During any year, twenty percent of Americans suffer from a diagnosable mental disorder. One fifth of school-age children also are affected by these conditions. Severe and persistent mental illness is less common, afflicting about three percent of the population. Most people with mental illness continue to function and go about their daily lives with varying degrees of impairments. The exact causes of mental disorders are unknown, but there does seem to be a familial component as well as environmental factors.

Parents are often the first to notice that their child has a problem with emotions or behavior. The first step is to gently talk to the child about their feelings. Consulting with the child’s physician, teachers, members of the clergy or other adults who know the child well may be another avenue to explore. Signs which may indicate that a child and adolescent psychiatric evaluation would be useful include:

• Marked changes in school performance
• Severe worry or anxiety
• Hyperactivity, fidgeting, constant movement beyond regular playing
• Persistent nightmares
• Marked changes in sleeping and/or eating habits
• Frequent physical complaints
• Sexual acting out
• Abuse of alcohol or drugs
• Threats of self-harm or harm to others
• Strange thoughts, feelings, beliefs

If signs persist over an extended period of time and others who know the child are concerned, consultation with a child and adolescent psychiatrist or other clinician specifically trained to work with children may be helpful.

The consultation involves a comprehensive approach including a full mental and physical health evaluation. If intervention is warranted, an individualized treatment plan is developed which may include psychotherapy (talk therapy), medication, accommodations at school, and other modalities.

Common childhood disorders include Attention Deficit/Hyperactivity Disorder, anxiety disorders, and depression. Other conditions include Oppositional Defiant Disorder, Conduct Disorder, Bipolar Disorder and Schizophrenia. There are varying degrees of impairment within each illness.

Attention Deficit/Hyperactivity Disorder (ADHD) affects 3-5 % of school-age children. It is characterized by inattention, distractibility, impulsivity, or hyperactivity behaviors that occur more frequently and severely than in other children of the same age or developmental level. It must begin before the age of seven and it can continue into adulthood. ADHD runs in families and about 25% of biological parents also have this medical condition. Typical signs of the illness include: trouble paying attention, inattention to details, making careless mistakes, being easily distracted, losing school supplies, forgetting to turn in homework, trouble finishing homework and class work, trouble listening and following multiple adult commands, blurting out answers, impatience, fidgeting or squirming, leaving their seat and running or climbing about, seeming to be “on the go”, talking too much and have difficulty playing quietly, and interrupting or intruding on others.

Anxiety is experienced by all children at some time. It is expected and normal at specific times in development, for example from approximately age 8 months through the preschool years, healthy youngsters may show intense distress at times of separation from their parents or other persons with whom they are close. In addition, young children may have short-lived fears such as of the dark, storms, or animals. Anxious children are often overly tense or uptight and may seek a lot of reassurance. Their worries may interfere with activities. The anxious child may also be quiet, compliant and eager to please and their difficulties may be missed. Parents should be alert to signs of severe anxiety so that they may be treated early to help prevent complications such as loss of friendships, failure to reach social and academic potential, or feelings of low self-esteem. Such signs include constant thoughts and intense fears about the safety of parents and caretakers, refusing to go to school, frequent physical complaints, being overly clingy, having nightmares, having an extreme fear about a specific thing, fears of talking to people, avoidance of social situations, few friends outside the family, or constantly worrying.

Depression is an illness that strikes all ages, including young children. It is characterized by frequent sadness, tearfulness, crying and hopelessness, decreased interest in activities or inability to enjoy previously pleasurable activities. There may be a major change in sleeping or eating patterns. Low self esteem, guilt, extreme sensitivity to rejection or failure may arise. The child or adolescent may talk of running away from home or may express thoughts of suicide or self destructive behavior. They may abuse alcohol or drugs as a way to try and feel better. Again, early diagnosis and treatment are essential.

All children can be oppositional at times. This may happen when they are tired, hungry, upset or stressed. Behaviors may include arguing, talking back, being disobedient, and defying parents, teachers, and other adults. This can be a normal part of development for two to three year olds and early adolescents. But when openly hostile and uncooperative behavior are frequent and consistent and are more so than in other children of the same age, and are seen in multiple settings, it needs a comprehensive evaluation.

Conduct Disorder is a group of behavioral and emotional problems in young people that involves aggression to people and animals, bullying, threatening, intimidating, fighting, using a weapon, stealing, property destruction, being deceitful and serious violations of rules. If left untreated, there may be difficulty adapting to demands of adulthood and may have problems with relationships and holding down a job. There may also be law breaking and antisocial behavior.

Bipolar Disorder is a mood disorder that involves manic and/or depressive symptoms. Some children have mostly depression and others may have a combination of manic and depressive symptoms, alternating highs and lows. Manic symptoms include severe changes in mood whether unusually silly, happy, very irritable, angry, agitated or aggressive. There may be unrealistic highs in self esteem, feeling one is very powerful like a super hero. There can be a great increase in energy and the ability to go without sleep or have little sleep without feeling tired. There can be an increase in talking or in high risk taking behavior. Depressed symptoms may include ones already covered under depression.

Schizophrenia is a serious illness that causes strange thinking, strange feelings, and unusual behavior. It is uncommon in children. More typically it manifests in the later teen years or early twenties. Symptoms include seeing things or hearing voices which are not real, odd or eccentric behavior, unusual or bizarre thoughts and ideas. Other symptoms include confused thinking, withdrawn behavior, isolation, decline in personal hygiene, and having ideas that others are out to get them or talking about them. The behavior may change slowly over time and may first be noticed at school.

There are effective treatments for the conditions noted above. It is important to know one’s child and be aware of their behavior and actions. If serious changes occur that interfere with one’s development and cause distress, it is time to seek assistance. Early intervention is better. One can seek help by talking to the Pediatrician or Family Physician. Good resources are available by going to the websites of the American Academy of Child and Adolescent Psychiatry or the American Psychiatric Association. Ω