Mental health disorders (MHD) are very common in childhood and they include emotional-obsessive-compulsive disorder (OCD), anxiety, depression, disruptive (oppositional defiance disorder (ODD), conduct disorder (CD), attention deficit hyperactive disorder (ADHD), or developmental (speech/language delay, intellectual disability) disorders or pervasive (autistic spectrum) disorders.
While low-intensity naughty, defiant, and impulsive behavior from time to time, losing one’s temper, destruction of property, and deceitfulness/stealing in the preschool children are regarded as normal, extremely difficult, and challenging behaviors outside the norm for the age and level of development, such as unpredictable, prolonged, and/or destructive tantrums and severe outbursts of temper loss are recognized as behavior disorders.
Emotional problems, such as anxiety, depression, and post-traumatic stress disorder (PTSD) tend to occur in later childhood. They are often difficult to be recognized early by the parents or other carers as many children have not developed appropriate vocabulary and comprehension to express their emotions intelligibly. Many clinicians and carers also find it difficult to distinguish between developmentally normal emotions (e.g., fears, crying) from the severe and prolonged emotional distresses that should be regarded as disorders. Emotional problems including disordered eating behavior and low self-image are often associated with chronic medical disorders such as atopic dermatitis, obesity, diabetes, and asthma, which lead to poor quality of life.
Biswas Heart and Mind Clinic (BHMC) can help in the identification and management of mental health problems in children and young people.
These may manifest as a disturbance in:
This range of disorders may be caused by a number of factors such as parenting style which is inconsistent or contradictory, family or marital problems, child abuse or neglect, overindulgence, injury or chronic illness, separation, or bereavement
The child's problems are often multi-factorial and how they are expressed may be influenced by a range of factors including developmental stage, temperament, coping and adaptive abilities of family, and the nature and duration of stress. In general, chronic stressors are more difficult to deal with than isolated stressful events.
Children do not always display their reactions to events immediately, although they may emerge later. Anticipatory guidance can be helpful to parents and children in that parents can attempt to prepare children in advance of any potentially traumatic events - eg, elective surgery or separation. Children should be allowed to express their true fears and anxieties about impending events.
In stressful situations, young children will tend to react with impaired physiological functions such as feeding and sleeping disturbances. Older children may exhibit relationship disturbances with friends and family, poor school performance, behavioral regression to an earlier developmental stage, and development of specific psychological disorders such as phobia or psychosomatic illness.
It can be difficult to assess whether the behavior of such children is normal or sufficiently problematical to require intervention. Judgment will need to take into account the frequency, range, and intensity of symptoms and the extent to which they cause impairment.
These include a range of phenomena that may be described as tension-reducing.
|Tension-reducing habit disorders|
|Thumb sucking||Repetitive vocalisations||Tics|
|Air swallowing||Head banging||Manipulating parts of the body|
|Body rocking||Hitting or biting themselves|
All children will at some developmental stage display repetitive behaviors but whether they may be considered as disorders depends on their frequency and persistence and the effect they have on physical, emotional, and social functioning. These habit behaviors may arise originally from intentional movements which become repeated and then incorporated into the child's customary behavior. Some habits arise in imitation of adult behavior. Other habits such as hair pulling or head-banging develop as a means of providing a form of sensory input and comfort when the child is alone.
Anxiety and fearfulness are part of normal development; however, when they persist and become generalized they can develop into socially disabling conditions and require intervention. Approximately 6-7% of children may develop anxiety disorders and, of these, 1/3 may be over-anxious while 1/3 may have some phobia. Generalized anxiety disorder, childhood-onset social phobia, separation anxiety disorder, obsessive-compulsive disorder, and phobia are demonstrated by a diffuse or specific anxiety predictably caused by certain situations.
School phobia occurs in 1-5% of children and there is a strong association with anxiety and depression. Management is by treating the underlying psychiatric condition, family therapy, parental training, and counseling with Behavioral and cognitive treatments.
Many behaviours, which are probably undesirable but a normal occurrence at an early stage of development, can be considered pathological when they present at a later age. In young children, many behaviors such as breath-holding or temper tantrums are probably the result of anger and frustration at their inability to control their own environment. For some of these situations, it is wise for parents to avoid a punitive response and, if possible, to remove themselves from the room. It is quite likely that the child will be frightened by the intensity of their own behavior and will need comfort and reassurance. While some isolated incidents of stealing or lying are normal occurrences of early development, they may warrant intervention if they persist. Truancy, arson, antisocial behavior, and aggression should not be considered as normal developmental features.
Around one in ten children under the age of 12 years are thought to have an oppositional defiant disorder (ODD), with boys outnumbering girls by two to one. Some of the typical behaviors of a child with ODD include:
Children with conduct disorder (CD) are often judged as ‘bad kids’ because of their delinquent behavior and refusal to accept rules. Around five percent of 10-year-olds are thought to have CD, with boys outnumbering girls by four to one. Around one-third of children with CD also have attention deficit hyperactivity disorder (ADHD).
Some of the typical behaviors of a child with CD may include:
Around two to five percent of children are thought to have attention deficit hyperactivity disorder (ADHD), with boys outnumbering girls by three to one. The characteristics of ADHD can include:
For the diagnosis to be made, the condition must be evident before the age of 7, present for >6 months, seen both at home and school, and impeding the child's functioning.[The condition is diagnosed in 3-7% of children of school age. Methylphenidate (initiated by specialists only) is a stimulant medication that provides reduction of symptoms, at least in the short term. Behavioral modification and neuro-feedback are the non-pharmacological treatments with the largest evidence base. Various dietary interventions have been mooted, of which the addition of essential fatty acids has the widest support.
Sleep disorders can be defined as more or less sleep than is appropriate for the age of the child. By the age of 1-3 months, the longest daily sleep should be between midnight and morning. Sleeping through the night is a developmental milestone but, at the age of 1 year, 30% of children may still be waking in the night. Stable sleep patterns may not be present until the age of 5 but parental or environmental factors can encourage the development of circadian rhythm.
The causes of ODD, CD and ADHD are unknown but some of the risk factors include:
Disruptive behavioral disorders are complicated and may include many different factors working in combination. For example, a child who exhibits the delinquent behaviors of CD may also have ADHD, anxiety, depression, and difficult home life.
Diagnosis methods may include:
A diagnosis is made if the child’s behavior meets the criteria for disruptive behavior disorders in the Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association.
It is important to rule out acute stressors that might be disrupting the child’s behavior. For example, a sick parent or victimized by other children might be responsible for sudden changes in a child’s typical behavior and these factors have to be considered initially.
Untreated children with behavioral disorders may grow up to be dysfunctional adults. Generally, the earlier the intervention, the better the outcome is likely to be.
A large study in the United States, conducted for the National Institute of Mental Health and the Office of School Education Programs, showed that carefully designed medication management and behavioral treatment for ADHD improved all measures of behavior in school and at home.
Treatment is usually multifaceted and depends on the particular disorder and factors contributing to it, but may include: