Overview of Behavioral Problems in Child and Adolescent
Arifah Nur IstiqomahDepartemen/SMF Ilmu Kedokteran JiwaFK Unpad/RSHS
Behavioural Problems
Normal behavio
ur
Behavioural
symptoms
Behavioural disorder
Normal Behaviour
Emile Durkham (Rules of Sociological Method )
Child and adolescent behaviour considered as normal as far as behavior does not lead to unrest in society, occurs within certain limits and unintentional
Behavioral Disorder
Behavioural symptoms of varying levels of severity are very common in the population.
Only children and adolescents with a moderate to severe degree of psychological, social, educational or occupational impairment in multiple settings should be diagnosed as having behavioural disordersWHO Mgap,
2010
Behavioral Disorder
Behavioural disorders is an umbrella term that includes more specific disorders: Attention deficit hyperactivity disorder* Disruptive behavioral disorder:
Conduct Disorder Oppositional Behavioral ProblemsWHO Mgap, 2010
Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder
Impaired attention Breaking off from tasks and leaving
activities unfinished; shifts frequently from one activity to another
Diagnosed as a disorder only if they are excessive for the child or adolescent’s age and intelligence, and affect their normal functioning and learningWHO mhGAP, 2010
Attention Deficit Hyperactivity Disorder
Overactivity Excessive restlessness, especially in
situations requiring relative calm Running, jumping around Getting up from a seat when he or
she was supposed to remain seated Excessive talkativeness and
noisiness Fidgeting and wrigglingWHO mhGAP, 2010
DisruptiveBehavioral Disorders
Disruptive Behavioral Disorders
These disorders are compelling to understand and treat because: Common in community High rates of morbidity High rates of associated psychiatric
illness and psychopathology Very costly for society
Connor MD, 2009
Oppositional Deviant Disorder A recurrent pattern of negativistic, defiant,
disobedient, and hostile behavior toward authority figures
Clearly more frequent, more intense, and more persistent across the child's development than is typically observed in individuals of similar age and developmental level.
The symptoms cause impairment in the child's social, academic, or occupational functioningConnor MD, 2009
Conduct Disorder
Repetitive and persistent pattern of dissocial, aggressive or defiant conduct
Such behaviour, when at its most extreme for the individual, should be much more severe than ordinary childish mischief or adolescent rebelliousnessConnor MD, 2009
Interactional Developmental Model
Corwin M, 2005
Course of Ilness
Course of Illness
Symptoms of ADHD persist into adolescence or adult life in approximately 50% of cases.
In the remaining 50 %, they may remit at puberty, or in early adulthood.
In some cases, the hyperactivity may disappear, but the decreased attention span and impulse-control problems persistConnor MD, 2009
Course of Ilness
Many youth who exhibit negativistic or oppositional behaviors will find other forms of expression as they mature and will no longer demonstrate these behaviors in adulthood
Connor MD, 2009
Course of Ilness
Children who develop enduring patterns of aggressive behaviors that begin in early childhood and violate the basic rights of peers and family members, may be destined to an entrenched pattern of conduct disordered behaviors over time
Sadock & Sadock, 2007
Intervention for Behavioral Problems
Intervention
Biological intervention: psychopharmacology
Psychosocial intervention
Psychopharmacology
Do not use medication in primary care for behavioral problems
without consulting a specialist
WHO mhGAP, 2010
Psychopharmacology
ADHD Stimulant medication
Methylphenidate Non stimulant medication
Atomoxetine HCL, venlavaxine, clonidine
Sadock & Sadock, 2007
Psychopharmacology
Disruptive Behavioral Problems: Focus on impulsivity, affective lability,
negative emotions (fear,irritability), explosive aggression
Psychopharmacological interventions are generally palliative and not curative: typical and atypical antipsychotics, mood stabilizers for explosive agressionConnor MD, 2009
Family Psychoeducation
Consistent about what the child is allowed and notallowed to do
Praise or reward the child after observe good behaviour and respond only to most important problem behaviours;
Avoid severe confrontations or foreseeable difficultsituations.
Give clear, simple and short commands that Emphasize what the child should do rather than not do.
WHO mhGAP, 2010
Family Psychoeducation
Never physically or emotionally abuse the child. Make punishment mild and infrequent compared to praise.
As a replacement for punishment, use short and clear-cut “time out” after the child shows problem behaviour. (temporary separation from a rewarding environment, as part of a planned and recorded programme to modify behaviour).
Put off discussions with the child until parent become calm.WHO mhGAP, 2010
Teacher’s Role
Make a plan on how to address the child’s special educational needs
WHO mhGAP, 2010
Support for carers
Identify psychosocial impact on carers. Assess the carer’s needs and promote
necessary support and resources for their family life, employment, social activities and health arrange for respite care, which means a break now and then when other trustable caregivers take over temporarily.WHO mhGAP, 2010