Marina Alves Sao Paulo, BBC News Brazil
Apathy is not a disease, but rather a set of behavioral signs that stem from a particular condition, such as mental trauma or physical illness.
In general, apathy can be characterized by lack of motivation, social disinterest, isolation, indifference.
“Anyone can have a momentary apathy, so it can be normal, like anxiety or sadness,” said Luiza Bisol, a psychiatrist at the Mental Health Outpatient Clinic at the Federal University of Ceará Hospital Complex (UFC) and a lecturer at the same university affiliated with Ebserh network.
It can appear at any age, but here we will make an incision in children whose symptoms may appear in the first months of life or throughout childhood.
In the case of young children – up to five years – the symptoms can range from irritation, crying for no apparent reason, sadness, difficulty showing affection and emotion.
“We assess the development over time, but it is possible to have babies who show apathy,” says Bisol.
In older children – up to twelve years – the most common symptoms of apathy range from isolation, discouragement and sadness to a lack of interest in communicating with family or making friends. But there is no rule.
“The pediatrician is the first doctor to assess the child and do an individual screening. And if he tells the family that it is nothing or that it is just a phase, we do not intervene, and the more important in psychiatric conditions is the intervention. . ” , emphasizes Débora Passos, pediatrician neonatologist at the neonatal intensive care unit at the hospital and maternity Pro Matre.
Apathy can be confused with certain personality traits, such as inhibition or shyness.
“In shyness, the individual has a reaction and initiative to the world, but he is more restrained. In this case, he simply needs more stimuli, which is different from apathy when you give stimuli, try to interact, and the child does not respond,” describes Mauro Victor de Medeiros Filho, Child and Adolescent Psychiatrist in the Child and Adolescent Psychiatry Service at the Department of Psychiatry (IPq) at the Hospital das Clínicas de la FMUSP (Medical School at the University of São Paulo).
It is possible to feel this difference when taking the child to a new environment, such as a party. At first he may come with some fear, but then he relaxes and starts playing. This attitude is characterized only by inhibition or shyness, not by apathy.
The psychiatrist from the Department of Psychiatry at the University of São Paulo also claims that apathy can also be confused with rejection.
“So ‘against’ children who do not want to do anything or confront each other may not react or react simply because they are against it. To be against, which is the opposite of apathy,” reports Filho.
And there are several causes that can justify a persistent apathy, among them mental problems like:
- childhood depression;
- ADHD (attention deficit hyperactivity disorder)
- Anxiety disorders;
- Disorders related to trauma or acute stress that the child has suffered: sexual and moral abuse, abuse, grief, separation from parents, bullying, financial difficulties in the home;
- Schizophrenia (this disease is not so common in children).
Among the most important physical conditions we already find:
- Hypovitaminosis (when there is a deficiency 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 may, indeed, have apathy because these children may have great difficulty in socializing,” assesses Bisol, a psychiatrist at the Federal University of Ceara.
According to specialists, the changes in behavior due to the pandemic and social isolation are numerous.
“They are a reflection of what we are going through and have no related diseases. It is absolutely behavioral,” explains pediatrician Débora Passos, emphasizing that these cases also require clinical evaluation and psychological follow-up.
José Martins Filho, pediatrician, professor of pediatrics at the State University of Campinas (Unicamp) and a member of the Brazilian Society of Pediatrics (SBP) draws attention to another important point: the lack of encouragement from the family.
“I have a book called The Outsourced Child where I talk about mothers and fathers who go to work and can’t play with their children. Then they go to school and either retire or stay on their devices.
All of this can lead to this symptom of apathy, ”warns the expert, who has a YouTube channel called Family Love and Care aimed at parents and caregivers.
The first step is to observe the child’s behavior because apathy is usually very noticeable.
“It is necessary to analyze the consistency and frequency of these signs of behavior, because it is necessary to find out what causes this apathy in an early way,” states child psychologist Cynthia Marden, from the outpatient department of psychiatry at Hospital Universitário Lauro Wanderley, from the Universidade Federal da Paraíba (HULW-UFPB), which is part of the Ebserh network.
In that sense, it should be emphasized that each child has a different developmental time, while some walk, talk and show interest in learning earlier, others take a little longer. And that’s fine, as long as the child achieves what is expected for his age group in terms of physical and cognitive development.
That is why it is so important that the child, even after the first year of life, continues to be followed at regular intervals.
“The pediatrician is not just the child’s doctor, he is a family doctor. It is much more than weighing and measuring the child. Often the pediatrician draws attention to what parents do not notice, and this often happens in practice, but it is not just the pediatrician. , which draws attention to what the parents do not notice, and this often happens in practice. “says Mr. Passos, a pediatrician at Pro Matre Hospital and Maternity Hospital.
In addition to the doctor, teachers also play a significant role in a possible diagnosis, as they spend at least half a day with the children.
“Setting aside time during the week or even weekends to interact with the child is crucial, otherwise parents will not notice atypical behavior in their children,” warns Passos.
And after excluding physical illnesses during clinical first aid, the pediatrician refers the child to an assessment by a psychologist or psychiatrist.
“As long as there is frequency and persistent damage in the functional domain, such as the child not wanting to take a shower, do homework, go out, have no interest in a musical instrument or that there is social damage such as. the lack of interaction with friends or family, we can say that apathy has started to become a problem “, defines Filho, psychiatrist at the Department of Psychiatry at Hospital das Clinicas.
Can apathy be treated?
Since apathy is not a disease, treatment is aimed at the cause of the symptom. In other words, if it is anemia, this condition should be treated to improve the negative effects.
The same goes for mental disorders, which are usually treated with therapies and in some cases medication.
“Keep in mind that this is a symptom that may be present in multiple diagnoses,” Filho says.
The attitude of the parents in the light of this symptom is oriented according to the pathology.
“So we will have a different attitude to depression if the issue is anxiety. Parental guidance should be associated with diagnoses related to apathy,” concludes Filho, a child and adolescent psychiatrist at the Department of Psychiatry at Hospital das Clínicas.