Behavioral and

Developmental Problem

Dr. Abdulwahab TelmesaniDr. Abeer A Bargawi ( R1 )

..\My Documents\My Videos\RealPlayer Downloads\Full. Fledged. Temper. Tantrum..

flv

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.

..\My Documents\My Videos\RealPlayer Downloads\Why waste a temper tantrum if nobody is around to see

it.flv

..\My Documents\My Videos\RealPlayer Downloads\Funniest temper tantrum ever!.

flv

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.

..\My Documents\My Videos\RealPlayer Downloads\

Supernanny - The Minyon Family 5 11.flv

Head Banging

..\My Documents\My Videos\RealPlayer Downloads\Baby Head-

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

..\My Documents\My Videos\RealPlayer Downloads\Breath Holding

Spell.flv

..\My Documents\My Videos\RealPlayer Downloads\breath holding spell2.flv

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.

THANK YOU