Mental disorders among children and adolescents
Childhood is a crucial stage in human development that can influence the future course of one’s life, making a person vulnerable or resilient depending on the scope of risk and protective factors. The risk factor is a situation that will result in a negative outcome, while a protective factor minimizes the probability of a mental disorder (Mash and Wolfe 15). Children who had an adverse childhood experience are more likely to have psychiatric issues and an inability to attain stability in their careers and personal life. However, some individuals manage to overcome an unfavorable influence and achieve incredible success or at least are capable of becoming functioning units of society. These children either had some protective factors or had resilience, the ability to withstand stress. Indeed, resilience is a critical asset that can alter someone’s life direction by allowing them to transform difficulties into positive experiences.
Mental disorders among children and adolescents are a significant problem worldwide. For example, every eighth child in North America was found to have critical psychological issues (Mash and Wolfe 17). Such circumstances as poverty, single parenting, sexual abuse, childhood neglect, domestic violence, and a parent with substance use problems can dramatically increase the likelihood of social withdrawal, anxiety, depression, and addiction later in life (Mash and Wolfe 19). The magnitude of these stressors may exacerbate the problem, resulting in a child being unable to adapt to social life. For instance, children from low-income families are more likely to have conduct disorders and learning disabilities (Mash and Wolfe 20). Still, having a supportive relative, friend, or community can substantially change this situation, preventing these psychopathologies despite the harsh environment.
Main reasons for later psychological problems
Various mental health issues can have distinct causes resulting in a similar negative outcome. Four main reasons for later psychological problems are known: biological, emotional, cognitive, and social influence (Mash and Wolfe 27-29). Firstly, physiological influence implies physiological factors such as high circulating cortisol levels that affect a child’s brain development and maturation in the prenatal period or early in life (Mash and Wolfe 27). Secondly, abnormal emotional reactions such as fear and anxiety in circumstances that do not usually elicit these responses may stem from adverse childhood experiences. Thirdly, cognitive influence is referred to a person’s perception of events and other people’s attitudes (Mash and Wolfe 28). Fourthly, social factors include difficult relationships with family and peers, leading to psychiatric conditions or exacerbating an existing problem. Overall, these causes can be intertwined or act separately in developing mental health disorders in children and adolescents.
Scientific studies about the impact of adverse childhood on future psychological issues helped to formulate theories about abnormal development. The three primary theories are multiple determinants of deviant behavior, the interdependence of child and surroundings, and continuities and discontinuities of dysfunctional development (Mash and Wolfe 31-32). The first theory claims that a multitude of factors determines any abnormal behavioral pattern. Therefore, any conduct problem or learning difficulty should be viewed from various angles, considering biological and societal influence. According to interdependence theory, children can react to the same stimuli differently at school and at home because a child and environment are in constant informational exchange; thus, both can contribute to the psychological issue (Mash and Wolfe 32). The last theory states that some mental health problems can progress continuously or discontinuously, in a gradual or abrupt manner, respectively (Mash and Wolfe 32). For example, conduct disorder seems to follow a continuous pattern from childhood to adolescence, while eating disorders are discontinuous.
Diagnostic and therapeutic decisions
Making diagnostic and therapeutic decisions in children with mental health issues is challenging. The clinical assessment aims to evaluate a child’s cognitive, emotional, and behavioral state, considering age, gender, and cultural peculiarities (Mash and Wolfe 83). An interview to collect a comprehensive patient history should involve children and their caregivers. Furthermore, clinicians incorporate behavioral assessment to understand a child’s thoughts and feelings and neuropsychological testing to screen for potential problems. Next, the diagnosis is derived from the collected information that helps understand the nature of psychiatric issues (Mash and Wolfe 87). Therefore, it is crucial to understand normal development and reactions in specific situations to distinguish abnormal behavior and establish a diagnosis based on symptoms and patterns.
The classification system of psychiatric illnesses grouped mental issues and formulated standard methods for treating children’s developmental and behavioral problems. American Psychiatric Association introduced its first Diagnostic and Statistical Manual (DSM) in 1952, which was revised several times, and the most recent one is DSM-5 which was updated in 2013 (Mash and Wolfe 104). It categorized neurodevelopmental disorders into six groups: intellectual disabilities, autism spectrum disorders, communication disorders, specific learning disorders, attention-deficit/hyperactivity disorders, and motor disorders (Mash and Wolfe 105). Other childhood and adolescent mental issues include bipolar, anxiety, mood, obsessive-compulsive, trauma-related, and eating disorders grouped based on similarity of neurobiological factors (Mash and Wolfe 105). Overall, DSM-5 is an improved version of this manual because it removed stigmatization in classification. Still, this classification system lacks a deeper understanding of the interrelatedness and transition between various childhood disorders. Thus, clinicians should constantly assess etiologic factors that caused the disease rather than focusing on existing symptoms to ensure assigning the most effective therapy.
Therapeutic methods for children and adolescents
The last several decades are known for a tremendous improvement in therapeutic methods for children and adolescents diagnosed with psychiatric conditions. Intervention in these patients involves preventive actions and treatment at multiple levels, from an individual to the community (Mash and Wolfe 110). Specifically, prevention strives to minimize the likelihood of the adverse outcome, while therapy aims to help eradicate symptoms that developed due to one or several negative experiences (Mash and Wolfe 111). Furthermore, treatment should be appropriate for the particular condition and age and culturally compatible (Mash and Wolfe 111). Importantly, clinicians are oriented toward a dual goal: reducing symptoms and helping a child adapt to family and one’s educational institution.
Although therapy often requires a combined approach, the treatment methods were divided into distinct categories. Psychodynamic therapy aims to reveal underlying conflicts through play or verbal communication with the child or adolescent (Mash and Wolfe 114). The family approach tries to improve child-family relations that are thought to cause the problem. Similarly, behavioral treatment focuses on eliminating abnormal learned patterns by working with the patient and environment, whereas the cognitive approach alters children’s distorted perceptions (Mash and Wolfe 115). Cognitive-behavioral therapy is a combination of the two previous methods. The client-centered approach seems to utilize the abovementioned techniques but in a more personalized manner. Finally, neurobiological treatment involves administering medications that target specific neural circuits, which were found to be involved in the disease. These drugs are grouped according to the mechanism of action and use: antidepressants, antipsychotics, anti-anxiety, and mood stabilizers (Mash and Wolfe 116). All these methods can be combined to help children cope with stress, anxiety, depression, and many other mental health problems.
Mash, Eric J., and David A. Wolfe. Abnormal Child Psychology. 7th ed., Cengage Learning, 2018.