Childhood Mental Disorder in Nepal

Mental health disorders in children and adolescents are caused by biological, environmental, psychological factors or a combination of these. Examples of biological factors are genetic abnormalities, chemical imbalances in the body, and damage to the brain due to many causes such as a head injury. Many environmental factors also can affect mental health, including exposure to violence, extreme stress, and the loss of an important person. Families and communities working together can help children and adolescents with mental disorders. A board range of services is often necessary to meet the needs of these young people and their families. Mental problems (Emotional and behavioral problems) are common among of all ages. Children and adolescents can have mental, emotional, and behavioral problems. These problems, or "mental disorder," are sources of stress for children and their families, schools, and communities. The number of young people and their families who are affected by mental, emotional, and behavioral disorders is significant. It is estimated that as many as one in children an adolescents may have a mental health disorder that can be identified and require treatment. Children can suffer from mental illnesses similar to those seen in the adults including depression, schizophrenia or anxiety. In addition, children can have other types of mental illnesses specifically seen in this age group. Some of these conditions include:- a) Mental Retardation b) Attention deficit hyperactive disorder (ADHD) c) Conduct Disorder d) School Refusal e) Enuresis f) Temper tantrum and breath holding spells g) Child hood depression Besides these, there are many other mental disorder which can afflict a child. A) Specific developmental disorders: These include either the non-development or abnormal development of a specific development skills leading to various difficulties that makes it harder for children and adolescents to receive or express any information. These disorders can show up as problems with spoken and written language or motor coordination. Examples include reading disorder, disorder of written expression, mathematics disorder or stuttering. B) Attention-deficit/Hyperactivity Disorder: Children with attention-deficit/hyperactivity disorder are unable to focus their attention and are often impulsive and easily distracted. Most children with this disorder have great difficulty remaining till, taking turns, and keeping quite. Symptoms must be evident in sat least two settings, such as home and school, in order for attention-deficit/hyperactivity disorder to be diagnosed. These children are restless, fidgety and cannot sit still for long. They have difficulty in attending to one thing for long and in following instructions. Their schoolwork is disorganized and contains many careless mistakes. They are reckless and accident-prone. Their behavior is tiresome to their parents and it leads to poor academic performance and poor adjustments with peers. C. Conduct Disorder: Children with conduct disorder usually have little concern for other and repeatedly violate the basic right of other the rules of society. They are aggressive towards other children. Conduct disorder causes children and adolescents to act out their feelings or impulses in destructive ways. The offenses these children and adolescents commit often grow more serious over time. Such offenses may include lying, stealing, aggression, truancy, disobedience, setting of fires, and vandalism. Alcohol and drugs use may start at very early age. D. School refusal: The reluctance or fear to go school is seen among many fear to go school is among many children. This is knows school refusal or school phobia. School refusal may be associated with separation anxiety, shyness and carious fears. The child's mother may be over protective and anxious The child my refuse school because of problems at school, problems at home or at times, the child him/herself maybe having some problem. E. Enuresis: Enuresis is the repetitive voiding of urine, either during the day or night, at inappropriate places beyond the age of 5 years. F. Temper tantrum and breathe holding spells: Most toddlers have occasional mild temper tantrums, and only frequent or server temper are abnormal. Tantrums are often provoked by inconsistent discipline. This may include behaviors like biting, head banging, rolling on floor, incessant crying, throwing objects or hitting. These are reinforced unintentionally by attention to the child when they take place. Periods of breath- holding are not uncommon in per - school children. Like temper tantrums, they are often caused by frustration leading to rage. The behavior can be alarming for parents, especially if the becomes cyanosed before breathing resumes. G. Childhood depression: It is common psychiatric disorder on children. Many children are presented with vague symptoms like pain abdomen, headache and irritability repeatedly. We may get history of fearfulness, irritability, poor school performance, nausea, vomiting, and sleep disturbances etc. H. Child Abuse: This is defined as physical or psychological damage to under the age of 18 that is sustained as a result of neglect or maltreatment. The abuse my be physical, sexual and/ or emotional. Usually the abuse is done by the child's parent/s, a parent surrogate (e.g. a step mother), a relative or an employer. Child abuse of any nature has long lasting effects on the overall personality development and has negative psychological effects as well. A child can be suspected of having some kind of Mental health problem if: • The child's behavior is not appropriate for his / her age • The child's behavior leads to academic or social dysfunctional. • The child's behavior is against social norms and expectations If there is suspicion of any mental health problem in a child, the concerned health worker should: • Find out details about the problems • Explore any difficulties / problems at home / school • Reassure the parents • Try to inform / explain the parents about the nature of the problems • Refer the psychotic treatment center.