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Behavioural / Mental Health conditions

Pathological demand Avoidance Syndrome (PDA)

What is it?

People with a PDA profile are driven to avoid everyday demands and expectations to an extreme extent. The underlying cause for this avoidance is said to be a high level of anxiety, usually from expectations of demands being placed on children, which can lead to a feeling of not being in control of a situation.

How PDA Affects Children?

Children with a PDA profile can present with increased social understanding and communication skills and are often able to use this to their advantage. However, these apparent social abilities can often mask difficulty with processing and understanding communication and social situations. Children with a PDA profile are likely to need a lot of support. The earlier the recognition of PDA, the sooner appropriate support can be put in place.

The distinctive features of a demand avoidant profile include:

  • Anxiety
  • Difficulties in processing language
  • Resists and avoids the ordinary demands of life
  • Uses social strategies as part of avoidance, for example, distracting, giving excuses
  • Appears sociable, but lacks some understanding
  • Experiences excessive mood swings and impulsivity
  • Appears comfortable in role play and pretence
  • Displays obsessive behaviour that is often focused on other people.
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Behavioural / Mental Health conditions

Oppositional Defiance Disorder (ODD)

What is it?

Children can be oppositional from time to time, particularly when tired, hungry, stressed or upset.  They may argue, talk back, disobey, and defy parents, teachers, and other adults. Oppositional behaviour is often a normal part of development for children between two and three years old and early adolescents.  Oppositional Defiant Disorder (ODD) is described as an ongoing pattern of disobedient, hostile and defiant behaviour toward authority figures which goes beyond the bounds of normal childhood behaviour.

Many children with ODD will respond to positive parenting techniques. Parents may ask their paediatrician or family physician to refer them to a child and adolescent psychiatrist or qualified mental health professional who can diagnose and treat ODD and any coexisting psychiatric condition.

How ODD affects children?

Openly uncooperative and frequent hostile behaviour is a key sign in children with ODD. The symptoms are usually seen in multiple settings but may be more noticeable at home or at school.  Symptoms of ODD may include:

  • Excessive arguing with adults
  • Frequent temper tantrums
  • Often questioning rules
  • Active defiance and refusal to comply with adult requests and rules
  • Deliberate attempts to annoy or upset people
  • Blaming others for his or her mistakes or misbehaviour
  • Often being touchy or easily annoyed by others
  • Frequent anger and resentment
  • Mean and hateful talking when upset
  • Spiteful attitude and revenge seeking

Behavioural / Mental Health conditions

Anxiety Disorders - Anxiety disorders in Children

What are anxiety disorder in children?

Anxiety is a mental health disorder characterised by feelings of worry or fear that are strong enough to interfere with daily activities. Things like panic attacks, obsessive-compulsive disorder and post-traumatic stress disorder are all associated with anxiety. Symptoms include stress that’s out of proportion to the impact of the event, inability to set aside a worry and restlessness.

What causes Anxiety Disorders?

A big event or a build-up of smaller stressful life situations may trigger excessive anxiety — for example, a death in the family, other family stresses or school stress. People and children with certain personality types are more prone to anxiety disorders than others are.

How Anxiety Disorders Affect Children?

Symptoms of anxiety in children include getting angry or irritable quickly and being out of control during outbursts. Children may also express constantly worry or negative thoughts. They can also seem tense and fidgety, or use the toilet often.

Symptoms can present themselves in the following ways:

  • A 6-year-old can’t fall asleep at night.
  • A 7-year-old is the perfect student but destroys their bedroom and screams at their siblings after school.
  • An 8-year-old cries every morning before school or events and clings to their parents.
  • A 10-year-old snaps at family constantly, criticizing everything.
  • A 12-year-old experiences headaches that make it difficult to get out the door on time.

Though all of these behaviours appear unrelated and present different challenges, they have one common thread: anxiety or feelings of anxiousness.

Behavioural / Mental Health conditions

Major Depressive disorders

What is it?

Sadness is a natural part of the human experience and these feelings are normally short-lived. When children experience persistent and intense feelings of sadness for extended periods of time, then they may have a mood disorder such as major depressive disorder (MDD).

MDD, also referred to as clinical depression, is a significant medical condition that can affect many areas of your life. It impacts mood and behaviour as well as various physical functions, such as appetite and sleep. Most people with the disorder can learn to cope and function with treatment. Medications, psychotherapy, and other methods can effectively treat people with MDD and help them manage their symptoms. 

Children who have negative temperaments are more likely to develop major depressive disorder. Those who have first-degree family members who have depression are also more at risk, as are kids who have had adverse childhood experiences. Having another major disorder or a chronic or disabling medical condition also makes children more likely to develop depression. Abuse. Past physical, sexual, or emotional abuse can increase the vulnerability to clinical depression later in life.

Other causes include certain medications, conflict, death or a loss, genetics, major life events or serious illnesses.

How Major Depressive disorders Affects Children?

Children often find it difficult to explain how they’re feeling, especially if they’re experiencing depression. However, there are a few key signs and symptoms to look out for – particularly if they happen together over several weeks and are out of character for your child.

Children with depression may:

  • have low energy and be difficult to motivate
  • lose interest easily in an activity they usually enjoy
  • have difficulty listening and concentrating on tasks
  • make negative comments about themselves
  • withdraw from social situations, not want to spend time with friends
  • look for what’s wrong rather than see the positives in situations
  • be very difficult to please
  • be irritable, agitated, easily annoyed or upset
  • seem sad and cry easily and be difficult to soothe
  • either have no interest in food or overeat
  • have problems going to sleep or staying asleep, waking early, or sleeping a lot

Because the symptoms of depression are often characterised by negative behaviour such as irritability or whining, it’s easy to feel annoyed and to blame or punish the child for their behaviour. This can result in other signs of depression being missed.

Behavioural / Mental Health conditions

Obsessive Compulsive disorder – (OCD)

What is it?

Obsessive Compulsive disorder – OCD is characterised by excessive thoughts or obsessions that lead to repetitive behaviours commonly known as compulsions. OCD often centres on themes such as a fear of germs or the need to arrange objects in a specific manner. Symptoms usually begin gradually and vary throughout life.

How Klinefelter’s Syndrome affects children?

OCD can present itself as behavioural including things like compulsive behaviour, agitation, compulsive hoarding, hypervigilance, impulsivity, meaningless repetition of own words, repetitive movements, ritualistic behaviour, social isolation, or persistent repetition of words or actions.

Because obsessive thoughts and compulsive behaviour affect your child’s ability to relax and enjoy life, your child with OCD might have challenges like:

  • Problems at school – for example, your child has trouble paying attention or doing homework
  • Disrupted routines – for example, your child won’t go to school, come to dinner or go to sleep until his rituals are done
  • Physical problems from feeling stressed or not getting enough sleep
  • Social problems – for example, your child spends more time on his obsessions and compulsions than with his friends, or he feels ashamed of his OCD or has trouble dealing with other people’s reactions to his behaviour so he avoids social situations
  • Self-esteem problems – for example, your child worries that he’s different from his friends and family or that he isn’t in control of his behaviour
  • Other mental health problems – for example, child anxietychild depressionteenage anxiety or teenage depression.

Behavioural / Mental Health conditions

Post-Traumatic Stress Disorder – (PTSD)

What is it?

PTSD is a mental health condition that may occur after a traumatic event, or after multiple traumatic events. It can happen after there’s been actual or threatened serious injury, death or sexual violence. It can also occur after repeated and extreme exposure to the details of traumatic events.

 Symptoms include detachment, difficulty sleeping, irritability, dreaming about the traumatic event and re-enacting it during playtime. While all children can be expected to be upset after a very disturbing experience, those with PTSD are required to manage the implications of this for life.

PTSD can develop months after the event, and may seem oddly disconnected from it. Though PTSD-like symptoms are common among children and adolescents exposed to trauma, the disorder is rare in young people.

How PTSD affects children?

Children with PTSD can have lasting feelings of anxiety or physical reactions, trouble falling or staying asleep, feeling cranky, grouchy, or angry. They can also develop problems paying attention or focusing and always being on the lookout for danger or warning signs.

Signs of PTSD in teens are similar to those in adults. But PTSD in children can look a little different. Younger children can show more fearful and regressive behaviours and they may re-enact the trauma through play.

Symptoms usually begin within the first month after the trauma, but they may not show up until months or even years have passed. These symptoms often continue for years after the trauma. In some cases, they may ease and return later in life if another event triggers memories of the trauma.

A child who meets the criteria for PTSD shows symptoms commonly grouped in three areas:

  1. Intrusive memories, such as bad dreams and play that re-enact the event
  2. Avoidance and numbing, such as difficulty maintaining relationships, difficulty concentrating, and disinterest in formerly significant activities
  3. Increase in arousal, such as irritability, guilt, trouble sleeping, or fearful behaviour.
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Behavioural / Mental Health conditions

Gender Dysphoria

What is it?

The term “transgender” refers to a person whose sex assigned at birth (the sex assigned by a physician at birth, usually based on external genitalia) does not match their gender identity (one’s psychological sense of their gender). Some people who are transgender will experience “gender dysphoria,” which refers to psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity.

Though gender dysphoria often begins in childhood, some people may not experience it until after puberty or much later.

How Gender Dysphoria affects children?

Children may show an interest in clothes or toys that society tells us are more often associated with the opposite gender or they may be unhappy with their physical sex characteristics. However, this type of behaviour is reasonably common in childhood and is part of growing up. It does not mean that all children behaving this way have gender dysphoria or other gender identity issues. A small number of children may feel lasting and severe distress, which gets worse as they get older.

In younger children, it is common to see emotional and behavioural difficulties. For teenagers, there are higher rates of depression, anxiety, self-harm and suicide attempts. This often happens around puberty, when young people might feel that their physical appearance does not match their gender identity. This feeling can continue into adulthood with some people having a strong desire to change parts of their physical appearance, such as facial hair or breasts.

Getting help

How can the OTFC Group support clients with behavioural conditions?

Occupational therapists with the OTFC Group understand that education and providing strategies for behaviours of concern are important aspects of child development. Our occupational therapists remain up to date with best practices in order to inform parents and caregivers on behavioural management strategies.

Focusing on regulating and increasing capacities in sensory foundations through the ASI® framework of therapy, clients with behavioural concerns engage in occupational therapy to further enhance their engagement and confidence in everyday living skills.

How can the OTFC Group support clients with mental health conditions?

The OTFC Group understand that mental illness is very prevalent in today’s society; with the clients we work with it is important we support their mental health as well as their physical health. A large number of clients that access our service experience anxiety within everyday living, and our therapists will provide a safe space for clients as well as strategies to assist them with self-regulation.

We aim to continue to be leaders in the child and adolescent mental health sector,  by providing occupational therapy for clients that can address mental health in a considered, non-discriminatory and empathic way.

Getting help

Behavioural and mental health conditions should be addressed by medical professionals. Treatment may involve medication or therapy (sometimes both). If you are concerned at all with your child’s presentation or behaviours, please seek medical advice from your GP or another health professional who will be able to explore this further. In the case of an emergency or crisis management please call 000 or present yourself/your child to your local hospital Emergency Department. For urgent mental health concerns, please call 000 or Mental Health Triage on 13 14 65.

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