Childhood emotional disorders are a group of mental illnesses that occur in children and adolescents. The disorders are particularly characterized by anxiety.
What are childhood emotional disorders?
According to the ICD-10 classification system, all disorders that show an intensification of normal development belong to childhood emotional disorders. In the foreground is the fear of a certain thing or situation. The characteristic feature is that this object or situation is actually harmless. In contrast, childhood emotional disorders are not listed separately in the DSM-IV, another classification system for disorders. They are coded together with adult anxiety disorders and phobias, so no attention is paid to the developmental component here. However, according to the ICD and the World Health Organization (WHO), childhood emotional disorders include the following conditions:
- Childhood emotional disorder with separation anxiety.
- Disorder with social anxiety of infancy.
- Emotional disturbance with sibling rivalry
- Phobic disorder of childhood
- Other emotional disorders of childhood
Causes
There are several theories for the origin of emotional disorders in childhood. According to the doctrine of psychoanalysis, the disorders arise from a failure to meet the needs of the child. In addition, it is often observed that the caregivers of the ill children also appear anxious. Another theory of psychoanalysis states that the fears occur in connection with a fear of separation. According to classical learning theories and the cognitive approach, however, the fears are based on classical conditioning. An originally neutral stimulus receives through the spatio-temporal encounter with a fear-triggering stimulus that the actually neutral stimulus also triggers fear. Fear can also be learned through model learning. For example, the child can observe that the mother reacts fearfully to dogs. From this, the child concludes that dogs must be dangerous and consequently also reacts with fear. Some researchers suggest that fear of some objects or situations is innate. Fears can only be reduced by confrontation with the fear-inducing situation. If this does not happen, the fears remain. The American psychiatrist and psychotherapist Aaron Temkin Beck assumes that the emotional disorders of childhood are based on a cognitive triad. According to this, three triggers are required for the development of anxiety: a negative self-image, a negative interpretation of the situation/object, and a nihilistic attitude toward the future.
Symptoms, complaints, and signs
About ten percent of all children and adolescents suffer from an anxiety disorder at least briefly during the course of their development. One to four percent experience separation anxiety. Overall, fewer boys than girls are affected by emotional disorders at kindergarten age. Anxiety disorders often begin in early childhood and can become chronic by adulthood. The disorders can interfere with the child’s normal development. It is not uncommon for comorbid disorders to develop during the course of the disorder. Thus, there is quite a high comorbidity to other anxiety disorders in particular. Almost half of all children with an emotional disorder also suffer from another anxiety disorder. Many of those affected also have depressive disorders. Often the emotional disorders precede the depressive disorders. Comorbidities are also found with social behavior disorders, obsessive-compulsive symptoms, elective mutism, and depersonalization syndromes. Depending on the disorder type, different leading symptoms also occur. Emotional disorders with separation anxiety are expressed by a persistent worry that something might happen to the caregiver. The affected children refuse to go to school or kindergarten in order to stay with their caregiver. They have nightmares concerning the separation. Somatic symptoms such as nausea, headaches, or abdominal pain may also occur before or during the separation. In phobic disorder, children show pronounced fears of certain objects or situations.In the anxiety situation, children sweat or shake. They may exhibit difficulty breathing, dizziness, or trepidation. Persistent anxiety in social situations indicates disorders with social anxiety. Children act self-consciously toward strangers. They are embarrassed or overly concerned about their behavior. As a result, social relationships are significantly reduced and impaired. This, in turn, causes children to be silent, cry, and feel very unhappy. Emotional disturbances with sibling rivalry are manifested by competition with younger siblings. The child vies for the parent’s attention and often displays tantrums.
Diagnosis
If a childhood emotional disorder is suspected, the attending physician or treating psychiatrist or psychotherapist will interview the affected child and his or her parents. Extraneous histories with siblings, other children, or teachers may provide further clues as to whether an emotional disorder is present.
When should you see a doctor?
Childhood emotional disturbances should be clarified by a physician as soon as they are perceived as unusual by parents or close relatives. If the child’s behavior differs from that of peers, this is considered an indication to see a doctor and determine the causes. Children go through different phases in which they show conspicuous behavior. This is considered normal and does not need to be investigated or treated. However, persistent crying or screaming for several hours is an indication of an existing problem that needs to be discussed and medically clarified. There may be physical as well as emotional distress for which the child needs help to cope. If the child refuses to eat, immediately spits out the meal he or she has ingested, or noticeably withdraws from social contact, there is cause for concern. In the case of children who do not play, are apathetic, uninterested as well as apathetic, a visit to the doctor is necessary. If the child’s behavior changes suddenly after an event experienced, consultation with a physician should be sought. The loss of a parent, a move, or a change in attendance at social services may be triggers. In these cases, the child needs support in processing what has happened.
Treatment and therapy
In most cases, outpatient treatments are sufficient. A multimodal approach is usually used. First, children and parents should be given information about the anxiety disorder. This part of the therapy is also called psychoeducation. In addition, behavioral interventions, psychodynamic psychotherapies and also body psychotherapies can be carried out. Family therapies or involving the family in therapy can improve treatment outcomes. In individual cases, treatment with psychotropic drugs may be necessary. In particularly severe cases, outpatient treatment is not sufficient, so inpatient or day-care therapy may be necessary.
Outlook and prognosis
The prospect of recovery in childhood emotional disorders is tied to several influencing factors. Key predictors include the child’s personality, timing of treatment, environmental influences, and progression of existing disorders. The prognosis worsens as soon as multiple mental disorders are present and the social environment does not respond appropriately to the existing complaints. In these cases, there is a risk of an increase as well as manifestation of the complaints. If there is a lack of support, confidence and understanding, the symptoms can worsen or take a chronic course. In most cases, anxiety is the trigger for the emotional disturbances. Parents and legal guardians can also comprehensively discuss how to deal with fears and insecurities without therapeutic support. Specialist literature or various institutions offer many offers of help that can be used. With appropriate reactions as well as training in everyday life, improvements in the symptoms are possible. Emotional fluctuations occur in everyone. If the circumstances are explained to children and their fears are taken seriously, the symptoms are often alleviated. With the use of therapy, in many cases a faster improvement of the disorders is achieved.The competence of a therapist enables targeted work with the causes of the disorders. Parents receive comprehensive education and important behavioral advice.
Prevention
Because the exact causes of childhood emotional disorders are unknown, it is not possible to prevent the individual disorders.
Aftercare
Special measures of aftercare are usually not available for this disorder. In this regard, the emotional disorders in childhood should be detected as early as only possible and treated by a physician to prevent complications or other psychological upsets or depression later in adulthood. It is crucial that parents recognize the symptoms of emotional disorders in childhood at an early stage and consult a doctor. The treatment of this disorder always depends on the exact manifestation and is usually accompanied by a psychologist and in some cases also supported with the help of medication. Parents should ensure that their children take their medication correctly and regularly in order to alleviate the symptoms. Often, empathetic conversations with the children are also necessary to alleviate the fears and complaints and to limit these disorders. However, whether this will result in a complete cure cannot be universally predicted. The support of the entire family may also be useful in this process. The child’s life expectancy is not usually limited by disorders of this type.
Here’s what you can do yourself
Emotional disorders in childhood generally require professional therapy. This should begin early after diagnosis to give the child the best possible opportunities for development. Appropriately trained therapists for the specialty of emotional disorders in childhood can address the problem in a targeted manner and often achieve good results relatively quickly, from which the child’s social environment also benefits. Once a diagnosis of a disorder has been made, it is not advisable for parents to act as the child’s therapist in everyday life. In the absence of psychological expertise, no improvement can realistically be achieved, and procrastinating on professional therapy means suffering for the child. In terms of self-help, parents can do little when diagnosed with childhood emotional disturbance. Nevertheless, they have possibilities to support their child in everyday life and to accompany it through the therapy. This includes a positive view of the therapy and the willingness of the parents to work constructively with the therapist. It is also helpful for the child to have a clearly structured daily routine that helps him or her to find his or her way around despite the disorder, to know the rules and to be guided to follow them. Especially children with emotional disorders can often appear demanding and exhausting for their environment. These children in particular need explicit reassurance of parental love again and again in order to develop good self-esteem.
