Childhood Mental Illness
Whenever most people hear the term ‘mental illness’ it’s easy to assume it primarily affects adults. However, kids suffer from various mental health problems, too. And early intervention is absolutely key! Not only can this be hard to identify in our own children, it can also be hard to admit. Thankfully, many pediatricians are beginning to assess for the most common mental health conditions in children during their routine well checks. However, these assessments are just not thorough enough if your kiddo is on the milder end of a diagnosis. Mental health is not a pediatrician’s regular focus or speciality, so it is important as a parent to be vigilant if you notice any unusual patterns in your child’s behavior, no matter what age.
Many parents wonder, What exactly is “normal” behavior and what’s not? And what red flags should I be watching for? If you find your child’s behavior is either unmanageable for him/her or your family and/or is interfering with daily functioning such as socialization with other kids, daycare or school, etc., it is best to get a professional opinion…or two. Typically, the sooner you seek help, the easier and quicker a possible mental health problem can be alleviated, if not resolved. Unresolved or untreated mental illnesses can result in suicide, cutting, substance abuse, criminal activity, or other unhealthy coping mechanisms.
I often get asked whether certain mental health conditions are genetically acquired or a result of a child’s environment. The nature versus nurture debate is so complex so the short of it is—in most cases it’s a combination of both. For example, depression has been found to have a genetic link that may predispose us to the condition, but if a child is in a healthy and secure environment with minimal stress and a high support network, it’s not likely to surface. I do believe environment plays a heavy influence, but more longitudinal research needs to be conducted.
Below, I have broken down the most common childhood mental illnesses and the red flags associated with each that might warrant a visit to a professional. However, bear in mind that symptoms look different in infancy which look different in older childhood which look even different from adolescence. Thus, the following are just general guidelines. Also keep in mind that what separates normal behaviors and feelings from ‘abnormal’ behaviors and feelings is whether or not these highlighted symptoms regularly interfere with daily functioning. Lastly, this is not a comprehensive list, it’s merely some common examples and simplified warning signs.
ADHD
What is ADHD? ADHD stands for Attention Deficient Hyperactive Disorder and is a brain disorder that manifests in challenges with attention. Children diagnosed with ADHD struggle to pay attention, have difficulty remaining focused on tasks, and have trouble controlling their energy overall. ADHD is often overdiagnosed in children as many parents are often looking for an answer to restlessness. However, when diagnosed appropriately, it is also a very serious condition that can affect a child’s ability to learn, socialize, and be productive.
What age can this arise? The typical onset for ADHD in children is typically seen between 4 to 18 years old.
What are the red flags? Difficulties with concentration, disorganized, easily bored, impatient, trouble listening, fidgety, easily distracted, forgetful, interruptive, blurts out answers, inattention, hyperactive overall, impulsive, trouble following instructions or waiting in line, running from toy to toy, trouble focusing on one activity, or prone to outbursts.
ASD
What is ASD? ASD stands for Autism Spectrum Disorder and is a developmental disability that encompasses a wide range of challenges affecting a child’s speech, social skills, coping skills, and learning capabilities. Autism effects 1 in 59 children in the US and is more common in boys. Aspergers syndrome is a higher functioning diagnosis of ASD and tends to display milder red flags and symptoms.
What age can this arise? This can arise as early as infancy, but typically is not diagnosed until between 18 months to 3 years old.
What are the red flags? Lack of expression (modeling your reactions, smiling, etc), delayed speech, avoiding or lack of eye contact, repetitive motions (rocking back and forth, flapping hands, spinning), difficulty socializing with other children, easily overstimulated, prefers being alone, repetitive patterns such as words and phrases, upset over changes in routine, intense reactions to sounds, textures, etc. In infancy early signs are: no babbling, no gestures to communicate, and very few vocal sounds.
Anxiety Disorders
What are anxiety disorders? Generally speaking, anxiety disorders are intense fearfulness or excessive worry. There are various types of anxiety disorders. Generalized Anxiety Disorder is constant worry about everyday issues. Obsessive Compulsive Disorder arises unwanted but repeated thoughts, feelings, ideas, sensations that lead one to believe they need to perform rituals (compulsions) in order to control these thoughts and feelings. Panic disorder is where panic attacks are a regular occurrence. Phobic Disorder is an unrealistic or overwhelming fear of and object or situation (ie water, dark, animals)
What age can this arise? Typically around 6 years old is the earliest onset of anxiety disorders, but of course like any condition, it’s possible it could arise earlier.
What are the red flags? Unusual fears or worries, worrying about most everything (even minor things on an ongoing basis), irritability, restlessness, nervousness, frequent headaches, stomach pain, bedwetting, perfectionist tendencies, avoidance of people, places, or things, trouble sleeping, easily startled, clingy, nail biting, hair pulling, teeth grinding, nightmares, constipation, muscle aches or body shakes, or difficulty staying focused on playing.
Depression
What is Depression? Depression is a chemical imbalance causing a period of depressed, sad, or irritable moods which lead to a decrease in previously excitable activities. Depression can be triggered by a major life change or stressor such as a move, parental divorce, a loss in the family etc. It may only last a period of time or may be longer lasting. While other mental health disorders tend to be overdiagnosed in children, mood disorders such as depression and bipolar disorder tend to be underdiagnosed, given it’s difficult for children to express themselves and identify specific symptoms.
What age can this arise? The onset for depression has rarely been seen prior to the age of 3.
What are the red flags? Feeling hopeless or worthless, tiredness, changes in appetite, oversleeping, unmotivated, disengaged in social settings, isolating self, sudden crying, all consuming sadness, stomachaches or headaches, insomnia, difficultly making decisions, low self-esteem, sensitive to rejection or failure, feeling inadequate, persistent feelings of sadness, lack of success or decline in school performance, attempts to run away from home, self injury, or talk of suicide. Suicide is serious! So take this seriously! Get immediate assistance and do not leave your child alone! If necessary, take your child to an emergency room for a psychiatric assessment, or call the police for assistance if you are afraid to try to transport your child. See more on suicide below.
ODD
What is ODD? ODD stands for Oppositional Defiant Disorder and is a behavior disorder that displays in sudden anger and resentment towards others. A child may intentionally resist, constantly argue with, and defy others. (All of our kiddos match this to some degree right?!) This disorder is more commonly seen in boys and usually co-occurs with another disorder such as Conduct Disorder, Mood Disorders, or ADHD.
What age can this arise? This condition is typically diagnosed around 2 or 3 or in the early teenage years. It can be difficult to identify or appropriately diagnose given that some of the red flags are normal oppositional behaviors seen during toddlerhood or teenage years.
What are the red flags? Difficulty making friends, uncooperative, hostile towards others (especially authority figures), persistently arguing, blaming others to avoid punishment, not following rules at home or school, displaying aggressive behavior towards others, frequent temper tantrums, or vindictive.
Conduct Disorder
What is Conduct Disorder? Conduct Disorder is a behavior disorder that results in acting out physically and engaging in power struggles with authorities. Often these behaviors are hostile, aggressive, and deceitful—-all with a lack of remorse. This condition is often a precursor to Anti Social Personality Disorder, which is a common personality disorder seen in criminals.
What age can this arise? The early signs of Conduct Disorder surface as young as toddlerhood.
What are the red flags? Cruelty to animals, inappropriate fire setting, verbal threats or intimidation, bullying, lying, stealing, lack of empathy towards others, rageful anger, aggression, vandalism, persistent rule violation, fighting, or property destruction.
PTSD
What is PTSD? PTSD stands for Post Traumatic Stress Disorder and is an intense fear and anxiety experienced after a traumatizing or terrifying event. This can be anything from bullying at school to a car accident to child abuse in the home or witnessing domestic violence between parents. PTSD does not just affect war veterans!
What age can this arise? This can happen as young as infancy (0+). The age of onset for PTSD is less about age and more about timing of a traumatizing event.
What are the red flags? Nightmares, difficulty concentrating, hypersensitive startle reflex, avoidance of places, activities, or other triggers, socially withdrawn, decrease in positive emotions, flashbacks, or diminished interest in play.
Eating Disorders
What are Eating Disorders? Eating disorders are a severe disruption to diet where one eats small or large amounts of food. The most common types are Anorexia Nervosa and Bulimia. Anorexia is an obsession over one’s weight in an attempt to decrease weight or maintain weight that is far below normal for their proportions. He/she typically starves him/herself or exercise excessively to accomplish this. Bulimia manifests in secretly binge eating large amounts of food proceeded by purging it via vomiting or exercising excessively. It’s also important to note that 40% of people who suffer from an eating disorder also engage in self injury (see more on self injury below).
What age can this arise? Those aged 14-25 years old are most at risk, however, earlier onset continues to rise each year (even as young at 7, sadly).
What are the red flags? Fatigue, irritability, a negative or anxious relationship with food, skipping meals, low self esteem, avoiding meal times or events, food hoarding or hiding, frequent stomachaches or nausea, or calorie counting. Their dentist can also identify this from generalized acid erosion on the inside surfaces of their teeth for Bulimia.
With growing concerns over self injury and suicide in older childhood and adolescence, I wanted to take a few minutes to discuss each to help parents understand some drastic differences between the two. Both however, are typically a symptom of a larger mental health diagnosis.
Self injury is an intentional and impulsive act to harm oneself in a repetitive way, but is usually not intended to be lethal. Self harm, self mutilation, or self abuse are some common terms used to describe self injury. The most common ways of self injury are skin cutting, head banging, burning, or excessive scratching to the point of drawing blood. It is often used as a way to cope with or relieve painful feelings or achieve a euphoric state. If you notice unexplained scratches, cuts, burns or marks on your child’s body or notice they are wearing inappropriate clothing such as a sweatshirt in 90 degree weather, these may be signals something might be going on.
Suicide is the 10th most common death in the United States (approximately 123 suicides PER DAY). It is the SECOND leading cause of death for people ages 10-34 years old. THIS IS ALARMING! Suicide can be preventable in most cases. Some warning signs that could indicate possible suicidality in your child include extreme mood swings, withdrawing or isolating, talking about feeling trapped or hopeless, acting anxious or behaving recklessly, talking about wanting to die, giving away belongings, buying a gun, hoarding pills, or searching online for ways to kill themself. As terrifying as it might be to hear the answer, you must open up a conversation with your child if you see any red flags.
The US National Suicide Prevention Hotline is 1-800-273-TALK (24 hours, 7 days a week) .
TALK TO YOUR CHILDREN. Make it safe for them to come to you for anything. Help them find healthier coping strategies or connect with the right professional (many parents start with an onsite school counselor). No matter the mental health matter at hand, resist judgement as that will signal to your kiddo you are NOT a safe source to open up to. You must find ways to be compassionate to whatever they are going through.
Alright, so you can identify and are ready to seek a professional opinion, but where do you start? It can be very confusing trying to navigate all of the professional titles and degrees out there. So the Mama Advocate is here to help! Below I have broken down some of the common mental health professionals you might find:
Psychotherapist: A psychotherapist can range from an LMSW, to an LPC, to an LMFT. All of these are Master’s level degrees with different emphases. An LMSW is a Licensed Master of Social Worker, and although the Master’s program focuses on mental health, the majority of MSW programs tend to focus on social justice and client advocacy. An LMFT is a Licensed Marriage and Family Therapist with an emphasis on marriage and family counseling. An LPC is a Licensed Professional Counselor, where their degree program has more of an emphasis on mental health overall. All of these degrees are variations of each other with slightly different educational and licensure requirements. Nonetheless, all of these professionals can diagnose and treat. In my opinion, what’s more important than the type of degree is moreso the individual psychotherapist’s background and specialties.
Psychologist: A psychologist is a doctorate level counselor who can diagnose, treat, AND perform psychological testing. This can be broken down into two different types of psychologists. There is a PhD (doctor of philosophy) educated psychologist whose primary focus in their doctorate program was scientific research. And there is also a PsyD (doctor of psychology) educated psychologist whose primary focus during their doctorate program was more hands-on clinical practice.
Psychiatrist: A psychiatrist is a physician (MD) who specializes in psychiatry. Thus, a psychiatrist can diagnose, treat, perform psychological testing, AND prescribe medications. However, their main focus is on diagnosing, treating, and prescribing medications.
A helpful online platform that can help connect you to the right professional in your area is http://www.PsychologyToday.com. It has detailed profiles with accepted insurances, specialities, pictures, direct website, phone numbers, educational backgrounds.
Okay, so you see red flags and have an appointment scheduled with your chosen mental health professional. What should you expect the treatment to look like if your kiddo does in fact get a formal diagnosis? The mental health professional you chose will most likely have their own plan of action depending on the particular diagnosis and the severity of the diagnosis. Keep in mind there is no ‘one size fits all.’ Treatment can range from talk therapy to play therapy to family therapy to art therapy to a medication regimen— or a combination of a few of these. It’s also important to remember that if you or your child doesn’t feel a strong connection with the first counselor you find, keep looking! Every counselor has a different style and having a trusting connection is key to the treatment process. Furthermore, it’s important to know that while greater society often still embodies a stigma towards mental health diagnoses, you don’t have to fall into the same trap. In fact, it’s in your family’s best interest to not so that your child feels supported through their journey of getting help. Your child is not their diagnosis, their diagnosis is just a small part of who they are. Remember, our kiddos are very resilient and can overcome most any mental health condition with strong family support and professional health. Asking for help is a sign of strength, not weakness. It’s no different than being diagnosed with diabetes or cancer. You see the specialists and get the treatment you need to feel better and maybe even heal.
All of that being said, if YOU are having trouble coping with your child’s new diagnosis and need someone to talk to for support, I encourage you to reach out to a psychotherapist in your local area. Divorce rates among families who have a family member with a mental health condition (child or adult) are significantly higher than those who don’t. Be proactive!
[Additional resources used for supplemental information in writing this entry]
http://www.anorexiabulimiacare.org.uk/about/about-eating-disorders
http://www.acmh-mi.org/get-information/childrens-mental-health-101/possible-red-flags/
http://www.mentalhealthamerica.net/self-injury
https://www.sprc.org/about-suicide/warning-signs
