Keep tabs on whether your child is meeting all her developmental milestones—both emotionally and physically. Doctors say that it’s important for parents to be vigilant and aware of the warning signs that could signal
a problem. We tell you when you need to sit up and take notice, and when you should just relax.
By Anindita Ghosh
Parents of young children are quick to panic, and paediatricians are used to dealing with frantic calls about delayed speech, frightening tantrums or growth issues on a daily basis. While most of these calls turn out to be false alarms, there are times when a parent’s gut instinct does point to something serious. According to Delhi-based clinical and child psychologist Dr Dherandra Kumar, heightened panic is unwarranted, but a little caution is good. “If you do notice something out of the ordinary, do not panic, because a disorder is usually diagnosed only if a group of symptoms are present. It is best to consult your paediatrician or psychologist to put your mind at ease, just in case you’ve missed some symptoms.”
It’s important to get professional help the moment you suspect a problem because early intervention is the best way to deal with childhood disorders.
The brain’s ability to change reduces with age, so the earlier one starts treatment, the better.
“A child, who was almost three years old, was brought to me once,” says Dr Kumar. “He would keep moving all the time. In fact, it was difficult to make him sit still for even five minutes. He would also make unusual sounds, not respond to his name, and flap his hands. He had not picked up any speech and could only babble. However, his parents had got him to me at the right time and he responded extremely well to intervention for more than a year. Now, he’s managed to get admission to an inclusive school.”
Here’s a list of the developmental and behavioural problems that could be spotted in children aged four and above. However, please remember that only a doctor will be able to tell you what the signs you have noticed point to.
CONTINUED IMMATURE BEHAVIOUR, POOR COMPREHENSION, LACK OF CURIOSITY
What the problem could be: Deviations from normal behaviour depend on the severity of the condition. Lack of curiosity and quiet behaviour could be a sign of mild retardation; severe mental retardation is associated with immature behaviour that lasts for life. According to Dr Kumar, there are multiple causes like infections, trauma at birth, neurological conditions, genetic factors, etc, that could cause mental retardation, but in most cases, the causes remain unknown.
Other clear symptoms
What you need to do: If your child displays any of the above mentioned symptoms, consult a professional and work according to the prescribed guidelines. Dr Kumar says, “The child will require special education and training to develop her potential. Behavioural approaches are quite effective in developing social skills. Intervention can be started at infancy itself if a child shows poor development.”
DIFFICULTY IN COMMUNICATION, RESTRICTED INTEREST, REPETITIVE BEHAVIOURS
What the problem could be: These are the most obvious signs of autism. Theories abound on whether it is caused by genes, brain structure, brain chemicals, vaccines, diet, or environmental toxins. However, even though there is plenty of research being conducted on the disorder, there’s no conclusive evidence that points to a particular factor.
Other clear symptoms
What you need to do: Autism is not caused by poor parenting. There are courses of treatment for autism, like applied behaviour analysis, TEACCH (Treatment and Education of Autistic and related Communication-handicapped Children), occupational therapy, etc. The sooner you see a professional, the better.
EXCESSIVE HYPERACTIVITY, IMPULSIVE AND INATTENTIVE BEHAVIOUR
What the problem could be: ADHD (Attention Deficit Hyperactivity Disorder) is one of the most common childhood disorders and can continue through adolescence and adulthood. “Parents should also know that children with ADHD tend to suffer from emotional difficulties, insecurity and low self-esteem since they are generally rejected by their peers and disliked by adults because of their behaviour,” says Dr Sujatha Sharma, consultant clinical psychologist, Parivartan Centre for Mental Health, Delhi.
Other clear symptoms
What you need to do: ADHD can be treated with medication, behavioural intervention, and personalised instruction. “Children with ADHD handle neurotransmitters differently from their peers,” says Dr Kumar. “Whatever the cause may be, it seems to be set in motion early in life as the brain is developing. The therapist, parents and the school should work together to treat a child with ADHD.”
A HOT TEMPER, ARGUMENTATIVENESS
What the problem could be: ODD (Oppositional Defiant Disorder) often occurs along with other behavioural or mental health problems such as ADHD, anxiety and depression. It’s difficult to diagnose ODD and separate a willful child from one who has ODD. However, if the symptoms are persistent, have lasted at least six months and are clearly disrupting the home or school environment, it may be ODD. Treatment can help restore your child’s self-esteem and rebuild a positive relationship between you and your child.
Other clear symptoms
What you need to do: Talk with a mental health professional in an individual capacity, and also possibly, go in for family therapy. The parents should also learn how to manage the child’s behaviour and there are structured programmes for the same. “Try to find out what triggers anger and rage in your child and possibly try to shield her from such situations,” says Dr Sujatha Sharma. “Learn to be firm in the face of aggressive or violent behaviour but keep your reactions consistent so that your child doesn’t get mixed signals. Don’t forget to reward good behaviour.”
COMMON CONCERNS Not all symptoms require you to rush to a paediatrician. Here are some signs and symptoms that cause parents a lot of distress, but are generally considered harmless.
“Are tantrums linked to mental illness?”
Doc: “Very rarely!”
Parents who have had their child throw themselves to the floor, kicking, screaming, rolling around, and perhaps even frothing at the mouth, can be forgiven for thinking that they have some form of mental illness. However, according to Dr Sujatha Sharma, tantrums are very common among young children, and are rarely a cause for concern. “Tantrums are the way very young kids show their displeasure or discontent. Since many of them at this age are unable to express themselves properly through speech, it leads to frustration and anger.
A tantrum usually starts off with whining and crying, and then leads to shouting, throwing of objects, and refusal to cooperate.” Kids throw the worst tantrums in their toddler and pre-school years.
What you should do
• Kids often throw tantrums when they are stressed or upset. Keep calm and try to investigate what might be distressing your child.
• Disciplining through punishments will not work.
• Praise good behaviour, but don’t give in to unreasonable demands.
“Should I be worried if my kid is too shy?”
Doc: “Not really. Just give her time.”
There are many children who are painfully shy and withdrawn. They would rather play on their own than socialise. This could be because of a number of reasons. “For one, you have to accept that your child is probably genetically programmed to be that way,” says Dr Sharma. “Not everyone is a gregarious extrovert. Some children take time to open up. Most children will be shy in a new environment, around new people, or in new situations like a public function or school.” However, if your child displays this behaviour with known people
and familiar situations, it could be a problem.
What you should do
• Encourage your child to build social skills. Teach her how to carry on a conversation and share toys with other kids.
• Ease them into social situations. Never force the child to talk to strangers or embarrass the child by making them ‘perform’ in front of guests.
• If your child is scared, as opposed to shy of people, you must look into the underlying causes. Has your child been abused or traumatised by somebody, for instance? “You must use imaginative ways to coax the truth out of your child,” says Dr Sharma. “And if you do discover something disturbing, take professional help as soon as possible.”
“Is it ok for my child to be scared of imaginary creatures?”
Doc: “Yes, it’s normal.”
Fears form the normal process of a child’s development process with 90 per cent of them displaying a phobia of monsters and ghosts. “A child’s emotional apparatus cannot differentiate between reality and fantasy,” says Dr Sharma. “They feel scared of the dark because they don’t know what lies hidden.”
What you should do
• Don’t keep scolding your child for feeling scared of certain things.
• Try to get rid of her fears in a guided manner. She will need lots of reassurance as you gradually introduce her to new situations.
EXCESSIVE DISTRESS WHEN SEPARATED FROM PARENTS, FREQUENT NIGHTMARES
What the problem could be: Separation anxiety is a normal developmental stage and it helps children learn how to master their environment. It usually ends when the child is around two years old. At this age, children begin to understand that while parents may be out of sight for a while, they will return later. There is also a normal desire to test their independence. Even after children have successfully mastered this developmental stage, separation anxiety may return during periods of stress.
Other clear symptoms
What you need to do: “To get over separation anxiety, children must feel safe in their home environment, trust people other than their parents and trust that their parents will return,” says Dr Dherandra Kumar. “For normal separation anxiety, there is no treatment other than ensuring the above conditions are met. Treatment for severe cases may include educating the family, family therapy and individual psychotherapy.”
The National Study on Child Sexual Abuse commissioned by the Ministry of Women and Child Development and conducted by Prayas, UNICEF and Save the Children, found that more than 53 per cent of children in India are subjected to sexual abuse. Most cases go unreported because children can’t talk about their traumatic experiences and because many parents miss the signs that point to abuse. Don’t be caught unawares. Keep a watch on your child’s behaviour and look out for these symptoms:
If you suspect that your child has been abused, take your child to a doctor for a thorough check-up. You will also need to take the help of a child psychiatrist or counsellor, because the scars of abuse run deep. According to Delhi-based child psychologist Dr Priyanka Goenka, “Knee-jerk reactions like restricting your child’s movements outside your home will be counterproductive. Keep reassuring your child that you love them and that your support can be counted on.”
If your child is suddenly morose, cries easily and gets angry at little things, all is not well in her world. She could also be refusing food or urinating in her clothes. “Children who are undergoing significant emotional difficulties react in this manner,” says Dr Goenka. “Emotional abuse occurs when a child is constantly given negative feedback about herself. Statements like, ‘You can’t do it’ or ‘You are always behaving like this’, harm the child’s self image, and they begin to believe that these statements could be true.” Stop negative feedback and praise your child for all the effort she is making. Encourage a positive environment around her and she will grow up to be a better individual.