Hyperkinetic Disorders Research Articles

Patterns of the Diagnosis Prevalence of Psychiatric Disorders in the Population Aged 0-18 Years Based on the Nationwide Insurance Sample Data.

ObjectivesThis study aimed to examine the trend in diagnostic prevalence of psychiatric disorders in children and adolescents.MethodsIndividuals aged 0–18 years were included in the study based on the National Health Insurance Claims Data. To investigate the trends in diagnosis and diagnostic prevalence of psychiatric disorders reflecting the decrease in the birth rate, data were analyzed from 2010 as a reference year to 2015.ResultsThe number of patients diagnosed with psychiatric disorder decreased annually, from 23,412 on 2010 to 18,821 on 2015. The most common disorder was hyperkinetic disorder in male and depressive episode in female. Although there was no significant change in overall diagnostic prevalence rate of psychiatric disorders, age groups <10 years and some disorders had significant changes in prevalence rate. This study classified the diagnostic prevalence by age into two unique patterns: group in which the diagnosis rate increases with age and group in which the diagnosis rate peaks at a certain age and then decreases.ConclusionDiagnostic prevalence of psychiatric disorders was different according to age and sex. These patterns should be reflected in the formulation of policies related to mental health and in medical practice for pediatric patients. It is urgent to identify how these patterns change in young adults.

Punding Related to Methylphenidate-Aripiprazole Combination in a Hyperkinetic Low-Functioning Autism Spectrum Disorder Child.

Punding Related to Methylphenidate-Aripiprazole Combination in a Hyperkinetic Low-Functioning Autism Spectrum Disorder Child.

Hyperpolarization of the subthalamic nucleus alleviates hyperkinetic movement disorders

Modulation of subthalamic nucleus (STN) firing patterns with injections of depolarizing currents into the STN is an important advance for the treatment of hypokinetic movement disorders, especially Parkinson’s disease (PD). Chorea, ballism and dystonia are prototypical examples of hyperkinetic movement disorders. In our previous study, normal rats without nigro-striatal lesion were rendered hypokinetic with hyperpolarizing currents injected into the STN. Therefore, modulation of the firing pattern by injection of a hyperpolarizing current into the STN could be an effective treatment for hyperkinetic movement disorders. We investigated the effect of injecting a hyperpolarizing current into the STNs of two different types of hyperkinetic animal models and a patient with an otherwise uncontrollable hyperkinetic disorder. The two animal models included levodopa-induced hyperkinetic movement in parkinsonian rats (L-DOPA-induced dyskinesia model) and hyperkinesia induced by an intrastriatal injection of 3-nitropropionic acid (Huntington disease model), covering neurodegeneration-related as well as neurotoxin-induced derangement in the cortico-subcortical re-entrant loops. Delivering hyperpolarizing currents into the STN readily alleviated the hyperkinetic behaviors in the two animal models and in the clinical case, with an evident increase in subthalamic burst discharges in electrophysiological recordings. Application of a hyperpolarizing current into the STN via a Deep brain stimulation (DBS) electrode could be an effective general therapy for a wide spectrum of hyperkinetic movement disorders.

A simulation-based comparison of two methods for determining the treatment effect in children diagnosed with hyperkinetic disorder

In order to show the effect of treatment, the change between two repeated psychometric measurements at the individual level should be estimated. The simplest method is to calculate the absolute difference between two measurements. However, measurements obtained in a clinical setting are often influenced by other changes not related to the treatment. One of the typical sources of error is regression to the mean (RTM). Iachina and Bilenberg (2012) propose a new method to adjust to the RTM effect. In this work, we will evaluate the performance of absolute difference method and adjusted method in a simulation study.

Spinocerebellar ataxia type 48: last but not least.

Biallelic mutations in STUB1, which encodes the E3 ubiquitin ligase CHIP, were originally described in association with SCAR16, a rare autosomal recessive spinocerebellar ataxia, so far reported in 16 kindreds. In the last 2 years, a new form of spinocerebellar ataxia (SCA48), associated with heterozygous mutations in the same gene, has been described in 12 kindreds with autosomal dominant inheritance. We reviewed molecular and clinical findings of both SCAR16 and SCA48 described patients. SCAR16 is characterized by early onset spastic ataxia and a wide disease spectrum, including cognitive dysfunction, hyperkinetic disorders, epilepsy, peripheral neuropathy, and hypogonadism. SCA48 is an adult-onset syndrome characterized by ataxia and cognitive-psychiatric features, variably associated with chorea, parkinsonism, dystonia, and urinary symptoms. SCA48, the last dominant ataxia to be described, could emerge as the most frequent among the SCAs due to conventional mutations. The overlap of several clinical signs between SCAR16 and SCA48 indicates the presence of a continuous clinical spectrum among recessively and dominantly inherited mutations of STUB1. Different kinds of mutations, scattered over the three gene domains, have been found in both disorders. Their pathogenesis and the relationship between SCA48 and SCAR16 remain to be clarified.

Clinical and biochemical features of anxiety in children with hyperkinetic disorder

Clinical and biochemical features of anxiety in children with a hyperkinetic disorder, also known as a combined type of ADHD, have not been studied, although these data are extremely necessary for therapeutic intervention in cases of comorbidity of hyperkinetic and anxiety disorders.Objective: to study pathogenetic mechanisms and the role of anxiety level in the formation of the main symptoms of the disorder.Materials and methods. We examined 182 children with hyperkinetic disorder and 60 peers from control group aged 6–10 years. After clinical examination we studied the content of monoamines, their precursors, and metabolic products in daily urine. Assessment of the main clinical symptoms (inattention, hyperactivity, impulsivity) was carried out on the SNAP-IV scale. An assessment of the level of anxiety was carried out according to the questionnaire Lavrentieva G.P. and Titarenko T.M. Patients with hyperkinetic disorder were divided into subgroups according to the nature of the monoaminergic “profile”.The results of the study support the hypothesis that pathological and steady increase in anxiety level leads to increase in the impulsivity level in children with hyperkinetic disorder. And the main role in this process is played by the noradrenergic system and the weakening of the inhibitory effect of serotonin, causing an increase of anxiety level and aggravating the imbalance of the activity of monoamine systems.

Clinical and pathogenetic features and correction of hyperkinetic disorders in vegetative dysfunctions

One of the early syndromes in vascular pathology is motor disorders in the form of tremor. We examined 101 patients with cerebral dystonia on the background of chronic cerebral ischemia with compensated and subcompensated stages (n = 55) and autonomic dystonia syndrome (n = 46). Pathological mechanisms of formation of trembling hyperkinesis in cerebral angiodystonia of different etiology have been studied. Participation in these processes of the autonomic nervous system (ANS) is established. It is proved that the severity of this type of motor disorders depends on the condition of the ANS at different levels of its organization, especially on the background of sympathicotonic effects, as well as the vegetative characteristics of the patient. At the same time, signifi cant changes in electrophysiological parameters, as well as data of vegetative, emotional, psychometric testing, were obtained. For an objective evaluation of the severity of the tremor, a tremograph with the calculation of an integrative tremographic index was used. Developed a complex of cerebral angiodystonia with hyperkinetic syndrome and the use of antioxidants, nootropic drugs, which allowed to reduce or eliminate subjective experiences, to increase the adaptation capacity of the organism with the normalization of sympatho-parasympathetic relationships, to the normalization of the organism. also inhibition of the implementation of trembling hyperkinesis in both research groups. The average values of the tremographic index decreased towards an adequate distribution with sympathicolytic influence on the indices of vegetative testing and caused skin sympathetic potentials. At the same time, a greater effect was achieved when using the proposed method of treatment, with the maximum — in the syndrome of autonomic dystonia, as well as in the compensated stage of chronic brain ischemia. Keywords: cerebral angioedema, cerebral ischemia, autonomic disorders, tremor, treatment

Neonatal thyroid-stimulating hormone and association with attention-deficit/hyperactivity disorder.

Normal brain development is dependent on maternal, fetal and neonatal thyroid function. Measuring neonatal thyroid-stimulating hormone (TSH) 48-72 hours after birth screens for congenital hypothyroidism, allowing early treatment to avoid serious impairment. However, even within sub-clinical ranges, disrupted thyroid homeostasis during brain development has been linked to adverse neurodevelopmental outcomes, including attention-deficit/hyperactivity disorder (ADHD). To estimate the association between neonatal TSH below threshold for potential congenital hypothyroidism and subsequent ADHD diagnosis using a population-based birth cohort. Children with a diagnosis of ADHD in the Norwegian Mother, Father and Child Cohort Study (MoBa) were identified through linkage with the Norwegian Patient Registry using ICD-10 codes for hyperkinetic disorders. The study included 405 ADHD cases and 1,092 controls (born 2003-2008) with available neonatal TSH concentrations below 10 mU/L (cut-off for potential congenital hypothyroidism) measured in dried blood spots sampled 48-72 hours after birth. In multivariable, quintile models the relationship appeared to follow a U-shaped pattern with elevated odds ratios (OR) at lower and higher TSH levels. Among children with TSH in the lowest quintile, odds of ADHD was approximately 1.5-fold higher than children in the middle quintile (OR 1.60, 95% CI 1.09, 2.34), which was driven by substantially elevated risk among girls, with no association among boys (Pinteraction = 0.02; girls OR 3.10, 95% CI 1.53, 6.30; boys OR 1.16, 95% CI 0.73, 1.84). ADHD risk appeared to be elevated among newborns with low TSH levels (i.e. with hyperthyroid status), and this association was mainly found among girls. Because our findings are suggestive of increased risk at very low TSH concentrations, where analytical accuracy is low, future studies should employ highly sensitive assays capable of accurate quantitation at very low concentrations. Also, larger studies are needed to investigate these associations at higher neonatal TSH concentrations where data are more widely distributed.

Pattern of psychiatric morbidity in pediatric outpatient department

Mental health in child and adolescents is an essential component of overall health. Disturbed children are more likely to be disturbed adults. Therefore, early detection and treatment is important to decrease the long term disability. The objective of the study was to determine the morbidity pattern of psychiatric disorders among patients of pediatric outpatient department of tertiary level hospitals. This cross-sectional study was conducted from July 2012 to February 2013 in pediatric outpatient department of three prime tertiary level hospitals of Dhaka, Bangladesh. Purposive sampling technique was used and sample size was 240. A Semi- structured questionnaire containing socio-demographic and other relevant clinical information and the parent version of Development and Well Being Assessment (DAWBA) were applied. The results showed that most (70.8%) of the respondents were of 5 to 10 years’ age group with a male preponderance (54.2%). Out of 240 respondents, 44 (18.3%) were found with psychiatric morbidity. Categorically emotional disorder was 14.6%, behavioral disorder was 9.2% and developmental disorder was 0.4%. Hyperkinetic disorder (5.4%) and Oppositional defiant disorder (2.9%) were the most frequent diagnoses, followed by Obsessive compulsive disorder (2.5%). 29.5% of psychiatric cases were associated with other comorbid psychiatric diagnoses. Respondents with minor physical illness were mostly found with psychiatric morbidity (43.2%). Multiple patterns of psychiatric disorders were identified among the respondents. Therefore, the need to step up to the clinical and referral approaches is imperative to this special segment of children of our society.&#x0D; Bang J Psychiatry June 2017; 31(1): 1-6

Mind over matter: an analysis of the mechanism of deep brain stimulation in the treatment of Parkinson’s Disease

Relevance: In a population of increasing longevity, neurological disorders are becoming more prevalent - placing a large strain on NHS resources and funding, as well as an emotional burden on those affected and their families. One such example is Parkinson’s Disease (PD). This neurodegenerative disorder of the basal ganglia is characterised by a progressive loss of nigrostriatal dopaminergic transmission, commonly presenting as tremor, bradykinesia, rigidity, postural instability, akinesia, and impairments in cognition. Deep brain stimulation (DBS) has proven a successful approach to treating PD despite its mechanism of action being unclear. Summary: Three main problems of counteractive outcomes present when identifying a common mechanism of DBS within targets. Firstly, contrasting actions of DBS are required to explain DBS between targets, such as the GPe and GPi. Secondly, conflicting studies have reported both excitatory and inhibitory action of DBS within the same targets. Finally, the treatment has also paradoxically proven effective in treating hyperkinetic disorders, such as Dystonia. There remains no conclusive model for the treatment’s mechanism. Take Home Messages: To deliver effective treatment and care, it is important for doctors to understand the mechanism of action of procedures they are performing. Hence further investigation into PD aetiology and DBS action is required.

Cognitive deficit in children with hyperkinetic disorder

The review presents current data on the nature of cognitive deficit in children with hyperkinetic disorder, and possible pathophysiological mechanisms of the disease. Considering possible neurobiological components of hyperkinetic disorder, attention is given to pathological functional connections underlying specific clinical manifestations of the disease.

Pediatric Movement Disorders and Neuromodulation: An Overview.

Pediatric movement disorders are heterogeneous and complex disorders with various aetiologies. These are broadly classified as hypo and hyperkinetic disorders. Genetic causes of basal ganglia dysfunction or direct injuries to the basal ganglia mark the genesis of these abnormal movements. The management of pediatric movement disorders is multidisciplinary with pharmacotherapy as the first line of management along with physical therapy. Patients resistant to medications are candidates for invasive neuromodulation which is an upcoming treatment modality in pediatric movement disorders. Deep brain stimulation of basal ganglia and thalamic nuclei are associated with promising symptomatic benefit with reduction in disability and improvement in quality of life of these children. In this article, we have reviewed the management of pediatric movement disorders with emphasis on neuromodulation i.e., deep brain stimulation.

Hemifacial spasm

Hemifacial spasm (HFS), or facial hemispasm, is a paroxysmal hyperkinetic disorder involving muscles innervated by the facial nerve, mainly on the one hand. The development of HFS is based on neurovascular conflict. However, it is impossible to explain the clinical manifestations of HFS only by nerve compression. Both peripheral and central mechanisms are involved in the generation of HFS, with the formation of ephaptic transmission, antidromic excitation, primary or secondary hyper-excitability of the nuclear and supranuclear level of innervation. Two treatment methods are pathogenetically justified: microvascular decompression (MVD) and botulinum toxin (BTX) injections. The effectiveness of MVD is 95.37% with full or partial recovery. The recurrence rate does not exceed 2.4%. Facial nerve paralysis (2.7-22.5%) and hearing loss (1.9-20%) are the most common complications of treatment with the use of the MVD for HFS with partial or complete cure in most cases. Botulinum toxin injection chemo-denervation is a first-line treatment of primary and secondary HFS. HFS is an officially registered indication for the drug dysport (abobotulotoxin) (ABO) in the Russian Federation. Total doses of ABO ranged from 25 to 150 units for one side depending on the severity of the clinical manifestations. Studies demonstrate the statistically significant benefits of HFC treatment with ABO. ABO is generally well-tolerated. Adverse events (up to 3.6%) are transient and include ptosis, lacrimation, blurred vision, double vision, dry eyes and weak facial muscles.

School refusal - Psychosocial distress or Psychiatric disorder?

Background: School refusal is not a diagnosis by itself but a behavior described when a child frequently refuses to go to school or remain in school. It is often associated with several psychiatric disorders. A prevalence rate of 5-10% is described in most studies. Several psychosocial factors, individual, familial, societal, school and medical are also known to play an important role. The study intends to explore the association of school refusal to either psychiatric disorder or to distress due to psychosocial factors. Aim: To explore the psychosocial factors and psychopathology in children presented with school refusal. Materials and Method: A descriptive study conducted on children attending Child and Adolescent Psychiatry OPD at ASHA Hospital with primary complaint of school refusal, from January 2018 to December 2018. Data pertaining to 33 new cases of school going children between 6 years and 18 years, with school refusal as main symptom were collected using a semi structured proforma. Various psychosocial factors which were broadly classified as individual, family, school, societal factors and other medical disorders were analyzed. Psychiatric diagnosis made using ICD 10 criteria was assessed. Data analyzed using SPSS software. Results: About 6.6% of total new child cases in the year of 2018 were with primary complaint of School Refusal. Out of these 33 subjects, 30 (91%) had a psychiatric diagnosis at baseline. Depressive disorder (36.4%) was commonest followed by anxiety disorder (18.2%), conduct disorders (15.1%) and remaining Hyperkinetic disorder, mental retardation and bipolar disorders. Psycho-social factors influenced school refusal contributing to the psychiatric disorder. Conclusion: The study highlights school refusal as a symptom of one or two psychiatric disorder rather than psychosocial distress alone, indicating high psychiatric morbidity. Further it emphasizes that the symptom need to be taken as an emergency and intervened. This would e

Profile Of Tourette Syndrome In Children And Adolescents From A Tertiary Care Child Psychiatry Centre In India

Introduction: Tourette Syndrome is a type of tic disorder that is not as rare as it was once thought to be. There is a paucity of literature on Tourette syndrome in children and adolescents in the Indian setting. The objectives of this study were to elucidate sociodemographic and clinical profile of children and adolescents with Tourette syndrome. &#x0D; Material and Method: The present study is a retrospective chart review of children and adolescents up to age 18 years diagnosed with Tourette Syndrome in a tertiary care centre, India. This sample is from a subset of a larger sample of case records of patients with a diagnosis of tic disorder, coded as F 95, according to ICD 10 from 1st January 2014 to 31st December 2017 (4 years duration). &#x0D; Results: The sample included 28 children. All of them were male, and the mean age of onset was 8.2 years. The period prevalence of Tourette syndrome was 0.22%. The entire sample received pharmacotherapy and the most common medication prescribed was Risperidone followed by Clonidine, Aripiprazole, Haloperidol, and Tetrabenazine. Majority (64.28%) of the sample had a comorbid condition. The most common comorbid conditions were Hyperkinetic Disorders followed by Obsessive Compulsive Disorder Specific and Specific Developmental Disorder of Scholastic skills &#x0D; Conclusion: Tourette syndrome can be a disabling condition in school-going children. There is a need for population-based studies for estimating its prevalence in Indian subcontinent., and there is also a great need to increase awareness and sensitize the public to seek help to improve the quality of life of children and adolescents with Tourette syndrome.

Tourette syndrome in children in Norway.

Tourette syndrome first appears in childhood and is characterised by chronic motor and vocal tics. In other countries, the mean prevalence is estimated at 0.77% in children aged 6-15 years. Diagnostic practice and treatment have not been investigated in Norway. We used data retrieved from the Norwegian Patient Registry and the National Registry to calculate the percentage of children born during the period 2002-10 diagnosed with Tourette syndrome. The calculations were made for the country as a whole as well as by county. Drug therapy was investigated using data from the Norwegian Prescription Database. By the age of 12, altogether 0.43% had received a diagnosis of Tourette syndrome, broken down into 0.71% for boys and 0.15% for girls. The overall percentage varied from 0.15% to 1.23% between the counties. For Norway as a whole, the percentage of diagnoses remained stable between 2008 and 2016. Psychiatric and neurological conditions were often present - the most common being hyperkinetic disorder (50%) and autism spectrum disorder (11%). Antipsychotic drugs, probably for the treatment of tics, were prescribed for 16% in the year following the diagnosis. The percentage of children with a diagnosis of Tourette syndrome is lower than the mean prevalence in population studies internationally. The diagnostic practice varies considerably from county to county.

Diagnostic trajectories in child and adolescent mental health services: exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register

Community-based epidemiological studies show transitions between psychiatric disorders are common during child development. However, little research has explored the prevalence or patterns of the diagnostic adjustments that occur in child and adolescent mental health services (CAMHS). Understanding diagnostic trajectories is necessary to inform theory development in developmental psychopathology and clinical judgements regarding risk and prognosis. In this study, data from CAMHS clinical records were extracted from a British mental health case register (N = 12,543). Analysis calculated the proportion of children whose clinical records showed a longitudinal diagnostic adjustment (i.e. addition of a subsequent diagnosis of a different diagnostic class, at > 30 days’ distance from their first diagnosis). Regression analyses investigated typical diagnostic sequences and their relationships with socio-demographic variables, service use and standardised measures of mental health. Analysis found that 19.3% of CAMHS attendees had undergone a longitudinal diagnostic adjustment. Ethnicity, diagnostic class and symptom profiles significantly influenced the likelihood of a diagnostic adjustment. Affective and anxiety/stress-related disorders longitudinally predicted each other, as did hyperkinetic and conduct disorders, and hyperkinetic and pervasive developmental disorders. Results suggest that approximately one in five young service users have their original psychiatric diagnosis revised or supplemented during their time in CAMHS. By revealing the most common diagnostic sequences, this study enables policy makers to anticipate future service needs and clinicians to make informed projections about their patients’ likely trajectories. Further research is required to understand how young people experience diagnostic adjustments and their psychological and pragmatic implications.

Diagnostic Yield of a Targeted Next-Generation Sequencing Gene Panel for Pediatric-Onset Movement Disorders: A 3-Year Cohort Study.

In recent years, genetic techniques of diagnosis have shown rapid development, resulting in a modified clinical approach to many diseases, including neurological disorders. Movement disorders, in particular those arising in childhood, pose a diagnostic challenge. First, from a purely phenomenological point of view, the correct clinical classification of signs and symptoms may be difficult and require expert evaluation. This is because the clinical picture is often a mixture of hyperkinetic and hypokinetic disorders, and within hyperkinetic movement disorders, combined phenotypes are not unusual. Second, although several genes that cause movement disorders in children are now well-known, many of them have only been described in adult populations or discovered in patients after many years of disease. Furthermore, diseases that alter their mechanisms from childhood to adulthood are still little known, and many phenotypes in children are the result of a disruption of normal neurodevelopment. High-throughput gene screening addresses these difficulties and has modified the approach to genetic diagnosis. In the exome-sequencing era, customized genetic panels now offer the ability to perform fast and low-cost screening of the genes commonly involved in the pathogenesis of the disease. Here, we describe a 3-year study using a customized gene panel for pediatric-onset movement disorders in a selected cohort of children and adolescents. We report a satisfying diagnostic yield, further confirming the usefulness of gene panel analysis.

KARAKTERISTIKE UČENIKA SA HIPERKINETIČKIM POREMEĆAJEM I STRATEGIJE POUČAVANJA U VASPITNO-OBRAZOVNOM PROCESU

U radu su opisane karakteristike učenika sa hiperkinetičkim poremećajem (ADHD) i ukazano je na osnovne simptome hiperkinetičkog poremećaja: hiperaktivnost, impulsivnost i deficit pažnje. Posebno se ističu preterana promenljivost u reakcijama na situacije i problemi slabe regulacije i inhibicije ponašanja. Teškoće u učenju, slaba školska postignuća, problemi u međuvršnjačkim odnosima, problemi sa kontrolom ponašanja svakodnevica su dece s ADHD-om. Nerazumevanje karakteristika samog poremećaja i detetovih osećanja, kao i nemogućnost deteta da se adekvatno nosi sa svakodnevnim zahtevima škole, u aktuelnoj školskoj praksi sreću se svakodnevno. Kako bi učenici razumeli svoju okolinu i snalazili se u svakodnevnim situacijama, neophodno je da usvoje socijalne veštine. Nepoznavanje efikasnih strategija rada sa učenicima sa hiperkinetičkim poremećajem može negativno uticati na socijalno ponašanje i akademska postignuća te grupe učenika. Upravo iz tog razloga u radu se ukazuje na neophodnost primene adekvatnih strategija poučavanja i intervencija u vaspitno-obrazovnom radu sa ovom populacijom učenika.

PROTECTION OF CHILDREN - YOUTH MENTAL HEALTH IN A SCHOOL ENVIRONMENT

Maintaining good mental health in childhood is an important element of healthcare for each country. Efforts to protect child health are being are being carried out not only by medical, health and social care specialists, but also by the people who make up the social circle of the child. During this period, parenting techniques, as well as their behavior and attitude towards the child, play a vital role. Especially important is the support and assistance that parents and relatives give to the child in communicating with him. When unacceptable parenting practices, that degrade the child's personality, are undertaken, family counseling is needed to reduce the psycho-emotional stress and harassment applied to the child's psyche. To a great extent, worrying, depressive, neurotic and psychotic conditions are due to an inadequate family and social environment. The lack of conditions for development and proper social functioning of the child causes emotional imbalance, which the child can hardly cope with.In the case of untimely taken measures during school-age, psychotic disorders can cause many problems, the overcoming of which necessitates the inclusion of professionals from different fields. Child psychiatrists, clinical psychologists, psychologists, occupational therapists, social workers and educators form a multidisciplinary team that adequately takes decisions with regard to information received from parents, relatives and institutions. Mental health professionals have definedmanifestations of themental diseases as: emotional disorders, phobias, anxiety states and depression, aggression and antisocial behavior, hyperkinetic disorders, developmental disorders, primarily affecting children with autism and those with pervasive developmental disorders. The multidisciplinary team also takes action to implement the decisions taken to improve the quality of life of people experiencing difficulties in their personal development. Often in school age in people who do not have pathological changes in mental development, the social environment is this important factor that determines their behavior by which they are graded in society. Lack of attention by parents, excessive rigidity, strictness, hyperprotection, family conflicts and problems, school and social difficulties, predispose to a negative behavioral change. Behavioral anomalies are indicative of the low percentage of pupils with mental health problems attending mass schools. They self-exclude themselves from school and society as a whole because of the inability to meet the expectations of the environment. The individuals fall into social isolation as it predisposes them to participate in antisocial actions. This is a major reason for imprisonment, social degradation and marginalization.Teacherswithinschoolsarewellplacedtoobservechildrenday-to-dayandidentifybehaviourwhichsuggeststhatthechildmaybesufferingfrom a mentalhealthproblemorbeatrisk of developingone.