This document discusses mental health problems in children. It begins by stating that around 1 in 10 children will experience some type of mental health problem before age 18. Mental health problems typically manifest in two age periods - ages 5-12 and ages 12-18 - and can affect children emotionally, cognitively, educationally, and behaviorally. Common problems for children include ADHD, conduct disorders, and disorders like Asperger's syndrome, while teenagers commonly experience depression, anxiety, self-harm, and eating disorders. The document goes on to discuss factors that can influence children's mental health, developmental milestones, types of mental health problems, recognizing problems, autism spectrum disorder, and supporting children with mental health issues.

1. Mental health problems in
children
Dr: Ragaa Gasim Ahmed
Assistant professor in pediatric nursing
Al-Baha university

2. Objectives
By the end of this lecture the student will be
able to:
Describe the predisposing influences on mental
health in children.
Analyze developmental milestone in children.
Count the types of mental health problems in
children.

3. introduction
There are many factors that contribute to
mental health problems for young people and
children. Typical statistics suggest that 1 in 10 of
children and young people will require
professional help at some time in their lives
regarding their mental health before the age of
18.

4. Cont
• Typically, mental health problems show themselves in two
distinct age periods.
• First, for children aged from 5 to about 12 years and, second,
for young people aged 12–18 years.
• Mental health problems for both groups affect the emotional,
cognitive, educational and behavioural capacity of the
patient.
• The most common mental health problems for children are
those associated with inattentiveness and poor social
behaviour such as attention deficit hyperactivity disorder
(ADHD), disruptive behaviour such as conduct disorders, and
language and emotion type disorders such as Asperger’s
syndrome.

5. Cont
• For teenagers, mental health problems include depression, self-harm,
anxiety disorders, social disorders focused on an inability to cope
(including para-suicide), obsessive compulsive disorders (OCD), bipolar
disorders, psychosis and eating disorders such as anorexia nervosa.
• Unlike adult psychiatry, young people often have complex or dual
diagnosis, which means a combination of the above, on their path to
achieving their key maturational milestones.
• According to the World Health Organization (WHO), mental health is ‘a
state of well-being in which the individual realizes his or her own abilities,
can cope with the normal stresses of life, can work productively and
fruitfully’.
• For young people and the family, mental health is not only the absence of
mental health problems, but also the accomplishment of developmental
milestones that impact and compound difficulties in this life stage.

6. Predisposing influences on mental
health
Genetics
Some characteristics such as temperament and
intelligence are influenced by genetics. Specific
conditions such as autism, Down’s syndrome and
language disorders
Prenatal and perinatal complications
Maternal impact such as age, smoking, malnutrition,
blood type and drug use
Physiological dysfunction
Poorly functioning bodily systems indicative of anxiety,
acute psychosis

7. Cont
Parent, family and social factors
Attachment difficulties, neglect, poor parenting,
stress, abuse, social disadvantage, chaotic family
circumstances, domestic violence, criminality and
poor parental mental health, poverty, inadequate
role models
Psychological factors
Poor and low self-esteem, deficient cognitive
ability, immature defense and coping mechanisms.

8. Developmental milestones
Parenting roles
Safety, care, control, intellectual stimulation,
able to take instruction, moral development
Physical
Appropriate physical growth, puberty, sexual
maturity
Cognitive
Psychometric intelligence, Piagetian cognitive
development, skill acquisition, problem solving,
information processing

9. Cont
Emotional
Self-soothing skills, expression and appropriate
response to stimuli, curiosity, rudimentary
empathy, recognition and anticipation of others,
development of temperament toward
Social
Able to engage in creative play, responsive
arousal, identity development, autobiographical
memory, appropriate adaption to life transitions,
language development, ability to self-evaluate
and self-regulate, commitment to social values

10. Types of mental health problems
• Anxiety disorders (including panic disorders,
phobias, PTSD)
• Mood disorders
• Psychosis
• Language and learning disorders
• Autism and Asperger’s syndrome
• Conduct disorders

11. Recognizing problems
• Acting out: expressing distress and over arousal
in inappropriate ways such as tantrums,
screaming, running away, self-harm and physical
threats, somatic problems, dangerous risk-taking,
para-suicide.
• Withdrawal: a persistent rejection of company,
isolation in bedroom and solitary comfort,
elective mutism, phobias, chaotic family systems,
special education issues, psychosis, abuse,
neglect.

12. Cont
Emotional avoidance: procrastination, seeking risk, desire to
question reasonable requests, low self-esteem and
pessimistic outlook, seeking destructive relationships, dogged
denial, drug and alcohol abuse, engaging in distracting
activities, mental and social disengagement, generalized
anxiety disorder, PTSD, repetition problems such as ODC,
mood disorders, suicide.
Attachments and bonding: affected by neglect, failure to
thrive, inconsistent discipline, confused communication
patterns, poor protective systems.
Physical: anorexia nervosa, bulimia nervosa, eating disorders,
self-harm.

13. What is a learning disability?
Learning disability is the term that the Department
of Health use within their policy and practice
documents. In Valuing People (2001), they describe
a ‘learning disability’ as a:
• Significantly reduced ability to understand new
or complex information, to learn new skills
• Reduced ability to cope independently which
starts before adulthood with lasting effects on
development

14. Cont
Impairment: refers to a lack, or loss of some physical or intellectual function.
An ‘intellectual impairment’ suggests the incomplete development (or loss)
of mental abilities
Disability: a disability refers to the situation where someone cannot do
certain things because of their original impairment. A ‘learning disability’
refers to someone’s restricted, or reduced, ability to learn as quickly, or as
readily, as people without impairments
Handicap: a person is handicapped when, because of a disability, she/he has
fewer opportunities to take part in everyday life than non-handicapped
people.
A person with ‘learning disability’ may have some difficulties in speech or in
reading, but the real handicap may be other people’s attitudes or prejudice.
Handicaps can be reduced through changes in attitude, when people are
given more opportunities to take part in the everyday life of the community

15. How do we label a person? Or indeed
a family?
• Consider what you know about children who
have a learning disability and treat this as a
reflection or portfolio exercise
• When did you €first become aware of people
with a learning disability?
• What was the nature of the contact?
• What was the position of your community about
these people?
• How much did that influence you?

16. Autistic spectrum disorder
• It is common for children with ASD to have
symptoms of other conditions such as:
• ADHD
• Tourette’s Syndrome
• Epilepsy
• Dyspraxia

17. What is autistic spectrum disorder?
• Autistic spectrum disorder (ASD) is a neurobiological disorder of
development.
• It is a lifelong condition; people do not get better from ASD.
• It is a ‘spectrum’, which means that while all people with autism
share certain difficulties or characteristics, their condition will affect
them in different ways and can vary hugely.
• It includes Asperger’s syndrome as well as autism with learning
disabilities.
• It affects how a person communicates with, and relates to, other
people. It also affects how they make sense of the world around
them. Many people with ASD experience over-sensitivity or under-
sensitivity to sounds, touch, tastes, smells and light; this is called
sensory hypersensitivity or hyposensitivity.

18. Autism
• The three main areas of difficulty that all people with autism share are
sometimes known as the ‘triad of impairments’:
• Difficulty with social communication
• Difficulty with social interaction
• Difficulty with social imagination.
Children with ASD do not ‘look’ disabled. Parents of children with autism
often say that other people simply think their child is naughty but this is
not the case.
• Autism is a common condition with over half a million people in the
United Kingdom, that is around 1 in 100 people. People from all
nationalities and cultural, religious and social backgrounds can have
autism, although it appears to affect more boys than girls.

19. Causes
• The cause of autism is still not known. However,
research suggests that a combination of factors,
particularly genetic and environmental, cause
changes in brain development.
• Autism is not caused by the child’s upbringing,
their social circumstances and is not the fault of
the child with the condition or their parents.
• It is not linked to ‘bad parenting’ and it is not
caused by the MMR vaccination.

20. Cont
• Brain differences
• Studies have shown that the brains of people
with ASD are different in the:
• Frontal lobes
• Limbic system
• Brainstem and fourth ventricle.

21. Triad of impairment
• The areas of difficulty in the triad of impairment manifest in different
ways in each individual but below is a list of some of the ways it can affect
them.
Impairment of social communication:
• Talk at you
• Incessant communication
• Not true communication (e.g. may not follow the usual rules)
• Concrete understanding
• Do not engage in social chat
• Communication confined to own needs
• Struggle to understand non-verbal communication
• Echolalia
• Repetitive
• Formal speech.

22. Cont
• Impairment of social interaction:
• Abnormal eye contact
• Indifference to others
• Aloofness
• Pay little attention to responses
• Preference for isolation
• Impaired social behavior
• Empathy issues
• Active but odd
• Passive.

23. Cont
Impairment of social imagination:
• Rigid inflexible thinking
• Restrictive repetitive play
• Abnormal play; spinning, flapping
• Lack of imagination
• Self-stimulatory behaviours
• Difficulty in generalizing concepts
• Circumscribed interests.

24. Supporting children with ASD
When supporting children with ASD there are a few key
things to remember:
•Think about their sensory sensitivities and try to adapt
the environment accordingly
•Remember the triad of impairment and work with it
•Do not try to make the child conform (e.g. do not insist
on eye contact), as this is something children with ASD
may find difficult
•Remember the autistic brain processes information
differently, so allow extra time for this.

25. References
Alan Glasper, Jane Coad, Jim Richardson.(2015).
Children and Young People’s Nursing at a
Glance. Library of Congress Cataloging