Mental health issues of children and adolescents

Around seven per cent of children suffer moderate to severe mental health problems with a

further 15 per cent having mild problems. The prevalence of moderate to severe mental disorders among adolescents is between 15–20 per cent, about twice that found in childhood.

Child and adolescent mental health problems need to be understood in the context of:

a) the child’s stage of development

b) the child’s social context—family, school, peers and work.

What are the common psychological/psychiatric disorders of children and adolescents?

Most common presentation are for following conditions-

–          Attention deficit and hyperkinetic disorder (ADHD)

–          Pervasive developmental disorders (PDD) such as autism

–          Conduct problems and oppositional defiant disorders

–          Depression and suicidal tendencies

–          Anxiety related issues such as school refusal,

–          Obsessive compulsive disorder

–          Tic disorders

–          Problem disciplining children

When to suspect Pervasive developmental disorder such as autism?

These disorders are characterised by severe impairments in social interaction and communication

skills, and the presence of stereotyped behaviours, interests and activities.

The manifestations of these are as follows-

Impaired social interaction

� when spoken to, does not smile, look you in the eye, or use appropriate facial and other nonverbal


� has no friends at school

� shows no interest in sharing activities or interests by, e.g. bringing, showing or pointing to objects

of interest

� prefers solitary activities to social play or games

� unaware of the needs of others and does not notice another’s distress

Impaired communication

� unable to use spoken language

� if speech is present, a marked inability to hold a conversation

� stereotyped repetitive phrases, e.g. repeating jingles

� inability to understand abstract language including jokes

� lack of imaginative play such as dressing up or playing make-believe

Stereotyped behaviours interests and activities

� preoccupation with one area of interest, e.g. cricket statistics or the weather

� requires that objects always be in exactly the same place in the home

� resists changes in the home environment. e.g. a new piece of furniture

� rigid adherence to routines, e.g. always taking exactly the same route to school

� stereotyped rocking or clapping

� adopting odd body postures

� fascination with spinning objects, e.g. tops, wheels of toys or fans

� attachment to an inanimate object.e.g. piece of string

Associated features

� mental retardation

� uneven profile of cognitive skills on neurospsychological testing

� hyperactivity, inattention, impulsivity, aggressiveness, temper tantrums

� self-harming behaviours, e.g. head banging and hand biting

� exaggerated response to sensory stimuli, e.g. sensitivity to being touched

� odd eating patterns, e.g. limited diet

� odd sleeping patterns, e.g. waking at night rocking

� abnormal affective responses e.g. laughing or crying for no apparent reason

How the diagnosis of ADHD is made?

The diagnosis is based on persistent patterns of inattentionhyperactivity and impulsivity with

some symptoms presenting before the age of seven and causing significant disability and handicap

in at least two settings (e.g. school and home).

Symptoms of inattention include

– Inattention to details,

– Difficulty sustaining attention,

– Not listening when spoken to,

– Failing to follow through on instructions,

– Difficulty organising tasks (especially tasks requiring sustained mental effort),

– Losing things, being easily distracted and being forgetful.

Symptoms of hyperactivity include


– inability to remain seated,

– running and climbing in inappropriate situations,

-noisiness, being always on the go, and

-talking excessively

Signs of impulsivity include

-blurting out answers to questions,

-difficulty waiting turn, and

-constantly interrupting.

Associated features

include low self-esteem, labile mood, temper tantrums, academic underachievement, and accident proneness.

When to suspect conduct problems and oppositional defiant disorders in children and adolescents?

Common behavioural manifestations include-

-aggression to people and animals,

– destruction of property,

– deceitfulness and stealing,

– negativistic, disobedient, hostile and defiant behaviour towards parents, teachers and other authority figures

– The child often loses his or her temper,

– argues with adults, defies adult’s requests, deliberately annoys people, blamesothers for his or her mistakes,

– is easily annoyed by others, and is often angry, resentful, spitefuland vindictive

Is depression in children and adolescent different from adults?

-Depressed children and adolescents present with somewhat different symptoms and signs than

do depressed adults.

–          Children may have difficulty describing their mood and present instead with somatic symptoms.

–          behavioural problems— aggression, withdrawal, deterioration in school performance, disruption of peer relationships orschool refusal.

–          Anger, often directed at parents, may be a feature.

–          Poor concentration may lead to deterioration in school performance

–          They may have the perception of being unloved when depressed