Some Mental Health Issues Children and Adolescents May Experience

Abuse Victims:  Child abuse is widespread.  Because the problem is so extensive and the emotional damage so long-lasting, it is essential that it be recognized and treated as early as possible.
    Any act that harms the physical or emotional well-being of any child is abuse.  This includes:  striking, hitting, slapping, pushing, shoving, throwing, whipping, kicking, shaking, choking, tying up or locking inside a small space, burning with a match or cigarette, beating, pulling hair, biting, starving or any sexual activity between a child and an adult whether consensual or not.  Psychological abuse includes screaming, yelling, shouting, calling a child negative or offensive names, telling a child he or she is bad, stupid or worthless, shaming or embarrassing or belittling. 
    The harm that results from the emotional damage may not be evident until later in the child's life, during adolescence or even adulthood.  The damage may manifest itself in mood disorders, alcohol or drug abuse, physical illness, behavioral disorders, academic problems, difficulty in relationships either with chosen partners or even work related relationships. 
    If you have reason to think a child is being abused, you have an obligation to report this to your local police or a child welfare agency.  Don't hesitate.  You could be saving a child's life.  Teachers, therapists, law officials are obligated to report any child abuse they suspect is happening.
    The sooner a child can receive professional treatment, the better chances are for a complete recovery.  A therapist will want an opportunity to meet with the family of the child as well as the victim. 

Adoption:  Adopted children and adolescents and their families may struggle with  any of the following issues:

    Some of these are simply normal behaviors for children and adolescents.  However, if they are extreme, going beyond the normal adolescent experience, the child or adolescent needs some help resolving them.  These issues are more likely to cause problems for the adoptee and his or her family if the subject of adoption has not previously been openly discussed between them, or if the parents have not resolved their feelings about adoption.  

Angry Feelings (Helping Kids Manage Them):  All children (and adults) feel angry at times in response to something that happens to them such as something another child may do or not being allowed to do what they want to do.  Anger is a secondary emotion that is triggered by another emotion such as hurt, fear, or frustration.  To resolve such feelings, the child or adolescent must be helped to identify and express the primary emotions that lie beneath the angry feelings.
     Feelings of anger are neither good nor bad, but frequent or long periods of experiencing anger can cause long range physical problems such as heart problems, stomach and intestine problems or diseases of the nervous system. Children who express their anger by hitting or tantrums can upset the harmony of the home.

     Children or adolescents can be taught constructive alternatives to destructive expressions of anger such as:
     1. Physical exercise
     2. Walking away
     3. Making a joke of the situation
     4. Taking a nap
     5. Telling someone about the situation
     6. Writing about it
     7. Playing a game

     Child therapists may teach children responses to choose instead of flying off the handle such as:
     1. Teaching them to set limits with others
     2. Teaching them to speak up instead of waiting until annoyance escalates into anger.
     3. Teaching them positive ways to be assertive

Anxiety:  Occasional anxiety is normal for everyone.  But when this anxiety level is constant or at such a level as to disrupt the lives of children or adolescents or cause them to live severely restrict lives, treatment is needed.
    Common anxiety disorders include these: 
    Social anxiety or social phobia - Fear of being around others.  The child may feel self-conscious around others, feel others are watching them, need to be alone at all times in a room with the door closed.  Older children or adolescents my know that others are not watching them, but this knowledge does not make the feelings disappear. 
    Panic Disorder - The person experiences panic attacks that may last several minutes or even longer.  The attack is followed by depression and helpless feelings. 
    Generalized Anxiety Disorder - The child or adolescent is filled with worry, anxiety and fear; always thinking and dwelling on the "what ifs" of a situation. These are often accompanied with irritability, frustration, trembling, inability to concentrate and by sleep disturbances.
    Most children and adolescents begin to feel better when they receive proper treatment, but for some patients that treatment may take months or even years.  For children, treatment may include Play Therapy and/or relaxation training.  Some children experience relief from the symptoms when they receive neurofeedback training. In some cases, referral to a medical doctor who can prescribe antidepressants or anti-anxiety medications may be required, however medication without psychotherapy can seldom produce permanent healing.

Attention-Deficit/Hyperactivity Disorder (ADHD):  (See the special section on this disorder.)

Conduct Disorder:  Children or adolescents with this disorder engage in extremely antisocial behavior that will ultimately cause them to be arrested and incarcerated for serious crime unless they are treated.  The disorder is the result of significant impairment of mental capacity and most often found in children who have:

    Treatment for these children is long term.  Plans include (1) Behavior modification therapy; (2) Anger management training; (3) Special education if the child has learning disabilities; (4) Medication if the child has attention deficits and/or depression.  Unless these children are treated and healed, they carry a very high probability of:

Depression:  Depression is a serious disorder that is not just an adult issue.  It affects as many as 5 percent of children.  It is always troubling, and for some children it is disabling.  It impacts every aspect of the child or teenager's life. 
    Many physicians believe that depression results from chemical imbalance in the brain.  They often prescribe antidepressant medications, and some patients find relief as a result.  Many therapists have discovered abnormalities of the brain's electro-chemical performance is related to depression.  In these cases Neurofeedback has been effective in removing symptoms.  There may also be physical causes related to other diseases, physical trauma or hormonal changes.  A child or adolescent who is depressed should always have a physical examination as part of the assessment process.

   Signs of depression include: 

   Parents or guardians of a child or adolescent who exhibits some of these symptoms should seek a professional therapist without delay.

Divorcing Parents:  Divorce is upsetting for all children.  The stability of their world has become upset and they feel fear, confusion, sadness, yearning, and worry.  They are affected by the emotional upheaval being experienced by their parents as they go through the trauma of the divorce.  Sometimes, the child experiences irrational guilt resulting from the fear that they are somehow responsible for the breakup.
    Parents should seek professional help when the child or adolescent is experiencing the following feelings:  Loneliness, depression, numbness, exhaustion, hopelessness or when the child is sleeping too much or too little.
    Effective treatments include:  Individual psychotherapy - Often game or play therapy is used to help the child to deal with their feelings;  Family therapy - Since the entire family is affected by the divorce, it is important to help the entire group heal so that they can go on to a productive life.  A marriage and family therapist is the best choice for this treatment.

Eating Disorders:  These disorders include a group of serious and complex illnesses that affect mostly adolescent and young adult women.  These disorders present a severe threat to a person's health and can result in dangerous physical problems and even death.
    Anorexia nervosa.  Persons with this disorder have a distorted view of their actual body weight for their age and height and a dread of being fat.  They starve themselves and deny the reality of their physical condition and its physical effects which include missed menstrual cycles.  They exercise compulsively and to excess.  About a third of persons with this disorder develop bulimia nervosa.
    Bulimia nervosa.  These persons are overly concerned about their body shape and weight basing their self-image on how they think they look even though their weight may be normal.  They are obsessed with food, engaging in episodes of overeating or bingeing followed by efforts to void the food in order to avoid gaining weight. They may make themselves vomit, consume laxatives or diuretics or give themselves enemas.  Non purging types compensate by fasting or excessive exercise.
    Binge eating:  The most common type of eating disorder is compulsive overeating  They do not engage in binging and as a result experience rapid weight gain, weight fluctuation and obesity.  They are often secretive with food, hording it and eating alone.  They feel ashamed of their eating habits and often develop depression and anxiety.
    Treatment for the disorder requires cooperation between a physician who can provide medication for the physical effects of the disorder and a therapist who can provide cognitive behavior therapy and relationship counseling.  Self-help groups like Overeaters Anonymous provide support for people with this disorder.

Enuresis (bed wetting) and Encopresis (soiling):  These are common conditions that become problems if the child has passed the age of six and still cannot control his or her bladder and bowel movements.  It is embarrassing and frustrating for both parent and child  It is important that the child not be punished or teased when it happens, since this will not reduce the occurrence of the problem and may simply cause the child to feel more defeated and incapable of conquering it.
    Treatment involves conversation with the patient and a parent so that they learn together some techniques for bringing the problem under normal control.  A family therapist can help determine a plan that the parent and child can work together.  Typically the problem will disappear within a few weeks with treatment. 

Gender Identity Disorder:  Children with this disorder express an intense desire to be the opposite gender - may even insist that they are the opposite gender.  They may prefer activities appropriate for the opposite gender and even prefer to wear clothing of the opposite gender.  (This is not to be confused with homosexuality or lesbianism in which the subjects accept their own gender but prefer sexual relations with a person of their own gender.) 
    For young children (pre teen) this behavior may be nothing other than normal gender role experimentation such as a tomboy phase for a girl.  But if this behavior has persisted for more than six months, treatment should be sought.  Untreated, the disorder can develop into more serious problems such as transvestitism and transsexualism.  The child feels trapped in the wrong body, disgusted by their own genitals and wishes they could be altered to resemble the genitals of the opposite gender.
    Treatment generally includes several types of interventions including individual counseling, family therapy and behavior-modeling to teach appropriate gender role behaviors. 

Grief:  Children experience grief not only in the death of a friend or family member, but also in other significant losses such as loss of:

The effects of grief include intense sadness, depression, anger and general loss of interest in life.  If prolonged, physical debilitation can result.  A Christian therapist will show you how to help your child through the process toward healing and how to set up a space in which the grief can be expressed and experienced.  The therapist will show you how to affirm your faith in God so that His love and care becomes real for the child through the experience. 

Oppositional Defiant Disorder:  When a child regularly engages in a pattern of defiance and hostility, and that behavior begins to affect the child's social relationships and family life, oppositional defiant disorder (ODD) may be diagnosed.  It differs from attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) in important ways.  Children with ADHD are impulsive, while those with ODD are mainly aggressive.  Children with CD are unsafe when not supervised, while children with ODD do not have safety issues.
    Symptoms of ODD include:

    Careful diagnoses is important because children with ODD may also have other psychiatric disorders, such as ADHD, which must be treated as well.  A therapist will conduct an assessment to determine the nature of the disorder and plan a treatment which includes play therapy, individual counseling and family counseling to help others in the family assist in the healing process.  Through the process, the client must learn to experience the satisfaction they receive from new ways to relate to those around him or her.

 Phobias:  A phobia is an irrational fear of a specific situation (e.g., flying, standing in a high place) or thing (e.g., spiders, birds, clowns).  Exposed to those things or situations, the individual feels anxiety or even panic.  Even knowing that these fears are irrational does not dispel the dread or fear they experience.  Sometimes the fear is so great as to interfere with school, social relationships, etc.
     Usually, phobias are brought on by some early childhood trauma.  Many times phobias which begin in childhood will fade away by adulthood.
    Children and adolescents usually begin to feel better when they receive the proper treatment, but because each phobia is triggered by a unique set of factors, it can be frustrating when treatment takes longer than expected.  Some clients feel better after a few sessions.  Others may take longer. 
    Mental health professionals use a variety of treatments including cognitive therapy, behavior therapy, hypnotherapy and relaxation training. The speed of recovery is linked to the willingness of the client to try new behaviors and to practice new skills and techniques for controlling his or her feelings.

Self-Esteem:  Self-esteem is the image you have of yourself.  High self-esteem means you have a positive self image - high respect for yourself.  This self image is a complex web of beliefs we learn from the experiences of childhood and adolescence such as, what others said about us, told us or did to us.  People with low self-esteem believe they are not very smart, pretty, competent or valuable.  People behave in ways that reinforce for themselves that the beliefs they hold about themselves are true.  The fact is that people do not value persons who do not value themselves, so these beliefs of low self esteem tend to be reinforced by daily life. Since persons behave in harmony with their low self-esteem, persons with low self-esteem do poorly in school and work and perform poorly in developing close relationships with other.  They are the last hired and first fired.  They seldom excel in sports and tend to be followers rather than leaders.  Studies show that their record of illness is higher for persons of low self-esteem.
    Parents initially have the most influence on the child's self esteem.  Parents with poor self esteems tend to pass this low regard for self on to their children.  However, with training, parents can learn techniques for making a very positive impact on the child's self-esteem.  Simple things like telling a son or daughter that you love him or her can make a positive difference.  Telling the child you are glad he or she is your child.  Spending time with your son or daughter, or taking time to listen to him or her can help the child reevaluate his or her own opinion of self.
    Therapists have tools for measuring the self-esteem of a person and can pinpoint the best part of the child's self image to address in reversing low self opinion.  Typically, the therapist will work with both the child and parents.  The therapist's own behavior will be such as to show the child that he or she is important.  Moreover, the Christian therapist will communicate strongly to the child that he or she is a precious creation of God. 
    While the process of raising a person's self-esteem may be slow, the sooner the process is begun the more chance for success.  Some improvement will be seen almost immediately as the therapy and responses of those around the client begin to make their impact. 

Sleep Disturbances:  Sleeping well is important for the child's physical and emotional well-being.  Sleep disturbances include a wide variety of experiences:  Difficulty falling asleep, waking up often during the night, waking up early, talking in sleep, crying during the night, sleep walking, bed wetting (see enuresis), bad dreams.  Occasional occurrence of these experiences are not cause of concern, and each child has a different pattern of sleeping.  If a child seems to be alert and happy during waking hours, is healthy and thriving, unusual sleep behavior may not be cause for alarm. 
    Parasomnias are a group of sleep disturbances that are fairly rare.  Included are sleep-walking, sleep talking or terrors.  If a child screams hysterically and seems to be awake but is unable to describe what is happening or walks around often while asleep, professional help should be consulted.
    A psycho-therapist can help to rule out physical or emotional disorders that may interfere with a child's sleep and can suggest things you can do to alleviate sleep problems. 

Suicide Ideation:  Threats of suicide or preoccupation with death should prompt immediate action on the part of parents or guardians.  Five thousand children between the ages of 15 to 24 in the United States each year kill themselves.  The actual number may be many more, since suicide often goes unreported because of its stigma or because family members find it too painful to confront the truth.
    Children and teens are especially vulnerable to feelings of self-doubt, fear, poor self-esteem, or their appearance.  Moreover, they are not yet mentally capable of making good rational decisions that involve themselves.  As a result, they may see suicide as a logical solution.
    Early warning signs include:  Making threats of suicide like, "I wish I were dead," or "I'm going to end it;"  expressing hopelessness, helplessness or worthlessness; talking about death; seeming depressed, moody or angry; having trouble at school of work; abusing alcohol or drugs; taking risks; withdrawing from other people;  giving away prized possessions; loss of appetite; or difficulty sleeping.  Physical or mental illness can also play an important part in raising the risk of suicide.
     WHAT TO DO IF SOMEONE IS SUICIDAL:  Take the threats seriously.  Have the child or adolescent evaluated by a qualified mental health professions.  If this is impossible, and you fear the threat is imminent, call 911, and have the child or teen hospitalized until help can be found.

 Underachievement:  When a child is not performing in school up to his or her potential, this can be frustrating for parents and child.  If the underachievement is severe or lasts for more than a school year, it should be considered a problem.  If the problem is considered objectively and the student is provided with adequate support, the chances are very good that the problem can be solved.
    The role of a therapist is to do such assessment as necessary to rule out or treat depression, social conflicts, ADD or learning disabilities that can interfere with the child's performance.  The therapist can give the parents some specific homework to help address factors in school, home or in the child that may be causing underachievement. 
    The most important thing is to address the problem promptly before it adversely affects the child's self-esteem and creates resignation due to falling behind peers in school.
    Dr. Steven Gray's book, Motivating Marvin, is an excellent resource.  [See Additional Resources]

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