Managing Common Behavioural

Problems in Schools

Dr. V. Jithesh
AMCHSS - SCTIMST
When he was very young he was slow in
development. He didn't speak until he was
two years old, and even when he was older
he had trouble answering a question. He
would first silently mouth the words to
himself and then slowly answer out loud. His
teachers said he was dumb and would never
be successful at anything.
 His family moved to @@@@ where he attended a high
school called @@@. He was bored at the school. His
family next moved to @@@, but they wanted him to finish
the school year in @@@. He wanted to leave so badly that
he got a false paper from a doctor stating he had a lung
condition and must move to a dry climate. Then he
convinced the school to give him a certificate in Maths so
he could get into college. They complied because they
wanted to get rid of him. 
Dyslexia
Definition
 Dyslexia is difficulty with language.
People with dyslexia typically have
average to above average intelligence.
They may have difficulty with reading,
spelling, understanding language they
hear, or expressing themselves clearly in
speaking or in writing. An unexpected gap
exists between their potential for
learning and their school achievement.
Characteristics of Dyslexia

 Slow Word Recall

 Average or Above Intelligence
 Beyond third grade continuing to reverse and invert
letters and transpose words
 More difficulty decoding nonsense words than content
words
 Difficulty decoding single words in isolation
 Difficulty with letter/sound relationships
 Confusing small words such as at for to, said for and,
does for goes.
 Transposes number sequences and arithmetic signs (+,
-, x, =) although math skills are typically a strength
 May have difficulty learning to tell time
 Spelling is usually difficult, frequently spells
the same word differently in a single piece of
writing
 Frequently able to decode a word they cannot
spell
 Listening comprehension is usually a strength
and the student typically can comprehend at
grade level what he hears orally
 Poor grasp of abstract concepts
 Difficulty in telling or retelling a story
 Difficulty with rhyming words
 When he was six, his father gave him a compass. He
was fascinated by the way the needle always pointed
north. This experience helped to create a great
curiosity in him and had an impact on the rest of his
life. 
 Once a week his parents invited a poor medical
student, Max Talmey to eat with them. Max brought
science books to share with Albert, and they became
good friends. 
 His Uncle Jakob was a strong influence in his life. He
gave Albert math books about algebra and geometry.
Uncle Jakob described algebra as "a merry science".
He said algebra could be compared to hunting a little
animal. You didn't know the name of the animal, so
you called it "x". Then when you finally caught the
animal you gave it the correct name. He made
learning fun for the boy and also provided a model
for teaching that Albert would later use. In the future
he would explain his theories by using examples of
trains, elevators, and ships.
Some Talented Dyslexics

Inventors/Engineers/Scientists:
 Albert Einstein
 Thomas Alva Edison
 Alexander Graham Bell
Artists:
 Leonardo da Vinci
 Walt Disney
Military/Political Strategists:
 General George Patton
 Winston Churchill
 Woodrow Wilson
A 15 year old boy
 Difficulty sitting still in class and home
 Runs around the room
 Climbs on the furniture
 Becomes restless when he is forced to sit
in a chair
 Has difficulty for waiting his turn when
playing with other children.
 Attention Deficit
Hyperactivity Disorder
(ADHD)
ADHD is
 Poor attention span
 Easy distractibility
 Always restless, leaves seat, running,
climbing
 Careless mistakes

Biological, psychological and social

risk factors
ADHD in adolescents
 ADHD Continues in adolescence
and adulthood(50-70%)

-in adolescence more inattention and

impulsivity-not
identified-
HIDDEN MORBIDITY
 Pattern of ADHD in adolescents in
our schools…..

ADHD-17.4%
ADHD NOS-7.9%
Ref; Anil kumar TV,MKC Nair et al(2006) ‘Development and validation of a visual
explanatory screening tool for identifying ADHD, a common mental health
problem in adolescent school students’
ADHD - Hyperactivity symptoms
Leaving Seat
Play increased
Motor….
Fidgets
Runs, Climbs
Talkative
Impulsivity
Awaiting Turn
Intrudes
Q? Blurts out
ADD- without hyperactivity
‘Lazy’ ‘Oppositional’ ‘ unmotivated’

• Poor attention to details

• Easily distracted
• Careless mistakes
• Not listening
• Difficulty in organizing
• Forgetfulness and loosing things
• Avoidance of sustained mental effort
• Failing to finish academic works
independently
ADHD - Diagnostic criteria

A. Either 1 or 2
1. Attention -  6 symptoms x 6months
2. Hyperactivity – Impulsivity -  6 Sym. x 6 months

B. Onset < 7yrs

C.  2 settings
D. Impairment –Social, academic or occupational
E. Not due to ……. PDD, Schiz, Mood, Anxiety
 Complications?
Injury
Poor school performance

co morbidity

ADDICTION
Substance abuse
CONDUCT DISORDER
 Treatment & Management

Evaluation
Treatment tips

Essential information
 ADHD is not the child’s fault

 Better outcome –if calm and accepting

 They need extra help to remain calm

attentive
 May continue into adulthood
Counseling of patients and family

 Encourage parents to give positive

feedback
 Avoid punishment !
 Parents to discuss with school
teachers
 Minimise distractions
 Sport or Physical activity->help to
release energy
 Meet school
psychologist/counselor
Role of teacher?

TEACHERS are the key persons

to identify and intervene
Tips for teachers
 To increase chance of following
instructions
 Eye contact
 Stand near
 Soft voice
 Be specific
 Short and clear directions
Tips for teachers
 Break into simple directions
 Use visual cues
 Give 10 seconds to respond
 Check comprehension
 Ask to repeat
 Let the child ask
 Repeat direction in calm ,clear voice
Teaching techniques
1. Break lessons into small parts,
2. Use variety of Teaching Learning
methods- listening, seeing, touching
3. Use verbal and non verbal methods
4. Vary activities-group works
5. Short assignment with frequent
feedbacks and reinforcement
Class room rules
 Place class room rules in prominent
places
 Seating-close to teacher
 Near’ model’ students
 Not near windows

Good relation with parents

 Drugs

Stimulants – Methyl phenidate

Non stimulant - Atomoxetine
Anti depressant - Clonidine
 Attention Deficit Hyperactivity Disorder
ADHD and
 Conduct disorder (30.7%)
 Depression(10.3%)

 Adjustment disorder(8.3%)

Reference: Indu P S ,Anil Kumar TV et al, ‘Mental health

morbidity and associated factors in children and adolescents
attending a Child and Adolescent Psychiatry Clinic’, 2002.
Sadness

Depression
?
4-8%
more in girls
(2 times)
ASK…….
 HOW THEY ARE
FEELING ?
screening

1.Mood  low or sad mood

2.Interest  pleasure

1/2 x 2 weeks
Diagnostic criteria

 Sleep - ()

 Weight -  Appetite

 Worthlessness &
guilt
Diagnostic criteria
 Death wish or acts

 Energy - fatigue, libido

 PMA  (Psychomotor activity)

slowing of movement /speech

 Concentration  C/o  memory

 5/9 x 2 weeks
Diagnosis 5/9 2 weeks

1.Mood
2.Interest
3.Sleep
4.Weight
5.Worthlessness
6.Death wish
7.Energy
8.Psychomotor retardation
9.Concentration
Complications of depression if
untreated are

 Poor psycho social outcome

 School failure
 Recurrent depression
 Substance use.(alcohol, smoking etc)
 Suicide
Indication for drugs are
 Patient not responding to psychological
treatment alone.
 Severe symptoms.
 Bipolar depression (children with history of
mania and depression)..
 Psychotic symptoms (Delusions and
hallucinations).
 Chronic recurrent depression
Treatment

 Drugs.
 Antidepressants
 Fluoxetine 20 mg OD * 6 Months
 Fluoxetin

Preparation Starting Usual/daily

dose dose

.eg. .capsule 20 5 mg 20 mg.

Prodep mg
Flunil liquid 20
, mg/5ml
 Sertraline
Preparation Starting Usual/daily
dose dose

.eg. Serta. Tablets Children 50 mg

Serlift 50 mg 25mg.
Adolescents
- 50 mg.
 Depression
When to Refer?

1. No improvement

2. High suicidal risk

3. Psychotic symptoms – delusions/ hallucinations

4. Atypical features

5. Substance abuse

6. Need more intensive psychotherapy

Counseling
Counseling
 C-confidentiality
 O-open questions

 U-unconditional

 N-non judgemental

 S-sincere
Counseling
 E-empathy
 L-listening

 I-impartial

 N-non verbal communication

 G-guidance
Depression -Summary

• Common
• Disabling, fatal
• Simple diagnosis
• Simple treatment
• Family involvement
Angry…...

Assaultive…
Conduct Disorder 
Conduct Disorder “the aggressive teen”
 Clinical features- ‘ADDS’

Aggression
Destruction
Deceitfulness/ theft
Serious violation of rules
 
 CD-Clinical features ?

 Excessive level of fighting or bullying

 Cruelty to animals and other people
 Severe destruction to property, fire
setting
 Stealing, repeated lying
 Truancy from school, running away
from home and unusually frequent
temper tantrums
Complications ?

School drop out

 Antisocial behavior

 Substance use

 High-risk sexual behavior

The
lost lamb….
 Treatment tips
Essential information for patient and family

Effective discipline
(Clear and consistent)
but not harsh.
Avoid punishment
 Effective discipline - clear and
consistent, but not harsh, avoid
physical punishment
 Alter the circumstances resulting in

problem behavior
 Recognize good, pro-social  behavior

and reinforce by giving attention

 Set clear and firm limits, inform in

advance of the consequences,

respond immediately.
 Counseling to patient and family

 Alter the circumstances

 Recognize good behavior
 Consistent discipline, set clear and
firm limits, inform in advance of the
consequences, immediate response.
 Discuss with teachers
 Seek help from relatives, friends,
community resources
 ADHD vs CD

ADHD struggles
to control himself
and to maintain focus…….

Conduct disorder struggles

 with everyone and is

 against the society and societal rules.

Mismanaging an aggressive
disobedient Child
 Using force
 Ridiculing
 Forcing students to admit lies and
errors
 Demanding confession
Mismanaging an aggressive
disobedient Child

 Confronting students over issues

 Asking students why they act out
 Punishing students
 Making disapproving comments
90% of the success
in leadership is
attributed to EI
Emotional
Intelligence

Love
Trust

Hope