17.5: Childhood Mental Health

Learning Objectives

1. Describe the connection between brain development and mental health in middle childhood.
2. Identify common mental health disorders in school-aged children.
3. Explain the signs and symptoms associated with internalizing disorders in children.
4. Evaluate the role of accurate diagnosis and labeling in accessing support and shaping a child’s self-concept.

Childhood Mental Health Disorders

It is important to recognize that the physical development of the brain is tightly interwoven with children’s emotional and social growth. As they develop greater self-awareness, school-aged children become increasingly sensitive to how others perceive them. They may experience a range of social and emotional challenges, such as managing peer relationships or coping with feelings of self-doubt or exclusion. For some children, this developmental stage may also coincide with the onset of mental health concerns.

Mental health problems can disrupt daily life at home, at school, or in the community. Without help, mental health problems can lead to school failure, alcohol or other drug abuse, family discord, violence, or even suicide. However, help is available. Talk to your health care provider if you have concerns about your child’s behavior.

Mental health disorders are diagnosed by a qualified professional using the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual serves as a standard across the profession for diagnosing and treating mental disorders.⁴²

Understanding these neurological changes provides professionals and caregivers with insight into how children perceive the world around them and why middle childhood is a critical time for promoting healthy development.

Social and Emotional Disorders

• Phobias
• Anxiety
• Post-Traumatic Stress Disorder - PTSD
• Obsessive Compulsive Disorder –OCD
• Depression

Phobias

When a child who has a phobia (an extreme or irrational fear of or aversion to something) is exposed to the phobic stimulus (the stimulus varies), it almost invariably provokes an immediate anxiety response, which may take the form of a situational-bound or situational-predisposed panic attack. Children can exhibit specific effects and characteristics when it comes to phobias. The effects of anxiety show up by crying, throwing tantrums, experiencing freezing, or clinging to the parent with whom they have the most connection. Related conditions include anxiety.

Anxiety

Many children have fears and worries, and will feel sad and hopeless from time to time. Strong fears may emerge at various stages of development. For example, toddlers are often very distressed about being away from their parents, even if they are safe and cared for. Although fears and worries are typical in children, persistent or extreme feelings of fear and sadness could be due to anxiety or depression. Because the symptoms primarily involve thoughts and feelings, they are called internalizing disorders.

Figure \(\PageIndex{1}\): An anxious child. Image is in the public domain.

When children do not outgrow the fears and worries that are typical in young children, or when so many fears and worries interfere with school, home, or play activities, the child may be diagnosed with an anxiety disorder. Examples of different types of anxiety disorders include:

• Being very afraid when away from parents (separation anxiety)
• Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias)
• Being very afraid of school and other places where there are people (social anxiety)
• Being very worried about the future and bad things happening (general anxiety)
• Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)

Anxiety may present as fear or worry, but can also make children irritable and angry. Anxiety symptoms can also include trouble sleeping, as well as physical symptoms like fatigue, headaches, or stomachaches. Some anxious children keep their worries to themselves and, thus, the symptoms can be missed.

Related conditions include Obsessive-Compulsive Disorder and Post Traumatic Stress Disorder.

Post-Traumatic Stress Disorder (PTSD)

Exposure to traumatic events can have major developmental influences on children. While the majority of children will not develop PTSD after a trauma, the best estimates from the literature are that around a third of them will, which is higher than adult estimates. Some reasons for this could include more limited knowledge about the world, differential coping mechanisms employed, and the fact that children’s reactions to trauma are often highly influenced by how their parents and caregivers react.

The impact of PTSD on children weeks after a trauma shows that up to 90% of children may experience heightened physiological arousal, diffuse anxiety, survivor's guilt, and emotional liability. These are all normal reactions and should be understood as such (similar things are seen in adults. Those children still experiencing these symptoms three or four months after a disaster, however, may require further assessment, particularly if they also exhibit the following symptoms. For older children, warning signs of problematic adjustment include: repetitious play reenacting a part of the disaster; preoccupation with danger or expressed safety concerns; sleep disturbances and irritability; anger outbursts or aggressiveness; excessive worry about family or friends; school avoidance, particularly involving somatic complaints; behaviors characteristic of younger children; and changes in personality, withdrawal, and loss of interest in activities.⁴⁶

Obsessive Compulsive Disorder (OCD)

Although a diagnosis of OCD requires only that a person either has obsessions or compulsions, not both, approximately 96% of people experience both. For almost all people with OCD, being exposed to certain stimuli (internal or external) will then trigger an upsetting or anxiety-causing obsession, which can only be relieved by doing a compulsion. For example, a person touches a doorknob in a public building, which triggers an obsessive thought that they will contract an illness from the germs, which can only be relieved by compulsively washing their hands to an excessive degree. Some of the most common obsessions include unwanted thoughts of harming loved ones, persistent doubts that one has not locked doors or switched off electrical appliances, intrusive thoughts of being contaminated, and morally or sexually repugnant thoughts. ⁴⁷

Depression

Occasionally, being sad or feeling hopeless is a part of every child’s life. However, some children may feel sad or uninterested in things they used to enjoy, or feel helpless or hopeless in situations where they could take action to address the issue. When children feel persistent sadness and hopelessness, they may be diagnosed with depression.

Figure \(\PageIndex{2}\): Persistent sadness is a symptom of depression. Image is in the public domain.

Symptoms

We now know that youth who have depression may show signs that are slightly different from the typical adult symptoms of depression. Children who are depressed may complain of feeling sick, refuse to go to school, cling to a parent or caregiver, feel unloved, have hopelessness about the future, or worry excessively that a parent may die. Older children and teens may sulk, get into trouble at school, exhibit negative or grouchy behavior, be irritable, indecisive, struggle with concentration, or feel misunderstood. Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child who shows changes in behavior is just going through a temporary “phase” or is suffering from depression.

Treatment

With medication, psychotherapy, or combined treatment, most youth with depression can be effectively treated. Youth are more likely to respond to treatment if they receive it early in the course of their illness.⁴⁹

When You Have a Concern About a Child. What’s in a Label?

Children are continually evaluated as they enter and progress through school. If a child is showing a need, they should be assessed by a qualified professional who would make a recommendation or diagnosis of the child and give the type of instruction, resources, accommodations, and support that they should receive.

Ideally, a proper diagnosis or label is extremely beneficial for children who have educational, social, emotional, or developmental needs. Once their difficulty, disorder, or disability is labeled, then the child will receive the help they need from parents, educators, and any other professionals who will work as a team to meet the student’s individual goals and needs.

However, it’s important to consider that children who are labeled without proper support and accommodations, or worse they may be misdiagnosed, will have negative consequences. A label can also influence the child’s self-concept. For example, if a child is misdiagnosed as having a learning disability, the child, teachers, and family member interpret their actions through the lens of that label. Labels are powerful and can be good for the child or they can go detrimental for their development all depending on the accuracy of the label and if they are accurately applied.⁴³

References, Contributors and Attributions

42. Disease Prevention and Healthy Lifestyles by Judy Baker, Ph.D. is licensed under CC BY-SA (modified by Dawn Rymond)

43. Disease Prevention and Healthy Lifestyles by Judy Baker, Ph.D. is licensed under CC BY-SA (modified by Dawn Rymond)

46. Abnormal Psychology by Lumen Learning references Abnormal Psychology: An e-text! by Dr. Caleb Lack, licensed under CC BY-NC-SA

47. Disease Prevention and Healthy Lifestyles by Judy Baker, Ph.D. is licensed under CC BY-SA

49. Educational Psychology by Kelvin Seifert is licensed under CC BY 3.0

Disease Prevention and Healthy Lifestyles by Judy Baker, Ph.D. is licensed under CC BY-SA