Depression

Depression is a state of low mood and aversion to activity. It may be a normal reaction to occurring life events or circumstances, a symptom of a medical condition, a side effect of drugs or medical treatments, or a symptom of certain psychiatric syndromes. Depression in childhood and adolescence is similar to adult major depressive disorder, although young sufferers may exhibit increased irritability or aggressive, withdrawal from family and peers, poor scholastic performance and self-destructive behavior, rather than the all-encompassing sadness associated with adult forms of depression. Children who are under stress experience loss, or have attention, learning, behavioral, or anxiety disorders are at a higher risk for depression.

Signs and symptoms:

• Irritability or anger
• Continuous feelings of sadness and hopelessness
• Social withdrawal
• Increased sensitivity to rejection
• Changes in appetite  either increased or decreased
• Changes in sleep  sleeplessness or excessive sleep
• Outbursts or crying
• Difficulty concentrating
• Fatigue and low energy
• Physical complaints such as stomach aches, headaches
• Poor interest to do activities at home and  school
• Poor socialization
• Feelings of worthlessness or guilt
• Impaired thinking or concentration
• Thoughts of death or suicide

Treatment

Safety is the most immediate consideration in the treatment of depression. There are multiple treatments that can be effective in treating children diagnosed with depression. Psychotherapy and medications are commonly used treatment options. In some research, adolescents showed a preference for psychotherapy rather than antidepressant medication for treatment. For adolescents, cognitive behavior therapy and interpersonal therapy have been empirically supported as effective treatment options.

Oppositional Defiant Disorder (ODD)

Oppositional defiant disorder (ODD) is a behavior disorder in which the child is hostile, uncooperative and defiant toward peers, parents and other. Children who have ODD are often disobedient, easily angered and may seem to be angry much of the time. Very young children with the disorder will throw temper tantrums that last for 30 minutes or longer.

In addition, the child with ODD often starts arguments and will not give up. Winning the argument seems to be very important to a child with this disorder. Even if the youth knows that he or she will lose a privilege or otherwise be punished for continuing the tantrum or argument, he or she is unable to stop. Attempting to reason with such a child often backfires because the child perceives rational discussion as a continuation of the argument.

Most children with ODD, however, do not perceive themselves as being argumentative or difficult. It is usual for such children to blame all their problems on others. Such children can also be perfectionists and have a strong sense of justice regarding violations of what they consider correct behavior. They are impatient and intolerant of others. They are more likely to argue verbally with other children than to get into physical fights.

 Symptoms of ODD:

• Frequent temper tantrums
• Excessive arguing with adults
• Often questioning rules
• Refuse to do what an adult asks
• Deliberate attempts to annoy or upset people
• Blaming others for his or her mistakes or misbehavior
• Often being touchy or easily annoyed by others
• Excessive anger
• Mean and hateful talking when upset
• Spiteful attitude and revenge seeking

The symptoms are usually seen in multiple settings, but may be more noticeable at home or at school. The causes of ODD are unknown, but many parents report that their child with ODD was more rigid and demanding that the child’s siblings from an early age. Biological, psychological and social factors may have a role.

A child presenting with ODD symptoms should have a comprehensive evaluation for other disorders such as, attention-deficit hyperactivity disorder (ADHD), learning disabilities, mood disorders (depression, bipolar disorder) and anxiety disorders. It may be difficult to improve the symptoms of ODD without treating the coexisting disorder. Some children with ODD may go on to develop conduct disorder.

Treatment:

Individual therapy, family therapy, Training for parents and medications are necessary for controlling child’s defiant behavior.

Tips for parents:

• Always  give praise and positive reinforcement
• Take a time-out or break if you conflict with your child
• Set up reasonable, age appropriate limits with consequences
• Encourage in other activities like sports, music, arts etc…
• Spend more time with children
• Improve parent-child communication
• Reduce parental stress

Conduct Disorder

Conduct disorder is a group of behavioral and emotional problems that usually begins during childhood or adolescence. Children and adolescents with conduct disorder usually have behaviors characterized by aggression to persons or animals, destruction of property, deceitfulness or theft and multiple violations of schools such as truancy from school. These behavior patterns cause distinct difficulties in school life as well as in peer relationships.   Conduct disorder is more common among boys than girls with an onset of before age 13. Conduct disorder is associated with many other psychological disorders including ADHD, depression and learning problems, and it is also associated with certain psychosocial factors such as harsh, punitive parenting, family discord, lack of parental supervision, lack of social competence and low socioeconomic status.

Signs and symptoms:

Aggression to people and animals includes:

• Engaging in frequent bullying or threatening
• Often starting fights
• Using a weapon that could cause serious injury
• Showing physical cruelty to people & animals
• Engaging in theft
• Forcing someone into sexual activity

Property destruction includes:

• Deliberately setting fires to cause serious damage
• Deliberately destroying the property of others by means other than fire setting

Lying or theft includes:

• Breaking into building, car, or house belonging to someone else
• Frequently lying or breaking promises for gain or to avoid
• Stealing valuables without confrontation

Serious rule violations include:

• Frequently staying out at night against parents’ wishes
• Running away from parents overnight twice or more or once if for an extended period
• Engaging in frequent absence in school.

Treatment:

Behavior therapy, family therapy and cognitive behavior therapy are usually necessary to help the child appropriately express and control anger.  Remedial education may be needed for youngsters with learning disabilities.

Anger is a very common emotion that everyone experiences at times.  Children and adolescents tend to get angry when they are stressed, frustrated or feel that something is unfair.  Feeling angry at times is as natural as feeling happy and sad, and if it happens occasionally it is not a bad thing at all.  We tend to see anger as a bad thing, or even fear it because of the occasional explosive nature of it.  Many people try to avoid anger altogether, but this can lead to them expressing it in disruptive behaviour or turning their frustration on themselves in the form of self-calm. 

Children and adolescents tend to experience anger for the same reasons that adults do.  They may have been annoyed by something in the present and are reacting to it immediately.  It could also be that they were treated badly in the past and are still feeling angry about that, and end up carrying a lot of ‘bottled up’ anger around with them.

Causes of Anger

• Hereditary
• Environmental Stress- loses a parent, accident, parental neglect
• Physical or sexual abuses
• Emotional abuse
• Inconsistent parenting
• Learning Disabilities, ADHD, poor social communication skills

Treatment

The goal of anger management is to reduce both your emotional feelings and the physiological arousal that anger causes. Strategies that are used to control anger are relaxation, cognitive restructuring, problem-solving, better communication, using humour, change environment, timing, avoidance, finding alternatives etc…

Tips for parents when children are angry and fight

1. Help the children to calm down.
2. Separate the children.
3. Help the children to think about why they are angry.
4. Help each child think about what the other child is feeling.
5. Tell the children how you feel about the situation.
6. Help the children choose the best solution for the situation.
7. Praise the children when they resolve a conflict without violence.
8. Tell children it’s ok to be angry, but not ok to hurt others.

Addictions in Children and Adolescents

When we think of addictions we often think of smoking, chewing tobacco, alcohol, or illegal drugs.  More recently, we have seen different types of addictions in children and adolescents such as the Internet, gambling, pornography and shopping.

Addiction is considered a chronic disorder that occurs when a person develops an uncontrollable habit of using substances or participating in behaviours despite negative consequences. Many of these behaviours can become physically addictive, which means that the person’s body begins to crave the substance or behaviour. More of the substance or behaviour may be needed to achieve the desired effect. 

Addictions also have a psychological component that is often even more difficult to overcome. Psychological addiction includes the rituals and emotions that often surround using the substance or the addictive behaviour and the addiction may start to feel like it is a major part of who they are as a person. People can become addicted to almost any pleasurable activity and their behaviours become addictive when they lose control and “need” the substance or behaviour instead of wanting it. When a behaviour becomes an addiction, it always has some negative consequences, which at times may not be noticed immediately. Negative consequences may include failing in school, difficulties with family and friends, getting into legal trouble (dealing drugs, stealing) and problems with their physical or emotional health. The addicted child or adolescent is so caught up in their own behaviours that it is difficult for them to see how their behaviour impacts those around them.

The common addictions in children and adolescents are

Internet Addiction

Internet Addiction refers to the excessive use of the Internet for game playing (gaming) and other purposes and it interferes with everyday life and decision-making ability. The Definition is the inability to cut back on internet usage, preoccupation with online activities, and symptoms of withdrawal such as anxiety, boredom, or irritability after a few days of not going online. Internet addiction in children and adolescents is not necessarily about pornography or gambling; rather, it is about the excessive use of any online activity.  This can also include instant messaging, social networking (like Facebook, WhatsApp) and blogging.

Some studies suggest that boys appear to be at a higher risk of Internet addiction than girls.  In addition, those who use the Internet for more than 20 hours a week, every day for online gaming are at higher risk as well.

Signs and symptoms

Psychological Symptoms:

• Depression
• Dishonesty
• Feelings of guilt
• Anxiety
• Feeling of euphoria
• Inability to prioritize or keep schedules
• Isolation
• No sense of time
• Defensiveness
• Avoidance of work
• Agitation
• Mood swings
• Fear
• Loneliness
• Boredom with routine tasks
• Procrastination

Physical Symptoms:

• Backache
• Carpal Tunnel Syndrome
• Headaches
• Insomnia
• Poor nutrition
• Poor personal hygiene
• Neck pain
• Dry eyes and other vision problems
• Weight gain or loss

Treatment

Individual therapy, group therapy, family therapy, behaviour modification and cognitive behavioural therapy (CBT) are common psychological methods used to control Internet addiction.

Smoking/Tobacco Addiction

Smoking (Tobacco) in children and teens has decreased since the 1990s.  However, the rates of cigarette smoking among high school juniors and seniors are still higher than those of adults.  The younger the smoking begins, the more likely it is that the child or teen will smoke as an adult, and the harder it will be for them to quit.

Other forms of tobacco favoured by teens include flavoured cigarettes, bidis, cigars, and hookahs.

Cigarette smoking puts children and teens at risk of serious medical problems, including respiratory ailments, gum disease, poor lung growth and overall poorer physical health and fitness.  

Smoking cigarettes have also been linked to harmful behaviours such alcohol and substance abuse, aggressive behaviour, carrying weapons, attempted suicide, depression and hi-risk sexual behaviours.

Tips for Parents

• Talk with their children about the harmful effects of smoking.  
• Try to never use tobacco in front of your children,
• Talk about ways to say “no” to tobacco use, even if the child/teen has a friend who is already smoking.  
• Try to avoid threats
• Be supportive and offer some tips, such as deep breathing, drinking water.

Alcohol Addiction

Alcohol is the most frequently used drug in Kerala. The effects of alcohol use in adolescents are difficulty with attention and concentration, memory loss, the use of other substances like marijuana and the tendency to not pursue more years of education. Studies indicate that the younger the person is when they start drinking, the more likely they will develop a problem with alcohol.

Teenagers who develop drinking problems may present with family risk factors including minimal to poor parental supervision or communication, family conflicts, inconsistent or severe parental discipline, and a family history of alcohol or drug abuse. Individual risk factors include problems managing impulses, emotional instability, thrill-seeking behaviours and the perception that the use of alcohol does not present a great risk.

Tobacco (Smoking) or Alcohol Addictions are perhaps the two most significant drug addictions in children and adolescents.  Smoking and alcohol, though legal are often considered gateway drugs both can lead to other illegal drug usages such as marijuana and other illegal drugs. Research indicates that children and adolescents who smoke or drink alcohol are many times more likely to use marijuana than those who abstain.  In addition, the younger the age the smoking or drinking begins, the greater the risk of a serious health problem.  Cigarette smoking and alcohol consumption are also related to a higher risk of engaging in dangerous behaviours. 

Treatment

Alcoholism treatment is usually treated based on the stage of the addiction ranging from management of risk factors and education to out-patient treatment such as counselling by a psychologist to intensive residential treatment followed by long-term outpatient care.  There are medications that are considered effective in treating alcoholism.  Cognitive behaviour therapy and aversion therapy are also using in de-addiction treatment. Twelve-step programs, such as Alcoholics Anonymous (AA) and other programs specifically designed for teens have been proven most effective in the treatment of alcohol and substance abuse.  

Glue Sniffing Addiction

Glue Sniffing is one of the ways that teenagers and adolescents have found to get high. Glue when inhaled in a vapour form tends to have a toxic effect on the body. Teenagers and adolescents have found this way of getting de-stressed and simply passing time as it is very cost effective and is not easy to detect. Glue Sniffing Addiction can be quite detrimental to the health of the individual as it contains various toxic chemicals.

The most common way of sniffing glue is to empty the solvent in a plastic bag and wrap the plastic bag around their mouth and then inhale deeply. Some people also heat the glue and then inhale it. Due to the instant effects of glue sniffing people tend to start using it chronically leading to Glue Sniffing Addiction.

Long-term Glue Sniffing Addiction may lead to respiratory failure and even coma. Using high amounts of glue for sniffing may also lead to heart failure.

Symptoms:

• Smelling of glue always
• Always have a feeling being invincible and exhilaration
• Having problems with concentration
• Problems with doing tasks at work, home or school
• Deterioration in personal relationships
• Lack of interest in normal activities.

Treatment

Once an individual is identified as having Glue Sniffing Addiction then prompt treatment is necessary to prevent any long-term complications. Treatment is mainly aimed at reducing the physical and psychological dependency on glue sniffing so that any potential serious complications can be prevented.

Medications will be given to the patient to prevent any damage to the heart during the withdrawal phase of treatment for glue sniffing addiction. A process of detoxification will be carried to remove all the toxins of glue from the body which may have accumulated over time due to glue sniffing addiction.

Glue Sniffing Addiction is more of a psychological illness than a mere physical illness and hence admission to a de-addiction centre’s is recommended where a thorough counselling of the patient will be done so that the patient is able to understand the harmful effects of glue sniffing and can come back to lead a more normal sober life.