AAMFT Consumer Update
Mental Illness in Children

Mental Illness (MI) is a term used by mental health professionals that includes many disorders. Although MI usually does not occur until late adolescence or adulthood, it can and does occur in childhood as well. When MI occurs in childhood, it is considered childhood-onset mental illness (COMI). COMI can cause serious problems for the children and adolescents who have it, including problems in their biological, social, and emotional development. Children with COMI need the significant adults in their lives (parents, grandparents, siblings, aunts/uncles, teachers, religious leaders, and others) to understand what COMI is, how it impacts children's lives, and learn how to recognize its signs and symptoms. If untreated, children with COMI can live their lives misunderstood and mistreated. Fortunately, COMI can be treated and children with it can have meaningful lives. If you think a child may be experiencing symptoms of COMI, it is important to have the child evaluated by a mental health professional. Children with COMI who receive treatment soon after symptoms appear have the opportunity to experience a quality childhood.

What is Mental Illness?

Children, adolescents and adults of all ages can experience a MI. Mental illnesses are biologically based, meaning that chemicals or structures in the brain are not working as they are supposed to, resulting in symptoms that cannot be managed or overcome without treatment, often resulting in lives that are unstable and unfulfilled. Symptoms of MI include problems in thinking, behaving, and feeling (moods and emotions). When a person is experiencing the symptoms of a MI, relationships with family and peers, school or work performance, and basic daily activities (sleeping, eating, bathing, dressing) can be difficult. Children who have MI sometimes need to be hospitalized to stabilize their symptoms or attend special programs, schools, or classrooms that specialize in treating COMI. These children also can receive treatment in community based agencies or private practice settings.
 

There are many disorders that meet the criteria for COMI, including Major Depression, Bipolar Disorder, Schizophrenia, Schizoaffective Disorder, Attention Deficit Hyperactivity Disorder (ADHD), and certain Anxiety Disorders, including Obsessive Compulsive Disorder. Diagnosis can be difficult in children, as symptoms in children can look different than symptoms in adults. Additionally, some symptoms can suggest that the child may have more than one diagnosis, or an unusual presentation of a diagnosis. Organizations such as the NAMI and the National Institute of Mental Health (NIMH) have made gains in identifying and understanding how these symptoms specifically manifest themselves in children. Information on COMI is readily accessible to the general public through consumer-based resources like NAMI and NIMH. 
 

How is COMI Diagnosed and Treated?

Although a child with COMI may experience periods of instability even with treatment, when a child with COMI is correctly diagnosed and receives appropriate treatment, the likelihood of having a relatively normal childhood increases significantly. Often diagnosis begins when a parent, teacher, or other significant adult in a child's life notices subtle or significant changes in behavior, thinking or moods that signal the possible presence of a COMI and the need for a formal mental health evaluation. This evaluation can be the beginning of treatment or the beginning of a larger assessment process, depending on the severity of the problem and symptoms the child is experiencing. Mental health professionals who can evaluate for COMI include psychiatrists, psychologists, marriage and family therapists, clinical social workers, and professional counselors who specialize in the treatment of children.

Will a Child with COMI Need Medication?

Due to the biological basis of COMI, psychiatric evaluation and treatment is generally necessary. The disorders associated with COMI usually require medications for symptom management. Child psychiatrists specialize in evaluating and treating the various disorders of COMI. Since some symptoms of COMI also can be symptoms of other medical conditions, a thorough medical evaluation is needed. Additionally, substance use or abuse can produce symptoms similar to those found in COMI. An accurate diagnosis of COMI can be made only after a general medical condition and substance use have been ruled out as the cause of the child's symptoms. However, even when substance use has been identified, it is not uncommon for children with COMI disorders to use substances to cope with the symptoms associated with their disorders. Therefore, further assessment for COMI may be necessary.

Is Psychological Testing Necessary?

Some children with COMI will need formal psychological assessment or testing. This assessment will inform those parenting, educating and treating the child how the child is functioning, direct the treatment and educational programs, and identify the child's strengths and vulnerabilities. Psychological testing should be done by a qualified mental health professional.

Who is Involved in Treating COMI?

COMI increases the need to create supportive and stable environments for children. Consequently, a team of mental health professionals is needed to effectively intervene. The lives of children are complex and can involve many significant adults. The child with COMI will experience the need for help in multiple settings, including home, school, and the community.  The professionals involved with a child with COMI and his or her family may include 1) a family therapist, 2) a primary care physician, 3) a child psychiatrist, 4) a case manager, and 5) an occupational therapist or educational coordinator.

What Other Elements are Important for the Treatment of COMI?

In addition to medication, treatment for a child with COMI (regardless of the specific diagnosis) needs to include psychoeducation, behavior management, and psychotherapy. Psychoeducation teaches children and families about COMI and the impact it has on the child's life and family. This includes information about the disorder, its symptoms, treatment, and future risks. Children with COMI need age-appropriate psychoeducation regarding their illness, as well as an action plan to manage their symptoms and prevent the symptoms form reoccurring. Managing symptoms also includes behavior management techniques that help parents, teachers, and others provide a structured environment where the child with COMI can be most successful.

Children with COMI may also need individual and/or group psychotherapy to develop healthy coping skills. Therapy can focus on a variety of issues including positive peer interaction, self-esteem, and identity development. It is important for children with COMI to be able to understand the role their illness plays in their lives, but also to recognize other parts of their selves that are separate from the disorder.

Is Family Treatment Necessary?

Family involvement in treatment for the child with COMI is very important. Among other things, families provide structure, support and the opportunity for the child to stay interpersonally connected to others. Families themselves also need help in accepting, understanding, and coping with a diagnosis of COMI when it is made. Treatment for families with COMI includes psychoeducation and support that is balanced by attention to other family issues or problems that may be affecting the stability of the home--for example, substance abuse or domestic violence. If other family problems are not addressed and treated, there can be significant negative consequences for the child with COMI. Likewise, there can be significant gains for both the child and family when the family receives treatment for COMI. A marriage and family therapist can provide the necessary psychoeducation, support and therapy necessary for children and families dealing with COMI.

Consumer Resources

Child and Adolescent Bipolar Foundation
www.bpkids.org

Family Federation for Children's Mental Health
(703) 684-7710
http://www.ffcmh.org

NAMI
(800) 950-6264
http://www.nami.org

National Institute of Mental Health (NIMH)
(310) 443-4513
http://www.nimh.nih.gov

National Mental Health Association
(800) 969-6642
http://www.nmha.org

This text was written by Elisabeth R. Crim, PhD, and JoAnn C. Fitzpatrick, MA.

Keywords: mental health disorders in childhood, kids and therapy, childhood onset mental illness (COMI), children and depression, ADD, autism, pervasive developmental disorders, children's mental health, children and anxiety, obsessive compulsive disorder and children, childhood onset schizophrenia, children and antidepressants, children and psychotropic medication.

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