About 50% depressive disorders originate in childhood - Dr. Anjum Bashir


Childhood Emotional Disorders

About 50% depressive disorders originate
in childhood - Dr. Anjum Bashir

Anxiety disorders are rarely diagnosed in infancy

LAHORE: Dr. Anjum Bashir Consultant Child Neuropsychiatrist from UK made a presentation on Childhood Emotional Disorders during the Asia Pacific Psychosocial Rehabilitation conference held at Lahore recently in the first session on the second day. This session was chaired by Prof. Khalida Tareen along with Dr. Wajid Ali and Dr. Nazish Imran.

Dr. Anjum Bashir

Dr. Anjum Bashir pointed out that children do not talk to the strangers. Patients are just like a book for the treating physicians. There is a life long interactive process. Children are able to express their feelings and emotions in infancy. They are able to react to distress in others from a few months .They can also show their anger and pleasure. Speaking about how emotions develop Dr.Anjum Bashir said that the positive drive of anxiety has an adaptive and species survival role. These adaptive values decrease with age. Emotions are learnt the same way as behaviour. The parents transmit emotional traits by genes modeling. Childhood emotions develop by four months and they have distinct response by 6-12 months and it reaches its peak in 12-18 months. He also referred to stress and separation anxiety and pointed out that sadness is an early emotion. They have similarity like adults. The young cry while the toddlers withdraw. Unhappy feelings increase with age and almost 8% of children develop suicidal ideas early in life.
Continuing Dr. Anjum Bashir said that about 10% children suffer from emotional disorders and anxiety disorders are rarely diagnosed in infancy. Anxiety disorders result from either prolonged severe exposure or mismatch with coping capacity. The risk factors for developing anxiety include familial aggregation. It is a type of temperament. The children are slow to warm up. Parenting style also has its effects. Over protection by parents, certain life events, proneness to adversity, social learning and cognitive dynamic factors were all very important. Do not impeach the children freedom through over protection or love. Life events help develop anxiety disorders.
Speaking about depression, Dr.Anjum Bashir said that there is a history of controversy about diagnosis. Depression is difficult to diagnose in children because of changing cognitions. It requires linguistic skills. Somatization, Guilt feelings, hopelessness and tearfulness were the other issues. Almost 50% depressive disorders originate in childhood. Its prevalence in pre-adolescent is reported to be from 0.5 to 2.5%. In adolescents it is between 2-8%. The risk increases with adverse life events, hormonal changes and adolescent conflicts. There are protective factors of social support and reduced capacity to experience depressive cognition decreases.
The life time prevalence of MDD is 15-20%. Dysthymia accounts for 0.6 to 8% and it predicts both depression and MDD later in life. More than half of these depresses have other disorders particularly problems with conduct and anxiety. Co-morbidity predicts the risk of recurrence, longer duration, suicidal attempts or behavior and poor response to therapy. However, the episodes of major depression last for seven to nine months and almost 90% go away by the age of two years. Bipolar disorders in children can be identified earlier. It is important to treat parents to prevent childhood depression. Risk increases after parental divorce. Cognitive predisposition like self criticism, low self esteem, feelings of lack of control and being unloved are better recognized.
Obsessional disorders are repetitive intrusive thoughts and compulsive rituals which significantly impair function or cause marked distress. These obsessions are neutralized by controlling or yielding compulsions. There is less evidence of children obsessions but one should beware of normal rituals. Prevalence of obsessional disorders in children is reported to 1.9% in children as compared to 2.4% in adults. The commonest obsessions are concerns with dirt, germs, something terrible happening, and symmetry for exactness while the common rituals include hand washing or showering.
As regards post traumatic stress disorders (PTSD) its life time prevalence in children is reported to be 6.10% in adolescent but it is very rare below ten years of age. Dr. Anjum Bashir concluded his presentation by stating that childhood emotional disorders are difficult to diagnose in children because they are less articulate and find hard to verbalize feelings. They do not report core symptoms, protecting parents are always in trouble. There is overwhelming anxiety and it is identified with parental denial.