Child and Adolescent Issues
As children and adolescents grow, they are constantly in the process of developing the social skills and emotional intelligence necessary to lead healthy, happy lives. When children experience emotions or engage in behaviors that interfere with their happiness and ability to thrive, they may benefit from meeting with a mental health professional such as a therapist or counselor. Parents and children often attend therapy sessions together, as therapy can be a safe space in which to address the thoughts, feelings, and emotions experienced by all members.
As they grow, children will experience changes in their moods and behaviors. Some of these changes are relatively predictable and, though they may be challenging, most are completely normal aspects of child development. In general, as long as children are behaving in ways that are consistent with their age range, the challenges they experience should not create cause for concern.
There are many theories addressing the developmental phases that children go through, and recognizing these phases can be invaluable to parents and caregivers in understanding child behavior and developmental needs. Erik Erikson’s theory outlining the stages of psychosocial development from birth to adulthood is one of the most widely recognized stage-based theories. Erikson, an influential developmental psychologist, identified eight stages in life, five of which take place in childhood and adolescence:
- Infancy: Trust vs. Mistrust. In the first stage of human development, infants explore the world and learn whether their environment is a safe, predictable place. Infants require a significant amount of attention and comforting from their parents, and it is from the parents that they develop their first sense of trust or mistrust.
- Early Childhood: Autonomy vs. Shame and Doubt. In the second stage of psychosocial development, children begin to assert independence, develop preferences, and make choices. Defiance, temper tantrums, and stubbornness are common. It is in this stage that a person first begins developing interests, a sense of autonomy, and shame or doubt.
- Preschool Years: Initiative vs. Guilt. In this stage, children learn about social roles and emotions. They become active and curious. Imaginary play is a crucial part of this stage. Defiance, temper tantrums, and stubbornness remain common. As they develop, children will begin exhibiting behaviors of their own volition. The way parents and caregivers react will encourage a child's initiative to act independently or cause the child to develop a sense of guilt about inappropriate actions.
- School Age: Industry (Competence) vs. Inferiority. Relationships with peers and academic performance become increasingly important in this stage. Children begin to display a wider and more complex range of emotions. This is a time when problems or disappointment in academic and social settings may lead to mental health conditions such as depression or anxiety. As academic and social tasks become more demanding, conditions such as attention-deficit hyperactivity and oppositional behavior may interfere.
- Adolescence: Identity vs. Role Confusion. Adolescents become more independent and begin to form identities based on experimentation with new behaviors and roles. Puberty usually occurs during this stage, bringing with it a host of physical and emotional changes. Changes during these often volatile adolescent years may strain parent-adolescent relationships, especially when new behaviors go beyond experimentation and cause problems at school or home, or if emotional highs and lows persist and lead to experiences such as anxiety or depression.
Each developmental phase presents specific challenges for children that they tend to work through as normal parts of growing up. Mental health problems can exacerbate these challenges, though, and in many cases, mental health issues arise as a direct result of events in a child’s life, whether those events are traumatic experiences such as being bullied or ordinary experiences such as moving to a new home.
Every child will respond differently to changes in life, but some of the events that may impact a child’s mental health include:
- Parental divorce or separation.
- The birth of a sibling.
- The death of a loved one, such as a family member or a pet.
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- Physical or sexual abuse.
- Poverty or homelessness.
- Natural disaster.
- Domestic violence.
- Moving to a new place or attending a new school.
- Being physically or emotionally bullied.
- Taking on more responsibility than is age-appropriate.
A child’s age, gender, and other factors will influence his or her resilience to changes and challenges in life. Younger children and boys, for example, often have an easier time adjusting to divorce than do girls or older children. Genetics play a role, too, as some mental health issues, such as bipolar, tend to run in families.
According to the National Institute on Mental Illness (NAMI) about 4 million children and adolescents experience a mental health issue that significantly impairs them at home, school, or in their social groups. The Centers for Disease Control and Prevention (CDC) estimates prevalence rates for the following diagnosable mental health conditions among children ages 3 to 17:
- Attention-deficit hyperactivity (ADHD): 6.8%
- Behavioral conditions: 3.5%
- Anxiety: 3%
- Depression: 2%
- Autism: 1.1%
- Tourette syndrome: 0.2%
These mental health conditions represent a portion of those experienced by children and adolescents, but they are certainly not inclusive of all conditions experienced.
Child abuse and neglect are also prevalent concerns among the various stressful life events that can lead to mental health challenges. The U.S. Department of Health and Human Services recorded 686,000 cases of child maltreatment in the year 2012 alone. Children who are abused or neglected may be unable to share what they have experienced due to overwhelming fear or shame. However, most professionals who work with children—including therapists—are mandated by law to report child maltreatment to appropriate authorities, regardless of any agreements about confidentiality.
When children reach adolescence, relationships, romantic or otherwise, can be a point of significant strife. Relationships between parents and children are crucial to healthy development, but may become strained by the many ups and downs of adolescent life. For example, most teenagers worry about romantic relationships. However, for some teenagers, worrying about relationships may excessively drain their energy and make it difficult to enjoy life.
Disordered eating, a condition that, according to the American Academy of Child and Adolescent Psychiatry, affects about 10% of young women in the United States, may be attributed in part to the social pressures and stress of adolescent life. Two common forms of this condition, anorexia nervosa and bulimia, are more common in the female population but also occur in the adolescent male population. According to Dr. Kim Dennis, CEO and medical director for residential treatment center Timberline Knolls, disordered eating also frequently co-occurs with substance abuse.
When searching for a therapist or counselor, it may help to seek advice from a school counselor or pediatrician who can refer you to someone with specialized training and experience in working with youth. Treatment, whether it’s medication or therapy or a combination of both, works for many adolescents experiencing mental health issues, but it must be accessed in order to work. In late 2009, a study partially funded by the National Institute on Mental Health found that only about half of all children and adolescents experiencing generalized anxiety, panic, disordered eating, depression, attention-deficit hyperactivity (ADHD), and conduct issues actually received professional mental health services. The study also found that while prevalence rates were roughly the same across races, fewer African-Americans and Mexican-Americans were likely to seek help, which indicates gaps in access and/or barriers to treatment among minority adolescents.
Experimentation with alcohol and drugs is fairly common among adolescents and can lead to serious developmental, social, and behavioral issues. The CDC has estimated the following prevalence rates for problems associated with substance use among adolescents ages 12 to 17:
- Problematic illegal drug use: 4.7%
- Problematic alcohol use: 4.2%
- Physical dependence on cigarettes: 2.8%
Many programs exist for adolescents that experience problems associated with use of drugs or alcohol. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that supportive caregivers be involved in treatment for adolescent substance use. Supportive caregivers can play an important part in treatment by monitoring the adolescent’s use of substances, holding them accountable to therapy goals, and by helping find new and healthy ways to cope with the stress or conditions that may have led to substance use. SAMHSA also recommends that treatments address other mental health conditions that may co-occur in the adolescent receiving care. In some cases, residential treatment programs may prove beneficial. Residential treatment provides a safe, supportive environment and medical supervision, promotes camaraderie among residents, and removes residents from their daily lives where triggers may compel them to continue using substances.
Other examples of treatments for adolescent substance abuse may include:
- Teen Intervene: This is a fairly brief intervention for teens who show early signs of problems with drugs or alcohol. The treatment helps adolescents set goals and recognize their own values that may help them avoid using drugs and/or alcohol. The treatment also helps adolescents identify healthy coping strategies for dealing with stress without the use of substances.
- Adolescent Community Reinforcement: This treatment approach addresses substance use by identifying factors from the adolescent’s life and family that may have led to substance use. The treatment then helps the family develop a support system for the adolescent trying to move away from substance abuse.
- Multisystemic Family Therapy: This is a highly-individualized treatment that works to address problems that may occur at school, home, or in friendship circles. A combination of therapeutic approaches, including behavioral, cognitive behavioral, and family therapies are used to help families address substance use and other mental health conditions that occur for the adolescent in treatment.
Many types of therapy emphasize talking and thinking about feelings and experiences, which can be particularly challenging for young children. In working with children, counselors often use therapies that allow children to express themselves non-verbally, such as play therapy, sand tray therapy, and art therapy. In some cases, eye movement desensitization and reprocessing therapy (EMDR), which relies very little on verbalization of experiences, can be appropriate for work with youth.
Youth of any age may feel uncomfortable, afraid, or ashamed about communicating what they are experiencing to an adult they do not know. If you are a parent or caregiver, these tips can help when talking to children about therapy and mental health treatment:
- Find a good time to talk and assure them that they are not in trouble.
- Listen actively.
- Take your child’s concerns, experiences, and emotions seriously.
- Try to be open, authentic, and relaxed.
- Talk about how common the issues they are experiencing may be.
- Explain that the role of a therapist is to provide help and support.
- Explain that a confidentiality agreement can be negotiated so children—especially adolescents—have a safe space to share details privately, while acknowledging that you will be alerted if there are any threats to their safety.
When searching for a therapist or counselor, it may help to seek advice from a school counselor or pediatrician who can refer you to someone with specialized training and experience in working with youth. Some therapists specialize in family therapy, in which multiple family members may attend sessions together, as well as independently, if necessary. There are also treatments designed to address parenting skills, such as parent-child interaction therapy. These treatments may be useful when a child’s behavior becomes difficult to manage.
Many prominent bodies of research highlight the efficacy of a combined treatment approach, or the use of both medication and therapy, when medication is prescribed by a physician or psychiatrist for a mental health issue. In fact, the American Psychological Association’s Practice Guidelines Regarding Psychologists’ Involvement in Pharmacological Issues encourages, whenever possible, to include psychotherapy when medication is prescribed. Many mental health professionals argue that medication is overprescribed as a “quick fix,” while therapy, which may teach a person long-term coping strategies and self-management, is not encouraged enough. If your child is prescribed an antidepressant, antipsychotic, anxiolytic, stimulant, or other psychotropic drug, consider finding a therapist or counselor to pair with the drug treatment.
- Conflict between teen and her mother: Zara, 15, and her mom Cassy, 39, begin family therapy together after communication between them reaches a breaking point. They fight daily. Zara often refuses to listen to Cassy, at times walking out of the room or leaving the house mid-conversation. Cassy frequently nags Zara about chores, school work, friends, and how much she misses spending time with her. In therapy, Zara reveals that she wants her mom to stop nagging, and Cassy explains she wants Zara to communicate more effectively with her. The therapist provides the two with some education regarding Zara's stage of psychological development as well as several healthy communication strategies. With the help of the therapist, Zara and Cassy outline rules for communication and negotiation. With mother and daughter both speaking, actively listening, and learning new ways of relating, both Cassy and Zara find that their relationship becomes less stressful.
- Child who repeatedly runs away: Camden, 9, runs away from home each afternoon. His parents have him talk with police officers, his pastor, and teachers at his school about the dangers of running away. When his behavior does not change, Camden's parents arrange for him to meet with a child counselor. In the first session, the counselor takes a family history and learns that Camden's mother works throughout the day, his father works overnight, his three older siblings spend a lot of time away from home. In subsequent conversations with Camden, the counselor learns that Camden feels as if no one pays attention to him. However, when he runs away, his parents and other adults drop everything to search for him—he becomes the focus of everyone's attention. The counselor explains to Camden's parents that Camden has learned that running away is an effective way to get the attention he craves. Through continued counseling, Camden and his parents develop a stronger relationship, and Camden is able to receive the attention he seeks in safer ways, and he no longer runs away.
- Age- and gender-based populations (2014). Retrieved from http://www.samhsa.gov/specific-populations/age-gender-based
- Children’s mental health – new report (2013). Retrieved from http://www.cdc.gov/features/childrensmentalhealth/
- National registry of evidence-based program and practices (2014). Substance and Mental Health Services Administration: SAMHSA. Retrieved from http://www.samhsa.gov/nrepp
- Talking to your kids when they need help (2014). Retrieved from http://www.apa.org/helpcenter/help-kids.aspx
- Child Welfare Information Gateway (2014). Mandatory reporters of child abuse and neglect. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau
- Merikangas, K.R., Nakamura, E.F., and Kessler, R.C., (2009). Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience, 11, 7-20
- U.S. Department of Health and Human Services (2014). Child Maltreatment, 2012. Washington, DC: US Government Printing Office.
Last updated: 07-19-2016