Childhood is supposed to be a carefree, innocent time. A period of life filled, for the most part, with fun, laughter, friends and happiness. This is, however, sadly not the case for the increasing number of children and adolescents across the globe who are affected by mental health issues.
A recent study, published in the JAMA Pediatrics journal earlier this week revealed that of the 46.6 million US-based children aged 6 to 18 years whose parents were surveyed, 7.7 million had at least one identifiable mental health condition such as anxiety, depression or ADHD. Of these 7.7 million, only half received treatment in the year prior to the survey1.
This seems startling in a developed nation, however, research reveals that this trend is prevalent across the globe. In fact, it is estimated that 20% of children and adolescents have a mental health disorder, with more than half of mental illnesses and substance abuse issues starting before the age of 142,3. Considering that mental health issues go largely unidentified and undiagnosed, these figures could be considerably higher.
According to the World Health Organisation, neuropsychiatric conditions are the primary cause of disability in the global youth. When these conditions are left untreated, they hinder childhood development and the potential for educational achievements as well as children’s ability to lead productive and rewarding lives.
Not only do children with mental disorders generally encounter a lack of access to adequate healthcare and educational facilities, they also have to face the major challenges of dealing with social stigmas, isolation and discrimination4. All of which can compound the matter, leading to depression (or more severe depression if this the primary mental health disorder experienced) that often culminates in self-harm and suicide.
Defining mental health disorders
The words ‘mental disorder’, also termed a ‘mental illness’ or ‘psychiatric disorder’ refer to a broad range of behavioural or mental patterns that cause a variety of issues and symptoms, depending on the particular condition present.
In general, these types of conditions are characterised by a combination of abnormal thoughts, emotions, behaviours and relationships with others5. The issue/s experienced may occur as a single episode in response to a particular event (as is the case of trauma victims), may be relapsing and remitting (i.e. they will occur then stop, before beginning again) or persistent over the long term.
Examples of mental disorders range from anxiety, depression, intellectual disabilities and disorders due to substance abuse to bipolar disorder and schizophrenia. Many of these conditions are linked to an elevated suicide risk6,7.
Putting mental disorders into perspective
Global health statistics reveal that between one in four and one in six people globally (15 – 20%) will be affected by some form of mental or neurological disorder at some point in their lives8,9.
This makes mental disorders far more common than most realise, probably due to the fact that the majority of people don’t naturally equate conditions like anxiety, depression and substance abuse (i.e. the excessive use of alcohol and drugs) that have become commonplace in modern society with mental disorder.
Nevertheless, given the fact that children make up approximately 27% of the world’s population, 16% of the global burden of disease and injury can be attributed to mental health conditions in those aged 10 to 19 years of age, and that suicide is the third leading cause of death in 15 to 19 year olds7, something has to be done, and the solution often begins at home.
The challenge in identifying mental disorders in children
In general, the adults involved in a child’s life are responsible for identifying any mental health concerns. To do this effectively, however, means knowing the signs and symptoms of the various mental disorders, and even if one does, differentiating between normal childhood behaviour and signs of a problem can be difficult.
This is largely due to the fact that the symptoms of mental health disorders often overlap with those exhibited in normal childhood and adolescent behaviour and emotions10. In addition, children may lack the developmental ability and vocabulary required to explain the issue/s they are having.
Other factors that may cause parents to refrain from seeking counselling and/or treatment include:
- The fear of social stigma associated with mental health condition diagnosis
- Suffering from the same condition themselves (which often means it is not regarded as an issue)
- A lack of access to the appropriate healthcare professionals
- Logistical issues relating to treatment
- The unwillingness to allow a child to take certain medications due to the potential side effects
So how do you know that a child may be suffering from a mental health disorder rather than just experiencing a transient emotional or behavioural issue that is ‘normal’ in their particular stage of development? Let’s examine the most common disorders affecting children and adolescents, the general symptoms to look out for and what to do about them.
Mental health conditions affecting children and adolescents
Common mental health disorders include:
- Anxiety disorders: Approximately one in eight children suffer from some form of anxiety disorder11. These include generalised anxiety disorder, social phobia, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD). In these cases, anxiety is a chronic problem that interferes with normal daily functioning. While some degree of stress, worry and/or nervousness is part of every child’s natural life experience, and this changes as they grow and develop, worry and stress that affects normal functioning should be investigated.
- Mood disorders: These include conditions like anxiety and bipolar disorder, which may cause a child to experience ongoing feelings of sadness and/or irritability or lead to extreme mood swings that are uncommon in most people.
- Attention-deficit hyperactivity disorder (ADHD): This condition is probably the most diagnosed of all mental health disorders in children, even though it only affects approximately one in 20 children. This is usually due to increased awareness and because the symptoms are easier to identify and are displayed both at home and at school (they include rather obvious difficulties in paying attention, hyperactivity and/or impulsive behaviour). A suspected case of ADHD is one of the most common reasons why children are referred to mental health practitioners12.
- Eating disorders: Children also experience eating disorders including anorexia, bulimia and binge-eating disorder. These conditions result in a pre-occupation with food, weight, and/or physical appearance but the underlying cause is emotional. While these types of conditions typically manifest in adolescence, increasing numbers of childhood cases (i.e. in kids under the age of 12) are being recorded13.
- Autism spectrum disorder (ASD): This serious developmental disorder appears in early childhood. Symptoms vary depending on where the child is on the spectrum, but the condition always inhibits the affected child’s ability communicate and interact with others.
- Schizophrenia: This chronic psychiatric condition which commonly occurs in the late teens and early 20s, causes the affected adolescent to lose touch with reality and exhibit signs of psychosis.
Mental health condition signs and symptoms
As you can see from the above, children develop the same mental health conditions as adults, but the expression of these often differs quite significantly. For example, while depressed adults may exhibit sadness, children suffering from depression tend to express it through increased irritability. As such, the root cause may not be immediately obvious to an untrained parent or caregiver.
Here are the general signs and symptoms to look out for14:
- Changes in mood: If your child displays signs of sadness or withdrawal from family, friends and social situations or severe mood swings for two weeks or more that lead to problems in relationships and behaviour at home and school, this could signal an issue.
- Increased emotional intensity: Pay attention to the surfacing of overwhelming feelings, especially those with no apparent reason such as fear and anger, particularly when they are accompanied by a racing pulse and fast breathing. Also be aware of worries or fears that are experienced with great enough intensity to disrupt daily activities.
- Behavioural changes: Any radical changes in personality and behavioural patterns, especially those that seem out of control or that are dangerous, such as frequent arguments that escalate violently, threats to hurt others, using weapons and involvement in physical altercations are cause for concern and shouldn’t be ignored or dismissed as normal childhood behaviour.
- Concentration issues: Be vigilant and aware of signs that indicate problems with focussing or sitting still which may lead to trouble at school and a decline in academic performance.
- Academic decline across the board: If your child’s academic performance suddenly declines, do not ignore the issue. While it may be simply a lack of understanding of a certain subject, issues across the board may indicate a deeper issue.
- Physical symptoms: Be aware of the fact that children with mental health conditions may frequently manifest physical symptoms such as headaches, stomach aches and loss of appetite, rather than expressing them through emotional means such as sadness.
- Changes in personal hygiene: Lookout for changes in your child’s personal hygiene practices and neglect of his/her appearance.
- Lethargy: If your child suddenly becomes lethargic with no rational or medical explanation (i.e. they didn’t stay up late or aren’t sick or lacking anything in their diet), then keep an eye on it. If symptoms persist, it may be cause for concern.
- Changes in sleeping patterns: If your child suddenly starts to sleep more than usual, suffers from insomnia or experiences recurring nightmares on an ongoing basis, this can be a sign of an underlying mental issue.
- Unexplained weight loss: If your child suddenly loses his/her appetite, vomits frequently and loses weight with no medical explanation (such as due to a stomach bug), this may be a sign of an eating disorder. Investigate the potential use of laxatives.
- Abuse of alcohol and drugs: These substances may be used as a coping mechanism for an underlying mental health condition. Do not just put it down to experimentation if you find it is an ongoing issue.
- Self-harm: In some instances, mental health conditions may lead to self-harming behaviours such as purposefully cutting or burning oneself. These types of behaviours may also escalate to thoughts and attempts of suicide and should not be ignored.
Causes of mental health conditions in children
While the exact causes of mental illness are largely unknown, scientific evidence reveals that the following factors may be involved:
- Genetics: It has been proved that mental illness runs in families, making it a potentially heridatary condition that can be passed from parents to children.
- Biology: Imbalances in brain chemistry (neurotransmitters) may lead to the development of certain mental health conditions. Certain brain defects and injuries may also lead to the development of some mental illnesses.
- Psychological trauma: Some mental health conditions may be triggered by psychological trauma such as severe abuse of an emotional, psychological and/or sexual nature, emotional and/or physical neglect or the death or loss of a close loved one.
- Environmental triggers: Environmental factors such as living in poverty, homelessness, exposure to extreme discrimination, having to take on adult responsibilities and a caregiver role, may trigger mental illness in those with a predisposition to it.
What to do if your child displays signs, symptoms and behaviours associated with mental illness
If your child is behaving unusually, the first step is to note the signs, symptoms and behaviours you find worrying. Next discreetly discuss these with your family, your child’s teacher, caregiver/s, and possibly even their friends (by asking casual questions and not in front of the child) in order to ascertain whether these issues are being displayed outside of the home and whether others are noticing any differences.
Discuss the issue/s of concern with your child in a calm, loving way and ask whether they know why they are occurring. If applicable, using an example of when you experienced similar symptoms and how you felt and why may help your child to open up. If your child does not know why they are having these issues, or will not open up to you, consult your doctor. Also make him/her aware of the fact that others are picking up on the problems.
Based on the symptoms, your doctor may then refer you to the appropriate mental healthcare professional.
How are mental health conditions diagnosed and treated?
A mental healthcare professional (psychologist or psychiatrist) will work with your child to determine whether they have a mental health condition or if a medical condition or underlying trauma is present and make treatment recommendations based on these findings.
Treatment may involve:
- Psychotherapy, a form of talk therapy that equips your child to learn about the issue he/she is having and how to deal with the emotions, thoughts and behaviours it causes.
- The administration of medication, where necessary, to assist in the management of the symptoms experienced due to the condition in question.
- A combination of the above.
Outlook for children with mental health conditions
Mental health conditions are treatable and manageable. Avoiding treatment often leads to persistent and often compounding issues such as antisocial behaviour, substance abuse, and even suicide.
However, when the correct diagnosis is made and all associated issues are addressed and the condition is treated appropriately in childhood or adolescence, the prognosis for living life as a healthy adult is far more positive.
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