COMMON PROBLEM EXPERIENCE BY CHILDREN

COMMON PROBLEMS EXPERIENCE BY CHILDREN


Childhood Mental Disorders and Illnesses

Basic Information
Introduction to Disorders of Childhood


Children are precious; As parents we worry about their health. When our children have issues and crises, these issues and crises affect us just as much, if not more, than it affects them. We fear that which might bring them fear; we hurt when we see them hurt; and sometimes, we cry just seeing them cry. Writer Elizabeth Stone once said "Making the decision to have a child is momentous. It is to decide forever to have your heart go walking around outside your body." So, when it seems like something is not quite right with your children - perhaps they seem more afraid than other kids, or they seem to get a lot angrier than their playmates do over certain things - this odd or "off" behavior can be experienced as terrifying. In fact, a child's difficulty can be just the starting point for your parental worry and concern. You might not know what to do to help your child, or where to go for help. Possibly, you may worry because you don't even know if your child's problem is something you should be concerned about in the first place.
We've created this survey of childhood mental and emotional disorders to help worried parents better understand the various ways that mental illness can effect children; what it looks like and how it can be helped. Children's mental and emotional disorders are problems that affect not only their behavior, emotions, moods, or thoughts, but can also affect the entire family as well. These problems are often similar to other types of health problems that your child might have, and can generally be treated with medications or psychotherapy (or a combination of both).




Behavioral Problems in Children
These can be usefully classified into psychosocial disorders, habit disorders, anxiety disorders, disruptive behavior and sleeping problems.
Psychosocial disorders
These may manifest as disturbance in:
• Emotions e.g. anxiety or depression
• Behaviour e.g. aggression
• Physical function e.g. psychogenic disorders
• Mental performance e.g. problems at school
This range of disorders may be caused by a number of factors such as parenting style which is inconsistent or contradictory, family or marital problems, child abuse or neglect, overindulgence, injury or chronic illness, separation or bereavement.1

The child's problems are often multi-factorial and the way in which they are expressed may be influenced by a range of factors including developmental stage, temperament , coping and adaptive abilities of family, the nature and the duration of stress. In general, chronic stressors are more difficult to deal with than isolated stressful events.

Children do not always display their reactions to events immediately although they may emerge later. Anticipatory guidance can be helpful to parents and children in that parents can attempt to prepare children, in advance, of any potentially traumatic events e.g. elective surgery or separation. Children should be allowed to express their true fears and anxieties about impending events.

Young children will tend to react to stressful situations with impaired physiological functions such as feeding and sleeping disturbances. Older children may exhibit relationship disturbances with friends and family, poor school performance, behavioural regression to an earlier developmental stage, development of specific psychological disorders such as phobia or psychosomatic illness.

It can be difficult to assess whether the behaviour of such children is normal or sufficiently problematical to require intervention. Judgement will need to take into account the frequency, range and intensity of symptoms and the extent to which they cause impairment.
Habit disorders
These include a range of phenomena that may be described as tension reducing.
Tension reducing habit disorders
Thumb sucking Repetitive vocalisations Tics
Nail biting Hair pulling Breath holding
Air swallowing Head banging Manipulating parts of the body
Body rocking Hitting or biting themselves
All children will at some developmental stage display repetitive behaviours but whether they may be considered as disorders depends on their frequency and persistence and the effect they have on physical, emotional and social functioning. These habit behaviours may arise originally from intentional movements which become repeated and then become incorporated into the child's customary behaviour. Some habits arise in imitation of adult behaviour. Other habits such as hair pulling or head banging develop as a means of providing a form of sensory input and comfort when the child is alone.
• Thumb sucking - this is quite normal in early infancy. If it continues it may interfere with the alignment of developing teeth. It is a comfort behaviour and parents should try to ignore it while providing encouragement and reassurance about other aspects of the child's activities.
• Tics - these are repetitive movements of muscle groups that reduce tension arising from physical and emotional states, involving the head, the neck and hands most frequently. It is difficult for the child with a tic to inhibit it for more than a short period. Parental pressure may exacerbate it while ignoring the tic can reduce it. Tics can be differentiated from dystonias and dyskinetic movements by their absence during sleep.
• Stuttering - this is not a tension reducing habit. It arises in 5% of children as they learn to speak. About 20% of these retain the stuttering into adulthood. It is more prevalent in boys than girls. Initially it is better to ignore the problem since most cases will resolve spontaneously. If the dysfluent speech persists and is causing concern refer to a speech therapist.
Anxiety disorders
Anxiety and fearfulness are part of normal development, however, when they persist and become generalised they can develop into socially disabling conditions and require intervention. Approximately 6-7% of children may develop anxiety disorders and of these 1/3 may be over-anxious while 1/3 may have some phobia. Generalised anxiety disorder, childhood onset social phobia, separation anxiety disorder, obsessive compulsive disorder and phobia are demonstrated by a diffuse or specific anxiety predictably caused by certain situations.

School phobia occurs in 1-2% of children of which an estimated 75% may be suffering some degree of depression and anxiety. Management is by treating underlying psychiatric condition, family therapy, parental training and liaison with school to investigate possible reasons for refusal and negotiate re-entry.

Disruptive behavior
Many behaviours, which are probably undesirable but a normal occurrence at an early stage of development, can be considered pathological when they present at a later age. In the young child many behaviours such as breath-holding or temper tantrums are probably the result of anger and frustration at their inability to control their own environment. For some of these situations it is wise for parents to avoid a punitive response and if possible to remove themselves from the room. It is quite likely that the child will be frightened by the intensity of their own behaviour and will need comfort and reassurance. While some isolated incidents of stealing or lying are normal occurrences of early development they may warrant intervention if they persist. Truancy, arson, antisocial behaviour and aggression should not be considered as normal developmental features.

Attention deficit hyperactivity disorder This is characterised by poor ability to attend to tasks, (e.g. makes careless mistakes, avoids sustained mental effort) motor overactivity (e.g. fidgets, has difficulty playing quietly) and impulsiveness (e.g. blurts out answer, interrupts others). For the diagnosis to be made, the condition must be evident before age 7 years, present for >6 months, seen both at home and school and impeding the child's functioning. The condition is diagnosed in 3-7% of school-age children.

Methylphenidate (initiated by specialists only) is a stimulant medication that provides reduction of symptoms, at least in the short term.2 Management usually includes family therapy (a programme of behavioural modification for the child and the parents), although further research confirming its benefits is needed. 3,4,5 Essential fatty acids may alleviate some symptoms.6
Sleeping problems
Sleep disorders can be defined as too much or too little sleep than is appropriate for the age of the child. By the age of 1-3 months the longest daily sleep should be between midnight and morning. Sleeping through the night is a developmental milestone but at the age of 1 year 30% of children may still be waking in the night. Stable sleep patterns may not be present until age 5 years but parental or environmental factors can encourage the development of circadian rhythm.

Sleep disturbance can have a deleterious affect on the cognitive development of children, as well as the functioning of the parents. One study of 2-3 year olds found a significant link between sleep disturbance and emotional and behavioural disorders.7 Other links include memory loss and obesity.8

Regular bedtimes, quieter activities and the creation of marked differences between the sounds, activities and light levels associated with night time sleeping and daytime activities may help to encourage better sleep patterns. A solid evidence base now supports the use of behavioural treatments in infants and pre-school children (under 5).9 All of these are based on the objective of the parents gaining control of the bedtime routine. They include unmodified extinction (ignoring the child's cries but monitoring for illness or injury), modified extinction (ignoring the child for a specified period of time) and positive routines (doing some quiet pre-sleep activity and ensuring that falling asleep is associated with a positive parental-child interaction).10 One study found that parental interventions that encourage independence and self-soothing were associated with extended and more consolidated sleep compared to more active interactions that were associated with shorter and more fragmented sleep.11

Hypnotherapy has been found to be of benefit in school-age children.12

The BNF for Children states that the use of hypnotics, except for occasional short-term treatment of night terrors and sleep-walking, is never justified.13 However, it is recognised that the treatment of paediatric insomnia is an area that needs further research.14

Melatonin is sometimes of benefit in sleep disorder associated with visual impairment, cerebral palsy, attention deficit hyperactivity disorder and autism. It is unlicensed for this indication and specialist supervision is recommended for initiation and monitoring.1
Children experience behavior problems both in and out of the classroom. Read on to learn about these behavioral problems and what you can do as a parent.
Parents whose children exhibit signs of poor behavior can become frustrated and do not know what they can do to help correct their child's behavior. They find that grounding their children for getting into problems at school does not always help the situation, and sometimes causes their behavior to deteriorate further. Fortunately there is help for students who have behavioral problems.
Cheating
Cheating can start as a minor problem but left unchecked will develop into a major issue. According to the American Academy of Pediatrics, www.aap.org, cheating often is due to the competitiveness of the American culture and often starts during early childhood when a child is confronted with the competitive nature of games and sports. If a child is presented with homework and sports that are too complex for them to understand and to handle, they may develop a habit of cheating as a self-defense mechanism to help them prevent failure and embarrassment.
The American Academy of Pediatrics recommends that parents deal with each cheating episode by teaching the child that cheating is wrong and discussing how they might have handled the situation differently. Also, discuss the stress and pressures the child is facing and make sure you, the parent, doesn't have too high expectations for your child in school and in sports. Most importantly, too severe of a punishment rarely works to correct the cheating habits.
ADD and ADHD
Attention Deficit Disorder, also known as ADD, and Attention Deficit and Hyperactivity Disorder, more commonly known as ADHD, can occur in up to 20% of children, reported a 1999 study conducted by the U.S. Department of Health and Human Services.
Children who have these disorders often have problems focusing their attention and are easily distracted. Other symptoms include difficulty taking turns, remaining still, and keeping quiet. All of these symptoms must be present in both the school and home environment in order for a child to be properly diagnosed with ADD or ADHD.
One of the most widely-used treatments for these disorders is drug therapy. The most common drug prescribed to youth who have ADD/ADHD is Ritalin. Ritalin helps calm children and is effective in 70 percent of those treated. As with any medication, however, there can be some negative effects. Ritalin is classified among 'Schedule II' controlled substances, all of which have a high drug abuse potential. Therefore, if a child is taking Ritalin, it is important to discuss the dangers of drug abuse. Additionally, discuss with them why they are taking the drug to ensure they know that taking drugs will not solve all of their life problems.
PSYCHOLOGICAL PROBLEMS IN CHILDREN


Dr.Sanchoo Balachandran MD(Hom)
Calicut. Kerala

Psychosocial Problems
Causes
Physical or emotional stress
• Birth defects
• Physical injury
• Inconsistent and contradictory child rearing practices.
• Marital conflict.
• Child abuse and neglect, overindulges.
• Chronic illness.
Many psychological disorders first diagnosed in children involve physiological and/or genetic components. However, there are many other psychological disorders found in children without any physical causes. Disorders caused by physiological or biological problems are more likely to be identified early in life, but some of these problems are not identified until adulthood.
Mental retardation, learning disorders, communication skills disorders and pervasive developmental disorders (such as autistic disorder) appear to have biological components. Some psychologists specialize in the identification and treatment of these disorders, but they are not frequently encountered in a general psychological practice because of the need for specialized training and treatment. Therefore, they will not be discussed here. Elimination disorders are encountered in general psychological practice, but are typically seen as a symptomatic expression of other psychological problems. They will also not be discussed here.
Attention-deficit disorder and disruptive behavior disorders are quite common, and treatment is provided by psychologists to both children and parents to assist in managing these problems. Dr. franklin provides treatment for Attention-deficit hyperactive disorders, oppositional disorder and conduct disorders. These problems will be addressed here.
Separation anxiety is also described here. This problem is distinct from the other anxiety disorders, because it applies exclusively to children and adolescents. Separation anxiety also occurs frequently after some emotional stress or trauma, such as relocation or divorce, so the problem may also be connected to life stress issues frequently treated in private practice. It also occurs more frequently in children whose mothers have been diagnosed with panic disorder. This may suggest a biological component, or it may suggest that separation anxiety can be a psychosocial byproduct of the panic disorder in the parent. This problem is relatively common, and is usually treated by psychologists after the child has encountered adjustment problems with peers or in school.

• Oppositional Defiant Disorder
• Conduct Disorder
• Attention Deficit Hyperactive Disorder (ADHD or ADD)
• Separation Anxiety Disorder
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Mental Retardation
More than 2% of our children are considered to be mentally retarded. In order to understand retardation, we need to look a little at the concept of intelligence. We define intelligence as "general cognitive ability," meaning how well a person can solve problems, how easily they learn new things, and how quickly they can see relationships among things.
Intelligence Quotient (IQ) is the score you get on an intelligence test. Originally, it was a quotient (a ratio): IQ= MA/CA x 100, where MA is mental age and CA is chronological age. So a child who is 10 and has the same level of intellectual ability as most 10 year olds has an IQ of 10/10 x 100 = 100. If that 10 year old has the same ability as a 15 year old, his IQ will be 15/10 x 100 = 150 (very smart indeed). If the 10 year old has the ability of a 5 year old, his IQ would be 5/10 x 100 = 50, which is considered mentally retarded.
Nowadays, IQ is a matter of comparing a person with many others of the same age, and assigning a score based on their place on a normal curve:

Here you get to see several important points about not only IQ but about descriptive statistics.
1. The normal curve, also called the bell-shaped curve, is an idealized version of what happens in many large sets of measurements: Most measurements fall in the middle, and fewer fall at points farther away from the middle. Here, most people score near 100 (the average), and much fewer people score very high or very low.
2. The mean is just the average of all scores. The sum of everyone’s IQ scores, divided by the number of scores, is the mean, which was originally set at 100. That has become the tradition.
3. The standard deviation (sd). The standard deviation is like the average degree to which scores deviate from the mean. For our purposes, just know that 1 standard deviation above and below the mean contains (in an ideal normal curve!) 68% of all the scores, 2 standard deviations contain 95.6%, and 3 standard deviations contain 99.7%. Or, you could say that there are only 2.2% above 130 and 2.2% below 70, and so on. By tradition, one standard deviation is 15 points. The percentages you see in the normal curve above are based on 10 point spreads: 10 points above or below the mean (90 to 110) contains 50% of all the scores.
The names for various "smart" people are of relatively little importance to us. But the differences among retarded people can be very significant. Please understand that the ranges are approximations, and labeling people is always a difficult and dangerous thing!
• 0 - 20: profound mental retardation - these folks will likely need nursing care their entire lives.
• 20 - 35: severe mental retardation - these people can learn to talk and develop basic hygiene habits.
• 35 - 50: moderate mental retardation - they can achieve as much as a second grade education (e.g. learning to read and count change, etc.), but will likely need sheltered care.
• 50 - 70: mild mental retardation - these people can achieve the equivalent of a sixth grade education, be self-supporting and have a partially independent life.
Basically, mental retardation is believed to be a matter of some sort of damage to the brain. There are many factors that can lead to that kind of damage:
• heredity (e.g. Downs syndrome)
• embryonic problems (e.g. fetal alcohol syndrome, rubella...)
• birth complications (anoxia, infection)
• childhood medical conditions (infections, traumas, lead poisoning)
• neglect and abuse
• other psychological disorders that involve neurological impairment (e.g. autism)
An interesting question to ask is: If being below, say, 50 is due to "brain damage," what do we say about people above, say, 150? Are they "brain enhanced?" Or do they have a different, more beneficial sort of "brain damage?"
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Autism
Autism, the most common of the pervasive developmental disorders (with a prevalence of 10 to 12 children per 10,000 [Bryson & Smith, 1998]), is characterized by severely compromised ability to engage in, and by a lack of interest in, social interactions. It has roots in both structural brain abnormalities and genetic predispositions, according to family studies and studies of brain anatomy. The search for genes that predispose to autism is considered an extremely high research priority for the National Institute of Mental Health (NIMH, 1998). Although the reported association between autism and obstetrical hazard may be due to genetic factors (Bailey et al., 1995), there is evidence that several different causes of toxic or infectious damage to the central nervous system during early development also may contribute to autism. Autism has been reported in children with fetal alcohol syndrome (Aronson et al., 1997), in children who were infected with rubella during pregnancy (Chess et al., 1978), and in children whose mothers took a variety of medications that are known to damage the fetus (Williams & Hersh, 1997)
The causes of autism are still not known. It is believed by most researchers that it involves problems with neural circuits, and twin studies suggest that genetic influences are likely. For a long time, it was assumed incorrectly that autism resulted from parental neglect.
Because autism is a severe, chronic developmental disorder, which results in significant lifelong disability, the goal of treatment is to promote the child’s social and language development and minimize behaviors that interfere with the child’s functioning and learning. Intensive, sustained special education programs and behavior therapy early in life can increase the ability of the child with autism to acquire language and ability to learn. Special education programs in highly structured environments appear to help the child acquire self-care, social, and job skills.
There has been some limited success with antipsychotic drugs and with antidepressants.

In the last 20 years or so, a number of finer differentiations have evolved regarding what is now seen as an autistic spectrum. First, we have something called Asperger's Syndrome. These children (and adults) are generally of normal (and sometimes high) intelligence, but have difficulty in social interaction. They seem exceptionally shy and have a hard time making eye contact. They have trouble learning what is called pragmatics - the part of communication between people that involves recognizing turn-taking, facial expressions, gestures, and other non-verbal cues. They tend to focus intensely on one thing at a time, don't like abrupt changes, and develop obsessive routines. As adults, they usually adapt, but are seen as being socially inept, absent minded, and eccentric. Of course, that begs the question a little: Is this truly a separate disorder, or just a little out there on the continuum of normal behavior? I think you can tell that some of your professors may be Asperger's people.
There are other syndromes that focus more on language: The semantic-pragmatic disorder is sometimes used to label certain children who are similar to Asperger's children but more sociable. The focus of their problem is more on the communications side.
Hyperlexia is more a symptom than a disorder. It is a matter of being rather precocious in reading words, and being fascinated by letters and numbers. On the other hand, children with hyperlexia don't communicate well, nor do they socialize well.
Non-verbal learning disability is a matter of having a hard time with visual, spatial, and motor skills. They have a hard time picking out, say, one house out of a row of them, tying their shoes, getting dressed, kicking a ball, reading facial expressions, and recognizing the tone of someone's voice. One of the notable symptoms is the tendency to stare, especially when visually over-stimulated.
A related problem that is close to my heart (because I have a mild version of this) is prosopagnosia or face blindness. This affects about 2 1/2 % of the population, and people with this problem have a difficult time recognizing faces. It can be so severe that a man can walk past his own mother and not recognize her! Generally, people with this problem develop other ways of recognizing people, such as clothing or hair styles. I recognize people I have known for a long time, but cannot place less familiar people out of the context of, say, a specific classroom or circumstance. It makes one seem rude, but it is unintentional. I deal with it by simply saying hello to everybody. Interestingly, people with prosopagnosia often also have a hard time identifying some other things, such as dogs and cars! It is believed to be a problem involving the fusiform gyrus, which is involved in facial recognition.
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Learning Disorders
We say a child has a learning disorder when his or her performance is significantly below his or her IQ, i.e. they are not learning "up to their potential." We estimate that about 5% of students in US public schools have a learning disorder. Learning disorders are often found accompanying other medical problems such as lead poisoning, fetal alcohol syndrome, and so on.
Reading disorder - better known as dyslexia - is the most common learning disorder. Here, the child's reading scores are significantly below their IQ, their expected age level, or their general abilities. These kids seem to have trouble with the usual left to right scanning of words, which leads them to reverse letters and jumble the spelling. It could be compared to trying to read a newspaper in a language you have little familiarity with.
It is estimated that about 4% of US school kids have dyslexia. 60 to 80% of those diagnosed are boys, but this may be a matter of identification: boys with reading disorder act up more, drawing attention to their problems, while the girls tend to be quieter and less trouble. This is, of course, a problem for the girls in that their dyslexia is less often caught early.
Helping children with learning disorders has become a big part of educational research. Basically the help involves slow, careful teaching that gives the child an opportunity to work without the pressures of competition and frustration that exist in the ordinary classroom setting. In England, they take a different attitude towards dyslexia, seeing it as more a maturational problem rather than a more permanent neurological condition.
It should also be noted that dyslexia is a far greater problem for children who speak English than other languages: Of all languages written with a western alphabet, English has the most inconsistent spelling. Spelling is not even a subject in most western languages, because words are spelled pretty much as they sound! Unfortunately, there are few signs that English-speaking people will ever change their spelling system. Too bad.
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Attention-Deficit/Hyperactivity Disorder
ADHD is really two different problems - inattentiveness and hyperactivity-- that nevertheless often go together. It has been the focus of a great deal of controversy. Opinions range from considering ADHD to be a purely physical, highly genetic, medical problem to the belief that it is nothing more than the differences between children's maturation rates. Here are the opinions offered by the Surgeon General’s report:
Inattention or attention deficit may not become apparent until a child enters the challenging environment of elementary school. Such children then have difficulty paying attention to details and are easily distracted by other events that are occurring at the same time; they find it difficult and unpleasant to finish their schoolwork; they put off anything that requires a sustained mental effort; they are prone to make careless mistakes, and are disorganized, losing their school books and assignments; they appear not to listen when spoken to and often fail to follow through on tasks (DSM-IV; Waslick & Greenhill, 1997).
The symptoms of hyperactivity may be apparent in very young preschoolers and are nearly always present before the age of 7 (Halperin et al., 1993; Waslick & Greenhill, 1997). Such symptoms include fidgeting, squirming around when seated, and having to get up frequently to walk or run around. Hyperactive children have difficulty playing quietly, and they may talk excessively. They often behave in an inappropriate and uninhibited way, blurting out answers in class before the teacher’s question has been completed, not waiting their turn, and interrupting often or intruding on others’ conversations or games (Waslick & Greenhill, 1997).
Many of these symptoms occur from time to time in normal children. However, in children with ADHD they occur very frequently and in several settings, at home and at school, or when visiting with friends, and they interfere with the child’s functioning. Children suffering from ADHD may perform poorly at school; they may be unpopular with their peers, if other children perceive them as being unusual or a nuisance; and their behavior can present significant challenges for parents, leading some to be overly harsh (DSM-IV).
Inattention tends to persist through childhood and adolescence into adulthood, while the symptoms of motor hyperactivity and impulsivity tend to diminish with age. Many children with ADHD develop learning difficulties that may not improve with treatment (Mannuzza et al., 1993). Hyperactive behavior is often associated with the development of other disruptive disorders, particularly conduct and oppositional-defiant disorder (see Disruptive Disorders). The reason for the relationship is not known. Some believe that the impulsivity and heedlessness associated with ADHD interfere with social learning or with close social bonds with parents in a way that predisposes to the development of behavior disorders (Barkley, 1998).
Even though a great many children with this disorder ultimately adjust (Mannuzza et al., 1998), some—especially those with an associated conduct or oppositional-defiant disorder—are more likely to drop out of school and fare more poorly in their later careers than children without ADHD. As they grow older, some teens who have had severe ADHD since middle childhood experience periods of anxiety or depression. This seems to be especially common in children whose predominant symptom is inattention (Morgan et al., 1996)....
ADHD, which is the most commonly diagnosed behavioral disorder of childhood, occurs in 3 to 5 percent of school-age children in a 6-month period (Anderson et al., 1987; Bird et al., 1988; Esser et al., 1990; Pelham et al., 1992; Shaffer et al., 1996c; Wolraich et al., 1996).
We don’t have any solid knowledge about the origins of ADHD, but it is believed to include some very basic genetic, prenatal, and neurotransmitter problems. It is thought that children with ADHD do not have enough dopamine - a neurotransmitter that has a lot to do with controlling behavior - in their nervous system. It does seem to run in families, so a genetic factor is quite possible. And ADHD occurs more often in children from mothers who smoked while pregnant, in children exposed to lead, and in children who suffered from anoxia (low oxygen) during birth. (Whittaker et al., 1997).
Treatment of children with ADHD usually involves two approaches: Medication and behavioral training. The behaviorial training involves the parents as much as the child, and usually includes finding the appropriate ways of rewarding and punishing the child, including rewarding with attention and using the famous “time-out” approach to discipline.
Medication takes the form of amphetamines and amphetamine-like stimulants such as Ritalin. Research shows that stimulants are effective in 75 to 90% of all ADHD children (Spencer et al., 1995; Greenhill, 1998a, 1998b; Greenhill et al., 1998). Many peple have expressed some concern that we are overdiagnosing and overmedicating children, and that Ritalin is just a way teachers and parents get rid of annoying kids. But there is, in fact, little evidence of this (Goldman et al., 1998; Jensen et al., 1999).
All this said, it should nevertheless be noted that some researchers see ADHD as a false category, and the use of stimulants akin to the way in which cocaine (or coffee) makes the average person temporarily more creative and productive. In fact, coffee has been used with some success in helping ADHD kids!
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Stuttering, Tics, and Tourette's Syndrome
There are a number of problems kids face that involve neuromotor dysfunction. One of the most common is stuttering, which is found in about 1% of all children. It is found 3 times more commonly in boys. The good new is that 60% of stutterers recover on their own, usually by the age of 16. With the help of speech therapists, another 20% recover as well. Stuttering is strongly connected to anxiety, and it often disappears when the child is relaxed or, for example, when they are singing!
Somewhat more problematic are tics, which are repetitive abnormal movements that cannot be controlled. Most of us think of facial tics - a repetitive squint or upward jerk of the cheek and so on. But some tics are far more dramatic. For example, there are various twisting movements, where the person's arm moves out like a snake, or dancing movements involving the whole body, even sudden deep knee bends. Like stuttering, tics are strongly associated with anxiety and therapy often concentrates on developing a relaxed attitude that diminishes the severity of the tics.
The most severe tics are found in people with Tourette's Syndrome. This is usually a life-long problem involving many different kinds of tics. Fortunately, it is very rare - about 5 in 10,000 people. They may have tics involving complex movements, such as touching things or full body motions. Most characteristics of Tourette's are vocal tics, including a variety of clicks, grunts, barks, snorts, and coughs. About 10% of Tourette's sufferers have what is called coprolalia (Greek for "shit-talk"), which is the involuntary shouting of obscenities. Often the obscenities are situational, so that when the person is dealing with a woman, they may be unable to restrain themselves from shouting "bitch!" or when dealing with an African American person, they may shout "nigger!" That might seem amusing, until you put yourself in their shoes. They are likely not sexist or racist - they just can't stop themselves.
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Separation Anxiety
Separation anxiety is a very common problem among children, especially younger ones. It is found in about 4% of kids. The problem is excessive anxiety about separation from the child's parents, other family members, or even their home. When separated, they become withdrawn and depressed and may have difficulty concentrating. They often develop other fears, anxiety about death, and nightmares. Of course, some separation anxiety is a normal part of childhood, so this can be a bit of a subjective call.
Separation anxiety usually occurs in tight, loving families. It often begins with some kind of life stress, such as moving to a new home or town, starting at a new school, or the death of a pet or relative. Fortunately, for most children, it ends sometime in adolescence if not earlier.
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Conduct disorder
Children or adolescents with conduct disorder behave aggressively by fighting, bullying, intimidating, physically assaulting, sexually coercing, and/or being cruel to people or animals. Vandalism with deliberate destruction of property, for example, setting fires or smashing windows, is common, as are theft; truancy; and early tobacco, alcohol, and substance use and abuse; and precocious sexual activity. Girls with a conduct disorder are prone to running away from home and may become involved in prostitution. The behavior interferes with performance at school or work, so that individuals with this disorder rarely perform at the level predicted by their IQ or age. Their relationships with peers and adults are often poor. They have higher injury rates and are prone to school expulsion and problems with the law. Sexually transmitted diseases are common. If they have been removed from home, they may have difficulty staying in an adoptive or foster family or group home, and this may further complicate their development. Rates of depression, suicidal thoughts, suicide attempts, and suicide itself are all higher in children diagnosed with a conduct disorder (Shaffer et al., 1996b).
The etiology of conduct disorder is not fully known. Studies of twins and adopted children suggest that conduct disorder has both biological (including genetic) and psychosocial components (Hendren & Mullen, 1997). Social risk factors for conduct disorder include early maternal rejection, separation from parents with no adequate alternative caregiver available, early institutionalization, family neglect, abuse or violence, parents’ psychiatric illness, parental marital discord, large family size, crowding, and poverty (Loeber & Stouthamer-Loeber, 1986).... Physical risk factors for conduct disorder include neurological damage caused by birth complications or low birthweight, attention-deficit/hyperactivity disorder, fearlessness and stimulation-seeking behavior, learning impairments, autonomic underarousal, and insensitivity to physical pain and punishment. A child with both social deprivation and any of these neurological conditions is most susceptible to conduct disorder (Raine et al., 1998)....
Studies have shown a correlation between the behavior and attributes of 3-year-olds and the aggressive behavior of these children at ages 11 to 13 (Raine et al., 1998).
Among children from 9 to 17, we find between 1 and 4 percent showing evidence of conduct disorder, and the problem being worse in the cities. Between 25 and 50% of these children are believed to develop into antisocial adults.
Treatment of children with conduct disorder tends to focus on making their family lives happier and more consistent. If the parents or other caretakers are responsive, there are programs that teach them how to use rewards and punishments more effectively. For many of these kids, it is a matter of trying to find a home for them at all! Medications have not been found to help.

SOCIAL COGNITIVE DISORDERS
These are mysterious brain abnormalities, which prevent infants and children from developing normal social and/or cognitive skills. It is not yet known where in the brain the complex interaction of genes and environment causes things to go astray, but many researchers are currently working to understand this aspect of brain (neurological development and more facts are becoming known every year.
Autism
At the most severe level of abnormality is the disability known as Autism. Autism undermines many aspects of human behavior, including movement, attention, learning, memory, language, mood and social interaction. It can be detected in the movements of babies who roll over, sit up, crawl and walk in oddly uncoordinated ways. At 18 months, many autistic toddlers will not point, share attention with others or follow the expressions of other people. By age 2 or 3, autistic children display a profound lack of responsiveness to others. Many do not talk; instead they may engage in rituals, like arm flapping, that stimulate their bodies. They dislike change of any sort. About a quarter of autistic children appear normal until age 14 to 22 months and then experience the sudden onset of autistic symptoms.
The symptoms of Autism range from mild to severe, making the true incidence of the disorder difficult to assess. Classical autism in its most severe form, which results in mental retardation, occurs in about 1 in every 1,000 births. When milder forms (which are often referred to as High Functioning Autism or Asperger's Syndrome) are included, the incidence is 1 in 500.
Autism researchers agree that it will take years before the genetics and neurochemistry of the disease are understood completely. But thanks to a combination of new tools for examining brain anatomy and keen observation, much of the mystery surrounding this disorder has recently begun to shrink. Within the last year (2004), several laboratories have reported exciting new findings. Clues focus on brain development and circuitry. In addition, certain areas of the autistic brain show signs of chronic inflammation which appears to last a lifetime. While these clues are exciting, they do not lead to immediate treatments. In the meantime, intensive one-on-one therapies that teach children how to control their movements and interact socially succeed in only 30 to 50 per cent of treated children, ideally by age 2 or 3. But newer treatments based upon the new research, is emerging. The goal is to intercept the miswiring of the autistic brain and, as the brain is developing, help it grow the connections it needs. *
Asperger's Syndrome
This disability is generally considered a (mild) form of Autism. While it remains little known, the number of diagnoses has soared since psychiatric authorities formally defined it in 1994.
Hans Asperger, the Viennese pediatrician who first described the condition in 1944, called his patients "little professors" who often use words as their lifeline to the world. Most Asperger's patients have average intelligence or above (unlike autistic people, by contrast, who often suffer some degree of cognitive disability).
The most striking characteristic of the syndrome is a consuming interest in arcane subjects. For example, they can be obsessed with clocks; the Titanic; deep-fat fryers; ex-presidents, spouses and aides; refrigerators; assassins; and train, plane and bus schedules. Although everyone knows someone with an all-encompassing interest in something, the key to the diagnosis is that their obsessive behavior significantly impairs their social functioning.
Youngsters with the condition are unable to pick up on the nonverbal cues that underlie most interactions with others, but they are smart enough to come to realize, and regret, a gap they can cross only with extreme difficulty. As teenagers they may experience what one expert called "extreme teasing." While many adults manage to master enough social skills to attend college, find good jobs and even marry, others sink into isolation. Researchers report high levels of depression and suicide, and antidepressants are the most common medications given to Asperger's patients.
Treatment is usually a mix of therapies to help with some patients' problems with motor skills and sound recognition combined with the most important kinds of help; behavioral training focused on social skills, and supportive psychotherapy to deal with the emotional impact of being different. The overall goal is to use the children's strengths - intelligence and verbal ability - to overcome their deficits.
WHAT TO LOOK FOR..
Asperger's syndrome can be difficult to diagnose in preschool children. Dr. Ami Klin of the Yale Child Study Center recommends that parents seek help if they notice several of the following behaviors:
A marked lack of interest in other children, or a consistently inappropriate style of engaging others, like long monologues.
Significant difficulty in understanding other children's feelings and expressions (inability to get jokes or teasing).
Few facial or bodily gestures; speech that is pedantic in tone or vocabulary.
Little make-believe and much repetition in play.
Overreaction to minor changes in routine or environment.
Precocious verbal skills and marked self-absorption in subjects unusual for the child's age.
These symptoms usually become more prominent in older children and therefore easier to spot. Clinicians also look for the combination of high intelligence and verbal skills, the absence of same-age friendships despite desire to form them and the growth of highly circumscribed interests. Even so, every child is different, and many experts recommend a full-scale evaluation by a multidisciplinary center/ clinician familiar with the syndrome*. (See section on Psychological Evaluation)
*Much of this information was reproduced from various articles in the NY Times Science Section, 2000, 2005
ADD/Social Learning Disability
This disability is the least severe in the continuum of psychoneurological disorders that effect social and/or cognitive functioning. Sometimes a social disability can occur in conjunction with disorders of attention (ADD/ADHD) and sometimes it can occur independently. Because it is less pervasive than the two previous disorders, it can be more easily overlooked until problems occur in school or socially. Parents eventually notice that the child does not get along well with others or seems socially isolated. As teens, these children are more likely to be teased and isolated; thus angry and/or depressed.
Treatment involves helping these children to recognize their strengths and abilities and to learn the cognitive and social skills they lack, preferably in a one-on-one setting. Often older children need supportive and insight psychotherapy to help them feel more acceptable, less alienated from their peers, less depressed and angry. Because children are so individual in their degree of disability and reaction to it, experts recommend a full-scale evaluation by a multidisciplinary center or trained clinician familiar with the disability (see section on Psychological Evaluation).
Physical growth disorders in children
The new born baby goes through a genetically and environmentally determined and streamlined process of physical growth to attain adult stature in the years to come. This is an orderly process with some peaks and rapid growth spurts at certain designated times in the life of an individual. The most rapid growth occurs in the first two years of life and at that stage nutrition plays a major role in providing the necessary nutrient growth factors to facilitate this process. The second enhanced growth spurt occurs in and around puberty. In between these times, physical growth progresses but at a lower pace. Following puberty, the growth rate is tailed off and adult height is reached by late teens in both sexes. The final height has a relationship to the height of parents and the mid parental height is a good index of the likely height that the child will finally reach in adult life. Environmental influences, particularly nutrition, are known to have a strong bearing on the physical growth rate.

There are several instances where one sees abnormal growth patterns. Some of these may not be due to a genuine medical problem as they are variations of normal growth. Others are abnormal and are due to some problem that needs to be addressed. These may manifest generally as either short stature or more rarely, excessively tall height. Careful evaluation of the many different aspects of the problem needs to be addressed before deciding on whether the situation needs further investigation.

It may appear that at a particular point in time a child has to sort of "look up" to his or her classmates. It is not in a figurative sense of looking up to people whom he or she admires but the child may be quite short compared to others in the same class that the child has to look up to communicate with them. Perhaps the other children in the class have been getting taller and developing into young adults but the index child seems to be lagging behind. Classmates now literally tower over that child. In such situations, one has to decide whether there is something wrong or whether he or she will develop a little later. It is difficult to be sure immediately but maybe there is a problem or perhaps there may not be. Some children just grow more slowly than others because their parents did too. But others may have an actual growth disorder, which is any type of problem that prevents them from meeting realistic expectations of growth varying from failure to gain height and weight in young children to short stature or delayed sexual development in teens.

It is important to realise that there are variations in normal growth patterns. Some of these are seen in the growth patterns of normal children and they are not pathological growth disorders. One such variation is constitutional growth delay. This condition describes children who are small for their ages but who are growing at a normal rate. They usually have a delayed "bone age," which means that their skeletal maturation is younger than their age in years. Bone age is measured by taking an x-ray of the hand and wrist and comparing it with standard x-ray findings seen in children in the same age group. Such constitutionally growth delayed children do not have any signs or symptoms of diseases that affect growth. They tend to reach puberty later than their peers do, with delay in the onset of sexual development and the pubertal growth spurt. But because they continue to grow until an older age, they tend to catch up with their peers when they reach adult height. One or both parents or other close relatives of these children are known to have had similar "late-bloomer" growth patterns. Familial or genetic short stature is a condition in which shorter parents tend to have shorter children. This term applies to short children who do not have any symptoms of diseases that affect their growth. These children with familial short stature still have growth spurts and enter puberty at normal ages. However, they usually will only reach a height similar to that of their parents.

With both constitutional growth delay and familial short stature, children and their families need to be reassured that the child does not have a disease or medical condition that poses a threat to health or one that requires treatment. However, because they may be short or may not enter puberty when their classmates do, some may need extra help coping with teasing or they may need reassurance that they will go through full sexual development eventually. Very rarely, a few normal children who are very short or very late entering puberty, may need some specialised forms of treatment such as hormone therapy. However, under those circumstances, the treatment should only be undertaken with scrupulous medical supervision.

It is also important to realise that chronic diseases of the kidneys, heart, gastrointestinal tract, lungs, bones or other body systems may affect growth. Optimal functioning of all systems of the body is necessary to establish normal physical growth. Other symptoms or physical findings in these children with such illnesses usually give clues as to the disease causing the growth delay. However, in certain instances, poor growth can be the first sign of a problem in some types of organ specific chronic diseases.

One important cause for poor growth that is not commonly recognised is emotional deprivation. Such children could have very significant lagging behind of their growth patterns which may improve and often show catch-up growth when the root cause of the underlying problem of disturbing emotional deprivation is satisfactorily addressed. In other instances, failure to thrive, which is generally not considered to be a specific growth disorder by itself, can be a sign of an underlying condition causing growth problems. Although it is common for newborns to lose a little weight in the first few days, failure to thrive is a condition in which some infants continue to show slower-than-expected weight gain and growth. Most often it is caused by inadequate nutrition or a feeding problem and, in that sense, it is most common in children younger than age 3 years. It may also be a symptom of another problem such as an infection, a digestive problem, child neglect or even child abuse.

Specific growth disorders include several medical conditions. A whole group of endocrine diseases which are diseases involving hormones, the chemical messengers of the body, are perhaps the most important group of such disorders. These involve either a deficiency or an excess of hormones and can be responsible for growth failure during childhood and adolescence. Out of this group, growth hormone deficiency is a disorder that involves the pituitary gland which is the small gland at the base of the brain that secretes several hormones, including growth hormone. This latter hormone is responsible for controlling physical growth of the human. A damaged or malfunctioning pituitary gland may not produce enough hormones for normal growth. In most cases, it is an isolated deficiency specifically of growth hormone and the other hormonal functions of the pituitary gland are retained.

Hypothyroidism is a condition in which the thyroid gland fails to make enough thyroid hormone, which is essential for normal physical and bone growth. There are several types of thyroid deficiency and the commonest presents from birth. These babies are born either with an absent or rudimentary thyroid gland or their intact glands are not able to produce sufficient amounts of thyroid hormones due to an intrinsic defect of the workings of the gland. It is extremely important to diagnose this problem as early as possible after birth since delayed treatment leads to poor development and maturation of the brain too. In many countries, especially of the developed world, there is a routine scheme of newborn careening which could detect thyroid gland inadequacy. Prompt treatment leads to entirely normal growth in the following years.

Turner syndrome is one of the reasonably common genetic growth disorders which occur in girls. It is a syndrome in which there is either a missing or an abnormal X chromosome. In addition to short stature, girls with Turner syndrome usually do not undergo normal sexual development because their ovaries, the sex organs that produce eggs and female hormones, fail to mature and function normally.

When a reasonable suspicion is aroused regarding a possible problem with growth, it is necessary to seek qualified medical advice on the matter. The concerned doctor would, in all probability, go into details about many different aspects of the problem before deciding on whether further evaluation is necessary. In some cases the medical person may decide to just watch the situation over a period of time to ascertain the necessity for further action. In other convincing cases, he or she may decide to go ahead straightaway with further testing procedures. The tests a doctor may recommend to detect a growth disorder depend on the findings at each step of evaluation. A short child who is healthy and growing at a normal rate may just be observed throughout childhood. However, a child who has stopped growing or is growing more slowly than expected, will often need additional testing.

A doctor or an endocrinologist will look for signs of the many possible causes of short stature and growth failure. Blood tests may be done to look for hormone and chromosome abnormalities and to rule out other diseases associated with growth failure. A bone age X-ray might be done and special scans such as CT or MRI may be needed to especially check the pituitary gland for abnormalities.

To measure the ability of the pituitary gland to produce growth hormone, the doctor may do a growth hormone stimulation test. This involves giving the child medications that cause the pituitary gland to secrete growth hormone and then drawing several small blood samples over time to check growth hormone levels.

Although the treatment of a growth problem usually is not all that urgent, earlier diagnosis and treatment of can help some of the children catch up with peers and increase their final height. If an underlying medical condition is identified, specific treatment may result in improved growth. Growth failure due to hypothyroidism, for example, is usually treated with thyroid hormone replacement pills.

Growth hormone injections for children with growth hormone deficiency, Turner syndrome, and chronic kidney failure may help children reach a more normal height. Human growth hormone is generally considered safe and effective, although full treatment may take many years and not all kids will have a good response. This treatment is extremely expensive and involves regular injections of the growth hormone.

In certain special cases, growth hormone may be administered as treatment for short children who are not growth hormone deficient when tested. In some countries like the USA, the authorities have approved its use in such children if they are predicted to reach a very short final height such as under 4 feet 11 inches or 150 centimetres for a girl or 5 feet 4 inches or 163 centimetres for a boy. These are set by their standards but may well be applicable for other countries as well.

There are some conditions where children grow up to be excessively tall. It is well recognised that children with simple obesity due to excessive eating and lack of exercise are generally taller than their peers. In the strictest sense, this is a consequence of obesity and the tallness is not due to any other medical problem. In contradistinction, some chromosomal disorders and hormonal disturbances are known to be associated with tall stature. These will have other specific physical signs and appropriate investigation would delineate the cause. These children will need specialised treatment for the specific problem.

One could boost a child’s self-esteem by providing positive reinforcement and emphasizing other characteristics like intelligence, personality and talents. It is always useful to try and take the focus off height as a measure of social acceptance. Young children who are very self-conscious about their size may need some additional help in coping. In some cases, evaluation and treatment by a mental health professional may be needed. It is also important to watch for the social and emotional problems that children with growth disorders face. It is not easy being the shortest one in the class and it is never any fun when one is being teased. Helping a child build self-esteem and emphasizing strengths, regardless of how tall he or she may grow up to be, might be just what the doctor ordered.

Physical growth and particularly height has very many determinants. It is essential to seek medical advice if the parents are concerned about the height. In very many instances of growth disorders leading to shortness of stature, a lot could be done to ameliorate the problem. However, it must be stressed that early intervention is necessary as treatment is very difficult and perhaps is not likely to be all that successful if the condition is diagnosed beyond the normal growth spurt phases and when interventions are targeted beyond the ending of natural growth segments.


SUBMITTED BY;
CONDINO, SHIALA O.