Common Definition

Behavioural Disorders A young person is said to have a

in behaviour disorder
when he or she demonstrates behaviour that is
Children 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.
•C.S.N.Vittal
•C.S.N.Vittal

Dysfunctional Behaviours What can affect Behaviour in a child?

1. Habit Disorders • Heredity

2. Conduct Disorders • Environment

• Learning Conditioning
3. Emotional Disorders • Positive reinforcements

•C.S.N.Vittal •C.S.N.Vittal

1. Repetitive Behaviors
1. Habit Disorders
• Benign & self-limiting
• Begin between 6 – 10 yrs
1. Repetitive Behaviors – Eg. Body rocking, Head banging
2. Finger (thumb) sucking
3. Pica Head banging
4. Nail biting – In 5-20% of children during infancy & toddler years
– Can result in callus formation, abrasions, contusions
5. Teeth grinding (Bruxism)
• Tt.
6. Breath holding spasms
– Assurance
7. Temper tantrums – Teach parents to ignore – as concern and punishment
8. Tics can reinforce it.
– Padding

•C.S.N.Vittal •C.S.N.Vittal

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 2.Finger (Thumb) sucking & Nail Biting 2.Finger (Thumb) sucking & Nail Biting

• Sensory solace for child • Most give up by 2 yrs

(“internal stroking”) to • If continued beyond 4 yrs –
cope with stressful number of squelae
• If resumed at 7 – 8 yrs : sign of
situation in infants and
Stress
toddlers.
• Adverse Effects
• Reinforced by attention – Malocclusion – open bite
from parents. – Mastication difficulty
– Speech difficulty (D and T)
• Predisposing factors:
– Lisping

Developmental delay
– Paronychia and digital

Neglect abnormalities

•C.S.N.Vittal •C.S.N.Vittal

2.Finger (Thumb) sucking & Nail Biting

Management
3.Temper Tantrums

• In 18 months to 3 yr olds due to

• 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.
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.

•C.S.N.Vittal •C.S.N.Vittal

3.Temper Tantrums 3.Temper Tantrums –

Precipitationg factors Management

• In general, parents advised to:

• Hunger
Set a good example to child
• Fatigue
Pay attention to child
• Lack of sleep
Spend quality time
• Innate personality of child
Have open communication with child
• Ineffective parental skills
Have consistency in behavior
• Over pampering • During temper tantrum:
• Dysfunctional family / Family violence
Parents to ignore child and once child is calm, tell child
that such behavior is not acceptable
• School aversion
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.
•C.S.N.Vittal •C.S.N.Vittal

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 4.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
• Diagnosis :
“ Infant cries for > 3 hrs per day for > 3 day
per week for > 3 weeks”
•C.S.N.Vittal
4.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
•C.S.N.Vittal
5.Stranger Reaction / Anxiety
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
If infant on approach of stranger behaves with
more intense discomfort – such as
continuous crying, vomiting, refusal to
socialize : Stranger anxiety.
It might be an indication for later development of
behavioural problem as separation anxiety.
•C.S.N.Vittal
4.Evening Colic
Cause
• Not known
• More likely if the child is over active and
parents are over anxious
• Could be a manifestation of
• hunger,
• aerophagia,
• cow’s milk intolerance,
• immaturity of intestine,
• overfeeding,
• intake of food with high CHO content
•C.S.N.Vittal
4.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
•C.S.N.Vittal
5.Stranger Reaction / Anxiety
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
behaviour gradually declines
– But if persists, refer to child psychiatrist
•C.S.N.Vittal
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 6.Pica 6.Pica

Repeated or chronic ingestion of Geophagia Eating of mud, soil, clay, chalk, etc.
non-nutritive substances. Pagophagia Consumption of ice
– Examples: mud, paint, clay, plaster, Hyalophagia Consumption of glass
charcoal, soil.
• It’s an eating disorder. Amylophagia Consumption of starch

• Normal in infants and toddlers. Xylophagia Consumption of wood

• Passing phase. Trichophagia Consumption of hair

Urophagia Consumption of urine

Coprophagia Consumption of feces

•C.S.N.Vittal •C.S.N.Vittal

6.Pica 6.Pica
Pica after 2nd yr of life needs investigation • Screening indicated for:

Iron deficiency anemia
• Predisposing factors :
Worm infestations

Parental neglect
Lead poisoning

Poor supervision
Family dysfunction

Mental retardation

Lack of affection Psychological neglect,
• Treat cause accordingly.
orphans)

Family disorganization
• Usually remits in childhood but can

Lower socioeconomic class
continue into adolescence

Autism

•C.S.N.Vittal •C.S.N.Vittal

7.Breath Holding Spasms 7.Breath Holding Spasms

Management
• Behavioral problem in infants and
toddlers. • Referral to Child Guidance Clinic:
• Child cries and then holds breath
until limp. • Referral to Child Psychologist
• Cyanosis may occur. – If BHS accompanied with head
• Sometimes, loss of consciousness, banging or highly aggressive
or even seizure can occur. behavior
• It is child’s attempt to control
environment: parents /caregivers.
• Benign condition: no risk of epilepsy
developing in later life.
•C.S.N.Vittal •C.S.N.Vittal

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 8.Stuttering / Stammering 8.Stuttering / Stammering

• Defect speech • Usually begins between 2 – 5 yrs

• Stumbling and spasmodic • Reminding and ridiculing
repetition of some syllables with aggravate
pauses
• Child loses self confidence and
• Difficulty in pronouncing
consonants become more hesitant
• Caused by spasm of lingual and • They can often sing or recite
palatal muscles poems without stuttering
•C.S.N.Vittal •C.S.N.Vittal

8.Stuttering / Stammering
Management

• Parents should be reassured

• They should not show undue concern
and accept his speech without
pressurizing him to repeat
Thank Q
• Children should be given emotional
support • CSN Vittal
• Older children with secondary
stuttering should be referred to speech
therapist

•C.S.N.Vittal