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A guide to mental health problems in children

07/03/2018

Clinical Psychologists, Summer Fakhro and Daniel Stark, at Great Ormond Street Hospital for Children (GOSH) in London discuss everything parents need to know mental health problems in children.

Background

Over the last decade there has been increasing interest in the emotional wellbeing and mental-health of children. Across multiple countries, there has been a corresponding increase in the number of children and families seeking services and professional input for mental-health related difficulties.

Whilst this was once thought to be rare, it is now well established that child mental-health problems are common. For instance, the World Health Organization estimates 10-20% of children and adolescents experience a mental health disorder at some point before adulthood. This includes common problems such as anxiety disorders, panic, trauma, depression, obsessive compulsive disorder and so on. If left untreated, these can become persistent problems that have a substantial impact on a young-person’s development. This can affect their family life, education, friendships and create barriers to them achieving their potential and living happy, productive lives. It is also important to recognise that the majority of adults with mental health difficulties first began experiencing problems in their adolescence. It is vital for parents to be increasingly aware of such difficulties so that appropriate treatment and support can be given as soon as possible.

Risk factors

Some factors can substantially increase a child or young person’s risk of developing a mental health difficulty. For example, it is well established that children with long-term physical health needs, including illness or physical disabilities can increase the risk of mental health problems. Problems with a child’s physical health can create additional difficulties in their day-to-day life, as well as isolating them from the support of friends and family. This can increase the likelihood of low mood or other emotional difficulties.

Other factors, such as difficult relationships with caregivers or their peers (e.g. neglect, abusive relationships or bullying) can put children at a risk of developing attachment difficulties and longer term mental health difficulties, affecting their ability to form and sustain friendships and relationships. Other conditions can also make children more vulnerable to experiencing mental-health problems. This includes conditions such as autism spectrum conditions or attention deficit hyperactivity disorder (ADHD). Not only do such children experience more day to day challenges, but they are also more susceptible to difficulties with regulating and managing their emotions. This might show itself early on as frequent tantrums or challenging behaviour. However, it is also the case that many mental health difficulties can arise without having had any of these risk factors. The cause of mental health difficulties is not always identifiable, and therefore focusing on how children are doing day-to-day at the current time is a good place to start.

Signs

Children show their difficulties in a variety of ways that can include changes in their behaviour, such as withdrawing from social events or from activities that they once enjoyed. They may also show in increase in challenging behaviour, such as tantrums or physical aggression. Some children might be overly focused on certain activities or routines. Although many young people like to have things in a particular order, for some people high levels of anxiety can emerge from breaks to these routines. Changes to a child’s sleeping, such as having difficulty getting off to sleep or staying asleep can be an indication of emotional difficulties. Similarly, changes in eating such as skipping meals may be another symptom. It is also important to be mindful as to whether there are things that your child is unable to do, or finds it hard to do, that other children their age have no problems with. This includes things like socialising, speaking to other people, undertaking morning routines and going to school. It is also important to watch out for any sudden changes in behaviour, or withdrawal from activities that they used to find enjoyable or ok. We often think of children’s behaviour as an expression of a need. You might ask yourself, what is my child seeking to gain from the behaviour? Are they avoiding activities that make them feel uncomfortable, are they seeking emotional contact from those around them, and so on. 

Strategies for parents

In our work, we find that integrating at least 15 minutes of uninterrupted one-to-one time with your child every day is a good way to build a positive relationship. The child might be playing and we encourage parents to put their own electronics and work away and play alongside their children. This can be a good opportunity to find out what is happening in the child’s world day-to-day.

Another important strategy is becoming an expert of your child’s specific needs, and to anticipate what might make him or her upset. This can help you adjust your approach or other things in their environment to minimise the disturbance it causes your child. Finally, for children who have lots of fears or worries, we encourage parents to support their kids in being brave to face these fears. If the task seems too difficult for him or her, start by breaking it down into easier more manageable steps. This will support the child in building confidence and learning to tolerate anxiety.

If difficulties continue despite these efforts, we encourage you to seek a thorough assessment from a healthcare professional. You might choose to start with your family doctor or a local paediatrician, or directly access a mental health service near you, which could include an assessment with a Psychologist or Psychiatrist.

Treatments

The good news is that there are multiple evidence-based treatments, meaning they have been tested and shown to be effective in treating mental health difficulties. It is important that when undertaking treatment that you establish that it is proven to be effective in scientific research studies. This can be done through speaking with your mental health professional. In the first instance parents often work with mental health professionals to adjust the environment and better understand the child’s needs. Following this, many treatments are often most effective when they use a combination of psychological treatments in conjunction with medication. However, the different combinations of treatment can be discussed and agreed with the relevant mental-health professional.

It is shown that half of all of those who develop mental health disorders will begin to show symptoms before the age of 14, which makes it essential that we are aware of and talk about child mental health. Early intervention can increase the chances of preventing or reducing the effects of mental illness, therefore leading to children and young people living fulfilling lives. Mental health difficulties should not be stigmatising, they are very common and talking about them will be an important part of working towards recovery.

Dr Summer Fakhro and Dr Daniel Stark

Dr Summer Fakhro and Dr Daniel Stark are based at Great Ormond Street Hospital. They see children and families with a range of mental health difficulties who often have co-occurring physical or neurodevelopmental problems. This often includes conditions such as epilepsy, ADHD and autism spectrum conditions.
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