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