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How to recognise mental illness in children and adolescents

Children as young as two years old, as well as adolescents, suffer from a range of mental illnesses, including anxiety, panic disorders and depression. But these are seldom addressed, and hence left untreated.

Children, unlike adults, do not not know how to verbalise what is bothering them or how to describe symptoms of anxiety or depression.

Children often manifest their mental conditions through unexplained physical symptoms or odd behaviour.

Some common ways that children manifest their mental illness are complaining of constant headaches or stomach cramps, screaming in their sleep, refusing to go to school, withdrawing from social activities, looking and feeling miserable, or becoming disruptive and angry.

Common causes for mental illness in children include divorce, family violence, separation anxiety, parents having a serious illness, death of a parent, fear of failing, performing poorly at school, having a chronic illness or a physical deformity, and last but not least being intimidated or teased by bullies, peers and gangs. The worst mental illness occurs after children are sexually abused and the abuse is brushed under the carpet.

A 15-year-old girl presented to me, accompanied by her dad, with a history of losing 10kgs in two months. She did not display any obvious signs of physical or mental illness.

I referred her for investigations to exclude tuberculosis (TB). I was glad that her tests were negative for TB, but that left me with the problem of determining the cause for her huge weight loss. Her dad cursorily mentioned that she had missed her period for about six months. I was obliged to exclude pregnancy. It turned out negative.

The girl mentioned to me that she always had stomach pains. Her dad informed me that his daughter had complained of stomach pains from the age of eight, but that they had still not found a reason for it.

I suspected that the child might be suffering from anxiety.

After gentle probing, she mentioned that she was worried about her marks. She studies very hard to get good grades and is very disappointed when she doesn’t do as well as expected. I was glad that there was no parental pressure for her to do well, because parental pressure is often a huge contributing cause for children’s depression and anxiety.

I was most impressed by the child’s comment that she wants to do well so that she can go to college and make a difference in her country. I was impressed because, at such a tender age, she had such compassion for the people of her country.

I explained that she did not have her period because of her stress and that it will return to normal when she stops stressing.

She felt relieved and encouraged when I told her that one doesn’t have to be a genius to do good. I told her that I admired her for caring for the people in her country.

Children need to be recognised and acknowledged for their good qualities. It’s a great morale booster and helps them to develop their self-esteem. To me, this child was a little gem that few adults can compare with, because of her compassion for her fellow human beings.

I could see her face light up when I told her that doing her best is good enough, because I stressed that no one judges you by your grades, but by your character. I mentioned to her that we don’t have to be the best, nor can we all be the best. It is sufficient if we can just try our best.

Modern society, particularly the media, is guilty of making a big issue of being the top achiever. This type of attitude puts an enormous amount of pressure on our learners.

A  few positive words to the young woman and some words of advice to her dad made a huge difference to both of them. 

What was most important was that we identified that her weight loss was because of her worrying excessively and not caused by a physical ailment.

This example made me wonder how many children in the world suffer like this young girl without being noticed and without being counselled. It certainly explained the increasing suicide rate among teenagers. According to the World Health Organisation, suicide is the third leading cause of death in 15-19-year-olds.

The sad part is that many children go from one health facility to another looking for answers and, unfortunately, the diagnosis of anxiety or depression is rarely picked up.

This is because mental health, which ranks very high in the list of non-communicable diseases, is given the least attention in medical schools and in government health budgets.

Children generally don’t speak to their parents either because of fear or because they just don’t know how to express their own fears.

My advice to parents who have children who constantly complain of symptoms that cannot be explained medically, that it is worth getting them to a counsellor to save a lot of pain. Many of these children end up suffering right into adult life without seeking attention.

Governments and society must and should do more to alleviate the pain and suffering of people with mental illness. As the world grapples with one of the most baffling pandemics, Covid-19, we are going to see a phenomenal rise in mental illness because of isolation, poverty, starvation, severe job losses, homelessness and salary cuts.

There is more to mental illness than the layperson’s  flippant dismissal of it as, “something  in the mind that people must just get over”. You don’t get over it, you treat it.

The views expressed are those of the author and do not reflect the official policy or position of the Mail & Guardian.

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Ellapen Rapiti
Ellapen Rapiti

Dr Ellapen Rapiti is a family physician, specialising in child and mental health and addiction counselling.

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