Behavioural Problems Flashcards
Define school refusal?
School refusal is the inability to attend school to overwhelming anxiety.
Children may not complain about anxiety but of physical somatic features such as headache, nausea and general feeling of being unwell.
Symptoms tend to be confined to weekdays during term time.
What is the aetiology behind school refusal?
The anxiety is thought to stem from:
- Separation anxiety which has continued into later childhood
- Adverse events at school such as bullying
How should school refusal be managed and who should be involved in the management?
- Advice and support parents and school about the condition
- Treat any underlying emotional disorder
- Plan and facilitate an early and graded return to school
- Help the parents make it more rewarding for the child to go to school than stay at home
- Address bullying or educational difficulties if present
Parents, paediatricians, psychiatrist and teachers should all be involved in care.
In what age range are tantrums normal?
Toddlers 2-3 yo’s
Terrible 2s
How should tantrums be managed?
Remain calm and do not get angry
Attempt distraction
If unsuccessful leave the room and allow the tantrum to run its course.
General Rules:
Give positive instructions (what you want them to do)
Reward positive behaviour
Give time outs if behaviour is bad
What is conduct disorder?
Repetitive and persistent pattern of aggression
Destruction of property
Deceitfulness or theft
Not in keeping with social expectations
At what age does conduct disorder present and what is the prognosis?
Usually present in 10-12yo in boys and 14-16yo in girls.
Many improve whilst others will go on to develop antisocial personality disorders.
What is the management of nocturnal enuresis?
Lifestyle measures:
Reduce fluid intake before bed
Encourage going to the toilet before bed
Star chart for dry nights (important not to punish children for wet nights as it is beyond control)
An enuresis alarm may be used to wake the child and prompt them to empty their bladder.
Desmopressin (an ADH analogue) can provide short-term relief for holidays or sleepovers.
