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July 2011
Childhood Disorders

Children are susceptible to a variety of emotional problems, in part due to their immaturity and their abilities to deal with stress. These problems may be apparent in a range of behavioral or emotional symptoms, disruptions in family home life, or in the school setting. There are also disorders which seem to be related to a biological vulnerability, and two of the most common of these are Attention Deficit Hyperactivity Disorder and Autism.

Attention Deficit and Hyperactivity Disorder (ADHD) is characterized by a high level of inability to pay attention, hyperactivity, or impulsivity. Some children with ADHD mainly have problems in paying attention, others are mainly hyperactive and impulsive, yet other children may have the presence of both these types of symptoms.  

Examples of inattention symptoms include:

  • Failure to pay close attention to details or regularly making careless mistakes
  • Difficulty sustaining attention
  • Decreased ability to appear to be able to listen attentively when spoken to directly
  • Frequent evidence of inability to follow through on instructions or in completing tasks
  • Difficulty organizing one’s self in a variety of ways including school work
  • Avoidance of  tasks that require sustained attention
  • Easily distracted 
  • Forgetful in daily activities

Symptoms related to hyperactivity:

  • Fidgets with hands or feet
  • Difficulty remaining seated when required
  • Running about or climbing excessively 
  • Difficulty engaging in leisure activities quietly
  • Excessive talking
  • Appearance of being in constant motion

Symptoms of impulsivity may include:

  • Inappropriately and regularly answering questions too rapidly
  • Difficulty waiting for turn one’s turn in an activity
  • May often disrupt others or be intrusive

Many of these symptoms become apparent in the school situation, so they are often diagnosed during school age. Many children who have these symptoms will have problems because of this either at school or at home.

While no specific causes for ADHD are known, there is increasing evidence that because most children have a family member with this disorder, genetic influences play a substantial role. Treatments include medications and specific types of therapy focused on improving the ability of the child to control one’s own behavior. Medications known as stimulants are a common effective form of treatment, for adults or children with ADHD. Other medications which are not considered stimulants are also affective for some. Helping the parents to learn effective ways of responding to the child with ADHD and helping to shape behavior in a positive way is also useful for nearly all affected children.  Behavior therapies involve a variety of exercises, best carried out with good coordination between parents and teachers, to help children learn how to better control the symptoms which are causing the problems. Parent education and assistance to parents can also be extremely helpful in improving the child’s condition. Treatment is very important because there seem to be some long-term positive effects of early treatment. There include positive effects on a variety of problems in school performance and difficulties in social situations, as well as the possibility of decreased risk for depression and alcohol or drug abuse.

Another common disorder in children is Autism, or what is now known as Autism Spectrum Disorders ( which includes Asberger’s Syndrome). These disorders are evident at an early age, most commonly well under three years of age, in which there is substantial impairment in social interactions, communication, and usual age typical behavior. The child’s ability to form relationships, to communicate verbally or non-verbally, or to engage in a wide range of interests or activities is much less than what is usually considered acceptable or expected, according to the age and developmental stage of the child. Because this disorder has a spectrum of severity, children present with a wide range of symptoms.

Communication difficulties may include:

  • Delayed or total lack of development of spoken language
  • Limited ability to start or maintain a conversation 
  • Stereotyped or repetitive use of particular aspects of language, such as frequently repeating a specific phrase
  • Play lacking in the usual variety seen in most children

Difficulties in Social Interaction include:

  • Problems in the use of non-verbal behaviors such as eye-contact, facial expressions, physical gestures
  • Failure to develop appropriate peer relationships
  • Apparent lack of desire to share in interactions and pleasurable activities of interest to most others
  • Inability to have appropriate emotional interaction with others

Symptoms involving Behavior, Interests, and other Activities:

  • Abnormally intense focus on one particular interest to the exclusion of other areas of activity
  • Inflexible ritualistic behaviors and behavioral patterns
  • Repetitive behaviors such as continual head banging, flapping of hands, or repeating sounds or phrases 
  • Abnormal preoccupation with a specific part of an object

The specific causes of autism and autism spectrum disorders are not known, but there is an increased risk of autism if there is a family member who has this disorder.  It appears that the genetic component is the most substantial risk component for the development of autism. While some individuals believe that childhood vaccinations cause autism, repeated research studies with large groups of children shows there is no association with vaccination and the onset of autism.  The scientist who first published an article many years ago suggesting a link between vaccination and autism has withdrawn the paper and has been severely sanctioned, and prohibited from practice by his national medical association.

With appropriate treatment the child’s symptoms can be reduced and ability to function can be improved.  Treatment success, as in most disorders, is best when there is a very early diagnosis and the beginning of treatment.  Treatments are often complex and time consuming.  One of the most common approaches is a set of treatments known as applied behavioral analysis.  This form of treatment involves several hours a day, most days of the week for an extended time period.  However, clinical outcomes are usually positive, with improvement of the child’s ability to function.  Modification of educational settings, if possible, is often helpful for children with autism.  An important part of intervention is helping parents learn about the illness, and how to best help their child to function optimally.  In addition, because of the stress of having a child with autism and helping treat the child, helping the parents deal with the stress is often an important part of the treatment.

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