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 Behavioral Problems

Mental, Emotional, and Behavior Problems Are Real

Young people can have mental, emotional, and behavior problems that are real, painful, and costly. These problems, often called "disorders," are a source of stress for the child as well as the family, school, community, and larger society.

The number of families who are affected by mental, emotional, and behavior disorders in young people is staggering. It is estimated that as many as one in five children or adolescents may have a mental health problem that can be identified and treated. At least 1 in 10-or as many as 6 million young people-may have a "serious emotional disturbance." This term refers to a mental health problem that severely disrupts a person's ability to function socially, academically, and emotionally.

Mental health disorders in children and adolescents are caused by biology, environment, or a mix of both. Examples of biological factors are genetics, chemical imbalances in the body, and damage to the central nervous system, such as a head injury. Many factors in a young person's environment can affect his or her mental health, such as exposure to violence, extreme stress, and loss of an important person.

Caring families and communities working together can help children and adolescents with mental disorders. A broad range of services often is necessary to meet the needs of these young people and families.

The Disorders

Following are descriptions of some of the mental, emotional, and behavior problems that can occur during childhood and adolescence. All of these disorders can have a serious impact on a child's overall health.

Some disorders are more common than others, and conditions can range from mild to severe. Often, a child has more than one disorder.²

Anxiety disorders the most common of childhood disorders. They affect an estimated 8 to 10 of every 100 children and adolescents. These young people experience excessive fear, worry, or uneasiness that interferes with their daily lives. Anxiety disorders include:

• Phobia - an unrealistic and overwhelming fear of some object or situation;
• Generalized anxiety disorder - a pattern of excessive, unrealistic worry not attributable to any recent experience;
• Panic disorder - terrifying panic attacks that include physical symptoms such as rapid heartbeat and dizziness;
• Obsessive-compulsive disorder - being trapped in a pattern of repeated thoughts and behaviors such as counting or hand washing; and
• Post-traumatic stress disorder - a pattern of flashbacks and other symptoms that occurs in children who have experienced a psychologically distressing event such as physical or sexual abuse, being a victim or witness of violence, or exposure to some other traumatic event such as a bombing or hurricane.

Major depression is recognized more and more in young people. Years ago, many people believed that major depression did not occur in childhood. But we now know that the disorder can occur at any age. Studies show that up to 6 out of every 100 children may have depression. The disorder is marked by changes in:

• Emotion - the child often feels sad, cries, looks tearful, and feels worthless;
• Motivation - schoolwork declines, the child shows no interest in play;
• Physical well-being - there may be changes in appetite or sleep patterns and vague physical complaints; and
• Thoughts - the child believes that he or she is ugly, that he or she is unable to do anything right, or that the world or life is hopeless.

Some adolescents or even elementary school children with depression may not place any value on their own lives, which may lead to suicide.

Bipolar disorder (manic-depressive illness) in children and adolescents is marked by exaggerated mood swings between extreme lows (depression) and highs (excitedness or manic phases). Periods of moderate mood occur in between. During a manic phase, the child or adolescent may talk nonstop, need very little sleep, and show unusually poor judgment. Bipolar mood swings can recur throughout life. Adults with bipolar disorder, as common as 1 in 100 adults, often experienced their first symptoms during teenage years.

Attention-deficit/hyperactivity disorder occurs in up to 5 of every 100 children. A young person with attention-deficit/hyperactivity disorder is unable to focus attention and is often impulsive and easily distracted. Most children with this disorder have great difficulty remaining still, taking turns, and keeping quiet. Symptoms must be evident in at least two settings (for instance, at home and at school) for attention-deficit/hyperactivity disorder to be diagnosed.

Learning disorders affect the ability of children and adolescents to receive or express information. These problems can show up as difficulties with spoken and written language, coordination, attention, or self-control. Such difficulties can make it harder for a child to learn to read, write, or do math. Approximately 5 of every 100 children in public schools are identified as having a learning disorder.

Conduct disorder causes children and adolescents to act out their feelings or impulses toward others in destructive ways. Young people with conduct disorder repeatedly violate the basic rights of others and the rules of society. The offenses that these children and adolescents commit often get more serious over time. Examples include lying, theft, aggression, truancy, fire-setting, and vandalism. Children and adolescents with conduct disorder usually have little care or concern for others. Current research has yielded varying estimates of the number of young people with this disorder; most estimates range from 4 to 10 of every 100 children and adolescents.

Eating disorders can be life threatening. A young person with anorexia nervosa, for example, cannot be persuaded to maintain a minimally normal body weight. This child or adolescent is intensely afraid of gaining weight and doesn't believe that he or she is underweight. Anorexia affects 1 in every 100 to 200 adolescent girls and a much smaller number of boys.

Youngsters with bulimia nervosa feel compelled to binge (eat huge amounts of food at a time). Afterward, to prevent weight gain, they rid their bodies of the food by vomiting, abusing laxatives, taking enemas, or exercising obsessively. Reported rates vary from 1 to 3 out of 100 young people.

Autism spectrum disorder or autism appears before a child's third birthday. Children with autism have problems interacting and communicating with others. They behave inappropriately, often repeating behaviors over long periods. For example, some children bang their heads, rock, or spin objects. The impairments range from mild to severe. Children with autistic disorder may have a very limited awareness of others and are at increased risk for other mental disorders. Studies suggest that autism spectrum disorder affects 7 to 14 of every 10,000 children.

Schizophrenia can be a devastating mental disorder. Young people with schizophrenia have psychotic periods when they may have hallucinations (sense things that do not exist, such as hearing voices), withdraw from others, and lose contact with reality. Other symptoms include delusional or disordered thoughts and an inability to experience pleasure. Schizophrenia is even more rare than autism in children under 12, but occurs in about 3 out of every 1000 adolescents.

Treatment, Support Services, and Research: Sources of Hope

Many of the symptoms and much of the distress associated with childhood and adolescent mental, emotional, and behavior problems may be alleviated with timely and appropriate treatment and support services.

A child or adolescent in need of treatment or services and his or her family may need a plan of care based on the severity and duration of symptoms. Optimally, this plan is developed with the family, service providers, and a service coordinator, who is referred to as a case manager. Whenever possible, the child or adolescent is involved in decisions.

Tying together all the various supports and services in a plan of care for a particular child and family is commonly referred to as a "system of care." A system of care is designed to improve the child's ability to function in all areas of life-at home, at school, and in the community. For a fact sheet on systems of care, call 1.800.789.2647.

Researchers are working to produce new knowledge and understanding about mental, emotional, and behavior disorders. Studies are also exploring ways to prevent and treat mental, emotional, and behavior problems, including the range of services that may be required.

Many of these studies are funded by Federal agencies within the Department of Health and Human Services, which include:

• The National Institutes of Health:
  • The National Institute of Mental Health
  • The National Institute of Child Health and Human Development
  • The National Institute for Drug Abuse
  • The National Institute on Alcoholism and Alcohol Abuse.
• The Substance Abuse and Mental Health Services Administration:
  • The Center for Mental Health Services
  • The Center for Substance Abuse Prevention
  • The Center for Substance Abuse Treatment
• The Administration for Children and Families
• The Health Resources and Services Administration

• The Department of Education
• The Department of Justice.

There is now more reason than ever for youngsters with these problems and their families to lead normal, happy lives.

For free information about children's and adolescents' mental health-including publications, references, and referrals to local and national resources and organizations-call 1.800.789.2647; TTY 301.443.9006.

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