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Mental disorders in children

he Centers for Disease Control and Prevention describes mental disorders among children as “serious deviations from expected cognitive, social and emotional development.”
There has been a significant increase in the use of services for mental health disorders among children over the past 20 years. Mental disorders might result from serious difficulties in the home setting, with friends or at school. Nearly half of the children with one mental health disorder also have another. A total of 13 to 20 percent of children living in the United States experience a mental disorder in a given year. Sadly, suicide is the second leading cause of death in children 12 to 17 years of age in the United States
In children 3 to 17, ADHD is the most prevalent parent-reported diagnosis, 6.8 percent; 3.5 percent of children in this age group have behavioral or conduct disorders; 3 percent have anxiety; 2 percent have depression and 1.1 percent have autism. Nearly 5 percent of adolescents aged 12 to 17 years old have reported illicit drug use disorder. Just under 10 percent of adolescents 12 to 17 years of age report more than two weeks of mentally unhealthy days over the past month.
There appear to be many factors which contribute to mental illness in children. Early adverse life experiences (toxic stress) such as trauma or a history of witnessing or being a victim of physical or mental abuse are associated with higher rates of mental illness. There is also a biological/genetic link for some forms of mental illness. Ongoing chronic medical conditions, diabetes, cancer, etc., can also contribute to increases in anxiety and depression.
Mental health contributes to the overall physical health in children. All children should have access to screening, assessment and evidence-based therapies to treat mental health conditions. All routine checkups should include some assessment of the overall mental health of the child. By identifying stressors, such as anxiety about school, sleep problems or bullying, pediatricians can help prevent more serious problems.
It is important that children who have signs of mental illness get access to appropriate mental health services. Signs of mental illness in children can vary by the age and also by the type of illness the child might have.
There are some disorders which actually occur in preschool years. Extremes in behavior for an age of the child, such as being significantly more hyperactive or aggressive or withdrawn, might warrant further attention. Likewise, hard to explain negative changes in behavior such as anxiety or being withdrawn are also red flags.
In the preschool/early elementary school years, behavior problems include extremes in behavior such as extreme hyperactivity and impulsivity which disrupts classroom activity, trouble sleeping, persistent nightmares and excessive anxiety should be reasons for concern.
Additional behaviors which might warrant a visit to a mental health professional include extreme disobedience or aggression, and frequent extreme temper tantrums. While most parents might notice these behaviors at home, it is especially important to listen to the concerns of childcare workers and teachers when they bring these behaviors to the parent’s attention. These individuals have the opportunity to observe your child’s behavior in a group setting.
In the grade school years, anxiety and depression can be manifested by excessive fears and worries. Some other children might have a sudden decrease in school performance and/or loss of interest in friends and favorite activities. Sudden loss of appetite or sudden change in weight or preoccupation with body image might also be of concern. If these children exhibit prolonged sadness or see and hear things that are not there, the child needs to be seen by a mental health professional.
Other behaviors become more common during the teen years. These include comments or writings that suggest a desire to harm themselves or others. Suicidal thoughts and/or self-mutilation might also be present in the teenagers. Constantly threatening to run away, and destructive behavior such as damaging property or setting fires might also occur in the teenage years. These children need to be evaluated.
If your child ever makes comments about harming themselves or others, take him/her to a mental health facility or emergency room. Other problems can be handled by a psychologist or some primary care providers.
Behavioral therapy (counseling) is the cornerstone for treatment of most mental health issues. However, there are occasions when medications are required to control the child’s behavior so that they may interact appropriately with peers in a group setting.
The bottom line is, don’t ignore the warning signs of mental illness in children, get some help for them.

Rob Revelette is a pediatrician with the Pediatric Associates-KY One Health in Nicholasville who contributes often to both the Jessamine Life magazine and the Jessamine Journal.