RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
"A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PARENTS KNOWLEDGE REGARDING CONDUCT DISORDER AMONG CHILDREN IN SELECTED SCHOOLS AT BANGALORE".
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
SUBMITTED BY:
Ms. SUNITHA BOLLARAPU
I YEAR M.Sc. NURSING
CHILD HEALTH NURSING
SRI SHARADA COLLEGE OF NURSING
BANGALORE- 560061.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATEAND ADDRESS / Ms. SUNITHA BOLLARAPU
I YEAR M.Sc NURSING,
SRI SHARADA COLLEGE OF NURSING,
BANGALORE-560061.
2 / NAME OF THE INSTITUTION / SRI SHARADA COLLEGE OF NURSING,
UTTARAHALLI MAIN ROAD,
BANGALORE-560061.
3 / COURSE OF STUDY AND SUBJECT / MASTERS DEGREE IN NURSING
CHILD HEALTH NURSING
4 / DATE OF ADMISSION TO COURSE / 13.06.2012
5 / TITLE OF THE STUDY / A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PARENTS KNOWLEDGE REGARDING CONDUCT DISORDER AMONG CHILDREN IN SELECTED SCHOOLS AT BANGALORE.
6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION:
Children are the most important asset and wealth of a nation. Healthy children make a healthy nation. The children under 15 years of age constitute about 40% of the population. The quality of childhood one has lived will determine the ultimate nature of the adulthood. Now a day, because of the rapid industrialization and urbanization, majority of young couples are employed, so unavoidably they get less time to look after their children. Under these circumstances, emotional, behavior and psychiatric problems are on the rise.1
Between 200,000 and 300,000 children suffer from autism, a pervasive developmental disorder that appears in the first three years of life. Millions suffer from learning disorders, attention deficit disorder, and attachment disorders, conduct disorders and substance abuse.2
Parents whose children suffer from these illnesses often ask themselves, "What did I do wrong?" Self-blaming is not appropriate, since the causes are complex and never due to any single factor. The key is to recognize the problem and seek appropriate treatment. As with other types of illnesses, mental disorders have specific diagnostic criteria and treatments, and a complete evaluation by a child psychiatrist can determine whether a child needs help.3
Conduct Disorder is a psychiatric disorder of childhood and adolescence that is characterized by a persistent disregard for societal norms and rules, as manifested by aggression toward people or animals, destruction of property, theft or persistent lying, and other serious rule violations such as truancy and running away from home.4
Conduct disorder is one of the most frequently diagnosed disorders of childhood and adolescence. Currently, 2 to 6 percent, or from 1 to 4 million children and adolescents in the United States have Conduct Disorder. Conduct Disorder is as prevalent in preadolescent youths as in adolescent youths. Research has found prevalence rates of Conduct Disorder from 6 to 16 percent for boys and 2 to 9 percent for girls.5
The DSM-IV defines the 2 major subtypes of Conduct Disorder as childhood-onset type and adolescent-onset type. The childhood-onset type is defined by the presence of 1 criterion characteristic of Conduct Disorder before an individual is aged 10 years; these individuals are typically boys displaying high levels of aggressive behavior. These individuals often also meet criteria for attention deficit/hyperactivity disorder (ADHD). Poor peer and family relationships are present, and these problems tend to persist through adolescence into adult years. These children are more likely to develop adult antisocial personality disorder than individuals with the adolescent-onset type. 6
Adolescent-onset type is defined by the absence of any criterion characteristic of Conduct Disorder before an individual is aged 10 years. These individuals tend to be less aggressive and have more normative peer relationships. They often display their conduct behaviors in the company of a peer group engaged in these behaviors, such as a gang. These children are less likely to fit criteria for ADHD; however, the diagnosis of ADHD is still possible. 6
Conduct Disorder is caused mainly by society, especially by the family, parental rejection, harsh punishment, alcoholic or drug addict parents, and illegitimate child and absent father. 7 Children with conduct disorder will show aggressive behavior that harms or threatens other people or animals, destructive behavior that damages or destroys property, lying or theft, truancy or other serious violations of rules, early tobacco, alcohol, and substance abuse and precocious sexual activity. 8
Treating conduct disorder requires an approach that addresses both the child and his environment. Behavioral therapy and psychotherapy can help a child with conduct disorder to control his anger and develop new coping skills. Family group therapy may also be effective in some cases. Parents should be counseled on how to set appropriate limits with their child and be consistent and realistic when disciplining. If an abusive home life is at the root of the conduct problem, every effort should be made to move the child into a more supportive environment. 9
Follow-up studies of conduct-disordered children have shown a high incidence of antisocial personality disorder, affective illnesses, and chronic criminal behavior later in life. However, proper treatment of coexisting disorders, early identification and intervention, and long-term support may improve the outlook significantly. 10
6.1. NEED FOR THE STUDY:
Conduct disorder is a major health and social problem. It is the most common psychiatric disorder in childhood, with a prevalence of around 5% across the world, which is rising. Although delinquent adolescents do the greatest damage to society, the disorder usually starts below the age of 7 years .11
A study was conducted in Pondicherry, India to find out the prevalence of mental disorders in school-age children attending a general pediatric department. Out of 313 children of age 5, 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. Mental disorders were significantly related to urban background, middle-class socioeconomic status and literate parents compared with age and sex-matched controls. There was no significant relationship with the type of family and number of siblings. Conversion disorder (31%) was the commonest, followed by conduct disorders (16%). 12
Among other Indian studies, Deivasigamani has reported the prevalence of Conduct Disorder to be 11.13%.13 Sarkar reported the prevalence rate of antisocial behavior to be 7.1%.14. ADHD is common co morbidity in children with conduct disorder.15
Ineffective parenting and poor disciplinary practices at home and at school are major determinants of this disorder. However, researchers have not yet discovered what exactly causes conduct disorder, but they continue to investigate several psychological, sociological and biological theories. Psychological and psychoanalytical theories suggest that aggressive, antisocial behavior is a defense against anxiety, an attempt to recapture the mother-infant relationship, the result of maternal deprivation, or a failure to internalize controls. 16
Sociological theories suggest that conduct disorders result from a child's attempt to cope with a hostile environment, to get material goods that come with living in an affluent society, or to gain social status among friends. Other sociologists say inconsistent parenting contributes to the development of the disorders. 16
Finally, biological theories point to a number of studies that indicate youngsters could inherit a vulnerability to the disorders. Children of criminal or antisocial parents tend to develop the same problems. Moreover, because so many more boys than girls develop the disorder, some think male hormones may play a role. Still other biological researchers think a problem in the central nervous system could contribute to the erratic and antisocial behavior. 16
Difficulty in school is an early sign of potential conduct disorder problems. While the child’s IQ tends to be in the normal range, they can have trouble with verbal and abstract reasoning skills and may lag behind their classmates. Consequently, they feel as if they don't "fit in." The frustration and loss of self-esteem resulting from this academic and social inadequacy can trigger the development of conduct disorder. 17
The management of this disorder requires input from the family, society, education sector, health sector, social services, and the police 18. The family and parents are the most important influence in a child’s life especially in promoting social, emotional and academic development. Parents play a very important role in early identification of the behavioral problems among their children. Hence, the knowledge of parents in this area is helpful in identifying and analyzing what the problematic behavior actually means to the individual child. This can lead to an early referral to health services that can change the behavior. So the investigator had an interest to assess the effectiveness of structured teaching programme on knowledge of parents regarding conduct disorder and its management among children.
6.2. REVIEW OF LITERATURE:
A study was conducted in Germany to find out whether conduct-disordered children differ from healthy children in reference to their moral development and to what extent cognitive and education factors; respectively psychosocial stress factors mediate the level of socio-moral development. A sample of 16 boys aged 9 to 14 years with an ICD-10 diagnosis of Conduct Disorder were compared to 16 age-matched healthy controls. Socio-moral Reflection Measure was used to collect data. Results revealed that conduct-disordered boys differ from their healthy counterparts in terms of the level of socio-moral maturity of judgment. The factors "intelligence" and "maternal support" exercise a decisive influence on socio-moral development.19
A prospective longitudinal epidemiological study was conducted in Germany on the prevalence and follow-up of psychiatric disorders in childhood and adolescence in the age group of 8-13yrs. Study revealed that one of every four children suffered from a psychiatric disorder for at least 10 years. In childhood, conduct disorders had a very poor prognosis. In adolescence, the course of disorders depended on an interaction between diagnosis and gender. Boys with un socialized disturbances and girls with emotional problems had a poor prognosis.20
A screening interview was conducted among 240 students who are studying in V to X classes in 4 schools of kanke. The study result shown that 19 students were subjected to conduct disorder and ADHD .Conduct disorder was found in 4.58%; the ratio of boys to girls being 4.5:1. Childhood onset was found in 73% and adolescent onset in 27%. Mild conduct disorder was found in 36%, moderate in 64% and severe conduct disorder in none. Co morbid ADHD was found in 36%, hyperactive-impulsive being predominant. Lying, bullying and cruelty to animals were most frequent symptoms. It was concluded that conduct disorder was prevalent among boys and the majority had childhood onset, and one-third had co-morbid ADHD.21
A study was conducted to explore the association between adult delinquency and several different childhood diagnoses in an in-patient population. Former Norwegian child psychiatric in-patients (n = 541) were followed up 19-41 years after hospitalization by record linkage to the National Register of Criminality. On the basis of the hospital records, the patients were re-diagnosed according to ICD-10. The association between diagnoses and other baseline factors and later delinquency were investigated using univariate and multivariate Cox regression analyses. At follow-up, 24% of the participants had been convicted of criminal activity. Result shown conduct disorder (RR = 2.0, 95%CI = 1.2-3.4) and hyperkinetic conduct disorder (RR = 2.7, 95% CI = 1.6-4.4) significantly increased the risk of future criminal behaviour. Pervasive developmental disorder (RR = 0.4, 95%CI = 0.2-0.9) and mental retardation (RR = 0.4, 95%CI = 0.3-0.8) reduced the risk for a criminal act. Male gender (RR = 3.6, 95%CI = 2.1-6.1) and chronic family difficulties (RR = 1.3, 95% CI = 1.1-1.5) both predicted future criminality. Conduct disorder in childhood was highly associated with later delinquency both alone or in combination with hyperactivity, but less associated when combined with an emotional disorder. 22
A study was conducted in Dhaka, Bangladesh to estimate the prevalence of different types of behavior disorders and to assess whether and how this prevalence were associated with the children’s gender. Sample of 1288 children were taken. Multivariate logistic regression analysis was used in this study. 13.4% had some type of behavior disorder, with males more than twice as commonly affected than females (20.4% vs. 9.9%). Emotional, conduct, and undifferentiated disorders were detected in 3.2%, 8.9% and 1.2%, respectively. The results suggest that a mental health care programme for these children comprising screening and, if indicated, full evaluation and expert care would be worthwhile. 23
A study was conducted in Ludhiana, India to assess Behavioral Problems in School-going Children. Sample size was 957 children. Rutter B scale was used to collect data. 45.6% of the children were estimated to have behavioral problems, of which 36.5% had significant problems. Study revealed that close cooperation between schoolteachers, parents, and health care providers were essential to ensure healthy development of children.24
From the above studies it is concluded that conduct disorder is more prevalent among school going children, which is seen more in boys than in girls. The parents have the responsibility to identify their children with conduct disorder and structured teaching programme can improve the knowledge of parents.
STATEMENT OF THE PROBLEM:
A study to assess the effectiveness of structured teaching programme on parents knowledge regarding conduct disorder among children in selected schools at Bangalore.
6.3. OBJECTIVES OF THE STUDY
1. To assess the knowledge of parents regarding conduct disorder among children.
2. To educate parents regarding conduct disorder by using a structured teaching programme.
3. To determine the effectiveness of structured teaching programme by comparing the pre and post-test scores.
4. To determine the association between the pre and post test knowledge scores with selected demographic variables.
OPERATIONAL DEFINITIONS:
KNOWLEDGE:
It refers to the response of the parents regarding conduct disorder among children.
EFFECTIVENESS:
Refers to gain in knowledge scores regarding conduct disorder as determined by difference between pre and post-test knowledge scores.
STRUCTURED TEACHING PROGRAMME:
Refers to the systematically developed instructional and teaching method by using teaching aids designed by the investigator for to teach parents regarding conduct disorder.