Mr. PRASANTHA.H.J.
1ST YEAR M Sc NURSING
PSYCHIATRIC NURSING,
2011 – 2013 BATCH,
SHREE SIDDAGANGA INSTITUTE
OF NURSING SCIENCES AND
RESEARCH CENTRE,B.H.ROAD
TUMKUR-572102.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / MR. PRASANTHA.H.J1STYEAR M.Sc. NURSING, SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE, B.H.ROAD TUMKUR. KARNATAKA.
2. / NAME OF THE INSTITUTION / SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE, B.H. ROAD TUMKUR. KARNATAKA
3. / COURSE OF THE STUDY AND SUBJECT / 1ST YEAR MASTER OF SCIENCE IN NURSING
PSYCHIATRIC NURSING
4. / DATE OF ADMISSION TO COURSE / 11-07-2011
5. / TITLE OF THE TOPIC / “ A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE REGARDING EARLY IDENTIFICATIONAND PREVENTION OF CONDUCT DISORDERS IN SCHOOL CHILDREN AMONG TEACHER TRAINING STUDENTS IN SELECED D.Ed. COLLEGES AT TUMKUR.”
6. BRIEF RESUME ON INTENDED WORK
6.1 Introduction:
“When virtue is lost, benevolence appears, when benevolence is lost right conduct appears, when right conduct is lost, expedience appears. Expediency is the mere shadow of right and truth; it is the beginning of disorder.”
- Lao Tzu
WHO defines mental health as a state of well-being in which an individual realize his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to mark a contribution to his or her community. The mental illness can dramatically impact on overall state of health decreasing community participation, productivity personal being1.
Childrencontribute around 40% of the population. Children are vulnerable, who need to be protected and cared. The developmental phase from infancy to childhood is a significant period to prevent a number of behavioural and other problems. Conduct disorder is one of those behavioural problems2.
Diagnostic and Statistical Manual (DSM-IV) mentions conduct disorder as one of the most frequently diagnosed conditions in outpatient and inpatient mental health facilities for children. Conduct disorder has been separated from the adult diagnosis of antisocial personality in order to acknowledge what psychiatrists believe to be a greater potential for change in the young3.
There is a repetitive and persistent pattern of behaviour in children and adolescents in which the rights of others are violated or basic rules of society are not followed. The child or adolescent usually exhibits these behaviour patterns in a variety of settings at home, at school, and in social situations and they cause significant impairment in his or her social, academic, and family functioning is known as “conduct disorder” 1.
Communitystudies on emotional/behavioural disorders in children and adolescents conducted in India have yielded disparate point of prevalence rates are 9.4% in children aged 8-12 years, 12.5% in children aged 0-16 years and 1.81% in adolescents aged 12-16 years2.
There are several causes and factors which may leads to conduct disorder.Like genetic factor; monozygotic and dizygotic twins and psychosocial factor; parental rejection, absent father, alcohol dependence, large family size, marital conflicts and divorce in parents. Biochemical factor; elevated plasma levels of testosterone and aggressive behaviours. And organic factor; children with brain damage and epilepsy.The onset of conduct disorder occurs much before eighteen years of age, usually even before puberty4.
Characteristics of conduct disorder includes:Aggressive behaviour that causes or threatens harm to other people or animals, such as bullying or intimidating others, often initiating physical fights, or being physically cruel to animals. Non-aggressive conduct that causes property loss or damage; such as fire-setting or the deliberate destruction of other’sproperty1. A child with conduct disorder rarely performs at the level predicted by IQ or age,causing academic social and developmental problems. Perform poorly at school or work, may have problems with the law. Serious rule violations, such as staying out at night when prohibited, running away from home overnight, or often being truant from school3.
Prevention of Conduct Disorder often consists of group, individual and/or family therapy and education about the disorder, limit setting, discipline, consistent rules, identification with healthy role models, social skill training, behaviour modification, remedial education, School interventions and sometimes residential or medicine, the parents , teachers, psychiatrist, physician, psychologist, counsellors have the greatest role in preventing conduct disorders among children 5.
Prevention programmes need to start early andtarget high-risk groups. They should be modelled after the most promising programs that focus on early child education, home-based parent training programmes and school-based teacher training programmes.Universal interventions that have been found to successfully impact on prevention of conduct problems are allschool-based, and include classroom behaviour management, enhancing child social skills andmultimodal strategies including the involvement of parents. Classroom behaviour management programmes attempt to help children better meet the socialdemands of the classroom through the overt encouragement of desired behaviours and the discouragement of undesired behaviours. And better relationshipsamong students and between students and teachers18.
The knowledge of teacher training students of D.Ed. colleges on early identification and prevention of conduct disorder can be improved in many ways but planned teaching programme is one of the best methods.
Children’s are wealth of the nation and they may face many behavioural problems during their developmental stages. So emphasis should be given on early identification and prevention of conduct disorder in children’s at an early stage that is in childhood by the teachers in schools and also by the parents in the developmental period.
6.2 Need for the study:
According to World Health Organisation children are priceless resources and that any nation which neglect them would do so as it is peril. WHO day spot light on the basic truth that we must all safeguard the healthy minds and bodies of world’s children as a key factor in attaining Health For All by 2010 AD6.
Conduct disorder is one of the serious and persistent mental health problemsthat involve antisocial behaviour and impaired functioning in multiple domains in a child’s life. It is likely caused by a web of interacting factors in families and communities that create disadvantage and affect children’s development over time7.
Conduct disorder is characterized by a persistent and significant pattern of conduct in which the basic rights of others are violated or rules of society are not followed, it is the behaviour of the total individual as expressed in both psychological as well as physical activity, For example; physical violence against person or property like rape, assault, suicidal thoughts, poor perform in school or work, poor relationship with peer and adults8.
Conduct disorder usually appears in early or middle childhood as oppositional defiant behaviour. Nearly one half of children with early oppositional defiant behaviour have an affective disorder, conduct disorder or both. Thus, careful diagnosis to exclude irritability due to another unrecognized internalizing disorder is important in childhood. Evaluation of teacher - child interactions and parent - child interactions is also critical9.
The school makes up a significant part of a child’s life and for children with conduct disordersthe school environment can be particularly challenging. The nature of the school that enforces rules, boundaries and expectations on students’ behaviour is problematic for a child suffering from conduct disorders whom opposes the authority of the teacher and the school. This causesdifficulties for the child and the teacher’s ability to ensure positive learning outcomes for allmembers of the classroom. Thus conduct disorders is a significant challenge for teachers,educational psychologists and the education system itself, placing high demands on the skillsand knowledge of teachers, educational psychologist and other professional involved10.
Epidemiological Studies shows that in elementary school 2% of girls and 7% of boys are diagnosed with conduct disorder. In middle school, 2 - 10% of girls and 3-16% of boys are diagnosed and in high school, 4-15% of both boys and girls. Overall 2-6% of children and adolescents display symptoms of conduct disorder11.
As per the recent research publishedaround the world the prevalence of conduct disorder is 5%. In India from 12 January 2010 to 9 February 2011 estimates that, the prevalence rate of conduct disorder increases throughout childhood and they are more common in boys than girls. For example, 7% of boys and 3% of girls aged 5 to 10 years; for children aged 11 to 16 years the number rises to 8% for boys and 5% for girls. and also the prevalence rate of conduct disorder varies between ethnic groups, being lower than some groups that is 2.1% in British Indian children but higher in the other group that is 8.6% in black British children, and the diagnosis of conduct disorder is strongly associated with poor educational performance, social isolation, drug and alcohol miss use and contact with criminal justice system and it is co-existing with other mental health disorder that is 46% of boys and 36% of girls have at least one other co-existing mental health disorder. 40% of the people with conduct disorder are also diagnosed with attention deficit hyperactivity disorder12.
A study was conducted to find out the prevalence of conduct disorder and its DSM-IV subtypes and co morbid with attention deficit hyperactivity disorder in four schools of Kanke block of Ranchi district among students of classes V to X. A total of 240 students, selected by stratified random sampling, were subjected to the schedule for affective disorders. Nineteen students who qualified were subjected to conduct disorder. 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 is 27%. Mild conduct disorder was found in 36%, moderate is 64% and severe conduct disorder is none. Finally the prevalence of conduct disorder was 4.58% more common in boys, the majority had childhood onset,and in childhood onset type the ratio of boys and girls was found to be 7:12.
In the view of above there is a vast range of childhood onset conduct disorder in children’s. The Teacher training students are the future teachers who will build the behaviour of the children’s. So creating an awareness regarding early identification and prevention of conduct disorderthrough planned teaching programme wecan improve their knowledge, as it provides enough information regarding conduct disorder causes, signs and symptoms and its prevention. Soit is better to take care that a problem does not happen than to have to solve the problem afterwards. It is easier to stop something bad from happening in the first place than to fix the damage after it has happened. Hence the investigator felt that there is a need to evaluate and to improve the knowledge of teacher training students.
6.3 Review of literature:
“ A literature review is an account of what has been already established or published on particular research topic by accredited scholars and researchers”13.
(University of Toronto, 2001)
A qualitative study was conducted on teacher's perceptions to prevent conduct problems in Jamaican pre-schools. Teachers reported benefits to their own teaching skills and professional development, to their relationships with children and to the behaviour, social-emotional competence and school readiness skills of the children in their class. The hypothesis suggests that intervention effects were due to teachers' gains in skills and knowledge in three main areas: (1) a deeper understanding of young children's needs and abilities; (2) increased use of positive and proactive strategies; and (3) explicitly teaching social and emotional skills. Teachers reported few difficulties in implementing the majority of strategies and strongly recommended wider dissemination of the intervention. And finally teachers felt they were able to successfully integrate the strategies learned into their regular practice14.
A study was conducted on Preventing conduct problems and improving school readiness: evaluation of the Incredible Years Teacher and Child Training Programs in high-risk schools on a total of 153 teachers and 1,768 students are presented. Children and teachers were observed in the classrooms by blinded observers at the beginning and the end of the school year. Results indicated that intervention teachers used more positive classroom management strategies and their students showed more social competence and emotional self-regulation and fewer conduct problems than control teachers and students. Further study concludes that findings provide support for the efficacy of this universal preventive curriculum for enhancing school protective factors and reducing child and classroom risk factors faced by socio-economically disadvantaged children15.
An evidence-based Incredible Years Teacher Classroom Management (TCM) Programme was developedto meet demands from teachers for strategies to manage disruptive behaviours in the classroom (Webster-Stratton, 1999). This paper describes the programme and reports on its first use in the United Kingdom. In the first study 23 teachers attended the five-day classroom management programme, Teachers who implemented the training in their classrooms reported satisfaction with the programme and believed that the strategies taught were effective and improved pupils’ conduct. In the second study, blind observation of teacher classroom behaviour was undertaken in 21 classes, 10 teachers had received the TCM training and 11 had not. Teachers who received TCM training gave clearer instructions to children and allowed more time for compliance before repeating instructions. The children in their classes were more compliant than children in the classes of untrained teachers16.
An Incredible Years Treatment Programswas conducted onYoung Children with Conduct Problems. The incidence of Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) in children is alarmingly high, with reported cases of early-onset conduct problems occurring in 4-6% of young children, and as high as 35% of young children in low-income families. Children with ODD and CD are clearly identifiable as early as 3–4 years of age, and there is evidence that the younger the child is at the time of intervention, the more positive the behavioural adjustment at home and at school following treatment. Intervention that is delivered prior to school entry and during the early school years can strategically target risk factors across multiple domains; home and school, and through multiple change agents; parent, teacher, and child17.
A Randomised Clinical Training was conducted to prevent conduct disorder and anti social behaviour among oxford sample of 76 children aged two to nine years, the programme was based on conduct problems by using video clips, group discussions, practice tasks and regular phone contact. Care givers were trained in positive parenting including engagement in joint play and pre emptive strategies for avoiding conflict. Follow up at six months showed clear improvements in both child behaviour and parenting skills. The second Randomised clinical training, administered in 11 Sure Start communities in Wales, Involved parents of 153 with children’s 3 to 4-year-olds. Interestingly the 12-week intervention showed impressivereductions in antisocial behaviour among both the target children and their siblings18.
ANational Statistical Surveywas conducted to know whether Conduct disorders are the most common mental health disorder in children and young people. The Office of 1999 and 2004 reported that prevalence for conduct disorders with associated impairment was 5% among children and young people. The prevalence without impairment was not much larger, because conduct disorders nearly always have a significant impact on functioning and quality of life. The first survey demonstrated that conduct disorders have a steep social class gradient, with a three- to fourfold increase in the lowest social classes compared with the highest. The second survey found that almost 40% of looked after children, those who have been abused and/or those on child protection/safeguarding registers, between 5 and 17 years old, have conduct disorders19.
A cross-sectional study was conducted to estimate the prevalence of conduct disorders in youth vary between 2 and 10%. Such disordersare more likely in boys than in girls. Conduct disorders tend to co-occur with a variety of other serious problems, Economists have estimated the average yearly costs of a child diagnosed with conduct disorder to be 25 806 US dollars. The most successful preventive interventions to reduce the risk of aggressive behaviour and conduct disorders focus on improving the social competence and pro-social behaviour of children, parents, peers and teachers. These interventions are developed in tandem with a consensus developmental model for conduct problems with its emphasis on social interaction between children, caregivers and peers. New intervention attempts inform the model, and new cross-sectional and longitudinal research findings inform innovative intervention attempts. Among students and between students and teachers20.
An experimental study was conducted to evaluate the effectiveness of parent and teacher training as a selective prevention programfor 272 Head Start mothers and their 4-year-old children and 61 Head Startteachers. Constructscores combining observational and report data were calculated for negativeand positive parenting style, parent–teacher bonding, and child conduct problems at homeand at school, and teacher classroom management style. Experimental children showed significantly fewer conduct problems at school than control children. Children of mothers who attended 6 or more intervention sessionsshowed significantly fewer conduct problems at home than control children.Implications of this prevention program as a strategyfor reducing risk factors leading to delinquency by promoting social competence, School readiness, and reducing conduct problems are discussed21.
An Observational study was conducted to know influence of classroom aggression and classroom climate on the early development of aggressive-disruptive behaviour problems in school. Total 4,179 aggressive behavioural children from kindergarden to second-grade (ages 5-8) were included; and then study examined the impact of 2 important features of the classroom context-aggregate peer aggression and climates characterized by supportive teacher-student interactions. The aggregate aggression scores of children assigned to first-grade classrooms predicted the level of classroom aggression (assessed by teacher ratings) and quality of classroom climate (assessed by observers) that emerged by the end of Grade 1. Result have shown that Hierarchical linear model analyses revealed that first-grade classroom aggression and quality of classroom climate made independent contributions to changes in student aggression22.