Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder (ADHD) is a behavioural disorder – that, due to its symptoms, affects learning. It is also commonly referred to as ADD or ADD/ADHD. Signs and symptoms include increased distractibility, difficulty focusing and completing tasks, an inability to follow instructions, restlessness, boredom, daydreaming and forgetfulness.
ADHD sufferers fall into one of the following three subgroups:
1. They are either predominantly hyperactive-impulsive and show little or no attention difficulties.
2. They are predominantly inattentive, showing little or no sign of impulsivity and hyperactivity.
3. They have a combination of both, with signs of distractible, hyperactive and impulsive behaviour. ADHD has been linked to genetics and diet and treatment may include a combination of medication, diet and therapy.
Autism
Autism is a developmental disorder affecting physical, social, and language skills, with onset typically before age three. Autism, Asperger Syndrome, and PDD-NOS (Pervasive Developmental Disorder – Not Otherwise Specified) fall under an umbrella of disorders commonly referred to as Autism Spectrum Disorders. The cause of autism remains unclear. Some studies suggest the disorder is hereditary, while others have linked autism to chromosomal abnormalities. The signs and symptoms of autism fall into three major categories of abnormalities.
1. Social abnormalities may include poor eye contact, reduced showing of objects and pointing at objects, a narrow range of facial expressions, difficulty establishing relationships with peers, and social avoidance.
2. Communication abnormalities may include delayed or lack of spoken language, poor conversation skills, lack of appropriate developmental play, and diminished gestures.
3. Behavioural abnormalities may include restricted and repetitive behaviour, stereotyped motor mannerisms such as hand-flapping, restricted interests, inflexible adherence to routines (with or without tantrums), and a preoccupation with specific objects.
Treatment is directed mainly at controlling behavioural signs and symptoms. Early intervention, including promoting language, developing social skills, and regulating behaviour allow for significant improvement in many children. Medication can improve behavioural problems, anxiety, depression, aggression and seizures. Some autistic individuals also experience gastrointestinal problems, and certain therapies directed at calming the GI tract can lead to an improvement in attention and learning in some autistic individuals.
Cerebral palsy (CP)
Cerebral palsy (CP) is a neurological disorder characterised by paralysis, resulting from abnormal development of (or damage to) the brain either before birth or during the first years of life. There are four types of cerebral palsy: spastic, athetoid, ataxic and mixed. Cerebral palsy does not necessarily include mental retardation; however, any cerebral disorder in early life may result in impairment of intellectual and emotional development. Epileptic attacks are common in many children with CP.
The causes of CP are multiple but may involve foetal diseases, embryonic malformations of the brain, an incompatibility of blood types between mother and foetus, respiratory problems during birth, paediatric infections, severe head injuries and poisoning. Genetics plays a small role. Treatment includes medication to relax the muscles and prevent seizures and psychotherapy to develop sensory, motor and intellectual assets.
Depression
Depression is a serious condition that lingers for weeks or months at a time and limits a child’s normal ability to function. Signs and symptoms include a persistent sad mood, daily feelings of worthlessness and hopelessness, consistent irritability, a lack of energy, an inability to enjoy simple pleasures, social withdrawal, weight gain or loss, unhealthy eating and sleeping patterns, constantly being down in the dumps, low self-esteem and frequent thoughts about death or suicide.
Depression is caused by a chemical imbalance in the brain and often runs in families. It can be triggered by a major event, such as the death of a loved one, a divorce, a big move or a relationship breakup. Stress can also trigger depression, especially in the teenage years. Depression can always be brought on by a chronic illness and the side effects of certain medicine. For a long time, it was believed that children did not get depressed, but depression in children is becoming more common. Depression can be treated successfully with psychotherapy and medicine.
Down syndrome
Down syndrome is a congenital disorder caused by a defect of chromosome 21.
There are three forms of Down syndrome:
1. The most common form is trisomy 21, in which all of an individual’s cells contain three, as opposed to two, copies of chromosome 21. The extra chromosome is a result of abnormal events in cell division that occur during embryonic development or during the development of egg or sperm cells.
2. A rare form of the disorder, known as mosaic Down syndrome, occurs when only some of an individual’s cells contain a third copy of the chromosome. Because there are some cells that retain the normal number of chromosomes, certain aspects of the disorder are not as severe as they are in people with trisomy 21.
3. Translocation Down syndrome is the only hereditary form of Down syndrome. It occurs when the extra chromosome 21 breaks off and attaches itself to another chromosome. Signs and symptoms range from mild to severe, and may include intellectual disability, a small head, flattened face, short neck, up-slanted eyes, low-set ears, an enlarged tongue and lips, and a sloping underchin. Other characteristics may include congenital heart disease, poor muscle tone, heart or kidney malformations and abnormal dermal ridge patterns on the hands and feet. With modern medical care, many persons with Down syndrome live into adulthood, although they do have a shorter life expectancy because they age prematurely. Depending on the severity of intellectual disability, some people with Down syndrome never become self-supporting; however, the majority can be taught to contribute usefully in the home or in a special working environment after they reach adulthood.
Dyslexia
Dyslexia is a chronic learning difficulty affecting approximately 10 percent of the population. It tends to run in families. People with dyslexia have normal intellectual functions but have difficulty with reading, writing, spelling and therefore learning in general. Signs and symptoms may include illegible handwriting, reversal of letters, improper letter or word sequences, difficulty reading aloud, frequent spelling errors, poor concentration, increased distractibility and difficulty memorising information. Dyslexia is more common among boys and is normally diagnosed in the early school years. If the disorder is not addressed, it can result in low self-esteem and a lack of confidence, as sufferers often feel stupid or incompetent. There is no known cause for the disorder but it can be treated successfully with special assistance usually involving a series of reading and learning exercises.
Dyspraxia
Dyspraxia is a disorder that affects the organisation of movement, as well as fine and gross motor skills, making movement clumsy and awkward. Other signs and symptoms may include language impairment, disrupted thought and learning processes, sensitivity to noise and touch, speech difficulties, emotional and behavioural problems. Children with dyspraxia are late in reaching developmental milestones. Dyspraxia affects each person in different ways and at different stages of development. It may be caused by anything that injures the brain, such as problems during embryonic development, a lack of oxygen during birth, brain damage following illness, a stroke or an accident later in life. Often there is no obvious cause and it sometimes runs in families. There is no cure for dyspraxia, but through various types of therapy, sufferers can achieve their full potential.
Hearing impairment
Children with hearing loss frequently appear to be normal, and often their handicaps are not easily apparent. The early identification and treatment of hearing loss can prevent delays in language, communication, and cognitive skills. Signs and symptoms that a child may be experiencing problems with their hearing include speaking very loudly or shouting, non-responsiveness to being called or to someone speaking behind them or out of their visual range, a dip in academic performance, complaints of ringing in the ears, turning up the volume on the TV, incorrect pronunciation of words, increased inattentiveness and daydreaming. Temporary hearing loss can be caused by an ear infection, a build-up of wax, a foreign object lodged in the ear canal, the common cold, disease and exposure to high frequencies or noise. Permanent hearing loss may be genetic or caused by disease, noise or injury. Treatment depends on the type and severity of the disorder but may involve antibiotics, surgery, hearing aids and speech therapy.
Obsessive Compulsive Disorder (OCD)
Obsessive Compulsive Disorder (OCD) is based on a cycle of unwanted thoughts and impulses (obsessions) and the need to repeat certain behaviours (compulsions). We all have habits and routines, but for sufferers of OCD these patterns of behaviour get in the way of their daily lives. A person with OCD may find their obsessions disturbing, but he or she can’t control them. Obsessions may present themselves randomly or they may be constant. Obsessive thoughts often bring on anxiety and fear, and sufferers attempt to get rid of the obsession by performing certain behaviours or compulsions. For example, a person with OCD may have obsessive thoughts about germs and will wash their hands every half an hour. Acting out the compulsion may suppress the obsession for a short time but as soon as it returns the cycle begins again. Common behaviour includes constant cleaning and grooming, checking locks and appliances, touching a body part or object repeatedly, ordering and arranging items. People with OCD often suffer from other anxiety disorders such as phobias, panic attacks and general anxiety. They may also suffer from depression or ADHD. There is no proven cause for OCD; however, research suggests it is linked to brain chemicals, and treatment includes medication
and therapy.
and therapy.
Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)
All young children can be naughty, defiant and impulsive from time to time, which is normal. However, some children exhibit extremely difficult and challenging behaviours that are outside the norm for their age. ODD and CD are behavioural disorders that share common signs and symptoms, such as a refusal to obey parents and teachers, a keenness to argue and aggravate others, a short fuse or low frustration threshold, frequent tantrums or dark moods and low self-esteem. ODD is a serious disorder which, if left untreated, can develop into the more serious CD, where behaviour escalates to include frequent truancy, drug use, bullying, aggression towards people and animals, lying, running away, and a keenness to start physical fights and to use weapons. Left untreated, CD often develops into criminal behaviour, such as sexual abuse, theft, robbery, vandalism and arson. Diagnosis should be made by a paediatrician in conjunction with a child psychiatrist. Treatment may include parental education, family therapy, behavioural therapy, anger management and medication.
Selective Eating Disorder (SED)
Selective Eating Disorder (SED) is characterised by the inability and unwillingness to try new foods or eat certain foods. It is normal for babies and toddlers to avoid certain foods as they grow and develop their palates. This is known as fussy or picky eating and is not cause for serious concern. However, when this type of behaviour towards food persists through childhood into adolescence it is known as Selective Eating Disorder.
People with SED only eat familiar or “safe” foods. Their food choices may be based on a particular food type, group, texture or aroma. In severe cases, they may even limit their food choice to specific brands. There is no limit to the amount of food they will eat within their range of acceptable foods. This disorder often leads to extreme distress and anxiety and sufferers will avoid social situations, especially ones where food will be present such as parties. The causes of SED vary greatly. Food choices can usually be traced back to events, memories and preferences from childhood. A single traumatic eating experience as a child, or fears of contamination, may contribute to the disorder. The effects of SED vary and include malnutrition, social avoidance, medical problems, an increased risk of osteoporosis and other problems related to vitamin and mineral deficiencies. SED is treated through various types of therapy and a slow exposure to new tastes.
Selective Mutism (SM)
Selective Mutism (SM) is an anxiety disorder in which a person, who is fully capable of speech and understanding language, fails to speak in certain social situations when it is expected of them. They function normally in other areas of behaviour and learning, though appear severely withdrawn and shy and might be unwilling to participate in group activities. A child with SM may be completely silent at school but speak quite freely or even excessively at home. The disturbance in speech interferes with educational achievement and social development. No single cause has been established, although evidence suggests a hereditary component and a link to anxiety. It is also more common in girls than boys. People with SM do not choose to be silent but are forced into silence by their extreme anxiety and are often perceived to be rude as they struggle to make eye contact, don’t smile, move awkwardly and can be sensitive to noise and crowds. Treatment involves a variety of psychotherapies, such as stimulus fading and desensitisation.
Sensory Processing Disorder (SPD)
Sensory Processing Disorder (SPD), sometimes referred to as Sensory Integration Dysfunction, is a neurological disorder in which the nervous system receives messages from the five senses and fails to interpret them into the appropriate responses. A person with SPD finds it difficult to act upon information received through touch, taste, smell, hearing and vision, resulting in a range of signs and symptoms. The most common of these include a heightened awareness of noise, a fascination with lights, fans and water, repetitive movements, walking on tiptoes, unusual awareness of pain and temperature, coordination problems, self-injury or aggression, avoidance of touch or certain textures, a dislike of grooming activities, sensitivity to sounds and smells. SPD may affect only one sense or multiple senses. Research suggests that SPD may be inherited. Other causes may include complications during pregnancy and birth, and environmental factors. Children with SPD are of normal intelligence and many are gifted. However, if they are not taught in a method that is suited to the way they process information, they may suffer academically and – coupled with low self-esteem – may become socially isolated. Treatment of SPD usually involves a combination of occupational therapy and other sensory integration therapies.
Separation Anxiety Disorder
All infants and toddlers experience separation and stranger anxiety as part of their normal development. When faced with strangers or routine separation from their parents and caretakers, children may cry and become anxious or clingy. Stranger anxiety usually starts at about eight months and ends by two years. Normal separation anxiety is at its strongest at 10–18 months and gradually subsides by the age of three. Separation Anxiety Disorder is something more serious. It begins in childhood and is characterised by excessive worrying that is out of proportion to the situation involving separation. Signs and symptoms of Separation Anxiety Disorder may include anxiety about losing loved ones, being kidnapped, getting lost, refusal to go to school or to bed at night, and nightmares about being separated. The cause of separation anxiety is usually a combination of environmental and genetic factors and treatment involves therapy with the possible use of medication.
Speech impairments
The most common types of speech disorders are articulatory in nature, and include cluttering, stuttering and lisping. Parents should not confuse normal developing speech with a speech disorder.
1. Cluttering is a congenital disorder, characterised by hasty, sloppy and erratic stumbling and poorly intelligible speech. It may resemble stuttering but the difference is that the clutterer is usually unaware of it, remains unconcerned, and does not seem to fear speaking situations.
2. Lisping is characterised by the mispronunciation of sibilants (“s” and “z” sounds) and may be caused by an abnormal number or position of teeth, the imitation of other lispers, a palatal-closure defect, slight hearing loss in the high frequencies as well as other psychological causes.
3. Stuttering is characterised by repeated sounds, syllables or words, which disrupt the normal flow of speech. No single cause has been identified and treatment involves a combination of psychotherapy and speech therapy. Children often mispronounce words, have difficulty with sibilants, hesitate, repeat or struggle to find the right words and use the sound “um” in their speech.
Tic disorders and Tourette syndrome
A tic, which may be motor or vocal, is a sudden and recurring muscle contraction occurring more often in the upper parts of the body. Tics are typically uncontrollable and limited to one part of the body but do not necessarily interfere with the use of the part involved. Tics occur most commonly in children between the ages of five and 12, and more so in boys than girls. The most common tics are grimaces, blinks, sniffs, snorts, clicks in the nose or throat, twitches and shrugs. Tourette syndrome is a neurological disorder characterised by sudden recurrent motor and vocal tics. Although the cause of Tourette syndrome is unknown, evidence suggests that there may be an abnormality of one or more chemical neurotransmitters in the brain. The onset of Tourette syndrome usually occurs between the ages of two and 15, and continues into adulthood. Signs and symptoms include the spontaneous repetition of words (either the individual’s own or heard words) and sometimes includes obscenities. Other vocalisations that may occur include grunts, barks, hisses, whistles and other meaningless sounds. Motor tics may be simple actions that are virtually unnoticeable or more complex, such as hopping, clapping, blinking, and fist-clenching. Sleep, intense concentration and physical exertion tend to suppress the signs and symptoms, while stress exacerbates them. There is no cure for Tourette syndrome, although signs and symptoms may improve with age. Medication is effective in reducing the frequency and intensity of tics. Psychotherapy and relaxation techniques can also be helpful.
Visual disorders
Children should have their eyes examined regularly as many visual disorders can be detected and treated early. Signs and symptoms that a child may have a visual disorder include constant eye rubbing, light sensitivity, poor focusing and visual tracking, abnormal alignment of the eyes, chronic redness or tearing, white pupils, an inability to see or read from a distance, squinting, difficulty reading, and complaints of headaches and dizziness. Common eye problems include lazy eye, eye misalignment, near- or farsightedness, astigmatism, congenital glaucoma and infantile cataracts. If caught early, most eye conditions can be treated and reversed. Children of all ages can wear glasses and even contact lenses.
Glossary
Syndrome
A set of signs and symptoms that tend to occur together and which reflect the presence of a particular disease or an increased chance of developing one
Chronic
A medical condition lasting a long time, usually three months or longer
Congenital
Present at birth
Chromosome
A visible carrier of genetic information. Most human cells contain two sets of 23 chromosomes, one set from each parent making up a total of 46 chromosomes in each cell.
Psychotherapy
The treatment of a disorder, mental illness or condition by psychological means. Psychotherapy may utilise insight, persuasion, suggestion, reassurance and/or instruction, so that patients may see themselves and their problems more realistically and have the desire to cope effectively with them.
Cerebral
Pertaining to the brain, the cerebrum or the intellect
Signs and symptoms
A symptom is evidence of disease that only the patient can perceive – for example, anxiety, back pain or fatigue. A sign is evidence of disease that can be seen or felt by a doctor, nurse or other observer – for example, a bloody nose.
Developmental disorder
A disorder that interrupts normal development in childhood. It may affect a single area of development (specific developmental disorders) or several areas (Pervasive Developmental Disorders).
Neurological
Pertaining to the nerves or the nervous system
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