Behavioural Disorders in Children

Behavioural Disorders in Children

• A behaviour disorder is when a child's behaviour is noticeably different from what is expected in the school or community.
• Classification of individuals with emotional or behavioural disorders is affected by heredity, environment, learning conditioning, and positive reinforcements.

Categories of Behaviour Disorders

• Habit disorders (tension-releasing disorders):
  • Finger (thumb) sucking
  • Nail biting
  • Tics
  • Teeth grinding (Bruxism)
• Emotional disorders:
  • Breath holding spasms
  • Temper tantrums
• Eating disorders:
  • Pica

Head Banging

• Rhythmic hitting of the head against a solid surface, often the crib mattress
• Occurs in 5-20% of children during infancy and toddler years
• Benign and self-limiting
• Can result in callus formation, abrasions, and contusions
• Treatment: assurance, ignoring the behaviour, and padding

Finger Sucking and Nail Biting

• Sensory support for the child to cope with stressful situations
• Reinforced by attention from parents
• Predisposing factors: developmental delay, neglect
• Adverse effects: malocclusion, mastication difficulty, speech difficulty, and lisping
• Management: reassurance, improving parental attention, ignoring the behaviour, and teaching substitute behaviours

Temper Tantrums

• Occurs in 18-month to 3-year-olds due to the development of sense of autonomy
• Child displays defiance, negativism, and oppositionalism
• Normal part of child development, gets reinforced when parents respond with punitive anger
• Precipitating factors: hunger, fatigue, lack of sleep, innate personality, ineffective parental skills, over pampering, and dysfunctional family
• Management: setting a good example, paying attention to the child, spending quality time, having open communication, and consistency in behaviour

Evening Colic

• Intermittent episodes of abdominal pain and severe crying in normal infants
• Begins at 1-2 weeks of age and persists until 3-4 months
• Definition: infant cries for more than 3 hours per day, more than 3 days a week, for more than 3 weeks
• Attack: begins suddenly, lasts for several hours, and terminates after exhaustion or passage of flatus or feces
• Management: holding the child erect or prone, avoiding drugs, and counselling parents to cope with the situation

Eating Disorder: Pica

• Repeated or chronic ingestion of non-nutritive substances
• Examples: mud, paint, clay, plaster, charcoal, soil, and fecal matter
• Normal in infants and toddlers, but needs investigation after 2 years of age
• Predisposing factors: parental neglect, poor supervision, mental retardation, lack of affection, and family disorganization
• Screening indicated for: iron deficiency anemia, worm infestations, lead poisoning, and family dysfunction

Breath Holding Spasms

• Types: simple, cyanotic, pallid, and complicated breath-holding spells
• Precipitating factors: frustration, injury, anger, and anemia
• Management: no treatment is usually needed, iron supplements for children with iron deficiency, and general measures to calm the child during a spell

Emotional Disorders

• School Phobia: approximately 1 to 5% of school-aged children, most common in 5- and 6-year-olds and 10- and 11-year-olds
• School refusal differs from truancy, and is caused by fear or anxiety about school

Tics

• Definition: sudden, repetitive, non-rhythmic motor movement or vocalization involving discrete muscle groups
• Types: motor tics (12-20% of children, peak age 5-7 years) and phonetic tics (more common in boys)
• Common types:
  • Simple tics: grimacing, yawning, grunting, sighing, blinking, and wrinkling
  • Complex tics: jumping, spinning, touching objects or people, echopraxia, copropraxia, palilalia, and echolalia
• Tic disorders: transient, chronic, and Tourette's syndrome (Gilles de la Tourette syndrome)
• Management: various strategies to manage tics, including medication and therapy