Mental Illness in Children (cont.)
Roxanne Dryden-Edwards, MD
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Mental illness in children facts
- What are the most common mental illnesses in children?
- What are causes and risk factors for mental illness in children?
- What are symptoms and signs of mental illness in children?
- How is mental illness in children diagnosed?
- What is the treatment for mental illness in children?
- What is the prognosis of mental illness in children?
- Can mental illness in children be prevented?
- What research is being done on mental illness in children?
- Where can parents find information or support groups for mental illness in children?
- Find a local Psychiatrist in your town
What is the treatment for mental illness in children?
There are a variety of treatments available for managing mental illnesses in children, including several effective medications, educational or occupational interventions, as well as specific forms of psychotherapy. In terms of medications, medications from specific drug classes are used to treat childhood mental illness. Examples include the stimulant class for treating ADHD, serotonergic medications for treating depression and anxiety, and neuroleptic medications for management of severe mood swings, anxiety, aggression, or in the treatment of childhood schizophrenia.
For individuals who may be wondering how to manage the symptoms of a childhood mental illness using treatment without prescribed medications, psychotherapies are often used. While interventions like limiting exposure to food additives, preservatives, and processed sugars have been found to be helpful for some people with an illness like ADHD, the research evidence is still considered to be too limited for many physicians to recommend nutritional interventions. Also, placing such restrictions on the eating habits of a child or teenager can prove to be difficult at best, nearly impossible at worst.
Psychotherapy ("talk therapy") is a form of mental-health counseling that involves working with a trained therapist to figure out ways to solve problems and cope with childhood emotional disorders. It can be a powerful intervention, even producing positive biochemical changes in the brain. Two major approaches are commonly used to treat childhood mental illness, interpersonal psychotherapy and cognitive behavioral therapy. In general, these therapies take weeks to months to complete. Each has a goal of alleviating symptoms. More intense psychotherapy may be needed for longer time periods when treating very severe mental illness.
The behavioral, educational/vocational, and psychotherapy components of treatment for childhood mental illnesses are usually at least as important as the medication treatment. Dealing with the specific challenges that mentally ill children present takes patience, understanding, and a balance of structure and flexibility. One kind of psychotherapy used to treat children with mental illness is cognitive behavioral therapy (CBT). This form of therapy seeks to help those with many different kinds of psychiatric disorders identify and decrease the irrational thoughts and behaviors that reinforce maladaptive behaviors. This therapy can be administered either individually or in group therapy. CBT that seeks to help the sufferer of many childhood mental illnesses may decrease the tendency of the depressed or anxious child to pay excessive attention to potential threats, while helping the child with ADHD appropriately refocus their attention.
Behavioral techniques that are often used to decrease symptoms in children with behavioral disorders like ADHD, oppositional defiant disorder, or conduct disorder or to help children with anxiety disorders like separation anxiety disorder or obsessive compulsive disorder involve the parents, teacher, and other adult caretakers understanding the circumstances surrounding both positive and negative behaviors and how each kind of behavior is encouraged and discouraged. Specifically, learning when and where specific behaviors occur can go a long way toward understanding how to encourage the behavior to happen again if it's positive or extinguishing it if the behavior is negative. Being aware of how the reactions of others contribute to a behavior's continuing or not continuing tend to help the child with a behavior disorder shape their behaviors more positively. Also, developing a fair, meaningful, and effective repertoire of ways to encourage positive behaviors and provide consequences for negative behaviors is a key component of any behavior-management plan and therefore in parenting children with behavioral disorders.
Often, a combination of medication and nonmedication interventions produces good results in helping the child with a mental illness. Depending on the illness, the length of time it existed before treatment starts, as well as the course of treatment deemed most appropriate, improvement may be noticed in a fairly short period of time, from two to three weeks to several months. Thus, appropriate treatment for mental illness can relieve symptoms or at least substantially reduce their severity and frequency, bringing significant relief to many children. There are also things that families of children with a mental illness can do to help make treatment more effective. Tips to better manage symptoms of most childhood mental-health problems include getting adequate sleep, having a healthy diet, and having the support and encouragement of parents and teachers.
If symptoms indicate that your child is suffering from mental illness, the health-care professional will likely strongly recommend treatment. Treatment may include addressing any medical conditions that cause or worsen the psychiatric symptoms. For example, an individual who is depressed and found to have low levels of thyroid hormone might receive hormone replacement with levothyroxine (Synthroid, Levoxyl). It may be found that a hyperactive, anxious, or psychotic child is having a reaction to a medication. Other components of treatment may be supportive therapy, such as changes in lifestyle and behavior, psychotherapy, and may include medication for moderate to severe mental illness. If symptoms are severe enough to warrant treatment with medication, symptoms tend to improve faster and for longer when medication treatment is combined with psychotherapy.
Interpersonal therapy (IPT): This helps to alleviate symptoms of mood disorders like anxiety and depression and helps the sufferer develop more effective skills for coping with relationships. IPT employs two strategies to achieve these goals:
- The first is educating the child and family about the nature of their illness. The therapist will emphasize that depression is a common illness and that most people can expect to get better with treatment.
- The second is defining problems (such as abnormal grief, interpersonal conflicts, or having significant anxiety when meeting new people). After the problems are defined, the therapist is able to help set realistic goals for solving these problems and work with the child and his or her family using various treatment techniques to reach these goals.
Cognitive behavioral therapy (CBT): This has been found to be effective as part of treatment for childhood mental illness. This approach helps to alleviate depression, anxiety, and some behavioral problems and reduce the likelihood that symptoms will come back by helping the child change his or her way of thinking about or otherwise reacting to certain issues. In CBT, the therapist uses three techniques to accomplish these goals:
- Didactic component: This phase helps to set up positive expectations for therapy and promote the child's cooperation with the treatment process.
- Cognitive component: This helps to identify the thoughts and assumptions that influence the child's behaviors, particularly those that may predispose the sufferer to having the emotional or behavioral symptoms that they have.
- Behavioral component: This employs behavior-modification techniques to teach the child more effective strategies for dealing with problems.
Most practitioners will continue treatment of a mental illness for at least six months. Treatment for children with a mental illness can have a significantly positive effect on the child's functioning with peers, family, and at school. Without treatment, symptoms tend to last much longer and may never get better. In fact, they may get worse. With treatment, chances of recovery are much improved.
The major type of antidepressant and anti-anxiety medication prescribed for children is the selective serotonin reuptake inhibitors (SSRIs). SSRI medications affect levels of serotonin in the brain. For many prescribing doctors, these medications are the first choice because of the high level of effectiveness and general safety of this group of medicines. Examples of medications in this class that are approved for use in children are listed here. The generic name is first, with the brand name in parentheses.
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
The medications available for attention deficit hyperactivity disorder (ADHD) can have slightly different effects from individual to individual, and currently no way exists to tell which will work best. Medications indicated for ADHD are thought to work by improving the imbalance of neurochemicals that are thought to contribute to ADHD. Some commonly prescribed medications include the following:
- Methylphenidate (Ritalin, Concerta, Metadate, Daytrana patch)
- Dexmethylphenidate (Focalin)
- Dextroamphetamine or pre-Dextroamphetamine (Adderall, Dexedrine, Dextrostat, Vyvanse)
- Atomoxetine (Strattera)
- Guanfacine (Tenex or Intuniv)
- Clonidine (Catapress or Kapvay)
Treatment of bipolar disorder with medications tends to address two aspects: relieving already existing symptoms of mania or depression and preventing symptoms from returning. Medications that are thought to be particularly effective in treating manic and mixed symptoms and have been approved by the Food and Drug Administration (FDA) for use in children (in children 10 years of age and older) include
- Risperidone (Risperdal)
- Aripiprazole (Abilify)
- Quetiapine (Seroquel)
For treatment of irritability in individuals with autism spectrum disorder, Risperdal has been FDA approved in children 5 years of age and older, while Abilify has been approved in children 6 years of age and older.
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