INTRODUCTION:

Temper tantrum is a normal characteristic feature for a child under toddler period. when tantrum persist in young children that leads to problematic behavior and predictor of anti-social behavior in future. And during childhood may show symptoms of disruptive behavior¹Assessment of disruptive behavior of children is a highly subjective process.

A child with disruptive behavior always seek to draw the attention of teachers and trying to prevent the teacher to make attention towards other children in a classroom.²More concern given towards disruptive behavior children by respective teachers, school workers and mental health professionals in primary school.³

It is essential that the nation find ways to support emotional health of children and adolescents and their families through a continuum of comprehensive, individualized and culturally compatible services^.4Oppositional Defiant Disorder (ODD), attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD) are collectively known as childhood disruptive behavioir disorders, which requires immediate intervention and treatment.⁵

In 2016 Niec LN^, Barnett ML conducted a study among young children having conduct problems with the help of randomized control trial method and parent-child interaction therapy was provided to them. Total 42 no. of children were participated in the study having conduct problems and adaptive functioning, as well as significant decreases in parenting stress. After intervention, results showed Parents were having significant improvements in their parenting skills and parents in Group PCIT did not experience greater social support or treatment adherence.⁶

In march 2013, Deepa K conducted a study, in which research explained that Parent child interaction therapy was proposed by Eyberg et al in1995 with certain goals and designed to improve the parent –child interaction, relationship quality,decrease the child’s behavioural problems, improve the social behavior in disciplinary way,reduce parenting stress and improve parenting skills.parent child interaction therapy has 2 components: one is child directed interaction(CDI)therapy another is parent directed interaction(PDI).This approach provide treatment to both parent and child together to manage disruptive behavior of children and parent child relationship.⁷

Melanie A. Fernandez, Ashley M. Butler and Sheila M. conducted a study in 2009 among African American Families who were having low Socioeconomic Status with the use of Parent-Child Interaction Therapy and its outcomes. This study examined disruptive behavior disorders of preschoolers and the effectiveness of parent-child interaction therapy (PCIT) in 18 socioeconomically backward African American families. Result revealed that Mothers were showing significant improvements in child disruptive behavior rather than in parenting stress or maternal depressive symptoms. Results concluded that PCIT may lead to changes in behavior for disruptive young African American children after end of treatment. Reduction of parenting stress also requires study in this population⁸Daniel S Shaw examined and concluded that risk factors from infancy associated with the development of preschool disruptive behavior problems across child, parent, and socio demographic domains. Risk factors which were associated with the occurrence of disruptive behavior at 5 years of age included infants had history of disorganized attachment with parents or family members and disturbed maternal and child-rearing disagreements during the period of second year showed significantly higher aggressive problems.⁹

Children are our near future who make a difference and greater development of nation, so it very much crucial to develop them in a good and healthy environment with proper guidance of elder adults. In Family, parents are the first teacher who helps them to learn about right or wrong things, responsibility, independency, love and affection, caring etc. children always watch to their parents activities and trying to follow them. Behavioural problems mainly develops due to internal conflict and failure in adjusting the outer environment. Children with behavioural problems always need special attention towards them.¹⁰

Now a days most common Disorder found in school aged children and in child psychiatric treatment unit is childhood disruptive behaviour disorder. In 2014, a Descriptive study was conducted by using convenient sampling technique among primary school children with total 30 number of students to identify disruptive behaviour disorders. Result revealed that majority 47.36% children had moderate disruptive behavior, 42.12% had severe disruptive behavior and 10.52% children had mild disruptive behaviour disorders. study concluded that early identification and proper intervention can yield better outcome for children with disruptive behavior.¹¹

Childhood behavioural disorders are characterized into disruptive behaviour disorder of a child which includes Oppositional Defiant Disorder, Attention Deficit Hyperactivity Disorder and Conduct Disorder. These disorders have different psychopathology and requires proper management by parents and health professionals to modify their maladaptive behavior. Hence, its vital for nurses to play a crucial role to reduce symptoms of childhood behavioural disorders and provide accurate nursing management.¹²

Rachel A. Gershenson, Aaron R. Lyon, Karen S. Budd in 2010 conducted a study on Promoting Positive Interactions in the Classroom: Adapting Parent-Child Interaction Therapy as a Universal Prevention Program concluded that The adaptation of Parent-Child Interaction Therapy may provide an opportunity to improve the relationship between teacher and child and also guide teachers as a effective tool for behavior management.¹³Webb HJ, Thomas R, MC Gregor L, et al in 2016 Conducted a study on an evaluation of parent child interaction therapy with and without motivational enhancement to reduce to attrition. The study depicted that child externalizing behavior report promising outcomes for families. A parent child interaction therapy with 3 session individual motivational enhancement component started to reduce attrition and improves outcomes. Total 192 number of Australian caregivers were participated, among them 91.7% were female, 33.3% were their children, and 51% Families referred from child welfare or health services for risk of maltreatment were assigned to PCIT. It depends on their time of entry to the study. Those families who were in waiting list, they received phone calls once in a week for 12 weeks. At the end there were major reductions found in externalizing and internalizing parental stress and child behavior problems among families. There was generally no significant difference between the two treatment conditions.¹⁴

In 2017, Rajanidevi. Hiremath, Sanjay Shinde conducted a study among 100 number of primary school teachers about knowledge regarding childhood behavioural problems and its prevention at Bagalkot. In school teachers play a important role in health promotion and prevention of diseases. So, it is teacher’s responsibility to find out the behavioural problems of children as early as possible and initiate preventive action. Hence its vital to assess the knowledge level of teachers regarding childhood behavioural problems. In this study result revealed that majority 58.82% teachers had moderate knowledge about behavioural problems of children and their prevention.¹⁵

Rag pickers under the age of 14years are most vulnerable to various psychological disturbances. Children are doing such type of hazardous work and living in an unhealthy environment usually exploited physically, socially, mentally and morally. So, they are involved in more anti-social activities. Study revealed that children having such bad working conditions and poor demographic conditions influence their mental health, which promotes to the children for developing deviant behavioural attitude.¹⁶

Namasivayam AK, Jethava V, Pukonen M, et al in 2016 Dec Conducted a study on parent child interaction in motor speech therapy. It was concluded that, this study was carried on to measure the reliability and sensitivity of a modified parent child interaction observation scale (PCIOs). It is used to monitor the quality of parent child interaction. Child related items were more strongly affected by differences in treatment intensity than parent related items, where a greater number of reasons positively influenced.¹⁷

Bagner, D.M. and Eyberg, S.M. in 2007 conducted a RCT study on Parent-child interaction therapy among children having disruptive behavior with mental retardation. Children assigned to the PCIT group were scored by parents as having lower levels of externalizing behavior (effect size = 1.08), less frequent disruptive behavior (effect size = 1.5), and less total problem behaviors on the Child Behavior Checklist (effect size = 0.97). No significant impacts were shown for the severity of problem behavior as measured by the Eyberg Child Behavior Inventory. Mixed results were found on the parenting stress index, with a positive impact found for the difficult child scale, but not the parental distress or dysfunctional parent-child interactions.¹⁸

In 2016 Archana Maurya, B. Lakhakar, Darshana Kumari conducted a study at Wardha among 200 school going children to detect the prevalence of behavioural problem. Researchers used descriptive survey approach to collect the information from parents of selected children. Result depicted that age of children was statistically associated with behavior problem score and prevalence of behavior problem was seen in school going children.¹⁹

Children education, development in a healthy environment depends on sources available in their surrounding and opportunities provided by parents. Behaviour, thinking, attitude etc are influenced by their parents, family and society. Now a days various advertisements directly or indirectly influencing needs and desires of people and also child development. Strong parent-child interaction and healthy decisions towards development of child can prevent childhood behavioural problems in school going children.²⁰

MATERIALS AND METHODS:

An evaluative research approach and quasi-experimental design was used in this current study. Prior permission was obtained about ethical issues from dean and authorities. The main study was conducted at Malipara village of Khurda, Odisha with total 40 number of children 3to 8 year of age having disruptive behaviours taken as sample by using total enumeration sampling technique. Then formal permission was obtained from the parents and informing about the procedure, purpose and benefits of data collection. Pre test was conducted in the two weeks prior the therapy (pre intervential 2 week), the children both experimental group and control group. Followed by the intervention was carried out under the guidance of guide and experts. Each Individual was exposed to the therapy for 1 hour, twice a week. Child Directed Session for 30 Minutes and Parent Directed Session for 30 minutes. Total no. of 5 session was carried out.

RESULTS:

Table: 1 Frequency and percentage distribution of study samples according to age, child education, occupation of father, type of family, education of father, education of mother and religion.

N (n₁+ n₂) = 40

Items	Frequency (f)	Percentage (%)
Age in year
< 4	Nil	------
4 to 6	14	35
7 to 8	26	65
Child education
Nursery	15	37.5
Primary	25	62.5
Occupation of father
Employed	14	35
Govt. Job	2	5
Labourer	18	45
Unemployed	6	15
Type of family
Nuclear family	9	22.5
Joint family	28	70
Extended family	3	7.5
Education of father
Illiterate	2	5
Primary school	13	32.5
Middle	22	55
Higher secondary	3	7.5
Education of mother
Illiterate	12	30
Primary school	27	67.5
Higher secondary	1	2.5
Religion
Hindu	40	100

Figure-1: Pre test and Post test scores of disruptive behavior in experimental group (intensity scale). n₂= 20

Figure-1 reveals that out of total children in experimental group 90% children shown mild disruptive behavior and 10% children found moderate disruptive behavior before giving intervention, and after intervention 10% children did not show any disruptive behavior and, 90% children had mild disruptive behavior.

Figure-2 Pre-test post test scores of disruptive behavior of experimental group of children (problem scale). n₂ = 20

Figure- 2 shows that in experimental group prior to intervention only 20% children’s parents stated that they were significantly bothering about their children disruptive behavior but 80% parents were not bothering at all. No one complained about their children’s disruptive behavior after intervention.

Figure- 3: Pre test post test scores of disruptive behavior of control group of the children (problem scale) n₁= 20

Figure-3 shows that in pre test and post test there was no changes found in disruptive behavior of children in control group.

Table. 2 Comparison between pre test and post test scores of disruptive behavior of children in experimental group using Paired ‘t’ test. N(n₁+n₂)= 40

Item	Mean	SD	Paired t value	DF	p value
Intensity scale	1.7	3.64	2.086	19	0.025 *
Problem scale	2.7	2.735	4.413	19	0.00015*

*P value ≤ 0.05

There is significant difference between the scores of pre-test and post -test level of disruptive behavior of the children in experimental group.

Table -3 Comparison between pre test and post test scores of disruptive behavior of children in control group using Paired ‘t’ test N(n₁+n₂)= 40

Item	Mean	SD	Paired t value	DF	p value
Intensity scale	0.15	0.812	2.311	19	0.016
Problem scale	0.3	2.028	0.661	19	0.258

P value > 0.05

There is no significant difference between the scores of pre-test and post -test level of disruptive behavior of the children in control group.

Table: 4 Comparison between pre test scores of disruptive behavior of children in experimental group and control group by using unpaired ‘t’ test.

Items	Groups	Mean	Variance (sd)²	Unpaired ’t’ test	df	p value
Disruptive behavior	Experimental	65.4	0.542	0.66516	38	0.5696
(Intensity scale)	Control	64.7	0.565
	Experimental	58.05	0.287
(Problem scale)	Control	58.1	0.234	0.06921	38	0.0694

P value>0.05

There is significant difference between the post test scores of disruptive behavior of the children both in experimental and control group.

Table-6 Chi square analysis of selected demographic variables i.e age of child, child education, occupation of parent, type of family, education of the father, education of the mother with parent child interaction therapy. N(n₁+n₂)= 40

Demographic Variable	Chi- square Value	Df	P value
Age in year of Child	0.062794	1	0.802
Child Education	0.173789	1	0.676
Occupation Of Parent	7.3825	3	0.06
Type Of Family	19.395	2	6.1E-05 *
Education of The Father	15.684	3	0.001 *
Education of The Mother	8.333	2	0.015 *

*P value ≤ 0.05

DISCUSSION:

Mariëlle E Abraham, Marianne Junger et al in 2012 conducted a study on Parent–child interaction therapy for preschool children with disruptive behaviour problems. the study reveals that This study is based on the data of 37 referred families. Whereby the results of which are analysed from an analysis of parent reports of the Eyberg Child Behavior Inventory (ECBI), obtained during each therapeutic session. Furthermore, demographic information, derived from client files, was also utilized. This study revealed that 27.5% families dropped out from treatment before treatment was completed. And results indicated that parent child interaction therapy significantly reduces the disruptive behavior of children. At post treatment, there were no significant differences were found concerning the frequency of behavioral problems of children who completed treatment and those who participated in the non-clinical comparison group.²¹Brain Allen, Susan G. Timmer, Anthony J. Urquiza in 2014 conducted a study in US on Parent child interaction therapy as an attachment based on intervention with total 85 number of children having disruptive behavior as participants. Results demonstrate significant improvements in externalizing and internalizing concerns and in the intensity and number of behavior problems overall P (2.68) = 38.86, P<0.001, as well as improvements in positive parenting techniques and reductions in parenting stress. Also had repeated measures analysis by using two assessment points (pre treatment or post treatment) of co-variance of scores on two measures (Child behavior checklist, Eyberg child behavior inventory).²²In present study ’p’ value (0.025*) and 0.00015 respectively in intensity and problem scale which was less than 0.05 level of significant. it shows significant improvement after intervention. Like wise there is chi square association of disruptive behavior of children with type of family, education of father, education of mother as the ‘p’ value of this calculated chi square value less than 0.05 level of significance i.e 6.1E-05*, 0.001*, 0.015*.

CONCLUSION:

On the basis of findings of the study the following conclusion were drawn, The present study reveals that the children with disruptive behavior who receive parent child interaction therapy show lower level of disruptive behavior in compared to who don’t receive the therapy. The present study shown that disruptive behavior level mean score in experimental group after receiving parent child interaction therapy varies between 63.85 and 65.4 in intensity scale, 55.35 and 58.05 in problem scale. Assessment of disruptive behavior of the children and parent child interaction therapy had a significant effect on reducing the level and frequency of disruptive behavior among children. So parent child interaction therapy can be used effectively in community settings for maintaining and improving health status.

REFERENCES:

1. Mahesh M. Rebinal. Temper Tantrum among Children. Int. J. Nur. Edu. and Research. 2017; 5(1): 120-123. doi: 10.5958/2454-2660.2017.00025.4

2. Available from-http://psychtutor.weebly.com/disruptive-behaviour-in-schools.html

3. Jacobsen, Kari. (2013). Educators’ Experiences with Disruptive Behavior in the Classroom. Retrieved from Sophia, the St. Catherine University repository website: https://sophia.stkate.edu/msw_papers/199

4. Michael O Ogundele, Behavioural and emotional disorders in childhood: A brief overview for paediatricians, World J Clin Pediatr. 2018 Feb 8; 7(1): 9–26

5. Ritika Rocque. Oppositional Defiant disorder. Int. J. Nur. Edu. and Research. 2016; 4(4): 493-496.

6. LN Niec, Ml Barnett, MS prewett, JR Chatham Shan ley, Group parent-child interaction therapy: A randomized control trial for the treatment of conduct problems in young children, 2016, 682 -698

7. Deepa K. Damodaran. Parent Child Interaction Therapy (PCIT): Child Well-being through an effective Parenting Intervention. Asian J. Nur. Edu. and Research 3(1): Jan.-March 2013; 18-20.

8. A Melanie. Fernandez, Ashley M. Butler etal, Predicting Treatment and Follow-up attrition in Parent–Child Interaction Therapy, Journal of Abnormal Child Psychology, 2009

9. Shaw Daniel s, Ownens Elizabeth B, etal early risk factors and pathways in the development of early disruptive behavior problems, Developmental and Educational Psychology, 1996 (8), 679 - 699

10. Chandramani Sahu. A Descriptive Study to Assess the Knowledge and Attitude of Parents regarding Behavioral Problem of Pre-School Children in Selected Rural Community of Durg District (C.G.). Asian J. Nur. Edu. and Research 4(4): Oct.- Dec., 2014; 469-471.

11. Sampoornam. W. Identification of Disruptive Behaviour Disorders. Int. J. Adv. Nur. Management 2(3): July-Sept., 2014; 139-140.

12. Radhakrishnan. Role of a Nurse in the Management of Childhood Behavioral Disorders. Int. J. Adv. Nur. Management 3(2): April- June, 2015; 145-151

13. A. Rachel, Gershenson, Lyon R Aoron, Budd S Karen, Promoting Positive in the Classroom: Adapting Parent-Child Interaction Therapy as a Universal Prevention Program, education and treatment of children, 2010, vol 33, issue no 3, 261-287.

14. AK Namasivayam, V Jethava, M pukonen, A Huynh, D Goshulak, R K roll, Leieshent Van etal, parent-child interaction in motor speech therapy, child devlopment society for research in child development, 2017, 1-6.

15. Rajanidevi. Hiremath, Sanjay Shinde. Assess the Knowledge of Primary School Teachers regarding Behavioral Problems and Their Prevention among school going Children in Selected Government Primary Schools at Bagalkot. Int. J. Adv. Nur. Management. 2017; 5(3): 215-222. doi: 10.5958/2454-2652.2017.00046.4

16. Ritu Bala, Satwant Singh. Minor Psychological Disorders among Child Rag Pickers in Patiala. Int. J. Ad. Social Sciences. 2017; 5(4): 211-216.

17. M. Danko Christina, Legato Garbacz lauren, S. Budd Karen, children and youth services review, Elsivier Publication Volume 60, January 2016, page 42-51

18. D.M Bagner. and S.M. eye berg, Parent-child interaction therapy for disruptive behavior in children with mental retardation: A randomized controlled trial, Journal of Clinical Child and Adolescent Psychology, 2007, Vol. 36, No. 3, 418–429.

19. Archana Maurya, B. Lakhakar, Darshana Kumari. Prevalence of behaviour problem among school going children in rural area of Sawangi Meghe Wardha. Int. J. Adv. Nur. Management. 2016; 4(3): 353-358 doi: 10.5958/2454-2660.2016.00062.4

20. Minakshi Sarmah.Parent Child Interactin and Parental Attitudes on Child Development Print Advertisements. Res. J. Humanities and Social Sciences.2018; 9(3): 551-556

21. Marielle Abraham, Junger Marianne, et al Parent–child interaction therapy for preschool children with disruptive behaviour problems, Biomed Central 2012

22. Allen Brian, Timme G Susan etal, “Parent child interaction therapy as an attachment based on intervention. Theoretical rational and pilot data with adopted children, children and youth services view, 2014, vol 47, 334- 341

Received on 24.09.2020 Modified on 21.10.2020

Asian J. Nursing Education and Research. 2021; 11(3):369-374.

DOI: 10.52711/2349-2996.2021.00089