Serious behavioural and emotional problems are common in children. About 1 in 5 children has or will have a mental disorder at some point in their lives, the National Institute of Mental Health has found. Unfortunately, even though effective treatments are widely available, most children who suffer from a mental health disorder aren't getting the help they need.
It is normal for children and teenagers to go through periods when they feel sad, anxious, or angry. For example, the death of a beloved pet or a switch to a new school is likely to be upsetting to any child. However, when your child's distress lasts for a long period of time and begins to interfere with his ability to cope with everyday situations, you may need to seek the help of a mental health professional. A thorough assessment may help to identify the problem.
What is a mental health disorder?
A mental health disorder is a disease of the brain that affects mood, thinking, behaviour, or memory; it may also affect a combination of these things. If left untreated, a mental health disorder is likely to get worse. That's why it is important to seek help as soon as you have concerns.
Signs of a problem
If you think your child might have a mental health disorder, you might first try to engage her in an open and honest discussion. Try to remain calm and avoid saying anything critical. You might mention your concern about a specific issue, such as poor grades. Then ask your child if anything is bothering her. You might say, "I've noticed you haven't seemed like yourself lately. How are you feeling?" Some children will open up, but others may deny that anything is wrong.
Here are some signs that a child needs professional help right away:
- severe temper tantrums
- harming other children or pets
- lack of interest in activities that used to provide pleasure
- anxiety about going to sleep at night or fear of separating at bedtime
- worrying or talking about harming self or others
- talking about wanting to die
- expressing that others would be better off without him or her
- cutting, or hurting him- or herself in other ways
Here are some other signs that a child may need professional help:
- poor grades despite hard work
- social isolation or difficulty making friends
- persistent worry or anxiety
- fidgeting or restlessness
- chronic sadness or irritability
- frequent nightmares
- refusal to engage in normal activities (such as going to school)
- sudden weight loss or weight gain
- anger toward authority figures, law-breaking activity, or both
- reluctance to spend time with friends or family
- frequent complaints about bodily aches and pains
- difficulty falling asleep or waking up
- wanting to sleep all the time
- feelings of worthlessness or extreme guilt
- excessive sadness or crying in response to minor frustrations
Common mental health disorders in children
Like adults, children can have a wide range of mental health disorders, which vary in severity and duration. Following are common disorders in children:
- Anxiety. Anxiety disorders are the most widespread, affecting up to 1 in 10 children, the National Alliance on Mental Illness (NAMI) says. There are several types of anxiety disorders:
- Obsessive-compulsive disorder (OCD). If your child engages in repetitive behaviours that appear senseless, such as needing things in a particular place or getting very upset about a break in routine, he may be suffering from obsessive-compulsive disorder. OCD can also include perfectionism (dwelling on something until it is perfect), not dealing well with change, performing rituals, or making lists.
- Panic disorders. A child with a panic disorder has intense fear accompanied by uncomfortable physical sensations, such as a pounding heart and nausea.
- Phobias. Children with phobias have persistent fears about specific objects or things, such as snakes or heights.
- Posttraumatic stress disorder (PTSD) Children who have endured sexual or physical abuse, have witnessed or been the victim of violence, have been in an accident, or have experienced a natural disaster may develop posttraumatic stress disorder. Even though a traumatic event may have happened long ago, it can resurface in the form of intrusive flashbacks or nightmares.
- Separation anxiety. A child who has separation anxiety may have a temper tantrum whenever he has to be apart from you. In severe cases, children may refuse to attend school. Separation anxiety can also cause a child to have constant worries about his own safety.
- Depression. Children, particularly young children, tend to experience depression differently than adults do. A child will hardly ever acknowledge the disorder directly. Instead, she is likely to act in ways that cause problems at home or in school. A depressed child often has difficulty in relationships. She may have frequent conflicts with other children or may withdraw from them. Angry outbursts or chronic irritability are common, as are feelings of sadness and hopelessness. A severely depressed child may also express thoughts of killing herself or others.
- Attention-deficit hyperactivity disorder (ADHD). Children with ADHD may have trouble paying attention or controlling their impulses, or they may be too active. Experts recognize several types of the disorder. Children with the predominantly inattentive type are easily distracted and forget details of their routines. They have trouble organizing or finishing tasks, paying attention to specifics, or following directions or conversations. Those with the predominantly hyperactive-impulsive type of ADHD talk and squirm a lot. They find it hard to sit still when needed -- for example, while eating dinner or doing homework. Younger children may seem to run or climb all the time, or they may interrupt conversations more often than others, grab things from people, or speak at inappropriate times. Children with this form of ADHD find it hard to take turns or listen to directions, and may have an unusual number of accidents or injuries. Children with the combined type of ADHD have symptoms of both of the other two types. The form of ADHD that someone has may change over time.
- Conduct disorder. Aggressive or destructive behaviour is the hallmark of conduct disorder. Children with this disorder may routinely start fights, harm animals, or bully other children. In addition, they may commit crimes such as breaking into homes, stealing cars, setting fires, or engaging in vandalism. Children with conduct disorder may have another mental health disorder at the same time, such as ADHD or PTSD.
- Oppositional defiant disorder (ODD). Children with ODD are often hostile, defiant, and uncooperative with authority figures, both at home and at school. Sometimes these children say mean, spiteful things or blame others for their mistakes.
What causes mental health disorders?
Children or teenagers develop mental health disorders for reasons that are:
Types of treatment
If you suspect that your child has a mental health disorder, make an appointment with a pediatrician or primary care physician who has experience working with children to rule out any medical issue. Your health care provider may be able to do screening tests in the office to give you information, such as whether your child is dealing with depression or has an anxiety disorder.
In diagnosing ADHD, your health care provider may ask if teachers can complete screening forms, such as the Vanderbilt ADHD Diagnostic Teacher Rating Scale. The doctor may refer you to a mental health professional or to a children's hospital or medical centre to conduct an assessment.
The mental health professional who conducts the initial evaluation will usually discuss treatment options with you. If you are confused or want more information on treatment options, ask your doctor to refer you to another physician or therapist to get a second opinion. Depending on the disorder, treatment may consist of:
- Psychotherapy. The two basic forms of therapy available for children are talk therapy andplay therapy. By talking about her thoughts and feelings in a safe setting, a child can often learn to change her behaviour. A therapist -- a mental health professional who typically has a background in psychiatry, psychology, or social work -- might help an anxious child identify her fears and learn ways to cope with them. Therapists tend to use play therapy with children too young to put their feelings into words. In play therapy, a child might be asked to express herself by drawing pictures or by telling stories with dolls. Psychotherapy is not needed for uncomplicated ADHD.
- Family therapy. Sometimes it's useful for one or both parents and siblings to attend a few therapy sessions. In family therapy, a therapist might help family members improve communication and resolve conflicts.
- Drugs can ease some mental health disorders by fixing faulty brain chemistry. Among mental health professionals, only psychiatrists can prescribe drugs, but most psychologists and social workers work closely with a doctor who can monitor your child's medication. The three main classes of psychiatric drugs are stimulants, antidepressants, and anti-anxiety agents, which are used to treat ADHD, depression, and anxiety, respectively. These drugs are generally safe, but they are not usually recommended for very young children.
- In a crisis (if your child is suicidal, for example), you may need to consider hospitalization. With round-the-clock care provided by a hospital, a child can usually be stabilized within days. Most hospital stays last only a few days or weeks. If your child still needs intensive treatment, you may choose to send him to a partial hospitalization program where he will receive extensive mental health services during the day, but can return home in the evening. Mental health professionals should determine what level of care is necessary.
You can learn more about mental health disorders that affect children from these organizations:
Canadian Pediatric Society (CPS)
Caring for Kids, a website of the CPS, is dedicated to providing reliable health information to parents. Visit the site and search for "Your Children's Mental Health."
Centre for Addiction and Mental Health (CAMH)
CAMH is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health. Visit their website under "Health Information" and click on "Info for Children & Youth" to access a variety of articles, resources, and apps designed specifically to support children and youth.
Canadian Mental Health Association (CMHA)
CMHA is a national not-for-profit organization that provides direct service to
100,000+ Canadians in more than 120 communities. As a nation-wide, voluntary organization, CHMA supports the resilience and recovery of people experiencing mental illness.
Canadian Academy of Child and Adolescent Psychiatry (CACAP)
The Canadian Academy of Child and Adolescent Psychiatry is a national organization of child and adolescent psychiatrists and other professionals in Canada, committed to advancing the mental health of children, youth, and families.
Mental Health Commission of Canada (MHCC)
MHCC has a unique 10-year mandate until 2017 from Health Canada to bring together leaders and organizations from across the country to accelerate changes to the mental health system in Canada. The website contains information and reports about mental illness, as well as a section specific to children and youth.
National Alliance on Mental Illness (NAMI)
The National Alliance on Mental Illness has online discussion groups for teenagers with mental health disorders and for their parents or caregivers. In addition to a wealth of information and resources on mental illness, NAMI can also help you find support groups where you can talk with other parents who share your concerns.
Accepting that a child has a mental health disorder is difficult for parents, but the earlier that mental health disorders are addressed, the better the outcomes. Many organizations support parents dealing with children who have mental health disorders. In order for you to take care of your child, be sure to take care of yourself by asking for the help you may need to handle any of the emotions that you are feeling about your child's diagnosis.
© LifeWorks Canada Ltd 2017