Helping your child successfully navigate the stages of development can be a daunting task in itself. Routine developmental changes in hormone levels and neurophysiology alone can precipitate significant behavioral changes. Add environmental stress and social conflict to the mix and these factors and impairments in functioning are likely to arise. So, how do we know when the two year-olds sudden terribleness is due to his quest for autonomy, or if our school –aged young folk is acting out, or if our teen’s withdrawal and limit testing is indicative of her quest for identity and independence? We simple consider the level of impairment. Routine developmental changes should not cause interruptions in functioning. While some individuals may have difficulty adapting, notable sudden or even gradual changes in mood and behavior should be attended to.
Autism is a disorder in which the onset occurs in early childhood. The Center for Disease control estimates that 1 in 68 children between 18 months and 4 years have been identified with autism spectrum disorder last year. Do we think that this is an overestimation- YES! In a society where uniqueness must be explained away by science and logic, we all too eagerly strive to label everything that deviates from the norm. Ok, I’m off my soapbox now. Children with autism have sustained deficits in social communication and social interaction across situations and settings. They struggle with reciprocal communication, and may not respond to or initiate social interaction with others. They may also have difficulty exhibiting appropriate affect/emotions (smiling when happy). Children with autism tend to have restrictive routines and generally experience anxiety become agitated when there are changes or breaks in their normal activities. They can also experience abnormal preoccupation with objects or activities (i.e. abnormal obsession with a toy and tantruming when the toy is removed from possession). One common misconception is that children with autism are of subpar intellectual ability. When in actually about half of children diagnosed with autism have average or above average IQs.
If you think your child may have autism please see you primary care physician as soon possible. Having a child diagnosed with autism can be challenging but it is certainly not the end of the world. There is a wealth of resources dedicated to assisting children diagnosed with autism and their families; and often, these services are provided without out-of-pocket costs.
Attention Deficit/ Hyperactivity Disorder (ADHD)
There has been extensive debate surrounding the validity of diagnosing. ADHD tends to be overused as diagnosis. As mental health professionals we are aware that hyperactivity does not always equal ADHD. Yet, as of 2011, approximately 6.4 million individuals between 4 and 17 years of age have been diagnosed with ADHD as of 2011. ADHD is characterized by difficulty attending to and staying on task; difficulty listening when spoken to directly; general disorganization; appearance of forgetfulness. Children with this disorder are often fidgety and have problems sitting still and tend to climb and run about in situations where doing so is inappropriate. They also may talk a mile a minute and speak out of turn.
In order to meet criteria for ADHD, individuals must exhibit the above symptoms across contexts. Difficulty completing school assignments and adhering to classroom rules is not enough to classify one as having ADHD.
Mood Disorders (Depression, Bipolar, and Anxiety)
It is estimated that 3.7 percent of individuals between the ages of 8 and15 years were diagnosed with a mood disorder in 2013. Mood disorders are typically not circumstantially based (i.e. symptoms cannot be attributed to bereavement). Children experiencing depression may appear lethargic and disinterested in activities that were once highly preferred. They may request to be excused from school and/or extracurricular activities. They may experience somatic pain and complain of feeling sick often. They tend to isolate. Changes in eating and sleeping habits may also occur. The child may present increased irritability and over-internalize criticisms. They may also exhibit low self-esteem, consistently downgrading their worth.
Bipolar disorder consists of the symptoms mentioned above with at least one episode of mania. The symptoms of mania are: increased energy despite insomnia; racing thoughts; tangential speech; trouble concentrating or paying attention; unlimited energy and taking on more activities or responsibilities than usual; excessive engaging in risk taking or pleasure seeking behaviors. These symptoms, lasting for at least seven days combined with the aforementioned symptoms of depression for a minimum of two weeks constitute as criteria for bipolar disorder. It is important to mention that younger children (under ten) suffering from bipolar disorder usually experience increased irritably and agitation; therefore the symptoms listed above may not be present in this age group.
As far as anxiety disorders are concerned, it's important to remember that the amount of stress response is normal. Coping strategies differ by individual. While some children will approach challenges with ease, others may do so with much cautiousness and come off as nervous or worrisome when placed when under pressure. The level of impairment, duration and the context in which the anxious symptoms occur should be taken into consideration when considering an anxiety disorder. Some of the symptoms include: Excessive anxiety and worry (apprehensive expectation); restlessness; difficulty concentrating or mind going blank; irritability.
The last disorder I feel that is notable for discussion is Post Traumatic Stress Disorder (PTSD). The sudden onset of nightmares, fear for self-safety and the safety of others may indicate that the child may have suffering from the symptoms of PTSD. An individual does not have to experience a trauma directly but can traumatized indirectly. Nowadays children are being traumatized by common occurrences such as bullying and humiliation rituals such as hazing. So, the application of PTSD to the younger generations is not so far-fetched anymore.
Even if your child does not meet criteria for a clinical diagnosis, it is important that attention be given to mental health. Sadly, mental fitness is often more neglected than physical health. As a society, we expeditiously utilize medical services when we are feeling bad physically while we perpetually tuck away our psychological distresses. It is just as hazardous to ignore physical symptoms that could indicate a life threatening disease as it to ignore psychological aches, especially when diminished quality of life is will likely be the end result.
So what do you do if you feel that child needs help?
One important factor to keep in mind is that there are several different factors that can impact psychological functioning. Certain health disorders are known to affect mood. For example hyperthyroidism can mirror the symptoms of depression. Vitamin deficiencies and even food allergies can have an altering effect on mood and cognition as well. A physical exam should be the first step in getting to the bottom of the changes your child is experiencing, especially changes that occur abruptly or seem to worsen with time.
Autism Speaks provides a number of resources for individuals diagnosed with autism and their families- just visit the Family Resources Tab at their website. They can also recommend providers in your location that specialize in treatment for autism if you are concerned that your child may have autism. The National Alliance on Mental Health has resources for individuals with mental illness and their families. It is also recommended that parents contact their medical insurance as they can assist in directing you to the appropriate services, and better yet steer you to providers that are covered under your benefits. Lastly, your county assistance office can help you apply benefits if you are not currently insured or your insurance does not include a behavioral health benefit. Your child may qualify for assistance depending on the type of illness despite your income.
One last thought I would like to stress is the importance of holistic treatment. Some providers have a tendency to be trigger happy when it comes to medications. Medications should actually be a last resort. Most medications that treat mental health disorders directly target the brain, which continues to develop into late adolescence. Studies have shown that some medications may negative effects later on. It also reported that antidepressants are likely to have a paradoxical (opposite) affect when used on children in teens whereas the depressive symptoms are actually worsened.