Behavioral and experiential difficulties and disorders

13. srpna 2014 v 14:12 | Prof.PhDr.Rudolf Kohoutek,CSc.
Behavioral and experiential difficulties and disorders in children and young people constitute a very serious social problem determining the further psycho-social development of the young generation.
A competent pathopsychological and psychopathological classification and identification of such difficulties and disorders is a prerequisite for an adequate approach, or rather a re-education, re-socialization and rectification thereof.

In the Czech Republic, the first monograph, Závady a poruchy chování v dětském věku (Behavioral Difficulties and Disorders in Children) by Pavel Vodák,a physician, and Antonín Šulc, an educator, was published in Prague in 1964. Disorders in psychological development were also explored by Josef Švancara (1974). Individual issues related to behavioral difficulties and disorders in children were addressed by Pavel Říčan in his book, Agresivita a šikana mezi dětmi (Aggression and Bullying among Children), published by the Prague-based Portál (1995). In 1997, Marie Vágnerovápublished her Psychologii problémového dítěte školního věku (Psychology of the Problem Schoolchild), and in 2008, with Jarmila Klégrová, Poradenská psychologická diagnostika dětí a dospívajících (Counseling and Psychological Diagnostics of Children and Adolescents). a short monograph on aggression in children was also published byIvo Čermák (1998).
In Slovakia, the first important monograph on this topic was published by Ladislav Košč, Julius Marek and Ladislav Požár et al. in 1975 under the titles Patopsychológia (Patho-psychology) and Poruchy učenia a správania (Learning and Behavioral Disorders). In 1975, J. Jakabčic and L. Požár's Všeobecná psychopatológia (General Psychopathology) was also published in Slovakia.
Psychológia a patopsychológia dieťaťa, Pedagogika, Pedagogická orientace and Speciální pedagogika were among periodicals which contributed the most to work in the field of behavioral difficulties and disorders in children and young people.
This paper proposes a scientific and practical classification of ten categories of difficulties (behavioral difficulties) and their general distinction from behavioraldisorders and personality disorders. The main method employed to define the categories was an analysis of case documentation of pedagogical and psychological counseling centers and psychiatric counseling centers for children and young people.
The general aim of education developed, balanced personality exhibiting maturity appropriate to the age group concerned. However, a fairly large number of children fails to reach this condition in the educational process. Due to a whole host of factors, problems occur in the development of behavior and personality in a significant percentage of children and youth. Education sciences must seek ways for more effective work with children's mental preconditions and potential personality so as to achieve good adaptation and success in life. Educators are often the first ones able to identify various behavioral and experiential difficulties which signal a threat to normal, healthy mental development of the pupil, together with the consequences for the pupil's social and professional integration.
Children with such behavioral and experiential difficulties require non-standard, often more tolerant and truly individual approach from the educator, still ultimately with not very satisfactory or even unsatisfactory outcome.
The term behavioral and experiential difficulty is deemed to be synonymous with the term difficulty.
In this paper, we will not primarily focus on the causes and rectification of behavioral difficulties but rather on their classification and identification. If we want to determine the correct individual approach, the correct type of educational incentives, stimulation, motivation and activation of the child, we first need to realize what type of personality we are dealing with. The types of educational stimulation used for children with a complex personality will differ from those used for pupils with reduced or disharmonious mental faculties, minimal brain dysfunction, neurotic or psychopathic children, etc. a differentiated approach has to be applied to form positive attitudes and personality traits in different types of problem children.
The theory of difficulties is addressed by pathopsychology as a science studying mental processes, conditions and traits on the borderline between the standard and pathology, and as a science studying accompanying mental phenomena which contribute to the occurrence, process and consequences of any life insufficiency butwhich do not reach the level and quality of mental abnormality or pathology (Košč et al., 1975).
In conformity with Smékal (1961), we are of the view that difficulties are those educational and learning difficulties which still fall within a broader standard, and as such are not primarily organic, psychopathic, psychotic or oligophrenic.
Difficulties are partly or completely reversible. While they are developmentally inappropriate (dysontogenetic), they are non-pathological and defect-free mental states which are manifested socially (and possibly also subjectively) through unfavorably viewed behavior and experience.
Difficulties may be multi-conditional, poly-etiological, which is important for both their diagnostics (which ought to be based on personality and comprehensive) and treatment.
In the diagnostics of difficulties, we rely on behavioral and experiential manifestations in children and youth. The distance of a specific form of behavior from the actual essence of the child's personality allows us to organize the child's behavioral manifestations on a certain scale which can be used in diagnostics. The symptoms are as follows:
random - completely untypical of the personality,
secondary - more frequently occurring insignificant manifestations, more typical forthe group or age, subsidiary,
central - manifestations which mark the specific individuality of the personality preci-sely,
cardinal - very important, significant, permanent manifestations decisive for the reco-gnition of the dominant traits of the personality in question, forming a behavioral syn-drome which refers directly to the relevant personality traits.
Therefore, we always need to ask ourselves whether the behavior observed is random, secondary, central or cardinal. Unlike personality disorders and behavioral disorders, difficulties are more frequently only manifested by random or secondary symptoms; such symptomatic levels tend to be more closely associated with exogenous, in particular social conditions, and are less inherent in the personality itself. On the other hand, personality disorders and behavioral disorders are often conditioned on more permanent (endogenous) factors and personality traits (e.g., genetic).
Compared to behavioral disorders and personality disorders, difficulties:
are of a shorter-term nature
have less intense manifestations
are less socially consequential
tend to be conditioned on and caused by exogenous, situational and social factors, rather than endogenous, personality, genetic or biological factors
are more often reversible in terms of prognosis (i.e., there is a more optimistic prognosis)
Classification of children and youth with behavioral and experiential difficulties
According to symptomatology (i.e., the symptoms manifested) which can help us as the search methodology for the identification of individual types of children, the main areas of behavioral and experiential difficulties (occasional, shorter-term, situational, not yet reaching the quantitative and qualitative levels and severity of personality disorders and behavioral disorders listed for instance in the International Classification of Diseases (ICD) published in Geneva) can be divided into ten categories:
1) increased mental tension
2) infantilism
3) behavior outside the social and educational norm
4) increased intropunitivity
5) partial defects in communication abilities and skills (in particular in spoken and written speech) and cognitive processes
6) motor, locomotion and praxis difficulties
7) psychomotor instability
8) social, educational and cultural neglect
9) problems in school performance
10) problems in professional and study orientation and adaptation
It needs to be stressed that problem behavior
may also occur
in combination or change or transform, especially
in children.
If we provide
a symptomatological classification, we also need to note by way of an introduction that in order to diagnose a difficulty, not all the symptoms need to be present, and in some cases, a single one is sufficient (e.g., the child stammers occasionally, suffers from a reading difficulty, etc.). Certain symptoms are of an unspecific nature and can occur in several different types of difficulty.
Every symptom has to be assessed in terms of quantity as well: e.g., does not manifest itself (0) manifests itself seldom (1), frequently (2), very frequently (3).
To a competent expert, symptoms which manifest themselves very frequently (3rd degree) in certain combination then may indicate a disorder, rather than a mere difficulty.

Increased mental tension
Manifestations of mental tension include the following:
examination fright, tremor, shaking hands, voice (0 - 1 - 2 - 3)
overly sensitive reaction to failure, compunction, tearfulness (0 - 1 - 2 - 3)
daydreaming, absent-mindedness (0 - 1 - 2 - 3)
bad mood (seems discontent) (0 - 1 - 2 - 3)
anxiety over one's appearance and its changes (0 - 1 - 2 - 3)
increased mental vulnerability, low self-esteem (0 - 1 - 2 - 3)
emotional deprivation (0 - 1 - 2 - 3)
change of face coloring, blushing, blotches, pallor (0 - 1 - 2 - 3)
fear of ordinary things (e.g., heights, solitude, dark, animals) (0 - 1 - 2 - 3)
nail-biting (0 - 1 - 2 - 3)
headache, stomach ache, subjective weakness despite no medical findings (0 - 1
- 2 - 3)
increased sweating (0 - 1 - 2 - 3)
blinking, facial tics, arm tossing, shrugging (0 - 1 - 2 - 3)
throat clearing, sniveling without a cold (0 - 1 - 2 - 3)
rubbing one's ear, chin, twisting one's hair, pinching, finger sucking (0 - 1 - 2 - 3)
The frequency of the occurrence and intensity of the tension is determined by the specific mental and physical condition of the child and the social environment affecting the child.
A special, specific group of children with increased mental tension is represented by physically and mentally abused children (Vágnerová, 1997) who are frequently abused by the very people who were supposed to be their source of certainty and security. All this frequently damages the overall personality development.
We have to distinguish difficulties manifested only by an increased mental tension from various neurotic disorders.
Neurotic disorders are divided according to prevailing clinical manifestations, e.g., into phobic anxiety disorders, panic disorder and the obsessive-compulsive disorder. A phobic anxiety disorder is characterized primarily by various phobias, e.g., a phobia of sharp objects, water, flying, enclosed space, insects, snakes, disease, blood, etc. These are specific phobias.
Agoraphobia is a fear of open spaces, as well as large enclosed spaces, such asan airplane, subway, department store, etc. It includes the fear of leaving one's home, traveling. It is a separate diagnostic unit which occurs twice as often in women, as do specific fobias, a generalized anxiety disorder and panic disorder. Agoraphobia tends to be associated with the panic disorder, secondary depression and various physical complaints. Social phobia is in a category of its own. It occurs in men and women equally. Anindividual suffering from social phobia is excessively fearful of embarrassing himself/ herself in his/her contacts with people and in social situations (he/she blushes, sweats, has a tight throat, shaking hands and voice and various vegetative symptoms). Anxiety symptoms lead to unpleasant emotional states, concerns that one would be observed and viewed in an unfavorable light, avoidance of unpleasant situation, general evasive behavior, social isolation, and, in extreme cases, to suicide. And yet, the sufferers are aware of the fact that their concerns and behavior are excessive, inappropriate.
A periodic, recurrent massive anxiety is typical of the panic disorder. It occurs suddenly, without any objective threat. The panic arises suddenly and lasts several minutes. The state is accompanied by an unbearable fear of losing control, going insane, dying. An attack experienced once leads to a certain fixation and repetition.
Generalized anxiety disorder is a different diagnostic unit. It includes permanent,excessive concerns, anxieties and bad premonitions of a general nature, associated with everyday life events. The sufferers live in a constant state of anxious tension and expectations. The symptoms are not triggered by any specific situations. Anxiety disorders constitute a significant burden and lead to social maladptation of the sufferer.
Obsessive-compulsive disorder is characterized by persistent thoughts, ideas(obsessions) or acts (compulsions). The obsessions include fear of dirt, infection, damage, loss, of something not having been done or something not having been done in a required fashion. Compulsions (acts) alleviate the anxiety brought about by the obsessions (ideas). Entire compulsive rituals which in the patient's belief are to prevent a future "catastrophe", avert a threat to the patient or his/her loved ones or prevent evil the patient could cause are encountered frequently. These disorders are treated by psychotherapy which - depending on the severity of the various symptoms and associateddisorders - is supplemented with pharmacotherapy. Analytical and dynamically oriented psychotherapy and cognitive -behavioral therapy (CBT) tend to be applied. In addition to CBT, many cases respond favorably to hypnosis and additional support therapy involving relaxation techniques. Social skill training, group psychotherapy and social support also tend to be effective.

Typical symptoms of infantilism which can be easily established by observation and interview, include the following:
psycho-social behavior corresponds to a lower age (0 - 1 - 2 - 3)
age-inappropriate playfulness (0 - 1 - 2 - 3)
excessive use of diminutives in speech (0 - 1 - 2 - 3)
inappropriate need for caressing (0 - 1 - 2 - 3)
inappropriate naivety (0 - 1 - 2 - 3)
emotional instability (0 - 1 - 2 - 3)
lack of independence (0 - 1 - 2 - 3)
egocentricity (0 - 1 - 2 - 3)
fantasizing (0 - 1 - 2 - 3)
lack of interest in work (0 - 1 - 2 - 3)
excessive dependency on assistance from others at work, when dressing (0 - 1 - 2
- 3)
preference for friendships with mostly younger or mostly older people (0 - 1 - 2
- 3)
emphasis on conspicuous clothes, hairstyle and footwear (0 - 1 - 2 - 3)
neglects to perform assignments (0 - 1 - 2 - 3)
generally infantile behavior and experiencing (0 - 1 - 2 - 3)
All of the above with intelligence within the norm.
Manifestations of immaturity and inaptitude have an extremely significant impact on the child's adaptation with regard to the beginning of primary school attendance and later on to choice of career and study.
The beginning of school attendance means an important change for the child, a serious milestone in the child's life. Until now, the child was carefree and could play but now it will have to work in a disciplined manner. Until now, the child could simply abandon its play when it grew bored with it, and start doing something else. Now it will have to be able to concentrate and make a sustained conscious effort in order to fulfill work assignments, including those the child will not find interesting. While the child can
now move spontaneously without permission, it will soon have to follow the teaching with discipline, accept assignments, work on them and complete them by a stipulated deadline.
A child who is still too immature (not yet capable of) for school attendance manifests for instance the following typical behavior when examined at the pedagogical and psychological counseling center:
• does not want to leave its parents, resists, cries
• does not establish contact, is negativistic, does not talk, acts scared
• shows no inhibitions, is excessively relaxed, treats adults in a familiar fashion, is obtrusive
• is unable to follow commands without individual assistance
• is easily distracted, does not concentrate
• interrupts work, refuses to continue, leaves the work station, sings while working
• has difficulty expressing itself, is difficult to communicate with
• has an obviously small vocabulary
• appears too infantile and playful overall
• appears to be mentally retarded
• defective articulation (lisping, mumbling, cluttering, stammering, etc.);
• is obviously restless
• poor graphic expression
• behavior appropriate to a lower age
• underdeveloped hygienic routines
• is not looking forward to starting school yet.
Infantilism must be distinguished from mental retardation and dementia.
Mental retardation is an affliction involving a slight, medium, seriousand severe retardation of development of intellectual abilities and skills, different development of certain mental traits and social behavior disorders. Mental handicap or mental retardation refers to a permanent diminishment of intellectual abilities caused for instance by organic damage to the brain.
An infantile personality may be manifested at a higher age by immaturity in professional and study orientation and adaptation.

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