RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE & ADDRESS / G. INDUMATHIGOLDFINCH COLLEGE OF NURSING
NO. 150 /24 , KODIGEHALLI MAIN ROAD,
MARUTHI NAGAR ,
BANGALORE – 560092
2 / NAME OF THE INSTITUTION / GOLDFINCH COLLEGE OF NURSING
MARUTHI NAGAR, BANGALORE
3 / COURSE OF STUDY & SUBJECT / M.SC. NURSING
PSYCHIATRY NURSING SPECIALITY
4 / DATE OF ADMISSION / 30-06-2010
5 / TITLE OF THE STUDY :
A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAM ON KNOWLEDGE OF PRIMARY SCHOOL TEACHERS ON BEHAVIOURS INDICATING EMOTIONAL PROBLEMS AMONG SCHOOL AGE CHILDREN IN SELECTED SCHOOLS AT BANGALORE
6.0 BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Children are mirror of a nation. They are our future and our most precious resources. The quality of tomorrow’s world and perhaps even its survival will be determined by the well-being, safety and the physical and intellectual development of children today. To predict the future of a nation, it has been remarked, one need not consult the stars; it can more easily and plainly be read in the faces of its children.
India has 375 million children, more than any other in the world. There are more children under the age of 14 and above 14 in India than the entire of USA 18.
According to World Health Report 15 % of children have serious emotional disturbance. Epidemiological study of child and adolescent psychiatric disorders conducted by ICMR indicated the overall prevalence of mental and behavioural disorders in Indian children to be 12.5% . Mental disorders account for 5 of the top 10 leading causes of disability in the world for children above 5 years of age. Besides the increase in number of children seeking help for emotional problems, over the years, the type of problems has also undergone a tremendous change.
Indian studies also reflect similar variability. Studies conducted in rural and urban areas of different part of India suggest prevalence range ranging from approximately 1.16 % to 43.1 % .In a review article Prakash concluded that various studies reflected diversity in diagnostic criteria , selection procedures , methods of identification , nature of population and finally the prevalence of the behaviour. 18.
A study of 353 residential school children in the age range of 10 to 16 years in Karnataka, reported a prevalence rate of 25 percent on CBQ. The most frequently reported symptoms were irritability (71 per cent ) telling lies (65 per cent ), fearful and fussy ( 40 percent each ) aloof and withdrawn ( 39 percent ). A significantly greater extent of psychological disturbance was reported in the 11 to 12 years old and scholastic problems in 11 to 13 years old. 40 percent had average or above average scholastic performance16.
According to the Office for National Statistics 2004, 10% of children in the UK suffer extreme behavioural or emotional problems that put a strain on their family situation. The BBC reported in 2003 that at least 1 in 20 school children in England and Wales are Thought to have Attention Deficit Hyperactivity Disorder ( ADHD) to a certain degree with prescriptions for the drug Ritalin doubling between 1999 and 2003. For 70% of children with ADHD the condition Continues into adolescence and for 10%, into adulthood.
The British Medical Association reported in 2006 that at any one time a million children are encountering behavioural problems, including depression, violence and self-harm 7.The early years of life are important in the development of young children. Parents in 21st Century face many challenges and issues such as poverty, stress and health problems which affect the health and development of children and have linked to behavioural problems in childhood.
Schools provide important places to offer preventive intervention by teachers by following certain guidelines of programmes .It will be helpful if parents and teachers work
together in identifying the early signs of behavioural problems .It is vital that school children with behavioural problems are properly diagnosed so that treatment can be started 15.
Later behavioural studies
An epidemiological study of bevioural problems in schools childern was done in china. A local of 2432 primary school children , aged 7 to 10 years in urban areas of beijing , were evaluated with the children behaviour questionaire developed by RUTTER .The frequency of behavioural problems in primary school was 8.3 % to 7.4% antisocial behaviour and 0.62% neurotic behaviour.
The researcher also found that behaviour problems were higher in boys than girls, antisocial behaviour was dominant in boys, while neurotic behaviour was common in girls. It is generally acknowledged that behavioural and social problems in schooling are most prevalent during the middle years. Teachers in the middle years typically experience challenges around managing the behaviour of their students, maintaining effective and productive classroom environments, and ensuring students’ engagement in learning and their achievement progress especially in literacy. This also raises issues related to the vital link between education and health.
Past researchers suggest that teachers who are the most the effective classroom managers are teachers who are the most confident in their abilities . Therefore, the importance of preparedness and classroom experiences as factors that are involved in the development and maintenance of teacher’s efficiency in behaviour management were assessed. The results revealed a significant positive association between efficiency in behaviour management, preparedness and classroom experiences.
Research using Emmer and Hickman’s scale revealed self-efficacy in behaviour management was a significant predictor for the preference of behaviour management strategies employed. Teachers high in self-efficacy were more likely to use positive teaching strategies, such as praise, modifying teaching approaches, and encouragement for effort. While teachers low in self-efficacy tended to employ reductive strategies, such as time out, warnings, and loss of privileges (Emmer & Hickman, 1991). There is limited research using appropriate measures to assess self-efficacy in specific teaching skills, and further research using such scales is needed. What is known, however, is that the development of teacher self efficacy in specific domains is influenced by a number of variables 12.
Conduct problems
In a study of 50 cases of schools refusal and 50 of truancy, reported that truants came from larger families, with consistent home discipline, parental absence infancy and in later childhood. They changed schools frequently, their standard of work was poor, and truancy was an indication of conduct disturbance. The younger children have less experience in coping with parental absence and tended to be overprotected. Neurosis was also present in the families of
School phobia 16
In a follow up study of 110 conduct disordered found that five setting trouble with the low and sexual promiscuity were not found in India. But going to the movies without informing the families, fighting , hitting, temper tantrums, being demanding and disobedient in the family context were frequently reported. 16 .
In a study on disruptive children stand out or differ from others of their group because of certain undesirable habits, personality traits or behaviour in the home , school or community whose conduct interferes, or is likely to be interfere with the individuals or the groups fullest
development and usefulness socially , educationally, or hygienically and whose behaviour may result in more serious handicaps of one sort or another in later life. Such behaviour conflicts with acceptable standards of obedience, orderliness and mortality. It becomes a social problem when the destructive child fails to confirm to classroom routine , described school work, violates standards of integrity and is against the authority (Carr and Sharma,1990) 16.
Emotional problems
In a study out of the 950 children attending a child guidance clinic , 32 had behaviour disorders . Three out of 32 were hyperkinetic, yielding a prevalence rate of 0.4 percent . In a multicentre in four cities of India (Bangalore, Delhi, Lucknow and Visakhapatnam) sponsored by Indian council of medical research (1984) 9 per cent cases (out of 1,836 cases attending psychiatric clinics ) were diagnosed as hyperkinetic 16.
A study of 428 urban adolescents belonging to middle and upper socio- economic
status in the age group of 13 to 16 years .Rao reported an overall prevalence rate of 19.6 per cent i.e., 84 cases were found to be disturbed ( 29 girls and 55 boys ). 47 had minor depression, 21 had symptoms of anxiety, 8 had psychogenic headache, 7 had giddiness, inability to concentrate and vague pains and aches, and 1 boy was schizophrenic .The boarders were significantly more disturbed than day scholars, 8 were reported to be in need of psychiatric help. This study reported that academic performances and psychiatric morbidity were inversely related 16.
In a study 980 school children were assessed. Among those 73.06 per cent of the children, problems such as enuresis, mental retardation, behavioural problems and hyper activity were identified. 16
A study of10 children who had been rated as hyperactive on the O' Connor scale by the teachers. Out of these 10, only 1 child was diagnosed as having hyperkinetic syndrome by the clinician. when compared to a group of 10 children diagnosed as hyper kinetic in the child psychiatric NIMHANS, the children rated as overactive in the school setting were also found to be superior to the clinic cases in their level of intellectual functioning, special perception and organization, better memory for visual and auditory stimuli, were less impulsive, and had higher social maturity. The overactive children in the school setting were also superior in their performance on some tests, when compared to their normal counterparts.16
Achenbach listed items of disruptive behaviour or inappropriate behaviour in a class room which are as follows: humming odd noises, argument, failure to finish things started, behaving like opposite sex , defiant ,talking back , hyperactive , irritable , fidgeting , day dreaming ,destroying own things getting into fights, biting finger nails , anxious , sleeping in class , clumsy behaviour , refusing to talk , acting out behaviour , screaming , stubborn , moody, sulking ,swearing , obscene language , overtalking and withdrawn behaviour.
6.1 NEED FOR THE STUDY
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. 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 7.
Behavioural and emotional problems in primary school aged children can cause significant difficulties in children's healthy development. For many children, they are also predictive of longer-term antisocial behaviours and mental health problems. Some children show symptoms that are consistent with diagnoses of Anxiety, Depression, Oppositional Defiant Disorder (ODD), Attention-Deficit Disorder (ADHD), and Conduct Disorder (CD) (American Psychiatric Association, 1994). As well as causing significant distress for children and families during their childhood, children with emotional and behavioural problems face an increased risk of low self-esteem, relationship problems with peers and family members, academic difficulties, early school leaving, adolescent homelessness, the development of substance abuse issues and criminality.
In order to address the current impacts on children's lives, as well as prevent long-term antisocial behaviours and mental health problems in adolescence and adulthood, early identification and effective treatment of childhood behavioural and emotional problems is crucial. Research has shown that the most effective interventions include parent training programs, children's social problem solving and emotion management training, parent-child interaction therapy and a combination of these components.
An effective intervention that combines parent behaviour management training, children's social problem solving and emotion management training and parent-child interactive therapy is the Exploring Together Program (ETP). Small groups of six to eight primary school aged children and their primary caregivers attend the ETP for 1¾ hours per week for 10 weeks. Separate, concurrent groups are held simultaneously for parents/carers and children (lasting 1 hour) each week, immediately followed by a combined parent-child group (lasting 45 minutes).
Throughout the program, additional meetings are held on two occasions for attending parents and their partners or support people. Group leaders also meet twice with children's teachers, once near the start and again near the end of the program. ETP was designed to be conducted as a short-term intervention program for primary school aged children (6 to 12 years old). It has also been adapted for secondary school students (12 to 16 year olds) and for preschool aged children (3 to 6 year olds). Since the early 1990s, Exploring Together Programs for primary school students have been implemented in suburban and regional areas of Australia in a large variety of schools and community agencies, with the majority of programs being conducted by teachers, social workers and psychologists trained in the program. Studies have revealed the program's continuing effectiveness and efficacy.
The prevalence of behavioural problems in the western literature has been reported to vary between 5 - 15% 2`3 the position in developing countries remains less clear. An awareness of the prevalence of these problems is important to plan mental health services for children in order to offer help and thereby improve the quality of life of the affected children. This could also have a bearing on the physicians approach to management of such children and the counseling of parents would make them better equipped to deal with these problems.
Epidemiology of behavioural disorders of children in India is not well studied. It is time we pay more importance and attention to all the influences that impede normal development of a child and to circumstances that prevent children developing normally in situations of stress, deprivation and social disadvantage. The schoolteachers are in a unique position to observe the child both at work and play and their role in detection of early symptoms cannot be overlooked 16.
However we need to advocate more active involvement of parents with the teachers, with the realization that early detection and intervention may go a long way in preventing a deviance from becoming a disorder. A large number of studies carried out in our own country have only reiterated this fact. A study by Deivasigamani using the same scale and similar methodology showed that 16.1% of 755 children screened had a deviant score. Usha Naik applied the scale on children attending the Rural School Health Clinic in Hyderabad using a cutoff point of 5 and reported a prevalence of 10.6%.