Child and adolescents mental health

1. CHILD AND ADOLESCENT
MENTAL HEALTH
Dr. Sanchit Kharwal
Dr. Suhas Kadam

2. Definition (WHO)
• “Child and adolescent Mental Health is the capacity to
achieve and maintain optimum psychological functioning
and well being. It is directly related to the level reached
and competency achieved in psychological and social
functioning”

3. Reasons why • Current shortage of child and
adolescent psychiatrists
children with • Low income families have no
transportation to travel to a health
Mental Illness facility.
• Parent’s are afraid that they will be
are left blamed for their child’s health issues.
untreated
• Family conflicts
• Becoming a bullier
Future of • Poor Grades in School
•
children left •
High School Dropout
Criminal activity
untreated • Suicide

4. Broad Classification
1. Emotional Disorders:
 Anxiety Related Disorders: GAD, Agoraphobia, OCD
 Somatoform Disorder: Somatization Disorders, Conversion
disorders
 Depressive disorders and suicide.
2. Behavioral Disorders:
 ADHD
 Conduct Disorders
 Oppositional Defiant Disorder
3. Psychoses
4. Other mental Health Problems: Mental Retardation,
Learning Disabilities, Speech disorder, Eating Disorders,
Epilepsy

5. Depression: A Global Crisis
• Depression is a common mental disorder that presents with
depressed mood, loss of interest or pleasure, feeling of guilt
or low self worth, disturbed sleep or appetite, low energy and
poor concentration. (WHO)
• Interferes with cognitive, emotional and social development
occurring at young age
Adolescents Depression:
Mood and Anxiety Disorder
Substance use Disorders
Depression can also lead to the ultimate tragedy — almost
90,000 young people commit suicide each year across the
world

6. Determinants of Depression: Psychosocial
 Female Gender
 Economic Impoverishment
 Low Education
 Violence and Trauma
 Chronic physical ailments and Disabilities
 Increased Stress, lonely lives
 Lack of Social Support systems
 Substance abuse Habit
 Psychological Factors
 School Factors: Academic performance, Peer pressure &
influences
 Family and Social environment
 Genetic Factors
 Neurobiological Factors

7. Symptoms
Infancy Childhood Adolescence
Distress Anhedonia Depressed or irritable
mood
Crying, screaming Low self esteem Anhedonia
Sleep disturbance Feeling of Hopelessness
worthlessness
Weight loss Hallucinations Feeling of guilt
Separation Anxiety Increased appetite,
Hypersomnia
Withdrawl and Delusions, suicidality
Dejection

8. Suicidality among Children & adolescents
•“ a conscious act of self induced annihilation, best
understood as a multidimensional malaise in a needful
individual who defines an issue for which suicide is the best
perceived solution” Shneidman, 1985
• According to NIMHANS, Suicides resulted in death of more
than 110,000 persons in India during 2004.
• Risk Factors: Depression and other mental
disorders, Substance abuse disorder (often in combination
with other mental disorders), Prior suicide attempt, Family
history of suicide, Family violence including physical or
sexual abuse, Firearms in the
home, Incarceration, Exposure to suicidal behavior

9. Mental Retardation:
• “a condition of arrested or incomplete development of the mind
characterized by impaired developmental skills that contribute
to the overall level of intelligence” (Kaplan &Sadock, 1998).
• cognitive, language, motor, social and other adaptive behavior
skills are affected and thus should be used to determine the
level of intellectual impairments.
• Etiology: Genetic, Biological, Environmental
Beliefs related to MR:
“...It’s all related to our doings (karmo ka natiza hai)..Don’t
know what bad deeds (burre karam) we have done in the
past life (pichle janam) that we are bearing the brunt in this
life..”(Father of 7 Year old son with MR)
“I have done a lot for my child took him to allopathic and
homeopathic hospitals but there was no benefit…. I kept a dua
and I used to come to this shrine in karjan from handod after
walking bare foot for 10 kms for 9 Thursdays….we also took
him to our ancestoral God (kuldevi) but nothing happened”
(Mother of 8 year old son with MR)

10. 1. LEARNING DISABILITIES
2. SUBSTANCE ABUSE
3. OCD
4. IMPACT OF HIV/AIDS ON CHILD AND ADOLESCENT
MENTAL HEALTH
5. PREVENTIVE ASPECTS
Dr. Suhas Kadam

11. Learning Disabilities
• A term for a wide variety of learning problems.
• LD is not a problem with intelligence or motivation.
• Children with LD aren’t lazy or dumb.
• The difference only is how they receive and process
information.
• LD can lead to trouble with learning new information and
skills, and putting them to use.
• The most common types of LD involve problems with
reading, writing, math, reasoning, listening, and speaking.

12. Learning Disabilities
Common Types of Learning Disabilities
Dyslexia Difficulty reading Problems reading, writing, spelling,
speaking
Dyscalculia Difficulty with math Problems doing math problems,
understanding time, using money
Dysgraphia Difficulty with writing Problems with handwriting, spelling,
organizing ideas
Dyspraxia (Sensory Difficulty with fine Problems with hand–eye coordination,
Integration Disorder) motor skills balance, manual dexterity
Dysphasia/Aphasia Difficulty with language Problems understanding spoken
language, poor reading comprehension
Auditory Processing Difficulty hearing Problems with reading, comprehension,
Disorder differences between language
sounds
Visual Processing Difficulty interpreting Problems with reading, math, maps,
Disorder visual information charts, symbols, pictures

13. Learning Disabilities
Signs and symptoms
Preschool signs and symptoms of learning disabilities
• Problems pronouncing words
• Trouble finding the right word
• Difficulty rhyming
• Trouble learning the alphabet, numbers, colors, shapes,
days of the week
• Difficulty following directions or learning routines
• Difficulty controlling crayons, pencils, and scissors or
coloring within the lines
• Trouble with buttons, zippers, snaps, learning to tie shoes

14. Learning Disabilities
Grades K-4 signs and symptoms of learning disabilities
• Trouble learning the connection between letters and
sounds
• Unable to blend sounds to make words
• Confuses basic words when reading
• Consistently misspells words and makes frequent reading
errors
• Trouble learning basic math concepts
• Difficulty telling time and remembering sequences
• Slow to learn new skills

15. Learning Disabilities
Grades 5-8 signs and symptoms of learning disabilities
• Difficulty with reading comprehension or math skills
• Trouble with open-ended test questions and word
problems
• Dislikes reading and writing; avoids reading aloud
• Spells the same word differently in a single document
• Poor organizational skills (bedroom, homework, desk is
messy and disorganized)
• Trouble following classroom discussions and expressing
thoughts aloud
• Poor handwriting

16. Solution to LD
• Learn the specifics about child’s learning disability
• Research treatments, services, and new theories
• Pursue treatment and services at home
• Nurture child’s strengths

17. Substance Abuse
Substance abuse
• Out of risk taking behaviour/ adventure
• Peer pressure
• Stress
Commonly used substances
1. Alcohol
2. Tobacco
3. Cannabis
4. Heroin
5. Prescription drugs-opioids, CNS stimulants, CNS
depressants

18. Substance Abuse
Adverse effects
1. Impairment of general abilities
- Senses
- Speed of reaction
- Co-ordination
- Thinking concentration
2. Increased risk taking with poor inhibitory control over behaviour
3. Mood changes with poor control over mood.
Consequences include increased probability of
- Accidents & Unintentional injuries
- Violence
- Suicide
- Risky sexual behaviours

19. OCD
(Obsessive-Compulsive Disorder)
(OCD), usually begins in adolescence or young adulthood and is
seen in as many as 1 in 200 children and adolescents.
OCD is characterized by recurrent intense obsessions or
compulsions that cause severe discomfort and interfere with
day-to-day functioning. they interfere with the child's normal
routine, academic functioning, social activities, or relationships.
Obsessions are recurrent and persistent thoughts, impulses, or
images that are unwanted and cause marked anxiety or distress.
Frequently, they are unrealistic or irrational.
Compulsions are repetitive behaviors or rituals (like hand
washing, hoarding, keeping things in order, checking something
over and over) or mental acts (like counting, repeating words
silently, avoiding).

20. OCD
Studies related to OCD
Research shows that OCD is a brain disorder and tends to
run in families, although this doesn't mean the child will
definitely develop symptoms if a parent has the disorder.
Recent studies have also shown that OCD may develop or
worsen after a streptococcal bacterial infection. A child may
also develop OCD with no previous family history.
Children and adolescents often feel shame and
embarrassment about their OCD. Many fear it means
they're crazy and are hesitant to talk about their thoughts
and behaviors.

21. Impact of HIV/ AIDS on children and adolescents mental health, Shankar Das et.al, 2012
Adapted from Bailey, 1992, p. 669

22. Problems among children and families affected by HIV/AIDS

23. Impact of HIV/ AIDS on children and adolescents mental health
• Children's may be compelled to take on adult roles in
order to accommodate an infected parent. (Bauman,
2006)
• They must learn to interact with helping professionals and
manage chronic stress.
• Nicholas and Abrams (2002) reported that a considerable
number of HIV-positive children in the child welfare
system in the US displayed severe behavioral problems
and developed mental illness during adolescence.
• Scharko (2006) suggested that children and adolescents
infected with HIV suffer high rates of psychiatric disorders.

24. Impact of HIV/ AIDS on children and adolescents mental health
Prevention Aspect
• Intervention should be at individual, family and community
level
• Parental Training
• Issues related to stigma and discrimination must be
tackled within communities
• Programs and policies to reduce disease burden
• Life skills education: life skills education Methodology
often practiced: Dynamic teaching & Dynamic learning
Working in small groups & pairs Brainstorming Role-plays
Experiential learning Games & debates Home
assignments, to further discuss and practice skills with
family & friends.

25. References
• Child and Adolescent Mental Health, Usha S. Nayar (Nov 2012)
• LIFE SKILLS EDUCATION IN SCHOOLS- WHO,1994 (WHO /MNH
/PSF/ 93.7A.Rev.2 )
• http://www.nimhans.kar.nic.in/epidemiology/epidem_p4.htm
• FAMILY LIFE & LIFE SKILLS EDUCATION FOR ADOLESCENTS :
TRIVANDRUM EXPERIENCE- Dr M K C Nair,Director & Professor
of Paediatrics,Child Development Centre,Medical College,T’puram
• MENTAL HEALTH PROBLEMS OF SCHOOL CHILDREN- MON
Foundation
• CHILD AND ADOLESCENT MENTAL HEALTH POLICIES AND
PLANS- WHO,2005