treatment should be directed fowards the primary cteorder

treatment should be directed fowards the primary cteorder. Behavioural therapy may be required for treatment of obsessional symploms. 5 Depressive disorder.tiofogy. Disturbing environmental situations like serious illness of a parant, death of lamily member or parental disharmony. Endogenous depression is extremely rare in children. Clinical features ;A diagnosis of depressive illness In children should be made when there Is clear evidence of depression A depressive mood change is characteristic but may not be obvious at first children become teartful and lose interest and concentration. They may appear to be bored and may eat and sleep poorly. Sometimes, depressive disorder in children may appear in a "masked form1, presenting with avariety of somatic symptoms, enuresis , running away from home or truancy from schoof. Treatment -Reducing unhappy circumstances, if possible, and encouraging the child to take pan in activities. Treatment antidipressant is usually reserved for ofder children with severe depression. 6 .Schoof refusal: This is characterised by repeated absence from schoof when such absences are not due to physcal illness, condut disorder or when children are deliberatety kapt at home by Ihalr parents. Etiofogy - (a) Separation anxiely as In younger children (b) Fear or phobia of certain aspects of school the, or fears of failure and rejection. often associated with depresion Clinical features -Refusal id attnd schoof may besudAn In onset. More often. however,there is an Increasing reluctance to go to school with signs of increasing unhappiness and anxiety. Some cnildren may have somatic complaints like headache, abdominal pain, or vague complaints of feeling ill. This refusal may appear after a period of enforced abserce for another reason, such as illness, change of class or a problem in the family. The school refusal is usually very resistantiant to efforts to send him to school Treatment - (a) Alleviation of stressful aspecis of school life, it possible This may require co-operation of school authorities (b) Counselling of parents (c) Behaviour therapy In which a graded behavioural plan is drawn out 10 help the child overcome his fears (d) Treatment of associated depression if any (e) Psychotherapy wih the child to encourage him to talk about his fears. 7. Functional anurasis and encopresis FUNCTIONAL ENURESIS -is the repealed invotuntary voiding of urine Occurring after the age at which continence is usual, and in the absence