Mental health disorders are complex, can take many forms, and remain widely under-reported, so in an effort to bring awareness to some of the more common disorders and mental health issues that children and teens experience, I’m going to list off their definitions and key attributes for Children’s Mental Health Week.
Most of the estimates presented in this entry are produced by the Institute for Health Metrics and Evaluation and reported in their flagship Global Burden of Disease study. This study estimates that in 2017, approximately 792 million people lived with a mental health disorder. This is slightly more than one in ten people globally (10.7%). If there is one certainty about mental health disorders, it is that they are common everywhere. Improving awareness, recognition, support and treatment for this range of disorders should therefore be an essential focus for global health.
Around 14% of children and adolescents aged four to 17 meet diagnostic criteria for at least one mental health disorder. The most common mental health disorders in Australian children are anxiety disorders, which affect 6.9% of children, and attention deficit hyperactivity disorder (ADHD), which affects 7.4% of children. Approximately 50% of all adult mental disorders begin before the age of 14. Yet in 2017-18, children under the age of 15 had the lowest use of Medicare-rebated mental health services (5.1%) of any Australian age group.
Childhood conditions form a critical component of health and wellbeing later in life. Negative experiences, either at home or outside of the home (for example, bullying in school) can have lifelong impacts on the development of core cognitive and emotional skills. Poor socioeconomic conditions also have a significant effect on vulnerability to mental health disorders; in a study in Sweden, the authors found that children raised in families of poor socioeconomic backgrounds had an increased risk of psychosis.
Poor economic resources, shown through poor housing conditions for example, can be seen by children as shameful or degrading and affect aspects of childhood learning, communication and interaction with peers. Children with a parent who has a mental illness or substance use disorder have a higher risk of psychiatric problems themselves. This effect between generations can occur as a result of genetic, biological, psychological and social risk factors.
As teens go through adolescence, this stage of life is typically where mental health disorders tend to become more apparent. The risk factors and contributors to wellbeing in childhood apply equally to those in adolescence. In addition, several other contributing factors appear. It is in the years of adolescence that the use of substances including alcohol and drugs first appear and become accessible.
Substance use is particularly hazardous and harmful for adolescents because individuals are still developing both mentally and physically. Peer pressure, and media influences also become more prominent over these years. Exposure to substance use is not only an important risk factor for other mental health disorders, but also linked to poorer educational outcomes, more risky sexual behaviour and increased exposure to violence and conflict.
Below is a general overview of some of the more common mental health disorders that young people are more likely to experience in their formative years.
Depressive disorders occur with varying severity, yet all forms of depressive disorders experience some of the following symptoms:
- (a) reduced concentration and attention
- (b) reduced self-esteem and self-confidence
- (c) ideas of guilt and unworthiness (even in a mild type of episode)
- (d) bleak and pessimistic views of the future
- (e) ideas or acts of self-harm or suicide
- (f) disturbed sleep
- (g) diminished appetite
Mild persistent depression (dysthymia) tends to have the following diagnostic guidelines:
“Depressed mood, loss of interest and enjoyment, and increased fatiguability are usually regarded as the most typical symptoms of depression. None of the symptoms should be present to an intense degree. Minimum duration of the whole episode is about 2 weeks. An individual with a mild depressive episode is usually distressed by the symptoms and has some difficulty in continuing with ordinary work/studies and social activities, but will probably not cease to function completely.”
Severe depressive disorder tends to have the following diagnostic guidelines:
“In a severe depressive episode, the sufferer usually shows considerable distress or agitation. Loss of self-esteem or feelings of uselessness or guilt are likely to be prominent, and suicide is a distinct danger in particularly severe cases. It is presumed here that the somatic syndrome will almost always be present in a severe depressive episode. During a severe depressive episode it is very unlikely that the sufferer will be able to continue with social, study, work, or domestic activities, except to a very limited extent.”
Anxiety disorders arise in a number of forms including phobic, social, obsessive compulsive (OCD), post-traumatic (PTSD), or generalised anxiety disorders.
The symptoms and diagnostic criteria for each subset of anxiety disorders are unique. However, collectively it is noteworthy of the frequent symptoms across all anxiety disorder subsets:
- (a) apprehension (worries about future misfortunes, feeling “on edge”, difficulty in concentrating, etc.)
- (b) motor tension (restless fidgeting, tension headaches, trembling, inability to relax)
- (c) autonomic overactivity (lightheadedness, sweating, tachycardia or tachypnoea, epigastric discomfort, dizziness, dry mouth, etc.)
Bipolar disorder (also termed bipolar affective disorder) is defined by the WHO’s International Classification of Diseases as follows:
“This disorder is characterised by repeated (i.e. at least two) episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (mania or hypomania), and on others of a lowering of mood and decreased energy and activity (depression). Characteristically, recovery is usually complete between episodes, and the incidence in the two sexes is more nearly equal than in other mood disorders. As patients who suffer only from repeated episodes of mania are comparatively rare, and resemble (in their family history, premorbid personality, age of onset, and long-term prognosis) those who also have at least occasional episodes of depression, such patients are classified as bipolar.”
Eating disorders are defined as psychiatric conditions defined by patterns of disordered eating. This therefore incorporates a spectrum of disordered eating behaviours. The underlying sources presented here present data only for the disorders of anorexia and bulimia nervosa (as defined below). It is however recognised that a large share of eating disorders fall within the definition of either anorexia or bulimia nervosa.
Anorexia nervosa is a disorder exemplified by deliberate weight loss, and associated with undernutrition of varying severity. For a definite diagnosis, the ICD note that all the following are required:
- (a) Body weight is maintained at least 15% below that expected (either lost or never achieved)
- (b) The weight loss is self-induced by avoidance of “fattening foods”. One or more of the following may also be present: self-induced vomiting; self-induced purging; excessive exercise; use of appetite suppressants and/or diuretics
- (c) There is body-image distortion in the form of a specific psychopathology whereby a dread of fatness persists as an intrusive, overvalued idea and the patient imposes a low weight threshold on himself or herself
- (d) If onset is prepubertal, the sequence of pubertal events is delayed or even arrested, ceasing many forms of developmental growth. With recovery, puberty is often completed normally
Bulimia nervosa is an illness defined by repeated behaviours of overeating, preoccupation with control of body weight, and the adoption of extreme measures to mitigate the impacts of overeating.
For a definite diagnosis, the ICD note that all the following are required:
(a) There is a persistent preoccupation with eating, and an irresistible craving for food; the patient succumbs to episodes of overeating in which large amounts of food are consumed in short periods of time
(b) The patient attempts to counteract the “fattening” effects of food by one or more of the following: self-induced vomiting; purgative abuse, alternating periods of starvation; use of drugs such as appetite suppressants, thyroid preparations or diuretics. When bulimia occurs in diabetic patients they may choose to neglect their insulin treatment
(c) The psychopathology consists of a morbid dread of fatness and the patient sets herself or himself a sharply defined weight threshold, well below the premorbid weight that constitutes the optimum or healthy weight in the opinion of the physician. There is often, but not always, a history of an earlier episode of anorexia nervosa
These disorders as we all know are very real and very attainable if we as adults choose to turn a blind-eye. Things like a lack of Nutrition, Exercise, and Parenting are all factors that can feed into the deterioration of young people’s mental states. So what are some practical steps we can take as adults to encourage and cultivate an all-round healthier lifestyle and environment for our loved ones.
As a parent, the ball is very much in your court to persevere with opening lines of communication with your children. It can almost feel like you’re speaking different languages sometimes, but this is all the more reason why you need to learn to listen to them. The impact of taking a moment to close your laptop, set your phone down, look your teen in the eye, and actually listen to what he/she’s saying is immeasurable.
Giving your children a safe place to compartmentalise and talk out what they’re going through can yield positive results not only for strengthening their mental fortitude but also in strengthening your relationship.
Monitor screen time
Previous studies have strongly suggested that there is a paralleled correlation between the more time your kids spend on screens, and the more prone they are to things like depression, anxiety, and even suicide. Social technology isn’t going away anytime soon, and this isn’t necessarily a negative thing, there are plenty of benefits to all age groups using these forms of technology throughout their daily lives. That being said, there’s certainly a tipping point for technology turning from beneficial to detrimental, and that point is often discovered with excessive consumption.
The addictive qualities from easy access technology such as smartphones is being experienced by young and old alike, as we both learn to navigate this altering of the social landscape together. But as parents, we need to set the standard and help our kids make wise decisions about their screen time. Why not begin by taking a few simple steps like prohibiting screens during meals or setting a curfew on devices (no screens within 30 minutes of bedtime, etc.
Assemble a team
As a parent, you are the first point of contact, you are the example , you are the enforcer, you are irreplaceable. That being said, there will be times when your teen is convinced you have no idea what you’re talking about (and frankly, there will be times when they’re right).
There’s a quote from Professor Alexander McCall Smith, “Everybody in a village had a role to play in bringing up a child—and cherishing it—and in return that child would in due course feel responsible for everybody in that village. That is what makes life in society possible. We must love one another and help one another in our daily lives.”
In the vain of this quote, your children need input from other trusted role models and mentors in your teen’s life. They may come in the form of a coach, teacher, a youth pastor, friends’ parents, etc. Be intentional with what environments and people you place around your children. Place them around others whom you trust, that care about them, and can serve as a mentor in their life. Sometimes words of wisdom need to come from what can be viewed as an unbiased source.
A lot of adults have the belief that the human body requires somewhere between 6-8 hours of sleep each night but this is not the case with teens as they go through development, with their recommended sleep being between 8-10 hours of sleep. If they don’t, this doesn’t simply affect their ability to stay awake during class. It also takes a toll on their ability to regulate their emotions. If your teen is struggling to get to sleep or stay asleep, they are more likely to experience symptoms of depression and anxiety.
If your child is struggling to get adequate sleep, consider something as simple as getting a diffuser and putting a few drops of lavender in it at night or talking to your paediatrician about having your child take melatonin or other natural sleep aids. And like everything else, explain to your teens why sleep matters, especially at their age, so that they do not feel that you’re undermining them.
Take them to a licensed therapist
Many of us hesitate when we consider the idea of taking our teen to a therapist. We worry that it’ll send a message that communicates to our child that we think he or she is ‘crazy’ or, sadly, we worry about what others will think. But the reality is sometimes you need a specialist. We don’t think twice about booking in a specialist for physical injuries and ailments, so why are we so hesitant towards issues related to mental health? In the same way we depend on specialists to help our children with physical injuries and ailments we need specialists who understand the unique mental health needs of teenagers, in order to walk with them (and us) for a season.
There’s no shame in this. The real shame is when we allow our biases and fear of other’s judgment keep us from getting our teen the assistance he or she needs to thrive. You wouldn’t tell your child after breaking his leg to ‘walk it off’, why would you do so for a mental health issue?
Promote nutrition and exercise
Not all teens are naturally athletic or even inclined toward physical activity but we can all benefit from regular exercise, in fact a lot of therapists often prescribe exercise as a practical first step towards better mental health. Exercise reduces stress and can help alleviate feelings of anxiety and depression. The reward of achieving goals and the natural release of endorphins from physical exercise helps naturally rewire your mental outlook towards a healthier state.
Help your teen think through a reasonable exercise regime, plan out a schedule and possibly negotiate joining in out of solidarity. It’s good for you AND your relationship with your teen! The other aspect of healthy living is of course nutrition.
Think about it. Your brain is always “on.” It takes care of your thoughts and movements, your breathing and heartbeat, your senses — it works hard 24/7, even while you’re asleep. This means your brain requires a constant supply of fuel. That “fuel” comes from the foods you eat — and what’s in that fuel makes all the difference. There are even studies that show that certain foods, such as cumin, can improve mental health. Put simply, what you eat directly affects the structure and function of your brain and, ultimately, your mood.
Being mindful of what your family is regularly consuming in their diets is a practical way to regulate levels of serotonin and other attributes the human body requires in order to operate on a fully-functioning level.
These are just a handful of practical tips that you can perform to ensure your loved ones are avoiding falling victim to any of the aforementioned mental disorders. There are many articles on how to handle the above issues (such as anxiety), but if you're looking for some qualified help in this area or if you know of someone else who is, here are some contacts below that can be of service to you:
- Lifeline on 13 11 14
- Kids Helpline on 1800 551 800
- MensLine Australia on 1300 789 978
- Suicide Call Back Service on 1300 659 467
- Beyond Blue on 1300 22 46 36
- Headspace on 1800 650 890
- ReachOut at au.reachout.com
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