Psychiatry Made Ridiculously Simple by Jefferson E. Nelson & William V Good & Michael S Ascher

Author:Jefferson E. Nelson & William V Good & Michael S Ascher [Nelson, Jefferson E.]
Language: eng
Format: epub
ISBN: 9781935660132
Publisher: Medmaster
Published: 2017-04-17T17:00:00+00:00

CHAPTER 13.PSYCHIATRIC CONDITIONS OF CHILDHOOD

The psychological complaints and symptoms of children can be confusing. Children can be very symptomatic despite no serious psychological problems. Approximately 95% of children will develop a phobia, while 30-40% suffer night terrors. Enuresis occurs in 10% of 5-year-old boys. When do these and other problems warrant a workup and/or treatment? This chapter will help you decipher the odd array of symptoms and complaints that children present to their pediatricians, family doctors, and psychiatrists.

Here are some principles of human development to help you decide whether the cause of a child’s symptom is serious:

1.Commonly, chronic exposure to stress in childhood leads to psychopathology. In contrast, exposure to an isolated traumatic event (e.g., 1 automobile accident, 1 surgical procedure) usually does not cause lasting personality changes. However, some families may react pathologically to a traumatic event for their child. They treat the child differently than before. This can cause difficulty for the child.

2.Some development in childhood occurs sequentially and inalterably. For example, it’s not possible to walk before you can sit. A child’s struggle for autonomy (age 2) precedes his development of more individualized interests in particular activities and goals.

3.Boys appear to be more vulnerable to developing psychopathology than girls; most childhood disorders are more common in boys with the exception of anorexia nervosa and other feeding and eating disorders.

4.Certain traumatic events in childhood can be reactivated throughout the lifespan. For example, a 3-year-old who loses a parent may become seriously depressed or anxious later in life in response to a minor loss or separation (such as attending summer camp).

5.Certain psychological symptoms are normal if they occur at the appropriate developmental phase. For example, it’s normal for a 2-year-old to be oppositional. Oppositional behavior in a 9-year-old is not normal.

When a child presents with a behavior problem, the history can be important, too:

1.Is the problem chronic or acute? Long-standing problems usually are serious.

2.Is there a family history for psychiatric disorders? There is strong evidence for the contribution of genetic factors to the risk of developing certain disorders (e.g., schizophrenia, bipolar disorder, enuresis, substance abuse).

3.How is the child being raised? Is discipline too severe?

4.Does either parent have a psychiatric disturbance? Children of depressed mothers are more likely to suffer developmental delays than children of “normal” mothers.

5.Is the behavior problem very disruptive (e.g., fighting in school)? This usually indicates a more serious problem.

6.Is there a history of divorce? Divorce adversely affects preschool age children more than older children. Chronic marital discord is probably harder on a child than divorce.

Now let’s move on to the most common childhood problems.

Enuresis

Enuresis refers to wetting at a point in a child’s development when he or she is physiologically capable of controlling his or her bladder (age 5). However, maturation occurs at variable rates in children. That means that a 4-year-old could have occasional loss of control of his bladder and still be within the range of normal.

It may be helpful to distinguish between primary and secondary enuresis. The former refers to wetting that has occurred continually in the child’s life.

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