Mental Illness In Children Research Articles

Programs Aim to Help Schools Identify and Address Mental Illness in Children

Mental illness often goes unidentified in children and adolescents, in some cases being confused with typical �growing pains.� But real problems are prevalent in this age group�for the first time in more than 30 years, the top 5 disabilities in US children are mental health conditions (Slomski A. JAMA. 2012;308[3]:223-225). And in most cases, those affected are not getting treatment.

Trauma-informed practices with children and adolescents

We have accepted the privilege of steering the editorial direction of the Journal of the Canadian Academy of Child and Adolescent Psychiatry with anticipated apprehension. What began as an information bulletin just over two decades ago, through growing pains, has been transformed into a notable scientific publication, now openly available on-line to the public and indexed in PubMed, PsychINFO, CINAHL, and Scopus. We owe much gratitude to Vivek Kusumakar, Mary Kay Nixon and Normand Carrey for their commendable efforts as past Editors. Times are rapidly changing in the field of child and adolescent mental health. Practitioners, policy makers and scientists from many disciplines are responding to the challenges of mental illness among youth by drawing on an increasingly wide range of perspectives from the social and psychological to the biological to enhance our understanding of mental illness. Today, we understand that many factors contribute to the onset and persistence of mental illness in youth and that each of these influences must be understood in order to develop effective intervention for affected individuals and communities. The issues of children and youth with mental illness are not simply after-thoughts in the minds of scientists and policy makers as they once might have been but are, instead, increasingly central to policy and science on mental illness in general. Disorders such as attention deficit hyperactivity disorder and autism play a key role in the advancement of the genetics and nosology of psychiatric disorders of all kinds in ways that could scarcely have been imagined a decade ago. These successes reflect the long-standing tradition of collaborative and multidisciplinary research and practice that characterizes child and adolescent psychiatry. Together, these forces and the diverse perspectives that drive them are creating a new science of children’s mental health. The uniqueness of the resulting perspective was acknowledged by the Royal College of Physicians and Surgeons of Canada in making Child and Adolescent Psychiatry a formal subspecialty in 2009. As the official voice of Canadian Child and Adolescent Psychiatry, the Journal has the mandate to make available state-of-the-art information that advances the understanding of mental illness in children and youth. The Journal is not only the voice of academic Child and Adolescent Psychiatry in Canada but also a prominent voice of practitioners, policy makers and scientists in Canada and beyond. In order to continue building its breadth, depth and excellence, the Journal will expand its efforts to reach out to all professionals interested in child and adolescent mental health in order to foster trans-disciplinary discussion of critical themes informed by qualitative and quantitative empirical evidence that will range from biology to social policy and include basic and clinical sciences, ethics and advocacy. Accordingly, it is our intent to expand the Journal’s editorial board and actively seek input from a wide range of perspectives on mental health of youth. Complementing this renewed vision, the Journal of the Canadian Academy of Child and Adolescent Psychiatry has moved towards an electronic manuscript submission platform that will facilitate the process of review, allowing prompt response to manuscript authors.

Sofrimento psíquico em crianças e adolescentes: a busca pelo tratamento

Trata-se de uma pesquisa de natureza descritiva com abordagem qualitativa, realizada em um centro de atenção psicossocial infantil - CAPSi, do município de Fortaleza-CE. Este estudo objetiva descrever a atitude da família na busca de tratamento da criança/adolescente em sofrimento psíquico. Os sujeitos desta pesquisa constituem-se de 42 familiares cuidadores de crianças e adolescentes, usuários do CAPSi. A coleta de dados foi realizada por meio de entrevistas semiestruturadas. A análise dos dados foi feita por meio de entrevistas divididas em categorias, em que as falas com ideias semelhantes se reuniam em uma mesma categoria. Os resultados mostram um importante elemento sobre a falta de assistência à família do indivíduo em adoecimento psíquico, evidenciando a fundamental importância de englobar toda a família no processo terapêutico. Concluiu-se que se fazem necessárias reflexões acerca da atenção de saúde direcionada ao adoecimento psíquico, em relação às crianças e adolescentes, bem como em relação às famílias envolvidas, prevenindo ou intercedendo precocemente no adoecimento psíquico.

Challenges of caring for children with mental disorders: Experiences and views of caregivers attending the outpatient clinic at Muhimbili National Hospital, Dar es Salaam - Tanzania

BackgroundIt is estimated that world-wide up to 20 % of children suffer from debilitating mental illness. Mental disorders that pose a significant concern include learning disorders, hyperkinetic disorders (ADHD), depression, psychosis, pervasive development disorders, attachment disorders, anxiety disorders, conduct disorder, substance abuse and eating disorders. Living with such children can be very stressful for caregivers in the family. Therefore, determination of challenges of living with these children is important in the process of finding ways to help or support caregivers to provide proper care for their children. The purpose of this study was to explore the psychological and emotional, social, and economic challenges that parents or guardians experience when caring for mentally ill children and what they do to address or deal with them.MethodologyA qualitative study design using in-depth interviews and focus group discussions was applied. The study was conducted at the psychiatric unit of Muhimbili National Hospital in Tanzania. Two focus groups discussions (FGDs) and 8 in-depth interviews were conducted with caregivers who attended the psychiatric clinic with their children. Data analysis was done using content analysis.ResultsThe study revealed psychological and emotional, social, and economic challenges caregivers endure while living with mentally ill children. Psychological and emotional challenges included being stressed by caring tasks and having worries about the present and future life of their children. They had feelings of sadness, and inner pain or bitterness due to the disturbing behaviour of the children. They also experienced some communication problems with their children due to their inability to talk. Social challenges were inadequate social services for their children, stigma, burden of caring task, lack of public awareness of mental illness, lack of social support, and problems with social life. The economic challenges were poverty, child care interfering with various income generating activities in the family, and extra expenses associated with the child’s illness.ConclusionCaregivers of mentally ill children experience various psychological and emotional, social, and economic challenges. Professional assistance, public awareness of mental illnesses in children, social support by the government, private sector, and non-governmental organizations (NGOs) are important in addressing these challenges.

A Pilot Survey of Clergy Regarding Mental Health Care for Children

Collaborations between healthcare and faith-based organizations have emerged in the drive to improve access to care. Little research has examined clergy views on collaborations in the provision of mental healthcare, particularly to children. The current paper reports survey responses of 25 clergy from diverse religious traditions concerning mental health care in children. Subjects queried include clergy referral habits, specific knowledge of childhood conditions such as depression and anxiety, past experiences with behavioral health workers, and resources available through their home institutions. Overall, surveyed clergy support collaborations to improve childhood mental health. However, they vary considerably in their confidence with recognizing mental illness in children and perceive significant barriers to collaborating with mental health providers.

The Promotion of Mental Health: Role of the Family

Increasing awareness of the prevalence of mental illness in children and adolescents has been followed by an awareness of the global burden—economic and social, in addition to the suffering of individuals and their families. The Institute of Medicine recently acknowledged that insufficient attention has been paid to attempting to reduce the global burden of mental illness. In light of what we know about development and the important role of the family in promoting healthy development in children, it is crucial to support the role of the family. The author draws on his long career as a therapist, an administrator of clinical services, and a leader in mental health service agencies, as well as his personal experience as a father and grandfather, to present a comprehensive overview of what we know and what we need to do to promote mental health in our children and adolescents. Keywords: Mental health promotion, prevention, adolescents, children, child and adolescent development, mental health professionals, Michael G. Kalogerakis, Nikos Zilikis, global burden, EMOTIONAL, MENTAL

Pediatric and Adolescent Mental Health Emergencies in the Emergency Medical Services System

Emergency department (ED) health care professionals often care for patients with previously diagnosed psychiatric illnesses who are ill, injured, or having a behavioral crisis. In addition, ED personnel encounter children with psychiatric illnesses who may not present to the ED with overt mental health symptoms. Staff education and training regarding identification and management of pediatric mental health illness can help EDs overcome the perceived limitations of the setting that influence timely and comprehensive evaluation. In addition, ED physicians can inform and advocate for policy changes at local, state, and national levels that are needed to ensure comprehensive care of children with mental health illnesses. This report addresses the roles that the ED and ED health care professionals play in emergency mental health care of children and adolescents in the United States, which includes the stabilization and management of patients in mental health crisis, the discovery of mental illnesses and suicidal ideation in ED patients, and approaches to advocating for improved recognition and treatment of mental illnesses in children. The report also addresses special issues related to mental illness in the ED, such as minority populations, children with special health care needs, and children's mental health during and after disasters and trauma.

Parents of Children with Mental Illness: Exploring the Caregiver Experience and Caregiver-Focused Interventions

Serious mental illness in children can significantly impact the parents who care for these children in both positive and negative ways. Caregiver strain and enrichment manifests in all areas of parents' lives, including work, mental and physical health, and social and family relationships. Research has identified numerous predictors of caregiver strain such as severity of child's illness and impairment, race, and social support. These parents need strengths-based, parent-focused interventions to help them care for themselves and their family in a healthy, effective manner. A brief summary describes 4 types of interventions for parents of children with mental illness and the supporting research. Education, support, and skill building are all important components in parent interventions. A parent focus for interventions and research will decrease caregiver strain and create a healthier environment for the entire family.

Obsessive-Compulsive Disorder in Children and Adolescents

Early-onset obsessive-compulsive disorder (OCD) is one of the more common mental illnesses of children and adolescents, with prevalence of 1% to 3%. Its manifestations often lead to severe impairment and to conflict in the family. In this review, we summarize the manifestations, comorbidity, pathophysiology, and course of this disease as well as current modes of diagnosis and treatment. We selectively review the relevant literature and the German-language guidelines for the diagnosis and treatment of mental illnesses in children and adolescents. Obsessive-compulsive manifestations are of many types and cause severe impairment. Comorbid mental disturbances are present in as many as 70% of patients. The disease takes a chronic course in more than 40% of patients. Cognitive behavioral therapy is the treatment of first choice, followed by combination pharmacotherapy including selective serotonin reuptake inhibitors (SSRI) and then by SSRI alone. OCD often begins in childhood or adolescence. There are empirically based neurobiological and cognitive-behavioral models of its pathophysiology. Multiaxial diagnostic evaluation permits early diagnosis. Behavioral therapy and medications are highly effective treatments, but the disorder nonetheless takes a chronic course in a large percentage of patients.

Randomized trial of the effect of zinc supplementation on the mental health of school-age children in Guatemala

Rates of mental illness in children are increasing throughout the world. Observational studies of depression, anxiety, and attention-deficit hyperactivity disorder suggest that zinc is an alternative treatment. We examined the effect of zinc supplementation on the mental health of school-age children in Guatemala. From January to October 2006, we conducted a 6-mo randomized, double-blind, controlled trial comparing zinc supplementation (10 mg ZnO/d for 5 d/wk) with a placebo (10 mg glucose) in 674 Guatemalan children in grades 1-4. Outcome measures included internalizing (ie, depression and anxiety) and externalizing (ie, hyperactivity and conduct disorder) problem behaviors, positive behaviors (ie, socialization and leadership), and serum zinc concentrations. Zinc and placebo groups did not differ significantly in any behavioral measures at baseline or at follow-up. At baseline, 21.4% of children had serum zinc concentrations <65 μg/dL. At follow-up, both groups improved significantly, and zinc concentrations were higher in the zinc group. Increases in serum zinc concentrations were inversely associated with decreases in depressive symptoms (estimate: -0.01 points per μg Zn/dL; P = 0.01), anxiety (estimate: -0.012 points per μg Zn/dL; P = 0.02), internalizing symptoms (estimate: -0.021 points per μg Zn/dL; P = 0.02), and social skills (estimate: -0.019 points per μg Zn/dL; P = 0.01) in adjusted models that were controlled for child age, sex, socioeconomic status, household, and treatment group. Six months of zinc supplementation did not induce differences in mental health outcomes between zinc and placebo groups. However, increases in serum zinc concentrations were associated with decreases in internalizing symptoms (ie, depression and anxiety) in a community-based sample of children at risk of zinc deficiency. This trial was registered at clinicaltrials.gov as NCT00283660.

Room for Improvement: Mixed Portrayal of Young People with Mental Illness on Australian Television News

The aim of the present study was to review television news depiction of mental illness in children and adolescents to test the hypothesis that positive portrayals of adults with mental illness also apply to young people. Content and frame analysis of first-person depictions and overall news angle was carried out to determine whether depictions were positive, neutral or negative. The media portrayal of young people with mental illnesses was mixed. Overall, 10 items (29%) of news angles were positive, 13 items (37%) neutral and nine items (26%) negative. Positive themes were significantly less frequent for young people compared to adults (10 items, 29% compared to 151 items, 66%), and negative themes were more frequent (nine items, 26% vs 21 items, 9%). First-person depictions, however, were similar for young people and adults (24 items, 69% vs 150 items, 66%). An anti-medication sub-theme was notable. Overall the portrayal of young people with mental illnesses on television news is not as positive as that for adults. Similar to adults, however, first-person depictions resulted in a more positive representation of young people. Fewer first-person depictions in combination with an anti-medication theme and historically less access to appropriate services for young people may have contributed to the less positive results for young people with mental illnesses.

Olanzapine approved for the acute treatment of schizophrenia or manic/mixed episodes associated with bipolar I disorder in adolescent patients.

BackgroundSevere and persistent mental illnesses in children and adolescents, such as early- onset schizophrenia spectrum (EOSS) disorders and pediatric bipolar disorder (pedBP), are increasingly recognized. Few treatments have demonstrated efficacy in rigorous clinical trials. Enduring response to current medications appears limited. Recently, olanzapine was approved for the treatment of adolescents with schizophrenia or acute manic/mixed episodes in pedBP.MethodsPubMed searches were conducted for olanzapine combined with pharmacology, schizophrenia, or bipolar disorder. Searches related to schizophrenia and bipolar disorder were limited to children and adolescents. The bibliographies of the retrieved articles were hand-checked for additional relevant studies. The epidemiology, phenomenology, and treatment of EOSS and pedBP, and olanzapine’s pharmacology are reviewed. Studies of olanzapine treatment in youth with EOSS and pedBP are examined.ResultsOlanzapine is efficacious for EOSS and pedBP. However, olanzapine is not more efficacious than risperidone, molindone, or haloperidol in EOSS and is less efficacious than clozapine in treatment-resistant EOSS. No comparative trials have been done in pedBP. Olanzapine is associated with weight gain, dyslipidemia, and transaminase elevations in youth. Extrapyramidal symptoms, neuroleptic malignant syndrome, and blood dyscrasias have also been reported but appear rare.ConclusionsThe authors conclude that olanzapine should be considered a second-line agent in EOSS and pedBP due to its risks for significant weight gain and lipid dysregulation. Awareness of the consistent weight and metabolic changes observed in olanzapine-treated youth focused attention on the potential long-term risks of atypical antipsychotics in youth.

Project Tries to Identify First Signs of Psychosis

Project Tries to Identify First Signs of Psychosis

From the National Institute of Nursing Research — Measuring Mental Illness in Children with Epilepsy

From the National Institute of Nursing Research — Measuring Mental Illness in Children with Epilepsy

Introduction to the Special Section: Transformative Research on Emotion Regulation and Dysregulation

ABSTRACT— Scholars are giving increased attention to the need to incorporate research on more basic developmental processes into new paradigms for understanding and treating mental illness in children and adolescents. The study of emotion regulation, rooted in neurodevelopment, has proven a fruitful model for understanding and characterizing problems of behavior and risk in children and adolescents. This article summarizes NIMH initiatives designed to encourage transformational research on the neurodevelopment origins of mental illness. It highlights the NIMH Strategic Plan and the Report on Transformative Neurodevelopment Research as part of an introduction to a collection of articles that grew out of a previously organized NIMH workshop on developmental and translational models of emotion regulation and dysregulation.

Assessment of need for a school-based mental health programme in Nigeria: Perspectives of school administrators

The majority of children in Nigeria are unable to access mental health services. In this resource-poor setting, a school-based mental health service can be used to reach children who would otherwise not have access. An essential first step in the development of a school-based mental health programme is a needs assessment. Key informants (KIs) from southwest Nigeria were interviewed to identify their perspectives on child mental illness and needs for a school mental health programme. Data were analysed using interpretative phenomenological analysis. Although KIs sometimes used derogatory terms to describe mental illness, they were able to give full descriptions of different kinds of mental illnesses in children and a range of causes based on the bio-psychosocial model of disease. KIs acknowledged deficiencies in their training even though they currently use parent, child and environment-centred interventions to deal with mental health problems in school. KIs reported teachers as comfortable with handling mental health issues in children and suggested interventions that included development of basic and ongoing training. Barriers, such as poverty, ignorance and stigma need to be addressed, while government involvement and enlightenment campaigns are critical components of a successful programme.

Editorial: Answering questions in developmental science: separating the wheat from the chaff

Editorial: Answering questions in developmental science: separating the wheat from the chaff

Enjeux actuels de l’évaluation psychologique dans la clinique de l’enfant et de l’adolescent : vers une approche intégrée de la psychopathologie

This article will discuss different theoretical approaches and methods of data collection in view of the psychological assessment of children and adolescents. There are generally two different approaches; one being the single case study using a subjective method and the second consisting of clinical interviews and psychological tests using the objective method. In our opinion, psychological assessments should rely on two main axes. The first should be based on an updated knowledge of psychopathology, integrating new models and scientific findings with the methodology of Evidence Based Medicine (EBM). The second axis should be concerned with the psychological assessment combining subjective and objective methods. For example, the use of standardized tools such as scales or projective tests is essential to understand the interaction between multiple clinical variables influencing child psychopathology as well as to understand family and social interactions. The diversity of risk factors (e.g. family, personality, social, biological factors, etc.), implicated in mental illness shows the multi-dimensional aspects of psychopathology. Different theoretical approaches have been developed to study psycho-pathological mechanisms (neuro-psychology, psychoanalysis, biological psychiatry approaches, etc.). Therefore an integrative approach of psychopathology using different models and factors is needed to understand psychiatric disorders. A thorough psychological assessment is essential to the comprehension of mental illness in children and adolescents and is the first step to tailor treatments to individual needs. In order to answer these objectives, psychological assessments must be multi-modal, multi-disciplinary and multi-source: - Multi-disciplinary: For a better clinical assessment, psychologists and psychiatrists will need information from other professionals such as speech therapists, psychomotor therapists, neurologists… - Multi-modal: This aspect is crucial in clinical assessment. It characterizes all tools that clinicians will use in their assessment practice: Psychological tests, clinical interviews or clinical scales. - Multi-source: A comprehensive assessment of child and adolescent psychopathology includes assessments of different informants and sources (family, teachers…). These different approaches will be discussed in the perspective of the actual stakes of psychological assessment in children and adolescents. Developing integrative assessment approaches seems to be a promising field for the future in mental health services, allowing the tailoring of specific therapeutics for each child.

A systematic review of reviews of interventions to promote mental health and prevent mental health problems in children and young people

There is a growing policy imperative to promote positive mental health as well as prevent the development of mental health problems in children. This paper summarises the findings of published systematic reviews evaluating such interventions. A search was undertaken of ten electronic databases using a combination of medical subject headings (MeSH) and free text searches. Systematic reviews covering mental health promotion or mental illness prevention interventions aimed at infants, children or young people up to age 19 were included. Reviews of drug and alcohol prevention programmes and programmes to prevent childhood abuse and neglect were excluded because these have been the subject of recent good quality reviews of reviews. A total of 27 systematic reviews were included. These targeted a range of risk and protective factors, and a range of populations (including parents and children). While many lacked methodological rigour, overall the evidence is strongly suggestive of the effectiveness of a range of interventions in promoting positive mental well‐being, and reducing key risk factors for mental illness in children. Based on this evidence, arguments are advanced for the preferential provision of early preventive programmes.

Mental Health Problems in Children and Caregivers in the Emergency Department Setting

Although mental health problems are increasing in the primary care sector, the prevalence of mental health problems in families presenting for nonpsychiatric complaints in the emergency department (ED) setting is generally unknown. As such, we set out to assess the frequency of mental health concerns and associated risk factors in children presenting for care in a pediatric ED. A total of 411 mother-child dyads were randomly selected during a 2-year period from the less acute area of a large pediatric ED. Mothers were interviewed for child mental health concerns using structured diagnostic instruments. Mothers were also interviewed for their own mental health symptoms. Risk factor analysis for the outcome of a pediatric mental health concern was performed using bivariate and multivariate techniques. Of all children, 45% met criteria for a mental health concern, with 23% of all children meeting criteria for two or more mental health concerns; 21% of mothers screened positive for a mental health problem themselves. Once adjusted, children whose mothers' screened positive for a mental illness were more likely to have a mental health concern themselves. There is a large burden of mental health concerns in children and their mothers presenting to the ED for medical care. Efficiently and accurately identifying mental illness in children presenting to a pediatric ED is the first step in the intervention process for a population that might otherwise slip through the system.