Recognizing Emotional Distress in Your Child with JA

By Beth Axtell

Feelings of sadness, anger and fear when dealing with a diagnosis of juvenile arthritis (JA) are completely normal and healthy. Your child may also feel different from her peers, be restricted in her activities and become socially isolated.

When these normal emotional difficulties are not dealt with, they can lead to bigger psychological adjustment problems.

According to a 2017 article published in PLoS One , children and adolescents with chronic arthritis are more likely to have psychological adjustment problems compared to children without chronic arthritis. Another study found that the rate of emotional, developmental and behavioral problems for children with arthritis or other joint problems was nearly five times the rate for children in the general U.S. population.

Tuning in to emotional or behavioral cues will help you identify potential problems so you can provide guidance and support.

Signs of Emotional Distress

Watch for these signs and talk with your pediatrician or rheumatologist about them. You may also consider reaching out to your child’s teachers or parents of your child’s friends. Sometimes kids will cover up their feelings around home but be more revealing with others. Depending on the severity of the issues, you may be referred to a mental health professional.

• Regression: Acting young for their age.
• Acting out: Being rebellious or seeking negative attention.
• Moodiness: Lashing out, throwing tantrums, acting irritable.
• Withdrawal: Avoiding family and friends or activities they used to enjoy.
• School reluctance: Complaining more than usual about school or being reluctant to go to school.
• Poor grades: Dropping grades or reduced effort on homework.
• Somatization: Having physical symptoms like headaches or stomach aches not related to JA.
• Anxiousness: Expressing worries frequently or about things that would not usually cause distress.
• Weepiness: Crying more than usual.
• Clinginess: Clinging to a parent or teacher.
• Fearfulness: Displaying fearful reactions that seem out of place.
• Sleep problems: Sleeping too much or too little.
• Appetite issues: Eating too much or too little.
• Interference: Avoiding or interfering with medical treatments.

For teens particularly:

• Significantly avoiding parents (though certain amount is normal teenage behavior).
• Abandoning long-time friendships for a new set of peers.
• Expressing excessive hostility toward family members.
• Engaging in risky behaviors – cutting, alcohol, drugs or early sexual activity.

Mood Disorders: What to Watch For

The regular ups and downs of living with a chronic disease can, for some people, develop into an anxiety disorder or major depression. Separating how JA affects your child’s mobility, activity level and exercise tolerance from signs of depression can be difficult.  Sadness and worry cross the line into depression or anxiety disorder when they interfere with your child’s ability to function.

Elizabeth Roth-Wojcicki, CPNP, advanced practice nurse practitioner in rheumatology at Children's Hospital of Wisconsin in Milwaukee, says if your child’s lab reports and joint counts look good, fatigue and low activity levels should be looked at as possible signs of a mood disorder.

Depression Signs

Prolonged behavioral changes may signal the onset of depression among children and teens with JA. Here are 10 common depression symptoms:

• Sadness or moodiness.
• Hopelessness.
• Loss of interest in friends and/or activities.
• Poor school performance.
• Change in eating/sleeping.
• Extreme sensitivity to rejection/failure.
• Isolation.
• Low self-esteem; guilt.
• Prolonged irritability, hostility or anger.
• Thoughts or expressions of self-destructive behavior or suicide.

Anxiety Disorder Signs

In children and teens, anxiety becomes a problem when the feeling is out of proportion to the situation, gets worse over time and persistently affects daily life. Examples of anxiety symptoms your child may experience include:

• Inability to stop worrying.
• Inability to stop unwanted thoughts.
• Avoiding non-dangerous situations that the child previously was comfortable with.
• Feelings of panic (heart pounding, dizziness, shortness of breath, sweating).
• Feeling overwhelmed.
• Butterflies in the stomach or stomachaches.
• Headaches.
• Fatigue.
• Sleep problems.
• Agitation.
• Restlessness.
• Inattention, poor focus.
• Avoidance.
• Tantrums.
• Crying.
• Refusing to go to school.
• Meltdowns about clothing, hair, shoes, socks, homework.
• Difficulties with transitions within school, and between school and an activity/sport.

Getting Help

If your child is exhibiting negative coping behaviors or if their worry or sadness is affecting their daily life for a prolonged time, your doctor may recommend counseling. Roth-Wojcicki recommends that if your child balks at going to therapy, get the whole family involved in family counseling so the child does not feel singled out.