A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE ON ...



A STUDY TO “ASSESS THE KNOWLEDGE AND ATTITUDE ON BEHAVIOURAL PROBLEMS OF PRESCHOOL CHILDREN AMONG PARENTS” IN SELECTED AREAS OF

MADHUGIRI WITH A VIEW TO DEVELOP

INFORMATION BOOKLET.

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DESSERTATION

MRS.B.K. MUNILALITHA.

CHILD HEALTH NURSING

MADHUGIRI SRI RAGHAVENDRA INSTITUTE

OF

NURSING SCIENCES

RAJIV GANDHI UNIVERSITY OF HEALTH SCINCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

| | | |

|1. |NAME OF THE CANDIDATE |MRS. B.K. MUNILALITHA |

| |AND ADDRESS |1 Year M.Sc., Nursing |

| | |Madhugiri Sri.Raghavendra Institute of Nursing Sciences, Shankar|

| | |Matt Road, Raghavendra Colony, |

| | |Madhugiri- 572132, Tumkur district. |

| | | |

|2. |NAME OF THE INSTITUTION |Madhugiri Sri.Raghavendra Institute Of Nursing Sciences, |

| | | |

|3. |COURSE OF STUDY AND |1st Year M.Sc., NURSING |

| |SUBJECTS |Child Health Nursing |

| | | |

| | | |

|4. |DATE OF ADMISSION TO |10-06-2009. |

| |COURSE | |

| | | |

|5. |TITLE OF THE TOPIC |A Study to “Assess the knowledge and attitude on behavioral |

| | |problems of pre school children among parents” in selected areas|

| | |of Madhugiri with a view to develop information booklet. |

| | | |

| | | |

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION :

“Believe that problems do have answers that they can be overcome and that you can be solve them.”

- Nightingale nursing times.

Normal children are healthy, happy and well adjusted. This adjustment is developed by providing basic emotional needs along with physical and physiological needs for their mental well being. The emotional needs are considered as emotional food for healthy behavior. The children are dependent on their parents, so parents are responsible for fulfillment of the emotional needs. Every child should have tender loving care and sense of security about protection from parents and family members. They should have opportunity for development of independence, trust, confidence and self respect. There should be adequate social and emotional interaction with discipline. The child should get scope for self expression and recreation. Parent should be aware of about achievements of their children and express acceptance of positive attitude with in the social normsf.1

The preschool years extending from approximately 3 to 5 years of age.2 Common behavioral problems of childhood are tempertantrum breath holding spell, thumb sucking, nail biting, enuresis, encopresis, pica, tics, and stuttering or stammering, delayed speech and attention deficit disorder.1

The causes for all behavioral problems in preschool childrens are due to parents negligence poor supervision or poor attention , family conflict and maladjustment eg, too strict parents, rejection, sibling rivalry, unconscious anger and defiance in the child, insecurity, conflict or hostility, aggression, neurotic attitudes of the mothers.4

The study was conducted on relationship between the occurrence and intensity of nail biting in Department of Psychology. A sample of children were selected . The study resulted in a conclusion that the most consistent trait associated with nail biting was oral aggression. 20

Temper tantrums will be managed by alerting parents about the beginning of tempertantrum when the child loses control. Parent should provide alternate activity at that time. The child protected from self injury. Breath holding spells will be managed by giving assurance to the parents about harmless effects of the attack and should be tolerant , calm and kind. Thumb sucking managed with praising and encouraging child for breaking the habits are very useful.1 Nail biting is managed by keeping Childs hands busy with creative activities or play, punishment to be avoided. Enuresis will be reduced by encouraging and rewarding the child for dry nights. Pica will be managed with psychotherapy.4

6.1. NEED FOR STUDY :

As children move in to the preschool years (ages 2 ½ to 5 ½ ), cries of “ No and I will do it myself”, are frequently heard. Children this age may be easily frustrated when faced with limits. They will cry, throw tantrums and even lash out a parent, caregiver or friend. However some preschoolers show even more extreme and difficult behaviors, often defying adults and deliberately hurting other people. Some may be so disruptive that they are banned from preschool.5 Major behavioral problems are the significant deviations from socially accepted normal behavior. These problems are mainly due to failure and adjustment to external environment and presence of internal conflict. Behavioral problems always special attention.1

Identifying and helping these children is a vital task. Current research suggests that, without help these children may go on to have serious problems with aggression. Indeed researchers are finding that intervening at this time in life can be highly effective in helping children develop better coping skills.5

A study was conducted on tools (DSM-IV ) to help with behavioral problems of preschool children in Chicago. A sample of 79 children were selected. The study resulted in a conclusion that using a modified version of

the DSM –IV ( Diagnostic and statistical Manual of mental disorders- fourth edition ) criteria and discovered that over 70% met the DSM -4TH definition for disruptive behavioral problems. 5

These behavioral problems in children will be managed by adequate guidance to parents regarding how to tackle with problems and psychotherapy for the preschool children in extreme condition.4 In many communities the parents are more anxious towards their preschool children behavioral problems. In this Madhugiri area the parents are illiterates and also less attention seeking towards their preschool children behavioral problems.

Now a days in many communities the parents are more anxious towards their preschool children behavioral problems due to less attention or negligence or ignorance. So the researcher felt that to study the knowledge attitudes on behavioral problems of preschool children’s among parents

6.2 . REVIEW OF LITERATURE :

6.2.1: A study was conducted to determine the prevalence of child behavior problems reported by parents in “Child Development and Neurology unit”. A sample size of total 4003 children aged 2-9 years were identified during a population based survey of 2231 house holds. The study resulted in a conclusion that the prevalence and nature of reported behavior impairments in rural Bangladesh have implications for public health planning and delivery of health services. 6

6.2.2: A study was conducted to analyze the clinical symptoms of tic disorders (TG) and sleep habits in children in chair and Department of Developmental Neurology. A sample size of 84 children with treatment group (TC), control group included 156healthy children work selected by cluster sampling. The study resulted in a conclusion that Quote frequently treatment group are connected with other behavioral symptoms, in particular Attention Deficit Hyperactivity disorder and obsessive compulsive disorder. Sleep habits are different in treatment group (TG) than in control group.7

6.2.3: A study was conducted on prevalence of tic disorders among primary school children in Department of child Neurology and Psychiatry. A sample size of 2347 primary school children were selected. The study resulted in conclusion that a total 68 children (56 boys, 12 girls) aged 6-11 years were identified with tic disorders. The prevalence was 4.4% in boys and 1.1% in girls with no detectable trends at the age 6-11 years. Situation related takes were noted in 37 cases. A significant correlation was found between the presence of tick disorders and impaired school performance.8

6.2.4: A study was conducted to determine prospectively the duration of non-nutritive sucking behaviors of children between 1 and 8 years of age and the effect of persistent habits on selected occlusal characteristics in the late deciduous dentition in college of Dentistry. A sample size of 797 children were selected by observation method. The study resulted in a conclusion that to intercept the development of cross bites and functional shifts, the developing occlusion should be observed in the deciduous dentition in children with prolonged digit or pacifier habits. 9

6.2.5: A study was conducted on the attitudes of Saudi Mothers towards the digit sucking habit in their children and their attempts to stop this fixation in Department of preventive Dental sciences. A sample size of 50 Saudi Mothers were selected. The study resulted in a conclusion that no mother accepted the habit in their children after the age of 4 years. The majority of mothers had notices the adverse effect of the digit sucking. The results shown that 48 mothers did not like to see the habit at any age. Most mothers (86%) tried to stop their children digit sucking. 66% of the present sample and noticed the adverse effect of this fixation on their child’s occlusion, and this was given as the main reason for their attempts to stop the habbit.10

6.2.6: A study was conducted about how will private practice Pediatricians can identify emotional or behavioral problems among pre-school childrens (No.3876) in Department of Child Psychiatry and Pediatrics. A sample size of 1 of 68 pediatricians who rendered on opinion about the presence of emotional behavioural problems were selected. The study resulted in a conclusion that a substantial number of pre-school children with behavioral problems in primary care are not being identified or treated. 11

6.2.7: A study was conducted on assessments of developmental status, attachment, and behaviour problems of Romanian orphans adopted in Ontario. A sample size of 56 Romanian orphans were selected. The study resulted in conclusion that children who had more institution experience, those who were developmentally less competent, and those who were insecurely attached had more parent reported behavior problems12.

6.2.8: A study was focused to investigate the prevalence of co-Morbid psychiatric disorders in a clinical sample of children with nail biting who present at a child and adolescent mental healthcare out patient clinic and the prevalence of psychiatric disorders in their parents in Director of Research Center for psychiatry and behavioral sciences. A sample size of 450 referred children were selected. The study resulted in a conclusion that nail biting present in a significant proportion of referrals to a mental health care clinic setting..13

6.2.9: A study was focused to investigate whether difference in tantrum behaviors of health verses disruptive disorder preschoolers. It involved care givers of 279 preschool children completed the preschool age psychiatric assessment, to determine pre schoolers diagnostic classification and to measurement tantrum behavior. The study resulted in a conclusion that disruptive pre-schoolers displayed violence during tantrum significantly more greater than the depressed and healthy groups. 14

6.2.10: A study was conducted to explore behavioral and emotional problems in toddlers with pervasive developmental disorders (PDDS), those with delay without a PD, and their families in centre for Developmental psychiatry and psychology. A sample size of 123 children aged 20-51 months were selected. The study resulted in a conclusion that the need for early support and intervention for mothers fathers and families in this context was also evidenced. As research has shown that behavioral and emotional problems persists in to adolescence and young adult hood, understanding of these issued in very young children and their parents has important implications for intervention and long term out comes. 15

6.2.11: A study was conducted to examine the prevalence of features of attention deficit Hyperactivity disorder in a special school. The study also explores the reliability of the conners teachers rating scale in this population in department of child guidance clinic. A simple size of 84 children between the age of 5 and 18 years were selected. The study resulted in a conclusion that attention deficit hyper activity disorder may be under diagnosed in children with in attention disorder. The conners teachers rating scale was found to be internally reliable and had a normal distribution with our results. Overall 55.9% of participants had markedly elevated the scores for at least one of the target subscales, which were the ‘Hyperactivity’, In attention and the “ADHD Index” subscales of the corners teachers rating scales. 16

6.2.12: A study was conducted to examine the empirical evidence on the impact of bed wetting and its treatment on a Childs self esteem and behavior in Department of General practice and Primary health care. A sample of children aged 5 to 16 years old with primary nocturnal Enuresis using measures of self esteem or behavior were selected. The study resulted in a conclusion that fifteen empirical studies matched the inclusion criteria. There is empirical evidence for increased behavioral problems in bedwetting children.17

6.2.13: A study was conducted on teeth grinding in preschoolers has been linked to with drawn behaviors. A sample of 1,956 pre-scholars, whose parents completed a questionnaire were selected. The study resulted in a conclusion that 36.8% of the pre-scholars ground their teeth one or more times per week and 6.7% of them, four or more times per week. As the study suggests, it will benefit parents to keep a close eye on their children’s sleep patterns and their social behavior. 18

6.2.14: The study was conducted on exploration the relationship between mothers and father’s discipline, as well as their disagreement on discipline, with externalizing behaviors of preschool children in the home and class room in department of psychology. A sample of parents and teachers of 39 preschool children participated in the study. The study resulted in a conclusion that multiple regression analyses indicated that maternal authoritarian discipline and paternal permissiveness were related to externalizing behaviors in the home and classroom. These findings indicate a different relationship between parent discipline, and the development of externalizing behaviors in preschool children.19

STATEMENT OF THE PROBLEM

A Study to “Assess the knowledge and attitude on behavioral problems of preschool children among parents” in selected areas of Madhugiri with a view to develop information booklet.

6.3 OBJECTIVES

1. To assess the knowledge on behavioral problems of preschool children among parents.

2. To assess the attitude on behavioral problems of preschool children among parents.

3. To create awareness on behavioral problems of preschool children among parents.

6.3.4.To associate the knowledge and attitude of parents with selected variables.

6.4. VARIABLES UNDER STUDY:

Age of the parents, No. of children, Education of parents, occupation, socio-economic status, type of family and exposure to mass media.

5. OPERATIONAL DEFINITIONS:

ASSESS : To evaluate the level of knowledge of parents regarding

behavioral problems of preschool children.

KNOWLEDGE : The level of understanding of parents regarding behavioral

problems of preschool children.

ATTITUDE : It is feeling of a parents regarding behavioral problems of

preschool children.

PARENTS :The parents who have 3-5 year age group children.

BEHAVIORAL :Behavioral problems refers tempertantrum

PROBLEMS :breath holding spell, thumb sucking, nail biting, enuresis, encopresis, pica, tics and stuttering or stammering, delayed speech and attention deficit hyper activity disorder.

PRESCHOOLER :The children’s of 3-5 years age group

INFORMATION :It refers a book that contain scientific information

BOOK LET regarding behavioral problems of preschool children.

6.6. ASSUMPTIONS:

1. Parents may have little knowledge on behavioral problems of preschool children.

2. Information booklet will enhance knowledge of parents regarding management of behavioral problems of preschool children.

7. MATERIALS AND METHODS:

1. Source of Data

❖ Research approach : Descriptive approach

❖ Research design : Survey method

❖ Setting of the study : Community setting Madhugiri

❖ Population : Parents

❖ Sampling Technique : Simple random sampling

❖ Sample size : 100 Parents

❖ Sampling criteria

* Inclusion criteria

Parents of preschool children’s

Parents who are living in Madhugiri

Parents who can understand Kannada and English

* Exclusion Criteria

Parent who are not willing to participate in study

The parents who cannot read and write Kannada or English.

2. METHOD OF DATA COLLECTION

❖ Tools of data collection:

Part A : Demographic Proforma.

Part B : Structured questionnaire of knowledge and attitude.

❖ Data analysis and Interpretation.

Data analysis will be through descriptive and inferential statistics.

❖ Duration of the study – 6weeks.

❖ Does the study requires investigation or intervention on patients or other persons or animals described briefly.

- No -

❖ Has ethical clearance has been obtained from your institution.

Yes, ethical clearance will be obtained from

- The research committee of Madhugiri Sri Raghavendra

Institute of Nursing Sciences, Madhugiri

- The authorities of selected communities, Madhugiri

- The informed consent from the candidates willing to

participate in the study.

8. LIST OF REFERENCES.

1 Parul Datta “A Text Book of pediatric Nursing”, second edition, published by Jaypee, Page No.

2. Wong’s “A text book of Essentials of Pediatric Nursing”, 7th Edition, Published by Marilyn J. Hocken berry, Page No. 417.

3. Op. Ghai, Piyush Gupta, VK. Paul “ A text book of Pediatrics”, 6th Edition, published by CBS publishers Page No. 57.

4. Suraj Gupte “The short Text of Pediatrics”, 9th Millennium Edition, Published by Jaypee, Page No. 400-405.

5. Keenank, Wakschlag LS, “Journal of Abnormal child Psychology” 2000, 28(1): 33-46.

6. Naila Z Khan et al “ Behaviour problems in young children in Rural Bangladesh”, December 2007.

7. Mlodzikowska – Albrecht J et al “The symptomatology of tic disorders and concomitant sleep habits in children” poland, 2007, 1; 212-4.

8. lanzi G, Zambrino CA , et al “Prevalence of tic disorders among primary school students” city of pavia, Italy,2004 Jan 89 (1): 45-7.

9. Bishara SE, Et al “Changes in the prevalence of non nutritive sucking patterns in the first 8 years of life” Lowa City, USA, 2006 Jul:130(1):31-6.

10. Al – Jobair A, AL – Amran SE, “Attitudes of SaudiArabianMothers towards thedigit-sucking habit in children”- SaudiArabia, 2004 Sept, 14 (5):347-54.

11. John V.Lavigne Phd Et al “Behavioural andemotional problems among preschool children in Pediatric primary care”, Chicago March 1993, 649-655.

12. Karla Krekewich, “Determinants of behavioral problems in Romanian children Adopted in Ontar”, Canada, 1997 17-31.

13. Ahmed Ghanizadeh “Association of nail biting and psyctriatric disorders in children and their parents in a psychiatrically referred sample of children”, Iran, June 2, 2008.

14. Eric.Ed. .

15. Herrings, Et.al “Behavioral and Emotional problems in toddlers with pervasive developmental disorders and developmental delay; associations with parental mental health and family functioning”, Austrilia, 2006, Dec (50), 875-82.

16. Buckely S, Et al “The prevalence of features of attention deficit hyper activity disorder in a special school”, Irland, 2008 Feb; (52); 156-162.

17. Redsell SA, Collierj, “Bedwetting behavior and self esteem”, Leicester, UK, 2001 Mar. 27(2); 149-62.

18. Dr.Jeseph, “Healthyliving teeth Grinding and Behaviour problems in Preschoolers”, 2009 May (15).

19. Martha carlton, Et al “The relationship between mother’s and father’s decipline, as well as their dis agreement on discipline with externalizing behaviour of preschool children in the home and class room, Mid Western Community 2008 .

20. Gilleard, Et al “Nail biting and oral aggression in a Turkish, student population”, Turky, 1988, Jun; 61; 197-201.

9. SIGNATURE OF THE CANDIDATE ……………………………

10. REMARKS OF THE GUIDE.

11. NAME AND DESIGNATION OF GUIDE

11.1. SIGNATURE ……………………………………………………..

11.2. H.O.D. OF THE DEPERTMENT.

11.3. SIGNATURE .

12. REMARKS OF THE CHAIRMAN/PRINCIPAL.

12.1 SIGNATURE: ……………………………………………………

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