Child Mental Health Resources (page 3)
Young people can have mental, emotional, and behavioral problems that are real, painful, and costly. These problems, often called "disorders," are sources of stress for children and their families, schools, and communities.
The number of young people and their families who are affected by mental, emotional, and behavioral disorders is significant. It is estimated that as many as one in five children and adolescents may have a mental health disorder that can be identified and require treatment.
Mental health disorders in children and adolescents are caused by biology, environment, or a combination of the two. Examples of biological factors are genetics, chemical imbalances in the body, and damage to the central nervous system, such as a head injury. Many environmental factors also can affect mental health, including exposure to violence, extreme stress, and the loss of an important person.
Families and communities, working together, can help children and adolescents with mental disorders. A broad range of services is often necessary to meet the needs of these young people and their families.
Below are descriptions of particular mental, emotional, and behavioral disorders that may occur during childhood and adolescence. All can have a serious impact on a child's overall health. Some disorders are more common than others, and conditions range from mild to severe. Often, a child has more than one disorder.
This list of disorders must not be used for the purpose of making a diagnosis. It is to be used only as a reference about behavior encountered in the classroom.
All children feel anxious at times. Many feel stress, for example, when separated from parents; others fear the dark. Some though suffer enough to interfere with their daily activities. Anxious students may lose friends and be left out of social activities. Because they are quiet and compliant, the signs are often missed. They commonly experience academic failure and low self-esteem.
As many as 1 in 10 young people suffer from an AD. About 50% with AD also have a second AD or other behavioral disorder (e.g. depression). Adolescent girls are more affected than boys. Etiology is unknown (biological or environmental) but studies suggest that young people are at greater risk if their parents experienced AD. The most common anxiety disorders are:
- Generalized: extreme, unrealistic worry unrelated to recent events. They are often self-conscious and tense; they may suffer from aches and pains that appear to have no physical basis.
- Phobias: unrealistic and excessive fears. Specific phobias center on animals, storms, or situations such as being in an enclosed space.
- Panic Disorder: repeated attacks of intense fear w/o apparent cause. They may be accompanied by pounding heartbeat, nausea or a feeling of imminent death. Some may go to great lengths to avoid the attacks (such as refusing to attend school).
- Obsessive Compulsive Disorder: being trapped in a pattern of repetitive thoughts and behaviors. These may include hand washing, counting, or arranging and rearranging objects.
Asperger's is a subset of the autism spectrum disorders. Before our knowledge base expanded it was referred to as "high functioning autism." It is a neurobiological disorder that impacts behavior, sensory systems, and visual and auditory processing. Students are usually highly verbal and test average to above-average IQ's. The disorder impacts cognition, language, socialization, sensory issues, visual processing and behavior. There is often a preoccupation with a single subject or activity. They might also display excessive rigidity (resistance to change), nonfunctional routines or rituals, repetitive motor movements, or persistent preoccupation with a part of an object rather than functional use of the whole (i.e. spinning the wheels of a toy car rather than "driving" it around). The most common characteristic occurs with impairment of social interactions, which may include failure to use or comprehend nonverbal gestures in others, failure to develop age-appropriate peer relationships and a lack of empathy.
Attention-Deficit Hyperactivity Disorder (AD/HD)
Symptoms may be situation-specific. For example, students with AD/HD may not exhibit some behaviors at home if that environment is less stressful, less stimulating or is more structured than school. Or students may stay on task when doing a project they enjoy, such as art.
An estimated 5% of children have a form of AD/HD. More boys are diagnosed than girls; it is the leading cause of referrals to mental health professionals, SPED, and juvenile justice programs. Students with ADD only, tend to be overlooked or dismissed as "quiet and unmotivated" because they can't organize their work on time.
Students with AD/HD are at higher risk for learning disorders, anxiety disorder, conduct disorder, and mood disorders such as depression. Without proper treatment children are at high risk for school failure. They may also have difficulty maintaining friendships, and their self-esteem will suffer from experiencing frequent failure because of their disability.
If you suspect AD/HD refer the student for mental health assessment. Many will benefit from medication. This must be managed by an experienced mental health professional (psychiatrist, pediatrician, neurologist) in treating AD/HD. Multi-disciplinary approaches that include family, school and mental health can prove successful.
Children identified at an early age should be monitored because changing symptoms may indicate related disorders such as bipolar, depression, Tourette's disorder, or underlying conditions such as FASD (Fetal Alcohol).
Remember that AD/HD is a neurobiological disorder. Students can't get organized or learn social skills on their own, but you can find interventions that greatly increase their capacity to succeed.
Also know as manic-depressive illness, bipolar disorder, is a brain disorder that causes unusual shifts in a person's mood energy, and ability to function. The symptoms are severe and can result in damaged relationships, poor job or school performance, and even suicide. More than 2 million adults (1% of the population18 and older) in any given year have bipolar. Children and adolescents can also develop the disorder. Like diabetes, or heart disease, it is a long term illness that requires careful management. Youth with the illness experience very fast mood swings between depression and mania many times a time. Manic children are more likely to be irritable and prone to destructive tantrums than to be happy or elated. Older adolescents tend to develop classic, adult-type episodes and symptoms. Bipolar disorder in youth is often hard to differentiate from symptoms of other disorders (e.g. drug abuse). Effective treatment requires appropriate evaluation and diagnosis. Adolescents with bipolar are at higher risk of suicide. Any talk about of feelings of suicide require immediate referral.
Conduct Disorder (CD)
Youth with conduct disorder are highly visible, demonstrating a complicated group of behavioral and emotional problems. Serious, repetitive, and persistent misbehavior is the essential feature. These behaviors fall into 4 main groups:
- aggressive behavior toward people or animals
- destruction of property
- serious violations of rules.
To receive a diagnosis, the youth must have displayed 3 or more characteristic behaviors in the past 12 months. At least 1 must have been evident during the part 6 months. Diagnosing can be a dilemma because youth are constantly changing. Many children with CD also have learning disabilities and about 1/3 are depressed. Many stop exhibiting the behavior problems when treated for depression.
USDHHS estimate between 6 and 16% of males and 2 to 9% of females under 18 have CD that ranges in severity from mild to severe.
Other disorders associated with CD are AD/HD or oppositional defiant (ODD). The majority of youth with CD may have life-long patterns of anti-social behavior and are at higher risk for mood or anxiety disorder. But for many, the disorder may subside in later adulthood.
Social context (poverty, high crime) may influence what we view as anti-social behavior. In these cases, CD may be misapplied to individuals whose behaviors may be protective or exist within cultural context. A child with suspected CD needs to be referred for assessment. If symptoms are mild, the child may receive services and remain in the school environment. More seriously troubled youth, however, may need more specialized educational environments.
All children feel blue or sad at times, but feelings of sadness with great intensity that persist for weeks/months may be a symptom of major depressive disorder or dysthymic disorder (chronic depression). These disorders affect a young person's thoughts, feeling, behavior, body and can lead to school failure, alcohol/drug abuse and even suicide.
Recent studies reported by USDHHS show that as many as 1 in every 33 children may have depression; among adolescents, the ratio may be as high as 1 in 8. Boys appear to suffer earlier in childhood. During adolescence, the illness is prevalent among girls. Depression is hard to diagnose, more difficult to treat, more severe, and more likely to reoccur than adult forms. Depression also affects a child's development. A depressed child becomes "stuck" and unable to pass through normal developmental stages. Common symptoms are:
- Sadness that won't go away
- School avoidance
- Changes in sleeping and eating patterns
- Frequent complaints of aches and pains
- Thoughts of death or suicide
- Self-deprecating remarks
- Persistent boredom, low energy, or poor concentration
- Increased activity
Students who used to enjoy playing with friends may now spend most of their time alone or they may start "hanging out" with a completely different peer group. Activities that were once fun hold no interest. They may talk about dying or suicide. Depressed teens may "self-medicate" with alcohol or drugs.
Children who cause trouble at home or at school may actually be depressed, although they may not seem sad. Younger children may pretend to be sick, be overactive, cling to their parents, seem accident prone, or refuse to go to school. Older children and teens often refuse to participate in family and social activities and stop paying attention to their appearance. They may also be restless, grouchy, or aggressive.
Most mental health professionals believe that depression has a biological origin. Research indicates that children have a greater chance of developing depression if one or both of their parents suffered from this illness.
Eating Disorder (ED)
Nearly all of us worry about our weight; however, when one becomes so obsessed with their weight and the need to be thin they may develop an eating disorder. The two most common are anorexia nervosa and bulimia nervosa. Once seen in teens and young adults, these disorders are increasingly seen in younger children as well. Children as young as 4 and 5 are expressing the need to diet, and it's estimated that 40% of 9 year olds have already dieted. Eating disorders aren't limited to girls- between 10 and 20% of adolescents with ED are boys.
Individuals with anorexia fail to maintain minimally normal body weight. They engage in abnormal eating behavior and have excessive concerns about food. They are intensely afraid of even the slightest weight gain, and their perception of their body shape and size is significantly distorted. Many individuals with anorexia are compulsive and excessive about exercise. Children and teens with this disorder are perfectionists and overachieving. In teenage girls with anorexia, menstruation may cease, leading to the same kind of bone loss suffered by menopausal women.
Youth with bulimia go on eating binges during which they compulsively consume large amounts of food within a short period of time. To avoid weight gain, they engage in inappropriate compensatory behavior, including fasting, self-induced vomiting, excessive exercise, and the use of laxatives, diuretics, and enemas.
Athletes such as wrestlers, dancers, or gymnasts may fall into disordered eating patterns in an attempt to stay thin or "make their weight." This can lead to a full blown disorder. Adolescents who have eating disorders are obsessed with food. Their lives revolve around thoughts and worries about their weight and their eating. Youth who suffer from eating disorders are at risk for alcohol and drug abuse as well as depression.
If you suspect a student may be suffering from an eating disorder, refer that student immediately for a mental health assessment. Without medical intervention, an individual with an eating disorder faces serious health problems and, in extreme cases, death.
Fetal Alcohol Spectrum Syndrome (FASD)
Fetal Alcohol Spectrum Disorder refers to the brain damage and physical birth defects caused by women drinking alcohol during pregnancy. Fetal Alcohol Syndrome (FAS), can include growth deficiencies, central nervous system dysfunction that may include low IQ or mental retardation, and abnormal facial features (e.g. small eye openings, small upturned nose, thin upper lip, small lower jaw, low set of ears, and an overall small head circumference).
Children lacking the distinguishing facial features may be diagnosed with Fetal Alcohol Effects (FAE). A diagnosis of FAE may make it more difficult to meet the criteria for many services or accommodations. The Institute of Medicine has recently coined a new term to describe the condition in which only the central nervous system abnormalities are present from prenatal alcohol exposure: Alcohol Related Neuro-developmental Disabilities (ARND).
Because FAS/FAE are irreversible, lifelong conditions, children with FASD have severe challenges that may include developmental disabilities (e.g. speech and language delays) and learning disabilities. They are often hyperactive, poorly coordinated, and impulsive. They will most likely have difficulty with daily living skills, including eating (as a result of missing tooth enamel, heightened oral sensitivity, or an abnormal gag reflex).
Learning is not automatic for them. Due to organic brain damage, memory retrieval is impaired, making learning difficult. Many of these children have problems with communication, especially social communication, even though they may have strong verbal skills. They often have trouble interpreting actions and behaviors of others or reading social cues. Abstract concepts are especially troublesome. They often appear irresponsible, undisciplined, and immature as they lack critical thinking skills such as judgment, reasoning, problem solving, predicting, and generalizing. In general, any learning is from a concrete perspective, but even then only through ongoing repetition.
Because FAS/FAE children don't internalize morals, ethics, or values (these are abstract concepts), they don't understand how to do or say the appropriate thing. They also do not learn from past experience; punishment doesn't seem to faze them, they often repeat the same mistakes. Immediate wants or needs take precedence, and they don't understand the concept of cause and effect or that there are consequences to their actions. These factors may result in serious behavior problems, unless their environment is closely monitored, structured, and consistent.
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