In Blog #1 and #2 of this series, I talked about mental health, how the brain works, and the effect our current environment and how ACEs (adverse childhood experiences) affects brain growth and development and increases the likelihood of developing a mental illness. We know that 50 percent of all lifetime mental illnesses show signs and symptoms by age 14 and 75 per cent of all mental illnesses show signs and symptoms by age 24. Interestingly, of those diagnosed with a mental illness, 45 per cent meet the criteria for two or more other mental disorders e.g. A 15-year girl with major depressive disorder also has an eating disorder and an anxiety disorder.
I know this sounds scary, however, using proven treatment methods and utilising appropriate recovery supports, 70 to 90 percent of children/teenagers will experience a significant reduction of symptoms and 45 to 60 percent make a complete recovery. Of those with a mental illness of less than one year, the recovery rate increases to 80 percent.
There are over 200 mental illnesses/disorders listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition).
The five most common mental illnesses diagnosed in children and teenagers are anxiety disorders, attention deficit hyperactivity disorder, mood disorders, obsessive compulsive disorder and eating disorders.
1. Anxiety Disorders
Whilst there are a many different anxiety disorders, the most common disorders in children/teenagers are generalized anxiety disorder and social anxiety disorder. The symptoms are as a result of the body’s flight-fright-fight response to danger. In an anxiety disorder, this danger response is overactive and happens even when there is no danger or threat.
The most common signs and symptoms are:
- Acting scared, nervous, jittery, anxious
- Refusing to speak, participate in activity, go to school
- Crying, embarrassed
- Short of breath, dizzy, dry mouth, feeling clammy, racing heart, hot red face, “butterflies in stomach”
The most effective treatment for anxiety disorders is cognitive behavioural therapy (CBT). This therapy will help the child/teenager and parents/family learn techniques and strategies to help manage an anxiety provoking situation and develop coping skills so he/she can face fear and worry less.
2. Attention Deficit Hyperactivity Disorder (ADHD)
It is estimated that approximately 5.2 million school age children in the USA have ADHD. Signs and symptoms usually show up around the age of 4 to 12 years and may include:
- Difficulty sitting still and general restlessness
- Easily bored, impatient and easily distracted
- Difficulty concentrating, planning, organising and completing tasks
- Easily angered, frequent mood swings
- Talks quickly and incessantly
- Prone to misplacing items
- Doesn’t appear to listen to others or process what is being said
There is no definitive test for ADHD and diagnosis comprises several steps including a physical exam, possibly blood tests, reviewing medical history and discussions with the child/teenager, parents, the school and any other people directly involved in the child/teenager’s daily life.
There are three types of ADHD:
- Hyperactive/impulsive type.
- Inattentive type (attention deficit disorder).
- Combined type (inattentive/hyperactive/impulsive) which is the most common form of ADHD.
Multimodal treatment for ADHD may include psychological assessment, medication regime, and possibly a special education program in school. Studies have found that children/teenagers managed with medications and behavioural therapy (social skills training, parent skills training) do much better.
3. Mood Disorder
It was generally believed that signs and symptoms of depression occur around the age 13 yrs. and older. However, recent information reveals that children as young as 6 yrs. old are presenting with a mood disorder, specifically depression and dysthymia. It is estimated only 38 per cent of children/teenagers with a depressive disorder receive help. It is important to point out that depression in a child/teenager is slightly different from adult depression and should not be confused with normal childhood/teenager mood changes.
Signs and Symptoms:
- Persistent and fluctuating changes in mood unrelated to environment e.g. angry, crying
- Noted change in friendships, temper, activities, schoolwork
- Withdrawal from family, friends, favourite activities
- Headaches, stomach pain, fatigue, low energy
- No appetite or eating all the time
- Insomnia or sleeping too much
- Cutting
- Feelings of sadness, hopelessness, worthlessness, guilt
- Thought of suicide or wanting to die
Treatment usually includes a combination of medications (anti-depressants) and counselling (individual and family).
4. Obsessive Compulsive Disorder (OCD)
OCD is a disorder in the signaling area of the brain. Contrary to popular opinion, children and teenagers can have OCD, in fact, it is increasing with children as young as 3 to 4 yrs. old displaying repetitive, compulsive and obsessive behaviors. Being a neat freak is not OCD, color coding your socks, is not a little OCD. OCD can severely impact a child/teenager’s daily life and lead to isolation, increased anxiety, depression, suicidal thoughts, panic disorder. Children with OCD are also at increased risk of being bullied.
Signs and symptoms of OCD:
- Recurrent obsessions (thoughts, feelings, fears) that makes the child/teenager stressed and anxious e.g. germs on objects, parent will die, etc.
- Repeated compulsions or actions or behaviors that the child/teenager does to try and reduce the anxiety and discomfort from the obsession e.g. constantly washing hands, checking door handle repeatedly, tapping or touching a certain number of times
- Child/teenager may also be angry, irritable, sad, embarrassed
- Withdraw from family, friends, school and social activities
Obsessive Compulsive Disorder is a serious mental illness, however, with the right treatment and support, it can get better. Treatment includes intensive counselling, usually cognitive behavioral therapy (CBT) and parent coaching, and medication (SSRIs selective serotonin reuptake inhibitors).
5. Eating Disorders
Children as young as 7 to 8 yrs. old have an eating disorder. It is estimated that 35 per cent of teenage girls have an eating disorder, that equates to 7 in 25 girls, and of all children/teenagers with an eating disorder, 10 per cent are male, this rises to 35 percent with males who binge eat. There are three types of eating disorders: anorexia, bulimia and binge-eating.
Eating disorders can lead to some very serous medical problems and research is finding that this disorder usually goes together with other mental disorders/illnesses e.g. depression, anxiety, substance abuse.
Anorexia
Signs and symptoms:
- Excessive exercise
- Fear of being fat and sees self as fat in mirror
- Dieting despite being very thin
- Rapid weight loss
- Anxiety, depression, a need to be perfect
- Periods usually stop in teenage girls
Treatment for anorexia is very specialized and sometimes hospitalization and/or artificial feeling may be required. Long-term treatment involves dealing with psychological issues: behavioural therapy, psychotherapy, support groups, family counselling and medication such as an antidepressant.
Bulimia
Signs and symptoms:
- Abusing laxatives
- Bingeing on large amounts of food then vomiting afterward
- Excessive exercise
- Mood swings, anxiety, sadness
- Sees self as fat or not thin enough
- Preoccupation with food, eating in secret
- Increased risk of using drugs and alcohol
- Disappearing to the bathroom after eating
Treatment aims to break the binge-purge cycle and may include nutritional counselling, therapy, behaviour modification therapy and possibly an antidepressant medication
Binge Eating
Whilst similar to bulimia, there is no vomiting after eating a very large meal. Binge eating is usually indicative of a child/teenager who is struggling with managing his/her emotions and is usually due to lots of stressors in life e.g. bullying, abuse, abandonment, etc.
A child/teenager with bulimia requires intensive counselling, which may include behavioural therapy and psychotherapy. Nutritional counselling, plus a supervised weight loss plan and exercise program is also an essential part of the treatment plan.
What Can a Parent(s) Do?
The most important thing a parent can do is to talk with and listen to your child/teenager’s concerns, fears, etc. Sit close, make eye contact, look at the body language, offer a caring touch or hug. Hear what is being said, or not being said (silence can speak volumes), be non-judgemental and open minded, do not invalidate or laugh, be responsive not reactive. Your child/teenager needs you to believe him/her, be kind, supportive and understanding, offer reassurance and show love. The child/teenager needs to know that you will be there, that you will help him/her and that you will do whatever it takes to help him/her manage the symptoms of the mental illness, improve health and well being and recover.
Once you have spoken with your child/teenager, the next step is to schedule an appointment with a doctor for an assessment and physical examination. Additional things to do will be to make appointment with a psychotherapist, implement the treatment plan, follow up with the school, talk with child/teenager’s siblings and any family/friends who play an active role in your child/teenager’s life.
In my next Blog #4
I will be talking about Non-Suicidal Self Injury (NSSI) in children and teenagers
