The manifestations and prevention methods of common psychological and behavioral problems in childhood are as follows:
(A) the performance of children's mental health problems
Children's mental health problems mainly refer to behavioral deviations in childhood. In a narrow sense, it is equivalent to behavioral problems, and in a broad sense, it refers to all psychological and social problems, that is, those abnormal behaviors that exceed the allowable range of the corresponding age in severity and duration.
Childhood has the following common psychological and behavioral problems:
1. Academic-related problems: learning difficulties, attention disorder, poor self-control, excessive activities, refusal to go to school, etc. , mostly in primary schools, especially children who have just entered school. Some of these problems are temporary maladjustment during the transition from preschool to school age.
2. Emotional problems: such as emotional instability, tension, loneliness, obsessive ideas, excessive willfulness or impulsiveness, withdrawal, fear, etc. If such problems are serious, mental illness must be ruled out.
3. Personality problems: boys are obviously more than girls, such as stealing, lying frequently, truancy, vandalism, aggressive behavior and all kinds of sabotage.
4. Bad habits: such as habitual convulsions, finger sucking, nail biting, addiction, enuresis, stuttering, partial eclipse, etc.
When judging children's psychological and behavioral problems, we should follow two principles: First, children have different psychological manifestations at different ages, and their dominant, typical and essential characteristics are called children's psychological age characteristics. Families, schools and society have different educational expectations and requirements for children of different ages. Only by linking children's psychological age characteristics with educational requirements can we make a realistic judgment on whether they have psychological and behavioral problems. Second, we can't treat all temporary behaviors in children's development as psychological and behavioral problems. Only those behaviors that have particularity and directly affect children's psychological development are treated as behavioral problems. Most children will have various psychological and behavioral temporary maladjustments at a certain stage of development, which are called "psychological and social development obstacles" and can be cured through appropriate behavioral guidance; If it is not cured for a long time, the problem will often become complicated and serious, leading to psychological obstacles.
Prevention and treatment of psychological and behavioral problems in childhood.
There are many manifestations of psychological and behavioral problems in childhood. In primary schools, kindergartens and schools, we should focus on preventing and correcting the following four types of problems (especially the first type):
1. Academic related issues
(1) Attention deficit hyperactivity disorder, commonly known as "children's hyperactivity disorder", refers to a group of children's abnormal behavior syndrome caused by non-intellectual factors, which is not consistent with their age, including attention disorder, impulsiveness and hyperactivity, accompanied by learning difficulties and low social adaptability. The prevalence rate is about 3% ~ 5% of the total number of school-age children, with more boys than girls. Usually before the age of 7, the main manifestations are: ① cognitive aspects. Narrow attention span, poor anti-interference and unpredictable behavior consequences. (2) Emotionally, excitable, lacking impulse control. ③ Behavior: hyperactive partner aggressive behavior. ④ In interpersonal communication, the relationship with parents, teachers and peers is not good. The etiology is complex, which is often the result of the comprehensive effects of heredity, brain injury, lead poisoning, psychosocial factors and bad family environment. The key to prevention and treatment is to raise parents' and teachers' awareness of the disease. Although the role of family, school and society in the occurrence of attention deficit hyperactivity disorder (ADHD) is not clear, the conclusion that it has an influence on the development and prognosis of the disease is affirmative. Family disharmony, single-parent family, improper parenting style, early emotional deprivation of mother and child, foster care, etc. It may increase the incidence of ADHD, and then affect the child's behavior and emotional development. Therefore, the intervention of ADHD requires the efforts of families, schools and professional institutions, and comprehensive correction combining psychotherapy, education and behavioral training, with the focus on providing behavioral guidance. Behavioral therapy mostly adopts the method of positive reinforcement to help them establish some adaptive behaviors. Sensory integration training and biofeedback training can also be used. At the same time, parents and teachers should fully understand, participate and cooperate with the treatment. For example, we can deliberately ignore the performance of some of its problem behaviors; On the contrary, encourage them as soon as they see good behaviors and guide them to gradually strengthen these behaviors.
(2) Learning disabilities are a group of syndromes characterized by difficulty in acquiring special learning skills such as reading, writing, spelling, expression, reasoning and calculation, including reading disabilities, mathematics/operation disabilities, writing disabilities and nonspecific learning disabilities. Children do not have mental retardation, audio-visual impairment, environmental and educational deprivation and primary emotional disorder. The detection rate of school-age children is about 3% ~ 8%, males are more than females, and the lower grades of primary schools are relatively high. Typical manifestations are: ① low grades in one or more subjects; ② Difficulty in reading, calculating and spelling. Hand-eye disharmony; ③ hyperactivity and inattention; (4) Low self-awareness, followed by a series of emotional problems. The prevention and treatment of learning disabilities focuses on early prevention and intervention, including: strengthening perinatal health care to avoid possible brain damage; Carry out early education correctly; Early psychological counseling and guidance for parents. Teachers and parents easily misunderstand children's learning difficulties, which leads to improper handling or punishment of children and has a great impact on their personality growth and mental health. Many children can't get the right education, and their studies are frustrated, which leads to dropping out of school and even committing crimes. Therefore, we should accept and encourage patients with learning disabilities, accept their shortcomings, and attach importance to his/her advantages and abilities in other aspects; Improve children's self-awareness, enhance self-confidence and learning motivation; According to their cognitive characteristics, targeted education and treatment are carried out. Try to get the cooperation of parents and teachers, and avoid giving up because of strict requirements. Comprehensive corrective measures such as educational therapy, psychological counseling, game behavior therapy and social skills training can often achieve good results.
(3) Refusing to go to school, also known as "truancy" or "not going to school", means that you can't insist on going to school regularly because of different physical complaints, which is a serious emotional obstacle. Children account for about 1% ~ 5% of school-age children, and they are older (if they appear in junior high school). Refusing to go to school essentially means that students fail to go to school; Its social function and emotional development will inevitably be seriously affected. Refusing to go to school is related to anxiety, social phobia, adjustment disorder, rhythmic sleep disorder, depression and other emotional-behavioral disorders, but a considerable number of children may be accompanied by the following symptoms: ① unexplained fatigue, low enthusiasm, ② low attention and memory function. ③ Nerve symptoms such as headache, dizziness and bad mood; Similar to chronic fatigue syndrome in children. Most children with chronic fatigue syndrome may have obvious school function destruction and reduced social activities, and they cannot maintain their daily life and go to school. This means that children's chronic fatigue syndrome (CCFS) is also a possible reason why students refuse to go to school. Japan's Ministry of Education reported in 2002 that about 2.8% of Japanese junior high school students refused to go to school because of CCFS.
School-age children also have a special emotional disorder called "school phobia". Beginners (especially girls) are more common, showing abnormal fear of the specific environment of school and strong refusal to go to school. The attack was accompanied by anxiety and autonomic nervous system dysfunction. Most of them are caused by separation anxiety in childhood, and may also be related to poor academic performance, difficulty in adapting to the school environment, excessive doting by parents, protection and intervention, and great pressure of life events.
Refusing to go to school and school phobia often become a continuum, the most prominent symptom is refusing to go to school, and the reasons given are physical symptoms (headache, abdominal pain, general fatigue, etc.). ); Being forced to go to school leads to anxiety and pain, and then more symptoms such as nausea, vomiting and low fever appear. However, the nature and degree of diseases are different. Children with school phobia are often late for school, unable to persist until school, and even often absent from school, but when they get home, the above symptoms disappear on their own and their mood is as calm as ever; In other words, the inner pressure is not great; With the increase of age and the improvement of physiological maturity, most symptoms can gradually disappear. Children who refuse to go to school are not. They show more rebellious behaviors unique to teenagers, often accompanied by serious emotional disorders such as anxiety and depression, and usually accompanied by different physical symptoms and functional disorders, such as general fatigue (unable to relieve after rest), headache, sleep disorders (irregular sleep, difficulty getting up in the morning, etc. ), poor attention and memory, muscle pain, decreased activity, abdominal pain, nausea, fever, dizziness, sore throat, etc. Children's activities are significantly reduced, and bed rest time is prolonged. Serious people don't go to school for more than half a week, which has a serious adverse effect on interpersonal communication. The more serious the physical symptoms, the less time you spend participating in peer activities, and the more serious the depression and anxiety. If you don't intervene, you will often drop out of school.
It is precisely because these two symptoms (especially the latter) will have a destructive impact on children's schooling, physical health and social function, so once they are found and diagnosed, they should be intervened promptly and effectively. The full cooperation of doctors, parents and teachers is the key to successful treatment. Cognitive behavioral therapy is an effective treatment for children who refuse to go to school. The goal is to adjust and change one's cognition and behavior (such as panic and escape) with the help of family members and under the guidance of professional therapists, so as to improve one's physiological reaction (such as fatigue) and realize self-rehabilitation. The traditional educational support treatment model also has curative effect. It combines education and supportive treatment for children. First, through face-to-face communication, we can understand the reasons for refusing to go to school and the factors such as anxiety, tension and depression that follow. Then patiently explain and guide them, teach them relevant knowledge and skills, and help and encourage them to overcome their fear of school. Parents should fully understand their children's psychosomatic symptoms and the real reasons for refusing to go to school; Don't urge children to go to school too much. Abuse, satire, reprimand and corporal punishment are even more inappropriate. Always keep in touch with the teacher to learn more about the children's school. For children with obvious sleep and emotional disorders, antidepressants and sleep-improving drugs can be given when necessary. Parents and teachers should show firm confidence and patience, and understand and trust children's physical and psychological complaints. In the process of onset, the most important thing is not to investigate the absenteeism in the previous stage, but to prevent the symptoms from changing from accidental and specific situations to long-term and uncontrollable States.
2. Emotional problems: Emotional problems not only have a negative impact on children's learning, communication and personality development, but also often turn into behavioral abnormalities. There are many reasons for emotional problems, such as excessive study pressure, high expectations of parents, tense relationship between teachers and students, negative personality characteristics and so on.
(1) Anxiety: refers to sudden fear without obvious physical reasons. If it happens frequently and repeatedly, it is easy to form children's anxiety disorder, which is one of the most common emotional disorders in childhood. The prevalence rate is 2% ~ 9%, which is more common in children of lower grades, and girls are slightly higher than boys. Children with anxiety are sensitive and anxious, lack of self-confidence and afraid of failure; Poor adaptability to the environment, nervous and afraid when encountering setbacks, resulting in unnecessary troubles, worries and anxieties, and serious symptoms such as poor sleep, night terrors, loss of appetite, palpitation, sweating, frequent urination and constipation. Excessive anxiety will affect children's intelligence, personality and behavior development. Children often have genetic susceptibility, but continuous environmental stress has a more direct impact. We should create a good environment for them, improve educational methods, eliminate all kinds of stimulating factors that cause anxiety, and cooperate with psychotherapy.
(2) Aggressive pursuit behavior: refers to a syndrome in childhood, which is dominated by obsessive-compulsive ideas and behaviors, accompanied by anxiety and adaptation difficulties. Obsessive-compulsive concept is emotional, manifested as involuntary, repeated, unrealistic and unreasonable compulsive concept, doubt, intention and compulsive exhaustion, which often leads to anxiety, self-blame and depression. Forced action is behavioral, which is manifested in forced counting, forced washing, forced ritual action and so on. 3 ~ 7 years old is the peak age of some behaviors similar to obsessive-compulsive disorder, but its symptoms are mostly transient, which is essentially different from morbid obsessive-compulsive disorder and generally disappears with age. If the compulsive behavior is serious, psychological counseling and treatment should be provided and measures should be taken to eliminate psychological tension. In daily life, encourage children to participate in group activities and cultivate an open-minded and cheerful personality. Treatment should be fully understood and actively cooperated by parents.
(3) Fear: when participating in an activity or facing a certain situation, excessive and persistent tension, fear and avoidance are generated. There are three common fear reactions: first, fear of physical harm, such as fear of injury, death, kidnapping and so on. The second is the fear of natural events, such as floods, earthquakes, lightning, darkness, animals and so on. The third is social fear, such as being separated from parents, going to school, and being afraid of meeting strangers. Fear is one of the most common psychological phenomena in childhood. 90% children will have a fear reaction at some stage of their development, but the degree of reaction is commensurate with the actual danger they face. If you know that something or a situation is actually not dangerous, but you have an unusual fear, and you can't get rid of it after all kinds of persuasion, it indicates that you have a phobia. In order to prevent children from having lasting fears, we should pay attention to cultivating children's optimistic, cheerful and brave personality from an early age. Parents should be calm when facing things and situations they don't like, and don't show too much fear, so as not to set a bad example for their children. Children should not be intimidated by animals or natural phenomena. Schools should try their best to create a warm learning environment, and teachers should adopt correct educational methods to avoid children's anxiety and fear about school and study life. Systematic desensitization therapy, demonstration method, operation method, positive reinforcement method, impact therapy, etc. , can improve children's mood, reduce children's fear; Music game therapy has a good effect on children's phobia.
3. Personality problem: refers to a series of sexual behavior problems that appear repeatedly and continuously among children and adolescents and are characterized by frequent lying, stealing, truancy, attack and destruction. Children usually develop into conduct disorders because they are difficult to adapt to school life, which are manifested in fighting, aggression, cruelty to animals or others, destruction of public property, domestic violence, running away from home, gambling, sexual assault and so on. , lasting more than 6 months. The incidence of conduct problems and confrontational attacks is about 4% ~ L4%, and the sex ratio is 2 ~ 4: 1, which is significantly higher for boys than for girls. The causes of behavioral problems are complicated. In addition to the characteristics of their own psychological development, family indifference, domestic violence, improper parental education, excessive autocracy and neglect, lack of education and emotional support for their children, or excessive doting and pampering are the key factors leading to the occurrence and development of conduct problems. More than half of children with conduct problems have poor prognosis. Adult may also have criminal behavior, antisocial personality, alcohol dependence and various psychological obstacles. There are also many problems in health, study, work and social adaptation, which are very harmful to family, school and society. Sexual diseases (such as ADHD, emotional disorders, etc.). ) Problems with children's conduct are also common. Therefore, the intervention and treatment of such children must be based on a comprehensive assessment of children's own, family, social and school environment, and a targeted multi-sectoral intervention program should be formulated. Provide positive psychological support and behavioral guidance to children with conduct problems, encourage parents and teachers to take positive guidance, establish parent-child interaction, improve family atmosphere, play a demonstration role, and guide children with conduct problems to change bad behaviors as soon as possible and set a good behavior example.
4. Stubborn bad habits: A few children can be induced by mental and physical discomfort under bad environmental conditions, and the following rigid bad habitual actions appear. This habit has various manifestations, but most of them have no special psychological abnormality.
(1) Finger sucking and nail biting: Finger sucking occurs in a few months after the child is born, and it is most frequent when 1 ~ 2 years old, and most of them disappear at school age. A few children still retain the habit of sucking because of lack of environmental stimulation and caress; It is more likely to have psychological conflicts and evolve into habits such as biting nails and pencils. Nail biting is more common in childhood, starting from 4 or 5 years old, peaking at 6 years old, and gradually decreasing after 1 1 year old, and some of them can last until adulthood. Finger sucking often happens when you are bored or want to sleep, while nail biting often happens when you are stimulated by stress, which is related to emotional instability. The main preventive measures are: reducing children's psychological pressure and tension; Don't deliberately remind or pay attention to their behavior, and there is no need to reprimand them, so as not to strengthen bad habits; Encourage and guide children to do other things by hand, distract attention, and naturally relieve symptoms; Aversion therapy and other behavioral therapies can also be used.
(2) Habitual twitch: Children's habitual twitch is mainly manifested as involuntary, repeated rapid, single-site or multi-site muscle motor twitch and vocal twitch, accompanied by inattention, hyperactivity and compulsive movements. It is more common in children aged 5 ~ 12, and boys are obviously more than girls. The frequency of convulsions increases with emotional tension, decreases when attention is distracted, and disappears after falling asleep. Habitual TIC can be divided into transient TIC, chronic motor or vocal TIC, Tourette's syndrome and other stages. Most of them are simple motor convulsions, such as blinking, frowning, shrinking nose, biting lips, pouting, opening mouth, shaking head, torticollis, looking sideways and shrugging. Simple vocal cord twitch is characterized by simple, rapid and meaningless sounds (such as clearing throat, coughing or other guttural sounds). Chronic motor or vocal twitch is characterized by simple or complex motor twitch; Simple or complex vocal cord twitch; It lasts at least a year, and some can last for years or even for life. Tourette's syndrome can be complicated with severe motor/vocal TIC disorder, which interferes with and damages people's cognitive function and development to varying degrees, and is often accompanied by inattention, hyperactivity, emotional disorder, learning difficulties, behavioral problems, violation of discipline and social adaptation difficulties. The reason is unclear, which may be related to heredity, physical organic diseases and psychological-emotional factors. The most common psychological and emotional factors are sudden fear or long-term anxiety; Common physical factors are often induced by local stimuli, such as itching, upper respiratory tract infection, rhinitis, conjunctivitis and so on. The fundamental prevention and treatment measures of habitual twitch are to eliminate the cause and relieve psychological pressure; Avoid excessive excitement; Eliminate tension and fatigue. Those with severe symptoms should be treated with psychology, behavior and medicine at the same time. Behavioral therapy mainly includes relaxation therapy, biofeedback training, positive conditioning reinforcement/regression method, habit reverse training method and so on. Let children gradually learn to relax and adjust their breathing and emotions independently, thus promoting the improvement of symptoms.
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