Children’s Mental Health: A Complex Problem

The World Health Organization (2011) defines mental health as:

‘A state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.’

While there is no doubt that most parents wish this for their children, many experience significant obstacles to finding adequate help for their children’s mental health issues. That is, if they can recognize that there is a problem in the first place. In Ontario, it is estimated that 20% of children struggle with a mental health problem but 80% of these kids do not receive the necessary treatment (MHASEF Research Team, 2015). Put differently, this equates to about 6 students in every classroom. It is likely that the prevalence rate is even higher than these conservative estimates, however, since children’s mental health disorders often go undetected or fail to meet the stringent diagnostic criteria, despite the presence of symptoms that impair and interfere with daily functioning (Girio-Herrera, Owens, & Langberg, 2013).

Children can develop all of the same mental health disorders that adults can, although they may be expressed in very different ways. Potential conditions include Generalized Anxiety Disorder (GAD), Separation Anxiety Disorder, Social Anxiety, Obsessive Compulsive Disorder (OCD), Attention-deficit/hyperactivity disorder (ADHD), Autism Spectrum Disorder (ASD), Eating Disorders, Depression, and Bipolar Disorder. Belden (2005) notes that although mental illness, like anxiety and depression, are becoming more common, it’s difficult to determine whether increased numbers of children are actually experiencing these disorders or if an increase in awareness and screening techniques are bringing them to our attention (or a combination of both). Regardless, it is reported that 70% of lifetime mental health issues begin during childhood or adolescence (Children’s Mental Health Ontario, 2017), indicating an opportune period for prevention and early intervention.

Extensive research demonstrates that early diagnosis and intervention enhance the individual’s ability to cope with a mental illness and provide improved outcomes for recovery (Belden, 2005; Crawford, 2016; Honeyman, 2007; Reidenberg, 2011) The effects of untreated mental health disorders, however, are often chronic and cumulative. For example, untreated childhood anxiety is associated with mood disorders, substance use, and delinquency in adolescence (Bittner, Egger, Erkanli, Costello, Foley, & Angold, 2007; Cole, Peeke, Martin, Truglio, & Seroczynski, 1998; Kendall, Safford, Flannery-Schroeder, & Webb, 2004; Mian, 2014). Evidence suggests that providing mental health treatment with young children is effective due to the high level of neuroplasticity in the brain structure of children, thus allowing adaptive changes to occur in neural pathways (Mian, 2004). In other words, the child’s developmental stage better facilitates positive learning through neural flexibility. Early intervention is also beneficial from an economic standpoint. It is estimated that for every dollar spent on prevention and intervention, 7 dollars are saved in future health and social costs (SickKids Centre for Community Mental Health, 2017). Furthermore, the Ottawa Citizen (2016) reports that schizophrenia, bipolar disorder, and depression cost Canada more money than every type of cancer combined.

So why is it that so many kids do not get the help they need? First, it’s difficult for parents to recognize mental health problems in their children. Children, due to their level of development, do not yet have the awareness and vocabulary to express their emotions or concerns (Mayo Clinic, 2015). In addition, many parents cannot differentiate between a symptom of mental illness and problem behaviour that is typical in childhood or adolescence. Every child is moody, anxious, or sad at least some of the time.

Even once a problem has been identified, several parents face additional barriers that fall into two main categories: structural and attitudinal (Ohan, Seward, Stallman, Bayliss, & Sanders, 2015). Structural barriers are the logistical considerations associated with mental health treatment, including transportation, time, child care, financial cost, and accessibility of services (Ohan et al., 2015; Ingoldsby, 2010). Attitudinal obstacles are beliefs related to stigma, fear of judgment, and skepticism of mental health providers or services (Ohan et al., 2015). Some parents may also minimize the problem or believe that it can be managed without professional help.

Unfortunately, even when the obstacles mentioned above are overcome, many Ontario parents encounter difficulties gaining access to treatment. Children’s Mental Health Ontario (2016) reports that 6,500+ children and youth waited over a year for treatment in 2016 and 76% of families stated that it was very or extremely difficult to know where to find help (Parents for Children’s Mental Health, 2013). Although the Ministry launched a plan, Moving on Mental Health, in 2012 to improve access to mental health services in Ontario, the Auditor General’s 2016 Report has indicated an overwhelming lack of progress to date. It is hoped that with increased awareness and funding that this gap can be narrowed.

Tips for Parents

Know the Warning Signs 

While the presence of any of the following signs is not necessarily indicative of a mental health disorder, they can help you to determine whether there might be an underlying condition to investigate further.

Changes in mood: intense feelings (e.g. sadness, withdrawal, fear) that last at least two weeks

Extreme mood swings: with little/no provocation that cause problems in relationships with others (Elements Behavioral Health, 2010)

Changes in behaviour: uncharacteristic and sudden changes in behaviour or personality (Mayo Clinic, 2015)

Dangerous or violent behaviour: frequent fighting and a propensity to use violence or weapons; expressing habitual anger towards others (Mayo Clinic, 2015)

Difficulty concentrating/focusing on a task; distracted easily

Unexplained weight loss or gain

Loss of appetite, frequent vomiting, or overeating

Evidence of self-harm or unexplained injuries (e.g. wounds or burns)

Talking/writing about suicide or death and feelings of hopelessness; statements that suggest a lack of future

Loss of pleasure or interest in activities enjoyed in the past (Elements Behavioral Health, 2010)

Use of alcohol or drugs

Uncharacteristic impulsive or risky behaviour

Physiological complaints (e.g. headaches, stomach pain, heart racing, difficulty breathing)

Persistent irritability

Lack of self-care and personal hygiene

Dramatic increase or decrease in sleep (Elements Behavioral Health, 2010)

Fatigue or low energy

Extreme and unwarranted feelings of guilt

Stress or worry that interferes with functioning on a regular basis

Feels uncomfortable around others

Engages in ritualistic or repetitive behaviour

Frequent nightmares or distressing memories (Elements Behavioral Health, 2010)

Acts hypervigilant, fearful or “on guard” frequently (Elements Behavioral Health, 2010)

Communicate with Teachers or Childcare Providers

If you suspect that your child is struggling with a mental illness, talk to their teacher. It is likely that your child’s teacher spends more waking hours with your child than you do, and they see them in a structured environment amongst other children. Therefore, they will have a perspective that is different from yours and may be able to shed some light on your child’s daily behaviour and functioning. A teacher’s position offers them the opportunity to observe and compare behaviour across several same-age peers in a social and academic setting (Girio-Herrera et al., 2013). These open lines of communication and sharing of mutual concerns can lead to increased surveillance and detection of a mental health issue.

Prioritize Mental Health

Emphasize the importance of mental health at the same level as physical health in your household. Recognize it as an essential pillar of holistic wellness. Your kids will likely pick up on this ideology and adopt it for themselves. 

Talk to your Doctor

In an ideal world, all health professionals would be mandated to screen for mental health issues as standard protocol during annual physical health assessments. Unfortunately, the onus of identification is on the parents and other adults in children’s lives. If you begin to suspect that your child is displaying symptoms of a mental health issue, keep track (in writing, if necessary) of the concerning behaviours and when they typically occur, the frequency (how often), and when you began to notice them. Bring this information to your next doctor or pediatrician appointment. For diagnosis and specialized treatment, your doctor may then refer you to a psychiatrist, psychologist, social worker, or behavioural therapist. 

Talk to your Child

Although they may not be ready to talk as soon as you broach the subject, letting your children know that you are open and available for conversations about mental health will help to ensure that stigma and shame will not silence them. Kids need to hear from their parents that they are loved and supported unconditionally, and that a mental health concern will be taken seriously. Research has recognized parental support as a major factor in fostering resilience among children (Brown, Khan, & Parsonage, 2012; Membride, 2016). If your child discloses mental health issues, believe them and take appropriate action. 

Don’t Use the “Wait & See” Approach

It may be tempting to put off treatment for your child until you are absolutely certain that there is a mental health condition to treat, but adopting the “wait and see” strategy can have lasting negative repercussions (Girio-Herrera et al., 2013). Mental health symptoms can interfere with normal development and learning, producing a cumulative effect. Furthermore, crisis intervention and delayed treatment are more costly and challenging than prevention and early intervention.

Be an Advocate

As mentioned above, the mental health system in Ontario is underfunded and hard to navigate. Finding effective treatment can be difficult, but don’t give up! You may need to push and fight to get your child the help they need.

Get Help for Yourself

Coping with your child’s mental health conditions can be stressful and scary. It may be helpful to speak with a mental health professional to address your needs and validate your fears in these unfamiliar circumstances. Therapy or counselling can assist you in coming to terms with a diagnosis and in turn, better support your child. Therapy can also provide important coping strategies, like stress management and mindfulness techniques, that will improve the way you interact with your child and respond to their challenging behaviours (Elements Behavioral Health, 2010).

 

Additional Resources

For expert advice on strategies and information regarding specific behaviours, symptoms, or disorders, visit The ABCs of Mental Health – Resources for Parents, A free web-based resource regarding children and adolescents aged 3 to 18. The Resource is searchable by “worrisome behaviour” or by chapter.

www.hincksdellcrest.org/abc

 

Child Mind Institute Symptom Checker – You indicate the behaviors that are making you concerned about your child by answering a series of questions. The Symptom Checker analyzes your answers to give you a list of psychiatric or learning disorders that are associated with those symptoms.

Since individual symptoms can reflect more than one disorder, this tool will give you a range of possibilities and guide you toward next steps. This tool cannot diagnose your child, but it can help you inform yourself about possible diagnoses and will offer information and articles to help you learn about them in order to facilitate a conversation with a professional.

https://childmind.org/symptomchecker/

References

Belden, A. C. (2005). When children have a mental illness. Portland, OR: United Parenting Publications.

Bittner, A., Egger, H. L., Erkanli, A., Costello, E. J., Foley, D. L., & Angold, A. (2007). What do childhood anxiety disorders predict? Journal of Child Psychology and Psychiatry, 48(12), 1174-1183.

Brown, E. R., Khan. L., & Parsonage, M. (2012). A chance to change: Delivering effective parenting programmes to transform lives. London, UK: Centre for Mental Health.

Children’s Mental Health Ontario. (2016). 2016 report card: Child & youth mental health. Toronto, ON: Children’s Mental Health Ontario. Retrieved from https://cmho.org/about-cmho/improving-mental-health-care-for-children-and-youth/our-work/report-card.

Children’s Mental Health Ontario. (2017). Key facts & data points. Retrieved from https://www.kidsmentalhealth.ca/education-resources/facts-figures.

Cole, D. A., Peeke, L. G., Martin, J. M., Truglio, R., & Seroczynski, A. D. (1998). A longitudinal look at the relation between depression and anxiety in children and adolescents. Journal of Consulting and Clinical Psychology, 66(3), 451-460.

Crawford, B. (2016, October 19). Research into early diagnosis of mental illness in children wins The Royal’s $100,000 prize. Ottawa Citizen. Retrieved from http://ottawacitizen.com/news/local-news/research-into-early-diagnosis-of-mental-illness-in-children-wins-the-royals-100000-prize.

Elements Behavioral Health. (2010). Recognizing signs of mental illness in your child. Retrieved from https://www.elementsbehavioralhealth.com/news-and-research/recognizing-signs-of-mental-illness-in-your-child/.

Girio-Herrera, E., Owens, J. S. & Langberg, J. M. (2013). Perceived barriers to help-seeking among parents of at-risk kindergarteners in rural communities. Journal of Clinical Child & Adolescent Psychology, 42(1), 68-77.

Honeyman, C. (2007). Recognising mental health problems in children and young people. Pediatric Nursing, 19(8), 38-44.

Ingoldsby, E. M. (2010). Review of interventions to improve family engagement and retention in parent and child mental health programs. Journal of Child and Family Studies, 19, 629-645.

Kendall, P. C., Safford, S., Flannery-Schroeder, E., & Webb, A. (2004). Child anxiety treatment: Outcomes in adolescence and impact on substance use and depression at 7.4-year follow-up. Journal of Consulting and Clinical Psychology, 72(2), 276–287.

Mayo Clinic. (2015). Mental illness in children: Know the signs. Rochester, MN: Author.

Membride, H. (2016). Mental health: Early intervention and prevention in children and young people. British Journal of Nursing, 25(10), 552-557.

MHASEF Research Team. (2015). The mental health of children and youth in Ontario: A baseline scorecard. Toronto, ON: Institute for Clinical Evaluative Sciences.

Mian, N. D. (2014). Little children with big worries: Addressing the needs of young, anxious children and the problem of parent engagement. Clinical Child and Family Psychology Review, 17, 85-96.

Ohan, J. L., Seward, R. J., Stallman, H. M., Bayliss, D. M., & Sanders, M. R. (2015). Parents’ barriers to using school psychology services for their child’s mental health problems. School Mental Health, 7, 287-297.

Parents for Children’s Mental Health. (2013). Family input survey: A system that truly makes sense. Retrieved from http://www.pleo.on.ca/family-input-survey-a-system-that-truly-makes-sense/.

Reidenberg, D. (2011). Ways to identify mental illness — and help save our children. Retrieved from http://www.ourkids.net/blog/tips-to-identify-mental-health-problems-9584/.

SickKids Centre for Community Mental Health. (2017). Prevention and early intervention services. Retrieved from https://www.hincksdellcrest.org/Home/Services-to-Infants-Youth-and-Children/Prevention-and-Early-Intervention.aspx.

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