Children’s Behaviour Disorders

ATTENTION DEFICIT HYPERACTIVITY DISORDER

Diagnostic criteria (DSM-5)

1. Either 1 or 2 or both combined

   1. inattention

   2. hyperactivity and impulsiveness

2. 6 or more of the symptoms listed under 1 and 2 in children and 5 in people aged 17 and older (see DSM-5)

3. Symptoms must be present in 2 or more situations (e.g. at school and at home or work)

4. Disturbance causes clinically significant distress or impairment in social, academic or occupational functioning

Management of children (based on initial accurate diagnosis)

• Refer to appropriate consultant (e.g. child psychiatrist) or preferably to a multidisciplinary clinic

• Protect child’s self-esteem

• Counsel and support family

• Involve teachers

• Refer to parent support group

Diet: Exclusion diet probably ineffective but encourage good diet (consider dietitian’s help).

Pharmacological: Based on psychostimulants for ≥4 yrs:

• methylphenidate (start with immediate release agent) or dexamphetamine

• antidepressants (e.g. SSRIs) second line but may become first line Combine medication with psychosocial interventions. Review regularly.

BREATH-HOLDING ATTACKS

78–9

CONDUCT DISORDERS

Conduct disorders affect 3–5% of children and represent the largest group of childhood psychiatric disorders. Their behaviour violates the rights of others.

Clinical features

• Antisocial behaviour which is repetitive and persistent

• Lack of guilt or remorse for offensive behaviour

• Generally poor interpersonal relationships

• Manipulative

• Tendency to aggressive, destructive, ‘criminal’ behaviour

• Learning problems (~50%)

• Hyperactivity (⅓)

Management

• Early intervention and family assistance to help provide a warm, caring family environment

• Family therapy to reduce inter-family conflict

• Appropriate educational programs to facilitate self-esteem and achievement

• Provision of opportunities for interesting, socially positive activities (e.g. sports, recreation, jobs, other skills)

• Behaviour modification programs

CRYING AND FUSSING IN INFANTS

Crying and fussing is quite normal in first 3 mths. Crying is excessive if it lasts for long periods when baby should be sleeping or playing (usually 6–9 p.m.). Organic causes which are uncommon should be considered.

Checklist of common causes

• Hunger (usually underfeeding)

• Wet or soiled nappy

• Loneliness (crying ceases when picked up)

• Period of purple crying or ‘colic’ (usually 2–16 wks) 8

• Individual temperament

• Teething ( 448)

Management

• Perform physical examination (include assessment of child’s temperament)

• Give parental reassurance and education

• Reassure that extra attention (not overstimulation) is okay

• Provide soothing alternatives (e.g. use of dummy/pacifier, extra cuddling and carrying, gentle massage)

The five Ss

1. Swaddling—firm clothes

2. Side or stomach—lie baby on side or stomach

3. Shush, i.e. ‘sshusshing’ as loud as the child

4. Swing—sway from side to side

5. Suckling—nipple, teat or pacifier

HABIT COUGH

• Only occurs when child awake (not during sleep)

• Usu. loud, harsh, honking or barking

• Lasts for ...