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Psychological Childhood DisordersThe 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.

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