Disorders
Autism
Autism is a type of pervasive developmental disorder (PDD). It interferes with a person's ability to communicate with and relate to others. Autism is a lifelong condition that results in some degree of social isolation.
Autism affects how a person perceives and processes sensory information. Signs of autism almost always develop before a child is 3 years old, although the condition is frequently not diagnosed until later. Typically, parents first become concerned when they notice their toddler does not respond or interact like other children of the same age. Toddlers with autism do not usually babble or talk normally, and may seem to have hearing problems.
The severity of autism varies. Some individuals need assistance in almost all aspects of their daily lives, while others are able to function at a very high level and can even attend school in a regular classroom. Although it is difficult to determine, studies show that below-normal intelligence occurs in about 70% of autistic children.1 In addition, the social functioning of autistic children is less than what is expected for their intelligence quotient (IQ) levels.
Symptoms
The severity of symptoms varies greatly between individuals; however, all people with autism have some degree of difficulty in the following areas:
Social interactions and relationships. These problems are the central feature of autism. They are evident early in a child's development.
Verbal and nonverbal communication. Unusual speech patterns and body language can make communication with an autistic person difficult.
Limited interests in activities or play. Children with autism may have unusual focuses or fascinations. This trait lasts throughout life, although the types of interests often change.
Home Treatment
Having an autistic child requires taking a proactive approach to learn about the condition and its treatment, while working closely with others involved in your child's care. You also need to take good care of yourself so you are able to successfully face the many challenges that go along with having an autistic child.
Educate yourself about autism
Ask your health professional or contact autism organizations to find professional training that helps you and other family members learn about autism and how to effectively manage the symptoms of an affected child. This type of training has been shown to reduce household stress and improve the functioning of an autistic child.5 Understanding the condition and knowing what to expect is an important part of helping your child develop independence as he or she grows older.
You should also become informed about your child's educational rights. Federal laws exist to provide services for handicapped children, which includes those with autism. In addition, there may be state and local laws or policies to aid children with autism. Find out what services are available for your child in your area.
Educating yourself about autism will also help prepare you for when your affected child reaches adulthood. Some adults with autism can live by themselves, work, and be as independent as other people their age. Other people with autism need continued support and help.
Asperger's Syndrome
Asperger's syndrome, also called Asperger's disorder, is a type of pervasive development disorder (PDD). PDDs are a group of conditions that involve delays in the development of many basic skills, most notably the ability to socialize with others, to communicate and to use imagination.
Although Asperger's syndrome is similar in some ways to autism -- another, more severe type of PDD -- there are some important differences. Children with Asperger's syndrome typically function better than do those with autism. In addition, children with Asperger's syndrome generally have normal intelligence and near-normal language development, although they may develop problems communicating as they get older.
Asperger's syndrome was named for the Austrian doctor, Hans Asperger, who first described the disorder in 1944. However, Asperger's syndrome was not recognized as a unique disorder until much later.
Symptoms of Asperger's Syndrome
The symptoms of Asperger's syndrome vary and can range from mild to severe. Common symptoms include:
Problems with social skills: Children with Asperger's syndrome generally have difficulty interacting with others and often are awkward in social situations. They generally do not make friends easily.
Eccentric or repetitive behaviors: Children with this condition may develop odd, repetitive movements, such as hand wringing or finger twisting.
Unusual preoccupations or rituals: A child with Asperger's syndrome may develop rituals that he or she refuses to alter, such as getting dressed in a specific order.
Communication difficulties: People with Asperger's syndrome may not make eye contact when speaking with someone. They may have trouble using facial expressions and gestures, and understanding body language. They also tend to have problems understanding language in context.
Limited range of interests: A child with Asperger's syndrome may develop an intense, almost obsessive, interest in a few areas, such as sports schedules, weather or maps.
Coordination problems: The movements of children with Asperger's syndrome may seem clumsy or awkward.
Skilled or talented: Many children with Asperger's syndrome are exceptionally talented or skilled in a particular area, such as music or math.
What Causes Asperger's Syndrome?
The exact cause of Asperger's syndrome is not known. However, the fact that it tends to run in families suggests that a tendency to develop the disorder may be inherited (passed on from parent to child).
How Common Is Asperger's Syndrome?
Asperger's syndrome has only recently been recognized as a unique disorder. For that reason, the exact number of people with the disorder is unknown, although it is more common than autism. Estimates suggest Asperger's syndrome affects from 0.024% to 0.36% of children. It is more common in males than in females, and usually is first diagnosed in children between the ages of 2 and 6 years.
How Is Asperger's Syndrome Diagnosed?
If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no tests for Asperger's syndrome, the doctor may use various tests -- such as X-rays and blood tests -- to determine if there is a physical disorder causing the symptoms.
If no physical disorder is found, the child may be referred to a specialist in childhood development disorders, such as a child and adolescent psychiatrist or psychologist, pediatric neurologist, developmental pediatrician, or another health professional who is specially trained to diagnose and treat Asperger's syndrome. The doctor bases his or her diagnosis on the child's level of development, and the doctor's observation of the child's speech and behavior, including his or her play and ability to socialize with others. The doctor often seeks input from the child's parents, teachers and other adults who are familiar with the child's symptoms.
How Is Asperger's Syndrome Treated?
There currently is no cure for Asperger's syndrome, but treatment may improve functioning and reduce undesirable behaviors. Treatment may include a combination of the following:
Special education: Education that is structured to meet the child's unique educational needs.
Behavior modification: This includes strategies for supporting positive behavior and decreasing problem behavior by the child.
Speech, physical or occupational therapy: These therapies are designed to increase the child's functional abilities.
Medication: There are no medications to treat Asperger's syndrome itself, but medications may be used to treat specific symptoms, such as anxiety (nervousness), depression, hyperactivity and obsessive-compulsive behavior.
What Is the Outlook for People With Asperger's Syndrome?
Children with Asperger's syndrome are at risk for developing other mental illnesses, such as depression, attention-deficit/hyperactivity disorder (ADHD), schizophrenia and obsessive-compulsive disorder. But, there are various treatment options available for these conditions.
Because the level of intelligence often is average or higher than average, many people with Asperger's syndrome are able to function very well. They may, however, continue to have problems socializing with others through adulthood.
Can Asperger's Syndrome Be Prevented?
Asperger's syndrome cannot be prevented or cured. However, early diagnosis and treatment can improve function and quality of life.
Tourette Disorder
Tourette disorder (TD) is a neurological (brain) condition that usually begins in childhood. It causes a child to make sounds or words (vocal tics) and body movements (motor tics) that are beyond his or her control. Tourette disorder is also known as Tourette syndrome and Gilles de la Tourette Syndrome. However, not all tics are TD and your child may have tics and not develop TD.
Motor tics usually begin between ages 3 and 8. Vocal tics can begin as early as age 3 but usually develop a few years after motor tics. Tics generally peak in severity at age 12. In most children, tics go away or decrease significantly in the teen years. However, tics can continue into adulthood.
The effect tics have on children varies. Some children have mild tics that have a small impact on their lives. However, even mild or infrequent tics may affect your child's self-esteem and relationships with friends and family. Severe and frequent tics may require treatment, including medication and counseling. Children may have tics that appear minor but which interfere with their ability to learn and cause embarrassment.
Children with TD often are depressed or unhappy or have attention deficit hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD).
It is important to remember that:
Tics are not a sign of lack of intelligence and do not affect intelligence.
The severity of your child's tics is not a good indicator of how well he or she will perform in school or in social situations.
Your child's intelligence and ability to adjust to change and the amount of support he or she receives from other people affect how well he or she will cope with the tics.
Symptoms
Symptoms of Tourette disorder (TD) include motor tics (sudden body movements) and vocal tics (sounds and words) that are not under your child's control. Motor and vocal tics can be simple or complex.
Simple motor tics involve only one muscle group, while complex motor tics can be a combination of many simple motor tics or a series of movements that involve more than one muscle group.
Simple vocal tics involve simple sounds made by moving air through the nose or mouth, and complex vocal tics involve words, phrases, and sentences.
The tics are not always obvious. They may come and go over a period of months, change from one type to another, or disappear for no apparent reason. Tics tend to lessen during sleep; your child may be tic-free when asleep. Tics can be suppressed (much like you can suppress a sneeze) or absent for short periods of time and are often absent during visits to a health professional or when your child is actively engaged in another interest. Tics may sometimes last longer and be more severe than usual, such as after your child tries to suppress them or when your child is ill, under stress, or highly excited.
However, not all tics are TD and your child may have tics and not develop TD. A common stereotype of people with TD is that they all have uncontrollable outbursts of cursing or socially taboo expressions and/or make obscene gestures or engage in uncontrollable, sexually inappropriate touching. This is not true. Very few people with TD have these types of tics. Other myths about TD include a belief that the child can control tics if he or she wants to or that people with TD are trying to get attention.
Bipolar Disorder in Childhood and Adolescence
What is bipolar disorder?
Bipolar disorder is characterized by extreme mood swings between mania (elevated mood or irritability) and depression. These mood swings are beyond the normal ups and downs that most people experience—they greatly affect the lives of those who experience them. Doctors used to think that bipolar disorder symptoms did not appear until the teen or early adult years. They now believe even a young child may show symptoms of bipolar disorder, although the symptoms in children are often different from those of adults. Early diagnosis and treatment can lead to more effective management of bipolar disorder and may reduce the risk of long-term problems that can result when bipolar disorder remains undiagnosed or untreated.
Bipolar disorder has also been called manic depression and manic-depressive disorder.
Symptoms
There are different types of bipolar disorder that are classified according to whether your child experiences more depression or more mania and how quickly the mood cycles occur. All types of bipolar disorder consist of cycles of depression and mania.
In children, the cycles often occur within the same day or can be continuous, rarely returning to a normal mood in between extremes. The rapid and severe mood changes may make your child appear constantly irritable, and they significantly interfere with your child's ability to function at school, at home, and with peers.
A combination of depressive and manic mood swings must occur for at least 1 week before considering bipolar disorder.
What Increases Your Risk
Your child's risk of developing bipolar disorder or other mood disorders increases if the child:
Has a parent or sibling with bipolar disorder. This condition may run in families. It is also possible that the behaviors of a parent with bipolar disorder are passed down to the child due to family dynamics and observance of these behaviors.
Have had several episodes of major depression. At least 15% of adolescents with recurring depression go on to develop bipolar disorder.4
Is entering puberty.
Certain factors can trigger depressive or manic episodes in your child, such as:
Erratic sleep or changes in daily routines.
Treatment with antidepressants, which can increase risk for a manic episode.
Stressful life events.
Not taking medications as prescribed.
Using alcohol or drugs (substance abuse).
Home Treatment
There are steps you can take at home to reduce your child's symptoms of bipolar disorder.
Keep your child's room quiet, and have the child go to bed at the same time every night.
Control the amount of stress in your child's life. You may need to seek ways to help your child reduce academic requirements during severe mood swings.
Learn to recognize the early warning signs of your child's manic and depressive mood episodes.
Steps your child can take to help control moods include:
Getting enough exercise. During a depressive episode, your child may feel like doing only gentle exercises, such as taking a walk or swimming.
Getting enough sleep and keeping a consistent sleep schedule.
Eating a balanced diet.
Avoiding the use of alcohol or drugs. Substance abuse makes bipolar disorder worse.
Learning to recognize the early warning signs of your child's manic and depressive mood episodes.
Asking for help from friends and family when needed.
Attention Deficit-Hyperactivity Disorder
Attention deficit-hyperactivity disorder (ADHD) is a developmental and behavioral disorder that affects 3% to 5% of all school-age children.
Although the condition usually manifests in childhood, it can persist into adulthood, causing difficulties at home, at school and at work if not recognized and treated.
In fact, experts now estimate that ADHD affects 30% to 50% of adults who had ADHD in childhood.
What Are the Symptoms?
The symptoms of ADHD include inattention, impulsiveness and hyperactivity that are inappropriate for a person's age level.
Children who have ADHD often:
Are easily distracted by sights and sounds in their environment.
Are unable to concentrate for long periods of time.
Are restless and impulsive.
Have a tendency to daydream.
Are slow to complete tasks.
What Causes ADHD?
The exact cause of ADHD isn't known.
Experts do know that there are changes in the brains of people with the condition. It is not caused by home or school situations or by poor parenting.
There's a lot of research in the medical community about the potential causes of ADHD. Learn more in the article Causes of ADHD.
How Is ADHD Diagnosed?
There is no single test used to diagnose ADHD. It is diagnosed after a child has shown some or all of symptoms of ADHD on a regular basis for more than 6 months.
The diagnosis of ADHD involves the gathering of information from several sources, including school, caregivers and parents. The health care provider will consider how a child's behavior compares with that of other children the same age.
The health care provider will also do a physical exam to look for any medical problems that may affect a child’s behavior.
How Is ADHD Treated?
Although there is no cure for ADHD, treatment can help control symptoms. There are several types of treatments available.
- Stimulants
- Stimulant medications (or psychostimulants) have been used to successfully treat ADHD symptoms for many years. Stimulants are used to treat both moderate and severe ADHD in adults and children over age 6.
- Stimulants used to treat ADHD include:
- Adderall and Adderall XR
- Concerta
- Cyclert
- Dexedrine, Dexedrine Spansules Capsules
- Focalin
- Metadate CD, Metadate ER
- Methylin
- Ritalin, Ritalin LA
Nonstimulant Therapy
In November 2003, the FDA approved Strattera as the first nonstimulant treatment for ADHD. It is the first treatment approved to control ADHD symptoms in children, adolescents and adults.
Antidepressant Therapy
Several types of antidepressant drugs can be used to treat ADHD. Antidepressant therapy for ADHD is sometimes used as the initial treatment in children or adults who also suffer from significant depression. Antidepressants, however, are generally not as effective as stimulants or the newer nonstimulant treatments at improving attention span and concentration. It also may take 2-4 weeks for the full benefits of antidepressants to appear.
Note: In October 2004, The FDA has determined that antidepressant medications increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health care provider. Learn more
Other Drugs
Two drugs, Catapres and guanfacine, normally taken to treat high blood pressure, have been shown to be of some benefit for ADHD when used alone or in combination with stimulant drugs. The drugs can improve mental functioning as well as behavior in ADHD.
Behavior Management
Learning behavior management techniques is considered to be an essential part of any successful ADHD treatment program. Most experts agree that combining medication treatments with extended behavior management is the most effective way to manage ADHD in children and adolescents.
Obsessive-Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD) is a type of anxiety disorder that causes you to experience obsessive, unwanted thoughts and to compulsively and repeatedly perform tasks to try to get rid of those thoughts.
Some common obsessive thoughts include excessive neatness, fear of germs, or worrying that you might think bad thoughts. A few common compulsive behaviors include frequent hand-washing, repeatedly checking zippers or buttons on clothes, and constantly cleaning or organizing things.
The effects of OCD range from mild to severe. OCD can greatly impair how you function socially, at your job, or in school. OCD is not a life-threatening condition, but it can cause major disruption in your relationships and daily functioning. People with OCD often need to make great changes in their lives because of the disturbing thoughts and repetitive behaviors.
Symptoms
Symptoms of obsessive-compulsive disorder (OCD) vary. Anxiety is a major symptom of OCD, and significant anxiety can interfere with the quality of your life. Repetitive behaviors (compulsions) often are closely connected to the disturbing thoughts (obsessions). For example, if you fear germs, you may wash your hands over and over again.
Common obsessive thoughts
Fear of dirt or germs or over concern about body smells/secretions or the proper functioning of the body
Over concern with order, neatness, and exactness
Fear of thinking bad thoughts or doing something embarrassing
Constantly thinking of certain sounds, words, or numbers or a preoccupation with counting or checking
Constant need for approval or the need to apologize
Fear that something terrible will happen or fear of harming yourself or someone else
Home Treatment
Taking care of yourself every day can be very important in dealing with obsessive-compulsive disorder (OCD). Learning as much as you can about your condition by reading or going to support or self-help groups can be very beneficial.
In addition, there are many ways you can reduce the amount of overall stress in your life, including:
- Reducing anxiety.
- Doing relaxation exercises.
- Eating a balanced diet.
What Increases Your Risk
If you have a parent or sibling with obsessive-compulsive disorder (OCD), your chance of developing OCD is slightly increased.
The period of greatest risk of developing OCD is from childhood to middle adulthood. Since the cause of OCD has not been found, there may be other factors that increase the risk of developing OCD that are not yet known.
OCD often accompanies Tourette disorder or other tic syndromes. Up to 50% of people who have a tic syndrome also have OCD.
Anxiety
Anxiety is an uncomfortable feeling of fear, uneasiness, or concern about something that is going to happen or that a person thinks is going to happen. Anxiety can have both physical and emotional symptoms, which can be mild or severe. When anxiety is severe, a person may not be able to do daily activities as well as usual.
Anxiety disorders are a type of mental illness characterized by severe anxiety that interferes with a person's life.
Anxiety disorders include:
- Generalized anxiety disorder, which may involve physical symptoms that occur along with anxiety.
- Panic disorders, which include sudden, irrational fear and feelings of danger or impending doom.
- Obsessive-compulsive disorder, which includes frequent, repeated thoughts leading to repeated or persistent behavior (such as excessive hand-washing).
- Post-traumatic stress disorder, which involves reliving a traumatic event (such as a war experience or rape) and feelings of numbness and disinterest in daily activities.
What is depression in childhood and adolescence?
Depression is a mood disorder with symptoms such as low energy, irritability or sadness, and lack of pleasure in daily activities. Children and adolescents can develop depression, although it was once believed they did not. This condition can be a chronic disorder made up of periods of time where the child experiences symptoms of depression, sometimes with periods of normal mood in between the depressive episodes. Just as in adults, symptoms of depression in children and adolescents can range from mild to severe.
Because “mood swings” and other emotional changes are considered a normal part of growing up, depression in children and adolescents often goes unrecognized. Children and adolescents do develop depression, and it can affect a child's quality of life. If prolonged or severe depression is left untreated, it can lead to serious outcomes, including suicide attempts and even completed suicide.
Seeing symptoms of depression in your child can be alarming. Trying to decide whether the symptoms are normal preteen or teenage moodiness or a medical condition that needs treatment can be difficult and stressful. However, depression in children and adolescents can be effectively treated with professional counseling and medications.
What Happens
Depression in a child or adolescent may first appear as irritability or sudden, unexplained crying. The child may lose interest in activities once enjoyed and feel unloved and hopeless. Sometimes the young person can become aggressive or defiant or have other disruptive behavioral problems.
The child may have a decline in school performance and become withdrawn. Depressed children may have difficulty making decisions or concentrating, or may have no energy. They usually have trouble sleeping or sleep too much. Depressed youth may complain of unexplained physical aches such as headaches, stomachaches, or pain in the back, legs, or arms.
It is common for others to notice that the child's body movements are slow, restless, or agitated. Your child may be self-critical or feel that others are unfairly critical of him or her. These feelings sometimes can lead to suicidal thoughts or attempts.
A depressive episode lasts an average of 8 months.4 Even with initially successful treatment, as many as 70% of children who experience depression will experience another episode of depression within 5 years.6
Approximately 30% of adolescents will develop alcohol or drug use problems along with depression.7 This can make depression more difficult to treat, increase the length of time before treatment is successful, and increase the risk of suicide.
Adolescents with depression are at particularly high risk for suicide and suicide attempts. In the United States, approximately 2,000 adolescents commit suicide each year.3 While adolescent girls attempt suicide almost twice as often as adolescent boys, boys are more likely to succeed because girls usually use less lethal means and survive the attempt.5 It is important that any warning signs of suicide be taken seriously. Suicide attempts in children younger than 12 are not common.
Home Treatment
In addition to taking medications and seeking professional counseling, good lifestyle habits can help reduce your child's symptoms of depression. Encourage your child to:
Get regular exercise, such as swimming or walking daily.
Avoid alcohol and illegal drugs, nonprescription medications, herbal therapies, or medications that have not been prescribed because they may interfere with the medications used to treat depression.
Be sure to get enough sleep. If your child has problems sleeping, he or she might try:
Going to bed at the same time every night.
Keeping the bedroom dark and quiet.
Not exercising after 5:00 p.m.
Eat a balanced diet. If your child lacks an appetite, try to get him or her to eat small snacks rather than large meals.
Encourage your child to be hopeful about improving. Improvement sometimes occurs gradually and takes time.
If your child is depressed, try to spend some quiet time together. Avoid giving advice, but encourage your child to stay in professional counseling and take medications as prescribed. If you notice any warning signs of suicide, seek professional help immediately by calling your child's doctor, professional counselor, local mental health emergency services, or 911 if you feel your child is in immediate danger.
Dyslexia
Developmental dyslexia is characterized by an unexpected difficulty in reading in children and adults who otherwise possess the intelligence and motivation considered necessary for accurate and fluent reading.
Children with dyslexia have problems translating the sounds within words (phonemes) into meaningful concepts, and therefore have difficulties learning to read and spell. This disability is also often marked by poor memory of spoken and written words. Other names for dyslexia are specific reading disability, reading disorder, and reading disability.
Reading is a complex cognitive process. Children learn to read by "cracking the code" of the symbolic language of letters. For example, the beginning reader must sound out each phoneme in a word. The word bat has three phonemes, the b, a, and t sounds. The combination of these sounds, its phonological pattern, creates the word bat. With fluency, a child instantly recognizes words and reading becomes automatic.
For children with dyslexia, reading is a different matter. They often cannot recognize phonemes, divide words into individual phonemes, or blend phonemes into words. They may have problems recognizing other written symbols such as numbers and mathematical symbols.
They may have problems recalling phonemes and words from memory, making reading slow and inaccurate. Children with dyslexia also may have difficulties with one or more of the following: pronouncing words, handwriting, planning and organization, and math computation.
Cause
What causes dyslexia is not known. However, there is strong evidence that suggests dyslexia is passed from parent to child genetically. Researchers have found that identical twins have a higher rate of dyslexia than nonidentical twins, an indication that genetic factors are involved in dyslexia.
Adding to this evidence, studies show a child with one parent who is dyslexic has 8 times more risk than the general population of developing dyslexia. Furthermore, researchers have found links between chromosome 6 and chromosome 15 and reading disabilities.
Numerous imaging studies show the dyslexic brain has different patterns of activity during reading than the nondyslexic brain. These studies reveal that people with dyslexia have abnormal function and structure in the regions of the brain involved in reading.
One study claims that covering one eye helped children with dyslexia read better. However, the American Academy of Pediatrics and the American Academy of Ophthalmology refute these findings and state that these treatments are not valid because dyslexia is caused by altered brain function and not by altered visual function.
Helping your Child
You can be a positive force in your child's education. Following is a list of ways parents can help their young children with dyslexia develop reading skills and feel good about themselves.
Read to your child. Starting when your child is 6 months old, find time to read to your child every day. Point to the words as you read. Draw attention to words that you run across in daily life, such as traffic signs, billboards, notices, and labels.
Be a good reading role model. Show your children how important reading is to their daily life. Make books, magazines, and other reading materials available for your children to explore and enjoy on their own.
Focus on phonemes. Play rhyming games, sing songs that emphasize rhyme and alliteration, play word games, sound out letters, and point out similarities in words.
Work on spelling. Point out new words, play spelling games, encourage your child to write.
Help with time and planning. Hang up simple charts, clocks, and calendars, so your child can visualize time and plan for the future.
Share in the joy of reading. Find books that your child can read but that you will also enjoy. Sit together, take turns reading, and encourage discussion. Revisiting words that cause trouble for your child and rereading stories are powerful tools to reinforce learning.
Read, read, read. Research has shown that parents who read to and with their children make a positive difference in learning basic reading skills.
Treatment Overview
Early identification and special education are important to overcoming your child's risk for reading failure. Finding the correct educational methods is part of an Individualized Education Program (IEP). Once a child 3 years and older has been diagnosed, federal law requires that your public school personnel develop an IEP, an education plan tailored to your child.
A treatment team made up of the child's parents and teacher, and other school personnel, including school counselors and special education teachers, will develop the IEP. The IEP details the child's specific disabilities, appropriate teaching methods, and goals and objectives for the academic year. It is evaluated at least once a year, with changes made depending on the child's progress. Parents have the right to appeal if they do not agree with their child's IEP.
According to a comprehensive federal study on how children learn to read, a combination of methods is the most effective way to teach children to read. These methods include teaching phonics, which is, making sure that the beginning reader understands how letters are linked to sounds (phonemes) to form words. The study also concluded that guided oral reading, in which the student reads aloud with guidance and feedback, is important for developing reading fluency. Also, the instruction must be explicit and systematic.
