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Early identification of mental illnesses in children

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Dr Milan Balakrishnan, Consultant Psychiatrist and Counsellor, Masina Adolescent and Child Therapy Unit, Masina Hospital speaks about identification of mental and behavioural problems that parents and elders need to take notice of in their children to address any issues of mental illness

Just like adults, children are not immune to and can suffer from mental health disorders. In India about 12 per cent of children suffer from behavioural problems and mental health issues though 95 per cent of them don’t get help due to social stigma or lack of access to help.

Parents often misinterpret mental health issues in their child to be a variation of normal behaviour or are often afraid to seek help. This delays the process of detection for mental illness and the child ends up suffering. Hence it is essential for parents to be aware of the problems that children may face making it easier for the child to seek help in turn improving the outcome.

Mental health issues in children can present itself in very unusual ways. Recently, we saw Shubham (name changed) who was brought by his parents for a gaming addiction but on evaluating the child in detail we found he had a severe anxiety disorder and the games were the child’s way of avoiding the world and his anxiety. Once the anxiety was dealt with his gaming reduced drastically and he could use gaming as a reward rather than an escape mechanism.

Parents and teachers are in the best position to identify mental and behavioural problems in children as they are in close contact with the child and they can best observe the red flags.

Some of these red flags to look out for are as follows:

Change in school performance

Deterioration in school work and drop in marks or grades, loss of focus and concentration, difficulty sitting in one place in school and increasing complaints from school are important changes.

Behaviour changes

Children may be less verbal than adults about their problems and often show signs of behavioural problems like aggression, anger outbursts in school or at home, picking up fights and increased arguments. Increased risky behaviours like sexual experimentation may also be seen in children and adolescents.

Mood changes

A child who is unusually and excessively withdrawn for long periods of time is a worrying sign. Moody behaviour that seem to last for more than two weeks and has an impact in school or at home must be picked up by parents or teachers. Sudden cutting down on play time and staying locked up in the room may also be signs to lookout for.

Intense feelings

Experiencing overwhelming fear, distressing emotions with a high palpitation, and heavy breathing in day to day activities should be a looked at with caution.

Unexplained weight loss

A sudden loss of appetite or increased appetite may represent an emotional problem. Frequent vomiting or use of laxatives could be signs of an eating disorder. Eating disorders often go undiagnosed until they are brought to us in a critical stage.

Physical symptoms

Children also develop constant headaches and stomach aches as a sign of depression and anxiety, unlike adults. They also exhibit constant change in sleep patterns and appetite.

Physical harm

Sometimes a mental health issue can lead to self-injury or self-harming behaviour. These could be acts like cutting or burning oneself and have suicidal thoughts or attempt suicide. Children talking about death quite often or inflicting self-harm must be taken seriously and taken to seek professional help.

Substance abuse

Often, young children might fall into the influence of drugs and alcohol and use it as an escape for their problems. This can lead to addiction from a young age.

Other issues

Some children may exhibit signs of being withdrawn, not able to retain friends and have issues with maintaining eye contact.

Children with red flags should be evaluated by a mental health professional and it is important for the parents to involve the child in the decision making process. Often parents coerce the child and bring them to the doctor, making the child feel more upset and confused.

The most common disorders seen in children:

Anxiety disorders – Worrying is a normal part of every child’s life, often changing from one developmental stage to the next. However, when worry or stress makes it hard for a child to function normally, it might be an anxiety disorder. Social anxiety, obsessive compulsive disorder (OCD) and generalised anxiety disorder are the common ones.

Attention-deficit hyperactivity disorder (ADHD) – This condition typically includes symptoms of difficulty in focussing on one thing, not able to sit in one place and impulsive behaviour.

Autism Spectrum Disorder (ASD) – Autism spectrum disorder is a developmental disorder that appears in early childhood, usually before the age of three. ASD affects a child’s ability to communicate and interact with others.

Eating disorders – This includes anorexia nervosa, bulimia nervosa and binge-eating and are life-threatening conditions. Children can become so occupied with food and weight that they focus on nothing else.

Mood disorders – Depression and bipolar disorder can cause a child to feel persistently sad or have dramatic mood swings.

Schizophrenia –  This chronic mental illness causes a child to lose connection with reality (psychosis).

How does a mental health professional help?

With the help of a few simple tests or questionnaires or just having a conversation with the child, the child psychiatrist or psychologist will be able to evaluate his condition better. If a diagnosis is made, the doctor will explain the problem and provide a plan of management to the parent.

For conditions like psychosis, severe anxiety disorders, and severe aggression, the plan of management may include talk therapy for the child. However, severe depressive illnesses might even require medication. When needed, medications are prescribed taking into account weight of the child. Though contrary to popular belief they are safe and not addictive.

What can the parent do?

The child needs all the support that he can get. Hence mental health professionals always guide the parents with parenting techniques specific to the needs of the child.

It is important to identify the child’s strengths and appreciate him for his achievements. Another way to keep the child active is by planning fun activities. Support groups are essential to help the child address the problem better and learn from the experiences of others. Academically, liasoning with child’s teacher can help parents accurately understand his strengths and weaknesses.

If you are concerned about your child’s problems don’t hesitate to seek help. Don’t let shame or stigma prevent you from exploring the right treatment. With the right help the child can overcome his problems at an early stage and live a productive and fulfilling life.

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