LITMIR.BIZ

Скачать книгу

may persist into the teenage years and are more lilkely to do so when a student has special or additional needs. Common difficulties include:

      •food refusal

      •restrictive eating

      •selective eating

      •food phobia

      •food avoidance emotional disorder.

      These difficulties are not all well understood and are commonly misdiagnosed. It’s important also to remember that many children will experience difficulties that don’t fit neatly into one category or another, but these classifications will help you to gain some understanding of the range of behaviours you could encounter when working with younger children or older children with special or additional needs.

      Food refusal

      Food refusal is commonly found in pre-school children, where the refusal of food can be used as a way to communicate a message or for a child to ‘get their own way’. However, this can persist in slightly older children, where the main feature is an inconsistent refusal of food. These children will tend to eat their favourite foods without any problem at all and may refuse food only when they are with particular people or in a particular situation – for example, refusing to eat at school but eating normally at home or vice versa.

      Worry or unhappiness underlies the food refusal in many cases, but the child may not have the capacity to express their concerns using language. These children are usually of normal weight and height, and this problem does not usually pose a threat to the child’s health.

      ‘It took us a while, but eventually we understood that he was trying to tell us something by refusing to eat or drink at school. It turned out he was being teased by the other kids at school about his lisp.’

      Restrictive eating

      These children eat smaller amounts of food than they should do for their age. Their diet is normal in terms of the range of food eaten and the nutrients that it contains and is unusual only in terms of the volume of food consumed. Restrictive eaters are often thin compared to their peers and they tend to be short, but otherwise they generally seem healthy and happy. It’s common for other members of the family to have a history of the same pattern of food intake.

      Selective eating

      The most obvious feature of this condition is the narrow range of food that is eaten – it is sometimes referred to as ‘extreme faddiness’. This can persist for months or even years. Selective eaters are very unwilling to try new types of food and the behaviour of these children, which is usually normal, is likely to deteriorate if they feel that they are being forced to eat a wider range of foods than they feel comfortable with. Social problems may start to occur beyond the age of about five because selective eating causes difficulties when attending birthday parties or visiting a friend’s house.

      Additionally, children who eat only a restricted sugary diet may have problems with their teeth. The weight of these children does not give much of an indication as to whether there is a problem – they may be of low, normal or high weight.

      Food phobia

      Children who have developed food phobias are typically very resistant to eating and drinking, which can cause a great deal of concern. Food phobias are typically developed following a choking or vomiting incident and sufferers tend to avoid foods that have certain textures because they think they will choke, gag or be sick. Some children with food phobias will claim that eating and drinking hurts. Mealtimes often turn into a battleground. The majority of these children do, however, seem to grow and develop because the food and drink that they are willing to consume provides enough calories and nutrients.

      ‘He was convinced that if he ate he would be poisoned. He got thinner and thinner. At first we thought he needed treatment for anorexia, but in fact he needed talking therapy to overcome his phobia, which started after some food gave him vomiting and diarrhoea on holiday.’

      Food avoidance emotional disorder

      Children with food avoidance emotional disorder experience a loss of appetite which is usually associated with depression or anxiety and may follow a traumatic incident such as a bereavement. There is often a more general disturbance in behaviour that does not centre on food and mealtimes; for example, in addition to a loss of appetite the child may experience problems with sleeping, poor concentration, tearfulness and a general sense of hopelessness.

      Food avoidance emotional disorder is sometimes mistakenly diagnosed as anorexia as these children tend to become very underweight. However, a key distinguishing feature is that, unlike children with anorexia, those with food avoidance emotional disorder recognize that they are underweight and often express a desire to eat more but they simply cannot bring themselves to do so.

      ‘She was only seven, but you could tell just by looking at her that her spirit was broken. Her father was dying and she had lost the will to carry on. She hated that she was worrying everyone by getting thinner but each time she tried to eat, she just broke down in tears.’

      IS IT A PROBLEM?

      Eating difficulties in children under 11 and the special needs population are relatively commonplace. Whilst some issues are passing phases and present no real threat to the child’s physical or emotional wellbeing, some cases do require professional support. If a child is displaying unusual behaviour around food, and you’re not sure if you need extra help, ask yourself:

      •Are they taking in enough calories/nutrients so that they are not hungry?

      •Are they growing normally?

      •Do they seem happy and healthy in themselves?

      If you can answer ‘yes’ to each of these questions then the behaviour should be monitored but there is no cause for alarm. It is quite normal for children to go through phases with food and most will simply pass with time. However, if you begin to become concerned about the child’s health or wellbeing then you will need to act. In many cases, the child is trying to communicate something that they do not have the skills, language or confidence to communicate, and trying to find alternative methods for the child to communicate their concerns – for example, through art therapy or play therapy – can be the key to overcoming their unusual food-related behaviours.

      Self-harm explained

      A generally accepted definition of self-harm is causing harm to one’s own body, usually through physical abuse. Self-harm is usually conducted at times of anger, distress, fear, worry, depression or low self-esteem in order to manage negative feelings. Self-harm can also be used as a form of self-punishment for something that the self-harmer has done, thinks they have done, are told by someone else that they have done or feel they have allowed to be done to themselves.

      Common forms of self-harm

      Self-harm takes many different forms, but by far the most common type of self-harm we see in adolescents is cutting, followed by burning, aggressive behaviours (punching walls or doors in anger) and self-poisoning (taking non-lethal overdoses). Amongst younger children and the special needs population, the most common forms of self-harm are bruising/battering, hair-pulling, scratching and picking, including not allowing wounds to heal. Some behaviours, such as hair-pulling and scratching, can start out as a deliberate act but become a compulsive habit over time.

      Indirect self-harm

      There are further behaviours which do not fall neatly under the category of self-harm, but which may indicate similar underlying issues and which you may choose to respond to in the same way as more clear-cut forms of self-harm. These behaviours are sometimes referred to as ‘indirect self-harm’ and include:

      •substance misuse through excessive alcohol or drug consumption

      •eating disorders

      •physical risk-taking

      •sexual risk-taking

      •self-neglect

      •misuse of prescribed medication (this is relatively common in adolescents with diabetes).

      In

Скачать книгу