A Guide to Children’s Mental Health
Recognizing mental illness in children
- Nearly 8 in 10 children (78.1%) aged 3-17 years with depression received treatment
- 6 in 10 children (59.3%) aged 3-17 years with anxiety received treatment
- More than 5 in 10 children (53.5%) aged 3-17 years with behavior disorders received treatment
Signs of mental illness in children
- Severe mood swings that can negatively impact school or relationships
- Intense worries or a sense of impending doom that interfere with a child’s normal daily activities, including class, hanging with friends, and sports
- Signs of sadness or withdrawal for longer than two weeks, including crying regularly, lack of motivation or energy, and a wide range of emotions that can include feelings of fatigue, worthlessness, or hopelessness
- Overwhelming fear for no reason, often accompanied by a quickened heart rate, physical discomfort, or hastened breathing
- Significant changes in personality, behavior, or sleeping habits, such as waking up early, becoming agitated, increased aggression, or lack of sleep altogether (insomnia)
- Difficulty concentrating or remaining still in school, leading to poor work performance or failure in classes
- Having discussions about or exhibiting signs of self-harm, or making plans or attempts to kill or harm oneself
- Participating in out-of-control or high-risk behavior that causes harm to themselves or others
- Lack of eating, signs of vomiting up or utilizing laxatives to lose weight, or signs of significant weight loss or weight gain can signal an eating disorder as well as body dysmorphia
- Signs of repetitive use of drugs or alcohol
- Adults are often more withdrawn when experiencing depression, even withdrawing from groups of friends. Teenagers, however, may become more withdrawn from family, but may still be close with friends at school.
- Teens with depression may experience a significant change in sleep patterns but are less likely to develop insomnia compared to adults with depression.
- Teenagers may be more likely to express irritability or anger when struggling with anxiety, depression, or related conditions, whereas adults are more likely to express sadness, feelings of worthlessness, and become increasingly withdrawn from those around them.
Children’s mental health statistics
- According to WHO: “Worldwide 10-20% (1 in 5) of children and adolescents experience mental disorders. Half of all mental illnesses begin by age 14 and three-quarters by the mid-20s. Neuropsychiatric conditions are the leading cause of disability in young people in all regions.”
- The Child Mind Institute’s 2017 Children’s Mental Health Report focused on the teenage years, which are a period of significant risk for adolescents in the potential development of mental health conditions. As noted by the report, the adolescent brain isn’t fully developed until age 25, and many mental health conditions become apparent before age 24. Increasing understanding around these conditions, as well as combating stigma, will help future generations of children and their parents become more aware of these conditions and potentially seek help at an early stage.
- The Center for Disease Control and Prevention (CDC) has compiled statistics related to childhood mental health disorders and their prevalence over the years. According to its research:
- The most prevalent diagnosed mental health conditions for children between ages 2 or 3 and 17 include ADHD (9.4%), behavioral problems (7.4%), anxiety (7.1%), and depression (3.2%). For some children, these conditions may occur together or simultaneously. Most notably, depression and anxiety commonly occur together, and depression or anxiety occur alongside behavioral problems.
- Additionally, the prevalence of depression and anxiety amongst adolescents and children has increased steadily over time.
- Many mental conditions and behavioral problems can begin between ages 2 and 8. According to the CDC, one in six children between 2 and 8 have a behavioral or mental health condition.
- The rate of depression and anxiety among adolescents increases over time, with many symptoms manifesting between ages 12 and 17. Behavioral problems, however, are more likely to affect children between ages 6 and 11.
- Additionally, boys are more likely than girls to have behavioral issues, and underprivileged children can be more susceptible to the development of mental health conditions either in childhood or later in life.
- The United States Department of Health and Human Services (HHS) Office of Adolescent Health offers additional information on the impact mental health disorders can have on children, youths, and adolescents. Specifically, within adolescents, the prevalence of major depressive episodes (depression lasting longer than two weeks out of a year) have increased by nearly a third from 2005 to 2014. Additionally, suicide has become the second leading cause of death for adolescents between ages 15 and 24, and in 2013 and 2014, adolescents between ages 10 and 14 were more likely to die by suicide than a motor vehicle accident.
Causes of mental illness in children
Biology and brain structure
Psychological or physical trauma
Risk factors for mental illness
Puberty or hormone fluctuations
Poor social skills, antisocial behavior, or communication problems
Family environment, divorce, or marital conflict
Community violence or trauma
Common mental Health Disorders in Children: Signs, Causes, and Treatment
Attention-Deficit/Hyperactivity Disorder (ADHD)
Signs of ADHD/ADD
- Trouble paying attention
- Trouble controlling impulsive behaviors (unable to think of the outcome before taking action)
- Being overly active or physically unable to stay still (specifically for ADHD, as ADD does not have the “hyperactive” component of this condition)
Treatment for ADHD/ADD
Types and signs of anxiety
- Generalized anxiety disorder (GAD): In children and adolescents, GAD may appear as obsession about a variety of things, such as family issues, relationships, grades, performance in school or sports, or about similar subjects. Often children with GAD may describe themselves as “perfectionists” who are hyper-critical of everything they do or say. Children in this category may be very hard on themselves. They may also seek constant approval and praise from peers or authority figures to reassure themselves.
- Panic disorder: Panic disorder is more common in adults, but it can affect children at any age as well. This disorder is characterized by multiple panic attacks that occur, followed by a period (usually a month) of fear that another attack may happen. Panic attacks (also known as anxiety attacks) typically manifest with a rapid heart rate, accelerated breathing, sweating, trembling, chest pain or discomfort, feeling dizzy, nausea, and numbness. Other symptoms may also occur during these attacks.
- Separation anxiety disorder: Separation anxiety is common and normal for young children, as being separated from a parent can be difficult for developing children and toddlers. However, if a child is older and still has trouble leaving the side of a parent or family member, experiences extreme homesickness and feelings of misery when away from the home, or takes longer to calm down after a family member has left for a short time, then separation anxiety disorder may be the cause. The ADAA notes that 4% of children are affected by this condition, and it commonly affects children between ages 7 and 9.
- Social anxiety disorder: This condition is also known as “social phobia,” or the intense fear of social situations and performance activities. For children, this condition may appear as fear of being called on in class, fear of presenting a project in class, or fear of talking with peers. This condition can severely impact a child’s performance, peer relationships, and participation grade in school, but ADAA notes that cognitive behavioral therapy (CBT) is often a beneficial treatment.
- Selective mutism: This condition is characterized by children feeling unable to speak in unfamiliar environments or in school. In comfortable environments, such as the home, the child may not show any symptoms of anxiety, but in school and public situations, they may look away, withdraw to a corner, and be unable to speak. Most commonly, this condition begins to affect children at age 5, as they’re first beginning to attend school.
- Specific phobias: Phobias are feelings of intense, irrational fear of specific situations (such as flying, speaking in public, etc.) or things (dogs, spiders, etc.). Children experiencing a phobia may try to avoid the triggering situation or object or endure them with feelings of intense anxiety. As the ADAA notes, “Unlike adults, [children] do not usually recognize that their fear is irrational.”
- Additionally, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are both closely related to anxiety disorders, but will be discussed in further detail below.
Causes and treatment of anxiety
Conduct disorder (CD)
- An apparent ongoing pattern of aggression toward others
- Consistent and serious violations of rules and social norms either at home, in school, or with peers
Treatment for CD
- Irritability and anger
- Body aches (occasionally)
- Distress when separated from parents
Causes of depression
Treatment for depression
Obsessive-compulsive disorder (OCD)
Signs of OCD
- Persistent, disturbing worries, doubts, or fears
- Unreasonable and repetitive religious rituals
- Uncontrollable, inappropriate thoughts or mental images
- Habits or patterns of behavior that interfere with daily life
- Repeated requests for reassurance
- A need to do things “perfectly” or “just right”
- Problems with lateness or being slow to get ready for school
- Urges to wash, organize, or check on things repetitively
- Urges to hoard objects for no rational reason
- A tendency to avoid specific areas or activities
Causes and treatment for OCD
Oppositional defiant disorder (ODD)
Signs of ODD
- Angry and irritable mood, where the child often and easily loses their temper
- Frequent annoyance by others
- Consistent angriness or resentfulness of others
- Frequent arguments or defiance of adults or people in authority
- Deliberate annoyance of others
- Placing blame on others for their personal mistakes or misbehavior
- Spitefulness and vindictiveness (at least twice in a six-month period)
Cause of ODD
Treatment for ODD
Post-traumatic stress disorder (PTSD)
Signs of PTSD
- Reliving the event repeatedly through thoughts or play
- Nightmares or issues sleeping
- Becoming very upset when memories of the event are brought up or triggered
- Depressive symptoms for a prolonged period following the event, or lack of overall positive emotions
- Intense and ongoing fear or sadness
- Angry outbursts or irritability
- Easily startled or fearful of threats
- Feeling numb or denying the event happened altogether
- Avoiding people or places associated with the event
Treatment for PTSD
Tourette syndrome (TS)
Signs of TS
- Simple tics (affecting only some muscles):
- Eye blinking or darting
- Head jerking or shoulder shrugging
- Nose twitching or mouth movements
- Grunting, throat clearing, barking, or coughing
- Complex tics (affecting multiple muscles or a coordinated pattern):
- Touching or smelling objects
- Repeated observed movements or patterns
- Obscene gesturing
- Bending, twisting, or hopping
- Repeating one’s words, phrases, or the phrases or words of others (known as echolalia, and rare)
- Using vulgar, obscene words (known as coprolalia, and rare)
- The first symptoms are often motor tics in the head or neck area.
- Tics may become worsened in stressful or exciting environments and improve when a person is calm or focused.
- Symptoms will change and develop over time and may appear, disappear, or reappear as the condition is chronic (lasting longer than 3 months).
- Some people may have the symptoms disappear in adulthood, while others may have them throughout their life.