sábado, 30 de junio de 2018

Mental Health Disorders and Children

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By Liji Thomas, MD

Children may develop mental illnesses just as adults do, but the symptoms may be difficult to pick up. This results in unnecessary treatment delays in many cases.

Signs of a mental disorder often mimic the behavior of an upset child who is completely normal. This may hinder its recognition, as parents feel that the behavior is unacceptable in general but most children display such behavior at one point or another. Moreover, children are not equipped to analyze and vocalize their feelings and difficulties clearly as adults are.

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Other reasons why mental illness is often diagnosed late in children include the perceived shame of the diagnosis, the fear of having to treat children with psychotropic medications (such as mood-altering or antidepressant drugs), and the difficulty of paying for the required costs of treatment.

Types of Mental Disorders in Children

Mental illnesses in children follow the same general patterns as in adults, but the symptoms and signs may vary. For instance, irritability is more often seen in depressed children rather than the sadness that is typical of depressed adults.

Anxiety Disorders

Anxiety disorders in children include post-traumatic stress disorder, obsessive-compulsive disorder (OCD), social phobia, and generalized anxiety disorder, all of which produce persistent and abnormal anxiety that prevents the child from taking part in normal daily activities. These are internalizing disorders because they involve feelings and thoughts.

Worry at having to face certain situations is normal in children, and may characterize certain periods of life. For instance, small children are upset when they are separated from their parents. However, normal functioning is typically not affected unless an anxiety disorder is present. Sadness and fear do not persist for unduly long periods either in most children.

Separation anxiety is extreme fear of being separated from the loved ones
Phobias are intense fears about certain things or situations
Generalized anxiety is worry about the occurrence of misfortunes in the future
Panic attacks are sudden episodes of intense fear with physical symptoms such as a pounding heart, sweating, trembling, and difficulty in breathing

Post-traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) often affects children who have been exposed to stress and who lack the resources to recover normally. This leads to long-term distress in the form of symptoms such as recurrent nightmares or flashbacks, intense fear, jitteriness, anxiety, or being unable to deal with any reminders of the event. This makes the children unable to function normally.

Obsessive-Compulsive Disorder

OCD is diagnosed when children are bothered by unwanted thoughts (obsessions), and habitually do something (compulsions) to get rid of such thoughts, though their action is not actually related to the intrusive thought, or even if it is, it is excessively performed.

Examples include repeating the same action an enormous number of times, or checking over and over that something important has been done, or being meticulous about having things in a particular arrangement to the point of losing control if they are misplaced.

Depression

Children may develop feelings of despair or helplessness over some situations or about their life with or without reason. This may be diagnosed as depression.

Such children may also show behaviors related to sleep and appetite disturbances, fatigue, tension, and inattention or lack of concentration, as well as feelings of poor self-worth or despair.

Attention Deficit-Hyperactivity Disorder

Attention deficit-hyperactivity disorder (ADHD) is another condition in which children find it difficult to keep their attention on one thing for more than a few minutes, are hyperactive, and are prone to function on impulse.

All these features need not be present in the same patient, that is, the child may show symptoms of predominant hyperactivity and impulsivity, predominant inattention, or equal proportions of both.

Such children may daydream excessively, lose or forget things, be very careless, or fidget too much, among other symptoms.

Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a serious disorder of development that affects the child socially due to severely impaired communication and interaction skills. It is typically diagnosed before the age of three years.

Tourette Syndrome

Tourette syndrome (TS) is a condition affecting the nerves which causes tics, sudden uncontrollable movements which are often repeated, such as blinking or grunting.

Tics can be motor or vocal, and simple (only one part of the body is involved) or complex (different parts of the body are involved). They begin between 5 and 10 years of age, and worsen with stress or excitement, but may disappear when the child is engaged with something or is calm.

They often persist into adult life. Tics co-exist with other mental conditions in 90% of the affected children.

Eating Disorders

Eating disorders such as anorexia and bulimia may occur in children with excessive stress levels or poor body image, and may be severe enough to endanger life.

Such children are so bothered about food and their weight that they cannot take part in other meaningful activities.

Mood Disorders and Psychoses

Mood disorders include bipolar disorder and depression, and can make children feel sad persistently, or have unpredictable and apparently intractable mood swings which affect normal functioning.

Schizophrenia is a mental disorder that results in the child being detached from reality, and is usually seen to occur late in adolescence.

Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is diagnosed when children show persistent defiance with people (usually authority figures) whom they know in school or at home. It manifests before the age of eight years in most children and rarely arises after twelve years.

Such children are typically very bad-tempered. They fight or disobey rules or requests, are habitually sullen, and blame others for their misconduct.