arifah nur istiqomah departemen/smf ilmu kedokteran jiwa fk unpad/rshs
TRANSCRIPT
![Page 1: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/1.jpg)
Overview of Behavioral Problems in Child and Adolescent
Arifah Nur IstiqomahDepartemen/SMF Ilmu Kedokteran JiwaFK Unpad/RSHS
![Page 2: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/2.jpg)
Behavioural Problems
Normal behavio
ur
Behavioural
symptoms
Behavioural disorder
![Page 3: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/3.jpg)
Normal Behaviour
Emile Durkham (Rules of Sociological Method )
Child and adolescent behaviour considered as normal as far as behavior does not lead to unrest in society, occurs within certain limits and unintentional
![Page 4: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/4.jpg)
Behavioral Disorder
Behavioural symptoms of varying levels of severity are very common in the population.
Only children and adolescents with a moderate to severe degree of psychological, social, educational or occupational impairment in multiple settings should be diagnosed as having behavioural disordersWHO Mgap,
2010
![Page 5: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/5.jpg)
Behavioral Disorder
Behavioural disorders is an umbrella term that includes more specific disorders: Attention deficit hyperactivity disorder* Disruptive behavioral disorder:
Conduct Disorder Oppositional Behavioral ProblemsWHO Mgap, 2010
![Page 6: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/6.jpg)
Attention Deficit Hyperactivity Disorder
![Page 7: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/7.jpg)
Attention Deficit Hyperactivity Disorder
Impaired attention Breaking off from tasks and leaving
activities unfinished; shifts frequently from one activity to another
Diagnosed as a disorder only if they are excessive for the child or adolescent’s age and intelligence, and affect their normal functioning and learningWHO mhGAP, 2010
![Page 8: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/8.jpg)
Attention Deficit Hyperactivity Disorder
Overactivity Excessive restlessness, especially in
situations requiring relative calm Running, jumping around Getting up from a seat when he or
she was supposed to remain seated Excessive talkativeness and
noisiness Fidgeting and wrigglingWHO mhGAP, 2010
![Page 9: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/9.jpg)
DisruptiveBehavioral Disorders
![Page 10: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/10.jpg)
Disruptive Behavioral Disorders
These disorders are compelling to understand and treat because: Common in community High rates of morbidity High rates of associated psychiatric
illness and psychopathology Very costly for society
Connor MD, 2009
![Page 11: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/11.jpg)
Oppositional Deviant Disorder A recurrent pattern of negativistic, defiant,
disobedient, and hostile behavior toward authority figures
Clearly more frequent, more intense, and more persistent across the child's development than is typically observed in individuals of similar age and developmental level.
The symptoms cause impairment in the child's social, academic, or occupational functioningConnor MD, 2009
![Page 12: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/12.jpg)
Conduct Disorder
Repetitive and persistent pattern of dissocial, aggressive or defiant conduct
Such behaviour, when at its most extreme for the individual, should be much more severe than ordinary childish mischief or adolescent rebelliousnessConnor MD, 2009
![Page 13: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/13.jpg)
Interactional Developmental Model
Corwin M, 2005
![Page 14: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/14.jpg)
Course of Ilness
![Page 15: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/15.jpg)
Course of Illness
Symptoms of ADHD persist into adolescence or adult life in approximately 50% of cases.
In the remaining 50 %, they may remit at puberty, or in early adulthood.
In some cases, the hyperactivity may disappear, but the decreased attention span and impulse-control problems persistConnor MD, 2009
![Page 16: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/16.jpg)
Course of Ilness
Many youth who exhibit negativistic or oppositional behaviors will find other forms of expression as they mature and will no longer demonstrate these behaviors in adulthood
Connor MD, 2009
![Page 17: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/17.jpg)
Course of Ilness
Children who develop enduring patterns of aggressive behaviors that begin in early childhood and violate the basic rights of peers and family members, may be destined to an entrenched pattern of conduct disordered behaviors over time
Sadock & Sadock, 2007
![Page 18: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/18.jpg)
Intervention for Behavioral Problems
![Page 19: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/19.jpg)
Intervention
Biological intervention: psychopharmacology
Psychosocial intervention
![Page 20: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/20.jpg)
Psychopharmacology
Do not use medication in primary care for behavioral problems
without consulting a specialist
WHO mhGAP, 2010
![Page 21: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/21.jpg)
Psychopharmacology
ADHD Stimulant medication
Methylphenidate Non stimulant medication
Atomoxetine HCL, venlavaxine, clonidine
Sadock & Sadock, 2007
![Page 22: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/22.jpg)
Psychopharmacology
Disruptive Behavioral Problems: Focus on impulsivity, affective lability,
negative emotions (fear,irritability), explosive aggression
Psychopharmacological interventions are generally palliative and not curative: typical and atypical antipsychotics, mood stabilizers for explosive agressionConnor MD, 2009
![Page 23: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/23.jpg)
Family Psychoeducation
Consistent about what the child is allowed and notallowed to do
Praise or reward the child after observe good behaviour and respond only to most important problem behaviours;
Avoid severe confrontations or foreseeable difficultsituations.
Give clear, simple and short commands that Emphasize what the child should do rather than not do.
WHO mhGAP, 2010
![Page 24: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/24.jpg)
Family Psychoeducation
Never physically or emotionally abuse the child. Make punishment mild and infrequent compared to praise.
As a replacement for punishment, use short and clear-cut “time out” after the child shows problem behaviour. (temporary separation from a rewarding environment, as part of a planned and recorded programme to modify behaviour).
Put off discussions with the child until parent become calm.WHO mhGAP, 2010
![Page 25: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/25.jpg)
Teacher’s Role
Make a plan on how to address the child’s special educational needs
WHO mhGAP, 2010
![Page 26: Arifah Nur Istiqomah Departemen/SMF Ilmu Kedokteran Jiwa FK Unpad/RSHS](https://reader035.vdocuments.net/reader035/viewer/2022062407/56649d8a5503460f94a70a3e/html5/thumbnails/26.jpg)
Support for carers
Identify psychosocial impact on carers. Assess the carer’s needs and promote
necessary support and resources for their family life, employment, social activities and health arrange for respite care, which means a break now and then when other trustable caregivers take over temporarily.WHO mhGAP, 2010