The Types of Mental Health Problems in Children

It is important to keep in mind that one in four people will experience a mental health problem and although some individuals are more susceptible to them, anyone can develop any mental health problem at any point in their life.

The scope of this course is not large enough to consider all forms of mental illness and what their signs, symptoms and effects might be, so those which have been included are those which are more common or are misunderstood.

There is clear crossover between signs and symptoms in some of the conditions that are included, which highlights the importance of the individual being thoroughly assessed when they present to any medical professional so that the treatment and support that they receive is in line with the illness that has been identified.

How children’s mental illness differs from adults

The prevalence rate of mental illness in children is 1 in 10, which is lower than it is for adults where the prevalence rate is about 1 in 4.

However, the impact of mental illness on children is very similar to the impact on adults in that it can affect children’s ability to go about their normal daily routine and so can disrupt many different areas of their life.

For children, the signs and symptoms of some mental illnesses may be slightly different but, again, they are similar to those that would be expected in adults.

For children, early intervention when a mental health problem is identified is key so that it does not go on to affect them into adulthood. It is thought that about half of adult mental health problems begin before the age of 14 and when they are not treated and managed successfully, they have the potential to impact the child for the rest of their lives.

Depression

Depression is a major disorder that is thought to affect approximately 1 in every 10 people within the United Kingdom at some point in their life.

When it is being clinically diagnosed, health professionals will use the definition from the Diagnostic and Statistical Manual for Mental Disorders (DSM) in order to decide if someone has the condition: “Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks. The mood represents a change from the person’s baseline and they will also have impaired function: social, occupational, educational.”

In children, depression can be caused by a wide range of factors but some of the factors that are most likely include a combination of two or more of the following – depression is almost never caused by a single factor:

• Family problems.
• Poor physical health.
• Bullying and/or abuse.
• A history of mental health in a family.
• A traumatic incident.
• A difficult environment, such as living in an area with a high rate of crime or no outside spaces.

Common signs and symptoms of depression in children include:

• Sadness or low mood that does not go away.
• Being irritable a lot of the time.
• Not being interested in things that used to bring enjoyment.
• Unexplained physical ailments such as headaches and joint pain.
• Feeling tired and exhausted.
• A change in sleeping pattern.
• A change in eating habits.
• Inability to concentrate.
• Less socialising with friends.
• Lowering of confidence.
• Feeling guilty or worthless.
• Being emotionally numb.
• Having thoughts about self-harm or suicide.
• Actual self-harm or suicide attempts.

Many of these signs and symptoms are common to some children who may just be having a difficult time because of puberty or a single temporary issue that is taking place in their life, and so it can be hard to determine if a child has depression or if they are simply feeling low.

Children should, however, be monitored to check that their behaviour is not changing to a point where it is impacting their ability to go about their everyday life.

Children who are affected by depression

Children who are affected by depression are more likely to be affected by poor mental health into adulthood, particularly if they are unable to effectively treat symptoms in childhood.

The effects of depression are wide ranging and can include:

• Poor performance at school, leading to missed exams or not reaching potential when sitting exams.
• Withdrawal from friends.
• Increase in physical illnesses.
• Higher potential for exclusion from school.
• Increased risk of misuse of drugs or alcohol.
• Self-injurious behaviours.
• Increased risk of becoming involved in the criminal justice system.
• Increased risk of self-neglect.

Anxiety

Anxiety has various definitions but in its most general sense, it refers to a feeling of fear and dread. This is perfectly normal to experience when a situation warrants it but anxiety can become a mental health condition when it is experienced to a point where it impacts a person’s ability to go about their normal daily tasks.

It is particularly an issue when someone cannot work out why they are feeling anxious and in instances where it leads to panic attacks.

The source of anxiety in children, just like for any other mental health problem, can vary enormously.

Some of the most common causes of anxiety are thought to include:

• Transitions such as moving house or school.
• A traumatic experience.
• Family conflict.
• Social gatherings.
• Bullying and/or abuse.

Common signs and symptoms of anxiety in children include:

• Being irritable or clingy.
• Problems going to sleep or staying asleep.
• Wetting the bad.
• Having nightmares.
• Significant changes in behaviour.
• Lacking confidence, especially when facing new things.
• Problems with memory and concentration.
• Outbursts of anger.
• Having a lot of negative thoughts.
• Avoiding friends and/or activities.
• Changes in sleeping and eating habits.

Anxiety can be a very isolating condition and because of this one of the major effects that it has on someone is that they do not want to go out or socialise in any way at all.

Avoiding situations can mean that someone’s behaviour changes in order to avoid what it is that they fear will bring them anxiety; this, unsurprisingly, is known as developing ‘avoidant behaviours’.

These types of behaviour include typical anxiety behaviours as well, of which some examples are:

• Avoiding people or places.
• Staying at home.
• Going to certain places at certain times, such as when there are less people or when they have just opened.
• Only going out when accompanied by someone else.
• Using negative coping strategies such as drinking or misusing drugs.

Children may or may not know that they are experiencing avoidant behaviours as some will genuinely not realise that they have changed. Children can be supported to be self-aware in relation to their feelings and behaviours, but a lot of the time they may rely on others to support them to identify that they are unwell.

Impacts of anxiety

Another one of the most significant harmful effects of anxiety is the weakening effect that it has on the immune system. Cortisol is released when someone is undergoing stress (which is what happens when someone feels anxious) and when this hormone does not have time to get back to its original level because the anxiety is ongoing, it has been shown to impact the immune system, leaving children prone to infection and many other types of illness.

As well as harmful physical effects, anxiety can also cause harmful mental health effects as well. For example, it is directly linked with stress and depression and these are the most common mental health problems within the UK at the moment, said to affect one in five individuals during their lifetime. It is also linked with various panic disorders, which can have a negative effect on anyone’s ability to live their life in a normal way.

Parents who experience anxiety

Parents of children who experience anxiety can find that the challenges of trying to support them and the constant worry about them can mean that they actually develop a mental health difficulty of their own. Additionally, parents may find that they are in conflict with each other about how best to support their child and they may find they have become isolated if they cannot take their child out anywhere because of their child’s anxiety.

Conditions which may increase incidents of mental health difficulties

There is consistent misunderstanding about some conditions in terms of whether or not they are mental health problems.

Autism and ADHD are not mental health problems but each one does have the capacity to increase a child’s risk of developing a mental health problem.

• Autism: This is a condition where individuals have difficulties with social interactions, fixed behaviours and communication. Individuals will not always develop a mental health condition if they live with autism but the chances of this happening are increased; for example up to 40% of people with autism develop anxiety, and due to rigid behaviours the chances of OCD developing are also significantly higher in this group of people than they are in the general population. Depression can develop if individuals do not feel as though they are understood, have problems forming relationships or cannot come to terms with being ‘different’ from others and have no one to speak to about what upsets them.
• ADHD: ADHD is a behavioural condition that is mostly diagnosed in boys. It is a condition that causes someone to have problems in regulating their behaviour, problems with concentration and with making and maintaining relationships. ADHD is closely linked with anxiety and, in some individuals, poor regulation of behaviour can cause an increase in the risk of developing an eating disorder. As with autism, it can lead to depression if the child or adult does not feel as though they have support or that they have meaningful relationships.

Trauma and childhood PTSD

Just like in adults, PTSD can come about in children because of a situation that they have perceived to be traumatic. They need not be directly involved in such a situation; simply hearing about it or witnessing it can bring about traumatic stress.

Some of the incidents that are likely to cause PTSD in children include:

• Road accidents.
• Assault.
• Invasive medical procedures.
• Serious injuries.
• Witnessing a crime.
• Abuse.
• Bullying.
• Exploitation.
• Neglect.
• Threats of death.
• The death of a parent or other close individual.
• Diagnosis of a serious illness, either their own or that of a close individual.
• Natural disasters such as an earthquake.
• Animal bites.
• Terror related incidents.

As children are often not able to process or understand their emotions in the same way as most adults, they may be more prone to developing secondary trauma, which comes about due to indirect exposure to a traumatic incident.

For example, a child may witness a parent being subjected to domestic violence; they may see or hear a parent being beaten or threatened and the effect of this, alongside feelings of anger and guilt and not being able to do anything to stop the perpetrator, can be significant factors in the development of trauma.

Secondary trauma should be taken just as seriously as PTSD as the impact that it can have on the child in both the short and long term are likely to be the same.

Many of the symptoms of PTSD in children are similar to those which are identifiable in adults, such as:

• Flashbacks.
• Nightmares.
• Trembling.
• Numbness.
• Sweating.
• Nausea.
• Diarrhoea.
• Palpitations.
• Headaches.
• Hyperarousal, which is a constant feeling of being on alert or on edge that makes the individual easily startled.
• Hyper vigilance, where the individual feels the need to be constantly aware of what is going on around them.
• Irritability.
• Angry outbursts.
• Worrying about death and dying.
• Loss of touch with reality.
• Insomnia.

In children, however, there are some other signs of PTSD which may indicate that a child is having difficulties coping after a traumatic event. Children cope differently depending on their age and on other factors such as how much support they have.

Therefore, it is important to also keep in mind that some children may not feel the effects of trauma for some time after the event has taken place, which may make it difficult for caregivers to make the link between the child’s later behaviour and their experience of trauma.

Some of the specific signs of PTSD that may be identified in children include:

• Becoming fearful about being separated from their parents.
• Regressing back to bedwetting and thumb sucking.
• Preoccupation with memories of the event.
• Inability to concentrate.
• Irritability.
• Disobedience.
• Physical symptoms with no apparent cause such as headaches and stomach aches.
• Withdrawal from friends.
• Extreme temper tantrums.
• Problems with falling asleep or staying asleep.
• Reliving the event in play or drawings.

Behavioural changes

Changes in a child’s behaviour can be indicative of a mental health problem but it is important to keep in mind that what is abnormal behaviour for some children is normal for others.

So, whilst some types of behaviour may be a cause for concern for some children; they may not be for all. The important point is to identify any behaviour that changes without an overt cause, as this may be a sign that the child is experiencing mental health problems.

Examples of behavioural changes include:

• Not wanting to socialise.
• No longer doing previously enjoyable activities.
• Being involved in conflict, for example with parents and/or teachers.
• No longer completing schoolwork.
• Staying out late.
• Risk-taking behaviours.
• Excessive aggression.
• Self-neglect.
• Self-harm.
• Substance misuse.

Behavioural changes

In cases where a child may be experiencing a more serious form of mental illness such as schizophrenia or bipolar disorder, their behaviour may change so that they:

• Have hallucinations, such as seeing, hearing, feeling or smelling things that are not there.
• Speak to someone who is not there.
• Cause destruction to property.
• Develop disorganised speech.
• Have extreme agitation.
• Suffer from delusions.
• Experience apathy (a severe lack of interest in life activities).

Impacts into adulthood

The impact on children’s mental health into adulthood is significant and there are many ways in which it can be affected:

• Trust: Children find it harder to see the world as a safe place and may therefore not want to maintain relationships with others. This makes them more vulnerable to isolation, which is a key element in the onset of mental health problems. It also means that they won’t have a support network, which is important for mental well-being.
• Management of stress: Abuse can affect resilience and so when stressful situations occur, these are not dealt with effectively and stress can become the foundation of more serious mental health issues, often linked with anxiety and depression.
• Impulsivity: Children who are impacted by abuse may take part in risk-taking behaviours, the consequences of which can impact mental health. For example, using alcohol or drugs as coping strategies or becoming involved in the criminal justice system.
• Dissociation: This is a term that refers to when the mind somehow separates itself from what is happening in a person’s life so that they are able to better cope with negative events and emotions. It can make both adults and children feel as though what is going on around them is not connected to them and is a common reaction to pain, fear and distress.
• Self-harm: Children may injure themselves but without wishing to take their own lives. Often self-harm takes place as a way of trying to control things or to draw attention to the fact that the child is distressed and in pain.
• Substance misuse issues: Children who survive childhood abuse are more likely to develop misuse issues with drugs and alcohol and this is more likely to happen from a younger age as well.

If you would like to find out more about how to support a child suffering from mental health problems.