Child Focus

What is ADHD?

Attention Deficit Hyperactivity Disorder is a Neuro Psychiatric condition affecting preschoolers, children, adolescents and adults. Characterised by a display of inattention and/or hyperactivity/impulsivity that interferes with the functioning or development of an individual.

Types of ADHD

-Inattention

Overlooks details, difficulty remaining focused during lectures, easily distracted, disorganized work, loses things necessary for tasks, avoids tasks that requires focus.

-Hyper Activity

Leaves seat, runs/climbs in situations when remaining seated is expected, unable to engage in leisure activities quietly, talks excessively, constantly restless

-Impulsivity

Has difficulty waiting for turn, interrupt or intrudes others, blurts out an answer before a question has been completed.

Co-morbidities

-65% Defiance Problems

-25% Learning Problems

-50% Problems in Listening & Comprehension

-20% Mood Disorder

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How kids describe their ADHD

• Is restless and exhibits out of seat behaviour
• Doesn’t follow teacher’s instructions
• Starts to work independently in class but gets distracted by other children
• Participates in a group project but then drifts off
• Appears lost in ongoing class
• Interrupts with comments.
• Distracts other children by talking during work time
• Won’t let other children talk and insists on being the one to talk.
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ADHD is more than just “Not being able to sit still” or “Not being able to focus”.
People with ADHD also have difficulty with:-

• Prioritising
• Handwriting
• Time Management
• Outburst
• Making Decisions
• Translational Tolerance
• Self Regulation
• Essay Writing
• Motor Coordination
• Handling Transition
• Losing Containers
• Hard Time Making Friends
• Getting overstimulated and not knowing what to do with yourself
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ADHD Myths

• ADHD is caused by watching too much TV
• Children will grow out of ADHD
• All Kids with ADHD are Hyperactive
• Children of ADHD are not as smart as their peers
• All hyperactive children have ADHD
• Only Boys can have ADHD

Without a prompt diagnosis an ADHD child is likely to be labelled “Slow”, “Lazy”, “Naughty”, etc. Such labels undermine self-esteem and can lead to academic underachievements and relationship issues.

As a parent, you’ll probably be the first one to notice if your child has problems paying attention. If this happens often and if the behaviour becomes a pattern consult a psychiatrist.

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conduct disorder (CD) is defined as persistent and repetitive behavior that violates the rights of others or breaks age-appropriate societal norms

• Aggression towards people and/or animals
• threatens, bullies, or intimidates others
• initiates physical fights
• has used a weapon that can cause harm
• has been physically cruel
• has partaken in stealing while confronting an individual
• has forced someone to partake in sexual activity
• Destruction of property
• has intentionally started fires to cause damage
• has intentionally destroyed property
• Deceitfulness or theft
• has broken into someone’s house, car, or building
• lies to obtain things or to avoid obligations
• has stolen without confronting the victim
• Serious violation of rules
• before age 13, stays out at night despite parental commands not to
• before age 13, is often absent from school
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The Confusion Between Oppositional Defiant Disorder and Conduct Disorder

ODD is more temperament based, while conduct disorder is more action oriented. Someone with ODD isn’t necessarily engaging in delinquent behavior. Yes, the behavior of someone with ODD may be unpleasant, unwanted, and uncalled for, but it isn’t delinquent in the way that breaking into someone’s house is.

What Causes Conduct Disorder?

Genetic factors: Damage to the frontal lobe of the brain that may be genetic, inherited or caused by brain damage because of an injury. ( This part of the brain is what regulates cognitive skills, including problem-solving, memory and emotional expression.)

Environmental factors :

• Child abuse.
• Dysfunction in the family.
• Parents who abuse drugs or alcohol.
• Being poor.
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Is There Treatment for Conduct Disorder?

Individuals with Conduct Disorder are instilled with negative attitudes

Psychotherapy

Counseling, one type of psychotherapy, assists children in the whole treatment process to learn how to control and express anger in an acceptable manner without harming anyone.

Children are also subjected to cognitive-behavioral therapy which tries to model the children's cognitive abilities so as to enhance the basic skills required in life, like problem solving, aggression control, moral skills and impulse control.

There is also family therapy which encourages children to interact more with their family members. For completing these sessions, parents have to go through a pre-requisite course of parent management training (PMT) which will help parents monitor and correct their children's behaviors at home.

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Its normal for children of all ages to have lots of energy. If we look at toddlers, they are like energy bombs, move from one place to another. Even teenagers are so energetic and have less attention span as compared to adults.

Understanding ADHD?

Attention deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder that can affect a child’s success at school, as well as their relationships.

ADHD is generally diagnosed in children by the time they’re teenagers, with the average age being 7 years.

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Symptoms of ADHD

Inattentive Type

• Displays poor listening skills
• Loses and/or misplaces items needed to complete activities or tasks
• Side tracked by external or unimportant stimuli
• Forgets daily activities
• Diminished attention span
• Lacks ability to complete schoolwork and other assignments or to follow instructions
• Avoids or is disinclined to begin homework or activities requiring concentration
• Fails to focus on details and/or makes thoughtless mistakes in schoolwork or assignments
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Hyperactive/Impulsive Type

Hyperactive Symptoms:

• Squirms when seated or fidgets with feet/hands
• Marked restlessness that is difficult to control
• Appears to be driven by “a motor” or is often “on the go”
• Lacks ability to play and engage in leisure activities in a quiet manner
• Incapable of staying seated in class
• Overly talkative
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Impulsive Symptoms:

• Difficulty waiting turn
• Interrupts or intrudes into conversations and activities of others
• Impulsively blurts out answers before questions complete
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It is normal for child to display this kind of behavior once in a while. But when it becomes a habit and threatens to define the child’s personality, it is a cause for concern. It is not ODD when a child refuses to do something when they don’t know how to do it successfully.

What Is Oppositional Defiant Disorder?

Oppositional defiant disorder is a childhood behavioral disorder that is characterized by irritable moods and other unacceptable behaviors. ODD affects both children and adolescents.

Signs Of ODD In The Child

Signs and symptoms of ODD appear in children before they are eight. look out for these signs in ur child to determine if its just another tantrum or it is because of ODD.

Frequent temper tantrums: The child is almost always angry and loses temper often.

Irritable moods: Children with ODD are very touchy. They are easily annoyed or affected by what others do.

Defiant behavior: Consciously and actively refuses to adhere to rules or follow instructions.

Argumentative: Often argues with adults, especially authority figures such as parents or guardians and teachers.

Deliberately disrespecting rules and annoying others by questioning rules.

Shifting blame: Children with ODD do not take responsibility for their actions. They are always looking to blame others.

Revengeful attitude: They develop resentment quickly and have a spiteful or revengeful attitude towards others.

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Causes of ODD

The cause of disruptive behaviour disorders is unknown,it likely develops due to a combination of different factors, including genes, environment, personality, and temperament.

Genetic and biological factors

Children with a family history of depression or ADHD also have a higher chance of developing ODD.

• Environment and upbringing
• Poor parenting skills (inadequate supervision, harsh or inconsistent discipline, rejection ,negative reinforcement for problematic or disruptive behavior, which can promote future acting out inconsistent or neglectful parenting)
• Marital conflict
• Domestic violence
• Physical abuse
• Sexual abuse
• Neglect
• Poverty
• Substance misuse by parents or carers.
• Having a series of caregivers, especially ones who offer inconsistent or detached care
• Rejection from peers
• A stressful or unpredictable home life
• Personality and temperament
• Underlying personality traits linked to ODD
• Impulsivity
• Irritability
• High emotional reactivity
• Difficulty with emotional regulation
• Callous-unemotional traits, like emotional insensitivity and lower empathy
• Low frustration tolerance
• Of course, not everyone with these traits will go on to develop ODD.
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Diagnosis of ODD

child with ODD often don’t recognize their own behavior as defiant or oppositional. Instead, they might simply believe they’re reacting to unfair circumstances or unjust demands from parents, adults, and other authority figures.

A child can be considered to have ODD if the pattern of extreme negativity, defiance, irritability, and hostility:

• has existed for over six months,
• is constant – not just occasional outbursts,
• is more than normal for the child’s age – it may seem like a mature behavior at times, not just some childish act,
• disrupts the child’s school and family as well,
• is particularly directed towards all and any authority figures – parents, teachers, coaches, etc.

ODD Facts

• In every 16 children may have ODD
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Smartphones, tablets, laptops, game consoles, and other screen devices have becoming an extension of our child’s everyday lives, They dictate how we interact with each other, and how we manage virtually every other aspect of our lives.

Teens spend on average 9.3 hours on their digital devices each day. That’s more than the time they spend sleeping or in school.

Screen time addiction is a compulsive preoccupation, to the point of the inability to stop, with engagement with screen devices like smartphones, tablets, laptops, and videogames. As of now, screen addiction is not included as a verifiable condition in the latest addition of the Diagnostic and Statistical Manual (DSM-V),

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Screen time addiction is represented through a number of signs, including but not limited to:

• Inability to control or abstain from screen engagement
• Loss of interest in the world beyond screen engagement
• Decline in Academic Performance Due to Screen Use
• Interference with family and lifestyle activities
• Excessive changes in behavior like irritability and agitation
• Psychological withdrawal
• Constant preoccupation with screen usage
• Deception regarding screen use
• Using screen devices as a mechanism to deal with stress
• Tolerance and increased need for more screen engagement

Very often, parents of screen-addicted teens fail to recognize their behavior as a legitimate psychological condition and dismiss their behavior as ordinary teen angst or “acting out.” This type of dismissal can escalate the issue and lead to increased dependence.

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Physiological Consequences of Screen Addiction

Prolonged and uninterrupted engagement with screen devices can actually create lasting changes in cognitive function ,structural and functional changes in brain regions involving emotional processing, executive attention, decision-making, These changes include, but are not limited to:

• Gray-matter atrophy
• Compromised white-matter integrity
• Reduced cortical thickness,
• Impaired cognitive function,
• Cravings and impaired dopamine release

Emotional and social issues related to screen addiction

• Increased social isolation
• Underdeveloped interpersonal skills
• Inability to properly communicate
• Lack of empathy
• Stunted maturity

Other Impairments

• Hearing damage- ringing, roaring, pain, or buzzing in their ears.
• Vision damage - Eye Strain
• Blurred Vision
• Double Vision
• Dizziness
• Dry, Red Eyes
• Eye Irritation
• Headaches
• Musculoskeletal issues such as Occipital Neuralgia, Text Neck, iPosture, and text claw.

Screen Addiction Increases Mental Health Issues

1. Depression

• At least 70% of teens will have more than one episode of depression before adulthood
• Internet addictions
• Problems at school
• Running away
• Violence
• Suicidal tendencies

2. Nomophobia

60% of teens admit they’re addicted to their smartphones. The addiction has given rise to a new medical term: Nomophobia. Nomophobia originated because of the

3. Phantom Vibrations

High rates of fear and anxiety teens experienced without their device.

4. Adolescent obesity has quadrupled over the past 30 years. 1 in 3 teens are now defined as overweight or obese and screen time may be contributing.

With around 7 hours for sleep, 7 hours in school, and 9.3 hours in front of a screen, not much time is left for physical activity.

Screen Addiction Causing Sleep Deprivation

• 1 in 5 teens wake up solely to check their phone
• 65% of teens sleep with their smartphone on or near their bed

Don’t Get Worried, Get Educated

If you’re concerned that your teen, or even yourself, is on the verge of screen addiction, consider taking measures to curtail screen time at the earliest.

It’s important to remember that just because there is no chemical dependency element of screen addiction, the disease does create serious and potentially permanent changes in the brain, and clinical intervention may very well be necessary.

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SEPARATION ANXIETY DISORDER

School refusal also called School avoidance refers to a child’s refusal to go to school on a regular basis or problems staying at school

It’s a symptom that can be a part of underlying disorders like:

• social anxiety disorder
• generalized anxiety disorder
• specific phobia
• major depressive disorder
• oppositional defiant disorder
• post-traumatic stress disorder
• adjustment disorder
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What Does School Refusal Look Like?

Your child may experience/exhibit:

• physical symptoms like stomach aches, abdominal pain, headaches, nausea, diarrhoea and shortness of breath
• excessive worry about going to school
• defiance and non-compliance
• running away from home or school
• verbal and physical aggression
• temper tantrums
• clinging and refusing to get ready or get out of the car

these symptoms can be very real physical manifestations of anxiety and not just made up excuses they might be present only during school days and the child might be symptom free on weekends.

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Why Does School Refusal Behaviour Happen?

school refusal is associated with a combination of interrelated factors related to a child’s family, school and illness.

School based factors:

• Change of school
• Conflict with a classmate or teacher
• Transition periods from Primary to secondary school.
• Fear of specific subjects
• Academic pressures and struggling with work – incomplete work
• Bullying or perceived bullying.
• Not being able to make friends

Family based factors:

• Family breakdown, separation and divorce.
• Traumatic events at home such as bereavement, death of a family member
• Domestic Violence and abuse
• Inadequate parenting, lack or organisation or control over the child

Child related factors:

• low self-esteem, anxiety issues or low social skills.
• Separation anxiety with parent
• Social anxiety

School refusal behavior is an extremely challenging issue for the child, parents and schools., if left unchecked, can get worse quickly.

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What u can do as a parent ?

Take an immediate action Rule out any underlying medical disorders

Have a frank and calm conversation with your child : Talk about what's bothering them, while at the same time be assertive enough to explain him that a plan will be made to return to school.at any time,don't force conversation and avoid lengthy lectures.

Be emotionally supportive :

Let the child know that you believe he can get through this and you'll be there to help her throughout.

Don’t give special or treatment

Make their time at home as school like as possible so they don’t find it rewarding to stay at home. This means no screen time or staying in bed unless they’re genuinely sick.

Talk to your child’s teacher

Ask the teacher if they’ve noticed anything in the classroom or outside at recess that is concerning or out of the ordinary that might have provoked childs anxiety.

Set a routine

A clear routine lets them know what’s going to happen instead of stressing over unknowns. Keep an eye that the routine isn’t too rigid or it’s overscheduled as this can stress your child out more. Involve ur cgild while setting up the routine which will ensure it is followed properly.

Consider therapy

Cognitive behavioural therapy (CBT) is a short-term psychotherapy method that helps your child identify thought patterns that are triggering their anxiety and learn strategies to replace those negative thought habits.

Obsessive Compulsive Disorder (OCD)

An anxiety disorder that involves constant thoughts, actions, or impulses that are in intrusive. As a result, there is a need to perform certain rituals or routines to ease their anxiety.

signs that your child may have OCD

A strong fear of contamination or germs (for example, they go out of their way to avoid touching other children)

Worry about their loved ones dying or going away

A strong need for order or symmetry — always rearranging or “evening up” their toys

A constant need to re-do their work over and over, determined to make it “just right”

Trouble leaving the house on time because they are constantly rechecking things (for example, making sure the door is locked multiple times)

Trouble leaving the house on time because they are constantly rechecking things (for example, making sure the door is locked multiple times)

Hours spent in grooming rituals, including washing hands, showering, and toothbrushing

Repeated requests for reassurance — a child may ask the same question over and over, and it may seem that no amount of reassurance provides them comfort

Elaborate rituals — for example, their bedtime routine may become more complicated and elaborate over time. If their ritual is interrupted, they often need to start everything from the beginning.

A preoccupation with religious observances

A strong need to count and recount objects repeatedly

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Types of ADHD

physical symptoms to look for in a child with OCD:

Children with OCD often use their compulsions as a way to manage their anxiety, but doing so tends to lead to even more anxiety. In children, this can present with more physical symptoms, such as:

• Headaches
• Stomach aches
• Sleep disturbances
• Emotional outbursts
• Tics (tic disorder is one of the most common diagnoses associated with OCD)

Distractibility; it can be hard to focus when a child is managing obsessive thoughts. In the school setting, OCD can often look a lot like ADHD.

Rashes — sometimes children with OCD can develop red or raw skin from excessive washing or scars from frequent picking at their skin.

childhood OCD is different from adult OCD:

Children and adults with OCD usually present with similar symptoms. In fact, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) uses the same criteria to diagnose children as it does adults. But there are some important differences worth noting.

Children with OCD:

Are more likely to have other mental health disorders. Up to 75% of children with OCD have another disorder, most commonly ADHD, depression, anxiety, tic disorder, Tourette’s, or oppositional defiant disorder.

Tend to have less insight into the irrational nature of their behaviors

• Are less likely to have aggressive obsessions and compulsions
• Are more likely to have a family member with OCD
• Are more likely to be boys. In adults, females are slightly more likely to be affected.

factors that increase a child’s likelihood of developing OCD

Some preoccupation with rituals is common in young children. In fact, about 5% to 8% of children display some obsessive-compulsive symptoms in childhood. These behaviors are most common in children ages 2 to 4, and can occur as part of normal development.

Most children will grow out of that phase, but having obsessive-compulsive symptoms early in childhood is associated with a six-fold increase in the likelihood of developing full-blown OCD in adulthood compared to children who do not have obsessive-compulsive symptoms. Other factors that play an important role include:

• Family history of OCD
• comorbid mental health disorder: Anxiety and ADHD
• overprotective parenting
• Stressful life events

Strep infection: Although strep throat is usually a harmless infection, very rarely some children have been known to develop OCD or tic-like symptoms after infection with strep. This syndrome is known as PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus. In these cases, symptoms develop abruptly, often overnight.

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When should you seek treatment for your child’s symptoms of OCD?

Sometimes it’s hard to tell what is “normal” childhood obsessive behavior versus a pattern that is more concerning for OCD.

Red flags to watch for compulsions and behaviors:

• Take up a lot of time (sometimes hours each day)
• Interfere with functioning either at school, at home, or in social situations
• Are often distressing to the child and family

Need to be done to relieve anxiety — they are not pleasurable tasks (i.e., a child who enjoys building towers), but rather things that a child feels they need to do to feel less stress

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Stress is an integral part of our everyday life and we all have to deal with it in life almost every day. Some amount of stress what we call as “positive stress” is perfectly normal and can be healthy if it’s kept firmly in check.

Examination stress is one of such stress that troubles almost every student

What is exam stress?

Examination stress is a combination of perceived physiological over-arousal with a constant feeling of worry, self-depreciating thoughts of fear of failure, tension, and somatic symptoms that occur during exam.

If your stress levels rise too high for too long, it can prove to be harmful to both student and his performance during the exam

Exam Stress Symptoms :

• Feelings of not being able to cope with revision
• Feeling pressure from home or school
• Fear of failing the exam or not getting the grades needed
• Negative self-talk such as “I can’t do this” or “I am going to fail”
• Loss of perspective, thinking that their whole life will fall apart if they are not a success in the exams
• Fear of letting people down
• Difficulty in getting sleep or waking up in the morning on time
• Loss of interest in activities
• Anxiety symptoms :Worry and Dread, Increased heart rate
• Anger and a feeling of hopelessness
• Forgetfulness
• Physical symptoms like : Blurred vision, Dizziness, Migraines/headaches, Unexplained aches and pains,
• over-eating or under-eating
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Exam stress affects mental health of a child

For most of these symptoms, the support of a loving family, strong friendships, and a caring school is enough. For some, things can become more extreme and it’s important to talk to your medical professional and school to seek more specialist support and advice.

Causes of Exam Stress :

Exam stress is caused by the complex interplay of internal factors related to the child, exteranal factors that affect a child directly or indirectly and the test related factors.

External factors :

• Unrealistic expectations from family members or teachers.
• Pressure from peers, family, and teachers
• Ineffective teaching

Internal factors :

• Perfectionist tendencies and unrealistic expectations
• Negative self-esteem, self-statements, and criticism
• Poor motivation and procrastination
• Lack of confidence
• Competition
• Poor eating, sleeping and exercising habits
• Time management problems

Test related factors:

• Lack of Preparation
• Unfavourable testing environments
• Invalid, flawed, and timed tests
• Poor Studying Habits
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As many as 1 in 33 children suffer from depression and As teenagers, that number jumps to as high to 1 in 8. Sadly, only 1 in 5 receive help.

Depression not only affects adults but people of all ages, including children. But as children are unable to understand their own emotions and parents usually fail to notice the symptoms in their kids, childhood depression typically goes unnoticed and untreated.

Understanding whatis normal and what is not

It can be difficult to tell the difference between the ups and downs that is mostly attributed to :

• hormone imbalances occurring during periods of accelerated growth, such as in adolescence
• just part of being a teenager or
• when teen enters adulthood or
• the result of a single difficult event or
• it is part of the emotional blueprint of your child.
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What does Depression looks like in children?

• Persistent sadness or hopelessness.
• Irritability, anger, and rage
• Changes in eating and/or sleeping habits.
• Withdrawal from friends and activities once enjoyed.
• Lack of enthusiasm, interest, or motivation
• Moving or talking very slowly; or very agitated, moving all the times.
• Difficulty making decisions, lack of concentration or forgetfulness.
• Low self-esteem or guilt.
• Thoughts or expressions of death or suicide
• Hypersensitivity to criticism or rejection.
• Frequent physical complaints (e.g., headaches and stomachaches).
• Drug and/or alcohol abuse.
• Poor school work.
• School absences
• Problems with authority figures.
• Increase in difficulties getting along with others
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What causes Depression in a child ?

Depression is caused by a complex interplay of varied factors

For example, your child may have inherited a tendency to depression and also have experienced some difficult life events.

Biochemical changes imbalance in the neurochemicals and hormonal levels that affects the functioning of the brain

Chronic medical condition that interferes with the daily routine of the child can increase the chance of depression like – epilepsy, diabetes, asthma, allergies, heart conditions,Neurobiological disorders : like ADHD, Autism and Obesity

Drugs and alcohol use

Family h/o Depression or Bipolar mood disorder

Familial disharmony- separation,divorce,neglect

Inconsistent parenting

Increases screen use/internet addiction

Sequale of childhood depression :

• Suicidal thoughts or behaviors
• Worsening symptoms of current episode
• Increased risk of developing depression that’s worse or prolonged later
• Severe future depressive episodes
• Other mood disorders

Suicide risk

• Childhood depression can cause thoughts of suicide, even suicidal behavior.
• In fact, suicide is the third leading cause of death for children ages 5 to 14.

Warning Signs of Suicide Risk

• Multiple symptoms of depression
• Social isolation
• Increased problematic behavior
• Talking of suicide, death, or dying
• Talking about hopelessness or feeling helpless
• Frequent accidents
• Substance use
• Interest in weapons
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How can u prevent depression in ur child?

As a parent, to see your previously happy and uncomplicated child has suddenly turned into an irritable, unresponsive and aggressive can be very disturbing and intimidating. Depression can happen to anybody anytime, here s spme tips u can follow to have ur child communicate with you in stressful times and u can help him cope in a better way

Appreciate and praise your child’s achievements, no matter how small they are

Slow down on punishment

Don’t dwell on mistakes and recognize and appreciate the rights.

Gain their trust so that the child expresses his fears or problems to you first

If you feel you are observing signs of Depression in ur child, don’t take it lightly and consult a psychiatrist at the earliest. Observce the child so that you know when doies the symptoms surfaces and what triggers them. Show unconditional love and respect for ur child.help ur child Maintain a health routine inclusive of moderate physical exercise,balanced diet, sufficient sleep.

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• Physical symptoms are very common in children, almost 10 percent of children reports a pain or worry per day.
• Children and adolescents often find it difficult to express their feelings and emotions through language. Because of this, expression of psychological distress can manifest as physical (somatic) symptoms.
• When these physical symptoms are not able to be confirmed by medical testing and don’t have a medical explanation due to illness or disease, it may be due to a somatic symptom disorder.
• it’s important to know that somatic symptoms are real and are affected by everything we think, feel, and do
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What is somatic symptom disorder?

• A somatic symptom disorder is when emotional distress is felt as physical distress. These symptoms are biological in nature and are involuntary.
• A child may feel extremely distressed about his or her health symptoms and it interferes with daily activities like refusing to go to school, isolating with friends/family, or avoiding previously enjoyed activities.
• It is one of the most commonly reported disorders in the primary care setting with 5 to 7 % prevalence rate in child and adults
• Girls are more likely to be diagnosed with somatic symptom disorder as compared to boys
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How does a child present with Somatic Symptom Disorder?

• Pain in head, chest, arms, legs, joints, back, abdomen and other areas.
• Feeling tired/low energy level
• Stomach ache, nausea, vomiting
• Shortness of breath, trouble breathing
• Rapid heart beat
• Dizziness
• Fainting
• Bowel problems (diarrhea, constipation, bloating, gas)
• Movement disorders, weakness, paralysis, seizure-like episodes, memory problems
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Why does somatic symptoms occur?

• Somatic symptoms happen as a result of how the brain interprets stressors and communicates this information to the body.
• The autonomic nervous system plays a big role in how the brain communicates with the body.
• Any type of physical, emotional, or social stressor (exercise, worry, negative interactions) can activate the autonomic nervous system.. that switches on “fight-or-flight.” mode, the body speeds up and tries to protect itself from danger and the symptoms become more intense and severe.
• As the intensity of the stressfull situation declines, a person relaxes, the body moves into “rest-and-digest.” State where symptoms become less intense and noticeable as the body slows down and recovers.
• The body’s response to the stressor becomes a learned pattern over time. And then it can start to happen even when the stressor isn’t present.
• So, Somatic symptoms are not caused by anxiety alone. However, anxiety makes them worse because of the activating effect it has on the body.
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How to help ur child?

• It can be frustrating for the child and the parent to cope up with medical appointments, diagnostic tests and then finally have normal reports as the symptoms cant be explained due to any medical condition.
• Try to help the child take small steps to break the activation of symptoms like for instance :You can say something like, “I know your stomach hurts on the way to school, so let’s play a game or listen to your favourite music on the way there.
• If your child is experiencing frequent severe symptoms seek a medical professional.
• CBT is the mainstay of treatment apart from medications that helps Your child learn more about why symptoms are happening, how to cope with physical, emotional, and social stressors that might make symptoms worse. Additionally, he’ll learn specific skills to prevent or manage symptoms when they happen.
• It’s important to know that somatic symptoms are real and are affected by everything we think, feel, and do. With the right support and encouragement, children can overcome somatic symptoms to do everything they want to do in their lives!
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when a child is being toilert trained in his early years, accidents are expected to happen, but when instances of eliminating urine occurs outside of the bathroom, inappropriately and frequently. Specifically, at least 1-3 times for 3 months and the child is older than 4 or 5, it can be termed as enuresis.

Features:

• Occur at night, during the day, or both
• May not be due to effects of a medicine or another medical condition
• Primary type (child was never fully toilet trained) vs secondary type (problem develops after child was toilet trained)

Dsm 5 criteria :

Repeated voiding of urine into bed or clothes (whether involuntary or intentional)

Behavior must be clinically significant as manifested by either a frequency of twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

Chronological age is at least 5 years of age (or equivalent developmental level).

The behavior is not due exclusively to the direct physiological effect of a substance (such as a diuretic, antipsychotic or SSRI) or to incontinence uncured as a result of polyuria or during loss of consciousness.

Comorbid disorders:

• Mood disorders
• Attention deficit hyperactivity disorder (ADHD)
• Anxiety
• Insomnia

Specific types:

• Nocturnal (night-time) only
• Diurnal (daytime) only
• Nocturnal and diurnal

Factors that may contribute to toileting difficulties include but are not limited to:

• Stress & anxiety
• Inconsistent toileting training & routines
• Constipation / medical problem
• Genetics
• Control
• Discipline methods used around toileting successes & failures
• Behavioral factors

What to do if your child is exhibiting toileting troubles:

• Involve the pediatrician to rule out a medical condition
• Obtain education about nutrition and how to have a healthy diet to help with digestion and sustain regular toileting / bowel movements
• Consult a psychiatrist
• Keep positive and remain patient

GENERALIZED ANXIETY DISORDER

Anxiety is a normal human emotion and involves behavioural, affective, and cognitive responses to the perception of danger.

It is considered to be excessive or pathological when it is out of proportion to the challenge or stress or when it results in significant distress and impairment.

It is viewed as a normal part of childhood. Children experience fear, nervousness, shyness, and avoidance of places and activities that persist at times despite the helpful efforts of parents, caretakers, and teachers.

Anxiety disorders are one of the most common disorders seen among children and adolescents

How does parental factors affect child’s anxiety?

1. The Anxious Parent

Children absorb the mannerisms of every adult they interact with, and so if a parent or other family member has problems with anxiety, it's very likely that these anxious tendencies will end up transferring to the children. For example, if a parent is afraid of mouse and reacts anxiously on witnessing a mouse, the child may start feeling anxiety around mouse as well. “Children can pick up anxious behaviors from being around anxious people”

2. The Perfectionist parent

Perfectionists are demanding in nature. A perfectionist parent expect their children to perform in a certain flawless way that indirectly pressurises a child making him anxious

3. The hurried parent

Such parents want their child to be occupied with a structured activity every single minute leaving no down time to simply relax and unwind. This robs children of the unstructured free play time that they very much need for their emotional regulation.

4. The Overprotective Parent

overprotective parents tend to exhibit anxiety about things that might happen to their kids and eventually transfer their anxiety to their child. They always hover around the children which sends an implicit message to the child that they can't handle things on their own, get no practice in solving problems or coping with stress on their own. Thus, they have poor social-emotional competence, and are easily overwhelmed when problems arise.

What else increases the risk of anxiety in children?

• Genetic predisposition
• pressure to perform a certain way in school or sports
• Bullying and teasing at school
• lack of friends
• Change of school
• Loss and bereavemnet
• Familial disharmony: Separation , divorce , domestic violence, change of house, parental neglect
• Trauma: witnessing or involvement in a traumatic event.
• serious illness or injury in an accident
• Comorbid conditions: ADHD and/or autism

Generalized Anxiety Disorder (GAD)

Children with GAD experience worries about a wide range of negative possibilities, that something bad will happen.

Signs to look for for GAD in a child :

Repeated and extensive worry about several areas such as family finances, friendships, schoolwork, sports performance, self and family health, and minor, daily issues.

Tendency to repeatedly seek reassurance from parents or others about fears.

Avoidance of novelty, negative news, uncertain situations, and making mistakes.

Physical symptoms, sleeplessness and irritability when worried

PANIC DISORDER

Anxiety is a normal human emotion and involves behavioural, affective, and cognitive responses to the perception of danger.

It is considered to be excessive or pathological when it is out of proportion to the challenge or stress or when it results in significant distress and impairment.

It is viewed as a normal part of childhood. Children experience fear, nervousness, shyness, and avoidance of places and activities that persist at times despite the helpful efforts of parents, caretakers, and teachers.

Anxiety disorders are one of the most common disorders seen among children and adolescents

How does parental factors affect child’s anxiety?

1. The Anxious Parent

Children absorb the mannerisms of every adult they interact with, and so if a parent or other family member has problems with anxiety, it's very likely that these anxious tendencies will end up transferring to the children. For example, if a parent is afraid of mouse and reacts anxiously on witnessing a mouse, the child may start feeling anxiety around mouse as well. “Children can pick up anxious behaviors from being around anxious people”

1. The Anxious Parent

Leaves seat, runs/climbs in situations when remaining seated is expected, unable to engage in leisure activities quietly, talks excessively, constantly restless

2. The Perfectionist parent

Perfectionists are demanding in nature. A perfectionist parent expect their children to perform in a certain flawless way that indirectly pressurises a child making him anxious

3. The hurried parent

Such parents want their child to be occupied with a structured activity every single minute leaving no down time to simply relax and unwind. This robs children of the unstructured free play time that they very much need for their emotional regulation.

3. The Overprotective Parent

overprotective parents tend to exhibit anxiety about things that might happen to their kids and eventually transfer their anxiety to their child. They always hover around the children which sends an implicit message to the child that they can't handle things on their own, get no practice in solving problems or coping with stress on their own. Thus, they have poor social-emotional competence, and are easily overwhelmed when problems arise.

What else increases the risk of anxiety in children?

• Genetic predisposition
• pressure to perform a certain way in school or sports
• Bullying and teasing at school
• lack of friends
• Change of school
• Loss and bereavemnet
• Familial disharmony: Separation , divorce , domestic violence, change of house, parental neglect
• Trauma: witnessing or involvement in a traumatic event.
• serious illness or injury in an accident
• Comorbid conditions: ADHD and/or autism

Panic Disorder

A child with panic disorder experience panic attacks and extreme terror that comes about unexpectedly that is characterized by several somatic symptoms and fears of dying or going Crazy.

Signs to look for:

Several somatic symptoms that usually peak relatively quickly and last for a specific period

• Symptoms commonly include palpitations, breathlessness, dizziness, trembling, and chest pain
• At least some attacks occur unexpectedly or "out of the blue"

Agoraphobia

Agoraphobia involves an additional fear and avoidance of several "agoraphobic" situations, commonly due to a fear of experiencing a panic attack in those situations

Common agoraphobic situations include places from which quick escape is difficult such as public transport, enclosed spaces, cinemas, hairdressers, or heavy traffic.

• There is a common reliance on specific safety cues, commonly a safe attachment figure

Autism Spectrum Disorder

Autism spectrum disorder is a neurodevelopmental disorder that describes the developmental delays in a person that affect his social and communication skills and recognition and motor skills.

What are the symptoms of autism?

Symptoms of ASD typically become clearly evident during early childhood, between ages 12 and 24 months. However, symptoms may also appear earlier or later.

Early symptoms may include a marked delay in language or social development.

Problems with communication and social interaction

ASD can involve a range of issues with communication, many of which appear before age 5.

Here’s a general timeline of what this might look like:

• From birth: trouble maintaining eye contact
• By 9 months: not responding to their name
• By 9 months: not displaying facial expressions reflective of their emotions (like surprise or anger)
• By 12 months: not engaging in basic interactive games, like peek-a-boo or pat-a-cake
• By 12 months: not using (or only using a few) hand gestures, like hand-waving
• By 15 months: not sharing their interests with others (by showing someone a favorite toy, for example)
• By 18 months: not pointing or looking where others point
• By 24 months: not noticing when others appear sad or hurt
• By 30 months: not engaging in “pretend play,” like caring for a baby doll or playing with figurines
• By 60 months of age: not playing turn-taking games, like duck-duck goose

Additionally, autistic children might have trouble expressing their feelings or understanding those of others starting at 36 months.

These challenges with communication can persist throughout adulthood.

Restricted or repetitive patterns of behaviour or activities

• repetitive movements, like rocking, flapping their arms, spinning, or running back and forth
• lining objects, like toys, up in strict order and getting upset when that order is disturbed
• attachment to strict routines, like those around bedtime or getting to school
• repeating words or phrases they hear someone say over and over again
• getting upset over minor changes
• focusing intently on parts of objects, like the wheel of a toy truck or the hair of a doll
• unusual reactions to sensory input, like sounds, smells, and tastes
• obsessive interests
• exceptional abilities, like musical talent or memory capabilities

Other characteristics

• delayed movement, language, or cognitive skills
• seizures
• gastrointestinal symptoms, like constipation or diarrhea
• excessive worry or stress
• unusual levels of fear (either higher or lower than expected)
• hyperactive, inattentive, or impulsive behaviors
• unexpected emotional reactions
• unusual eating habits or preferences
• unusual sleep patterns

what are the Causes and Risk Factors for ASD in Children?

• The exact cause of autism spectrum disorder is not known. However, it
could be a combination of environmental and genetic factors
• Exposure to toxins before or after birth
• Infections before birth and low birth weight
• Having an older parent or a sibling with ASD
• Viral infections such as meningitis or encephalitis, which lead to brain damage.
• Various genetic conditions are said to be involved in autism spectrum disorder like Rett syndrome, fragile X syndrome, Down syndrome.

Autism spectrum disorder is a lifelong condition; early intervention can help the child learn the necessary skills to improve the quality of their life.