Childhood Psychiatric Disorders
Not A Spoilt Ill-Behaved Child

Emotional and behavioural disabilities are common child health problems. Its incidence is as high as 10-20 percent.

Due to lack of awareness, majority of these children never reach specialist child-psychiatric services. Consequently, they lose their precious years of learning and development. This results in permanent mental health disabilities in children.

Childhood psychiatric disorders do not conform to strict medical illness model. They are deviations from the normal cognitive development.

The resultant mental health leads to social maladjustment of the affected children and teenagers. Some psychiatric disturbances of childhood, like Autism, have major implementations for child’s development and adaptation in adult life.

Hurdles in the management of childhood psychiatric disorders

1. Existing community bias associated with mental health.

Psychiatrization of emotional-behavioural problems of young children and teenagers has been shunned away for a long time.
Besides, many spurious interests endanger an unbiased, objective approach to normal developmental issues and tend to unduly put many problems of normal living in the basket of mental disorders.

2. Distinction between disturbances & normality is often imprecise in childhood psychiatric disorders.

Isolated deviated behavior presentation is common during childhood and can not be considered as a symptom of compromised mental health. For example it is normal for children to be episodically sad, unhappy or have a temper tantrum, that does not make them disturbed or maladjusted.

The parents therefore need to take the reins in their own hands, educate themselves on the subject and unbiasedly seek authentic specialized professional help as and when need arises.

Why are children prone to psychiatric disorders?

1. Childhood is the period of changes, challenges, and compelling necessities for adaptation. The child growth process and motor skills development accomplishes children to meet the ever rising expectations of their environment.

So, is it surprising that some behavioural disturbances do surface when the demands get too much for the child?

Do not let any prevalent stigma associated with psychiatric disorders be a barrier in your child’s mental health care.

2. Children have situation specific behavior and each situation imposes its own expectation. Thus their behaviour varies markedly from time to time depending on the environmental challenges.

Moreover, children usually do not have the same capacity to cope with all type of stresses and so their behaviour varies.

This causes discrepancy between the evaluation of child’s behaviour by different social group like teachers, neighbours and parents, who often misunderstand and reject them.

Predisposing factors of childhood psychiatric disorders.

As in normal growth and development both constitutional and environmental factors play role in the development of childhood psychiatric disorders.

1. Constitutional Factors

a. Genetical predisposition to childhood psychiatric disorders

b. Intelligence

c. Temperament

2. Environmental Influences

a. Family

b. School

c. Community

3. Learning conditions

4. Positive reinforcements

Influences of the family on mental health of children

The family is the most potent force for promotion of child health and for development of disturbances in a child’s emotional-behavioural development.

We can not influence the school or the community, but we certainly can make the environment at home healthy for our children.

Factors like birth of a sibling, or starting at school are of course inevitable stress that a child should normally be able to cope with.

However, the major current stressful circumstances in the family like death of a family member, life threatening illness in a near one and marital disharmony in the parents leave long lasting impact on child’s mental health.

Parents under any stress, like financial, sickness, professional dissatisfaction, emotional insecurity and so on, fail to have quality interaction with the children.

The feelings of general dissatisfaction and/or apprehension are unknowingly passed on to the growing children in the family. This often results in an ineffective or improper parenting with ill effect on child’s psychological development.

Stressful environment in the family should be resolved, if need be with the help of a professional consular. The disturbed child and sometimes parents themselves or even the whole family may need help.

Disturbed children are often misunderstood

Most disturbed children do not express their distress.
They try to cope up with the stress. If they succeed in their efforts it enhances their self esteem, but if they do not then they are overwhelmed.

Children do not even want to admit the problem, not even on direct interrogation.

Disturbed children are therefore often misunderstood and isolated, which only worsens their situation.

Indirect signs of oncoming childhood psychiatric disorders

1. Frequent stomach pain with no sickness detected

2. Persistent sadness

3. Generalised disinterest

4. Withdrawal

5. Poor interaction with peer group

6. Increasing aggressive behaviour

Resolve the mounting stress in yourself and your child as early as possible. Lack of attention towards the mental health of children and adolescents may lead to childhood psychiatric disorders with lifelong consequences. It can also undermine compliance with health regimens and reduces child’s capacity for safe and productive life.

Childhood psychiatric disorders

Psychiatric disturbances during childhood and adolescence
are divided in three groups.

1. Emotional

2. Behavioural

3. Social (Relationships)

To rule out psychiatric disorders look for the following features in a disturbed child

1. Inappropriate behaviour for age

2. Combinations of several predisposing factors contribute to development of disorders.

3. Regressive behaviour, that is behaves developmentally immature.

4. Abnormal behaviour episodes.
Number, frequency, severity and duration of symptoms rather than the form of symptomatology indicate the possibility of disturbed child.

5. Hallucinations and delusions like definate pathological symptoms are seldom seen in children.

6. Developmental deficit.
For example- A child with enuresis would be said to have not attained the skills necessary to use the toilet.

7. Developmental excess.
For example – An aggressive child would be evaluated as showing disproportionately excessive assertive behaviour in relation to the situation.

8. Anxiety in excess, such that it prevents the child from learning to cope with normal stress in his environment.
All children experience anxiety as a part of the growing process. Childhood development is the result of coping with external threats and strange situations.

9. Denial is a psychological defence mechanism. Child is unable to accept the psychological impact of a particular action/event for the fear of resultant loss of self esteem. Overwhelming guilt makes it impossible for the child to own even the most obvious wrong act committed.

10. Rationalization is children’s way to deal with a failure.
They justify the psychological consequence of an unsuccessful event.
– “Grapes are sour” philosophy.

11. Displacement is transfer of hostile feelings from their original source onto another person. For example – getting angry with a sibling instead of the parents.

12. Impaired social relationship.

a. Primary failure, as seen in Autism.

b. Secondary phenomenon, is more commonly seen.

13. Conduct disorder leads to isolation of the affected children.
These children get unpopular with their peer group, usually because they themselves do not mix with them.

At times they may even be excluded by the peer group due to their deviant behaviour. Their deviant behaviour also causes conflict between them and their adult contacts, such as parents and teachers.

To be able to distinguish normal behaviour from childhood psychiatric disorder, it is also important to understand
personality development of children.

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