Mental Health Problems in Children

Dr Ajay NihalaniMD,MRCPsych

Member American Psychiatric Association

What do we mean by mental health problem?

Involves mind rather than body

Varies in severity

More than one cause

Can be assessed & managed effectively.

What are the types of mental health problems?

Delays & Deviations from normal dev.Language delay,stammering,reading difficulties,clumsiness,ASD,Intellectual disability.

Habit problems..feeding,obesity,sleeping difficulties,bed wetting,soiling,tics and other jerky movs.

Emotional problems..panic attacks,fears n phobias,school refusal,separation anxiety,shyness,depression ,misery & unhappiness,obsessions & compulsions.

Behavior problems...temper tantrums & disobedience,ADHD,Agressive behaviour,fire setting,lying,stealing,truancy.

Self harm n suicide

Mental health difficulties arising from chr physical illness

Physical Sx for which no physical cause is found

Severe mental illness....psychosis

Alcohol n drug dependency

Stressful/damaging experiences...abuse

More than one of the above

Importance of mental health problems

1 in 5-10 children have mental health problems reducing QOL

4 out of 5 are not recognised(Geil et al 1981)

Effective assessment n Mx methods available

Cause of mental health problems in childhoodOur genes influence our temperamentsPhysical health affects mental healthStressful experiences at home n school

Lotika a 15 yr. old is b/b mother for period painsSoon evident period pains are a minor problemMain difficulty ---crying all the time, feeling life not worth livingTurns out has had a breakupNo previous signs of depression...always a cheerful,happy,fun loving girl Mother has h/o severe depressive episodes

Main stressors for children

Disturbed family. Unhappy parental marriages,DV

Loss of family,friends,pets

Physical/mental illness in self /family

Alcohol/drug problems in parents

School n neighborhood problems(learning difficulties, bullying)

Emotional problems

Excessive worrying,fear,anxiety

Excessive misery,unhappiness,depression

Compulsions & Obsessions

Alok is a 15 yr. old boy b/b father to paeds because of a fear of cardiac illness as his grandfather father has had a previous MI. He has had 6 episodes which occurred suddenly without warning.They started when he was leaving the house to spend the evening at his friend's house. He would walk a few steps and then find his heart beating very fast. Someone had told him how to feel his pulse and it would be racing. He felt panic stricken. His legs felt weak and he thought he would collapse but he managed to stagger home. There did not seem to be any reason for these attacks.His friend comes from a respected family and has a very beautiful 16 yr. old sister.

Shreya is a 4 yr. old girl. About a week ago she was out shopping with her mother in the market buying fruit n vegetables when a large black dog snarled at her then started to bark. The dog was held by a strong lead, but the owner a young lad pretended to untie the lead to frighten Shreya more.The group of boys laughed at Shreya. Shreya was petrified. Now she has been brought by her mother to the paeds by her mother because she will not go out of the house in case she meets the dog again. She is sleeping poorly and has nightmares of being bitten by the dog. Her mother is at her wits end and does not know what to do.

Deepender is a 10 yr. old boy who is brought to the paeds because he will not go to school. This began about 6 months ago. He at first was reluctant to go to school and kept making excuses why he should not go. He complained of headaches and also said boys were picking on him at school. Ten days ago he refused to go at all .He has been spending the time at home playing, going out to play with his grandfather and watching TV. His mother and father(a rather quiet man, not very forceful),have tried to get him back to school but without success. Because of the headaches the paeds examined Deepender but found no physical problem. He talked a bit more with the mother .It turned out that when the problem with school began ,his mother was depressed because her own mother had died. Also at this time ,a male teacher of whom Deepender was rather frightened had shouted at him for talking when he should have been paying attention. Deepender has always been a rather sensitive boy and was very upset, saying he thought this teacher might beat him.

Amrita a 14 yr. old is b/b mother because she has a mole on her face. The mole is really small and the paeds cannot see what the fuss is all about. Is there any other problem? It turns out Amrita has dizzy spells. It is clear that these occur because she does not want to go out to mix with other girls in their homes. She can see one girl at a time, and indeed she has one good friend, but when it comes to little groups of girls she says she does not want to go and then says she feels dizzy and cannot stand up. She gives the mole as an excuse for not socialising.She says she thinks other girls see her ugly and do not want to have anything to do with her. Recently she has even stopped wanting to see her only friend. Her mother is worried that Amrita will get a bad reputation and does not want the news to get around.

Benazir is a 14 yr. old b/b mother because she is having headaches. It turns out the headaches are not much of a problem. But her mother says that for the past 6 months BENAZIR has been very moody and unhappy. This is not like her at all. Normally she is a very bubbly girl with lots of friends who loves playing with her 4 yrs. old brother. Now she does not want to see her friend sand shows no interest in her brother. She often tries to get out of going to school by saying she has a headache. She gets angry and irritable very quikly.Her mother thinks that maybe she is being bullied at school or that she has lost her friends there. Maybe they are picking on her. Her schoolwork remains good. Nothing the mother can think of has upset her at home.

Amar is a 13 yr. old brought in by his very anxious mother.For the past 1 yr or so according to the mother he has been developing a no of funny habits. The worst is he will not sit down in any chair. He has also become extremely preoccupied with cleanliness, spending ages in the bathroom. Especially after he has been to the toilet. In the morning he seems to need an hr. in the bathroom. This is a religious Hindu household and each of the family members worship the household deity for 10 mins.Amar kneels in front of the image ,chanting mantras for longer and longer periods in the evening for up to an hr. He also takes ages to get to bed, needing to check that his sheet is clean and all his clothes are exactly in the right place before he is happy to settle to sleep. Things seem to be getting worse with longer and longer periods of praying and checking everything is in order before he will do anything at all.

Thank You