Signs of mental illness in children

and childhood mental illnesses

Dr Utkarsh Karki
MD, DM Child & Adolescent Psychiatrist
Identification of mental health
problems in children

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 Symptom presentations
Emotional symptoms - sadness, anger, irritability, crying, fearful and anxious.

Physical symptoms - headaches, stomach aches, body aches, eye

pains, muscle pains, lethargy, weakness

Behavioral symptoms - restlessness, argumentative, aggression,

increase in substance use, self harm, regression etc.

Cognitive symptoms – excessive thinking, negative thinking,

repeated thoughts, suicidal ideations

Unable to perform their daily routines and responsibilities.

Sleep and appetite disturbances

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2-10% of children in
the general population
complain of bothersome
aches & pains that are
likely to be medically
unexplained
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Understanding a child’s behaviour

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 When to call it a problem?

pervasive Impairme
Persistent Distress MHP
ness nt

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 Mental health problems in children
– simple classification
 Neurodevelopmental problems
 Internalizing disorders
 Externalizing disorders
 Stress related and somatoform disorders
 Adult- type disorders
 Organic disorders
 Children at risk / with sub-threshold symptoms
 Normal variation

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 Neurodevelopmental disorders

1. Onset invariably during infancy & childhood

3. Usually on a continuum of mild, moderate and severe
4.Developmental disorders tend to overlap
5. Likely to have multiple causes
6. Improves over the life span, with training
7. No complete cure, but early detection and early
intervention greatly improves the outcome

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 Neurodevelopmental Disorders
• Intellectual Disability/Intellectual Developmental
Disorder (IDD)

• Autism Spectrum Disorder (ASD)

• Attention Deficit/Hyperactivity Disorder (ADHD)

• Speech and Language Disorder

• Specific Learning Disorders (SLD)

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 Externalizing symptoms
• Hyperactivity, impulsivity, poor attention and
concentration

• Disobedience, defiance, demanding behavior, temper

tantrums, argumentativeness, demanding behaviors

• Aggression - physical, verbal, towards people, property

• Dissocial or anti-social behaviors - lying, stealing,

deceitfulness, truancy, burglary, running away

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 Externalizing Disorders

• ADHD

• Oppositional Defiant Disorder (ODD)

• Conduct Disorder (CD)

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 Internalizing Disorders

 Subjective distress

 Functional impairment

 Behaviorally not very apparent

 Often indirect presentation

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 A child who….

Recent decline in Repeated aches and

School refusal
school performance pains

Is withdrawn, pre- Is tense, Talks of death and

occupied, looks apprehensive, dying, ending life,
worried fearful, & sensitive or DSH

Is too shy, hardly Sleep disturbances,

Looks unhappy, sad,
speaks and nightmares, Loss of
easily cries, irritable
interacts appetite

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 Other indicators
 “off-mood”, “bored” “no-interest”, “doesn’t enjoy”
“watches TV or uses gadgets endlessly”

 Recent onset bedwetting, Encopresis

 Thoughts of running away

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 Internalizing Disorders
 Anxiety disorders
Separation, Social, Specific phobias, Generalized
anxiety, PTSD
Selective mutism

 Depressive disorders
Depressive episode
Dysthymia

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 Stress related and somatoform
disorders
 Adjustment disorder

 Acute stress disorder

 PTSD

 Somatic symptom and related disorder

• Psychogenic headache
• Dissociation / conversion disorder

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 Other disorders
• Enuresis
• Breath-holding spells
• Stammering
• Feeding problems
• Sleep related problems - Nightmares, sleep terrors,
sleep walking, insomnia etc

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 Adult type problems
• Psychotic disorders

• Bipolar affective disorder

• Schizophrenia

• Substance abuse – Alcohol, Nicotine, Cannabis,

Inhalants

• Organic disorders
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 “Non-disorder” problems

• Children at risk

• Sub-threshold symptoms

• Normal variations

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• Post traumatic stress symptoms -10 to 51%

• Emotional problems 12.9% to 17%

• Behavioral problems

• Anxiety disorder – 18.8 % to 24.4%

• ADHD - 10% to 11.7%

• ASD – 0.3%
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 Reading resources
• https://iacapap.org/english/

• http://asd.pedialink.courses.aap.org/course?req=202107
281921585613

• Temper tantrums
https://www.nepjol.info/index.php/JPAN/article/view/22
932

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