DID diagnosis in children

I found some really interesting information tonight on DID/MPD diagnosis in children tonight and just wanted to share it. It is from http://www.empty-memories.nl/article.html

What was so interesting to me, personally, was that I could have been diagnosed in KINDERGARTEN, had anyone
a. known what to look for and b.noticed I was ALIVE and c.paid attention to me.

Here are a few quotes from the website:
Why children are not often diagnosed:
Unluckily, children are not often diagnosed with DD or DID because of several reasons:

Dysfunctions existing in the family that cause or contribute to the development of DD or DID will not allow or will prevent family from seeking help.
Health workers may lack familiarity with symptoms / presentations of dysfunction in children and may overlook or misdiagnose these children.
Initial presentation distracts from real diagnoses. These children are usually referred because of complicated psychiatric histories, including multiple caregivers/placements, and behavioral difficulties that have not responded well to a variety of interventions, including pharmacotherapy.
Presentations of DD or DID in children, is more subtle and different than those seen in adults. Thus, identification is more difficult.
As with adults, children mistrust workers, and protect himself or herself from showing alternate identities

Importance of early intervention:
Early intervention with children is crucial for five main reasons:

DD and DID are among the sequela of childhood trauma, particularly sexual abuse. Thus, early recognition makes early intervention possible.
Early intervention is desirable because children often respond rapidly to appropriate therapeutic intervention, unlike their adult counterparts, who take many years.
If not treated the condition usually is for life though switching decreases with age. Different identities appear over years in reaction to new life situations but usually this is if the dissociation “skill” is practiced (e.g. a new part after 16 years when having marital difficulties, but had dissociated through this time).
Pattern of dissociation can remain and significantly affect the person, causing serious dysfunction in work, social life and daily activities (e.g. cutting off at social gathering because of fear of groups).
Repeated dissociation may also result in a series of separate entities, or mental states, that eventually take identities of their own (eg. a client, no longer in traumatic environment, but associating children with her past trauma, had one of the “identities” care for her children and she could not remember bringing them up. Another client had an identity going to work/university).

OBSERVATIONS (AT PLAY – PROJECTIVE AND DIRECTED, AT SCHOOL, etc.):

Observations should be carried out when the child is in similar neuropsychological states to that which caused DID, through narratives, games, location assessments, etc.. In these situations the “trauma” or “memory” is “retrieved” because of the highly stimulated neurological, psychological and physiological state.
Memories are activated/retrieved by the association/ conditioning that has occurred in the past, which are similar to the “recreated” state during the observation/ assessment.

Outside of the main presentations (above) there are various symptoms that should be observed/considered in the assessment of DID children:
a vast variety of symptoms, particularly:

Post traumatic stress disorder symptoms (e.g. nightmares, night terrors, intrusive traumatic thoughts /memories/flashbacks, disturbing hypnagogic hallucinations, traumatic re-enactment, numbing and avoidance) and differentiating these with DID
self injurious behaviors
fears that are unusual or exaggerated for their age or their situation (e.g. terrified of shower, where skin scalded or bathtub because of drawing attempts took place), or social phobias in adolescence, due to group ritual abuse.
somatic concerns / complaints
high anxiety levels
significant behavioral inconsistencies/shifts/ fluctuations that occur between settings, tasks, abilities, age appropriate, etc. activities, during different environmental settings, etc. or during observations conducted over extended periods
calling/referring to oneself in third person, using or answering to other names – a belief of the existence of other identities that take over or of having imaginary friends that control their behavior
requests to be called by a different name or treated differently
marked mood swings and circumstances
fluctuation moods and behavior, including rage states indicating lack of self-regulation
mood disorders / intermitted depression (e.g. seasonal; after a calm period representing periodical abuse)
depression or intense episodes of depression and suicidal feelings
trance states
amnesia and transient forgetting
inattentiveness/lack of concentration in some settings but not in others
excessive daytime dreaming “spacey” behavior
hysterical symptoms
sleep disturbances
sexually reactive or offensive behavior
auditory hallucinations/ hearing voices experienced “inside the head”(Schneiderian symptoms include auditory hallucinations and passive influence experience)
sudden shifts in behaviors, postures, expressions, voice, language, etc.
tantrums or destructive behaviors
inconsistent consciousness / fluctuation of attention, such as trance states or black-outs
denial of behavior observed by others, specially behaviors considered negative (believed to be lying)
extreme inconsistencies in knowledge, skills and abilities, accompanying personality switches. Developmental issues are inconsistent / inappropriate, e.g. active imagery companionship, inappropriate sexual behavior.
physical complaints or injuries of vague origin
substance abuse in older children / adolescents
* feeling of dividedness, experienced as discrete alter states, hallucinated internal voices, or behavior outside the child’s control – most important finding in assessment.

These quotes are from an article at the above listed website by
Dr. M. C. Barreda-Hanson
Director, Department of Psychology
ACT Community Care
and The Canberra Hospital

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