Abnormal Psychology: Childhood Depression and Disorders

Childhood Depression

• Childhood depression is difficult to detect because children may not express their feelings and tend to act out their problems and concerns.
• Some states of depression are temporary and acute, precipitated by traumatic events.
• Causes of childhood depression include:
  • Physical health: chronic or severe medical conditions, such as obesity, diabetes, cancer, and chronic renal failure.
  • Stressful events: changes at home, school, or with friends.
  • Environmental factors: stressful home life.
  • Family history: mood disorders or depression in family members.
  • Biochemical imbalances: uneven levels of certain hormones and chemicals.
• Characteristics of a child with depression:
  • Behavioral signs:
    • Predominant sad facial expression.
    • Solitary play or work.
    • Disinterest in play.
    • Withdrawal from previously enjoyed activities or relations.
    • Lower grades in school.
    • Lack of interest in homework or achieving in school.
    • Diminished motor activities.
    • Tearfulness or crying.
    • Being dependent or aggressive.
  • Internal signs:
    • Statements reflecting low self-esteem.
    • Sense of hopelessness, guilt.
    • Suicidal ideation.
  • Physiologic signs:
    • Constipation.
    • Not feeding well.
    • Change in appetite resulting in weight loss or gain.
    • Alteration in sleep patterns, sleepiness, or hypersomnia.

Nursing Considerations for Childhood Depression

• Identification of depressed children requires a complete history, including:
  • Healthy growth and development.
  • Social family health.
  • Interviews with the child and family.
  • Observation by the nurse, parent, and teacher.
• Instruct parents about the importance of early treatment.
• Depressed children are managed by a healthcare team prepared in the care of children with mental disorders.
• Suicidal children may be admitted to the hospital for protection if the family is unable to provide constant monitoring.
• Pharmacological management may involve antidepressant drugs, with consideration of the child's age and close monitoring by parents and caregivers.

Enuresis

• Definition: intentional or involuntary passage of urine into bed or clothes during the day, usually in children beyond the age of bladder control.
• Inappropriate voiding of urine must occur at least 2 times a week for at least 3 months.
• Signs and symptoms:
  • Urgency.
  • Acute discomfort.
  • Restlessness.
  • Urinary frequency.
• Incidence: more common in boys, usually nocturnal bedwetting ceases between 6-8 years.
• Causes:
  • Organic causes: structural disorders in the urinary tract, urinary tract infections, neurological defects, and disorders that increase normal urine output.
  • Emotional causes: emotional factors, fear, anxiety, and stress.
• Therapeutic techniques:
  • Medications: tricyclic antidepressants, anti-diuretics, and anti-spasmodics.
  • Bladder techniques and training: scheduled bathroom visits, restriction and elimination of fluids after evening meal, and interruption of sleep to void.

Nursing Considerations for Enuresis

• Help children and parents understand enuresis as a problem that needs a treatment plan.
• Provide constant support and encouragement to both the child and parents during the treatment process.
• Advise parents that punishment is contraindicated due to its negative emotional impact and limited success in reducing behavior.
• Provide the child with a feeling of confidence.

School Phobia

• Definition: an overwhelming fear of school, often a symptom of other anxiety disorders.
• School phobia is more likely to affect children during times of transition, such as starting middle school or high school.
• Children with school phobia often become physically ill at the thought of going to school.
• Incidence: affects about 2-5% of all children, most common in young children ages 5-6 or middle school-age children ages 10-11.
• Children at risk:
  • Those with an overprotective caregiver.
  • Those who are naturally more anxious.
  • Those who are an only child, the youngest child, or chronically ill.
• Causes:
  • Home-related causes: violence, financial instability, food insecurity, lack of adequate housing, lack of attention from parents, and significant family changes.
  • School-related causes: bullying, fear of criticism or punishment, learning difficulties, and worry about terrible events.

Symptoms of School Phobia

• Physical symptoms:
  • Diarrhea.
  • Headaches.
  • Nausea and vomiting.
  • Stomach aches.
  • Tremors or uncontrollable shaking.
• Psychological symptoms:
  • Being afraid to leave caregivers.
  • Fear of the dark.
  • Nightmares.
  • Thoughts about their safety or the safety of others.
  • Tantrums.

Management of School Phobia

• Talk therapy: cognitive behavioral therapy helps children identify unhelpful or untrue thoughts and replace them with rational ones.
• Exposure therapy: gradually introducing the fear of school into daily life, eventually facing the fear in real life.
• Medication: particularly if a child has an underlying mental health condition, such as an anxiety disorder, antidepressants like selective serotonin reuptake inhibitors (SSRIs) may be helpful.