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Most Common Mental Health
Diagnoses in Children
There are many different kinds of brain disorders experienced by children
and adolescents. Untreated, disorders of the brain profoundly disrupt
a young person's ability to think, feel, and relate to others or their
environment. Studies over the last few decades have found both the
biological basis for brain disorders and treatments that work. As this
community assesses the issue of Children's Mental Health, it is important
that a brief overview of common mental health diagnoses are reviewed
and estimated prevalence in Travis County considered.
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Attention Deficit Hyperactivity Disorder (ADHD)
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ADHD is the most commonly diagnosed behavioral disorder in childhood.
ADHD occurs in 5 out of every 100 children (USDHHS, 1999, p. 144). It
is estimated that 3,467 children in the Travis County School Districts
have this disorder.
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Approximately one-half of parents with ADHD have a child with the
disorder. It is estimated that between 10-35 percent of children with
ADHD have a first-degree relative with ADHD (USDHHS, 1999, p. 144).
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In Travis County it is estimated
that 3,467 children in Travis County School Districts have ADHD.
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Symptoms are frequently first recognized when the child enters pre-school
or kindergarten. As the name implies, there are two distinct sets of
symptoms: inattention and hyperactivity-impulsivity. It should be noted
that often these symptoms occur along side of each other but one may
be present without the other. Some common characteristics of these
symptoms are disorganization of materials (e.g., school supplies),
difficulty in finishing school work, losing schoolbooks, inappropriately
answering in class, fidgeting, talking excessively, and so on. Many
of these symptoms occur in children without ADHD. However, children
with ADHD will have these symptoms more frequently, in multiple settings
(school, home, church, visiting friends, etc.), and they interfere
with the child's functioning. ADHD affects a child's ability to succeed
at school and develop age-appropriate social skills.
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Major Depression
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The National Institute of Mental Health report that scientists believe
major depression has a genetic component, meaning families with
a history of depressive illness may have a "biological susceptibility".
However, behaviors of the families are not a direct cause of the
illness. It is suspected that environmental stressors contribute
to the onset of depressive disorder. Depression is not just a case
of the blues, but a severe and persistent biological disease. The
two most common types of depressive illness are unipolar (characterized
by irritability and lack of interest in once pleasurable activities)
and bipolar (characterized by cycles of depression and inappropriate
highs).
The Surgeon General's Report on Mental Health notes population studies
show 6 out of 110 children or about 3,782 students in Travis County
school districts have had some symptoms of depression (USDHHS, 1999).
Frequently onset of depression occurs in early adolescence, but it
can be diagnosed earlier in childhood. Prevalence data of a clinical
diagnosis of major depression among all children ages 9 to 17 is estimated
at five percent. For a one-year estimate, the figures range from .4
to 2.5 percent. There are some studies that indicate adolescent depression
can be as high as 8.3 percent (USDHHS, 1999, p. 151).
The treatment of depression in our community is important due to the
fact that children and adolescents who suffer from depression are at
a greater risk of committing suicide than are children without depression
(USDHHS, 1999, p. 152).
Note: Five or more of these symptoms must persist for 2 or more weeks
before a diagnosis of major depression is indicated.
The recovery rate from a single episode of major depression in children
and adolescents is high even though other episodes are likely to recur.
The prompt identification and treatment of depression can reduce the
duration, severity, and associated functional impairment (NIMH, 2000,
November 9).
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Bipolar Disorder
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Bipolar disorder is a serious mental illness characterized by recurrent
episodes of depression, mania, and/or mixed symptom states. Often children
and adolescents will experience mood shifts, hyperactivity, and behavior
that interfere significantly with normal, healthy functioning. Recent
findings conclude that bipolar disorder, also called manic-depressive
illness, can occur in children and adolescents. It is difficult to
recognize and diagnose youth with this disorder because it does not
fit the symptom criteria established for adults and its symptoms can
resemble or co-occur with those of other common childhood-onset mental
disorders. Sometimes symptoms may be initially mistaken for normal
emotions and behaviors of children and adolescents. But unlike normal
mood changes, bipolar disorder significantly impairs functioning in
school, with peers, and at home with family. The National Institute
for Mental Health reports that the illness may be at least as common
among youth as among adults. One percent of adolescents ages 14
to 18 were found to have met criteria for bipolar disorder (USDHHS,
1999). In Travis County school districts, this equals 374 children.
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Disruptive Disorders
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Oppositional defiant disorder and conduct disorder are characterized
by antisocial behavior. These disorders appear to be a collection of
behaviors rather than a coherent pattern of mental dysfunction. These
behaviors are also frequently found in children who suffer from attention-deficit/hyperactivity
disorder (see ADHD section), another disruptive disorder. Children
who develop the more serious conduct disorders often show signs of
these disorders at an earlier age (USDHHS, 1999).
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Oppositional Defiant Disorder (ODD)
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Some children display a persistent pattern of defiance, disobedience,
and hostility toward authority. Characteristic behaviors include: fighting
and arguing, being easily annoyed, deliberately mistreating other people,
repeatedly losing their temper, arguing with adults, deliberately refusing
to comply with requests or rules of adults, blaming others for their
own mistakes, and being repeatedly angry and resentful. Stubbornness
and testing of limits are common. These behaviors cause significant difficulties
with family and friends and at school or work. Oppositional defiant disorder
is sometimes a precursor of conduct disorder (USDHHS, 1999).
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Conduct Disorder
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Aggressive behavior (fighting, bullying, intimidating, physically
assaulting, sexually coercing, and/or cruelty to people or animals),
vandalism, theft, truancy, and early substance use or abuse, and sexual
activity are all indicators of conduct disorders. Female characteristics
of this disorder include running away from home and possibly becoming
involved in prostitution. Relationships with peers and adults are often
poor. Rates of depression, suicidal thoughts and attempts, and suicide
are all higher in children diagnosed with a conduct disorder.
The prevalence of conduct disorder is 4 to 10 of every 100 children
and adolescents or 4,271 to 10,677 in Travis County School Districts.
Children with an early onset of the disorder, i.e., onset before
age 10, are predominantly male. Twenty-five to fifty percent of highly
antisocial children become antisocial adults (USDHHS, 1999).
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Eating Disorders
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Similar to other mental disorders children and adolescents with eating
disorders have little control over their symptoms. Eating disorders
are serious and sometimes life-threatening conditions that require
medical and psychiatric attention. In the U.S., eating disorders are
most common among adolescent and young women. It is estimated that
between 0.5 and 1.0 percent suffer from anorexia nervosa, 1 to 3 percent
have bulimia nervosa, and 0.7 to 4 percent experience binge-eating
disorder. There is limited data concerning the prevalence in males.
In addition to causing various physical health problems, eating disorders
are associated with illnesses such as depression, substance abuse,
and anxiety disorders (USDHHS, 1999). Overall in Travis County School
districts there are approximately 374 to 1,123 young people with eating
disorders.
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Anxiety Disorder
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Anxiety disorders are among the most common mental, emotional, and
behavior problems that occur during childhood and adolescence. As many
as 8 to 10 of 100 children and adolescents are affected. In Travis
County School Districts, it is estimated that 8,541 to 10,677 young
people may have an anxiety disorder. Among adolescents, more girls
are affected. Some scientists believe this is because female bodies
produce less serotonin, a brain chemical that is vital in maintaining
mood stability. About half of the children and adolescents with anxiety
disorders also have a second anxiety disorder or other mental or behavioral
disorder, such as depression (NIMH, 2000).
Typically, young people with an anxiety disorder are so afraid, worried,
or uneasy that they cannot function normally. Children and adolescents
with this disorder experience extreme, unrealistic worry that does
not seem related to any recent event. These young people are very self-conscious,
feel tense, have a strong need for reassurance, and complain about
stomachaches or other discomforts that don't appear to have any physical
basis. If not treated early, anxiety disorders can lead to missed school
or an inability to finish school, impaired relations with peers, low
self-esteem, alcohol or other drug use, problems adjusting to work
situations, and anxiety disorder in adulthood (NIMH, 2000).
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Obsessive-Compulsive Disorder (OCD)
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Approximately one million children and adolescents in the United States
suffer from OCD. This can mean three to five youngsters with OCD per
average-sized elementary school and about 20 teenagers in a large high
school. Youngsters with OCD are compelled to repeat illogical behavior
such as constant washing of hands, counting windows or tiles on a wall
or floor, checking and rechecking to see if a particular possession
is safe or a pet is well (NIMH. 2000).
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Phobias
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A phobia is an unrealistic and excessive fear of a situation or object.
Some phobias, called specific phobias, center on animals, storms, water,
heights, or situations such as being in an enclosed space. Children
and adolescents with social phobias are terrified of being criticized
or judged harshly by others. Because young people with phobias will
try to avoid the objects and situations that they fear, the disorder
can greatly restrict their lives (NIMH, 2000).
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Schizophrenia
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Schizophrenia is a brain disorder that usually strikes young people
between the ages of 16 and 25, but can occur as early as eight or nine
years. Schizophrenia impacts about 3 out of every 1,000 adolescents
or approximately 112 adolescents in Travis County. The rate of schizophrenia
is low, yet its severity and debilitating effects are noticed by the
individual diagnosed, to family, friends, and the system impacted.
Schizophrenia is characterized by profound alterations in cognition
and emotion. Youth with schizophrenia may experience hallucinations
and delusions during which they cannot distinguish what is real from
what is not. The course of the illness is variable with most people
experiencing periods of exacerbation and remission. This can be a debilitating
effect of the illness when perceived recovery is reversed by another
episode (USDHHS, 1999).
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Autism
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In our community autism is a significant disorder that impacts the
lives of many children and their families. In Travis County, persons
with autism are served by mental retardation/developmental disabilities
service and support providers. Issues related to autism will be explored
in the upcomming C.A.N. Mental Retardation/Developmental Disabilities
Assessment.
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Description of Children's Mental Health
Home Page
Children's Mental Health Home Page
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