often sing or recite poems without stuttering

31. 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