It is seen as absolutely normal and acceptable for a child to still have accidents up to the age of five. Developmentally they should be able to control their bladders when they are about six, during the day and also during the night. When they struggle to do this a diagnosis of enuresis might be considered by your physician. There are many physical problems that should be excluded by a medical professional before this diagnosis can be made:

• An urinary tract infection
• Constipation
• Small bladder
• Diabetes
• Slow development of the Central Nervous System
• Hormonal problems
• Abnormalities in the urethral valves in boys or ureter in boys and girls
• Abnormalities of the spinal cord
• Stress.

Enuresis is seen as primary when the accidents continue from baby years on, or as secondary when it starts happening after your child had six months of being accident free. Enuresis seem to be more common with boys than girls and includes both involuntary and intentional accidents.

How can I help my child?

• Limit your child’s fluid intake before bedtime
• Get him to go to the loo at the start of the bedtime routine and again just before going to bed
• A reward system for dry nights or days, for instance a sticker chart, works very well
• Get your child to help you to change his clothes and sheets or let him sleep in his own bed on towels to not wake him too much with the changing of sheets
• Night lights and a lit bathroom helps children feel safe to find their way to the toilet
• Some parents feel that waking their child to go to the loo, just before they go to bed, prevents accidents
• Constipation should be treated, because it can lead to accidents
• Refrain from giving any caffeinated drinks before bedtime
• Do not revert to using diapers at night
• Bed wetting alarms teaches children to wake up when they wet their beds
• DO NOT PUNISH your child for accidents, it will only lead to low self esteem and cause more stress for your child
• Assure your child that accidents can happen to anyone.

When should I consult my doctor?

• It is necessary to go to the doctor when your child suddenly start having accidents after being dry for six months.
• When he starts wetting his pants during the day
• When accidents are accompanied by misbehavior at home or at school
• When he complains of burning when he urinates or when he has to urinate more frequently than usual
• When he eats or drinks more than usual (possible indication of diabetes)
• Swelling of the feet or ankles
• A child who has accidents after the age of 7 warrants a doctor visit.

Treatment usually involves behavior modification and medication should really only be considered as a last resort, seeing that this will usually resolve itself.

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As I explained, oppositional behavior is expected at certain times during a child’s development. But many parents ask the question: “When is my child’s behavior not just a symptom of growing up? When should I worry about this behavior that is making the family’s life unbearable?”

Oppositional behavior becomes a problem when he is frequently and consistently defiant of authority and his behavior is worse that that of his peers.  It becomes a problem when his behavior affects his social, family and academic life. Children who suffer from Oppositional Defiant Disorder have an ongoing pattern of uncooperative, defiant and hostile behavior when it comes to authority figures.

Symptoms of Oppositional Defiant Disorder:

• Frequent tantrums
• Excessive arguing with adults
• Always questioning the rules
• Active defiance and refusal to comply with requests and rules
• Deliberate attempts to annoy and upset others
• Blaming others for their mistakes or misbehavior
• “Touchy”, over sensitive and easily annoyed by others
• Frequent anger and resentment
• Mean and hateful speech when they are upset
• Spiteful attitude
• Seeking revenge.

These symptoms have to be present in multiple setting in order for your child to be diagnosed as Oppositional Defiant.

Will my child become Oppositional Defiant?

Early signs of oppositional defiant behavior is when infants are very fussy, colicky and difficult to soothe.  Power struggles ensue over eating, sleeping and potty training. These children throw many temper tantrums in an attempt to change their parents’ behavior.

When they get older you will find that the child consistently dawdle and procrastinate when it comes to tasks and requests.  They often claim to not have heard your request. Older children will turn homework, keeping their room clean, picking toys up and bathing into a battle field, and they will do almost anything to end up as the winner. You will find that this child talks back and interrupts conversations.

What causes Oppositional Defiant Disorder?

The jury is still out on this issue, but we generally agree that it is a combination of genetics and environment.

1. A circular family dynamic is common in the households from which children with ODD comes. These children who are temperamentally inclined to be difficult and easily angered cause frustration for the parents. Being frustrated with their child they start expecting certain reactions when they request things. Anticipating a negative response from their child they become unresponsive parents, leaving the child feeling helpless, needy and frustrated.
2. These children find that negative attention is better than no attention at all.  They annoy their parents on purpose just to get a reaction from them.
3. Parents with children with ODD are often inconsistent when disciplining their child. Today he is allowed to put his feet on the table, but tomorrow it is unacceptable.  Inconsistent parenting leads to a child feeling unsafe and unsure of rules.

How can I help my child with Oppositional Defiant Disorder?

There is no medication that can change oppositional defiant behavior.  Medication can, though be given to children with ODD to help them cope with the co-morbid  conditions of Attention Deficit Hyperactivity Disorder and Learning Disorders. Many children with ODD also suffer from debilitating Depression that can be effectively treated with medication.

Parent Management Training helps parents change their own behavior which in turn can alter their child’s negative behavior.  Parents often need training to rather focus on their child’s pro-social behavior instead of giving negative attention. Ineffective harsh punishment and poor parent modeling should be replaced by the use of effective brief non-aversive punishment.

How can I help myself as a parent of a child with Oppositional Defiant Disorder?

• Organize a baby sitter at least once a week to give you and your partner the opportunity to go out.
• Give yourself some time to vent and moan about your difficulties with your child.
• Get regular exercise.
• Make sure you get enough sleep.
• Follow a balanced diet and avoid drastic diets.
• Try to not take too many things on at the same time.
• Avoid alcohol.
• Get a hobby to distract yourself.
• Limit the amount of TV, video and computer games in the house.

The prognosis for children with ODD is not all bad.  Some children simply out of it, whilst others’ diagnosis change to ADHD or Conduct Disorder. Unfortunately other disorders are common with children with ODD, it is unusual but about 5% of these children retain their diagnosis.

Conduct Disorder is often only the result of ODD when Opposition Defiant Disorder is already present when the child is 3 or 4 years old and the defiant behavior is severe.  It has been found that children with Conduct Disorder usually have a biological parent who is a career criminal.

Stuttering or also known as stammering, is a speech disorder where sounds, syllables or words get repeated or prolonged, which in turn have an impact on the fluency of speech. Children who stutter often experience blocks which are periods of silence whilst he is struggling to make a sound.  During blocks children seem to be trying to force the word out.  This might be with an open mouth or his lips squeezed together.

Examples of prolongations are:

• Aaaaaaaaaask our teacher.
• Pu…………….put the pencil back.
• This is y………….yours.
• Give it to mmmmmmm-me.

Examples of repetitions are:

• B-b-b-b-b-b-but not now.
• Bu-bu-bu-bu-but not now.
• But-but-but-but not now.
• But not – but not – but not – but not now.

In mild cases of stuttering the child repeats sounds more than twice, eg. “li-li-li-li-like” with visible tension in the facial muscles.  Their pitch tends to rise with repetition and sometimes they can experience blocks.  Disfluencies in their speech is regular.

In severe cases of stuttering more than 10% of their speech is affected by stuttering.  Great effort and tension is visible in effort to vocally communicate.  These children avoid stuttering by using other words instead of the ones giving them problems, they experience complete blocks, have many repetitions and prolongations.

What parents can do:

• Do not put pressure on your child to speak correctly at all times, it will only lead to increased levels of anxiety and add to the stuttering.
• Use meal times as a conversation time with your child where there are no distractions, for instance the TV.
• Avoid trying to correct your child of finish a word for him, it will only lead to an increase in self consciousness.
• Do not interrupt your child or ask him to start over.
• A calm atmosphere in the house will help to address anxiety and stress that can contribute to stuttering.
• Do not tell your child to think before speaking.
• Always speak slowly and clearly to your child.
• Maintain natural eye contact, even when your child is struggling to verbalize a word.
• Allow your child the opportunity to speak for himself and finish his own sentences.

There are no one known cause of autism.  It is speculated that it is a combination of genetic and environmental factors that cause this disorder.  Autism might be present from the start of a baby’s development or can manifest as a sudden loss of previously attained abilities. Signs of autism are usually present before the age of 3.  Boys have 3 to 4 times higher chance of becoming autistic than girls.  When there is a family history of autism, the probability of autism increases.  Other disorders like Fragile X syndrome, Tuberous sclerosis, Tourette’s syndrome and epilepsy puts a child at a higher risk to develop autism.  It was found that when the father is older than 40 years the chances of a child developing autism increases six fold.

Children suffering from autism cannot make sense of the world in the way that we do, they experience the world differently.  These children have difficulty in mainly three areas:

1. Communication
2. Emotions
3. Senses.

Early Indicators of Autism:

• No babbling or coo-ing by the age of 1
• No making use of gestures by the age of 1
• No use of single word by 16 months
• No two word phrases by the age of 2
• No response when he is called by his name
• Sudden loss of previously acquired language or social skills
• Poor eye contact when  spoken to
• Excessive lining up of toys or other objects of interest
• No smiling or other social responsiveness.

Later Indicators:

• Inability to make friends
• Difficulty initiating or sustaining any conversation
• Lack of imaginative and social play
• Stereotyped, repetitive and unusual use of language
• Restricted patterns of interest, which is abnormal in its intensity and focus.
• These children have a preoccupation with certain objects or subjects
• An inflexible adherence to their rituals and routines.

When we break their symptoms into social skills, language skills and behavioral skills we will notice the following symptoms present in autistic children:

Social Skills: These children do not respond to their own name being called out.  They have poor eye contact when spoken to and appear not to hear when people try to engage with them.  They resist cuddling and holding, probably due to sensory overloading.  Autistic children seem unaware of others’ feelings and also prefer solitary play.

Language Skills: Autistic children generally start talking later than their peers or loses the ability to use words and sentences they were using previously.  They seem to avoid eye contact when they are requested to complete certain tasks.  When they do speak they show abnormal rythm and tone – speaking either in a sing-song voice or robot-like.  These children struggle to start or sustain any form of communication and may repeat words or phrases with no actual understanding of how to use them correctly in a conversation.

Behavioral Skills: Their repetitive movement are probably one on the signature symptoms of autistic children.  They adhere to specific routines and rituals and will become very disturbed when there is a change in their routine.  These children are constantly on the move, never sitting still.  They are often fascinated by parts of an object like the wheels on a toy car.  It seems like these children are over-sensitive to light, sound and touch, but sometime oblivious to any form of pain.

There is no cure for autism.  Treatment for children should focus on how they can adjust to the world that they are living in.  Of primary concern is the communication skills of these children and associated with this social skills.  Certain medicines are used, but these medications rather focus on the eliminating of symptoms of associated anxiety, depression, obsessive compulsive behavior, seizures and attention deficit hyperactivity disorder.  Of utmost importance is the education of the parents, siblings and family as how to deal with this child that is so different from them.

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A learning disability is on the contrary, not related to your child’s intellect at all.  Some children with learning disabilities grow up to accomplish great things in life – it is thought that even Einstein had learning disabilities as a child. Children with a learning disability differ from their friends in the way that their brains receive, process, analyze and store information.  It is usually shown as problems with maths, reading and written expression.  In other words these children hear, see or understand things differently than most of us.  About 4 million children in the US are currently thought to have some or the other learning disability.

Possible signs of a Learning Disability:

• Difficulty speaking or vocalizing
  
• Problems with reading
• Problems with writing
• Difficulty in solving mathematical problems
• Problems with communication
• Short attention span, or concentration problems
• Struggling to follow instructions
• Struggling with work that you would expect that she should me able to master.

Before any diagnosis of a learning disability can be made, a professional physician should rule out any possibility of a vision or hearing problem. In the absence of any physical problems, we can differentiate between the following three learning disabilities:

1. Reading Disorder: Children with this learning disability struggle with reading accuracy, reading speed or understanding the meaning of what they have read.
2. Mathematics Disorder: These children struggle with calculation or mathematical reasoning.
3. Disorder of Written Expression: There is generally a combination of difficulties in the child’s ability to compose written texts as shown by grammatical or punctuation errors in sentences, poor paragraph organization, multiple spelling errors, and extremely bad handwriting.

What You as a Parent can do to Help your Child:

Your behavior as a parent will impact on your child’s ability to deal with this disability and ultimately your child’s success.  Parents should assure your child of your constant unconditional love and support. A good attitude will boost your child’s confidence and give her hope for the future.  As a parent, you should keep this problem in perspective and remember that it is only one aspect of your child – a learning disability does not define your child. Keep on researching your child’s disability and become an expert in the field.  You have to be an advocate for your child to protect their rights and get the best possible education for your child.  Your influence socially and also intimately in your child’s life is the key factor in success.

What is Tourette’s Syndrome?

TS is an inherited neurological disorder that is shown as sudden, repetitive motor and vocal tics. This one of a few disorders that has to manifest before the age of 18 to meet the diagnostic criteria.

What is a Tic?

The web defines a tic as: A stereotyped , involuntary, spasmodic, nonrhythmic movement or vocalization. Tics are experienced as virtually irresistible although mild forms can be surpressed to some extent. Stress and anxiety typically exacerbate the condition.

Because the face has the most muscles in the body – we find that children that suffer from TS usually show tics in the head and facial area. Repetitive blinking and frowning are very common tics. These tics waxes and wanes over time and usually peaks at the age of 10 years. It has been found that after 10 years of age that there is a steady decline in the prevalence of the tics. Some studies found that after 18 years of age a half to two thirds of TS children show no tics at all.

You can differentiate between simple and complex tics. Simple tics consist of 1 or more movement or vocal tics which seems to have no meaning or significance. Complex tics involve more than one muscle group and seem to have some meaning to the individual.  Complex tics are rare.  Very few children exhibit tics that involve swearing or using obscene phrases, that would actually be the last thing that they would like to utter.

Who is at Risk of Having Tourette’s Syndrome?

A child who has a parent with TS, have a 50% chance of having inherited the gene for TS.  That does not necessarily mean that your child will manifest the symptoms of TS.  About 50% of girls born with the gene will never show any signs or symptoms of TS.  A boy born with the gene however, has a 99% chance of manifesting TS symptoms.

What other Associated Behavior do we find?

• Obsessive Compulsive Behavior
• Attention Deficit Disorder (up to 60% of children with TS have ADD/ADHD)
• Problems with impulse control
• Learning Disabilities
• Sleeping disorders
• Depression

What makes these Children Unique?

Different studies showed that these children are visually oriented and often excel in activities where they have to analyze pictures.  It has been found that TS children are quicker at mental grammar skills and are often unusually intellectually gifted children with no cognitive deficits.  TS children tend to be more introspective than other children of their own age and find themselves perplexed with how their own minds work.

Treatment for TS

Pharmaceutical treatment for TS is very controversial – the antipsychotic medicines’ side effects often outweigh the benefits of it in reducing the frequency of the tics. These medicines often lead to sedation and mental dulling.  Many physicians feel that if the disorder is not debilitating, treatment should focus on addressing the associated conditions first.

Psychological intervention can help your little one with dealing with the knowledge that she is different from other children and help alleviate depression and self esteem problems.

Occupational therapy can help to address associated attention deficit and hyperactivity problems that can cause problems in the class room and academic lagging.

Most important is that a child with TS should not feel like she is constantly under parental and teacher scrutiny.  It does not help to ask her to stop ticking or change her behavior. She is not capable of doing it  and it will only lead to more anxiety which unfortunately will have the effect of more tics appearing.

Love and accept your child for who she is and enjoy her vivid imagination and uniqueness that comes with TS!

Children do not necessarily present with the signs of depression that we notice in adults. The following can be possible signs that your child is depressed:

• Crying, sadness, feelings of hopelessness and helplessness
• Feelings of being discouraged or worthless
• Loss of interest in the activities she enjoyed previously
• Constant tiredness, low energy levels and boredom
• Temper tantrums, irritability and being easily annoyed
• Feelings of rejection
• Drop in achievement levels at school
• Constant fidgeting or feeling restless
• Emotional outbursts, shouting or complaining
• Inability to communicate
• Physical complaints without a sound medical reason behind it. Children often complain of headache, stomachache or pain in their limbs.
• Parents might notice an increase or decrease in their child’s appetite
• Children who are depressed might show changes in their sleeping pattern – either sleeping more or struggling to sleep.
• Problems with concentration.

We have to realize that depression is different from just having the “blues ”. Depression lasts longer and is more intense, leaving a child immobilized and broken down with no self-esteem. It affects interpersonal relationships and school performance. A child that once was popular may become withdrawn, lonely and an academic under-achiever.

What causes a child to become depressed?

There are different things that can contribute to depression. We distinguish between underlying factors that predispose a child to having depression and events that can trigger a depressive episode.

Some children are genetically predisposed to becoming depressed. Often there is a family history of depression. Developmental events can also play a role – for instance severe separation anxiety can predispose a child to depression. Physiological stressors for instance an illness or handicap and psychological stressors like grieving or an adult with depression in the house can contribute to depression.

The type of events that can trigger depression is prolonged separation from parents, divorce, death of a person or pet, moving or academic and sport failure can trigger a depressive episode. Failure to live up to perceived expectations play a more important role than parents often realize. Any kind of abuse, whether physical, emotional or verbal can lead to severe depression, breaking the child down up to the point where they feel like an empty shell.

What to do if you suspect your child is depressed:

• Get professional medical and mental health advice as soon as possible.
• In older children, make sure there are no concurrent alcohol or drug abuse.
• Check that any medication your child is taking does not have depression or any symptoms of depression as side-effects.
• Know that normal grieving and reactions to stressful life events should have a short life span and pass over time. Depression tends to be more permeating and longer lasting.
• Make sure that your child’s diet is healthy and complete.
• Monitor your child’s sleeping pattern.
• Stay involved in your child’s life. Try to prevent your child from isolating herself and cutting her off from peer interaction.
• It is important that your child gets regular exercise and stays active.
• Spend time with her and give her the opportunity to communicate to you in a safe environment.
• Try to schedule pleasurable activities on a one-to-one basis, but also as a family.

Children with depression often end up being adults with depression. Stop the cycle as soon as possible. Psychotherapy at a young age can prevent medication use at a later stage. Children do very well in play therapy and family therapy. Family therapy helps to recognize roles in the family and enable children to voice their problems and concerns appropriately.