About Children's Mental Health

Anxiety Disorder

 What is it?

Everyone experiences anxiety at some time. When people describe their anxiety, they may use terms such as anxious, stressed, wound up, nervous, on edge, worried, tense, or hassled. Although anxiety is an unpleasant state, it can be quite useful in helping a person to avoid dangerous situations and motivate the solving of everyday problems. Anxiety can vary in severity from mild uneasiness to a terrifying panic attack. Anxiety also can vary in how long it lasts, from a few minutes to many years. An anxiety disorder differs from normal anxiety in the following ways:

• It is more severe
• It is long lasting
• It interferes with the person’s studies, other activities, and family and social relationships

 Signs and Symptoms

Physical

• Pounding hear, chest pain, rapid heartbeat, and blushing
• Rapid, shallow breathing, and shortness of breath
• Dizziness, headache, sweating, tingling, and numbness
• Choking, dry mouth, stomach pains, nausea, vomiting, and diarrhea
• Muscle aches and pains (especially neck, shoulders, and back), restlessness, tremors, and shaking

Psychological

• Unrealistic or excessive fear and worry
• Racking thoughts or mind going blank
• Decreased concentration and memory
• Indecisiveness
• Irritability
• Impatience
• Anger
• Confusion
• Feeling on edge
• Nervousness
• Sleep disturbance
• Vivid dreams

Behavioral

• Avoidance of situations
• Obsessive or compulsive behavior
• Distress in social situations
• Phobic behavior
• Increased use of alcohol or other drugs

At home, young people may:

• Complain about headaches and other physical problems to avoid going to school
• Be tearful in the morning, saying they do not want to go to school
• Spend more time doing homework or express unnecessary concerns that the work is not good enough
• Demand constant reassurance from parents
• Be touchy and irritable in interactions with family
• Spend a long time getting ready for social occasions, worrying about their appearance or what they might do, or decide at the last minute not to attend social occasions

At school, young people may:

• Be extremely well behaved and quiet, fearful of asking questions
• Demand extra time from teachers, asking questions constantly and needing a great deal of reassurance
• Not hand in assignments on time because the work is seen as less than perfect
• Complain of sudden, unexplained physical illness, such as stomachache or headache, when exams or presentations have been scheduled

In a social setting, a young person may:

• Avoid meeting new people or socializing with groups, spending time with only a few safe friends
• Use alcohol or other drugs at parties to make it easier to talk to people
• Leave social events early
• Avoid speaking up for fear of embarrassment

 Support Strategies

• Assess for risk of suicide or harm
• Listen nonjudgmentally
• Give reassurance and information
• Encourage appropriate professional help
• Encourage self-help and other support strategies

Attention Deficit Hyperactivity Disorder

 What is it?

Attention deficit hyperactivity disorder (ADHD) is a disorder in which inattention, overactivity, impulsivity, or a combination are common. A young person with ADHD will have at least some signs before they are seven years old and the signs will be severe enough to affect their school and relationships.

 Signs and Symptoms

• Difficulty paying attention to details
• Easily distracted
• Difficulty finishing schoolwork
• Putting off anything requiring sustained mental effort
• Disorganized and prone to making mistakes
• Appearing to not listen when spoken to or follow through on given tasks

Most youth with ADHD continue to have symptoms when entering adolescence. Although hyperactivity tends to decrease as a child ages, teens who continue to be hyperactive may show the following behaviors:

• Feel restless
• Try to do too many things at once
• Choose tasks or activities that have a quick payoff, rather than those that take more effort but provide bigger, delayed rewards
• Struggle with school and other activities in which they are expected to be more self-reliant
• Have difficulty sticking with treatment

 Support Strategies

• Assess for risk of suicide or harm
• Listen nonjudgmentally
• Give reassurance and information
• Encourage appropriate professional help
• Encourage self-help and other support strategies

Bipolar Disorder

 What is it?

Bipolar disorder, previously called manic depressive disorder, is a brain disorder that causes extreme shifts in a person’s mood, energy, and ability to function. People with bipolar disorder can experience periods of depression, periods of mania, and long periods of normal mood in between. The time between these different episodes varies greatly from person to person.

 Signs and Symptoms

Signs and symptoms of mania (or a manic episode) include:

• Increased energy, activity, and restlessness
• Excessively “high,” overly good, euphoric mood
• Extreme irritability
• Racing thoughts and talking very fast, jumping from one idea to another
• Distractibility, can’t concentrate well
• Little sleep needed
• Unrealistic beliefs in one’s abilities and powers
• Poor judgement
• Spending sprees
• A lasting period of behavior that is different from usual
• Increased sexual drive
• Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
• Provocative, intrusive, or aggressive behavior
• Denial that anything is wrong

Signs and symptoms of depression (or a depressive episode) include:

• Lasting sad, anxious, or empty mood
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in activities once enjoyed, including sex
• Decreased energy, a feeling of fatigue or of being “slowed down”
• Difficulty concentrating, remembering, making decisions
• Restlessness or irritability
• Sleeping too much, or can’t sleep
• Change in appetite and/or unintended weight loss or gain
• Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
• Thoughts of death or suicide, or suicide attempts

 Support Strategies 

• Assess for risk of suicide or harm
• Listen nonjudgmentally
• Give reassurance and information
• Encourage appropriate professional help
• Encourage self-help and other support strategies

Depression

 What is it?

The word depression is used in many different ways. People feel sad or blue when bad things happen. However, everyday “blues” or sadness is not a depressive disorder. We all may have a short-term depressed mood, but we cope and soon recover without treatment. A major depressive disorder lasts for at least two weeks and affects a person’s ability to work, to carry out usual daily activities, and to have satisfying personal relationships.

 Signs and Symptoms

A person who is clinically depressed would have at least one of these two symptoms nearly every day, for at least two weeks:

• An unusually sad mood
• Loss of enjoyment and interest in activities that used to be enjoyable

A person may also have these symptoms:

• Lack of energy and tiredness
• Feeling worthless or feeling guilty though not really at fault
• Thinking often about death or wishing to be dead
• Difficulty concentrating or making decisions
• Moving more slowly or sometimes becoming agitated and unable to settle
• Having sleeping difficulties or sometimes sleeping too much
• Loss of interest in food or sometimes eating too much. Changes in eating habits may lead to either loss of weight or weight gain

 Support Strategies

• Assess for risk of suicide or harm
• Listen nonjudgmentally
• Give reassurance and information
• Encourage appropriate professional help
• Encourage self-help and other support strategies

Eating Disorders

 What is it?

Eating disorders are not just about food, weight, vanity, or willpower, but are serious and potentially life-threatening mental disorders. Most eating disorders occur when a person has distortions in thoughts and emotions relating to body image, leading to marked changes in eating or exercise behaviors that interfere with the person’s life.

 Signs and Symptoms

Behavioral

• Dieting behaviors, such as fasting, counting calories, avoidance of food groups or types
• Evidence of binge eating
• Evidence of vomiting or laxative use
• Excessive, obsessive, or ritualistic exercise patterns
• Changes in food preferences
• Development of rigid patterns around food selection, preparation, and eating such as cutting food into small pieces, or eating very slowly
• Avoidance of eating meals
• Lying about amount or type of food consumed or evading questions about eating and weight
• Behaviors focused on body shape and weight
• Development of repetitive or obsessive behaviors relating to body shape and weight, such as pinching waist or wrists, repeated weighing, or excessive time spent looking in mirrors
• Social withdrawal or avoidance of previously enjoyed activities

Physical

• Weight loss or weight fluctuations
• Sensitivity to cold or feeling cold most the time, even in warm temperatures
• Changes in menstruation
• Swelling around cheeks or jaw, calluses on knuckles, or dental discoloration from vomiting
• Fainting

Psychological

• Preoccupation with food, body shape, and weight
• Extreme body dissatisfaction
• Distorted body image, such as complaining of being, feeling, looking fat when actually having a healthy weight or being underweight
• Sensitivity to comments or criticism about exercise, food, body shape, or weight

 Support Strategies

• Assess for risk of suicide or harm
• Listen nonjudgmentally
• Give reassurance and information
• Encourage appropriate professional help
• Encourage self-help and other support strategies

Post-Traumatic Stress Disorder

 What is it?

Post-Traumatic Stress Disorder (PTSD) is a real illness. You can get PTSD after living through or seeing a dangerous event, such as war, a hurricane, or bad accident. PTSD makes you feel stressed and afraid after the danger is over. It affects your life and the people around you. PTSD can happen to anyone at any age.

Potential causes of PTSD include:

• Being a victim of or seeing violence
• The death or serious illness of a loved one
• War or combat
• Car accidents and plane crashes
• Hurricanes, tornadoes, and fires
• Violent crimes

 Signs and Symptoms

• Bad dreams
• Flashbacks, or feeling like the scary event is happening again
• Scary thoughts you can’t control
• Staying away from places and things that remind you of what happened
• Feeling worried, guilty, or sad
• Feeling alone
• Trouble sleeping
• Feeling on edge
• Angry outbursts
• Thoughts of hurting yourself or others

Children may show other signs:

• Behaving like they did when they were younger
• Being unable to talk
• Complaining of stomach problems or headaches a lot
• Refusing to go places or play with friends

 Support Strategies

• Assess for risk of suicide or harm
• Listen nonjudgmentally
• Give reassurance and information
• Encourage appropriate professional help
• Encourage self-help and other support strategies

Psychosis

 What is it?

Psychosis is when a person has lost some contact with reality, resulting in severe disruptions in thinking, emotion, and behavior. Psychosis can have a severe impact on a person’s life. Relationships, school, work, other usual activities, and self-care can be difficult to initiate or maintain. Disorders where psychosis may appear include: schizophrenia, psychotic depression, schizoaffective disorder, and substance-induced psychosis

 Signs and Symptoms

Changes in emotion and motivation:

• Depression
• Anxiety, fearfulness
• Irritability, extreme moodiness, sudden outbursts or highly emotional reactions
• Suspiciousness, feeling that people are out to get them
• Blunted, flat, or inappropriate emotion
• Change in appetite
• Reduced energy and motivation
• Significantly increased sleep

Changes in thinking and perception:

• Difficulties with concentration or attention
• Sense of alteration of self, others, or outside world
• Odd ideas (feels they or others have changed or are acting differently)
• Unusual perceptual experiences (reduction or greater intensity of smell, sound, or color)

Changes in behavior:

• Sleep disturbance social isolation or withdrawal
• Reduced ability to carry out social roles
• Seeing things and hearing voices that are not real
• Severe problems in making and keeping friends
• Social isolation

 Support Strategies

• Assess for risk of suicide or harm
• Listen nonjudgmentally
• Give reassurance and information
• Encourage appropriate professional help
• Encourage self-help and other support strategies

Self-Harm

 What is it?

The term self-harm is used to refer to situations where self-injury has no suicidal intent. It is not easy to tell the difference between self-harm and a suicide attempt. The only way to know is to ask the person directly, “Are you suicidal?”

 Signs and Symptoms

• Cutting, scratching, or pinching skin enough to cause bleeding or a mark that remains on the skin
• Banging or punching objects to the point of bruising or bleeding
• Ripping and tearing skin
• Carving words or patterns into skin
• Interfering with the healing of wounds
• Burning skin with cigarettes, matches, or hot water
• Pulling out large amounts of hair
• Deliberately overdosing on medications when this is not meant as a suicide attempt

Reasons people engage in self-harm

There are many reasons for people engaging in self-harm including:

• To escape unbearable anguish
• To change the behavior of others
• To escape from a situation
• To show desperation to others
• To get back at other people or make them feel guilty
• To relieve tension
• To seek help

 Support Strategies

• Assess for risk of suicide or harm
• Listen nonjudgmentally
• Give reassurance and information
• Encourage appropriate professional help
• Encourage self-help and other support strategies