Mental illnesses in children: Symptoms, therapy

Brief overview

  • Definition: mental abnormalities that have a negative impact on the child’s daily life and from which the child suffers.
  • Forms: age-independent forms such as depression, anxiety disorders, bipolar disorder, eating disorders (such as anorexia), obsessive-compulsive disorder. Age-dependent forms specific to childhood such as ADHD, oppositional behavior disorder, social behavior disorder, autism, Rett syndrome, fragile X syndrome, attachment disorder, language disorders, tic disorders.
  • Symptoms: e.g. sudden social withdrawal, seemingly causeless, persistent sadness, loss of interest, listlessness, frequent tantrums, wetting after a permanent dry phase
  • Diagnosis: medical interview, medical examinations, behavioral observation, psychological tests.
  • Treatment: usually multimodal with (family) psychotherapy, if necessary medication and accompanying social, speech or mobility support measures

Mental illness in children: Definition

Only when such conspicuousnesses accumulate and turn from the exception to the rule should parents and caregivers become alert and take a closer look: Are the negative feelings interfering with the child’s life and daily routine? Is he or she suffering as a result? If this is the case, there may be a mental illness.

Frequency

Mental health problems are observed more frequently in boys than in girls. This is especially true between the ages of three and 14.

Forms of mental illness: Age and gender differences

Age and gender also have an influence on which type of mental abnormalities or illnesses dominate among young people:

  • Mental disorders in young children under four years of age are mostly based on developmental disorders.
  • Depression, eating disorders, and addictions dominate among youth ages 15-18.

Boys are more likely to develop ADHD (about four times as often as girls), aggressive behavior disorders, and addictive disorders, while eating disorders, psychosomatic illnesses, and depression predominate among girls.

Mental illnesses in children: symptoms

But how can mental disorders in children be recognized, which symptoms are among the warning signs? And does the child have a mental disorder with typical symptoms or is it a temporary behavioral disorder?

A look at the symptoms, which can be alarm signs for a mental illness, helps to distinguish between the two. It is important that parents, educators, teachers and other caregivers react sensitively to such warning signals.

A first possible sign is a sudden persistent change in the child’s behavior. If your child suddenly withdraws, is sad, loses interest in hobbies, playing or previous favorite activities, has unusually frequent tantrums, or if children who were actually “dry” wet the bed again, a mental disorder may be behind it.

  • How long has the child been showing altered behavior? Only if the changed behavior persists over a longer period of time (several weeks), there may be a mental disorder behind it.
  • How often do the abnormalities occur? Information about the frequency of the conspicuous behavior is helpful for the first discussion with the pediatrician or psychiatrist. Therefore, note in a calendar when your child behaves in a psychologically conspicuous manner.
  • How serious is the problem? Ask yourself and your child how intense the abnormalities are. A scale of 1 to 10 can be helpful, with 1 being the weakest and 10 the most severe.
  • Are there known triggers for the problematic behavior? What helps to eliminate the symptoms? If you know what triggers your child, you can temporarily avoid triggering situations or events. In the long run, however, avoidance behavior is not a solution. If the problematic behavior does not improve after some time, you should consult a specialist.
  • Do you think you can solve the problem on your own or do you need help? Mental abnormalities and the associated worries can be very stressful – for you and for your child. Therefore, do not be afraid to seek medical help early on.

Mental illness in children: Diagnosis

Medical history

In the first step, the specialist will conduct a detailed interview with you and your child to obtain a medical history (anamnesis). The following information, for example, is important:

  • What mental abnormalities are you concerned about?
  • How, when, how often and in which situations do the problems manifest themselves?
  • Do you or your child suspect certain triggers behind the problems?
  • Does your child suffer from the changes?
  • Is your child known to have a physical or mental illness?
  • In which family and social environment does your child live? For example, does he or she have stable relationships and caregivers?
  • Have there been recent changes in this environment, for example deaths, divorce or similar?

With your consent, the doctor may also talk with relatives, teachers, or caregivers to get as complete a picture of your child as possible.

Behavioral observation

In the next step, the specialist may recommend a behavioral observation. For example, he or she may ask you to observe and record your child’s eating or playing behavior over a certain period of time.

Medical examinations

Psychological tests

Numerous aspects of a child’s development can be assessed with the help of standardized psychological tests, for example the development of language, mental abilities, movement skills and reading, spelling and arithmetic skills.

The physician can also examine personality traits or abnormalities with the help of standard tests.

Multiaxial classification scheme (MAS)

  • Axis 1 indicates the mental disorder.
  • Axis 2 indicates whether developmental disorders have been identified.
  • Axis 3 indicates the intelligence level of the child/adolescent.
  • Axis 4 indicates any physical symptoms or illnesses.
  • Axis 5 maps the psychosocial circumstances.
  • Axis 6 indicates the child’s psychosocial adjustment, for example, social contacts, interests, and hobbies.

Mental illness in children: Forms

In addition to these age-independent disorders, there are also mental disorders that always develop in childhood, “childhood mental illnesses,” so to speak. They often remain present in adulthood. Experts distinguish here between two groups:

  • neurodevelopmental disorders: They affect not only mental health, but overall child development. They include, for example, autism, Rett syndrome and fragile X syndrome.

The following is an overview of major mental health disorders in children and adolescents:

Depression

Learn more about symptoms, causes, diagnosis and treatment of depression in the article Depression.

Anxiety disorders

Anxiety disorders are also common among children and adolescents. These include phobias (= fear of certain situations, animals or objects), panic disorder and generalized anxiety disorder.

You can find out everything you need to know about anxiety and anxiety disorders in the article Anxiety.

Bipolar disorder

You can learn everything important about this serious mental illness in the article Bipolar Disorder.

Post-traumatic stress disorder

Children who have experienced neglect, violence or abuse often develop post-traumatic stress disorder (PTSD). Symptoms include a general tense, anxious, and irritable feeling, haunting memories, or mentally reliving the traumatic experiences (flashbacks).

Eating disorders

People with anorexia nervosa have a pathological desire to keep losing weight. Binge eating (bulimia), on the other hand, is classically characterized by recurrent “binge eating” followed by forced vomiting. Pure binge eating manifests itself with recurring “binge eating” episodes.

You can learn everything you need to know about these eating disorders in the articles Anorexia, Bulimia, and Binge Eating.

Personality disorders

Other forms of personality disorder include dissocial, narcissistic, and paranoid personality disorder.

Read more on the topic in the articles Borderline Syndrome, Dissocial Personality Disorder, Narcissistic Personality Disorder, and Paranoid Personality Disorder.

Schizophrenia

You can learn everything important about this serious clinical picture in the article Schizophrenia.

Obsessive-compulsive disorder

This form of mental disorder manifests itself in compulsive, ritualistic behavior or thinking. Examples include compulsive washing, compulsive thinking, and compulsive checking.

You can learn more about these mental abnormalities, which often occur in childhood and adolescence, in the article Obsessive-Compulsive Disorder.

ADHD

You can learn more about this clinical picture in the article ADHD.

Oppositional behavior disorder

However, the behavior of these children does not pose a danger to others, they do not actually harm others, and they are capable of feeling remorse and guilt.

Social behavior disorder

The social behavior disorder often manifests itself in physical aggression against people, cruelty to animals, theft, fraud and damage to property. Affected individuals do not follow any rules, often run away from home and skip school. They feel no remorse or guilt about their behavior and its consequences.

Autism

You can learn everything important about autism spectrum disorders in the article Autism.

Rett syndrome

Rett syndrome is a rare, genetic developmental disorder that affects almost exclusively girls. It is based on a gene change (mutation) on the X chromosome. After an initially normal development, it causes various abnormalities to manifest themselves, such as:

  • stereotyped hand movements (washing, kneading hand movements)
  • autistic traits
  • sudden screaming and lantern attacks
  • short stature
  • gait disturbances, disturbance in the execution of voluntary, purposeful movements (apraxia)
  • epileptic seizures
  • sleep disorders

Fragile X syndrome

This hereditary disease is also caused by a mutation on the X chromosome. However, it affects boys more often than girls. Possible signs of the disease are:

  • more or less reduced intelligence
  • Learning difficulties
  • behavioral problems: e.g. restlessness, avoidance of eye contact, attention deficit disorder, mood swings, tantrums, sensitive reaction to bright light and sounds
  • psychological abnormalities: autistic behavior, ADHD or anxiety disorders
  • external characteristics: e.g. elongated head, high forehead, often open mouth, over-extensible joints, large testicles

Other mental disorders in children

  • Attachment disorders: They occur in infancy up to five years of age and manifest themselves in overprotective behavior combined with extreme fear of separation (reactive form) or in indiscriminate and distant attachment behavior. The cause is usually extreme neglect or maltreatment of the affected child.
  • Speech disorders: These disorders include stuttering and poluttering. In the latter, the affected children speak very quickly, unrhythmically and choppily.

Mental illness in children: Therapy

My child has mental problems – and now?

Once the diagnosis has been made, the question arises as to the best treatment. Often, mental illnesses in children and adolescents are treated by a combination of psychotherapeutic measures, educational and social approaches and, if necessary, drug therapy (multimodal therapy approach).

Psychotherapy

Psychotherapy is the main focus of the treatment. It can be carried out with the child alone or with the whole family. Decisive for the success of the therapy is the relationship of trust between therapist and patient. Therefore, it is important that the child and all other participants (parents, siblings, etc.) get along well with the treating therapist.

The therapist discusses how often and how long psychotherapy should take place with the parents and the child.

Medication treatment

For some disorders, such as ADHD or depression, medication can supplement treatment, at least temporarily. Calming medicines and so-called anti-aggressives are also sometimes indicated, for example, to stop severe states of agitation.

The treating specialist pays attention to the approval of the preparations for children and adolescents and adjusts the dosage individually.

Accompanying measures

Youth and family support measures, support programs to improve reading or language skills, and occupational therapy measures can also help to get the problems of mentally ill children under control. The individual case determines which of these measures are appropriate.

How can I help my child?

  • Inform relatives, educators, teachers and parents of friendly children about the disease, so that they can classify the deviant behavior of your child.
  • Actively accompany your child’s therapy and take part in it.
  • Stay in emotional contact with your child.
  • Encourage your child and convey confidence.
  • Put an end to possible traumatizing relationships or situations in the family or in the environment.
  • Take care of yourself, because dealing with a mentally ill child can be very stressful. For example, look for a support group where you can exchange ideas with other affected parents.

Mental illness in children: Causes and risk factors

The causes of mental illness in children and adolescents are varied. In most cases, several factors interact in the development of such disorders.

Biological causes and risk factors

Possible biological risk factors for psychological illness in children include:

  • genetic predisposition
  • physical illnesses
  • impaired brain function (e.g., inflammation or malformation of the brain)
  • gender – some disorders, such as depression, are more common in girls overall, while others, such as oppositional behavior disorder, are more typical of boys

Psychological causes and risk factors

Possible psychological triggers of mental illness in children and adolescents include:

  • Abuse and experiences of violence
  • Neglect, unkindness of parents/caregivers
  • Loss of parents or other significant caregiver
  • mental illness of parents
  • unstable relationships with key caregivers
  • inconsistent parenting methods
  • frequent quarrels and violence within the family

Socio-cultural causes and risk factors

Last but not least, the social environment, for example at school, influences mental health. Children with stable friendships and interests are less likely to become mentally ill than those who are ostracized or bullied.

Usually, several of the above factors come together when mental illness develops in children. Rapid treatment is important. Then the chances are good that a mentally ill child will become a healthy adult.