Attention to children and adolescents

Childhood and adolescence are two decisive moments in the mental development of all people.

We advise parents to know the characteristics of normal and pathological development of children and adolescents, we use the most modern evaluation strategies, adapting them to the characteristics of the child’s developmental stage, the psychopathology of the children and adolescents, and the disorders that usually start in these ages, as well as their peculiarities.

We offer advice to parents so that they know the basic principles of learning, basic strategies of behavior modification to face tantrums, tantrums and behavioral difficulties, imposition of rules and limits, educational styles, guidelines for parenting, as well as the acquisition of adaptive habits in relation to sleep, eating, sphincter control.

We also provide support in the adoption and family reunification processes.

In the pre-adolescence and adolescence phase, if necessary, we offer support and psycho-education on the subject of sexual and affective relationships, body changes and age-appropriate image. We offer support when difficulties arise with the consumption of alcohol and drugs, as well as with the use of new technologies.

Normal and pathological development in childhood and Adolescence

Normal child development

From birth to 6 years of age, early childhood takes place. Within this arbitrary delimitation, we can speak of two phases, one that corresponds to early childhood itself until the age of three, and another that is the pre-school period until the age of 6.

Childhood

Early childhood (0-6 years) 

Early childhood (0-3 years)

Preschool (3-6 years)

School stage (6-12 years)

Adolescence (12-18 years)

The newborn baby has many capabilities: it sucks and swallows food, removes waste, sleeps and interacts with the environment. In addition to crying, which is the reflex response to a state of discomfort, the baby is born full of reflexes, some of which will disappear after a few months and others will remain unchanged throughout its life.

Evolution of reflexes 

Examples

They appear around birth and are maintained with little alteration during the rest of the life: Patellar, Palpebral, Sneezing.

They disappear after a few months, without a trace, and without these behaviours being learned again: Babinski, Moor, Tonic-cervical, Plant

They disappear after a few months, and then reappear voluntarily: Walking, Climbing, Swimming, Crawling.

From the second quarter of life, the following become voluntary activities: Suction and Pressure

When the baby is born, its senses, although they have begun to develop, they have not as yet completed this process, and continue to do so during the first year of life. Also during this first year, a series of evolutionary milestones at the motor level take place, as well as the beginning of language development, with the first vocalizations and babbling.

With respect to language development we can say:

• At 9 months, the child points to an object with the intention of getting it.
• At 12 months of age children produce what their parents consider to be the first word.
• From 12 months to 24 months they use one-word sentences.
• From the age of 2 years they begin to combine words.
• From the age of 3 there is an incredible increase in vocabulary that coincides with the appearance of more complex sentences and phrases.
• At the age of 4, children’s speech is similar to that of adults.

Between the ages of six and 12 is a second childhood, a transitional stage between early childhood and adolescence, which can also be called the schooling stage.

At this stage, there is an incorporation into the primary school and the development of intellectual skills (ability to make classifications, distinguish similarities and differences, elaborate concepts) takes place. There is also an increase in the capacity for concentration and memory, which will make it possible to incorporate new knowledge. An increase in demands at all levels, including demands to be more independent, which in many children can translate into difficulties in separation, suffering anguish, in the face of separations, which they can express by crying, or in a more subtle way by waking up at night, going to their parents’ bed or through belly and headaches.

By the age of 7, the child already knows very well the limits he cannot cross, which does not mean that he does not transgress them from time to time.

At this age, motor skills are also important. They learn to ride a bicycle, swim, ski, skate, skip, and they begin to participate in regular group sports activities such as football, basketball or swimming. At this stage motor skills are very important in social development.

At these ages children are more able to accept reality, and better tolerate what they don’t like about it, they can anticipate a goal, and can wait to reach it, having more self-control.

They accept and understand the rules that regulate social relationships. In spite of them, children at this age show jealousy and rivalry, feelings that cause them discomfort. Here we can find two types of manifestations:

• Violent children, who cannot contain their anxiety, and manifest it through physical and verbal fights, dominating the other.

• Children who show themselves to be overly good in order to counteract and hide their hostility even from themselves. This is because of their need to feel good, and their fear of not being good.

By the age of 11, there is a greater demand for school work, and important changes are introduced in the school curriculum.

Between 10 and 12 years of age, puberty takes place, and adolescence is a time of important changes in all areas: biological, psychological and social.

Normal adolescent development

Adolescence begins with puberty, and as we have already said, adolescence implies a series of changes in all spheres, at a biological level a series of bodily changes appear, at a social level the relationships established by the adolescent change. And at the psychological level, where the child seeks his identity. There are authors who define the adolescent as a character in search of identity.

Adolescence implies separation, questioning, doubt and choice. The child separates physically and emotionally from his parents, thinking and feeling in a different way.

We are facing a stage of development where the state of crisis predominates, identity is renewed and there is a process of elaboration of losses that gives way to new acquisitions.

Why are we talking about losses?

Because during adolescence it happens:

The loss of the child’s body.

The loss of child dependency and identity.

The loss of the parents of their childhood, whom they can no longer treat physically or emotionally in the same way.

The adolescent’s body faces many changes:

 

Teenage growth spurt.

1. The development of primary sexual characteristics (those involved with reproduction): growth and development of the external genitals, ovaries, testicles, and their products, menarche in girls and first ejaculation in boys.

2. The development of secondary sexual characteristics, which are those important features to distinguish between men and women but which are not key to reproduction, the appearance of hair on the face or pubic hair, changes in the voice, breast enlargement etc.
3. The development of the circulatory and respiratory systems that lead to increased strength and endurance in children.

4. Changes in body composition: amount and distribution of fat.

These changes constitute a process in different phases that can last between 4 and 5 years.

In addition to the physical changes, social changes take place, as the adolescent has to adopt new social roles. The child has to face a series of developmental tasks when reaching adolescence.

Developmental tasks of adolescence:

1. To reach new and more mature relationships with age-mates of both sexes.

2. Acquiring a male or female social role.

3. Accepting one’s physicality and using the body efficiently.

4. Achieve emotional independence from parents.

5. Prepare for marriage and family life.

6. Prepare for a financial career.

7. Acquire a set of values and an ethical system as a guide of conduct.

8. Develop socially responsible behaviour.

Psychological changes are related to personality development, and to cognitive development, which is related to the development of formal operations, which implies the ability to think abstractly. When this happens children can deal with the possible, the hypothetical, the future and the remote.

Erikson defined the stag e of adolescence as Identity vs. role confusion, in this stage the adolescent must answer the question who am I?

Identity is formed when the young person resolves three important issues:

• Choice of an occupation.
• Adopting values you will believe in.
• Developing a satisfying sexual identity.

Pathological development of the child and adolescent

When innate conditions and environmental conditions are favorable (psychosocial stimulation, bonding and attachment relationships, amongst others), development occurs satisfactorily, but when these conditions are precarious, disorders of all kinds and severity can occur.

We define mental disorders on the basis of normal childhood and adolescent development, pointing out the importance of the age criterion in determining whether a behaviour (and with all its parameters of frequency, intensity, and duration) is normal or pathological. Thus, once again we Wílsones see there are manifestations that at one age constitute a disorder, while at earlier ages they are indicative of normal functioning.

In the aetiology of mental disorders we therefore find constitutional neurobiological and psychic elements that predispose, but then we have the relational factors coming from the environment, which can act by correcting or increasing this predisposition (innate conditions and the developmental environment conditins). So within mental disorders we will not talk about unique causes, but rather we will talk at all times about MULTICAUSALITY, talking about protective factors, salutogenic or beneficial factors, and predisposing, harmful, triggering, precipitating risk factors, etc.

Understanding health as a state of harmony and balance, or as the WHO understands it to be a complete state of physical, mental and social well-being, and not just the absence of disease or infirmity, we can see that many children and adolescents present mental or mental health problems that interfere with their development as well as with their daily activities. Some mental health problems are mild, while others are more serious. Some last only short periods, while others may last a lifetime. While we quickly recognize fever, measles, and chickenpox, mental health problems are often more difficult to identify and recognize, and sometimes involve specialist interventions and assessments that can delay the diagnosis and therefore intervention.

Syndromes such as the currently known pervasive developmental disorders or autism spectrum disorders manifest themselves in the early years of life. These children present difficulties in the social, language and behavioural areas, and which in 75% of cases are associated with intellectual disability.

In the preschool stage between the ages of 3 and 6, difficulties related to sphincter control, or eating disorders such as pica and rumination may appear. Sleep disorders, such as nightmares and night terrors, may also occur.

In the school age with the incorporation into primary school, the difficulties of the child in the classroom become evident, and one begins to speak of difficulties in the learning, as well as difficulties to maintain the attention in the classroom.

Also at this age, behavioural disorders appear, with children becoming disobedient, hostile and irritable and demonstrate difficulties with the assuming rules and limits.

Clinical experience with adolescents shows us that the post-pubertal period is particularly conducive to triggering pathological conditions.

In adolescence, body-related disorders appear. As we have already said this stage is a phase of changes, physical changes that can be lived in a favourable, adjusted and adequate way, or in the worst case live the body changes as something detestable, disappointing, and which to blame for all their discomfort and suffering. In this context appear anorexia, and bulimia, disorders that are not about a bad handling of food, but a hatred and contempt for their own body.

In this stage the children put themselves to the test, playing with their new physical possibilities, assuming risks with which they try to achieve the admiration of the other, which sometimes causes frights, and on other occasions accidents. In this context, they begin to consume legal and illegal substances, and impulsive behaviour appears, which is usually one of the most frequent reasons for consultation. According to the World Health Organization (WHO, 2001), the prevalence of psychological disorders in children ranges from 10 to 20%.

Children between the ages of 0 and 5 are at particular risk of behavioral, communication, impulse control and pervasive developmental disorders.

Conduct disorders occur more frequently between the ages of 6 and 11, followed by attention-deficit hyperactivity disorder (ADHD); this is the age range in which most diagnoses are made.

Conduct disorders, along with anxiety disorders, are most common between the ages of 12 and 18; either because of the higher demands or academic level, the various physical, psychological, and hormonal changes of puberty, or because of increased interaction, intimacy, and engagement among peers.

There is a higher incidence of conduct disorder in boys, and anxiety in girls at any age. Evaluation is essential for diagnosis and treatment. But we shouldn’t understand evaluation as an isolated thing, rather it’s a part of the process.

1. It necessarily involves different sources of information. Parents are the key informants. But their information is partial, which is why it is essential to turn to other sources of information, and coordination with teachers, monitors, as well as other significant persons is necessary, since the lack of agreement is a reality in itself. The lack of agreement among the different informants does not imply a lack of credibility or reliability towards them.

– The child perceives the problem, but does not report certain behaviors to others. For example, a child who has not told their parents that they are involved in vandalism.

– Different informants have different perceptions, which reflect contextual differences in specific contexts. For example, parents who indicate that they have not perceived concentration difficulties or attention problems in their child, while the teacher frequently gives warnings of inattention.

– The information does not agree because it depends on the type of symptoms. For example, parents who claim that their child had never had thoughts of suicide prior to the attempt he just made, while the child claims and informs the clinician that the thoughts were present for some time.

 

Disharmonious information may be given because parents’ responses are influenced by the negative halo effect, whereby they tend to assign more negative characteristics or exaggerate their child’s behaviour. Also when parents tend to accentuate externalizing or disturbing behaviors such as hyperactivity, oppositional and aggressive behaviors. However, symptoms such as isolation and sadness can be hidden in “good” children who do not give problems.

Thus, the evaluation of the child and adolescent must include different sources of information, and each source will communicate what it observes in its field. We should not disregard any of them, and the evaluation of the child themselves is very important.

If we wish to understand the child’s beliefs, perceptions, reasoning capacity, attitudes and affective experiences that are relevant to his or her current difficulties, it is logical to ask the child about this, using the available tools adjusted to their developmental level.

2. All children and even teenagers are brought to the clinic by their parents. In most cases they do not come voluntarily, and many do not recognize that they have a problem. This makes the process of collecting information very difficult.

 Most consultations in psychology are determined both by the severity of the disorders and by the parents’ tolerance of the symptoms or problems manifested by their children, so the lower the parents’ tolerance, the more likely they are to seek help from a professional.

Sources of information when starting child therapy:

1. Psychological evaluation of the child.
2. Parent interview.
3. Collection of information from the educational, medical and social community environment.

 Techniques and instruments used in the evaluation of the child and teenager

During the evaluation process we will use different instruments, techniques (multi-component evaluation), in order to collect necessary and sufficient information in the different areas of the patient’s life.

 

Within the different types of techniques the interview plays a fundamental role. But also, depending on the age of the patient and the reason for consultation, we may use other instruments or tests, which will undoubtedly provide complementary information to that provided in the interview.

The interview, through which we will gather information about the reason for the consultation, and nature of the problem, history of the problem, genogram, family history, personal medical, psychological and substance use history, attempts to solve the problem and expectations regarding treatment. This information will allow us to make the first hypotheses of the therapeutic work, as well as to establish goals and objectives of the treatment.

Self-reporting, collects the subject’s verbalizations about their own manifestations. The subject matter of self-reports is varied: physiological responses, motor responses, cognitions, emotions, personality traits. Within the self-reports we use the CDS, CDI, CAS and STAIC-C among others.

Projective tests are especially sensitive instruments to reveal unconscious aspects of behavior, which allow us to provoke a wide variety of subjective responses, evoking unusually rich data, with a minimum of knowledge by the subject of the test objectives. We use the TAT, CAT-A, CAT-H, Blacky, Blackleg, Fairytale Test, Human Figure, Machover and HTP.

Instruments to evaluate development and intellectual capacity, these scales provide an index of development, and most evaluate children between one month and 42 months (4 years) approximately. These tests emphasize simple sensorimotor and social skills, such as sitting, walking, grasping objects, attending to visual and auditory stimuli, laughing, imitating adults, etc.

To use these tests, it is necessary to take into account the different developmental milestones of the child. To evaluate the development we have: BL-R, BSID – III, Carolina Curriculum, MP – R and MSCA. To evaluate the intellectual capacity we use:

WISC-IV, Kaufman K-BIT, Toni-2 and Raven.

We also use the following tests:

Neuropsychological area: King Figure, D2, Face Test or Difference Perception Test, Family Figure Matching Test, Brief-P and ENFEN.

Scales for externalized disorders: Achenbach CBCL, ADHD, Conners and BASC scales.

Scales for internalized disorders: Childhood Depression Inventory (CDI), Kovacs. Childhood Depression Scale (CDS), Lang and Tisher.

State-Trait Anxiety Inventory for Children (STAI-C), Speilbeger.

Childhood Anxiety Questionnaire. CAS. Yale-Brown Obsessive-Compulsive Scale for Children (CY-BOCS), Goodman.

Attention Deficit Hyperactivity Disorder ADHD

There are a number of children who have excessive motor activity and very poor impulse control. In recent years there has been much controversy regarding this clinical picture, although for a few years it has been the diagnosis par excellence, and any child who shows excesive motor activity has been labeled as ADHD without many implications at the level of treatment, there are many researchers who deny the existence of this diagnosis in childhood. Apart from the label that does not really solve anything, children with these characteristics and their families need special attention and support.

Attention difficulties and impulsiveness are the basic characteristics of this clinical picture. Although hyperactivity is an important symptom, it takes a back seat.

Inattention is a phenomenon that involves different consequences: such as difficulties in resisting distraction, difficulties in selectively attending to specific stimuli, and difficulties in exploring complex stimuli in a planned and efficient way. With this set of difficulties in focusing attention, it is not surprising that the ADHD child presents difficulties in school performance, and difficulties in acquiring academic learning, since attention is the previous step to understanding and memorization.

Impulsivity manifests itself mainly through two facts: The child does not consider the possible consequences of his actions and shows himself incapable of postponing gratifications. This leads them to be reckless, to break rules, to lack of caution in dangerous situations, to social disinhibition, to suffer more accidents, to rush to the desired object, to have difficulty in keeping their turn in line or in games with equals, and to respond with aggression to small frustrations.

These behavioral irregularities cause these children to be considered immature and ill-mannered, to be continually rejected by their peers and adults, with the subsequent consequences that this has on the child’s identity and self-image.

The hyperactive child tends to carry a history of school, social, family and even physical sporting failures, since sometimes they can suffer from motor clumsiness, which together with the difficulty in following rules, can also leads them to failure in team sports.

Oppositional Defiant Disorder

The affected child manifests a pattern of negativistic, defiant, disobedient and hostile behaviours directed at authority figures. They often have difficulty in following rules and limits, the child is often a provocateur, who deliberately annoys, accuses others of their mistakes and infractions, is easily angered and is often vengeful and spiteful. This is pathological disobedience, and these are behaviours that occur in the family environment.

Intermittent Explosive Disorder and Conduct Disorder

It is a disorder characterized by an inability to control impulses and behavior. It includes activities such as stealing, running away from home, lying, setting fires, playing truant, destroying other people’s property, acting cruelly to animals, engaging in sexual violence, using weapons, etc.

 

We speak of conduct disorders in children and adolescents when they manifest a pattern of antisocial behaviour, accompanied by a significant alteration in family and school behaviour, or when the behaviours involved are considered impossible to control by the significant people in the environment. (Parents, educators etc…).

These children often show little empathy, no concern for the emotions and feelings of others, are insensitive, and lack feelings of guilt and remorse. They also tend to have a low tolerance for frustration.

They are usually initiate earlier than usual in various activities such as sexual activities, smoking, drinking alcohol, as well as the consumption of other toxic substances. These behaviours can have serious consequences, which worsen the boy’s functioning as well as the seriousness of the disorder.

Mood disorders

It is currently considered that there are depressive episodes in childhood and that they are generally similar to the depressive episodes that occur in adults.

This disorder can appear at any age, and its fundamental characteristics are: guilt, fatigue, loss of interests and activities, concentration difficulties, psychomotor agitation or slowness, sleep and appetite disorders and suicidal ideation, also known as suicidal thoughts.

In minors who are depressed, the mood tends to be dysphoric and irritable rather than depressive. There are different symptoms depending on age:

• Preschool child: refusal to play, agitation, shyness, temper tantrums, encopresis, insomnia, hyperactivity, feeding difficulties and other somatic symptoms.

• School age: irritability, insecurity, learning difficulties, shyness, enuresis, encopresis, onicophagia (nail-biting habit), night terrors, genital manipulation, tantrums, and psychosomatic symptoms. Somatic discomfort (abdominal pain, headaches and nausea). Suicidal thoughts may also occur.

• Pre-adolescence and adolescence: rumination, suicidal urges, despondency, feelings of inferiority and oppression, headaches, and psychosomatic symptoms. Hallucinations and delusions may also occur, as well as suicidal thoughts and attempts.

Different manifestations can also be observed depending on the sex, so in girls there are symptoms of inhibition, anxiety, difficulties in establishing social contact, conformism, good behaviour, mutism, aggressiveness, tantrums, enuresis, and food compulsion. And in boys, inhibition, aggressiveness, enuresis, unmotivated crying, school difficulties, sleep disturbances, onicophagy, etc., appear more frequently.

Anxiety disorders

Let’s first define the concepts that relate to anxiety:

 Fear: it is a primary emotion, it is a feeling that occurs in response to a present danger, and therefore it is closely linked to the stimulus. The presentation of the stimulus produces the fear response.

Anxiety: an emotion similar to fear, in fact it involves the same set of bodily changes, but it involves the anticipation of a coming danger, indefinable, the cause being more vague and less understandable.

Anxiety therefore is an emotion that has an activating function, preparing the body to carry out the fight/run response. When this is excessive in intensity, frequency and/or duration or appears before stimuli that do not represent a real threat to the organism, and produce discomfort, and interference in the different areas of activity of the individual, then we speak of anxiety disorders.

 

Phobia: intense fear or anxiety about a specific object or situation, or social situations in which the individual is exposed to possible examination by others.

Separation anxiety disorder

Separation anxiety is a milestone or characteristic of the early stages of a child’s development, which prevents the emergence of dangerous situations, however as the child matures, transforms this anxiety into fears more specific to certain situations such as darkness, strangers, animals, etc..

Separation anxiety disorder includes as a nuclear phenomenon the experience of 

significant (excessive) distress over the real or perceived separation of people with whom an affective bond has been established, usually their relatives and mainly the mother.

When faced with situations of separation, the child fears that any misfortune may happen to these people, or that they will not return, and also thinks that all kinds of evils may happen to him, such as kidnappings, accidents and murders, 

refusing as a consequence to attend school, resisting going to bed alone, or staying home alone, even being in a room alone. 

These children often become shadows of their parents, being very demanding, intrusive and requiring a lot of attention.

Manifestations of anxiety and distress are evident during the separation and before it (anticipation). When the separation finally occurs, the most depressing clinic predominates, with apathy, withdrawal, sadness, difficulty concentrating on games etc…

 This disorder can be complicated by refusal to attend school, which in turn can become a cause of school tardiness and peer relationship difficulties.

Selective mutism

The inability to speak in certain situations or to certain people, often all those who are not familiar. This is the constant failure of the intention to speak in specific social situations where there is an expectation or demand, despite doing so in other situations, for example, at school or at social gatherings.

Phobias

As we mentioned at the beginning, phobias are defined as an intense and persistent fear of some object, animal or situation. It is understood as a fear of a type that is disproportionate to the danger of the situation, irrational (resistant to explanations and arguments), involuntary, and leads to avoiding the feared situation. In addition, it does not correspond to the age or stage of development of the child.

Fear is understood as a normal reaction, with an important adaptive and functional value. Fear is part of normal development, with these child fears temporary and transient, and which do not usually interfere with normal functioning.

At each age we can observe how it is usual and normal to have certain fears, observing how in the different evolutionary stages not only the stimuli or objects that trigger the fear response change, but also the response or manifestations of the emotion.

For example, in the first months children respond with screaming and crying. Between 8 and 12 months, when the child can discriminate between family members and strangers, the fear of strangers appears, and having developed ambulation, the fear responses are characterized by responses of avoidance to the feared stimuli, and approach to the figure of attachment.

By the age of two, the child acquires language and a symbolic function, and fears of imagined beings, of the dark or of being alone appear.

 In the second childhood 7-9 years, the child is able to remember experiences and anticipate possible dangers, and the fears are usually focused on physical harm, failure and ridicule.

From puberty onwards 10-12 years, fears focus on the judgement of others, physical harm and family problems.

In childhood there is a set of phobias that tend to appear more frequently: school phobia, fears of physical harm and death, fears in interpersonal relationships (failure or criticism), and specific fears of certain objects or situations such as animals, natural phenomena, enclosed places, etc.

 

Generalized anxiety disorder

It is characterized by a fearful, excessive and uncontrollable, persistent and unrealistic concern that extends to situations, past, present and future. Affected children are often perfectionists, rigid, and often seek security in adult control and approval.

Obsessive Compulsive Disorder

OCD is a condition characterized by the presence of intrusive ideas called obsessions and repetitive acts intended to relieve anxiety.

1. The age of onset is around 10 years, though it ranges between 7.5 and 12.5 years, and in most cases is associated with a stressful event.

2. More boys than girls suffer from it.

3. It is frequently associated with other disorders.

4. It usually presents neuropsychological irregularities, mainly in executive functions.

5. The child is more likely to have a family history of OCD and tics.

6. It’s often accompanied by tics. Giles de la Tourette’s disorder is an early-onset neurodevelopmental disorder, appearing around 5 years, and 25-50% of these cases end up developing OCD symptoms. That’s why there’s talk of an obsessive-compulsive spectrum today and why it’s believed that the two share the same genetic makeup, although it remains unknown.

7. With respect to the course of the disorder, in 41% it persists in the adult stage, in 39% it remits and the rest, the symptoms fluctuate in relation to the stress.

Developmental disorders

 Intellectual disability

A mental disability is defined as an intellectual ability with an IQ of 70 or less.

There is a deficit or alterations of occurrence in the current adaptive activity (efficiency of the person to satisfy the demands set for his or her age and cultural group), in at least two of the following areas: personal communication, domestic life, social-interpersonal skills, use of community resources, self-control, functional academic skills, work, leisure, health and safety.

Severity level:

Mild mental retardation: IQ between 50-55 and approximately 70.

Moderate Mental Retardation: IQ between 35-40 and 50-55.

Severe mental retardation: IQ between 20-25 and 35-40.

Deep mental retardation: IQ less than 20-25.

Global developmental delay

This diagnosis is reserved for individuals under 5 years of age when the level of clinical severity cannot be reliably assessed during early childhood. This category is diagnosed when a subject fails to meet expected developmental milestones in various fields of intellectual functioning, and is applied to individuals in whom a systematic assessment of intellectual functioning cannot be performed, including children too young to participate in standardized tests. This category should be reassessed after a period of time.

Autism spectrum disorders

 There are multiple definitions of Autistic Disorder, most of which point out that in autism there is a significant impact on the development of the child’s abilities, referring to three fundamental areas 

• Qualitative alteration of the reciprocal social alteration (socialization).

• Qualitative alteration of verbal and non-verbal communication and imaginative activity (communication and imagination)
• A notably reduced repertoire of activities and interests.

It is not a category, but a continuum with six main factors on which the nature and concrete expression of the alterations presented by persons with autism spectrum in the above dimensions depends:

1. The association or not of autism with more or less severe mental retardation (or, what is the same, intellectual level).

2. The severity of the disorder it presents.

3. The age of the person with autism.

4. Sex: autism disorder is less common, but with a greater degree of alteration to women than to men.

5. The appropriateness and efficiency of the treatments used and the learning experiences.

6. The commitment and support of the family.

Elimination disorders

Within this section we include enuresis and encopresis. Enuresis is a clinical picture characterized by the presence of repeated emission of urine in the bed or in the clothes, either voluntarily or involuntarily, and it generates discomfort and deterioration in the child over 5 years old.

Encopresis implies the presence of repeated excretions of faeces in inappropriate places, either involuntarily or voluntarily. These episodes appear in the child over 4 years old.

Eating disorders

The pica

It is defined as a clinical picture characterized by persistent ingestion by the patient of substances that are not nutritious, behavior that is inappropriate to the developmental level or age of the subject. Babies during the first two years of life tend to put all kinds of objects in their mouths, this is not considered pica. Although it usually starts in childhood, persists for a few months and then subsides, it rarely continues or appears during adolescence and adulthood.

Rumination

It involves repeated regurgitation of food over a period of at least one month. The food is first swallowed and then regurgitated  and chewed, swallowed or spat out.

Anorexia nervosa

It begins between 14-18 years of age and is the psychiatric disorder with the highest mortality rate, around 10%. The causes of death are starvation, electrolyte imbalance and suicide.

 Anorexia nervosa involves the presence of a refusal to maintain body weight at or above the minimum value established for the person’s age and height, intense fear of gaining weight or becoming obese despite being underweight, alteration of body image or perceptual distortion, exaggerated importance of weight and shape in self-evaluation, and denial of the consequences and dangers of low weight.

Bulimia

It is usually appears later than anorexia, between 18 and 25 years. And it is characterized by the presence of recurrent binges. Bingeing is defined as eating food in a short period of time, in an amount greater than most people would eat in a similar time and under similar circumstances, as well as by the feeling of loss of control over food intake. In addition, inappropriate compensatory behaviors appear in order not to gain weight, such as vomiting, excessive exercise, laxatives, diuretics, fasting, etc.

MOTOR DISORDERS

It is a non-progressive disorder of mobility or posture due to a malformation of the brain. It is produced congenitally: by damage to the brain during pregnancy, and acquired: by infections of the central nervous system, accidents, among others.

The most common pathology is cerebral paralysis: a non-evolutionary lesion or malformation of the central nervous system produced, generally before the end of the total development of the brain, which occurs in the periods before birth due to infections, poor diet, drug, alcohol and cigarette consumption, among others, during birth due to lack of oxygen, use of forceps or suction cups, among others, and after birth due to accidents, meningitis, high fevers, among others.

Types of cerebral palsy (CP)

Spastic ICP: stiffness of movement, inability to relax muscles, and characterized by exaggerated and uncoordinated movements.

Athetotic ICP: presents frequent involuntary movements that mask and interfere with normal body movements, contortion of the extremities, face and tongue, gestures, grimacing and clumsiness of speech, and flaccidity.

Ataxic ICP: poor body balance and unsteady gait, difficulty controlling hand and eye movements.

Mixed ICP: stiffness of the muscles, tremors, flaccidity.

PARTS OF THE BODY AFFECTED BY ICP

-Hemiplegia or Hemiparesis: Affects one of the two side halves of the body (right, left).

-Diaplegia or Diparesia: lower half (legs) is more affected than the upper half (arms).

-Quadriplegia or Quadriparesis: all four limbs are immobile.

-Paraplegia or Paraparesis: affects the lower limbs (legs)

-Monopexy or monoparesis: only one limb of the body is affected (arm or leg).

-Triplegia or triparesia: three extremities of the body are affected.

Symptoms that children with ICP may have

• Slow, clumsy or hesitant movements.
• Rigidity
• Weakness
• Muscle spasms
• Sagging
• Strabismus among others.

Other neuromotor disorders

• Brain vascular accident (stroke)
• Mielomeningocele
• Microcephaly (small head)
• Macrocephaly (big head)
• Muscular dystrophy
• Spina bifida
• Polyomyelitis
• Multiple Arthrogryposis
• Rheumatoid arthritis
• Scoliosis
• Lordosis
• Ciphosis
• Psychomotor delay