‘Separation Anxiety’
 

 

Problem in Children

By: Damilola Aliu - Psychology Dept.

Some children if separated from their caregivers become anxious and upset. They cry loudly and cannot be consoled by anyone but their caregivers. This is however a normal reaction of child to separation. With normal development, however, most infants come  to understand that their caregivers will return with time and they find ways to comfort themselves while their caregivers are away.

Some children continue to be extremely anxious when separated from their caregiver, even into childhood and adolescent age.

Separation anxiety is not diagnosed unless a child shows symptoms for at least 4 weeks and the symptoms seriously affects the child’s ability to function in every day life.

 

What to look out for:

  • Children with this emotional disorder may refuse to go to school because they fear separation from the parents.
  •  They cannot sleep at night unless they are with their caregivers.
  • They experience nightmares with fears of separation.
  •  If separated from their parents, they worry so much that something bad will happen to them.
  •  They exaggerate fears of natural events (thunder, storm, lightening) and or robbers, kidnappers, and accidents.
  • They may have stomachaches and headaches, become nauseated and vomit if forced to separate from their parents.

This problem is more common in girls than in boys and if left untreated can recur frequently throughout childhood and adolescent, significantly interfering with the child’s schooling and peer relationships.

 

Causes

It may be triggered off by severely stressful life events such as:

  • Child abuse.
  • The loss of parents, siblings or loved ones.
  •  Institutionalization (e.g. being placed into an orphanage, into foster care).
  • Moving to a new house. What should parents do?

Persuade the child to confront and remain in the presence of the feared situation (by leaving the child), then very gradually expose him/her to progressively longer duration of time that you are absent from him. Eventually, the child gets used to it over time and becomes less anxious when the parents leave home.

 

Medications may sometimes also be required to treat Separation Anxiety problems if the problem is severe and persistent. Both antidepressants and anxiety reducing medications have been used with success. Children who are using these medications should meet regularly with a mental health therapist so that they can be closely monitored.

 Juvenile Delinquent
 

 

Dr. (Mrs.) Ijarogbe. T.G. - Consultant Psychiatrist

 

Stubborn, wicked, callous, disobedient, thief, unruly, disrespectful, cunning, disorderly, cruel, extravagant, destructive, temperamental, troublesome, inconsiderate, selfish, lawless, obstinate, cheats, vandal, promiscuous are a few of the terms used to describe the delinquent child. Most of these children are boys rather than girls and abnormal trends of manipulative behaviors would have been noticed in these children as early as 3-4 years of age and could become distinctly obvious by about 8 years of age.

 

Initially, most of the disturbances from such a child are within the family circle towards parents, siblings, etc but as the child grows older and attains schooling and goes out of the home he begins to offends other individuals outside the family setting his/her peers, teachers and authority figures, in worship centres, neighbors and sometimes even law enforcement officers. This pattern of disturbing behaviors is usually persistent and parents tend to get varied complaints from all the aforementioned people outside his home.

 

Incidentally, though all the authority figures both within and outside the home should help to modify and configure the child’s character, unlike other children, these authority figures would have noted that the delinquent child has a been particularly evasive and uninhibited by “correction”.

 

Rather he is un-daunting or unflinching pattern of behavior that is resistive to correction.

 

Possible causes of juvenile delinquency

  • Parental reinforcement of bad behaviors
  • Inadequate parenting skills
  • Lack of authoritative instructions to the child
  • Family disruption like divorce, parental separation etc.
  • Lack of time by authority figures for adequate child supervision
  • Bad peer pressure and influence
  • Criminal behaviors by older family members
  • Child role models e.g. parents or caregivers have bad character.
  • Economic setback or poor living conditions in family
  • Environmental influences, like living in slums, where most of the child’s peer group are touts
  • Sending child on criminal errands
  • Childhood losses like death of a parent, sibling or a strong attachment figure to child
  • Childhood diseases especially the immunizable diseases, brain infections, major illnesses or surgery in childhood
  • Birth problems or complications when child was born or illness in the mother when pregnant with child
  • Mental illness of any type.

How do you recognize the delinquent child at home

  • Child usually disobeys household rules
  • Child could be very wicked and destructive for no reasonable reason.
  • Child is never remorseful for any misdeeds
  • Child blames other people for his own misdeed and always refuses to act responsibly
  • He is constantly at war with the school or any other authority figure that has to do with him and lacks minimum respect for these constituted authority figures
  • He is always  cunning and manipulative to ensure gain on his side also steals.
  • He has careless disregard for the consequences of his bad behaviors
  • He engages in behaviors forbidden for children who are his own age
  • Child lies and cheats others with ease and finds nothing wrong in it
  • He uses hard drugs and other substances
  • He keeps the company of other children/adults who are known of bad influence
  • Child has a preference for criminal company
  • Child has an increasing tendency to resist correction or any punitive measure after erring
  • Child engages in criminal behaviors like murder, arson, fire or other acts for which an adult could have been jailed.

 

How do you cope with the delinquent child.

This is very difficult and challenging for the family involved. An approach of systematic management of child’s behaviors may be professional psychiatric services who would be able to diagnose the child and treat any other treatable condition in the child. It is very dangerous to take it for granted that child will eventually grow out of it.

Management will have to address the social, interpersonal, educational, legal, ethical and family problems in a multi-modal fashion . professional intervention will be in form of drug treatment, family enlightenment, training, education, care and control as well as correction of bodily problems. Integrative planning by all stakeholders is crucial if any success is to be achieved.

 

Possible prevention may still best cure

  • Recognize the delinquent child early enough
  • Seek for professional help early enough
  • Reinforce moral and spiritual values within the home setting early in life
  • Monitor the child’s activity closely and do not hesitate to challenge any inconsistent or suspicious activity.
  • Be persistent in punitive measures towards any adverse behaviors in child. Do not shift the goal past.
  • Also, do not hesitate to reward any good behaviors noted in child
  • Encourage only good peer association. Discourage the child from associating with bad company.
  • Occupy child’s time with enough good and rewarding activities within and outside the home setting and ensure that schedules are adhered to.
  • Though difficult, make sure that child is in the society figures when he/she is away from home.
  • Talk and counsel child often, make him realize the consequences of his bad behaviors.
  • Child should be taught to respect other people in person, respect other views and control his urge for outburst/violence when his views are side-stepped.
  • Supervision is important. Do not just scold the child for doing wrong and walk away. Take time to explain why the action is wrong and why the punitive measure is deserved.

 

Remember that you are the child’s greatest role model. Be around the child long enough for him to role model you. The houseboy or girl could be the role model if you replaced your attention with theirs.

Emotional separation could be present if you are in the house but distant from the child. Plan activities that encourage active interaction between you and the child. this fosters trust and gives room for the child to learn.

 

Where the active intervention of your psychiatrist has been sought and recommended, do not fail to attend the clinic sessions personally with the child as a parent. It is important to adhere to all the instructions given at these sessions and to consistently give a feedback to the mental Health team.

 

“Change” does not come is a day, but management of the difficult child using several modalities over several months may produce the desired attitudinal and behavioral changes.

 Child Abuse
 

 

Dr. Nwagbo (Resident Doctor)

Child abuse is the one deliberate maltreatment of the child either through direct physical “assault”, neglect, emotional abuse, sexual exploitation, etc. it also includes fabrication of illness such that the child is exposed to the pain and discomfort of unnecessary physical investigations e.g. lumbar puncture, needle pricks, etc.

FORMS OF CHILD ABUSE

  1. Physical abuse (non-accidental injury)
  2. Emotional Abuse
  3. Sexual Abuse.

Sexual abuse refers to the involvement of children in sexual activities which they do not fully comprehend and to which they cannot give informed consent. This violates generally accepted cultural rules and also covers some activities like posing for pornographic  photographs or films.

 

Emotional abuse refers to persistent neglect or rejection of the child and this affects his development. This comes in form of frequent belittling or sarcastic remarks about a child from the parents.

 

Physical abuse is a term used when serious physical injuries are inflicted by adults on a child.

 

CAUSES OF CHILD ABUSE

Some risk factors are usually identified either in the abuser, the abused or in     both.

  1. Sexually deviant behavior in the abuser.
  2. Lack of moral conscience in the abuser
  3. Lack of cultural restraint by the environment
  4. Excessive fear of adults in the child
  5. Ignorance that sex is wrong for a child in the abused
  6. Presence of mental illness in the abuser or parents of the child
  7. Poor parenting skills
  8. Lack of awareness of child’s abuse status by parents
  9. Presence of a stranger in the home
  10. Lack of home supervision especially from nuclear family members
  11. Mentally retarded child
  12. Criminal behavior in people living around the child
  13. Persistently sick children

 

The Abused Child

Most the abused children are between 4 months to 18 years of age whist children of about 12 years are mostly involved. Most of the brutally beaten kids of about 3-4 years are abnormal children who may need medical attention.

 

HOW TO PREVENT CHILD ABUSE

By the community

The first part of treating child abuse is to ensure the child’s safety and well being. This often requires admission to hospital. Subsequently, some children can be managed at home, but some need foster care.

  1. If help is feasible, it should be intensive and should probably focus on changing patterns of parenting skill to improve parental function.
  2. Diminish the social or environmental stress on family if possible.
  3. Reduce the adverse physchological effects of social problems on the parents through counseling groups, religious activities.
  4. Reduce the demands on the child’s smother to a bearable level through day care placement of the child or provision of a house keeper or baby sitter among others
  5. Provision of emotional support for the child
  6. Ensure effective home supervision.

 

By the health team

To prevent child abuse, clinicians must identify those families at high risk and intervene before a child becomes a victim. Once high risk families have been identified, a comprehensive program should include psychiatric monitoring of the families including the identified high risk child. Families can be educated to recognize when they are being neglectful or abusive and alternative coping strategies can be suggested.

In general, child abuse prevention and treatment programs should try to prevent the separation of parents and children if possible, prevent the placement of school in institutions, encourage parental attainment of self care status and encourage the families’ attainment of self-sufficiency.

 

The outcome of treatment

The outcome of child abuse depends on the severity, duration and nature of the abuse, parents’ readiness to help child and the child’s vulnerability. It could be a success story if the community, the health workers and child’s caregivers are ready to monitor progress consistently. Children who already suffer from mental retardation, psychiatric problems, physical disability, disruptive behavior and attention deficit problems are likely to have a poorer outcome than children who are unhampered by mental or physical problems. Children who have been subjected to physical abuse are at high risk of further problems, for example, the risk of further severe injury, mental problems, delay in development, learning difficulty and sometimes development of criminal behavior.

  Stress Management for Caregiver of Children with Mental Ill-health

 

Caleb Ademola Gbiri - Physiotherapists

Stress is the body’s reaction to undue demand placed on it. Every activity performed by an individual results in one or more stress reactions. Excess of these reactions may produce responses that will limit the performance of other systems in the body. Things that induce stress includes situations such as traffic congestion, frequent power failure, work demand, home demand, human congestion, longstanding illnesses etc.

 

Caring for a child with neuro-developmental challenges like epilepsy, cerebral palsy, autism among others could pose additional stress to the primary caregivers. The combination of the conventional daily stressors with that of caring for a ‘totally dependent child’. If not well managed could result in mental breakdown. It is worth nothing that for an event to be stressful, it has to be perceived as stressful, the nature of the event and the person’s resources, psychological defenses and coping mechanisms. These involve individual ego, a collective abstraction for the process by which a person perceives, thinks, and acts on external drives. A person whose ego is functioning properly is in adaptive balance with both external and internal worlds; if the ego is not functioning properly and resulting imbalance continues long enough, the person develops body reaction resulting into stress with an experience of chronic anxiety and restlessness/panic. When these symptoms are prolonged, they can result into other conditions like, hypertension, depression, heart attack, palpitation, mood disorders severe mental illness and even stroke. The challenges for caring for a neurologically defective child could have impact on the ego of the care-giver (parent). Apart from caring for this child, the care-giver also goes through additional stressors (work and domestic) like any other person does. Therefore, this is a case of double jeopardy.

 

The psychological effect of this stressor, if not well managed may result into mental illness. Whether the imbalance is external, between the pressure of outside world and the person’s ego, or internal, between his or her impulses and conscience, the imbalance produces a conflict. In the case of a person caring for a totally dependent child, the conflict is always the combination of interpersonal and intrapersonal. This often rub on his/her ego and rub his/her self-esteem. A person who has a child with epilepsy for example may be denied of some social engagement because of the condition of the child.

 

This is often more on the mother than the father. Most often, they may not have time to engage in recreation and leisure activity. Hence, making them to accumulate more stress metabolites and making mental illness imminent. A child with cerebral palsy needs care for all activity of daily living and often exhibits bizarre behaviors. However, everybody should understand that giving birth to this kind of child is not bore out of sin or misconduct. This child also is not in any way the architect of his/her fate. Therefore, adequate care should be provided. They can live comparable life any other child if well cared for.

 

Signs and symptoms of stress.

As one goes through his/her daily activities, stress responses are being elicited in one way or the other. Some of the obvious signs and symptoms of stress are:

 

Sleeplessness, palpitation, emotional disturbance, muscular tightness/ache/joint pains, loss of appetite, difficult swallowing, nervous ties, stuttering/shaky/strain voice, frowned/wrinkled forehead, headaches/migraine, grinding/clinching teeth, jaw pain, back ache, gas pain/cramp, acid stomach/heartburn, urinary difficulty, constipation, diarrhea, rigidity/impotence, dry mouth/throat, dizziness, cold hands/feet, panic, anxiety, frustration/irritation, hopelessness/desperate, poor memory, mental confusion/poor mental judgement, trouble concentration/indecisiveness, frequent cold, skin rash, excessive thirst with or without diabetic, sore in the mouth and or throat, indisposition, aggression  or overreaction to situations, decrease libido, restlessness persistent fever/runny nose or cough without any obvious infection, shortness of breath, coarse of slaw speech, body ache, chest pain, severe headache/head pain, undue fatigue or tiredness, pimples in the face, skin reactions, blurred and double vision, lack of concentration, among others.

 

Stress also lowers the body immunity. Stress signs and symptoms involves the combination of at least two or more of the above listed signs and symptoms.

 

Stress management and coping mechanisms

The way an individual manages and develop a coping strategy to stress is an important tool in healthy ego and personality. The ability of an individual to identify his/her stressors and manage it adequately is very mandatory if one is to live a life of good quality. Stress coping mechanism is influenced by age, gender, culture, income, race, and genetic factors. Some situations that will beyond the stressor threshold of a person might be still under for some other people.

 

Therefore, stress management and coping mechanism is an individualized process, depends on the interplay between the external factors and internal factors. The important goal of healthy life style is to increase the number of days in a year that an individual reports a pain free pain day and increasing the life expectancy in good health. Stress has been identified as one of the factors that increase pain reporting day in an individual. It is one of the major factors that contribute to reduction in life expectancy and quality of life. There is enough evidence that well prescribed and meticulously monitored physical exercises by the experts can reduce the incidence and accumulation of stress and stress induced reactions in the body.

 

Relaxation and exercise can be used to address stress and its complications well prescribed exercise regulates the body homeostasis, the nervous and the endocrine system thereby suppressing the negative body systems reaction to stress. People who engage in recreational activities have been shown to have less chance of developing mental illness as a result of stress even with genetic predisposition.

 

Adequate sleep and rest are very important in stress management. An individual who has less than eight hours sleep and faces tedious work situation that overwhelm the body system is likely to experience stress reaction. All work and no play make a jack boy. At least between 30 minutes and 1hour of rest and recess within 8 hours working period is also very important in reducing the incidence of the accumulation of stress induces reaction.

Engagement in recreation and leisure activity during the off working period is very important in stress management. People who engage in physical exercise have reduced chance of developing health condition, are happier and healthier. Religious activity has also been shown to be a good modulator of the mind towards effective performance. People who engage in social activities and relate socially are likely to express less stress than those that does not.

 

Eating habit also goes a long way in management of stress. The dimension health and wellness include the emotional (mental), intellectual, physical, social and spiritual. These dimensions are interdependent with the emotional dimension playing a pivotal role. A person who is able to cope well with stress and also manage adequately his/her stress is likely to live a healthy life style. Stress can be a hindrance to the achievement of goals by an individual. A person who is easily stressed up will have reduced efficiency and proficiency. It is therefore very pertinent for an individual not to allow stress to reduce his/her sense of well-being and quality of life.

 Caring for Children with Special Needs

Written By: Mrs. O.C. Ogun

A Parent in the Child Clinic

Children with special needs are children born with one form of disability or the other. Disability is the inability to carry out certain needed task due to physical or mental challenges.

Children with disability are born into every race, social class, culture, and sphere of influence known to mankind. Some of these children were born with these disabilities while some of them became disabled from one cause or the other after birth.

 

MY CHALLENGES AND NEEDS AS A PARENT

Parents of mentally challenged children face a lot of difficulties and I as a parent faced and I am still facing the following:

It was so difficult to psychologically accept the fact that my child had the diagnosed medical condition which the doctors said she had. I was worried and devastated and I visited all manners of places I shouldn’t have gone to just to seek for solutions but ended up complicating my issue.

My already meager finances became more difficult to manage. I could not cope with the dietary and helpful supplements recommended from the clinic. More so, the  services of various professionals like the physiotherapist, speech therapist, special educators at the same time were difficult to afford. My child needed a one to one attention and I had to cut down on all my comfort to afford it.

I faced a lot of problems with stigmatization from my neighbors and friends. It hurts deeper when it came from family members. When I go with my child to public places like the church, market, parties, on the streets or at the bustop, people tend to avoid us or scoff at us especially when the child just wants to interact with these people in her own little way.

My employer was becoming fed up with my repeated permissions take my child pot to the hospital for her scheduled appointments and because of this I became afraid for my job and started skipping some of my clinic visits. I have found that this is slowing down the initial good response to treatment I got when she first started therapy.

 

HOW HAVE I COPED

  • First, I have accepted this child and I show her a lot of love and attention no matter how other people feel about her.
  • I have been able to get her siblings to accept her and not to feel ashamed of her in the presence of the other.
  • I now seek for help and medical attention at recognized and reputable centers.
  • I have understudies and tried to understand my child and her perculiar needs and nature so that managing her would be easier for me.
  • I protect and defend my child from undue external aggression especially from people in public places.
  • I also watch out for this girl child who is blossoming into a youth now so that I can guard against unscrupulous men who may want to take undue sexual advantage of her.
  • As I pray, I watch out for every little potential she has and try to encourage and develop it. My greatest aim for this child is for her to be able to have an independent life after I might have gone.
  • May God continue to help and strengthen all parents who live with and care for children with special needs and may God also bless our hospital caregivers. Amen!
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