CHAPTER 15
Common Behavioural and Psychiatric Disorders Among Children
Learning Objectives
Chapter Outline
DEFINITION
Behavioral disorders are defined as persistent and repetitive patterns of disruptive behaviors, in children that last for at least 6 months and violates societal norms or rules, seriously impair their functioning, or create distress at school, home, or in social situations.
PATTERNS OF BEHAVIORAL DISORDERS
Behavioral disorders among children can be broadly classified as:
Enuresis is defined as the involuntary, repeated voiding of urine into bed or clothes; in children aged 5 years or older, in whom normal bladder control is usually acquired.
Enuresis is broadly classified as:
Based on the timing of bed wetting
Fig.: Bed wetting
alarm
Types :
1.Non-retentive encopresis
2.Constipation-associated encopresis or overflow encopresis
Shyness is considered a problem if it leads to complete withdrawal.
Definition :
Nail biting or Onychophagia is a common oral-compulsive, self-injurious disorder of putting one or more fingers in the mouth and biting on nails with teeth without any preference for any of the fingernails.
This behavioral problem has been reported in children and adults.
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HABIT DISORDERS
Definition:
Thumb sucking is defined as a non-nutritive behavior that serves as an adaptive function by providing stimulation or self-soothing.
Within this group, the use of pacifiers, blankets, or sucking on other fingers as a comforting behavior can also be found.
Fig: Deformity of nails
Fig.: Periarticular tumor near the metacarpophalangeal joint of the thumb.
Fig.: Malocclusions such as anterior open bite of teeth happens if the habit persists during permanent teething.
Fig.: Intraoral cemented modified bluegrass appliances
PERSONALITY DISORDERS
Definition:
Temper tantrums are defined as disruptive, undesirable and unpleasant angry, emotional outbursts displayed in response to unmet needs or desires, or an inability to control emotions stemming from frustration or difficulty expressing the particular need or desire.
Stealing (taking something without permission what does not belong to oneself) and lying (purposefully telling an untruth) are socially inappropriate behavior usually found in children under seven years of age.
Table : Causes of stealing and lying
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Definition:
Juvenile delinquency refers to an adolescent who breaks the law or engages in any criminal behaviour which is considered as illegal, and socially unacceptable and the actions are proved to be dangerous to the society and for him or her.
Definition:
Definition
“A disorder in one or more of the basic psychological processes involved in understanding or using language, spoken or written, which disorder may manifest itself in imperfect ability to listen, think, speak, read, write, spell or do mathematical calculations. The term does not include children who have learning problems which are primarily result of visual, hearing and motor handicaps, or mental retardation or emotional disturbance or of emotional, cultural or economic disadvantage.”
—American Official of Education, 1997
Types of Learning Disabilities
Dyslexia also known as reading disabilities is characterized by a significant impairment in reading acquisition. It is estimated that 2-8% of primary school children suffer from reading disorders.
This is usually apparent in the 1 or 2 standards, when children are required to write.
Fig. : Dysgraphia (Writing disability)
Mathematical disability or dyscalculia is evident when the child starts mathematical calculations in 2nd or 3rd standard of the school.
Speaking disorder is an impairment to express the thought process verbally
Definition
Tics are defined as “sudden, rapid, recurrent, nonrhythmic motor movement (motor tics) or vocalization (vocal or phonic tics)”.
Tics are more common in boys than girls.
1.Simple
2.Complex
Definition:
Pica is an eating disorder typically defined as the persistent, compulsive urge to eat non-nutritive, inedible substances for a period of at least one month at an age in which the behavior is developed mentally inappropriate (18–24 month) and is not related to the individual’s sociocultural customs and traditions.
• Constipation
• Seizures
• Stomach, liver and kidney damage
Fig.: Large hair mass in Rapunzel syndrome reported by Khanna K, Tandon S, Yadav DK, et al. Rapunzel syndrome: a tail too long to tell! Case Reports 2018;2018:bcr-2018-224756.
Sleep disorders are common in preschoolers and among school-going children. Alteration in sleep pattern than recommended hours of sleeping along with any unusual behavioral manifestations are called as sleep disorders.
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SPEECH DISORDERS
Stammering/stuttering is a speech disorder in which the flow of speech is disturbed by the prolongation of sound due to delayed uttering and involuntary repetition of sounds.
Definition :
Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder with an ongoing developmentally inappropriate pattern of inattention and/or hyperactivity and impulsivity that interferes with functioning or development.
As per the Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV), ADHD are of the following types:
Inattentive symptoms
Hyperactive symptoms
COMMON PSYCHIATRIC DISORDERS AMONG CHILDREN
Definition:
Childhood-onset schizophrenia (COS), a very rare and severe chronic psychiatric condition is defined by an onset of positive symptoms (delusions, hallucinations and disorganized speech or behavior) before the age of 13 years.
The symptoms include hallucinations, delusions, disorganized thinking and speech patterns and abnormal motor behaviour, including bizarre movements or catatonia.
The symptoms include blunt or flat affect, lack of motivation, absence or diminished speech patterns, diminished interest in social interaction and anhedonia.
Childhood depressive disorder is a common mental disorder which involves a depressed mood or loss of pleasure or interest in activities for a prolonged period of time.
Clinical Manifestation
Definition :
Conversion disorder is defined as a condition in which a child presents with symptoms of deficits in sensory, motor function suggesting a neurological or other physical condition which cannot be explained by an identified medical condition.
Definition:
Posttraumatic stress disorder (PTSD) is a mental disorder that may develop in some children and adolescents after exposure to a traumatic event; and are characterised by symptom clusters such as avoidance, negative alterations in cognition and mood, intrusion, and hyperarousal with adverse outcomes in their physical and mental health and impaired social, and occupational functioning.
Definition:
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and the presence of restricted interests and repetitive behaviours.
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EATING DISORDER IN CHILDREN
Eating disorders among children are umbrella term that includes various patterns of eating deviations. The three most common eating disorders anorexia nervosa, bulimia nervosa, binge eating-related obesity are discussed here.
Types of Eating Disorders
Anorexia nervosa (AN), is defined as a disorder of inadequate and restricted energy intake due to distorted perception of one’s weight and shape, and fear of weight gain or becoming fat which results in low body weight.
Bulimia nervosa (BN) is defined as binge-eating episodes followed by compensatory purging mechanisms such as vomiting, or use of laxatives or diuretics.
Binge eating is defined as recurrent episodes of over eating within a distinct period of time (e.g., 2 hours apart), and eating an amount of food that is clearly larger than usual requirement by most individuals within the specific intervals.
Clinical Manifestation
Due to inadequate intake / malnutrition:
Clinical Manifestation
Purging-related signs:
Clinical Manifestation
Excess energy intake
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