Behavioral & Mood Disorders in Toddlers

It seems as though more and more children are being diagnosed with different types of behavioral & mood disorders these days! It has been something that I have had on my mind for quite some time now and since I work in a daycare, I have done numerous amounts of research on these different disorders.  During my research I have come to realize there are a lot more different disorders than I thought! 

 The most common Behavioral & Mood Disorders:

• Oppositional Defiant Disorder (ODD)
• Conduct Disorder
• Attention Deficit Hyperactivity Disorder (ADHD)
• Bi-polar Disorder

Oppositional Defiant Disorder (ODD)

Surprisingly, 1 in 10 children who are under 12 years old are diagnosed with ODD.  It is hard to diagnose, because all children experience episodes of defiance at one point or another.  However, when the behavior stands out far beyond the other children in the classroom it is cause for concern.  When there is an ongoing pattern of uncooperative, defiant, or hostile behavior toward teachers, parents, or others in authority, this is a cause for concern and parents should seek help immediately. 

Symptoms of ODD in Children:

• Frequent temper tantrums
• Excessive arguing with adults
• Often questioning rules
• Active defiance and refusal to comply with adult requests and rules
• Deliberate attempts to annoy or upset people
• Blaming others for his or her mistakes or misbehavior
• Often being touchy or easily annoyed by others
• Frequent anger and resentment
• Mean and hateful talking when upset
• Spiteful attitude and revenge seeking

These symptoms are seen in multiple different settings, but mostly at home and a school.  The cause of ODD is unknown.

To help a child with ODD, try the following things.

• Always build on the positives, give the child praise and positive reinforcement when he shows flexibility or cooperation.
• Take a time-out or break if you are about to make the conflict with your child worse, not better.  This is good modeling for your child.  Support your child if he decides to take a time-out to prevent overreacting.
• Pick your battles.  Since the child with ODD has trouble avoiding power struggles, prioritize the things you want your child to do.  If you give your child a time-out in his room for misbehavior, don’t add time for arguing.  Say “your time will start when you go to your room.”
• Set up reasonable, age appropriate limits with consequences that can be enforced consistently.
• Maintain interests other than your child with ODD, so that managing your child doesn’t take all your time and energy.  Try to work with and obtain support from the other adults (teachers, coaches, and spouse) dealing with your child.
• Manage your own stress with healthy life choices such as exercise and relaxation.  Use respite care and other breaks as needed

Conduct Disorder 

Children who have conduct disorder have a problem following rules and behaving in a socially acceptable way.  The cause of conduct disorder includes brain damage, child abuse or neglect, genetic vulnerability, school failure, and traumatic life experiences.

Symptoms of Conduct Disorder:

• Bullies, threatens, or intimidates others
• Often initiates physical fights
• Has used a weapon that could cause serious physical harm to others
• Physically cruel to people or animals
• Steals from a victim while confronting them (e.g. assault)
• Forces someone into sexual activity 
• deliberately destroys other's property
• Has broken into someone else's building, house, or car
• Lies to obtain goods, or favors or to avoid obligations
• Steals items without confronting a victim (e.g. shoplifting, but without breaking and entering) 
• Often stays out at night despite parental objections
• Runs away from home
• Often truant from school 

"Treatment of children with conduct disorder can be complex and challenging. Treatment can be provided in a variety of different settings depending on the severity of the behaviors. Adding to the challenge of treatment are the child's uncooperative attitude, fear and distrust of adults. In developing a comprehensive treatment plan, a child and adolescent psychiatrist may use information from the child, family, teachers, community (including the legal system) and other medical specialties to understand the causes of the disorder.

Behavior therapy and psychotherapy are usually necessary to help the child appropriately express and control anger. Special education may be needed for youngsters with learning disabilities. Parents often need expert assistance in devising and carrying out special management and educational programs in the home and at school. Home-based treatment programs such as Multisystemic Therapy are effective for helping both the child and family.Treatment may also include medication in some youngsters, such as those with difficulty paying attention, impulse problems, or those with depression."
(This information is from http://www.aacap.org/cs/root/facts_for_families/conduct_disorder)

Attention Deficit Hyperactivity Disorder (ADHD) 

Children with ADHD have a problem with inattentiveness, over-activity, impulsivity, or a combination of these.  ADHD is the most commonly diagnosed disorder in children (3%-5% of children).  The cause of ADHD is unknown; however, it does run in families.  There are 3 different categories of symptoms for ADHD.   

1. Inattentive symptoms:

• Fails to give close attention to details or makes careless mistakes in schoolwork
• Has difficulty keeping attention during tasks or play
• Does not seem to listen when spoken to directly
• Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
• Has difficulty organizing tasks and activities
• Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
• Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
• Is easily distracted
• Is often forgetful in daily activities

 2. Hyperactivity symptoms:

• Fidgets with hands or feet or squirms in seat
• Leaves seat when remaining seated is expected
• Runs about or climbs in inappropriate situations
• Has difficulty playing quietly
• Is often "on the go," acts as if "driven by a motor," talks excessively

3. Impulsivity symptoms:

• Blurts out answers before questions have been completed
• Has difficulty awaiting turn
• Interrupts or intrudes on others (butts into conversations or games) 

Some children are incorrectly labeled with ADHD. On the other hand, many children who do have ADHD remain undiagnosed.  These are guidelines from the American Academy of Pediatrics for the diagnosis of ADHD. 

• Children should have at least 6 attention symptoms or 6 hyperactivity/impulsivity symptoms, with some symptoms present before age 7.
• The symptoms must be present for at least 6 months, seen in two or more settings, and not caused by another problem.
• The symptoms must be severe enough to cause significant difficulties in many settings, including home, school, and in relationships with peers.

Here some ways (other an medication) to help your child with ADHD.

• Set specific, appropriate target goals to guide therapy.
• Start medication and behavior therapy.
• Follow-up regularly with the doctor to check on goals, results, and any side effects of medications. During these check-ups, information should be gathered from parents, teachers, and the child.
• Communicate regularly with the child's teacher.
• Keep a consistent daily schedule, including regular times for homework, meals, and outdoor activities. Make changes to the schedule in advance and not at the last moment.
• Limit distractions in the child's environment.
• Make sure the child gets a healthy, varied diet, with plenty of fiber and basic nutrients.
• Make sure the child gets enough sleep.
• Praise and reward good behavior.
• Provide clear and consistent rules for the child.

Bi-Polar Disorder

This is something very near and dear to my heart as I have done a whole lot of research on this, because someone I know has a child with bi-polar disorder.  Bi-polar I is when a child experiences at least one episode of mania.  (For an episode to qualify as mania, there must be elevated mood plus at least three other symptoms, or irritable mood plus at least four other symptoms.)

Mania Symptoms:

• elevated mood - silliness or elation that is inappropriate and impairing
• grandiosity - unrealistic sense of superiority
• flight of ideas or racing thoughts
• more talkative than usual or pressure to keep talking
• irritability or hostility when demands are not met
• excessive distractibility
• decreased need for sleep without daytime fatigue
• excessive involvement in pleasurable but risky activities (daredevil acts)
• poor judgment
• hallucinations and psychosis

Depression Symptoms:

• lack of joy and pleasure in life
• withdrawal from activities formerly enjoyed 
• agitation and irritability
• pervasive sadness and/or crying spells
• sleeping too much or inability to sleep
• inability to concentrate
• thoughts of death and suicide
• fatigue or loss of energy
• feelings of worthlessness
• significant change in appetite

An episode must last at least one week and stable periods occur between episodes of mania and depression.

This is taken straight from thebalancedmind.org.  I think it is a wonderful checklist and can help identify if your child may have bi-polar disorder.

Since its founding in 1999, The Balanced Mind Foundation has reviewed numerous family accounts that repeatedly report similar behaviors. If your child exhibits more than a few of these behaviors and you know something is wrong, follow through with our First Steps plan. This is especially crucial if there is a history of mood disorders or substance abuse in your child's family.

  Severe and recurring depression
  Explosive, destructive or lengthy rages, especially after the age of four
  Extreme sadness or lack of interest in play
  Severe separation anxiety
  Talk of wanting to die or kill themselves or others
  Dangerous behaviors, such as trying to jump from a fast moving car or a roof
  Grandiose belief in own abilities that defy the laws of logic (possessing ability to
       fly)
  Sexualized behavior unusual for the child’s age
  Impulsive aggression
  Delusional beliefs and hallucinations
  Extreme hostility
  Extreme or persistent irritability
  Telling teachers how to teach the class, bossing adults around
  Creativity that seems driven or compulsive
  Excessive involvement in multiple projects and activities
  Compulsive craving for certain objects or foods
  Hearing voices telling them to take harmful action
  Racing thoughts, pressure to keep talking
  Sleep disturbances, including gory nightmares or not sleeping very much
  Drawings or stories with extremely graphic violence

 To read more, go to http://www.thebalancedmind.org/learn/library/about-pediatric-bipolar-disorder?page=all

Causes of Bi-Polar Disorder:

Bi-polar disorder tends to be genetic, meaning it runs in the family.  Over half of the children who have bi-polar disorder have a family member (usually a mom or dad or both) who suffer from a mood disorder, usually depression or bi-polar disorder.  A child who has one parent with bipolar disorder has a 15% to 25% chance of having the disorder.  A child who has 2 parents with a mood disorder has a 50% or higher chance of having a mood disorder. 

If you suspect your child has any of these disorders, it is necessary to talk to your child's doctor.  If these are treated at an early age, it is much easier overcome the battle later in life!!