Mental Health Issues

The disorders that specifically characterize children and adolescents have been the subject of intensive study in recent years.  These disorders encompass a wide variety of behavioural problems, ranging from pervasive developmental disorders which may severely affect many aspects of development and are clearly abnormal, to the less severe developmental disturbances which are exaggerations of behaviour problems shown by most children. 

Depression

Depression is characterized by significantly impaired mood with a loss of interest or pleasure in activities that are normally enjoyable.  Depression may be mild, moderate and severe.

In mild depression, effort is required to do normal daily tasks.
In moderate depression, occupational and social impairment prevents the individual from doing things that need to be done. 
In severe depression, marked social and occupational impairment results and may include psychotic symptoms such as hallucinations or delusions.

Children demonstrate a relatively low incidence of depression.  However, most adolescents experience depression, from time to time, as part of their normal life and they consequently have an increased risk of the development of depression at certain levels.  Often, loneliness and social withdrawal are antecedents to depressive disorder in adolescents. 

Anxiety disorder

The disorder will usually have social consequences for the person, with relationships being impaired.  There are four common types of anxiety disorder in adolescents, as described in DSM – IV –TR generalized anxiety disorder, social phobia, specific phobia and obsessive-compulsive disorder. 

In generalized anxiety disorder, adolescents experience the symptoms of nervousness, restlessness, and trouble falling or staying asleep, poor concentration, frequent urination, irritable mood, depressed mood, light headache, dizziness, muscular tension or becoming easily fatigued.  In social phobia the adolescents are exposed to certain types of social or performance situations, often leading to avoidance behaviour.  Specific phobia is characterized by a persistent and irrational fear of a particular object or situation, and can also lead to avoidance behaviour.  With obsessive compulsive disorder, individuals may experience unpleasant and intrusive thoughts which are difficult to control.  Obsessional thoughts often lead to uncontrollable compulsive rituals. 

Suicidal ideation and behaviours

Many individuals experience some level of suicidal ideation at some point of time during adolescentce.  Whether an adolescent thinks of suicide as an option, and/or chooses it, will depend on their personal coping resources and style.  Adolescents who choose suicide as their option for coping are obviously seriously psychologically disturbed.  Adolescents who attempt suicide often have more stressful lives, fewer coping skills and are under-achievers, with poor school performance. 

Post – traumatic stress disorder

This psychological disorder occurs following acute or ongoing trauma.  If post-traumatic stress disorder is left untreated, it can develop into severe incapacitating disorders which will impact on the adolescent’s social and occupational functioning. 

Attention deficit hyperactivity disorder (ADHD)

Hyperactive is part of our everyday vocabulary.  The term ADHD is used to capture the idea that a child’s difficulty involves not just his activity level but also his ability to pay attention.  It is characterized by behaviours such as heightened motor activity, short attention span, distractibility, impulsiveness, and lack of self-control.  ADHD is a prevalent problem nowadays, especially in boys, and usually regarded as the most common psychological difficulty of childhood.  Manifestation of ADHD changes across the life span, even within the childhood years.  Infants show poor regulation of patterns of activity, eating and sleeping.  Toddlers with ADHD show signs of gross overactivity, running, jumping and climbing.  A somewhat older child with ADHD does not show this overall flurry of movement but is instead fidgety and restless and may have poor peer relationships. 

Conduct disorder

Conduct disorder involves a persistent pattern of antisocial behaviours that violate the rights of others.  Many children and adolescents display isolated instances of antisocial behaviour, but this diagnosis is only given when the behaviour is repetitive and persistent.  Conduct disordered children are frequently violent.  They can be cruel not only to people but also to animals as well.  And they have been known to set fires or otherwise destroy the property of others.  Stealing is also common.  These children obviously show little concern for others, and they express scant remorse for their deeds.  Conduct disorders and group delinquency have resisted traditional forms of psychotherapy.  However cognitive behavioural therapy and parent training appear promising. 

Identity disorder

Identity disorders are defined as severe subjective distress about an inability to reconcile aspects of the self into a relatively coherent and acceptable sense of self.  The disturbances are manifested by uncertainty about a variety of identity issues, including long term goals.  career choice, friendship patterns, values and loyalties.  The major changes during adolescence, particularly the development of sexual awareness and interest and the reactions to these changes by family and society, threatens the continuity of self or identify.  These conflicts/disturbances are responsible for producing an “identity crisis”, during adolescence. 

The onset of identity disorder is most frequent in late adolescence.  It is during this period, that a person develops a system of social, ethical, moral and religious standards. The onset is usually manifested by a gradual increase in anxiety, depression, loss of interest in friends, school or activities, irritability, sleep difficulties and changes in eating habits. 

Learning disabilities

Learning disabilities are circumscribed difficulties with acquiring or performing a specific skill such as reading, writing and arithmetic.  These problems usually surface when the child enters the school system.  There are different types of learning difficulties.  They are

Reading disorder:  Impairment in the development of skills at reading.

Writing expression disorder: Impairment in the development of skills at writing.

Mathematical disorders: Impairment in the development of skills at arithmetic.

Motor skills disorders:  Impairment in the development of skills at coordinating the body.

Expressive language disorder: Impairment in the development of skills at communicating with speech and in general acquiring speech slowly or incorrectly. 

Phonological disorder:  impairment in the development of skills at pronouncing sounds and words correctly. 

The current most effective treatment of learning disabilities is remedial educational intervention.  The treatment of this disorder requires an optimal patient-therapist relationship.  The success or failure in sustaining the patient’s motivation greatly affects the treatment’s long term efficacy.  On the other hand, parental counselling helps reduce the parents' anxiety and guilt over the child’s impairment and increase their awareness, giving them confidence to cope with the child. 

Avoidant disorder:

In avoidant disorders, the patient shows a persistent and excessive shrinking from contact with unfamiliar people of sufficient severity to interfere with social functioning in peer relationships and coupled with a clear desire for social involvement with familiar people. 

Temperamental differences may account for some of the predispositions to this disorder, particularly if a parent supports the child’s shyness and withdrawal.  Loss of loved ones in early childhood, sexual traumas and other kinds of physical abuse or neglect may also contribute to avoidant disorder of childhood or adolescence. 

Avoidant disordered children hold back excessively from establishing interpersonal contacts or satisfactory relationships with strangers to an extent that noticeably interferes with their peer functioning. 

These children relate warmly and naturally in their home situations.  At the same time, they may be clinging, whining and overly demanding with care takers, making great demands as to those who are with them.  Embarrassment and timidity are conveyed in their voices, and they may tend to whisper and stand behind people or hide behind furniture in an attempt not to be noticed.  Anger, resentment, rage or grandiosity are often expressed in close relationship.  Children with this disorder may become fearful and anxious when pressured into social participation.  They will be with the caretakers and refuses to become involved in new activities. 

Over-anxious disorder

The essential feature of over-anxious disorder is excessive and unrealistic anxiety or worry.  Children with this disorder tend to be extremely self conscious, to worry about future events, about meeting expectations and to be concerned about the discomforts or dangers of a variety of situations. 

Over-anxious disordered children are greatly concerned about their competence and about being judged negatively.  At times, these worries may have an obsessive pattern.  Physical symptoms such as insomnia nail biting, palpitation and respiratory and gastrointestinal distress are common.  Children with over anxious disorder are excellent candidates for insight oriented therapy, either individually or with their families.  Behaviour therapy can also be coupled with this.