NOTES ON THE MENTAL HEALTH OF
CHILDREN AND ADOLESCENTS
future of our country depends on the mental health and strength
of our young people. However, many children have mental health problems
that interfere with normal development and functioning. In the U.S.,
1 in 10 children and adolescents suffer from mental illness severe
enough to cause some level of impairment. However, in any given
year, it is estimated that fewer than 1 in 5 of these children receives
needed treatment. Recent evidence compiled by the World Health Organization
indicates that by the year 2020, childhood neuropsychiatric disorders
will rise proportionately by over 50 percent, internationally, to
become one of the five most common causes of morbidity, mortality,
and disability among children. The mental health problems affecting
children and adolescents include the following:
research studies have reported that up to 3 percent of children
and up to 8 percent of adolescents in the U.S. suffer from depression,
a serious mental disorder that adversely affects mood, energy, interest,
sleep, appetite, and overall functioning. In contrast to normal
emotional experiences of sadness or passing mood states, the symptoms
of depression are extreme and persistent and can interfere significantly
with the ability to function at home or at school. There is evidence
that depression emerging early in life often recurs and continues
into adulthood, and that early onset depression may predict more
severe illness in adult life. Diagnosing and treating children and
adolescents with depression is critical in preventing impairment
in academic, social, emotional, and behavioral functioning and to
allow children to live up to their full potential.
in children and adolescents is associated with an increased risk
of suicidal behaviors. Since 1964, the suicide rate among adolescents
and young adults has doubled. In 1996, the most recent year for
which statistics are available, suicide was the 3rd leading cause
of death in 15 to 24 year olds and the 4th leading cause among 10
to 14 year olds.
medications are prescribed to treat children and adolescents with
depression. Recent studies indicate that certain selective serotonin
reuptake inhibitors (SSRIs) are safe and efficacious treatments
for depression in young people. However, care must be used in prescribing
and monitoring all medication. Special forms of psychotherapy, such
as cognitive-behavioral therapy, have proved effective for adolescents
with depression, and current studies are evaluating the effectiveness
of individual, family, and group therapies for young people. A current
multi-site study of adolescents who are depressed is evaluating
the comparative effectiveness of medication, psychosocial, or combined
disorders are the most common mental health problems that occur
in children and adolescents. According to one large-scale study
of 9 to 17 year olds, entitled Methods for the Epidemiology of Child
and Adolescent Mental Disorders (MECA), as many as 13 percent of
young people had an anxiety disorder in a year.
Anxiety Disorder: symptoms include exaggerated worry and tension
over everyday events.
Compulsive Disorder (OCD): characterized by intrusive, unwanted,
repetitive thoughts and rituals performed out of a feeling of urgent
need; at least one-third of adult cases begins in childhood.
Disorder: characterized by feelings of extreme fear and dread that
strike ffunexpectedly and repeatedly for no apparent reason, often
accompanied by intense physical symptoms, such as chest pain, pounding
heart, shortness of breath, dizziness, or abdominal distress.
Traumatic Stress Disorder (PTSD): a condition that can occur after
exposure to a terrifying event, most often characterized by the
repeated re-experience of the ordeal in the form of frightening,
intrusive memories, and brings on hypervigilance and deadening of
social phobia, extreme fear of embarrassment or being scrutinized;
specific phobia, excessive fear of an object or situation, such
as dogs, heights, loud sounds, flying, costumed characters, enclosed
disorders: separation anxiety, excessive anxiety concerning separation
from the home or from those to whom the person is most attached;
and selective mutism, persistent failure to speak in specific social
forms of psychotherapy, including cognitive-behavioral therapy and
family therapy, as well as certain medications, particularly selective
serotonin reuptake inhibitors (SSRIs), are used to treat anxiety
disorders in children and adolescents. Research on the safety and
efficacy of these treatments is ongoing.
deficit hyperactivity disorder (ADHD) is the most commonly diagnosed
psychiatric disorder of childhood, estimated to affect 3 to 5 percent
of school-aged children. Research shows that ADHD tends to run in
families. Its core symptoms include developmentally inappropriate
levels of attention, concentration, activity, distractibility, and
impulsivity. Children with ADHD usually have impaired functioning
in peer relationships and multiple settings including home and school.
ADHD has also been shown to have long-term adverse effects on academic
performance, vocational success, and social-emotional development.
medications, including methylphenidate (Ritalin®), amphetamine (Dexedrine
® and Adderall ®), and pemoline (Cylert ®), are by far the most
widely researched and commonly prescribed treatments for ADHD. Numerous
short-term studies have established the safety and efficacy of stimulants
and psychosocial treatments for alleviating the symptoms of ADHD.
A multisite study of children with ADHD recently concluded that
the two most effective treatment modalities for elementary school
children with ADHD are a closely monitored medication treatment
and a treatment that combines medication with intensive behavioral
interventions. Another study, jointly funded by the NIMH and the
National Institute on Drug Abuse, has shown that boys with ADHD
who are treated with stimulants are significantly less likely to
abuse drugs and alcohol when they get older. In previous studies,
these same researchers found that nearly twice as many adults with
ADHD (that was generally not diagnosed or treated until much later
in life) also abused drugs and/or alcohol at some point in their
lives, compared to adults without ADHD.
the U.S., eating disorders are most common among adolescent and
young women. In addition to causing various physical health problems,
eating disorders are associated with illnesses such as depression,
substance abuse, and anxiety disorders. Among adolescent and young
adult women in the U.S., 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 are limited data concerning the prevalence in males.
to other mental disorders, such as obsessive-compulsive disorder
and depression, patients with eating disorders have little control
over their symptoms, and suffer from often serious and sometimes
life-threatening illnesses that require medical and psychiatric
attention. Because of their complexity, eating disorders call for
a comprehensive treatment plan involving medical care and monitoring,
psychotherapy, nutritional counseling, and medication management.
Studies are investigating the causes of eating disorders and effectiveness
illness causes extreme shifts in mood, energy, and functioning.
Overly energized, disruptive, and reckless periods alternate with
periods of sadness, withdrawal, hopelessness, and other depressive
symptoms. Unlike normal mood states of happiness and sadness, symptoms
of manic-depressive illness can interfere with school performance,
family relationships, peer interactions, and other everyday activities.
Although manic-depressive illness typically emerges in late adolescence
or early adulthood, there is increasing evidence that the disorder
also can begin in childhood. According to one study, one percent
of adolescents ages 14-18 were found to have met criteria for manic-depressive
illness or cyclothymia, a milder form of the illness, in their lifetime.
research efforts are attempting to clarify the diagnosis, course,
and treatment of manic-depressive illness in youth. Evidence suggests
that manic-depressive illness beginning in childhood or early adolescence
may be a different, possibly more severe form of the disorder than
older adolescent and adult-onset manic-depressive illness. When
the illness begins before or soon after puberty, it is often characterized
by a continuous, rapid-cycling, and mixed symptom state that may
co-occur with ADHD or other behavioral disorders, or may have features
of these disorders as initial symptoms. In contrast, later onset
manic-depressive illness appears to begin suddenly, often with a
manic episode, and to have a more episodic pattern with relatively
stable periods between episodes.
treatments known to be effective in adults with manic-depressive
illness also may help relieve the symptoms in young people. The
essential treatment for this disorder is the use of appropriate
doses of mood stabilizing medications. The most typical is lithium,
known to be very effective in adults for controlling mania and preventing
recurrences of manic and depressive episodes. Research on the effectiveness
of this and other medications in children and adolescents with manic-depressive
illness is ongoing. In addition, studies are investigating various
forms of psychotherapy to complement medication treatment for this
illness in young people.