Things left unsaid

J.R. Ram addresses your concerns about your kids

  • Published 2.09.18
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My daughter is 13 years old. She is very intelligent. She is very good in her studies and is also a dancer. But for the last seven-eight months, she has been behaving peculiarly. Whenever she goes to the toilet, she takes one to two hours and does not  come out even if we ask her to. When she washes her hands, she goes on washing for a long time. While dressing up, she keeps on changing her mind before finally selecting an outfit. We have tried to make her understand that what she is doing is not right and she needs to stop. She temporarily understands my point, but again goes back to doing unnecessary things. She says that she feels whatever she is doing is not perfect and has to redo that particular thing. We are very worried and cannot understand whether this is just a prank or she is going through a difficult psychological problem. And we have also noticed that she has become a little restless and cannot focus on her studies.

Please help.
 
It is possible that your daughter is suffering from Obsessive Compulsive Disorder (OCD). Repeated washing of hands is one of the commonest signs of this disorder. Patients with OCD who cannot stop washing or wash for many hours believe that they have not cleaned their hands or other body parts properly and, therefore, keep on doing it. There can be other symptoms of OCD like repeated checking, repeated counting or repeated touching. These acts are known as compulsions. Obsessions are repetitive thoughts which occur without any basis. For your daughter they are (possibly) “my hands are unclean and dirty”. Because of these repetitive thoughts which are known as obsessions, she is washing her hands for long hours.
 
Patients with OCD also have problems in concentrating and focusing on one task, because at the back of their minds the obsessions keep coming back. Therefore, she has become restless and cannot sit at one place except for things which are very interesting for her.
 
She has another sign of OCD, which is trying to do things perfectly. For example, some children may erase their entire homework if they feel one line has not been written in a straight line. They redo the whole thing and the same problem may occur again when they redo the same thing. Hence they keep on doing the same thing again and again.
 
OCD occurs because of a chemical imbalance in the brain. She is not doing this because she is naughty or wants to evade her responsibilities. You must consult a psychiatrist urgently. This is a common illness and treatment is also widely available. And you can go to any of the medical colleges where such treatment is available. 
 
My son is four years old. He is very restless and hyperactive. If we stop him from running around excessively and do not give in to his demand of playing with the mobile phone, he starts banging his head and screaming. He also never wants to eat and hits others if he is angry, especially during meal times. Please advise us.
 
Your son has severe temper tantrums. He is trying to get his demands fulfilled by scaring you. You have to learn to analyse under what situations he throws these tantrums. Make a note of these situations. You have mentioned he does it before eating his food. Try and see whether he is really hungry, or you are force-feeding him. If you are sure that he should be eating when you are trying to feed him, couple the activity with something he likes to do. For example, reading out a story from a book, playing songs which he likes to listen to, or telling him that you will do an activity that he enjoys with him after he finishes his food. Do not make him watch cartoons on television or on the mobile while feeding him.
Essentially, you will need to be able to predict situations where he can get angry and try and find a cause. Once you have found the cause, you will be able to manage the situation better.
 
My son is eight. I have always felt he is different from his brother, who is four years older. I have been wanting to take him to a psychologist for a long time but my husband denies that there could be anything wrong with him. He started talking quite late but now his speech is quite all right except that he occasionally picks up difficult words and uses them in sentences or situations even when they are not required. 
 
Recently his class teacher called us to say that his behaviour is unusual and we need to see a psychologist. He always has difficulty making friends, and all he is interested in are dinosaurs and computer games which have car chases in them. He wants to talk about mainly these two topics and that is why his friends think he is strange. Also, he has this strange habit of smelling objects which is also is quite embarrassing, especially when we are in any public space. His teacher told us that they are not worried about his intelligence or school results but it is his behaviour that concerns them. He seems to be lost in his own world and does not pay attention to instructions. When he is called, he will never look at you and answers back as if he is talking to someone who is sitting next to you. I am worried about him. 
 
Your son definitely needs to see a child psychiatrist or a child psychologist as there is a possibility he could be having Autism Spectrum Disorder (ASD). Autism can be mild, moderate or severe and it appears that your son is in the milder end of the spectrum. In some situations,  milder forms of autism are also referred to as Asperger’s Syndrome. The diagnosis of Asperger’s Syndrome or Mild Autism can be quite difficult to make, so you definitely need to see an expert in this area. Asperger’s syndrome or Mild Autism is known as a hidden disability, which means that looking at the child you cannot tell that they have this condition as they look like any other child.
 
There are many and varied symptoms of autism but the key features in your son’s case, which indicate that he could be having autism, is his inability or deficit in social understanding. He does not realise that not all children share a same interest as he does. Hence, he continues to talk about dinosaurs and car chases even when no one else is interested. Hence, having a conversation with him can be difficult because he will talk only about things that interest him and does not understand how to judge the other person’s interest in the same conversation. 
 
So, your son does have at least some characteristics which are typical of children with ASD. They have some fixed interest and in your son’s case, they are car chases and dinosaurs. Smelling objects is part of an overall sensory problem which most children and adults with autism have. My advice will be to read up on autism and then consult a specialist.
 
I have a three-year-old son. He joined kindergarten a few months ago. In the beginning he was going to school in a happy mood, but for the last few days he has been unhappy and sullen. He has not been interacting with the other children in school as much as before and has expressed a desire to not go to school. I am not sure what we should do next.
 
Your child may have experienced some adverse incident in school which is making him unhappy about going there.
The problem with such young children is that they cannot express their sad or unhappy thoughts clearly in words. They also may be too traumatised by a particular incident and may not have the verbal ability to narrate the entire incident clearly. Therefore, it is important for you to gently ask him what has happened. You can also encourage him to draw or play with him to know how his day has been in school. He may be able to describe the incident through his play or his drawings. Also, check with his friends and teachers in school. Is he being bullied? Has anyone hurt him physically? If you cannot clarify what has happened and if his reluctance to attend school continues, then you definitely need to seek the help of a child psychologist.
 
Dr Jai Ranjan Ram is a senior consultant psychiatrist and co-founder of Mental Health Foundation (www.mhfkolkata.com). Find him on Facebook @Jai R Ram
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