CHILDHOOD BEHAVIOURAL DISORDERS

Childhood Behavioural Disorders

A general term including more sepcific disorders such as attention deficit hyperactivity disorder (ADHD) and other
behavioural disorders. Only children and adolescents with moderate to severe degree of psychological, social,
educational or occupational impairment should be diagnosed as having behavioural dsorders. In some children
the problem persists into adulthood.


Investigate if the child’s behaviour is a reaction to trauma and/or fear (child is bullied or harmed at home or outside  home). In this case, it is NOT a behavioural disorder!

Causes

  • Genetic
  • Depression
  • Medical conditions, alcohol or drug use
  • Reaction to fear or trauma

Clinical features

Attention Deficit Hyperactivity Disorder (ADHD)

  • Impaired attention (breaking off from tasks and leaving activities unfinished) so severe as to affect normal
    functioning and learning
  • Excessive restlessness, overactivity especially in situations requiring calm, talkativeness, fidgeting
  • Of early onset (<6 years) and lasting >6 months

Other behavioural disorders

  • Unusually frequent and severe tantrums, persistent severe disobedience
  • Repetitive and persistent pattern of dissocial, aggressive or defiant conduct (bullying, cruelty to animals,
    destructiveness, fire setting etc), more severe than ordinary mischief, not only in response to severe family or
    social stressors, and lasting >6 months

Differential diagnosis

  • Depression, psychosis
  • Epilepsy, developmental disorders
  • Medical conditions e.g hyperthyroidism

Management

  • Family psychoeducation and counselling
  • Parent skill training
  • Contact teachers, advise and plan for special needs education
  • Psychosocial interventions if available
  • Support to family
  • Refer to specialist for further management

For ADHD not improving with above interventions

  • Consider methylphenidate under specialist supervision