Parenting

Globally, about 10-20% of children and adolescents (ages 10 to 19) struggle with a mental disorder each year, according to the World Health Organization (WHO).¹ It’s been estimated that half of all mental illnesses manifest by the age of 14, and about three-quarters by the mid-20s; left untreated, they can severely influence a child’s healthy development.¹

Although parenting a child with a mental health disorder can be challenging, seeking support and educating yourself as much as possible can help make life easier for both you and your child. If you suspect that your child has a mental health disorder, it’s important to be aware of specific warning signs and symptoms so you can get them the help they need.

What Mental Illnesses Affect Children?

While children can suffer from a wide array of mental health disorders, there are a few that are more prevalent such as depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), eating disorders, certain behavior disorders (i.e., conduct disorder), and substance use disorders (SUD).^{2, 3, 4}

If your child has a substance use disorder and a mental health disorder, they are said to have a “co-occurring disorder.” Children may also be affected by other less prevalent mental illnesses such as panic disorder, posttraumatic stress disorder (PTSD), borderline personality disorder, schizophrenia, and autism spectrum disorders (Autism/Asperger’s syndrome).²

Youth Mental Health Stats

It is estimated that around: ^{2, 5} 

• 3% to 5% of adolescents are affected by depression.
• 4% to 6% by anxiety.
• 2% to 4% by ADHD.
• 1% to 2% by eating disorders.
• 4% to 6% by conduct disorder.
• 2% to 3% by substance abuse disorders.
• 13% to 20% of children experience a mental health disorder in a given year in the United States.

Among children age 2 to 17: ^{6, 7}

• 4% have been diagnosed with ADHD.
• 4% between ages 3 and 17 have a diagnosed behavioral/conduct problem.
• 1% of children between ages 3 and 17 have an anxiety disorder.
• 2% of children between ages 3 and 17 have experienced depression.
• 7% of adolescents between ages 12 and 17 had an illicit drug use disorder.
• 2% had alcohol use disorder.
• 8% experienced cigarette dependence over the past month.

Among children between the ages of 12 and 17: ⁶

• Slightly more than 6% have depression.
• More than 10% have anxiety disorders.
• Around 7% have had a behavior disorder.

Signs & Symptoms

Every mental illness has its own specific symptoms and warning signs. General signs and symptoms that a child or adolescent may have a mental health disorder include:^{8, 9}

• Changes in school performance.
• Excessive worry or anxiety.
• Hyperactive behavior.
• Frequent nightmares.
• Frequent disobedience or aggression.
• Feeling very angry.
• Losing interest in previously enjoyed activities.
• Obsessively dieting, exercising, or binge eating.
• Having thoughts of suicide.
• Using alcohol, tobacco, or other drugs.
• Social isolation.

Some of the potential warning signs of anxiety can include:¹⁰

• Being afraid to be away from parents.
• Extreme fear of specific things, such as dogs or insects.
• Worry about the future.
• Having sudden attacks of fear and worry.

Some warning signs of depression include:¹⁰

• Feeling sad or hopeless.
• Changes in eating or sleeping patterns.
• Changes in energy levels.
• Avoiding favorite activities.
• Difficulty paying attention.

Some of the behaviors associated with behavior disorders such as conduct disorder or oppositional defiant disorder include:¹⁰

• Being angry or having temper tantrums.
• Arguing with adults or refusing to comply with requests.
• Blaming others for their mistakes.
• Breaking serious rules (such as running away, staying out late).
• Aggressive behavior (harming animals, setting fires).
• Lying, stealing, or damaging property.

The diagnosis of ADHD is based on certain criteria involving several symptoms of inattention and hyperactivity/impulsivity; some examples include:¹¹

• Symptoms of inattention: losing important things, being easily distracted, seeming to not listen when spoken to.
• Symptoms of hyperactivity and impulsivity: frequent fidgeting, tapping hands or feet, running around in class, or always seeming “on the go.”

Younger children may exhibit these signs and symptoms differently from older children, so it’s also important to take into account a child’s developmental stage.¹²

Child Development Stages

Not all psychologists and mental health professionals agree on the “stages” of childhood development—some believe that children pass through distinct developmental stages, while others believe that development is a more of a continuous, smooth process. Stage theorists believe that children develop skills in time-specific “chunks” or periods, while continuous development is seen as a gradual process where children add to and build on existing skills.¹³

In addition to a child’s developmental stage, it is also important to keep in mind that different regions of the brain develop at various times, as do specific functions associated with those regions, so mental health disorders can affect children differently depending on their age.¹⁴

Certain behaviors may be considered normal during different developmental stages. For example, adolescence is a time to experiment with new activities, learn new ways of processing stress, and deal with hormonal changes that can make it seem like your child is a stranger.¹⁵ Being aware of the potential age-based warning signs may help you distinguish typical behavior from dysfunctional ones that may indicate a mental health disorder.

Mental health disorders generally tend to persist for longer periods of time, cause great distress to the child and the family, and interfere with the child’s functioning. When in doubt, it’s advisable to consult your child’s pediatrician or a qualified mental health professional.

Younger children may benefit from an evaluation if they:¹⁶

• Have frequent temper tantrums.
• Complain about stomachaches regularly or other pains with no obvious cause.
• Seem to be in constant motion (unable to sit still or quietly).
• Sleep too little or too much; have recurrent nightmares.

Older children may benefit from an evaluation if they:¹⁶

• Lose interest in favorite activities.
• Use drugs or alcohol.
• Engage in self-harm (cutting, burning their skin).
• Have thoughts of suicide.
• Isolate themselves socially.

Parents may face a number of issues when a child is diagnosed with a mental health disorder in their developmental years. These issues can include finding proper treatment, knowing how to talk about the problem, and parental stress from dealing with the issue.

Certain factors may be associated with mental, behavioral, and developmental disorders in childhood and adolescence. These can include trauma, environmental changes (such as moving), or specific socio-economic factors like poverty.^{17, 18}

Factors That May Contribute to Childhood Mental Illness

According to WHO, certain environmental factors can influence the likelihood of mental illness in children.³ However, risk factors do not mean that a child is guaranteed to develop a mental illness. Whether or not a given individual will go on to develop a mental illness is influenced by both certain risks and protective factors, and such a likelihood is a reflection of the complex interplay between a person's genes and their environment.¹⁹

Specific issues that can increase a child’s likelihood of developing a mental illness include:^{3, 18}

• Trauma.
• Abuse.
• Divorce.
• Natural disaster.
• A negative home environment (e.g., parents constantly fighting, trouble with siblings, parents struggling with addiction).
• School environment (e.g., being exposed to bullying or violence; difficulty with friendships).
• Underage drinking/drugs.
• Poor living conditions (poverty, dangerous neighborhood)
• Stigma.
• Discrimination.
• Lack of access to support or services.

What to Do if You Suspect Your Child Has a Mental Health Condition

If you are concerned that your child may have a mental health disorder, it’s important to address the issue rather than ignore it. Discuss your concerns with a pediatrician and talk to your child about how they are feeling.²⁰ You may not be able to prevent a mental illness, but by monitoring your child’s symptoms and keeping a close eye on any changes that occur, you’ll be better prepared to address the issue.

Talking to your child about a mental illness can be difficult. Avoid blaming them and try to communicate in a straightforward manner. Speak at their developmental level (i.e. give fewer details to younger children and talk on a more mature level with an adolescent). You might consider asking questions such as:²¹

• Can you tell me more about what’s happening?
• How are you feeling?
• Have you felt like this before?
• Do you want to talk to me or someone else about this?
• Can you tell me if you ever think about hurting yourself?

How is it Diagnosed in Children?

Remember that you know your child better than anyone else. If you are concerned about your their behavior at home, school, or with friends, and you’ve noticed that it has been lasting for more than a few weeks, it’s probably a good time to seek help from your pediatrician and/or a qualified child and adolescent mental health professional.¹⁶

An evaluation for a mental health disorder is a comprehensive process that usually entails specific steps such as:¹⁶

• An interview with parents to better understand the child’s developmental history, temperament, friendships and other relationships, medical history, interests, prior treatment, and current psychosocial situation, such as whether there have been any changes (moving to a new home, a new sibling, illnesses in the family).
• Obtaining information from the child’s school, such as behavior reports or standardized test results.
• An interview with the child about their experiences.
• Testing and observational reports.

Remember that mental health disorders are complex and can be the result of many factors, including genetics and upbringing, so it’s important to be honest about any family history of mental illnesses and any other environmental issues. The sooner a mental health disorder is diagnosed, the sooner a child can receive appropriate treatment and obtain access to needed resources.⁴

How is it Treated?

Since children communicate on different levels than adults, the mental health treatment they receive also varies from adult treatment. For example, children between the ages of 3 and 12 may participate in play therapy, in which toys are used to help represent words. Children of varying ages may also receive art or animal-assisted therapy to help treat ADHD, depression, anxiety, and autism.²²

Like adults, children also often participate in talk therapy, such as in individual counseling or group therapy. Many times, family counseling may be recommended to help families understand the child’s specific struggles and challenges. If necessary, children may also receive specific medications such as antidepressants, psychostimulants, or mood stabilizers.¹⁶

The specific type of therapy a child receives depends on their specific mental health challenges. Some children may receive behavioral therapies, such as cognitive-behavioral therapy (CBT), which has been shown to be an effective treatment for children who experience depression.²³ Children who function at a significantly lower level than their peers may benefit more from another type of behavioral therapy known as operant conditioning, designed to help children with severe mental health challenges.²²

Adolescents with suicidal thoughts and/or behaviors may receive dialectical behavioral therapy, or DBT, which was originally developed to treat borderline personality disorder in adults. However, research has shown that DBT may also be useful at reducing suicidality in adolescents.²⁴

Increasingly, parents may look to complementary and alternative therapies to help address mental health disorders in children. One study showed that herbal remedies, mind-body therapies, and chiropractic care were among the most-commonly used alternative modalities in children with mental illness.²⁵

How to Help at Home

Helping a child feel safe, understood, and supported is vital for their recovery and well-being. Be sure to check in with your child regularly to talk about how they are feeling. Devote your attention to them and allow them to speak while you listen.

Children often find routine soothing (especially if your child has ADHD), so be sure to adhere to your child’s usual routine as much as possible.²⁶ Model appropriate behavior and avoid using drugs or alcohol in your child’s presence. Keep them locked away or hidden to discourage underage substance use.

Parenting a child with a mental illness can be stressful, so seek support from other parents who may be in a similar situation. Therapist-led support groups are available that can help you connect with other parents, receive guidance, and help you better manage the situation. You might also consider seeking individual counseling as an additional form of support so you can focus on specific issues and learn strategies to help support your child.¹⁶

Sources

[1]. World Health Organization. (n.d.). Mental Health.

[2]. Michaud, P. A., & Fombonne, E. (2005). Common Mental Health Problems. BMJ (Clinical research ed.), 330(7495), 835–838.

[3]. U.S. Department of Health & Human Services. (2019). Common Mental Health Disorders in Adolescence.

[4]. World Health Organization. (2018). Adolescent Mental Health.

[5]. Centers for Disease Control and Prevention. (2019). What Are Childhood Mental Health Disorders?

[6]. Centers for Disease Control and Prevention. (2019). Data and Statistics on Children's Mental Health.

[7]. Centers for Disease Control and Prevention. (2019). Key Findings: Children's Mental Health Report.

[8]. National Alliance on Mental Illness. (n.d.). Know the Warning Signs.

[9]. U.S. Department of Health & Human Services. (2019). Common Mental Health Warning Signs.

[10]. Centers for Disease Control and Prevention. (2019). Children’s Mental Health Disorders.

[11]. Centers for Disease Control and Prevention. (2018). Symptoms and Diagnosis of ADHD.

[12]. National Institute of Mental Health. (2019). Child and Adolescent Mental Health.

[13]. Crowley, K. (2014). Child Development: A Practical Introduction. Los Angeles: Sage Publications.

[14]. U.S. Department of Health & Human Services. (2019). Cognitive Development.

[15]. U.S. Department of Health & Human Services. (2019). Adolescent Development Explained.

[16]. National Institute of Mental Health. (2018). Children and Mental Health.

[17]. Mental Health Foundation. Children and Young People.

[18]. Bitsko, R., Holbrook, J., Robinson, L, et. al. (2016).  Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders in Early Childhood — United States, 2011–2012. MMWR Morb Mortal Wkly Rep 2016,(65)221–226.

[19]. Institute of Medicine, Committee on Prevention of Mental Disorders. (1994). Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. 6, Risk and Protective Factors for the Onset of Mental Disorders. National Academies Press.

[20]. Canadian Mental Health Association. (2014). Mental Illnesses in Children and Youth.

[21]. MentalHealth.gov. (2019). For Parents and Caregivers.

[22]. Kids Mental Health Information Portal. (2009). How Is Mental Illness in Children Treated.

[23]. Das, J. K., Salam, R. A., Lassi, Z. S., Khan, M. N., et. al. (2016). Interventions for Adolescent Mental Health: An Overview of Systematic Reviews. The Journal of Adolescent Health: official publication of the Society for Adolescent Medicine, 59(4S), S49–S60.

[24]. National Institute of Mental Health. (2018). Therapy Reduces Risk in Suicidal Youth.

[25]. Wang, C., Pressier, J., Chung, Y. & Li, K. (2018). Complementary and alternative medicine use among children with mental health issues: results from the National Health Interview Survey. BMC Complementary & Alternative Medicine, 18: 241.

[26]. HelpGuide. (2019). ADHD Parenting Tips.