Beh Prob in Sch Children

8/8/2019 Beh Prob in Sch Children

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Dr. V.Dr. V. JitheshJitheshAMCHSS - SCTIMST


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When he was very young he was slow indevelopment. He didn't speak until he was

two years old, and even when he was olderhe had trouble answering a question. Hewould first silently mouth the words tohimself and then slowly answer out loud. His

teachers said he was dumb and would neverbe successful at anything.


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His family moved to @@@@ where he attended a highschool called @@@. He was bored at the school. His

family next moved to @@@, but they wanted him to finishthe school year in @@@. He wanted to leave so badly thathe got a false paper from a doctor stating he had a lungcondition and must move to a dry climate. Then heconvinced the school to give him a certificate in Maths so

he could get into college. They complied because theywanted to get rid of him.


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Dyslexia


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Definition Dyslexia is difficulty with language.

People with dyslexia typically have

average to above average intelligence.They may have difficulty with reading,spelling, understanding language theyhear, or expressing themselves clearly inspeaking or in writing. An unexpectedgap exists between their potential forlearning and their school achievement.


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Characteristics of Dyslexia

Slow Word Recall Average or Above Intelligence Beyond third grade continuing to reverse and invert

letters and transpose words More difficulty decoding nonsense words than content

words Difficulty decoding single words in isolation Difficulty with letter/sound relationships Confusing small words such as at for to, said for and,

does for goes. Transposes number sequences and arithmetic signs (+, -,

x, =) although math skills are typically a strength


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May have difficulty learning to tell time Spelling is usually difficult, frequently spells

the same word differently in a single piece ofwriting

Frequently able to decode a word they cannotspell

Listening comprehension is usually a strength

and the student typically can comprehend atgrade level what he hears orally Poor grasp of abstract concepts Difficulty in telling or retelling a story

Difficulty with rhyming words


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When he was six, his father gave him a compass. Hewas fascinated by the way the needle always pointed

north. This experience helped to create a greatcuriosity in him and had an impact on the rest of hislife.

Once a week his parents invited a poor medicalstudent, Max Talmey to eat with them. Max brought

science books to share with Albert, and they becamegood friends.


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His Uncle Jakob was a strong influence in his life. Hegave Albert math books about algebra and geometry.

Uncle Jakob described algebra as "a merry science".He said algebra could be compared to hunting a littleanimal. You didn't know the name of the animal, soyou called it "x". Then when you finally caught theanimal you gave it the correct name. He made

learning fun for the boy and also provided a modelfor teaching that Albert would later use. In the futurehe would explain his theories by using examples oftrains, elevators, and ships.


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Some Talented Dyslexics

Inventors/Engineers/Scientists:

Albert Einstein

Thomas Alva Edison

Alexander Graham Bell

Artists:

Leonardo da Vinci

Walt Disney

Military/Political Strategists: General George Patton

Winston Churchill

Woodrow Wilson


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A 15 year old boy Difficulty sitting still in class and home

Runs around the room

Climbs on the furniture

Becomes restless when he is forced to sit

in a chair

Has difficulty for waiting his turn whenplaying with other children.


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Attention DeficitHyperactivity Disorder

(ADHD)


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ADHD is Poor attention span

Easy distractibility

Always restless, leaves seat, running,climbing

Careless mistakes

Biological, psychological and social

risk factors


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ADHD in adolescents ADHD Continues in adolescence

and adulthood(50-70%)

-in adolescence more inattention and

impulsivity-not identified-HIDDEN MORBIDITY


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Pattern of ADHD in adolescents in

our schools..

ADHD-17.4%

ADHD NOS-7.9%

Ref; Anil kumar TV,MKC Nair et al(2006) Development and validation of a visualexplanatory screening tool for identifying ADHD, a common mental healthproblem in adolescent school students


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ADHD - Hyperactivity symptoms

Leaving Seat

Play increased

Motor.

Fidgets

Runs, Climbs

Talkative

Impulsivity

Awaiting Turn

Intrudes

Q? Blurts out


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ADD- without hyperactivity

Poor attention to details

Lazy Oppositional unmotivated

Easily distracted

Careless mistakes

Not listening Difficulty in organizing

Forgetfulness and loosing things

Avoidance of sustained mental effort

Failing to finish academic works

independently


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ADHD - Diagnostic criteria

A. Either 1 or 2

1. qAttention - u 6 symptoms x 6months

2. Hyperactivity Impulsivity - u 6 Sym. x 6 months

B. Onset < 7yrs

C. u 2 settings

D. Impairment Social, academic or occupational

E. Not due to . PDD, Schiz, Mood, Anxiety


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Complications?

InjuryPoor school performance

comorbidity

CONDUCT DISORDER

ADDICTIONSubstance abuse


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Treatment & Management

Evaluation


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Treatment tips

Essentialinformation

ADHDis not the childs fault

Better outcome if calm and accepting

They need extra help to remain calmattentive

May continue into adulthood


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Counseling of patientsandfamily

Encourage parents to give positivefeedback

Avoid punishment ! Parents to discuss with school

teachers

Minimise distractions

Sport or Physical activity->help torelease energy

Meet school psychologist/counselor


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Role of teacher?

TEACHERS are the key persons

to identify and intervene


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Tips for teachers To increase chance of following

instructions

Eye contact

Stand near

Soft voice

Be specific Short and clear directions


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Tips for teachers Break into simple directions

Use visual cues

Give 10 seconds to respond

Check comprehension

Ask to repeat

Let the child ask Repeat direction in calm ,clear voice


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Teaching techniques1. Break lessons into small parts,

2. Use variety of Teaching Learning

methods- listening, seeing, touching

3. Use verbal and non verbal methods

4. Vary activities-group works

5. Short assignmentwith frequentfeedbacks and reinforcement


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Class room rules Place class room rules in prominent

places

Seating-close to teacher

Near model students

Not near windows

Good relation with parents


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Drugs

Stimulants Methyl phenidate

Non stimulant - Atomoxetine

Anti depressant - Clonidine


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Attention Deficit Hyperactivity DisorderADHD and

Conduct disorder (30.7%) Depression(10.3%)

Adjustment disorder(8.3%)

Reference: Indu P S ,Anil Kumar TV et al, Mental healthmorbidity and associated factors in children and adolescents

attending a Child and Adolescent Psychiatry Clinic, 2002.


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Sadness

Depression

?


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4-8%more in girls(2 times)


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ASK.HOW THEY AREFEELING ?


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screening

1.Mood q low or sad mood

2.Interest

qpleas

ure

1/2 x 2 weeks


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Diagnostic criteria

Sleep -q (o)

Weight - q Appetite

Worthlessness &guilt


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Diagnostic criteria Death wish or acts

Energy q- fatigue, libido

PMA q (Psychomotor activity)slowing ofmovement /speech

Concentration q C/o q memory

5/9 x 2 weeks


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Diagnosis

1.Mood2.Interest3.Sleep4.Weight5.Worthlessness

6.Death wish7.Energy8.Psychomotor retardation9.Concentration

5/9 2 weeks


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Complications of depression if

untreated are

Poor psycho social outcome

School failure

Recurrent depression

Substance use.(alcohol, smoking etc) Suicide


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Indication for drugs are Patient not responding to psychological

treatment alone. Severe symptoms. Bipolar depression (children with history of

mania and depression).. Psychotic symptoms (Delusions and

hallucinations). Chronic recurrent depression


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Treatment

Drugs.

Antidepressants

Fluoxetine 20 mg OD * 6 Months


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Fluoxetin

Preparation Startingdose

Usual/dailydose

.eg.Prodep

Flunil

,

.capsule 20mg

liquid 20mg/5ml

5 mg 20 mg.


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SertralinePreparation Startingdose

Usual/dailydose

.eg. Serta.Serlift

Tablets

50 mg

Children25mg.

Adolescents- 50 mg.

50 mg


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When to Refer?

1. No improvement

2. High suicidal risk

3. Psychotic symptoms delusions/ hallucinations

4. Atypical features

5. Substance abuse

6. Need more intensive psychotherapy

Depression


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Counseling


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Counseling

C-confidentiality

O-open questions

U-unconditional

N-non judgemental

S-sincere


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Counseling E-empathy

L-listening I-impartial

N-non verbal communication

G-guidance


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Depression -Summary

Common

Disabling, fatal

Simple diagnosis

Simple treatment

Family involvement


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Angry...

Assaultive


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Conduct Disorder

C d t Di d th i t


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Conduct Disorder the aggressive teen

Clinical features- ADDS

Aggression

Destruction

Deceitfulness/ theft

Serious violation of rules


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CD-Clinical features ?

Excessive level of fighting or bullying

Cruelty to animals and other people

Severe destruction to property, firesetting

Stealing, repeated lying

Truancy from school, running awayfrom home and unusually frequenttemper tantrums


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Complications ? School drop out

Antisocial behavior

Substance use

High-risk sexual behavior


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Thelost lamb.


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Treatment tipsEssential information for patient and family

Effective discipline

(Clear and consistent)

but not harsh.

Avoid punishment


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Effective discipline - clear andconsistent, but not harsh, avoidphysicalpunishment

Alter the circumstancesresulting inproblem behavior

Recognize good, pro-social behavior

andreinforce by giving attention Set clear andfirmlimits, inform in

advance of the consequences,respondimmediately.


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Counselingto patientandfamily

Alterthe circumstances

Recognize goodbehavior

Consistentdiscipline, setclearandfirm limits, inform inadvance oftheconsequences, immediate response.

Discusswith teachers

Seek help from relatives, friends,communityresources


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ADHD vs CD

ADHDstruggles

to controlhimself

andto maintainfocus.

Conductdisorderstruggles

with everyone andis

againstthe societyand societalrules.


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Mismanaging an aggressive

diso

bedient Child Using force

Ridiculing

Forcing students to admit lies anderrors

Demanding confession


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Mismanaging an aggressive

diso

bedient Child

Confronting students over issues

Asking students why they act out

Punishing students

Making disapproving comments


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90% of the success


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90% of the successin leadership is

attributed to EI


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Beh Prob in Sch Children