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CHILDHOOD DISORDERS

The natural instinct of parents is to protect their children, whose happiness and well-being is of paramount importance. Thus, parents whose children have mental or emotional problems may tend to ask, "What did I do wrong?" Most people would consider childhood to be a happy, trouble-free time of life, so parents could almost be expected to blame themselves. But the causes of mental illnesses are complex and never due to any single factor.

Children do suffer from disorders once thought only to affect adults. From 3 to 6 million children suffer from clinical depression. Suicide is a major concern: 14 young people commit suicide every day. Autism affects between 200,000 and 300,000 children; learning disorders affect millions. Presented here are an overview and the symptoms of mental illnesses that can be seen in children, as well as available treatments.

Depression
As many as one in 10 children between ages 6 and 12 experience persistent feelings of sadness - the hallmark of depression. Since children may not be able to express or understand many of the core symptoms that would indicate depression in adults, parents should be aware of some key behaviors - in addition to changes in eating or sleeping patterns - that may signal depression in children:

• A sudden drop in school performance
• Loss of interest or pleasure in activities once enjoyed
• Outbursts of shouting, complaining, unexplained irritability, or crying
• Thoughts of death or suicide
• Expressions of fear or anxiety
• Aggression, refusal to cooperate, antisocial behavior
• Use of alcohol or other drugs
• Constant complaints of aching arms, legs, or stomach with no apparent cause

Treatment is essential for children struggling with depression so that they can be free to develop necessary academic and social skills. During psychotherapy, children learn to express their feelings and to develop ways of coping with their illness. Some children also respond to antidepressant medications, but use of these medications must be closely monitored. Psychiatric medication should not be the only form of treatment but rather should be part of a comprehensive program.

Attention-Deficit/Hyperactivity Disorder (ADHD)
The main features of ADHD include hyperactivity, impulsiveness, and an inability to sustain attention or concentration. These main symptoms occur at levels that cause significant distress and impairment and are far more severe than typically found in children of similar ages and developmental levels. ADHD is found in 3% to 5% of all school-age children. Much more common in boys than in girls, this disorder often develops before age 7 but is most often diagnosed when the child is between ages 8 and 10. Children with ADHD:

• Have difficulty finishing any activity that requires concentration
• Don’t seem to listen to anything said to them
• Are excessively active - running or climbing at inappropriate times, squirming in or jumping out of their seats
• Are very easily distracted
• Talk incessantly, often blurting out responses before questions are finished
• Have serious difficulty waiting their turn in games or groups

In addition, children with ADHD may have specific learning disabilities, which can lead to emotional problems as a result of falling behind in school or receiving constant reprimands from adults or ridicule from other children.

Treatment can include the use of medications, special educational programs to help the child keep up academically, and psychotherapy. Between 70% and 80% of children with ADHD respond to medications, which allow them a chance to improve their attention span, perform tasks better, and control impulsive behavior. As a result, children get along better with their teachers, classmates, and parents, which, in turn, improves their self-esteem. Psychotherapy enables children to cope with their disorder and the reaction of others to it. An essential component of psychotherapy involves the work of the child psychiatrist with both the child and the parents to develop techniques for behavior management.

Anxiety
Nearly all children develop fears of the dark, monsters, witches, or other fantasy images. Over time, these normal fears fade. But when these fears persist or when they begin to interfere with a child’s normal daily routine, professional attention may be needed.

Simple Phobias
Simple phobias are overwhelming fears of specific objects (such as an animal) or situations (such as being in the dark). These are very common among young children: nearly half of all 6- to 12-year-old children have seven or more fears. These are not phobias, however, since these fears do not cause substantial distress or impairment. In fact, few children who suffer from fears or even mild phobias get treatment. However, professional attention should be sought if, for example, a child is so afraid of dogs that he or she is too terror-stricken to go outside, no matter whether there is a dog nearby or not.

Effective relief from phobias can be gained through medication or behavior therapy. Behavior therapy involves confronting the feared object or situation in a carefully planned, gradual way as well as learning to control the physical reactions of fear.

Separation Anxiety Disorder
As the name implies, children with separation anxiety disorder develop intense anxiety, even to the point of panic, when separated from a parent or other loved one. It often appears suddenly in a child who has shown no previous signs of a problem. This anxiety is so intense that it interferes with children’s normal activities. When these children are separated from a parent, they become preoccupied with morbid fears that harm will come to them or that they will never be reunited. Separation anxiety may give rise to what is known as school phobia, where children refuse to attend school because they fear separation from a parent.

Medications can significantly reduce the anxiety and allow these children to return to the classroom. These medications may also reduce the physical symptoms that many of these children feel, such as nausea, stomachaches, or dizziness. Psychotherapy also has been found useful for reducing and helping the child overcome the anxiety caused by separation.

Conduct Disorder
Children with conduct disorder exhibit behavior that shows a persistent disregard for the norms and rules of society. Conduct disorder, one of the most frequently seen mental disorders in adolescents, affects approximately 6% to 16% of boys and 2% to 9% of girls under age 18.
Because the symptoms are closely tied to socially unacceptable or violent behavior, many people confuse this illness with either juvenile delinquency or the turmoil of the teen years. However, young people with conduct disorder often have underlying problems that have been missed or ignored, such as epilepsy or a history of head and facial injuries. Children who have demonstrated at least three of the following behaviors over 6 months should be evaluated for possible conduct disorder:

• Stealing
• Constantly lying
• Deliberately setting fires
• Skipping school
• Breaking into homes, offices, or cars
• Deliberately destroying others’ property
• Displaying physical cruelty to animals or humans
• Forcing others into sexual activity
• Often starting fights
• Using weapons in fights

Appropriate treatment for conduct disorder is essential. Aimed at helping young people realize and understand the effect their behavior has on others, treatment includes behavior therapy and psychotherapy, in either individual or group sessions. Some youngsters have depression or ADHD in addition to conduct disorder. For these children, use of medications as well as psychotherapy has helped lessen the symptoms of conduct disorder.

Autism
Children with autism, which strikes as many as five out of every 10,000 children, have a dramatically impaired ability to communicate and interact with others. The level of activity and range of interests of these children are also extremely limited. Autism is generally apparent by the time the child is 2½ years old. It is three times more common in boys than in girls.
As infants, children with autism don’t cuddle and may even stiffen and resist affection. Many don’t look at their caregivers and may react to all adults with the same indifference. On the other hand, some cling tenaciously to a specific individual. In either case, children with autism fail to develop normal relationships with anyone - not even their parents.

As they grow, these children also fail to develop friendships and generally prefer to play alone. Children with autism cannot communicate well because they never learn to talk, they don’t understand what is said to them, or they speak a language all their own. Sometimes they may repeatedly say phrases or words they have heard in conversation or on television. Some also go through repetitive body movements such as twisting or flapping their hands and arms or banging their heads. Some children become preoccupied with parts of objects, or they may become extremely attached to an unusual object such as a piece of string or a rubber band. They become distressed when any part of their environment is changed. Likewise, these children insist on following rigid routines in precise detail.

Although the illness is chronic, different therapies can be of benefit in treating many of the symptoms of autism. Early identification and intervention can help children with autism maximize their potential.

It is unfortunate that childhood offers no protection against mental illnesses. For parents, the key to handling these childhood disorders is to recognize the problem and seek appropriate treatment. As with other types of illnesses, mental disorders have specific diagnostic criteria and treatments, and a complete evaluation by a child psychiatrist can determine whether a child needs help.

Other Sources of Information

American Academy of Child and Adolescent Psychiatry
3615 Wisconsin Avenue, N.W.
Washington, DC 20016
(202) 966-7300

American Academy of Pediatrics
P.O. Box 927
Elk Grove Village, IL 60007
(847) 228-5005

American Pediatrics Society
3400 Research Forest Drive, Suite B7
The Woodlands, TX 77381
(281) 296-0244

Association for the Care of Children’s Health
19 Mantua Road
Mt. Royal, NJ 08061
(609) 224-1742

Child Welfare League of America, Inc.
440 1st Street, N.W., 3rd Floor Washington, DC 20001 (202) 638-2952

© Copyright 1999 American Psychiatric Association ISBN 0-89042-360-1

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NAMI (National Alliance for the Mentally Ill)
Colonial Place Three
2107 Wilson Blvd. - Suite 300
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(703) 524-9094 (fax)
NAMI HelpLine: 1-800-950-NAMI (6264)
http://www.nami.org

National Autism Society of America
7910 Woodmont Avenue, Suite 650
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(800) 328-8476

National Institute of Mental Health
Information Resources and Inquiries Branch
5600 Fishers Lane, Room 7C-02
Rockville, MD 20875
FACTS ON DEMAND: (301) 443-5158
http://www.nimh.nih.gov

National Mental Health Association
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(800) 969-NMHA
http://www.nmha.org