Let’s talk about children’s mental health

May 10 is National Children’s Mental Health Awareness Day. We look at the mental disorders that can affect children and what parents can do to identify and manage them.

We might be a lot more open-minded and accepting of people’s differences than we were a century ago, but certain topics remain taboo – and children’s mental health is one of them. With 13 to 20 percent of children living in the U.S. experiencing a mental disorder in a given year, it’s time to shine some light on this issue.

Half of all mental disorders begin to show signs before the age of 14 and three-quarters appear before the age of 24. Sadly, less than 20 percent of children and adolescents with diagnosable mental health conditions receive adequate treatment. The earlier treatment is started, the more effective it can be and the more likely it is to prevent more severe problems in the future.

Warning signs to look out for

Being aware of the signs and symptoms of mental illness can help you detect any issues your child might be having much earlier on. Talk to your healthcare provider if your child:

  • Feels very sad or withdrawn for more than two weeks
  • Feels frequently anxious or worried
  • Has very frequent tantrums or is very irritable most of the time
  • Experiences sudden overwhelming fear for no apparent reason, which may include a racing heart or fast breathing
  • Has severe mood swings
  • Has trouble sleeping or frequent nightmares
  • Experiences frequent headaches or stomachaches with no physical explanation
  • Loses interest in activities they used to love
  • Avoids their friends
  • Has trouble doing well a school or doesn’t do as well as before
  • Can’t sit quietly and is constantly moving
  • Has low or no energy
  • Fears gaining weight, which may include avoiding eating, throwing up, using laxatives or exercising obsessively
  • Shows a drastic change in behavior or personality
  • Engages in risky behavior that could be harmful to self or others
  • Gets into fights or wants to hurt others
  • Engages in self-harm, such as cutting or burning their skin
  • Smokes, drinks or uses drugs repeatedly
  • Has suicidal thoughts and/or plans
  • Thinks their mind is being controlled or hears voices

These symptoms may be more likely to arise after a difficult life event, so be on the lookout for them after a divorce, the loss of a loved one, a move to a new home or school, a natural disaster or other traumatic event, or when the child is experiencing bullying.

Types of mental disorders affecting children

Here are some of the most common mental health issues experienced by children.

  1. Anxiety disorders

Anxiety disorders involve persistent worries or fears that don’t disappear once stressful situations have passed. They can get worse over time and interfere with school performance and relationships.

There are several types of anxiety disorders. Generalized anxiety disorder (GAD) involves excessive anxiety or worry lasting for several months and can include other symptoms such as restlessness, difficulty concentrating, irritability and being easily fatigued. Panic disorderis characterized by recurrent panic attacks, which may include heart palpitations, shaking, sweating and feelings of being out of control. Social anxiety disorder is marked by an intense fear of social situations in which the child might feel judged, embarrassed, humiliated or rejected by others.

People with obsessive-compulsive disorder (OCD) have recurring thoughts (obsessions) or behaviors (compulsions) they can’t control and which cause them anxiety. These can include obsessive handwashing to get rid of germs, checking that doors are locked over and over, and ordering objects in a precise way.

  1. Attention-deficit/hyperactivity disorder (ADHD)

ADHD is a brain disorder defined by persistent inattention (difficulty focusing and staying on task) and/or hyperactivity-impulsivity (constant moving, fidgeting, tapping or talking; and making hasty decisions or desiring immediate rewards). Some people with ADHD only experience one of the symptoms, while others have both inattention and hyperactivity-impulsivity.

“Benjamin was diagnosed with ADHD when he was in the second grade and it was the biggest relief,” says Grand Rapids mom Julie. “I’d always known his lack of concentration wasn’t due to defiance, but the diagnosis helped to prove that to our family members and his teachers too. He started medication and improved immediately.”

  1. Autism spectrum disorder (ASD)

There’s a lot of debate in the medical community as to whether autism is a mental, neurological or developmental disorder. Because ASD is in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), we’ve included it here.

Children with ASD may have trouble communicating and interacting with others, exhibit narrow interests and repetitive behaviors, and have difficulty functioning properly at school or in other areas of life. But they may also have specific strengths, such as memorizing large amounts of information about topics that interest them, or excelling in subjects such as math, science or art. Find out more about ASD in our Early signs of Autism: What to look for article.

  1. Bipolar disorder

Also known as manic-depressive illness, bipolar disorder is a brain disorder involving dramatic changes in mood, energy and activity levels. Manic episodes featuring extremely energized and euphoric behavior alternate with depressive episodes characterized by sad and hopeless feelings.

  1. Depression

Children with depression will exhibit a sad or “empty” mood for at least two weeks, and they may also experience feelings of hopelessness, worthlessness, pessimism, irritability or guilt. Other symptoms may include decreased energy, difficulty sleeping, appetite changes and suicidal thoughts.

  1. Disruptive mood dysregulation disorder (DMDD)

DMDD is a new diagnosis which first appeared in the DSM-5 published in 2013. It’s a childhood disorder characterized by constant and extreme irritability and anger, as well as intense temper outbursts that go far beyond normal temper tantrums exhibited by other children. The symptoms must be present for 12 months for a diagnosis of DMDD to be administered. Children with DMDD may be more susceptible to anxiety and depression in adulthood.

  1. Eating disorders

Eating disorders cause obsessions with body weight and food. Anorexia nervosa is characterized by severely restricted eating, extreme thinness and a debilitating fear of gaining weight. People with bulimia nervosa alternate periods of binge eating with compensatory behaviors such as forced vomiting, use of laxatives or intense exercise. They often maintain a relatively normal weight. Those with binge-eating disorder lose control and eat large amounts of food, but because they don’t compensate like those with bulimia, they’re often overweight or obese.

  1. Schizophrenia

Schizophrenia is an uncommon but severe mental disorder involving problems with thinking, emotions or behavior. It often includes delusions, hallucinations such as hearing voices, and extremely disordered thinking and speech. Childhood schizophrenia (diagnosed before age 13) can be more severe than schizophrenia diagnosed later in life.

Maryland mom Patty took in baby Krissy as a foster placement when she was 13 months old and she fell in love at first sight. When the official adoption went through two weeks after Krissy’s second birthday, Patty was overjoyed – she’d been wanting a baby for years. But little did she know that the next decade would bring a series of mental health issues and hospitalizations that kept increasing in severity. Despite it all, Patty never gave up on her daughter.

“As of April 2018, Krissy has had 300 days without being inpatient,” says Patty. “That’s the longest time she has been out of the hospital in four years. Our goal? To make it through Mother’s Day at home. Is Krissy ‘fixed’? No. She’ll struggle for the rest of her life. She still takes 15 pills a day to treat her schizophrenia and I still sleep holding her hand as I have for years. But together, our family’s love is strong enough to fight because her story isn’t over yet!”

What to do if you’re concerned about your child’s behavior

The first step is to talk to your family doctor about the symptoms that are worrying you and find out whether you should see a specialist for further evaluation. If your doctor recommends a specialist, make an appointment without delay. The specialist may recommend psychotherapy or medication, or a combination of both, to treat your child’s symptoms.

You can also talk to your child about how they’re feeling by asking them open-ended questions such as: Can you tell me how you’re feeling? Have you felt like this in the past? I’m here to listen – how can I help you feel better? Is there another adult you’d prefer to talk to?

For more resources on children’s mental health, as well as crisis lines you can call for help, head to MentalHealth.gov. If the situation is life-threatening for you or your child, call 911 right away.