Mental Health Disorders in Children: Information & Specialists

Whether symptoms are classified as a “disorder” also depends on the child’s stage of development. For example, occasional nightmares are completely normal in preschool-aged children. Anxiety and insecurity during early puberty are also not disorders and usually resolve on their own.

A mental disorder is present when the problem goes significantly beyond what is considered normal for the child’s developmental stage and causes distress.

In child and adolescent psychiatry (CAP), parents, family members, and other significant caregivers (including teachers) play a crucial role. They must be taken into account both in the assessment and in the treatment of these disorders.

Various mental disorders can be identified in children and adolescents. Among the most common are the following behavioral and emotional disorders in childhood and adolescence:

• ADHD (Attention-Deficit/Hyperactivity Disorder)
• Social behavior disorders
• Anxiety disorders
• Psychoses
• Tic disorder
• Eating disorders
• Enuresis
• Encopresis
• Sleep disorders

ADHD is characterized by extreme motor (movement-related) restlessness and agitation. Affected children feel the need to

• run around,
• talk,
• make noise, and
• fidget.

In addition, those affected exhibit impaired attention in the form of

• being extremely easily distracted,
• poor ability to concentrate, and
• frequent shifts in activity.

Added to this is impaired impulse control: The children have difficulty “pulling themselves together” in every respect and have a low tolerance for frustration.

The symptoms begin within the first five years of life and persist over time. In about one-third of cases, the disorder continues into adulthood. Approximately 3 to 5 percent of all children are affected, with boys being about 3 to 8 times more likely to be affected than girls.

Inattention often leads to dangerous situations and accidents. In addition, affected children frequently experience social problems because they get into conflicts with classmates, teachers, and others.

In adolescence, motor restlessness usually decreases. However, increased impulsivity and reduced attention persist. As a result, those affected have an increased risk of substance abuse, traffic accidents, and delinquency (committing crimes).

The cause of the disorder is not entirely clear. In addition to genetic factors, birth complications and changes in brain metabolism may play a role.

ADHD is a common mental disorder in children © Photographee.eu | AdobeStock

ADHD is treated, on the one hand, through a consistent parenting style and appropriate educational measures. In addition, the medication methylphenidate (Ritalin®) is frequently used.

Case Study on ADHD

Nine-year-old Andreas was referred to the pediatric outpatient clinic due to constant disciplinary problems at school. He is in third grade, cannot sit still, and therefore constantly runs around the classroom. He almost never raises his hand to answer questions, frequently interrupts the teacher, and has to be constantly reminded to stop talking. During recess, he repeatedly gets into fights. At home, Andreas is also extremely difficult to handle; his homework usually drags on throughout the entire afternoon amid major arguments. He also has many conflicts with his siblings because he gets on their nerves. In addition, he repeatedly destroys his siblings’ belongings—sometimes accidentally, sometimes on impulse and intentionally.

This disorder is a persistent pattern of antisocial, aggressive, or defiant behavior. Affected children

• frequently get into arguments, sometimes involving severe outbursts of anger,
• behave aggressively toward their caregivers,
• lie and fail to keep their promises, or
• be cruel to other children or animals.

This can lead to

• deliberate destruction of other people’s property,
• intentional arson,
• theft, and
• disciplinary problems at school, including truancy

.

Conduct disorder often occurs alongside other mental disorders in children and adolescents, such as

• ADHD,
• developmental disorders, or
• substance abuse,

Between 2 and 10 percent of all children are affected, predominantly boys. The disorder often remains very stable over many years.

Those affected are more likely to commit criminal acts (delinquency). An important goal of therapy is to prevent this and the prison sentence that often follows.

Therapeutic interventions may include individual therapy for the children or family therapy. In addition, community-based measures (e.g., youth outreach in “high-risk neighborhoods”) play a role.

The stability of the social behavior disorder is very high. This means that the disorder often persists beyond adolescence. If children exhibit aggressive behavior at a young age, it can be assumed that 40 percent of these elementary school students will still exhibit social behavior disorders in adulthood.

In some cases, medications such as lithium or carbamazepine can be used successfully. They are prescribed, for example, in cases of severe impulsive aggressive behavior.

Psychosocial preventive measures are undoubtedly the key to improving these children’s outcomes.

Anxiety is a relatively common phenomenon, especially in childhood. Many children exhibit fear of specific situations or objects (so-called “phobic fears”), e.g.,

• thunderstorms,
• of dogs, or
• the dark.

In 2 to 9 percent of all children, phobic fears are so severe that a mental disorder can be diagnosed.

In addition to phobic fears, separation anxiety is the most common anxiety disorder in childhood and adolescence. Three to five percent of all children suffer from it.

Affected children refuse to leave their caregivers. They experience intense anxiety when they do so. This usually leads to refusal to attend school. Children with separation anxiety are often very clingy even in early childhood. For example, they do not like going to preschool.

Severe separation anxiety is often triggered by

• the experience of being abandoned (e.g., getting lost in a department store) or
• difficult family situations (e.g., the threat of parental separation).

Children with school anxiety do say goodbye to their parents in the morning, but then tend not to go to school. These two anxiety disorders can easily be confused, as in both cases, refusal to attend school may initially be the most noticeable symptom.

Schizophrenia and other psychoses relatively rarely (in about 4 percent of all cases) begin before the age of 15. Only about 1 percent begin before the age of 10. The younger the age of onset, the more difficult it is to recognize psychoses, as their clinical presentation differs significantly from that of psychoses in adult patients.

At a younger age, “hebephrenic” course patterns and prodromal symptoms frequently occur. Prodromal symptoms refer to a set of symptoms that precedes many acute psychotic episodes—sometimes for years—and is characterized by problems such as

• difficulty concentrating,
• suspicion,
• a decline in academic performance,
• anxiety, and
• social withdrawal

. “Hebephrenia” refers to a psychosis in which the affected person shows increasingly less emotional involvement and little drive. Their mood becomes increasingly flat and “trivial.”

Tics are sudden, brief, repetitive, involuntary movements or vocalizations. They have no specific purpose or meaning. Those affected can often suppress tics voluntarily for short periods of time.

There are simple tics such as

• shrugging,
• blinking,
• whistling, or
• sniffing.

There are also complex tics such as

• jumping,
• reaching out,
• stomping, and
• saying entire words or sentences.

In cases of transient tic disorder, only simple tics usually occur, and they do not last longer than one year. In cases of chronic tic disorders, multiple and more complex tics may occur over a longer period of time.

A severe combination of vocal and motor tics over a long period of time is referred to as Tourette syndrome.

Between 4 and 12 percent of elementary school-aged children suffer from a tic disorder. That is approximately 10 times as many affected individuals as in adulthood. Boys are affected much more frequently.

Many tic disorders resolve on their own over time. Chronic and complex tic disorders have a relatively poor prognosis even with behavioral therapy and medication.

In childhood and adolescence, there are some distinctive features regarding the symptoms of various eating disorders.

Obesity in childhood and adolescence is a growing problem in our society. Children from lower socioeconomic backgrounds are more severely affected. Obese children usually remain overweight as adults. The consequences of obesity often include

• heart disease,
• orthopedic problems,
• diabetes, etc.

Anorexia nervosa (anorexia) very often begins during adolescence. Many child and adolescent psychiatric facilities specialize in treating this disorder.

Bulimia, on the other hand, often occurs only as a consequence of anorexia. It is therefore primarily treated in adult psychiatry.

Enuresis refers to children over the age of 5 who still wet themselves regularly without any organic causes. A distinction is made between nocturnal enuresis and daytime enuresis. Approximately 11 percent of children are affected by nocturnal enuresis, with boys being more commonly affected. Daytime enuresis is much less common and occurs more frequently in girls.

Enuresis is believed to be largely hereditary. However, psychosocial stress also plays a role.

It can be treated with a behavioral therapy program. For nocturnal enuresis, alarm devices are primarily used; these sound an alarm when bedwetting occurs. This helps children learn to wake up at the right moment and go to the bathroom.

In some cases, medication that suppresses nighttime urine production may also be indicated.

Encopresis means that a child repeatedly and involuntarily soils themselves or defecates in places not intended for that purpose. Among 7- to 8-year-old schoolchildren, approximately 1.5 to 3 percent are affected, with boys being affected twice as often as girls.

As part of the diagnostic process, it is essential to rule out any underlying physical illness as the cause.

Many children with encopresis hold in their stool so tightly that it leads to constipation. Therefore, laxatives may need to be used initially to normalize bowel movements.

Sleep disorders that frequently occur as psychological disorders in children include

• sleepwalking,
• pavor nocturnus, and
• nightmares.

In sleepwalking, which usually occurs early in the night, the child gets up while asleep and walks around. It is very difficult to wake the child. After waking up, the child remembers nothing.

In the case of pavor nocturnus, the affected child often lets out a panicked scream and suddenly sits up in bed, fully awake. The child is then completely disoriented and immediately falls back asleep, remaining difficult to wake. This course of the mental disorder is hardly influenced even by attempts to calm the child.

In contrast, when experiencing nightmares, those affected have vivid memories of them upon waking. They are responsive to attempts to calm them down. Nightmares tend to occur during the second half of the night.

Whether symptoms are classified as a “disorder” also depends on the child’s stage of development. For example, occasional nightmares are completely normal in preschool-aged children. Anxiety and insecurity during early puberty are also not disorders and usually subside on their own.

A mental disorder is present when the problem goes significantly beyond what is considered normal for the child’s developmental stage and causes distress.

In child and adolescent psychiatry (CAP), parents, family members, and significant others (including teachers) play a crucial role. They must be taken into account both in the assessment and in the treatment of these disorders.

Various mental disorders can be distinguished in children and adolescents. Among the most common are the following behavioral and emotional disorders in childhood and adolescence:

• ADHD (Attention-Deficit/Hyperactivity Disorder)
• Social behavior disorders
• Anxiety disorders
• Psychoses
• Tic disorder
• Eating Disorders
• Enuresis
• Encopresis
• Sleep disorders

ADHD (Attention-Deficit/Hyperactivity Disorder)

ADHD is characterized by extreme motor (movement-related) restlessness and agitation. Affected children feel the need to

• run around,
• talk,
• make noise, and
• fidget.

In addition, those affected exhibit impaired attention in the form of

• being extremely easily distracted,
• poor ability to concentrate, and
• frequent changes in activity.

Added to this is impaired impulse control: The children have a hard time “pulling themselves together” in every respect and have a low tolerance for frustration.

The symptoms begin within the first five years of life and persist over time. In about one-third of cases, the disorder continues into adulthood. Approximately 3 to 5 percent of all children are affected, with boys being about 3 to 8 times more likely to be affected than girls.

Inattention often leads to dangerous situations and accidents. In addition, affected children frequently experience social problems as they get into conflicts with classmates, teachers, and others.

In adolescence, motor restlessness usually decreases. However, increased impulsivity and reduced attention persist. As a result, those affected have an increased risk of substance abuse, traffic accidents, and delinquency (committing crimes).

The cause of the disorder is not entirely clear. In addition to genetic factors, birth complications and changes in brain metabolism may play a role.

ADHD is treated, on the one hand, through a consistent parenting style and appropriate educational measures. In addition, the medication methylphenidate (Ritalin®) is frequently prescribed.

Case Study on ADHD

Nine-year-old Andreas was referred to the pediatric outpatient clinic due to constant disciplinary problems at school. He is in third grade, cannot sit still, and therefore constantly runs around the classroom. He almost never raises his hand to answer questions, frequently interrupts the teacher, and has to be constantly reminded to stop talking. During recess, he is repeatedly involved in fights. At home, Andreas is also extremely difficult to handle; his homework usually drags on throughout the entire afternoon amid major arguments. He also has many conflicts with his siblings because he gets on their nerves. In addition, he repeatedly destroys his siblings’ belongings—sometimes accidentally, sometimes on impulse and intentionally.

Social Behavior Disorder in Children

This disorder is a persistent pattern of antisocial, aggressive, or defiant behavior. Affected children

• frequently get into arguments, sometimes involving severe outbursts of anger,
• behave aggressively toward their caregivers,
• lie and fail to keep their promises, or
• be cruel to other children or animals.

This can lead to

• deliberate destruction of other people’s property,
• intentional arson,
• theft, and
• disciplinary problems at school, including truancy

.

Conduct disorder often occurs alongside other mental disorders in children and adolescents, such as

• ADHD,
• developmental disorders, or
• substance abuse,

Between 2 and 10 percent of all children are affected, predominantly boys. The disorder often remains very stable over many years.

Those affected are more likely to commit criminal acts (delinquency). An important goal of therapy is to prevent this and the prison sentence that often follows.

Therapeutic interventions may include individual therapy for the children or family therapy. In addition, community-based measures (e.g., youth outreach in “high-risk neighborhoods”) play a role.

The stability of the social behavior disorder is very high. This means that the disorder often persists beyond adolescence. If children exhibit aggressive behavior at a young age, it can be assumed that 40 percent of these elementary school students will still exhibit social behavior disorders in adulthood.

In some cases, medications such as lithium or carbamazepine can be used successfully. They are prescribed, for example, in cases of severe impulsive aggressive behavior.

Psychosocial preventive measures are undoubtedly the key to improving these children’s outcomes.

Anxiety Disorders in Childhood and Adolescence

Anxiety is a relatively common phenomenon, especially in childhood. Many children exhibit fear of specific situations or objects (so-called “phobic fears”), e.g.,

• thunderstorms,
• of dogs, or
• the dark.

In 2 to 9 percent of all children, phobic fears are so severe that a mental disorder can be diagnosed.

In addition to phobic fears, separation anxiety is the most common anxiety disorder in childhood and adolescence. Three to five percent of all children suffer from it.

Affected children refuse to leave their caregivers. They experience intense anxiety when they do so. This usually leads to refusal to attend school. Children with separation anxiety are often very clingy even in early childhood. For example, they do not like going to preschool.

Severe separation anxiety is often triggered by

• the experience of being abandoned (e.g., getting lost in a department store) or
• difficult family situations (e.g., the threat of parental separation).

Children with school anxiety do say goodbye to their parents in the morning, but then tend not to go to school. These two anxiety disorders can easily be confused, as in both cases the refusal to attend school may initially be the most noticeable symptom.

Psychoses in Children and Adolescents

Schizophrenia and other psychoses relatively rarely (in about 4 percent of all cases) begin before the age of 15. Only about 1 percent begin before the age of 10. The younger the age of onset, the more difficult it is to recognize psychoses, as their clinical presentation differs significantly from that of psychoses in adult patients.

At a younger age, “hebephrenic” course patterns and prodromal symptoms frequently occur. Prodromal symptoms refer to a set of symptoms that precedes many acute psychotic episodes—sometimes for years—and is characterized by problems such as

• difficulty concentrating,
• suspicion,
• a decline in academic performance,
• anxiety, and
• social withdrawal

. “Hebephrenia” refers to a psychosis in which the affected person shows increasingly less emotional involvement and little drive. Their mood becomes increasingly flat and “trivial.”

Tic Disorders in Elementary School-Aged Children

Tics are sudden, brief, repetitive, involuntary movements or vocalizations. They have no specific purpose or meaning. Those affected can often suppress tics voluntarily for short periods of time.

There are simple tics such as

• shrugging,
• blinking,
• whistling, or
• sniffing.

There are also complex tics such as

• jumping,
• reaching out,
• stomping, and
• saying entire words or sentences.

In cases of transient tic disorder, only simple tics usually occur, and they do not last longer than one year. In cases of chronic tic disorder, multiple and more complex tics may occur over a longer period of time.

A severe combination of vocal and motor tics over a long period of time is referred to as Tourette syndrome.

Between 4 and 12 percent of elementary school-aged children suffer from a tic disorder. That is approximately 10 times as many affected individuals as in adulthood. Boys are affected much more frequently.

Many tic disorders resolve on their own over time. Chronic and complex tic disorders have a relatively poor prognosis even with behavioral therapy and medication.

Eating Disorders in Childhood and Adolescence

In childhood and adolescence, there are some distinctive features regarding the symptoms of various eating disorders.

Obesity in childhood and adolescence is a growing problem in our society. Children from lower socioeconomic backgrounds are more severely affected. Obese children usually remain overweight as adults. The consequences of obesity often include

• heart disease,
• orthopedic problems,
• diabetes, etc.

Anorexia nervosa (anorexia) very often begins during adolescence. Many child and adolescent psychiatric facilities specialize in treating this disorder.

Bulimia, on the other hand, often occurs only as a consequence of anorexia. It is therefore primarily treated in adult psychiatry.

Enuresis (bedwetting)

Enuresis refers to children over the age of 5 who still wet themselves regularly without any organic causes. A distinction is made between nocturnal enuresis and daytime enuresis. Approximately 11 percent of children are affected by nocturnal enuresis, with boys being more commonly affected. Daytime enuresis is much less common and occurs more frequently in girls.

Enuresis is believed to be largely hereditary. However, psychosocial stress also plays a role.

It can be treated with a behavioral therapy program. For nocturnal enuresis, alarm devices are primarily used; these sound an alarm when bedwetting occurs. This helps children learn to wake up at the right moment and go to the bathroom.

In some cases, medication that suppresses nighttime urine production may also be indicated.

Encopresis (fecal incontinence in children)

Encopresis means that a child repeatedly and involuntarily soils themselves or defecates in places not intended for that purpose. Among 7- to 8-year-old schoolchildren, approximately 1.5 to 3 percent are affected, with boys being affected twice as often as girls.

As part of the diagnostic process, it is essential to rule out any underlying physical illness as the cause.

Many children with encopresis hold in their stool so tightly that it leads to constipation. Therefore, laxatives may need to be used initially to normalize bowel movements.

Sleep Disorders in Children

Sleep disorders that frequently occur as psychological disorders in children include

• sleepwalking,
• pavor nocturnus, and
• nightmares.

In sleepwalking, which usually occurs early in the night, the child gets up while asleep and walks around. It is very difficult to wake the child. After waking up, the child remembers nothing.

In the case of pavor nocturnus, the affected child often lets out a panicked scream and suddenly sits up in bed, fully awake. The child is then completely disoriented and immediately falls back asleep, remaining difficult to wake. This course of the mental disorder is hardly influenced even by attempts to calm the child.

In contrast, people who experience nightmares have vivid memories of them upon waking. They are responsive to attempts to calm them down. Nightmares tend to occur during the second half of the night.