Looking out for our Children's Mental Health.
So, a few days ago I was nominated by a close friend of mine, a very inspiring young woman to complete a 25-day, 25 push-up challenge to raise awareness on mental health. Now if I’m being honest, when I got the nomination on Facebook, at first, I thought… Ugh – No one wants to see a pregnant lady do push-ups, right? Haha. But then I remembered that I never back down from a challenge and truthfully something far greater started to stir inside of me. I realised that this could possibly be an opportunity for me to play a role in addressing a topic that I am passionate about. Although just talking about it might not change much. I truly believe that tackling this topic head on could aid in the eradication of the stigma and in some cases hype around mental health or mental illness.
We certainly seem to be making small dents in addressing the stigma of mental illness but it’s still a far cry from where we can be. Western cultures tend to be more accepting and supportive of mental illness, whereas our African and Eastern cultures tend to face more upheaval. It is up to us to speak out and educate one another as much as possible. My opinion is that especially Teachers, Therapists, Nurses and General Practitioners should bring themselves up to speed with the most common mental health issues seen in children and adolescents. It’s often easier to pick up on these issues as an objective person rather than parents that will most likely be looking at their children purely subjectively.
So, if I’m being vulnerable, I myself suffered from Depression as a teenager, for a brief period. I’ve also experienced mental illnesses firsthand in some family members. Diagnosis such as, Post-partum Depression, General Anxiety Disorder, Major Depressive Disorder, Substance Abuse; as well as previous physical and mental abuse leading to other mental health problems were just some of the things that we’ve had to acknowledge, address and overcome together within the broader scheme of our family set-up. I’m blessed to have a family that’s relatively open about our journey, although at times it might have seemed hard to do so. There is no shame in owning your story, speaking your truth and in the process aiding and supporting others that might face similar challenges.
I’ve also worked in acute as well as long-term mental health institutions, where I’ve had the absolute privilege to learn from my fellow multi-disciplinary team (i.e. other OT’s, Nurses, Psychologists, Psychiatrists, Social Workers etc.) and the unique and very important role that each one has to play in the treatment of mental health. Even more so, I’ve had the honour to work with real, authentic, brave and absolutely inspiring individuals whom have suffered from or continue to suffer from mental illness.
Having said that, although I’ll be addressing mental health, especially pertaining to children and adolescents, in today’s blog post. Never ever solely rely on the internet / Dr Google when it comes to concerns or queries regarding a person’s mental health. Your first point of reference should always be a Medical Professional. If you are unsure of who to contact. PLEASE send an email to firstname.lastname@example.org and I will gladly refer you to an appropriate Professional.
Bear in mind that today’s post is written from an Occupational Therapist’s point of view and although I will be touching on some of my own accumulated knowledge and experience, I will also be referring to Occupational Therapy in Psychiatry and Mental Health (Fifth Edition) by Rosemary Crouch and Vivyan Alers; as well as the DSM V.
I think a good place for us to start would be to better acquaint ourselves with the more common diagnosis seen in children and adolescents and how they might manifest / what they could look like in our children (Although each child is their own – so let’s not generalise):
1. Anxiety Disorders
Some of the anxiety disorders seen in children include generalised anxiety, social anxiety, obsessive-compulsive disorders (OCD) and specific phobias.
Although each has their own DSM V criteria (i.e. the symptoms required to make a formal diagnosis). Some warning signs could include irrational, severe and prolonged crying or tantrums; becoming physically immobilised when faced with the trigger / fear (e.g. large crowds, spider, being separated from a loved one etc.); shrinking away from other people; extreme clinging; and not being able to communicate in social settings. Anxiety tends to progress from worry to fear to panic. OCD on the other hand could include a wide variety of rituals or obsessions which generally looks different from one child to the next.
Bear in mind that the symptoms have to be quite severe and consistent; as well as physically effect a child’s ability to function within their normal daily life (i.e. school, play, personal hygiene, dressing etc.).
2. Behavioural, Conduct or oppositional Disorders
There is also a wide variety of behavioural disorders including; disruptive mood dysregulation disorder, oppositional defiant disorder as well as conduct disorder. Such disorders tend to be characterised as severe and recurrent temper outbursts and a persistent irritable mood. In addition to the above, children that struggle with conduct disorder may have little empathy and concern for others, they can be highly aggressive and exhibit acting-out behaviour. No, we’re not just talking about you average teenage moodiness!
I want to urge us to look out for such behaviours in the children that we work with. Often times there are severe social factors at play (e.g. dysfunctional family relationships, familial aggression, substance abuse, history of psychiatric problems, low socio-economic statuses or even highly privileged, spoilt or disturbed environments). It could be a cry for help and those of us that work with such children or adolescents need to be weary and sensitive to the hinderances they might be facing.
3. Mood Disorders (Bipolar / Depression)
Although I won’t be going into too much detail on Bipolar Mood Disorder. It is important to know that there are two types, Bipolar I and II and that Bipolar includes the fluctuation between two types of episodes, manic and depressive episodes. Mania – Think Tigger from Winnie the Pooh. Depression – Think Eeyore from Winnie the Pooh.
In a general sense Bipolar could be seen in children through mood swings, extreme tiredness, intense temper tantrums, frustration and defiant behaviour. So, let’s look out for this in our own children and the children that we work with.
Manic episodes could include grandiosity (which is thinking highly of oneself) / inflated self-esteem, overwhelm, aggressive and hostile behaviour or extreme excitation. It also often results in extremely impulsive behaviour.
Depressive episodes / Unipolar Depression could include separation anxiety, loss of interest in previously enjoyable situations, lack of motivation to play, school refusal, feelings of worthlessness / guilt, withdrawal and self-injurious behaviour.
Ask about the mental health history of a child’s parents. Children who are the biological offspring of parents with bipolar mood disorder have a relatively high genetic risk of developing bipolar themselves. Also note that Depression rates tend be lower before puberty, but rise significantly from early teens, especially with girls.
4. Selective Mutism
This if often seen in children who have the ability to speak but chooses not to, especially in certain social settings. For example, they might speak allot at home with their siblings or parents but when they arrive at school or any other social setting, they DO NOT OPEN THEIR MOUTHS. It can often be confused with other mental health fallouts.
5. Psychotic Disorders
I won’t be going into too much detail. I do, however, want to stress that we need to be aware that children can also suffer from psychosis. It should not be mistaken for age-appropriate fantasy play. Psychosis may cause severe delusions and hallucinations. In South Africa, it’s more often seen in our impoverished areas – More so related to substance abuse amongst homeless street children or those in severely abusive households. However, schizophrenia, autism and chronic depression can also cause psychosis.
Today's post was really just to become more aware of the warning signs or red flags to be kept in mind when we work with children. I’ve said it before, and I’ll say it again. Never doubt your influence. It often just takes one person to see and acknowledge a child’s cry for help. Refer them to the correct professional and remember that we all have a role to play in their treatment. Parents, Teachers, Therapists, Psychologists, Doctors, Nurses etc. – All of us are equally important and if we’re all rowing in the same direction, we’ll most probably see much greater results, much quicker than we would if we all decided to row in different directions. The child should always be kept at the centre.
Watch this space for some more discussions on mental health in children and adolescents.