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Child Psychiatry

Asperger Syndrome

What is Asperger Syndrome?

Asperger Syndrome (AS) is a neurobiological disorder on the higher-functioning end of the autism spectrum. An individual’s symptoms can range from mild to severe.

Individuals with AS and related disorders exhibit serious deficiencies in social and communication skills. Their IQ’s are typically in the normal to very superior range. They are usually educated in the mainstream, but most require special education services. Because of their naivete, those with AS are often viewed by their peers as “odd” and are frequently a target for bullying and teasing.

They desire to fit in socially and have friends, but have a great deal of difficulty making effective social connections. Many of them are at risk for developing mood disorders, such as anxiety or depression, especially in adolescence. Diagnosis of autistic spectrum disorders should be made by a medical expert to rule out other possible diagnoses.

Characteristics of Asperger Syndrome

Each person is different. An individual might have all or only some of the described behaviors to have a diagnosis of AS.

These behaviors include the following:

  • Marked impairment in the use of multiple nonverbal behaviors such as: eye gaze, facial expression, body posture, and gestures to regulate social interaction.
  • Extreme difficulty in developing age-appropriate peer relationships. (e.g. AS children may be more comfortable with adults than with other children).
  • Inflexible adherence to routines and perseveration.
  • Fascination with maps, globes, and routes.
  • Superior rote memory.
  • Preoccupation with a particular subject to the exclusion of all others. Amasses many related facts.
  • Difficulty judging personal space, motor clumsiness.
  • Sensitivity to the environment, loud noises, clothing and food textures, and odors.
  • Speech and language skills impaired in the area of semantics, pragmatics, and prosody (volume, intonation, inflection, and rhythm).
  • Difficulty understanding others’ feelings.
  • Pedantic, formal style of speaking; often called “little professor,” verbose.
  • Extreme difficulty reading and/or interpreting social cues.
  • Socially and emotionally inappropriate responses.
  • Literal interpretation of language; difficulty comprehending implied meanings.
  • Extensive vocabulary. Reading commences at an early age (hyperlexia).
  • Stereotyped or repetitive motor mannerisms.
  • Difficulty with “give and take” of conversation.
Oppositional Defiant Disorder

It’s not unusual for children — especially those in their “terrible twos” and early teens — to defy authority every now and then. They may express their defiance by arguing, disobeying, or talking back to their parents, teachers, or other adults. When this behavior lasts longer than six months and is excessive compared to what is usual for the child’s age, it may mean that the child has a type of behavior disorder called oppositional defiant disorder(ODD).

ODD is a condition in which a child displays an ongoing pattern of an angry or irritable mood, defiant or argumentative behavior, and vindictiveness toward people in authority. The child’s behavior often disrupts the child’s normal daily activities, including activities within the family and at school.

Many children and teens with ODD also have other behavioral problems, such as attention deficit disorder, learning disabilities, mood disorders (such as depression), and anxiety disorders. Some children with ODD go on to develop a more serious behavior disorder called conduct disorder.

Symptoms of Oppositional Defiant Disorder

  • Throwing repeated temper tantrums
  • Excessively arguing with adults, especially those with authority
  • Actively refusing to comply with requests and rules
  • Deliberately trying to annoy or upset others, or being easily annoyed by others
  • Blaming others for your mistakes
  • Having frequent outbursts of anger and resentment
  • Being spiteful and seeking revenge
  • Swearing or using obscene language
  • Saying mean and hateful things when upset

In addition, many children with ODD are moody, easily frustrated, and have a low self-esteem. They also sometimes may abuse drugs and alcohol.

What Causes Oppositional Defiant Disorder?

The exact cause of ODD is not known, but it is believed that a combination of biological, genetic, and environmental factors may contribute to the condition.

  • Biological: Some studies suggest that defects in or injuries to certain areas of the brain can lead to serious behavioral problems in children. In addition, ODD has been linked to abnormal functioning of certain types of brain chemicals, or neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are not working properly, messages may not make it through the brain correctly, leading to symptoms of ODD, and other mental illnesses. Further, many children and teens with ODD also have other mental illnesses, such as ADHD, learning disorders, depression, or an anxiety disorder, which may contribute to their behavior problems.
  • Genetics: Many children and teens with ODD have close family members with mental illnesses, including mood disorders, anxiety disorders, and personality disorders. This suggests that a vulnerability to develop ODD may be inherited.
  • Environmental: Factors such as a dysfunctional family life, a family history of mental illnesses and/or substance abuse, and inconsistent discipline by parents may contribute to the development of behavior disorders.
Pervasive Developmental Disorder

Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) refers to a group of disorders characterised by impairment in the development of social interaction, verbal and non-verbal communication, imaginative activity and a limited number of interests and activities that tend to be repetitive.

A PDD-NOS diagnosis is given when a child does not fully meet the criteria for Autism Spectrum Disorder (ASD), Asperger’s Syndrome, Rett Syndrome or Childhood Disintegrative Disorder, but has several of the characteristics.

What are the common features of Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)?

Children are generally 3 to 4 years old before they exhibit enough symptoms for a diagnosis. There is no set pattern of symptoms or signs in children with PDD-NOS. Children with PDD-NOS may exhibit some of the following features:

Social and Emotional

  • Poor social skills
  • Experience difficulties interacting meaningfully.
  • Reluctant to give eye contact.
  • Appears to lack desire to share activities with others.
  • Prefers to be alone.
  • May want to make friends, but doesn’t know how.
  • Lacks an understanding of issues from another person’s point of view – social empathy.
  • Difficulty understanding that other people have their own beliefs, desires and intentions, which guide their behaviour.
  • Difficulty in taking turns and/or sharing with peers.
  • Difficulty differentiating between familiar and unfamiliar people.
  • May be unintentionally aggressive in an attempt to be social.
  • Treats people as tools or equipment – something to use to open a door, get food, get carried by or lean on.
  • Is limited in their play skills and may become fixated on only playing with specific toys in a particular way.
  • Has poor imaginative play skills.
  • Has low self-esteem

Language and Communication

  • Difficulty understandingor using appropriate forms of communication including verbal language, body language, facial expression, tone of voice and gestures.
  • Difficulty in developing and understanding other forms of communication, such as gestural systems or picture-based systems.
  • Limited or no speech and/or lack typical communicative gestures.
  • As babies, a child with PDD-NOS may not babble or when they do learn words, they exhibit “echolalia” repeating words or phrases over and over again.
  • Children with PDD-NOS often take language literally and do not understand when someone is joking or being sarcastic.
  • Speech may develop to varying degrees but rarely develops to an age-appropriate level of ability.
  • Does not always clearly communicate wants, express concerns or fears, or answer questions reliably.

Sensory Processing

  • May experience great difficulty processing information received from senses (e.g. touch, sound, visual information).
  • Over-sensitive to surroundings and unable to screen out irrelevant stimuli.
  • May appear to ignore some sounds but over-react to other sounds.
  • May focus intently on the small visual details of walls, furniture, objects, prints, pictures or body parts whilst not seeing the whole picture.
  • May show intense interest in light or shiny reflective surfaces (e.g. may filter light through fingers or stare at lights or reflections in glasses or watch water going down the plughole).
  • May explore by smelling or mouthing objects, people and surfaces.

Adaptation to the Environment

  • Finds it very difficult to interpret and process new information.
  • Small changes to routine, activity or surroundings may cause stress and anxiety.
  • Has difficulty coping with change.
  • May avoid strangers or new activities due to fear and anxiety.
  • Develops routines and rituals and may stay involved with them for long periods or be upset if interrupted.
  • Becomes very concerned about doing work perfectly and may become unwilling to attempt work that he/she feels they cannot do perfectly.
  • May want to be in control of situations and may become very successful at manipulating people in order to maintain control.

Cognitive

  • May have learning difficulties.
  • May have poor memory and attention span resulting in difficulty persisting with activities.
  • Requires repetition of instructions or directions and may require time to process before responding or acting.
  • May have difficulty understanding concepts such as turn taking, sharing or how to enter into play situations.

Common difficulties often (but not always) experienced by those with Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS):

  • Poor understanding of the conventions of social interaction.
  • Immature play skills/interests.
  • Resistant to change and very rigid in routine.
  • Poor non-verbal communication.
  • Poor understanding of instructions, questions and/or jokes.
  • Difficulty with fine and gross motor skills.
  • Difficulties accessing the school curriculum.
  • Poor conversational skills and may talk too much or too little.
  • Poor ‘listening’ skills, despite intact hearing.
  • Fails to notice that other people are not interested in what they are saying.
  • Finds it difficult to understand the non-verbal language/cues of others (such as facial expressions, gestures      and/or body movements) or the rules of social behaviour.

Causes

  • Finding all the causes of ASDs is a big topic of research. Scientists know that genetics are one of the risk factors. But they don’t have all of the answers yet. There’s not one “autismgene” that’s at work. Many things, in addition to genes, may be involved.

 

Reactive attachment disorder (RAD)

Reactive attachment disorder (RAD) is a condition found in children who may have received grossly negligent care and do not form a healthy emotional attachment with their primary caregivers — usually their mothers — before age 5.

Attachment develops when a child is repeatedly soothed, comforted, and cared for, and when the caregiver consistently meets the child’s needs. It is through attachment with a loving and protective caregiver that a young child learns to love and trust others, to become aware of others’ feelings and needs, to regulate his or her emotions, and to develop healthy relationships and a positive self-image. The absence of emotional warmth during the first few years of life can negatively affect a child’s entire future.

What Are the Symptoms of Reactive Attachment Disorder?

RAD can affect every aspect of a child’s life and development. There are two types of RAD: inhibited and disinhibited.

Common Symptoms of Inhibited RAD Include:

  • Detached
  • Unresponsive or resistant to comforting
  • Excessively inhibited (holding back emotions)
  • Withdrawn or a mixture of approach and avoidance

Common Symptoms With Disinhibited RAD Include:

  • Indiscriminate sociability
  • Inappropriately familiar or selective in the choice of attachment figures

 

What Causes Reactive Attachment Disorder?

RAD occurs when attachment between a young child and his or her primary caregiver does not occur or is interrupted due to grossly negligent care. This can occur for many reasons, including:

  • Persistent disregard of the child’s emotional needs for comfort, stimulation, and affection
  • Persistent disregard of the child’s basic physical needs
  • Repeated changes of primary caregivers that prevent formation of stable attachments (for example, frequent changes in foster care)

 

School refusal

School refusal is the refusal to attend school due to emotional distress. School refusal differs from truancy in that children with school refusal feel anxiety or fear towards school, whereas truant children generally have no feelings of fear towards school, often feeling angry or bored with it instead.

Signs and symptoms

Symptoms of school refusal include the child saying they feel sick often, or waking up with a headache, stomachache, or sore throat. If the child stays home from school, these symptoms might go away, but come back the next morning before school. Additionally, children with school refusal may have crying spells or throw temper tantrums.

Warning signs of school refusal include frequent complaints about attending school, frequent tardiness or unexcused absences, absences on significant days (tests, speeches, physical education class), frequent requests to call or go home, excessive worrying about a parent when in school, frequent requests to go to the nurse’s office because of physical complaints, and crying about wanting to go home.

It is important for parents to keep trying to get their child to go back to school. The longer a child stays out of school, the harder it will be to return. However, it may be hard to accomplish as when forced they are prone to temper tantrums, crying spells, psychosomatic or panic symptoms and threats of self-harm. These problems quickly fade if the child is allowed to stay home.

Parents should take their child to the doctor, who will be able to rule out any illness that may be causing the problem. Parents should also talk to the child’s teacher or school counselor. Although school refusal is not a clinical disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, it can be associated with several psychiatric disorders, including Separation Anxiety Disorder, Social Phobia, and Conduct Disorder. Therefore it is critical that youths who are school refusing receive a comprehensive evaluation by a mental health professional.

A medical condition often mistaken for school refusal is delayed sleep phase syndrome (DSPS). DSPS is a circadian rhythm sleep disorder which is characterized by a chronic delayed sleep cycle.

The attempt to control by means of threats or pressure, the behaviour of the student, is also still in danger as external (extrinsic) motivation to undermine intrinsic motivation and a sense of self-control, self-worth and self-responsibility. Some social scientists and evaluaters view the condition as a pseudophobia.

Cause

Factors that can cause reluctance to attend school can be divided into four categories. These categories have been developed based on studies in the United States under the leadership of Professor Christopher Kearney. Some students may be affected by several factors at once.

  • The child possibly wants to avoid school-related issues and situations that cause unpleasant feelings in her or him, such as anxiety, depression, or psychosomatic symptoms. The reluctance to attend school is one symptom that can indicate the presence of a larger issue, such as anxiety disorder, depression, learning disability, sleep disorder, separation anxiety or panic disorder.
  • The child may want to avoid tests, presentations, group work, specific lessons, or interaction with other children. The child should be assessed for learning disabilities if academic performance is low.
  • The child may want attention from significant people outside of school, such as parents or older acquaintances.
  • The child possibly wants to do something more enjoyable outside of school, like practice hobbies, play computer games, watch movies, play with friends such as riding bikes, etc., or learn autodidactictally.

Other factors can be:

  • Anxiety about academic achievementand being tested can arise on the basis of inflated claims by teachers and/or parents, but also unrealistic ambitions of the upset child themselves.
  • School refusal may arise as a response to bullying.
  • Shyness or a social phobia can contribute to school refusal.
  • The child might worry about parents or siblings, for instance, a parent with substance abuse, or a parent who physically abuses other family members.
  • Some students may refuse to go to school due to anxiety or fears of emergency drills, such as fire, lockdown, and tornado

 

Suicidal Behavior

A Serious Problem  Boys are more likely than girls to die from suicide of the reported suicides in the 10-24 age group, 81% were males . Girls attempt suicide more than boys.

Risk Factors:

  • Intrapersonal  Recent or serious loss.
  • Mental disorders (particularly mood disorders)
  • Hopelessness, helplessness, guilt, worthlessness.
  • Previous suicide attempt.
  • Alcohol and other substance use disorders.
  • Disciplinary problems.
  • High risk behaviours.
  • Sexual orientation confusion.
  • Social/Situational  Recent or serious loss (e.g., death, divorce, separation,broken relationship; self-esteem; loss of interest in friends, hobbies, or activities previously enjoyed)
  • Family history of suicide.  Witnessing family violence.
  • Child abuse or neglect. Lack of social support.
  • Sense of isolation.
  • Victim of bullying or being  a bully
  • Cultural/Environmental  Access to lethal means (i.e. firearms, pills).
  • Stigma associated with asking for help.

Barriers to accessing services.  Lack of bilingual service providers¤  Unreliable transportation¤  Financial costs of services¤  Cultural and religious beliefs (e.g., belief that suicide  is noble resolution of a personal dilemma)

Specific Warning Signs:- 

Talking About Dying – Any mention of dying,  disappearing, jumping, shooting oneself, or other types of self harm  Change in Personality – Sad, withdrawn, irritable, anxious, tired, indecisive, or apathetic  Change in Behavior – Difficulty concentrating on school, work, or routine tasks , Change in Sleep Patterns – Insomnia, often with early waking or oversleeping, nightmares , Change in Eating Habits – Loss of appetite and weight, overeating , Fear of losing control – Acting erratically, harming self or others.

Thumb sucking

Thumb sucking usually involves placing the thumb into the mouth and rhythmically repeating sucking contact for a prolonged duration. It can also be accomplished with any piece of skin within reach (such as the big toe) and is considered to be soothing and therapeutic for the person. As a child develops the habit, it will usually develop a “favorite” finger to suck on.

At birth, a baby will reflexively suck any object placed in its mouth; this is the sucking reflex responsible for breastfeeding. From the very first time they engage in nutritive feeding, infants learn that the habit can not only provide valuable nourishment, but also a great deal of pleasure, comfort, and warmth. Thumb-sucking can become a habit in babies and young children who use it to comfort themselves when they feel hungry, afraid, restless, quiet, sleepy, or bored.

Whether from a mother, bottle, or pacifier, this behavior, over time, begins to become associated with a very strong, self-soothing, and pleasurable oral sensation. As the child grows older, and is eventually weaned off the nutritional sucking, they can either develop alternative means for receiving those same feelings of physical and emotional fulfillment, or they can continue experiencing those pleasantly soothing experiences by beginning to suck their thumbs or fingers. This reflex disappears at about 4 months of age; thumb sucking is not purely an instinctive behavior and therefore can last much longer.

Thumb sucking is sometimes retained into adulthood and may be due to stereotypic movement disorder, another psychiatric disorder, or simply habit continuation.

Why do babies suck their thumbs?

Thumb-sucking after age 5 is in response to an emotional problem or other disorder, such as anxiety.

Kids suck their thumbs because it’s comforting and calming.

Child turns to her thumb when tired, scared, bored, sick, or trying to adjust to challenges such as starting daycare or preschool. They may also use her thumb to help fall asleep at bedtime and to lull back to sleep when they wakes up in the middle of the night.

It can also possibly serve as a compensation for the less nurturance that the child gets. The child also learns to associate it with the comforting needs that people should experience. As a result, it helps in relieving psychological stress. It helps in achieving relaxation, which becomes helpful when it comes to concentrating.

Trichotillomania

People who have trichotillomania have an irresistible urge to pull out their hair, usually from their scalp, eyelashes, and eyebrows.

Trichotillomania is a type of impulse control disorder. People with these disorders know that they can do damage by acting on the impulses, but they cannot stop themselves. They may pull out their hair when they’re stressed as a way to try to soothe themselves.

Symptoms of Trichotillomania:

Besides repeated hair pulling, other symptoms may include:

  • Feeling tense before pulling hair or when trying to resist the urge to pull hair
  • Feeling relieved, satisfied, or pleased after acting on the impulse to pull hair
  • Distress or problems in work or social life due to hair pulling
  • Bare patches where the hair has been pulled out
  • Behaviors such as inspecting the hair root, twirling the hair, pulling the hair between the teeth, chewing on hair, or eating hair

Causes:

The exact cause of trichotillomania isn’t known. It may be related to abnormalities in brain pathways that link areas involved in emotional regulation, movement, habit formation, and impulse control.

Some people with trichotillomania may also have depression or anxiety.

The cause of trichotillomania is unclear. But like many complex disorders, trichotillomania probably results from a combination of genetic and environmental factors.

Risk factors:

These factors tend to increase the risk of trichotillomania:

  • Family history.Genetics may play a role in the development of trichotillomania, and the disorder may occur in those who have a close relative with the disorder.

Age. Trichotillomania usually develops just before or during the early teens — most often between the ages of 10 and 13 years — and it’s often a lifelong problem. Infants also can be prone to hair pulling,

Signs and symptoms of trichotillomania often include:

  • Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes, but sometimes from other body areas, and sites may vary over time.
  • An increasing sense of tension before pulling, or when you try to resist pulling
  • A sense of pleasure or relief after the hair is pulled
  • Noticeable hair loss, such as shortened hair or thinned or bald areas on the scalp or other areas of your body, including sparse or missing eyelashes or eyebrows
  • Preference for specific types of hair, rituals that accompany hair pulling or patterns of hair pulling
  • Biting, chewing or eating pulled-out hair
  • Playing with pulled-out hair or rubbing it across your lips or face
  • Repeatedly trying to stop pulling out your hair or trying to do it less often without success
  • Significant distress or problems at work, school or in social situations related to pulling out your hair

Many people who have trichotillomania also pick their skin, bite their nails or chew their lips. Sometimes pulling hairs from pets or dolls or from materials, such as clothes or blankets, may be a sign. Most people with trichotillomania pull hair in private and generally try to hide the disorder from others.

For people with trichotillomania, hair pulling can be:

  • Some people pull their hair intentionally to relieve tension or distress — for example, pulling hair out to get relief from the overwhelming urge to pull hair. Some people may develop elaborate rituals for pulling hair, such as finding just the right hair or biting pulled hairs.
  • Some people pull their hair without even realizing they’re doing it, such as when they’re bored, reading or watching TV.

The same person may do both focused and automatic hair pulling, depending on the situation and mood. Certain positions or rituals may trigger hair pulling, such as resting your head on your hand or brushing your hair.

Trichotillomania can be related to emotions:

  • Negative emotions.For many people with trichotillomania, hair pulling is a way of dealing with negative or uncomfortable feelings, such as stress, anxiety, tension, boredom, loneliness, fatigue or frustration.
  • Positive feelings.People with trichotillomania often find that pulling out hair feels satisfying and provides a measure of relief. As a result, they continue to pull their hair to maintain these positive feelings.

Trichotillomania is a long-term (chronic) disorder. Without treatment, symptoms can vary in severity over time. For example, the hormonal changes of menstruation can worsen symptoms in women. For some people, if not treated, symptoms can come and go for weeks, months or years at a time.

Although far more women than men are treated for trichotillomania, this may be because women are more likely to seek medical advice. In early childhood, boys and girls appear to be equally affected.

Complications

Although it may not seem particularly serious, trichotillomania can have a major negative impact on your life. Complications may include:

  • Emotional distress.Many people with trichotillomania report feeling shame, humiliation and embarrassment. They may experience low self-esteem, depression, anxiety, and alcohol or street drug use because of their condition.
  • Problems with social and work functioning.Embarrassment because of hair loss may lead you to avoid social activities and job opportunities. People with trichotillomania may wear wigs, style their hair to disguise bald patches or wear false eyelashes. Some people may avoid intimacy for fear that their condition will be discovered.
Causes of Aggression in Children

Aggression is one of the first responses to frustration that a baby learns. Grabbing, biting, hitting, and pushing are especially common before children develop the verbal skills that allow them to talk in a sophisticated way about what they want and how they feel.

Children are often rewarded for their aggressive behavior. The child who acts out in class generally gets the most attention from the teacher. The child who breaks into the line to go down the slide at the playground sometimes gets to use the slide the most. One of the toughest problems parents and teachers face in stopping aggressive behavior is that in the short term it gets the child exactly what he wants. It’s only after a few years that inappropriately aggressive children must cope with a lack of friends, bad reputations, and the other consequences of their behavior.

For some children, this tendency toward physical aggression and other difficult behaviors appears to be inborn. There’s some evidence that a proportion of these children may be identified as restless fetuses that kick significantly more than other fetuses. Many very aggressive children are noted to be restless infants even before they begin to crawl and walk.

These overly aggressive children appear to have less mature nervous systems than other children their age. This shows up in a variety of problems with self-control. They cannot sit still for more than a few minutes. They are easily distracted. Once they begin to get excited or angry, they have difficulty stopping themselves. They are impulsive and have trouble concentrating on a task for more than a few minutes or even seconds.

 

Aggression in children can be a symptom of many different underlying problems. It’s a very polymorphic thing, a commonality for any number of different psychiatric conditions, medical problems, and life circumstances. And so at the very essence of treating aggression is first to find out what’s driving it.

We can break down the causes for aggression into several groups.

Mood disorders – First, are there mood issues? Kids who are bipolar, in their manic stages, very frequently become aggressive. They lose self-control, they become impulsive. On the other end of the spectrum, when they become depressed, although aggression is less common, they can become irritable, and sometimes that irritability and cantankerousness causes kids to lash out.

Psychosis – The psychotic illnesses may also manifest with aggression. For example, kids with schizophrenia are often responding to internal stimuli that can become disturbing. Sometimes kids with schizophrenia become mistrustful or suspicious—or full-blown paranoid—and they wind up striking out because of their own fear.

Frustration –Kids who have problems with cognition (what’s now called intellectual impairment) or communication (including autism) may also manifest with aggression. When children with these conditions become aggressive, they often do so because they have difficulty dealing with their anxiety or frustration and can’t verbalize their feelings as others do. The aggression may also be a form of impulsivity.

Impulsivity- And then there are the disruptive behavior disorders. In children with ADHD, the most common of them, impulsivity and poor decision-making can lead to behavior that’s interpreted as aggressive. These children often don’t consider the consequences of their actions, which may come across as callous or malicious when they’re really just not thinking.

Conduct Disorder –With conduct disorder, aggressiveness is part of the matrix of the illness, a large component of what that is. Unlike the child who just isn’t considering consequences of his actions, kids with CD are intentionally malicious, and prognosis is quite different.

Injury – And sometimes there are organic reasons for aggressive outbursts, when a child has frontal lobe damage or certain types of epilepsy. In these cases there may be no comprehensible reason for the aggressive episode, and the episode could have an explosive component.

Trauma – Finally, there are times when aggression in children or teenagers is provoked by stressors in their situation, and do not represent an underlying emotional illness. But it is important to understand that this is fairly rare, and when aggression begins to happen on a more frequent basis, it could represent a brewing emotional problem.

There are times when even the most docile children appear to have the aggressive tendencies of a professional wrestler. While a certain amount of pushing and shoving is to be expected from all children, especially when they are very young, there are a few for whom aggression becomes a way of coping with almost any situation.

These overly aggressive children are not bullies; they often get into fights with people who are stronger than they are. They face problems not because they are aggressive, but because they become aggressive at times that are inappropriate and in ways that are self-defeating. They routinely argue with teachers and wind up in far more than their share of schoolyard scraps.

In some cases, this pattern of easily triggered aggression appears to be rooted in the children’s developing nervous systems. They appear to be physiologically unable to control their impulses as much as other children their age. For others, it is often a matter of needing to learn and practice social skills.

 

Antisocial Behaviour

What is childhood antisocial behavior?

  1. Common antisocial behavior symptoms include aggression, hostility, and defiance.
  2. It’s important for parents to work with their child’s school and physician to treat antisocial behavior.
  3. In some cases, antisocial behavior can be identified by age 3.

It’s normal for children to exhibit positive and negative social behaviors as they age and develop. Some kids lie, some rebel, some withdraw.

But some children exhibit high levels of antisocial behaviors. They are hostile and disobedient. They may steal and destroy property. They might be verbally and physically abusive.

This type of conduct often means your child is showing signs of antisocial behavior. Antisocial behavior is manageable, but can lead to more severe problems in adulthood if left untreated.

Risk factors for antisocial behavior in children

  • school and neighborhood environment
  • genetics and family history
  • poor and negative parenting practices
  • violent, unstable, or tumultuous home life

Hyperactivity and neurological problems can also cause antisocial behavior. Youth with attention deficit hyperactivity disorder (ADHD) have been found to be at a higher risk of developing antisocial behavior.

Symptoms of antisocial behavior in children

Antisocial behavior can occasionally be identified in kids as young as 3 or 4 years old, and can lead to something more severe if not treated before age 9, or third grade.

The symptoms your child might exhibit include:

  • abusive and harmful to animals and people
  • lying and stealing
  • rebellion and violating rules
  • vandalism and other property destruction
  • chronic delinquency

Research shows that childhood antisocial behavior is associated with a higher rate of alcohol and drug abuse in adolescence. This is because of shared genetic and environmental influences.

Antisocial personality behavior in children

Severe forms of antisocial behavior can lead to conduct disorder, or an oppositional defiant disorder diagnosis. Antisocial children may also drop out of school and have trouble maintaining a job and healthy relationships.

The behavior could also lead to antisocial personality disorder in adulthood. Adults living with antisocial personality disorder often display antisocial behavior and other conduct disorder symptoms before age 15.

Some signs of antisocial personality disorder include:

  • lack of conscience and empathy
  • disregard and abuse of authority and people’s rights
  • aggression and violent tendencies
  • arrogance
  • using charm to manipulate
  • lack of remorse

 

Breath holding spell

Breath holding spell

Some children have breath holding spells. This is an involuntary stop in breathing that is not in the child’s control.

Causes

Babies as young as 2 months old and up to 2 years old can start having breath holding spells.

Children can have breath holding spells when they are responding to:

  • Fear
  • Pain
  • Traumatic event
  • Being startled or confronted

 

Breath holding spells are more common in children with:

  • Genetic conditions, such as Riley-Day syndrome or Rett syndrome
  • Iron deficiency anemia
  • A family history of breath holding spells (parents may have had similar spells when they were children)

Symptoms

Breath holding spells most often occur when a child becomes suddenly upset or surprised. The child makes a short gasp, exhales, and stops breathing. The child’s nervous system slows the heart rate or breathing for a short amount of time. Breath holding spells are not thought to be a willful act of defiance, even though they often occur with temper tantrums. Symptoms can include:

  • Blue or pale skin
  • Crying, then no breathing
  • Fainting or loss of alertness (unconsciousness)
  • Jerky movements (short, seizure-like movements)

Normal breathing starts again after a brief period of unconsciousness. The child’s color improves with the first breath. This may occur several times per day, or only on rare occasions.

 

Treatment

No treatment is usually needed. But iron drops or pills may be given if the child has an iron deficiency.

Breath holding can be a frightening experience for parents. If your child has been diagnosed with breath holding spells, take the following steps:

  • During a spell, make sure your child is in a safe place where they will not fall or be hurt.
  • Place a cold cloth on your child’s forehead during a spell to help shorten the episode.
  • After the spell, try to be calm. Avoid giving too much attention to the child, as this can reinforce the behaviors that led to the spell.
  • Avoid situations that cause a child’s temper tantrums. This can help reduce the number of spells.
  • Ignore breath holding spells that do not cause your child to faint. Ignore the spell in the same way you ignore temper tantrums.

Outlook (Prognosis)

Most children outgrow breath holding spells by the time they are 4 to 8 years old.

Children who have a seizure during a breath holding spell are not at higher risk of having seizures otherwise.

When to Contact a Medical Professional

Call your child’s provider if:

  • You think your child is having breath holding spells
  • Your child’s breath holding spells are getting worse or happening more often

Call 911 or your local emergency number if:

  • Your child stops breathing or has trouble breathing
  • Your child has seizures for more than 1 minute

 

Childhood disintegrative disorder (CDD)

Childhood disintegrative disorder (CDD), or Heller’s syndrome, is a rare pervasive developmental disorder (PDD) which involves regression of developmental ability in language, social function and motor skills. It is a devastating condition of unknown cause.

PDDs are a spectrum of behavioural problems associated with autism and autism-like syndromes. They include CDD, Rett’s Syndrome and pervasive developmental disorder – not otherwise specified (PDD-NOS). CDD is considered a low-functioning form of autistic spectrum disorder. However, autism does not show the severe regression after several years of normal development which characterises CDD, and children with CDD show a more dramatic loss of skills compared with children with autism. CDD also tends to develop later than autism, and can develop very much later (up to the age of 10 years).

Symptoms

Affected children show clinically significant losses of earlier acquired skills in at least two of the following:

  • Expressive language skills
  • Receptive language skills
  • Social skills and self-care skills
  • Bowel or bladder control
  • Play skills
  • Motor skills

Abnormal function also occurs in at least two of:

  • Social interaction
  • Communication
  • Repetitive interests or behaviours

The child presents after at least two years of apparently normal development. This occurs usually between the ages of 3 to 4 years, but generally before the age of 10 years.

  • The onset may be abrupt or gradual.
  • It can be severe enough that children are aware themselves of the regression, and may ask what is happening to them.
  • Usually parents and professionals have not previously noticed abnormalities in terms of language and non-verbal communication, social relationships, play, adaptive behaviour or emotional development.
  • A typical presentation would be of a child who is able to communicate in two- or three-word phrases losing this ability. They would eventually stop talking altogether or retain only fragments of their former speech.
  • There may be social and emotional problems, such as a child previously happy to be cuddled becoming averse to physical contact.
  • Some children describe or seem to be reacting to hallucinations.

 

Dementia

What Is Dementia For Kids?

Dementia is a psychological condition, which occurs due to injury, damage or changes in a child’s brain. The most common cause is a brain injury. Your child may appear healthy and normal, but her brain may not function properly. Children with dementia face difficulty remembering common things, have trouble speaking and sometimes cannot recognize the immediate family as well.

Causes Of Dementia In Children:

Children suffer from dementia due to many health reasons and disorders. Here we mention some prominent causes of dementia in children:

  1. Heavy metal poisoning, such as lead.
  2. A brain injury or brain tumor.
  3. Underactive thyroid gland (hypothyroidism).
  4. Encephalitis
  5. Neuronal Ceroid lipofuscinosis (NCL).
  6. Niemann-Pick disease.
  7. Lafora body disease.
  8. Batten disease.
  9. Various other neurological and brain disorders

Symptoms Of Dementia In Children:

Symptoms of dementia vary from child to child, depending on the cause and type of dementia. Here is a list of common symptoms of dementia in children.

  1. Memory loss.
  2. Improper intellectual functioning.
  3. Inability to exercise emotional control.
  4. Frequent forgetfulness.
  5. Behavioral problems, such as delusions, hallucinations, and agitation.
  6. Confusion about time, place, and people.
  7. She cries a lot.
  8. Unreasonable fear, anger, and nervousness.
  9. Confusion with words and information.
  10. Repeating same words or story and asking same queries several times.
  11. Inability to learn new things.
  12. Negligence in personal safety and hygiene

 

Down syndrome

Down syndrome is a genetic disorder caused when abnormal cell division results in an extra full or partial copy of chromosome 21. This extra genetic material causes the developmental changes and physical features of Down syndrome.

Down syndrome varies in severity among individuals, causing lifelong intellectual disability and developmental delays. It’s the most common genetic chromosomal disorder and cause of learning disabilities in children. It also commonly causes other medical abnormalities, including heart and gastrointestinal disorders.

Symptoms

Each person with Down syndrome is an individual — intellectual and developmental problems may be mild, moderate or severe. Some people are healthy while others have significant health problems such as serious heart defects.

Children and adults with Down syndrome have distinct facial features. Though not all people with Down syndrome have the same features, some of the more common features include:

  • Flattened face
  • Small head
  • Short neck
  • Protruding tongue
  • Upward slanting eye lids (palpebral fissures)
  • Unusually shaped or small ears
  • Poor muscle tone
  • Broad, short hands with a single crease in the palm
  • Relatively short fingers and small hands and feet
  • Excessive flexibility
  • Tiny white spots on the colored part (iris) of the eye called Brushfield’s spots
  • Short height

Infants with Down syndrome may be average size, but typically they grow slowly and remain shorter than other children the same age.

Intellectual disabilities

Most children with Down syndrome have mild to moderate cognitive impairment. Language is delayed, and both short and long-term memory is affected.

Causes

The genetic basis of Down syndrome

Human cells normally contain 23 pairs of chromosomes. One chromosome in each pair comes from your father, the other from your mother.

Down syndrome results when abnormal cell division involving chromosome 21 occurs. These cell division abnormalities result in an extra partial or full chromosome 21. This extra genetic material is responsible for the characteristic features and developmental problems of Down syndrome. Any one of three genetic variations can cause Down syndrome:

  • Trisomy 21.About 95 percent of the time, Down syndrome is caused by trisomy 21 — the person has three copies of chromosome 21, instead of the usual two copies, in all cells. This is caused by abnormal cell division during the development of the sperm cell or the egg cell.
  • Mosaic Down syndrome.In this rare form of Down syndrome, a person has only some cells with an extra copy of chromosome 21. This mosaic of normal and abnormal cells is caused by abnormal cell division after fertilization.
  • Translocation Down syndrome.Down syndrome can also occur when a portion of chromosome 21 becomes attached (translocated) onto another chromosome, before or at conception. These children have the usual two copies of chromosome 21, but they also have additional genetic material from chromosome 21 attached to another chromosome.

There are no known behavioral or environmental factors that cause Down syndrome.

Fear

Fear and anxiety in children: What’s normal, and what’s not

 In a young child’s world, so much is new and unfamiliar. When you consider a toddler’s inexperience, coupled with their limited reasoning skills, it’s easy to understand why a toddler might react in fear to a host of benign, everyday things.

But what if that fearfulness remains as your child grows older? How can you tell if your child’s apprehensiveness is normal, or something to be concerned about?

First of all, rest assured that the vast majority of children wrestle with a least a few fears at any given age. Whether a child is two, twelve or sixteen years old, it would be unusual for him or her to be “fear-free.”

As a child matures, old fears are overcome, and new fears arise to take their place. Interestingly, children of similar ages tend to share similar types of fears.

Some common fears in children according to age group:

Infants and toddlers – fear of separation from parent, strangers, loud noises, imposing objects

Ages 2-4 – fear of separation from parent, dogs and/or large animals, darkness, sleeping alone, monsters, loud and/or unfamiliar noises, burglers

Ages 5-6 – separation from parent, dogs, darkness, sleeping alone, monsters, bugs, strangers, getting lost, thunder, injury, illness, death

Ages 7-12 – dogs, school issues, performance anxiety, social anxiety, fires, heights, darkness, thunderstorms, burglars, kidnappers, injury, illness, death, natural disasters, nuclear war

Teens – school issues, performance anxiety, social anxiety, personal future, natural disasters, nuclear war

Some children are naturally more fearful than others. If your child’s fear is usually fleeting and, once comforted, he or she is soon able to return to normal activities again, there is no reason to suspect that your child is excessively fearful.

If you are still concerned that your child seems unusually anxious, however, you may want to consider whether your child exhibits some of the characteristics in the list below. If you have any doubts at all, you should seek professional advice.

Some possible signs of unusually high levels of anxiety include:

  • Resolute avoidance of specific situations or places (that similar-aged children have no problem with)
  • Resists separation from parent; often seeks reassurance or is clingy
  • Persistent fears that most children of the same age have already grown out of
  • Difficulty falling asleep and staying asleep
  • Frequent nightmares
  • Frequent stomach aches and/or headaches
  • Fidgety or restless; often chews fingernails, toys with hair or sucks thumb
  • Excessive shyness
  • Resistant to change – for example, reacts negatively to changes in schedule, or insists on wearing specific clothing, or not eating/only eating certain foods
  • Is unusually fearful of germs or of becoming ill
  • Performs repetitive actions such as hand washing, checking door locks or belongings over and over, or has recurring disturbing thoughts
  • Seems unable to recover from major life changes such as moving home, changing schools, loss of a pet
  • Often worries that a “bad guy” might break in or try to hurt someone
  • Tends to be bossy or seems determined to control other family members
  • Panics for no obvious reason
  • Is easily overwhelmed by challenges; gives up easily
  • Exhibits negative and catastrophic thinking – imagines and expects the worst possible outcome
  • Worries excessively about performance in tests or that completed assignments may not be good enough
  • Or on the other hand, may be inexplicably underachieving in school or resistant to doing schoolwork
  • Has difficulty making friends or participating in group activities
  • One or both parents tend to be anxious

Symptoms of true anxiety disorders don’t usually show up before the age of six years old. One of the most definitive signs of an anxiety disorder is an excessive, irrational fear or dread that lasts for at least six months, and that significantly interferes with a child’s enjoyment of life at school and at home.

Some common anxiety disorders in children include:

Separation Anxiety Disorder – extreme reluctance to leave home, parents or caregiver

Generalized Anxiety Disorder – excessive worrying about everyday issues

Specific Phobias – overwhelming irrational fear of specific things or situations; some very common phobias in children are phobias of dogs, water, storms and lightening, bugs, heights

Obsessive Compulsive Disorder – repetitive behaviour carried out to relieve anxiety, such as frequent hand washing

Some common anxiety disorders in adolescents include:

Social Anxiety Disorder – extreme fear of being embarrassed in front of peers

Generalized Anxiety Disorder 

Specific Phobias 

Obsessive Compulsive Disorder 

Panic Disorder – unexpected and repeated panic attacks

Post-Traumatic Stress Disorder – following a traumatic event such as a car accident: avoidance, detachment, difficulty sleeping and concentrating, depression, constantly “reliving” the event

Summary

  • Sometimes children are afraid of situations or objects that adults don’t find threatening.
  • Making fun of the child or forcing them to confront their fear will only make things worse.
  • You can help your child by taking their fears seriously and encouraging them to talk about their feelingr child by taking their fears seriously and encouraging them to talk about their feelings.

The fearful child

Some children are more fearful than others. Contributing factors may include:

  • Genetic susceptibility – some children are generally more sensitive and emotional in their temperament
  • At least one anxious parent – children learn how to behave from watching their parents
  • Overprotective parenting – a dependent child is more likely to feel helpless and this can lead to generalised anxiety
  • Stressful events – such as parental separation, an injury or hospital stay.

Common fears for babies

Once a baby has reached six or seven months of age, they have formed strong attachments to their parents or caregivers. Separation from their ‘special people’, even for short periods of time, can cause considerable anxiety and plenty of crying. Similarly, many babies prefer the exclusive company of their special people so much that they develop a fear of strangers for a while. Babies grow out of this phase with time.

Common fears for toddlers

Children aged around two to three years are only just starting to learn how to cope with their strong feelings, such as anger. A common fear for a toddler is that they will be overwhelmed by powerful emotions.

Toddlers have a limited understanding of size and may develop seemingly irrational fears, such as falling down the plughole or toilet.

Common fears for children of primary school age

As a child learns more about the world, the list of things they fear tends to grow. Some fears are real and some are imaginary. Common fears include fear of the dark, burglary, war, death, separation or divorce of their parents, and supernatural beings (such as ghosts and monsters).

Understanding Childhood Fears and Anxieties

My child seems to be afraid of a lot of things. Should I be worried?

From time to time, every child experiences fear. As youngsters explore the world around them, having new experiences and confronting new challenges, anxieties are almost an unavoidable part of growing up.

Fears are Common:

According to one study, 43% of children between ages 6 and 12 had many fears and concerns. A fear of darkness, particularly being left alone in the dark, is one of the most common fears in this age group. So is a fear of animals, such as large barking dogs. Some children are afraid of fires, high places or thunderstorms. Others, conscious of news reports on TV and in the newspapers, are concerned about burglars, kidnappers or nuclear war. If there has been a recent serious illness or death in the family, they may become anxious about the health of those around them.

In middle childhood, fears wax and wane. Most are mild, but even when they intensify, they generally subside on their own after a while.

About Phobias:

Sometimes fears can become so extreme, persistent and focused that they develop into phobias. Phobias – which are strong and irrational fears – can become persistent and debilitating, significantly influencing and interfering with a child’s usual daily activities. For instance, a 6-year-old’s phobia about dogs might make him so panicky that he refuses to go outdoors at all because there could be a dog there. A 10-year-old child might become so terrified about news reports of a serial killer that he insists on sleeping with his parents at night.

Some children in this age group develop phobias about the people they meet in their everyday lives. This severe shyness can keep them from making friends at school and relating to most adults, especially strangers. They might consciously avoid social situations like birthday parties or Scout meetings, and they often find it difficult to converse comfortably with anyone except their immediate family.

Separation anxiety is also common in this age group. Sometimes this fear can intensify when the family moves to a new neighborhood or children are placed in a childcare setting where they feel uncomfortable. These youngsters might become afraid of going to summer camp or even attending school. Their phobias can cause physical symptoms like headaches or stomach pains and eventually lead the children to withdraw into their own world, becoming clinically depressed.

At about age 6 or 7, as children develop an understanding about death, another fear can arise. With the recognition that death will eventually affect everyone, and that it is permanent and irreversible, the normal worry about the possible death of family members – or even their own death – can intensify. In some cases, this preoccupation with death can become disabling.

Fears of an Infant or Toddler

  • Loud noises or sudden movements
  • Large looming objects
  • Strangers
  • Separation
  • Changes in the house

Fears During Preschool Years

  • The dark
  • Noises at night
  • Masks
  • Monsters and ghosts
  • Animals such as dogs

Fears During School Years

  • Snakes and spiders
  • Storms and natural disasters
  • Being home alone
  • Fear of a teacher who’s angry
  • Scary news or TV shows
  • Injury, illness, doctors, shots, or death
  • Fear of failure and rejection

 

Nail Biting

Nail Biting (onychophagia) is a common stress-relieving habit. You may bite your nails in times of stress or excitement, or in times of boredom or inactivity. It can also be a learned behavior from family members. Nail-biting is the most common of the typical “nervous habits,” which include thumb-sucking, nose-picking, hair-twisting or -pulling, tooth-grinding, and picking at skin.

You may bite your nails without realizing you are doing it. You might be involved in another activity, such as reading, watching television, or talking on the phone, and bite your nails without thinking about it.

Nail-biting includes biting the cuticle and soft tissue surrounding the nail as well as biting the nail itself.

Who bites their nails?

People of all ages bite their nails.

  • About half of all children between the ages of 10 and 18 bite their nails at one time or another. Nail-biting occurs most often during puberty.
  • Some young adults, ages 18 to 22 years, bite their nails.
  • Only a small number of other adults bite their nails. Most people stop biting their nails on their own by age 30.
  • Boys bite their nails more often than girls after age 10.

Other body-focused repetitive behaviors include excoriation disorder (skin picking), dermatophagia (skin biting), and trichotillomania (the urge to pull out hair), and all of them tend to coexist with nail biting. As an oral parafunctional activity, it is also associated with bruxism (tooth clenching and grinding), and other habits such as pen chewing and cheek biting.

In children nail biting most typically co-occurs with attention deficit hyperactivity disorder (75% of nail biting cases in a study), and other psychiatric disorders including oppositional defiant disorder (36%) and separation anxiety disorder (21%).It is also more common among children and adolescents with obsessive–compulsive disorder. Nail biting appeared in a study to be more common in men with eating disorders than in those without them.

 

OCD

OCD IN CHILDREN: SIGNS, SYMPTOMS, CAUSES, TREATMENTS

  • If your child has Obsessive Compulsive Disorder, or is exhibiting symptoms that could be OCD, he or she is not alone. Current estimates suggest that one in 100 children has OCD, which means that millions of children worldwide are suffering with this disorder.  When you include parents, other family members, friends, and school personnel who are affected by a child with OCD, this unwanted condition has an impact on many millions more.
  • OCD is not a “phase” your child is going through.  And your son or daughter isn’t deliberately misbehaving or trying to get attention.  Your child is not to blame.  Perhaps most importantly, it’s not your fault that your child has OCD.  OCD is a neurobiological disorder, which means that the brain of a child with OCD functions differently than the brain of child who does not have OCD.
  • OCD is a disorder that has a neurobiological basis. This brain condition affects how children (and adults) think.  It is characterized by obsessions and compulsions that take up at least an hour a day.  For many people, however, obsessions and compulsions consume several hours a day.  Obsessions are involuntary intrusive thoughts, images or impulses that cause unbearable worry, fear or discomfort.  To cope with the obsessions, the OCD sufferer devises processes or actions called compulsions, or rituals.  In some cases, rituals are observable: a child washes his or her hands excessively or checks locks for extensive periods of time.  In other cases, compulsions may be completed mentally and cannot be detected by an outside observer: the child is saying a prayer mentally to prevent something terrible from happening.  These repetitive, ritualistic acts make a child feel better, but the relief is only temporary.

Symptoms of OCD in Children

The symptoms of OCD in children involve repetitive thoughts or images called obsessions. Compulsions represent the ritual behaviors that they repeat again and again to banish the thoughts.

Examples of obsessive thoughts in OCD kids may include:

  • Excessive preoccupation with germs, dirt, illness
  • Expresses repeated doubts, such as whether the stove is turned off
  • Intrusive thoughts about a parent getting hurt
  • Excessive preoccupation with symmetry, order, and exactness
  • Disturbing thoughts that do not align with personal religious training
  • Excessive drive to know or remember facts that seem very trivial
  • Unreasonable attention to detail
  • Excessive worry about something bad happening like a car accident or home intruder breaking in
  • Aggressive thoughts and urges (may be more likely in teens)

Examples of compulsive behaviors in OCD kids may include:

  • Washing hands excessively, frequently over 100 times a day
  • Repeated checking and rechecking to ensure stove is turned off or door is locked
  • Rigidly follows self-imposed rules of order like arranging personal items in room in a particular way and becoming very upset if someone disrupts the arrangement
  • Excessive counting and recounting
  • Preoccupation with sequencing or grouping objects
  • Repeatedly and excessively asking the same questions
  • Repeating words spoken by self or others
  • Repeating sounds, words, numbers, or music to him- or herself

OCD in Children – Causes

Biological factors – research shows a link between insufficient levels of the neurotransmitter, serotonin, in the development of OCD in children. Some evidence exists that indicates parents can pass serotonin inefficiencies to their children. Because of this scientists also suspect a genetic component in OCD development.

Environmental factors – Certain environmental situations and stressors can trigger OCD in children already at risk for the disorder. Environmental situations that can cause symptoms to appear or worsen include:

  • Physical or emotional abuse
  • Drastic changes in living environment
  • Illness (such as streptococcus infections)
  • Death of a loved one
  • Parental divorce
  • School-related changes or issues
  • Other traumatic events and experiences

 

Autism Spectrum Disorder

Definition

Autism spectrum disorder (ASD) is the name for a group of developmental disorders. ASD includes a wide range, “a spectrum,” of symptoms, skills, and levels of disability.

People with ASD often have these characteristics:

  • Ongoing social problems that include difficulty communicating and interacting with others
  • Repetitive behaviors as well as limited interests or activities
  • Symptoms that typically are recognized in the first two years of life
  • Symptoms that hurt the individual’s ability to function socially, at school or work, or other areas of life

Some people are mildly impaired by their symptoms, while others are severely disabled.

Signs and Symptoms

Parents or doctors may first identify ASD behaviors in infants and toddlers. School staff may recognize these behaviors in older children. Not all people with ASD will show all of these behaviors, but most will show several. There are two main types of behaviors: “restricted / repetitive behaviors” and “social communication / interaction behaviors.”

Restrictive / repetitive behaviors may include:

  • Repeating certain behaviors or having unusual behaviors
  • Having overly focused interests, such as with moving objects or parts of objects
  • Having a lasting, intense interest in certain topics, such as numbers, details, or facts.

Social communication / interaction behaviors may include:

  • Getting upset by a slight change in a routine or being placed in a new or overly stimulating setting
  • Making little or inconsistent eye contact
  • Having a tendency to look at and listen to other people less often
  • Rarely sharing enjoyment of objects or activities by pointing or showing things to others
  • Responding in an unusual way when others show anger, distress, or affection
  • Failing to, or being slow to, respond to someone calling their name or other verbal attempts to gain attention
  • Having difficulties with the back and forth of conversations
  • Often talking at length about a favorite subject without noticing that others are not interested or without giving others a chance to respond
  • Repeating words or phrases that they hear, a behavior called echolalia
  • Using words that seem odd, out of place, or have a special meaning known only to those familiar with that person’s way of communicating
  • Having facial expressions, movements, and gestures that do not match what is being said
  • Having an unusual tone of voice that may sound sing-song or flat and robot-like
  • Having trouble understanding another person’s point of view or being unable to predict or understand other people’s actions.

People with ASD may have other difficulties, such as being very sensitive to light, noise, clothing, or temperature. They may also experience sleep problems, digestion problems, and irritability.

ASD is unique in that it is common for people with ASD to have many strengths and abilities in addition to challenges.

Strengths and abilities may include:

  • Having above-average intelligence – the CDC reports 46% of ASD children have above average intelligence
  • Being able to learn things in detail and remember information for long periods of time
  • Being strong visual and auditory learners
  • Exceling in math, science, music, or art.
Persistant Weeping and Crying

Excessive crying in infants

Crying is an important way for infants to communicate. But, when a baby cries a lot, it may be a sign of something that needs treatment.

Considerations

Infants normally cry about 1 to 3 hours a day. It is perfectly normal for an infant to cry when hungry, thirsty, tired, lonely, or in pain. It is also normal for a baby to have a fussy period in the evening.

But, if an infant cries too often, there might be a health problem that needs attention.

Causes

Infants may cry because of any of the following:

  • Boredom or loneliness
  • Colic
  • Discomfort or irritation from a wet or dirty diaper, excessive gas, or feeling cold
  • Hunger or thirst
  • Illness
  • Infection (a likely cause if the crying is accompanied by irritability, lethargy, poor appetite, or fever.)
  • Medicines
  • Normal muscle jerks and twitches that disturb the sleep
  • Pain
  • Teething

 

When should I take my baby to see the doctor with excessive crying?

Even colicky babies take a break now and then, so if your child has been crying nonstop for an hour or more and you’ve tried all the typical tactics mentioned above (feeding, changing, burping, rocking, etc.) there’s probably something more concerning to investigate.

Recurrent paroxysm of causeless crying are indication of low immunity.

Homoeopathic treatment helps to fight body against disease thus enhances our immunity.

PICA

Pica

Pica is a pattern of eating non-food materials, such as dirt or paper.

Causes

Pica is seen more in young children than adults. Up to one third of children ages 1 to 6 have these eating behaviors.

Pica can also occur during pregnancy. In some cases, a lack of certain nutrients, such as iron and zinc, may trigger the unusual cravings. Pica may also occur in adults who crave a certain texture in their mouth.

Symptoms

Children with pica may eat:

  • Animal feces
  • Clay
  • Dirt
  • Hairballs
  • Ice
  • Paint
  • Sand

Depending on what is being eaten and how much, symptoms of other problems may be present, such as:

  • Belly pain, nausea, and bloating caused by blockage in the stomach or intestine
  • Fatigue, behavior problems, school problems and other findings of lead poisoning or poor nutrition.

Conventional Approach

Treating pica involves behaviors, the environment, and family education. One form of treatment associates the pica behavior with negative consequences or punishment (mild aversion therapy). Then the person gets rewarded for eating normal foods.

Medicines may help reduce the abnormal eating behavior if pica is part of a developmental disorder such as intellectual disability.

Possible Complications

Complications include:

  • Bezoar(a mass of undigestible material trapped inside the body, most often in the stomach)
  • Infection
Rett syndrome

Rett syndrome

Rett syndrome (RTT) is a disorder of the nervous system. This condition leads to developmental problems in children. It mostly affects language skills and hand use.

Causes

RTT occurs almost always in girls. It may be diagnosed as autism or cerebral palsy.

Most RTT cases are due to a problem in the gene called MECP2. This gene is on the X chromosome. Females have 2 X chromosomes. Even when one chromosome has this defect, the other X chromosome is normal enough for the child to survive.

Males born with this defective gene do not have a second X chromosome to make up for the problem. Therefore, the defect usually results in miscarriage, stillbirth, or very early death.

Symptoms

An infant with RTT usually has normal development for the first 6 to 18 months. Symptoms range from mild to severe.

Symptoms may include:

  • Breathing problems, which may get worse with stress. Breathing is usually normal during sleep and abnormal while awake.
  • Change in development.
  • Excessive saliva and drooling.
  • Floppy arms and legs, which is frequently the first sign.
  • Intellectual disabilities and learning difficulties.
  • Scoliosis.
  • Shaky, unsteady, stiff gait or toe walking.
  • Seizures.
  • Slowing head growth beginning at 5 to 6 months of age.
  • Loss of normal sleep patterns.
  • Loss of purposeful hand movements: For example, the grasp used to pick up small objects is replaced by repetitive hand motions like hand wringing or constant placement of hands in mouth.
  • Loss of social engagement.
  • Ongoing, severe constipation and gastroesophageal reflux (GERD).
  • Poor circulation that can lead to cold and bluish arms and legs.
  • Severe language development problems.
Psychosis (Schizophrenia)

Schizophrenia and other psychotic disorders are medical illnesses that result in strange or bizarre thinking, perceptions (sight, sound), behaviors, and emotions. Psychosis is a brain-based condition that is made better or worse by environmental factors – like drug use and stress. Children and youth who experience psychosis often say “something is not quite right” or can’t tell if something is real or not real. It is an uncommon psychiatric illness in young children and is hard to recognize in its early phases.

The appearance of symptoms of psychosis before age 12 is rare (less than one-sixtieth as common as the adult-onset type), but studying these cases is important for understanding this disorder. For those who might develop psychotic disorders or schizophrenia as adults (adult-onset), it is not uncommon for them to start experiencing early warning signs during puberty or adolescence. The period of time when an adolescent experiences the early warning signs of psychosis is called prodrome. During this time, youth recognize that their experiences (hearing or seeing things that are not there) are strange or concerning. They may not easily admit these problems unless asked. Being aware of the early warning signs and offering support is crucial.

Childhood-onset – Most children with schizophrenia show delays in language and other functions long before their psychotic symptoms (hallucinations, delusions, and disordered thinking) appear. In the first years of life, about 30% of these children have transient symptoms of pervasive developmental disorder, such as rocking, posturing, and arm flapping. Childhood-onset of psychosis may present with poor motor development, such as unusual crawling, and children may be more anxious and disruptive compared to those with later onset.

It is especially important to pay attention to sudden changes in thoughts and behaviors. Keep in mind that the onset of several of the symptoms below, and not just any one change, indicates a problem that should be assessed. The symptoms below should not be due to recent substance use or another medical condition.

Early Warning Signs:

  • Feeling like their brain is not working
  • Feeling like their mind or eyes are playing tricks on them
  • Seeing things and hearing voices that are not real
  • Hearing knocking, tapping, clicking or their named being called
  • Confused thoughts
  • Vivid and bizarre thoughts and ideas
  • Sudden and bizarre changes in emotions
  • Peculiar behavior that seem unusual
  • Increased sensitivity to light, sounds, smells or touch
  • Concept that people are “out to get them”
  • Fearfulness or suspicion that isn’t warranted
  • Withdrawal from others
  • Severe problems in making and keeping friends
  • Difficulty speaking, writing, focusing or managing simple tasks

Symptoms and causes

Symptoms

Schizophrenia involves a range of problems with thinking, behavior or emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function. The effect can be disabling.

Schizophrenia symptoms generally start in the mid- to late 20s. It’s uncommon for children to be diagnosed with schizophrenia. Early-onset schizophrenia occurs before age 18. Very early-onset schizophrenia in children younger than age 13 is extremely rare.

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present. Schizophrenia can be difficult to recognize in the early phases.

Early signs and symptoms

The earliest indications of childhood schizophrenia may include developmental problems, such as:

  • Language delays
  • Late or unusual crawling
  • Late walking
  • Other abnormal motor behaviors — for example, rocking or arm flapping

Some of these signs and symptoms are also common in children with pervasive developmental disorders, such as autism spectrum disorder. So ruling out these developmental disorders is one of the first steps in diagnosis.

Symptoms in teenagers

Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize in this age group. This may be in part because some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:

  • Withdrawal from friends and family
  • A drop in performance at school
  • Trouble sleeping
  • Irritability or depressed mood
  • Lack of motivation
  • Strange behavior
  • Substance use

Compared with schizophrenia symptoms in adults, teens may be:

  • Less likely to have delusions
  • More likely to have visual hallucinations

Later signs and symptoms

As children with schizophrenia age, more typical signs and symptoms of the disorder begin to appear. Signs and symptoms may include:

  • These are false beliefs that are not based in reality. For example, you think that you’re being harmed or harassed; that certain gestures or comments are directed at you; that you have exceptional ability or fame; that another person is in love with you; or that a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
  • These usually involve seeing or hearing things that don’t exist. Yet for the person with schizophrenia, hallucinations have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
  • Disorganized thinking.Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can’t be understood, sometimes known as word salad.
  • Extremely disorganized or abnormal motor behavior.This may show in several ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, which makes it hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
  • Negative symptoms.This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion ― doesn’t make eye contact, doesn’t change facial expressions, speaks in a monotone, or doesn’t add hand or head movements that normally occur when speaking. Also, the person may have reduced ability to engage in activities, such as a loss of interest in everyday activities, social withdrawal or lack ability to experience pleasure.

 

Speech Disturbance

What is stuttering?

Stuttering, also called stammering, is a speech disorder where an individual repeats or prolongs words, syllables, or phrases.

A person with a stutter (or stammer) may also stop during speech and make no sound for certain syllables.

  • Stuttering affects more boys than girls.
  • In some cases, stuttering completely blocks an individual from producing a sound.
  • For an official diagnosis the individual will meet with a speech-language pathologist.
  • Most children with a stutter grow out of it.
  • Sometimes, a stutter can be the result of a head injury.

Symptoms of stuttering

A person who stutters often repeats words or parts of words, and tends to prolong certain speech sounds. They may also find it harder to start some words. Some may become tense when they start to speak, they may blink rapidly, and their lips or jaw may tremble as they try to communicate verbally.

According to the American Speech-Language-Hearing Association, some individuals who stutter appear extremely tense or out of breath when they talk. Their speech may be completely “blocked” (stopped).

“Blocked” is when their mouths are in the right position to say the word, but virtually no sound comes out. This may last several seconds. Sometimes, the desired word is uttered, or interjections are used in order to delay the initiation of a word the speaker knows causes problems. Examples of interjections include such words as “um,” “like,” “I mean,” “well,” or “umm.”

Common signs and symptoms associated with stuttering:

  • Problems starting a word, phrase, or sentence.
  • Hesitation before certain sounds have to be uttered.
  • Repeating a sound, word, or syllable.
  • Certain speech sounds may be prolonged.
  • Speech may come out in spurts.
  • Words with certain sounds are substituted for others (circumlocution).

Also, when talking there may be:

  • rapid blinking
  • trembling lips
  • foot tapping
  • a trembling jaw
  • the face and/or upper body tightens

Causes of stuttering

Experts are not completely sure what causes stuttering. We do know that somebody with a stutter is much more likely to have a close family member who also has one, compared with other people. The following factors may also trigger/cause stuttering:

Developmental stuttering

As children learn to speak, they often stutter, especially early on when their speech and language skills are not well developed. The majority of children experience fewer and fewer symptoms as this developmental stage progresses until they can speak flowingly.

Neurogenic stuttering

This is when the signals between the brain and speech nerves and muscles are not working properly. This may affect children, and can also affect adults after a stroke or some brain injury. The following may cause neurogenic stuttering:

  • stroke
  • head trauma
  • ischemic attacks – temporary block of blood flow to the brain
  • tumors
  • degenerative diseases, such as Parkinson’s
  • meningitis

Psychological factors

Stress can make stuttering worse for some individuals.

It used to be believed that the main reasons for long-term stuttering were psychological.

However, psychological factors may make stuttering worse for people who already stutter.

For instance, stress, embarrassment, and anxiety can make the stutter more pronounced; but they are not generally seen as the underlying cause.

In other words, anxiety, low self-esteem, nervousness, and stress do not cause stuttering; rather, they are the result of living with a stigmatized speech problem, which can sometimes make symptoms worse.

Stuttering risk factors

Family history – many children who have a stutter that persists beyond the developmental stage of language have a close family member who stutters. If a young child has a stutter and also a close family member who stutters, their chances of that speech disorder continuing are much greater.

Age when stutter starts – a child who starts stuttering before 3.5 years of age is less likely to stutter later in life. The earlier the stuttering starts, the less likely it is to continue long-term.

Time since stuttering started – about three-quarters of all young children who stutter will stop doing so within 1 or 2 years without speech therapy.

The longer the stuttering continues, the more likely it is that the problem will become long-term without professional help (and even with professional help).

Temper Tantrums

TEMPER TANTRUM IN ELEMENTARY SCHOOL AGE

tantrumtemper tantrummeltdown or hissy fit is an emotional outburst, usually associated with children or those in emotional distress, that is typically characterized by stubbornness, crying, screaming, defiance, anger ranting, a resistance to attempts at pacification and, in some cases, hitting. Physical control may be lost; the person may be unable to remain still; and even if the “goal” of the person is met, he or she may not be calmed.

Thankfully, tantrums may be less frequent during the preschool years than they were during the terrible twos. But when tantrums do hit, they’re as challenging as ever. And as many veteran parents attest, tantrums may continue to flare up well into the grade-school years.

Tantrum may develop due to jealousy between siblings, narcissistic rages, or uncouncious reaction to feeling of guilt.

We may find such tantrums in food choices also, where child may become unyielding for eating his favourite dish without thinking whether good for his health or not leading to some health issues. If this stubbornness is accepted by parents child get appreciated in negative way and get headstrong in every matter. Looking on other side if child is not cared enough he may become a victim of depression, neglected feeling, lack of confidence, phobias, etc. Sometimes child may develop psychosomatic disorders like school going headache, pain in tummy, anticipatory diarrhoea, etc.

Homoeopathically human psyche is classified as sensitivity, developmental level of love, care, security, creativity and responsibility, as well as one upmanship behaviour where child feels competitiveness, rivalry, jealousy.

In this vast homoeopathic science, there are hundreds of medicine which addresses these psychological states of human development. Homoeopathic medicine prescribed by understanding this unique nature of child helps in getting rid of present developmental error, enhancing balance and harmony in child thus elevating child to his next level of development.

At this age group, there is no scope of counselling, if Doc’s are expected for counselling, parents are the best counsellor too. But when this all proves  worthless, homoeopathy serves miraculous results.

I remembered  param, of 4yr age. He wants all things new, he always wants new glass of milk. When ask for ice cream that how it taste, immediately he refused to eat. If his mother remove his shoes, he get hyper and ask to repeat the whole process ask her to drop him back to school then he will come back to home and finally he will remove shoes. After 15 days of homoeopathic medicine choosen according to his mind state, child behaviour improved drastically. Obstinacy reduced. He now started to understand what his mother ask for easily.

For this kind of unique pyschological behaviour homoeopathy has medicines like sulphur,silicea, calcarea carb,phosphorus,natrium mur,chamomilla,cina,thuja,iodum,belladonna,tuberculinum,lachesis,tarantula, which can be given by expert understanding of nature of child to make him or her in better equilibrium.

 

Tics

Stress is a factor we’ve come to accept as part of our modern-day society. As adults, we generally recognize situations that cause stress in our lives and develop strategies for dealing with it, such as exercise, meditation and relaxation techniques.

Young children, however, typically are unable to recognize situations that cause stress in their lives, nor are they equipped to deal with stress in positive and productive ways. Instead, they often exhibit stress and anxiety in physical and emotional outbursts. Sometimes stress can lead to a tic— a sudden, repetitive, non-rhythmic movement involving a distinct muscle group—like an uncontrolled eye blinking.

Surprisingly, tics are fairly common among kids. In fact, up to 24 percent of children may have a tic at some point in their young lives. This ailment is referred to as Transient Tic Disorder, and it is very common.

Blinking, Grunting and Jerking
Facial tics, like an eye blink, represent only one type of tic. Others include hand-clapping; neck stretching; mouth movements; head, arm or leg jerks; and facial grimacing. Sometimes tics can be in the form of an audible sound, like throat clearing, sniffing, or grunting.

It’s important for parents to understand that children cannot consciously suppress a tic. Once children begin to think about it, holding in a tic is as hard as holding in a sneeze or a yawn.

Tics are rarely diagnosed before the age of 2 and can begin anytime during childhood. Boys are three to four times more likely to develop a tic than girls. Generally, tics come on slowly, last for a few weeks or up to a years.

When a child develops a tic, a parent inevitably begins to wonder, “Will my child develop Tourette’s Syndrome?” The answer is: very rarely. While having a transient tic is common, Tourette’s is not. In general terms, Tourette’s involves multiple tics, at least one is vocal, and symptoms must be present for one year.

So what do you do if your child develops a tic? When you first notice a tic—like eye blinking—take your child to the doctor.

ADHD (Attention Deficit Hyperactivity Disorder)

Definition

Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

  • Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
  • Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
  • Impulsivitymeans a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.

Signs and Symptoms

Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD.

In preschool, the most common ADHD symptom is hyperactivity.

It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors:

  • are more severe
  • occur more often
  • interfere with or reduce the quality of how they functions socially, at school, or in a job

Inattention

People with symptoms of inattention may often:

  • Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
  • Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
  • Not seem to listen when spoken to directly
  • Not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus and get easily sidetracked
  • Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines
  • Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms or reviewing lengthy papers
  • Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
  • Be easily distracted by unrelated thoughts or stimuli
  • Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments

Hyperactivity-Impulsivity

People with symptoms of hyperactivity-impulsivity may often:

  • Fidget and squirm in their seats
  • Leave their seats in situations when staying seated is expected, such as in the classroom or in the office
  • Run or dash around or climb in situations where it is inappropriate or, in teens and adults, often feel restless
  • Be unable to play or engage in hobbies quietly
  • Be constantly in motion or “on the go,” or act as if “driven by a motor”
  • Talk nonstop
  • Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in conversation
  • Have trouble waiting his or her turn
  • Interrupt or intrude on others, for example in conversations, games, or activities

ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood. Symptoms of ADHD can be mistaken for emotional or disciplinary problems or missed entirely in quiet, well-behaved children, leading to a delay in diagnosis. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult or failed relationships.

ADHD symptoms can change over time as a person ages. In young children with ADHD, hyperactivity-impulsivity is the most predominant symptom. As a child reaches elementary school, the symptom of inattention may become more prominent and cause the child to struggle academically. In adolescence, hyperactivity seems to lessen and may show more often as feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Many adolescents with ADHD also struggle with relationships and antisocial behaviors. Inattention, restlessness, and impulsivity tend to persist into adulthood.

Risk Factors

Like many other illnesses, a number of factors can contribute to ADHD, such as:

  • Genes
  • Cigarette smoking, alcohol use, or drug use during pregnancy
  • Exposure to environmental toxins during pregnancy
  • Exposure to environmental toxins, such as high levels of lead, at a young age
  • Low birth weight
  • Brain injuries

ADHD is more common in males than females, and females with ADHD are more likely to have problems primarily with inattention. Other conditions, such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance abuse, are common in people with ADHD.

 

Anticipatory anxiety

As a parent, you may be familiar with anticipatory anxiety, even if you haven’t heard the term before. Anticipatory anxiety is what’s at play when your child spends weeks dreading her vaccination appointment, yet when the day arrives, she sails through it like a champ. “What was that about?” you wonder. Or when your son negotiates for days trying to get out of attending a friend’s birthday but eventually gives in and goes, and has a great time! Just like us, children and teens experience anticipatory anxiety, which is the body’s response to perceived future threats. In the days and hours leading up to an important event your child or teen may be a bundle of nerves, which is the fight-flight-freeze system in action. It is anticipating the need to protect the body from threat or danger. Although this system is critical to our survival when there is actual threat or danger, it’s a big problem when there isn’t.

Common areas of anticipatory anxiety include:

  • Applying to college or university
  • Athletic, musical or other performances
  • Going on a date or to a party
  • Joining a club, team or sport
  • Starting a job
  • Starting school
  • Tests, projects and oral reports

In addition to specific events or situations, for youth who have panic disorder, anticipatory anxiety is a contributing factor to ongoing panic attacks. Panic attacks result from misinterpreting bodily sensations associated with the “fight-flight-freeze” response, as being dangerous. For example, a youth may believe that an increase in his heart rate means he is having a heart attack. As a result, he is always anxiously anticipating the worst outcome, staying on the “lookout”, and constantly scanning his body for sensations that might signal another attack.

Bipolar Disorder

Although bipolar disorder more commonly develops in older teenagers and young adults, it can appear in children as young as 6.

Bipolar Disorder in Young Children

Diagnosing bipolar disorder in young children is difficult, because many of the symptoms are similar to those of attention deficit hyperactivity disorder (ADHD) or conduct disorders — or even just normal, childhood behavior.

Young children in a manic phase might be more irritable than adults; they may be more likely to have psychotic symptoms, hearing and seeing things that aren’t real. During a depressive episode, they might be more likely to complain of physical symptoms, like aches and pains.

One of the most notable differences is that bipolar disorder in children cycles much more quickly. While manic and depressive periods may be separated by weeks, months, or years in adults, they can happen within a single day in children.

The criteria for childhood bipolar disorder are similar to that of adult bipolar disorder, requiring a child or adolescent to meet at least four or more of the following:

  • severe temper outbursts that are verbal or aggressive behavior toward others or things
  • the temper outburts occur 3 or more times per week and are inconsistent with the child or teen’s age level
  • an expansive or irritable mood
  • extreme sadness or lack of interest in play
  • rapidly changing moods lasting a few hours to a few days
  • explosive, lengthy, and often destructive rages
  • separation anxiety
  • defiance of authority
  • hyperactivity, agitation, and distractibility
  • sleeping little or, alternatively, sleeping too much
  • bed wetting and night terrors
  • strong and frequent cravings, often for carbohydrates and sweets
  • excessive involvement in multiple projects and activities
  • impaired judgment, impulsivity, racing thoughts, and pressure to keep talking
  • dare-devil behaviors (such as jumping out of moving cars or off roofs)
  • inappropriate or precocious sexual behavior
  • grandiose belief in own abilities that defy the laws of logic (ability to fly, for example)

 

Cerebral Palsy

Symptoms, causes, and treatments

Cerebral Palsy is a term used to describe a set of neurological conditions that affect movement. It is the most common form of childhood disability.

The condition makes it hard to move certain parts of the body. There are many degrees of severity.

Because of damage to certain parts of the brain, voluntary or involuntary movements or both can be affected.

Cerebral palsy is not contagious, it does not necessarily affect intelligence or cognitive ability, and it is not progressive, so it does not get worse with age.

Symptoms and types

An infant with cerebral palsy may have muscular and movement problems, including poor muscle tone. Muscle tone refers to a person’s automatic ability to tighten and relax muscle when required.

Features can include:

  • Overdeveloped or underdeveloped muscles, leading to stiff or floppy movements
  • Poor coordination and balance, known as ataxia
  • Involuntary, slow writhing movements, or athetosis
  • Stiff muscles that contract abnormally, known as spastic paralysis
  • Crawling in an unusual way
  • Lying down in awkward positions
  • Favoring one side of the body over the other
  • A limited range of movement

Other signs and symptoms include:

  • Late achievement of developmental milestones such as crawling, walking, or speaking
  • Hearing and eyesight problems
  • Problems controlling bladder and bowel movements
  • Seizures
  • Drooling, and problems with feeding, sucking, and swallowing
  • Being easily startled

Symptoms normally start to show during the first 3 years of life.

Types

There are four types of cerebral palsy: Spastic, athetoid-dyskinetic, ataxic, and hypotonic.

Spastic cerebral palsy

There are three different types of spastic cerebral palsy.

Cerebral palsy does not necessarily affect intelligence.

Spastic hemiplegia: A child with spastic hemiplegia will typically have spasticity, or muscle stiffness, on one side of the body. This is usually just a hand and an arm, but it may also involve a leg. The side that is affected may not develop properly. There may be speech problems. Intelligence is not usually affected. Seizures may occur.

Spastic diplegia: The lower limbs are affected, and the upper body has no spasticity or only a little. The leg and hip muscles are tight. Legs cross at the knees, making walking more difficult. The crossing of the legs when upright is often referred to as scissoring.

Spastic quadriplegia: The legs, arms, and body are affected. This is the most severe form of spastic cerebral palsy. It may involve cognitive deficits. Walking and talking will be difficult. Seizures may occur.

Athetoid or dyskinetic cerebral palsy

Also known as athetoid dyskinetic cerebral palsy, this is the second most common type. Intelligence is usually normal, but muscle problems affect the whole body. Weak or tight muscle tone causes random and uncontrolled body movements.

The child will have problems walking, sitting, maintaining posture, and speaking clearly because the tongue and vocal cords are hard to control. Some children drool if they have problems controlling facial muscles.

Ataxic cerebral palsy

Balance and coordination are most affected. Tasks that need fine motor skills will be difficult, such as tying shoelaces, buttoning up shirts, and cutting with scissors.

Balance difficulties may cause the child to walk with their feet far apart. Most children with ataxic cerebral palsy have normal intelligence and good communication skills, but some may have erratic speech.

Hypotonic cerebral palsy

Hypotonic cerebral palsy results from an injury to the cerebellum.

Muscle problems appear earlier. The infant’s head and body will be floppy, “like a rag doll.” There is only moderate resistance when an adult tries to move the infant’s limbs. The infant may rest with their elbows and knees loosely extended, instead of flexed. There may be breathing difficulties.

Causes

Muscle control takes place in a part of the brain called the cerebrum. The cerebrum is the upper part of the brain. Damage to the cerebrum before, during, or within 5 years of birth can cause cerebral palsy.

The cerebrum is the upper part of the human brain.

The cerebrum is also responsible for memory, ability to learn, and communication skills. This is why some people with cerebral palsy have problems with communication and learning. Cerebrum damage can sometimes affect vision and hearing.

Some newborns are deprived of oxygen during labor and delivery.

In the past, it was thought that this lack of oxygen during birth led to the brain damage.

Most often, the damage occurs before birth, probably during the first 6 months of pregnancy.

Several factors can cause a stroke in a fetus during pregnancy:

  • A blood clot in the placenta that blocks the flow of blood
  • A clotting disorder in the fetus
  • Interruptions in arterial blood flow to the fetal brain
  • Untreated pre-eclampsia in the mother
  • Inflammation of the placenta
  • Pelvic inflammatory infection in the mother

During delivery, the risk is increased by the following factors:

  • Emergency cesarean
  • The second stage of labor is prolonged
  • Vacuum extraction is used during delivery
  • Fetal or neonatal heart anomalies
  • Umbilical cord abnormalities

Anything that increases the risk of preterm birth or low birth weight also raises the risk of cerebral palsy.

Factors that may contribute to a higher risk of cerebral palsy include:

  • Multiple births, for example, twins
  • Damaged placenta
  • Sexually transmitted infections(STIs)
  • Consumption of alcohol, illegal drugs, or toxic substances during pregnancy
  • Malnourishment during pregnancy
  • Random malformation of the fetal brain
  • Small pelvis in the mother
  • Breech delivery

Brain damage after birth

A small proportion of cases happen because of damage after birth. This can happen because of an infection such as meningitis, a head injury, a drowning accident, or poisoning.

When damage occurs, it will do so soon after the birth. With age, the human brain becomes more resilient and able withstand more damage.

 

Conduct disorder

Conduct disorder is a serious behavioral and emotional disorder that can occur in children and teens. A child with this disorder may display a pattern of disruptive and violent behavior and have problems following rules.

It is not uncommon for children and teens to have behavior-related problems at some time during their development. However, the behavior is considered to be a conduct disorder when it is long-lasting and when it violates the rights of others, goes against accepted norms of behavior and disrupts the child’s or family’s everyday life.

What Are the Symptoms of Conduct Disorder?

Symptoms of conduct disorder vary depending on the age of the child and whether the disorder is mild, moderate, or severe. In general, symptoms of conduct disorder fall into four general categories:

  • Aggressive behavior: These are behaviors that threaten or cause physical harm and may include fighting, bullying, being cruel to others or animals, using weapons, and forcing another into sexual activity.
  • Destructive behavior: This involves intentional destruction of property such as arson (deliberate fire-setting) and vandalism (harming another person’s property).
  • Deceitful behavior: This may include repeated lying, shoplifting, or breaking into homes or cars in order to steal.
  • Violation of rules: This involves going against accepted rules of society or engaging in behavior that is not appropriate for the person’s age. These behaviors may include running away, skipping school, playing pranks, or being sexually active at a very young age.

In addition, many children with conduct disorder are irritable, have low self-esteem, and tend to throw frequent temper tantrums. Some may abuse drugs and alcohol. Children with conduct disorder often are unable to appreciate how their behavior can hurt others and generally have little guilt or remorse about hurting others.

What Causes Conduct Disorder?

The exact cause of conduct disorder is not known, but it is believed that a combination of biological, genetic, environmental, psychological, and social factors play a role.

  • Biological: Some studies suggest that defects or injuries to certain areas of the brain can lead to behavior disorders. Conduct disorder has been linked to particular brain regions involved in regulating behavior, impulse control, and emotion. Conduct disorder symptoms may occur if nerve cell circuits along these brain regions do not work properly. Further, many children and teens with conduct disorder also have other mental illnesses, such as attention-deficit/hyperactivity disorder (ADHD), learning disorders, depression, substance abuse, or an anxiety disorder, which may contribute to the symptoms of conduct disorder.
  • Genetics: Many children and teens with conduct disorder have close family members with mental illnesses, including mood disorders, anxiety disorders, substance use disorders and personality disorders.
  • Environmental: Factors such as a dysfunctional family life, childhood abuse, traumatic experiences, a family history of substance abuse, and inconsistent discipline by parents may contribute to the development of conduct disorder.
  • Psychological: Some experts believe that conduct disorders can reflect problems with moral awareness (notably, lack of guilt and remorse) and deficits in cognitive processing.

How Common Is Conduct Disorder?

It is estimated that 2%-16% of children in the U.S. have conduct disorder. It is more common in boys than in girls and most often occurs in late childhood or the early teen years.

Depression

What is depression in children and teens?

Depression is a serious mood disorder that can take the joy from a child’s life. It is normal for a child to be moody or sad from time to time. You can expect these feelings after the death of a pet or a move to a new city. But if these feelings last for weeks or months, they may be a sign of depression.

Experts used to think that only adults could get depression. Now we know that even a young child can have depression that needs treatment to improve.

Still, many children don’t get the treatment they need. This is partly because it can be hard to tell the difference between depression and normal moodiness. Also, depression may not look the same in a child as in an adult.

If you are worried about your child, learn more about the symptoms in children. Talk to your child to see how he or she is feeling. The sooner a child gets treatment, the sooner he or she will start to feel better.

What are the symptoms?

A child may be depressed if he or she:

  • Is irritable, sad, withdrawn, or bored most of the time.
  • Does not take pleasure in things he or she used to enjoy.

A child who is depressed may also:

  • Lose or gain weight.
  • Sleep too much or too little.
  • Feel hopeless, worthless, or guilty.
  • Have trouble concentrating, thinking, or making decisions.
  • Think about death or suicide a lot.

The symptoms of depression are often overlooked at first. It can be hard to see that symptoms are all part of the same problem.

Also, the symptoms may be different depending on how old the child is.

  • Both very young children and grade-school children may lack energy and become withdrawn. They may show little emotion, seem to feel hopeless, and have trouble sleeping. Often they will lose interest in friends and activities they liked before. They may complain of headaches or stomachaches. A child may be more anxious or clingy with caregivers.
  • Teens may sleep a lot or move or speak more slowly than usual. Some teens and children with severe depression may see or hear things that aren’t there (hallucinate) or have false beliefs (delusions).

Depression can range from mild to severe. A child who feels a little “down” most of the time for a year or more may have a milder, ongoing form of depression called dysthymia. In its most severe form, depression can cause a child to lose hope and want to die.

Whether depression is mild or severe, there are treatments that can help.

What causes depression?

Just what causes depression is not well understood. But it is linked to a problem with activity levels in certain parts of the brain as well as an imbalance of brain chemicals that affect mood. Things that may cause these problems include:

  • Stressful events, such as changing schools, going through a divorce, or losing a close family member or friend.
  • Some medicines, such as steroids or narcotics for pain relief.
  • Family history. In some children, depression seems to be inherited.

 

Enuresis

What Is Enuresis?

Enuresis is more commonly known as bed-wetting. Nocturnal enuresis, or bed-wetting at night, is the most common type of elimination disorder. Daytime wetting is called diurnal enuresis. Some children experience either or a combination of both.

This behavior may or may not be purposeful. The condition is not diagnosed unless the child is 5 years or older.

What Are the Symptoms of Enuresis?

The main symptoms of enuresis include:

  • Repeated bed-wetting
  • Wetting in the clothes
  • Wetting at least twice a week for approximately three months

What Causes Enuresis?

Many factors may be involved in the development of enuresis. Involuntary, or non-intentional, release of urine may result from:

  • A small bladder
  • Persistent urinary tract infections
  • Severe stress
  • Developmental delays that interfere with toilet training

Voluntary, or intentional, enuresis may be associated with other mental disorders, including behavior disorders or emotional disorders such as anxiety. In addition, toilet training that was forced or started when the child was too young may be a factor in the development of the disorder, although there is little research to make conclusions about the role of toilet training and the development of enuresis.

Children with enuresis are often described as heavy sleepers who fail to awaken at the urinary urge to void or when their bladders are full.

How Common Is Enuresis?

Enuresis is a common childhood problem. Estimates suggest that 7% of boys and 3% of girls age 5 have enuresis.

 

Head Banging

Head banging is surprisingly common. Up to 20 percent of babies and toddlers bang their head on purpose, although boys are three times more likely to do it than girls. Head banging often starts in the second half of the first year and peaks between 18 and 24 months of age.

Causes

Self-comfort. As strange as it may sound, most toddlers who indulge in this behavior do it to relax. They bang their head rhythmically as they’re falling asleep, when they wake up in the middle of the night, or even while they’re sleeping. Some rock on all fours as well.

  • If your toddler bangs his head during temper tantrums, he’s probably trying to vent some strong emotions. He hasn’t yet learned to express his feelings adequately through words, so he’s using physical actions. And again, he may be comforting himself during this very stressful event.
  • A need for attention. Ongoing head banging may also be a way for your toddler to get attention. Understandably, you may tend to become solicitous when you see your child doing something that appears self-destructive. And since he likes it when you fuss over his behavior, he may continue the head banging in order to get the attention he wants.
  • A developmental problem. Head banging can be associated with autism and other developmental disorders — but in most of these cases, it’s just one of many behavioral red flags. Rarely does head banging alone signal a serious problem.
  • Pain relief. Your toddler may also bang his head if he’s in pain — from teething or an ear infection, for example. Head banging seems to help kids feel better, perhaps by distracting them from the discomfort in their mouth or ear.

If your child bangs his head a lot during the day or continues to bang his head even though he’s hurting himself, you may have cause for concern. Though it’s uncommon, head banging can be associated with autism and other developmental disorders, which sometimes become apparent during the toddler and preschool years.

Nightmares

Nightmares occur from time to time in many children, but they are most common in preschoolers(children aged 3-6 years) because this is the age at which normal fears develop and a child’s imagination is very active. Some studies estimate that as many as 50% of children in this age group have nightmares. Nightmares involve frightening or unpleasant dreams that disrupt the child’s sleep on several occasions and cause distress or problems with everyday life. When children wake up because of a nightmare, they become aware of their surroundings and usually need comfort. As a result, these children often wake up their parents as well.

When Do Nightmares Occur?

Sleep is divided into two types: rapid eye movement (REM) and nonrapid eye movement (non-REM). REM and non-REM sleep alternate in 90- to 100-minute cycles. Most dreaming occurs during REM sleep. Nightmares usually occur in the middle of the night or early morning, when REM sleep and dreaming are more common.

What Is Nightmare?

A nightmare is a bad dream that usually involves some imagined danger or threat to the person having it. The child may dream about danger or a scary situation. Nightmares may involve disturbing themes, images, or figures such as monsters, ghosts, animals, or bad people. Loss of control and fear of injury are common themes. Children do not usually cry out or move around while they are having a nightmare. When the child wakes up and calms down, she often remembers what the dream was about.

Nightmares are different from night terrors. Children with night terrors experience episodes of extreme panic. They are confused and often cry out and move around. During a night terror, waking the child is difficult, and the child often does not remember the dream that caused the terror.

Causes

Being too tired, not getting enough sleep, having an irregular routine for sleep, and having stress or anxiety may all increase the risk of having nightmares. Nightmares can be related to the child’s stage of development. Most nightmares are a normal part of coping with changes in our lives. For children, nightmares could be related to events such as starting school, moving to a new neighborhood, or living through a family divorce or remarriage.

Some genetic and psychological factors can also lead to nightmares. Nightmares are more common in some children, including those with mental retardation, depression, and certain diseases that affect the brain. Nightmares may also be associated with fevers. Some medications can cause frightening dreams, either during treatment or after the treatment has stopped. Conflicts and stress that happen during the day can affect a child’s sleep and lead to nightmares. Nightmares can also occur after a traumatic event. These nightmares may be a sign of post-traumatic stress disorder.

 

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