More Effort Needed To Prevent Mental, Emotional, And Behavioral Disorders In Young People
The federal government should make preventing
mental, emotional, and behavioral disorders and promoting mental health in young people a national priority, says a new report
from the National Research Council and Institute of Medicine.
These disorders - which include:
- conduct disorder
- and substance abuse
- are about as common as fractured limbs in children and adolescents.
Collectively, they take a tremendous toll
on the well-being of young people and their families, costing the U.S. an estimated $247 billion annually, the report says.
Research has shown that a number of programs are effective at preventing these problems
and promoting mental health, the report says. Such programs could be implemented more broadly, but currently there is no clear
federal presence to lead these efforts.
The White House should create an entity
that can coordinate agency initiatives in this area, set public goals for prevention, and provide needed research and funding
to achieve them, said the committee that wrote the report.
is a substantial gap between what is known about preventing mental, emotional, and behavioral disorders and what is actually
being done," said Kenneth E. Warner, committee chair and dean of the University of Michigan School of Public Health.
"It is no longer
accurate to argue that these disorders can never be prevented. Many can. The nation is well-positioned to equip young people
with the skills and habits needed to live healthy, happy, and productive lives in caring relationships. But we need to develop the systems to deliver effective prevention programs to a far wider group of children and adolescents."
Most mental, emotional, and behavioral
disorders have their roots in childhood and adolescence, the report notes. Among adults who have experienced these disorders,
more than half report the onset as occurring in childhood or early adolescence.
In any given
year, an estimated 14% to 20% of young people have one of these disorders.
First symptoms typically occur 2 to 4 years before the onset of a full-blown
disorder - creating a window of opportunity when preventive programs might make a difference, the report says. And some programs
have shown effectiveness at preventing specific disorders in at-risk groups.
the Clarke Cognitive-Behavioral Prevention Intervention, which focuses on helping adolescents at risk for depression learn
to cope with stress, has prevented episodes of major depression in several controlled experiments.
Other programs have demonstrated
broader preventive effects in general populations of young people, the report says. Programs that can be offered in family
or educational settings show particular promise in promoting mental health and addressing major risk factors.
One example of an effective school-based
program is the Good Behavior Game, which divides elementary school classes into teams and reinforces desirable behaviors with
rewards such as extra free time and other privileges. Studies have shown that the program significantly reduces aggressive
and disruptive behavior during first grade. The one-year intervention also has benefits over the long term, lowering the students'
risk of alcohol and drug abuse, as well as rates of suicidal thoughts and attempts.
And it significantly reduces
the likelihood that highly aggressive boys will be diagnosed with antisocial personality disorder as adults. Research has
shown that programs that focus on enhancing social and emotional skills can also improve students' academic performance, the
other programs improve children's mental health and behavior by enhancing parenting skills, the report says. The Positive
Parenting Program, for example, uses a range of approaches, from a television series on how to handle common child-rearing
problems to in-person skills training for parents struggling to handle children's aggressiveness or lack of cooperation. These
methods have been shown to lower kids' disruptive behaviors, a positive change that persisted one year later.
The report recommends that the White
House create an entity to lead a broad implementation of evidence-based prevention approaches and to direct research on interventions.
The new leadership body should set public goals for preventing specific disorders and promoting mental health and provide
the funding to achieve them.
The departments of Education,
Justice, and Health and Human Services should align their resources and programs with this strategy. These agencies should
also fund state, county, and community efforts to implement and improve evidence-based programs. At the same time, the report
cautions, federal and state agencies should not support programs that lack empirical evidence, even if they have community
The committee also urged
continued research to build understanding of what interventions work for whom and when, and how best to implement them. The
National Institutes of Health should develop a comprehensive 10-year plan to research ways to promote mental health and prevent
mental, emotional, and behavioral disorders in young people.
In addition, agencies and
foundations should establish equality in research funding between ways to prevent mental and behavioral disorders and ways
to treat these problems, the report says; currently, the balance is weighted toward research on treatment.
The report also discusses screening
programs that attempt to identify children with risk factors for mental, emotional, or behavioral disorders. Screening can
be helpful for targeting interventions, but it should be used only if it meets certain criteria, including that the disorders
to be prevented are a serious threat to mental health and that there is an effective intervention to address the risks or
Parents should be given
detailed information about the purpose and methods of screening, and the wishes of those who don't want their children included
should be respected. Without community acceptance and sufficient capacity to respond to the needs identified, screening is of limited value, the committee noted. It added that approaches to connecting screening with specific
interventions need to be tested.
report was sponsored by the Substance Abuse and Mental Health Services Administration, the National Institute on Drug Abuse,
the National Institute of Mental Health, and the National Institute on Alcohol Abuse and Alcoholism. The National Academy
of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.
They are private, nonprofit
institutions that provide science, technology, and health policy advice under a congressional charter. The Research Council
is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering. A committee
Copies of Preventing Mental, Emotional, and Behavioral Disorders Among
Young People: Progress and Possibilities are available from the National Academies Press on the Internet at http://www.nap.edu.
Article adapted by Medical News Today from original press
[ This news release and report are available at http://national-academies.org ]
NATIONAL RESEARCH COUNCIL and INSTITUTE OF MEDICINE
Board on Children, Youth, and Families
Board on Health Care Services
Committee on Prevention of Mental Disorders and Substance Abuse Among Children,
Youth, and Young Adults: Research Advances and Promising Interventions
Kenneth E. Warner, Ph.D. (chair)
Donabedian Distinguished University Professor of Public Health and Dean
School of Public Health
University of Michigan
Thomas F. Boat, M.D. (vice chair)
Executive Associate Dean
College of Medicine
William R. Beardslee, M.D.
Gardner Monks Professor of Child Psychiatry
Medical School; and
Department of Psychiatry
Children's Hospital Boston
C. Bell, M.D.
President and CEO
Community Mental Health Council and Foundation Inc.; and
Professor of Psychiatry
and Public Health
University of Illinois
Anthony Biglan, M.D.
Senior Scientist, and
Center on Early Adolescence
Oregon Research Institute
C. Hendricks Brown, Ph.D.
University Health Professor of Public Health, and
Prevention Science and Methodology Group
of Epidemology and Biostatistics
College of Public Health
Elizabeth Jane Costello, Ph.D.
of Medical Psychology
Department of Psychiatry and Behavioral Sciences
Duke University Medical Center
Teresa D. LaFromboise, M.D.
Associate Professor of Counseling Psychology
School of Education, and
Native American Studies
Ricardo F. Muñoz, Ph.D.
San Francisco General Hospital; and
Professor of Psychology
University of California
J. Pecora, Ph.D.
Casey Family Programs, and
School of Social
University of Washington
Bradley S. Peterson, M.D.
Deputy Director of Pediatric Neuropsychiatry
Director of MRI Research
New York City
Linda A. Randolph, M.D.,M.P.H.
President and CEO
Developing Families Center Inc.
Irwin Sandler, M.D.
of Psychology, and
Prevention Research Center
Arizona State University
Mary Ellen O'Connell, MMHS
Source: Sara Frueh
National Academy of Sciences
source site: click here
from the report of the sugeon general....
Children & Mental Health
Spanning roughly 20 years,
childhood and adolescence are marked by dramatic changes in physical, cognitive and social-emotional skills and capacities.
in childhood and adolescence is defined by the achievement of expected developmental cognitive, social and emotional milestones and by secure attachments, satisfying social relationships and effective coping skills.
Mentally healthy children and
adolescents enjoy a positive quality of life; function well at home, in school and in their communities and are free of disabling symptoms of psychopathology (Hoagwood et al., 1996).
If interested, Read Chapter Two of the Report of the Surgeon
General concerning mental health by clicking here
. (more important information concerning mental health)
interrupting the present article with this excerpt from: Child and Adolescent Mental Health SAMHSA
Mental Health Is Important
Mental health is how people think, feel and act as they face life's situations.
- how people handle stress
- relate to one another
- 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
Caring for and protecting our children is an obligation and is critical to their daily lives and their independence.
The basic principles for understanding health and illness discussed in the previous chapter apply to children and adolescents, but it's important to underscore
the often heard admonition that “children are not little adults.”
Even more than is true for
adults, children must be seen in the context of their social environments, that is, family, peer group and their larger physical and cultural surroundings.
Childhood mental health is
expressed in this context, as children proceed through development.
by periods of transition and reorganization, is the focus of much research on children and adolescents. Studies focus on normal
and abnormal development, trying to understand and predict the forces that will keep children and adolescents mentally healthy and maintain them on course to become mentally healthy adults.
These studies ask what places
some at risk for mental illness and what protects some but not others, despite exposure to the same risk factors.
In addition to studies of
normal development and of risk factors, much additional research focuses on mental illness in childhood and adolescence and
what can be done to prevent or treat it. The science is challenging because of the ongoing process of development.
The normally developing child
hardly stays the same long enough to make stable measurements. Adult criteria for illness can be difficult to apply to children
and adolescents, when the signs and symptoms of mental disorders are often also the characteristics of normal development.
i.e., a temper tantrum could
be an expected behavior in a young child but not in an adult. At some point, however, it becomes clearer that certain symptoms and behaviors cause
great distress and may lead to dysfunction of children, their family and others in their social environment.
interrupting the present article with this excerpt from: Child and Adolescent Mental Health SAMHSA
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:
Untreated mental health
disorders can be very costly to families, communities and the health care system.
Disorders Are More Common in Young People than Many Realize
Studies show that at least
1 in 5 children and adolescents have a mental health disorder.
At least 1 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.
of biological causes are:
- chemical imbalances in the body
- damage to the central nervous system, such as a
Many environmental factors
also put young people at risk for developing mental health disorders. Examples include:
At these points, it's helpful
to consider serious deviations from expected cognitive, social and emotional development as “mental disorders.” Specific treatments and services are
available for children and adolescents with such mental disorders, but one can't forget that these disorders emerge in the
context of an ongoing developmental process and shifting relationships within the family and community.
These developmental factors
must be carefully addressed, if one is to maximize the healthy development of children with mental disorders, promote remediation of associated impairments and enhance their adult outcomes.
The developmental perspective
helps us understand how estimated prevalence rates for mental disorders in children and adolescents vary as a function of the degree of
impairment that the child experiences in association with specific symptom patterns.
i.e., the MECA Study (Methodology for Epidemiology of Mental Disorders in Children & Adolescents)
estimated that almost 21% of U.S. children ages 9 to 17 had a diagnosable mental or addictive disorder associated with at least minimum impairment (see Table 3-1).
Table 3-1. Children & adolescents age 9 - 17 w/mental or addictive
disorders, combined MECA sample, 6-month (current) prevalence*
|Substance Use Disorders
* Disorders include diagnosis-specific impairment and CGAS < or
= 70 (mild global impairment) Source: Shaffer et al., 1996a
When diagnostic criteria required
the presence of significant functional impairment, estimates dropped to 11%. This estimate translates into a total of 4 million youth who suffer from a major mental illness that results in significant impairments
at home, at school & with peers.
extreme functional impairment is the criterion, the estimates dropped to 5%.
Given the process of development,
it isn't surprising that these disorders in some youth are known to wax and wane, such that some afflicted children improve
as development unfolds, perhaps as a result of healthy influences impinging on them.
Similarly, other youth, formerly
only “at risk,” may develop full-blown forms of disorder, as severe and devastating in their impact on the youth and his or her family as are the analogous conditions that affect adults. Characterizing such
disorders as relatively unchangeable underestimates the potential beneficial influences that can redirect a child whose development
has gone awry.
Likewise, characterizing children
with mental disorders as “only” the victims of negative environmental influences that might be fixed if societal factors were just changed runs the risk of underestimating the severity of these conditions and the need for focused, intensive clinical interventions for suffering children and adolescents.
Thus, the science of mental
health in childhood and adolescence is a complex mix of the study of development and the study of discrete conditions or disorders.
Both perspectives are useful. Each alone has its limitations, but together they constitute a more fully informed approach that spans mental health and illness and allows one to design developmentally informed strategies for prevention and treatment.
Development is the lifelong
process of growth, maturation and change that unfolds at the fastest pace during childhood and adolescence. An appreciation of normal development is crucial to understand mental health in children and adolescents and the risks they face in maintaining mental health.
Distortions in the process
of development may lead to mental disorders. This section deals with the normal development of understanding (cognitive development) in young children and the development of
social relationships and temperament.
Theories of Development
Historically, the changes that take place in a child’s psyche between birth and adulthood were largely ignored. Child development first became a subject of serious inquiry at the beginning of this century but was mostly viewed
from the perspective of mental disorders and from the cultural mainstream of Europe and white America.
Some of the“grand theories”
of child development, such as that propounded by Sigmund Freud, grew out of this focus and they unquestionably drew attention
to the importance of child development in laying the foundation for adult mental health.
Even those theories that resulted
from the observation of healthy children, such as Piaget’s theory of cognitive development, paid little attention to the relationship between the development
of the“inner self” and the environment into which the individual was placed. In contrast, the interaction of an individual with
the environment was central to the school of thought known as behaviorism.
Theories of normal development,
introduced in Chapter 2, are presented briefly below, because they form the basis of many current approaches to understanding and treating mental illness and mental health problems in children and adults. These theories haven't achieved the
broader objective of explaining how children grow into healthy adults.
More study and perhaps new
theories will be needed to improve our ability to guide healthy child-rearing with scientific evidence.
Viewed as a Series of Stages
the psychoanalyst Erik Erikson proposed a series of stages of development reflecting the attainment of biological objectives.
The stages are
expressed in terms of functioning as an individual and with others, within the family and the broader social environment (particularly in Erikson’s theories) (see Chapter 2).
as unscientific and relevant primarily to the era and culture in which they were conceived, these theories introduced the
importance of thinking developmentally, that is, of considering the ever-changing physical and psychological capacities and
tasks faced by people as they age.
the concept of “maturation” and moving through the
stages of life, adapting to changing physical capacities and new psychological and social challenges.
And they described
mental health problems associated with failure to achieve milestones and objectives in their developmental schemes.
These theories have guided
generations of psychodynamic therapists and child development experts. They're important to understand as the underpinnings of many therapeutic approaches, such as interpersonal therapy, some of which have been evaluated and found to be efficacious for some conditions.
By and large, however, these
theories have rarely been tested empirically.
Swiss psychologist Jean Piaget also developed a stage-constructed theory of children’s intellectual development. Piaget’s
theory, based on several decades’ observations of children (Inhelder & Piaget, 1958),
was about how children gradually acquire the ability to understand the world around them thru active engagement with it.
was the first to recognize that infants take an active role in getting to know their world and that children have a different understanding of the world than do adults. The principal limitations of Piaget’s theories are that they're descriptive rather than explanatory.
he neglected variability in development and temperament and didn't consider the crucial interplay between a child’s intellectual development and
his or her social experiences (Bidell & Fischer, 1992).
Other approaches to understanding development are less focused on the stages of development. Behavioral psychology focused on observation and measurement,
explaining development in terms of responses to stimuli, such as rewards.
Not only did the
theories of the early pioneers (e.g., Pavlov, Watson & Skinner) generate a number of
valuable treatments, but their focus on precise description set the stage for current programs of research based on direct observation.
Social learning theory (Bandura, 1977) emphasized role
models and their impact on children and adolescents as they develop. Several important clinical tools came out of behaviorism
(e.g., reinforcement and behavior modification) and social learning theory (cognitive-behavioral therapy). Both treatment approaches are used effectively with children and adolescents.
Social and Language
common knowledge that infants and for the most part, their principal caretakers typically develop a
close bond during the first year of life and that in the 2nd year of life children become distressed when they're forcibly separated from their mothers.
However, the clinical importance of these bonds wasn't fully appreciated until John Bowlby introduced the concept of attachment in a report on the effects of maternal deprivation (Bowlby, 1951). Bowlby (1969) postulated that the pattern
of an infant’s early attachment to parents would form the basis for all later social relationships.
On the basis of
his experience with disturbed children, he hypothesized that, when the mother was unavailable or only partially available during the first months of the child’s life, the attachment process would be interrupted, leaving enduring emotional scars and predisposing a child to behavioral problems.
A mother’s bond with her child often starts when she feels fetal movements during pregnancy. Immediately after birth, most, but by no means all, mothers experience a surge of affection that is followed by a feeling that the baby belongs to them.
may not occur at all or be delayed under conditions of addiction or postnatal depression (Robson & Kumar, 1980; Kumar, 1997). Yet, like all enduring
relationships, it seems that the relationship between mother and child develops gradually and strengthens over time.
Some infants who experience severe neglect in early life may develop mentally and emotionally without lasting consequences, i.e., they're adopted and their adoptive parents provide sensitive, stable and enriching care or if depressed or substance-abusing mothers recover fully (Koluchova, 1972; Dennis, 1973; Downey & Coyne, 1990).
however, early neglect is all too often the precursor of later neglect. When the child remains subject to deprivation, inadequate or insensitive care, lack of affection, low levels of stimulation and poor education over long periods of time, later adjustment is likely
to be severely compromised (Dennis, 1973; Curtiss, 1977).
In general, it appears that
the particular caregiver with whom infants interact (i.e., biological mother or another)
is less important for the development of good social relationships than the fact that infants interact over a period of time
with someone who is familiar and sensitive (Lamb, 1975; Bowlby, 1988).
One of the problems in the
later development of children who experience early institutionalization or significant neglect is that there may have been no opportunities for the caretakers and the infants to establish strong and mutual attachments in a reciprocating relationship.
interrupting the present article with this excerpt from: Child and Adolescent Mental Health SAMHSA
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.
if a child or adolescent you know has any of these warning signs:
A child or adolescent
is troubled by feeling:
A child or adolescent experiences big changes, such as:
- Showing declining
performance in school.
- Losing interest
in things once enjoyed.
unexplained changes in sleeping or eating patterns.
- Avoiding friends or family and wanting to be alone all the time.
too much and not completing tasks.
- Feeling life is too hard to handle.
- Hearing voices
that can't be explained.
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.
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
- 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.
research has established that successful use of language and communication is a cornerstone of childhood mental health.
only are strong language capabilities critical to the development of such skills as listening and speaking, but they also are fundamental to the acquisition of proficient reading and writing abilities. In turn, children
with a variety of speech and language impediments are at increasing risk as their language abilities fall behind those of their peers.
and baby start to communicate with each other vocally as well as visually during the first months of life. Many, but not all, developmental psychologists believe that this early pattern of mother-infant reciprocity and interchange
is the basis on which subsequent language and communication develop.
theorists have attempted to explain the relations between language and cognitive development (Vygotsky,
1962; Chomsky, 1965, 1975, 1986; Bruner, 1971; Luria, 1971), but no single theory has achieved preeminence.
a number of theories address language development from different perspectives, all theories suggest that language development
depends on both biological and socio-environmental factors. It's clear that language competence is a critical aspect of children’s
With Other Children
To be healthy,
children must form relationships not only with their parents, but also with siblings and with peers. Peer relationships change over time.
In the toddler period, children’s social skills are very limited; they spend most of their time playing side by side rather than with each other in a give and take fashion.
As children grow, their abilities
to form close relationships become highly dependent on their social skills. These include an ability to interpret and understand other children’s nonverbal cues, such as body language and pitch of voice.
Children whose social skills develop optimally respond to what other children say, use eye contact, often mention the other child’s name and may
use touch to get attention. If they want to do something that other children oppose, they can articulate the reasons why their
plan is a good one.
They can suppress their own
wishes and desires to reach a compromise with other children and may be willing to change, at least in the presence of another child, a stated belief or wish. When they're with a group of children they don't know, they're quiet but observant until they have a feeling for
the structure and dynamics of the group (Coie & Kuperschmidt, 1983; Dodge, 1983; Putallaz,
1983; Dodge & Feldman, 1990; Kagan et al., 1998).
In contrast, children who
lack such skills tend to be rejected by other children. Commonly, they are withdrawn, don't listen well and offer few if any reasons for their wishes; they rarely praise others and find it difficult to join in cooperative
activities (Dodge, 1983). They often exhibit features of oppositional defiant or conduct
disorder, such as regular fighting, dominating and pushing others around, or being spiteful (Dodge
et al., 1990).
Social skills improve with opportunities to mix with others (Bridgeman, 1981). In recent years, knowledge
of the importance of children’s acquisition of social skills has led to the development and integration of social skills training components into a number of successful therapeutic interventions.
During the past 2 decades,
as psychologists began to view the child less as a passive recipient of environmental input but rather as an active player in the process, the importance of temperament has become better appreciated (Plomin, 1986).
Temperament is defined as the repertoire of traits with which each child is born; this repertoire determines how people react to the
world around them. Such variations in characteristics were first described systematically by Anna Freud from her observations
of children orphaned by the ravages of World War II.
She noticed that some children
were affectionate, some wanted to be close but were too shy to approach adults and some were difficult because they were easily angered and frustrated (A. Freud, 1965).
The first major longitudinal
observations on temperament were begun in the 1950's by Thomas & Chess (1977). They distinguished 10 aspects of
temperament, but there appear to be many different ways to describe temperamental differences (Goldsmith et
Although there's some continuity
in temperamental qualities throughout the life span (Chess & Thomas, 1984; Mitchell, 1993), temperament
is often modified during development, particularly by the interaction with the caregiver.
i.e., a timid child can become
bolder with the help of parental encouragement (Kagan, 1984, 1989). Some traits of temperament, such as attention span, goal orientation, lack of distractibility and curiosity, can affect cognitive functioning because the more pronounced these traits are, the better a child will learn (Campos et al., 1983).
Of note, it isn't always clear
whether extremes of temperament should be considered within the spectrum of mental disorder (i.e., shyness or anxiety) or whether certain forms of temperament might predispose a child to the development of certain mental disorders.
Developmental Theory Applied to Child Mental Health and Illness
A number of central
concepts and guiding assumptions underpin our current understanding of children’s mental health and illness. These have been variously defined by different investigators (Sroufe & Rutter, 1984; Cicchetti & Cohen, 1995; Jensen, 1998), but by and large these tenets are based
on the premise that psychopathology in childhood arises from the complex, multi-layered interactions of specific characteristics
of the child (including biological, psychological and genetic factors),
his or her environment (including parent, sibling and family relations, peer and neighborhood factors, school and community factors and the larger social-cultural context) and the specific manner in which
these factors interact with and shape each other over the course of development.
Thus, an understanding of a child’s particular history and past experiences (including biologic events
affecting brain development) is essential to unravel the why’s and wherefore’s of a child’s
particular behaviors, both normal and abnormal.
While this principle assumes
developmental continuities, to the extent that early experiences are “brought forward” into the current behavior,
it's also important to consider developmental discontinuities, where qualitative shifts in the child’s biological, psychological and
social capacities may occur.
These may not be easily discerned
or predicted ahead of time and may reflect the emergence of new capacities (or incapacities)
as the child’s psychological self, brain and social environment undergo significant reorganization.
A second precept underlying
an adequate understanding of children’s mental health and illness concerns the innate tendencies of the child to adapt to his or her environment.
This principle of adaptation
incorporates and acknowledges children’s “self-righting” and “self-organizing” tendencies; namely, that a child within a
given context naturally adapts (as much as possible) to a particular ecological niche, or
when necessary, modifies that niche to get needs met.
When environments themselves
are highly disordered or pathological, children’s adaptations to such settings may also be pathologic, especially when
compared with children’s behaviors within more healthy settings.
This principle underscores
the likelihood that some (but not all) “pathologic” behavioral
syndromes might be best characterized as adaptive responses when the child or adolescent encounters difficult or adverse circumstances.
Notably, this ability to adapt
behaviorally is reflected at multiple levels, including the level of brain and nervous system structures (sometimes called neuroplasticity).
A third consideration that
guides both research-based and clinical approaches to understanding child mental health and illness concerns the importance of age and timing factors. i.e.,
a behavior that may be quite normal at one age (e.g., young children’s distress when separated from their primary caretaking figure) can be an important symptom or indicator of mental illness
at another age.
Similarly, stressors or risk factors may have no, little, or profound impact, depending on the age at which they occur and whether they occur
alone or with other accumulated risk factors.
A 4th premise underpinning
an adequate understanding of children’s mental health and illness concerns the importance of the child’s context. Perhaps the most important
context for developing children is their caretaking environment.
Research with both humans
and animals has demonstrated that gross disruptions in this critical parameter have immediate and long-term effects, not just
on the young organism’s later social-emotional development but also on physical health, long-term morbidity and mortality,
later parenting practices and even behavioral outcomes of its offspring.
Moreover, context may play
a role in the definition of what actually constitutes psychopathology or health. The same behavior in one setting or culture
might be acceptable and even “normative,” whereas it may be seen as pathological in another.
Yet another principle central
to understanding child mental health and illness is that normal and abnormal developmental processes are often separated only by differences
of degree. Thus, supposed differences between normal and abnormal behavior may be better understood by taking into account the differences in the amount or degree of the particular behavior, or the degree of exposure
to a particular risk factor. Frequently, no sharp distinctions
can be made.
The virtue of these developmental
considerations when applied to children is that:
- (a) they enable a broader,
more informed search for factors related to the onset of, maintenance of and recovery from abnormal forms of child behavior
- (b) they help move beyond
static diagnostic terms that tend to reduce the behaviors of a complex, developing, adapting and feeling child to an oversimplified
- (c) they offer a new perspective
on potential targets for intervention, whether child-focused or directed toward environmental or contextual factors
- (d) they highlight the possibility
of important timing considerations: windows of opportunity during a child’s development when preventive or treatment
interventions may be especially effective.
In the sections that follow,
these considerations will help the reader understand the important differences from chapters focusing principally on adults, as well as the unique opportunities for intervention
that occur because of these differences.
Overview of Risk
Factors and Prevention
to understanding the etiology of mental disorders in childhood are driven by empirical advances in neuroscience and behavioral research rather
than by theories.
research on the factors that make children vulnerable to mental illness is important for several reasons: delineating the range of risk factors for particular mental disorders
helps to understand their etiology; the populations most at risk can be identified; understanding the relative strength of different risk factors allows for the design of appropriate prevention programs for children in
different contexts and resources can be better allocated to intervene so as to maximize their effectiveness.
There is now good evidence
that both biological factors and adverse psychosocial experiences during childhood influence, but not necessarily “cause,”
the mental disorders of childhood. Adverse experiences may occur at home, at school or in the community.
A stressor or risk factor
may have no, little, or a profound impact, depending on individual differences among children and the age at which the child
is exposed to it, as well as whether it occurs alone or in association with other risk factors. Although children are influenced
by their psychosocial environment, most are inherently resilient and can deal with some degree of adversity.
However, some children, possibly
those with an inherent biological vulnerability (e.g., genes that convey susceptibility
to an illness), are more likely to be harmed by an adverse environment and there are some environmental adversities,
especially those that are long-standing or repeated, that seem likely to induce a mental disorder in all but the hardiest
A recent analysis of risk
factors by Kraemer and colleagues (1997) has provided a useful framework for differentiating
among categories of risk and may help point this work in a more productive direction.
Risk factors for developing
a mental disorder or experiencing problems in social-emotional development include:
- prenatal damage from exposure to alcohol, illegal drugs and
- low birth weight
- difficult temperament or an inherited predisposition to a mental disorder
- external risk factors such as poverty, deprivation, abuse and neglect
- unsatisfactory relationships
- parental mental health disorder
- exposure to traumatic events
Influences on Mental Disorders
seems likely that the roots of most mental disorders lie in some combination of genetic and environmental
factors, the latter may be biological or psychosocial (Rutter et al., 1999). However,
increasing consensus has emerged that biologic factors exert especially pronounced influences
on several disorders in particular, including:
pervasive developmental disorder (Piven & O’Leary, 1997)
& O’Leary, 1997)
early-onset schizophrenia (McClellan & Werry, in press)
also likely that biological factors play a large part in the etiology of social phobia (Pine, 1997), obsessive-compulsive disorder (Leonard et al., 1997) and other disorders such as Tourette’s disorder (Leckman et al., 1997).
Two important points about
biological factors should be borne in mind. The first is that biological influences aren't necessarily
synonymous with those of genetics or inheritance. Biological abnormalities of the central nervous system that influence
behavior, thinking, or feeling can be caused by:
- poor nutrition
- exposure to toxins, such as lead in the environment
These abnormalities aren't inherited. Mental disorders that are most likely to have genetic components include:
Second, it's erroneous to assume that biological and environmental factors are independent of each other, when in fact they
i.e., traumatic experiences may induce biological changes that persist. Conversely, children with a biologically based behavior may modify their
i.e., low-birth-weight infants
who have sustained brain damage and thereby become excessively irritable, may change the behavior of caretakers in a
way that adversely affects the caretaker’s ability to provide good care.
Thus, it is now well documented
that a number of biologic risk factors exert important effects on brain structure and function and increase the likelihood
of subsequently developing mental disorders.
These well-established factors
include intrauterine exposure to alcohol or cigarette smoke (Nichols & Chen, 1981),
perinatal trauma (Whitaker et al., 1997), environmental exposure to lead (Needleman et al., 1990), malnutrition of pregnancy, traumatic brain injury, nonspecific forms of mental retardation
and specific chromosomal syndromes.
A landmark study on risks from the environment (Rutter & Quinton, 1977) showed that several factors can endanger a child’s mental health. Dysfunctional aspects of family life such as:
- severe parental discord
- a parent’s psychopathology or criminality
- overcrowding or large family size can predispose
to conduct disorders and antisocial personality disorders, especially if the child doesn't have a loving relationship w/at
least one of the parents (Rutter, 1979)
- economic hardship can indirectly increase a child’s
risk of developing a behavioral disorder because it may cause behavioral problems in the parents or increase the risk of child abuse (Dutton, 1986; Link et al., 1986; Wilson, 1987; Schorr, 1988)
- exposure to acts of violence also is identified
as a possible cause of stress-related mental health problems (Jenkins & Bell, 1997)
- studies point to poor caregiving practices as being
a risk factor for children of depressed parents (Zahn-Waxler et al., 1990)
The quality of the relationship
between infants or children and their primary caregiver, as manifested by the security of attachment, has long been felt to be of paramount importance to mental health across the life span.
In this regard, the relationship
between maternal problems and those factors in children that predispose them to form insecure attachments, particularly young infants’ and toddlers’ security of attachment and temperament style and their impact on the development of mood and conduct disorders, is of great interest to researchers.
Many investigators have taken
the view that the nature and the outcome of the attachment process are related to later depression, especially when the child is raised in an abusive environment (Toth & Cicchetti, 1996) and to later conduct disorder (Sampson
& Laub, 1993).
The relationship of attachment to mental disorders has been the subject of several important review articles (Rutter, 1995; van
IJzendoorn et al., 1995).
There's controversy as to
whether the key determinant of “insecure” responses to strange situations stems from maternal behavior or from
an inborn predisposition to respond to an unfamiliar stranger with avoidant behaviors, such as is found in socially phobic children (Belsky & Rovine, 1987; Kagan et al., 1988; Thompson et al., 1988; Kagan, 1994, 1995).
Kagan demonstrated that infants
who were more prone to being active, agitated and tearful at 4 months of age were less spontaneous and sociable and more likely
to show anxiety symptoms at age 4 (Snidman et al., 1995; Kagan et al., 1998).
These findings are of considerable
significance, because long-term study of such highly reactive, behaviorally inhibited infants and toddlers has shown that
they are excessively shy and avoidant in early childhood and that this behavior persists and predisposes to later anxiety (Biederman
et al., 1993).
There is also some controversy
as to whether “difficult” temperament in an infant is an early manifestation of a behavior problem, particularly in children who go on to demonstrate such problems
as conduct disorder (Olds et al., 1999).
One analysis of the attachment literature suggests that abnormal or insecure forms of attachment are largely the product of maternal problems, such as depression and substance abuse, rather than of individual differences in the child (van IJzendoorn et al., 1992).
The relationship between a
child’s temperament and parenting style is complex (Thomas et al., 1968); it may be either protective if it's good or a risk factor if it's poor. Thus, a difficult child’s chances of developing mental health problems
are much reduced if he or she grows up in a family in which there are clear rules and consistent enforcement (Maziade et al., 1985), while a child exposed to inconsistent discipline is at greater risk for later behavior problems (Werner & Smith, 1992).
Family and Genetic Risk Factors
noted above in the relationships between temperament and attachment, in some instances the relative contributions of biologic influences and environmental influences are difficult to tease
apart, a problem that particularly affects studies investigating the impact of family and genetic influences on risk for childhood
research has shown that between 20 & 50% of depressed children and adolescents have a family history of depression (Puig-Antich et al., 1989; Todd et al., 1993; Williamson et al., 1995; Kovacs, 1997b).
The exact reasons for this increased risk haven't been fully clarified, but experts tend to agree that both factors interact
to result in this increased risk (Weissman et al., 1997).
research has found that children of depressed parents are more than 3 times as likely as children of nondepressed parents to experience a depressive disorder (see Birmaher et al., 1996a and 1996b for review).
Parental depression also increases the risk of anxiety disorders, conduct disorder and alcohol dependence (Downey & Coyne, 1990; Weissman et al., 1997; Wickramaratne & Weissman, 1998). The
risk is greater if both parents have had a depressive illness, if the
parents were depressed when they were young, or if a parent had several episodes of depression (Merikangas et al., 1988; Downey & Coyne, 1990; McCracken, 1992a, 1992b; Mufson et al., 1992; Warner et al., 1995;
Wickramaratne & Weissman, 1998).
of Parental depression
Depressed parents may be withdrawn and lack energy and consequently pay little
attention to, or provide inadequate supervision of, their children.
such parents may be excessively irritable and overcritical, thereby upsetting children, demoralizing them and distancing them (Cohn et al., 1986; Field et al., 1990).
At a more subtle
level, parents’ distress, being pessimistic, tearful, or threatening suicide, is sometimes seen or heard by the child, thereby inducing anxiety. Depressed parents may not model effective coping strategies for stress; instead of “moving on,” some provide an example of“giving up” (Garber
& Hilsman, 1992).
Depression is also often associated with marital discord, which may have its own adverse effect on children and adolescents. Conversely, the behavior of the depressed child or teenager may contribute to family stress as much as being a product of it.
The poor academic performance, withdrawal from normal peer activities and lack of energy or motivation of a depressed teenager may lead to intrusive or reprimanding reactions from parents that may further reduce the youngster’s self-esteem and optimism.
The consequences of maternal depression vary with the state of development of the child and some of the effects are quite subtle (Cicchetti & Toth,
i.e., in infancy, a withdrawn or unresponsive depressed mother may increase an infant’s distress and an intrusive or hostile depressed mother may lead the infant to avoid looking at and communicating with her (Cohn et al., 1986). Other studies have shown that if
infants’ smiles are met with a somber or gloomy face, they respond by showing a similarly somber expression and then
by averting their eyes (Murray et al., 1993).
During the toddler stage of
development, research shows that the playful interactions of a toddler with a depressed mother are often briefer and more likely to be interrupted (by either the mother or the child)
than those with a nondepressed parent (Jameson et al., 1997).
Research has shown that some
depressed mothers are less able to provide structure or to modify the behavior of excited toddlers, increasing the risk of out-of-control behavior, the development of a later conduct disorder, or later aggressive dealings with peers (Zahn-Waxler et al., 1990; Hay et al., 1992).
A depressed mother's inability to control a young child’s behavior may result in the child failing to learn appropriate skills for settling
disputes without reliance on aggression.
Stressful Life Events
between stressful life events and risk for child mental disorders is well established (e.g., Garmezy, 1983; Hammen, 1988; Jensen
et al., 1991; Garber & Hilsman, 1992), although this relationship in children and adolescents is complicated, perhaps
reflecting the impact of individual differences and developmental changes.
a relationship between stressful life events, such as parental death or divorce and the onset of major depression in young children, especially if they occur in early childhood and lead to a permanent and negative change in the child’s circumstances.
Yet findings are
mixed as to whether the same relationship is true for depression in mid-childhood or in adolescence (Birmaher et al., 1996a & 1996b; Garrison et al., 1997).
Child abuse is a very widespread problem; it's estimated that over 3 million children are maltreated every year in the US (National Committee to Prevent Child Abuse, 1995).
Physical abuse is associated with insecure attachment (Main &
Solomon, 1990), psychiatric disorders such as post-traumatic stress disorder, conduct disorder, ADHD (Famularo et al., 1992), depression (Kaufman,
1991) and impaired social functioning with peers (Salzinger et al., 1993).
maltreatment is believed to occur more frequently than physical maltreatment (Cicchetti
& Carlson, 1989); it is associated with depression, conduct disorder and delinquency (Kazdin
et al., 1985) and can impair social and cognitive functioning in children (Smetana &
Peer and Sibling Influences
of maladaptive peers can be very damaging to a child and greatly increases the likelihood of adverse outcomes such as delinquency,
particularly if the child comes from a family beset by many stressors (Friday & Hage, 1976;
Loeber & Farrington, 1998).
One way to reduce
antisocial behavior in adolescents is to encourage such youths to interact with better adapted youths under the supervision of a mental health worker (Feldman
et al., 1983). Sibling rivalry is a common component of family life and especially in the presence of other risk factors,
may contribute to family stresses (Patterson &
universal, in the presence of other risk factors it may be the origin of aggressive behavior that eventually extends beyond the family (Patterson & Dishion, 1988). In stressed or large families, parents have many demands placed on their time and find it difficult to oversee, or place limits on, their young children’s behavior.
attention is in short supply, young siblings squabbling with each other attract available attention. In such situations, parents
rarely comment on good or neutral behavior but do pay attention, even if in a highly critical and negative way, when their
children start to fight; as a result, the act of fighting may be inadvertently rewarded.
Thus, any attention,
whether it be praise or physical punishment, increases the likelihood that the behavior is repeated.
and Interactions Among Risk Factors
evidence suggests that social/environmental risk factors may combine with physical risk factors of the child, such as:
testing models of the impact of risk factor interactions for the development of mental disorders is difficult, because some
of the risk factors are difficult to measure.
Thus, the trend these days is to move away from the consideration of individual
risk factors toward identifying measurable risk factors and their combinations and incorporating all of them
into a single model that can be tested (Patterson, 1996).
The next section describes
a series of preventive interventions directed against the environmental risk factors described above.
is an important time to prevent mental disorders and to promote healthy development, because many adult mental disorders have related antecedent problems in childhood.
it's logical to try to intervene early in children’s lives before problems are established and become more refractory.
The field of prevention has now developed to the point that reduction of risk, prevention of onset and early intervention
are realistic possibilities.
methodologies in prevention are increasingly sophisticated and the results from high-quality research trials
are as credible as those in other areas of biomedical and psychosocial science.
a growing recognition that prevention does work; i.e., improving parenting skills through training can substantially reduce antisocial behavior in children (Patterson
et al., 1993).
human services and law enforcement communities, not just the mental health community, have made prevention a
priority. Policymakers and service providers in health, education, social services and juvenile justice have become invested
in intervening early in children’s lives:
they've come to appreciate that mental health is inexorably linked with general health, child care and success in the classroom and inversely related to involvement in the juvenile justice system.
perceived that investment in prevention may be cost-effective. Although much research still needs to be done, communities and managed health care organizations eager to develop, maintain and measure empirically supported
preventive interventions are encouraged to use a risk and evidence-based framework developed by the National Mental Health
Association (Mrazek, 1998).
of primary prevention are so familiar that they are no longer thought of as mental health prevention activities, when, in fact, they are. For example, vaccination against measles prevents its
neurobehavioral complications; safe sex practices and maternal screening prevent newborn infections such as syphilis and HIV,
which also have neurobehavioral manifestations.
to control alcohol use during pregnancy help prevent fetal alcohol syndrome (Stratton et al., 1996).
All these conditions may produce mental disorders in children.
describes several exemplary interventions that focus on enhancing mental health and primary prevention of behavior problems and mental health disorders.
of a disorder or its recurrence or exacerbation is discussed together with that disorder in other sections of this chapter.
Prevention strategies usually target high-risk infants, young children, adolescents and/or their caregivers, addressing the
risk factors described above.
Project Head Start
Project Head Start, though generally conceived of as an early childhood intervention program, is probably
this country’s best known prevention program.
In 1965, when it was designed and first implemented in 2,500 communities, Head Start’s target population
was economically disadvantaged preschool children.
Its goal was to
improve the social competence of these children through an 8-week comprehensive intervention that included a center-based
component and a home visit by community aides, focusing on social, health and education services (Karoly
et al., 1998).
A number of psychologists, most notably Jerome Bruner (1971), argued
that children can be trained to think in a more logical way and that the development of logic isn't entirely predetermined.
Bruner’s views were very influential in launching early intervention programs such as Head Start.
There is now ample evidence that, by providing an appropriately stimulating environment, significant advances in knowledge
and reasoning ability can be achieved.
has served over 15 million children and has cost $31 billion since its inception (General Accounting
Office, 1997). It has changed in many ways in the intervening years and there now is considerable program variation
across localities (Zigler & Styfco, 1993).
evaluations of Head Start showed promising results in terms of higher IQ scores, but over the years many of
the findings have met with criticism and skepticism. The reason is that there has been no national randomized controlled trial
to evaluate the program as originally designed (Karoly et al., 1998).
evaluations of Head Start programs that did not employ such a rigorous design (Berrento-Clement
et al., 1984; Seitz et al., 1985; Lee et al., 1990; Yoshikawa, 1995) have shown that, although focused early education
can improve test scores, the advantage is short-lived.
scores of children of comparable ability who don't receive early childhood education quickly catch up with those
who have been in Head Start programs (Lee et al., 1990). Yet there appear to be more enduring
of 36 studies of Head Start and other early childhood programs found them to lower enrollment in special education and to
enhance rates of high school graduation and promotion to the next grade level (Barnett, 1995).
and other forms of early education offer arguably even more important benefits, which don't become apparent until children are older.
are mainly social, rather than cognitive, and include better peer relations, less truancy and less antisocial behavior (Berrento-Clement et al., 1984; Provence, 1985; Seitz et al., 1985; Webster-Stratton, 1998; Weikart, 1998).
important from a societal perspective, it isn't known whether these very significant benefits are due to direct effects on the
child or to the parent education programs that often accompany Head Start programs (Zigler &
Carolina Abecedarian Project
The Carolina Abecedarian Project is an example of an early educational intervention for high-risk children
that has been tested more rigorously than Head Start in well-designed, randomized and controlled trials.
It addresses the issue of the timing of the intervention, that is, when an intervention should begin and
how long it should continue. Unlike Head Start, children were enrolled in this program at birth and remained in it for several
Carolina Abecedarian Project, children who had been identified at birth as being at high risk for school failure
on the basis of social and economic variables were enrolled in a child-centered prevention-oriented intervention program delivered
in a day care setting from infancy to age 5 (Campbell & Ramey, 1994 1).
intervention operated 8 hours a day for 50 weeks a year and included an infant curriculum to enhance development
and parent activities.
school age, a 2nd intervention was provided: the children, who were then in kindergarten, received 15 home visits
a year for 3 years from a teacher who prepared a home program to supplement the school’s basic curriculum. There were
significant positive effects from the 2-phase intervention on intellectual development and academic achievement and these
effects were maintained through age 12, which was 4 years after the intervention ended.
Infant Health and
The Infant Health and Development Program (IHDP) also began
at birth and continued for several years and was also designed for low-birth-weight and premature infants (McCarton et al., 19972).
was provided until the children reached 3 years of age. It included pediatric care, home visits, parent group meetings and
center-based schooling 5 days a week from 12 months of age to 3 years.
At the end of the intervention, the group receiving it had significantly higher mean IQ scores than did
the control group. Of note, although children’s behavior problems weren't targeted by the intervention, mothers of children in the intervention group reported significantly fewer behavior
problems than those in the control group.
Elmira Prenatal / Early
The Elmira Prenatal/Early Infancy Project is an excellent example of a preventive intervention that targeted
an at-risk population to prevent the onset of a series of health, social and mental health problems in children and in their
mothers (Olds et al., 1998 & previous years3 ).
warrants special attention because of its positive and enduring findings, randomized, controlled design, cost-benefit
analysis and unusually long-term follow up of 15 years. The study began by focusing on pregnant women bearing their first
child in a small, semi-rural county in upstate New York.
of these women were considered high risk because of their mother’s young maternal age, single-parent status,
or low socioeconomic level. There were 4 study groups to which random assignment was made.
group received developmental screening at ages 1 and 2.
group received screening and free transportation to health care.
group received screening, transportation and nurse home visits once every 2 weeks during pregnancy.
group received all of the above plus continued home visits by a nurse on a diminishing schedule until the infants
were 24 months of age.
focused on parent education, enhancement of the women’s informal support systems and linkage with community services.
in both groups receiving home visits from nurses had many positive behavioral outcomes compared with groups
that received screening only or screening plus transportation.
the women at highest risk for caregiver dysfunction, those who were visited by a nurse had fewer instances of
verified child abuse and neglect during the first 2 years of their children’s lives.
observed in their homes to restrict and punish their children less frequently and they provided more appropriate
play materials. There were no differences between groups in the rates of new cases of child abuse and neglect or in the children’s intellectual functioning in the period when the children were 25 to 48 months of age.
nurse-visited children had fewer behavioral and parental coping problems (as noted in the physician record). Nurse-visited mothers were observed
to be more involved with their children than were mothers in the comparison groups.
analysis estimated program costs (direct costs of nurse visitation, costs of services
to which nurses linked families & costs of transportation) and benefits (cost outcomes
presumed to be affected by the program thru improved maternal & child functioning, such as less use of Aid to Families
With Dependent Children, Medicaid, food stamps, child protective services & greater tax revenues generated by women’s
a time point of 2 years after the program ended, the net cost of the program for the sample as a whole was $1,582
per family, but for low-income families, the cost of the program was recovered with a dividend of $180 per family.
years after the birth of the index child (13 years after termination of the intervention),
women who were visited by nurses during pregnancy and infancy had significantly fewer subsequent pregnancies, less use of
welfare, fewer verified reports of abuse and neglect, fewer behavioral impairments due to use of alcohol and other drugs and fewer arrests.
Their children, now adolescents, reported fewer instances of running away, fewer arrests, fewer convictions and
violations of probation, fewer lifetime sex partners, fewer cigarettes smoked per day and fewer days having consumed alcohol in the last 6 months. The parents of these adolescents reported that their children had fewer behavioral problems related
to use of alcohol & other drugs.
Primary Mental Health Project
The Primary Mental Health Project (PMHP) is a 42-year-old program for early detection and prevention of
young children’s school adjustment problems.
operates in approximately 2,000 schools in 700 school districts nationally and internationally. 7 states in the United States
are implementing the program systematically, based on authorizing legislation and state appropriations..
PMHP has 4 key elements:
(1) a focus on primary grade
(2) systematic use of brief
objective screening measures for early identification of children in need
(3) use of carefully selected,
trained, closely supervised nonprofessionals (called child associates)
to establish a caring and trusting relationship with children
(4) a changing role for the school professionals that features selection, training and supervision of child associates, early systematic
screening and functioning as program coordinator, liaison and consultant to parents, teachers and other school personnel.
model has been applied flexibly to diverse ethnic and sociodemographic groups in settings where help is most
needed. Over 30 program evaluation studies, including several at the state level, underscore the program’s efficacy (Cowen et al., 1996).
improvements were detected in children’s grades, achievement test scores and adjustment ratings by teachers
and child associates. PMHP represents a successful mental health intervention that doesn't require highly trained and skilled mental health professionals.
Other Prevention Programs and Strategies
These and other prevention trials demonstrate that positive adaptation and social-emotional well-being in children and youth can be enhanced and that risk factors for behavioral and
emotional disorders can be reduced, by intervening in home, school, day care and other settings. Programs have focused not
only on mental health but also on other problem behaviors. (Botvin et al., 1995; St. Lawrence et
al., 1995;Kellam & Anthony, 1998).
prevention trials are showing similar benefits. i.e., a large-scale, four-site school and home-based prevention
trial, known as FastTrack, has shown clear benefits in reducing behavior problems among high-risk children, as well as in
reducing needs for and use of special education, which has substantial cost-effectiveness implications (Conduct
Problems Prevention Research Group, 1999a, 1999b).
Another trial is now under
way to test the efficacy of a preventive intervention provided to adolescents whose parents are currently being treated for
depression within a health maintenance organization (Clark et al., 1998).
Treatment of mood disorders also has potential effectiveness for the primary prevention of suicide, as explained in the later section on Depression and Suicide in Children and Adolescents
note: concerning the surgeon general's report on your left, it's very informative for those who aren't familar with mental health
perceptions & past history, as well as the changing face of mental health & illness in our world today.
unfortunately, it's an old piece. perhaps with the new appointment in health & human services we'll see a new &
updated report in the near future. being familiar with the information is important though, as a basis or foundation, for
future knowledge concerning the same. it's really helpful.
below you will find some additionall & very pertinent information as to why the overall picture concerning raising
children will become increasingly important to you as a parent in recognizing personal issues that you may be or have
been facing throughout your adult life & simply weren't aware of their basis.
thanks for visiting!
Anxiety Disorders & Depression in Children
what is attention deficit hyperactivity disorder?
Attention Deficit Hyperactivity Disorder (ADHD)Attention Deficit Hyperactivity
Disorder, ADHD, is one of the most common mental disorders that develop in children. Children w/ADHD have impaired functioning
in multiple settings, including home, school & in relationships w/peers. If untreated, the disorder can have long-term
adverse effects into adolescence & adulthood.
Attention Deficit Disorder (ADD) &
Learning "Disabilities" - By DeAnne Joy
that between 4-10% of our youth are now diagnosed as having Attention
It can be frustrating and discouraging to deal with symptoms of ADD.
Here’s the great
news: there's nothing "wrong" with your child or with you as the parent; there's nothing that needs to be “fixed.”
You and your child
have ALL of the resources within you to experience success in school, at home and in the world. If your child is not succeeding in school or at home, it simply means that she doesn't have effective tools for doing so.
Once we teach her
world-class skills for succeeding at home and in school, she'll no doubt be successful.
A diagnosis can
be helpful in giving us a framework for understanding what the reason is behind the challenging behaviors or the poor school performance. You can understand the behavior better when you understand where it's coming from.
When you understand that it’s not a matter of whether or not your child is trying hard enough, rather that it's simply a matter
of her not having the tools to be successful in learning, then you can respond differently to it.
ADD, Dyslexia and
other learning “differences” are a way of describing how a person’s brain is wired or the way in
which they process information. It doesn’t mean that they don't process or learn information; it simply means that they
do it better using certain strategies or processes than with others, as we all do.
In order to help you
understand your child's experience of the world, you need to understand exactly what goes on in the mind of a young person with ADD.
Here’s a way
in which you can begin to understand the experience of a child with ADD.
I want you to imagine
that you’re driving in a rainstorm without the windshield wipers on. Pretty frustrating, isn't it? Imagine the effort it would require to keep your mind focused on the road ahead just in order to keep yourself
and others feeling safe and protected.
Yet, that's precisely
what goes on in the mind of a young person with ADD. The screen simply becomes blurred without
the ability to use the wipers to get rid of unnecessary cloudiness.
She's trying as hard
as she can to process all of the information coming into her experience. Of course, what often happens is that the conscious
mind becomes overwhelmed and she may simply shut down, stop paying attention and give up or it might be played out physically in the body which might
be seen as anxious, aggressive or hyperactive behavior.
The first step in helping your child to learn effectively
is to help her determine what her particular strategy is for learning and then to teach her very precise, effective strategies
for learning information most effectively.
A visual learning strategy
is the most effective strategy for learning academic tasks like spelling words, math facts and vocabulary words; learning
visually makes learning fun, interesting and much less time-consuming.
In order to teach
a young person a visual learning strategy, she must first believe that she CAN learn by making pictures in her mind. Often, young people who are diagnosed as having ADD
or some other "learning difference" feel that they can't control their own mind, but rather that their mind controls them.
In order to begin
to teach effective learning strategies, we need to begin with helping the child to see that indeed she CAN control her own mind and the pictures that she makes in her mind.
The first step is to assist
the child in slowing down the pictures in her own mind and slowing her body down so that she can learn and implement simple,
effective learning strategies and begin to experience more success at school as well as at home.
In addition, we
want to provide her with the kind of environment that will best support her and her particular needs; for most kids and especially for kids with ADD, the environment that's most supportive of their needs is one that's unconditional, structured and consistent while providing them enough freedom to learn to negotiate the world on their own.
My Take on the Mental Health Issues Facing Children Today
by Kathleen Howe
I'm not only a mom, I'm the mom of kids who have experienced
mental health issues. I've been on a lifelong path of dysfunction, mental illness, abuse and other very negative factors.
It wasn't until about six years ago that I discovered how mental illness entered into my life and that it entered into
my life in my childhood.
You see, you can get all the information that is in the
left hand column from research professionals, medical professionals and mental health professionals, but unless they've been
parents experiencing a mental illness themselves or with their children - I have an advantage of knowledge AND experience
on my side.
First of all there's millions of people that aren't AWARE
of the presence of mental illness in our world today. They have no idea. There are even very educated medical professionals
who don't have a Blue's Clues Clue concerning mental illnesses. When I began this journey almost six years ago there was a
very high percentage - over 50% of professional, educated people including medical doctors who believed that mental illness
was a state of mind. Get over that myth. Mental illness is very real and if you don't believe me - then read the professionally
written gobble-dee-gook in the left hand column. Check the sources as well!
In my own personal growth recovery journey I decided that I had to go back into my own history to see exactly what happened to me that determined I would live forty
plus years living in abusive relationships. I used to blame my own inadequacy believing I was stupid for putting up to it.
Much of it I just couldn't explain. But after researching long and very hard I learned some important information. Let me
give you a time line and what I learned about mental health and mental development.
I began from before birth!
What was happening during the years my mother and father were raised? What was happening in
the world? What were the social standards and expectations?
Yes, these factors affected my individual growth as a child.
Amazing isn't it? What my grandmother believed had a direct effect on how I was raised as a child. My grandmother raised my
mother and my mother believed what she was taught for the most part, so she continued on raising me believing the same things
she was taught. See how it goes?
My mother was the oldest daughter in a family with a mother
and father who were married and living together with a stay at home mom; as well as the three sisters she had. A family of
four girls - what does this mean? Well, dig into your past and your parents' past as far as you can. Ask questions. I had
heard through eavesdropping that my mother had actually been a twin. What would that have changed if my mother had been a
twin? And that twin died sometime, what happened? Most important factor - that twin was supposedly a boy. The only boy in
the family to carry on the family name - dies. That's important to realize.
So, if that rumor was true - how did it affect my mother? How would you feel
if your twin had died at birth? How would you feel if no one ever talked about it like it was wrong or something horrible
to be ashamed of? Wouldn't you think that this factor would affect my mother's thinking processes and belief systems?
This is how it all works. So my father is the oldest
of three siblings, but his father had a family prior to my father's family. There had been a previous marriage and his wife
had died from a medical problem. That wife had given birth to two boys. Why weren't they all closer with each other? We had
a very close family, but I don't think I ever met the step brothers. Good reason for one of them, come to find out - one died
from a physical ailment.
My father was raised in a family that prohibited
alcohol in the house, and yet he was a drinker - often too much. I knew both sets of my grandparents because they lived in
the same town. They were very different. My parents were high school sweethearts. But what happened that would cause my parents
to be the narcissists they were? These are the things that you want to look into in your investigation.
Checking for important factors
will allow you to develop your natural curiosity. Most of us have forgotten how to use it! I discovered that my father wasn't at my birth, but my grandfather instead of my grandmother was with my mother through her labor.
The reason was that my father had enlisted into the Army. He was gone for some very long lengths of time during my first few
years of life. I never realized this, but having an absent parent early in your childhood when
you are developing who you really are - can make a difference! Read about absent parents and you'll find out!
Many parents don't realize until it's too late that having
two parents can have a bearing on mental health.
Absent Parents and Left Behind Kids
Judy H. Wright
“Why did my daddy leave? Was it because I
was a bad girl or he didn’t love us anymore?”
Explaining the absent
parent is never easy, but it is necessary. For children, their primary fear is of abandonment and loss of parental love. There may be a number of reasons that the family is no longer intact, if it ever was, but the child is looking for reassurance
that it is not their fault and that they will be cared for.
Children’s lives revolve around
their family: The family unit is all they have ever known and to hear that a parent or caregiver is no longer going
to be there is very traumatic and almost unbelievable. They will jump to a number of conclusions,
most of them wrong and blaming themselves, in an effort to find answers and just cope. In an effort to make sense of the situation, they may become clingy to the caregiver and
think “If he left, maybe you will too.”
Feelings of Abandonment and isolation:
No matter what other reactions
children may demonstrate to the adults in their lives, almost all have a deep and pervasive sorrow
and sadness about them. One of the best things you can do for your children is to allow them to express their grief. Prolonged crying and preoccupation with the lost relationship are normal responses.
Parents and family frequently
try to hide their own despair and disappointment from the children, but by talking with them about feelings and emotions, you can give them permission to open up and share.
1 out of every 4 American children
lives in a single-parent home. While most single-parent homes are the result of divorce, many parents and grandparents are raising children alone for other reasons as well. Some may be alone due to the death of
a spouse, military assignments, single parent adoption, incarceration, drug or alcohol abuse and a myriad of other reasons for a parent to be absent in the life of a child.
Put the children’s needs first:
As an adult it is your responsibility to care for the children, both physically and emotionally. Recognize that a long period of grief and mourning are natural.
A preschooler may regress
in such things as toilet training or begin to have nightmares or new fears. School age children may be showing signs of anger, guilt and sadness.
You may see a drop in school grades
and activities. Teenagers may assume they will be forced into an adult role or not have money enough for his needs. No matter what the age, some children feel responsible for the absent parent and harbor dreams about making it all right again.
If you can not work out problems
by open communication and cooperation, do not hesitate to get professional help. Their self-esteem and future happiness may depend on it.
Family: Absent Parents And Left Behind Kids
©2006 Judy H. Wright, Parent Educator
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Perhaps the most important word
in the article above is - "recognize." Reason being: it's up to parents to know their children well enough that they can "recognize" that there is something bothering their child. Do you believe that your parents knew enough about you that they would "recognize" when something was bothering you enough to affect your behavior? Would they deal with the problem by talking to you about
it? Did you parent ever try to get you to talk about whatever it was that was bothering you?
If you're a baby boomer reading this - it's most likely
that your parents didn't recognize that anything was bothering you. It was too difficult for mothers to perform their expected duties and recognize if something
was bothering their child. Besides, my parents' generation believed whole heartedly that children were to be seen - not heard.
They believed that it didn't matter how we felt. We were the minority or the subservients.
After researching the social norms in my parents' upbringing
I found it amazing what women were expected to do.
women's role in the 50's?
pearls & oven mitts?
...it must be a 50's housewife!
Business If You Do
"Your family, my family - which is composed of an
immediate family of a wife & 3 children, a larger family w/ grandparents & aunts & uncles."
Vice President Dan Quayle
THOSE OF US WHO
grew up in the 1950's got an image of the American family that wasn't, shall we say,
We were told,
Father Knows Best, Leave It to Beaver & Ozzie & Harriet weren't just the way things were
supposed to be, but the way things were.
Things were not that
It's probably good
that life wasn't like the television shows in the '50s - we wouldn't have many women now. Take a look at the ratio of boys
to girls on the most popular family shows.
Ozzie & Harriet had 2 boys, 0 girls.
Leave It to Beaver had 2 boys, 0 girls.
Rifleman had 1 boy, 1 rifle, 0 girls.
Lassie had 1 boy, one dog (supposedly a girl, but
played by a boy) & 0 girls.
My Three Sons had - well, that one's obvious.
Bonanza had 3 grown-up boys.
Although Lucille Ball & Desi Arnaz in real life
had 1 boy & 1 girl, on I Love Lucy they had 1 boy.
The only shows w/daughters were The Donna Reed Show
(1 boy, 1 girl) & that lighthouse to womanhood despite its title....
Father Knows Best (1 boy, 2 girls).
maturity, that's a late -1960's dating population of 15 men to 3 women.
"Whatever trouble he's in,
his family has the right to share it w/him. It's our duty to help him if we can & it's his duty to let us & he doesn't
have the privilege to change that."
The Big Valley
No children from prior relationships
No threat or even thought
The closest thing we saw to physical abuse was Ralph Kramden's,
"One of these days, Alice, one of these days . . to the moon!"
There were no infidelities
No drinking problems
- Almost all the households were mama-papa-kiddies: the nuclear
(The exceptions were
My Three Sons & Bonanza: Steve Douglas [Fred MacMurray] & Ben Cartwright were widowers.)
- There were no prior marriages
(not even prescription tranquilizers)
(How could there be?
With the exception of Hop Sing & Ricky Ricardo, there was only 1 race; even the Hispanic gardener on Father Knows Best
was named Frank Smith)
- There was no dropping out of school
- No political discussion
(much less political differences)
(except for Ozzie's early retirement)
- No severe economic problem
(except for a crop failure
on Lassie, when they had to sell all the livestock, including Lassie; but just before being carted off, Lassie pawed the ground
& struck oil & everything was okay again. Except for Lassie, who looked as though the Exxon Valdez had dumped
its forward holding tanks on her)
- The father was the breadwinner
- The mother was the bread maker
(the only mother who
came close to working was Lucy, becoming the spokeswoman for Vitavita-Vegimen or that afternoon at the candy factory)
- There was no fear of the bomb
(which is what we kids were terrified about in
(although white lies,
mischief & misunderstandings were needed for laughs)
- Life was wholesome, wholesome, wholesome.[*FN]
As much as the religious right
likes to point to 1950's sitcom wholesomeness as the Ideal American Family, these shows, in fact, had a remarkable lack of
What religion were
these people? They certainly weren't Jewish. And, other than possibly Ricky Ricardo, none of them was Catholic.
They were probably safely
But that was the name of the
game: play it safe. In playing it safe, there was less mention of God & religion on these shows than actually took place
in American families in the '50's.
That life doesn't exist anymore.
But then, it never did.
When I was a boy, my family took great care w/our
snapshots. We really planned them. We posed in front of expensive cars, homes that weren't ours. We borrowed dogs. Almost
every family picture taken of us when I was young had a different borrowed dog in it.
The Good Wife's Guide
Housekeeping Monthly - May 13, 1955
- Have dinner ready. Plan ahead, even the night before, to have a delicious meal ready, on time for his return. This is a way of letting
him know that you've been thinking about him & are concerned about his needs. Most men are hungry when they come home & the prospect of a good meal (especially his favorite
dish) is a part of the warm welcome needed.
- Prepare yourself. Take 15 minutes to rest
so you'll be refreshed when he arrives. Touch up your make-up, put a ribbon in your hair & be fresh-looking. He has just
been with a lot of work-weary people.
- Be a little gay & a little more interesting for him. His boring day may need a lift & one of your duties is to provide it.
- Clear away the clutter. Make a last trip thru the main part of the house just before your husband arrives.
- Gather up schoolbooks, toys, paper, etc. & then run a dust cloth over the tables.
- Over the cooler months of
the year you should prepare & light a fire for him to
unwind by. Your husband will feel he has reached a haven
of rest & order & it'll give you a lift too. After all, catering for his comfort will provide you with immense personal satisfaction.
- Prepare the children. Take a few minutes to wash the children's
hands & faces (If they're small), comb their hair & if necessary, change their clothes.
They're little treasures & he would like to see them playing the part. Minimize all noise. At the time of his arrival,
elminate all noise of the washer, dryer or vacumn. Try to encourage the children to be quiet.
- Be happy to see him.
- Greet him with a warm
smile & show sincerity in your desire to please him.
- Listen to him.
You may have a dozen important things to tell him, but the moment of his arrival isn't the time. Let him talk first -
remember, his topics of conversation are more important than yours.
- Make the evening his. Never complain if he comes home late or goes out to dinner or other
places of entertainment without you, instead try to understand his world of strain & pressure & his very real need to be at home & relax.
- Don't greet him with complaints &
- Don't complain if he's late home for dinner or even if he stays out all night. Count this as minor compared to what he might have gone thru that day.
- Make him comfortable. Have him lean back in a comfortable chair or have him lie down in the bedroom. Have a cool or warm drink ready for
- Arrange his pillows & offer to take off his shoes. Speak in a low, soothing & pleasant voice.
- Don't ask him questions about his actions or question his judgment of integrity. Remember, he's the master of the house & as such will always exercise his will with fairness & truthfulness. You have no right to question him.
- A good wife always knows her place.
Do you understand now why your mother is neurotic? That's a tongue in cheek joke, but it's most likely true.
Did you have a family history of anxiety disorders or depression? Were you depressed early
on - perhaps with postpartum depression or depression in the early years of toddler time? Children that grow up with a parent
how is depressed have a much higher risk of becoming depressed themselves!
HEALTHY PSYCHOLOGICAL PRINCIPLES
Lloyd J. Thomas, Ph.D. has
30+ years experience as a Life Coach and Licensed Psychologist. He is available for
coaching in any area presented in “Practical Life Coaching” (formerly “Practical Psychology”).
Initial coaching sessions are free. Contact him: DrLloyd@CreatingLeaders.com or LJTDAT@aol.com.
By Lloyd J. Thomas, Ph.D.
Over the past few months,
millions of Americans have lost their jobs; the economy has spiraled downward; and the amount of anxiety in our lives has spiraled upward. Health care professionals know that approximately 85 %
of the reasons we seek medical treatment are “stress-related.” I suspect that the incidence of stress-related illness is also dramatically increasing.
I have spent the last 35 years
of my professional career helping people to maximize the wellness of their lives. During that time, I have identified
several principles which, if understood and followed, lead to health, wealth and happiness beyond our usual imaginings, even when we are going through extremely stressful times. Here are seven of those principles.
1. If you don’t
learn the lesson now, it will return over and over again. So many of us are into quick and easy solutions to life’s
perceived problems. We take a “Band-Aid” approach. When something bad happens, rather than feeling
helpless and victimized, take extreme steps to discover and resolve the source of the difficulty.
Become aware that by the time
you realize the event as a “lesson,” you have probably experienced it at least 3-4 times before. Learn from
repeated (and undesired) experiences and replace them with new (and desired) ones based upon resolution of the source of the undesired experience.
Example: if you are currently
unemployed, spend 8 hours a typical workday seeking employment:
- sending out resumes
- seeking retraining
- advertising yourself as available (and skilled)
- checking websites and newspapers for “want ads”
2. We attract who and
what we are ready for. We don’t like to believe this one, but it’s true. The sooner we take full responsibility
for the quality of who we are, the quicker we will attract what the universe needs to give us.
Someone once said,
is not God’s denial.”
The solution is to grow, and
to grow out of what you are attracting now, and into what you want to have. A willingness and desire to change, sometimes
drastically, is often the signal for the Universe to provide you everything you desire.
Success at anything begins
with change in yourself. Ask yourself,
“What character traits
do I need to develop or strengthen so I will contribute to the change in my life I really want?”
When you express that character
trait(s) in your daily life, you more likely attract the outcomes you desire.
3. We are all interrelated
and connected, yet distinct as individuals. Energy, like the air, is always flowing between people, objects and the
universe. Energy is exchanged between the smallest of molecules as well as the largest of stars.
Energy is either beneficial
for you or it’s not. You need to protect yourself from people or situations which deliver energy that is harmful
to you. While we are all influenced by the energy of others, we can still do what we feel is best for us.
We needn’t live through
others. Money is another form of energy. Never commit yourself to spending it when you don’t already have
4. Having it all is
merely the beginning. Most people spend their lives striving to “get it all.” Don’t spend your
lifetime getting it all. Live your life as though you already have it all.
At some point, your wants
will diminish and if you’re still alive, you begin to realize you have it all. When you have all you truly require,
life becomes easy and choices become clear. When you start from the position of having it all, your present and future
becomes abundant and joyful.
5. A personal foundation,
based on positive values, makes all of life available and a whole lot easier. You cannot effectively express yourself
unless you have strengthened yourself. Distinguish between being strong and having personal power.
Many people have power, but
are personally weak. Life becomes a whole lot easier as you become fully responsible for its quality and nature.
When you value the highest and best in life, you become strong and effective at living.
6. Healthy personal
- integrity first
- needs second
- wants third
Being true to yourself is
critical. Having integrity really means that what you think, say and do, are consistent and congruent with your highest
It is your responsibility
to see to it that your needs are met. Meeting your needs is no one else’s job. Only when your true needs
are satisfied, can you trust your wants to be the best for you. Only through helping others get what they want can you
receive the best of what you want.
Cheating others always ends
up with cheating yourself. Bernie Madoff and others know this principle all too well.
7. The truth shall set
you free, but it may make you miserable at first. Our lives simply haven’t been set up to have the Truth come
Most of our human problems
arise when we are either unaware of the truth or deny it. Telling the truth is a skill that is learned through practice.
If we model ourselves after liars, we come to believe lying is what is needed to make it in life.
Most of us find changing our
untruthful habits difficult and fear-producing. However, when we always express the truth, we simplify our lives, reduce
our anxiety and allow room for love to flourish.
Apply these principles to
your own way of living, and you may just create the lifestyle you desire …even it stressful times.
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