Psychological Problems in School Children
“School” is the most important place for children, a place where they find out about themselves and their world, where they meet and learn from each other and from teachers, a place where they prepare themselves for the future.
Just as adults, children too suffer from psychological problems. These may be simple behavioural, emotional or learning problems to complex psychological problems. Treatment exists for all types of problems and Clinical Psychologists can determine if the child has a problem. Many problems cycle with periods of worsening followed by periods of improvement. Some issues resolve with a little help while others persist through adulthood. Prompt diagnosis and appropriate treatment increases the likelihood of successful management of these problems and help children live their lives without breakdowns.
Problems range from school refusal, difficulty with concentration and learning, disruptive behaviour, eating and sleeping problems. Some are transitory, mild and moderate, others serious causing distress, confusion, lack of control, become unmanageable.
Problems at school can show up as poor academic performance, lack of motivation in school, loss of interest in school work, or poor relationships with peers or teachers. Teachers are expert observers, and after proper training they can recognize the early warning signs of psychological problems. Their observation of students and judgment on the characteristics of their cognitive and emotional behaviours can provide vital insight for preparing prevention and intervention programmes for children and their problems. Common psychological problems we face in school children are as follows –
Children experience a range of anxiety disorders, including generalised anxiety, panic, phobias and obsessive-compulsive disorder. These disorders are characterised by significant fear and uneasiness that lasts for a month or longer and affects the child’s quality of life manifesting in school refusal, distress when separated from parent, social withdrawal and timidity, pervasive worry and fearfulness and restless sleep and nightmares. Often these anxieties can be easily dealt with counselling; a long delay requires initial medication as well.
Some children have difficulty in learning at the same level as their peers. It may help to determine how the child learns best. For some children, reading is easy, while other children benefit from a visual demonstration. Still others work best by having hands-on learning. Testing is required to determine the specifics of the disorder and develop a specialised learning plan. Learning disabilities are characterised by a significant difference in the child’s achievement in some areas, as compared to his or her overall intelligence. The student may have some of these difficulties in problems with reading comprehension, delays in speaking and listening, difficulty performing arithmetic functions and understanding basic concepts, difficulty with reading writing and spelling, difficulty organising and integrating thought and poor organisation skills. These problems can be dealt by simple to complex learning and teaching interventions by multi professional approach.
The American Academy of Child and Adolescent Psychiatry describes conduct disorder as a mental illness in which the child encounters difficulty behaving in the way that is expected of him. He may run away from home, steal, set fires, destroy property or harm animals, siblings or peers. This serious disorder requires treatment that may include medication, counselling and behavioural management. Some of the easy identifiable symptoms include easily angered, annoyed or irritated, frequent temper tantrums, argues with adults / teachers, aggressive towards animals and other people, low self-esteem, blames others for misdeeds, refusal to obey parents/teachers, lack of empathy, frequent lying, difficulty concentrating/forgets things, never completes a task and restlessness and fidgeting. These problems require multi pronged approach, sometimes medication, and intense individual counselling along with family intervention for good outcomes.
Some children fall victim to eating disorders, including anorexia nervosa and bulimia. Typical symptoms are being underweight, feeling she is fat even when she is thin, obsession with counting calories, and frequent excuses for not eating. Currently, we are seeing obesity on the rise in Indian children. These children will become victims of bullying and lose self esteem and confidence resulting in being physically inactive or lethargic leading to excessive eating and depression which is the beginning of acute health related problems in the future.
Attention-deficit Hyperactivity Disorder
ADHD is suspected when a school-aged child has difficulty focusing on homework, does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities, has trouble keeping attention on tasks or play activities, does not seem to listen when spoken to directly, does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace, has trouble organising activities, avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework), loses things needed for tasks and activities (such as toys, school assignments, pencils, books, or tools), easily distracted, forgetful in daily activities. Some of the common Symptoms for Hyperactivity/Impulsivity may include – often fidgets with hands or feet or squirms in seat, gets up from seat when remaining in seat is expected, runs about or climbs when and where it is not appropriate, has trouble playing or enjoying leisure activities quietly, “On the go” or often acts as if “driven by a motor”, talks excessively, blurts out answers before questions have been finished, has trouble waiting one’s turn and interrupts or intrudes on others. Most often these children can be treated with medication and intensive behaviour modification to manage adequate behaviours in the class.
Autism is a pervasive disorder in which the child does not communicate at the same level as his/her peers and may show little interest in contact with others. S/he may have learning difficulties and become focused on rigid routine and particular objects instead of showing interest in new things. Autistic children often have particular mannerisms, such as flapping their hands and an exaggerated startle response. Some of the observable behaviour in the class is that the child has difficulty with communication, delayed developmental milestones, particularly speech, difficulty making or maintaining friendships, difficulty in understanding how others feel/empathy, isolated or indulges in repetitive play, takes language literally, having obsessional behaviour and rituals, tantrums, extreme sensory sensitivity and sometimes flapping arms or toe walking. While no medication directly treats autism, behaviour modification treatment and a specialised learning environment can maximise the child’s potential.
Older children may fall into substance abuse and addiction. Substances commonly abused include alcohol, marijuana and prescription drugs, among other drugs. Inhalants such as gasoline, paint, glue and solvents are also used for getting ‘high’. There is a rise in our school children getting addicted to inhalants; we have come across students who keep their solvents in the wash rooms and in their bags. They do inhale when no one around them. We have witnessed children as young as in 6th standard getting addicted and these children sometimes become psychologically or physically addicted to substances and require treatment for recovery. Parents must become familiar with signs of substance abuse. These children like to stay away from people, stay in their rooms behind closed doors, argue vehemently for pocket money, frequently become sick with fevers, colds/chills, etc decreased appetite, excessive sleeping at odd times and sudden behavioural changes.
Common treatments include intensive individual counselling, family intervention and sometimes inpatient hospitalisation. Depression and Bipolar Disorder Depression may begin in childhood, particularly if the child has close biological relatives who suffer from depression. Depression is often marked by a lack of interest in activities, sadness and exhibition of poor self-esteem. Bipolar disorder is a disorder in which a child suffers from periods of depression cycle with periods of mania; it can also become apparent by late childhood. Some of the observable symptoms include ongoing sadness, irritability, loss of interest in friends, toys and activities, loss of energy and concentration, loss of weight or appetite, deterioration in school work and thoughts of suicide or self-harming. Depression and bipolar disorder occasionally lead to suicide attempts, and parents must monitor the child as well as seek appropriate treatment. Therapeutic techniques for these disorders involve medication and intensive individual counselling along with family intervention.
Rare but this psychotic illness may strike children during their late school years around Class 10 to 12. Early manifestations may include withdrawing from friends, developing unusual speech patterns, seeming to have no emotions, acting peculiar and elevating suspiciousness. Schisophrenia is commonly treated with medication and may require periods of hospitalisation.
John Victor is a Senior Clinical Psychologist, formerly with VIMHANS as Faculty & Consultant. Trained all the counsellors of MSF India, CANSUPPORT and SPARSH in association with MSD (Merck Pharmaceuticals) in Basic Counselling Skills. Conducted workshops on Fear and Love for Maths, Living with Teachers Stress, Dealing with Anger and Aggression in Children, etc. Worked with all the staff of MSF Kashmir (Médecins Sans Frontières) in dealing with their professional burnout at the time of severe conflict in 2011, (Kashmir) Conducted series of public awareness programmes at IHC on topics like ‘Violence & Aggression in Children’ and ‘Personality Re-Engineering’. Currently associated with SANOFI in conducting Conscious Parenting Workshops all over India.