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WHAT PARENTS SHOULD KNOW ABOUT CHILDREN’S DISORDERS Introduction If your child has emotional, behavioral or mental health issues, or has been diagnosed with a specific disorder, you should learn as much about the disorder as possible. It will help you understand why your child behaves the way he does and can help you be a better parent. There are many sources of information about children’s disorders. The following is only a short summary. To learn more about children’s disorders, talk with your child’s mental health professional, Primary Care Physician or pediatrician. They will have additional information about children’s disorders. Your library also will have information. If you suspect your child may have mental health issues, you should have your child evaluated by a mental health professional. In the evaluation, the professional will talk to you and if appropriate, your child and other family members. She will ask questions about your child’s development and about his behavior both at home and at school. She may also ask about family history and whether or not there are problems or issues at home that may be affecting the behavior. The professional may also observe your child in different situations. With this information, the professional will form a mental health diagnosis. If you are interested in learning about how your mental health professional diagnosed your child, you can get information from a book called the Diagnostic Statistical Manual of Mental Disorders, which is published by the American Psychiatric Association (1994). Professionals use this book as a guide to help them diagnose their clients. Your library should have a copy that is available for the public. Children’s disorders fall into several categories: behavioral disorders, mood disorders, anxiety disorders, psychotic disorders, developmental disorders and others that don’t fall neatly within a special category. Each diagnosis has a preferred type of treatment or "best practice," so it is important to get the right diagnosis. Because the origin of children’s disorders is so complex, your child’s mental health diagnosis may change over the course of his treatment and some children won’t fall neatly into one diagnostic category. The following is intended as a brief summary. It is not intended to replace anything your PCP or mental health professional has told you. If you have additional questions, please talk to your mental health professional, pediatrician or PCP. ADHD Attention-Deficit/Hyperactivity Disorder (ADHD) is a condition that can make it hard for a person to sit still, control behavior, and pay attention. These behaviors usually begin before the child is 7 years old but may not be noticed until the child is in school. Doctors do not know what causes ADHD but we do know what does not cause it. It is not caused by too much sugar, bad parenting or watching too much TV. Researchers who study the brain believe that some people with ADHD do not have enough of certain chemicals (called neurotransmitters) in their brain. These chemicals help the brain control behavior. As many as 5 out of every 100 children in school may have ADHD. Boys are three times more likely than girls to have it. In fact, ADHD is one of the most common of all the children’s disorders. There are three main signs, or symptoms, of ADHD. These are:
These behaviors can cause a child to have many problems at home, at school, and with friends. Because of these problems, many children with ADHD feel anxious, depressed and unsure of themselves. These feelings are not symptoms of ADHD. They come from having problems again and again at home and in school. There is no quick treatment for ADHD. However, the symptoms of ADHD can be managed. It’s important that the child’s family and teachers:
School can be hard for children with ADHD. Success in school often means being able to pay attention and control behavior and impulses. These are the areas where children with ADHD have trouble. There are many ways the school can help students with ADHD. Some students may be eligible to receive special education services under the Individuals with Disabilities Education Act (IDEA). Your child may be eligible for special education services. Supports or changes in the classroom (called adaptations) help many students with ADHD do better in school. Tips for Parents
Oppositional Disorders At some time or another, all children become oppositional. They may argue, throw tantrums, talk back to teachers and parents and intentionally disobey authority figures. In fact, at some ages, being oppositional is a normal developmental trait. Toddlers and young teens become oppositional from time to time to help them separate from their parents and gain their independence. Yet some children display oppositional behavior that is far out of line with other children, or causes severe problems at school or in the family. If this is the case, your child may be helped by treatment. Some common signs of oppositional disorder include:
TIPS FOR PARENTS
Conduct Disorders A conduct disorder can be thought of as being at the further end of the spectrum of behavior disorders. Children with conduct disorders often violate the basic rights of others and break major rules. They may become involved in criminal behavior or behavior that is dangerous to them or to others. Unfortunately, many authorities don’t view children with a conduct disorder as having a mental health problem. Instead, they are seen as juvenile delinquents or as "bad" kids. Many of our children in juvenile justice facilities may have a conduct disorder. In fact, it is estimated that over half of all children in juvenile justice facilities are dealing with a mental health issue. Many are not receiving any treatment. Symptoms of a conduct disorder include:
These behavior problems are serious and can lead to long term consequences such as dropping out of school and jail time, so it’s important to get treatment for your child. If your child ends up in the legal system because of this disorder, you need to advocate for him to ensure he gets treatment while he is incarcerated. Depression Children and adolescents can be depressed, just like adults. Depression is more than just feeling sad or blue. It is a medical disorder that can affect your child’s relationships, school performance and overall functioning. Depression can also be deadly. It can result in suicide and suicide is one of the leading causes of death in teenagers and young people. The good news is that both children and teens respond very well to treatment.
Depression affects people of all ages, sexes, races and economic backgrounds. Depression can happen in a single episode (only once) it can be recurrent (happen in cycles) or go along with a manic episode (high or euphoric mood). Depression isn’t caused by one single event. It’s caused by a combination of factors and the causes vary from person to person. Depression can be caused by lowered levels of neurotransmitters, chemicals in the brain that send messages to the nerves. While depression can be triggered by stressful or tragic events, they do not cause depression. Some studies show that depression runs in families. Stress or loss can trigger a bout of depression, but some depression happens without any kind of obvious external causes. In some children and teens, the signs of depression are similar to the symptoms in adults. These include:
Children may also show other kinds of symptoms. They include:
In teens, depression can show in many ways:
Symptoms of depression may also look like alcohol or drug abuse, Attention Deficit Disorder, or other kinds of problems. Watching the child carefully over a long period of time is the best way to make a diagnosis. Treatment for depression starts with an evaluation by a mental health professional. Your mental health professional may also talk to you about your child’s general health and about situations at home or school that might be contributing to the depression. Be as honest as possible with the professional. They are not prying, they are only trying to get enough information to make an accurate diagnosis. Treatment may include medication, one-to one therapy, group therapy or family therapy. Therapy that focuses on helping your child to talk about her problems can help her learn skills to deal with problems and can help her see her problems in a new perspective. School may or may not be a problem for a child with depression. Depression does not always show up as behavior problems in school, like other disorders such as ADHD. If your child has recently become depressed, your teacher may notice a drop in school performance and grades, and may contact you about her concerns. Some children do not come to the attention of teachers at all, because their depression causes them to become withdrawn. Other children will become involved in drugs, alcohol or dangerous behavior as a result of their depression. That is why it is important to be involved in your child’s school life. Changes that might not be obvious at home may show up at school. Tips for Parents
Bipolar Disorder Bipolar disorder is a disorder that can cause extreme mood swings. The mood swings can range from mania (excited, high or frantic) to depression (sad, hopeless) with periods or normal moods as well. It affects people of all ages, sexes, races and economic backgrounds, and is usually first diagnosed in adulthood. Occasionally, it is diagnosed in teenagers, and in rare instances, has been diagnosed in children as young as five. In adults, these moods usually last weeks or months. In children or teens, the mood swings are much more frequent. In fact, in many children, the mood swings cycle many times within a day. A child with bipolar disorder may have other disorders such as ADHD, obsessive compulsive disorder, substance abuse or oppositional disorders. Everyone has mood swings, but a person with bipolar disorder has severe mood swings. The moods vary from mania to depression. The person’s feelings may be so intense that they lose contact with the real world. The symptoms of mania include:
In a child with bi-polar disorder, the depressive symptoms are similar to the symptoms of someone with depression. The length and intensity of episodes vary between people. People also have periods of normal moods in between the high and low cycles. TIPS FOR PARENTS
Autism and Asperger’s Syndrome Babies and very young children are social beings that need love and attention in order to thrive. Some babies, however, not only avoid attention, but actually seem to dislike it. Autism is a disorder that affects a child’s ability to develop socially. Children with autism do not develop language skills at the appropriate age, they don’t make eye contact, and cry or are very uncomfortable when they are cuddled or touched. As they grow older, they may use language in odd ways, refer to themselves as "he" or "she", and display odd gestures such as rocking, or hand waving. The child may also have delays in developing their motor skills. Activities that require coordination such as riding a bicycle or handwriting may be hard for the child. The effects of autism span a wide range. Some children with autism may not speak at all and be severely retarded. Other children with autism are bright, can attend school and will be able to get a job and live independently when they become adults. Autism affects about one in every 700 children. Scientists don’t know exactly what causes it, but believe that children who have autism can’t process certain brain chemicals. It is not caused by anything the parents did. We are learning more and more about autism each day. We are also learning more about how professionals and families can work together to help the child with autism. Asperger’s syndrome (AS) is a disorder that is similar to autism. It is commonly described as "high functioning autism." Children with the disorder will display many of the same symptoms as children with Autism, but have normal or even superior intelligence. In contrast to children with autism, they want to play with other children, but may be unable to read communication cues. Tone of voice, facial expressions and body language are communication cues. It is these small cues that children with AS are unable to understand. For example, they may not know that someone is angry by the tone of their voice, so their response will be entirely inappropriate. They do develop language at the normal ages, but don’t seem to use their language to communicate with others. Children with AS may speak in a monotone, or with a sing-song voice. The majority of children with Autism or Aspergers Syndrome respond well to treatment, but treating these children takes time, effort and patience. It requires patience because these disorders are best treated by a combination of interventions, and it may take some time to find the best combination. Some children will need support for the rest of their lives, while other children will be able to live independently. The disorders are not cured by medication, but medication can help to control some of the behaviors such as aggression or irritability. All children with AS or Autism have the right to an education. Your child may be eligible for special education services. Work with the child’s teachers to find the best educational program. Some children should be included in the regular classroom, while others will get more benefit from small, specialized classrooms. Fears and worries are a normal part of life. In fact, certain kinds of fears are a normal part of child development. For example, older infants and toddlers experience separation anxiety when they are away from their parents. As young children begin developing an imagination, they may fear the monster in the closet. Yet some children are significantly affected by their worries. Their fears affect their schoolwork, their ability to make friends and their relationships with their family. Teens who have untreated anxiety disorders may develop a substance abuse problem because they use drugs or alcohol to ease their symptoms. Anxiety disorders are probably the most common of all mental health problems that affect children and teens. In fact, about one in ten children will have an anxiety disorder some time during their lives. Anxiety disorders often go undiagnosed, because children can hide the symptoms from their parents and teachers. Anxiety disorders can disappear without treatment or explanation, or they can be long term. Anxiety disorders also respond very well to treatment. There are several types of anxiety disorders that are common in childhood. They include:
TIPS FOR FAMILIES:
Children with eating disorders will have unusual or abnormal eating behavior. Anorexia Nervosa is a disorder that causes a person to restrict their eating to the point where weight drops more than 15 percent of what is considered normal. Bulimia is a disorder where a person binges by consuming large amounts of food, then purges by forcing herself to vomit or by taking laxatives. Eating disorders usually start in puberty or adolescence, when other body changes begin happening. Some cases of eating disorders have been noted in children as young as 9 years of age. They more commonly affect girls, but about 5 percent of these children disorders are boys. The family may be unaware that their child has an eating disorder because these children are experts at hiding their disorders. Left untreated, these disorders can have serious consequences on a child’s health. In rare instances, people have died from eating disorders to develop. Eating disorders happen for a variety of reasons. Usually, the child has an unrealistic body image. She believes she is fat when she really isn’t. Some believe that children with eating disorders feel like they have no control over their lives, so their food intake represents one way to have control in their life. Other effects may be present in a child with and eating disorder such as depression, peer pressure, abuse, and media pressure to be thin. Because children with eating disorders are experts at hiding their disorders, you need to trust your own instincts. There are certain behaviors to be aware of. Be aware if your child constantly complains about being fat, avoids meals, or makes excuses about why she has lost a great deal of weight. Also, be aware if your child spends long periods of time in the bathroom right after a meal. Coaches who constantly criticize your child’s weight can also encourage an eating disorder. TIPS FOR PARENTS
Schizophrenia Schizophrenia is a medical illness that affects people from all races, genders and income levels. This disorder makes it hard for a person to tell the difference between the real world and unreal experiences. It also makes it hard for a person to think and act normally. Schizophrenia is not a split personality. It is not caused by growing up in a dysfunctional family nor is it caused by laziness or having a weak moral character. It has a physical cause just like diabetes or heart disease. Schizophrenia is a common mental illness. Some estimates say that 1% of the population is affected by schizophrenia. The first symptoms usually appear between the ages of 15 and 25, but occasionally, symptoms appear before the age of 12. The behavior of a child with schizophrenia will be different than the behavior of an adult with schizophrenia. If your psychiatrist suspects your child has schizophrenia, he or she will look for the following early warning signs:
Adult onset schizophrenia usually comes on fairly suddenly. Children with the disorder, on the other hand, will show slow, gradual changes in their behavior. Many parents also report that their child with schizophrenia showed signs of being "different" from a very early age. Medication is the main treatment for schizophrenia. There are many new medications that treat schizophrenia. If the first medication does not help the symptoms, ask your doctor to try another medication. Also, it may take time to adjust the dosage, so be patient. Family therapy and one-to one therapy can also help the family cope with the changes that their family is experiencing as the result of their child’s disorder. Structured education programs can help your child with his daily functioning and he may be eligible for special education services. TIPS FOR PARENTS
OTHER PROBLEMS THAT AFFECT CHILDREN & FAMILIES Substance Abuse Many children experiment with drugs and alcohol. They do it for a variety of reasons: to be accepted by their peers, to feel grown up, because they are curious, to relieve stress, or to mask the symptoms of a mental health disorder such as depression or anxiety. Not all children who experiment with drugs or alcohol will develop a problem or become dependent. Some will try it a few times, and stop, while others will go on to develop serious problems. If you believe your child is using drugs or alcohol, talk openly to your child. Let her know your concerns and reassure her of your love and care. Many times, all it takes is a parent’s acknowledgement of the problem. If nothing else, it will open up the lines of communication between you and your child. If your concerns continue, you may want to have your child evaluated by a mental health or substance abuse professional. There are a variety of treatments that work to help people overcome a substance abuse problem. Your child should first be evaluated for a co-occurring disorder such as depression or anxiety. Many youngsters use drugs or alcohol to mask the symptoms of other mental illnesses. Medication may be prescribed to treat the symptoms of co-occurring disorders. Other treatment approaches may include one to one therapy, family therapy, residential recovery programs, self-help and support groups and 12-step groups such as Alcoholics Anonymous. TIPS FOR PARENTS
Gay and Lesbian Youth This is included in this section, not because it is a mental disorder in and of itself, but rather, because being Gay or Lesbian in our culture is not often tolerated by others. This intolerance, and sometimes even hatred and violence, can cause serious problems for children with sexual identity issues. Part of growing up is learning how to express yourself sexually. Many teens experiment sexually. They may do it with someone of the same sex or someone of the opposite sex. This experimentation does not mean someone is gay or lesbian. Being gay or lesbian means that a person has a continual desire to become emotionally or sexually involved with people of the same sex. Homosexuality is not something new to the twentieth century. It has been a part of humankind for thousands of years and across countless cultures. Many cultures, in fact, accept homosexuality as a normal part of the range of human experiences. In our culture, homosexuality is less tolerated. Because of this intolerance, gay or lesbian children feel different than their peers, worry about the reaction from family members and loved ones, face uncertainty about their futures, and are afraid of being humiliated or attacked. In fact, these kinds of problems have lead to a very high suicide rate among young people who are gay or lesbian. As a parent, it is important to understand that no one chooses to be gay or lesbian. It happens, just like blue eyes. It is nothing to be ashamed of. Your child deserves the same love and respect as she has always had. TIPS FOR PARENTS:
Gangs As teens struggle with finding their own identity, they may reject the values and behavior of their family, and adopt new behavior that reflects that of their peer group. When kids come home with blue hair, piercings, or strange clothes, this may alarm parents. But some rebellion and resistance to adult standards of behavior is developmentally normal. It is a sign of the child’s struggle to become an individual. This is where the group comes in. The group serves an important purpose in helping your child reach these developmental milestones. The group helps teenagers separate from their parents. This separation is a very important part of becoming an independent adult. The groups also provide self esteem, make the child feel good about him or herself, and gives them an identity they feel comfortable with. It also provides a protective factor where group members take care of each other. Groups span a wide range, from church sponsored teen groups and fraternities to street gangs and satanic cults. Outwardly, they look different, but they still serve the same purpose for the child. While most groups, even the ones that promote odd dress, are fairly harmless, some groups, such as street gangs and cults, can cause long-term problems for the teen. Some gangs engage in illegal and dangerous behavior. Others, such as cults, prey on vulnerable children and can subject children to mental and physical abuse. If you suspect your child is involved in such a group, you should intervene. Contact a mental health professional for an evaluation. Some youth become involved with gangs as a way to deal with the symptoms of other disorders such as depression or anxiety. Even if your child is not suffering from a mental health disorder, a mental health professional may be able to help your family with counseling or refer you to a therapist who specialize in gang or cult intervention. TIPS FOR PARENTS
No discussion about children’s mental health issues is complete without mentioning suicide. Suicide is a real threat to young people. In fact, suicide is the 3rd leading cause of death for young persons ages 15-24 and has increased more than 200% in the last decade. Colorado typically ranks between 3rd and 7th in the nation in suicide deaths. Spring is a higher risk time of year. While not all teenagers who try or succeed at suicide show warning signs, most teens will have some behaviors that draw the attention of adults. If you suspect your child or teenager is thinking about suicide, even if the signs are absent, have a talk with your child. Signs that may be present in a teen who is thinking about suicide include: 1. A change in sleeping habits, eating, studying, activity level, sexual activity, school or job performance. 2. Giving away prized possessions. 3. Increase in drug or alcohol use. 4. Depression 5. Suicidal threats or talk. 6. Previous suicide attempts 7. Sudden change in behavior 8. Isolation or cutting off friendships 9. Thrill-seeking behavior 10. Expressing helplessness or an "I don’t care" attitude. 11. Feeling and/or expressing that life is meaningless or hopeless. 12. Family disruption: move, divorce, or other major changes. Some suicidal thinking may be preceded by a stressful event such as a breakup with a girlfriend, divorce or significant loss, but not all suicides are bought on by a stressful event. The most common feature is a sense of hopelessness. A suicidal person feels that nothing he does will change his situation and suicide seems to be the only way out. Talking about suicide will not make someone want to try it. In fact, the caring and concern shown by others can dispel the hopeless feelings. Talking openly can help your child sort through the problems and provide a sense of relief and understanding. It is one of the most helpful things you can do. If you have any indication that a youth is considering it, that youth needs intervention from a responsible and caring adult. When a hero, friend, family member, neighbor, etc. has committed suicide, adolescents are more likely to consider it an option for dealing with their problems. Talking about it openly is also very important. Someone who has been considering suicide may look happier and more relaxed once they have decided to follow through with a plan. They feel a sense of relief because they have made a decision that promises to stop the pain. Tips for Parents
The following is a list of questions you can ask: "Have you been feeling sad or unhappy? "Does it ever seem like things will never get better?" "Have you felt so bad that you thought about hurting yourself?" "Do you have any thoughts of ending your life?" "Have you thought about how you might kill yourself?" "Have you made plans how to kill yourself?" "What are your plans? When do you intend to do it?" "Is there anything that might keep you from hurting yourself such as people who care about you, religious beliefs, responsibilities to others or something you wanted to live to do or see?"
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