HOW TO THINK ABOUT THE MENTAL HEALTH OF OUR CHILDREN

(Article published in HWW Jan-Feb 2005)

by Denise Torres, Director of Social Services, Care for the Homeless

Increasingly, we hear about “mental illness” in children. The United States Surgeon General estimates almost 5 million children and adolescents have a mental illness. Mental illness is difficult to talk about because there is still fear and shame about being “sick”. It is really important to remember that mental illnesses are diseases and need to be evaluated, diagnosed, and treated early—just like any other disease. Early and consistent treatment often means a full and happy adjustment to the illness.

How do you know there is a problem?

As with any disease, there are signs and symptoms that help in diagnosing mental illness. It is often very difficult to tell if a child has a disorder because some of the signs can be part of a child’s personality, a reaction to changes in the child’s life, or are just a part of growing up. Think of the child with outbursts/tantrums. Is this because she is not old enough to understand limits or tolerate something frustrating (those terrible twos)? Is it because things in her world have changed and she is feeling upset? Is it because she is rebelling against her parents (those teen years)?

Behaviors become symptoms when the behavior:

1) is not “acceptable” or “appropriate” for the child’s age. An example is bedwetting: For young children who have recently been potty trained it is not unusual to have an accident, but we expect 11 year olds to be able to control their bladders.

2) has lasted a long time. A good example is sadness. Sadness is a normal feeling, but feeling sad for many weeks is not.

3) is frequent. Occasional disobedience and testing of rules and limits is normal in children, but constant and repeated disobeying of rules is not.

4) is impacting the child’s or the family’s ability to live or function. An example is a child who likes routines. She feels better and safer if she does A then B and then C. At first this is not a problem, but she becomes unable to ever do things out of the routine. She, and everyone in the family, become prisoner to the routine.

5) is not a result of some medical condition. Let’s look at bedwetting again. That same 11 year old would not be considered mentally ill if there is an infection or other physical reason for the behavior. To make sure there is not another medical explanation, it is extremely important that children be given full physicals and other procedures like laboratory tests and X-rays.

What do you look for?

There are some general symptoms to look for in children and adolescents:

• Feeling helpless or hopeless with thoughts of death

• Changes in sleeping and/or eating habits including appetite

• Changes in school performance, such as poor grades despite good efforts

• Loss of interest in friends and activities they usually enjoy

• Significant increase in time spent alone

• Excessive worrying, sadness or anxiety

• Hyperactivity

• Persistent nightmares

• Substance use (including cigarettes, alcohol and drugs or inhalants)

• Persistent disobedience or aggressive behavior

• Defying authority, skipping school, stealing or damaging property

• Frequent temper tantrums or anger

• Hearing voices or seeing things that are not there (hallucinations)

These symptoms could mean different diagnoses or disorders. It is important to be assessed by a mental health clinician such as a psychiatrist, psychologist, clinical nurse practitioner, or licensed clinical social worker. During the evaluation process the child’s and the family’s history and current circumstances should be discussed. Also, input from teachers, care providers, or others who spend time with the child concerning the behaviors and symptoms should be obtained. Evaluation tools and tests are used to make sure the child is being given the correct diagnosis.

What diagnoses are common?

Some mental illnesses are specific to children. Some diagnoses only occur in adults. There are many diagnoses that are used in both children and adults. Because there are so many, mental illnesses are grouped into disorders. Common disorders in children include:

• Anxiety disorders: Children with anxiety disorders respond to certain things or situations with fear and dread, as well as with physical signs of anxiety (nervousness), such as a rapid heartbeat and sweating.

• Disruptive behavior disorders: Children with these disorders tend to defy rules and often are disruptive in structured environments, such as school.

• Tic disorders: These disorders cause a person to perform repeated, sudden, involuntary and often meaningless movements and sounds, called tics.

• Pervasive development disorders: Children with these disorders are confused in their thinking and generally have problems understanding the world around them.

• Eating disorders: Eating disorders involve intense emotions and attitudes, as well as unusual behaviors, associated with weight and/or food.

• Elimination disorders: These disorders affect behavior related to the elimination of body wastes (feces and urine).

• Learning and communication disorders: Children with these disorders have problems storing, organizing, and processing information, as well as relating their thoughts and ideas.

• Affective (mood) disorders: These disorders involve persistent feelings of sadness and/or rapidly changing moods.

If the symptoms and disorders above match what a child you know has been experiencing—get help—it could mean saving a life.