 The
Psychology Service
Childhood Disorders
Children
of all ages may develop a variety of psychological problems both
as a result of traumatic life events, such as a road traffic accident
or childhood abuse, but also following periods of stress in their
lives such as a breakdown in the parental relationship, birth of
a new sibling or even simply starting school.
It
is often difficult to distinguish between what is normal behaviour,
and appropriate for their level of development, and what is abnormal.
Children, particularly of young ages often find it difficult to
talk about their problems and consequently distress tends to be
expressed through their behaviour.
Below
is a description of some of the psychological problems that children
typically experience. Psychological problems in very young children
can be slightly different from the older age range/adolescents,
whose symptoms tend to be more in parallel to those found in adults.
As a result, treatment tends to be dependent upon the age of the
child and consequently this will only be briefly summarised.
Click
on one of the following for more information or simply scroll down
to view some of the typical problems children might encounter .
Post
Traumatic Stress Disorder
Post
Traumatic Stress Disorder (PTSD) is not very common in very young
children although symptoms of the disorder can be found after notably
traumatic events. Clearly, though, what may be traumatic to the
adult is not necessarily the same for the child. For example, in
a serious road traffic accident, whilst the point of the trauma
for the adult may be the collision itself, for the child it may
be seeing their parent being taken away in the ambulance. At times
of trauma, young children often become disorganised or agitated
in their behaviour. Others may freeze, and simply become very quiet
and pale.
Again,
in the aftermath of a traumatic event, whilst some younger children
may re-experience the trauma through repetitive play, with the theme
of recurring accidents, others may avoid all conversations or reminders
of it. They may begin to suffer upsetting dreams such as with the
theme of monsters and the like, rather than the trauma per se. There
is often some regression in their level of development. Otherwise,
similar symptoms to those experienced in adulthood are present.
(see PTSD)
Children
will often talk about the event for many months, even years, after.
This does not necessarily reflect an abnormal response but that
simply it was a notable life event for them. Distress is more often
displayed through a persistent change in behaviour i.e. they remain
upset by reminders of the event, want to avoid certain situations
and become abnormally aggressive in their close relationships. Their
sleep pattern may change in so much that they have problems getting
off to sleep or wake regularly at night-time in a distressed state.
Problems are not only apparent in the home but also in other situations
such as the school environment.
Whilst
many children may experience some symptoms of PTSD in the early
weeks or even months after a traumatic event, these generally subside
through reassurance from the parent. It is important not to avoid
talking about the event if the child wishes to discuss it. Gentle
but firm encouragement to confront situations that they want to
avoid will help to overcome some of their anxieties. For some, professional
intervention is required and treatment techniques in younger children
often involves play therapy and behavioural management, with the
parents being actively involved in the process. EMDR can also be
highly effective with children. With older children similar psychological
therapy approaches are utilised to those used with adults.
Generalised
Anxiety Disorders
Generalised
Anxiety Disorder is diagnosed where there is excessive worry about
a number of events or activities that persists for several months
and can not be easily controlled. Such worry is often accompanied
by symptoms such as: muscle tension; restlessness; difficulty concentrating;
sleep problems; and being easily fatigued. Children tend to worry
about their performance at school or in sporting events, or about
catastrophic occurrences. They tend to be overly perfectionist and
constantly seek approval, requiring excessive reassurance. Younger
children can be very clingy.
Such
anxiety and worry tends to take a fluctuating course but is often
worse at times of particular stressful events. Usually, it will
gradually improve with reassurance from the parent. However, if
it persists for many months and causes significant disruption to
the child’s life, in respect to relationships, school and
so forth, then professional help may well be required.
Phobias
Many
children naturally experience fears about certain situations, or
objects such as the dark, dogs, spiders, even the hoover, which
are a normal part of their development and understanding about the
world. Usually such fears do not have a marked impact upon their
lives, and gradually or even dramatically improve. Sometimes, even
where the fear about a situation has been strong for many months,
even years, children will suddenly announce that they no longer
have that fear anymore. However, a Phobia is diagnosed where there
is marked distress associated with experiencing the feared situation
or object, such as crying, tantrums, freezing or clinging, and that
this reaction persists for at least six months. In addition, the
impact of such a fear will have a notable impact upon the child’s
family, school or social life.
Most
Phobias in children will eventually fade, alongside their normal
development. However, should the Phobia persist and cause disruption
to the child’s life, then professional help should be sought.
Treatment involves typical CBT anxiety management techniques specifically
directed towards the children’s needs and usually involves
the parents engaging in a behavioural exposure programme.
Separation
Anxiety Disorder
This
reflects excessive worry about being separated from a particular
attachment figure i.e. the parent or primary carer, in excess of
what would normally be expected given the child’s level of
development. Such worry is often associated with fears about harm
occurring to the person, even death, or that something may happen
to cause such a separation i.e. being kidnapped. There may be school
refusal, or the child may refuse to stay with relatives or friends
unaccompanied. Sleep may be a problem because the child is restless,
waking up to check upon the parent, for example, or wanting to sleep
near them. They may have nightmares about similar matters, and they
may experience physical symptoms such as stomach ache, headaches
or vomiting, if they are separated.
Again,
with reassurance, children will often grow out of this but sometimes,
where symptoms persist and disrupt their lives, they will require
professional intervention. Similarly to dealing with Phobias, typical
CBT approaches are used, with a strong emphasis on working with
the parent and even family as a whole in overcoming this problem.
Enuresis and Encopresis
Learning
to control bladder and bowel movements are a natural part of a child’s
development which some manage more easily and at different times
than others. Typically, children tend to achieve continence around
the ages of two to three years although for some children it can
be earlier or later. Enuresis is diagnosed where a child, over the
age of five years, continues to wet either during the day or at
night on a regular basis and for a number of months. Often this
causes significant disruption to the child’s lifestyle in
so much as they might be teased by their peer group, feel unable
to go for sleep overs or camps. Their confidence is often effected
and such problems can be associated with some depressed mood.
Encopresis
is diagnosed where children can not control their bowel movements,
usually involuntarily although occasionally it may be intentional.
Often it can be associated with constipation and anxiety about defecating.
Similarly to Enuresis, it can have a marked impact upon the child’s
life and personality.
Enuresis
in particular and also sometimes Encopresis can often occur at times
of stress and will naturally resolve once the stressor has gone.
However, if the problem persists then medical and/or psychological
intervention would need to be sought. There are often special clinics
available for these very common problems or help can be sought from
the Child and Family Services.
Conduct
Disorders
The
essential features of a Conduct Disorder are repeatedly breaking
rules and social norms, that they could be expected at their age
to obey. The young person shows difficult aggressive and threatening
behaviour, with several of the following behaviours: aggression
against people or animals, often including serious criminal acts;
property destruction; lying or theft; and serious rule violation.
Onset is usually in late childhood or early adolescence, and it
rarely commences after 16. In most cases it resolves by adulthood,
but many also continue to show behavioural problems into adulthood.
In
most cases, and always in the younger age group, the family, and
others such as teachers have to be involved in treatment. CBT, with
an emphasis on behaviour modification, using systematic reward to
encourage acceptable behaviour has been used with some effect.
Sleep
Terrors
Sleep
Terrors, or sometimes known as Night Terrors, are diagnosed when
a child (or adult) repeatedly wakes up abruptly in the night, in
a very distressed state, either crying or screaming with a frightened
expression on their face. This is often associated with physical
symptoms such as rapid breathing, increased heart rate, sweating,
and/or dilated pupils. It occurs during the first third of the night
and, if awakened, the child is unresponsive and disorientated for
several minutes. Indeed, often they do not fully awake but will
return to sleep with no memory of the experience the following morning.
Sleep
Terrors usually begin in childhood and often resolve in adolescence.
They can also occur in adults. Whilst a traumatic or stressful event
can trigger sleep terrors, more often they arise spontaneously and
naturally resolve. If they persist with such frequency and for an
extended period of time that they cause notable disruption to the
child’s life, i.e. not wanting to go to sleep overs lest one
occurs, then help can be sought from the local Child and Family
Services. If they are related to a traumatic or stressful event
then the underlying trauma or stressor would need to be addressed.
|
SERVICES
COMPANY
Therapy
Division 