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Abstract
Childhood disorders may go undetected and the suffering child is perceived as naughty or antisocial depending on how the illness manifests itself. This has lead to many children suffering without receiving treatment. Lack of treatment of these psychological problems can have catastrophic ends such as death or permanent social problems.
This essay discusses some of the common childhood disorders that affect children and pays particular attention to Separation anxiety disorder. It also discusses the symptoms associated with these disorders and the methods of treatment including social interventions.
Introduction
Childhood disorders are the psychiatric abnormalities that affect school going or younger children. These disorders impair the child’s behavioral emotional, mental and social development. Symptoms of disorders usually start in early childhood though some begin during adolescence. Sometimes these disorders continue all through adulthood.
Etiology of childhood disorders
Childhood disorders can be caused by two key factors:
- Genetic abnormalities.
- Physical stress.
Genetic abnormalities can be divided into two groups: functional and structural.
The functional genetic abnormalities involve abnormalities in the brain chemicals called neurotransmitters which are involved in communication in the brain. Neurotransmitters include noradrenaline, dopamine, adrenaline, and GABA. These chemicals are responsible for the way a person feels and behaves. Abnormal working of the neurotransmitters or abnormalities in the brain leads to abnormal mental functioning and development. Neurochemicals serve as the brain’s messengers in communication between the brain and the neuron system. A change in the amount of neurotransmitters secreted can result in psychiatric disorders as can their absence and their chemical variants.
Neurochemical problems are associated with autism, schizophrenia, Attention Deficit Hyperactivity Disorder (ADHD), dyslexia, and so on.
Structural abnormalities of the brain can also cause mental disorders. For example, enlargement of the cerebral ventricles has been found to be a common finding in people suffering from schizophrenia. The common assumption is that enlarged ventricles occur from wasting of brain tissues around the ventricles. Other structural abnormalities include a decrease in the amount of gray matter in the brain. The gray matter is where most of the brain activity takes place. Lack of enough gray matter means lack of optimized brain activity. This could explain the difficulties associated with mental disorder in children. Brain structure abnormalities are associated with schizophrenia and autism.
Factors such as psychological trauma, illness or injury can lead to stress which can cause childhood disorders associated with behavioral problems and also problems in interaction with other people. Examples of these disorders include selective autism, reactive attachment disorder, conduct disorders and so on.
Classification and subtypes and symptomatology
Attention – Deficit/Hyperactivity Disorder (ADHD)
This is the highest occurring childhood disorder involving neurological disorders. It can persist through adolescence and adulthood. The Diagnostic and Statistical Manual-IV, Text Revision book says that the percentage of children with ADHD is around 3-7. This disorder is characterized by lack of attention and hyperactivity. A child of school going age is generally very active especially in playing. However, the symptoms in this disorder are usually more exaggerated than normal and usually interfere with the child’s normal life. The condition is among the most misunderstood conditions with many parents and guardians thinking the abnormally hyperactive child is just being naughty.
The disorder begins to manifest itself at age 8-9 though 50% cases of the disorder usually arise before 4 years. The condition is more common in males than females with three out of four patient being boys (Barkley, R.A., 2005).
The condition sometimes occurs together with other mental disorders and this makes it hard to properly diagnose it.
There are three types of ADHD. This classification is based on the magnitude of strength of the symptoms present.
- Predominantly Inattentive Type – it is characterized by lack of concentration. The child is unable to complete given tasks or follows instructions or conversation. The child is prone to distractions.
- Predominantly Hyperactive–Impulsive Type – it is characterized by hyperactivity. The child cannot sit still and talks incessantly.
- Combined Type – in this type the sufferer usually has lack of concentration and is hyperactive. It is a combination of the two previously mentioned disorders.
Symptoms
The DSM-IV-TR outlines the criteria for spot on diagnosing this disorder. The first criteria outlines symptoms of inattentiveness that must be present for about 6 months to a point that causes disruption and hinders development for a diagnosis on ADHD to be made. These symptoms include:-
- Not paying attention to detail
- Inattentiveness when performing a task or playing
- Appears not to notice direct communication directed towards them
- Has problems in following instructions
- Is easily distracted
The second criteria helps to diagnose ADHD in a situation where six or more symptoms of hyperactivity are present for approximately six months and are disruptive and inhibit development. These symptoms of hyperactivity and impulsiveness include:
- The child finds it hard to stay still
- Restlessness which is characterized by standing when the child is supposed to be seated or playing at inappropriate times.
- Incessant talking
- Talking before statements or questions are completed
- Problems in waiting their turn especially when playing with others
- Constant interruptions and intrusions into other people’s affairs
ADHD is treated using drugs or behavioral therapies. A combination of the two is sometimes used (Barkley, R.A., 2005).
Autism
This disorder begins to manifests itself at infancy and is characterized by impairment in social interaction and inability to communicate (American Psychiatric Association, 2000). Those who are able to communicate verbally normally start doing so much later than their normal age-mates. The child also behaves in an unusual manner and possesses unusual interests. The disease is usually heartache to the parents of an autistic child as the child does not acknowledge the parents.
Autistic children do not like to be touched or even cuddled. They also tend to gaze inappropriately at something. Children with autism can possess unique intelligence in certain field such as music or painting. Some however tend to be severely mentally challenged. This disorder is detectable in a child of above 18 months. Disease such as congenital rubella syndrome in pregnancy and the use of thalidomide increase the risk of autism disorders.
Symptoms
- Poor social skills. The child may show lack of interest in social activities such as games around them. The sufferers may also not be interested at all in the people around them even their close family members. They also do not understand other people’s feelings and sometimes their own.
- Varied degree of poor communication skills with some autistic children not being able to talk at all. Those who are able to speak may have unusual words for things.
- May have repeated behaviors and routines
- Avoid eye contact prefer to be alone
- May experience problems adapting to change in their routine
- Repeat words said to them without comprehending them
- Learned skills are usually forgotten after a while. This often happens with learned words
Conduct disorders
According to the DSM- iv TR book the criteria for diagnosing this disorder states that patterns of ‘a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated’ should be present. Children with this disorder often lack feelings of remorse and tend to have a low self esteem despite them projecting an image of ‘toughness’ through their callous behavior. This condition can be classified as mild, moderate, or severe depending on the intensity of the symptoms.
The condition is associated with risky behavior such as substance use. The sufferer also experiences problems in school and at work. The condition is associated with suicidal thoughts and attempts.
Conduct disorders are of two types:
- The childhood onset type which begins before the age of 10 and which happens to be the most severe type. It persists into childhood. the disorder at times coexists with the Attention-Deficit/ Hyperactive Disorder. It is characterized by violent and victim oriented offenses.
- The adolescent onset type which begins after 10 years and is less severe as compared to the childhood onset type. This type is characterized by playing truant, stealing, and destruction of property.
Conduct disorders can be grouped into four: Aggressive conduct, Non aggressive conduct, Deceitfulness or theft, and Violation of rules conduct disorders.
The criteria for diagnosis of conduct disorders is that three or more symptoms of the disorders are present for approximately 12 months with one occurring in the past 6 months.
Symptoms
- physical cruelty to people and animals
- Use of weapon to cause harm or threaten others
- Deliberately destroying property especially through arson
- Use of lie to gain favors
- Skips school often
- Steals items of no value without force for example in a case of shoplifting
Dyslexia
Dyslexia is a learning disability that impairs someone’s ability to read orally with the child substituting words with others and leaving out some (American Psychiatric Association, 2000). The person usually has difficulty in manipulating sounds and/or responding visual-verbally. They also have problems in understanding what they are reading. It usually affects males more than females due to the male’s disruptive attitude towards learning.
This reading disorder is associated with the Mathematical Disorder and the disorder of Written Expressions.
The condition is diagnosed if the child’s reading abilities fall below the expected score for their age, intelligence, and age-appropriate knowledge.
Symptoms
- clumsiness and uncoordinated movements
- difficulty in rhyming for example, ‘cat’ and ‘hat’
- trouble with dressing or tying laces
- trouble learning the alphabet
- inability to read
Opposition defiant disorders
This disorder is characterized by disobedience hostility and a defiant attitude toward authority persons. It usually starts at the age of 8 and is one common in boys than girls.
It is associated with a constant disruption in the care givers such as babysitters, harsh parenting, and in cases where the child has been neglected
Symptoms
- shows anger and resentment towards others
- argues with adults
- has a bad temperament
- is spiteful and seeks revenge
Separation anxiety disorder
This is the excessive inappropriate fear in children of being set apart from close family members especially parents. At some stage of their development, children will usually develop unwillingness toward separation from people they are fond of. This is usually accompanied by anxiety which is characterized by arguing and distress. However, in separation anxiety disorder, this anxiety is exaggerated. This excessive fear often greatly disrupts the child’s normal activities (American Psychiatric Association, 2000).
Children with this disorder are often scared of things that pose a danger to the closeness of the family such as kidnappers, muggers, car and plane travel, and so on. They also think about death quite often and they wish they were dead when they feel unloved. They also tend to lash out at the person responsible for the separation and can at times result in violence. These children will at times report seeing things that are just fragments of their imagination: things like seeing monsters when left alone especially in a dark room.
This disorder usually has a toll on the child’s life as it disrupts their social and academic life. A child with this disorder is usually reluctant to make friends with other people except family. Therefore the child usually leads a lonely life in school and this makes them hesitant to go to school. This fear of separation also makes a child skip school in order to avoid separating with the parent. This leads to long observe from school and this affects the child’s performance.
If left unattended this fear would have a negative effect on the child’s later relationship involving love and trust. Untreated separation anxiety disorder also predisposes one to panic attacks and phobias such as agoraphobia (American Psychiatric Association, 2000).
An imbalance in the neurotransmitters in the brain in thought to cause this disorder. Other factors that increase the risk of a child developing this disorder include the parent having agoraphobia the child coming from a very close family and the child having a personality that doesn’t embrace change.
Separation anxiety disorder can be triggered by a traumatic event in a child’s life such as child abduction, divorce, stress in the family say due to death, significant changes such as moving to a new neighborhood.
Symptoms
- Pains especially headaches or stomach that appear just before the separation
- Following the family member around
- Excessive nightmares that involve separation
- Resistance to attend school or move away from home
- Excessive persistent distress that is shown by crying, misery or tantrums in anticipation to separation. It may continue long after the separation
Separation anxiety is diagnosed as a disorder if the symptoms of anxiety continue to be experienced for over four weeks in children above 5 years of age (American Psychiatric Association, 2000). This disorder is treated using family play and cognitive behavior therapy. Treatment should include giving the sufferer and their family information about the condition so as to improve their understanding on the disorder.
This is particularly important as it will help the figure of attachment to understand why the child is behaving as they do. It will also help; the person to avoid the triggers of anxiety in the child. The children can be taught how to relax by say, deep breaths and self-soothing language.
Social interventions
Social interventions have been known to have a considerable positive effect in helping both the patient and the patient to cope. The technique is especially of help where the patient refuses to take the prescribed drugs to manage their condition. Interventions that are easy to understand and spot on combined with cognitive therapy bring out positive changes in the child’s health and also in the way the family and the child perceive and manage the condition. This method also prevents progression of some diseases into psychosis. It also improves the child’s social life and raises their self esteem, both of which are greatly negatively affected in most mental disorders.
This style of management is particularly client friendly as it allows the sufferer’s condition to be managed at home and hence reduces the chances of the patient being admitted to hospital due to a relapse. This is an advantage as it helps to avoid the big financial and mental strains that are incurred when one is admitted to hospital.
The social work intervention should be in line with the type of disorder. The interventions applied should cater for that particular child for it to be successful. It should be focused on the child as well as the parents. Working together with families to reduce high expression of emotion and to improve ways of coping is recognized as a way of reducing the rate of relapses in children with behavioral disorders such as schizophrenia. Social work interventions focusing on the child should be geared towards promoting the mental and social health of the sufferer (Vdebeck, S.L., 2007).
For children with behavioral problems the social worker should employ tactics that will rectify this behavior to a manage level whereas for children with emotional disorders such as separation anxiety disorder, the social worker should focus on increasing the self esteem of the child. Social interventions are particularly useful in helping children with social problems such as those with autistic disorders and separation anxiety disorders.
Conclusion
Of course tackling different disorders will require different techniques. Therefore the social worker should focus on bringing out the emotional strength of the child. They should also help the child to cope with these disorders and avoid triggers that make their emotions erupt (Ronen T., 1994).
Despite its effectiveness, social intervention remains a method that is least used in the management of childhood disorders. This is because this intervention still remains inaccessible to many sufferers who need it. This method of management is also faced by a problem in lack of trainees due to the restrictions on the NHS funding. Lack of trainees means that the number of therapists available is inadequate to cater for the large number of children in need of this intervention.
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of Mental Disorders-fourth edition, text revision. American psychiatric publishers Inc.
Barkley, R.A. (2005). Attention-Deficit Hyperactivity Disorder, Third Edition: A handbook for diagnosis and treatment. New York. Guilford Publications Inc.
Centers for Disease Control and Prevention. Autism/ Attention – Deficit/Hyperactivity Disorder (ADHD). Web.
Ronen T. (1994). Cognitive – behavioral social work with children. British journal of social work. Volume 24, pp 273-285.
Separation Anxiety Disorder: Causes, Prevention and Treatment. Web.
Vdebeck, S.L. (2007). Psychiatric-mental health nursing. Lippincott Williams and Wilkins Publishers. Pp 71.
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