Emotional wellbeing and mental health problems affect about one in 10 children and young people. They include depression, anxiety and stress, and are often a direct response to what is happening in their lives.
Here's an A-Z list of some of the emotional/mental health problems that can affect children and young people and some useful online resources for you to learn more about what can help:
ADHD (attention deficit hyperactivity disorder)
ADHD is a pattern of problems which is usually picked up in childhood. Parents and teachers may notice that a child is unusually over-active, gets distracted all the time, cannot stick to doing something for any length of time, is impulsive, and does things on the spur of the moment without thinking and has great difficult in concentrating.
Many of us have at least some of these problems, but do not have the diagnosis. To have the diagnosis of ADHD, these problems must be bad enough to interfere with how you get on with other people or with how you perform at work or school. ADHD is a condition that affects how well someone can sit still, focus, and pay attention. People with ADHD have differences in the parts of their brains that control attention and activity. This means that they may have trouble focusing on certain tasks and subjects, or they may act impulsively, and get into trouble. In Hertfordshire there are ADHD clinics where children are assessed to see if they reach a diagnosis and offered treatment options. For more information on ADHD visit youth info at http://www.rpsych.ac.uk/
Young people can struggle with keeping good eating patterns for many different reasons. As teenagers get more independent from their families they start to make choices about what they want to do and sometimes sticking to good routines can seem low in priority. Anxiety can have a big impact on appetite. Also young people being organised enough to make sure they are able to access food at the right times of day to keep energy levels up is a practical issue that can contribute to low mood. Worries about body image and a wish to control something, be good at something, can lead to problems such as anorexia or bulimia. Eating problems can have a different root cause and it is important to try and work out what it is that is affecting the loss of appetite in your child.
Several features of anorexia (not just your child looking and behaving in an unhealthy way) can really challenge and affect the confidence of parents. Mealtimes can become a battleground, previous tasks that may have been achieved quickly (food purchase, food preparation) or with pleasure can become times of increased anxiety. Anorexia can affect a family’s confidence together, and can be a scary time for all in the family. One of the hardest things may be the child’s unwillingness to accept that they are ill. This can make it hard to all join together and share the task of getting help. Anorexia can affect both family routines and feelings. It is important to recognise how increasingly isolated you could feel and seek support for both yourself and your child.
Family interventions can often be recommended in the treatment of anorexia. This is because research has shown that family environment has a marked impact on outcome of treatment in anorexia, meaning that you can be a valuable part of the solution.
Anorexia depletes energy for all the family, not just the sufferer, so it is really important to try to stay healthy, so that you can in turn help to tackle the problem from a position of strength - so try eating well yourself and trying not to become sleep deprived are important. If you feel you are becoming depressed or anxious, get some support, from a friend relative or professional. http://www.b-eat.co.uk/ is a useful website for young people and http://www.youngminds.org/ has a good parents section, and parent’s helpline.
Anxious children are on the lookout for threat. They have a tendency to see danger everywhere and they think that they will not be able to cope. They can get caught up in negative thinking, over-exaggerating the threat, and can avoid things as a coping strategy for dealing with the threat. It can be hard to know what anxious children are thinking sometimes. They can feel anxious about sharing their thoughts, for fear of ridicule for example, or because they get caught up in vicious cycle of negative thoughts, which go round and round, and are difficult to untangle.
There are a number of things that as a parent you can do to help a child experiencing anxiety. Help to work out the story behind it. Helping your child understand how their anxiety impacts upon them is vital. So what’s the story? Does it make sense? (e.g. with a school move or friendship difficulty) or is it out of context (e.g. high anxiety with no obvious trigger which goes round and round). Are other family members prone to anxiety and excessive worry? What ways have they found helpful in bringing anxiety levels down?
Talking about anxiety can help some children, or it can increase anxious thoughts further, so think about your child’s temperament in relation to the anxiety that they are experiencing, when you are trying to work out some strategies to help them.
There are many good self-help guides on helping your child manage worries available from book shops and online. Some of these have lots of ideas for you to try out about how to help your child develop skills in managing anxiety.
Sometimes high anxiety levels can be a sign of something else. For instance, children on the autistic spectrum experience high levels of anxiety as their understanding of the world, communication and social interactions around them can seem daunting. Similarly, high anxiety is a core symptom of OCD (obsessive compulsive disorder). Getting help to work out what is driving your child’s anxiety is also an option. Services in CAMHS can help with this, and if needed can provide interventions to help bring down anxiety levels by supporting the development of skills to manage anxiety.
Asperger’s Syndrome and Autism
Asperger’s syndrome is a form of autism, which affects how a person makes sense of the world, processes information and relates to other people. Impairments in social behaviours, understanding of language, and imagination are all features of Asperger’s and autism. It is often described as a 'spectrum disorder' because the condition affects people in many different ways and to varying degrees.
People with autism have said that the world, to them, is a mass of people, places and events which they struggle to make sense of, and which can cause them considerable anxiety. In particular, understanding and relating to other people, and taking part in everyday family and social life may be harder for them. Other people appear to know, intuitively, how to communicate and interact with each other, and some people with autism may wonder why they are 'different'.
The National Autistic Society website has lots of useful information on Asperger’s Syndrome and what it’s like to have it. HARC http://harc-online.org.uk/ is the local branch in Hertfordshire.
Many young people have experienced the death of someone close to them. Bereavement is a general – if difficult – part of growing up. One study has found that as many as 92 per cent of young people in the UK will experience what they see as a 'significant' bereavement before the age of 16. For some young people a major loss may be a huge disruption to their lives, and they may need additional support at this time. There are different phases to grief – shock, deep sadness, anger and avoidance (or denial). These phases are all an important part of working through the experience of loss. They can come and go in a different order - there is no “right” way to grieve – everyone is different and it lasts for different time scales for different people. Whilst many young people find bereavement deeply upsetting, much depends on the context and nature of the bereavement and the meaning it holds for that person. Peer deaths (someone a similar age to you) and suicides can be particularly painful, difficult to understand and scary. There are useful websites for support on coping with bereavement –http://www.winstonswish.org.uk/ http://www.youngminds.org.uk/, and http://www.chums.uk.com/ all have useful information for parents who may be worried about the impact of a bereavement on their child’s wellbeing.
If you or other family members are suffering from grief and from the impact of a bereavement it can be really challenging to keep going with normal family routines. Grieving is like suffering a depression and it impacts on energy levels, attention span and confidence (all needed in abundance in parenting!) Getting help for yourself if you are feeling overwhelmed by a bereavement is really important too. Your GP should have more advice on bereavement counselling options available and Cruse http://www.cruse.org.uk/ is a national charity offering support with bereavement issues.
Bipolar disorder can also be known as manic depression. People with the disorder can swing between feeling very depressed, to being very happy and excited, which is also known as “mania”. In between this they can seem relatively calm. A prolonged period of staying awake (not sleeping at all for a few days) is a key feature of bi-polar disorder. http://www.mind.org/ has an entire section of its website dedicated to Bipolar disorder, and http://www.moodscope.com/ has a useful tool for tracking mood daily, helping to build up a picture as to what might be influencing it, which can be useful for general depression or bi-polar type symptoms.
Body Dysmorphic disorder (BDD)
Body dysmorphic disorder affects people and the way they view themselves. It can lead people to become obsessed and preoccupied with their appearance, focusing on minor imperfections they may feel they have. They have a distorted view of how they appear. Exaggerating some features in an over-critical and unrealistic way is a key feature of this disorder, as is excessive appearance checking. The psychological explanation relates BDD to low self-esteem and the way a person judges themselves almost exclusively by their appearance. They may fear being alone and isolated all their life, or believe that they are worthless if they cannot correct the aspect of their appearance that causes distress (the perceived defect). They demand perfection, or an impossible ideal, in their appearance. Once the disorder has developed, it is then maintained by excessive self-focused attention and behaviour, such as checking the perceived defect, making comparisons with other people, avoiding social situations and seeking reassurance. Whilst many aspects of BDD can be experienced by all young people, for example a preoccupation with appearance and close scrutiny of the self, it is only judged to be a disorder if symptoms are distressing and significantly getting in the way of daily living for the young person.
Bulimia Nervosa is a type of eating disorder. People with Bulimia Nervosa find it really hard to stick to a healthy, balanced eating pattern. They may constantly think of calories, dieting and ways of getting rid of excess food. Many people will binge (over eat) and then feel guilty so will make themselves sick, starve themselves, take laxatives or over-exercise. http://www.b-eat.co.uk/ is a good website for getting advice and support.
Conduct disorder is a behavioural and emotional disorder that can occur in children and teens. A child with this disorder may display a pattern of disruptive and violent behaviour and have problems following rules. It is not uncommon for children and teens to have behaviour-related problems at some time during their development. However, the behaviour is considered to be a conduct disorder when it is long-lasting and when it violates the rights of others, goes against accepted norms of behaviour and disrupts the child's or family's everyday life.
Symptoms of conduct disorder vary depending on the age of the child. In general, symptoms of conduct disorder fall into four general categories: Aggressive behaviour that threatens or causes physical harm, destructive behaviour, deceitful behaviour and violation of rules (going against accepted rules of society or engaging in behaviour that is not appropriate for the person's age).
Many children with conduct disorder are irritable, have low self-esteem, and tend to throw frequent temper tantrums. Children with conduct disorder are often unable to appreciate how their behaviour can hurt others and generally have little awareness, guilt or remorse about hurting others. See http://www.choosing.org/ for what can help in treating conduct disorder.
It is sometimes hard to know what the usual ups and downs of teenage adjustment are (as there are many stressful periods in adolescence) and what might be signs of something more serious, such as depression, which is an illness. Sometimes when people feel stressed they may start to think that they are useless and no good, which can then cause their mood to spiral down and get stuck. Things that they may once have found fun, no longer make them happy and they can’t seem to laugh anymore. There are things that you can do to help prevent this downward spiral (see our top tips section) by keeping balance in your life. It is also really important to get help recognising if you are depressed and then get some treatment for it (see our section on depression in the A-Z of mental health problems). http://www.moodscope.co.uk/ is a good website with a useful tool for tracking your mood and http://www.youngminds.org.uk/ has lots of useful information too.
Most people feel sad or unhappy from time to time, however people suffering from depression feel very down for prolonged periods, or episodes. Sometimes there is clear link to an event in their lives that has made them feel down – we call this a reactive depression. Sometimes there does not appear to be a link, which can leave someone feeling scared and bewildered about why they are feeing low. In teenage years young people can describe intense emotions and reactions to things around them, which may be linked to the demands placed on young people at school (where there is lots of pressure to do well), at home (as they seek more independence from parents) and with peers (as friendships can be intense or awkward). Everything can feel like too much effort and there can be a feeling that they cannot shake off the constant feeling of unhappiness. Irritability, insomnia, tearfulness, loss of energy, and a feeling that life is not worth living anymore are all symptoms of depression.
It is important to work out what is usual teenage adjustment and what might be depression, which is an illness. Sometimes when people feel stressed they may start to think that they are useless and no good, which can then cause their mood to spiral down and get stuck. Things that they may once have found fun, no longer make them happy and they can’t seem to laugh anymore.
There are lots of ways to help people with depression. See our “top tips” section for some advice on how you can help yourself. Prescribed medication such as anti-depressants can help some people, as well as talking therapy to help people develop better links between their thoughts, feelings and behaviours, http://www.youngminds.org.uk/ has lots of good information about depression on its website, also the youth info section at http://www.rpsych.ac.uk/ . Also visit http://www.moodscope.co.uk/ for a useful tool for tracking your moods and helping you to make links about what may be affecting your mood.
Divorce and separation
When divorce and separation is a prevalent family theme children can become really stressed. If one of their parents is being criticised it makes them feel guilty and divides their loyalty which causes them pain. They may feel that they have to show more love to one parent than another, which may not be what they want, out of loyalty and worry. If you act jealous or upset, children can feel like they need to take sides and love one parent more than the other. This also causes them stress.
There are certain things that parents can do to help them continue to be good parents together even if they are not going to be partners together in other areas of their life. There may be many challenges at this transition point for both you and your child – for example what your children want and need may be different to what you want and need or what you feel you can provide. Just recognising these points of difference can help a family to navigate this upsetting and unsettling transition. Adjustment to new circumstances takes time and raises different challenges for every individual.
Generally what children need at this time of transition is
- Patience, reassurance, and a listening ear to their fears, as children learn to cope with new circumstances.
- Routines to rely on – this reminds them they can count on you for stability, structure, and care.
- Where possible maintaining a working relationship with your co-parent, to protect children from the stress that comes with watching parents in conflict. As with most things you can control and alter your own behaviour but not so easily that of another, so concentrate on this and avoid excessive blame.
- Notice if your child is expressing stress and / or anxiety with split loyalties. Children benefit from both parents staying involved in their life.
For more advice on helping children come to terms with divorce or separation visit http://www.oneplusone.org.uk/ and http://www.rpsych.ac.uk/ young people and http://www.youngminds.org/ parent advice.
OCD (obsessive compulsive disorder)
Obsessive-Compulsive Disorder (OCD) can be a serious anxiety-related condition. OCD can take many forms, but, in general, sufferers experience repetitive, intrusive and unwelcome thoughts, images, impulses and doubts which they find hard to ignore. These thoughts form the obsessional part of ‘Obsessive-Compulsive’ and they usually (but not always) cause the person to perform repetitive compulsions to try to relieve themselves of the obsessions and neutralise anxiety feelings. http://www.ocdyouthinfo/ and http://www.ocdaction.org/ are both useful websites. There are some useful talking therapies for OCD (see http://www.choosing.org.uk/) and sometimes older children can find medication is helpful as part of a combined approach, if the OCD is very intrusive. See one of our CAMHS audio books for younger children, which describes aspects of OCD and its link with anxiety.
Phobias are fears of a situation or thing that isn’t dangerous and which most people don’t find troublesome. A phobia is described as an irrational or excessive fear of an object or a situation. So whilst we may all be scared of some things, which maybe seem irrational, it would not be judged to be a phobia unless it is significantly interfering with our daily life ( e.g. getting in the way of going to school, or being content in everyday situations). There's a CAMHS audio book for younger children, that describes aspects of fears and phobia, here.
PTSD (post-traumatic stress disorder)
In children – especially those who are very young – the symptoms of PTSD can be different than the symptoms in adults. Symptoms in children include:
- Fear of being separated from parent
- Losing previously-acquired skills (such as toilet training)
- Sleep problems and nightmares without recognisable content
- Sombre, compulsive play in which themes or aspects of the trauma are repeated
- New phobias and anxieties that seem unrelated to the trauma (such as a fear of monsters)
- Acting out the trauma through play, stories, or drawings
- Aches and pains with no apparent cause
- Irritability and aggression
It is important to work out the difference between response to a trauma that is “natural” and PTSD. Generally we would expect to see symptoms fading with the passage of time in a natural response to trauma, and symptoms either staying stuck or increasing over time (rather than decreasing) may be an indication of PTSD. It is important to get help for your child if you think that they may be showing signs of PTSD. http://www.chums.org/ is a good website giving parents information on trauma and how to support their child.
Self-injury/ Self-harm (cutting)
People have many different coping strategies to deal with the stress that they experience. Some of these are positive (e.g. hobbies, relaxation, socialising). Some are negative and are known as self-harm. Self-injury is a negative form of self-harm, which involves cutting or scratching. It can be described as an “inner scream” – a way of expressing painful feelings that are hard to communicate. Some young people engage in cutting or scratching briefly, before finding other ways of dealing with emotions. For others it can develop into a longer term coping strategy. The important things to think about are
- How often does it happen?
- How severe is the cutting?
- How safe is the young person when they do self-injure (e.g. do they cut or scratch superficially, clean the area afterwards etc)
It can be deeply upsetting for a parent to discover that their child is engaging in self-injury. It can affect parental confidence and increase stress in the whole family unit as a result.
Young people can get support with helping to reduce or stop cutting. It is best to do this gradually, to gain confidence in managing feelings in other ways. So whilst the parent in you might want this upsetting behaviour to stop immediately, it is generally best to not encourage your child to do this without thinking through these questions
Do they want to stop?
If not then feeling pressurised to stop immediately might take away a coping strategy that is in some way (though not ideally) working for your child in the short term, so getting advice is useful before trying to impose this strategy.
If they do want to stop or reduce their self-injury, then therapy can be a good place to support a young person in this goal. If they do not wish to stop or reduce the self-injury, then the issue of engaging in the behaviour as safely as possible is really important. Young people can get advice from websites such as http://www.youngminds.org.uk/, which can help them to reach a better understanding of the possible reasons behind the self- injury from listening to other young people’s accounts.
If your child does not want to stop self -injury as a coping strategy, it is important to give them the access to good psycho-educational information (such as YoungMinds) and remember that sometimes people are pre-motivational – they will listen and store the information for when they feel that the time is right and then they are motivated to act.
If your child is engaging in self-injury and you think that this is risky and they are putting themselves in medical danger by not keeping safe then it is important to get help with this, either by attending A&E to deal with the medical emergency and risk, or to your GP for an assessment of risk.
Drug addiction can relate to the excessive use of illegal drugs such as cannabis, cocaine and heroin, or legal drugs that you would find on prescription. http://www.talktofrank.com/ is a national service for young people who are worried about drug addiction. In Hertfordshire, there is a team dedicated to helping support young people with problems with alcohol or drug use called A-DASH.
Voice hearing and psychosis
There can be different reasons that people may hear voices. We all tend to have a “critical voice” in our head that checks our behaviour, and sometimes at times of stress this can really interfere with our sense of wellbeing. So hearing a voice can be a feature of anxiety. It can also be a sign of depression when some people can experience a psychotic episode. Schizophrenia is an illness that also has voice hearing as a symptom. There are other symptoms that go alongside psychosis or schizophrenia, not just voice hearing. If you (or others in your family or at school) are worried about these then it is important to get advice, to work out what is going on for your child.
Psychosis symptoms can vary greatly from person to person and a number of symptoms can be experienced, such as hallucinations, confused thoughts and trouble knowing what is real and what is not. It can be quite scary to witness someone having a psychotic episode as they really do not seem themselves at all and can be exhibiting mistrust, fear, and high anxiety levels. A psychotic episode does not mean that a person has schizophrenia. In Hertfordshire, there is a specific team who can help young people suffering from an episode of psychosis, called Early Intervention in Psychosis (EIP).
*Content provided by Hertfordshire’s NHS mental health services provider, Hertfordshire Partnership NHS University Foundation Trust (HPFT) - see original here.