Mental Disorders in Children

Overview How to help a child who has a mental disorder. What is a mental disorder? Signs of a problem Common mental disorders in children What causes mental disorders? How to find help Types of treatment Resources

Over the past few decades, psychiatrists have learned that mental disorders are nearly as common in children as in adults. Experts now estimate that as many as one in 10 children may suffer from a serious behavioral or emotional problem. Unfortunately, even though effective treatments are widely available, about two-thirds of children arent getting the help they need. It is normal for children and teenagers to go through periods when they feel sad, anxious, or angry. For example, the death of a beloved pet or a switch to a new school is likely to be upsetting to any child. However, when your childs distress lasts for a long time and begins to interfere with his ability to cope with everyday situations, you may need to seek the help of a mental health professional. A thorough assessment will identify the problem so that your child can overcome his particular difficulties -whatever they may be. What is a mental disorder?
Mental disorders are brain diseases that affect mood, thinking, behavior, and/or memory. Since mental disorders involve changes in brain chemistry, they rarely go away on their own. In fact, if left untreated, a mental disorder is likely to get progressively worse. Thats why it is important to seek help as soon as you notice a problem.

Signs of a problem
If you think that your child might have a mental disorder, you might first try to engage her in a frank discussion. Try to remain calm and avoid saying anything critical or disapproving. You might begin by mentioning your concern about a specific issue, for example, poor grades. Then, ask your child if anything is bothering her. You might say, Ive noticed youve been feeling a little anxious today. Is anything bothering you? Some children will open up, but others may deny that anything is wrong. Here are some of the warning signs that indicate the need to get professional help: poor grades despite hard work social isolation or difficulty making friends persistent worry or anxiety
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Mental Disorders in Children

fidgeting or restlessness chronic sadness or irritability severe temper tantrums frequent nightmares refusal to engage in normal activities (such as going to school) harming other children or pets use of alcohol or illegal drugs sudden weight loss or weight gain anger toward authority figures and/or law-breaking activity lack of interest in activities that used to provide pleasure reluctance to spend time with friends or family frequent complaints about bodily aches and pains difficulty falling asleep or waking up worry about harming self or others feelings of worthlessness or extreme guilt sadness or crying a lot in response to minor frustrations

Common mental disorders in children

Like adults, children can suffer from a wide range of mental disorders, and these disorders can vary greatly in severity and duration. If your child has a common mental disorder, there are numerous methods of treatment available, and many children who receive treatment make a complete recovery. The common disorders in children are: Anxiety. Anxiety disorders are the most widespread, affecting up to one in 10 children. There are several different types: - Separation anxiety. If your child has separation anxiety, he may have a temper tantrum whenever he has to be apart from you. In severe cases, children may refuse to attend school. Separation anxiety can also cause a child to have constant worries about his own safety. - Phobias. When a child has a phobia, she has persistent fears about specific objects or things (such as snakes or heights). - Panic disorders. In panic disorder, a child experiences intense fear accompanied by uncomfortable physical sensations such as a pounding heart and nausea.

Mental Disorders in Children

- Obsessive-compulsive disorder. If your child engages in repetitive behaviors that appear senseless, such as counting or rinsing his hands, he may be suffering from obsessive-compulsive disorder. - Posttraumatic stress disorder. Children who have endured sexual or physical abuse, have witnessed or been the victim of violence, have been in an accident, or have experienced a natural disaster may develop posttraumatic stress disorder. Even though a traumatic event may have happened long ago, it can resurface in the form of intrusive flashbacks or nightmares. Depression. Children, particularly young children, tend to experience depression differently than adults do. For example, a child will hardly ever acknowledge the disorder on her own. Instead, she is likely to engage in behavior that causes problems at home or in school. A depressed child often has difficulty in relationships. She may have frequent conflicts with peers, or may withdraw from others altogether. Outbursts of anger or chronic irritability are common, as are feelings of sadness and hopelessness. A severely depressed child may also express thoughts of killing herself or others. Attention-deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD). Children with ADHD often have problems in school because they have great difficulty sitting still and concentrating. They may frequently blurt out answers and are likely to be impulsive. They also have trouble staying focused on any particular task, preferring to move from one activity to the next. They are easily distractible and often cant follow directions. ADHD affects nearly 10 times as many boys as girls. ADD is similar but without the hyperactivity. Your child may seem dreamy, sluggish, or distracted, but is not hyperactive. In some children, both sets of symptoms can appear intermittently. Conduct disorder. Children with conduct disorder often suffer from another disorder as well. For example, about 30 percent have ADHD and about 20 percent are clinically depressed. Aggressive or destructive behavior is the hallmark of conduct disorder. A child may routinely start fights or harm animals. In addition, he may commit crimes such as breaking into homes, stealing cars, or setting fires.

What causes mental disorders?

Children and teenagers develop mental disorders for a variety of reasons. Sometimes, a particularly distressing event, such as divorce in the family, serves as a trigger, but this is not always the case. Experts point to a series of factors that often work in combination with one another. Here are the major causes for mental disorders: Biological. Some mental disorders such as ADHD, for example, appear to be transmitted genetically. Mental disorders can also be caused by a chemical imbalance in the brain, toxins such as lead, and accidents like a head injury that can damage the central nervous system.

Mental Disorders in Children

Environmental. Stress and trauma can have a major impact on your childs mood and behavior. For a teenager, stress might take the form of too many activities (such as a demanding part-time job in addition to a full course load). Examples of traumatic events include a serious medical illness, sexual abuse, or a mugging. In addition, witnessing violence can often be traumatic. Social. The loss of an important person, such as a parent or grandparent, can be very upsetting to a child. So, too, can parental conflict. Another social factor that can lead to problems -- particularly for adolescents -- is peer pressure, such as bullying at school. Psychological. Some children have trouble learning effective coping skills. When faced with a big change, such as a move to a new neighborhood, they may not be able to adjust easily. Psychotherapy often helps by teaching children new strategies for managing stressful situations.

How to find help

If you suspect that your child has a mental health disorder, you first need to make an appointment with a pediatrician or primary care physician who has experience working with children to rule out any medical issue. The pediatrician or primary care physician will be able make a referral to an individual mental health professional or a childrens hospital or center to conduct an assessment. You might try one of the following options: Contact your employee assistance program (EAP) or employee resource program. Your EAP can usually schedule a prompt appointment with an employee assistance professional -- a therapist who typically has a masters degree or Ph.D. in psychology or social work. Although this therapist may not be able to see your child for more than a few sessions, he or she can usually help you find another therapist if more extensive treatment is needed. Call professional associations in your state. Every state has several associations of mental health professionals that can give you the names of specific clinicians in your city. Unfortunately, at the present time, there is a shortage of child psychiatrists throughout the nation, so it may take longer to schedule an appointment with a psychiatrist than with a social worker, psychologist, nurse practitioner, or professional counselor. Call your local medical school. Many university hospitals run specialized clinics that provide a wide variety of mental health services to children, including assessments. Call local childrens hospitals or medical centers. Many urban areas are fortunate to have hospitals and/or medical centers that specialize in the treatment of children and can serve as excellent resources for assessment and/or ongoing care.

Mental Disorders in Children

Types of treatment
The mental health professional who conducts the initial evaluation will usually discuss various treatment options with you. You might also want to get the opinion of other people, such as a family doctor, a trusted friend, or a family member. For most common mental disorders, your child will need to begin receiving psychotherapy on a weekly or biweekly basis. Sometimes medication may be prescribed. Although many parents initially worry about the length and cost of treatment, most children improve significantly within a few months. In addition, most health plans cover mental health services. Since parents are the primary caretakers of their children, they need to be actively involved in any treatment, especially the treatment of young children. Older adolescents may need more time alone in treatment; however, parents still need to be involved in the overall treatment plan in order to help support the goals of the treatment. Psychotherapy. There are two basic forms of therapy for children: talk therapy and play therapy. By talking about his thoughts and feelings in a safe setting, a child can often make needed changes in behavior. For example, a therapist -- a mental health professional who typically has a background in psychiatry, psychology, or social work -- might encourage an anxious child to identify his biggest fears in order to help him develop new ways of coping with them. Therapists tend to use play therapy for younger children because they are less able to put their feelings into words. In play therapy, a child might be asked to express himself by drawing pictures or by telling stories with dolls. Family therapy. Sometimes it is also useful for one or both parents to attend a few therapy sessions. In family therapy, a therapist might help family members improve communication and resolve conflicts. Medication. Although drugs can provide relief for some mental disorders by fixing faulty brain chemistry, they are usually most effective when combined with psychotherapy. Among mental health professionals, only psychiatrists can prescribe drugs, but most psychologists and social workers work closely with a doctor who can monitor your childs medication. There are three main classes of psychiatric drugs: stimulants, antidepressants, and antianxiety agents, which are used to treat ADHD, depression, and anxiety, respectively. These drugs are generally safe, but they are not usually recommended for very young children. Hospitalization. In case of a crisis (if your child is suicidal, for example), you may need to consider hospitalization. Usually, the round-the-clock care provided by a hospital can help stabilize your child in a matter of days. Most hospital stays last only a few days or weeks. If your child still needs intensive treatment, you may need to send her to a partial hospitalization program where she can receive extensive mental health services during the day, but can return

Mental Disorders in Children

home in the evening. The level of care is determined by the mental health professionals. Although accepting that a child has a mental disorder is difficult for parents, and sometimes brings up issues of guilt and feelings of failure as a parent, parents can take comfort from knowing that the earlier mental disorders are addressed, the better the outcome. Seeking help is what being a good enough parent is about. In addition, there are many organizations that deal specifically with helping parents dealing with children with mental disorders. In order for you to take care of your child, be sure to take care of yourself by asking for the help you may need to handle any of the emotions that you are feeling about your childs diagnosis.

Resources
The following organizations can give you useful background information on mental disorders in children: National Mental Health Association, 703-684-7722, www.nmha.org. National Alliance for the Mentally Ill, 800-950-6264, www.nami.org. American Academy of Child and Adolescent Psychiatry, 202-966-7300, www.aacap.org. New York University Child Study Center, 212-263-6622, Aboutourkids.org.
Written with the help of Rebecca Dion, M.S.S., L.C.S.W., Q.C.S.W., C.E.A.P. Ms. Dion is regional director of Behavioral Health Residential Services at Northwestern Human Services and is a member of the National Association of Social Workers. She is a past board member of the Philadelphia chapter of the National Association for the Prevention of Child Abuse. 2001, 2004 Ceridian Corporation. All rights reserved.