Performa for Registration Of

PERFORMA FOR REGISTRATION OF

SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE WITH ADDRESS:

Mr. VINODKUMAR PATIL

1ST YEAR M.Sc. (N)

J.S.S.COLLEGE OF NURSING

MYSORE.

2. NAME OF THE INSTITUTION:

J.S.S.COLLEGE OF NURSING

I MAIN, SARASWATHIPURAM,

MYSORE.

3. COURSE OF THE STUDY AND SUBJECT:

M.Sc. NURSING

PSYCHIATRIC NURSING

4. DATE OF THE ADMISSION TO THE COURSE:

04-06-2007

5. TITLE OF THE TOPIC:

“AN EXPLORATORY AND EVALUATIVE STUDY OF THE

PREVALENCE OF BEHAVIORAL PROBLEMS AMONG

SCHOOLGOING CHILDREN AND EFFECT OF PARENTAL

TEACHING PROGAMME REGARDING ITS MANAGEMENT

ON THE KNOWLEDGE OF PARENTS IN SELECTED SCHOOLS

OFMYSORE.”

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION:

Normal behavior In children depends on the child’s age, personality, and physical & emotional development. A child’s behavior may be a problem if it does not match the expectations of the family or if it is disruptive. Normal or good behavior is usually determined by whether it’s socially, culturally and developmentally appropriate. Knowing what to expect from children at each age will help us to decide whether his or her behavior is normal.

Bringing up children is complicated and tiring experience, but it can also be great fun and very rewarding. It is ironic that despite the fact that it is one of the most important jobs anyone ever does, it does not receive that recognition and there is virtually not training available.

Children can be lovable one minute, and thoroughly disagreeable the next. They can be the source of immense joy but the cause of the much frustration and irritation, they can make enormous demands on their parents but equally they can give you unconditional love and an immeasurable sense of importance.

It is inevitable that as parents they will worry from time to time when they suspect their child may have serious problems. But all children occasionally have problems, difficulties; most are fortunately mild and short lived. Some, however, are more serious or long lasting and for such long lasting problems parents should seek advice from child mental health professionals.

An important point to remember is that parents & teachersshould expect different behavior at different ages. A particular type of behavior tiresome, may be quite normal at one age, and yet could be the sign of a problem at another. Teachers & parents play an important role in identifying behavioral problem in children.

The parents should know all the common factors, which puts a child into a problem. All parents want to be good parents, and give their children the very best, this can be a very difficult task, for children grow and change so quickly and each new stage can bring another set of problems.

A famous British pediatrician and psychoanalyst, “Donald Winnicott”, coined the phrase good-enough mothering. he used the term to refer to a mothers ability to recognize and respond to her child’s needs, without necessarily having to be a perfect mother who does everything right, all the time.

Assuming parenting is “good-enough” most behavior or emotional problems that arise can be short lived. Inevitably, there will be some problems that are a result of ill health, personality idiosyncrasies, extreme shyness, or major traumas such as a loss of loved one. Even so, good enough parenting can help many such children to cope relatively satisfactorily, and is the key to helping a child with emotional and behavioral problems.

6.1 NEED FOR THE STUDY:

“Children are one third of our population and all of our future” The care, survival and development of children are our concern1. Every child is unique. They develop Physically, Mentally and emotionally at their own pace.2 However all children follow basic patterns of growth and development from infancy to childhood3. Issues regarding behavioral problems related to socialization, school phobia, supranational anxiety, and temper tantrums, etc., most parents will face.

In school age children, return of temper tantrum may be of verbal abuse, physical attack, wiggling, nose picking, chewing of hair and the adolescents establishes interdependent relationship with parents, severe ties with parents, have fewer but closer friends. Each and every child will pass all the stages of growth and development, whose normal behavior brings more fun and happiness into the family.4 It can be difficult to assess whether the behavior of children is normal or sufficiently problematical to require intervention. Judgment requires taking into account the frequency, range and intensity of symptoms and the extent to which they cause impairment.14

The parents and teachers must know about the behavior, which commonly characterize each different age level, so that parents and teachers can do a better job in dealing with the child also; the problems they will face or not all unpredictable, they too follow asset pattern. eg: 5 year old child is loving, docile and obedient in his relation with mother & also with teachers. 5 to 6 year child tends to thrust out and resist her in his effort to be a big boy. The adolescent, if he is to grow up into a mature capable adult, must learn to think and act for himself; must grow beyond the places, where he is guided by what “parents says”.

A study was conducted by Susan Bradley in 1998 in Toranto Ontaria showed that, the parents who received intervention reported significantly greater reduction in child behavioral problem than the parents who did not receive. The gains in positive parenting behavior were maintained at one-year follow up in a subset of the experimental group.8

The child does not seek help by self. Often a child’s understanding of what troubles him/her may be at variance with the reports of parents & teachers. Also, many behavioral problems are situation-specific. For ex: a child may have severe temper tantrum only when he is with his parents, or a child who is obedient at home may be disruptive in classroom.1

The parents can be a cause for the abnormal behavior of children. eg: the parents who were abused or have experienced family disruption in their childhood, lack of family support and are unreasonable expectations of their baby and treat him as a much older child, parents with poor impulse control, may be generally rigid or authoritarian (eg: some strict religious groups and in families of military personnel) and children of depressed mothers, Children who born to those parents are not only at risk for occurrence of psychopathology and it may lead to behavioral problems. Children between the ages of 1-12 years whose mothers were depressed - displayed more conduct behavioral problems than others. Children of mothers with depressive symptoms were more likely to have internalizing problems.Sometimes the normal behavior of the child makes the mother frustrated, arrogant and strict towards the child, if it persists leads to behavioral problems in order to withstand the mother’s anger.

Child is always the passive recipient of treatment and hardly has only choice of taking any decision concerning itself. Early diagnosis and early intervention have tremendous rewards and importance in children as compared to an adult. Behavioral modification at an early stage can prevent many tragic squeals as compared to an adult where early intervention may not be that much cost effective.

Family members, especially parents are often the main providers of health care to the family. It is the mother, who renders care for the children, observes the condition of children and who notices and attempts to treat behavioral deviations in children. This means that mothers are the primary caretakers and plays a vital role in the normal growth and development of their children. Mothers need to have a good knowledge related to health care including hygiene, feeding and observation of child’s milestones, the signs of early deviations from the normal growth and development. and also parents should encourage the children, to develop adequate interpersonal relationships with family members and friends, peer groups and neighbors, which is a sound basis for social life and the children will be able to make good personal and social adjustment.

A study was conducted over a period of 18 months in a medical college hospital in southern India. Of 313 children of age 5 and above referred for detailed psychiatric evaluation, 101 were found to have a mental disorder according to DSM-III-R criteria; the remaining had organic disorders. Children above 8 years (74%) registered higher morbidity. There was no sex difference in overall morbidity. Precipitating factors were discernible in half of these cases, of which school-related problems were found in the majority. Almost two-thirds had multiple stressors, of which chronic family and social adversity (39%) and learning disabilities (28%) were common.

A cross sectional study was conducted to identify Prevalence of psychiatric Morbidity among 6 to 14 Year old Children. Sample collected from 400 children each from urban and rural field practice areas the study result showed that, Prevalence of Psychiatric disorders in children was found to be 16.5%. Conduct disorder was the most common psychiatric disorder observed (4.5%) in these children followed by mental retardation (3.25%). Prevalence was more in male children (18.37%) than in female children (14.44%), more common among scheduled caste children (18.4%), also in children who belonged to nuclear families(17.35%).School refusal is a problem that is stressful for children, families, and school personnel. Failing to attend school has significant short- and long-term effects on children's social, emotional, and educational development. School refusal often is associated with comorbid psychiatric disorders such as anxiety and depression. It is important to identify problems early and provide appropriate interventions to prevent further difficulties.

Recent children's health surveys have documented a high prevalence of emotional, developmental, and behavioral problems among children. Data from the 2003 National Survey of Children's Health provide new insights into these problems and their association with family function and community participation. These issues have become a current focus of the World Health Organization. The most commonly diagnosed problems among children 6–17 years of age were learning disabilities (11.5%), attention-deficit/hyperactivity disorder (8.8%), and behavioral problems (6.3%); among preschoolers, speech problems (5.8%) and developmental delay (3.2%) were most common. One in 200 children was diagnosed with autism. In contrast, rates of parental concerns about emotional, developmental, or behavioral problems were much higher; for example, 41% of parents had concerns about learning difficulties and 36% about depression or anxiety. Children with developmental problems had lower self-esteem, more depression and anxiety, more problems with learning, missed more school, and were less involved in sports and other community activities. Their families experienced more difficulty in the areas of childcare, employment, parent-child relationships, and caregiver burden.

Hence the children should not be neglected and should be provided love, affection and emotional security. The parents should maintain good quality of relationship within them self and with their children.

The review of literature revealed that most of the studies done abroad regarding to assess the behavioral problems in school going children and very few studies have been done among parents. In India, though some non-research literature is available but no researched literature could be traced out regarding parents’ knowledge on management of behavioral problems among school going children. This promoted the researcher to take this study which aims at exploring the prevalence of behavioral problems among school going children and evaluate the effect of PTP regarding its management on the knowledge of parents at selected schools of Mysore.

6.2 REVIEW OF LITERATURE:

The study was conducted on 957 school children using Rutter B scale which was to be completed by the class teachers in Ludhiana, India. One hundred and forty-one children (14.6%) scored more than 9 points and were included in the second part of the study. An equal number of sex matched children scoring less than 9 points served as controls. Both these groups were called for an interview with a child psychiatrist along with their parents. Only 117 and 124 children turned up and were included in the analysis. Based on the screening instrument results and parental interview, 45.6% of the children were estimated to have behavioral problems, of which 36.5% had significant problems. It was noticed that neither the screening instrument nor the interview was able to detect all the problems. Scholastic under-achievement was found to be associated with maximum problems. Scholastic under-achievement can be a useful starting point of identifying children with behavioral problems. Close cooperation between school teachers, parents, and health care providers is essential to ensure healthy development of children.13

A study was conducted to assess the sleep habits and problems of 103 young school going healthy children (3-10 yr) during their visit to hospital for minor illnesses or routine health visits for immunization. The average duration of daily sleep (nocturnal and daytime nap) was 10.32 ± 1.18 hours and the percentage of children who took regular daytime nap was 28.2%. Co- sleeping, a traditional cultural practice in India was found in 93% of the children. Sleep related problems were reported in 42.7% children that included nocturnal enuresis (18.4%), sleep talking (14.6%), bruxism (11.6%) nightmares (6.8%), night terrors (2.9%) snoring (5.8%) and sleepwalking (1.9%) Mental health problems can affect school performance and academic achievement. When mental health problems are not recognized, students may be unable to reach their academic potential. School nurses & teachers are in a key position to provide interventions to address mental health and academic achievement.12

A study was conducted to identify behavioral Problems in Children with Newly Diagnosed Idiopathic or CryptogenicEpilepsyAttendingNormal Schools. The purpose of the study was to investigate relevant adults' perceptions of behavioral problems in 66 children with newly diagnosed "epilepsy only" and in 63 healthy gender-matched classmates. Parents' and teachers' perceptions of the children's behavioral problems were quantified by using the Total Problem score of the Child Behavior Checklist (CBCL) and the Teacher's Report Form (TRF), after correction for epilepsy-related item ambiguity. Questionnaires were filled out immediately after diagnosis and 3 and 12 months later. Relations with demographic and educational variables, school attitudes, and interview-derived prior adversities were analyzed. The result showed that children with cryptogenic rather than those with idiopathic epilepsy have more behavioral problems than do healthy classmates.11

A comparative study was conducted to investigates child self rating of behavioral problems & competence as compared with their parent’s ratings, samples are collected in Kurdistanian refugee children in Sweden & a group of Swedish children. Samples composed of 32 children each matched in age, sex & trauma level, in the same community, & their parents. Among large battery of instruments, the child behavioral checklist was used in separate interviews with parents & their children. When compared to the children’s self reported problems scores, the Swedish parents reported significantly lower scores than their children, compared to the Kurdistanian refuge parents. The study was concluded that, regardless of cultural backgrounds, there were more similarities than the differences in the children’s reporting of their behavioral problems & competence. The discrepancy between the Swedish parents’ estimation of their children’s behavioral problems & the children’s self reported behavioral problems could be an effect of the individualistic nature of Swedish society compared with the more collective nature of Kurdistanian culture.5

A evaluative study was conducted to evaluate the risk of long term behavioral problems & psychiatric disorders associated with being born with low birth weight. A population based. Controlled follow up study at 11 years of age of 130 low birth weight children weighing less than 2000g at birth who were without major handicaps, & a random sample of 131 normal birth weight children born at term weighing over 3000g. the main outcome measures were validated questionnaires addressing behavior completed by mothers & teachers & child evaluation by child evaluation by child psychiatrist using a semi structured interview. Behavioral problems, as defined by abnormal scores on more than four of 32 measures, were found in 40% of LBW children compared with 7% of NBW children. A psychiatric disorder was diagnosed in 27% of LBW children compared with 9% of the NBW children. The LBW children were more often inattentive, had social problems, & low self esteem. The study was concluded that, behavioral problems & psychiatric disorders were as common in those with birth weight less than 1500g as those with birth weight 1500-2000g.7

STATEMENT OF THE PROBLEM:

“An exploratory and evaluative study of the prevalence of behavioral problems among school going children and effect of parental teaching progamme regarding its management on the knowledge of parents in selected schools of Mysore.”

6.3 OBJECTIVES:

1. To identify the prevalence of behavioral problems among school going children

at selected primary schools.

2. To assess the knowledge of parents regarding management of behavioral

problem amongschool going children before and after parental teaching

progrmme.

3. To determine the effect of parental teaching programme regarding management

of behavioral problems in terms of gain in knowledge score of parents.

4. To determine the association between knowledge score of parents regarding

management of behavioral problem among school going children with their