paediatric posting common behavior disorder

1. COMMON BEHAVIORAL
DISORDER IN CHILDREN

2. • A young person is said to have a behaviour disorder when he or she
demonstrates behavior 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.
.

3. Categories of Behaviour Disorders:-
• Habit Disorders
(Tension releasing disorders)
– Head banging
– Finger (thumb) sucking
– Nail biting
– Tics
– Teeth grinding (Bruxism)
• Emotional Disorders
– Breath holding spasms
– Temper tantrums
– School phobia
• Eating Disorders
– Pica

4. HABIT DISORDER

5. 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
– Can result in callus formation, abrasions, contusions
1. Head Banging
Treatment:
• Assurance – significant injury unlikely
• Teach parents to ignore as concern and punishment can reinforce it.
• Padding

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

7. • Adverse Effects
– Paronychia and digital
abnormalities

8. • 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.
Management
• Most give up
by 2 yrs
• If continued
beyond 4 yrs –
number of
squelae
• If resumed at
7 – 8 yrs : sign
of Stress

9. 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
Treatment Options:

10. • Finger guards / Thumb guards , etc.:

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

12. Simple Tics:
• Grimacing
• Yawning
• Grunting
• Sighing
• Blinking
• Wrinkling
• Scratching nose
• Head jerking
• Throat clearing
Tics : Common types
• 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
Complex Tics:

13. 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.
Formulations in the Management
contd..
• haloperidol,
• pimozide,
• clonidine,
• nifedipine are use in low doses.
• risperidone,
• olazapine
• mecamylamine,
• tetrabenazine,
• Benzodiazepines
• baclofen,
• botulinum toxin

14. EMOTIONAL DISORDER

15. 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.
• Precipitating factor:
• Hunger
• Fatigue
• Lack of sleep
• Innate personality of
child
• Ineffective parental skills
• Over pampering
• Dysfunctional family /
Family violence
• School aversion

16. 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
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.

17. 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 hours/day
>3 days/ week
>3 weeks
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

18. Management
During Episode
• Hold the child erect or prone
• Avoid drugs
• No much role to antispasmodics, carminatives, simethicone, sup
positories 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

19. Breath Holding Spasms
1. Simple breath-holding spell
2. Cyanotic breath-holding spells
3. Pallid breath-holding spells
4. Complicated breath-holding spells
Precipitating Factors:
• Frustration
• Injury
• Anger
• Anemia

20. Management – General:
• No treatment is usually needed
• Iron supplements to children with iron deficiency
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

21. 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)
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
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.

22. EATING DISORDER

23. Pica
Repeated or chronic
ingestion of
• non-nutritive
substances.
– Examples:
• mud, paint, clay, plaster,
char
• coal, soil.
• Normal in infants and
toddlers.
• Passing phase.

24. • 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
Screening indicated for:
• Iron deficiency anemia
• Worm infestations
• Lead poisoning
• Family dysfunction
• Treat cause accordingly.
• Usually remits in childhood but
can continue into adolescence

25. SPEECH DISORDER

26. 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
• 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
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

27. BEHAVIORAL DISORDER

28. 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.

29. 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
• Aggressive 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.

30. Attention Deficit hyperactivity disorder
(ADHD)
1. Inattention – difficulty concentrating, forgetting
instructions, moving from one task to another without
completing anything.
2. Impulsivity – talking over the top of others, having a
„short fuse‟, being accident-prone.
3. 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.