Mental disorders in children and adolescents, overview - information

Mental disorders in children and adolescents can differ in their characteristics and symptoms from disorders in adulthood. Two important groups of mental disorders in childhood and adolescence are developmental disorders and reduced intelligence. Typical child and adolescent psychiatric disorders that cannot be characterized as a disorder in the development of certain skills or functions are described below.

When is there a mental disorder in children and adolescents??

It should be borne in mind that the importance of symptoms as a disorder always depends on the child’s level of development. For example, occasional preschool nightmares are just as normal as fears and insecurity in early puberty.

A problem only becomes a mental disorder if it is beyond what is normal in the corresponding stage of development goes out clearly and leads to suffering. Another special feature of child and adolescent psychiatry (KJP) is that parents and family or the relevant caregivers (including teachers) are of great importance, both in the assessment and in the treatment of the disorders.

What mental disorders are there in children and adolescents??

Different mental disorders in children and adolescents can be distinguished. The most common are the following behavioral and emotional disorders in childhood and adolescence:

ADHD (Attention Deficit Hyperactivity Disorder)
Disorders of social behavior
anxiety disorders
psychosis
tic disorder
eating disorder
enuresis
encopresis
sleep disorders

ADHD (Attention Deficit Hyperactivity Disorder)

Attention deficit hyperactivity disorder (ADHD) is characterized by extreme motor (movement-related) restlessness and drive that occurs in many situations, e.g. in the form of walking around, talking, making noise and fidgeting. In addition, those affected show one disturbed attention in the form of extremely easy distraction, low concentration and frequent changes of activity. In addition, there is a disturbed impulse control, i.e. the children find it difficult to "pull themselves together" in all respects and have little tolerance for frustration.

The symptoms begin in the first five years of life and persist in time, in about a third the disorder also persists in adulthood. About 3 to 5 percent of all children are affected, boys 3 to 8 times as often as girls.

Due to the inattentiveness, hazards and accidents occur relatively often, and the children affected often have social problems because they come into conflict with classmates, teachers, etc. Motor agitation usually decreases in adolescence, while increased impulsiveness and reduced alertness persist, increasing the risk of drug use, traffic accidents and delinquency (becoming punishable).

The origin of the disorder is not entirely clear, in addition to genetic factors, birth complications and changes in brain metabolism may play a role. ADHD is treated by one consistent parenting style and corresponding pedagogical measures. In addition, methylphenidate (Ritalin®) is often used as a medication; this is currently considered the most effective treatment method.

Case study on ADHD

The 9-year-old Andreas is introduced to the children’s outpatient clinic due to constant disciplinary problems. He went to the third class, could not stay seated and therefore walked around the class all the time. He almost never reports, often calls in between and must be constantly warned because of his chatter. In the breaks there are always brawls. At home, Andreas is also extremely exhausting, the homework usually takes the whole afternoon under big arguments. He also had a lot of conflicts with his siblings because he annoyed them and repeatedly destroyed things from them, partly by mistake, partly on purpose.

Disorder of social behavior in children

This disorder is an ongoing pattern of dissocial, aggressive or defiant behavior with children. The affected children fight e.g. frequently, even with massive outbursts of anger, are aggressive towards their caregivers, lie and do not keep promises or are cruel to other children or animals. Deliberate destruction of property, fire, theft and disciplinary problems at school, including truancy, may occur.

The social behavior disorder often occurs along with other mental disorders in children and adolescents, such as ADHD, developmental disorders or substance abuse. Between 2 and 10 percent of all children, mainly boys, are affected, although the disorder is often very stable over many years.

An important goal of therapy for this mental disorder consists in preventing delinquency, i.e. committing criminal acts, and the prison career that often follows. Therapeutically, individual therapies for children or family therapies can be carried out; municipal measures (e.g. youth work in "problem areas") also play a role.

The stability of the disorder in social behavior is very high. Especially if the children show aggressive abnormalities at a young age, it can be assumed that 40 percent of these elementary school students still show disorders of social behavior in adulthood. In some cases, such as when there are severe impulsive aggressive behaviors, medications such as Lithium or carbamazepine can be used successfully. Psychosocial prevention measures are undoubtedly the crucial criteria for improving the fate of children.

Anxiety disorders in childhood and adolescence

Fears are above all in childhood relatively common phenomenon. Many children show fear of certain situations or objects (so-called “phobic fears”), e.g. before thunderstorms, dogs or before dark. In 2 to 9 percent of all children, the phobic anxieties are so pronounced that the diagnosis of a mental disorder can be made. In addition to phobic fears, separation anxiety is the most important anxiety disorder in childhood and adolescence, which affects 3 to 5 percent of all children.

The affected children refuse to leave their caregivers or are very afraid if they do. This usually leads to the refusal to go to school. Children with separation anxiety are often already in toddler age very affectionate and go e.g. don’t like going to kindergarten. Serious fears of separation are often triggered by experiencing being abandoned (e.g. getting lost in a department store) or by difficult family situations (e.g. impending separation of parents).

While the fear of separation from the parents is in the foreground when it comes to separation anxiety, the fear of separation has to be differentiated school phobia the children fear school. They may separate easily, but tend not to go to school. These two anxiety disorders can be easily confused because the first thing that strikes both of them is the refusal to go to school.

Psychoses in children and adolescents

Schizophrenics and other psychoses start relatively rarely (in about 4 percent of all cases) before the age of 15, only about 1 percent begin before the age of 10. The lower the age of onset, the more difficult it is to identify psychoses, because their clinical picture is very different from that of adult patients.

While "productive" psychotic symptoms with delusion and hallucinations often occur in adulthood, so-called "elevated" forms and so-called prodromes also occur more frequently in younger age. Prodromes are symptoms that precede many acute psychoses – sometimes over years – and are characterized by problems such as

difficulty concentrating,
mistrust,
Performance kinks in school,
Fears and
social withdrawal

express. A “psychosis” is called “lift up” if it expresses that the person concerned always less emotional participatione and shows little drive, and in the mood becomes increasingly flat and "foolish".

Tic disorders in primary school age

Tics are sudden, short, repeated, involuntary movements or expressions, that have no specific purpose or meaning. Those affected can often suppress tics arbitrarily for a short time. There are simple tics like shrugging shoulders, blinking, whistling or sniffing, as well as so-called complex tics like jumping, smelling, pounding and saying whole words or sentences.

In the case of a temporary tic disorder, usually only simple tics that do not last longer than one year occur; in the case of chronic tic disorders, several and more complex tics may occur over a longer period. A serious combination of vocal and motor tics over a long period of time is called the Gilles-de-la-Tourette syndrome.

Between 4 and 12 percent of children of primary school age suffer from a tic disorder, which is about 10 times as many people as adults. Boys are affected much more often. While many tic disorders resolve themselves over time, chronic and complex tic disorders have a relatively poor prognosis even with behavioral therapy and medication.

Child and adolescent eating disorders

For children and adolescents, there are some special features to be considered when it comes to the symptoms of various eating disorders. The obesity (morbid obesity) in childhood and adolescence is a growing problem in our society from which children lower social classes are more affected. This is of concern because obese children mostly remain overweight as adults, with all the related complications such as heart disease, orthopedic problems, diabetes etc.

Anorexia nervosa (anorexia) very often begins in adolescence, many child and adolescent psychiatric institutions specialize in the treatment of this disorder. Bulimia, on the other hand, often arises only after anorexia and is therefore primarily treated in adult psychiatry.

Enuresis (involuntary wetting)

Enuresis is spoken of when children are still older than 5 years wetting regularly, without organic causes. The nighttime enuresis and the daytime enuresis can be distinguished from each other. While around 11 percent of children are affected by nightly enuresis, with boys predominating, enuresis occurs much less frequently and more often in girls during the day.

Enuresis is probably largely inherited, more psychosocial stress however, it also plays a role. You can with one behavioral therapy program are treated, whereby for the nocturnal enuresis v.a. Wake-up devices are used that ring when there is wetting. As a result, the children learn to wake up at the right moment and to use the toilet. In some cases, the use of a drug that suppresses night-time urine production is also indicated.

Enkopresis (defecation in children)

Enkopresis means that a child repeats and involuntarily vomiting or his chair at not intended for it Put settles. Approximately 1.5 to 3 percent are affected in schoolchildren aged 7 to 8, boys twice as often as girls.

In the context of diagnostics, it must be ruled out that a physical illness is the cause. Therapeutically, laxatives may have to be used first to normalize bowel movements, since many children with encopresis behave so strongly that constipation occurs.

Sleep disorders in children

Sleep disorders, which are common mental disorders in children, include sleep walking, pavor nocturnus, and nightmares. At the somnambulism, which usually occurs at the beginning of the night, the child gets up in his sleep and walks around, although it is difficult to wake him up. After waking up, it remembers nothing.

At the Pavor nocturnus The victim often screams and suddenly wakes up in bed, being completely disoriented and immediately falling asleep again. This course of the mental disorder can hardly be influenced by attempts to calm down.

In contrast, those affected have nightmares after waking up vivid memories of it and attempts to calm down are accessible. Nightmares tend to occur in the second half of the night.

Author:
Dr. Gitta Jacob