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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 are often dismissed by adults as a normal
part of growing up. Also, 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.
Major
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, one
of the most important signs of depression is the loss of
interest in previously enjoyed activities. However, it should be
noted that as children develop their interests change, so losing
interest must be related to an activity that a child would normally
still likely to enjoy. Also, 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.
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 is the first step to make sure that children
suffering
from
posttraumatic stress receive appropriate
intervention.
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