These kids are not crazy!

Q: When should a child or teenager be referred for psychiatric evaluation?

A: When his or her ability to function socially and academically at school, at home, and other usual setting are compromised due to behavioral, emotional, and/or psychiatric problems

Some of the more common psychiatric problems seen among children and adolescents include:

1. Attention Deficit Hyperactivity Disorder (ADHD) – 3 main types involve difficulty staying focused, forgetfulness, procrastination, talkativeness, hyperactivity, and/or impulsivity

2. Learning Disorder – Math, Reading, and Written Expression

3. Communication Disorders – include problems with expressive & receptive language, stuttering, and articulation

4. Anxiety Disorders – school avoidance or refusal, extreme shyness, performance & test anxiety, obsessions & compulsions that interfere with accomplishing tasks, panic attacks & chronic worry

5. Mood Disorders – chronic and acute depression, mania, severe irritability or abrupt mood swings that may or may not be related to trauma

6. Eating Disorders – marked loss of weight over a short period of time due to extreme dieting, exercise, and/or purging. Repeated binges, self-induced vomiting, the Female Athlete Triad (disordered eating, absence of regular menses, and osteorperosis)

7. Substance – use related issues – Frequent binges or regular use of alcohol, tobacco, cannabis, amphetamines, as well as misuse of prescribed medications (diversion. This could be a primary problem or exacerbate a pre-existing problem and then take on a life of its own

8. Tic Disorders & Tourette’s Syndrome – sudden involuntary movements or vocalizations. Frequent eye blinking, mouth, neck, shoulder & limb movements, throat clearing, coughing, grunting, or snorting

9. Oppositional Defiant Disorder & Conduct Disorder – “negative attitude”, arguing, bullying, talking-back, disrespectfulness, stealing, running away from home, frequent fighting, cruelty to animals, breaking the rules, committing crimes

10. Autistic Spectrum Disorders – including Autism, Asperger’s Syndrome, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS): difficulty with verbal & non-verbal communication despite being physically capable of using language, along with other unusual behaviors & the child “being in his own world” with little social interaction

11. Mental Retardation – lower than average intellectual capacity resulting in delays or failures to develop language, motor & social skills

Frequently, more than one of the above conditions are present at the same tine in an individual. This is known as co-morbidity. Therefore treatment must be individualized and usually needs to be adjusted over time. Once there has been proper diagnosis, regular follow-ups are very important to monitor response, progress, and make adjustments to the individual treatment plan.

If you suspect that your child or teen might have any of the above conditions causing social or academic problems then referral to child & adolescent psychiatrist is appropriate. Pediatric neurologists and neuro-developmental pediatricians may also be helpful with these children who are not crazy!

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Dr. Nancy Cinco, a Child and Adolescent psychiatrist, is a native of Cebu City & a graduate of Cebu Doctor’s College of Medicine. She completed her internship at the Philippine General Hospital, General Psychiatry residency at Albert Einstein Medical Center in Philadelphia, PA and fellowship in Child & Adolescent Psychiatry in Boston, MA at Harvard Medical School’s Combined Program in the Massachusetts General Hospital and Mc Lean Hispital and consults on pediatric inpatients at Cebu Doctor’s University Hospital. She also volunteers weekly at Vicente Sotto Memorial Hospital and is a consultant at Cebu Hope Center, Inc., a home for abused girls.