Children's Mental Health Week

May is Mental Health Awareness month, and it begins with Children's Mental Health week May 1st to May 9th. As any of my previous readers will know, this is a topic close to my heart. So, are mental health issues really a problem for children? Do children really get clinically depressed? Aren't kid's with behavior problems just brats? In short, yes, yes and no. Let's look at some of the facts:

How many children are mentally ill in America today?

 I hope you're sitting down, because unless you are pretty up to date on the stats for child metal illness, you'll probably be surprised. Let's break it down by the most common childhood disorders (yes, there are a whole bunch). Beginning with ADHD, which most people have heard of, the American Academy of Adolescent and Child Psychiatrists have put out the following statistics:

ADHD- 2 million, or 3-5% of children in the United States today are believed to have ADHD. Given an average class size of 25 + children, at least  child will suffer from this disorder. It's important to note that these are a clinical population, in other words their symptoms are sever enough to be causing significant impairment in one or more areas of their lives and be causing a significant level of distress. These are not kids who are occasionally a little distracted.

Autistic spectrum disorders- this includes Autism, Asperger's disorder and Pervasive Developmental Disorder. A recent (February, 2009) NIMH study of a U.S. metropolitan area estimated that 3.4 of every 1,000 children 3-10 years old had autism. 

Moving along, Bipolar disorder- at one time, and not so long ago, it was believed that Bipolar disorder was primarily an adult disorder and that pediatric bipolar disorder was extremely rare. Unfortunately, we now know that is far from true. About 2.5% of the general adult population suffers from Bipolar disorder, that's over 5 1/2 million people! There are no clear statistics on how many children are affected as, until recently people actually debated it's existence.

Although pediatric bipolar disorder is not common, there is no reason to think that it would be significantly different from the adult figure - there are some people whose bipolar symptoms only become apparent in adolescence or adulthood, but pediatric bipolar disorder is not something you grow out of. The current research indicates that many of the people who are diagnosed later in life have been previously misdiagnosed, most frequently as unipolar depression. Some studies have indicated that these people have been misdiagnosed for an average of 9 years!

Conduct Disorder- which involves serious rule violations and disregard for the rights of others is estimated to affect 4% of 9-17 year olds and is considerably more prevalent in boys.

Depression- a serious, but treatable, chronic illness that is probably under-diagnosed and certainly misunderstood. Although there is the common myth that children can't be depressed because - what do they have to be depressed about? - much like adult depression, situational variables have little to do with depression. Although there is some evidence that stress may play a role in initial episodes, stress as a trigger appears to diminish over time.

Depression in children differs somewhat from adults in that it may present with irritable rather than depressed mood symptoms. These children are often mistaken for "going through a phase" or being willfully grumpy. Children may also show more somatic symptoms like recurrent headaches, tummy aches, nausea. Lethargy and amotivation are also symptoms commonly mistaken for bratty behavior. Sleep disturbances - trouble falling asleep, staying asleep or waking up too early in the morning as well as changes in eating patterns are all important changes to be aware of.

As much as people don't like to believe that children kill themselves, they can and do. Suicide is the 3rd leading cause of death among young adults of all races, in Native American youth it is the leading cause of death! In 2007, 6.9% of high school student surveyed through the Youth Risk Behavior Survey indicated they had attempted suicide in the last 12 months, and 14.5% had seriously considered attempting suicide. So, if as you may believe that if you talk to children about suicide it will give them ideas, the research has absollutely not borne this out, it just is not true. Kid's have thought of all these things, and probably a few that haven't occurred to us. Talk to your children about suicide and the signs of depression - you want to be the first person they think of going to if they start to feel suicidal or they see signs in one of their friends.

The best suicide prevention is education and awareness - and never take an "I'm going to kill myself" lightly - over 80% of those who completed suicide had told someone about it beforehand. There's no such thing as "it's for attention", if the child is so desperate to get attention that that is the only way they could think of to get someone to notice, they are really in trouble - and lastly? be available to your kids and their friends, hopefully your kids would go directly to you, but many kids will to talk to anyone but their parents. If there is a serious problem, you want to be the safe adult they think of going to - whomever's child they are.

 Eating Disorders  - occurring most often during adolescence and in females, the incidence of eating disorders in young children and males, is unfortunately on the rise, with males now comprising 5-15% of the eating disordered population. Eating disorders are treatable, but can be fatal without intervention. This disorder occurs in about 0.5% of the female population.

Oppositional Defiant Disorder (ODD)  - characterized by a chronic and ongoing pattern of disobedient, hostile, and defiant behavior towards others, usually authority figures. Some studies estimate from 1 - 6% of school aged children to be affected. This disorder is more common in boys prior to puberty but after puberty, the prevalence rate is equal for males and females. 

Post-Traumatic Stress Disorder (PTSD)  - this condition affects individuals who have experienced a disturbing or frightening event. PTSD generally starts within three months of the event, however for some individuals it doesn’t appear until much later. In any given year, 5.2 million Americans (including children and adolescents) suffer from PTSD. Until recently, this was another disorder which was under recognized and under diagnosed in children. We now know that PTSD presents slightly differently in kids and can be a consequence of witnessing domestic violence, even when very young.  

Risk-Taking and Self Harm Behavior has become a significant concern for young children and adolescents. Up to 72% of all deaths among 10-24 year-olds result from four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. The 2007 National Youth Risk Behavior Survey indicated that over a thirty day span, 29.1% of high school students surveyed had ridden in a car with a driver who had been drinking alcohol and 18% had carried a weapon. Over a 12 month span, 6.9% of high school students had attempted suicide, 75% had drunk alcohol, and 47.8% had sexual intercourse. This, along with the popularity of things like "the choking game" and self harm such as cutting or burning oneself account for many tragic and often unintended deaths.

Schizophrenia - This a severe, chronic and disabling brain disorder. It affects about 1% of Americans. Psychotic symptoms usually appear in males during their late teens and early 20s and in females in their mid-20s to early 30s. Although Schizophrenia is not common amongst young children, there is a small percentage who show extremely disturbed behavior and impaired reality testing from an extremely young age. Treatment for Schizophrenia must include medication, as well as other rehabilitative efforts.

Tourette's disorder- This disorder includes multiple motor and may include 1 or more vocal tics. Tics may be able to be briefly suppressed, but then the urge becomes overwhelming. Many people associate Tourette's with coprolalia or the need to swear/use foul language. Although this can be part of Tourette's disorder it is fairly rare, although does exist and, as one can imagine, causes untold agony to its sufferers and their families. Tourette's appears to be somewhat related to age with children experiencing a prevalence rate of between 5 & 30 per 10,000 and adults exhibiting symptoms in only 1-2 per 10,000.

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Where to from here?

So, what is becoming clear, is that for some, childhood is not the best years of their life and childhood is no defense against mental illness. As unfair as it seems, mental illness affects our youngest and oldest members of society, our best and brightest and those whose talents lie yet undiscovered. The statistics given by the Education department, indicate that between 6 and 12% of the school age population has a diagnosable mental disorder, so 1 in 10 children, as young as 5 or 6 years old are known to be suffering from mental illness - a statistic that probably under represents the real prevalence due to the stigma of mental illness and the fact that it is so often attributed to personality or "the brat factor".

If 1 out of every 10 schoolchildren were blind - wouldn't we be having a major public health campaign and spending billiions and billions to try and find a solution? Blame is simply something that shifts the focus (and generally makes the person blaming feel better about themselves). Unless you're trying to target a specific gene - it doesn't always matter how it got like that - that's for the researchers, but what we can do as a community and as a society is become educated, become aware - and look a little harder at our own prejudices, because 'there but for the grace of god go I'.

No one is immune from mental illness, we need to start helping these kids know that they have a serious and probably chronic illness, but just like with diabetes, we have strategies to deal with it which they can learn - and given the option between learning new coping skills and feeling bad because of out of control behavior - which would you choose? Let's help these kids and families get their lives back.

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Comments 5 comments

Teresa McGurk profile image

Teresa McGurk 7 years ago from The Other Bangor

Thanks. Dealing with ADHD alone can be challenging, never mind depression, too: I've wondered whether irritability and depression might be linked in children, the information here is helpful. Thank you.


dr c profile image

dr c 7 years ago from San Francisco Bay Area Author

Thanks for your comment, that's absolutely one of the most common reasons children are misdiagnosed. In children, depression often presents primarily with irritability and mood swings, rather than the 'down in the dumps' we expect from adults.


Helengi profile image

Helengi 7 years ago from London, England

An awesome piece of work Dr C. The problem (as you know better than I) with not getting children the help they need when they are young is that they grow up into even more disturbed adults. I am one such lucky victim/survivor. How I wish there had been a mental health advocate like you when I was a child. Keep up the fantastic work!


dr c profile image

dr c 7 years ago from San Francisco Bay Area Author

Thanks, glad you liked the hub & thanks for your support!


Beata Stasak profile image

Beata Stasak 7 years ago from Western Australia

Thank you for very informative article, I think you are doing great job raising awareness about this issue. Thank you for answering my question on the hub about the connection between harmonious family life and depression.

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