BEHAVIORAL

&
LEARNING
PROBLEMS IN THE
DISABLED

Dr Venkata Ramaiah Valluri

MPT-Ortho,MSc-Psychology,{MBA(HA)}
INTRODUCTION
Defination:
Behavior is defined as the manner or treatment shown to
others.
Classification:
Behaviour may be
overt; like speaking, or
covert like winking;
Behaviour may be:
verbal (communicating by words, like talking over the
telephone) or
non-verbal (gestures and body movements like miming).
BEHAVIORAL MEDICINE

This is a subspecialty in mental health that deals with

the interaction of psychological factors with those of

medical intervention.
There are two types of behaviour.
Respondent Behavior

Operant Behavior
Respondent Behavior
This is behavior which is reflex in nature and

controlled by involuntary smooth muscles and glands.

It is involuntary and instinctive, e.g. when a person is

chased by a dog, his pulse starts racing, adrenaline gets

pumped into his system, he gets goose pimples;
These are typical features of a fright and flight

response to a perceived threatening situation.

There is no time to think, judge and react.
Operant Behavior
Operant behavior is voluntary behavior based on
earlier stimulation.
Hospitality shown to a guest, anger and irritation
directed at someone who has hurt you, these are
operant responses to a pre-existing stimulus.
 The strength of an operant response is subject to the
consequences.
If the consequence is positive, the frequency will
increase and vice versa.
If one has to do well in an exam, the positive
consequence of getting a medal will make one study
more and more to come out with flying colors
On the other hand, the fear of being fined by a cop would

bring down the incidence of traffic violations; careful

driving would thus be operant response to this ‘negative
consequence”.
Behavioral repertoire is a complex function of biological

predisposition, learning and environmental stimuli. The

disabled person faces a lot of aversive consequences due to
his disability- the pain in rheumatoid arthritis, the exertion
to do even simple ADL’s like toileting in paraplegics, can
lead to negative changes in behavior.
Behavior problems
It may result from:
organic causes and
inorganic causes.
Organic causes means that the problem may be linked to
pathology in the brain.
Examples of this are dementia, head injury, cerebral palsy,
epilepsy and stroke.
In organic cause:
But disabled people can undergo behavioral changes
without any organic neurological lesion; e.g. amputees,
paraplegics
Psychosis
PSYCHIATRIC PROBLEMS IN THE DISABLED

This is a group of major mental illnesses.

1.Organic Psychosis:
This is a type of psychosis characterized by or associated
with impaired brain tissue function.
The patient exhibits clinical disturbances of
consciousness, memory, intelligence and orientation.
2.Functional Psychosis:
This is a group of mental illnesses where the symptoms of
psychosis are present even though there is no
demonstrable disturbance of brain tissue.
Neurosis
In this group the patient’s symptoms do not interfere with
his capacity for insight and judgment; he is well-oriented to
his surroundings and his mental dysfunction is
comparatively milder than psychosis.
In this group patients suffers problems of a “minor”nature.
1.Anxiety Neurosis:
Anxiety reaction is a state of chronic apprehension with
recurrent symptoms of acute episodes of anxiety.
Many people get anxious before an exam or an interview
but when the client becomes hyperactive, his pulse is fast,
his blood pressure shoots up, his sleep gets affected, and he
cannot concentrate on the job at hand, then he or she could
be suffering from anxiety neurosis.
2.Phobic Neurosis:
Unexplained and irrational morbid fears about animate or
inanimate objects are known as phobias.
Some people are scared of closed spaces (claustrophobia);
while others cannot stand the sight of spiders (arachnophobia)
or are terrified of heights (vertigo).
3.Obsessive-compulsive Neurosis:
3a.Obsessions : These are persistent recurrences of unwelcome
ideas.
The ideas usually revolve around sex, dirt, or religion.
Some people are obsessed about starting for work at auspicious
timings.
Others are obsessed about cleanliness and would not mind
taking bath even a dozen times a day.
They often are miserable and guilty about these obsessions and
try to remove them from their mind without much success
3b.Compulsions :
These are irresistible urges to carry out meaningless and irrational

activities, if the patient does not carry out his impulse, he experiences
discomfort and tension.
We see people constantly checking if they have brought their keys,

purse or tickets with them, or inspecting if their room is locked—

these are compulsive disorders.
Hysteria:
conversion reaction:
When the tension of the unconscious or subconscious mind

manifests itself in to somatic symptoms the resulting illness is known

as conversion reaction.
Reactive depression:
This type of depression occurs usually in persons of anxious,

melancholic (depress) or obsessive personality.

The illness is preceded by a physical, physiological or

psychosocial stress situation like a death in the family, loss

of job or prestige, financial stress, marital and sexual
disharmony, etc.
The patient suffers from insomnia, and feels better in the

evening than in the morning.

He is more comfortable when in company than alone.
•Temper Tantrums:
This is one of the behavioral problems exhibited by some
children who will scream to get their way done when
frustrated.
This may be accompanied by breath holding spells.
Boys are more likely to show temper, aggressive behavior
and hyperactivity, while girls are more likely to be anxious,
fearful, shy and clinging.
Delusion:
It is a false or mistaken belief, which has for the patient the
force of conviction and is firmly held despite all evidence to
the contrary, e.g. delusion of grandeur—a mere commoner
believing that he is a king.
Hallucination:
A hallucination is a perception through one of the
senses, which does not correspond to any stimulus in the
outside world.
People have visual hallucinations of forms appearing in
front of them, auditory hallucinations of voices speaking to
them, and occasionally they complain of a feeling as if
someone is touching them or strangulating them (tactile
hallucination).
Illusion:
 An illusion is a perception, which although produced by
an external stimulus, is misinterpreted by the patient in
purely subjective terms.
The classic example is that of a person seeing a rope and
mistaking it for a snake.
 Behavioral Problems in the Disabled
Dementia:
These are pathological conditions where behavior gets
altered due to:
atrophy,
age related changes or
ischemia in the brain.
Public figures may keep poking their ears or gesticulating to
no one in particular on the platform of a political meeting.
Shameless and inappropriate behavior, such as crude sexual
advances to casual acquaintances or masturbation or micturition
in public, may be the first sign of something very seriously wrong
in a hitherto normal elderly and respected person.
Head Injury and Stroke:
Some brain injured patients display disinhibited,
aggressive, self-abusive or otherwise inappropriate
behavior.
They may also become depressed or withdrawn.
In hemiplegia they may not be aware of the affected
side, anosognosia(lack of ability to perceive the
realities of one's own condition), and may exhibit
inappropriate emotions and as emotional liability.
The primary objective is the modification of
inappropriate behaviors and the teaching of more
effective means of communication and social
interaction.
Assessment
Treat the patient with respect. Listen to him, and

chart out a program and specify goals with his

participation.
 The psychologist would have to monitor patient’s

improvement in the program and reinforce staff and

family behavior.
This is very important because the staff and family are

in constant contact with the patient and need to be

highly motivated to handle him.
 Psychological Evaluation:
It is essential to look at the mental framework of the patient to
predict his prognosis.
The better the persons coping skills are prior to the mishap the
better the outcome.
This is where the history taking skills of the examiner comes into
play.
He would have to delve into the past of the patient, the
educational background, his nature, whether gregarious or
withdrawn, details of the members of his family, his friends and
their comprehension of the situation.
This would have to be matched with the patient current behavior
samples by keen and continuous observation.
The reason for such elaborateness is because of the fact that
future behavior is based on past behavior.
 Tests for behavior assessment:
Portland adaptability inventory:
it is an instrument that measures degree of impairment in the
areas of temperament, emotion, activities, social behavior
and physical capabilities.
Halstead-Reitan Neuropsychological Battery:
It is a fixed battery approach in that a specific set of tests is
given to all patients.
Here sets of seven standardized tests are administered which
include:
 Wechsler Intelligence scale,
 trial making test,
 sensory perceptual examination, and
 Reitan-Indiana Aphasia screening examination.
 Behavior Disorders in Children
Behavior disorders are the result of complex interactions

between the child and his environment.

“If a child’s behavior has a negative effect on its own

adjustment or if it interferes with the lives of other

people, then it is said that the child is behaviour
disordered.”
It is generally estimated that 6 to 10 % of school age

children have noticeable behavior problems.

The incidence is greater in boys than girls.
 Delay in social cognitive development:
Characteristics of Children with Behavior Disorders

• They do not learn from their own past experiences or

the experiences of other children.

They are not sensitive to the fact that their behavior

affects others in a negative way.

• They are isolated from their peers.

• They lack a sense of right and wrong.

Low academic achievement:
Most of these children are poor in academics, do not
like school, and are poor in time bound tasks like
finishing home work or assignments.
They have a poor self image which interferes with
learning and they resist change.
 AUTISM
Autism means a developmental disability significantly
affecting verbal and nonverbal communication and
social interaction, generally evident before age three
that adversely affects a child’s educational
performance.
Autistic children generally engage in repetitive
activities and stereotyped movements.
There is lack of eye contact, resistance to change of
daily routine and abnormal responses to sensory
experiences.
It is generally accepted that autism is not a single
entity but a series of behaviors.
 THE MANAGEMENT OF BEHAVIOR DISORDERS
Drug Therapy:
Drugs have to be prescribed by a psychiatrist. Combinations
of the following may be used:
• Antipsychotic drugs
• Antianxiety drugs
• Antidepressant drugs.
Group Therapy:
When the patient is in a group he gets to interact with others
like him.
This visual feedback gives him information of what others are
going through.
He sees that there are others worse off than him, and decides
that life is worth living after all.
Family Therapy:
Sometimes the family members in all good intention end
up by doing more harm.
They discourage rehabilitation -appropriate behavior by
doing all functions for the patient, or by giving them
unwanted sympathy.
Giving a concrete job to the patient and family member
can prevent day dreaming and negative attitudes.
Behavior Therapy
Whenever called up on to correct a deviant behavior,
psychologists use behavior therapy which lays emphasis
on current individual behavior rather than the historical
origins of its problems.
First, the behavior to increase or decrease is identified.
It is also noted how often this behavior occurs and
reinforcers are identified.
Reinforcers are nothing but stimuli that increase or
decrease the frequency of a behavior.
Positive reinforcers (carrot) increase the frequency while
negative reinforcers (stick) decrease its frequency.
For example a child not co-operating to therapy can be
offered a sweet, or the therapy can be converted into a
game. An adult can be given the option of listening to
music while doing therapy. It is not enough to reduce
unwanted behavior it is equally important to provide
alternate behavior.
For complicated tasks which do not find approval or
cooperation with the patient, the tasks are broken
down into smaller steps and the patient is instructed
on what he can do.
Encouragement increases performance Leisure and
prevocational activities have to be given.
We must remember that the patient has a lot of time
on his hands.
An idle mind is the devils workshop.
Hence he must have something to occupy his mind
throughout his tenure.
Behavioral modification techniques are classified as:

Techniques for reducing anxiety including relaxation

training Graded exposure treatment involves exposing
the subject to the feared stimulus one step at a time.
Aversion therapy aims to reduce maladaptive behavior
by associating it with an unpleasant experience, such
as pain or a noxious smell.