Continuing our discussion on childhood psychiatric disorders, we will learn more about elimination disorders, tic disorders and disruptive behaviour disorders in this article.
![Childhood psychiatric disorders – Elimination and Tic disorders]( "Childhood psychiatric disorders – Elimination and Tic disorders")
Elimination disorders
These are of two types – enuresis concerned with involuntary passage of urine at an age where control should be achieved or encopresis which means involuntary fecal soiling at an age beyond which continence should be there. Generally urinary continence should be achieved by three years and bowel control by about four years.
Enuresis – This can occur during the night (most common) or during the day or both. The cause could be medical (due to spinal cord abnormalities, diabetes, seizures) or psychological (due to emotional upset). Sometimes the child may have never achieved bladder control while in other cases bladder control is achieved for a few months but then bed-wetting occurs.
Encopresis – The child may refuse to use the toilet or too much parental pressure may force the child to retaliate by refusing to pass stools in the toilet but pass them elsewhere like in the clothes or in the room. Or the child may be willing to pass stools at home but not in school due to the change of toilets. Encopresis may be associated with abdominal pain, constipation, anal abnormalities or may even be a consequence of sexual abuse. In most cases, no medical basis is found.
In both cases, positive reinforcement, rewarding good toilet habits and resisting from putting pressure on the child work well. The parents and a doctor whom the child trusts should work together and the prognosis is generally favourable.
Tic disorders
Tics are involuntary movements of the eyes, fingers, shoulders or feet or sounds that a person cannot control and usually manifest in childhood. Tics can be controlled for a little while but ultimately they will come out. An example of a tic disorder is Tourette’s syndrome. This is a neurological condition in which a person has two tics related to movement and one related to sound. It can be blamed on genes and may cause considerable psychological distress to a child as he may be ridiculed in school or called names like `weirdo’. Medication can be given to control the tics but psychological counselling is also important to build up the self-esteem of a child and enable him to interact with his peers without fear.
Disruptive behaviour disorders
The name is self-explanatory and includes Oppositional Defiant disorder (ODD)and Conduct disorder. These disorders are more prevalent in boys and are more commonly observed in urban areas. Family discord, absent or indifferent parenting and absence of a loving home environment are noted in children with disruptive behaviour problems.
About oppositional defiant disorder – It is characterised by hostility, irritability and temper tantrums. The child is uncooperative and shows this behaviour not only to authority figures like their parents but also towards siblings and friends. There is often a family history of substance abuse, mood disorders or behavioural problems. Depression, anxiety or ADHD may coexist.
About conduct disorder – This can be views as a more serious form of ODD and the child may threaten to do harm or actually be aggressive at home or in school. The child may steal or bully other children. The child may feel that everyone is against him and thinks negatively about people and situations.
Both disorders are treated with cognitive behaviour therapy along with family counselling and reworking social skills. Coexisting psychiatric conditions should be identified and treated. These disorders, if they go untreated may lead to delinquents or thieves in adulthood. Conduct disorder is more difficult to treat than ODD.
This concludes the topic common psychiatric conditions of childhood.
Photograph via sxc.hu
Written by Dr Nisreen Nakhoda, General Physician
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Childhood psychiatric disorders – Causes and types is a post from: mDhil
