Emotional and behavioural disorders (EBD) are not just a concern among adults, but also among children. If left unaddressed, the EBD malaise can hinder youngsters’ ability to learn and socialise with their peers, and challenge their capacity to cope in life.
EBD issues may arise from factors such as genetics, trauma, abuse, neglect, environmental stressors, besides social and cultural influences.
Genetic factors include inherited conditions such as autism and attention-deficit hyperactivity disorder (ADHD).
Environmental factors include exposure to stress, trauma, abuse, and violence, as well as other environmental influences such as school, family dynamics, or medical conditions.
Suman Sahil, a 10th-grade student at Mangalore Residential School, disliked arithmetic due to a traumatic incident in third grade: his mathematics teacher physically attacked him by throwing books. This had led to an emotional blockage and a fear of the subject. His mother Anuradha took him to a therapist who uncovered the root of the problem.
Sowmya G M Chandrashekar, an educational consultant with Manvanthara, an organisation that helps children to tackle challenges related to behaviour and academics, says, “We identified the root cause through reframing and consultation and worked on the child’s subconscious mind to remove unresourceful emotions.” By the next day, Sahil was showing interest and performing better in mathematics.
Although the exact cause remains unknown, there have been studies and suggestions regarding potential causes such as heredity, brain disorders, diet, stress, and family functioning.
Additionally, environmental factors like gadget use, bullying, familial issues, parents’ mental health, and pressure from parents and peers can also contribute to the development of EBD.
Dr K John Vijay Sagar, professor and head of the Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, says, “As adverse experiences may cause stress, it is important to recognise that protective factors such as a stable family environment, healthy parenting, positive peer relationships, and support from school help children to manage stress and behavioural issues,”
According to the Individuals with Disabilities Education Act (IDEA), children with emotional and behavioural disorders exhibit one or more of these five characteristics:
- Learning difficulties not attributable to mental, sensory, or physical issues.
- Difficulty in socialising with classmates and teachers.
- Display of inappropriate emotions or behaviour.
- Consistently feeling negative or unhappy, which affects the community.
- Prone to physical symptoms or anxiety caused by personal or academic problems.
Dr Vijay Sagar explains that depression and anxiety occur in 3-6 per cent of those aged 10-17 years – though those under 10 years of age may still develop them albeit at lower rates. Often, children suffering from depression go through anxiety-related issues, and vice-versa.
A 2018 review paper by Michael O Ogundele, Department of Community, Glenwood Health Centre, UK, says childhood behaviour and emotional problems, and their associated disorders, have significant effects on individuals, families and society. If not treated in childhood, they can have adverse effects on the child’s personal, educational, family and professional life, both in the short and long – term.
The signs of trouble
Along with ADHD, a common behavioural disorder is oppositional defiant disorder (ODD). Children going through it become stubborn, demanding and argumentative and show an oppositional or contradictory behaviour. They are unable to focus on or complete tasks, often disrupting others in the classroom. They may impulsively hit other people.
Adolescents may display more serious conduct disorders, both at home and outside. “We see conduct disorder in adolescents, which can include rule violations, threats, assault, weapon use, stealing, acts conflicting with the law, and juvenile delinquency,” says Dr Vijay Sagar.
Stress-related disorders also lead to emotional and behavioural disorders. Post-traumatic stress disorder (PTSD) is particularly common after a child has experienced trauma such as bullying, sexual abuse, an accident, or the death of a loved one.
Dr Anitha Bharathan, consultant clinical psychologist at Cadabams Group, Bengaluru, says that the most common emotional and behavioural disorders are stress, anxiety, depression, ADHD, conduct issues, ODD, and an autism spectrum disorder.
She further says that EBDs can also be classified as either “internalising” – emotional disorders such as depression and anxiety suffered silently by the child alone; or “externalising” – when a child openly shows disruptive behaviours such as ADHD and conduct disorder.
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Assessment is the key
Children may show symptoms like anger, threatening behaviour, changes in sleep and appetite, and decreased concentration..
Dr Vijay Sagar has this advice to parents: they should consult their child’s close friends and the school if the child shows abrupt changes in behaviour beyond a couple of weeks, and it affects daily activities.
Some adolescents may want to isolate themselves, eat less, lose weight, and show signs of potential self-harm.
Peers and games give clues
According to Dr Vijay Sagar, “We talk to parents, teachers, and the child and collect information to aid diagnosis.” A history of the child’s experience and behaviour garnered from parents helps a lot. “We try to understand how his nature was before this behavioural change and then what changes have happened.”
Children aged around 8 are not able to express themselves verbally, so they can be observed when they are engaged in activities like drawing or games. Watching their reaction and expressions while gently eliciting their responses to simple questions, and gathering information from their parents or surroundings can also help.
It is important not to `overdiagnose’ children. They can become anxious in new environments, but such an excitement does not necessarily indicate a problem. If the children can talk, ask them directly what made them cry or behave in a certain way, says the doctor.
- Therapy regime – different therapies including CBT or cognitive behavioural therapy help a child to solve a problem, communicate and control emotion.
- Contextual factor – information is gathered from friends, family and school to understand trigger point and solve it.
- Medication is given in some cases that need to manage a child’s mood and anger.
- No medicine is given to children below 4 years.
Role of family and school
Family plays an important role in providing a supportive atmosphere, which is both preventive and promotive for a child’s mental health. Signs of behaviour issues, such as not conforming to school rules, may indicate learning difficulties that need further attention.
Bharathan says, “Parents should be trained in management techniques. Mental health professionals should identify issues early and provide therapy and support to the children and their families.”
A common thread in the views of the experts is this: Parents should nurture their children, set healthy limits and encourage self-sufficiency. For school-going children and teenagers, a combination of training and therapy involving the child, family and school is often effective. Schools should focus on teaching essential skills, such as social and interpersonal skills.