Demystifying child and adolescent psychological problems

As a parent, one of your main goals is for your child to enjoy life and develop to reach their potential. Sometimes, however, your child may appear to be struggling but you cannot easily pin down what the issue is, whether it is something to be concerned about or how serious it may be. This blog post aims to help demystify and discuss the types of psychological problems that children and adolescents may be battling with in order to help parents make sense of it and know when to seek professional help. Please make contact if you would like to talk further about this topic or if you would like to book an appointment for your child. 

Developmental and adjustment problems

Sometimes child and adolescent feelings, thoughts and behaviours interfere with a sense of well-being and capacity for emotional, social and intellectual development. If these problems do not resolve with time and with support from parents, teachers or friends, then professional assistance can be effective. Childhood and adolescence are the most influential times in a person’s life and professional advice can play an essential role in promoting adjustment and development.

What is adjustment difficulty?

Adjustment difficulty refers to the difficulty a child or adolescent might have in adjusting to an identifiable stressor. These commonly include school problems, family problems or issues around identity. The stress response may be linked to a single event such as parental divorce or remarriage, school transitions or multiple events. Stressors may be recurrent events such as a child or adolescent witnessing parents constantly fighting or continuous such as living in a crime-ridden neighborhood. Factors that influence how well a child or adolescent reacts to stress may include social skills, intelligence, genetics, coping strategies and availability of social support. Severe adjustment difficulty may result in an adjustment disorder, which is an abnormal and excessive reaction to an identifiable life stressor. The reaction is more severe than would normally be expected and can result in significant impairment in family, social or academic functioning.

What is abnormal development?

Defining abnormal development involves agreement on particular patterns of “normal” behavioural, cognitive and physical development. Development is divided into three domains: physical, cognitive and emotional-social. Each domain influences and is influenced by the other domains.

Developmental pathways help to describe the course and nature of normal and abnormal development. A developmental pathway refers to the sequence and timing of development and highlights the known and suspected relationships of development over time. It helps us to understand the course and nature of normal and abnormal development. Terms used to describe abnormal development are meant to define behaviour and understand behaviour, not to be used as labels to describe people.

Developmental delay refers to the failure to attain the appropriate developmental milestones for a child’s age. In terms of normal development principles, development is a continuous process, the sequence is the same but the rate varies between children and adolescents, the sequence is set in each field but each field is not necessarily parallel and development is related to the rate of maturation of the Central Nervous System (CNS). There is no strict line between normal and abnormal development.

What are stages of development?

Normal development is often discussed within distinct developmental stages. These stages together with typical ages are listed below:

• Prenatal: from conception to birth. The most rapid period of change.
• Infancy and toddlerhood: from birth to 2 years. Dramatic changes in the body and brain that support the emergence of a wide array of motor, perceptual and intellectual capacities occurs; the beginnings of language and first intimate ties to others. Infancy spans the first year, and toddlerhood the second year when they take their first steps of independence.
• Early childhood: from approximately 3 to 6 years. Children become more self-controlled and self-sufficient. Thoughts and language develop at a quick pace, a sense of morality becomes evident and peer friendships develop. Thought processes are concrete and literal.
• Late childhood: from approximately 7 to 12 years. Improved athletic abilities, more logical and abstract thought processes, basic reading, writing, math and other academic knowledge and skills develop; advances in understanding the self, morality and friendship occur.
• Adolescence: from approximately 13 to 19 years. The adolescent period initiates the transition to adulthood. It is the period of time in a young person’s life starting from puberty until adulthood. Puberty brings about biological changes, thought becomes abstract and idealistic, development of autonomy from the family occurs and development of identity (personal goals and values) occurs. Adolescence is a challenging time for both the teens going through it and their parents. This can be exacerbated by other difficulties such as parental divorce that may be occurring in their lives at the same time.

What is developmental disability?

Developmental disabilities include limitations in functioning resulting from disorders of the developing nervous system. These limitations manifest during infancy or childhood as delays in reaching developmental milestones. These disabilities may be diagnosed within a spectrum of neurodevelopmental disorders:

• Intellectual disability characterised by deficits in general mental abilities such as reasoning, problem solving, planning, abstract thinking, judgement, academic learning and learning from experience.
• Communication disorders including Language Disorder, Speech Sound Disorder, Social-Communication Disorder and Childhood-Onset Fluency Disorder (stuttering).
• Autism Spectrum Disorder (ASD) characterised by persistent deficits in social communication and social interaction and restricted, repetitive patterns of behaviour, interests or activities.
• Attention Deficit Hyperactivity Disorder (ADHD) defined by levels of inattention, disorganisation and/or hyperactivity-impulsivity that impairs functioning.
• Motor disorders include Developmental Coordination Disorder, Stereotypical Movement Disorder and Tic Disorders.
• Specific Learning Disorder refers to ongoing problems in one of three areas, reading, writing and math, which are foundational to one’s ability to learn.

Social, psychological, emotional, behavioural, academic and cognitive problems

Challenges that a child may be facing can be categorised into social, psychological, emotional, behavioural, academic and cognitive issues. These issues may be as a result of adjustment and developmental problems, or due to another cause.

Social difficulties: include friendship difficulties, bullying (peer issues), communication skills deficits, playing and cooperating struggles, coping with parental divorce, family distress and discord, school refusal, video gaming / digital addictions, substance abuse and attachment difficulties.

Psychological difficulties: include anxiety, phobias, depression, self-harm, suicidal thoughts, self-esteem and confidence (body-image / appearance issues, etc.), grief, trauma, stress management and career development difficulties.

Anxiety: There are a variety of subtypes of anxiety including Generalized Anxiety Disorder, Separation Anxiety Disorder, Social Anxiety, Specific Phobia, Panic Disorder, Obsessive Compulsive Disorder and Selective Mutism. Anxiety is an intense sense of nervousness and discomfort. It can be accompanied by uncontrollable worries and avoidance. While some childhood fears are developmentally appropriate it can be important to seek help from a professional if your child’s anxiety is affecting their day to day functioning or sense of wellbeing. Anxiety in adolescence can be a scary and debilitating condition. Teenagers may experience fear of being judged, lack confidence to spend time with friends or become overly panicked about particular situations. Intense worries and preoccupied intrusive thoughts can also occur in anxiety disorders causing the individual to feel quite overwhelmed and drained by the extra mental activity. Sleep can be disrupted and day to day thoughts can become tiring. Seeking treatment for anxiety early is essential in order to learn skills and strategies to cope with these difficulties. Working on developing resilience and confidence can be a key part of a psychologist’s role in assisting children and adolescents with anxiety difficulties.

Obsessive Compulsive Disorder (OCD): This is a condition which can become seriously debilitating for young people and their families. OCD is technically classed as an anxiety disorder and occurs when the individual feels intense urges (obsessions) to carry out actions (compulsions) which temporarily reduce their anxiety. However the anxiety quickly returns and is often increasingly intense. OCD then progressively takes control of the individual’s life by implementing more rules and restrictions which the person believes they must follow to make themselves feel better.

It is important to seek help if obsessions and compulsions are causing undue anxiety, restricting daily living or disrupting functioning. Psychologists can teach children, adolescents and their families to challenge the OCD and reduce symptoms. OCD often begins in childhood and adolescence. In the majority of cases it commences before 25 years old. Parents may notice excessive cleaning, avoidance, checking or reassurance seeking which is distressing to the child and concerning to the family. It is important to seek help from a psychologist early in these instances.

Depression: Children and adolescents with depression may withdraw from their family and friends, feel a strong sense of hopelessness, experience difficulties sleeping and feel intense sadness. Some individuals may engage in self-harm or suicidal thinking. Treatment by an experienced child or adolescent psychologist can be an important step in assisting these individuals. A psychologist can help families and loved ones to understand the nature of the condition better. They can also work with the individual to teach them skills to improve their condition and experience more positive feelings.

Childhood Trauma & PTSD: Trauma at a young age can have far reaching effects on a child or adolescent’s development. Difficulties can exist into adulthood and early treatment should be sought for those who are suffering ongoing distress or disturbance following a serious incident. A traumatic experience includes those where an individual has been exposed to an extremely stressful situation which was perceived as life threatening or if the person could have experienced serious injury. Natural disasters, serious accidents, sexual assault, neglect and physical abuse can all be classed as traumatic events. In some instances during childhood and adolescence if a family member or close friend is exposed to a traumatic event, children can also present with symptoms upon learning of the incident. Post-Traumatic Stress Disorder (PTSD) is one condition which can occur as a result of traumatic experiences. Complex trauma can also occur when people are exposed to distressing events on multiple occasions or over extended periods. If a child or adolescent has been exposed to a traumatic event and are experiencing ongoing distress or dysfunction as a result, then a consultation with a psychologist is suggested. Psychologists can help the individual and their family to understand the condition, process the event and cope with the symptoms they are experiencing. Accessing support from a child or adolescent psychologist early on can promote better mental health outcomes later in life in instances of childhood trauma.

Emotional difficulties: children have many ways to communicate underlying emotional distress such as frustration, anger, sadness, grief, etc. They may present with behavioural difficulties such as acting out, but the underlying cause is emotional distress.

Sometimes children and adolescents experience emotional distress when they:

• Feel very unhappy, worried or frightened for reasons they cannot explain.
• Cling to their parents because they are fearful about independence.
• Cannot channel their energy and creativity in ways that develop their potential.
• Acquire rituals or phobias because they feel helpless in difficult situations.
• Do not know how to make friends or get along with others at school or in the family; sometimes they withdraw from social relationships (relationship issues / social skills).
• Experience family communications and boundary difficulties.
• Act meanly or aggressively because they cannot control their actions and cannot find other ways to express their feelings.
• Sometimes babies cry a lot or cannot establish regular patterns of eating or sleeping and their caregivers cannot figure out how to help them.
• Cannot learn in school because they are preoccupied with thoughts or feelings.
• Struggle to understand difficult life experiences.
• Are restless or cannot concentrate because they have not acquired better ways to maintain confidence and calmness (emotional regulation difficulties).
• Have negative attitudes toward themselves and cannot feel good about who they are, even though others can observe their obvious talents and abilities (self-esteem issues).
• Have been exposed to overwhelming, stressful situations that tax their ability to cope.
• A child has suffered a traumatic event or series of events. These may be of a sexual, physical or emotional nature.
• There has been an experience of serious illness within the family or a person close to the family.
• A child experiences grief and loss after the ending of a significant familial relationship or death of a significant person.
• There is upheaval after the end of parents’ marital relationship, or during adjustment to new living arrangements.
• A child experiences school stress, including feeling pressure to do well.
• A child experiences bullying and peer pressure.
• School refusal.
• When there is concern that developmental milestones are not being met.
• When a child has sudden unexplained changes in mood and/or behavior that may include rapid changes in emotion, and may include expressions of self-harming or suicidal ideation or intent.
• When a child complains of pains and illness that are not otherwise explained by a medical practitioner.
• ADHD and weak study skills.
• Difficulty managing their anger.
• Substance abuse.
• Video game / digital addiction.
• Changes in the family, including separation, adjustment to parental divorce, relocation.

Sometimes adolescents:

• Feel confused about their identity and uncertain about their future.
• Turn to drugs or alcohol to feel better because they are depressed.
• Develop eating disorders as a way to manage difficult feelings they cannot verbalize.
• Join particular groups of peers to find companions, community and a sense of safety.
• Experience peer pressure.
• Face social media influences.
• Battle with puberty and depression.
• Face cognitive difficulties.
• Struggle with individuation (forming identity, self-concept, gender identity, spirituality).
• Have difficulty adjusting to new experiences (biological such as puberty, social such as school and family transitions).
• Develop maladaptive coping mechanisms.

Behavioural difficulties: include hyperactivity/attention concerns, anger management issues, defiant behaviour (Oppositional Defiant Disorder (ODD), Conduct Disorder) or perfectionism. Behavioural difficulties are often as a result of underlying emotional difficulties.

Raising healthy, successful, happy and considerate children is the desire of every parent. When a child acts in ways that cause confusion, concern and urgency, a behavior evaluation may be an important tool in understanding and addressing those behaviours, as well as the factors contributing to the behaviour. In the behaviour evaluation, we identify the function as well as the precipitators and sustainers of inappropriate behaviour. Additionally, we explore the child’s internal self-statements, thoughts and beliefs to understand the child’s behavioural intent.

The behaviour evaluation includes child and parent interviews, school observation, teacher consultation, review of educational records, emotional assessments, a written report and a feedback session to review results of the evaluation.

Sample parental statements and questions that might prompt a behaviour evaluation are:

• Is my child’s behavior typical for his or her age?
• How can my child’s behavior be fine at home, but very disruptive at school?
• Why does my child always disobey me?
• My daughter spends all of her time in her room and I do not know what is going on with her. She seems depressed. How can I help her?
• Sometimes my son gets so angry that I am afraid that he will lose control. How can I help him?

Academic difficulties: or learning difficulties include reading, spelling, writing and mathematics difficulties, and concentration and focus. Usually scholastic assessments are administered in this regard in order to determine performance relative to benchmark levels. Reading, spelling, writing and mathematics ages are determined based on normative data and compared to the child’s actual age.

Cognitive difficulties: include memory difficulties, executive difficulties (attention, organization and processing speed), verbal related difficulties (verbal fluency, auditory processing and language related functions), non-verbal or visual related difficulties (visual-perceptual, visual-spatial), sensory-perceptual and motor difficulties.