Are there websites with sensory processing disorders
Mental disorders in infants, toddlers, and preschoolers
Definition and classification
At 10–15%, mental disorders are just as common at this early age as in older children and adolescents, but they are often overlooked and presented, diagnosed and treated less often, although specific, effective therapies are available. They differ depending on the stage of development with age-typical symptoms. The Anglo-American age classification into “infants” (0–18 months), “toddlers” (18–36 months) and “preschoolers” (4–5 years), which corresponds very well to the developmental psychology of these age groups, is helpful.
Typical disorders in young children are (affected age in brackets): attention deficit / hyperactivity disorder (ADHD) and hyperkinetic disorder (HKS) (from 3 years), disorder of social behavior with oppositional behavior (from 3 years), elimination disorders (from 4 or 5 years), post-traumatic stress disorders (from 18 months), attachment disorders (from 9 months), depressive disorders (from 3 years), anxiety disorders (from 18 months), sensory processing disorders (from 6 months), autistic disorders (from birth), eating disorders (from 4 weeks) and sleep disorders (from 6 months). Since some of these disorders are dealt with in further chapters, the focus here will be on sensory processing, sleeping, eating, and attachment disorders.
Every therapy is based on a precise diagnosis, which requires particularly good cooperation between pediatrics and child and adolescent psychiatry. To this end, interdisciplinary guidelines have been published specifically on mental disorders in young children.
Special diagnostic criteria were formulated for the young age, in particular according to the classification system DC: 0-5. The diagnosis always includes a detailed anamnesis, observation of the interaction between the child and the caregiver and a physical examination. This can be supplemented by a psychopathological finding as well as standardized procedures such as development and intelligence tests, questionnaires and interviews. Depending on the diagnosis, the most effective therapy is chosen, which always involves parents intensively.
Sensory processing disorders
In the German-speaking area, eating and sleeping disorders, excessive crying and a number of other symptoms have been summarized under the term regulatory disorders. Internationally, eating, sleeping and crying disorders are classified separately and the term regulatory disorder is dispensed with.
In contrast, sensory processing disorders are understood to be a group of disorders in which children show inherent difficulties in adequately processing and regulating external stimuli, i. H. maintain an internal emotional homeostasis so that specific emotional and behavioral patterns are triggered. A distinction is made between sensory underreactivity and overreactivity disorder, as well as a residual category of other sensory processing disorders.
Diagnosis and therapy
After the diagnosis, parents are advised to dose the optimal amount of stimulation for their children and to structure everyday life. Adequate setting of boundaries and dealing with feelings of guilt can also be topics of counseling. Some children benefit from occupational therapy and physiotherapy. Overall, sensory processing disorders are a poorly operationalized group of disorders with a poor empirical research basis.
According to the DC: 0-5, sleep disorders are defined as pronounced problems falling asleep and / or staying asleep from the age of 6 or 8 months. A distinction is also made between partial awakening disorders (pavor nocturnus and sleepwalking) and nightmares in children from the age of 12 months. In younger children, sleep problems can be very stressful for the family and require intensive counseling - but at this age they are not viewed as disorders.
In addition to general diagnostics, sleep logs should be kept for at least 2 weeks in which sleep and wake times as well as interaction behavior are documented. Questionnaires can also be helpful.
Therapeutically, counseling and the provision of information come first, structuring everyday life with so-called positive sleep routines and rituals is recommended. The therapy consists of behavioral extinction procedures in which the unwanted sleep behavior is "deleted" by calming down, positive reinforcement, but also by gradually letting you cry. They have been shown to be effective in many studies with a high level of evidence. Parents need to be prepared, supported and accompanied during these procedures. The procedure is recorded and discussed. In the event of family conflicts or the parents' own mental disorders, further psychotherapy may be necessary. Pharmacotherapy is not indicated.
Since young children are also actively involved in eating, the term feeding disorders is no longer used according to the classification system DC: 0-5. All disorders of food intake are generally referred to as eating disorders. Subclinical eating problems are common and affect 20% of young children, while manifest eating disorders have a prevalence of 1–2%. According to DC: 0-5, 3 different subtypes are distinguished, namely the disorder of overeating, the eating disorder with restricted food intake and the atypical eating disorder. The etiology includes both child and parental causes.
The excessive, uncontrolled preoccupation with eating with a risk of obesity is typical of the overeating disorder. The restricted eating disorder can be characterized by a lack of interest in food, selective eating, avoidance of certain foods, and problems in maintaining adequate vigilance. Atypical eating disorder is defined by food hoarding, pica (habitual eating of inedible substances), or rumination (gagging and repeated swallowing of food).
These disorders require particularly intensive pediatric diagnostics in order to rule out underlying organic diseases (such as gastroesophageal reflux disease). Video diagnostics of the feeding and eating situation should always be carried out.
The therapy depends on the specific diagnosis and combines interaction therapy, behavior therapy and other psychotherapeutic methods. Parents are intensively instructed to structure the eating situation and to prevent food intake between the planned meals. In the case of severe disorders, inpatient treatment in an interdisciplinary team is necessary, among other things. to stimulate the child's initiative to eat through controlled hunger attempts.
Excessive crying disorder
According to the classic “Wessel Rule”, excessive screaming means insatiable screaming for more than 3 hours and more than 3 days per week over a period of at least 3 weeks. According to DC: 0-5, the excessive crying disorder is regarded as a disorder of its own. Up to the age of 3 months it is a normal maturation phenomenon with no long-term consequences that can be a burden for parents. In infants from 3 months of age, persistent, excessive crying can be associated with later neurological, psychological and other developmental disorders. After the diagnosis, parents receive support and advice on structuring everyday life and their own coping mechanisms. Further psychotherapy is only indicated if the parents have psychological disorders.
Attachment disorders are severe disorders that occur as a residue of neglect, mistreatment and abuse and can persist for a long time. The decisive factor is disturbed, indiscriminate and age-appropriate attachment behavior, in which the child does not turn to a specific caregiver for comfort, support and care. A distinction is made between two subtypes: an inhibited, withdrawn pattern in which the child appears sad, anxious and emotionally underreactive (according to DC: 0-5: reactive attachment disorder). This subtype has a good prognosis in contrast to the disinhibited pattern, which is chronic and persistent (according to DC: 0-5: disinhibited social attachment disorder). For these children, the caregivers are interchangeable, they are distant, hyperactive and often blind to dangers.
The basis of every therapy is a reliable caregiver and a safe environment without further endangering the child. External placement in foster families is often necessary. Parent-child therapies with a focus on relationship behavior are therapeutically in the foreground.
AWMF (2015) Guidelines on Mental Disorders in Infants, Toddlers and Preschoolers (S2k). AWMF No. 028-041. http: // www. awmf.org / guidelines
Bolten M, Möhler E, von Gontard A (2013) Guide: Mental disorders in infants and toddlers: Excessive crying, sleep and feeding disorders. Hogrefe, Göttingen
Gontard A von (2018) Mental Disorders in Infants, Young and Preschool Children. Kohlhammer, Stuttgart
Luby JL (Ed) (2017) Handbook of preschool mental health - development, disorders, and treatment, 2nd ed. Gilford Press, New York
Zero to Three (2016) Diagnostic classification of mental health and developmental disorders of infancy and early childhood (DC: 0-5). Zero to Three Press, Washington, DC
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