Common Mental Disorders in Children: An Overview

What is mental illness?

Mental illness is a general term for a group of brain disorders that affect the way a person thinks, feels, acts and/or relates to others and his or her surroundings. Although the symptoms of mental disorders can vary from mild to severe, a person with a mental disorder often is unable to cope with life’s daily routines and demands.

The term "mental illness" is not entirely accurate, since there are many "physical" factors—including heredity and brain chemistry—that might be involved in the development of a mental disorder. As such, many mental disorders can be effectively treated with medication, psychotherapy (a type of counseling) or a combination of both.

Mental health in children

Identifying mental disorders in children can be tricky for health care providers. Children differ from adults in that they experience many physical, mental and emotional changes as they progress through their natural growth and development. They also are in the process of learning how to cope with, adapt and relate to others and the world around them. Further, each child matures at his or her own pace, and what is considered "normal" in children falls within a wide range of behavior and abilities. For these reasons, any diagnosis of a mental disorder must consider how well a child functions at home, within the family, at school and with peers, as well as the child’s age and symptoms.

Which mental disorders are most common in children?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association, is the standard reference book for recognized mental illnesses in the United States. It organizes mental disorders that begin in childhood and adolescence into nine main categories.

1. Anxiety disorders — Children with anxiety disorders respond to certain things or situations with fear and dread, as well as with physical signs of anxiety (nervousness), such as a rapid heartbeat and sweating.
2. Disruptive behavior disorders — Children with these disorders tend to defy rules and often are disruptive in structured environments, such as school.
3. Pervasive development disorders — Children with these disorders are confused in their thinking and generally have problems understanding the world around them.
4. Eating disorders — Eating disorders involve intense emotions and attitudes, as well as unusual behaviors associated with weight and/or food.
5. Elimination disorders — These disorders affect behavior related to the elimination of body wastes (feces and urine).
6. Learning and communication disorders — Children with these disorders have problems storing and processing information, as well as relating their thoughts and ideas.
7. Affective (mood) disorders — These disorders involve persistent feelings of sadness and/or rapidly changing moods.
8. Schizophrenia — This is a serious disorder that involves distorted perceptions and thoughts.
9. Tic disorders — These disorders cause a person to perform repeated, sudden, involuntary (not done on purpose) and often meaningless movements and sounds, called tics.

Some of these disorders—such as anxiety disorders, eating disorders, mood disorders and schizophrenia—can occur in adults as well as children. Others—such as behavior and development disorders, elimination disorders, and learning and communication disorders—begin in childhood only, although they can continue into adulthood. In rare cases, tic disorders can develop in adults. It is not unusual for a child to have more than one disorder.

What are the symptoms of mental illness in children?

Symptoms vary depending on the type of mental disorder, but some of the general symptoms include:

• Abuse of drugs and/or alcohol
• Inability to cope with daily problems and activities
• Changes in sleeping and/or eating habits
• Excessive complaints of physical ailments
• Defying authority, skipping school, stealing or damaging property
• Intense fear of gaining weight
• Long-lasting negative moods, often accompanied by poor appetite and thoughts of death
• Frequent outbursts of anger
• Changes in school performance, such as poor grades despite good efforts
• Loss of interest in friends and activities they usually enjoy
• Significant increase in time spent alone
• Excessive worrying or anxiety
• Hyperactivity
• Persistent nightmares
• Persistent disobedience or aggressive behavior
• Frequent temper tantrums
• Hearing voices or seeing things that are not there (hallucinations)

What causes mental disorders in children?

The exact cause of most mental disorders is not known, but research suggests that a combination of factors—including heredity, biology, psychological trauma and environmental stress—might be involved.

• Heredity (genetics) — Many mental disorders run in families, suggesting that the disorders—or more accurately, a vulnerability to the disorders—might be passed on from parents to children through genes. (Genes are the basic biological unit of heredity. They contain instructions for the function of each cell in the body.)
• Biology — Some mental disorders have been linked to special chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages might not make it through the brain correctly, leading to symptoms. In addition, defects in or injury to certain areas of the brain also have been linked to some mental disorders.
• Psychological trauma — Some mental disorders might be triggered by psychological trauma, such as severe emotional, physical or sexual abuse; an important early loss, such as the loss of a parent; and neglect.
• Environmental stress — Stressful or traumatic events can trigger a disorder in a person with a vulnerability to a mental disorder.

How common are mental disorders in children?

Mental disorders are common. According to the United States Surgeon General, about 20 percent of American children suffer from a diagnosable mental disorder during a given year. Further, nearly 5 million American children and adolescents suffer from a serious mental disorder (one that significantly interferes with functioning). Some mental disorders are more common in boys, and some are more common in girls.

How is mental illness in children diagnosed?

As with adults, mental disorders in children are diagnosed based on signs and symptoms that suggest a particular disorder. However, this process can be especially challenging with children. Many behaviors that are seen as symptoms of mental disorders—such as shyness, anxiety (nervousness), strange eating habits and outbursts of temper—can occur as a normal part of a child’s development. Behaviors become symptoms when they occur very often, last a long time, occur at an unusual age or cause significant disruption to the child’s and/or family’s functioning.

If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose mental disorders, the doctor might use various diagnostic tests—such as X-rays and blood tests—to rule out physical illness or medication side effects as the cause of the symptoms.

If no physical illness is found, the child may be referred to a child and adolescent psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illness in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental disorder. The doctor bases his or her diagnosis on reports of the child’s symptoms and his or her observation of the child’s attitude and behavior. The doctor often must rely on reports from the child’s parents, teachers and other adults because children often have trouble explaining their problems or understanding their symptoms. The doctor then determines if the child’s symptoms point to a specific mental disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association.

How is mental illness in children treated?

Mental disorders are like many medical disorders—such as diabetes or heart disease—that require ongoing treatment. Although much progress has been made in the treatment of adults with mental disorders, the treatment of children is not as well understood. Experts are still exploring which treatments work best for which conditions in children. For now, many of the treatment options used for children, including many medications, have been adjusted from approaches used with adults. The most common treatment options used include the following:

• Medication — Many mental disorders can be effectively treated with medications. The medications often used to treat mental disorders in children include anti-psychotics (neuroleptics), anti-depressants and anti-anxiety drugs, stimulants and mood stabilizing drugs.
  
  Note: Many medications used to treat mental disorders in adults do not come with specific instructions for their use in children. However, doctors use the drugs with children as they see appropriate, modifying dosages as needed. This practice is called "off-label" use of a medication.
  
  
• Psychotherapy — Psychotherapy (a type of counseling) addresses the emotional response to mental illness. It is a process in which trained mental health professionals help people deal with their illness, often by talking through strategies for understanding and dealing with their symptoms, thoughts and behaviors. Types of psychotherapy often used with children are supportive, cognitive-behavioral, interpersonal, group and family therapy.
• Creative therapies — Certain therapies, such as art therapy or play therapy, might be helpful, especially with young children who might have trouble communicating their thoughts and feelings.

What are the side effects of treatment?

Different medications have different side effects, and some children are not able to tolerate certain medicines. Although the medications used to treat mental disorders in children are generally considered safe, the doctor might need to change drugs or dosages to minimize side effects. In addition, it might take some trial and error to find the medication that work best for an individual child.

What are the complications of mental illness in children?

Untreated mental disorders can affect a child in many ways. Without treatment, many mental disorders can continue into adulthood and lead to problems in all areas of the person’s adult life. People with untreated mental disorders are at high risk for many problems, including alcohol or drug abuse, and violent or self-destructive behavior, even suicide.

What is the outlook for children with mental disorders?

When treated appropriately and early, many children can fully recover from their mental disorder or successfully control their symptoms. Although some children become disabled adults because of a chronic or severe disorder, many people who experience a mental illness are able to live full and productive lives.

What research is being done on mental disorders in children?

To date, most research on mental illness has centered on mental disorders in adults. However, the mental health community has now begun to focus on mental illness in children. Researchers are looking at childhood development in terms of what is normal and abnormal, trying to understand how factors affecting development can have an impact on mental health. The goal is to try to predict—and ultimately, prevent—developmental problems that could lead to mental illness. A key part of this research is the identification of risk factors—factors that increase a child’s chances of developing a mental disorder. In addition, the mental health community is calling for additional research on medications used to treat children with mental disorders.

Can mental disorders in children be prevented?

Most mental disorders are caused by a combination of factors and cannot be prevented. However, if symptoms are recognized and treatment is started early, many of the distressing and disabling effects of a mental disorder may be prevented or at least minimized.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 7/28/2005