Embedded Files
Claudia Juarez
Licensed Psychologist, Master in Social Communication and have a Postgraduate Course in Cognitive Behavioural Therapy. She collaborates with different health organisations promoting and teaching stress management and resilience workshops. In her private practice she provides individual consultation to stress related disorders patients. She is from Mexico City, Mexico
Summary
Mental health disorders affect childhood around the world. It has been recognised that a half of mental disorders worldwide begin before the age of 14 years.[World Health Organization] The importance of studying mental health problems in children seems clear.
Stress can be a part of our lives in modern society. Different cultures show how stress is increasing in all ages. This implies stress affects not only adults, but also children from early ages.
How stress affect children and how its effects can last during adulthood is an issue must concern to mental health professionals and others related.
Development
As we know, stress has been recognised as “epidemic of 21st century” due to its impact on society and mental health in general. Both children and adults are suffering stress across cultures.
A study done in Sudan, The Philippines, Colombia and India showed 12-29% of children aged five to 15 years had mental health problems while other study in Nigeria reported how psychosocial stress (62%) has been linked to new referrals.[World Health Organization 2008]
In countries where children have been exposed to extreme stressors such as terrorism, war, poverty, severe food shortage situation, among others, risk to develop mental health problems is high. Those children in developing countries could not receive any treatment or care.[Moroz 2005]
But children from developed countries are also suffering mental health problems. In US, overweight children are more likely to feel stress as well as others. Children can realise when their parents are also stressed makes them feel sad and worried. Most of their parents don’t think their children could be affected when they are arguing, yelling or complaining.[American Psychological Association 2010]
Some other studies pointed how particular situations such as taking an exam, sports competition, attending a new school or dealing with illness can affect children. These studies also state that stress, anxiety and fears are common in childhood and activate fight or flight response. Individual characteristics such as heightened physiological reactivity, temperament qualities, personality and heritability factors must be also considered.[Richtsmeier et al. 2003]
According to proposed revision of DSM V, stress can be classified in the following:
Acute stress disorder (ASD) (G 02)[American Psychiatric Association 2012a] It is the exposure to actual or threatened death, serious injury, sexual violation, in a person who directly experiences the traumatic event, or witnessing, in person, the event(s) as they occurred to others, learning that the event(s) occurred to a close family member or close friend, experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (Not apply to exposure through electronic media, television, movies or pictures).
Diagnostic criteria for acute stress disorder appear in next table.
* DSM V does not provide info about this symptom in children. Described behaviours meet to our experience
The presence of nine (or more) of the symptoms in any of the four categories beginning or worsening after the traumatic events occurred is required. Duration of disturbance is three days to one month, causing significant distress or impairment in different areas. Disturbance symptoms are not related to substance abuse or other medical conditions.
Posttraumatic stress disorder (PTSD) (G 03)[American Psychiatric Association 2012b] In this case, similar symptoms can have place. Differences for diagnosis are:
1. Traumatic event is described as overwhelming such as life threatening accident, torture or natural disaster.
2. Presence of one or two of symptoms in each category.
3. Duration of disturbance is more than one month.
4. Negative alterations in cognitions and mood associated with the traumatic event.
Proposed revision of DSM V includes a section for PTSD in preschool children. Diagnosis criteria for PTSD in preschool children are:
1. A child less than sex years old exposed to death or threatened death, serious injury, sexual violation thru experience the event him/herself, witnessing the event as it occurred to others as primary caregivers, learning that the events occurred to a close relative or a close friend.
2. Showing intrusive, avoidance and arousal symptoms plus negative alterations in cognitions and mood beginning or worsening after the traumatic event occurred, such as
a. Markedly diminished interest or participation in significant activities as play.
b. Socially withdrawn behaviour.
c. Persistent reduction in expression of positive emotions.
3. Disturbance can cause distress or impairment in relationships with parents, siblings, peers or other caregivers or with school behavior.
Next question in our discussion is: how stress can have impact not only in childhood but also in adulthood.
In a brief, neurosciences provide us for evidence about early childhood trauma causing massive plastic changes in the hippocampus, shrinking it, in the way new memories cannot form. Early release of glucocorticoids (stress hormones) actually kills some cells, blocking synaptic connections and interfering with learning and long term memory. Animals those are separate from their mothers, is one example of it. From early ages, those animals are more vulnerable to stress related illness than others as Dr Norman Doidge[2007] states: “Trauma in infancy appears to lead to a supersensitisation of the brain neurons that regulate glucocorticoids… if the stress is brief this decrease in size is temporary. If it is too prolonged, damage is permanent.”
When synthetic glucocorticoids are prescribed in pregnant mothers, as Dr Robert Sapolsky[2004] pointed, children have smaller head circumferences, emotional and behaviour problems and slowing of some developmental landmarks. Fetal stress increases disease risk.
As Drs Doidge and Sapolsky state, stress can have some great impact on memory, but as we know stress effects also can lead into different chronic diseases in adulthood.
Some challenges for mental health professionals
We have presented some important considerations in order to promote a discussion about how stress can affect children and having important effect in adulthood. We are impelling to create a movement toward multidisciplinary interventions to understand and treat stress in all ages. Unless pharmacological interventions will be diminished, it is also important psychologists, psychotherapists, social workers and family therapists work. We urge to create awareness in our societies about fast paced world and its consequences for mental health.
References
American Psychiatric Association (2012a) DSM-5 development [Internet]. [cited 2012 Sep 9]. Available from: http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=166
American Psychiatric Association (2012a) DSM-5 development [Internet]. [cited 2012 Sep 9]. Available from:
http://www.dsm5.org/proposedrevision/pages/proposedrevision.aspx?rid=165
American Psychological Association (2010) Stress in America Findings [Internet]. [cited 2012 Sep 9]. Available from: http://www.apa.org/news/press/releases/stress/national-report.pdf
Doidge N (2007) The brain that changes itself. USA: Viking
Moroz KJ (2005) The effects of psychological trauma on children and adolescents. Report prepared for the Vermont Agency of Human Services, Department of Health, Division of Mental Health, Child, Adolescent and Family Unit [Internet]. [cited 2012 Sep 9]. Available from: http://mentalhealth.vermont.gov/sites/dmh/files/report/cafu/DMH-CAFU_Psychological_Trauma_Moroz.pdf
Richtsmeier L, Culbert T, Kaiser P (2003) Helping children with stress and anxiety: an integrative medicine approach [serial online]. Biofeedback 31:12-17 [cited 2012 Sep 9]. Available from: http://www.resourcenter.net/images/AAPB/Files/Biofeedback/2003/BIOFEEDBACKSPRING_03.pdf
Sapolsky R (2004) Why zebras don’t get ulcers. USA: Owl Books
World Health Organization (2008) Mental Health Gap Action Programme. Scaling up care for mental, neurological, and substance use disorders [Internet]. [coted 2012 Sep 9]. Available from: http://www.who.int/mental_health/mhgap_final_english.pdf
World Health Organization. Fact file: 10 facts on mental health [Internet]. [cited 2012 Sep 9]. Available from:
http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/index.html
Citation
Juarez C. What we know about stress in childhood. In: Das S, editor. Souvenir-cum-Scientific Update for the 22nd Annual Conference of Indian Psychiatric Society, Assam State Branch. Guwahati: ABSCON; 2012. p. 88-90. Available from: https://sites.google.com/site/mindtheyoungminds/souvenir-cum-scientific-update/what-we-know-about-stress-in-childhood
Page updated
Google Sites
Report abuse