Author: Natasha Boskic

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2.8 Children with Communication Disorders: Pragmatic Difficulties

Children with Pragmatic Difficulties

Description

Pragmatic (see full Glossary) language impairment (PLI) is a difficulty in understanding the pragmatics or the semantics of language, that is, what words mean and how and why they are used.

“Pragmatics” refers to using language appropriately in social situations and “semantics” refers to understanding the meaning of what is being said.

Pragmatic language difficulties are often related to autism and asperger’s disorders1.

Intervention Options

A speech language pathologist makes the diagnosis and plans for the treatment and intervention. Methods of psycholinguistics and pragmatics (see full Glossary) have been used to provide support with this complex language disorder.

To learn about pragmatic disorders in the middle childhood years, please visit the six to 12 part of this course.

1 Bishop, D.V.M. & Leonard, L.B. (2000). Speech and language impairments in children. Causes, characteristics, intervention and outcome. East Sussex, England: Psychology Press LTD.
2 Adams, C. (2001). Clinical diagnostic and intervention studies of children with semantic–pragmatic language disorder. International Journal of Language and Communication Disorders, 36(3), pp.,289-305.
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2.9 Children with Mental Health Disorders: Anxiety

Children with Mental Health Disorders: Anxiety

Many children experience fears; these are developmentally normal. Children with anxiety disorders1 have fears and anxieties that are persistent. These disorders create symptoms that can last for months. Anxiety levels and types of anxiety may vary.

Anxiety is the number one mental health issue for children and occurs in about 10% of children and is more frequently seen in girls than boys.  Anxiety disorder is diagnosed when the anxiety makes it hard for children to live their daily lives with family and friends, at home and at school.

Children with Generalized Anxiety Disorder (GAD)

Description

Anxiety in children can involve thoughts, feelings and behaviors.

Common symptoms of anxiety in children may be:

  • Worries;
  • Requests for reassurance;
  • Frequent “what if” questions;
  • Upsetting, obsessive thoughts (see full Glossary);
  • Clinginess or difficulty separating for parents;
  • Avoiding situations with some risk, for example, going swimming;
  • Tantrums when faced with fears;
  • Freezing or mutism (see full Glossary) in fearful situations;
  • Repetitive rituals (compulsions) (see full Glossary);
  • Panic attacks (see full Glossary);
  • Hyperventilation (see full Glossary)
  • Stomachaches;
  • Headaches;
  • Insomnia (see full Glossary)
  • Tic disorders may also accompany anxiety. Tics are sudden, involuntary (not done on purpose), and often meaningless movements and sounds.

To find out quickly if a child may have signs of anxiety disorders, four questions are often useful:

  1. Does the child worry or ask for parental reassurance almost every day?
  2. Does the child consistently avoid certain age-appropriate situations or activities, or avoid doing them without a parent?
  3. Does the child frequently have stomachaches, headaches, or episodes of hyperventilation (see full Glossary)?
  4. Does the child have daily repetitive rituals (see full Glossary)?

Although younger children can show signs of excessive worry, children usually develop GAD at about 12 years old. Almost half of children with an anxiety disorder will continue to suffer from an anxiety problem when they are adults. Many children with generalized anxiety disorder also have other anxiety problems. The most common problems are social anxiety, depression, separation anxiety, and attention-deficit hyperactivity disorder (ADHD). 

Intervention Options

Depending on the level of anxiety the child experiences, intervention options may vary.

For a child with mild to moderate anxiety, cognitive behavior therapy (CBT) (see full Glossary) is helpful, particularly when done with the parents and family. CBT involves counseling the child and his or her parents on these topics:

  • Keeping things in perspective;
  • Soothing activities;
  • Modeling effective coping;
  • Helping child understand the difference between thoughts and actions (for obsessions);
  • Relaxation techniques and deep breathing;
  • Occupational therapy (OT)  to foster physical, and mental health and well-being;
  • Group support to foster social skills.

Psychotherapy (see full Glossary) may also be required.

1 Reference:
Manassis, K. (2004). Childhood anxiety disorders, Approach to intervention.
Categories
2.9 Children with Mental Health Disorders: Phobias

Children with Phobias

Description

Children with phobias (see full Glossary) have fears of an object or a situation that cannot be explained. These fears can make it hard for them to live their daily lives. The fears are beyond voluntary control. They are generally excessive and appear to be “unreasonable.” Some common phobias for children and teens include fear of dogs, swimming, heights, and injections.

Intervention Options

1 Source: http://www.childrenshospital.org/az/Site1448/mainpageS1448P0.html
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2.9 Children with Mental Health Disorders: Obsessive-Compulsive Disorder

Children with Obsessive-Compulsive Disorder

Description

Obsessive-Compulsive Disorder (OCD) is a mental health condition that sometimes develops in the early years.

OCD is related to anxiety disorder. Children with OCD report constant and disruptive thoughts, or obsessions. These obsessions may lead to the child repeatedly performing certain acts, or compulsions.

Children’s obsessions relate to a specific issues or theme. This is the same for the compulsions that usually follow.

For example:

  • Fear of contamination: This fear could lead to the child washing themselves over and over, sometimes until skin is raw.
  • Fear of lack of order and control: This fear could lead to counting and/or storing or displaying items over and over, lined up, or arranged in a symmetrical way.
  • Fear of getting hurt (self or others): This could lead to the constant checking of locked doors.

Depending on the type of fears, children with OCD are usually classified as either checkers or washers:

  • Checkersneed to constantly check virtually everything, including doors, windows, ovens, stoves and closets. The reason behind this need is to ensure that nothing bad will happen to them or to someone they love.
  • Washers fear contamination. Children with these fears spend most of the day washing their hands and other parts of their bodies to avoid germs
  • These behaviors do not stop the obsessions from coming back. Children continue to engage in repetitive actions, known as ritualistic behavior. These include placing objects in a certain order and/or making sure that everything in sight is symmetrical.

OCD is a very serious childhood disorder. The obsessions (followed by the compulsions) seriously interfere in the child’s daily life. These children are unable to participate in everyday school activities, such as field trips, playing on the playground, or participating in arts and crafts. They may constantly wipe their seating area. They also spend most of their time washing up, in the bathroom.

Intervention Options

SSRIs help the brain to “block” the specific anxiety and depression that are related to OCD and to use more of the “uplifting” elements called neurotransmitters (see full Glossary).

Research suggests that a combination of both therapy and medication work effectively in older children with severe OCD and adolescents. Most recently, strategies based on research about the brain have brought a different understanding on how to treat this disorder.

 

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2.9 Children with Mental Health Disorders: Separation Anxiety

Children with Separation Anxiety Disorder

Description

Separation anxiety1 is a disorder that affects some young children.

Most children experience some sort of separation anxiety, between the ages of 12 and 18 months. This type of anxiety usually disappears, on its own, when the child is about two years old. At this age, separation anxiety is not a red flag. It is, in fact, a sign of healthy attachment to the parent. A child is healthily attached to the caregiver and experiences fear and anxiety when separated from this caregiver. Children usually outgrow this anxiety, on their own, and without therapy.

Separation anxiety becomes problematic when it persists beyond the ages of two or three years.

  • Approximately 12% of children will suffer from Separation Anxiety Disorder before they reach age 18.
  • Separation Anxiety Disorder has three peaks: between ages 5-6, ages 7-9, and ages 12-14.

When a child continues to experience problems, every time he or she is separated from a primary caregiver, he or she may have a pathological type of separation anxiety (see full Glossary).

Some of the symptoms of separation anxiety include:

  • Fussing and crying;
  • Throwing temper tantrums;
  • Panicking;
  • Screaming;
  • Refusing to leave the parent’s side;
  • Wanting to sleep in the same bed as the parent;
  • Exhibiting certain psycho-somatic symptoms (e.g. tummy aches, vomiting);
  • Coming up with excuses not to be separated from the caregiver.

Separation Anxiety Disorder can really interfere with or restrict a child or teen’s normal activities. He or she can become isolated from peers, and have difficulty developing and maintaining friendships. It can also lead to missed opportunities to learn new activities. School attendance and performance can drop. The child, who cannot be separated from the parent, ends up missing out on many activities, both in and out of preschool or school. Even if the child manages to separate from the caregiver, he or she is so consumed with worry, he or she is unable to enjoy everyday activities. Many children and teens with Separation Anxiety Disorder appear depressed, withdrawn, and apathetic.

Intervention options

Psychotherapy (see full Glossary) is recommended as an effective treatment for this disorder.

1 see References
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2.9 Children with Mental Health Disorders: Attachment Disorders

Children with Attachment Disorders

Description

Reactive attachment disorder (RAD)1 is a complex and serious condition that impacts the lives of children and their families. It is believed that children develop RAD in response to traumatic events or situations lived between birth and 5 years of age.  Children with RAD usually grow up in homes where their needs may not have been met or with parents/caregivers who are unresponsive (see full Glossary) homes.Some of these children may have also experienced abuse, uncaring, or neglectful parenting. Growing up in such environments makes some children unable to form healthy relationships with others, including significant others, such as parents, relatives, and friends. Many children who have been in care and/or have survived abuse and neglect tend to develop RAD. This is especially true for foster children who are frequently moved from one home to the next, as this prevents them from forming healthy relationships with their foster parents.

Infants with RAD may show some of these symptoms:

Children with RAD usually:

  • Do not to smile to others;
  • Do not reach for others;
  • Do not react when their primary caregiver leaves them, even if they are left with strangers;
  • May try to soothe themselves by scratching, hitting, masturbating themselves in what is known as  self-stimulatory behaviors (see full Glossary);
  • May be aggressive with others;
  • Do not join their peers in play activities;
  • Do not ask for help, when needed;
  • May be quite withdrawn, or excessively shy;
  • Prefer to be alone;

There are two main types of RAD:

  • The outgoing or uninhibited type: These children may seem very friendly, even with strangers. This is because they are so desperate for attention they are willing to take it from everyone. They may seem quite compliant and may appear very charming. This usually lasts until they are told no, or prohibited from doing what they want. At this point they may show aggressive behaviors, to the point of destroying property and hurting people.
  • The more reserved, or inhibited type: These children completely dismiss others. They show no interest in grown-ups or peers. They appear to not to want love or affection from anyone. This is because they feel a need to protect themselves from being hurt, yet again.

Recent research suggests that when a child does not get the attention and care he or she needs, the development of his or her brain is altered, perhaps forever, in a very adverse way. This is why RAD requires intervention as early as possible, during the preschool years. It is important to stress that this condition has been seen to affect children who have experienced severe and traumatic home living conditions. Children are not “born with RAD;” it is not related to a genetic or medical condition.

Intervention Options

There is a combination of medical, counseling and educational strategies available to treat RAD. Treatment and strategies involve a team of specialists of different disciplines (see full Glossary) who understand mental health disorders in infants and young children, including anxiety, mood and depression disorders as well as attachment disorders. Family therapy and educational counseling needs to be in place for parents and other primary caregivers. Specialized therapy will involve both the child and their parents. Medical treatment might be needed if severe anxiety and depression are diagnosed with RAD.

1 see References
Categories
2.9 Children with Mental Health Disorders: Mood Disorders

Children with Mood Disorders

Description

Mood disorders are sometimes called affective disorders. This is a category of mental health problem that includes all types of depression and bipolar disorder. It is believed that 7% to 14% of children will experience an episode of major depression before the age of 15. Twenty to 30 percent of adult bipolar patients report having their first episode before the age of 20.

The following are the most common types of mood disorders experienced by children and adolescents. Many of these children and adolescents may also experience other conditions including ADHD (attention deficit /with hyperactive disorder):

  • Major depression: A period of at least two-weeks where child is in a depressed or irritable mood; the child also seems to have lost interest or pleasure in usual activities; there may be other signs of a mood disorder, for example, difficulty paying attention and concentrating and being agitated;
  • Dysthymia (dysthymic disorder): This term refers to a chronic, low-grade, depressed or irritable mood for at least one year.
  • Manic depression (bipolar disorder): At least one episode of a depressed or irritable mood and at least one period of a manic (or “high“) (see full Glossary) mood.
  • Mood disorder due to a general medical condition: Many medical illnesses (including cancer, injuries, infections, and chronic medical illnesses) can trigger (see full Glossary) symptoms of depression.
  • Mood disorders that are related to using certain medicines or drugs, or substance inducedmood disorder: Children will show symptoms of depression that are due to the effects of medication, drug abuse, exposure to toxins, or other forms of treatment. Examples of symptoms might include the following:
    • Feeling sad most of the time;
    • Feeling hopeless or helpless (for example, “The world is ending; no one can help”) me.;
    • Having low self-esteem (for example, “I am not good at anything I do.”)
    • Not feeling “ok” most of the time or feeling inadequate;
    • Excessive guilt (for example, “It is all because of me.”)
    • Feelings of wanting to die;
    • Loss of interest in usual activities or activities once enjoyed;
    • Difficulty with relationships (for example, not keeping friends; arguing with peers and adults most of the time);
    • Not sleeping well most nights (for example, insomnia, hypersomnia (see full Glossary);
    • Changes in appetite or weight (eating too little or too much);
    • Feeling with low energy most of the time;
    • Difficulty concentrating at school or in any activity during the day;
    • Finding it very difficult to make decisions;
    • Thinking about or attempting to take own life, or suicidal thoughts or attempts;
    • Frequent physical complaints (that is, headache, stomach ache, fatigue);
    • Running away or threats of running away from home;
    • Fearing they will fail and they will be rejected (see full Glossary);
    • Most of the time feeling irritable, and showing some level of hostility and/or aggression towards others.

Intervention Options

Specific treatment for mood disorders1 will be determined by the child’s physician based on:

  • The child’s age, overall health, and medical history;
  • How severe the child’s symptoms are;
  • Type of mood disorder;
  • How the child copes with certain medications, procedures, or therapies;
  • How the condition is progressing;
  • Parents’ or caregivers’ opinions or preferences.

Mood disorders can often be effectively treated. Parents play a vital role in any treatment process. It is recommended that professionals work with the family and try and understand their particular history and characteristics. It is also important to work in consultation with the child’s school. This will ensure that the treatment is the one that fits both the child and family. Some treatment options include one or more of the following options:

  • Antidepressant medications (see full Glossary) especially when combined with psychotherapy (see full Glossary) has shown to be very effective in the treatment of depression in children and teens);
  • Psychotherapy (most often cognitive-behavioral and/or interpersonal therapy) for the child (focused on changing the child’s distorted views of themselves and the environment around them; working through difficult relationships; identifying stressors in the child’s environment and how to avoid them);
  • Family therapy.
1 Sources: BC Children’s Mood and Anxiety Disorders Clinic
http://www.bcchildrens.ca/Services/ChildYouthMentalHlth/default.htm
Boston Children’s Hospital http://www.childrenshospital.org/az/Site3222/mainpageS3222P0.html
Categories
2.9 Children with Other Types of Mental Illness

Children with Other Types of Mental Illness

Description

Conduct Disorder (see full Glossary) is one of the types of mental health illnesses that may be easily missed because of a child’s difficult behaviour. Children with conduct disorder may have other challenges, including learning disabilities and attention deficit/hyperactive disorders.

Common behaviors or responses in children with conduct disorder include the following:

  • Stealing;
  • Consistent lying;
  • Setting fires;
  • Not attending school;
  • Breaking rules (at school and at home, in their community);
  • Breaking the law (adolescents, adults);
  • Destroying others’ property;
  • Being cruel to animals, other children and adults;
  • Forcing sexual activity on others (for example, being intrusive (see full Glossary) with other children);
  • Use of weapon(s) or using objects as weapons, including knives, sticks, bats and others.

Conduct disorders require treatment and intervention for children to overcome them. Psychotherapy (see full Glossary) is the recommended treatment. The aim of treatment is to begin to get the child to understand the effect their behaviors and actions have on others.

Oppositional Defiant Disorder or ODD:

Children with Oppositional Defiant Disorder (see full Glossary) usually show negative, hostile and defiant behaviors. Children with ODD, however, do not engage in physical aggression. To determine if a child is going through a phase of defiance or may have this disorder, it helps compare his or her behaviors to those of other children in the same age range.

These are some of the common traits for children with ODD:

  • Losing temper;
  • Arguing with authority figures (parents, teachers); adolescents/adults: also with boss/supervisor while at work;
  • Refusing to follow rules or requests;
  • Annoying people intentionally;
  • Touchy or easily annoyed by others;
  • Blaming others for his or her mistakes or misbehaviors;
  • Angry or resentful;
  • Spiteful or vindictive.

Intervention Options1

  • Therapy;
  • Special types of training to help build positive family interactions;

Sometimes medications are used to treat related mental health conditions.

Eating Disorder

Children with eating disorders may over-eat or under-eat, however, their feeding and nutrition needs are not being met. Eating disorders involve intense emotions and attitudes, as well as unusual behaviors associated with weight and/or food.

Elimination Disorders

Enuresis (or bed wetting), and encopresis (or passage of stools) (see full Glossary) are two disorders affecting behavior related to using the bathroom.

Enuresis: This is a medical condition where the child pees (urinating) during the night, while asleep. It is called enuresis only when children are older than six years old. Children may have small bladders. The normal capacity for children is 1 or more ounces per year of age.

Emotional problems do not cause enuresis; but they can make this condition worse than it is.

Encopresis

This is a condition in which a child 4 years old or older, accidentally or on purpose passes feces into inappropriate places (clothing, the floor). This behavior is not caused by medication or a medical condition; however, sometimes children with encopresis become constipated.

Intervention Options

  • For enuresis, the parent and physician need to measure the child’s bladder (take three measures of urine or pee for a day; the largest one equals the amount the bladder can hold). Parents and professionals may help the child by helping them become aware of their condition. Usually this condition is overcome after 10 years old.
  • For encopresis, professional help is needed to find out if there is a physical cause to the problem, or physiological encopresis, or if there is an emotional cause2.

Intervention options include (a) psychotherapy, (see full Glossary) (b) medical treatment, (c) behavioral therapy, and (d) a combination of medical and behavioral treatments.

Schizophrenia

This disorder involves distorted perceptions and thoughts.

Children with schizophrenia may show these symptoms:

  • Do not show feelings (for example, they appear apathetic);
  • Do not laugh or cry (for example, they are emotionally unresponsive);
  • Use very few words, or limited speech;
  • Do not express clear thoughts, or show confused thinking;
  • May suffer from hallucinations and delusions;
  • Show very unusual behaviors and inappropriate emotional reactions to others, for example screaming when hearing music or other sounds.

Intervention Options

Specific interventions for any disorders should be determined by a child and youth mental health team, a medical physician or psychiatric team based on3:

  • The child’s age, overall health, and medical history;
  • How severe  the child’s symptoms are;
  • How the child copes with certain medications, procedures, or therapies;
  • How the child’s condition is progressing;
  • Parents’ or caregivers’ opinions or preferences for one or more of these options:
Parents play a vital supportive role in any treatment process.
1 Source: Mayo Clinic: http://www.mayoclinic.com/health/oppositional-defiant-disorder/DS00630
2 Source: Ferguson, T. (1979). Diagnosis and treatment of encopresis: A review of the literature.  26(1), 24-34.
3 Source: http://www.nmha.org/index.cfm?objectid=C7DF980C-1372-4D20-C8BA1DC89DBEAD32
4  Source: Facts for families from Kidshealth: http://www.aacap.org/aacap/Families_and_Youth/Facts_for_Families/Home.aspx 
5 Source: http://kidshealth.org/parent/emotions/behavior/OCD.html and http://emedicine.medscape.com/article/1182258-overview

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