Mental disorders in children and adolescents: causes, symptoms, diagnosis, treatment

Although childhood and adolescence are sometimes viewed as a time of ease and problems, up to 20% of children and adolescents have one or more diagnosable mental disorders. Most of these disorders can be seen as exaggerations or distortions of normal behavior and emotions.

Like adults, children and adolescents vary in temperament; some are shy and reserved, others are verbose and active, some are methodical and cautious, while others are impulsive and inattentive. To determine whether a child's behavior is typical for his or her age or an aberration, it is necessary to assess the presence of damage or stress associated with the symptoms causing anxiety. For example, a 12-year-old girl may be afraid of the prospect of having to speak in front of the class about a book she has read. This fear would not be considered social phobia unless it were severe enough to cause clinically significant damage and distress.

In many ways, the symptoms of many disorders and the challenging behavior and emotions of normal children overlap. Thus, many of the strategies used to address behavioral problems in children (see below) can also be used for children with mental disorders. Moreover, proper treatment of behavioral problems in childhood can prevent the development of the full picture of the disorder in children with a sensitive and vulnerable nature.

The most common mental disorders in childhood and adolescence fall into four broad categories: anxiety disorders, schizophrenia, mood disorders (primarily depression), and social behavior disorders. However, more often, children and adolescents have symptoms and problems that cross accepted diagnostic boundaries.

Survey

Assessing mental health complaints or symptoms in children and adolescents differs from assessing them in adults in three key ways. First, the neurodevelopmental context is critical in children. Behavior that may be normal in early childhood may indicate a serious mental disorder in older children. Second, children exist within a family context, and the family has a profound effect on the child’s symptoms and behavior; a normal child living in a family with domestic violence and drug and alcohol use may superficially appear to have one or more mental disorders. Third, children often lack the cognitive and linguistic capacity to accurately describe their symptoms. Thus, the clinician must rely primarily on direct observation of the child, corroborated by observation of others, such as parents and teachers.

In many cases, problems and concerns arise regarding the child's neuropsychological development and are difficult to distinguish from problems resulting from a mental disorder. These concerns often arise due to poor school performance, delayed speech development, and inadequate social skills. In such cases, the assessment should include appropriate psychological and neuropsychological developmental testing.

Because of these factors, assessing a child with a mental disorder is usually more challenging than assessing a comparable adult patient. Fortunately, most cases are not severe and can be treated competently by a primary care physician. However, severe cases are best treated in consultation with a psychiatrist who specializes in working with children and adolescents.

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