Download behavioral disorders among school children – an overview

COMMONWEALTH ASSOCATION FOR EDUCATION,
ADMINISTRATION AND MANAGEMENT
VOLUME 2 ISSUE 4
ISSN NO 2322-0147
APRIL 2014
BEHAVIORAL DISORDERS AMONG SCHOOL
CHILDREN – AN OVERVIEW
INDEXED WITH PARIS, DAIS.NET, DRJI, WORLDCAT, EBSCO-USA, J-GATE
(EDITOR-IN-CHIEF)
DR MUJIBUL HASAN SIDDIQUI
ASSISTANT PROFESSOR, DEPARTMENT OF EDUCATION,
ALIGARH MUSLIM UNIVERSITY,
ALIGARH-202002,
UTTAR PRADESH,
INDIA
www.ocwjournalonline.com
website: www.ocwjournalonline.com
Excellence International Journal of Education and
Research (Multi- subject journal)
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BEHAVIORAL DISORDERS AMONG SCHOOL CHILDREN – AN OVERVIEW
By
Dr. Rama Reddy Karri
Director,
Manasa Hospital,
Rajahmundry Andhra Pradesh
Retired Professor of Psychiatry
GSL Medical College
Rajahmundry
Dr.R.S.S.Nehru
Assistant Professor
School of Education and Education Technology
Centre for Teacher Education
Koraput, Odisha-764020
Research Guide,
Bharathiar University,
Coimbatore, TN
Mobile: 9440594179 /9966004695
E-mail: [email protected]
INTRODUCTION
Psychological well-being in children is necessary for their healthy emotional,
physical, social, educational, and cognitive development.
Childhood is an important time to promote healthy development as many adult
mental disorders have related antecedent problems in childhood (David Mrazek & Patricia J.
Mrazek, 2009). There are limited studies based on children and adolescents in India and most
of the studies were done as part of adult psychiatric epidemiological studies. Currently we
have tertiary care centres for treatment of mental disorders but a large gap exists in the areas
of prevention and early intervention (Murray C.J & Lopez Ad, 1996). Many children and
their parents were not using the mental health services due to various reasons like lack of
trust, social stigma and inability to recognize the existing problem. We need appropriate and
updated prevalence rates and patterns of the diseases for planning and implementation of
mental health services for children (Bower P et al, 1999). Studies on children of school age
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have tended to focus on nutritional and other health problems related to communicable
diseases. School-age children may also suffer a variety of disabilities, emotional and
behavioural problems. As countries develop their school health services, it should be
necessary to ascertain the prevalence of different disorders in order to develop relevant
interventions and other resources (Zubrick Sr., Silburn Sr. & Barlon P Blaire, 2000). There is
increase in need and use of child mental health services as there is a rise in number of
problems like substance abuse, child abuse, teenage pregnancy, school dropouts, suicides
(Andres J. Pumariega, 2009).
Twenty per cent of students aged 6-17 years worldwide currently have significant
impairing pathology. Ten per cent do not receive any treatment. Most of the public schools
do not have educational psychologists or social workers to identify the affected children.
Children with biological vulnerabilities are more susceptible to psychiatric disorders when
they face traumatic experiences, family pressures, peer, school, or other stressors contributing
to dysfunctional behaviors. Research does not provide adequate data about prevalence and
demographic details of children suffering from psychological problems.
School Mental Health has been a major mental health movement which covers up the large
population of children and adolescents, but has been effectively implemented only in cities and
not in smaller towns and rural areas in the last four decades. Research publications during the
60s, 70s and 80s reported that mental retardation formed bulk of population attending child
guidance clinics (CGC) during that period. While emotional and behavioral disturbances were
less identified and referred, the trend has changed recently. All spectrums of diagnostic
categories are now referred and treated at various teaching hospitals, psychiatry departments,
pediatric departments, various colleges of social work and large number run by NGOs (Malhotra
HK, 1977).
The last three decades has shown highly specialized clinics rendering specialized
services to children with learning disability, autism, cerebral palsy and mental retardation mostly
in metros and urban areas. Such centers do run the genetic clinic and research in specific
disorders. Development clinics for 0 to 3 years age group for various disability groups and
multiple disability groups have special focus of identification, assessment and therapy. All these
centers are attended by general psychiatrists rendering highly specialized services (Malhotra HK,
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1977).
Child Mental Health Policy and School Mental Health programs have provided excellent
opportunity to enhance mental health program for children and adolescents. The focus is rightly
on preschool children and school based mental health program, which will prevent illness and
possibly promote positive mental health. It also ensures that it will reduce behavioral disorders in
children and prevent adult psychopathology. Effectiveness of child mental health intervention
programs will surely help in addressing mental health disorders among adults (Shastri PC, 2008).
In order to achieve desired outcomes one should embrace all those services that
contribute to the mental health care of children and adolescents, whether provided by health,
education, social services or other agencies. It is also crucial to partner with services whose
primary function is not mental health care, such as GPs and schools. They can always contribute
by offering general advice and treatment for less severe problems, contribute towards mental
health promotion, identify problems early in their development and refer to more specialist
services. This is to explicitly acknowledge that supporting children and adolescents with mental
health problems is not the responsibility of specialist services alone (Shastri PC, Shastri JP &
Shastri D, 2010). Importance of need for school-based programs has been reflected in inclusion
of
life
skill
education
program
by
NCERT
and
CBSC
in
present
syllabus.
According to the UNESCO report, 2008 (U.N.D.P. Report, 2008) India stands at
a)
102nd position in the "Education for all developmental index" out of 129 countries
b)
132nd place in the list of 172 nations on human development index (HDI).
Ten per cent of 5-15 year old has a diagnosable mental health disorder. This suggests that
around 50 million children under 18 would benefit from specialist services. There are up to
20 million adolescents with severe mental health disorders. Around 90% children with a
mental health disorder are not currently receiving any specialist service.
School Mental Health Research
The number of health promotion and prevention initiatives addressing mental health
difficulties is rapidly expanding. By the end of 2002, there were estimated to be over 1200
outcome studies on prevention, health promotion, and drug abuse prevention in youth (Philip
J, 1980). The New Freedom Commission on Mental Health’s Achieving the Promise:
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Transforming Mental Health Care in America emphasized the importance of mental health in
learning and social/emotional development of children and youth, recommending improved
and expanded school-based mental health services (Malhotra S et al., 2009). A number of
school-based programs and initiatives have been developed to address broad goals including
health promotion, early identification, crisis response, and prevention and treatment of
emotional and behavioral disorders (Begum S, Rao KN & Sudarshan CY, 2010). These
programs may use one or more distinct delivery mechanisms including full-service schoolbased health centers, screening programs, and classroom and school-based strategies and
curricula (Bhola P & Kapur M, 2003). Most programs face system obstacles and methods of
delivering service to young people in schools, ranging from the practical challenges in
maintaining school-based health centers (Sidans A & Nijhswan M, 1999; Dalal M, Pakur M
& Kaliaperumal, 1990) to the implementation and sustainability of evidence-based schoolwide programming (Rao PN, 1978) and the viability of screening programs ( Sinha UK
&Kapur M, 1999). Despite the growing number of school-based mental health initiatives,
there is no identified best practice model for delivering and sustaining these programs. Direct
service-models include school based mental health centers, crisis intervention, schoolcommunity mental health center collaborations, and fee-for-service mental health contracts.
Indirect service models include school system consultation, prevention and intervention
programs and early identification screening programs, Web-based mental health resources,
and on-site or video consultation with other mental health clinicians. The model adopted by a
school depends on resources, state law, student and school needs and priorities, and the focus
of the consultant.
Universal prevention programs address the school system as a whole and aim to better
the overall educational climate and learning environment by coordinating community and
outside resources. Specific intervention/prevention models target a wide range of risk
behaviors including anxiety, depression, substance abuse, and bullying/violence. Evidence
examining the effectiveness of whole-school programs suggests that the effectiveness of
universal programs (delivered to all students) is modest in addressing specific problems but
can have broad impact on school climate and has more success with a focus on developing
protective factors than by decreasing negative risk factors. In some cases indicated prevention
programs (delivered to students with elevated symptoms) and selected prevention programs
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(delivered to high-risk students) may be more effective in targeting specific problems (Bansal
PD & Barman R, 2011)
Young people can have mental, emotional, and behavioral problems that are real,
painful and costly. These problems, often called “disorders”, are sources of stress for children
and their families, schools and communities . Although it is difficult to get accurate estimates
of child mental disorders, the few available epidemiological data indicate that 12-51%; with
the average around 29% of the world's children suffer from emotional and other mental
problems that warrant mental health treatment. Out of this group, 6-19% is seriously
emotionally disturbed children who need intensive psychiatric care (Davis et al., 1998). In
addition, there are untold numbers of at-risk children who need attention and secondary
preventive service. Recent evidence indicates that emotional and behavioral disorders
frequently lead to poor school performance and to dropping-out of school. This wastes
educational resources and seriously impairs the economic and social potential of such
children (Nikapota et al., 1991). Some disorders are more common than others, and
conditions range from mild to severe. Often, a child has more than one disorder (SAMHSA's
National Mental Health Information Center, 2003). There is an ample weight of evidence
suggesting that, several risk factors including child, familial, and environmental risk factors
play an important role in the genesis of emotional and behavioural problems in
schoolchildren (Cummins Mental Health Centre, 2003; American Psychiatric Association,
1994). Many environmental factors can affect mental health, including exposure to violence,
extreme stress, and the loss of an important person (SAMHSA's National Mental Health
Information Centre, 2003).
Although children under 15 yrs. of age constitute about 40 to 50 percent of the
population of the developing countries, child psychiatry in these countries has shown
significant development only in the past two decades (Nikapota, 1991).
Epidemiological studies in India in both rural and urban setting have shown wide variation in
the prevalence rate of psychiatric disorders in children.
However, epidemiological studies in school children in Indian setting are very few in
numbers. Prevalence rate of 20 to 33 per cent of psychiatric disorders in school children has
been reported in Indian setting (Jiloha and Murthy, 1981; Deivasigamani, 1990). This is quite
high in comparison to the recently reported prevalence rate of 12 to 14 percent in school
children of some developed countries like Japan and France.
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Behavioral Disorders during Childhood
Psychiatric disorders diagnosed in childhood are divided into two categories: childhood disorders and
learning disorders. As the scope of the study excludes learning disorders, only childhood disorders are
described below. These disorders are usually first diagnosed in infancy, childhood, or adolescence, as
laid out in the DSM IV TR.
The fourth edition of DSM (DSMIV TR; American Psychiatric Association, 2000) begins with a
chapter devoted to disorders that begin in infancy, childhood, and adolescence. The following
disorders are included in that section: mental retardation, learning disorders, motor skills disorders,
communication disorders, pervasive developmental disorders (such as autistic disorder and Asperger’s
disorder), attention-deficit and other disruptive behavior disorders (such as conduct disorder and
oppositional defiant disorder), feeding and eating disorders of infancy, or early childhood, tic
disorders, elimination disorders, and others such as separation anxiety disorder (SAD), selective
mutism, and reactive attachment disorder of infancy or early childhood. However, many disorders
described in other sections of the manual may also be present in children and adolescents. These
include mood and anxiety dis orders, schizophrenia, somatoform disorders, and eating disorders.
Therefore, it is important that the clinicians who work with children and adolescents
do not restrict themselves to the so-called “child disorders” section. Additionally, physicians
who work with adults would be well served to familiarize themselves with the disorders that
first appear in childhood, since many of these persist into adulthood. The following
paragraphs briefly describe the diagnostic categories most often used with children and
adolescents.
Disorders of development
Disorders of development and attachment are most often present at an early age.
Examples include mental retardation, pervasive developmental disorders, and re active
attachment disorder. Mental retardation is de fined as general intellectual functioning that is
significantly below average. It is coded on axis II, and it is separated into mild, moderate,
severe, and profound subgroups based on the degree of intellectual impairment defined by the
IQ and the level of adaptive functioning. An IQ score below 65–70 (that is, two standard
deviations below the mean) is the upper limit of mental retardation. Parallel impairments in
adaptive functioning are also required to fulfill the criteria.
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Pervasive developmental disorders
The PDDs are defined by impairments in reciprocal social interaction and
communication and by a restricted range of behavior, interests, and activities. Autistic
disorder, Asperger’s disorder, Rett’s disorder, childhood disintegrative disorder, and
pervasive developmental disorder not otherwise specified (PDD-NOS) are all identified.
Children with these disorders exhibit varying abnormalities of language function that may
profoundly affect their abilities to communicate with others and to make their wishes and
needs known. There is also a qualitative impairment in reciprocal social interaction and
relatedness, even, with primary caregivers. Additionally, these children often have an in
ability to play symbolically, so pretend play is limited or non-existent. Stereotyped
movements such as hand flapping or head banging may be present, or there may be a
fascination with parts of objects, such as the wheels on toy cars. There is often, but not
always, an associated degree of mental retardation in individuals with autistic disorder
(approximately two-thirds have an IQ below 70). The onset of autistic disorder is usually
evident in the first years of life and, by definition, occurs before age 3.
Reactive attachment disorder is another disorder that is present in preschool children.
The features of this disorder begin before a child is 5 years old with disturbed and
developmentally inappropriate social relatedness (for example, a child may be overly friendly
with strangers or withdrawn).
By definition, the unrelatedness is associated with pathogenic care of the child. Children who
come to the physician with failure to thrive without a medical cause often qualify for this
diagnosis.
Attention-deficit hyperactivity disorder
There are more diagnostic categories that may apply to the school-age child. The most
prominent among these are ADHD and disruptive behavior disorders.
However, a variety of cognitive and learning disorders, such as specific
developmental or communication disorders, may also become apparent at this age. ADHD is
a disorder characterized by a pattern of inattention and hyperactivity- impulsivity that is
excessive relative to the behavior of other children of the same age and gen der. Children
with this disorder may have difficulty remaining seated, waiting their turn, completing
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assignments, sustaining attention, or organizing their work. By definition, some of these
symptoms must be present before a child reaches 7 years of age, and there must be some
symptoms causing impairment in more than one setting (for example, at home, at school, or
in other activities). ADHD often begins in preschool years and commonly extends into
adolescence or adulthood, but the largest number of cases can be found in school-age
children. Individuals with this disorder are commonly both inattentive and hyperactiveimpulsive, although a smaller number of children may have disturbances in only one of these
domains. Many children with ADHD show symptoms of aggression and defiance; comorbid
learning, behavior, mood, and anxiety disorders are often present. However, although these
conditions may coexist with ADHD, they must be distinguished from it. When multiple
disorders are present, they should all be diagnosed.
ADHD, as it is more commonly known, will normally be present in a child by the age of
seven, and behavior issues must be seen in two or more setting, (i.e. school, church, home,
etc.) but the behavioral issues need to be more than what would be expect for a child’s age.
There need to be at least six instances over a six month period for a child to be considered for
diagnoses. This disorder is diagnosed in about 3-7% of school are children, but 65-80% of the
cases will grow out of it as adolescence ends. Some characteristics of those who have ADHD
include: erratic behavior, being disorganized, worn out clothes, intrusive or aggressive
behaviors, and the ability to not be able to tell right from wrong.

There are two different ways for ADHD to be typed as:
1. Inattentive type: the ability to not pay attention or focus in their daily actives.
2. Hyperactive/Impulsive type: Being extremely active and having impulsive
movements, being fidgety and having outbursts in inappropriate places.
Oppositional defiant disorder
Oppositional defiant disorder or ODD is related to both attention deficit and conduct
disorder, but the behavior that is exhibited is not destructive or aggressive. This disorder is
psychological; those who have it may be annoying or annoyed easily, may argue with adults,
blame others for their mistakes, and may be defiant.
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Oppositional defiant disorder (ODD) and conduct disorder (CD) are the other
disruptive behavior disorders listed in DSM-IV. ODD is defined by the presence of persistent
minor violations of age-appropriate social norms. Children with ODD often argue with
adults, lose their temper, and refuse to follow rules, deliberately annoy people, and blame
others for their actions. They are often angry and resentful. Exclusionary criteria for this
disorder include the presence of a psychotic, mood, or conduct disorder.
Conduct disorder
Conduct disorder is defined by the DSM-IV-TR as any behavior that violates the
rights of others or societal norms. There are four categories that are used to determine if a
child’s behavior violates these rights:
1.
2.
3.
4.
aggression towards people or animals
destruction of property
deceitful nature or theft
serious violations of laws
There needs to be at least three instances of behavior that fit into these categories within a
year period and at least one within the last six months for a diagnosis. This disorder is
normally diagnosed in 4-16% of boys and 1-9% of girls, who come in for help. Boys
normally fight, steal, and vandalize, while girls have issues with lying, truancy, and running
away from home.
CD is a behavior pattern in which the basic rights of others or major age-appropriate
societal norms are violated.
Examples include aggression directed toward people and animals, destruction of property,
deceitfulness or theft, and serious violation of rules. This diagnosis takes precedence over
ODD if criteria for both diagnoses are met, since approximately
90% of children with CD also meet criteria for ODD. There is good evidence that ODD
represents a developmental precursor to CD in a subgroup of children.
Learning disorders (see Chapter 6) are defined by academic functioning that is significantly
below what is expected for an individual’s chronologic age, measured intelligence, and ageappropriate education. These disorders may involve deficits in reading, mathematics, and
written expression. The accurate diagnosis of learning disorders re-quires the use of
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standardized intelligence and achievement tests to establish a discrepancy score. (That is, the
score on a standardized achievement test is below what would be expected from the level of
intellectual functioning as measured on a standardized IQ test.)
Communication disorders
The communication disorders, which are characterized by difficulties in speech or
language, include expressive language disorder, mixed receptive expressive language
disorder, phonologic disorder, and stuttering. Communication disorders often appear in
preschool years, but they may not be properly identified until the child is in a school setting.
Expressive language disorder is characterized by lower than expected abilities in vocabulary,
use of tenses, production of complex sentences, and word recall. Mixed receptive –expressive
language disorder involves an impaired understanding of language and a concomitant
difficulty with expressive language. Phonologic disorder consists of errors in sound
production and substitutions or omissions of sounds that would be developmentally expected.
Stuttering is a disturbance of the fluency and time patterning of speech.
Tic disorder
Primary tic disorders, including Tourette syndrome, are usually diagnosed in
childhood and have childhood onset as part of their definition. Chronic tic disorders are often
comorbid with other mental disorders diagnosed in childhood, including ADHD and learning
disabilities, as well as anxiety and mood disorders, most prominently obsessive-compulsive
disorder.
Several types of tic disorders are listed in DSM-IV. The most common is transient tic
disorder, which involves the transient presentation of single or multiple motor or vocal tics. A
tic is a sudden, rapid, recurrent, non- rhythmic, stereotyped movement or vocalization. Tics
may be simple or complex. Tourette syndrome is the least common but most dramatic of the
tic disorders. The diagnosis is made when there is a history of multiple motor tics and at least
one vocal tic. The average age of onset of tics is 7 years. Approximately 40–50% of children
with Tourette syndrome in clinical samples also have symptoms of ADHD. Tourette
syndrome is also often comorbid with obsessive-compulsive disorder (OCD). However, it is
not clear to what extent Tourette syndrome causes impairment in non-referred samples, since
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referral bias as a function of psychiatric comorbidity is not uncommon. (That is, cases with
co morbidity and cases of greater impairment are more likely to be referred for treatment.)
Elimination disorders
Enuresis and encopresis comprise the elimination disorders in DSM-IV. These
disorders have a minimum age threshold defined by the child’s chronologic age or equivalent
developmental level. Encopresis is the repeated passage of feces in inappropriate places by a
child who is at least 4 years old. Enuresis is the repeated voiding of urine into the bed or
clothes by a child who is at least 5 years old.
Separation anxiety disorder
Separation anxiety disorder is a condition in which there is developmentally
inappropriate and extreme anxiety about separation from home, parents, or primary
caregivers. This is the most common anxiety disorder in childhood. It can have such
symptoms as school avoidance or phobia, sleep disturbance, and nightmares.
This disorder commonly follows an acute life event such as the medical illness of the
child or parent, the loss of a close family member, parental separation, or the birth of a new
sibling. Most often, separation anxiety disorder lasts for a limited time and good return to
normal function results from the use of simple behavioral measures and encouragement.
Eating disorders
The eating disorders involve severe disturbances in eating behavior and perceptions of
body shape and weight. These disorders have received considerable attention since the late
1970s, and there has been a resultant increase in case identification. Anorexia nervosa is the
refusal to maintain a minimally normal body weight accompanied by an unshakable fear of
gaining weight or becoming fat.
Bulimia nervosa involves repeated episodes of binge eating and purging behavior in an
attempt to control weight gain. Self-induced vomiting, use of laxatives or diuretics, and
compulsive exercising may all are seen. The most common age of onset of anorexia nervosa
is in the mid-teenage years, and the disorder is much more common in females. Bulimia
nervosa has a later age of onset and often begins in the late teens or the 20s. Both disorders
may be characterized by serious medical complications and comorbid psychopathologic
conditions.
Anorexia Nervosa
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Anorexia Nervosa can be thought of as a “distorted body image” disorder, since many
adolescents who have Anorexia see themselves as overweight and unattractive. In Anorexia
Nervosa, the individual refuses to maintain a minimally normal body weight, is intensely
afraid of gaining weight, and has no realistic idea of the shape and size of his or her body.
Signs of anorexia nervosa include extremely low body weight, dry skin, hair loss, depressive
symptoms, constipation, low blood pressure, and bizarre behaviors, such as hiding food or
binge eating.
Bulimia Nervosa
Bulimia Nervosa is characterized by episodes of “binge and purge” behaviors, where
the person will eat enormous amounts of food, then induce vomiting, abuse laxatives, fast, or
follow an austere diet to balance the effects of dramatic overeating. Essential features are
binge eating and compensatory methods to prevent weight gain. Bulimia Nervosa symptoms
include the loss of menstruation, fatigue or muscle weakness, gastrointestinal problems or
intolerance of cold weather. Depressive symptoms may follow a binge and purge episode.
Childhood onset adult disorders
Apart from the above described categories, general psychiatric conditions which are
known to occur even in adults can have their onset in children. Examples are Major
Depressive Disorder (296), Generalized Anxiety Disorder (300), and Separation Anxiety
Disorder (309).
However, some children develop more chronic symptoms and impairment.
Disorders that are also diagnosed in children and adolescents that are not described in the
childhood section of DSM-IV include schizophrenia and other psychotic disorders, mood
disorders, other anxiety disorders [such as obsessive compulsive disorder and generalized
anxiety disorder (GAD)], eating disorders, substance use disorders, and gender identity
disorder. Schizophrenia is phenotypically similar in children and adults, although children
may have a less pronounced onset of symptoms and may not meet the full criteria for months
or years after they are first brought to a physician. Children with schizophrenia have blunted
or inappropriate affect, isolation, withdrawal, auditory and visual hallucinations, and thought
disorders. There is some indication that the “negative symptoms” (such as thought disorder
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and isolation) predominate over the “positive symptoms” (such as hallucinations and
delusions).
However, the only diagnostic criterion that actually differs in children is that they may
fail to reach expected levels of social and academic functioning (rather than deteriorate from
a predetermined level). Schizophrenia is rare before puberty and must be aggressively
distinguished from the PDDs, developmental language disorders, and mood disorders
(depression and bipolar disorders) when it occurs in this age group. Since the 1980s, there has
been considerable interest in the subject of mood disorders in children and adolescents. Even
though it is now recognized that children of all ages can develop depression and often show
the same symptoms as adults, major depressive disorder (MDD) is not as common in young
children as in adolescents and adults. There are only minor differences in the diagnostic
criteria for the mood disorders in children and adolescents when compared with adults.
Associated changes in a depressed child or adolescent include social withdrawal, academic
decline, oppositional behavior and noncompliance. A child or adolescent with MDD may
have an irritable rather than depressed mood, and he may fail to make expected weight gain
instead of having a significant weight loss. In children or adolescents with dysthymic
disorder, the mood may again be irritable rather than depressed, and the duration of the mood
need only be 1 year, as compared with 2 years for adults. Even though there are no
differences in the criteria for bipolar disorder as a function of age, it can be much more
challenging to diagnose bipolar disorder in children and the presentation can more typically
include irritability tantrums, and agitation. Again, whereas bipolar disorder can exist in prepubertal children, it is not often present in its typical form until after puberty.
The “adult” anxiety disorders include panic disorder, specific phobias, social phobia,
obsessive-compulsive disorder, posttraumatic stress disorder (PTSD), acute stress disorder,
and generalized anxiety disorder. Anxiety disorders may be present in children and
adolescents as well as in adults, and they do not appear to be particularly different in children.
OCD is characterized by recurrent intrusive thoughts or behaviors. OCD symptoms often
have their onset in childhood or adolescence, although the specific disorder may not be
identified for several years. Common signs of OCD in children are excessive hand washing
and avoidance of supposedly contaminated objects. Adolescents may have any of the
disorders that begin in childhood, or they may have the initial onset of any of the disorders
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commonly seen in adults. Developmental differences related to a psychopathologic condition
must be considered.
For example, ADHD is often seen in adolescents, but there are usually fewer
hyperactivity and impulsivity symptoms than in the school-aged child. Symptoms of several
of the personality disorders may become clinically apparent in the adolescent period,
although they are not usually diagnosed until an adolescent reaches 18 years of age. Dis
orders that are common in adolescents include the eating disorders, anorexia nervosa and
bulimia nervosa, and the substance related disorders. These include disorders of drug use and
abuse. They may involve the use of alcohol, cannabis, cocaine, or other substances.
Substance abuse is defined as substance use that interferes with a person’s capacity to meet
obligations in work, school, or home that results in a physically dangerous situation, legal
problems, or continued use despite recurrent problems. Substance dependence preempts a
diagnosis of abuse. Dependence involves a long-standing pattern of abuse that shows
tolerance, withdrawal, and a lack of control over the substance.
Inclusion education for school children with Behavioral disorders
'Inclusion' in education and schooling is not a new idea. During the past decade or so,
this approach to provision has become the dominant consensual notion amongst most
educationalists in most of the countries. Its adoption rests on a general consensus in the
research literature that all teachers are qualified to teach children with special needs.
Therefore, 'Inclusive Education' has come to mean the integration into mainstream
schools of children with special or particular learning needs or disabilities (physical,
intellectual, emotional), rather than in "Special" schools. Although children with behavioral
disorders do not come under a special disability category, they do drain extra energy from the
teachers and poise special challenges to the teachers and peers.
Inclusion education is the latest trend in our country. Students in an inclusive
classroom are generally placed with their chronological age-mates, regardless of whether the
students are working above or below the typical academic level for their age. Also, to
encourage a sense of belonging, emphasis is placed on the value of friendships. Teachers
often nurture a relationship between a student with special needs and a same-age student
without a special educational need. This is used to show students that a diverse group of
people make up a community, that no one type of student is better than another, and to
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remove any barriers to a friendship that may occur if a student is viewed as "helpless." Such
practices reduce the chance for elitism among students in later grades and encourage
cooperation among groups. Hence it is necessary to know how many children have
behavioural problems and how far this has influenced their academic performance and how
they have fit into the mainstream. There is no much literature to understand how the teachers
and peers receive and cope up with the children with behavioural disorders.
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