Behavioural difficulties in children ~a birds eye view Dr. George Reddy MBBS.,DPM Healthy Brain Trimulgherry,Secunderabad Mobile:

Problem child???????

Growth & Development Genetic Endowment (Nature) Environment (Nurture)

Developmental Delay Genetic endowment deficit Non conducive environment Poor interaction Delayed deficient learning Lower adaptive behavior Secondary deprivation Social & emotional handicaps

Professionals who can play a VITAL ROLE in identification of developmental delay ??  Pre conception Obstetricians  Pre natal Pediatrician  Intranatal GP/ Neurologist  Postnatal Disability field per.  Infant Health assistants  Toddler Anganwadi worker School teacher

Causes of developmental delay PRENATAL  Malnutrition  Infection  Metabolic disorders  Endocrinal disorders  Chromosomal abnormalities  Exposure to radiation  Self medication  Trauma  Consanguinity  Developmental defects

Prevention at Prenatal stage  Genetic counseling(CCMB,CDFD)  Imaging techniques  Amniotic fluid studies  At Risk pregnancy (consanguinity, past history of disabled child, Birth order, etc)  Age of parents

 Premature rupture of membranes  Prolonged, obstructed labor  Birth asphyxia  Low birth weight  Sepsis during delivery  Cord round neck  Meconium stained amniotic Fluid Causes of developmental delay NATAL

Prevention at Natal stage  Hospital delivery  By trained persons only  Well equipped hospitals  Round the clock medical facility  Say no to forceps or by trained person only

 Respiratory distress  Seizures  Infections  Head injury  Jaundice  Hypoglycemia  Toxins  Inborn errors of metabolism Causes of developmental delay POST NATAL

Prevention at post natal stage  New born screening to be made mandatory(preferably by pediatrician)  Screen for metabolic errors (PKU, hypoglycemia, hypothyroidism)  Delayed mile stones  Identify seizures and treat appropriately

PSYCHOSOCIAL  Poor resources  Mental health problems in mother  Illiteracy  Family stressors  Low socio economic status Causes of developmental delay

 Oppositional defiant disorder(OD)  Conduct disorder  Attention Deficit hyperactivity disorder  Others include : Emotional problems, mood disorders, family difficulties, substance abuse. Common Behavioural difficulties include:

 One in ten children have ODD  Boys have more than girls  Child gets angry/frustrated easily  Frequent temper tantrums  Argues often with adults especially parents  Refusal to obey rules  Low self esteem  Blames others for misdeeds/misfortunes Oppositional Defiant Disorder

DSM-IV-TR- Diagnostic criteria for Oppositional Defiant Disorder  A pattern of negativistic,hostile and defiant behavior lasting at least 6 months during which four or more of the following are present : 1.often loses temper 2. often argues with adults 3. often actively defies or refuses to comply with adults’ requests or rules 4. often deliberately annoys people 5. often blames others for his or her mistakes or misbehavior 6. is often touchy or easily annoyed by others 7. is often angry and resentful 8. is often spiteful or vindictive

 Refusal to obey parents  Repeated aggressive behavior  Use of drugs,cigarettes,alcohol  Aggressive behavior  Fond of starting fights  Using weapons in fights  Frequent lying  Acts of stealing,lighting fires, vandalism Conduct Disorder

DSM-IV-TR : Diagnostic criteria for Conduct Disorder  Aggression to people and animals  Destructive of property  Deceitfulness or theft  Serious violations of rules

 2% to 5% children have ADHD  Boys outnumber girls  Inattention : difficulty in concentrating  Impulsive behavior  Constant restlessness, over- activity Attention Deficit Hyperactivity Disorder ( ADHD )

DSM-IV-TR : Diagnostic criteria for Attention Deficit Hyperactive Disorder  Inattention  Hyperactivity  Impulsivity

 BIOLOGY : Biological and genetic causes for emotional or bahavioural disorders are being identified  Pre-natal drug abuse affects childhood behaviours  Mood disorders, depression and schizophrenia may have a genetic foundation  It helps in treatment if biological cause of disorder is known Causes of behavioural difficulties

 Teachers and schools have a great influence on children  Teachers can help in solving problems  What the teachers do during their interactions with students makes a big difference Causes : School

 Society and environment affect behavior  The neighborhood, immediate family etc. shape and influence behavior in both positive and negative ways Causes : Community and Home

 Behavioural difficulties are complicated  A child who has CD for example can also have ADHD, anxiety and depression  Methods of diagnosis include : - Assessment by a Psychiatrist, Pediatrician and Psychologist - Interviews with parents, teachers - Use of behavior checklists and questionnaires - Finding out if there is any acute stressor in the child’s life like a sick parent or child is a victim of bullying etc. - Diagnosis of Behavioural Difficulties

 Detailed history taking, observation of a child’s appearance and performance  General medical history  Developmental history  Family history  Social history  Education history  Physical examination  Neurological examination : Vision,hearing,Syndrome/chromosomal abnormalities, motor skills, neurological signs Treatment of Behavioural Difficulties: Assessment methods

 Early treatment is important so that child does not grow to be a dysfunctional adult  Medication should be administered carefully  Treatment also includes : - Parental education - Family therapy - Cognitive behavioural therapy - Anger management - Encouragement - Social training Treatment of behavioural difficulties..

 UNICEF defines Street children as “any girl or boy for whom the street in the widest sense of the word including unoccupied dwellings, wasteland etc has become his or her natural abode and/or source of livelihood and who is inadequately protected, supervised or directed by responsible adults”  They have little or no education  They may steal, gamble drink alcohol, smoke etc.  Most children come from slums  Most children lack access to medical care  Frequently exposed to abuse and extortion  No access to nutritious food or sanitation. Case of Street Children

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