Research indicates that half of all lifetime cases of mental illness begin by age 14. Scientists continue to uncover evidence suggesting that changes in the body that lead to mental health issues may in fact start much earlier, before any symptoms appear.
The most commonly diagnosed mental health disorders affecting children today include anxiety disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, bipolar disorder, depression, eating disorders and schizophrenia. These conditions can seem quite harrowing, especially when diagnosed in children, but there is much hope. As scientists learn more about when and how fast specific areas of children's brains develop, a clearer picture is forming of the early stages of a range of mental illnesses that appear later in life. With this improved ability to identify these early stages, health care professionals can better help children and their parents manage these issues early in life and potentially prevent them from developing into more debilitating disorders later.
Unfortunately, some parents, caregivers and other people involved with children fail to appreciate that once a mental illness develops, it becomes a regular part of a child's behavior and more difficult to treat. So even though treatments--but not cures (yet)--are available for a number of mental health disorders, many children with these difficulties are not getting treatment.
If you are a parent or guardian of a child and are concerned that she or he might have a mental health disorder, the National Institutes of Mental Health has put together some answers to commonly asked questions regarding children and mental illness. The information that follows is meant to provide some guidance and even reassurance.
I'm concerned about my child's mental, behavioral, or emotional symptoms, but what should I do?
Talking to your child's health care provider is the first step. Before you go, learn everything you can about the behaviors or symptoms that worry you. If your child is in school, ask his or her teacher if your child's been showing worrisome changes in behavior. Share the information you gather with your child's health care provider.
Keep in mind that every child is different. Even normal development, such as when children develop language, motor and social skills, varies from child to child. When you're with your child's health care provider, ask if your daughter or son should be evaluated by a specialist with experience in child behavioral problems. Specialists may include psychiatrists, psychologists, social workers, psychiatric nurses and behavioral therapists. Educators may also help evaluate your child.
If you take your child to a specialist, ask that person if she or he has experience treating the problems you see in your child. Don't be afraid to interview more than one specialist to find the right fit for your child.
If your child is diagnosed with a mental health issue, learn as much as you can about it. The more you learn, the better you can work with your child's care provider(s) and make decisions that feel right for you, your child and your family.
How do I know if my child's problems are serious?
Not every mental health problem is serious. In fact, everyday stresses can cause your child's behavior to change, and not necessarily permanently. For example, the birth of a sibling may cause a child to temporarily act much younger than he or she is. You need to be able to tell the difference between typical behavior changes and those associated with more serious problems. Pay special attention to behaviors that include the following:
- Problems across a variety of settings, such as at school, at home or with peers
- Changes in appetite or sleep
- Social withdrawal, or fearful behavior toward things your child normally is not afraid of
- Returning to behaviors more common in younger children, such as bed-wetting, for a long time
- Signs of being upset, such as sadness or tearfulness
- Signs of self-destructive behavior, such as head-banging, or a tendency to get hurt often
- Repeated thoughts of death
These behaviors are often symptoms of a mental health issue that needs to be addressed with professional help.
Keep in mind that every member of a family, even the youngest child, is affected by tragedy or extreme stress, such as an illness or death in the family, family financial problems, divorce or other events. It's normal for stress to upset a child and cause her or him to act out, so remember this information if you see mental, emotional or behavioral symptoms in your child. However, if it takes more than one month for your child to adjust to a new situation or change of circumstances or if your child has severe reactions, talk to your child's health care provider, for professional care may be needed. Stressful events are challenging, but they give your child the opportunity to learn ways to cope.
How are mental illnesses diagnosed in children?
Just like adults, mental health disorders are diagnosed in children after a doctor or mental health specialist carefully observes signs and symptoms. Some primary care physicians can diagnose a child themselves, but many such doctors will send a young patient to a specialist who can diagnose and treat children.
Before diagnosing a mental illness, the doctor or specialist tries to rule out other possible causes for a child's behavior. The doctor will typically take these and other steps to gather information about the child's health:
- Take a history of any important medical problems
- Take a history of the child's development
- Take a history of the problem, including how long the problem's been observed by caregivers
- Take a family history of mental disorders
- Inquire about the child's more recent history to determine if the child has experienced physical or psychological traumas, such as a natural disaster, a death in the family or some other stressful situation
- Consider reports from parents and other caretakers or teachers
Very young children often cannot express their thoughts and feelings, so making a diagnosis can be challenging. The signs of a mental illness in a young child may be quite different from those in an older child or adult.
As parents and caregivers know, children are constantly changing and growing. Diagnosis and treatment must be viewed with these changes in mind. While some problems are short-lived and don't need treatment, others are ongoing and may be very serious. In either case, more information can help you understand treatment choices and manage the disorder or problem most effectively.
While diagnosing mental health problems in young children can be challenging, it is important. A diagnosis can be used to guide treatment and link your child's care to research on children with similar problems.
What treatment options are available for children?
Once a diagnosis is made, your child's specialist can recommend a specific treatment. Treatment choices often include psychotherapy, medication or both. Talk about the options with a health care professional who has experience treating the illness observed in your child. Some treatment choices have been studied experimentally, and other treatments are part of accepted health care practice. In addition, not every community has every type of service or program.
Your child's care provider may recommend a psychotropic medication. The members of this class of drugs affect brain chemicals related to mood and behavior. Most of these medications were developed for and tested in adults, but in recent years, researchers have been seeking to better understand the benefits and risks of using psychotropics in children. That said, more information is sorely needed about the effects these medications have on children, especially children younger than 6.
While researchers are trying to clarify how early treatment affects a growing body, families and doctors should weigh the benefits and risks of medication therapy. Each child has individual needs, and each child needs to be monitored closely while taking medications.
Are there treatments other than medications?
Psychosocial therapies can be very effective alone and in combination with medications. Psychosocial therapies, also called talk therapy or behavioral therapy, help people with mental illness change their behavior. Therapies that teach parents and children coping strategies can also be effective.
Cognitive behavioral therapy (CBT) is a type of psychotherapy often used with children. It has been widely studied and is an effective treatment for a number of conditions, such as depression, obsessive-compulsive disorder and social anxiety. A person undergoing CBT learns to change distorted thinking patterns and unhealthy behavior. Children can receive CBT with or without their parents present, as well as in a group setting. CBT can be adapted to fit the needs of each child. It is especially useful when treating anxiety disorders.
Additionally, therapies for ADHD are numerous and include behavioral parent training and behavioral classroom management. The NIMH Web site for ADHD has more information about therapies for this condition.
Psychosocial therapies often take time, effort and patience. However, sometimes children learn new skills that may have positive long-term benefits.
Will my child get better with time?
Some children diagnosed with mental health issues do get better with time. Other children need ongoing professional help. Talk to your child's doctor or specialist about problems that are severe, continuous and that affect daily activities. Also, don't delay seeking help. Treatment may produce better results if started early.