The Emotionally Disturbed Child
By Dr. Annalease Richards
Senior House Officer, Department of Psychiatry, Adolescent Unit,
Sandilands Rehabilitation Centre


In today’s society where many children have become the primary targets of physical, emotional, and sexual abuse it is not surprising that the incidence of substance abuse, conduct disorder, posttraumatic stress disorder and depression are on the increase in the childhood and adolescent population. As a healthcare professional, the challenge comes with the rapid identification and management of these patients as the emotionally disturbed child can have many presentations. Some of the more common ones are:

Conduct disorder – This diagnosis accounts for more than 80% of court referrals sent to the Adolescent unit for evaluation. These children give a history of aggression to people or animals, property destruction, deceitfulness, lying or stealing and serious violation of rules. It is important to remember that in making this diagnosis co-morbidity must be excluded! Quite commonly behavioural problems and “acting out” can be the presentation of a depressed or abused child or a child with coexisting Attention Deficit Hyperactivity Disorder and/or a Low IQ who is frustrated and discouraged by his inability to keep up with is peers.

Post traumatic stress disorder/event – A history of trauma or abuse may or may not be present, as a child, fearful of his abuser, may not admit to being a victim. As a result, it is up to the parent or health professional to identify the symptoms and uncover the source of trauma. These children present with sudden changes in behaviour, avoidance of associated stimuli such as not wanting to visit a relative or friend they once adored, outbursts, increased alertness, regression, and unexplained physical symptoms.

Depression – this disorder although possibly presented with the characteristic symptoms of low self-esteem, suicidal thoughts, anhedonia (loss of interest in once pleasurable activities) and alterations in appetite and sleep pattern may be missed in this age group. In children especially those less than eight years, depression can present as somatic complaints such as unexplained headaches and abdominal pains. Changes in behaviour or a decline in school performance may lead to a diagnosis of behavioural problems or even conduct disorder.

Substance abuse – This diagnosis is common especially amongst young males. In our setting, the substances most commonly abused include marijuana and alcohol. Among teens this form of abuse may lead to academic, social and psychological and/or physical dysfunction. Thus these children can present as a child with deteriorating school performance, delinquent behaviour, medical emergencies or acute psychosis secondary to acute drug or alcohol intoxication.

As equally important as the diagnosis, is the management of such children. The primary areas addressed are geared towards the three primary facets which affect every child’s life. These are the individual issues, family environment and school life. Using a multidisciplinary approach, the team consisting of psychiatrist, psychologists, social workers and therapists work to devise an individualized treatment regime.

Treatment modalities include psychotherapy, occupational and recreational therapy and control of negative environment factors sometimes with the aide of the Department of Social Services. In some cases the use of medications may also be required. If indicated, such cases are co-managed with the medical, surgical and sexual abuse teams.

With these children it is important to always look at the whole picture and not only ask the relevant question but seek answers. Why is this child depressed? Why is this child smoking marijuana? Why is this child suddenly skipping classes and being disobedient? In our evaluation and assessment of these children, it is important to remember that children are products of their environment and the diagnosis of one disorder does not exclude the presence of another. Thus a child with Conduct Disorder can be depressed and a victim of abuse can present as a depressed child that smokes marijuana. Ultimately, as parents, physicians and healthcare professionals our primary goal should be the rapid identification and continued management of these children. Only in doing so can we promote holistic healthcare amongst today’s children and adolescents.

A publication of the Public Education Committee of the Public Relations Unit of Sandilands Rehabilitation Centre.

Bring up children has changed from when I was young. Child abusers were few and far between. They did not last long when a Father found out.

I hope you are not attributing all bad behavior to sexual abuse? I know that is the "in" thing these days but a bad kid is a bad kid and in my day here is how it was handled. Attention Deficit disorder was cured by a few sharp blows with a ruler, administered by a Nun. Conduct Disorders required harsher measures - the cane, or the strap!

"Acting out" was forbidden! For those kids who violated this the cane was brought out again. If a kid destroyed someones property he had to pay for the damages, even if that meant taking a job after school. Lying, or cursing got one's mouth washed out will Carbolic soap. Aggression was directed to the sports field. Kids who were really aggressive where handled by their peers. I can remember one occasion when a group of us had to teach a Bully his manners - that ended his days as a bully.

Post traumatic stress disorders, Depression and such were a luxury not afforded to children. One was sent out to play until they passed. The out-doors was full of wonderful distractions and pass times.

Substance abuse was limited to a stolen bottle of beer, or a clandestine sip of wine. It had to be that way because no adult would sell, or give one such substances, and if any adult found one intoxicated there would be hell to pay - for the person who gave you the stuff and the kid! Drugs were around but no dealer would dare sell to a kid! There would be an army of Mums and Dads after him in no time and they would pull him limb from limb.

Most of us survived these Draconian measures and we knew we were loved in spite of them. A kid felt save because he knew that all eyes were watching him and looking out for him - his parents, the neighbors, the cop walking his beat, even total strangers, all of them seemed involved in making sure the kid did the right thing. He knew, even if he got a caning that it was done for a reason and that reason was he had messed up! Messing up was not tolerated. It was not thought of as a mental disorder but as the natural state of a kid and it had to be drummed out of him.

Perhaps the new way is kinder but there is something missing. We have more kids with problems and more parents who don't know what to do. Our society has moved away from the "everybody's hands on" approach with children - such things are now left to professionals.

The old way might have been tough but most of us survived it. However, it is gone, we shall not see it again!
:walk: :walk: :walk:

good posting!
:tup:

The Emotionally Disturbed Child
By Dr. Annalease Richards
Senior House Officer, Department of Psychiatry, Adolescent Unit,
Sandilands Rehabilitation Centre


In today’s society where many children have become the primary targets of physical, emotional, and sexual abuse it is not surprising that the incidence of substance abuse, conduct disorder, posttraumatic stress disorder and depression are on the increase in the childhood and adolescent population. As a healthcare professional, the challenge comes with the rapid identification and management of these patients as the emotionally disturbed child can have many presentations. Some of the more common ones are:

Conduct disorder – This diagnosis accounts for more than 80% of court referrals sent to the Adolescent unit for evaluation. These children give a history of aggression to people or animals, property destruction, deceitfulness, lying or stealing and serious violation of rules. It is important to remember that in making this diagnosis co-morbidity must be excluded! Quite commonly behavioural problems and “acting out” can be the presentation of a depressed or abused child or a child with coexisting Attention Deficit Hyperactivity Disorder and/or a Low IQ who is frustrated and discouraged by his inability to keep up with is peers.

Post traumatic stress disorder/event – A history of trauma or abuse may or may not be present, as a child, fearful of his abuser, may not admit to being a victim. As a result, it is up to the parent or health professional to identify the symptoms and uncover the source of trauma. These children present with sudden changes in behaviour, avoidance of associated stimuli such as not wanting to visit a relative or friend they once adored, outbursts, increased alertness, regression, and unexplained physical symptoms.

Depression – this disorder although possibly presented with the characteristic symptoms of low self-esteem, suicidal thoughts, anhedonia (loss of interest in once pleasurable activities) and alterations in appetite and sleep pattern may be missed in this age group. In children especially those less than eight years, depression can present as somatic complaints such as unexplained headaches and abdominal pains. Changes in behaviour or a decline in school performance may lead to a diagnosis of behavioural problems or even conduct disorder.

Substance abuse – This diagnosis is common especially amongst young males. In our setting, the substances most commonly abused include marijuana and alcohol. Among teens this form of abuse may lead to academic, social and psychological and/or physical dysfunction. Thus these children can present as a child with deteriorating school performance, delinquent behaviour, medical emergencies or acute psychosis secondary to acute drug or alcohol intoxication.

As equally important as the diagnosis, is the management of such children. The primary areas addressed are geared towards the three primary facets which affect every child’s life. These are the individual issues, family environment and school life. Using a multidisciplinary approach, the team consisting of psychiatrist, psychologists, social workers and therapists work to devise an individualized treatment regime.

Treatment modalities include psychotherapy, occupational and recreational therapy and control of negative environment factors sometimes with the aide of the Department of Social Services. In some cases the use of medications may also be required. If indicated, such cases are co-managed with the medical, surgical and sexual abuse teams.

With these children it is important to always look at the whole picture and not only ask the relevant question but seek answers. Why is this child depressed? Why is this child smoking marijuana? Why is this child suddenly skipping classes and being disobedient? In our evaluation and assessment of these children, it is important to remember that children are products of their environment and the diagnosis of one disorder does not exclude the presence of another. Thus a child with Conduct Disorder can be depressed and a victim of abuse can present as a depressed child that smokes marijuana. Ultimately, as parents, physicians and healthcare professionals our primary goal should be the rapid identification and continued management of these children. Only in doing so can we promote holistic healthcare amongst today’s children and adolescents.

A publication of the Public Education Committee of the Public Relations Unit of Sandilands Rehabilitation Centre.


Annalease Richards How about GID (gender identity disorder) Or gender dysphoria.
We at the Alliance have been told of many young Bahamians being put out on the streets and forced into a life prostitution, drugs and alcohol.
They are put out because they have a gender identity issues. There is a case of a young person in PMH right now who is dying of AIDS because she was put out on the streets. Her parents did not understand anything about Gender ID issues. She was born male and when she did not fit the roll she was kicked to the street. Needles to say the predators moved in and used this 14 year old and now she is dying of AIDS. I personally spoke to a young Bahamian TG who was told she could get nice breasts using the fix a flat tire repair. I told her she was crazy and the people that told you that are crazy. Those cans are filled with propane and glue and it would kill her instantly. She had the cans at home she was asking me if I knew where she could get the needles from.

Why don't you and the rest of your colleges stand up and say something. Or is it just easer to look the other way.
Or is it you don't care because they/we don't fit your religious views??????

Bring up children has changed from when I was young. Child abusers were few and far between. They did not last long when a Father found out.

I hope you are not attributing all bad behavior to sexual abuse? I know that is the "in" thing these days but a bad kid is a bad kid and in my day here is how it was handled. Attention Deficit disorder was cured by a few sharp blows with a ruler, administered by a Nun. Conduct Disorders required harsher measures - the cane, or the strap!

"Acting out" was forbidden! For those kids who violated this the cane was brought out again. If a kid destroyed someones property he had to pay for the damages, even if that meant taking a job after school. Lying, or cursing got one's mouth washed out will Carbolic soap. Aggression was directed to the sports field. Kids who were really aggressive where handled by their peers. I can remember one occasion when a group of us had to teach a Bully his manners - that ended his days as a bully.

Post traumatic stress disorders, Depression and such were a luxury not afforded to children. One was sent out to play until they passed. The out-doors was full of wonderful distractions and pass times.

Substance abuse was limited to a stolen bottle of beer, or a clandestine sip of wine. It had to be that way because no adult would sell, or give one such substances, and if any adult found one intoxicated there would be hell to pay - for the person who gave you the stuff and the kid! Drugs were around but no dealer would dare sell to a kid! There would be an army of Mums and Dads after him in no time and they would pull him limb from limb.

Most of us survived these Draconian measures and we knew we were loved in spite of them. A kid felt save because he knew that all eyes were watching him and looking out for him - his parents, the neighbors, the cop walking his beat, even total strangers, all of them seemed involved in making sure the kid did the right thing. He knew, even if he got a caning that it was done for a reason and that reason was he had messed up! Messing up was not tolerated. It was not thought of as a mental disorder but as the natural state of a kid and it had to be drummed out of him.
I remember those days when they thought I was lazy and daydreaming all the time. I would not apply my self to the work at hand. I was drummed all right. My mother was told to take me to see Dr. Timothy McCartney (spelling) and he found out I had dyslexia. Very real also had to do with being forced to write with my right hand. Yeah I remember those days. I am very glad those days are gone, with ignorant teachers beating children because they did not take the time to understand.
My niece had to go to the principles office. She came to school late. (Because she has asthma very badly. Last night she slept at our house she had to do 6 treatments through the night.) She saw some students lined up out side of the classroom. She thought they were waiting to go in. The teacher stuck her head out and sent them to the principle office. She walked in the door was caned and sent to class. No Questions asked. But she had them call her mother. Did the poop hit the fan that day! We were all going up there to tear this man apart. To this day he cringes in fear when he sees us.
The thing is the man never even told the child he was sorry. We need those days like we need holes in our heads.

Perhaps the new way is kinder but there is something missing. We have more kids with problems and more parents who don't know what to do. Our society has moved away from the "everybody's hands on" approach with children - such things are now left to professionals.

The old way might have been tough but most of us survived it. However, it is gone, we shall not see it again!
:walk: :walk: :walk:

It seems as if more children are raising and responsible for other children.
Basic social problems need to be addressed and people needing treatment identified.

As for Vicky, we are all suffering from one identity problem or another! It’s sad though because sometimes we allow it to take control.

Sandilands has many solutions to our social ills but the organization has been so stigmatized that people give up before they even start looking.

yea...

im suffering from the hate vicky syndrome!
:bouncy:
it makes me say weird things, and type in a blind distorted haze!
:friday:
or is that when im drunk???
:dgi: :cool:

It seems as if more children are raising and responsible for other children.
Basic social problems need to be addressed and people needing treatment identified.

As for Vicky, we are all suffering from one identity problem or another! It’s sad though because sometimes we allow it to take control.
That's right why do we allow people to choose to be left handed. Fact gender dysphoria or GID or Transgender is very real. Many young people with gender dysphoria or GID or transgender turn to many things to try and cope. But many kill the selves as well. I know a transgender that admitted her self to a hospital to be cured of gender dysphoria. She was put through so much electro shock therapy that she can hardly hold a conversation But she still dress a a woman.
Met a Coke addict that said beating the addiction was a joke compared to the need to be female.
I think that before some of you speak you should do some research.

Sandilands has many solutions to our social ills but the organization has been so stigmatized that people give up before they even start looking.

We my wife and I spoke to a Dr. (who works out at Sandilands won't call any names as I have not asked his permission)
He explained to my wife that gender dysphoria is not a sickness it has no cure or treatment. Its has nothing to do with sexual orientation. His words helped my wife very much. Because as she said I was only dealing with people that dealt with gender dysphoria and they might be just saying what I wanted to hear. But here is a Dr. down here who was treating her sister, who told her this.

yea...

im suffering from the hate vicky syndrome!
:bouncy:
it makes me say weird things, and type in a blind distorted haze!
:friday:
or is that when im drunk???
:dgi: :cool:

I don't hate you. :cutie:

I don't hate you. :cutie:
only when i sleep....

:D

http://www.ifge.org/convention/tg03workshop_slides.php
click the next top right to see more pix

The convention begins with a plenary session presentation by Bernard and Terry Reed,
of the UK's Gender Identity and Research Society, discussing the biological origins of gender dysphoria.

For those of you that think its only about sex.

http://www.ifge.org/convention/tgconv_pictures.shtml

any relationship has a bit of sex to it vic!
you telling me it is wholesome are lying!

we all have lusts, and we all have the hotts for someone!
its just you cant do it as often as you like!
:D

any relationship has a bit of sex to it vic!
I do not look at a women with lust as you do. When I see a sexy woman I want to get to know her and talk fashion and make-up. :cutie: Like "girl where did you get those heels from."
you telling me it is wholesome are lying!

we all have lusts, and we all have the hotts for someone!
its just you cant do it as often as you like!
:D

I get more sex than you can dream of. Remember I have a very wonderful wife. You have no idea how many people try to pick you up when they find out you are transgendered. Both male and females come on to transsexuals big time. I am just older and they really like the young one.

I do not look at a women with lust as you do. When I see a sexy woman I want to get to know her and talk fashion and make-up. :cutie: Like "girl where did you get those heels from."

I get more sex than you can dream of. Remember I have a very wonderful wife. You have no idea how many people try to pick you up when they find out you are transgendered. Both male and females come on to transsexuals big time. I am just older and they really like the young one.



your kiddin me vic???
hahahahahahahahahahahahahahahahahah

please tell me some of your encounters!!!
hahahahahahahahahhahaha

it ought to give me a chuckle!!
:shaky: