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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / MISS.ALIKUTTY K.
1ST YEAR M.Sc NURSING
RATHNA COLLEGE OF NURSING
B.M. ROAD, HASSAN,
KARNATAKA.
2 / NAME OF THE INSTITUTION / RATHNA COLLEGE OF NURSING
B.M. ROAD, HASSAN,
KARNATAKA.
3 / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
CHILD HEALTH NURSING
4 / DATE OF ADMISSION TO THE COURSE / 31.05.2010
5 / TITLE OF THE TOPIC / EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON BEHAVIOURAL PROBLEMS OF SCHOOL CHILDREN.
5.1 / STATEMENT OF THE PROBLEM / “A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON SELECTED BEHAVIOURAL PROBLEMS OF SCHOOL CHILDREN AMONG TEACHERS OF SELECTED PRIMARY SCHOOLS AT HASSAN.”

6. BRIEF RESUME OF THE INTENDED STUDY:

Introduction

“It is our responsibility to ensure bright future for today’s children so that tomorrow society will benefit”. DanOfford

Children under 16 years of age constitute over 40% of India’s population and information about their mental health need is a national imperative. Identification and handling of behavioral problems of childhood is very essential because nations most important and precious resource is its children who constitute its hope for continued achievement and productivity. Today we are passing through a stage where the mental health of youngsters is a matter of much concern for the educationists, psychologists and sociologists. 1

Normal behavior in children depends on the child’s age, personality and physical and 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 is socially, culturally and developmentally appropriate. Knowing what to expect from your child at each age will help you to decide whether his or her behavior is normal. Developmental and behavioral issues require an in-depth examination of a child’s medical, social, and family history. Difficult behaviors and academic concerns may develop secondary to medical problems, behavioral problems, delayed cognition and mood disorders. All of these issues must be explored to create a comprehensive diagnostic and treatment plan. 2

Child behavioral problems are serious and may have indirect effect in the child’s life in the future if not taken care of fast. The growing years of a child are perhaps the most difficult a family ever has. It is during these years that a child comes to terms with various concepts of life, like family belonging, discipline, social norms etc. It is necessary to differentiate between mischievous children and child behavioral problems. There is no known medical treatment for such behavioral problems in children. However, the at the proper time may help to solve this problem. 3

A cross sectional survey of school children was conducted to determine magnitude of specific behavioral disorders in children in Butajira, Southern Ethiopia. Amharic version of the diagnostic instrument for children and adolescents was used to interview parents of 1,477 children. The survey concluded that 5 % children had at least one or more behavioral disorders. The most frequent diagnosis was anxiety disorders (1.6%), attention deficit hyperactivity disorder (1.5%) and disruptive behavior disorders (1.5%). The study shows that specific mental and behavioral disorders in the children are significant public health problems. 4

In the effort to deal with deviant and devious behavior and create safe environments schools increasingly have adopted social control practices. These include some discipline and management practices that analysts see as “blaming the victim” and modeling behavior that foster rather than countries development of negative values. Misbehavior disrupts; it may be harmful; it may disinhibit others. When a student misbehaves, a natural reaction is to wait that youngster to experience and other students to see the consequences of misbehaving. One hope is that public awareness of consequences will deter subsequent problems. As a result primary intervention focus in schools.5

The behavioral problems of children undertake different dimension due to the changes of life style of human beings, these days. It becomes therefore imperative for parents and teachers to deal with children with a right mix of discipline and love. Identification of behavioral problems and its early intervention will go a long way in improving quality of life of those children. The quality and nature of the parental nurturance that a child receives will profoundly influence his future development. But only few homes provide the right type of environment to the growing child. Many children are denied the opportunities for healthy all round development,.2

A child’s coping mechanism is influenced by the individual developmental level, temperament, previous stress experiences, role models, and support of parents, teachers and peers. The dysfunctional behaviors lead to further physical or developmental problems. The common areas of behavioural problems are the interplay of self-concept and self-esteem. So behavioral modifications at home and school are teaching family techniques to support clear expectations, consistent routines, positive reinforcement for appropriate behaviors time out for negative behavior and teachers to meet individual needs for remediation or alternate instruction methods if necessary, structure activities to respond to child’s needs.6

Behavioral problems among children are a deviation from the accepted pattern of behavior on the part of children when they are exposed to an inconsistent social and cultural environment. (Verma 1964). But these are not be equated with the presence of psychiatric illness in the child as these are only the symptoms or reactions to emotional and environmental stress. In this age of momentous change and stiffer competition most of the parents rely on pre-schools of different categories of child care. The school experiences have an effective role in molding the behavior pattern of children.7

6.1 NEED FOR THE STUDY

A nation’s health depends on physically and mentally healthy citizens. According to WHO, Health is defined as “A state of complete physical, mental, social and spiritual well-being not merely the absence of disease or infirmity”. In order to produce healthy citizens, it is necessary to concentrate our attention towards the well-being of our children. Today’s child is tomorrows’ adult. The studies conducted over last fifty years regarding behavioural problems of school children invite our attention towards them. Beyond our calculations the prevalence of different types of behavioural problems are extremely high among them.

Children and adolescents with behavioural problem usually exhibit a pattern of defiant and disobedient behaviour, including resistance to authority figures. The behavior pattern may include recurrent temper problems, frequent arguments, especially with adults and evidence of anger and resentment. Additionally, the defiant child or adolescent will often try to annoy others, and will become easily annoyed by others. When mistakes are made she/he will almost always blame others, avoiding taking responsibility for mistakes. Active defiance of adult authority is common, and the child or adolescent may also display vindicative behaviour.8

A cross sectional study was conducted in selected private and community schools to find out screening for emotional and behavioural problems among 5-11 year old children in Karachi, Pakistan with the active participation of parents. The study was based on SDQ by parents based on cuff-off provided by Good men. The study concluded children attending private schools are more likely to be normal as compared to community schoolchildren, 9

In younger children behavioural problems are more common in boys, but during adolescence, it occurs as often in boys and girls. The unset is usually gradual, and the severity of behavioural problems increases over time. Some children will eventually develop a conduct disturbance, if the oppositional disorder is left untreated. Generally, treatment for oppositional disorder requires a combination of counseling for the child, and parental training in behavioural management techniques. Often, parents become too severe in reacting to the child, out of frustration. This causes their efforts to become ineffective, as the child ignores the punishment.10

A cross sectional study was conducted to identify the prevalence of behavioural problems among a sample of 5 to 8 year old Indian children, with a two-instrument two-phase design. In the first phase (screening) 48 teachers rated 1535 children from the schools of Bangalore city, on the 26 item Children’s Behaviour Questionnaire(CBQ ) .281 Children were identified as disturbed. In the second phase ,279 of children were identified as disturbed on the CBQ.11

A recent study conducted by Nirmala Gangaduri estimate that the prevalence of behavioural and emotional problems in pre-school children has increased over the past two decades to more than 10%. This number is considerable higher among pre-school and children who live in at risk environment (Gimpel and Holland). Research has shown that the emergence of early onset conduct problems in young children is related to a variety of health and behavioural problems such as peer rejection, drug abuse depression and school dropout in later years. So a right start in the early years is an invaluable aid to continuous unfolding of a child’s potentials. 12

A study was conducted on behavioral problems of school children in a pediatric out-patient department,50 children of age 6-14 years were selected after randomization, and subjected to CBCL, which was filled by the teachers. Most common behavioral problems was found in children, argues a lot (56%), cannot concentrate (54%), cannot sit still, restless, hyperactive (50). Female children had behavioral problems like too concerned with neatness or cleanliness, feels has to be perfect, and argues a lot. Study concluded; behavioral problems of school children need more attention. 13

The school is one of the most organized and powerful systems in the society, which presents opportunity to work through it and to influence the health and well being of children. Behavioral problems in children and adolescents have considerably increased during the last few years. School places a crucial and a formative role in the spheres of cognitive, language, emotional, social and moral development of children. So hope you that trained teachers who have positive attitude and practical knowledge. Concerning individual needs and problems can prevent and manage emotional and behavioral problems of school children.14

It is in this contest, the importance of a teacher become vital in safeguarding and promoting the mental health of children and early identification of deviations from normal.Hence, I hope the trained teachers can manage and prevent behavioral problems of school children to a certain extent, if they get adequate and sufficient knowledge regarding behavioral problems among school children.

6.2 REVIEW OF LITERATURE

Review of literature is a key step in research process. Review of literature is the reading and organizing of previously written materials relevant to the specific problems to be investigated: framework and methods appropriate to perform the study.

6.2.1.Studies related to prevalence of behavioural problems.

6.2.2.Studies related to types of behavioural problems.

6.2.3.Studies related to prevention and treatment of behavioural problems.

6.2.1. Studies related to prevalence of behavioural problems.

A study was conducted to find out the prevalence of behavioural problems in 957 school children using Rutter B scale which was to be completed by the class teachers in Ludhiana, India. 141 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. Based on screening instruments results and parental interview 45.6% of the children were estimated to have behavioral problems, of which 36.5% had significant problems the study concluded that close co-operation between school teachers, parents and health care providers is essential to ensure healthy development of children.15

A comparative study conducted on parents and teachers report for elementary school children’s behavioral and emotional problems Kuopio University Hospital Finland this study assessed the agreement and parents concerning behavioral and emotional symptoms of children. 567 children born in 1981 were studied using the Rutter parent questionnaire and the Rutter teacher questionnaire boys had more behavioral symptoms on both scales, 3.6% of the boys and 2.3 % of girls deviant on both scales. Agreement between parents and teachers on single behavior was better for event girls than event boys for all children moderate co-relation between parents and teachers rating where found in externalizing behavior and hyper activity. Correlation of the factors were clearly higher for deviant girls than for deviant boys.16

A study was conducted on Nigerian children to find out behavioural problems with the active participation of Nigerian teachers. The findings were measured from traditional psychological assessment and Rutter child behaviour questionnaire. Rutter’s scale was found highly valid instrument for identifying Nigerian children with behavioural problems. The study was concluded that Nigerian children scoring>or = 10 on Rutter’s Behaviour Questionnaire(Teacher’s scale),should be regarded as children with behavioural disorders. 17

A cross sectional survey among school children aged 5-11 years was conducted in 2006 in Karachi ,Pakistan to find out behavioural problems with the active participation of school teachers. Assessment of children’s mental health was conducted using Strength and Difficulties Questionnaire (SDQ). In this study, teachers’ estimation was slightly higher than the parents estimation. There was also a gender difference in prevalence; boys had higher estimates of behavioural problems, whereas emotional problems were more common amongst females.18

A prevalence study of emotional and behavioural disorders among 1186 (6-12 year) children in Minia, Egypt: Data was collected from teachers and parents using the Strengths and Difficulties Questionnaire with a 98 and 91% response respectively. Prevalence of abnormal symptom scores is reported for both parents and teachers. These prevalence has then been compared to published UK data. The findings shown that (Abnormal total difficulties: teachers 34.7% (95% CI 32.0-37.5) parents 20.6% (18.2-23.2). Abnormal prosocial scores: teachers 24.9% (22.5-27.5) parents 11.8% (9.9-13.9) but prevalence of probable psychiatric diagnoses was much lower (Any psychiatric diagnosis 8.5% (6.9-10.5); Emotional disorder 2.0% (1.2-3.0); Conduct disorder 6.6% (5.1-8.3); Hyperactivity disorder 0.7% (0.3-1.4). Comparison with UK data showed higher rates of symptoms but similar rates of probable disorders. These findings were concluded that the prevalence of emotional and behavioral symptoms was high as reported by both parents and teachers.19