Learning More About Children

Blonde girl with blue eyes holding red maple leaf

Imaginative Play

Assessing children for psychiatric symptoms can be much different than assessing adolescents or adults. Children tend to be less patient, full of energy and interested in moving around and playing. Adolescents prefer no parents present and enjoy privacy and brief sessions. Adults are on the opposite end, ready to spill everything onto the table. Learning more about children requires a few different approaches.

For instance, children enjoy imaginative play with dolls, puppets and toys. Imaginative play is when children are role playing and acting out various experiences they may have had or that is of current interest to them. During role playing, they are experimenting with decision-making on how to behave, while at the same time, practicing their social skills.

It’s crucial to develop rapport with children, more so than with adults. Adults can compensate for less rapport, but no rapport with a child is like talking to a wall; no response or meaningful information will be obtained. The rapport with children must also be built off side-conversations that are not related to their symptoms and experiences, while with adults, you can jump straight to the symptoms most of the time.

When you have developed rapport with a child via side-conversations and imaginative play, it becomes easier to assess their psychiatric symptoms; the child has become comfortable with your presence. During role playing, you may gain essential information by talking through the puppet or toy; this is a nice technique that often works well.

Children love to get lost in imaginative play; it’s like an escape from school, parents and other children. A child can start talking to a toy as if a switch were suddenly pressed: one second he’s talking to you and the other second his voice has changed and he’s talking to the toy. But you must be comfortable role playing with a child, or else he or she will lose interest in playing with you.

Also keep in mind that depressed children oftentimes do not manifest the same symptoms as depressed adults. They will often experience irritability and somatic symptoms such as headaches or abdominal pain. It’s important to always assess their home life as well, to make sure that their parents are giving them medication and that they are safe.

It takes patience, good rapport and imagination to learn more about children, but with time, it can turn into a fun and pleasant experience, especially when they are improving from their psychiatric symptoms.

What are your experiences with children suffering from psychiatric symptoms?

Are you Ready? (This is Defeating Stigma Mindfully)

Childhood-Onset Schizophrenia

Girl with schizophrenia lying on floor staring at ceiling

Crying On The Inside

If you’ve seen schizophrenia or a psychotic disorder in an adult, then wait until you see childhood-onset schizophrenia; your heart will break into a million pieces. These children do not even have the opportunity to experience a normal childhood; their symptoms get in the way and prevent them from functioning normally in society and at home.

Imagine your child’s school telling you that something might be wrong with your 14 year old boy or girl, and that he or she will no longer be accepted at this school. Now what do you do? You take your child to a child psychiatrist and he or she becomes diagnosed with schizophrenia.

What is schizophrenia? It’s a psychotic disorder that may present with hallucinations, delusions, disorganized speech and behavior, apathy, avolition, anhedonia, etc. About 80% of children with schizophrenia report auditory hallucinations as their main positive symptom. “Positive symptoms” is a misnomer; there is nothing actually positive about them.

Positive symptoms include hallucinations, delusions and disorganization. Negative symptoms include apathy, anhedonia, anergia, avolition, etc. Imagine your child having these symptoms while going to his new behavioral school; a special school where children with behavioral issues and inappropriate behavior are temporarily sent to, usually not longer than a year.

But then imagine your child being so affected by hallucinations and other kids not talking to him, that he no longer wants to attend the behavioral school; he just wants to stay at home and sleep. He may even say, “sleeping is my hobby.” Believe it or not, this is how severe childhood-onset schizophrenia presents in some.

While it is sad and heartbreaking to see adults suffering from a psychotic disorder, it’s 10x more sad to witness a child suffering from psychosis. Imagine a child schizophrenic keeping his head down while informing you, “I don’t know how to make friends. They just laugh at me.” What you basically take away from these words is the child crying on the inside; you don’t physically see the tears.

Let us all come together and support ending mental health stigma, so that we can better help these children become integrated in society. They should not be left behind under the blankets of their bed for six days a week, only to get a glimpse of society once a week.

We can do better.

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Behavioral Issues In Children

Sad boy with dark hair leaning on white chair

Children Will Be Disrespectful

All children display behavioral issues to a certain extent. But there are children who are sent to special behavioral schools because their behavior is deemed to disruptive or inappropriate for their regular schools. Behavioral issues in children are not uncommon and children will be disrespectful; this is something that should be expected.

Children who are sent to special schools for their behavioral issues come from many different backgrounds. Some were raised in single-parent homes where the absent parent was not there to provide them with structure, discipline or even love. These children may end up rebelling out of anger.

Some children were raised by parents who were not responsible from the start. These parents tend to be selfish, involved with alcohol or drugs or do not have the instinct to properly raise their children. When children are emotionally neglected, they become lost in their ways, and utilize their anger to take it out on others.

And then there are the children who were born with a neurodevelopmental disorder or developed a mental illness at some point during their childhood. These children may have autism, ADHD, intermittent explosive disorder, conduct disorder, disruptive mood dysregulation disorder or even childhood schizophrenia.

Children with neurodevelopmental disorders or mental illness may struggle much more than their peers, due to the nature of their illness. Parents often become frustrated and worried, not knowing what to do with them and how to better help improve their behavior. These children also become easy targets of bullying once they enter school.

Whenever a child is being disrespectful or demonstrating behavioral issues, do not be quick to jump to conclusions; in other words, do not allow your implicit bias to control your perception of them. These children, oftentimes, have a story behind their behavior; get to learn their story and you will become much more understanding of their situation.

Are you Ready? (This is Defeating Stigma Mindfully)

Patience With Autistic Children

Mother hugging autistic boy on her lap

Autism Spectrum Disorder

Autism is a developmental disorder of variable severity characterized by difficulty in social interactions and communication, and restricted or repetitive patterns of thought or behavior. Many autistic children are incredibly gifted in terms of intelligence, while others struggle academically and/or socially. Patience with autistic children is a must, whether you are a clinician, parent, family member, teacher or friend.

Patience is key because autistic children are not used to interacting with others at the level that society considers appropriate for age. These children may desire friends and companionships, but do not have the strength, courage or sometimes even interest to initiate conversations; making friends often proves to be a challenging task.

Autistic children may also be socially awkward: they may randomly start talking about a topic that is completely irrelevant to the conversation at hand. For instance, a psychiatrist may be encouraging an autistic patient to make school as fun as possible, and the patient will randomly ask, “Doctor, how tall are you?”

Autistic children may also ask questions in class to which the answers are obvious. For instance, a teacher may take away points from disruptive children, and suddenly an autistic child who was not being disruptive will raise his hand and ask, “Did I lose points too?”

Autistic children are also typically involved in repetitive thoughts or behaviors regarding a topic of their interest. For instance, a child may be fascinated with Pokemon and will only focus on his Pokemon cards, and conversations revolving around this subject. When other children attempt to engage the child in different activities or conversations, he or she may find it difficult to connect, resulting in an awkward experience or even bullying.

Many autistic children recognize that they are different, but are happy just the way they are. And the truth is that they are different and special just the way they are! We should not be mourning autistic children because of their differences. Rather, we need to embrace their differences, respect their ways, maintain patience and guide them if they require it.

We are all special in many different ways. What separates us is not our differences, but our lack of desire to appreciate our differences. That is why as a community, DSM can help eliminate the stigma and hatred surrounding mental disorders, substance abuse and anything else that is causing people to shy away in the background.

Together we can.

Are you Ready? (This is Defeating Stigma Mindfully)

Courageous Parenting

Father in white shirt carrying blonde boy on shoulders

Willing To Provide Growth

The importance of proper parenting cannot be stressed enough. There are so many children with mental health issues due to terrible parenting. It’s so easy to believe that children who have mental health issues must have done something wrong in their lives. But the majority never did anything wrong: it was improper parenting that worsened their mental health. Courageous parenting is what is needed.

But courageous parenting is not that easy for many people, because of the difficulty required in consistently providing morals, direction, growth and warmth to children. Many parents are also “victims” of unplanned pregnancies; if “victim” is even the right word. Their irresponsibility led to the birth of a child for whom they do not show much interest in raising.

When children are raised around parents who are not affectionate or have their own mental health problems, they can become isolated, anxious, socially awkward or even direct their anger onto themselves. When a child directs his or her anger onto themselves, it often manifests into depression. Remember that in children, depression often manifests as irritability.

Then there are parents of children with autism spectrum disorder who do not know how to deal with them, because of the behavior manifested by their illness. Children with autism are often socially distant, exhibit ritualistic behavior and have trouble connecting with others. Parents who are irresponsible will often ignore these symptoms and not provide them with the professional care that they require.

And then there are the parents who suffer from a substance use disorder. How many of you have watched videos online or heard stories of children being passed a joint from their parent? This is not that uncommon, believe it or not. There are also children who steal their parent’s marijuana in the house and start smoking it themselves. And that’s because the marijuana is just sitting there!

Courageous parenting requires putting yourself second and your child first. This means that education, morals and values, safety and guidance need to be constantly provided, in order for a child to reach his or her full potential. Courageous parenting is going beyond what is expected, and hoping and believing that your child will happily succeed in life.

It’s not that easy to be a great parent, but it’s very easy to be an awful one! The children of this world depend on us to provide them with excellent parenting skills, as well as growth, direction and love. If we can improve our parenting skills, then we will improve the next generation of children who will one day make the important decisions for our society.

Courageous parenting is an important step in making this world a better place for the present generations, and all the future ones to follow.

Are you Ready? (This is Defeating Stigma Mindfully)

Mental Illness In Children

Young girl with depression covering her face with palm

Understanding A Young Child’s Mind

Children are much different than adults in many aspects, one of them being how mental illness manifests in them. While mania is mania and depression is depression, it doesn’t mean that a mental illness demonstrates the exact same presentation in children as it does in adults. Mental illness in children can be quite different. That’s why it’s important to understand a young child’s mind and where they’re coming from.

Children view the world much differently than adults. Jean Piaget established stages through which a child develops intellectually throughout the course of childhood. While the stages won’t be mentioned here, one can easily find them and understand what children experience when growing up.

For instance, depression in children does not always manifest with the obvious sadness that can be observed in adults. Children with depression often display irritability and oppositional behavior. Parents may report that their child “does not feel like doing anything anymore” and “he’s always moody or angry!”

Some children may display borderline traits such as self-injurious behaviors, unstable relationships, risky behaviors such as smoking marijuana or cat-fishing the opposite sex on dating apps, etc. But these same children may also experience inattention and hyperactivity.

It becomes a challenge to properly diagnosis a child: is it borderline personality disorder, ADHD or normal childlike behavior? Some children and teens may even present with psychotic features. Parents may complain that their child talks to themselves, refuses to leave their bedroom, has a hard time making friends, is isolated and even hypersexual!

In child psychiatry, it is very important to listen to the parent’s side of the story as well as the child’s. But most importantly, understanding a young child’s mind is key to making a proper diagnosis or any diagnosis. Some children may need a lot of time to express their thoughts and feelings, and they will often shy away in front of their parents.

While mental illness is mental illness, child psychiatry is a different world from adult psychiatry. As much as the patient comes first, the parents or caretakers are just as important for collateral information. This makes child psychiatry a very team-dependent field.

Are you Ready? (This is Defeating Stigma Mindfully)

Social Communication Disorder

Boy with social communication disorder holding toy

Impaired By Communication

Social communication disorder is a neurodevelopmental disorder that presents in early childhood. It involves persistent difficulties in the social use of verbal and nonverbal communication. Children have difficulties with social participation, relationships or occupational performance.

Academic achievement may also present as a difficulty; ineffective communication impairs the learning environment, increases distractions and makes it harder to properly learn. The symptoms may become apparent at a very young age, but may not fully manifest until social communication on a consistent basis is required.

Children with social communication disorder struggle to use effective communication that is appropriate for a specific social context. They may have trouble with greetings, sharing information or understanding non-literal uses of language and nonverbal communication. This behavior increases their chances of not making many friends from a young age.

Children may also have difficulty in adapting their communication to the appropriate environmental context, such as speaking differently in a classroom where learning is expected, versus a playground where having fun is expected. They may also speak with an adult in the same manner as they speak with other children, not knowing how to adapt their communication.

They also have difficulty taking turns in conversation; instead, they may keep talking at inappropriate and awkward times, annoying other children and making them lose interest. They may also have difficulty with expressions, not knowing how to use verbal and nonverbal signals to regulate interactions.

If not explicitly spoken to, children with social communication disorder struggle to make inferences and understand non-literal meanings of language, such as humor, jokes or metaphors. This usually causes awkwardness and may even make the child prone to bullying or teasing by his or her peers.

Social communication disorder is not caused by another medical or neurological condition and is not attributable to autism, intellectual disability or another mental disorder.

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