Kid’s Mental Health Problems

Kid’s Mental Health Problems

Attention Deficit Hyperactivity Disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders affecting children. Symptoms of ADHD include inattention (not being able to keep focus), hyperactivity (excess movement that is not fitting to the setting) and impulsivity (hasty acts that occur in the moment without thought). ADHD is considered a chronic and debilitating disorder and is known to impact the individual in many aspects of their life including academic and professional achievements, interpersonal relationships, and daily functioning (Harpin, 2005). ADHD can lead to poor self-esteem and social function in children when not appropriately treated (Harpin et al., 2016). Adults with ADHD may experience poor self-worth, sensitivity towards criticism, and increased self-criticism possibly stemming from higher levels of criticism throughout life (Beaton, et al., 2022). Of note, ADHD presentation and assessment in adults differs; this page focuses on children.

An estimated 8.4% of children and 2.5% of adults have ADHD (Danielson, 2018; Simon, et al., 2009). ADHD is often first identified in school-aged children when it leads to disruption in the classroom or problems with schoolwork. It is more commonly diagnosed among boys than girls given differences in how the symptoms present. However, this does not mean that boys are more likely to have ADHD. Boys tend to present with hyperactivity and other externalizing symptoms whereas girls tend to have inactivity.

Symptoms and Diagnosis

Many children may have difficulties sitting still, waiting their turn, paying attention, being fidgety, and acting impulsively. However, children who meet diagnostic criteria for ADHD, differ in that their symptoms of hyperactivity, impulsivity, organization, and/or inattention are noticeably greater than expected for their age or developmental level. These symptoms lead to significant suffering and cause problems at home, at school or work, and in relationships. The observed symptoms are not the result of an individual being defiant or not being able to understand tasks or instructions.

There are three main types of ADHD:

• Predominantly inattentive presentation.
• Predominantly hyperactive/impulsive presentation.
• Combined presentation.

A diagnosis is based on the presence of persistent symptoms that have occurred over a period of time and are noticeable over the past six months. While ADHD can be diagnosed at any age, this disorder begins in childhood. When considering the diagnosis, the symptoms must be present before the individual is 12 years old and must have caused difficulties in more than one setting. For instance, the symptoms can not only occur at home.

Inattentive Type

Inattentive refers to challenges with staying on task, focusing, and organization. For a diagnosis of this type of ADHD, six (or five for individuals who are 17 years old or older) of the following symptoms occur frequently:

• Doesn’t pay close attention to details or makes careless mistakes in school or job tasks.
• Has problems staying focused on tasks or activities, such as during lectures, conversations or long reading.
• Does not seem to listen when spoken to (i.e., seems to be elsewhere).
• Does not follow through on instructions and doesn’t complete schoolwork, chores or job duties (may start tasks but quickly loses focus).
• Has problems organizing tasks and work (for instance, does not manage time well; has messy, disorganized work; misses deadlines).
• Avoids or dislikes tasks that require sustained mental effort, such as preparing reports and completing forms.
• Often loses things needed for tasks or daily life, such as school papers, books, keys, wallet, cell phone and eyeglasses.
• Is easily distracted.
• Forgets daily tasks, such as doing chores and running errands. Older teens and adults may forget to return phone calls, pay bills and keep appointments.

Hyperactive/Impulsive Type

Hyperactivity refers to excessive movement such as fidgeting, excessive energy, not sitting still, and being talkative. Impulsivity refers to decisions or actions taken without thinking through the consequences. For a diagnosis of this type of ADHD, six (or five for individuals who are 17 years old or older) of the following symptoms occur frequently:

• Fidgets with or taps hands or feet, or squirms in seat.
• Not able to stay seated (in classroom, workplace).
• Runs about or climbs where it is inappropriate.
• Unable to play or do leisure activities quietly.
• Always “on the go,” as if driven by a motor.
• Talks too much.
• Blurts out an answer before a question has been finished (for instance may finish people’s sentences, can’t wait to speak in conversations).
• Has difficulty waiting for his or her turn, such as while waiting in line.
• Interrupts or intrudes on others (for instance, cuts into conversations, games or activities, or starts using other people’s things without permission). Older teens and adults may take over what others are doing.

Combined Type

This type of ADHD is diagnosed when both criteria for both inattentive and hyperactive/impulse types are met.

ADHD is typically diagnosed by mental health providers or primary care providers. A psychiatric evaluation will include a description of symptoms from the patient and caregivers, completion of scales and questionnaires by patient, caregivers and teachers, complete psychiatric and medical history, family history, and information regarding education, environment, and upbringing. It may also include a referral for medical evaluation to rule out other medical conditions.

It is important to note that several conditions can mimic ADHD such as learning disorders, mood disorders, anxiety, substance use, head injuries, thyroid conditions, and use of some medications such as steroids (Austerman, 2015). ADHD may also co-exist with other mental health conditions, such as oppositional defiant disorder or conduct disorder, anxiety disorders, and learning disorders (Austerman, 2015). Thus, a full psychiatric evaluation is very important. There are no specific blood tests or routine imaging for ADHD diagnosis. Sometimes, patients may be referred for additional psychological testing (such as neuropsychological or psychoeducational testing) or may undergo computer-based tests to assess the severity of symptoms.

The Causes of ADHD

Scientists have not yet identified the specific causes of ADHD. While there is growing evidence that genetics contribute to ADHD and several genes have been linked to the disorder, no specific gene or gene combination has been identified as the cause of the disorder. However, it is important to note that relatives of individuals with ADHD are often also affected. There is evidence of anatomical differences in the brains of children with ADHD in comparison to other children without the condition. For instance, children with ADHD have reduced grey and white brain matter volume and demonstrate different brain region activation during certain tasks (Pliszka, 2007). Further studies have indicated that the frontal lobes, caudate nucleus, and cerebellar vermis of the brain are affected in ADHD (Tripp & Wickens, 2009). Several non-genetic factors have also been linked to the disorder such as low birth weight, premature birth, exposure to toxins (alcohol, smoking, lead, etc.) during pregnancy, and extreme stress during pregnancy.

Treatment

ADHD treatment usually encompasses a combination of therapy and medication intervention. In preschool-age and younger children, the recommended first-line approach includes behavioral strategies in the form of parent management training and school intervention. Parent-Child Interaction Therapy (PCIT) is an evidence-based therapy modality to help young children with ADHD and oppositional defiant disorder.

According to current guidelines, psychostimulants (amphetamines and methylphenidate) are first-line pharmacological treatments for the management of ADHD (Pliszka, 2007). In preschool-aged patients with ADHD, amphetamines are the only FDA-approved medication, although guidelines suggest that methylphenidate rather than amphetamines may be helpful if behavioral interventions prove insufficient. Alpha agonists (clonidine and guanfacine) and the selective norepinephrine reuptake inhibitor, atomoxetine, are the other FDA-approved options for treating ADHD. There are newer FDA-approved medications for ADHD treatment, including Jornay (methylphenidate extended-release) which is taken at night and starts the medication effect the next morning, Xelstrym (dextroamphetamine) which is an amphetamine patch, Qelbree (viloxazine) which is a non-stimulant, Adhansia (methylphenidate hydrochloride), Dyanavel (amphetamine extended-release oral suspension), Mydayis (mixed salts amphetamine product), and Cotempla (methylphenidate extended-release orally disintegrating tablets).

Many children and families can alternate between various medication options depending on the efficacy of treatment and tolerability of the medication. The goal of treatment is to improve symptoms to restore functioning at home and at school.

ADHD and School-Aged Children

Teachers and school staff can provide parents and doctors with information to help evaluate behavior and learning problems and can assist with behavioral training. However, school staff cannot diagnose ADHD, make decisions about treatment or require that a student take medication to attend school. Only parents and guardians can make those decisions with the child’s health care clinician.

Students whose ADHD impairs their learning may qualify for special education under the Individuals with Disabilities Education Act or for a Section 504 plan (for children who do not require special education) under the Rehabilitation Act of 1973. Children with ADHD can benefit from study skills instruction, changes to the classroom setup, alternative teaching techniques and a modified curriculum.

Related Conditions

- Autism spectrum disorder

- Disruptive, impulse control and conduct disorders

- Social communication disorder

- Specific learning disorder

Autism spectrum disorder (ASD)

Autism spectrum disorder (ASD) is a complex developmental condition involving persistent challenges with social communication, restricted interests and repetitive behavior. While autism is considered a lifelong condition, the need for services and supports because of these challenges varies among individuals with autism.

According to the Centers for Disease Control and Prevention, an estimated one in 36 children has been identified with autism spectrum disorder.

Diagnosis of Autism Spectrum Disorder

Early signs of this condition can be noticed by parents/caregivers or pediatricians before a child reaches one year of age. However, the need for services and supports typically become more consistently visible by the time a child is 2 or 3 years old. In some cases, the problems related to autism may be mild and not apparent until the child starts school, after which their deficits may be pronounced when amongst their peers.

Social communication deficits may include:

• Decreased sharing of interests with others.
• Difficulty appreciating their own & others' emotions.
• Aversion to maintaining eye contact.
• Lack of proficiency with use of non-verbal gestures.
• Stilted or scripted speech.
• Interpreting abstract ideas literally.
• Difficulty making friends or keeping them.

Restricted interests and repetitive behaviors may include:

• Inflexibility of behavior, extreme difficulty coping with change.
• Being overly focused on niche subjects to the exclusion of others.
• Expecting others to be equally interested in those subjects.
• Difficulty tolerating changes in routine and new experiences.
• Sensory hypersensitivity, e.g., aversion to loud noises.
• Stereotypical movements such as hand flapping, rocking, spinning.
• Arranging things, often toys, in a very particular manner.

Parent/caregiver/teacher concerns about the child's behavior should lead to a specialized evaluation by a developmental pediatrician, pediatric psychologist, child neurologist and/or a child and adolescent psychiatrist. This evaluation involves interviewing the parent/caregiver, observing, and interacting with the child in a structured manner, and sometimes conducting additional tests to rule out other conditions. In some ambiguous cases the diagnosis of autism may be deferred, but an early diagnosis can greatly improve a child's functioning by providing the family early access to supportive resources in the community.

The first step is seeking an evaluation. Most parents start with their pediatrician who is checking on developmental milestones.

• If your child is under the age of 3 years, you can obtain an evaluation through your local early intervention system.
• If your child is over the age of 3, you can get an evaluation through your local school (even if your child does not go there). Contact your local school's preschool special education team to request an evaluation.

Example: Tomás is a 6-year-old boy whose family is troubled by Tomás' intense love of trains. His interest in trains, in addition to giving him great pleasure and serving to communicate his preferences, can sometimes lead to unintended consequences. For example, he gets angry and upset if his old trains are thrown away, or if his parents can't hold his train while he eats breakfast and gets ready for school in the morning. Teachers report that at school he tends to be very quiet and only listens when the topic of trains is brought up.

Risk Factors

The current science suggests that several genetic factors may increase the risk of autism in a complex manner. People with certain specific genetic conditions such as Fragile X Syndrome and Tuberous Sclerosis are at increased risk for being diagnosed with autism.These two conditions together with hundreds of individually rare genetic causes for autism explain over 30% of cases. Because of this, multiple professional medical societies recommend genetic testing as the standard of care after a diagnosis of autism is made.

Certain medications, such as valproic acid and thalidomide, when taken during pregnancy, have been linked with a higher risk of autism as well.2 Having a sibling with autism also increases the likelihood of a child being diagnosed with autism. Parents being older at the time of pregnancy is additionally linked with greater risk of autism. Vaccines on the other hand have not been shown to increase the likelihood of an autism diagnosis, and race, ethnicity or socioeconomic status does not seem to have a link either. Male children tend to be diagnosed with autism more often than those assigned female sex at birth.

Treatment

There are several effective interventions that can help a child reach their full potential.:

• Applied behavioral analysis: Involves systematic study of the child's functional challenges, which is used to create a structured behavioral plan for improving their adaptive skills and decreasing inappropriate behavior
• Social skills training: Done in group or individual settings, this intervention helps children with autism improve their ability to navigate social situations
• Speech & language therapy: Can improve the child's speech patterns and understanding of language
• Occupational therapy: Can address adaptive skills deficits with activities of daily living, as well as problems with handwriting
• Parent management training: Parents learn effective ways of responding to problematic behavior and encouraging appropriate behavior in their child. Parent support groups help parents cope with the stressors of raising a child with autism
• Special education services: Are provided by schools under an Individual Education Plan and can include a range of services and accommodations for social communication deficits, restricted interests and repetitive behaviors. This can include special classes for very young children to address language, social skills and other needs.
• Treating co-occurring conditions: Children with autism are more likely to experience insomnia, attention-deficit/hyperactivity disorder (ADHD), intellectual disability, anxiety, and depression than peers without autism. These conditional also need to be addressed. The impact of these conditions can be reduced with the proper services, which can include any of the above, as well as psychotherapy and/or medication. Treating these conditions typically involves coordination with a pediatrician or primary care clinician.
• Medication: A child psychiatrist can evaluate for other mental health conditions and prescribe medication if appropriate. For example, autism-related irritability that does not respond to behavioral interventions can be reduced by medications such as aripiprazole and risperidone (the two medications approved by the Food and Drug Administration for irritability associated with autism), prescribed judiciously by a knowledgeable clinician in collaboration with the child's parents.

Several complementary and alternative interventions involving special diets and supplements have been tried over the years. Most of these interventions, including therapies, diets, and "natural treatment," do not have scientific evidence supporting them and can lead to false expectations. Parents should be very cautious about treatments that are advertised as being able to "cure" autism. Research into these types of interventions continues, and parents/caregivers interested in them should discuss them with their child's treating clinician.

Tips for Parents

• Learn as much as possible about autism spectrum disorder.
• Provide consistent structure and routine.
• Connect with other parents of children with autism and resources in your community.
• Seek professional help for specific concerns.
• Take time for yourself and other family members.
• Understand your rights relating to your child's education, evaluation, and treatment.
• Having a child with autism affects the whole family. In addition to the unique contributions and characteristics of each person on the autism spectrum, navigating this process as a family can be stressful and lead to challenges. Paying attention to the physical and emotional health of the whole family is important.

Many national and local advocacy organizations provide information, resources and support to individuals with autism spectrum disorder and their families.

Related Conditions

- Attention-deficit/hyperactivity disorder

- Social communication disorder

- Specific learning disorder

- Intellectual disability

Source :- https://www.psychiatry.org/patients-families/adhd/what-is-adhd

Source :- https://www.psychiatry.org/patients-families/autism/what-is-autism-spectrum-disorder