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Child and adolescent mental health

Mental health is generally defined as how people think, feel, and act as they face life’s many different situations. It is the exact way in which the higher functions of the brain manifests itself in different circumstances. It affects how people handle stress, relate to one another and make decisions. Mental health influences the ways in which individuals look at themselves, their lives and at others in their lives. Like physical health, mental health is important at every stage of life and is a continuing process right throughout a lifetime. All aspects of our lives are affected by various different components of our mental health. Disorders of mental health are an important group of conditions which can have many variable influences in day to day life of individuals.

Like adults, children and adolescents can also have mental health disorders that interfere with the way they think, feel, and act. Young people can have mental, emotional, and behavioural problems that are real, painful, and costly. These problems, often called "disorders", are sources of stress for children and their families, schools, and communities. When they are not properly handled, mental health disorders can lead to school failure, family conflicts, drug abuse, violence and even suicide. Untreated mental health disorders can be very costly to families, communities, and the health care system. Studies show that an important and significant proportion of children and adolescents have a mental health disorder. As far as the entire population of Mother earth is concerned, at least one in ten, a very significant proportion of the global population, has a serious emotional disturbance.

Mental health disorders in children and adolescents are caused mostly by biological disturbances and environmental influences. Examples of biological causes are genetics, chemical imbalances in the body or damage to the central nervous system such as a head injury. Many environmental factors also put young people at risk for developing mental health disorders. Examples include exposure to environmental toxins such as high levels of lead, contact with violence such as witnessing or being the victim of physical or sexual abuse, drive-by shootings, muggings or other disasters including natural disasters, stresses related to chronic poverty, discrimination or other serious hardships and loss of important people through death, divorce or broken relationships.

It is of course quite easy to know when a child has a fever. A child’s mental health problem may be harder to identify but one can learn to recognize the symptoms. It is necessary to be vigilant and pay attention to excessive anger, fear, sadness or anxiety. Sudden changes in a child’s behaviour can tip one off to a problem. So can behaviours like exercising too much or hurting or destroying things. Some common mental health problems in children include depression, anxiety and behaviour disorders. Mental health problems can disrupt daily life at home, at school or in the community. Without help, mental health problems can lead to school failure, alcohol or other drug abuse, family discord, violence or even suicide.

A variety of signs may point to mental health disorders or serious emotional disturbances in children or adolescents. Some of these include :-

* Sadness and feeling hopeless for no reason. Persistence of these symptoms is characteristic.

* Being very angry most of the time and crying a lot or overreacting to things.

* Feelings of worthlessness or guilt feelings that occur very often.

* Being anxious or worried often.

* Inability to get over a loss or death of someone important.

* Being extremely fearful or having unexplained fears.

* Constant concerns regarding physical problems or physical appearance.

* Being frightened that his or her mind either is controlled or is out of control.

These may also be accompanied by other features such as:-

* Showing declining performance in school.

* Losing interest in things once enjoyed.

* Experiencing unexplained changes in sleeping or eating patterns.

* Avoiding friends or family and wanting to be alone all the time.

* Daydreaming too much and not completing tasks.

* Feeling life is too hard to handle.

* Hearing voices that cannot be explained.

* Experiencing suicidal thoughts.

A child or adolescent with a mental health problem may experiences poor concentration and is unable to think straight or make up his or her mind. Sometimes they are unable to sit still or focus attention. They worry about being harmed, hurting others or doing something "bad". Some may have a need to wash, clean things or perform certain routines, even hundreds of times a day, in order to avoid an unsubstantiated danger. Others may have racing thoughts that are almost too fast to follow and some suffer from persistent nightmares.

There are a whole host of mental, emotional, and behavioural disorders that may occur during childhood and adolescence. All can have a serious impact on a child’s overall health. Some disorders are more common than others and conditions range anywhere from mild to severe. Sometimes, an affected child could have more than one disorder. A child or adolescent with some of these conditions could behave in ways that cause problems. They may use alcohol or other addictive drugs as well. Some eat large amounts of food and then induce purging by abusing laxatives to avoid weight gain. Others diet and exercise obsessively. They may violate the rights of others or constantly break the law without regard for other people. Some may set up fires and be arsonists, do things that can be life threatening and habitually kill animals.

An important affliction is a group of conditions known as anxiety disorders. Young people who experience excessive fear, worry or uneasiness may have an anxiety disorder. Anxiety disorders are among the most common of childhood disorders. According to one study in children and adolescents between 9 and 17 years, as many as 13 of every 100 young people had an anxiety disorder. Anxiety disorders include phobias which are unrealistic and overwhelming fears of objects or situations, generalized anxiety disorder which causes children to demonstrate a pattern of excessive, unrealistic worry that cannot be attributed to any recent experience, panic disorder which causes terrifying "panic attacks" that include physical symptoms, such as a rapid heartbeat and dizziness, obsessive-compulsive disorder which causes children to become "trapped" in a pattern of repeated thoughts and behaviours such as counting or hand washing and Post-traumatic Stress Disorder which causes a pattern of flashbacks and other symptoms and occurs in children who have experienced a psychologically distressing events such as abuse, being a victim or witness of violence or exposure to other types of trauma such as wars or natural disasters. With the variety of everyday stresses that children are subjected to, it is not at all surprising that anxiety disorders are one of the commonest of the entire heap of psychological problems of children and adolescents.

Many people once believed that severe depression did not occur in childhood. Today, experts agree that severe depression can occur at any age. Studies in the West show that two of every 100 children may have major depression, and as many as eight of every 100 adolescents may be affected. This disorder is marked by changes in emotions where they often feel sad, cry or feel worthless. There is loss of motivation where they lose interest in play activities and schoolwork deteriorates. The physical well-being may be hampered with changes in appetite or sleeping patterns and some of them may have vague physical complaints. Some also get unusual thoughts such as being ugly, unable to do anything right or that the world or life is hopeless. It also is important for parents and caregivers to be aware that some children and adolescents with depression may not value their lives, which can put them at risk for suicide.

Children and adolescents who demonstrate exaggerated mood swings that range from extreme highs described as excitedness or manic phases to extreme lows or marked depression may have what is known as a bipolar disorder (sometimes called a manic depressive illness). Periods of moderate mood occur in between the extreme highs and lows. During manic phases, children or adolescents may talk nonstop, need very little sleep, and show unusually poor judgment. At the low end of the mood swing, they experience severe depression. Bipolar mood swings can recur throughout life. Adults with bipolar disorder, numbering about one in 100, often relate that they experienced their first symptoms during their teenage years.

Children or adolescents who are intensely afraid of gaining weight and do not believe that they are underweight may have eating disorders. Eating disorders can be life threatening. Young people with anorexia nervosa, for example, have difficulty maintaining a minimum healthy body weight. Anorexia affects one in every 100 to 200 adolescent girls and a much smaller number of boys. Youngsters with bulimia nervosa feel compelled to binge-eat huge amounts of food in one sitting. After a binge, in order to prevent weight gain, they rid their bodies of the food by vomiting, abusing laxatives, taking enemas, or exercising obsessively. Reported rates of bulimia vary from one to three of every 100 young people in the Western countries.

Young people with a conduct disorder usually have little concern for others and repeatedly violate the basic rights of others and the rules of society. Conduct disorder causes children and adolescents to act out their feelings or impulses in destructive ways. The offences these children and adolescents commit often grow more serious over time. Such offenses may include lying, theft, aggression, truancy, the setting of fires, and vandalism.

Schizophrenia is a chronic, severe and disabling brain disorder that affects about one percent of the population during their lifetime. Symptoms include hallucinations, delusions, disordered thinking, social withdrawal or withdrawal from others and loss of contact with reality. It is a profound disorder of the brain and mental make-up of an individual that make them completely irrational. Schizophrenia appears to be extremely rare in children and when it does occur, more typically, the illness emerges in late adolescence or early adulthood. However, research studies are revealing that various cognitive and social impairments may be evident early in children who later develop schizophrenia. These are probably the warning signs that need to be recognised early.

When there is a full-blown clinical picture, it is not too difficult to make the diagnosis. However some of these mental health disorders may present with rather subtle features and it is often quite a challenge to make the proper diagnosis. Many of these conditions need expert psychiatric care and prolonged management strategies. These involve behaviour therapy, psychotherapy and certain specific medications. Some of these conditions are rather easy to manage while others could be quite difficult. However, some form of interventional therapy is required in a significant proportion of these cases. Even the most complicated of these problems can be handled and treated by modern psychiatry but in some cases, protracted treatment, often for a prolonged period of time is necessary. Unlike some of the physical illnesses, one cannot expect "quick and magic cures" in some of these conditions.

The writer would appreciate feedback from the readers. Please e-mail him at bjcp@sltnet.lk

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