MENTAL HEALTH DISORDERS IN

CHILDREN

OVERVIEWChildhood mental illness affects the child,

family and community. Estimated cost= $247 billion per year

(NRCIM, 2009) 13%- 20% of children in the U.S.A,

experience a mental disorder in a given year (NRCIM, 2009)

Prevalence appears to be increasing

OVERVIEW CONTINUED Mental Disorders results in difficulties:

At home With peers At school (Schieve, Boutlet, and Kogan, 2007) With chronic health conditions (diabetes,

asthma, epilepsy) NRCIM, 2009 Continuation of mental health issues in

adulthood (NRCIM, 2009) And are associated with:

Substance abuse Criminal behavior High risk taking behavior (Copeland, et. al, 2007)

COMORBIDITY

Approximately 40% of children with one mental disorders have at least one other mental disorder (U.S. Department of Health and Human Services, 2010)

COMMON CHILDHOOD DIAGNOSIS ADHD ODD and CD RAD ASD

PTSD OCD Mood Dsrds

DepressionBipolar

ADHD Diagnostic Criteria

“A persistent pattern of inattention and/or hyperactivity- impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):” InattentionHyperactivity and impulsivity6 + symptoms for at least 6 months and

is inconsistent with developmental levelMust be present before age 12, interfere

with life functioning, symptoms are present in 2 or more settings

ADHD Special issues

Unintentional injuries, ER visits, drug and alcohol abuse (Charach, et. al, 2011)

More common with boys, lower income, white non-Hispanics and black non-Hispanics (NHIS)

Prevalence8.4 % of Parents in 2011 reported that they

had been told kid has ADHD (NHIS) Treatment options:

Medications and/or behavioral intervention therapies (CDC, 2013)

ODD AND CD ODD is not a “earlier, milder form” of CD

(Ddiamantopoulou, 2011) ODD often proceeds CD, but ODD does

not consequently “cause” CD ADHD, CD, and ODD are often comorbid

(CD paper reference)

ODD Pattern of:

angry/irritable moodargumentative behaviorvindictivenessAt least 6 monthsAt least 4 symptomsWith at least one non-sibling person

Behavior doesn’t occur due to substance abx, psychosis, etc. & doesn’t meet Disruptive mood dysregulation disorder

CD Pattern of behavior that violates the

basic rights of others OR major age- appropriate societal norms are violatedAt least 3 symptoms over 12 monthsAt least one criterion present in the past 6

monthsAggression to people and animalsDestruction of propertyDeceitfulness or theftSerious Violation of rules

Specify: With limited pro-social emotions

ODD & CD

ODD CD

Onset usually preschool

3.3% prevalence (DSM V)(concurrent with other research from NSCH)

Male as early as

preschool usually diagnosed

middle childhood/middle adolescents

prevalence median range of 4% (DSM V)

RADA. Pattern of inhibited, emotionally

withdrawn behavior toward CG shown by:

Minimally seeks or responds to comfort when distressed

B. Social and emotional disturbance characterized by at least 2:

A. Minimal social responsivenessB. Limited positive affectC. Episodes of unexplainable irritability,

sadness, or fearfulness that are evident during nonthreatening interactions with CGs

RAD CRITERIA CONTINUEDA. Child has experienced a pattern of

extremes of insufficient care:A. Neglect of basic emotional needsB. Repeated changes of PCG (i.e. Foster care)C. Rearing in settings that prevent formation

of attachment (i.e. Institutions)B. Insufficient care caused disturbance in

behaviorC. Not ASDD. 9 months to 5 years old

BETH CHILD OF RAGE

http://www.bing.com/videos/search?q=beth+child+of+rage&view=detail&mid=DA6FE76056A1B89B43E7DA6FE76056A1B89B43E7&first=0&FORM=NVPFVR

RAD Young children who were exposed to

abuse and neglect Prevalence is unknown Prevalence in severely neglected

children only 10% (DSM V) One study found 2.4% of children to be

insecurely attached (Minnus, et al., 2009)

Comorbidity of language and cognitive delays as well as depressive symptoms

ASD (AUTISM SPECTRUM DISORDER) https://www.youtube.com/watch?v=YtvP

5A5OHpU

DEPRESSION Most recent data shows prevalence of

3.9 % of kids 3-17 having ever been diagnosed (CDC, 2013)

Adolescent girls more likely (CDC, 2013) Symptoms can appear at any age but

likely onset is puberty (DSM-V)

BIPOLAR DISORDERS In 1996 was 1.3 /10,000 U.S. children and In 2004 rose to 7.3/10,000 BPD-related discharges also increased four-

fold among adolescents.BPD-related hospitalization was more

prevalent among female adolescents and adults, while male children had larger risk than females.

“Children’s BPD diagnoses tended not to specify a prevailing mood state” (Blader and Carlson,2007) More volatile behavior changes

OCD Males have earlier onset (25% before

age 10) 25% of all cases start before 14 years

old

PTSD See handout….

QUESTIONS….?

REFERENCESBlader, J. Ph.D. and Carlson, G. (2007) Increased R Rates of Bipolar Disorder Diagnoses among U.S. Child, Adolescent, and Adult Inpatients, 1996-2004. Biol Psychiatry. 62(2): 107–114.Published online 2007 February 16. doi:10.1016/j.biopsych.2006.11.006Charach, A., et al. (2011) Childhood attention-

deficit/hyperactivity disorder and future substance use disorders: comparative meta-analysis. Journal of American Academy of Child Adolescent Psychiatry. 50. 9-21.

National Research Council and Institute of Medicine. (2009). Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Washington, DC: The National Academic Press. Schieve, LA, Boulet, SL, Kogan MD, et al. (2011). Parenting aggravation and autism spectrum disorders. Disability Health Journal.American Academy of Child and Adolescent

Psychiatry. (2005). Practice Parameter for Assessment and Treatment of

Children and Adolescents with reactive attachment disorder of infancy and early childhood. 44:11

US Department of Health and Human Services. Health Resources and Services Administration, Maternal and Child Health Bureau. (2010). The mental and emotional well-being of children: a portrait of states and the nation.Center for Disease Control and Prevention (2013). Mental Health Surveillance Among Children- United States, 2005- 2011.Minnus. H, et al., (2009). An exploratory study of the association between reactive attachment disorder and attachment narratives in early school-age children. Journal of Child Psychology and Psychiatry. 50(8),931–942.

CDC; National Center for Health Statistics. National Health Interview Survey.

(2012). Available at http://www.cdc.gov/nchs/nhis.htm.Copeland, W., et al., (2007). Childhood

psychiatric disorders and young adult crime: a prospective, population-based study. American Journal of Psychiatry. 164. 1668-1675.Diamantopoulou, S, et. al, (2011).The parallel development of ODD and CD symptoms from early childhood to adolescence. European Child Adolescent Psychiatry. 20:301–309