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Children acquire many skills as they grow. Some skills, such as controlling urine and stool, depend mainly on the level of maturity of the child's nerves and brain. Others, such as behaving appropriately at home and in school, are the result of a complicated interaction between the child's physical and intellectual (cognitive) development, health, temperament, and relationships with parents, teachers, and caregivers
Behavioral problems can become so troublesome that they threaten normal relationships between the child and others or interfere with emotional, social, and intellectual development. Some behavioral problems include
NEXT IS MOVIE HICHKI
Behavioral problems in children
PROBLEMS IN CHILDREN
DR ANKUR PURI
• Causes of Behavioural Disorders
• Types of Behavioural Disorders
• Assessment of common Behavioural
• Description of Behavioural Disorders
Behavioural disorders include many tension reducing
activities that appear during childhood at various levels of
development. Some of these habits develop from adults
through imitation where as other as purposeful movement.
When children cannot
adjust to a complex
them, they become
unable to behave in the
socially acceptable way
resulting in exhibition of
peculiar behaviours and
this is known as
• Faulty Parental Attitude
• Inadequate Family
• Mentally and Physically
Sick or Handicapped
•Influence of Social Relationship
•Influence of Mass Media.
•Influence of Social Change.
Behavioural disorder results due to
deprivation in any one of the area
mentioned below :-
1. Emotional Deprivation.
2. Physical Deprivation.
3. Social Deprivation
4. Other forms.
It occurs when a child is criticized,
neglected, ignored or abused by primary
Behavioural problems resulting from
emotional deprivation are :-
• Temper tantrum
• Breath holding spells
• Nightmares/ night terrors
A physically deprived child has profound
effects on developing brain.
Behavioural disorders coming under this
• Enuresis (Bed wetting)
• Nail Biting
• Thumb Sucking
It is the reduction of culturally normal
interaction between individual and
society, It includes :-
• Juvenile Deliquency
• School Phobia
• Repeated Failures
• Sibling Rivalry
• Speech Disorder
Common Behavioral problems
Tics Bruxism Encopresis
• PICA - Persistent ingestion
of non‐nutritive substances
for at least 1 month in a
manner that is inappropriate
for the developmental level.
– Examples: mud, paint, clay,
plaster, charcoal, soil.
• It’s an eating disorder.
• Normal in infants and
• Passing phase.
Predisposing factors :
• Lack of parental nurturing
• Mental retardation
• Psychological neglect (orphans)
• Family disorganization
• Lower socioeconomic class
Consumption of feces
Consumption of glass
• Urophagia: Consumption
• Geophagia: Eating of mud,
soil, clay, chalk, etc.
• Trichophagia: Consumption
• Pagophagia: Consumption
Screening indicated for
• Iron deficiency anemia
• Worm infestations
• Lead poisoning
• Family dysfunction
• Parental care
• Developing safe eating habits
• Multivitamins and calcium intake
• Avoid punishment
• Evacuation of bladder at a
wrong place and time at
least twice a month after 5
yrs of age
‐ 5‐10 yr olds: 2‐3%
‐ adolescence: 0.5‐1%
Primary nocturnal enuresis : child has
never been dry at night (90% of cases).
Secondary nocturnal enuresis : child
has been continent for ≥ 6 months and
then begins to wet bed during sleep.
Diurnal enuresis : child passes urine in
clothes during day and while awake
• Marked familial pattern.
• 68% concordance rate in monozygotic twins.
• 38% concordance rate in dizygotic twins.
• Maturational delay is the most common
• Hypo secretion of arginine vasopressin (AVP)
hormone may be possible etiology.
• Psychosocial Stress : Family
• Urinary Tract Infection.
• Juvenile Diabetes Mellitus.
• Management of secondary
nocturnal enuresis depends
MANAGEMENT OF PRIMARY NOCTURNAL ENURESIS
• Detailed clinical/developmental history
• Family history
• Rule out urinary tract infection.
• Rule out occult spina bifida/abnormalities of urinary
• X‐ray lumbosacral spine
• USG abdomen
• Rule out Diabetes Mellitus
BEHAVIOR THERAPY FOR PRIMARY
• Adequate fluid intake during
the day as 40% in the morning,
40% in the afternoon and 20%
in the evening
• Caffeinated drinks to be
avoided in the evening
• Reassurance and emotional
support to the child
• Encourage child to
keep a dry night diary
and void urine before
• Dry nights to be
credited with praise
• If behaviour therapy fails or if
parents want prompt
• Imipramine (2.5 mg/kg/24 hrs
at bed time) for few weeks
• Desmopressin acetate
(DDAVP) orally or intra nasally
at bed time
• A habit disorder.
• Sensory solace for
• Normal in infants and
• Reinforced by attention from
• Predisposing factors:
• Developmental delay
• Most give up by 2 yrs
• If continued beyond 4 yrs – number of
• If resumed at 7 – 8 yrs : sign of Stress
• Adverse Effects
– open bite
– Mastication difficulty
– Speech difficulty (D and T)
– Paronychia and digital abnormalities
MANAGEMENT OF THUMB
• Reassure parents that it’s transient.
• Improve parental attention/nurturing.
• Teach parent to ignore; and give more
attention to positive behaviour.
• Provide child praise for substitute
• Bitter salves may be used reduce thumb
• Chronic thumb sucking in older children
may affect alignment of teeth.
BREATH HOLDING SPELLS
• Behavioral problem in infants
• Typically initiated by a
• Child cries and then holds
breath until limp.
• Cyanosis may occur.
• Sometimes, loss of
consciousness, or even seizure
• Reverts back to normal on
their own within several
• Rare before 6 months of age ;
peak at 2yrs and a bate by 5yrs
PALLID SPELLS CYANOSIS SPELLS
Triggered by sudden fright or pain Triggered by frustration or anger
Child may gasp/ Give brief cry Cries vigorously
Becomes pale , limp Following cry turns blue
Brief episode, less than a minute May become unconscious, less than one
Regains consciousness,, recognize
Regains consciousness, gasps.
Returns to normal.
DIFFERENCE BETWEEN SEIZURE AND BREATH
Identification and correction of precipitating factors
(emotional, environmental) are essential approach.
Overprotecting nature of parents may increase
unreasonable demand of the child.
Punishment is not appropriate and may cause another
Repeated attacks of spells to be evaluated with careful
history, physical examination and necessary investigations to
exclude convulsive disorders and any other problems.
Elicit clinical sequence of events
Parents reassured , told to ignore
Parents should remain calm
during the event
Iron supplementation for children
with iron deficiency anemia
• In 18months to 3 yr olds
due to development of
sense of autonomy.
• Child displays defiance /
• Normal part of child
• Gets reinforced when
parents respond to it by
• Lack of sleep
• Innate personality of child
• Ineffective parental skills
• Dysfunctional family/ Family violence
• School aversion
• Set a good example to child
• Spend quality time
• Have open communication with child
• Have consistency in behaviour
In general,parents advised to:
• Parents to ignore child, leave child alone
• Once child is calm, tell child calmly that
such behaviour is not acceptable
• Never beat or threaten child
During temper tantrum:
Praise/reward child for good
“Time Out” as disciplinary
method if temper
tantrum is disruptive and ,
out of control
Refer to Child Guidance Clinic
if temper tantrums persist.
• These are the
movements of muscle
groups of face, neck,
• Lip smacking
• Tongue thrusting
• Eye blinking
• Throat clearing
• TICS are
• Tension relieving habit disorder.
• Mostly transient.
• Persistent tics need psychotherapeutic intervention.
• Causes of persistent tics:
• Academic under achievement
• Low self esteem
• Neuropsychologic dysfunction
• Eye-blinking, throat-clearing, facial grimacing and sniffing – tics are brief
and sudden unwanted, repetitive, stereotyped movements or sounds.
• Though alarming to many parents, about 20 percent of school age children
develop tics at some point, though less than 3 percent of them display
those tics for more than a year.
• If tics persist for beyond 12 months, you may hear the diagnosis “Persistent
• If all of the tics are movements, we make the diagnosis “Persistent Motor
• If all of the tics are vocalizations, we call it “Persistent Vocal Tic Disorder.”
• If both motor and vocal tics persist more than a year, that defines
• Behavioral Therapy: The best-known behavioral treatment for tic
disorders is a form of cognitive-behavioral therapy (CBT) called habit
• A child is taught to recognize the premonitory urge that precedes an
oncoming tic, and to identify the situations that may trigger the tics.
• The child and therapist develop a “competing” response—an action
the child performs when he feels the urge—that is incompatible with
the tic, and less noticeable to others.
• For example, a child whose tic involves sniffling his nose may do a
breathing exercise instead. Children may also be taught relaxation
techniques to decrease the frequency of the tics.
• Pharmacological: There are a variety of medications commonly
prescribed to help control the symptoms of tic disorder, and an
experienced professional should closely monitor any course. Your
child’s doctor may prescribe neuroleptic medications, which appear
to help control tics by blocking the brain’s dopamine
• A habit disorder.
• Begins in first 5yrs
• Associated with day
• May lead to
problems with dental
• Help child find ways to reduce
anxiety : Parent reads relaxing
stories at bedtime Emotional
• Persistent bruxism leads to
muscular or temperomandibular
• Dental referral necessary.
• Passage of faeces at
inappropriate places after 4 yrs
• Usually associated with
constipation and overflow.
–Primary: persisting from infancy
– Secondary: appears after
successful toilet training
• Can be
A)Retentive(with constipation and
constipation and overflow
• – Ridicule by schoolmates / teachers
• – Punitive measures / scolding from parents /
Offensive odour leads to:
Poor school attendance and performance
Clearance of impacted faeces using enemas.
Short term use of mineral oil/ laxatives to prevent
Behavior therapy : Regular post prandial toilet habits
High fiber diet / improve water intake.
Individual or group psychotherapy sessions.
Family support : encourage child, rewards for
compliance, avoid power struggles.
• Get to know your child
• Develop rules
• Watch out for triggers
• Be positive
• Be firm with your child in
• Pay proper attention.
Keep Your Eyes Open
• Open your eyes and observe if a child
seems sad, withdrawn, distant, more
moody than usual, or angry.
• Recognize if there seems to be
greater confrontation between this
child and siblings, if friends stop
calling or coming over, or if the child
can’t seem to find his place in school.
Develop a Working Relationship With Teachers
• Reach out to your child’s
teachers before your
child reaches ‘zero hour.’
• If you think that there
may be an issue, it is a
good idea to set up a
meeting with the teacher
and ask how you can
work in harmony.
Work on social skills
• Help your child be successful
academically and socially.
• A child who is happy in
school is a child who can
focus on studying and doing
• One who believes that school
is all about academics and no
social life unfortunately
makes a big mistake.
• Set rules.
• Set routines for meals and
• Develop your child’s ability to
• Help your child learn how to
disappointment and anger without
• Establish basic rules of conduct: no
hitting, kicking, biting, spitting, (no
hands allowed), and no hurting
others through our words.
Help children become
When children feel as if they are
gaining skills and becoming self-
sufficient, they grow more
confident in their abilities. You
will watch their self-esteem take
off. Each year, every child should
be able to point with pride to a
newfound skill or added
responsibility that comes with
• Teaching our children to;
• Pick out their clothing
• dress themselves as they grow older
• Tie their own shoes
• Pack school snacks and make lunches
• set their own alarm clocks instead of
waking them up
• Allow a young child to complete
puzzles and feed himself on his
own and as he grows, to do his
homework and projects by
• Have your child help around the
house and gain responsibilities
instead of waiting to be served
• putting away laundry
helping to serve guests
keeping their room in order.
• Our children should never be
afraid to speak with us. No
matter how tough the topic.
• They should hesitate to
communicate with parents.
• After all, we are their parents and
if they cannot believe in our love
for them, whose love can they
• Work on communicating with your child
• Put the time and energy in so that he knows that he
matters in your life.
• Talk to your child every day-even if it’s just for a few
• Put down your iPhone
• Turn off your laptop when your child (or you) return
home, at mealtimes and story times, and when you
pick your child up from school.
• Look at him and make eye contact while having a
• Speak to your child in the tone and with the words
that you wish he would use with others.
• Express your love every day, no
matter how tough the day.
• Always encourage your child.
• Give positive reinforcement.