Dr. Eileen Callahan, Ph.D.: Children's Diagnosis

86524740_mother_and_daughter_web.jpg (Small 210px)Children's Diagnoses

Below is a list of some of the diagnoses commonly found in children where therapy for the entire family is highly recommended. These descriptions are not intended to be used for the purpose of diagnosis. If you suspect your child might be suffering from one of these disorders it is recommended that you seek the advice of a profesional.

Autism

A developmental disorder that appears in the first 3 years of life, and affects the brain's normal development of social and communication skills. Common impairments are listed below, but may vary from child to child.

Communication problems:

  • Difficulty starting or maintaining a social conversation
  • Communicates with gestures instead of words
  • Develops language slowly or not at all
  • Does not adjust gaze to look at objects that others are looking at
  • Does not refer to self correctly (for example, says "you want a cookie" when the child means "I want a cookie")
  • Does not point to direct others' attention to objects
  • Repeats words or memorized passages, such as commercials or TV programs
  • Uses nonsense rhyming

Social interaction:

  • Does not make friends or makes friends with children much younger or older than themself
  • Does not play interactive games
  • May not respond to or may avoid eye contact or smiles
  • May treat others as if they are objects
  • Prefers to spend time alone rather than with others
  • Shows a lack of empathy (awareness of how others might feel)

Sensory information:

  • Does not startle at loud noises
  • Has heightened threshold or low threshold for senses of sight, hearing, touch, smell, or taste
  • May find normal noises painful and hold hands over ears
  • May withdraw from physical contact because it is overstimulating or overwhelming
  • Rubs surfaces, mouths or licks objects
  • Seems to have a heightened or low response to pain

Play:

  • Doesn't imitate the actions of others
  • Prefers solitary or ritualistic play
  • Shows little pretend or imaginative play

Behaviors:

  • Displays intense tantrums
  • Gets stuck on a single topic or task (perseveration)
  • Has a short attention span
  • Has very narrow interests
  • Is overactive or very passive
  • Shows a strong need for sameness
  • Uses repetitive body movements

Asperger syndrome

A developmental disorder frequently considered a high functioning form of Autism. Common symptoms are listed below.

People with Asperger syndrome become over-focused or obsessed on a single object or topic, ignoring all others. They want to know everything about this topic, and often talk about little else.

  • May present many facts about their subject of interest, but there will seem to be no point or conclusion
  • Often do not recognize that the other person has lost interest in the topic
  • Areas of interest may be quite narrow, such as an obsession with train schedules, phone books, a vacuum cleaner, or collections of objects

People with Asperger will often approach other people rather than withdraw from the world in the way that people with Autism withdraw. However, their problems with speech and language in a social setting often lead to isolation.

  • Body language may be off
  • May speak in a monotone and may not respond to other people's comments or emotions
  • May not understand sarcasm or humor and often take a figure of speech literally
  • Do not recognize the need to change the volume of their voice based on their setting
  • Have problems with eye contact, facial expressions, body postures, or gestures
  • May be singled out by other children as "weird"

People with Asperger syndrome have trouble forming relationships with children their own age or other adults, because they:

  • Are unable to respond emotionally in normal social interactions
  • Are not flexible about routines or rituals
  • Have difficulty showing, bringing, or pointing out objects of interest to other people
  • Do not express pleasure at other people's happiness

Children with Asperger syndrome may show delays in motor development, and unusual physical behaviors, such as:

  • Delays in being able to ride a bicycle, catch a ball, or climb play equipment
  • Clumsiness when walking or doing other activities
  • Repetitive behaviors in which they sometimes injure themselves
  • Repetitive finger flapping, twisting, or whole body movements

Attention Deficit/Hyperactivity Disorder (ADHD)

A disorder characterized by difficulty with inattentiveness, over-activity, impulsivity, or all three. For these problems to be diagnosed as ADHD, they must be out of the normal range for a child's age and development. There are three forms of this disorder: ADHD combined type (difficulty with both inattentiveness as well as hyperactivity and impulsivity), ADHD predominantly inattentive type, and ADHD predominantly hyperactive-impulsive type.

Inattentive symptoms:

  • Fails to give close attention to details or makes careless mistakes in schoolwork
  • Has difficulty keeping attention during tasks or play
  • Does not seem to listen when spoken to directly
  • Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
  • Has difficulty organizing tasks and activities
  • Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
  • Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
  • Is easily distracted
  • Is often forgetful in daily activities

Hyperactivity symptoms:

  • Fidgets with hands or feet or squirms in seat
  • Leaves seat when remaining seated is expected
  • Runs about or climbs in inappropriate situations
  • Has difficulty playing quietly
  • Is often "on the go," acts as if "driven by a motor," talks excessively

Impulsivity symptoms:

  • Blurts out answers before questions have been completed
  • Has difficulty waiting turn
  • Interrupts or intrudes on others (butts into conversations or games)

Learning Disabilities

Learning disabilities, or learning disorders, is a term used for a wide variety of learning problems. A learning disability is not a problem with intelligence or motivation.  The brains of people with learning disabilities are wired differently which affects how they receive and process information. Simply put, children and adults with learning disabilities see, hear, and understand things differently. This can lead to trouble with learning new information and skills, and putting them to use. A learning disability is diagnosed when a person’s measured ability in a particular area is substantially below the person’s chronological age, measured intelligence and age-appropriate education. The most common types of learning disabilities involve problems with reading, writing, math, reasoning, listening, and speaking.


Oppositional Defiant Disorder (ODD)

A disorder characterized by a pattern of disobedient, hostile, and defiant behavior toward authority figures that is different from those of other children around the same age and developmental level.  This behavior leads to significant problems in school or social activities. Common symptoms of this disorder include:

  • Actively does not follow adults' requests
  • Angry and resentful of others
  • Argues with adults
  • Blames others for own mistakes
  • Has few or no friends or has lost friends
  • Is in constant trouble in school
  • Loses temper
  • Spiteful or seeks revenge
  • Touchy or easily annoyed

Separation Anxiety

A diagnosis characterized by intense anxiety when a child is separated from their home or from those to whom the child is attached. This anxiety is beyond what would be expected given the child’s developmental level. Common symptoms of this diagnosis are:

  • Recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated 
  • This distress may at times manifest itself in anger or aggression as well as anxiety or sadness   
  • Persistent and excessive worry about losing, or about possible harm befalling, major attachment figures
  • Persistent and excessive worry that a future event will lead to separation from a major attachment figure
  • Depending on their age this event may take on different forms including fear of animals, monsters, the dark, mugger, kidnappers, car accidents, or plane travel
  • Persistent reluctance or refusal to go to school or elsewhere because of fear of separation 
  • While at school may have difficulty concentrating due to worrying about the safety of the attachment figure
  • Persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings 
  • When alone may report unusual perceptual experiences such as seeing people in their room or scary creatures reaching for them
  • Persistent reluctance or refusal to go to sleep without being near a near a major attachment figure or to sleep away from home
  • Repeated nightmares involving the theme of separation
  • Repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated


Generalized Anxiety Disorder (GAD) in Children:

Children with GAD worry about anything and everything.  They tend to consider all the "what ifs?," going through a multitude of questions, trying to predict every possible scenario.  They need to know details about all situations.  They want to know what will happen next.  They want to know what the schedule will be, what new places they are going to will look like,etc… 

Parents of kids with GAD may regret telling their children information about bad things happening to other people (a neighbor has cancer, a relative lost a job, how germs make you sick) because they quickly turn it into days or weeks of distress about whether this might happen to them. They also think about these things long after they have happened (e.g. something they said to a friend which they think may have hurt his feelings). They worry a lot about whether they are good enough at school, sports, or other activities. Sometimes kids with GAD are unwilling to try new activities unless they are sure they will be good enough, or they may quit new activities if things aren't going well without giving themselves a chance to improve on or master the situation. Most times it is really difficult to get them to even try anything new. These kids often have headaches and stomachaches especially on school days.

Common signs of this problem include:

  • Excessive, unrealistic fears about day-to-day activities
  • "What if" concerns that span far into the future
  • Uncontrollable worry about multiple situations, performance, social, academic, health, financial
  • Physical symptoms: headaches, stomachaches, inability to unwind
  • Difficulty concentrating, always thinking what's next
  • Low risk-taking; Need for reassurance and approval for small steps
  • Perfectionism, great fear of making mistakes, fear of criticism; unrealistic unfavorable assessment of their grades, abilities
  • Over-responsibility, feels that tragedies are preventable by worry, and if disaster happens that it's their fault
  • Any negative piece of news that happens to others, fears will happen to them; everything is contagious by association: divorce, illness, car accidents, food poisoning
  • Reviewing events to make sure that didn't hurt anyone's feelings or do anything wrong
  • Sleep difficulties, irritability, fatigue

 

Obsessive Compulsive Disorder (OCD)

OCD is a neurobiological condition which is characterized by obsessions and compulsions.  Obsessions are  repetitive unwanted thoughts, ideas or images typically about harm (contamination, death of a loved one, violent or sexual thoughts) that intrude in the mind that aren’t easy to shake.  Compulsions are repetitive behaviors (washing hands, counting, tapping, checking) to try to ward off perceived risk and harm or stop the unwanted thoughts. Unlike everyday worries, obsessions are experienced as disturbing, bizarre, senseless and counter to the child's sense of himself (a devout child has thoughts about cursing at God; a loving child pictures stabbing his parents) and evoke dread, guilt, and discomfort. Categories of OCD symptoms include: contamination, checking, symmetry, religious scrupulosity, violent or sexual thoughts, fears of loss of essence (changing into someone else), fears about sexual orientation (am I gay?). The thoughts are so disturbing to the child that even though they make no sense (tapping everything four times to prevent harm to one's parents) the child feels compelled to believe the authority of those thoughts and comply with the commands.

Typically, when children are bombarded with bad and uncomfortable thoughts, they begin to blame themselves, I'm bad, I'm weird, I must want something bad to happen since I thought it. Rituals or compulsions such as asking for reassurance, cleaning, praying, re-doing, tapping, counting, making things symmetrical are the characteristic solutions to try to get rid of the feeling of incompleteness or uncertainty. Every time an unpleasant thought comes up, the child believes they have to do a compulsion.  However,  as time goes on, the compulsions change and  become more time consuming.   For example, repeating a behavior 4 times (checking or praying) turns into 16 or 32.  The solution perpetuates the problem. OCD requires more and more time and energy in the form of rituals and obsessions to address questions or concerns that were never valid in the first place.

Common symptoms of OCD include:

  • Obsessions and/or compulsions take up more than one hour a day or significantly interfere with a child's home life, school life or social functioning:
  • Intrusive thoughts, images, impulses that make no sense and are diametrically opposed to the child's being (loving child pictures stabbing parent; religious child fears that hates God; innocent child believes was sexually involved)
  • Repetitive behaviors: excessive washing, checking, redoing, counting, tapping to relieve anxiety
  • Interferes with functioning- child late for school, unable to get dressed on time for redoing, unable to complete homework due to erasing, rewriting, rereading
  • Child fears that he or she is going crazy because of the strangeness of the thoughts

 

Social Phobia

Children with social phobia are not just a little "shy," rather they are painfully uncomfortable in any situation where they could be embarrassed or feel they are being evaluated. They may see these threats even in relatively safe situations. These children often wish they had more friends but find it hard to do the things that are required to make new friends or maintain any friendships. Typically, adolescents will say they like being alone and don't need friends. For these children it is better not to try than take the risk they will be rejected.

Children with social anxiety appear uncomfortable and may choose to withdraw or not talk to prevent the risk of embarrassment. They are often very good  at being invisible, in that while they may not actually incur the social rejection that they fear, they may be unnoticed by their peers and have a socially neglected status because of their voluntary isolation, (eating lunch in the bathroom or alone at a table, avoiding recess by going to the library or helping the teacher).

Common symptoms of Social Phobia:

  • Fears being humiliated, embarrassing or laughed at in everyday situations
  • Avoid social contact or endures with great distress
  • Physical symptoms of anxiety- racing heart, sweaty palms, difficulty concentrating, stomachaches
  • Avoid eye contact, conversation with others
  • May be terrified of using the telephone, ordering in a restaurant, eating in a cafeteria
  • May be unable to raise a hand in class, do book reports or presentations, or ask for help which would require being the focus of attention
  • Avoidance of gym class or using school or public bathroom
  • Hesitant to go to friend's houses or talk to friend's parents
  • Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally based panic. In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from contact. Persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.

 

Conduct Disorder

Conduct disorder is a disorder of childhood and adolescence that involves long-term behavior problems involving defiant or impulsive behavior, drug use, and criminal activity.  These children often make no effort to hide their aggressive behaviors and have difficulty making friends.   They show little regard for the feelings of others.  This diagnosis is more common among boys and is often associated with Attention Deficit/Hyperactivity Disorder. 

Common symptoms of this disorder include:

  • Breaking rules without obvious reason
  • Cruel or aggressive behavior toward people or animals (for example: bullying, fighting, using dangerous weapons, forcing sexual activity, and stealing)
  • Failure to attend school (truancy -- beginning before age 13)
  • Heavy drinking and/or heavy illicit drug use
  • Intentionally setting fires
  • Lying to get a favor or avoid things they have to do
  • Running away
  • Vandalizing or destroying property

 

Enuresis

Enuresis is when a child repeatedly urinates in places other than the toilet. Enuresis that occurs at night, or bed-wetting, is the most common form of this disorder. This behavior may or may not be purposeful. The condition is not diagnosed unless the child is 5 years or older.  Nocturnal enuresis is the passage of urine during nighttime sleep, while diurnal enuresis is daytime wetting. Children with enuresis may experience either nocturnal or diurnal wetting, or they may experience a combination of both.

The main symptoms of enuresis include:

  • Repeated bed-wetting.
  • Wetting in the clothes.
  • Wetting at least twice a week for approximately three months.

Many factors may be involved in the development of enuresis. Involuntary, or non-intentional, release of urine may result from:

  • A small bladder.
  • Persistent urinary tract infections.
  • Severe stress.
  • Developmental delays that interfere with toilet training.

Voluntary, or intentional, enuresis may be associated with other mental disorders, including behavior disorders or emotional disorders including anxiety. Enuresis also appears to run in families, which suggests that a tendency for the disorder may be inherited (passed on from parent to child). In addition, toilet training that was forced or started when the child was too young may be a factor in the development of the disorder. Currently, however, there is little research to make firm conclusions about the role of firm or lax toilet training regimens in the development of enuresis. Children with enuresis are often described as heavy sleepers who fail to awaken at the urinary urge to void or when their bladders are full.

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