Disturbances in behaviour or mood in infancy and childhood

Chapter 4 Disturbances in behaviour or mood in infancy and childhood

Case 4.1

Amy is an 8-year-old girl, taken in for massage therapy by her mother. Her mother explains that Amy seems to be anxious, and hopes that the therapy may help her relax. Upon examination, her hands and knees are observed to have scrapes, cuts, and contusions. Amy explains this as simply being clumsy.

Prior to therapy, Amy seems to be inattentive, instead choosing to study the books, posters, and paraphernalia in the room, but when quizzed on the contents of the conversation, she is able to recall most of it. Her speech is verbose and overly formal, with poor prosody, occasionally veering off into tangents. During the therapy itself, she has trouble staying still, claiming that the massage is too hard, even at levels suitable for children. You are not able to continue with the massage, even though Amy was originally happy to try it out.

In conversation with Amy’s mother afterwards, she confirms that Amy has sensitivity towards touch and pressure, disliking to be touched and being picky about what clothes she wears, and that her hopes for the massage therapy was partially to relax her and partially to desensitise her to touch. This seems to have limited success, as Amy states bluntly that she didn’t like the massage, occupying herself with a textbook and ignoring the conversation.

Amy’s exasperated mother explains that this is typical of her, focusing on topics considered ‘inappropriate’ for an 8-year-old girl, including the musculoskeletal system (her current area of interest), airplane designs, and Japanese culture. She is able to discuss these easily and fluently, in great detail, but lacks motivation for schoolwork. Her mother says she never has friends over and doesn’t visit friends, spending time ‘holed up in her room’ with a book, often staying up for hours after her bedtime to continue reading. She believes that Amy’s current anxiety is about her lack of social interaction with her peers.

Amy is physically healthy, with only the usual childhood colds and sniffles and one instance of ‘strep throat’ at age 6. She is up to date with vaccinations. Her mother reports that she is a fussy eater, not liking the texture of many foods.

Amy’s parents are still happily married, and she has an older brother, Matthew, who is 10. The idiosyncrasies that Amy presents with are not visible in her brother, although Amy’s mother claims that her paternal grandfather was similarly eccentric.

Case 4.2

Michelle, an 11-year-old girl, has visited your clinic presenting with neck and shoulder pain. You observe immediately that her posture is poor, hunching her shoulders inwards, and during the examination she demonstrates a marked dislike of being touched.

During the consultation, she is fairly quiet, asking only one question — if you can ‘fix my body’. Further exploration of what she means by that question reveals that she is uncomfortable with the changes occurring in her body, in particular the early changes she has noticed in her chest. She is strongly resistant to the idea of doing anything to correct her posture, as it would ‘make them stick out more’.

Michelle appears to be a withdrawn, sullen girl; during examination, she speaks of wanting to be a child again and hates the way her body is changing. She responds negatively whenever referred to as a young woman.

Physically, she’s mildly underweight and her secondary sexual characteristics have only just started to become evident. She has yet to reach menarche, and is slightly below the typical height for a girl her age. She is not on any medications or supplements.

Michelle comes from a stable family situation, with both parents still married. She is an only child. At school she is a poor student, but this is a relatively recent development — during her earlier school years she was reasonably average. She shows behavioural problems at school and at home, including refusing to do ‘girl things’ and preferring to spend time with boys, and has recently started arguing with her parents over her clothing, preferring shorts and pants instead of skirts and dresses.

Physical examination is unremarkable, with only some tightness of the trapezius, rhomboids, levator scapulae and supraspinatus muscles.

When Michelle leaves the room, you ask her mother for some more information. She describes that she has always been a ‘bit of a tomboy’, but it is only in the last couple of years that she has been ‘changing’. She confides to you that her sister suggested that she should get Michelle ‘checked out’, in case she has gender identity disorder. Although she believes that this is ridiculous, she does ask you if you think that this is a possibility.

Case 4.3

History

Marcus, a 9-year-old boy, presents to your clinic with frequent mild headaches and lethargy of 2 months duration. He has not attended school for 3 days now, as he has not had the energy to get out of bed. Marcus describes his headaches as a ‘sort of fuzzy, always there, tight feeling’ and gestures around the temporal and frontal regions of his head bilaterally. There is no associated nausea, photophobia or phonophobia. He states that the headaches increase in intensity throughout the day and are relieved by paracetamol or rest. He feels that his headaches are worse when he is tired.

There is no history of major childhood illnesses, accidents or hospitalisations. However, he has had otitis media and upper respiratory tract infections, requiring antibiotic treatment on numerous occasions. Marcus currently takes no medications or supplements and is up to date with his vaccinations. His last vaccination was over 4 years ago.

During the consultation Marcus appears disinterested and withdrawn and his mother expresses concern over his lack of enthusiasm and uncooperative manner as of late. He is otherwise healthy and appears to be of appropriate height and weight for his age.

Marcus has a ‘typical’ diet for a 9-year-old, has no known allergies and drinks water and juice regularly. He is an average student at school, although his school reports express concern about his laziness in class. He makes friends easily but prefers to play alone.

Marcus’s parents have recently separated and Marcus spends equal time with both parents on a week-by-week rotation. Marcus’s mother reports a personal history of depression and anxiety.

Tags: Cases in Differential Diagnosis for the Physical and Manipulativ

Dec 26, 2016 | Posted by admin in MANUAL THERAPIST | Comments Off

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