Behavioral and Developmental Problem

1. Behavioral and Developmental Problem Dr. Abdulwahab Telmesani Dr. Abeer A Bargawi ( R1 )

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3. Temper Tantrums

4. Temper Tantrums • Cry • Shout • Scream • Roll on the floor • Hit and kick • Stomp their feet • Throw things. • Rage-like behavior and potentially harmful

5. Temper TantrumsCauses • Frustration • Tiredness • Hunger • Seek attention • Obtain something • Avoid doing something

6. Temper Tantrums • Parent often place the blame on themselves. • A combination of the child’s -Personality - Immediate circumstances -Development of normal behavior. • Mental ,physical, or social problems (rare) - T.T lasts >15 min or multiple time/day.

7. Temper Tantrums • It is common in childhood. • Appear toward the end of the first year • Peak between ( age 2 -4 years ) • Infrequent after age of 5 years. • If tantrums are frequent after age of 5, they may persist throughout childhood.

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10. Temper Tantrums • Distract or redirect the child by providing an alternative activity on which to focus. • Removed the child physically from the situation. • Time-out Technique.

12. Time-Out Technique • Disciplinary technique. • Awareness of the child. - Actions are incorrect or unacceptable. - Withholding of attention as a punishment - Around 2 years.

13. Time-Out Technique • Verbal statement and reminders. • Explained to the child. • Time 1 minute ( maximum 5 min). • Time-out is restarted. • Talking and eye contact are avoided.

14. Time-Out Technique • Asks about reason. 7. Recall and remind. 8. Identify good behavior and praise the child for it.

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16. Head Banging

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18. Head banging and rhythmic rocking • They are common among healthy toddlers. • Outgrow ( 18 months and 2 years ). • sometime it continue ( older children and adolescents).

19. Head banging and rhythmic rocking • Children with autism and other developmental problems. • Additional symptoms. • Safety environment.

20. Breath-Holding Spells

21. Breath-Holding Spells • It is an episode in which the child stops breathing (apnea) and loses consciousness for a short period immediately after a frightening or emotionally upsetting event or a painful experience. • Typical symptoms: - Paleness , Cyanosis - stoppage of breathing (1 minute) - Loss of consciousness - Short seizures like movement (one or two jerks)

22. Breath-Holding Spells • It occur in 5% of otherwise healthy children. • Begin in the 1st year of life and peak at age 2. • Disappear by age 4 in 50% of children and by age 8 in about 83% of children. • Positive family Hx in 25% of cases.

23. Breath-Holding SpellsTypes • The cyanotic form: - Initiated subconsciously. • Typically ( The child cries out, breathes out, and then stops breathing. shortly afterward ,the skin begins to turn blue and the child becomes unconscious .a brief seizure may occur .

24. Breath-Holding SpellsTypes • The pallid form: It follows a painful experience, such as falling and banging the head or being suddenly startled. • Typically (The child stops breathing, rapidly loses consciousness and become pale and limp. A seizure and incontinence may occur)

25. Breath-Holding SpellsTypes • Thepallid form: - Vasovagal effect. • It is rare, further diagnostic evaluation and treatment may be needed if spells occur often

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29. Breath-Holding Spells • Reassure the parent. • No investigation or treatment is necessary. • No epilepsy or brain damage. • When to investigate ? • CBC • ECG • EEG

30. Breath-Holding Spells • Avoid the initiating behavior.( best way). 2. Safety environment. 3. Calm the child and avoid giving too much attention ( reinforce the behaviors). 4. Provide appropriate structure for children. 5. Interrupt the episode (cold cloth).

32. School Avoidance • Avoiding school occurs in about 5% of all school-aged children. • Occurs between age 5-6 and 10-11. • Affect girls and boys equally.

33. School Avoidancecauses • Psychologic factors ( anxiety and depression). • Social factors ( having no friend , feeling rejected by peer, or being bullied). • Sensitive children may be overreacting with fear to a teacher’s strictness . • Fake illness or make other excuses to avoid school( stomachache , nausea,,,,,

34. School Avoidancecauses • Some children directly refuse to go to school. • Alternatively, children may go to school without difficulty but become anxious or develop various symptoms during the school day, often going regularly to the nurse’s office.

35. School Avoidanceresult • Poor academic performance. • Family difficulties. • Difficulties with peers.

37. School Avoidance • Return to school immediately. • Regular attendance at school: open communication among the child, parents, and school personnel; and sometime psychologic therapy . • Referral to a mental health practitioner.

38. School Avoidance • Most children recover from school avoidance ,although some develop it again after a real illness or vacation.

39. Stress Related Behavior

40. Thumb Sucking

41. Thumb Sucking • It is a normal part of early childhood. • Most children stop by 1-2 years old , but some continue into their school-age years. • Habitual sucking past the age of about 5years. • Persistent thumb sucking can be sign of an underlying emotional disorder.

42. Thumb Sucking • Encourage the child to understand why it would be good to stop. • Willing to stop , gentle verbal reminders are a good start.

43. Thumb Sucking • Symbolic rewards put directly on the thumb: -colored bandage -fingernail polish -star drawn with a nontoxic colored marker. -painting the thumbnail with a bitter substance -plastic guard over the

44. Nail Biting

45. Nail Biting • Common problem among young children. • Disappears as the child gets older but is typically related to stress and anxiety. • A reward system for avoiding the behavior reinforces desirable behavior.

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