Childhood Emotional Difficulties and Trauma | Psychological Assessment and Testing

Child Assessment & Testing - Emotional Disorder and Trauma

Emotional disorders are difficult to recognise in children and adolescents. Children find it difficult to verbalise their problems and some emotions, such as unhappiness or irritability, which are often dismissed by adults as a normal part of growing up. Contextual factors that influence the development of emotional disorders can be ignored by adults and children's emotional expressions may be seen as independent events.

While experiencing anger, sadness, fear and so on is normal part of learning about emotions and their regulation, some children experience intense emotional reactions that fall outside the normal range. The main childhood emotional disorders are major depression, anxiety disorders and trauma. Comprehensive Psychological Assessment Centre offers clinical/diagnostic assessments to help recognise and treat these disorders.

CHILDHOOD DEPRESSION

With a few exceptions, the symptoms of major depression in children are generally the same as in adults. These include persistent depressed mood, change in appetite, loss of interest in previously enjoyed activities, sleep difficulties, reduced energy level, frequent fatigue, feelings of guilt and worthlessness, reduced ability to concentrate and possible thoughts of suicide and self-harm.

Some of the symptoms of depression in children are slightly different from the adult form and/or require additional attention:

First, in adults one of the most important sign of depression is the loss of interest in previously enjoyed activities. With children, it should be noted that as they develop their interests change, so losing interest must be related to an activity that a child would normally still likely to enjoy.

Second, change in appetite and sleep patterns in children often involve an increase rather than a decrease. Children with depression may sleep more than usual and may over eat.

Finally, sadness may not be apparent among children suffering from depression. Instead children may act cranky, irritable and angry.

ANXIETY DISORDERS

The main forms of anxiety disorders in children are separation anxiety and posttraumatic stress. Both can co-occur with other childhood disorders, particularly externalising behaviour.

Separation Anxiety
Children with separation anxiety typically become very anxious when they are away from home or parents. For these children separation from the safety of home and parents is intolerable and they react strongly. The key characteristics are irrational fears that the parents will be harmed in some way or that the child will be abandoned by them. The worries and fears are more intense when a child is separated from the parents or required to separate from them. The anxiety reactions often involve:

Refusal to attend childcare, pre-school or school. The anxiety is not associated with the school or childcare facility, but with the inability to separate from parents.
Psychosomatic symptoms. Children with separation anxiety often become physically ill when they are required to go to childcare or school. They may experience headaches, nausea or vomiting. Monday mornings or the first attendance day during the week are often the most difficult times.
Reluctance or inability to sleep over at a friend's place or attend camps or overnight trips without the parents.
Persistent worry about harm to the parents when separated (e.g., accidents, burglary, murder, natural disasters...etc). Preoccupation with the worries and vivid fantasies about them.
Difficulty coping with the parents going out, whether staying with a baby sitter or older siblings. Children with separation anxiety may require detailed descriptions about the place where the parents are going to, how long they intend to stay, when are they going to be home and so on.
Recurring difficulty falling asleep. Children with separation anxiety need the company of their parents when go to bed and cannot fall asleep on their own.

Separation anxiety is relatively common and affect about 4% of children. While young children often experience separation anxiety, the condition peaks around early adolescence. Both boys and girls are affected, but girls experience it slightly more often.

Posttraumatic Stress
Reactions to trauma in children is very different from the adult experiences of traumatic stress. Generally, posttraumatic stress is characterised by the three symptom clusters of 1) recurring recollections of the trauma, 2) avoidance of any trauma related cues, and 3) persistent physiological hyperarousal. While adults more likely to express distress verbally, children, particularly young children, show a combination of problems.

Children typically show symptoms of hyperarousal through impulsivity, distractibility and attentional problems. Recollections of the traumatic incident may present through aggressive play, emotional numbing, avoidance of others and sleep problems. Additionally, children may experience sudden developmental regression or "return to a younger stage".

In the absence of clear knowledge about the traumatic incident, stress reactions in children can be misleading. Symptoms of hyperarousal may be interpreted as ADHD or conduct problems, whereas emotional experiences may be seen as childhood depression. In some cases parents can also misjudge their children's symptoms. Exposure to family violence and severe arguments during the early years may stay with children and may manifest through behavioural symptoms. Failing to recognise the connection between events in children's lives and later difficulties could lead to misdiagnoses and inaccurate treatment goals. A detailed diagnostic assessment by one of our expert child psychologists is the first step to make sure that children suffering from posttraumatic stress receive appropriate intervention.

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