A phobia is an irrational or exaggerated fear of objects, situations, or bodily functions that aren't inherently dangerous.
Phobias are different from the fears that 'are normal for the child's stage of development or fears caused by conflicts in the home. School phobia is one example of an exaggerated fear. It may cause a child 6 or 7 years of age to refuse to go to school. The child may either directly refuse to go to school or complain of a stomachache, nausea, or other symptoms that justify staying home. Such a child may be overreacting with fear to a teacher's strictness or rebukes, which can frighten a sensitive child. In older children, aged 10 to 14, school phobia may indicate a more serious psychologic problem.
The younger child with school phobia should return to school immediately so that he doesn't fall behind in his schoolwork. If the phobia is so intense that it interferes with the child's activity and if the child doesn't respond to simple reassurance by parents or teachers, referral to a psychologist or psychiatrist may be warranted. Some children recover from school phobia, only to develop it again after a real illness or a vacation. Immediate return to school isn't so urgent for an older child, whose treatment may depend on a mental health evaluation.
Hyperactivity is a level of activity and excitement in a child so high that it concerns the parents or care-givers.
Generally, 2-year-olds are active and seldom stay still. A high activity and noise level is also common in 4-year-olds. In both age groups, such behavior is normal for the child's stage of development. However, active behavior frequently causes conflicts between parents and child and may worry parents. Whether the activity level is perceived as hyperactivity often depends on how tolerant the annoyed person is.
However, some children are clearly more active and have shorter attention spans than average. Hyperactivity can create problems for those who supervise such children. Hyperactivity may have a variety of causes, including emotional disorders or abnormalities of brain function. Alternatively, hyperactivity may be simply an exaggeration of the child's normal temperament.
Adults usually deal with a child's hyperactivity by scolding and punishing. However, these responses usually backfire, increasing the child's activity level. Avoiding situations in which the child has to sit still for a long time or finding a teacher skilled in coping with hyperactive children may help.
Attention Deficit Disorder
Attention deficit disorder is a poor or short attention span and impulsiveness inappropriate for the child's age, with or without hyperactivity. Attention deficit disorder affects an estimated 5 to 10 percent of school-aged children and is diagnosed 10 times more often in boys than in girls. Many signs of attention deficit disorder are noticed often before age 4 and invariably before age 7, but they may not interfere significantly until the middle school years.
The disorder is usually inherited. Recent re-search indicates that the disorder is caused by abnormalities in neurotransmitters (substances that transmit nerve impulses within the brain). Attention deficit disorder is often exaggerated by the child's home or school environment.
Attention deficit disorder is primarily a problem with sustained attention, concentration, and task persistence. A child with attention deficit disorder may also be impulsive and overactive.
Many preschool children with attentioh deficit disorder are anxious, have problems communicating and interacting, and behave poorly. During later childhood, such children often move their legs continuously, move and fidget with their hands, talk impulsively, forget easily, and are disorganized, although they are generally not aggressive.
About 20 percent of the children with attention deficit disorder have learning disabilities, and about 90 percent have academic problems. About 40 percent are depressed, anxious, and oppositional by the time they reach adolescence.
About 60 percent of young children have such problems as temper tantrums, and most older children have low frustration tolerance. Al-though impulsiveness and hyperactivity tend to diminish with age, inattentiveness and related symptoms can extend well into adulthood.
The diagnosis is based on the number, frequency, and severity of symptoms. Often, diagnosis is difficult because it depends on the judgment of the observer.
In addition, many symptoms are not unique to children with attention deficit disorder; a child without the disorder may have one or more of the symptoms.
Treatment and Prognosis
Psychostimulant drugs are the most effective treatment. Behavior therapy conducted by a child psychologist is usually combined with drug therapy. Structures, routines, and modified parenting techniques are often needed. However, children who aren't too aggressive and who come from a stable home environment may benefit from drug treatment alone.
Metllylphenidate is the drug most often pre-scribed. It has proved more effective than anti-depressants, caffeine, and other psychostimulants and causes fewer side effects than does dextroamphetamine.
Common side effects of methylphenidate are sleep disturbances, such as insomnia, and appetite suppression; others are depression or sadness, headaches, stomach-aches, and high blood pressure. If taken in large doses for a long time, methylphenidate can slow growth.
Children with attention deficit disorder generally don't outgrow their difficulties. Problems that emerge or persist in adolescence and adulthood include academic failure, low self-esteem, anxiety, depression, and difficulty in learning appropriate social behavior.
People who have attention deficit disorder seem to adjust better to work than to school situations. If attention deficit disorder is untreated, the risk of alcohol or substance abuse or suicide may be higher among people with this disorder than among those in the general population.
G. G. Newaz
The author is a practing paediatrician in New Jersey, USA.
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