Behavioral Disorders in Children

In this blog post, we will discuss the most common behavioral disorders in children including their diagnosis, risk factors and treatment.

Keep reading to enhance your NEET PG preparation for Pediatrics and ace your exam. 

Nocturnal Enuresis

Is defined as involuntary passage of urine in children at night beyond 5 years of age

Epidemiology

60% of cases are seen in boys. Family history is positive in 50% cases. If one parent has nocturnal enuresis, each child has 44% of risk developing it. While if both parents has nocturnal enuresis , than each child has 77% of risk

Classification

Primary- child never attained urinary continence

1. Secondary- child have attained urinary continence but developed nocturnal enuresis again

Management

Ist Line of Management

1. Diet and lifestyle changes, which includes restriction of caffeine, sugary substances and fluids after dinner.
2. Motivational therapy (star chart). In the star chart, maintain a diary or calendar and mark the dry days the child had and if the child has seven consecutive stars , the child will get some reward. This therapy has shown amazing results. 

2nd Line of Management

Bed and alarm technique

There are moisture sensing alarms available. As soon as the child starts to pass urine in the bed,the alarm will detect moisture in the undergarment of the child and rings, that makes the child wake up and the child goes to the toilet to micturate. That has also shown to produce an excellent response. 

3rd Line of Management

Drugs

Used in short term management like child going out for a trip

1. Oral Desmopressin- previously desmopressin nasal sprays were advocated, but now no longer recommended due to the serious side effects
2. Imipramine

It has been seen that the combination of bed alarm technique and drugs produces lowest relapse rate

PICA

Refers to persistent eating of non nutritive, non food substances for at least 1 month. It is most common in children with intellectual disability and autistic spectrum disorder. It is usually associated with iron deficiency anemia. 

Treatment

Is mainly behavioural therapy and iron supplementation

Thumb sucking

It is a self soothing behavior, which is common in infancy. Seen around 25% of children at around 2 year of age. If it is present beyond 5 year of age , than it is called sequelae eg paronychia and dental malocclusion( anterior open bite).

Treatment

Behavioural therapy

Bruxism (Teeth Grinding)

Seen in 5-30% of children. Usually begins in the first 5 years of life. Usually associated with increased day time anxiety. Persistence bruxism can lead to complications like muscular or mandibulo temporal joint pain and dental malocclusion

Treatment

Behavioural therapy

Breath Holding Spells

Typically seen at 6-18 months of age and it is due to immaturity of the autonomic nervous system. The triggers are usually injury, anger, frustrations, which leads to crying of the child and causes apnea, hypoxic seizure, temporarily loss of consciousness, tonic posture

There are maily 2 types of breath holding spells:

1. Pallid spells- which is due to reflex vagal bradycardia and asystole
2. Cyanotic spell- is due to prolonged apnea during expiration and intra pulmonary shunting of blood 

Treatment

Reassurance and treatment of coexisting iron deficiency anemia

Tics and Stereotype

Tics are sudden rapid non rhythmic but recurrent motor movement or vocalisation and can be seen in Tourette syndrome

Stereotype

It is stereotyped rhythmic repetitive movements or patterns of speech with lack of variation over time. 

ASD (Autistic Spectrum Disorder)

They are characterized by persistent impairment in reciprocal social communication and interaction and restricted and repetitive pattern of behaviour and interest

Risk Factors

Closure spacing of pregnancies, antenatal exposure to drugs like Valproate, Thalidomide). Antenatal Rubella exposure, extreme maturity born at ,26 weeks gestation and family members with learning or psychological problem

Screening test

13. CHAT- modified checklist for autism in toddlers, age group 10-30 months. 

Treatment

Cognitive behavioural therapy and management associated comorbidities like Atomoxetine for hyperactivity. Intranasal oxytocin has also been found to have some benefit recently. 

ADHD (Attention Deficit Hyperactivity Disorder)

Is defined as persistent inattention or an hyperactivity or impulsivity that interferes with the functioning or development, present for at least 6 months in 2 or more settings , beginning before 12 years of age and must not be secondary to another disorder. 

Also Read: CARBOHYDRATE & Amino Acid Metabolism DISORDERS

Risk Factors

Maternal smoking, alcohol, lead or mercury. The genes that have been implicated are DAT-1 and DRD -4. Abnormal brain structure. CNS trauma,psychology family stress, epilepsy, tuberous sclerosis, neurofibromatosis

Epidemiology

ADHD is the most common neuro behaviour disorder of childhood. 2% of adults have ADHD. 60% - 80% of children continue to have it in adolescence, while 60% of adolescents with ADHD have symptoms in adulthood. 

Drugs

Methylphenidate, Amphetamine, Atomoxetine

RETT Syndrome 

It has X linked dominant inheritance. It has involvement of multiple genes. The most common gene involved is MCP-2 and it is more common in girls. The head circumference is normal at birth and the development also remains normal in the first few months in life. Later on there will be delayed development, deceleration of head growth and acquired microcephaly. Eventually there will be loss of purposeful hand movements and development of stereotypic hand wringing movements  and finally will be gait or posture apraxia. Associated problems like speech problems, seizures, breathing irregularities and intellectual disability 

Selective Mutism

Is basically a condition, where there is failure to speak in specific social situations, despite being able to speak normally in other situations. It is usually a symptom of underlying anxiety disorder and may be associated with excessive shyness or dependency on parents. History of anxiety symptoms in one or more parents may be present

Treatment

Cognitive behavioural therapy, focused on decreasing anxiety.

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