Mental illness in children

Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

More about the experts All content is checked by medical journalists.

Mental illnesses in children are not that rare. According to studies, a good 17 percent of three to 17-year-olds are mentally ill. Boys are more often affected than girls. Read here how you can recognize psychological abnormalities in your child, which mental illnesses occur in childhood and adolescence and how they can be treated.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F90Q99F31F40F42F50F91F84F41F20F32F98F60F43

Brief overview

Definition: psychological abnormalities that have a negative impact on the child's everyday life and from which the child suffers
Forms: age-independent forms such as depression, anxiety disorders, bipolar disorder, eating disorders (such as anorexia), obsessive-compulsive disorder. Age-dependent forms that occur especially in childhood such as ADHD, oppositional behavior disorder, social behavior disorder, autism, Rett syndrome, fragile X syndrome, attachment disorder, language disorders, tic disorders
Frequency: According to a recent survey, around 17% of three to 17-year-olds show mental health problems.
Symptoms: e.g. sudden social withdrawal, seemingly unfounded, persistent sadness, loss of interest, listlessness, frequent fits of anger, wetting after a long period of dryness
Causes and risk factors: e.g. increased emotional vulnerability, genetic factors, physical illnesses, impaired brain functions, temperament and personality, abuse, experiences of violence, neglect, loss of important caregivers, mental illnesses of the parents, family environment characterized by quarrels and violence, separation or Parental divorce, low level of education of the parents, precarious financial circumstances of the family
Diagnosis: consultation with a doctor, medical examinations, behavioral observation, psychological tests
Treatment: mostly multimodal with (family) psychotherapy, possibly medication and accompanying social, language or mobility-promoting measures

Mental illness in children: definition

Every child is different and every child exhibits psychological problems from time to time - bad moods out of the blue, sudden sadness and tantrums are part of a normal development. Even if a child doesn't feel like playing or going to school, it doesn't have to be a mental illness. Because like adults, children sometimes have psychological problems, but these can also go away on their own and are not a cause for concern.

Only when such abnormalities increase and become the rule from the exception should parents and caregivers pay more attention and take a closer look: Do the negative feelings affect the child's life and everyday life? Does it suffer from this? If so, you may have a mental illness.

frequency

According to the most recent wave of the long-term study on the health of children and adolescents in Germany (KiGGS Wave 2 from 2014 to 2017), almost 17 percent of three to 17-year-olds are mentally ill, according to their parents. This is a decrease of around three percentage points compared to the KiGGS baseline study (2003 to 2006).

Mental health problems are observed more frequently in boys than in girls. This is especially true between the ages of three and 14.

Forms of mental illness: age and gender differences

Age and gender also have an influence on which type of mental health problems or illnesses dominate in young people:

Mental disorders in toddlers under the age of four are mostly due to developmental disorders.
Anxiety disorders, depression, ADHD, and aggressive, defiant behavior disorders are the most common among elementary school children.
Depression, eating disorders and addictions dominate in adolescents between 15 and 18 years of age.

Boys are more likely to develop ADHD (about four times as often as girls), aggressive behavior disorders and addictions, while eating disorders, psychosomatic illnesses and depression predominate in girls.

Mental illness in children: symptoms

Mental illnesses in children and adolescents should be treated as early as possible. Because then there is a good chance of stopping the further development and thus preventing the disorder from continuing into adulthood.

But how can mental disorders in children be recognized, which symptoms are warning signs? And does the child now have a mental disorder with typical symptoms or is it a temporary behavioral problem?

A look at the symptoms, which can be warning signs of mental illness, helps to differentiate. It is important that parents, educators, teachers and other caregivers react sensitively to such warning signals.

Possible signs of mental disorders in children

One of the first possible signs is a sudden, persistent change in behavior in the child. If your child suddenly withdraws, is sad, loses interest in hobbies, games or previous favorite activities, has unusually frequent tantrums, or if actually "dry" children wet themselves again, this may be due to a mental disorder.

When assessing whether children with mental health problems show only temporary problem behavior or suffer from a mental disorder, specific considerations help:

How long has the child been shown changed? Only when the changed behavior persists over a longer period of time (several weeks), there may be a psychological disorder behind it
Have you noticed the change before? Some illnesses progress in flare-ups (e.g. depression). Typical behavioral and emotional changes such as withdrawal, sadness and disinterest appear during a push. Once the acute episode has passed, the affected children behave completely normally again.
How often do the abnormalities show up? For the first conversation with the pediatrician or psychiatrist, information about the frequency of the abnormal behavior is helpful. You should therefore note in a calendar when your child is behaving abnormally psychologically.
How serious is the problem? Ask yourself and your child how intense the abnormalities are. A scale from 1 to 10 can help, with 1 being the weakest and 10 being the strongest.
Does your child suffer from the emotional or behavioral changes? Do the changes affect the child's everyday life? For example, do they lead to social isolation or serious performance losses? If there is a high level of psychological stress, you should urgently consult a specialist with your child.
Are there known triggers for the problematic behavior? What will help to get rid of the symptoms? Knowing what triggers your child can help you temporarily avoid triggering situations or events. In the long run, however, avoidance behavior is not a solution. If the problematic behavior does not improve after a while, you should contact a specialist doctor.
How do outsiders (especially relatives, educators, teachers) assess the situation? The view from the outside sometimes opens up new perspectives - maybe other caregivers of your child assess the situation very differently from you? Or do you notice anomalies that you did not notice? The exchange with other caregivers is definitely a gain for you, because it can be immensely easier to share your worries and thoughts with others.
Do you think you can solve the problem on your own or do you need help? Mental health problems and the worries associated with them can be very stressful - for you and for your child. So don't be afraid to seek medical help at an early stage.

Mental illness in children: diagnosis

Before treatment begins, a careful diagnosis is made by the specialist, i.e. the child and adolescent psychiatrist. The aim is to state exactly what type of disorder it is. In this way, the treatment can be tailored precisely to the clinical picture. This is important for the success of the subsequent therapy.

anamnese

In the first step, the specialist will have a detailed discussion with you and your child to collect the medical history (anamnesis). The following information is important, for example:

Which psychological abnormalities are you talking about?
How, when, how often and in which situations do the problems arise?
Do you or your child suspect certain triggers behind the problems?
Is your child suffering from the changes?
Do the changes affect your child's everyday life? For example, are there problems at school, with classmates, or is your child afraid of certain situations?
Is your child known to have a physical or mental illness?
In which family and social environment does your child live? For example, does it have stable relationships and caregivers?
Have there been current changes in this environment, for example deaths, divorce or the like?

Answer the doctor's questions honestly and as accurately as possible. And always remember: It is not a matter of assigning blame, but of diagnosing your child's mental health problems as precisely as possible.

With your consent, the doctor may also speak to relatives, teachers or educators in order to get the most complete picture of your child as possible.

Behavior observation

The specialist may recommend behavior monitoring in the next step. For example, he asks you to observe and record your child's eating or play behavior over a certain period of time.

Medical examinations

Sometimes there are actually physical illnesses behind supposed mental disorders. The doctor must rule this out in the context of diagnostics. A blood test is usually carried out for this purpose. This allows, for example, increased inflammation values, deficiency symptoms and other changes in blood values to be detected, which can indicate a physical illness. The doctor can also track down neurological development disorders with a blood test.

Psychological tests

Numerous aspects of a child's level of development can be recorded with the help of standardized psychological tests, for example the development of language, mental abilities, mobility as well as reading, spelling and arithmetic skills.

The doctor can also examine personality traits or abnormalities with the help of standard tests.

Multiaxial classification scheme (MAS)

The so-called multiaxial classification scheme (MAS), which is often used in child psychiatric diagnostics, enables a holistic assessment. Six axes depict the mental disorder in a differentiated manner:

Axis 1 indicates the mental disorder.
Axis 2 indicates whether developmental disorders have been identified.
Axis 3 indicates the child's / adolescent's level of intelligence.
Axis 4 indicates any physical symptoms or illnesses.
Axis 5 depicts the psychosocial circumstances.
Axis 6 shows the psychosocial adaptation, for example social contacts, interests and hobbies of the child.

Mental illness in children: forms

There can be a wide variety of forms of illness behind psychological abnormalities in children. In principle, children and adolescents can develop the same mental illnesses as adults, such as depression, anxiety and eating disorders, which are among the most common mental illnesses in children and adolescents. On the other hand, psychotic illnesses such as schizophrenia rarely occur in childhood, but usually develop later (in young adulthood).

In addition to these age-independent diseases, there are also mental disorders that always develop in childhood, so to speak, "mental childhood diseases". They often remain present even in adulthood. Experts differentiate between two groups:

Disruptive behavioral disorders: These are mental disorders in children that primarily affect behavior, which can have a disruptive effect on others. Examples are ADHD, oppositional behavior disorder, and social behavior disorder.
Neurodevelopmental Disorders: They affect not just mental health, but all of a child's development. They include, for example, autism, Rett syndrome and fragile X syndrome.

The following is an overview of important mental illnesses in children and adolescents:

depression

Persistent sadness, lack of drive, lack of interest, and social withdrawal can all be signs of depression. Even toddlers can develop a depressive disorder. In female adolescents, depression is one of the most common mental illnesses.

You can find out more about symptoms, causes, diagnosis and treatment of depression in the article Depression.

Anxiety disorders

Anxiety disorders are also common among children and adolescents. These include phobias (= fear of certain situations, animals or objects), panic disorder and generalized anxiety disorder.

You can find out everything you need to know about anxiety and anxiety disorders in the article Anxiety.

Bipolar disorder

A moment ago, cheering as high as the sky, suddenly saddened to death: people with bipolar disorder are constantly commuting between extremes emotionally. Young people in particular can be affected.

You can find out everything you need to know about this serious mental illness in the article Bipolar Disorder.

Post-traumatic stress disorder

Children who have experienced neglect, violence, or abuse often develop post-traumatic stress disorder (PTSD). Symptoms are a general tension, fear and irritability, tormenting memories or the mental reliving of traumatic experiences (flashbacks).

You can find out everything you need to know about symptoms, causes, diagnosis and treatment of PTSD in the post-traumatic stress disorder.

eating disorder

People with anorexia nervosa have a morbid desire to keep losing weight. The eating-vomiting addiction (bulimia), on the other hand, is classically characterized by recurring "binge eating" followed by forced vomiting. The pure binge eating manifests itself with recurring "binge eating".

You can find out everything you need to know about these eating disorders in the articles Anorexia, Bulimia, and Binge Eating.

Personality disorders

Personality disorders are also serious mental illnesses. A relatively common personality disorder in adolescence is borderline disorder. It is characterized by impulsiveness and instability - feelings, thoughts and attitudes can change within a very short time.

Other forms of personality disorder include antisocial, narcissistic, and paranoid personality disorder.

Read more on the topic in the articles Borderline Syndrome, Dissocial Personality Disorder, Narcissistic Personality Disorder, and Paranoid Personality Disorder.

schizophrenia

Schizophrenia is rare in children and adolescents. Affected people suffer from massive changes in their thoughts, feelings and perceptions at times. Their behavior also changes dramatically and often appears bizarre or frightening to outsiders.

You can find out everything you need to know about this serious clinical picture in the article on schizophrenia.

Obsessive-compulsive disorder

This form of mental disorder manifests itself in compulsive, ritualized behavior or thinking. Examples are compulsion to wash, obsessive-compulsive thoughts, and compulsion to control.

You can find out more about these mental disorders, which often occur in childhood and adolescence, in the article Obsessive-Compulsive Disorder.

ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is believed to be genetic. Typical characteristics are inattention, hyperactivity and impulsiveness, which are excessively pronounced with regard to the level of development of the person concerned and occur across all situations.

You can find out more about this clinical picture in the article ADHD.

Oppositional behavior disorder

Oppositional behavior disorder manifests itself primarily in aggressive behavior towards persons in authority such as parents and teachers. The children affected tend to outbursts of anger, resist adults, refuse to obey rules, are easily provoked and like to annoy others - this behavior used to fall under the umbrella term "difficult to raise children". The symptoms present some challenges for parents, teachers and educators.

The behavior of these children does not pose a threat to others, they do not really harm others and are capable of feeling remorse and guilt.

Conduct social disorder

A social behavior disorder can have more serious consequences. In contrast to oppositional disorders, the children affected violate other people's rights or age-appropriate rules and norms through their behavior. Typical symptoms are a lack of empathy, i.e. the inability to empathize with others, and the high degree of aggressiveness.

The social behavior disorder often manifests itself in physical aggression against humans, cruelty to animals, theft, fraud and damage to property. Those affected do not follow any rules, often run away from home and skip school. They feel neither remorse nor guilty about their behavior and its consequences.

autism

Autism is a collective term for various profound developmental disorders (autism spectrum disorders). Those affected usually have problems with social contacts, communication and language. Many also show stereotypical behaviors and interests. Well-known forms of autistic disorders are early childhood autism and Asperger's syndrome.

You can find out everything you need to know about autism spectrum disorders in the article Autism.

Rett Syndrome

Rett syndrome is a rare, genetic developmental disorder that affects girls almost exclusively. It is based on a genetic change (mutation) on the X chromosome. It causes various abnormalities to manifest themselves after an initially normal development, such as:

stereotypical hand movements (washing, kneading hand movements)
Loss of skills already acquired (e.g. spoken language)
autistic traits
sudden attacks of screaming and lanching
Short stature
Gait disorders, disruption of the execution of voluntary, purposeful movements (apraxia)
epileptic seizures
sleep disorders

Fragile X Syndrome

This hereditary disease is also triggered by a mutation on the X chromosome. But it affects boys more often than girls. Possible symptoms are:

more or less severely decreased intelligence
Delayed development: e.g. late learning to speak, clumsy movements, balance disorders
Learning difficulties
Behavioral problems: e.g. restlessness, avoidance of eye contact, attention disorders, mood swings, fits of anger, sensitive reactions to bright light and noises
mental health problems: autistic behaviors, ADHD, or anxiety
External characteristics: e.g. elongated head, high forehead, often open mouth, overstretchable joints, large testicles

Other mental illnesses in children

Other forms of mental disorders in childhood are, for example:

Attachment disorders: They occur in toddlers up to five years of age and are expressed in overcautious behavior combined with extreme fear of separation (reactive form) or in indiscriminate attachment behavior. The cause is usually extreme neglect or abuse of the affected child.
Speech disorders: These disorders include stuttering and rumbling. In the latter case, the affected children speak very quickly, irregularly and abruptly.
Tic disorders: These are repeated involuntary, uncontrollable movements or sounds. Examples are throwing the head, twitching the eyelid, hopping, sniffing or repeating certain words.

Mental illness in children: therapy

My child has mental health problems - what now?

Once the diagnosis has been made, the question of the optimal treatment arises. Mental illnesses in children and adolescents are often treated using a combination of psychotherapeutic measures, educational and social approaches and, if necessary, drug therapy (multimodal therapy approach).

Before starting treatment, the question arises whether the young patient should be treated on an outpatient, inpatient or partial inpatient basis. The decision depends on the type and especially the severity of the mental disorder. Sometimes weekly outpatient therapy sessions are sufficient, in other cases therapy in a child and adolescent psychiatric clinic is indicated. The treating specialist makes the decision together with the parents.

psychotherapy

Psychotherapy is the main focus of the treatment. It can be done with the child alone or with the whole family. The relationship of trust between therapist and patient is decisive for the success of the therapy. It is therefore important that the child and all other participants (parents, siblings, etc.) get along well with the treating therapist.

The aim of the therapy sessions is to work out solutions for the problematic behavior together. Role plays and behavioral therapy measures can help. It is also important to find ways to integrate the newly learned behavior into the child's everyday life and relationships. This requires positive support from the entire family.

The therapist discusses with the parents and the child how often and for how long the psychotherapy should take place.

Medication

For some diseases such as ADHD or depression, medication can at least temporarily supplement treatment. Soothing drugs and so-called anti-aggressive agents are sometimes also indicated, for example to end a strong state of excitement.

Psychotic illnesses such as schizophrenia, which rarely occur in minors, usually also require drug therapy. Neuroleptics such as clozapine or risperidone are used here in patients aged 16 and over. Neuroleptics have also proven their worth in the treatment of tics and hyperkinetic disorders (uncontrolled movements of the skeletal muscles).

When making the selection, the treating specialist pays attention to the approval of the preparations for children and adolescents and adjusts the dosage individually.

Accompanying measures

Youth and family support measures, support offers to improve reading or language skills and occupational therapy measures can also help to get the problems of mentally ill children under control. The individual case decides which of these measures make sense.

How can I help my child?

Does my child have psychological problems? Even if you answer "yes" to this question - stay calm as possible. The best way to help your child is to accept and appreciate them for who they are. Make them feel accepted and actively support them:

Inform relatives, educators, teachers and parents of friendly children about the disease so that they can classify the deviating behavior of your child.
Accompany your child's therapy actively and take part in it.
Stay in emotional contact with your child.
Empower your child and instill confidence.
End possible traumatizing relationships or situations in the family or in the environment.
Seek professional help from an experienced child and adolescent psychologist or psychologist that you and your child trust.
Take care of yourself, because dealing with a mentally ill child can be very stressful. For example, find a self-help group in which you can exchange ideas with other affected parents.

Mental illness in children: causes and risk factors

The causes of mental illness in children and adolescents are diverse. Usually several factors work together in the development of such diseases.

Biological causes and risk factors

An increased emotional vulnerability increases the risk of becoming mentally ill. It can be passed on from parents to children. If other risk factors are added, a mental illness can develop more easily.

Possible biological risk factors for psychological illness in children include:

genetic predisposition
physical (physical) illnesses
a disturbed brain function (for example with inflammation or malformations of the brain)
gender - some diseases such as depression are more common in girls overall, others such as oppositional behavior disorder are more typical of boys
the temperament of the child - how does the child react to new stimuli, does it tend to withdraw or is it open and open to new ideas, how flexibly does it adapt to changes?

Psychological causes and risk factors

Possible psychological triggers of mental illness in children and adolescents include, for example:

Abuse and experiences of violence
Neglect, lovelessness of parents / caregivers
Loss of parents or other important caregiver
mental illness of parents
unstable relationships with central caregivers
inconsistent parenting methods
frequent quarrels and violence within the family
Separation or divorce of parents

Socio-cultural causes and risk factors

The social environment, the educational level of the parents and the income situation can also have an impact on the mental health of children. Studies show that children from poorly educated, poor families have a higher risk of developing mental health problems. One explanation for this is that cramped living conditions and financial worries favor disputes and violence - classic risk factors for the development of mental illness.

Last but not least, the social environment, for example at school, influences mental health. Children with stable friendships and interests are less likely to become mentally ill than those who are marginalized or bullied.

Usually several of the mentioned factors come together when mental illnesses develop in children. Prompt treatment is important. Then the chances are good that a mentally ill child will grow into a healthy adult.

Tags: prevention alcohol baby toddler