Neurotic manifestations of the child and adolescent During Pediatrics
Neurotic EVENTS IN CHILDREN:
If the neuroses are relatively well-defined medical conditions in adults since the works of Freud, this concept must be used with great caution when it comes to the child.
- Indeed, this state assumes a relatively stable personality, which is not the case in a child who is, himself, constantly evolving and crosses a number of successive stages maturatifs.
- This is why we prefer to speak of neurotic manifestations, this formulation does not refer to a fixed underlying structure of personality.
- There are two terms you should know, however, because of their historical importance in psychoanalytic theory:
- The infantile neurosis is an organization "physiological" accompanying and supporting the development of the child.
- The neurosis of the child is a condition in which, on the contrary, rigid defense mechanisms constitutes an obstacle to harmonious development. Has been criticized for being too this notion modeled on a disease model of the adult.
- The challenge is actually to be able to distinguish normal from neurotic symptomatology tables frankly pathological requiring specialized care. It should, for that familiar with the different stages of emotional development of children and learn to appreciate the role of symptoms in the subject's psychic economy.
Neurotic TEEN EVENTS:
In adolescents, the problem is a little different:
- We often find there neurotic developments which are only transient and correspond to coping at this time of multiple shocks.
- But you can also witness the consolidation of a genuine neurosis continuing into adulthood.
- Finally, some neurotic symptoms "massive" or atypical should alert the clinician because they are sometimes at the beginning of a psychotic process (see entry modes in schizophrenia).
CLASSIFICATION:
We usually distinguish five types of neurotic manifestations in children and adolescents (but usually there in the same subject from different types of events):
- Anxiety.
- Phobias.
- Obsessive manifestations.
- Hysterical manifestations.
- Inhibition.
Anxiety:
CHILD:
Anxiety is a fear without object. It is a normal part of child development and should be considered pathological if it is "very massive" or sustainable. It is manifest differently depending on the age of the child.
In infants and young children:
In infants and young children before the onset of language anxiety is expressed through the body:
- Screaming, crying with a particular color.
- Motor discharges.
- Autonomic disturbances (pallor, vomiting, urinary frequency ...).
- Psychosomatic diseases (colic, spasms of sobbing).
In children older:
Acute anxiety attack
In the acute anxiety attack:
- Anguish is never expressed directly.
- More the child is younger and more somatic complaints dominate the picture (headache, abdominal pain) and may be accompanied by functional disorders such as vomiting, diarrhea, anorexia ....
- Growing up, the more his anxiety child formula: anger, running away, agitation, abnormal behavior varied.
- A particular form of anxiety attack is the night terror:
- A hallucinatory phenomenon (terrifying visions) that occurs during the REM sleep stage IV (unlike the nightmare that occurs, he, during REM sleep).
- The child screams, sitting on his bed, his eyes haggard, and falls asleep after a few minutes.
- The episode is accompanied by autonomic signs (sweating, tachycardia).
- Amnesia of the episode is complete.
Chronic anxiety
- The anxiety can be chronic and found the same manifestations as those just described for acute anxiety, but often less "massive" and, of course, more spread out over time (as a restlessness).
- There are also:
- Sleep problems: bedtime opposition, demonstrations hypnagogic (occurring during sleep), nightmares.
- Hypochondriacal concerns (health concerns).
Treatment:
- The treatment of pathological anxiety of the child involves psychotherapy, always taking into consideration the family background whose role is often important in the genesis of symptoms.
- Drugs are of no use except for cases of night terror in which imipramine (Tofranil *) may be prescribed, but always after an overall assessment of the situation by a child psychiatrist.
TEEN:
- Anxiety is an affect very common.
- The acute anxiety attack approaches the table encountered in adults.
- There may also be a constant background anxiety.
- A privileged expression of anxiety is the somatic complaint.
- Treatment is mainly psychotherapy (supportive psychotherapy or inspired psychotherapy, family psychotherapy sometimes).
- An anxiolytic treatment is legal in some cases to pass a course or to prevent progression to addictive behavior.
- The prescription will always be carefully supervised, and as short as possible.
- It can be done with full agreement of the adolescent and his parents, and in a first overall difficulty of the subject
Phobias:
CHILD:
Phobias nonpathological age:
The phobia is the fear of an object unjustified or situation. Phobias are very common in children and a number of them are part of normal development of the latter:
- Fear of darkness to 2 years.
- Phobia of large animals to 3 years (the wolf).
- Phobia of small animals to 4 years.
- Situational phobias to 5 years.
These phobias are of concern if they persist durably beyond the usual age.
- Between 3 and 8 years, there are also frequent phobias:
- Natural elements (water, hail, thunder).
- Characters (doctors).
- Imaginary characters (ogres, ghosts).
- Disease or germs.
- Phobias diminish thereafter and are subject to psychotherapeutic support only if they hinder the development of the child.
School phobia:
School phobia is a clinical entity in its own right.
- It occurs in children who refuse, for irrational reasons, to go to school, and trigger a fierce anguish when we try to overcome their opposition.
- The school phobia must be differentiated from separation anxiety of the little child in kindergarten (transient response) and truancy or school refusal (no anxiety).
- It usually appears around the age of 10, usually in a boy, an only child or occupying a unique place in the sibling (eldest or youngest) often with a good grade.
- This condition does not occur only in a neurotic, and may refer to more serious disorders of personality.
- Support for individual and family psychotherapy is. An inpatient hospitalization, as part of a care contract, may be necessary in case of failure of outpatient treatment.
TEEN:
All phobias in adults may be during adolescence. However, a group of phobias is relatively specific: the dysmorphic. We close the erythrophobia.
Dysmorphic disorder:
Dysmorphophobias are obsessive concerns about body appearance, which places them in fact more in the field of pathology than for obsessive phobias.
The body part in question is of normal morphology or, if it has special, they are disproportionate with the fears related to it.
We distinguish:
- Excessive concern about the silhouette:
- Obesity (global or localized to the buttocks, thighs, abdomen ...).
- Thinness.
- Size (considered excessive, or too small).
- Concerns about excessive body part: all can be involved, but the face is of course often incriminated (nose, ears, acne ...).
- Concerns about excessive sexual characteristics:
- Hairiness.
- Chest.
- Genitalia.
- The deepening of the voice.
The unusual, bizarre, dysmorphic disorder is a question of an onset of psychosis.
Other phobias:
- It is closer to the erythrophobia dysmorphic disorder is the fear of blushing in public.
- The school phobia are also in adolescence. It is considered to have a worse prognosis than the child's school phobia.
Obsessive manifestations:
CHILD:
Normal manifestations
Again, there are events that are part of normal development of the child:
- Repetitive throwing of objects in the first year.
- Rites around learning sphincter control in the second year.
- Bedtime rituals to 2 or 3 years.
- After 5 years: collections, conjuring acts.
Pathological manifestations
Pathological manifestations may include:
- Ideative or impulsive obsessions, which are rare in children:
- Rites are found mostly varied and can be very invasive. They value exorcism.
- Ritual washing.
- Taboo of touch.
- Rites of proofreading.
- Various checks.
- Arythmomanie ...
- It brings in various tics (eye blinking for example).
The preferred treatment is psychoanalytic psychotherapy type.
TEEN:
- Among adolescents, obsessive compulsive disorders are quite common.
- Unlike the child, the obsessive ideas are often in adolescents.
- These disorders can develop into an obsessive-compulsive disorder in adults.
Hysterical manifestations:
CHILD:
Reminder to be cautious when talking about hysterical personality traits in children, because their definition is very imprecise. If one applied the criteria used in adults (theatricality, suggestibility, lability of affect ...), any child would be hysterical!
As for the hysterical symptoms, they are quite rare in children:
- Conversions mainly affect the musculoskeletal system, and in particular walking (paralysis, lameness varied). We can also meet: amaurosis, blindness, hearing loss, silence ...:
- The "belle indifference" is rarer than in adults, children frequently complained of his difficulties.
- Clinical examination, possibly supplemented by some additional tests simple, easily removes an organic origin.
- A symptom often found identical in the entourage (lameness of a parent for example).
- Functional disorders (chronic pain, dizziness, etc..) Are now assigned to manifestations of anxiety, not hysterical symptoms using a more complex symbolism.
- What to do includes:
- Sometimes diagnostic tests to rule out somatic pathology. However, it should avoid taking an escalation of invasive explorations that might fix the symptom.
- An approach taking into account the underlying suffering of the child, without dramatizing the symptoms and limiting secondary gains.
- The quality of collaboration between pediatrician and child psychiatrist is essential here.
- The individual and family psychotherapeutic approach is again the focus of treatment.
TEEN:
- The hysterical manifestations are much more frequent than in children and are to type:
- Conversions varied.
- Hysterical crises.
- Twilight states, fugues.
- We must distinguish the conversion of hypochondriacal complaints, psychosomatic diseases and simulations (conscious motivations), although these elements are often intertwined.
Inhibition:
The inhibition is most common between 8 and 12 years, and often leads to consult because of academic failure that may be involved.
- We differentiate:
- Intellectual inhibition, resulting in school failure.
- Inhibition to "fantasize".
- Relational inhibition (shyness).
- These children are sometimes hastily labeled "deficient" ("pseudo-neurotic debility"). It is crucial to identify the diagnosis by several assessment interviews possibly accompanied by psychometric tests.
- The psychotherapeutic approach may, in fact, helping the child to reinvest thought, have beneficial consequences spectacular.