What may be behind apathy in children

Apathy is not a disease, but a set of behavioral signs that originate from some specific condition, such as a psychic trauma or a physical illness.

In general, apathy can be characterized by lack of motivation, social disinterest, isolation, indifference.

“Anyone can have a moment of being apathetic, so it can be normal, like anxiety or sadness”, explains Luiza Bisol, a psychiatrist at the Mental Health Outpatient Clinic at the Hospital Complex of the Federal University of Ceará (UFC) and a professor at the same university, who is linked to the Ebserh network.

It can appear at any age, but here we will focus on children, whose symptoms can appear in the first months of life or throughout childhood.

In the case of younger children – up to five years old – the symptoms can range from irritation, crying for no apparent reason, sadness, difficulty showing affection, emotions.

“We evaluate development over time, but it is possible to have babies who show apathy”, says Bisol.

Already in older children – up to twelve years – the most common symptoms of apathy range from isolation, discouragement and sadness, to lack of interest in communicating with family or making friends. But there is no rule.

“The pediatrician is the first doctor who will evaluate the child and perform an individual screening. And if he tells the family that it is nothing or just a phase, we will stop intervening, and the most important thing in psychiatric conditions is intervention”, emphasizes Débora Passos, a pediatric neonatologist at the Neonatal ICU of the Hospital e Maternity Pro Matre.

Apathy can be confused with some personality traits, such as inhibition or shyness.

“In shyness, the individual has a response and initiative to the world, but it is more contained. In this case, it just needs more stimulation, unlike apathy, when you give the stimuli, try to interact, and the child does not respond”, he describes. Mauro Victor de Medeiros Filho, Child and Adolescent Psychiatrist at the Child and Adolescent Psychiatry Service of the Institute of Psychiatry (IPq) of the Hospital das Clínicas, FMUSP (School of Medicine, University of São Paulo).

It is possible to notice this difference when taking the child to a new environment, such as at a party. At first, she may arrive with some fear, but then she lets go and starts playing. This attitude is characterized only as inhibition or shyness, not apathy.

The psychiatrist at the Institute of Psychiatry at the University of São Paulo also says that apathy can also be confused with refusal.

“So ‘contrarian’ kids who don’t want to do something or confront may not respond or not react simply because they’re opposing it. In that case they’re straining and disposing of energy to be against, which is the opposite of apathy.” , reports Son.

And there are several causes that can justify a persistent apathy, among them, psychic problems such as:

• Childhood depression;
• ADHD (Attention Deficit Hyperactivity Disorder)
• Anxiety disorders;
• Disorders related to trauma or acute stress that the child has gone through: sexual and moral abuse, abuse, bereavement, separation from parents, bullying, financial difficulties at home;
• Schizophrenia (this illness is not as common in children).

Among the main physical conditions are:

• hypothyroidism;
• Anemia;
• Hypovitaminosis (when there is a lack of one or more vitamins in the body);
• Oncological and/or metabolic diseases.

Another reason that can lead to the development of apathy is autism spectrum disorder (ASD).

“In this group of disorders there is a diversity of symptoms and among them we can, yes, have apathy, because these children can have a lot of difficulty in socializing”, evaluates Bisol, a psychiatrist at the Federal University of Ceará.

Helpfully, according to experts, there are many behavioral changes due to the pandemic and social isolation.

“They are reflections of what we live and there are no related diseases. It is absolutely behavioral”, comments the pediatrician Débora Passos, emphasizing that these cases also need clinical evaluation and psychological follow-up.

José Martins Filho, pediatrician, professor of pediatrics at the State University of Campinas (Unicamp) and member of the Brazilian Society of Pediatrics (SBP) draws attention to another important point: the lack of family stimulation.

“I have a book called The outsourced child where I talk about fathers and mothers who go out to work and cannot play with the children. Then they go to school and stay withdrawn or else they just stay on electronic devices. All of this can lead to this symptom of apathy”, warns the specialist, who has a YouTube channel called Família Amor e Care aimed at parents and caregivers.

How to find out that the child is apathetic?

The first step is to observe the child’s behavior, as apathy is often quite noticeable.

“It is necessary to analyze the consistency and frequency of these behavioral signs, because it is necessary to discover what is causing this apathy early”, indicates child psychologist Cynthia Marden, from the psychiatry outpatient clinic of the University Hospital Lauro Wanderley, Federal University of Paraíba (HULW -UFBA), which is part of the Ebserh Network.

In this sense, it is worth noting that each child has a different development time, while some walk, talk and show interest in learning earlier, others take a little longer. And that’s okay, as long as the child reaches the expected for their age group in terms of physical and cognitive development.

That is why it is so important that, even after the first year of life, the child continues to be monitored periodically.

“The pediatrician is not just a doctor for the child, he is a doctor for the family. It is much more than just weighing and measuring the child. Pediatricians often call attention to what parents are not realizing, and this happens a lot. in the office”, says Passos, the pediatrician at the Pro Matre Hospital and Maternity Hospital.

In addition to the doctor, teachers also play an essential role in a possible diagnosis, as they spend at least part time with the children.

“Taking time during the week or even on the weekend to interact with the child is essential, otherwise parents will not notice any atypical behavior in their children”, Passos warns.

And after ruling out physical illnesses in the initial clinical care, the pediatrician sends the child to a psychologist or psychiatrist for evaluation.

“From the moment that there is frequency and persistence with impairment in the functional field, such as the child not wanting to take a bath, do the homework, go out to places, not having interest in front of a musical instrument or that there is social impairment such as lack of interaction with friends or family, we can say that apathy started to become a problem”, defines Filho, a psychiatrist at the Institute of Psychiatry at Hospital das Clínicas.

Is apathy treatable?

As apathy is not a disease, treatment is directed at the cause of the symptom. That is, if it is an anemia, the condition should be treated to improve adverse reactions.

The same is true of psychological disorders, which are usually treated with therapies and, in some cases, medication. “Remembering that it is a symptom that can be present in several diagnoses”, says Filho.

The attitude of the parents in relation to this symptom is guided according to the pathology. “So we will have a different posture for depression if the case is anxiety. The guidelines for parents should be associated with diagnoses related to apathy”, concludes Filho, a psychiatrist for Children and Adolescents at the Psychiatric Institute of Hospital das Clínicas.

This text was originally published here