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Behavioral and
Developmental Problem
Dr. Abdulwahab TelmesaniDr. Abeer A Bargawi ( R1 )
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Temper Tantrums
Cry Shout Scream Roll on the floor Hit and kick Stomp their feet Throw things. Rage-like behavior and potentially
harmful
Temper TantrumsCauses
Frustration Tiredness Hunger Seek attention Obtain something Avoid doing something
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.
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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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.
Time-Out Technique
Disciplinary technique.
Awareness of the child. - Actions are incorrect or unacceptable. - Withholding of attention as a
punishment - Around 2 years.
Time-Out Technique
1. Verbal statement and reminders.
2. Explained to the child.
3. Time 1 minute ( maximum 5 min).
4. Time-out is restarted.
5. Talking and eye contact are avoided.
Time-Out Technique
6. Asks about reason.
7. Recall and remind.
8. Identify good behavior and praise the child for it.
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Head Banging
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Banging.flv
Head banging and rhythmic rocking
They are common among healthy toddlers.
Outgrow ( 18 months and 2 years ).
sometime it continue ( older children and adolescents).
Head banging and rhythmic rocking
Children with autism and other developmental problems.
Additional symptoms.
Safety environment.
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)
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.
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 .
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)
Breath-Holding SpellsTypes
The pallid form: - Vasovagal effect.
It is rare, further diagnostic evaluation and treatment may be needed if spells occur often
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Breath-Holding Spells Reassure the parent. No investigation or treatment is
necessary. No epilepsy or brain damage. When to investigate ? CBC ECG EEG
Breath-Holding Spells
1. 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).
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.
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,,,,,
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.
School Avoidanceresult
Poor academic performance.
Family difficulties.
Difficulties with peers.
School Avoidance
1. Return to school immediately.
2. Regular attendance at school: open communication among the child, parents, and school personnel; and sometime psychologic therapy .
3. Referral to a mental health practitioner.
School Avoidance
Most children recover from school avoidance ,although some develop it again after a real illness or vacation.
Stress Related Behavior
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.
Thumb Sucking
Encourage the child to understand why it would be good to stop.
Willing to stop , gentle verbal reminders are a good start.
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
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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