Lesson 6: Children, Adolescents, and Mental Health

Attention

Clinging, crying infants and todldlers.

Slow to toilet-train toddlers.

Anxiety and depression in several months old babies.

Insecure, oppositional, confused attachment to caregiver(s).

How can this be? How would you know? It turns out that EVERYTING children do is significant. Even if they are pre-linguistic, they can still register emotions by facial expression, body posture, and vocalizations. They can show how they feel. They can vocalize distress. They can play repetitively, and seemingly pointlessly, but actually be showing their discomfort and confussion.

Jean Piaget gave psychology a roadmap for cognition. Erik Lenneberg the same for language throughout the lifespan. The work of Caroll Izard, Charles Darwin, and Paul Ekman describe an emotional landscape perhaps even more important. Arnold Gesell provided a normative timetable across physical/language, emotional, and social development.

Learning Outcomes

Upon completion of this lesson's material, students will be able to:

• Describe contributing factors to mental health problems among children and adolescents.
• Describe the challenges associated with diagnosing mental illness among children and adolescents.
• Explain several common mental health problems among children and adolescents and the related symptoms.

Teaching

Reading

• Read chapter 6 from the required course textook.
• Access article from Scientific American, March 2002, by Martin Teicher, entitled "The Neurobiology of Child Abuse." This was a then current, and retrospective on the neurological consequences of abuse and neglect, or either, seperately, when they occur early in development, are repeated, and are severe. What happens behind closed doors is frightening!! But, what happens to the timetable that the brain is on, which is set by genetics, is worse.
• You may also want to view "The Trouble with Evan," produced by Neil Docherty. This is very intense material. I have had students in class who could not sit through it. Parenting makes a difference, it "takes a village to raise a child" successfully. No kidding!

The Trouble with Evan...click HERE to view directly on YouTube  

Lecture

Years ago, I was in the Department of Psycholgy at St. John's University, Jamaica, New York. The doctoral program in clinical psychology had two separate tracks. Either you were in the childhood track, or, the other which was for working with patients beyond the age of adolesence. Parents of children calling for neurological consult with world famous neurologist Oliver Sacks, are frequently surprised to learn that he does NO casework with children. While he is a medical specialist per se, it it not with children.

Training to understand the signs and behavioral signals of distress is what the child, infant, early childhood, and adolescent training is about.

You need to see video on reserve in Lunder Library entitled "When the Bough Breaks." It is clinical work with three real families, for whom attachment issues emerge for the second borns. In and of itself, birth order may not be a marker for trouble. But, in these three families, comparing what they experienced with the first borns was so much at variance with the experience with the second ones, that they "knew" something was wrong. They were correct. And, the therapy addresses parent-child interaction. It is a success story. But, you have to wonder what untreated issues give rise to later in life. Life's foundation is built in childhood. If it is out of plumb, the "house" of your life is out of true. The issues become intergenerational. They repeat themselves. They do not easily, if ever, self-correct.

Possibly only exceeded by poor detection, and intervention, children and elders are both at high-risk as far as community mental health goes.

We are in an era of extraordinary growth in the rate of diagnosis for autistic spectrum disorder in childhood. It is interesting that this meteoric increase keys exactly to the change in DSM_IV (1994), and ONE word. An editorial decision to change one AND, to an OR, may have driven the diagnostic rise. Instead of symptoms having to be multiple across behavioral categories, it was only necessary to fit what as equivalent to one set of symptom parameters. Please do not misunderstand. I very well understand developmental challenge. But, if there is mis-diagnosis, or, missed-opportunity for diagnosis, this does not help the community mental health enterprise.

Assessment

Lesson 6 Quiz

1. Describe the symptoms of problems such as ADHD, depression, anxiety disorders, autism, mood disorders, and eating disorders. It is sad to say that there are many developmental challenges in infancy and childhhod.
2. Describe the protective/preventive, and risk/exposure factors for mental health in infancy, early childhood, childhhod, and adolescence here.. There is much to consider. And, even though neuroscience has identiied the extremely important role of biology and genetics, when development is on the ground, it is the social-emotional world that impacts as well.

Possible Class Discussion

As a society, we liicense many endeavors. However, there is no such gate for having children. There may be three crucial days in a person's life. The day they are born, the birth of their children, and understanding why you are here as an individual. Philosophers, theologians, psychologists, and others have wrestled with these issues. Now, it's your turn.

What should people know about children, childhood, and themselves??? The effort is in pursuit of bolstering community mental health.