PSYCHIATRIC PROBLEMS IN CHILDREN By J. H. Haldanc The following extracts are published from an address on "Mental Health as seen by a Local Practitioner" given in the Town Hall,
Dudley. subnormality may be det^L when the infant is a few ffl old, but the subnormal case is spotted in the primary school referred to the School Medical He may be educated in a school i educationally subnormal childrengeneral practitioner takes an ac'L. when called in to deal ^ part
often do we hear the expres"So and so is a bit odd"? Perhaps he dresses differently, like a Teddy Boy or a Beatnik. Perhaps he is a vegetarian. Perhaps he doesn't believe in motorcars or television, but anyone who does not conform to the broad pattern of life is "a bit odd". However, queerness or eccentricity do not necessarily imply mental disorder. The border between normality and abnormality may be a bit smudged and indistinct, but before we can diagnose abnormality we must have a standard of normal for comparison. Take the newborn child. We know the average weight is 7 lbs., height 20", 13". Precircumference of head
A
HOW sion:
maturity
produces
a
Slower in A
baby is slower in and the amount of prematurity should be added to these figures. For example, a baby born one month prematurely should smile at 6 weeks plus one month, sit up at 9 months plus one month. Many infants develop more quickly and can walk at one year, but the child who is not walking at 2 years or talking at 3 years requires investigation. Perhaps he has a congenital dislocation of the hip or a spastic condition of the legs. Perhaps he is deaf. If no physical abnormality is found, one suspects mental arrest or incomplete development of the mind. premature
only physical illness. It is now recognised
.a
^
that some from the Mi111;,!
ren may suffer Brain Damage syndrome, possibly to a minor injury at birth. The c shows no evidence of a lesion of nervous system, nor is he back\*'a but there are certain actions which P the spotlight on him. If we acC that there are four main areas i11 brain in which function may deranged, motor, sensory, intelleC / and convulsive, we know that in each area may produce a recogn' lesion, cerebral palsy in the motor
da^
nlinnnocc uunuuwoo
in ill
r\ r vji
lilt
^
cPlP
o
ib(
in the inte. j, tual area, the area. But suppose the damage is clinical or minor in degree, 1? j motor area this might produce trf^j excessive clumsiness, the sensory area it might produce paired memory for shapes and in the intellectual area minimal iy.U area, mental
deficiency epilepsy in
conyi-1'5^ stj
hyperrefieX13'^
development
development
Servlfj
proportionate
decrease. Small heads in full term babies are associated with mental deficiency, as in the microcephalic or mongol. The normal development of the full term baby proceeds in recognised steps. He smiles at 6 weeks, he can raise his head off the pillow at 3 months, sit up at nine months, walk by 18 months, string words together by 2 years, control the sphincters by 3 years.
severe
early
desigj
distractab'^
ation, impulsiveness, 3 tantrums; in the convulsive abnormal B.E.G. without seizure5' Usual
complaint
The usual complaint in these is of poor school work, and emotional problems, poor speech, behaviour problems U tractability). Many of these chjlj are of normal or above average gence as shown by intelligence The poor perception of pattern^
nervoU,s?S
clurns"^, ^
special relationship complicates
206
l
8 to read and write, and this can be by clumsiness or tremor of
^r^va.ted lhands. to 0
increasing age children learn read and write effectively. These sfs are not the offspring of retarded borderline parents difficultY is
the school S' Emotional problems abate With" u alteration of handling. There may between the child's thought -arK* behaviour reactions, and demands made on Ijj e over"active child could clean the k fr 111 blackboard or obtain a break prolonged periods of sitting still, ^ Patience is required with the who is slow to read and write, So is not discouraged. We too read condemn clumsiness making ci?_child more nervous and more
find' tea
1??S
to
interpret
to
a?d
parents
pr0c?nflict the?e^S
^vironmental
chi,r.e
^ thea,1y
_
lumsy.
Primary
teachers would recog-
syndrome and could perhaps examples. I know of a boy who Wa he l- 'cted by temper tantrums when floor, scarlet in the Uerally ^ay on ^Uot e
/\n otLace' kicking and screaming. 'ad was impulsive, destructiVe .
disobedient, can' had
effee
distractible.
The
only temporary sobering
Another lad of 10 had his bowels but he
tr0j
H0r coni
j
treatment
l0nH Psychiatry
C0nf?n' saidon Brjeifrence^at
at
physician in Guy's Hospital,
the International Health Education at in lhree Was *n needa'most one child PsychiatI*ic treatrrient Some stage of his school life. He that most mental problems 4. jQ^an between the ages of 2 and % ?f school children as a ^ho] Were in need of psychiatric nt- Many of the problems ? Parents have been brought on
{flrned
treaJl facin
the
suicide. These attempts increase with age, with a sharp rise in puberty. rate in The suicide European countries varies considerably, being high in countries like Sweden, Switzerland and Denmark, which have high living standards, and low in Ireland, Portugal and Spain, where living standards are lower. All the hospitals in Sweden were asked to supply notes on their cases of attempted suicide by persons under the age of 21, between the years 1955 and 1959. There were 1,727 cases, 351 boys and 1,376 girls. In 96% of cases the home environment was considered abnormal. Alcoholism was recorded in one or both parents in 15% of cases. In 28% the parents were mentally ill or had neurotic disorders. 44% of patients came from a broken home (divorce, death or un-
Bed-wetting
e^ding psychiatric Vaughan, chilHr" 0ia^
under
said to be due to emoA small girl of to be mentally subnormal was found to be deaf, and Physical defects must be
was
bUtPPeared
eXclu^j
Pathological depression
age of 18 is uncommon but when it does occur it may lead to attempted
*ntefligence.
a'tya
Depression
no con-
of is
and is tiQn?00factors. S
because of faulty training. The child is allowed to have what he likes and do what he likes. He grows up to disregard authority, becomes wilful and selfish, rude and ill-mannered and becomes sometimes unmanageable. How often I have heard mothers complaining that their 3 or 4 year old son or daughter will not go to bed, will not wear proper shoes, will not do this or that. Wise discipline would clear up a good many problems in child management. Some mental upsets in children are functional. A small child may become difficult when a baby brother arrives. This is a jealous reaction and soon The adolescent girl may passes. become more emotional or depressed before menstruation begins. I recall two girls who had frequent bouts of weeping. They were irritable and depressed for no obvious reason. The parents were worried but tended to be impatient with them because they could see no cause for the trouble. When the condition was explained to the parents, they became more sympathetic and eventually the girls recovered.
at
207
married mother).
Out of 1,360 cases,
mostly girls, 30% was because of a love problem and 25% because of a family problem. Boys formed the majority in the group with school problems and also in the group suffer-
ing from mental illness (boys 19J" girls 8%). Of 30 boys who were doijjmilitary service at the time of ? suicide, 17 found the service too try'"*: In 34 girls extra marital pregnant was
the
reason.
Dudley. subnormality may be det^L when the infant is a few ffl old, but the subnormal case is spotted in the primary school referred to the School Medical He may be educated in a school i educationally subnormal childrengeneral practitioner takes an ac'L. when called in to deal ^ part
often do we hear the expres"So and so is a bit odd"? Perhaps he dresses differently, like a Teddy Boy or a Beatnik. Perhaps he is a vegetarian. Perhaps he doesn't believe in motorcars or television, but anyone who does not conform to the broad pattern of life is "a bit odd". However, queerness or eccentricity do not necessarily imply mental disorder. The border between normality and abnormality may be a bit smudged and indistinct, but before we can diagnose abnormality we must have a standard of normal for comparison. Take the newborn child. We know the average weight is 7 lbs., height 20", 13". Precircumference of head
A
HOW sion:
maturity
produces
a
Slower in A
baby is slower in and the amount of prematurity should be added to these figures. For example, a baby born one month prematurely should smile at 6 weeks plus one month, sit up at 9 months plus one month. Many infants develop more quickly and can walk at one year, but the child who is not walking at 2 years or talking at 3 years requires investigation. Perhaps he has a congenital dislocation of the hip or a spastic condition of the legs. Perhaps he is deaf. If no physical abnormality is found, one suspects mental arrest or incomplete development of the mind. premature
only physical illness. It is now recognised
.a
^
that some from the Mi111;,!
ren may suffer Brain Damage syndrome, possibly to a minor injury at birth. The c shows no evidence of a lesion of nervous system, nor is he back\*'a but there are certain actions which P the spotlight on him. If we acC that there are four main areas i11 brain in which function may deranged, motor, sensory, intelleC / and convulsive, we know that in each area may produce a recogn' lesion, cerebral palsy in the motor
da^
nlinnnocc uunuuwoo
in ill
r\ r vji
lilt
^
cPlP
o
ib(
in the inte. j, tual area, the area. But suppose the damage is clinical or minor in degree, 1? j motor area this might produce trf^j excessive clumsiness, the sensory area it might produce paired memory for shapes and in the intellectual area minimal iy.U area, mental
deficiency epilepsy in
conyi-1'5^ stj
hyperrefieX13'^
development
development
Servlfj
proportionate
decrease. Small heads in full term babies are associated with mental deficiency, as in the microcephalic or mongol. The normal development of the full term baby proceeds in recognised steps. He smiles at 6 weeks, he can raise his head off the pillow at 3 months, sit up at nine months, walk by 18 months, string words together by 2 years, control the sphincters by 3 years.
severe
early
desigj
distractab'^
ation, impulsiveness, 3 tantrums; in the convulsive abnormal B.E.G. without seizure5' Usual
complaint
The usual complaint in these is of poor school work, and emotional problems, poor speech, behaviour problems U tractability). Many of these chjlj are of normal or above average gence as shown by intelligence The poor perception of pattern^
nervoU,s?S
clurns"^, ^
special relationship complicates
206
l
8 to read and write, and this can be by clumsiness or tremor of
^r^va.ted lhands. to 0
increasing age children learn read and write effectively. These sfs are not the offspring of retarded borderline parents difficultY is
the school S' Emotional problems abate With" u alteration of handling. There may between the child's thought -arK* behaviour reactions, and demands made on Ijj e over"active child could clean the k fr 111 blackboard or obtain a break prolonged periods of sitting still, ^ Patience is required with the who is slow to read and write, So is not discouraged. We too read condemn clumsiness making ci?_child more nervous and more
find' tea
1??S
to
interpret
to
a?d
parents
pr0c?nflict the?e^S
^vironmental
chi,r.e
^ thea,1y
_
lumsy.
Primary
teachers would recog-
syndrome and could perhaps examples. I know of a boy who Wa he l- 'cted by temper tantrums when floor, scarlet in the Uerally ^ay on ^Uot e
/\n otLace' kicking and screaming. 'ad was impulsive, destructiVe .
disobedient, can' had
effee
distractible.
The
only temporary sobering
Another lad of 10 had his bowels but he
tr0j
H0r coni
j
treatment
l0nH Psychiatry
C0nf?n' saidon Brjeifrence^at
at
physician in Guy's Hospital,
the International Health Education at in lhree Was *n needa'most one child PsychiatI*ic treatrrient Some stage of his school life. He that most mental problems 4. jQ^an between the ages of 2 and % ?f school children as a ^ho] Were in need of psychiatric nt- Many of the problems ? Parents have been brought on
{flrned
treaJl facin
the
suicide. These attempts increase with age, with a sharp rise in puberty. rate in The suicide European countries varies considerably, being high in countries like Sweden, Switzerland and Denmark, which have high living standards, and low in Ireland, Portugal and Spain, where living standards are lower. All the hospitals in Sweden were asked to supply notes on their cases of attempted suicide by persons under the age of 21, between the years 1955 and 1959. There were 1,727 cases, 351 boys and 1,376 girls. In 96% of cases the home environment was considered abnormal. Alcoholism was recorded in one or both parents in 15% of cases. In 28% the parents were mentally ill or had neurotic disorders. 44% of patients came from a broken home (divorce, death or un-
Bed-wetting
e^ding psychiatric Vaughan, chilHr" 0ia^
under
said to be due to emoA small girl of to be mentally subnormal was found to be deaf, and Physical defects must be
was
bUtPPeared
eXclu^j
Pathological depression
age of 18 is uncommon but when it does occur it may lead to attempted
*ntefligence.
a'tya
Depression
no con-
of is
and is tiQn?00factors. S
because of faulty training. The child is allowed to have what he likes and do what he likes. He grows up to disregard authority, becomes wilful and selfish, rude and ill-mannered and becomes sometimes unmanageable. How often I have heard mothers complaining that their 3 or 4 year old son or daughter will not go to bed, will not wear proper shoes, will not do this or that. Wise discipline would clear up a good many problems in child management. Some mental upsets in children are functional. A small child may become difficult when a baby brother arrives. This is a jealous reaction and soon The adolescent girl may passes. become more emotional or depressed before menstruation begins. I recall two girls who had frequent bouts of weeping. They were irritable and depressed for no obvious reason. The parents were worried but tended to be impatient with them because they could see no cause for the trouble. When the condition was explained to the parents, they became more sympathetic and eventually the girls recovered.
at
207
married mother).
Out of 1,360 cases,
mostly girls, 30% was because of a love problem and 25% because of a family problem. Boys formed the majority in the group with school problems and also in the group suffer-
ing from mental illness (boys 19J" girls 8%). Of 30 boys who were doijjmilitary service at the time of ? suicide, 17 found the service too try'"*: In 34 girls extra marital pregnant was
the
reason.
