The school refusal is usually very resistantiant to efforts to send him

Frightening experiences - anxiety state can be precipitated either by a short-lived frightening experience,e.g. hospltalization for surgery, or a profonged experience like conffict between parents. (b) Separation froinparents. (c) Response to chronically anxious parents. (d) Anxious temperaments - Excessive worry abcut stressful events, e.g. examinations, group activities, etc. CLINICAL FEATURES Anxious children are abnormally fearful. They cling to Their parents and are very timd with other children Their sleep pattern may ba ditsturbed and frequent nightmares. may be experienced Somatic symptoms, especially headaches and symptoms referable to Gl tract may occur at time. TREATMENT: (a) Environmental manipulation to reduce stressful factors if possible. e.g. improving relationship between parents. (b) The child should be encouraged to take part in group activities and should be helped to talk over his worries. (c) Counselling to parents. (d) Anxiofytic drugs -are usually avoided except in cases of severe anxiely. 2. Phobic dissorder. Etiofogy. Similar to phobic disordees in adults. Clinical features - Man or phobias are common in childhood and usually concern animals, Insects, darkness, schoof and death. Agoraphobia and phobias of social situations usually begin during adofescence. Treaiment - Meet childhood phobias Improve without specific treatrment Parents should be taught to adopt a firn but reassuring approach. Behaviour therapy techniques by which a child is encouraged to encounter phobic situations may be of help in some. 3 Hysteria Etiofogy Psycho analytical theories postulated for adJlts also apply to children More common In adofescents than in children Clinical features; Similar to those In adults. Treatment - Reducing stressful environmental factors and encouraging the child to talk about his problems. Counselling 10 parents may be required 4. Obsessive compulsive disorder Etiofogy Psychoanalytical theories as in adults. Rare deorder inchildren. Clinical features - Several fonrs of repetitive behaviour are common. These Include a preoccupation with numbers and counting, repeated handing, of certain objects, etc it is also common for children to adopt rituals such as avoiding cracks on apavament. Much of the behaviour cannot strictly be called compulsve, bacause the child does not struggle against these repetitive or rituatelic behaviour patterns as ha should, if he istosatify the dagnostic criteria of obaessive compulsive- dsorder (See under Neurosis) when persistent obsessional thoughts or compulsive symptomrs occur during childhood, they are often part of an anxiety disorder. The pure form
of this disorder is more common during adofescance than during childhood and is usually char acterised by prasence of rllualellc behaviour such as rachecking schoof work or repeated handwashing Trealment - when obsessive compulsion. occur as a part of an anxiety disorder. treatment should be directed fowards the primary cteorder. Behavioural therapy may be required for treatment of obsessional symploms. 5 Depressive disorder.tiofogy. Disturbing environmental situations like serious illness of a parant, death of lamily member or parental disharmony. Endogenous depression is extremely rare in children. Clinical features ;A diagnosis of depressive illness In children should be made when there Is clear evidence of depression A depressive mood change is characteristic but may not be obvious at first children become teartful and lose interest and concentration. They may appear to be bored and may eat and sleep poorly. Sometimes, depressive disorder in children may appear in a "masked form1, presenting with avariety of somatic symptoms, enuresis , running away from home or truancy from schoof. Treatment -Reducing unhappy circumstances, if possible, and encouraging the child to take pan in activities. Treatment antidipressant is usually reserved for ofder children with severe depression. 6 .Schoof refusal: This is characterised by repeated absence from schoof when such absences are not due to physcal illness, condut disorder or when children are deliberatety kapt at home by Ihalr parents. Etiofogy - (a) Separation anxiely as In younger children (b) Fear or phobia of certain aspects of school the, or fears of failure and rejection. often associated with depresion Clinical features -Refusal id attnd schoof may besudAn In onset. More often. however,there is an Increasing reluctance to go to school with signs of increasing unhappiness and anxiety. Some cnildren may have somatic complaints like headache, abdominal pain, or vague complaints of feeling ill. This refusal may appear after a period of enforced abserce for another reason, such as illness, change of class or a problem in the family. The school refusal is usually very resistantiant to efforts to send him to school Treatment - (a) Alleviation of stressful aspecis of school life, it possible This may require co-operation of school authorities (b) Counselling of parents (c) Behaviour therapy In which a graded behavioural plan is drawn out 10 help the child overcome his fears (d) Treatment of associated depression if any (e) Psychotherapy wih the child to encourage him to talk about his fears. 7. Functional anurasis and encopresis FUNCTIONAL ENURESIS -is the repealed invotuntary voiding of urine Occurring after the age at which continence is usual, and in the absence