Child Psychiatry



child psychiatry, branch of medicine concerned with the study and treatment of mental, emotional, and behavioral disorders of childhood. Child psychiatry has been recognized as a division of the field of psychiatry and neurology since the mid 1920s. By about the mid-1950s, the American Board of Psychiatry and Neurology had officially recognized the subspecialty and defined training and certification requirements for it. Subdivisions within the field include infant psychiatry and adolescent psychiatry.

Because the child is living through active and critical phases of development, the approach to the diagnosis and treatment of children’s mental and emotional disturbances is necessarily different from that used with adults. Given the personality changes that occur as a child grows, the child psychiatrist must have extensive knowledge of the developmental stages of personality.

Although many of the general principles relating to the therapy of adult psychological disorders apply to child psychiatry, a major distinction is that the child psychiatrist must obtain much of the critical information about the child’s behaviour from the adults who have been in frequent or close contact with the child—parents, pediatricians, psychologists, teachers, or social workers.

Child psychiatry is primarily concerned with the study and treatment of behavioral disorders and emotional problems that affect children. Emotional maladjustments of children frequently are characterized by anxiety reactions. They may include habit disorders—such as nail-biting, thumb-sucking, bed-wetting, and temper tantrums—and conduct disorders—such as extreme aggressiveness, lying, stealing, destructiveness, fighting, fire setting, cruelty, and running away from home. Among infants, deprivation of mothering or problems in the infant’s relationship with the mother may lead to withdrawn behaviour, continuous crying, inability to eat, insomnia, and physical or mental retardation or both. In the last half of the 20th century, child abuse and neglect came to be seen as significant factors in childhood disorders.

As in the treatment of adult patients, psychiatric treatment of children requires determining any genetic, constitutional, or physical factors that contribute to the disturbance. The parent-child relationship must also be assessed for its contribution to the disturbed behaviour. When parental actions are disruptive or disturbing—as, for example, in relationships coloured by alcoholism, hostility, cruelty, neglect, overprotection of the child, or excessive ambitions for and expectations of the child—behavioral disorders are commonly found in the children involved. Neurotic, psychotic, or psychopathic conditions in the parents often contribute to a faulty parent-child relationship. The death or loss of a parent may also have a lasting effect on a child’s emotional growth. Another source of personality problems may be the child’s relationship with brothers and sisters. Child psychiatry often involves some form of family therapy.

School experiences also can create personality problems. Many children exhibit conduct and learning disturbances because they are emotionally, temperamentally, or intellectually unable to learn. Children with perceptual difficulties such as dyslexia, for example, may fail to learn to read or to develop reading skills appropriate to their age level. As a consequence, they often become frustrated and anxious over their failure to meet the standards of their family and their classmates.

Many therapeutic techniques used with adults are also used with children, in addition to more-specialized methods such as play therapy. In the latter, play activities are used as the primary basis for communication between the child and the psychotherapist. Play activities enable children to express their feelings, thoughts, wishes, and fears more freely and easily than they can through purely verbal communication.


● ADHD
● ODD
● Aneuresis enuresis
● Eating Disorders
● Mental Retardation
● Autism
● Conduct Disorder
● Behavioral Problems associated with Puberty
● Childhood Depression




Attention-deficit/hyperactivity disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often continues into adulthood. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior.Children with ADHD may also struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful.
While treatment won’t cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions. Early diagnosis and treatment can make a big difference in outcome.
There are three subtypes of ADHD:

• Predominantly inattentive. The majority of symptoms fall under inattention.
• Predominantly hyperactive/impulsive. The majority of symptoms are hyperactive and impulsive.
• Combined. This is a mix of inattentive symptoms and hyperactive/impulsive symptoms.

When to see a doctor

If you’re concerned that your child shows signs of ADHD, see your pediatrician or family doctor. Your doctor may refer you to a specialist, such as a developmental-behavioral pediatrician, psychologist, psychiatrist or pediatric neurologist, but it’s important to have a medical evaluation first to check for other possible causes of your child’s difficulties.



Oppositional defiant disorder (ODD)

Oppositional defiant disorder (ODD) is a type of disruptive behavior disorder, a condition in which children show ongoing patterns of uncooperative and defiant behavior.
Although all children have moments when they’re not willing to do as they are told, children with ODD do this more frequently and with more hostility than their peers.
What Causes ODD?
It’s not known what causes oppositional defiant disorder, but doctors believe several factors may play a role. These factors include:
• Parent/Child Relationships. Parents of children with ODD may be found to provide inconsistent or overly harsh discipline. At times, parents’ actions may reinforce inappropriate behaviors.
• Genetics. Some children with ODD have parents with mental health disorders, such as substance abuse, attention deficit hyperactivity disorder (ADHD) and mood disorders.
• Environment. Children who are rejected, abused or neglected are at an increased risk for ODD.
• Psychological health. Children who have been diagnosed with ADHD are at an increased risk. Children with ODD often appear to have underlying temperamental factors, such as being easily frustrated or emotionally reactive, that increase their risk for meeting ODD criteria.

What Are The Signs & Symptoms of ODD?

Children with oppositional defiant disorder:

• Lose their temper often
• Are quick to argue with adults over rules, requests or even small, unimportant things
• Are uncooperative
• Are unwilling to follow rules
• Annoy others deliberately and become annoyed by others easily
• Blame others for their misconduct or mistakes
• Are spiteful and vindictive
• Get in frequent arguments with their peers
• Are disciplined at school frequently

It’s important to remember that all children behave this way sometimes. These behaviors can be developmentally appropriate, depending on the intensity, frequency and age of the child.
The difference between normal behavior and ODD is that, with ODD, a child behaves this way more frequently and with more hostility than other children his or her age. Your child’s care team will take frequency, level of impairment and developmental appropriateness into consideration when a child has behavioral issues.



Mental Retardation (MR)

Mental Retardation (MR) / Low IQ / Subnormal Cognition / Cognitive impairment
Intellectual Disability / Mental retardation refers to substantial limitations in present functioning. It is characterized by significantly sub average intellectual functioning, existing concurrently with related limitations in two or more of the following applicable adaptive skills areas: communication, self care, home living, social skills, community use, self direction, health and safety, functional academics, leisure, and work. Intellectual Disability manifests before the age of 18.

Prevalence
• As many as 3 out of every 100 children in the country have intellectual disability / mental retardation
• Characteristics / common features of ID / MR
• There is many signs of Intellectual Disability / Mental Retardation.
• Delayed in achieving sitting, crawling, and walking
• Learn to talk later, or can have trouble in speaking
• Poor memory-find it hard to remember things
• Does not understand how to pay attention for things
• Have trouble in understanding social rules
• Have trouble solving problems,
• Have trouble thinking logically, etc
• Associated Problems with Intellectual Disability / Mental Retardation
• Seizure disorder
• Drooling
• Hypothyroidism
• Microcephaly
• Vision problems
• Hearing problems
• Anxiety
• Mood disorders ,etc

All of the above disorders require separate treatments. Most of the disorders are managed successfully with proper treatments
Causes of Intellectual Disability / Mental Retardation
Most common causes are:
• Genetic conditions
• Problems during pregnancy
• Problems at birth
• Health problems
• Diagnosis Making
• ID / MR is diagnosed by looking at two main things. These are:
• The ability of a person’s brain to learn, think, solve problems, and make sense of the world (called IQ or intellectual functioning)
• Whether the person has the skills he or she needs to live independently (called adaptive behavior or adaptive functioning).
• People scoring below 70 IQ are thought to have ID / MR. To measure adaptive behavior, professionals look at what a child can do in comparison to other children of his or her age. Certain skills are important to adaptive behavior. These are:
• Daily living skills, such as getting dressed, going to the bathroom, and feeding one’s self
• Communication skills, such as understanding what is said and being able to answer
• Social skills with peers, family members, adults, and others
• Intelligence Quotient (IQ) and its impacts
• Mild mental retardation, with IQ scores of 50-55 to approximately 70
• Eighty-five percent of intellectually disabled people are at this level, and they can often live on their own with minimum support from others.
• Moderate mental retardation with IQ scores of 35-40 to 50-55
• Those with a moderate intellectual disability make up roughly 10% of cases on this spectrum. These individuals may need more support in day-to-day life and may live in a group home.
• Severe mental retardation, with IQ scores of 20-25 to 35-40
• They typically need daily supervision to keep them healthy and safe and may need help with basic self-care tasks.
• Profound mental retardation, with IQ l scores below 20 or 25
• They may need constant care and supervision to meet their basic needs.

Management and Treatment
Intellectual Disability / Mental retardation is not a disease. It is also not a type of mental illness, like depression. There is no cure for ID / MR. However, most children with ID / MR can learn to do many things. It just takes them more time and effort than other children
There is no standard medication available for “Intellectual disability / Mental retardation“.
Children with ID are managed with multimodal treatments. Multimodal / Combination therapy is considered best for majority of children with ID / MR



Autism

Autism, also called autism spectrum disorder (ASD), is a complicated condition that includes problems with communication and behavior. It can involve a wide range of symptoms and skills. ASD can be a minor problem or a disability that needs full-time care in a special facility.
People with autism have trouble with communication. They have trouble understanding what other people think and feel. This makes it hard for them to express themselves, either with words or through gestures, facial expressions, and touch.
People with autism might have problems with learning. Their skills might develop unevenly. For example, they could have trouble communicating but be unusually good at art, music, math, or memory. Because of this, they might do especially well on tests of analysis or problem-solving.
More children are diagnosed with autism now than ever before. But the latest numbers could be higher because of changes in how it’s diagnosed, not because more children have a disorder.

Common symptoms of autism include:

• A lack of eye contact
• A narrow range of interests or intense interest in certain topics
• Doing something over and over, like repeating words or phrases, rocking back and forth, or flipping a lever
• High sensitivity to sounds, touches, smells, or sights that seem ordinary to other people
• Not looking at or listening to other people
• Not looking at things when another person points at them
• Not wanting to be held or cuddled
• Problems understanding or using speech, gestures, facial expressions, or tone of voice
• Talking in a sing-song, flat, or robotic voice
• Trouble adapting to changes in routine

What Are the Types of Autism Spectrum Disorders?

• These types were once thought to be separate conditions. Now, they fall under the range of autism spectrum disorders including:
• Asperger’s syndrome. These children don’t have a problem with language; in fact, they tend to score in the average or above-average range on intelligence tests. But they have social problems and a narrow scope of interests.
• Autistic disorder. This is what most people think of when they hear the word “autism.“ It refers to problems with social interactions, communication, and play in children younger than 3 years.
• Childhood disintegrative disorder. These children have typical development for at least 2 years and then lose some or most of their communication and social skills.
• Pervasive developmental disorder (PDD or atypical autism). Your doctor might use this term if your child has some autistic behavior, like delays in social and communications skills, but doesn’t fit into another category.



Conduct disorder

Conduct disorder is an ongoing pattern of behavior marked by emotional and behavioral problems. Children with conduct disorder behave in angry, aggressive, argumentative, and disruptive ways.

Conduct disorder in children goes beyond bad behavior. It is a diagnosable mental health condition that is characterized by patterns of violating societal norms and the rights of others. It’s estimated that around 3% of school-aged children have conduct disorder. It is more common in boys than in girls.

It’s important for kids with conduct disorder to get professional treatment. Recognizing the early warning signs can help you take appropriate action.

Symptoms

Conduct disorder extends beyond normal teenage rebellion. It involves serious behavior problems that are likely to raise alarm among teachers, parents, peers, and other adults. In order to qualify for a diagnosis of conduct disorder, children must exhibit at least three of these symptoms in the past year and at least one in the past six months:
• Aggression Toward People and Animals
• Bullying, threatening, or intimidating others
• Initiating physical fights
• Using a weapon that could cause serious harm
• Physical cruelty to people
• Physical cruelty to animals
• Stealing while confronting a victim
• Forced sexual activities.



Childhood depression

Although most people think of depression as an adult illness, children and adolescents can develop depression as well. Unfortunately, many children with depression go untreated because adults don’t recognize they’re depressed. It’s important for parents, teachers, and other adults to learn about childhood depression.
Symptoms of depression in children:
• Depression in children and teens often presents differently than it does in adults. Irritability and/or anger are more common signs of depression in children and teens. Additionally, young children often find it difficult to explain how they’re feeling, while teens may attempt to hide their emotional painfearing judgment from others.
• Because normal behaviors vary as children develop, it can be challenging to know if your child is going through a phase or if it’s something more serious. The first step towards helping your child battle depression is learning how to spot it.

According to the American Academy of Child and Adolescent Psychiatry, common signs of depression in children and teens last longer than two weeks and include:

• Changes in appetite or weight
• Feeling or appearing depressed, sad, tearful, or irritable
• Fatigue or perceived lack of energy
• Feeling guilty or ashamed
• Having more trouble concentrating
• Loss of interest or pleasure in previously enjoyed activities
• Psychomotor slowing or agitation
• Recurrent thoughts of suicide and/or death
• Sleep disturbance: Insomnia or hypersomnia nearly every day
• addition to the above symptoms, some children have physical complaints, such as stomachaches and headaches, substance use, and poor school performance.

Treatment options:
If you feel that a child is in need of help,do not hesitate or delay meeting a professional. Timely intervention can often help a child get back to a normal life quickly. Use of medications,appropriate for the child along with CBT and Interpersonal therapies may be adviced by your consultant Psychiatrist. Be open to discuss your treatment options with your doctor and clear any doubts related to illness or treatment option you might have.



Depression

Depression exists on a continuum of severity, ranging from relatively mild, transient states of low mood to severe, long term symptoms that have a major impact on a person’s quality of life. When a person’s symptoms have reached the chronic end of the spectrum and require professional treatment, it’s typically referred to as clinical depression.

Common symptoms you may encounter if you are suffering from depression:
• Sadness, feelings of emptiness
• Loss of enjoyment of hobbies, work, other activities
• Appetite changes, weight loss or gain
• Trouble sleeping (too much or too little)
• Feeling “slowed down“ or being excessively agitated
• Tiredness, fatigue, lack of energy
• Physical symptoms and pain (such as body aches, stomach upset, headaches)
• Feelings of worthlessness or guilt
• Problems with concentration or focus
• Inability to make decisions or poor decision-making
• Thinking about death or dying; planning or attempting suicide.
Researchers have particularly been interested in investigating whether depression is an inherited condition. A major theory is that certain genetic changes make neurotransmitters (mood-regulating chemicals in the brain) ineffective or scarce.

The other major component is environmental triggers which may make a person who is genetically predisposed to depression more likely to develop it. Certain factors that make it more likely a person will experience clinical depression include:

• A family history of depression (especially a parent or sibling)
• Experiencing a traumatic event or major life change (such as loss of a job, death or serious illness of a spouse, divorce)
• Financial troubles (such as debt and worries about paying for big expenses)
• Being very ill or injured (such as from cancer or a car accident), needing to have surgery or undergo medical treatment, or having to manage a chronic and/or progressive health condition (such as multiple sclerosis)
• Caring for a loved one (spouse, child, parent) who has a major illness, injury, or disability
• Taking certain medications that can cause symptoms associated with depression (including medications used to treat depression)
• Using illegal drugs and/or misusing alcohol
If you have experienced a form of depression before, you may be more likely to experience it again or develop another form in response to certain stressors or life changes (such as having a baby).
• Coping with depression
• Remember you are not alone.
• Reach out to a friend whom you trust for help.
• See a qualified medical professional like a Psychiatrist.
• Try to maintain a daily routine.
• Try and regulate sleep and hygine.
• These are the times you need to have a good diet plan than ever before.
• Indulge in activities that calm you. You may get hold of an old hobby such as painting,singing or even listening to music.
• Exercise regularly as this can help decrease the stress you are experiencing. Meditation and yoga may also be helpful.
• Stay connected. Having the right friends,family and contacts around is always wise if you are depressed.
• Get professional help from a Psychiatrist in you are having difficulty in handling the situation.

Always remember,depression affects each individual in a unique manner. No same rule applies to all. Hence,be flexible when adviced to choose treatment options,be it the use of medications or behavioural therapies.


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