What is children's mental health?

Introduction

Mental health may be defined as how people interact with others, handle stress related to life situations, work through problems, and cope with daily living in an appropriate manner. Children, just like adults, face these same issues in their daily lives. Mental health disorders in children are usually a result of environment, genetics, injuries to the central nervous system, and chemical imbalances. The effects of environment may include exposure to toxins such as lead or pesticides, exposure to violence, physical or sexual abuse, and stress related to poverty, bullying, or loss of a parent or significant family member through divorce or death. Genetic factors are evident in mental disorders such as depression, schizophrenia, and autism spectrum disorders. Traumatic brain injuries from abuse or falls, for example, may lead to both physical damage and changes in behavior, including depression, acting out, and aggression. Children may also exhibit signs of post-traumatic stress disorder caused by violence they have witnessed or experienced.

Mental health disorders are often overlooked in children unless the child’s behavior is severely disruptive at home or school. If their disorder is untreated, children may experience school failure, conflicts with family and peers, and failure to achieve the developmental milestones of childhood that result in a healthy adulthood. Studies have reported that only one in five children with mental health issues receive needed services and intervention. Treatment for many disorders is effective; however, untreated disorders can have significant negative consequences.

The number of children in the United States being medicated for mental-health-related reasons is increasing at a rate higher than that of other countries, leading to the premise that mental health disorders in children are being overdiagnosed and overtreated with medications. Conversely, studies also show that some mental disorders are not being recognized and treated in an appropriate manner. Ways in which opportunities for children with mental health issues to be diagnosed and treated include increased awareness of mental health disorders in children due to media coverage; increased access to health care for children, which in turn leads to more physician-child observation; and programs designed to educate parents and educators on the mental health needs of children

Promoting Good Mental Health

The physical needs of children for shelter and safety, adequate nutrition, play and rest, timely health care, and immunizations are easily recognized; however, understanding how to promote good mental health in children is not as obvious. Good mental health allows children to progress through expected developmental stages of life, allowing for age-appropriate learning and social development. Childhood is a time to develop self-esteem, self-confidence, and a sense of security. Family, school, and community all play a vital role in promoting children’s mental health.

Children must feel a sense of love and security to try new skills and test the boundaries of their environment. Unconditional love from family allows children to experience both success and failure without feeling that love will be withdrawn if their accomplishments are not perfect. Attention, praise, and honesty in actions will promote self-esteem and support self-confidence. Providing a safe environment at home, day care, and school for play and learning will encourage exploration, leading to new skills. Positive verbal encouragement and realistic goal setting will reinforce desired behaviors. Negative or sarcastic comments may lead to discouragement and failure, if children perceive they are not good enough in the eyes of their caregivers. Negative comments should not be confused with teaching children when behaviors are unacceptable and when there are consequences to their actions. Criticizing the behavior, not the child, is central to the application of any needed discipline. When setting limits for acceptable behaviors, positive statements and unconditional love should guide the action.

Even with everyone surrounding the child providing unconditional love and respect, mental health disorders may still surface. Recognizing the need for early intervention is critical.

Recognizing Signs of Disorders

Parents, caregivers, teachers, and health care providers should all be sensitive to changes in children’s capabilities, behavior, or mood. Babies who develop normally and then begin to regress or children who show a decline in school performance, exhibit hyperactivity, have temper tantrums, fight with siblings and peers, or withdraw from activities usually perceived as fun may be signs of a mental health disorder. Excessive or unreasonable fears, nightmares, hearing voices, killing animals, and changes in eating patterns are often evident in children with mental health issues that need immediate intervention.

Parents and caregivers should discuss any concerns about children’s behavior in an open and honest manner without defensiveness. Recognizing that changes in behavior may be signs or symptoms of a mental health disorder is the first step in obtaining help for children in a timely manner. Discussing concerns about children with their pediatrician or school counselor will assist in determining if they need a referral for assessment or services from a mental health professional. Mental health organizations, libraries, the Internet, and hotlines are also resources for additional information.

Children’s mental health problems should be recognized and addressed early. Many children have mental health issues, and problems can be real and painful to the child and the family. Recognizing that psychotherapy, behavioral intervention, and medications are effective therapies and can make a difference in the child’s quality of life is essential to allowing a healthy and normal development.

Mental health disorders commonly seen in children include attention-deficit hyperactivity disorder (ADHD), attention-deficit disorder (ADD), anxiety disorders, autism spectrum disorders (ASD), depression, bipolar disorder, borderline personality disorder, eating disorders, and to a lesser degree, schizophrenia. Elimination disorders, when physical causes are ruled out, may also be considered a mental health disorder.

ADHD and ADD

Two of the most common mental disorders in children, which often overlap, are attention-deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD). Children with these disorders have difficulty functioning at home, in daycare or school, and in relationships with others. Behaviors evident in ADHD and ADD include hyperactivity, impulsiveness, and inattention. Children with ADHD or ADD often act without thinking, cannot sit still or focused for any length of time, run instead of walk, talk incessantly or interrupt others, daydream, and are distracted by the environment, all of which lead to an inability to focus on the task at hand. The diagnosis must be made by a professional such as a child psychiatrist, psychologist, or physician with training in ADHD and ADD who also uses medical and school records, interviews caregivers and/or parents, and rules out other possible reasons for the exhibited behaviors. Treatment is generally effective and includes behavioral therapy and medications.

Anxiety Disorders

Anxiety
disorders in children are common and are evidenced by fears, unease, or unrealistic worry not associated with a recent event; panic attacks that include physical manifestations such as high heart rate and lightheadedness; and obsessive-compulsive disorder. Children who are victims of abuse or neglect, or who have been exposed to trauma such as a natural disaster may exhibit signs of post-traumatic stress disorder. Separation anxiety disorder, normally seen in infants and toddlers, becomes an issue when older children cannot separate from their parents, are afraid to sleep alone, or are unable to leave the home for school or other events. Obsessive-compulsive disorder involves recurrent, compulsive behaviors such as hand washing that become so time-consuming as to interfere with daily activities. There is some evidence that an increase in obsessive-compulsive disorder occurs after a bout of streptococcal infection, and obsessive-compulsive disorder is considered to have a strong familial influence. Social anxiety disorder is said to occur when the child is afraid of being embarrassed in social or performance settings. Treatment depends on the symptoms exhibited and is focused on behavior changes. Psychotherapy is used in some disorders, but its efficacy is not certain.

Autism Spectrum Disorders

Autism
spectrum disorders are developmental disorders of brain function that range from autistic disorder in the most severe form, to pervasive developmental disorders not otherwise specified (PDD-NOS) in a less severe form, and to Asperger syndrome, a mild form. Two rare disorders include childhood disintegrative disorder and Rett syndrome. The disorder is usually diagnosed early in childhood, often when parents notice that their baby seems different or is not interacting with people. At times, the baby may develop normally to a point and then regress. A toddler who quits talking, does not interact with others, or becomes self-abusing may be exhibiting signs of autism spectrum disorders. The classic findings include impairments in social interactions and verbal and nonverbal communication; limitations in or severely restricted interests; repetitive movements such as hair twirling, rocking, or head banging; and heightened sensitivity to external stimuli. Diagnosis is made by assessing behavior based on a set of developed criteria that includes observation of play, social interactions, language, interests, rituals, and interaction with objects. Hearing and intelligence quotient
(IQ) testing may also be part of the diagnostic procedure. Treatments are individualized and may include behavioral, educational, and medical interventions, but there is no cure.

Depression

A report from the Federal Interagency Forum on Child and Family Statistics indicated that in 2011, major depression
occurred in approximately 8 percent of all children ages twelve to seventeen, with a major depressive episode occurring in girls more than twice than in boys. The percent of youths who reported a major depressive episode who were also receiving treatment in the form of therapy and/or medication was reported to be just under 40 percent in 2011. Causes of depression may include a variety of factors such as environment, life events, family changes, school problems, genetics, and biochemical disturbances. If a child seems sad or loses interest in activities normally of interest, withdraws from friends and family, or does poorly in school for an extended period of time, depression may be the cause. Depression is often overlooked, and changes in behavior are inappropriately blamed on emotional and hormonal changes as the child ages. Symptoms of depression in children may also include anger, changes in appetite or sleep patterns, fatigue, and thoughts of death and suicide. Although suicide in children is rare, it does occur. A diagnosis of depression is made by a physician or mental health professional based on duration and type of symptoms, interviews with family and others, and questionnaires and other nonmedical tests. Treatment may include psychotherapy and medications. The Food and Drug Administration (FDA) has determined that antidepressants in children may increase the risk of suicidal thoughts, so their use must be carefully monitored.

Bipolar Disorder

Bipolar
disorder, also known as manic-depressive disorder, is evidenced by sometimes rapid changes in mood, functioning, and activity or energy level. Dramatic shifts in mood from high or irritable to low or sad are classic symptoms of bipolar disorder and are called periods of mania or depression, respectively. These periods may occur multiple times in the same day in children. Differentiating mania episodes from ADHD may pose a challenge in diagnosis. Elated mood, lack of need for sleep, expansive or grandiose behaviors, and a feeling that rules do not apply are common in manic episodes and are not common in ADHD. Diagnosis is based on an assessment by a physician or mental health professional. Treatments are individualized and may include several medications in combination, accompanied by psychotherapy. Bipolar disorder in children is usually more severe than in adults, with shorter periods of time between manic and depressive periods. Adults may have longer periods of normal functioning between episodes.

Borderline Personality Disorder

Borderline
personality disorder (BPD) causes instability in behavior, interactions with others, personal image, and mood, including emotional regulation of actions, lasting hours rather than days as in other disorders. Individuals diagnosed with borderline personality disorder often report physical or sexual abuse, neglect, or separation from a parent or significant person as a young child. Genetic factors are also thought to play a role in borderline personality disorder. The onset of the disease is usually the late teens or young adulthood, and the disorder is more prevalent in female adolescents and young women. Borderline personality disorder is thought to begin with childhood issues related to environment and stress factors. In some instances, younger children may be diagnosed. The disorder is often the cause for psychiatric hospital admissions. Treatment includes psychotherapy and medications, including antidepressants, antipsychotics, and mood stabilizers. Dialectical behavior therapy (DBT) was developed to treat borderline personality disorder and shows promise. Neuroscience research, including brain imaging and studies of alteration in brain chemicals, is also showing promise in treatment.

Eating Disorders

Eatingdisorders, including anorexia nervosa, bulimia nervosa, and binge eating, are being seen in younger children at increasing rates. Collectively, eating disorders in children are said to exist when a child is overly preoccupied with weight, food selection or avoidance, and body image. Causes of eating disorders may include struggles at mealtime with a parent, being a picky eater, seeing mealtime and meals as unpleasant because of conflict or disruptions, and other environmental factors. Children with eating problems at a young age are more likely to develop eating disorders later in childhood or in their teenage years. Obesity, changes in weight, and unusual behavior are clues to eating disorders. Treatment is based on the severity of the disorder and includes psychotherapy, behavioral therapy, and hospitalization and medical intervention, such as the giving of electrolytes and fluids in more severe cases.

Schizophrenia

Schizophrenia
is a disabling brain disorder most common in young adults eighteen years of age and older. Although rare, it does occur in children. Individuals with the disorder often hear voices that others do not hear and believe that others are listening in on their thoughts and that people are trying to hurt them. Children with schizophrenia withdraw and become shy over time, may exhibit a decline in personal hygiene, and may talk about fears, strange ideas, and death. Causes are thought to be brain changes, biochemical changes, genetics, and environment. Symptoms include delusional thoughts, hallucinations, disordered thoughts, social withdrawal, and flat affect. Treatment is based on medication management, individual and group therapy, family therapy, and often a structured program at school. Careful management may allow the child to grow into independent living.

Elimination Disorders

Elimination disorders involve both defecation and urination. Encopresis is when a child passes feces in places other than the toilet, and enuresis is the passing of urine in places other than the toilet. Elimination disorders such as encopresis and enuresis are not to be confused with occasional accidents. When a child repeatedly demonstrates elimination disorders, especially if the child is over the age of five, and no physical reason exists, intervention may be needed. Encopresis is generally caused by constipation because of inadequate fluid and nutrition leading to poor nerve function in the anus, fear of using public toilets, and fear or frustration related to toilet training or stressful life events. Enuresis may be caused by a small bladder, urinary tract infection, severe stress, or developmental issues related to toilet training. Once all physical reasons for encopresis and enuresis are ruled out, treatment is focused on determining the influences on the child leading to the elimination disorder. Determining sources of anxiety and stress and eliminating or decreasing their influence is essential to treatment. Behavior therapy is usually successful in correcting mental-health-related reasons for elimination disorders. Diet modifications to prevent constipation and liquid restrictions to assist in bladder control support treatment success. Medications are available that may assist with encopresis (laxatives, stool softeners) and enuresis management (drugs that affect urine production in the kidney) but are generally used only if other methods of treatment fail. Early intervention will protect the child’s self-esteem, as an elimination disorder may result in social isolation and increased anxiety and depression.

Prompt Recognition of Mental Health Disorders

The prompt recognition of children’s mental health issues is essential to their health and well-being during childhood and leads to a healthy transition to adulthood. If children do not receive care for mental health disorders, they will experience recurring problems at home, school, and in relationships. Parents must also understand that mental disorders are not the fault of parenting in most situations and that a disorder is not something that the child can control. Treatment for mental health disorders may take months or years, but most disorders are manageable with appropriate interventions.

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