October 4, 2021 A Guide for Families: Childhood Mental Health Childhood Mental Health Mental health is the overall wellness of how people think, regulate feelings, and behave. Mental health is important at every stage of life, including childhood. Download this resource as a PDF in English and Spanish. Mental health disorders in children are generally defined as delays or disruptions in developing age-appropriate thinking, behaviors, social skills or regulation of emotions. These disorders can cause distress to children and disrupt their ability to function well at home, in school, or in other social situations. According to the Centers for Disease Control and Prevention (CDC), symptoms of mental disorders often start in early childhood, though some disorders may develop during the teenage years. The diagnosis is often made in the school years; however, some children with a mental disorder may not be recognized or diagnosed as having one. According to the CDC, 7.1 percent of children ages three to 17 (approximately 4.4 million) have diagnosed anxiety, while 3.2 percent of children aged three to 17 (approximately 1.9 million) have diagnosed depression. The National Alliance on Mental Illness (NAMI) reports that one in five teenagers between 13 and 18 will experience at least one “severe mental disorder” during their life, as will roughly 13 percent of kids between ages five and 15 years. Common Childhood Mental Health Disorders Anxiety: Anxiety disorders in children are persistent fears, worries, or anxiety that disrupt their ability to participate in play, school, or typical age-appropriate social situations. Diagnoses include social anxiety, generalized anxiety, and obsessive-compulsive disorders. Attention-deficit/hyperactivity disorder (ADHD): Symptoms of ADHD include inattention (not being able to keep focus), hyperactivity (excess movement that is not fitting to the setting), and impulsivity (hasty acts that occur in the moment without thought). Depression: Depression negatively affects how a person feels, thinks, and acts. It causes feelings of sadness and/or a loss of interest in activities. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function. Eating Disorders: Eating disorders are characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. They can be very serious conditions affecting physical, psychological, and social function. Types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, other specified feeding and eating disorder, pica, and rumination disorder. Obsessive Compulsive Disorder (OCD): OCD is a disorder in which people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things or cleaning, can significantly interfere with a person’s daily activities and social interactions. Post-Traumatic Stress Disorder (PTSD): PTSD can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, a death threat, sexual violence, or serious injury. People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear, or anger; and they may feel detached or estranged from other people. General Warning Signs of Mental Disorders Signs and symptoms to look out for include: Persistent sadness for two or more weeks. Withdrawing from or avoiding social interactions. Self-harm or talking about harming themselves. Talking about death or suicide. Extreme irritability or emotional outbursts. Drastic changes in mood, behavior, or personality. Changes in eating habits. Weight loss. Difficulty sleeping. Frequent headaches or stomach aches. Difficulty concentrating. Changes in academic performance. Avoiding or missing school. First Steps for Families Concerned About Their Child’s Mental Health Parents and caregivers who are worried about their child’s mental health should consult their child’s doctor and describe any concerning behaviors. Early diagnosis and appropriate services for children and their families can make a difference in the lives of children with mental disorders. Families play an important role in supporting their children through struggles and treatment. The CDC also offers resources and information for parents about common childhood mental health disorders, how to recognize them, and how to seek help for themselves and for their children. Visit: cdc.gov/childrensmentalhealth. Local Services Pennsylvania Infant Early Childhood Mental Health (IECMH) Consultation Program Infant and Early Childhood Mental Health (IECMH) Consultation is a free resource offered through the Office of Child Development and Early Learning (OCDEL) that supports children’s social–emotional development from birth through age five within early learning programs participating in Keystone STARS. IECMH Consultants specialize in early childhood development and mental health and well-being. They work with parents and caregivers in the early care and education setting to provide onsite or virtual classroom observations; screening/assessment strategies for children and classrooms; implement a process to identify strengths and opportunities for growth; facilitate the creation of an action plan to support children and classroom staff; and provide Referrals for additional supports if needed. For more information, visit pakeys.org/iecmh. National Alliance on Mental Illness (NAMI) – Keystone Pennsylvania Chapter NAMI Keystone Pennsylvania is a grassroots, nonprofit organization dedicated to improving the lives of children, adolescents, adults, and families affected by mental illness through recovery-focused support, education, and advocacy. Resources about mental illnesses and services are available. For more information, call 412.366.3788 or visit namikeystonepa.org. Steel Smiling Steel Smiling aims to bridge the gap between Black people and mental health support through education, advocacy, and awareness. Their 10-year vision is to connect every Black person in Allegheny County to a positive mental health experience that improves their quality of life. For more information, call 412.532.9458 or visit steelsmilingpgh.org. The Alliance for Infants and Toddlers The Alliance for Infants and Toddlers is an Early Intervention service provider in Allegheny County for children ages zero to three. For more information, call 412.885.6000 or visit afit.org. The Children’s Institute of Pittsburgh The Children’s Institute of Pittsburgh offers behavioral health services for children and adolescents ages five to 21. Their licensed therapists and Certified Nurse Practitioner work closely with each client and their family to develop skills to manage mood, thinking, and behaviors – making the move towards resiliency and healing. For more information, call 412.420.2400 or visit amazingkids.org. Allegheny Intermediate Unit DART The Allegheny Intermediate Unit offers DART Preschool Early Intervention for children in Allegheny County, ages three to five, who are experiencing developmental delays or disabilities at no cost to parents. For more information, call 412.394.5700 or visit aiu3.net. —- This resource was reviewed by Pennsylvania Keys Infant Early Childhood Mental Health (IECMH). For additional resources related to childhood mental health, such as social-emotional development or early intervention, please visit tryingtogether.org/parenting-resources.
Supporting Children with Anxiety Anxiety disorders in children are persistent fears, worries, or anxiety that disrupt their ability to participate in play, school, or typical age-appropriate social situations. Download this resource as a PDF in English and Spanish. Types of Anxiety Children can be diagnosed with different kinds of anxiety depending on what they are struggling with. Diagnoses include: Separation anxiety: Children experience great distress when they are separated from their parents or caregivers. Symptoms include worrying that they will lose someone through illness or death; fear of a separation event; fear of being alone; and refusal to leave home. Social anxiety: Children with social anxiety disorder are excessively self-conscious, making it difficult for them to socialize with others. Symptoms include panic reactions or tantrums in response to social situations; avoiding or suffering through social situations; and fear of being judged or appearing anxious. Generalized anxiety: Children with generalized anxiety disorder worry about a wide variety of everyday things. Their anxiety can be distinguished from typical worry in its excessiveness, duration, and lack of precipitating events. Obsessive-compulsive disorder (OCD): Children with OCD have intrusive thoughts and worries that make them extremely anxious, and they develop rituals they feel compelled to perform to keep those anxieties at bay. OCD can be diagnosed when a child has obsessions, compulsions, or both. Phobias: A child with a specific phobia has an excessive and irrational fear of a particular thing, like being afraid of animals or storms. Phobias are classified into five categories: animals, natural environment, blood injection injury, situational, and other stimuli. Selective mutism: Children with selective mutism have a hard time speaking in some settings like school or around strangers. Children become frozen and feel unable to speak. According to the Centers for Disease Control and Prevention (CDC), 7.1 percent of children ages three to 17 (approximately 4.4 million) have been diagnosed with anxiety. Anxiety is best treated with either behavioral therapy or a combination of cognitive behavioral therapy (CBT) and medication. CBT is a form of talk therapy designed to help people recognize unhelpful thoughts and behaviors and learn how to change them. This type of therapy can help your child understand the negativity of their thought patterns and learn how to replace them with more positive ones. Helping Your Child Manage Anxiety Parents and caregivers can implement several practices at home to help children cope with their anxiety. When your child is distraught, scared, and unhappy, it might be tempting to remove their stressors. Avoidance will help a child feel better in the short term, but it will only reinforce their fears. The best way to help a child with anxiety is to help them learn to tolerate their stressors. The goal is to manage anxiety, not to eliminate it. Here are some things you can do: Work with your child to set positive, realistic expectations. If your child is anxious about their soccer game, don’t promise that they are going to win. Instead, express confidence that he/she is going to be ok and that they will be able to manage their fear. Listen to your child’s fears. Being actively interested in your child helps them feel listened to and understood. Try to resist the urge to downplay or dismiss what your child is telling you. You can validate their feelings without amplifying their fears by saying things like, “I know you’re feeling scared about _____, and that’s ok. I am here to help you.” Talk through their fears. If a child is anxious about a test, talk through the situation with them. What would happen if their fear of failing the test came true? You could talk about getting a tutor, working with them to study more, or creating a plan with their teacher. For some kids, having a plan can reduce uncertainty in a healthy, effective way. Coping Exercises Deep breathing: Help your child relax by practicing belly breathing, and drawing in air by expanding the belly. This slow breathing can reduce the heart rate, blood pressure, and stress hormones. It can also help relax tense stomach muscles. Mindfulness exercises: Work with your child to focus on what’s around them. Techniques such as focusing on what they see and hear can help ground them in the moment. Preparation: Prepare your child for situations that might cause them anxiety or discomfort. Work with them to plan what they can do to counteract those feelings and push through them. Coping statements: Develop some mantras and coping statements with your child. They can repeat these back to themselves when they are struggling with their anxious feelings. Examples include: “I am feeling scared and I can handle it.” “I am bigger than my anxiety.” “Anxiety is not dangerous. It can’t hurt me.” “I will do the best I can.” “Right now, I have some feelings I don’t like but I will be fine.” For more information and resources about anxiety in children, visit Nemours KidsHealth at kidshealth.org/en/parents/anxiety-disorders.html. Journaling Activity Families can use this journaling activity to have a discussion with their children about their emotions and fears at the end of each day. The prompts can guide the dialogue and give children the opportunity to express themselves while parents and caregivers practice the management responses and coping strategies outlined above. Date: How I feel right now: Today I am thankful for: Something that made me sad today: I worried about this today: What I did to feel better today: This made me happy today: I am excited for: —- This resource was reviewed by Pennsylvania Keys Infant Early Childhood Mental Health (IECMH). For additional resources related to childhood mental health, such as social-emotional development or early intervention, please visit tryingtogether.org/parenting-resources.
The Differences Among Mental, Developmental, and Behavioral Conditions Mental, developmental, and behavioral conditions often get grouped together because they affect thought processes and behavior. Developmental disabilities and behavioral disorders might have negative impacts on a child’s mental health, resulting in mental illness. Like mental illnesses, some developmental disabilities and behavioral disorders are diagnosed and treated by mental health professionals, including therapists, psychologists, and psychiatrists. They can also be found in the Diagnostic and Statistical Manual of Mental Disorders, which is used to diagnose mental conditions. The term “dual diagnosis” is often used to refer to children and adults who have developmental disability and/or behavioral difficulties with co-occurring mental illness. While these conditions can affect children in similar ways, they are very much different. According to the Centers for Disease Control and Prevention (CDC): Having another disorder is most common in children with depression: about 3 in 4 children aged 3-17 years with depression also have anxiety (73.8%) and almost 1 in 2 have behavior problems (47.2%). For children aged 3-17 years with anxiety, more than 1 in 3 also have behavior problems (37.9%) and about 1 in 3 also have depression (32.3%). For children aged 3-17 years with behavior problems, more than 1 in 3 also have anxiety (36.6%) and about 1 in 5 also have depression (20.3%). Details and Differences Mental Illness Mental health disorders affect mood, thought processes, or behavior and can manifest in anyone at any time in their life. Mental illness does not directly impact cognitive abilities like some developmental disabilities, but they can change a person’s perceptions and thought processes and affect a person’s everyday functioning and ability to relate to others. While children can suffer from mental illnesses, these conditions can just as easily begin during adulthood and they may not be lifelong. Examples of mental illnesses that affect children: anxiety, attention-deficit/hyperactivity disorder (ADHD), depression, obsessive compulsive disorder (OCD), post-traumatic stress disorder. Developmental Disabilities According to the US Center for Disease Control and Prevention (CDC), developmental disabilities are “a group of conditions due to an impairment in physical, learning, language or behavior areas.” These include intellectual disabilities and physical disabilities. Some developmental disabilities begin before birth but all occur during the developmental period and continue throughout the person’s life. Examples of developmental disabilities that affect children: Autism Spectrum Disorder (ASD), vision impairment, cerebral palsy, hearing loss, and Down Syndrome. Behavioral Disorders Behavior disorders in children are diagnosed when the conduct becomes extreme and is considered pathological. The primary difference between a behavior disorder and another type of psychiatric disorder is the presence of choice. Psychiatric conditions are considered to be involuntary while in behavior disorders, choices are essential. Examples of behavior disorders that affect children: oppositional defiant disorder (ODD) and conduct disorder (CD). More Information More information about mental, developmental, and behavioral conditions can be found on the CDC website. Mental illness: cdc.gov/childrensmentalhealth Developmental disabilities: cdc.gov/ncbddd/childdevelopment Behavioral disorders: cdc.gov/childrensmentalhealth/behavior
Children’s Books About Mental Health There are various children’s books available that parents can use to help their children understand what specific mental health disorders are and how to cope with them. Here’s a list of some titles: Anxiety A Little SPOT of Anxiety: A Story About Calming Your Worries Written by Diane Alber Don’t Feed the Worry Bug Written and illustrated by Andi Green The Fix-It Friends: Have No Fear! Written by Nicole C. Kear, illustrated by Tracy Dockray Hector’s Favorite Place Written and illustrated by Jo Rooks How Big Are Your Worries, Little Bear? By Jayneen Sanders, illustrated by Stephanie Fizer Coleman Pilar’s Worries Written by Victoria M. Sanchez, illustrated by Jess Golden Ruby’s Worry Written by Tom Percival The Huge Bag of Worries Written by Virginia Ironside, illustrated by Frank Rodgers What to Do When You Worry Too Much Written by Dawn Huebner, Ph.D., illustrated by Bonnie Matthews The Red Tree Written by Shaun Tan When Worries Get Too Big Written and illustrated by Karl Dunn Buron Attention-deficit/hyperactivity disorder (ADHD) Cory Stories: A Kid’s Book About Living With ADHD Written by Jeanne Kraus, illustrated by Whitney Martin I Can’t Sit Still! Living With ADHD Written by Pam Pollack and Meg Belviso, illustrated by Marta Fabrega Why Can’t Jimmy Sit Still? Written by Sandra L. Tunis, PhD, illustrated by Maeve Kelly Depression Can I Catch It Like a Cold? Coping With a Parent’s Depression Written by the Centre for Addiction and Mental Health, illustrated by Joe Weissmann The Princess and the Fog: A Story for Children with Depression Written by Lloyd Jones The Sad Book Written by Michael Rosen Obsessive Compulsive Disorder Mr. Worry: A Story About OCD Written by Holly L. Niner, illustrated by Greg Swearingen Post-Traumatic Stress Disorders A Terrible Thing Happened Written by Margaret M. Holmes, illustrated by Cary Pillo Brave Bart: A Story for Traumatized and Grieving Children Written by Caroline H Sheppard Do You Have a Secret? Written by Jennifer Moore-Mallinos Healing Days: A Guide For Kids Who Have Experienced Trauma Written by Susan Farber Straus, PhD Once I Was Very Very Scared Written by Chandra Ghosh Ippen When I Was Little… A Child’s Journey in Overcoming Abuse & Trauma Written by Keri Vellis
Understanding Child Trauma, NCTSI More than two thirds of children have reported at least one traumatic event by age 16. It’s important to recognize the signs of traumatic stress and its short- and long-term impact. More Information The signs of traumatic stress may be different in each child. Young children may react differently than older children. This informative infographic developed by SAMHSA’s National Child Traumatic Stress Initiative (NCSTI) helps families recognize the signs of child traumatic stress by age.
Children and Mental Health: Is This Just a Stage?, NIMH Raising a child can be challenging. Even under the best circumstances, their behaviors and emotions can change frequently and rapidly. In most cases, these are just typical developmental phases. However, such behaviors may indicate a more serious problem in some children. More Information In Children and Mental Health: Is This Just a Stage? The National Institute of Mental Health outlines mental health disorders in children, and information for parents such as when to seek help, first steps to take, how to choose a mental health professional and more.
Q&A: What Are Some of the Risk Factors for Suicide, NIMH Risk factors for suicide vary with age, gender, or ethnic group and may change over time. More Information The National Institute of Mental Health (NIMH), the lead federal agency for research on mental disorders, has released a Q&A about risk factors and warning signs for suicide, as well as information about suicide prevention.
Sesame Street: Little Children, Big Challenges “Little Children, Big Challenges,” a video special from Sesame Street, offers caregivers tips on how to help children cope with uncertainty by building resilience. It focuses on building young children’s coping skills and fostering nurturing connections between them and the caring adults in their lives—whether parents, caregivers, or community providers. More Information With some of our favorite friends from Sesame Street and insights from early childhood education specialists and community service providers, the special offers tools and tips to families as they face each day with courage, optimism and hope. Suggestions include things that almost all of us can try, like sticking to a routine, talking about our feelings, and reaching out to friends and family we miss even if we are not able to see them in person. Watch the video.
Guide to Treatment for Children With Mental Health Needs, HealthyPlace How and where do you get help for your child’s psychological disorder? This guide from HealthyPlace can help families figure out where to start. More Information Families who have received help from systems of care participated with the Federation of Families for Children’s Mental Health in creating this guide. In seeking appropriate care for their children, family members reported having felt overwhelmed, alone, intimidated, or even blamed. They found strength by sharing their experiences with other families. They have used their experiences to help develop this guide, which can help families figure out what they need to know; what questions to ask; what to expect; and what they can do. Read the guide.
Sesame Street in Communities: Exploring Emotions Feelings come in all shapes and sizes. When you help children express and understand their emotions, you’re helping them to overcome challenges, understand others, and communicate. More Information Sesame Street in Communities: Exploring Emotions gives parents the tools to help their children learn about their feelings. Worksheet activities, videos, and articles will guide children as they handle big feelings, little ones, and every feeling in between.
