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Mental health disorders

  • Independent researcher
Child Trends
Publication # 2013-1 January 2013
Mental Health Disorders
By David Murphey, Ph.D., Megan Barry, B.A., and Brigitte Vaughn, M.S.
Mental disorders are diagnosable conditions characterized by changes in
thinking, mood, or behavior (or some combination of these) that can cause a
person to feel stressed out and impair his or her ability to function. These
disorders are common in adolescence. This Adolescent Health Highlight
presents the warning signs of mental disorders; describes the types of
mental disorders and their prevalence and trends; discusses the
consequences and risk of mental disorders; presents treatment options and
barriers to accessing mental health care; and provides mental health
The definition and complexities of mental disorders
Medical science increasingly recognizes the vital link between a person’s
physical health and his or her mental/emotional health. Mind and body are
connected as one, each affected by the other, and both are influenced by a
person’s genetic inheritance, environment, and experience. Just as the
absence of disease does not adequately define physical health, mental
health consists of more than the absence of mental disorders. Mental health
is best seen as falling along a continuum, which fluctuates over time, and
across individuals, as well as within a single individual.3
As defined in this Highlight, mental disorders are diagnosable conditions
characterized by changes in thinking, mood, or behavior (or some
combination of these) that are associated with distress or impaired
functioning.4 As with symptoms of physical illness, symptoms of mental
disorders occur on a spectrum from mild to severe. People with mental
disorders, however, often have to bear the special burden of the societal
stigma associated with their condition. This burden sometimes prevents
people from acknowledging their illness and from seeking support and
effective treatment for it. Just as with physical health, failure to address
symptoms early on can have serious negative consequences.
What are the warning signs of mental disorders?
It is important to make a clear distinction between the normal ups and
downs of mood and outlook, and diagnosable mental disorders. Everyone,
especially many adolescents, experiences mood swingsfrom feeling blue,
to expressing giddy excitement, to being anxious or irritable.
Adolescents are biologically prone to have more of these mood swings
because of the hormonal changes associated with this period in life, coupled
with the fact that their brains are still developing.6,8 Many adolescents can
worry that they’re “losing it,” when, in reality, these mood swings may be
normal occurrences.6,10
1. Mental disorders in adolescence are
common: An estimated one in five
adolescents has a diagnosable
2. Adolescence is the time when many
mental disorders first arise. More
than half of all mental disorders and
problems with substance abuse
(such as binge drinking and illegal
drug use) begin by age 14.2
3. The most prevalent mental disorder
experienced among adolescents is
depression,4 with more than one in
four high school students found to
have at least mild symptoms of this
4. Adolescents with mental disorders
are at increased risk of getting
caught up in harmful behaviors, such
as substance abuse and unprotected
sexual activity. 1,6,7
5. Many effective treatments exist for
mental disorders, most involving
some combination of psychotherapy
and medication.9
6. The majority of adolescents with
mental disorders do not seek out or
receive treatment, a consequence of
various barriers to care, including
the fear of being stigmatized by
peers and others.4
Fast Facts
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Mental Health
January 2013
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However, when psychological symptoms cause major emotional distress, or interfere substantially
with daily life and social interactions over a period of time, professional evaluation is warranted, just
as it is with any serious illness. Not all mental disorders among adolescents have obvious, reliable
symptoms, but parents, teachers, and others should be alert to some warning signs that an
adolescent may be in trouble. These signs include persistent irritability, anger, or social withdrawal,
as well as major changes in appetite or sleep.11,12
What are the types of mental disorders, and which are the most common among adolescents?
Mental health professionals use various classifications to identify the diverse range of mental
disorders. Many adolescent mental disorders fall under the broad categories of mood disorders
(e.g., depression and bipolar disorder); behavioral disorders (e.g., various acting-out behaviors,
including aggression, destruction of property, and some problems of attention and hyperactivity);
and anxiety disorders (including social anxiety disorder, obsessive-compulsive disorder (OCD), post-
traumatic stress disorder, and phobias).4,13 Many adolescents with mental disorders have symptoms
indicative of more than one disorder.3
Percentage of students in grades 9-12 who reported symptoms of depression*, by
gender, 2011
* Symtoms of depression in this survey are an affirmative response to the statement “reported feeling sad or hopeless
almost every day for two weeks or longer during the past year.
Source: Centers for Disease Control and Prevention. (2012). Youth Risk Behavior Surveillance Survey- United States, 2011.
Surveillance summaries: MMWR 2012; 61 (No SS-4) .
Adolescence is a time when many mental disorders first arise; in fact, more than half of all mental
disorders and problems with substance abuse (such as binge drinking and illegal drug use) begin by
age 14, and three-quarters of these difficulties begin by age 24.2 Accurate estimates of the number
of adolescents who have diagnosable mental disorders are difficult to come by, for several reasons:
many adolescents are reluctant to disclose these disorders; definitions of disorders vary; and most
diagnoses rely on clinical judgment rather than on biological markers (such as a blood test).14
However, available data suggest that 20 percent of adolescents have a diagnosable mental
disorder.1 Depression is the single most common type reported by adolescents, though it is often
Adolescents are
biologically prone
to have more mood
swings because of
the hormonal
changes associated
with adolescence,
coupled with the
fact that their
brains are still
suggest that 20
percent of
adolescents have a
diagnosable mental
disorder, and
depression is by far
the most common.
Child Trends
Mental Health
January 2013
Page 3
accompanied by other mental disorders.4 In 2011, more than one in four (29 percent) high school
students in grades 9-12 who participated in a national school-based survey reported feeling sad or
hopeless almost every day for two weeks or longer during the past yeara red flag for possible
clinical depression (see Figure 1).15
Another survey that collected information from adolescents between the ages of 12 and 17 found
that in 2008, about one in 12 (8 percent) reported experiencing a major depressive episode during
the past year (see Figure 2).16 These estimates have not changed much over the past five to 10
years.5 A slightly lower percentage of adolescents (3 percent) met the criteria for conduct disorders.4
Adolescents with conduct disorders are extremely uncooperative, are persistent in defying societal
rules and authority figures, and are often severely angry, aggressive, and destructive.17
Major depression
Conduct disorders
Anxiety disorders
Eating disorders
Attention deficit-
disorder (ADHD)
Percentage of adolescents with selected mental disorders*
*These data are from different reporting years: major depression, 2008; anxiety disorders, 1999; conduct disorders, 1995;
and eating disorders and ADHD, 2005. Estimates are based on adolescents’ self-reports of symptoms, not clinical
diagnoses, except for ADHD, where estimates are based parent’s reporting that a professional had given that diagnosis.
Sources: Substance Abuse and Mental Health Services Administration. (2009). Results from the 2008 National Survey on
Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-36, HHS Publication No. SMA 09-4434).
Rockville, MD. Knopf, D. et al. (2008). The mental health of adolescents: A national profile, 2008. National Adolescent
Health Information Center.
An estimated 10 percent of adolescents reported symptoms of an anxiety disorder.4 Among the
more common anxiety disorders are OCD, social anxiety disorder, post-traumatic stress disorder
(PTSD), and phobias. OCD is characterized by recurrent and persistent thoughts, images, or impulses
(obsessions) that are unwanted, and/or repetitive behaviors or rituals (compulsions) that cause
distress.18 PTSD can develop after a person has seen or lived through a dangerous or frightening
event. This disorder is characterized by flashbacks or bad dreams, emotional numbness, and/or
intense guilt or worry, among other symptoms.19 Phobias are intense, irrational fears of things or
An estimated 10
percent of
adolescents have
anxiety disorders,
the most common
of which are OCD,
stress disorder, and
29 percent of high
school students in
grades 9-12
reported feeling
sad or hopeless
almost every day
for two weeks or
longer during the
past yeara red
flag for possible
clinical depression.
Child Trends
Mental Health
January 2013
Page 4
circumstances that pose little or no actual danger. Facing, or even the thought of facing, the feared
object or situation can spur panic attacks or severe anxiety.13 Panic disorders (a type of anxiety
disorder characterized by a racing heartbeat, shortness of breath, and other pronounced physical
symptoms) affect around one percent of adolescents.20
About five percent of adolescents report symptoms of an eating disorder.4 Less common are autism
spectrum disorders (a diverse category of conditions, typically marked by severe impairments in
social and communication skills).21
Adolescents with attention deficit-hyperactivity disorder (ADHD) have difficulty paying attention,
controlling impulses, and staying organized.12 Some estimates put the prevalence of the disorder as
high as nine percent among 12- to 17-year-olds.4 Adolescent males are more likely than are females
to have ever been diagnosed with ADHD.4 However, biases may exist in the identification of young
people with ADHD, including lower rates of diagnosis among Hispanic children22 and higher rates for
those who are young for their grade.23
What are some of the consequences of mental disorders?
Mental disorders take a toll on adolescents, their parents, and friends, and contribute significantly
to health care costs. The consequences can be short- or long-term. Indeed, most mental disorders
diagnosed among adults began during adolescence, although other mental disorders experienced by
adolescents may diminish by early adulthood if they are treated.4,9
Substance abuse disorders frequently go hand in hand with mental disorders.4 In addition, mental
disorders are often associated with other negative emotional and behavioral patterns in
adolescenceincluding impaired relationships, lower academic performance, a higher risk of
unprotected sex and teen pregnancy, and increased involvement with the juvenile justice system.
However, many adolescents who experience these issues do not have a mental disorder, and many
youth with mental disorders do not have these problems.1,6,7 The single most disturbing potential
consequence of adolescent mental disorders is suicidethe third leading cause of death among 10-
to 24-year-olds in the United States. Although suicide can have multiple causes, 90 percent of
adolescents who commit suicide had a diagnosable mental disorder, and up to 60 percent of them
were suffering from depression at the time of their death.24
How do risks of mental disorders vary across adolescents?
Adolescent males generally are more likely than are their female peers to be diagnosed with
behavioral problems, including conduct disorders, ADHD, and autism spectrum disorders.4,25
Adolescent females are more commonly diagnosed with depression and eating disorders than are
males.4,26 Adolescents whose parents have lower levels of education (e.g., no college degree) have
more risk of having a mental disorder than do adolescents whose parents have higher levels of
education. Adolescents whose parents are divorced are also more likely to have mental disorders
than are adolescents whose parents are married or cohabiting.27 Other groups of adolescents
particularly at risk for mental disorders include those involved in bullying (either as victims or
perpetrators), those who have experienced sexual or physical abuse, and those whose parents have
a history of mental disorders.24,28 Among ethnic groups, Hispanic and black adolescent females have
a higher risk of depressive symptoms than do adolescent females from other racial/ethnic groups.15
Some estimates put
the prevalence of
ADHD as high as
nine percent
among 12- to 17-
The single most
consequence of
adolescent mental
disorders is
suicide—the third
leading cause of
death among 10-
to 24-year-olds in
the United States.
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Mental Health
January 2013
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How can mental disorders be treated?
As in other arenas of health, early intervention or prevention can be an effective way to address
potential mental disorders before they reach the stage requiring treatment. Although not all mental
disorders are accompanied by early warning signs, people who interact with and care about
adolescents should be alert to marked changes in mood or behavior that may suggest problems. At
the same time, concerned adults can help adolescents maintain positive mental health by providing
caring, supportive relationships, encouraging healthy behaviors, and teaching effective strategies for
coping with stress.29
Most mental disorders are treatable, although what works for particular individuals may vary. Often
a combination of psychosocial therapy (personal or group counseling with a psychotherapist) and
medication is effective. For many types of disorders (e.g., depression and OCD), cognitive-behavioral
therapies and medications have been shown to be effective in many cases.7 Cognitive-behavioral
therapies seek to help people modify negative or irrational thoughts and to replace dysfunctional
behaviors with more rational ones. For other types of disorders (such as ADHD), behavioral parent
training and classroom management techniques may be effective.9 When psychiatric medications
are prescribed, they are typically administered in combination with other treatment approaches,
such as individual psychotherapy, group therapy, or family therapy. In general, experts agree that
medication should not be the only treatment followed, and that any treatment plan should be
supervised by a clinician with specific training in adolescent mental health.9
Other strategies have also been used successfully with particular mental disorders. For depression,
some evidence shows that increased physical exercise may provide some benefits.30 For conduct
disorders, promising results have been found when the young person with the disorder is treated,
together with his or her family and community, using a “systems” approach. The systems approach
attempts to address multiple problem behaviors that the adolescent is exhibiting by providing
multiple types of services, such as education, child protection, juvenile justice, and mental health
services.7 In other words, systems approaches involve coordinating services from different providers
and are tailored to meet the needs of the individual adolescent.
Some families may choose unconventional therapies (sometimes referred to as complementary or
alternative medicine) as a way to treat physical and mental disorders. Examples of these include diet
modifications, such as eliminating sugar, or foods with dyes and additives; herbal or vitamin
supplements; and music or dance therapy. Although these practices have become more widespread
in recent years, particularly for autism spectrum disorders, they have not met the same rigorous
standards of evidence as more traditional treatments, and consumers should be skeptical of
dramatic or poorly substantiated claims for effectiveness.31 Talking to a trained clinician is key in
determining the proper treatment for any mental disorder.
How do adolescents access mental health services, and what are barriers to care?
Parents, other family members, and friends can all play roles in encouraging adolescents who are
experiencing emotional distress to seek help. Mental health services for adolescents are provided by
a mix of specialists (psychiatrists, psychologists, social workers, and others) in the public and private
sectors. In general, this system of diverse providers is crisis-oriented and designed for treating
people with diagnosed mental disorders (particularly as reflected in reimbursement policies.) The
system is less structured to address prevention and health promotion, early identification of
difficulties, and timely, effective treatment.14,32
Parents, other
family members,
and friends can all
play roles in
adolescents who
are experiencing
emotional distress
to seek help.
Mental disorders
are treatable,
although what
works for
individuals may
vary. Often a
combination of
therapy and
medication is
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School health centers are often helpful in identifying the mental health care needs of adolescents,
partly because adolescents spend much of their time in school, and partly because these clinics are
accessible to students in low-income and underserved racial and ethnic minority groups, who are
more likely to be without health insurance.14,33 However, few school mental health professionals are
able to provide intensive care on their own.14 Primary care providers (pediatricians and others) are
often the gatekeepers for identifying mental disorders in adolescents. However, these providers
may lack the time in their practicesas well as the specific expertiseto identify and manage these
disorders. Moreover, efforts to coordinate care between primary care providers and mental health
professionals vary considerably in their effectiveness.
Studies have found that most children and adolescents with mental disorders (between 60 and 90
percent) do not seek out or receive the services that they need.4 The societal stigma associated with
mental disorders may help explain why many adolescents do not seek treatment. Also, parents,
school officials, and medical providers often miss opportunities to address the prevention and early
identification of mental disorders. Additional barriers include services that are poorly coordinated
(e.g., among schools, primary health care providers, and social services agencies); a lack of health
insurance (although most adolescents are insured); restrictions by insurers on coverage for certain
services; and a shortage of providers with specific expertise in adolescent mental health.14
Implications for preventing risky adolescent behaviors
Young people with mental disorders, in general, are more vulnerable to involvement in risky
activities that jeopardize their health and well-being than are young people in the larger adolescent
population.1,6 Suicide attempts and self-injury are the most dire of these threats, but other
troublesome behaviors warrant scrutiny as well. For example, adolescents with depression are also
more likely than are their nondepressed peers to engage in substance abuse and early sexual
activity;5 and adolescents with conduct disorders are more likely to engage in early sexual activity,
early drug and alcohol use, interpersonal violence, and delinquency.12 Thus, preventionin addition
to early diagnosis and treatment of mental disordersis essential for reducing many other serious
problem behaviors.29
Strategies and approaches to reduce mental health disorders among adolescents
The National Prevention Strategy is a comprehensive plan designed the government’s National
Prevention Council to help improve the health of Americans at every stage of life. Its mental health
recommendations include:
Promoting early identification of mental health needs and access to quality services.
Clinicians are key to identifying mental health needs, so integrating mental health care into
traditional health care settings and social service, community, and school settings is
important, especially for adolescents who have experienced trauma.
Reducing the stigma associated with mental health services. Doing so will improve access to
and use of the effective mental health treatment that is available.34
The U.S. Preventive Services Task Force recommends that adolescents (ages 12-18) be screened for
major depressive disorder (MDD) when there are appropriate services available for accurate
diagnosis, psychotherapy, and follow-up.35
Young people with
mental disorders,
in general, are
more vulnerable to
involvement in
risky activities
that jeopardize
their health.
Primary care
providers may lack
the time in their
practices, as well as
the specific
expertise, to
identify and
manage mental
Child Trends
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The Child Trends DataBank includes brief summaries of well-being indicators, including several that
are related to mental disorders and mental health:
Attention Deficit-Hyperactivity Disorder (ADHD):
Adolescents Who Feel Sad or Hopeless:
Autism Spectrum Disorders:
Disordered Eating: Symptoms of Bulimia:
Suicidal Teens:
Teen Homicide, Suicide, and Firearm Deaths:
The Childs Trends LINKS (Lifecourse Interventions to Nurture Kids Successfully) database summarizes
evaluations of out-of-school time programs that work (or not) to enhance children's development. The
LINKS Database is user-friendly and directed especially to policy makers, program providers, and
Programs related to anxiety disorders/symptoms, conduct/disruptive disorders, and eating
disorders can be found by selecting those boxes under mental health.
Evaluations of programs proven to work (or not) for reducing depression/depressive symptoms,
suicidal thoughts or behaviors, anxiety/anxious symptoms, and post-traumatic stress disorder, in
addition to other mental health behaviors, are summarized in the fact sheet What works to
prevent or reduce internalizing problems or social-emotional difficulties in adolescents: Lessons
from experimental evaluations of social interventions.
Evaluations of programs proven to work (or not) for reducing ADHD are summarized in a fact
sheet What works for acting-out (externalizing) behavior: Lessons from experimental evaluations
of social interventions.
Other selected resources include:
The National Institute of Mental Health (NIMH) provides a number of resources, including fact
sheets on brain development and mental disorders in adolescence
The Centers for Disease Control and Prevention (CDC) has information about mental health
changes in early adolescence ( and
middle or older adolescence (,
as well as a number of resources on suicide prevention
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides the Mental
Health Services Locator, an online, map-based program people can use to find facilities in their
vicinity ( SAMSHA also maintains an online library of free
publications and resources, with more than 200 documents focused on adolescent behavioral
health issues ( In addition, SAMHSA supports the Suicide
Prevention Resource Center (, which helps organizations and individuals to
develop suicide prevention programs, interventions, and policies.
Institute of
Mental Health
provides a
number of
including fact
sheets on brain
development and
mental disorders
in adolescence.
The Child Trends
includes brief
summaries of
including several
that are related
to mental
disorders and
mental health.
Child Trends
Mental Health
January 2013
Page 8
ADOLESCENT HEALTH HIGHLIGHT provides prevention goals and guidelines for several key indicators of adolescent
mental health, including screenings for depression and decreasing the rate of suicide attempts
In addition, health professionals, educators, and others can direct adolescents and their families to a
number of federal resources., from the Office on Women’s Health, offers tip sheets about adolescents
and their feelings, including “How to know if your ‘blues’ are depression”
Adolescents (or anyone) in suicidal crisis or emotional distress can call the National Suicide
Prevention Lifeline at 1-800-273-TALK; calls made to this 24-hour hotline are routed to the
caller’s nearest crisis center.
The authors would like to thank Jennifer Manlove, Lina Guzman, and Marci McCoy-Roth at Child Trends for their careful
review of and helpful comments on this brief.
Editor: Harriet J. Scarupa
(or anyone) in
suicidal crisis or
emotional distress
can call the National
Suicide Prevention
Lifeline at 1-800-
Child Trends
Mental Health
January 2013
Page 9
1 Schwarz, S. W. (2009). Adolescent mental health in the United States: Facts for Policymakers Retrieved November 9, 2012,
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the Society for Adolescent Medicine. Journal of Adolescent Health, 39, 456-458.
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8 Casey, B. J., Jones, R. M., & Hare, T. A. (2008). The adolescent brain. Annals of the New York Academy of Science, 1124, 111-
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15 Centers for Disease Control and Prevention. (2012). Youth Risk Behavior Surveillance-United States, 2011. Morbidity and
Mortality Weekly Report, 61(4).
16 Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality. (2011).
The NSDUH Report: Major Depressive Episode and Treatment among Adolescents: 2009. Rockville, MD. Retrieved
November 9, 2012, from
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and youth with conduct disorder and oppositional defiant disorder: Systems of care. Washington, D.C.
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and adolescents Retrieved November 9, 2011, from
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fact sheet: Post-Traumatic Stress Disorder research. Retrieved November 9, 2012, from
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20 Diler, R. S. (2003). Panic disorder in children and adolescents. Yonsei Medical Journal Retrieved November 9, 2012, from
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2012, from
... These disorders are related to psychosocial factors. It is accepted as the poor reaction of the organism to psychosocial situations (Ozturk, 1990). ...
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... In addition to these negative effects of anxiety on daily routines of people, it also affects human health negatively by paving the way for many diseases such as coronary problems [3]. For this reason, healthcare professionals should protect patients from anxiety and stress as much as possible.Research shows that the prevalence of anxiety disorder or anxiety symptoms in the society is between 10-70% [4]. It has been reported that being a patient, being admitted to hospital and being exposed to a procedure for diagnosis and treatment may cause stress andnegative effects such as anger, fear, anxiety. ...
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Background and objective: Magnetic resonance imaging (MRI) causes severe anxiety in some patients. Anxiety during MRI leads to prolongation of the procedure and deterioration of image quality, resulting in loss of labor and cost increase. The aim of this study was to investigate the effect of written and visual information on state anxiety in patients undergoing MRI. Material and Methods: A cross-sectional prospective study was conducted with 294 participants. The study was carried out between January 2019 and March 2019 at the Radiology Clinic of the tertiary university hospital. The participants were divided into 3 groups as group 1 (control group), group 2 (written information) and group 3 (visual information). The trait anxiety and state anxiety of the participants were measured by State-Trait Anxiety Inventory (STAI) inventory, which can measure both anxiety status. Results: There was no statistically significant difference between demographic characteristics and trait anxiety scores (p = 0.20) of all three groups. The state anxiety scores of group 3 were statistically lower than the group 2 (p < 0.001) and control group (p < 0.001). The state anxiety scores of group 2 were statistically lower than control group (p < 0.001). Conclusion: MRI anxiety can be reduced by visual and written information. Visual information may be more effective in reducing MRI anxiety than written information.
... The onset of such difficulties is characterised by changes in thought, mood and/or behaviour that impair functioning. 9 The range of mental health difficulties are typically dichotomised in terms of their directionality, with a distinction made between those that are primarily internalising in nature (e.g. depression, anxiety) and those that are externalising in nature (e.g. ...
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Background Universal social and emotional learning interventions can produce significant practical improvements in children’s social skills and other outcomes. However, the UK evidence base remains limited. Objectives To investigate the implementation, impact and cost-effectiveness of the Promoting Alternative THinking Strategies (PATHS) curriculum. Design Cluster randomised controlled trial. Primary schools ( n = 45) were randomly assigned to implement PATHS or to continue with their usual provision for 2 years. Setting Primary schools in seven local authorities in Greater Manchester. Participants Children ( n = 5218) in Years 3–5 (aged 7–9 years) attending participating schools. Intervention PATHS aims to promote children’s social skills via a taught curriculum, which is delivered by the class teacher, generalisation activities and techniques, and supplementary materials for parents. Schools in the usual provision group delivered the Social and Emotional Aspects of Learning programme and related interventions. Main outcome measures Children’s social skills (primary outcome, assessed by the Social Skills Improvement System); pro-social behaviour and mental health difficulties (Strengths and Difficulties Questionnaire); psychological well-being, perceptions of peer and social support, and school environment (Kidscreen-27); exclusions, attendance and attainment (National Pupil Database records); and quality-adjusted life-years (QALYs) (Child Health Utility 9 Dimensions). A comprehensive implementation and process evaluation was undertaken, involving usual provision surveys, structured observations of PATHS lessons, interviews with school staff and parents, and focus groups with children. Results There was tentative evidence (at a p -value of < 0.10) that PATHS led to very small improvements in children’s social skills, perceptions of peer and social support, and reductions in exclusions immediately following implementation. A very small but statistically significant improvement in children’s psychological well-being [ d = 0.12, 95% confidence interval (CI) –0.02 to 0.25; p < 0.05) was also found. No lasting improvements in any outcomes were observed at 12- or 24-month post-intervention follow-up. PATHS was implemented well, but not at the recommended frequency; our qualitative analysis revealed that this was primarily due to competing priorities and pressure to focus on the core academic curriculum. Higher levels of implementation quality and participant responsiveness were associated with significant improvements in psychological well-being. Finally, the mean incremental cost of PATHS compared with usual provision was determined to be £29.93 per child. Mean incremental QALYs were positive and statistically significant (adjusted mean 0.0019, 95% CI 0.0009 to 0.0029; p < 0.05), and the incremental net benefit of introducing PATHS was determined to be £7.64. The probability of cost-effectiveness in our base-case scenario was 88%. Limitations Moderate attrition through the course of the main trial, and significant attrition thereafter (although this was mitigated by the use of multiple imputation of missing data); suboptimal frequency of delivery of PATHS lessons. Conclusions The impact of PATHS was modest and limited, although that which was observed may still represent value for money. Future work should examine the possibility of further modifications to the intervention to improve goodness of fit with the English school context without compromising its efficacy, and identify whether or not particular subgroups benefit differentially from PATHS. Trial registration Current Controlled Trials ISRCTN85087674 (the study protocol can be found at: ). Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research ; Vol 6, No. 10. See the NIHR Journals Library website for further project information.
... During the interview with the patient and her relatives; the diagnosis of delusional disorder was excluded, because her complaints were periodic rather than permanent [6], rapid recovery of symptoms, thoughts on deception were not so intense, and it was understood that domestic problems had originated from financial issues rather than the patient's thoughts. It was thought that the diagnosis of delusional disorder put on the patient 6 years ago might be wrong. ...
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Factitious disorder (FD) is a diagnostic entity in which patients intentionally create false physical or mental symptoms. Although the disorder is rare, having an early diagnose is critical, because it causes unnecessary health expenditures and tends to become chronic. In this article, a case of delusional disorder who had been monitored for 6 years, then hospitalized due to a pre-diagnosis of drug induced movement disorder, and had a final diagnosis of FD was discussed. Through this case report, it was aimed to emphasize the importance of careful monitoring of the patients for preventing unnecessary investigations and treatments.
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The existing literature shows mixed results of how the use of social networking sites (SNSs) is related to mental health. Some studies provided evidence that SNS users are more mentally healthy because of the exchanged social support, while others argued that users tend to engage in upward social comparison, which would result in mental illness. To shed light on this relationship, we conducted a meta-analytic review to examine a) the association between SNS use and mental illness and b) the factors that moderate the association. A total of 1,451 studies were retrieved from six databases (i.e., Communication & Mass Media Complete, PsycINFO, Academic Search Complete, Web of Science, PubMed, and Medline), among which 37 empirical studies (N = 84,955) were eligible for meta-analysis based on the inclusion criteria (i.e., empirical and quantitative studies with human subjects, including sufficient statistical information for effect size computation, concerned with SNS use and mental illness). Results showed that SNS use is associated with not only the likelihood of experiencing overall mental illness (r = .11) but also specific illness, including depression (r = .10), suicidal ideation (r = .22), schizophrenia/mania (r = .09), and ADHD/hyperactivity (r = .27). In addition, the intensity of SNS use, continuous measurement (vs. categorical), and participants’ health condition were found as positive moderators, whereas adopting social support as the theoretical framework and the proportion of African American participants as negative moderators of the association between SNS use and mental illness. Implications of the current study were discussed.
There are barriers to implementing SEL programming in schools and these are addressed in Chap. 5. There is a need for expanding mental health services to children in schools. In order to expand mental health services so that they will reach many more students, one possibility is shortening interventions for at risk and identified students. This may allow school-based mental health practitioners to service a larger number of students. Another possibility is bringing teachers into this effort as they are frontline workers. Ways to bring teachers on board might involve mental health literacy-training or Mental Health First Aid Training. Approaches such as single-session interventions for students with issues around alcohol and drug use, a need for goal setting, crisis intervention, and reducing internalizing problems are discussed. Brief behavioral interventions are examined in detail to determine if any of the interventions posed by Biglan (2004) and Embry and Biglan (2008) might be applied to SEL. An approach to evaluating studies and brief interventions for an expanded view of SEL (SEAD), to determine whether or not sufficient evidence exists for these strategies to be used in schools is detailed.
Purpose: In this study we identified the essential elements of adolescent-friendly care in school-based health centers (SBHCs) from the perspectives of the nurse practitioners (NPs) providing care to adolescents and the adolescents, as the consumers of these services. Design and methods: Complex adaptive systems provided the philosophical and theoretical foundation for this study. An explanatory sequential mixed methods study was conducted. A Delphi technique (strand one) was conducted with an expert panel of NPs (N = 21) to identify the essential elements of adolescent-friendly care in SBHCs. The second strand, a focus group study with adolescents (N = 30), elaborated on the Delphi results. Data from the two strands were then mixed. Results: This study generated expert opinion regarding the essential elements of adolescent-friendly health care in SBHCs. After four Delphi rounds, consensus was reached on 98-items (49% of the original 200; consensus level of 0.75). The results clustered into 6 essential elements: Confidentiality/Privacy (n = 8; 8.2%), Accessibility, (n = 15; 15.3%), Clinician/Staff (n = 51; 52%), SBHC Clinical Services (n = 12; 12.2%), SBHC Environment (n = 4; 4.1%), and Relationship between the School and SBHC (n = 8; 8.2%). The adolescent focus groups confirmed the essential elements identified in the Delphi and added two overarching themes: Comfortable and Trusted Relationship. Conclusions: These findings contribute to a greater understanding of essential characteristics needed in adolescent friendly care. Practice implications: SBHCs, as an important community resource for addressing the health care needs of adolescents, should incorporate these characteristics.
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Extensive research has identified parental monitoring to be a protective factor for youth. Parental monitoring includes parents’ solicitation of information from their child and the child’s voluntary disclosure of information. In today’s digital society, parental monitoring can occur using technology, such as text messaging, email, and social networking sites. The current study describes parents’ and youths’ communication technology use explicitly to solicit and share information with each other in a sample of 56 parent–youth dyads from the same family (youth were 13 to 25 years old). We also examined associations between in-person parental monitoring, parental monitoring using technology, parental knowledge, and youth substance use initiation. Results revealed great variability in frequency of parental monitoring using technology, with a subgroup of parents and youth reporting doing these behaviors very frequently. Parental monitoring using technology was not associated with greater parental knowledge or youth substance use initiation after controlling for youth age group (adolescent or emerging adult) and gender composition of dyads. However, in-person communication between youth and parents remained an important variable and was positively associated with parental knowledge. Youth workers could empower parents to focus on in-person communication, and not rely solely on communication using technology.
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Pediatricians have an important role not only in early recognition and evaluation of autism spectrum disorders but also in chronic management of these disorders. The primary goals of treatment are to maximize the child's ultimate functional independence and quality of life by minimizing the core autism spectrum disorder features, facilitating development and learning, promoting socialization, reducing maladaptive behaviors, and educating and supporting families. To assist pediatricians in educating families and guiding them toward empirically supported interventions for their children, this report reviews the educational strategies and associated therapies that are the primary treatments for children with autism spectrum disorders. Optimization of health care is likely to have a positive effect on habilitative progress, functional outcome, and quality of life; therefore, important issues, such as management of associated medical problems, pharmacologic and nonpharmacologic intervention for challenging behaviors or coexisting mental health conditions, and use of complementary and alternative medical treatments, are also addressed.
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G. S. Hall's (1904) view that adolescence is a period of heightened "storm and stress" is reconsidered in light of contemporary research. The author provides a brief history of the storm-and-stress view and examines 3 key aspects of this view: conflict with parents, mood disruptions, and risk behavior. In all 3 areas, evidence supports a modified storm-and-stress view that takes into account individual differences and cultural variations. Not all adolescents experience storm and stress, but storm and stress is more likely during adolescence than at other ages. Adolescent storm and stress tends to be lower in traditional cultures than in the West but may increase as globalization increases individualism. Similar issues apply to minority cultures in American society. Finally, although the general public is sometimes portrayed by scholars as having a stereotypical view of adolescent storm and stress, both scholars and the general public appear to support a modified storm-and-stress view.
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Panic disorder (PD) in children and adolescents is a disabling and chronic condition, which is accompanied by psychosocial and academic difficulties both during adolescence and into adulthood. In this article, the prevalence, clinical characteristics, risk factors, comorbid states, differential diagnosis, and treatment of PD are reviewed. Although PD was thought to be rare in children and adolescents, the prevalence of PD in community samples ranges between 0.5% and 5.0, and in pediatric psychiatric clinics from 0.2% to 10%. Panic attacks are reported to be equally prevalent in males and females. Clinical studies have shown that the majority of the PD pediatric patients receiving consultation in clinics are older adolescents, Caucasian, female, and middle class. Up to 90% of children and adolescents with PD have other anxiety disorders (generalized anxiety disorder/overanxious disorder, separation anxiety disorder, social phobia or agoraphobia), or mood disorders (major depressive disorder or bipolar disorder). PD patients can be misdiagnosed or having neurologic, cardiovascular, pulmonary, or gastrointestinal illness. Psychoeducation and psychosocial treatments are recommended, and it appears that selective serotonin reuptake inhibitors (SSRIs) are a safe and promising treatment for children and adolescents with PD. The clinical characteristics, long-term course, and treatment of PD in children and adolescents needs to be further assessed by well-designed studies.
Natural selection constantly removes those genetic variants (alleles) that even slightly decrease average reproductive success. Yet, given the high heritabilities and prevalence rates of severe mental disorders, human populations seem to be awash in deleterious alleles. Evolutionary genetics offers an illuminating framework for understanding why mental disorder risk alleles have persisted despite natural selection, and this framework can help guide future research in behavioral and psychiatric genetics.
Thomas Grisso points out that youth with mental disorders make up a significant subgroup of youth who appear in U.S. juvenile courts. And he notes that juvenile justice systems today are struggling to determine how best to respond to those youths' needs, both to safeguard their own welfare and to reduce re-offending and its consequences for the community. In this article, Grisso examines research and clinical evidence that may help in shaping a public policy that addresses that question. Clinical science, says Grisso, offers a perspective that explains why the symptoms of mental disorders in adolescence can increase the risk of impulsive and aggressive behaviors. Research on delinquent populations suggests that youth with mental disorders are, indeed, at increased risk for engaging in behaviors that bring them to the attention of the juvenile justice system. Nevertheless, evidence indicates that most youth arrested for delinquencies do not have serious mental disorders. Grisso explains that a number of social phenomena of the past decade, such as changes in juvenile law and deficiencies in the child mental health system, appear to have been responsible for bringing far more youth with mental disorders into the juvenile justice system. Research shows that almost two-thirds of youth in juvenile justice detention centers and correctional facilities today meet criteria for one or more mental disorders. Calls for a greater emphasis on mental health treatment services in juvenile justice, however, may not be the best answer. Increasing such services in juvenile justice could simply mean that youth would need to be arrested in order to get mental health services. Moreover, many of the most effective treatment methods work best when applied in the community, while youth are with their families rather than removed from them. A more promising approach, argues Grisso, could be to develop community systems of care that create a network of services cutting across public child welfare agency boundaries. This would allow the juvenile justice system to play a more focused and limited treatment role. This role would include emergency mental health services for youth in its custody and more substantial mental health care only for the smaller share of youth who cannot be treated safely in the community.
The incidence and prevalence of eating disorders in children and adolescents has increased significantly in recent decades, making it essential for pediatricians to consider these disorders in appropriate clinical settings, to evaluate patients suspected of having these disorders, and to manage (or refer) patients in whom eating disorders are diagnosed. This clinical report includes a discussion of diagnostic criteria and outlines the initial evaluation of the patient with disordered eating. Medical complications of eating disorders may affect any organ system, and careful monitoring for these complications is required. The range of treatment options, including pharmacotherapy, is described in this report. Pediatricians are encouraged to advocate for legislation and policies that ensure appropriate services for patients with eating disorders, including medical care, nutritional intervention, mental health treatment, and care coordination.
To present estimates of the lifetime prevalence of DSM-IV mental disorders with and without severe impairment, their comorbidity across broad classes of disorder, and their sociodemographic correlates. The National Comorbidity Survey-Adolescent Supplement NCS-A is a nationally representative face-to-face survey of 10,123 adolescents aged 13 to 18 years in the continental United States. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview. Anxiety disorders were the most common condition (31.9%), followed by behavior disorders (19.1%), mood disorders (14.3%), and substance use disorders (11.4%), with approximately 40% of participants with one class of disorder also meeting criteria for another class of lifetime disorder. The overall prevalence of disorders with severe impairment and/or distress was 22.2% (11.2% with mood disorders, 8.3% with anxiety disorders, and 9.6% behavior disorders). The median age of onset for disorder classes was earliest for anxiety (6 years), followed by 11 years for behavior, 13 years for mood, and 15 years for substance use disorders. These findings provide the first prevalence data on a broad range of mental disorders in a nationally representative sample of U.S. adolescents. Approximately one in every four to five youth in the U.S. meets criteria for a mental disorder with severe impairment across their lifetime. The likelihood that common mental disorders in adults first emerge in childhood and adolescence highlights the need for a transition from the common focus on treatment of U.S. youth to that of prevention and early intervention.
This paper presents evidence that diagnoses of attention-deficit/hyperactivity disorder (ADHD) are driven largely by subjective comparisons across children in the same grade in school. Roughly 8.4 percent of children born in the month prior to their state's cutoff date for kindergarten eligibility - who typically become the youngest and most developmentally immature children within a grade - are diagnosed with ADHD, compared to 5.1 percent of children born in the month immediately afterward. A child's birth date relative to the eligibility cutoff also strongly influences teachers' assessments of whether the child exhibits ADHD symptoms but is only weakly associated with similarly measured parental assessments, suggesting that many diagnoses may be driven by teachers' perceptions of poor behavior among the youngest children in a classroom. These perceptions have long-lasting consequences: the youngest children in fifth and eighth grades are nearly twice as likely as their older classmates to regularly use stimulants prescribed to treat ADHD.