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Emotional disorders are difficult to recognise in children
and adolescents. Children find it difficult to verbalise their problems
and some emotions, such as unhappiness or irritability, which are often
dismissed by adults as a normal part of growing up. Contextual factors that
influence the development of emotional disorders can be ignored by adults and
children’s emotional expressions may be seen as independent events.
While experiencing anger, sadness, fear and so on is normal part of
learning about emotions and their regulation, some children experience intense
emotional reactions that fall outside the normal range. The main childhood emotional
disorders are major depression, anxiety disorders and trauma. Comprehensive Psychological
Assessment Centre offers
clinical/diagnostic assessments to help recognise and treat these disorders.
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CHILDHOOD DEPRESSION
With a few exceptions, the symptoms
of major depression in children are generally the same as in
adults. These include persistent depressed mood, change in appetite,
loss of interest in previously enjoyed activities, sleep
difficulties, reduced energy level, frequent fatigue, feelings of
guilt and worthlessness, reduced ability to concentrate and possible
thoughts of suicide and self-harm.
Some of the symptoms of
depression in children are slightly different from the adult form
and/or require additional attention:
First, in adults one of
the most important sign of depression is the loss of interest
in previously enjoyed activities. With children, it should be noted
that as they develop their interests change, so losing
interest must be related to an activity that a child would normally
still likely to enjoy.
Second, change in appetite and
sleep patterns in children often involve an increase rather
than a decrease. Children with depression may sleep more than usual
and may over eat.
Finally, sadness may not be apparent among
children suffering from depression. Instead children may act
cranky, irritable and
angry. |
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ANXIETY
DISORDERS
The main forms of anxiety
disorders in children are separation anxiety and posttraumatic
stress. Both can co-occur with other childhood disorders,
particularly externalising behaviour.
Separation
Anxiety
Children with separation anxiety typically become
very anxious when they are away from home or parents. For these
children separation from the safety of home and parents is
intolerable and they react strongly. The key characteristics
are irrational fears that the parents will be harmed in some way or
that the child will be abandoned by them. The worries and fears are
more intense when a child is separated from the parents or required
to separate from them. The anxiety reactions often
involve:
- Refusal to attend childcare, pre-school or
school. The anxiety is not associated with the school or
childcare
facility, but with the
inability to separate from parents.
-
Psychosomatic symptoms. Children with separation anxiety often
become physically ill when they are required
to go
to childcare or school. They may experience headaches, nausea or
vomiting. Monday mornings or the first
attendance
day during the week are often the most difficult
times.
- Reluctance or inability to sleep over at a
friend's place or attend camps or overnight trips without the
parents.
- Persistent worry about harm to the parents
when separated (e.g., accidents, burglary, murder, natural
disasters...etc). Preoccupation with the worries
and vivid fantasies about them.
- Difficulty coping
with the parents going out, whether staying with a baby sitter
or older siblings. Children with
separation anxiety
may require detailed descriptions about the place where the
parents are going to, how long
they intend to
stay, when are they going to be home and so on.
-
Recurring difficulty falling asleep. Children with separation
anxiety need the company of their parents when go
to bed and cannot fall asleep on their
own.
Separation anxiety is relatively common and affect
about 4% of children. While young children often experience
separation anxiety, the condition peaks around early adolescence.
Both boys and girls are affected, but girls experience it slightly
more often.
Posttraumatic Stress
Reactions to
trauma in children is very different from the adult experiences
of traumatic stress. Generally, posttraumatic stress is
characterised by the three symptom clusters of 1) recurring
recollections of the trauma, 2) avoidance of any trauma related
cues, and 3) persistent physiological hyperarousal. While adults
more likely to express distress verbally, children, particularly
young children, show a combination of problems.
Children
typically show symptoms of hyperarousal through impulsivity,
distractibility and attentional problems. Recollections of the
traumatic incident may present through aggressive play,
emotional numbing, avoidance of others and sleep problems.
Additionally, children may experience sudden developmental
regression or "return to a younger stage".
In the
absence of clear knowledge about the traumatic incident,
stress reactions in children can be misleading. Symptoms of
hyperarousal may be interpreted as ADHD or conduct problems, whereas emotional
experiences may be seen as childhood depression. In some cases
parents can also misjudge their children's symptoms. Exposure to
family violence and severe arguments during the early years may stay
with children and may manifest through behavioural symptoms.
Failing to recognise the connection between events
in children's lives and later difficulties could lead to
misdiagnoses and inaccurate treatment goals. A detailed diagnostic
assessment by one of our expert child psychologists is the first step to make sure that
children suffering from posttraumatic stress receive
appropriate intervention.
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