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The following tabs provide some educational information about childhood mental illness that you may find of interest. Just click on the tab that you wish to read to navigate the information available. Feel free to comment on any of the information published using the comments form at the bottom of the page.
Schizophrenia
Studies into the causes of schizophrenia in children identify that damage to the child’s central nervous system during their development is very important: more so than in adult onset schizophrenia. It is also recognised that a genetic predisposition could also be significant. Risks of schizophrenia developing rise from one percent for individuals with no history within their family, to ten percent for individuals with a close family member with it: that is, the risk increases if the family member is a mother or father and so on. The risk of developing schizophrenia rises to fifty percent if an identical twin has the illness.
Additionally, complications during pregnancy such as viral infections or untreated blood compatibility issues could increase the risks of a child developing Schizophrenia. Unlike adults with Schizophrenia, a child’s brain progressively develops abnormally.
Symptoms of Schizophrenia in Children
Symptoms that can occur in a child with schizophrenia include the typical psychotic signs: auditory and visual hallucinations; as well as delusional and disordered thinking. However, these psychotic symptoms are not always initially apparent: delayed development of language skills and other motor functions are often indicative symptoms of schizophrenia developing. The psychotic symptoms are not usually apparent until a child is seven years of age. Before then, other ‘temporary’ developmental symptoms can appear; these include a child rocking whilst seated, or flapping their arms about. Further symptoms or signs that schizophrenia could be developing include: issues with separating dreams from reality, hallucinations, disordered and peculiar cognition's, and behaviour representative of a much younger child. As with ‘normal’ development, these symptoms can change as the child changes. The psychotic symptoms develop slowly in children, whereas in adults, the psychosis can develop suddenly and without warning. Children with schizophrenia have difficulty managing everyday lives, clinging to parents, and demonstrating illogical and irrational thinking patterns. Sadly, children with schizophrenia have a greater risk of suicide, than children without schizophrenia.
Misdiagnosis of Schizophrenia
As with many illnesses, there is always a risk of misdiagnosis: correlating the symptoms to other conditions such as spectrum disorders. Schizophrenia in children is often misdiagnosed as Autism; however, in spectrum disorders such as Autism, auditory and visual hallucinations are not persistent; as they often are in cases of schizophrenia. This ‘persistence’ is a significant factor in the diagnosis of schizophrenia: that is, psychotic symptoms such as hallucinations can present in cases of depression and personality disorders, but are often only temporary; whereas, in schizophrenia these symptoms are often persistent.
Furthermore, misdiagnosis can occur in the following cases: Children who have experienced abuse can sometimes claim to hear voices that no one else can, or have visions of their abuser: Adolescent children with bipolar disorder (manic depression) often have manic episodes which are commonly misdiagnosed as schizophrenia.
Bipolar Disorder
Many children, especially adolescents, can experience fluctuating mood patterns; it is all part of human growth and development. However, when this mood fluctuation begins to impede a child’s ability to function adequately in their day to day lives, bipolar disorder could be the reason. Most people recognise bipolar disorder, or manic depression as it is otherwise known, as extremes of mood; that is extreme highs or extreme lows.
Bipolar disorder is generally recognised as an inherited condition; however, it is clear that environmental factors are also influential in whether a child will develop this disorder.
Bipolar disorder can be present in some generations, but not others. As with schizophrenia, there is a one percent chance of an individual developing bipolar disorder; the risk increases up to thirty percent when one biological parent has the condition; the risk increases up to seventy-five percent when both biological parents have the condition; and the chance of developing the condition if an identical twin already has it is up to seventy percent.
Bipolar Disorder Symptoms
Like schizophrenia, bipolar disorder can develop in a child’s early years. However, bipolar disorder characteristically occurs in adolescence or adulthood. A study in America states that up to one third of American children who present with depressive symptoms, may be experiencing bipolar disorder. Symptoms of bipolar disorder include the following: extreme highs and extreme lows, experiencing extreme highs and lows at the same time, and unpredictable, alternating behaviour, such as a child being hyper one moment and then withdrawn the next. Children who have bipolar disorder also are at risk of developing other anxiety related disorders such as ADHD (attention deficit hyperactivity disorder). If a child develops a ‘dual’ condition, it is much harder to correctly diagnose them. Consequentially, there is a lack of recognition of bipolar disorder in children.
To examine the symptoms further, it is easier to break down the two sides of bipolar disorder. Remember, not all children with this condition will experience all of these symptoms: if you suspect your child might have bipolar disorder, please seek advice from your family doctor.
Symptoms of manic mood
- Unrealistic self esteem
- Significant, unexplained increase in energy
- No signs of tiredness after lack of sleep
- Excessive involvement in or obsession with a project
- Severe unexplained change in mood; for example sudden change from happy to aggressive
- Behaviour that is risking health such as misusing substances like alcohol or drugs
Symptoms of depressive mood
- Unexplained social withdrawal
- Lack of energy, enthusiasm, and motivation
- Severe lack of self esteem; feelings of worthlessness
- Talking of or thinking about death and suicide
- Many adolescents who have bipolar disorder, can abuse alcohol and/or drugs in an attempt to escape the extreme feelings that they are experiencing.
Often children with this condition can have great difficulty in establishing and maintain relationships.
Misdiagnosis of Bipolar Disorder
As mentioned above, bipolar disorder is notoriously difficult to diagnose in children. The main reason for this is because the behaviours that the child exhibits can correlate to ‘normal’ developmental behaviours; or the behaviour can be diagnosed as another condition such as ADHD. For adolescents, bipolar disorder can be misdiagnosed as a personality disorder, schizophrenia, or post-traumatic stress.
Depression
Every child has days where they feel down, or sad, but when these feelings become persistent and impede upon their abilities to function appropriately, depression could be the reason. Depression is one of the most common mental illnesses and can affect anyone of any age, including children. Statistically, depression affects one in thirty-three children under the age of thirteen, and one in eight people over the age of thirteen. In many people, depression can lead to underachievement, social withdrawal, and affect their ability to form and maintain personal relationships: children are not exempt from experiencing these problems, but in addition there is an increased risk of suicide. Estimations state that in nine out of ten cases of child and adolescent suicide, mental illnesses such as depression have been present: statistically adolescent males are most at risk, especially with the addition of misusing substances such as alcohol. In young people, depression can occur alongside other mental health problems such as anxiety; physical health problems such as diabetes; and substance misuse problems. Statistically, once a child has experienced depression they are five times more likely to experience it again within the following five years.
Causes of Childhood Depression
There is not one specific cause that can be attributed to depression. There may be a family history of depression; parental separation may induce stress that leads to depression; or there may be other underlying psychological issues that could trigger depression. It can probably be assumed that any child who experiences abuse, trauma, severe physical illness, or is neglected by their caregiver is more likely to experience the condition. Depression can occur alongside other mental illnesses such as bipolar disorder: adolescents are more likely to misuse substances to cope should they become depressed.
Symptoms of Childhood Depression
For children, the symptoms of depression are more or less the same as they are for adults; although recognising and diagnosing the condition can be very different. The developmental stage of a child is influential in how the symptoms are expressed. Additionally, because of this development, a child may not be able to identify their emotions correctly; for example, a child may act out being bad tempered instead of appropriately communicating how bad they are feeling emotionally. Research has identified that a parent is less likely to recognise depression in their teenage child, than the child themselves. Symptoms of a major depressive illness include: a persistent low mood, social withdrawal, lack of interest and motivation, considerable changes to appetite, excessive sleeping or not sleeping at all, low self esteem, and thoughts of suicide. Usually, five or more symptoms must be persistent for over two weeks for a diagnosis of depression to be made.
Symptoms that can be apparent with depression in children include: disruptive behaviour, frequent headaches, stomach aches, lethargy, absence from school, unexplained crying, social withdrawal, lack of interest and motivation, substance misuse, feelings of worthlessness, fear of failure, recklessness, and lack of communication. In relation to substance misuse, many adolescents will use substances like alcohol to escape the feelings they are experiencing. It is recommended that if a child is misusing substances, they should be assessed to see if depression may be an underlying cause. If an addiction develops then it is necessary to ensure that both problems are treated appropriately (See dual diagnosis).
If you have any concerns about depression, consult your family doctor who will be able to provide appropriate support and treatment. Treatment can include medication, talking therapies, or psychological assessments; all depending on the severity of the condition and the individual medical history.
Anxiety Disorders
In definition, an anxiety disorder is a mental health issue that can affect anyone, of any age, at anytime, and children are not an exception to this. Anxiety conditions are the most common mental health problem in children. Every child will experience some form of anxiety. It is a normal part of development and should be expected; for example, a child may become anxious when separated from their primary-care provider, with whom they have formed an attachment (known as separation anxiety). Like some of the other mental health issues discussed, anxiety only becomes an issue when it begins to impede upon the child’s quality of life. Persistence is always the key to identifying the beginning of a problem; that is, if anxiety is persistent and strong then professional intervention should be sought.
Symptoms of Differing Childhood Anxieties
Anxiety is something everyone experiences. If you think about a time when you felt worried or apprehensive about an upcoming event, such as an interview; anxiety is what you were experiencing. Characteristically, symptoms of anxiety disorders are experienced both physically and emotionally. Physical symptoms include: increased blood pressure and rapid heart rate, nausea and vomiting, diarrhoea, pins and needs, difficulty in breathing, and headaches. Emotional symptoms include: unexplained fear, nervousness, concentration difficulties, disordered thinking, and inability to settle. For anxiety in children, there are numerous types that they can experience, these include:
Generalised Anxiety
This is where children will have persistent fears that they have great difficulty in controlling. The child will worry about everything, from a class assignment through to the likelihood of a natural disaster occurring. The child may be unable to settle, have difficulty in sleeping, or have an inability to maintain concentration on other subjects other than the source of their anxiety. Often, children who exhibit generalised anxiety desire to please everyone, and can be disappointed if their performance does not fit their idea of perfection.
Social Phobia
In definition, social phobia is the fear of being judged negatively. This usually develops in older adolescents and characteristically does not affect younger children. Typically, social phobia causes the person to fear public situations where they are going to be judged or become centre of attention; for example, presentations, buying something over the counter, even talking on the telephone. Symptoms include: sweating, palpitations, blushing, and avoidance of situations where judgement may happen. Often the person experiencing social phobia will lack self confidence and assertiveness skills; lack self esteem; experience severe anxiety when dating; and be over sensitive. By its very nature, social phobia often stops the person who experiences it from seeking help: the fear of being judged negatively.
Social phobia can be linked to just one specific situation. For example, a person with social phobia may fear situations where there is an expectation to ‘get involved’ such as a party; whereas, they may be confident and assertiveness on the phone or when making a presentation.
Separation Anxiety Disorder
We probably all remember a time when we were children and became separated from our primary caregiver for the first time; for example, our first day at school. One reason we may remember this experience is because of separation anxiety. It is perfectly natural to experience this anxiety when separated from someone we have an attachment with. However, children with separation anxiety disorder will experience greater levels of anxiety when separated from their primary caregiver. Children, who experience this condition, will often be constantly and excessively concerned about their parents when separated. Symptoms include: a constant refusal to attend school; reluctance to leave the parent; when separated, constantly cry; cling to the parent; experience night terrors; and experience physical symptoms such as headaches or stomach aches.
For further reading on separation anxiety, any books or websites that discuss John Bowlby’s ‘attachment theory’ will be extremely useful.
Post Traumatic Stress Disorder
Any child that experiences a physical or emotional trauma such as sexual abuse or witnessing the death of a parent may develop PTSD (Post traumatic stress disorder). Children are much more susceptible to developing PTSD than adults, as they are more easily traumatised. For example, an adult may consider turbulence as an expected part of a flight; for a child, their experience of turbulence may be traumatic. Symptoms of PTSD are similar to those with general anxiety, but also include the following: increased irritability, persistent and constant ‘flash backs’ to the event, persistent and constant thoughts and dreams about the event, and role-playing where the event is relived.
If a parent or carer is aware of a traumatic event in the child’s life and they are demonstrating symptoms, or there is concern that a child could be experiencing PTSD, professional support and intervention should be sought.
Obsessive Compulsive Disorder
Obsessive Compulsive Disorder (OCD) usually starts in the earlier years of childhood or following puberty. It is estimated that about two in ten adolescents experience OCD. It has also been known that children as young as five have developed symptoms of OCD. In explanation, children who experience OCD experience constant and uncontrollable thinking about one specific object (obsessive thinking), and demonstrate ritualised routines. For example, washing hands seven times after using the toilet, or taking a t-shirt off and putting it on again five times before bed: performing these compulsions satisfies the obsessional thinking. If the person is unable to perform these rituals and the obsessional thinking is unable to be satisfied, the person will experience great anxiety. This anxiety is the motivational force that drives the person to continue with their compulsions, because once the obsessional thoughts have been satisfied, anxiety levels reduce, causing a sense of relief.
We have all experienced compulsive and obsessional behaviours before: checking the front door is locked, even though you checked it twice before, just to make sure. With OCD, so much time is taken up with these compulsions that they interfere with a person’s ability to function ‘normally’. In some cases, a person with OCD is unable to make time to go out because so much time is taken up with cleaning, or they are unable to go touch surfaces with their bare hands because of germs. The very thought of going out or touching something without gloves, for example, can lead to the person panicking.
Panic Disorder in Children
Any child or adolescent who has panic disorder will experience unanticipated and repetitive phases of panic: the person will feel intense fear, shortness of breath, and have a rapid heartbeat. These attacks of panic can last for just a few minutes, to a few hours. In adults, experiences likened to a heart attack are often described: generally it is the fear of dying that is correlated to a heart attack.
Panic disorder characteristically begins in adolescence, although it is known to develop in younger children. Panic attacks can interfere with a child or adolescent’s school work and abilities to maintain relationships. For some, panic disorder can induce agoraphobia (fear of going outside); for others depressive disorders can develop, along with risks of suicidal ideation. Similarly to other mental illnesses, alcohol and drugs are often misused in an attempt to cope or alleviate the panic and anxiety.
Panic disorder is often hard to recognise and diagnose; however, once it has been diagnosed, patients will usually positively respond. Talking therapies and medication are often the chosen treatments.
Written on Sunday, 21 September 2008 00:00 by Companion
