Comprehensive Overview of Emotional and Behavioral Disorders
Emotional and Behavioral Disorders
Mental Health Is Important
Mental health is how people think, feel, and act as they face life's situations. It affects how people handle stress, relate to one another, and make decisions. Mental health influences the ways individuals look at themselves, their lives, and others in their lives. Like physical health, mental health is important at every stage of life.
All aspects of our lives are affected by our mental health. Caring for and protecting our children is an obligation and is critical to their daily lives and their independence.
Children and Adolescents Can Have Serious Mental Health Problems
Like adults, children and adolescents can have mental health disorders that interfere with the way they think, feel, and act. When untreated, mental health disorders can lead to school failure, family conflicts, drug abuse, violence, and even suicide. Untreated mental health disorders can be very costly to families, communities, and the health care system.
In this fact sheet, "Mental Health Problems" for children and adolescents refers to the range of all diagnosable emotional, behavioral, and mental disorders. They include depression, attention- deficit/hyperactivity disorder, and anxiety, conduct, and eating disorders. Mental health problems affect one in every five young people at any given time.
"Serious Emotional Disturbances" for children and adolescents refers to the above disorders when they severely disrupt daily functioning in home, school, or community. Serious emotional disturbances affect 1 in every 10 young people at any given time.1
Mental Health Disorders Are More Common in Young People than Many Realize
Studies show that at least one in five children and adolescents have a mental health disorder. At least one in 10, or about 6 million people, have a serious emotional disturbance.¹
The Causes Are Complicated
Mental health disorders in children and adolescents are caused mostly by biology and environment. Examples of biological causes are genetics, chemical imbalances in the body, or damage to the central nervous system, such as a head injury. Many environmental factors also put young people at risk for developing mental health disorders. Examples include:
Exposure to environmental toxins, such as high levels of lead; Exposure to violence, such as witnessing or being the victim of physical or sexual abuse, drive-by shootings, muggings, or other disasters; Stress related to chronic poverty, discrimination, or other serious hardships; and The loss of important people through death, divorce, or broken relationships.
Signs of Mental Health Disorders Can Signal a Need for Help
Children and adolescents with mental health issues need to get help as soon as possible. A variety of signs may point to mental health disorders or serious emotional disturbances in children or adolescents. Pay attention if a child or adolescent you know has any of these warning signs:
A child or adolescent is troubled by feeling:
Sad and hopeless for no reason, and these feelings do not go away. Very angry most of the time and crying a lot or overreacting to things. Worthless or guilty often. Anxious or worried often. Unable to get over a loss or death of someone important. Extremely fearful or having unexplained fears. Constantly concerned about physical problems or physical appearance. Frightened that his or her mind either is controlled or is out of control.
A child or adolescent experiences big changes, such as:
Showing declining performance in school. Losing interest in things once enjoyed. Experiencing unexplained changes in sleeping or eating patterns. Avoiding friends or family and wanting to be alone all the time. Daydreaming too much and not completing tasks. Feeling life is too hard to handle. Hearing voices that cannot be explained. Experiencing suicidal thoughts.
A child or adolescent experiences:
Poor concentration and is unable to think straight or make up his or her mind. An inability to sit still or focus attention. Worry about being harmed, hurting others, or doing something "bad". A need to wash, clean things, or perform certain routines hundreds of times a day, in order to avoid an unsubstantiated danger. Racing thoughts that are almost too fast to follow. Persistent nightmares.
A child or adolescent behaves in ways that cause problems, such as:
Using alcohol or other drugs. Eating large amounts of food and then purging, or abusing laxatives, to avoid weight gain. Dieting and/or exercising obsessively. Violating the rights of others or constantly breaking the law without regard for other people. Setting fires. Doing things that can be life threatening. Killing animals.
Comprehensive Services through Systems of Care Can Help
Some children diagnosed with severe mental health disorders may be eligible for comprehensive and community-based services through systems of care. Systems of care help children with serious emotional disturbances and their families cope with the challenges of difficult mental, emotional, or behavioral problems. To learn more about systems of care, call the National Mental Health Information Center at 1-800-789-2647, and request fact sheets on systems of care and serious emotional disturbances, or visit the Center's web site at http://www.mentalhealth.samhsa.gov
Finding the Right Services Is Critical
To find the right services for their children, families can do the following:
Get accurate information from hotlines, libraries, or other sources. Seek referrals from professionals. Ask questions about treatments and services. Talk to other families in their communities. Find family network organizations.
It is critical that people who are not satisfied with the mental health care they receive discuss their concerns with providers, ask for information, and seek help from other sources.
Important Messages About Child and Adolescent Mental Health:
Every child's mental health is important. Many children have mental health problems. These problems are real, painful, and can be severe. Mental health problems can be recognized and treated. Caring families and communities working together can help. Information is available; call 1-800-789-2647.
Emotional and Behavioral Disorders
Below are descriptions of particular mental, emotional, and behavioral disorders that may occur during childhood and adolescence. All can have a serious impact on a child's overall health. Some disorders are more common than others, and conditions range from mild to severe. Often, a child has more than one disorder (U.S. Department of Health and Human Services, 1999).
Young people who experience excessive fear, worry, or uneasiness may have an anxiety disorder. Anxiety disorders are among the most common of childhood disorders. According to one study of 9- to 17-year-olds, as many as 13 of every 100 young people have an anxiety disorder (U.S. Department of Health and Human Services, 1999). Anxiety disorders include:
- Phobias, which are unrealistic and overwhelming fears of objects or situations.
- Generalized anxiety disorder, which causes children to demonstrate a pattern of excessive, unrealistic worry that cannot be attributed to any recent experience.
- Panic disorder, which causes terrifying "panic attacks" that include physical symptoms, such as a rapid heartbeat and dizziness.
- Obsessive-compulsive disorder, which causes children to become "trapped" in a pattern of repeated thoughts and behaviors, such as counting or hand washing.
- Post-traumatic stress disorder, which causes a pattern of flashbacks and other symptoms and occurs in children who have experienced a psychologically distressing event, such as abuse, being a victim or witness of violence, or exposure to other types of trauma such as wars or natural disasters.
Many people once believed that severe depression did not occur in childhood. Today, experts agree that severe depression can occur at any age. Studies show that two of every 100 children may have major depression, and as many as eight of every 100 adolescents may be affected (National Institutes of Health, 1999). The disorder is marked by changes in:
- Emotions—Children often feel sad, cry, or feel worthless.
- Motivation—Children lose interest in play activities, or schoolwork declines.
- Physical well-being—Children may experience changes in appetite or sleeping patterns and may have vague physical complaints.
- Thoughts—Children believe they are ugly, unable to do anything right, or that the world or life is hopeless.
- It also is important for parents and caregivers to be aware that some children and adolescents with depression may not value their lives, which can put them at risk for suicide.
Children and adolescents who demonstrate exaggerated mood swings that range from extreme highs (excitedness or manic phases) to extreme lows (depression) may have bipolar disorder (sometimes called manic depression). Periods of moderate mood occur in between the extreme highs and lows. During manic phases, children or adolescents may talk nonstop, need very little sleep, and show unusually poor judgment. At the low end of the mood swing, children experience severe depression. Bipolar mood swings can recur throughout life. Adults with bipolar disorder (about one in 100) often experienced their first symptoms during their teenage years (National Institutes of Health, 2001).
Young people with attention-deficit/hyperactivity disorder are unable to focus their attention and are often impulsive and easily distracted. Attention-deficit/hyperactivity disorder occurs in up to five of every 100 children (U.S. Department of Health and Human Services, 1999). Most children with this disorder have great difficulty remaining still, taking turns, and keeping quiet. Symptoms must be evident in at least two settings, such as home and school, in order for attention-deficit/hyperactivity disorder to be diagnosed.
Difficulties that make it harder for children and adolescents to receive or express information could be a sign of learning disorders. Learning disorders can show up as problems with spoken and written language, coordination, attention, or self-control.
Young people with conduct disorder usually have little concern for others and repeatedly violate the basic rights of others and the rules of society. Conduct disorder causes children and adolescents to act out their feelings or impulses in destructive ways. The offenses these children and adolescents commit often grow more serious over time. Such offenses may include lying, theft, aggression, truancy, the setting of fires, and vandalism. Current research has yielded varying estimates of the number of young people with this disorder, ranging from one to four of every 100 children 9 to 17 years of age (U.S. Department of Health and Human Services, 1999).
Children or adolescents who are intensely afraid of gaining weight and do not believe that they are underweight may have eating disorders. Eating disorders can be life threatening. Young people with anorexia nervosa, for example, have difficulty maintaining a minimum healthy body weight. Anorexia affects one in every 100 to 200 adolescent girls and a much smaller number of boys (National Institutes of Health, 1999).
Youngsters with bulimia nervosa feel compelled to binge (eat huge amounts of food in one sitting). After a binge, in order to prevent weight gain, they rid their bodies of the food by vomiting, abusing laxatives, taking enemas, or exercising obsessively. Reported rates of bulimia vary from one to three of every 100 young people (National Institutes of Health, 1999).
Children with autism, also called autistic disorder, have problems interacting and communicating with others. Autism appears before the third birthday, causing children to act inappropriately, often repeating behaviors over long periods of time. For example, some children bang their heads, rock, or spin objects. Symptoms of autism range from mild to severe. Children with autism may have a very limited awareness of others and are at increased risk for other mental disorders. Studies suggest that autism affects 10 to 12 of every 10,000 children (U.S. Department of Health and Human Services, 1999).
Young people with schizophrenia have psychotic periods that may involve hallucinations, withdrawal from others, and loss of contact with reality. Other symptoms include delusional or disordered thoughts and an inability to experience pleasure. Schizophrenia occurs in about five of every 1,000 children (National Institutes of Health, 1997).
Treatment, Support Services, and Research: Sources of Hope
Now, more than ever before, there is hope for young people with mental, emotional, and behavioral disorders. Most of the symptoms and distress associated with childhood and adolescent mental, emotional, and behavioral disorders can be alleviated with timely and appropriate treatment and supports.
In addition, researchers are working to gain new scientific insights that will lead to better treatments and cures for mental, emotional, and behavioral disorders. Innovative studies also are exploring new ways of delivering services to prevent and treat these disorders. Research efforts are expected to lead to more effective use of existing treatments, so children and their families can live happier, healthier, and more fulfilling lives.
Many of these research studies are funded by Federal agencies within the Department of Health and Human Services, including the:
- National Institutes of Health
- National Institute of Mental Health
- National Institute of Child Health and Human Development
- National Institute on Drug Abuse
- National Institute on Alcohol Abuse and Alcoholism
- Substance Abuse and Mental Health Services Administration
- Center for Mental Health Services
- Center for Substance Abuse Prevention
- Center for Substance Abuse Treatment
- Administration for Children and Families
- Health Resources and Services Administration
Related activities are taking place within the:
- Department of Education
- Department of Justice
Important Messages About Children's and Adolescents' Mental Health
- Every child's mental health is important.
- Many children have mental health problems.
- These problems are real and painful and can be severe.
- Mental health problems can be recognized and treated.
- Caring families and communities working together can help.
Mental Health Resources on the Internet
Centers for Disease Control and Prevention
ClinicalTrials.gov, National Institutes of Health
Substance Abuse and Mental Health Services Administration
National Institute of Mental Health
U.S. Department of Health and Human Services. (1999). Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services.
National Institutes of Health. (1999). Brief Notes on the Mental Health of Children and Adolescents. Retrieved September 5, 2001, from the World Wide Web.
National Institutes of Health. (2001). Fact Sheet: Going to Extremes, Bipolar Disorder. Bethesda, MD: National Institutes of Health.
National Institutes of Health. (1997). Press Release: Progressive Brain Changes Detected in Childhood Onset Schizophrenia.