Download Common Psychological Problems of Children

Common Psychological
Problems of Children
27/01/10
-Sudipta Roy
Clinical Psychologist
Introduction
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Worldwide, the prevalence of clinically
significant psychiatric disorders in
children is at least 7%.
This rate rises in socially disadvantaged
and densely populated urban areas.
It also increases by 3%–4% after
puberty.
Introduction……
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Childhood psychopathology
presents as:
1. disturbed or antisocial
behaviour(externalising disorders)
—prevalence 3%–5%
2. troubled emotions and
feelings(internalising disorders) —
prevalence 2%–5%
Introduction….
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3. a mixture of psychological problems
and physical illness (somatoform
disorders) — prevalence 1%–3%
4. more rarely as childhood psychosis or
pervasive developmental (autism
spectrum) disorders — prevalence
about 0.1%.
Some Essential features
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Linked to the developmental expectations
Transient
Environment Dependent
More often identified in Boys than girls
May have a continuity into Adulthood
problems
Responsive to psychological treatments
Early Screening and identification can work at
preventive level
Our Focus
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1 .Attention Deficit Hyperactive
Disorder (ADHD)
2. Autism
3. Sleep terrors and Sleep walking
4. Enuresis
5. Nail Biting
Pattern
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Diagnostic Features
Prevalence
Concomitant Problems
Causes
Assessments
Treatment
Illustrative case
ATTENTION DEFICIT
HYPERACTIVE DISORDER
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Six or more for atleast six months of the
following- maladaptive and inconsistent with
developmental level: (Inattention)
1. Fails to give close attention to details
2.Difficulty in sustaining attention or play
activities
3.Does not seem to listen when spoken
directly to
ADHD
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Avoids/ dislike doing things that need
sustained mental effort
Does not follow through instructions, leaves
work incomplete
Has difficulty organizing tasks and activities
Loses important things
Easily distracted
Forgetful in daily activities
ADHD
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Or Six for atleast six months of the
following: Hyperactivity- Impulsivity)
Hyperactivity Cluster
1. fidgets with hands, feet, squirms
2.Leaves seat and/or classroom even
when demanded
3. Runs or climbs excessively and
inappropriately
ADHD
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Has difficulty in working, playing quietly
Is on the “go”
Often talks excessively
IMPULSIVITY cluster
Blurts out answers when questions are not
yet complete
Has difficulty waiting for turns
Interrupts or intrudes on others
ADHD other criteria
Must present itself before 7 years of age
 Impairment across two or more settings
 Affects other areas of functioning
Types
 Attention Deficit predominantly inattentive
type
 Attention Deficit predominantly hyperactiveimpulsive type
 Combined type
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Prevalence
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Variable rates 2-20% of school going
children
Conservative reports claim 3-7%
Co-occurrence with: learning disorders,
sociopathy, anxiety and depressive
disorders, disruptive behavior disorders,
conversion disorders.
Causes
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Genetics
Biological Contributors to ADHD
Environmental Factors
Psychological Factors
Causes
Genetics
 Heredity or a positive family history
appears to be the most common
identifiable cause of ADHD
 The frequency of disorders in the
sibling is much greater than in the
general population
Biological Contributors to
ADHD
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ADHD is a biologically determined
spectrum disorder presenting a myriad
of variables and distinctions
Brain scans of children with ADHD
demonstrates decreased metabolic
activity in areas of the brain which is
thought to be responsible for the
regulation of attention and inhibition
Cont…
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The variability in symptoms in individuals with
ADHD can be explained in part by anomalies
in different parts of the brain circuitry
Children with ADHD show decreased
metabolic activity in cortical areas of the brain
that are thought to be responsible for the
regulation of inhibition and attention
Nerve Cells
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In children with ADHD these neuronsynaptic bridges are blocked or
incomplete which prevents learning
from becoming automatic
Neurotransmitters
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The two primary neurotransmitters’ systems
most directly involved in ADHD are the
dopamine and norepinephrine system which
are known to influence a variety of behaviors,
including attention, inhibition, motor activity,
motivation
Relative deficiencies in these
neurotransmitters help explain the signs and
symptoms seen in those with ADHD
Environmental Factors
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Environmental factors alone do not cause
ADHD
Early environmental insults like maternal
smoking, obstetric complications
Alcohol consumption
Significant prematurity of birth
Smallness for gestational age
These factors may increase the or play a
contributing role in the probability of
developing ADHD
Psychological Factors
Various psychological factors related to ADHD
are:
 Prolonged emotional deprivation
 Stressful psychic events
 Disruption of family equilibrium
 Child’s temperament
 Demands of society to adhere to a routinized
way of behaving and performing
Cont…
Other anxiety-inducing factors also
contribute to the initiation or
perpetuation of ADHD
Treatment
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Behavior Modification
Medication
Behavior Modification
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Routine
Environment Restructuring
Self Monitoring
Positive Reinforcements
Appropriate social skills
Parental Training
ENURESIS
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Enuresis is an elimination disorder
Also known as:
 Bed wetting
 Nocturnal bedwetting
Cont…
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DSM IV- TR defines Enuresis asInvoluntary or intentional
Repeated urination into bed or clothes
Occurring twice per week for at least 3 consecutive
months in a child of at least 5 years of age
Not due to either a drug side effect or a medical
condition.
Causes severe distress to the client or leads to
impairment in social academic, important areas of
functioning.
Classification
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Their time of occurrence
Whether achieved dryness for a while
or not
Types of enuresis
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Secondary: child or adult begins wetting
again after having stayed dry.
Nocturnal enuresis: Only at night during
sleep
Diurnal: Occurs in the day time either in
sleep or in waking state
Nocturnal and Diurnal: Occurs both in
day and night
Prevalence
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Variable according to age
7-10% in children below 10 yrs.
By age 10 yrs. Prevalence reduces to
less than 3%
Three times more prevalent in boys
than girls
Concurrent Problems
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Encopresis: Inappropriate passing of
stools
ADHD
Social and emotional immaturity
Investigate and Rule Out
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Diabetes
Spina bifida
Seizures
Hormonal factors: not enough anti diuretic
hormone
UTI
Small urinary tract, bladder
Abnormality in the urethral valve
Causes
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Genetic
Stress
Neurological-developmental delay
Poor habit development
Treatment
There are two types of treatments
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Behavior therapy
Medicines
Behavior Therapy
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Behavior therapy helps the child not to wet
the bed. Behavioral treatment include the
following points
Limit fluids before bedtime
Have your child go to the bathroom at the
beginning of the bed time routine and then
again right before going to sleep
An alarm system that rings when the bed
gets wet and teaches the child to respond to
bladder sensations at night
Cont…
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A reward system for dry nights
Asking your child to change the bed sheets
when he or she wets
Asking your child to change the bed sheets
when he or she wets
Bladder training: having your child practice
holding his urine for longer and longer times
during the day, in effort to stretch the bladder
so it can hold more urine
Indications of Medication
Doctor may prescribe the medicine if you’re
the child is 7 years of age or older
 Medicines are not cure for bed wetting
 One kind of medicine helps the bladder hold
more urine
 The other kind helps the kidneys make less
urine
Note these medicines may have side effects
such as dry mouth and flushing of the cheeks
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Sleep Terrors (Night terrors)
and sleep walking
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Introduction
These disorders are sleep disorders
known under the group of
parasomnias
The common feature: activities
associated with waking state are done
in sleep
Sleep Terrors (Night terrors)
and sleep walking
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Diagnostic FeaturesOccur mostly in deep sleep (stage 4)
In the 1st 3rd of the night b/w 12.00 to 2.00
a.m.
Screams, frightened, confused, thrash around
violently, not aware of the surroundings
Talking, comforting trying to awaken them
usually does not work
ST…
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Sweating,
breathing unevenly, fast heart rates
dilated pupils
Attacks last for 10-20 minutes
Child has no memory for that event
Occurrence
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Mostly in boys 5-7 yrs old
May also happen in girls 3- 7 years old
Occasional terrors estimated to take
place in about 0-40% of the age group
Persists in 1.3-27%
Sleep walking or
Somnambulism
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Introduction
Abnormal sleep behavior
Blank stare, unresponsive to
communication
More elaborate version of sleep talking
or
simple arousal e.g. sitting up without
actually walking
Sleep walking or Somnambulism,
Diagnostic features
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Recurrent episodes The arousal occurs
during Slow Wave Sleep,
stages 3 and 4 NREM
The subject typically leaves the bed
and is active in a confused and
disoriented state, often moving slowly
and clumsily
possibly with injury to themselves
Sleep walking or
Somnambulism
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The sleep walking may be preceded by a
scream or occurrence of a Sleep Terror
If terror is associated, movements maybe
much more rapid, with episodes of rushing
into walls, through windows or out into street
There is reduced responsiveness, but the
subject may yell, talk, scream
An unbelievable story of the sleepwalking
nurse who draws masterpieces in a trance
Sleep walking or
Somnambulism
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The response may include complex
behavior like escape or defense against
perceived threat
Acts such as starting a car and driving
in sleep can also be performed
On awakening temporary disorientation
Is associated with significant distress
Causes largely unknown but
associated with…
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Fever
Some medications
Lack of sleep
Irregular sleep times
Emotional tensions
Stress, conflicts
Can run in families
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Not emptying
bladder before sleep
Sleeping in a new
environment
Sleeping in a noisy
environment
Treatment
only if persistent, disrupts sleep, has
other symptoms and risk of injury
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Usually temporary
Handled by comfort, reassurances
Minor suggestions
Stress reduction
If prolonged: may need
1. Psychological evaluation
2. Psychotherapy/counseling
3. Medication