October 09, 2019

By Kristen Fuller, M.D.

Whether you are a parent, teacher, grandparent, aunt or uncle, our children are often our greatest pride and joy. They are our future. We love them, raise them, teach them, laugh with them, play with them and nurse them back to health. 
As protectors, we want to do everything we can to keep our little ones happy and healthy. But unfortunately, genetics, society and trauma all play a major role in the development of mental health conditions, and children are not exempt. Studies show that 7.7 million youth aged 6-17 experience a mental health disorder each year—that’s one out of every six children in the U.S.
With that in mind, it’s important to play close attention to a child’s mental health. While abnormal behavior could just be normal aspects of childhood or a phase of growth or puberty — it could also be a mental health disorder.

Recognizing the Warning Signs 

In addition to genetics, trauma is a major player in the development of mental health conditions in childhood. Emotional and psychological trauma are the result of extraordinarily stressful events that shattered your child’s sense of security, making them feel helpless in a dangerous world. Traumatic experiences often involve a threat to life or safety, but any situation that leaves an individual feeling overwhelmed and isolated can be traumatic, even if it doesn’t involve physical harm. 
Commonly overlooked causes of emotional and psychological trauma include the loss of a loved one, a recent surgery, changing schools, a divorce, a big move or a deeply disappointing experience. Untreated or unresolved trauma can result in mental health problems that can present in childhood or later in life. 
If your child has experienced trauma, it is imperative that they go to therapy that focuses on this past trauma. As a parent or guardian, you can also be a part of this healing process by going to family therapy sessions. Aside from therapy, your child may need special attention in school and it may be wise to inform school counselors and teachers about your child’s history. 
Whether your child has been through a traumatic event or not, it’s important to be able to recognize the warning signs that they may be struggling with a mental health disorder:

  • Feelings of sadness for two or more weeks
  • Social isolation or withdrawal 
  • Self-harm or talk of hurting oneself
  • Racing heartbeat, headaches or belly aches
  • ​Fighting or having a desire to harm others 
  • Severe, out-of-control behavior that can hurt oneself or others
  • Intense worries or fears that get in the way of daily activities
  • Extreme difficulty concentrating 
  • Severe mood swings 
  • Drastic changes in behavior or personality
  • Making excuses to miss school
  • Extreme excitability for long periods of time
  • Constantly defying authority

If a child is showing any of these signs, don’t assume it’s just a phase or a part of childhood. Let a professional make that distinction — especially as half of all mental health disorders begin before age 14.

Childhood Mental Health Diagnoses 

While children can develop some of the same conditions as adults, such as anxiety, depression and OCD, there are also several mental health disorders that specifically develop during childhood. 
Avoidant-Restrictive Food Intake Disorder (ARFID)
ARFID is an eating disorder characterized by the persistence refusal to eat specific foods or refusal to eat any type of food due to a negative response to the color, texture or smell of certain foods. Additionally, individuals may refuse to eat out of fear of becoming sick or the fear of choking on food. This disorder is not characterized by the obsession with body shape or weight, but rather is the disinterest and avoidance of certain foods. This disorder can result in excessive and unhealthy weight loss, malnutrition or nutritional impairment. 

Pica is an eating disorder formally recognized by The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as the persistent ingestion of non-edible substances for at least one month at an age when this behavior is considered developmentally abnormal (at least two years of age). Common substances a child with this disorder will ingest include ice, clay, lead, dirt, sand, stones, paint chips, coals, chalk, wood, light bulbs, needles, string, cigarette butts and wire.Pica is most frequently diagnosed in children, however, it is the most common eating disorder in individuals with developmental disabilities. 
Pediatric bipolar disorder
When a child has bipolar disorder, they experience extreme shifts in mood in behaviors that can result in a high, known as a manic episode, or a low, known as a depressive episode. Bipolar disorder is more likely to emerge in the late teen years or in early adulthood, but children as young as six years of age can experience it as well. Bipolar disorder is estimated to occur in 1-3%of youth, the majority of whom are adolescents rather than children.
Disruptive mood dysregulation disorder (DMDD)
DMDD is a condition in which a child is chronically irritable and experiences frequent, severe temper outbursts that seem out of proportion to the situation at hand. Children diagnosed with DMDD struggle to regulate their emotions in an age-appropriate way. In between outbursts they are irritable most of the time. 
DMDD is a somewhat new diagnosis that more accurately represent the symptoms of children who were previously diagnosed with pediatric bipolar disorder, even though they did not experience the episodic mania or hypomania characteristic of bipolar disorder. It is only diagnosed in children aged 7-18. 
Attention deficit hyperactivity disorder (ADHD)
ADHD is a developmental condition of inattention and distractibility, with or without accompanying hyperactivity. There are three basic forms of ADHD described in theDSM-5: inattentive, hyperactive-impulsive and combined.
The symptoms of ADHD and mania or hypomania associated with bipolar disorder are sometimes very similar. Kids might show distractibility, talkativeness, difficulty maintaining attention or loss of social functioning. Clinicians must assess whether it is one condition or whether the disorders are co-occurring. The treatment for ADHD is a stimulant, which can worsen manic episodes in children with bipolar disorder, so it’s important to rule out bipolar disorder before treating ADHD. 
Oppositional defiant disorder (ODD):
ODD is a recurrent pattern of angry/irritable mood, argumentative/defiant behavior or vindictiveness toward authority figures lasting at least six months. This behavioral disorder usually manifests before eight years of age. It is more commonly seen in boys before puberty,but is equally prevalent in boys and girls after puberty. This differs from DMDD because children with ODD have irritable or inappropriate outbursts that are specifically targeted toward certain authority figures such as parents and teachers. Children with ODD are commonly on their best behavior around other individuals, which can cause a lot of stress for the parents. 
Separation anxiety disorder (SAD):
Separation anxiety disorder is characterized by persistent and excessive anxiety during impending separation from the primary caretaker. Other symptoms include repeated nightmares involving the theme of separation, complaints of physical symptoms when separated from major attachment figures and reluctance to go to school or engage in social activities. To meet the criteria for  diagnosis, SAD must cause severe impairment in social, occupational or academic settings. Early and traumatic separation from the mother, father or other caretaker is a known to be a risk factor for the development of separation anxiety in children. 
A child who shows any signs of trauma or underlying mental health issues should be treated by a pediatric therapist or psychiatrist. Parents can also play an important role in their child’s treatment process by attending family support groups and family therapy sessions. 
As parents, guardians and educators, we are responsible for making sure our children receive the best treatment for their mental health disorder. 
Kristen Fuller M.D. is a family medicine physician with a passion for mental health. She spends her days writing content for a well-known mental health and eating disorder treatment facility, treating patients in the Emergency Room and managing an outdoor women's blog. To read more of Dr. Fuller's work visit her Psychology Today blog and her outdoor blog, GoldenStateofMinds.


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