Psychologic Disorders Among Pediatric Outpatients (Part I)

Moon, Hyung Ro

Abstract

One hundred and twenty-seven children with psychologic problems were encountered by the author at twice weekly morning walk-in clinics of the pediatric department of Seoul National University Hospital during the nine months period from January through September 1980. Diagnostic clues for psychogenic origin of various somatic complaints were obtained from complete history taking, thorough physical examination, tests and laboratory procedures as indicated, and psychologic assessment of the patients as well as their family. There were more boys than girls with sex ratio of 2.2 to 1. Distribution of children with psychosocial problem according to age and sex revealed that peak incidence for boys and girls was at ten years and six, respectively. Number of children with psychogenic problem according to the order of birth(rank) showed that the first born and only child accounted 40.2 per cent of total children with psychogenic problem. One boy including only child type of and position in sibship accounted for 24.4 per cent of all children with psychologic problem. Frequency and prercentage of various somatic complaints among one hundred and twenty-seven children with psychosocial problem revealed as follows: abdominal pain; cough; headache; pollakiruria, enuresis and dysuria, vomiting and nausea; dizziness, chest pain, fatigability, hyperpnea, hyperventilation and sigh; anorexia, weight loss and poor weight gain, and others in decreasing order as shown in table 5. There were sixteen children with facial tics and five children with conversion reactions. Distribution of various somatic complaints and problems according to age of children revealed that abdominal pain peaked at nine years of age and both headache and facial tics were distributed throughout school age period. The most frequently obtainable etiologic psychogenic factors in cases of children with psychogenic problem were sibling relationship such as rivalry, jealousy, bickering, quarreling and spacing of siblings less than two years which accounted for 29.1 per cent of cases, followed by parent-child interaction such as overprotection, oversolicitude, over-restriction(prohibition), overindulgence and conflicting parental attitude in 27.6 per cents; frustration such as unfulfilled wish and unacceptable demand in 17.3 per cent;marital discord(parental conflict) such as divorce, separation and mother dominating over father in 12.0 per cent; separation anxiety such as transplantation(change in residence, change in schools, immigration) and death of family in 8.7 per cent; ecomomic status such as financial stress and inadequate sleeping arrangement in three; physical handicaps such as short stature and alopecia in two; and factors outside home such as poor school performance and unsatisfactory peer group interaction in two.