Childhood and Adolesecent Disorders
Food refusal may lead to nutritional deficiencies. A common way to refuse food is dawdling, where the child takes two or three bites but does not chew or swallow the food. ·This child simply may not be hungry, or too busy to eat, or may be trying to avoid what follows the meal-naptime, bedtime, or having to sit on the toilet.
A more serious fonn of food refusal is vomiting. If we assume the child is not physically ill, chances are the child is trying to make the parents anxious. Refusal to eat can become the basis of a power struggle between parent and child.
Obesity from overeating has four common causes. First, overeating may develop in the child of five to eight years of age as he or she attempts to replace immediate members of his family with friends. Failing, the child becomes lonely; consolation is found in eating. Second, many psychoanalysts believe that maternal overprotection is at the root of obesity. Overfeeding symbolizes the parent's attempt to atone for her own loveless childhood. According to this theory, the mother equates food with love, and lavishes it on the child. Third, arnily patterns of abnormal food intake are responsible for childhood obesity. Here the child acquires the habit of overeating by imitation, encouragement, and even pressure from parents and relatives who believe that being obese is a sign of good health and nourishment. Fourth, obesity in the child may have the same cause as in the adult,
at is, some children overeat because they respond to external cues or eating rather than to internal visceral states.
Enuresis is usually psychogenic in origin. This failure to control rination is most common at night and is more frequent among boys than girls. It may vary from slight bedwetting to complete bladder emptying. In most cases, it stops around puberty, but occasionally it ay continue throughout life. Enuresis is commonly related to arrival " a new sibling, separation from family or loved ones, or extreme sensitivity to the inability to compete. Shyness and mild anxiety usually go along with enuresis. When the difficulty is not symptomatic a more serious personality disorder, the child usually gains control spontaneously as he or she develops and is praised for success.
Infantile autism is rare, but has received much public notice; it usually has its onset during the first year of life. The first noticeable sign is failure of the child to make anticipatory movements and postures prior to being picked up by an adult. Language takes on a range parrotlike quality because the child seems not to talk to anyone in particular or to expect a response to his or her sounds. The autistic child will sit motionless for hours staring into space, as if deep in thought. Some believe that· the disorder may be caused by brain damage. The treatment and prognosis for autism have not been favorable, in part because of these children's extreme detachment from relationships.
School phobia is a common dIsorder of adclescence, usually occurring between the ages of twelve and eighteen, although it may begin earlier. Child guidance clinics report this extreme fear of going to school to be one of their most common problems. The younger child pleads to stay home, cries, trembles; and comes up with a variety of aches and pains. At the younger ages, it is traceable to fears of separation from mother and anxiety about going to strange toilets; even eating in the school lunchroom creates fear. For the adolescent, school phobia is usually a symptom of a larger neurotic personality behavior pattern. Here the adolescent tends to avoid unpleasant situations because he or she has no skill in coping with them. The school just happens to be one among many of these situations. The adolescent is more disturbed than normal and tends to be demanding, especially at home. Pouting is characteristic, and negativism is common. The adolescent attributes fear of school to any· of a series of incidents which are exaggerated out of all proportion to their actual importance. Treatment varies with the individual, but basically it is aimed at having the youngster achieve some insight into the difficulty. Clinics usually try to get the phobic person back to school and away from the pleasant home situation in which be or she seeks refuge.
