About Mental Illness

Childhood Disorders
A fact sheet produced by the Mental Health Information Service

Childhood is often associated with happiness and trouble-free fun, so when a child is diagnosed with a mental illness, the parents often feel like they've done something wrong, like it's their fault. This isn't always the case though, as the causes of mental illness are complex and never involve only one factor. Most disorders are not specific to childhood or adolescence, however the symptoms usually develop during this period.

STATISTICS

	1 in 10 children between the ages of 6 and 12 experience persistent feelings of sadness
	11.2% of all children have the symptoms of Attention Deficit Hyperactivity Disorder
	Approximately 3% of children 17 & under have a conduct disorder
	Autism occurs in as many as 5 out of 10,000 children
	Up to 10% of women suffer an eating disorder during adolescence, less for men
	1 in 10 children have some sort of learning disability

As you can see, you are not alone if your child has a mental illness. Here are some facts about the more common forms of mental illness in children and adolescents.

DEPRESSION

Depressive disorders occur less frequently in children than adults, but rise dramatically in adolescence where depression is more frequent than adults. Parents need to be aware of the symptoms that may signal depression in children, as children may not be able or willing to express their feelings.

Symptoms may include:

	A marked drop in school performance
	Loss of interest in activities once enjoyed
	Sudden outburst of anger, aggression and/or crying
	Suicidal thoughts
	Excessive fear or anxiety
	Abuse of alcohol, drugs and/or self
	Constant physical complaints with no apparent cause
	Excessive concentration on studying or avoiding contact with friends

Treatment of depression is essential, as childhood and adolescence is a time where people learn their social and academic skills. Through the use of psychotherapy and sometimes medication, children and adolescents can learn to express their feelings and develop coping strategies to deal with their illness, hence improving their self-esteem and prospects for their future. Early diagnosis is extremely useful and can mean a minimal disturbance of typical functioning.

ANXIETY

Nearly all children develop fears of the dark, monsters, witches or other fantasy characters. Usually these fears fade away with age, however sometimes they may linger and interfere with a child's functioning. For children, this can be a traumatic time, professional intervention may be needed. Below is an outline of the more common childhood anxieties. 

SIMPLE PHOBIA

A simple phobia is an overwhelming fear of a specific object, for example an animal or a kitchen object. Nearly half of all children report having fears, and many more have phobias but don't get treatment. A simple phobia only becomes a problem when it interferes with the child's daily life, for example, when a child is too afraid to go outside at all for fear of being attacked by a dog, whether there is a dog around or not. When the child reaches this point, it is probably time to seek professional intervention. Treatment is usually through medication and/or behaviour therapy. Behaviour therapy is where the child is exposed to the feared object in a carefully controlled environment, the purpose being to reduce and control the child's fear.

SEPARATION ANXIETY DISORDER

Children can develop an attachment to a caregiver so strong that they experience intense anxiety and panic upon separation. This anxiety is so strong that it interferes with the child's ability to function normally, and can develop into a flat refusal to go to school for fear of permanent separation. Some of the more common symptoms that can occur are:

	Constant thoughts and fears about safety of self and/or parent
	Refusing to go to school
	Frequent stomach aches and other physical complaints
	Extreme worries about sleeping away from home
	Overly clingy behaviour at home
	Panic or tantrums at times of separation from parents

Parents should be alert to the signs of severe anxiety so they can intervene early to prevent complications. Early treatment can prevent future difficulties, such as, loss of friendships, failure to reach social and academic potential, and feelings of low self-esteem. Severe anxiety problems in children can be treated. Treatments may include a combination of the following: individual psychotherapy, family therapy, medications, behavioural treatments, and consultation with the school. 

GENERALISED ANXIETY DISORDER (GAD)

Generalised anxiety disorder is marked by unrealistic and excessive worry, accompanied by constant and often unnecessary concern about anything or everything. Less frequent in children, the irrational worry is accompanied by a feeling of constant apprehension. 

PANIC DISORDER

Panic attacks occur when the body gives off the same distress signals that occur when a person is faced with a life-threatening or similar event - yet no such trigger is present. This means that a person may be sleeping, relaxing or just going about their daily business when they suddenly feel some or all of the symptoms of a panic attack including: chest pain, palpitations, trembling legs. The person may feel they are going crazy or that they are about to have a heart attack.

AGORAPHOBIA

Agoraphobia is an anxiety disorder characterised by an uneasiness, fear or dread about leaving familiar surroundings. This may include a reluctance to travel, particularly on public transport, or to be in crowded places.  It is associated with severe physical symptoms of anxiety and panic attacks. It is a condition related to anxiety, depression, panic and other phobias.

OBSESSIVE COMPULSIVE DISORDER

Obsessive Compulsive Disorder is an Anxiety Disorder that is mainly characterised by intrusive thoughts (obsessions) and behaviours (compulsions). Individuals with OCD are besieged by patterns of unwanted, repetitive thoughts and repetitious behaviours that are distressing and difficult to ignore or overcome completely.

Adolescents and parents of children who seem to be exhibiting signs of an anxiety disorder should contact a child and adolescent psychiatrist, or their local mental health center. Telephone information and support lines can also provide valuable information and advice about anxiety and children, contact.

OPPOSITIONAL DEFIANT DISORDER

Many children can be oppositional or difficult from time to time. Oppositional Defiant Disorder is diagnosed when there is a history of continuous uncooperative and hostile behaviour that stands out when compared to other children of the same age and developmental level. This behaviour can adversely affect the child's social, family, and academic life and cause problems for parents, family and careers.

Children who exhibit a number of the following symptoms should be assessed for the possibility of OCD:

	Problems controlling temper
	Contnually argues with adults
	Actively defies or refuses to comply with adults' requests or rules
	Deliberately annoys people
	Blames others for his or her mistakes or misbehaviour
	Is touchy or easily annoyed by others
	Angry and resentful
	Spiteful and vindictive

CONDUCT DISORDER (CD)

Children with Conduct Disorder exhibit behaviour that shows a persistent disregard for the norms and rules of society and other people's basic rights. Conduct disorder, one of the most frequently seen mental disorders in adolescents, affects approximately 3% of adolescents under 17.

Children who exhibit a number of the following behaviours should be assessed for the possibility of conduct disorder:

	Stealing
	Constantly lying
	Deliberately lighting fires
	Truancy
	Deliberate cruelty to animals and/or humans
	Disregard for other people's property and self
	Starting conflicts
	Forcing others into sexual acts

Appropriate treatment for conduct disorder is essential. Treatment is by behaviour therapy and psychotherapy, either individual or group sessions. Conduct Disorder is distinct from ADHD and other personality disorders, however there is a high rate of co-morbidity. Medications are sometimes used. More information can be obtained from your local Pediatrician or community health center.

ARE ODD AND CD CONNECTED?

CD is sometimes considered to be a harsher form of ODD. Severe ODD could possibly become CD. When a child has CD there are usually safety concerns. Behaviour can become dangerous to the individual, their families and to other people in the community. Children with ODD are often annoying, but not especially dangerous. Carers of children with CD disorder often do not feel entirely safe around them and are often concerned about possible damage to their property and belongings.

AUTISM (SPECTRUM DISORDERS)

Autism Spectrum Disorders (ASD), also known as Pervasive Developmental Disorders(PDDs) include, autistic disorder, pervasive development disorder not otherwise specified (PDD-NOS) and Asperger sydndrome. Also included are two very rare disorders, Rett syndrome and childhood disintegrative disorder. This group of disorders are usually first diagnosed in early childhood and comprise a vast range of severity in the way they cause impairment in a child's thinking, feeling, language, and the ability to relate to others. Autism becomes apparent at around the age of 2 ½. It is marked by a dramatically impaired ability to communicate and interact with others. Children with autism also have a low level of activity and range of interests. These disorders do not have a single cause; instead, it is likely that a number of biological and psychosocial influences are involved.

Some of the symptoms are:

	Never learn to talk properly
	May repeatedly say a word or phrase heard in a conversation or TV
	Repetitive body movements
	Attachment to an unusual object (e.g. string)
	Extreme distress at a change in their environment

Parents are usually the first to notice something is different about their child. Sometimes a baby may seem 'different' from birth. There may be signs of disinterest in people or objects or they may seem to focus closely on one item for lengthy periods. Sometimes symptoms can appear in children who had previously been developing normally.

Symptoms may include:

	Impaired communication
	Impaired comprehension
	Flat facial expression and vocal tone
	Repetition of heard phrases and words
	Difficulties maintaining eye contact
	Difficulties initiating and sustaining conversation
	Very specific and unusual preoccupations and attachments
	Extreme preference for routines

There are many different therapies that seek to improve the individual symptoms of Autism Spectrum Disorders. Early detection and intervention is essential to help maximise a child's potential. For more information, it is best to contact a Child and Adolescent psychiatrist through your local Pediatrician.

LEARNING DISABILITIES

Whilst learning disabilities are not mental illnesses, some of the signs and symptoms may mimic, or co-exist with, mental illness. Children with learning disabilities are usually within the general range of intelligence. They may try hard at school and home, but never seem to master tasks. It is believed that learning disorders are caused by a irregularity within the nervous system, interfering with the receiving, processing and communication of information. Some children with learning disorders are also hyperactive and have a short attention span.

Some common symptoms are:

	Difficulty understanding and following instructions
	Trouble remembering what someone just told him or her
	Failing to master reading, spelling, writing, and/or math skills, and thus fails schoolwork
	Difficulty distinguishing right from left; difficulty identifying words or a tendency to reverse letters, words, or numbers, for example, confusing 25 with 52, 'b' with 'd', or 'on' with 'no'
	Lacking coordination in walking, sports, or small activities such as holding a pencil or tying a shoelace
	Easily loses or misplaces homework, schoolbooks, or other items
	Cannot understand the concept of time; is confused by "yesterday," "today," "tomorrow."

A child and adolescent psychiatrist who specialises in learning difficulties can evaluate the child, and work with school professionals and others to determine the existence and extent of any learning disorder. They can make recommendations for special educational requirements, speech therapy and learning techniques. It is important to address this problem, as it can affect a child's self-confidence, hence future potential. Further help and referrals can be obtained through your local Pediatrician.

SLEEP PROBLEMS

Many children have sleep problems. Some examples are:

	Frequent awakening during the night
	Talking during sleep
	Difficulty falling asleep
	Waking up crying
	Feeling sleepy during the day
	Nightmares
	Bedwetting
	Sleepwalking

As most parents will know, these symptoms are fairly standard occurrences for children. Normally they are due to irregular sleeping habits, separation anxiety or emotional difficulties. Whilst feeding and rocking a child to sleep is beneficial, it is not a long term solution. If the problem interferes with the child's regular activities, or occurs several times a night, it could be beneficial to see your local Pediatrician, or a child and adolescent psychiatrist. Fortunately, most sleep problems tend to disappear as the child gets older.

REFERENCES

	American Academy of Child and Adolescent Psychiatry www.aacap.org
	American Psychiatric Association www.psych.org
	Autism Association of NSW, www.autismnsw.com.au
	The National Institute of Mental Health (NIMH) US Department of Health and Human Services
	Barlow, D.H. and Durand, V.M. (1999) Abnormal Psychology 2nd Edition Brooks/Cole Publishing USA
	The Mental Health of Young People in Australia National Survey of Mental Health and Wellbeing, October 2000

DISCLAIMER
The information provided is to be used for educational purposes only. It should not be used as a substitute for seeking professional care in the diagnosis and treatment of mental health disorders. This information is reproduced from the Mental Health Association NSW. This, and other fact sheets are available for download from www.mentalhealth.asn.au. This fact sheet was last updated in June, 2005.