Child and adolescent anxiety and mental health

Bedwetting or enuresis is one of the most common pediatric conditions reported in children between 4 and 7 years of age. This can be a really embarrassing problem, which may affect a child’s confidence. Yet it is quite easily treated in a number of weeks (usually between 4 and 6 weeks). A great treatment for children with bedwetting (Enuresis) difficulties are bed wetting alarms.

Bedwetting alarms work by detecting very small amounts of moisture (urine) with a special sensor and then sound an alarm or vibrate to wake the child. A good bedwetting alarm usually wakes the child before they fully wet themselves and their bed. The repeated application works by the process of counter conditioning. The child learns to to substitute a new response (waking up or drifitng into lighter sleep) during their sleep cycle when the body detects the bladder is full.

There is now a reasonably good body of evidence demonstrating the effectiveness of using bedwetting alarm. Combining bed wetting alarms with a few sessions of cognitive behaviour therapy (CBT) is very effective in helping children overcome their bedwetting problem.

Some children really struggle with potty training and continue to mess their pants or nappies. At about the age of 3-4 children are generally mastering potty training and getting themselves (with the help of mom and dad) out of their nappies. Some however struggle with this. They continue to soil themselves. This is can be very embarrassing, especially for older children.

Some Cognitive Behaviour Therapy tips to help:

Toilet socialization –

Helping your child to become more acquainted with using a toilet cannot be underestimated. It is recommended that you help your child to first become comfortable with the idea of defecating in a potty if they are not using a toilet at all. Once they get used to the idea of using or sitting on the potty they can progress to the toilet. It can be useful to have your child sit on the potty or toilet, even if they do not necessarily need to use the

Making the Toilet fun, exciting, positive and approachable –

Make the toilet a fun place to be. Some parents decorate the toilet with their child/children’s favourite cartoon characters or interests. Glow in the dark stars or mobiles from a hanging light switch are all possible ways of making the toilet an interesting and potentially fun place to be.

Modeling –

Modeling is demonstrating through your own behaviour that the toilet is a great place to be. This can be done by praising toilet use, by trying to provide positive and encouraging statements when anyone uses the toilet. Trying not to make using the toilet an embarrassing or negative body based activity, but rather one where ‘making a poo’ is great to have.

Gradual exposure –

If your child finds it particularly hard to use the toilet and feels anxious about sitting down on the toilet. Help her/him to gradually become accustomed to using it. It can be helpful to start by just sitting on the toilet even if there is no need to use it and to start by making that experience a positive one. Sometimes it may even be spending a bit of time in the toilet or bathroom without even sitting down on the toilet itself. Just spending some time talking about being there and then being there talking about other things can help a child to become more accustomed to the space. Familiarity does help reduce any anxieties and apprehension. Gradually exposing your child to the toilet and encouraging the use of a toilet with patience will improve your child’s confidence and mastery of the whole process.

Do not scold, criticize or shout –

Never shout, scold or criticize your child about her or his toilet use or any ‘mistakes they may have made’. Although sometimes we feel that punishment can help, this can in fact actually make matters worse. Children who get punished or feel guilty for making mistakes often learn to associate these feelings with the whole process and don’t learn very well how to master the toilet themselves. This also does not help their confidence and may sustain the problem.

Never coerce and be patient –

Don’t coerce your child into using the toilet by pleading or suggesting that they only get a prize if they manage to use it properly. If your child is not happy to use the toilet, they won’t go. Children need time, patience and positive encouragement. If she or he goes on their own or chooses to do so without much external pressure, this will be a lasting and positively emotional building experience.

Reward toilet use –

However rewarding toilet use can be good. Creating a sticker or star chart and rewarding every time there is an attempt (even if not succesful) will build encouragement and help to provide incentive for using the toilet. A larger gift can be negotiated once a certain number of stars/stickers have been reached, for example: an outing, favourite food as a treat or small toy.

Encopresis is really embarrassing and children often hate to speak about it. If your child is having difficulties with this it is often best to see a specialist to get help.

Information on treatment can be found at www.childrenstherapy.co.za or

www.rosensteintherapy.com

Massage for children and teenagers can be a therapeutic and beneficial experience, especially for children and teenagers suffering from anxiety and distress.

Children and teenagers are not easily diagnosed with OCD and unfortunately it seems to go unnoticed.

Current research is beginning to shed light on the development of OCD, and it seems that it may have it’s onset slightly earlier than previously speculated. This does not mean that parents should be concerned, it means that we are becoming better at detecting, diagnosing and treating OCD earlier, so that it does not become a problem or difficulty fir a person later in life.

Also although OCD does have a strong genetic component or predisposition, it does not mean that if a parent has OCD or other anxiety difficulty their child will definitely develop it. It seems that many individuals also need certain circumstances in order for OCD to develop. We are not yet fully aware if exactly what all these circumstances are yet, but many include early life trauma, stress and or fear learning or modeling.

If you suspect your child may be suffering from OCD, there are a lot of really good resources. These can be found at

http://www.ocdinchildren.org/

http://www.childrenstherapy.co.za

https://childsminds.wordpress.com/

http://www.ocfoundation.org/

Social anxiety disorder is a problem that does not only affect adults, but is also quite common in children. A child may develop social anxiety disorder in a number of ways. They may inherit a predisposition or temperament that contributes to being socially anxious or they may experience a parent, care-giver or even a sibling who has social fears who may model fearful social behaviours that the child learns. Alternatively the child may also experience an uncomfortable social experience at cresh, school or other social situation. Sometimes traumatic childhood experiences such as neglect, abuse, illness or the death of a parent may contribute to the development of social anxieties or fears.

Compared with adults, there are differences in how children both experience and express their social fears. Some of the behaviours that may be common in children who have social anxiety disorder are: withdrawing from many social opportunities such as going to parties, functions or playing in groups with other children; appearing to be disinterested in communicating or wanting to communicate; shyness; passivity with friends, other children and adults; worries about being the centre of attention embarrassment; quietness when in the company of adults; worries about being with adults.  Some of these behaviours may be considered to be a part of other ‘childhood problems/difficulties’, such as autism spectrum, attachment disorders and separation anxiety. It is important that these other problems/difficulties are appropriately discriminated properly the child’s health-care provider, even though a child may have one or more these together.

For more information on social anxiety disorders visit www.socialanxiety.co.za

Bedwetting is a common problem in childhood and is more occasional in adolescents (In adolescents it is much more likely to be accompanied by an anxiety disorder or problem). It may accompany anxiety in childhood, but is often considered a behavioral difficulty. The child is often not aware of the problem and the wetting happens during the night. It can be quite embarrassing and children therefore wont speak about it to anyone. However there are likely to be many other children in their same class or grade who are also bed wetting. Many children who wet their beds cannot tell if their bladders are full or often sleep too deeply to wake up to go to the toilet.

Scolding or punishing a child for bedwetting does not help. Rather by explaining that this is common in children can help to normalize the anxiety associated with bedwetting. There are some useful steps that are often helpful. Firstly it is important to make sure your child has been to the toilet before bedtime and sometimes a few times before bedtime. Ask her or him if they are going to the toilet at school and that they are not holding in urine at any times of the day. Encourage them to go to the toilet whenever they need to and to ask to go. Going to the toilet at regular times during the day is important, as the child does not get used to the feeling of a full bladder. Bedwetting also seems to occur more at the child’s own house then when at sleep overs. There are some reasons for this: sometimes a child is more aware of not wanting to wet someone else’s bed, they sleep less deeply and they may unconsciously prime themselves not to wet the bed. This is important because creating a reward scheme for your child (such as star charts, records or ‘free nights of wet beds’, or success schedules) can help a child to be more conscious, in a positive way, to motivate them to reduce bed wetting. This has been shown to work in many studies of ‘child bedwetting’. Bedwetting alarms are also an option and have been known to help, however these need training for the both the child and the caregiver(s).

Psychological treatment for bedwetting such as cognitive behaviour therapy (CBT) can be very helpful and successful. CBT helps the parent and child manage the bedwetting behaviours, possible associated anxieties and the mastery of bedwetting difficulties. However before any psychological treatments are considered it is important that the child is seen by her or his general practitioner or pediatrician, as the bedwetting may be secondary to a health problem.

Often when parents see their children are very anxious and they are worrying a lot, there is an attempt to reassure them. However some very interesting research findings in the areas of child psychotherapy and in child development indicate that reassuring your child a lot is often more unhelpful than helpful. Anxiety is often about some uncertain situation and worrying can be an attempt to problem solve these uncertainties. However because anxious worries are uncertain the outcomes cannot be known. Children will therefore often seek reassurance from their parents or caregivers. When parents then attempt to reassure the child that everything is okay, it serves only to provide a respite from anxiety and worry, because sometimes parents also cannot know the outcomes of these worries and anxieties. When children are able to endure the uncertainties of anxiety and worry, they learn how to better master them and also to self regulate their anxiety.

A careful balance is suggested with regards to reassuring anxieties and worries. Reassuring a child once  for a given concern in a day is okay, more than that could become problematic. Rather show curiousness and empathy. Guide him or her in problem solving.

Rather than focusing on the symptoms of anxiety through reassurance, provide strategies through problem solving!

Obsessive Compulsive Disorder (OCD) is often misdiagnosed in children and teenagers. OCD is characterized by obsessions and compulsions. Obsessions are intrusive and repetitive thoughts, images or impulses (urges) that produce anxiety and distress. Compulsions (often called rituals) are repetitive and stereotypical behaviours, actions or ways of thinking that the child or adolescent uses to manage the obsessions and anxiety. The obsessions and compulsions are often thought to be irrational by the person doing them. Some of the symptoms may be (this list is by no means exhaustive and indicates some of the common symptoms, which a child may have some, but not all):

– A constant need to check things, such as checking possible mistakes in school work or reading or checking doors are locked at night repeatedly

– Needs a lot of reassurance and needs to confess thoughts and feelings

– A need to wash hands or other part(s) of the body, or fear of being contaminated or dirty

– Ritualistic and repetitive behaviours and ordering behaviours (such as a strong need to arrange things by color)

– A fear of accidentally causing harm to someone, often loved ones or caregivers

– Intrusive words, music or other thoughts

– Repeatedly checking that nothing bad has happened and that no accidents have been caused (and needing reassurance for this)

These symptoms often become a disorder when they cause the child or teenager a lot of distress or they consume a large amount of time doing them.

Childhood and teenage OCD can look very similar to adults, however some differences can be noted. Firstly younger children can find it hard to talk about their OCD and secondly they may also find it difficult to express that it is a problem. Some children and even some teenagers may not find their OCD very irrational, although their parents and family do.

For more information on treatment for OCD visit http://www.ocdtreatment.co.za

Try this experiment….”Try not to think of a Pink Elephant for 30 seconds”

Did you find the more you tried not to think of it the more it tried pushing its way into your head?

Worry can be like a Pink Elephant. We sometimes think that worry can help us to solve problems and to sort things out, but actually we just end up thinking more and worrying more about those things we want to sort out. The more we want worry to go away, the more it comes back. Sometimes we even worry about worrying. Good ways to help with this are to find distractions from thoughts that are going over and over in your head.