Mental Health in Children

boy in blue shirt covering his face

Mental Health: Children Face It Too

The COVID-19 pandemic has caused many disruptions not only economically, but also has interfered with academic schedules and social activities of all our daily lives. While adults are affected, many children and young people are also experiencing negative impacts from this pandemic – especially on their mental health.

According to the World Health Organisation (WHO), childhood and adolescence are the critical stages of life for mental health. How are these two different stages in life important? This is because this is a time when the brain experiences rapid growth and development.

Children and adolescents acquire cognitive and social-emotional skills that shape their future mental health and are important for assuming adult roles in society.

Understanding What is Mental Health

Mental health includes our emotional, psychological, and social well-being, and it encompasses more than just the absence of mental illness. It affects how we think, feel, and act. It is a state of well-being that empowers individuals to properly enjoy their lives; and a state of mind that helps children navigate the ups and downs of life. 

Defined by the World Health Organisation, mental health is “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”

We have to understand the complex connection between mental health and physical health where both are equally important, and complementing each other. Though more emphasis is placed on physical health over mental health sometimes, the decline of one can quickly lead to problems in the other. 

Ultimately, it’s about maintaining a balance between the two different aspects of health

Mental Health Conditions in Children

Mental health is the most discussed about topic during this time of the internet and social media, and there are many advocates for it as well. It has become an important focus for the government, schools and NGOs to give focus to mental health, nonetheless, mental health affects both children and adults as well though the latter can be easier to diagnose. 

Worldwide, 10% of children and adolescents experience a mental disorder, but the majority of them do not seek help or receive care. To put it into numbers, 1 in 10 children worldwide experience mental health concerns, however less than 33% of them seek help. 

Mental health is a continuum and the identification of specific mental disorders goes both ways to understand how well children are doing. Mental health in children affects the developing of age-appropriate thinking, behaviors, social skills or regulation of emotions. 

Mental disorders among children are described as the serious changes, delays or disruptions happening in the way children typically learn, behave, or handle their emotions. These problems are distressing to children, of which may cause distress and other problems that disrupt their ability to function well at home, in school or in other social situations. 

In Singapore, mental health professionals confirm that anxiety and depression are affecting growing numbers of young individuals. Recent results from the Singapore Mental Health Study by the Institute of Mental Health highlighted that in just under three years, there has been a fivefold increase in the number of children between the ages of five and nine calling in to their hotline to seek help.

How Does Mental Health Affect Children?

Mental health problems can be challenging to diagnose in younger children. Like older children and adults, the various mental health conditions that usually occur in children include:

  • anxiety
  • attention deficit disorders
  • behavioural disorders
  • childhood epilepsy
  • depression
  • developmental disabilities
  • post-traumatic stress disorder

These are also the major causes of illness and disability among young people. 

For children under 15 years old in Singapore, common mental illnesses include:

  1. Autism spectrum disorder (ASD)
  2. Attention deficit, hyperactivity disorder (ADHD)
  3. Anxiety
  4. Depression

Many psychiatric conditions stem from the influence of early stages of life, and these can be seen with individuals who have difficulty regulating emotions such as anger; forming and sustaining friendships and intimate relationships; attention-deficit/ hyperactivity disorder (ADHD); and substance abuse. And this is why early detection and treatment may result in a better prognosis and functional outcome in adult life.

The different stressors in three key areas that can impact the mental health of children include:

  1. Domestic issues: violence, family conflicts, divorce, death of a family member
  2. School: bullying, exams, peer pressure, transitioning from primary school to secondary school, etc.
  3. World events: terrorism, political upheavals, war, climate change

A 2010 study in Singapore found that mental illnesses accounted for the largest group of DALYs* (33%), for children under the age of 15. 

“Note: One disability adjusted life year (DALYs) is a term used to calculate disease burden and is also known as the loss of 1 year of ‘healthy life’.

Half of all mental health conditions start by 14 years of age, while suicide is the third leading cause of death in 15 – 19-year-olds. Mood swings and irritability on the other hand are usually being explained by puberty and the various changes that young people have to face as they grow up. Unfortunately, these attitude changes also are common signs of depression that may be brushed off or underestimated.

It is also crucial to understand that not all depressed children display the stated symptoms as they are more likely to display different symptoms at different times within different settings. When depression is significant, there are often noticeable changes in social activities, loss of interest in school and poor academic performance, or a change in appearance.

The Singapore Mental Health survey of 2010 for adults aged 18 and above showed that many mental health disorders have their onset in childhood. The consequences of not addressing mental health and psychosocial development for children and adolescents extend to adulthood and limit opportunities for leading fulfilling lives. 

Chronic Mental Health Disorders in Children

The chronicity and morbidity vary among disorders as well as individuals. Disorders such as autism spectrum, disordered eating, mood conditions and obsessive-compulsive disorders have been known to be chronic conditions.

For chronic conditions such as psychosis and mood disorders, research has shown that many people first showed signs of their illness between the ages of 12 and 17 years. This has been suggested to be a window of opportunity for treatment that could dramatically alter a person’s life for the better. 

Early intervention and treatment for these disorders can slightly decrease and interrupt the negative course of some mental illnesses and in some cases, may lessen long-term disability. 

Depression in Children

In a 2012 publication on Depression by the Ministry of Health, it was reported that depression affects between 2.5% to 18% of youth*. Depression among youths in Singapore is considered common, however, it is a serious mental health symptom because of what it reflects of children’s experiences in their environment. 

Signs to watch for in children who may be depressed:

  • Changes in appetite — either increased or decreased
  • Changes in sleep — sleeplessness or excessive sleep
  • Continuous feelings of sadness and hopelessness
  • Difficulty concentrating
  • Fatigue and low energy
  • Feelings of worthlessness or guilt
  • Impaired thinking or concentration
  • Increased sensitivity to rejection
  • Irritability or anger
  • Physical complaints such as stomachaches, headaches that do not respond to treatment
  • Social withdrawal or reduced ability to function during events and activities at home or with friends, in school, extracurricular activities, and in other hobbies or interests
  • Thoughts of death or suicide
  • Vocal outbursts or crying

How do we help, and what can we do to assist?

There has been a number of initiatives rolled out to educate and keep people more involved in spreading awareness for mental health. One of them include an online portal called mindline.sg.

As teachers or parents, we need to pay attention to the potential signs and symptoms that a child might need help. 

Some of the suggested good parenting practices and ideas that will be able to cultivate good mental health in children are as follows:

  1. Love your child/ children unconditionally: Genuine love goes a long way as children thrive under certain physical and emotional conditions. Loving well in the best interests of the child provides the best head start towards orienting the child to relate to themselves and others in an emotionally healthy way, and to also establish a healthy identity towards themselves, making them feel worthwhile. 
  1. Prepare safe and secure physical and emotional surroundings: Ensure the environments that the child will be growing up in are safe and secured. No matter where they are, the surroundings need to provide a sense of security and allowing the child to learn to feel safe and secure in the world, and to incorporate trust the various caregivers involved. This will also assist them in preparation to be independent over time. 
  1. Provide appropriate guidance and discipline: While children are provided various opportunities to explore and find out more about the world around them, they start to develop new skills and curiosity while enhancing their sense of independence and responsibility. Where punishments are involved for unacceptable behaviours that they portray, children need to be offered guidance and discipline that is fair and consistent. Always remind yourself to be understanding and empathetic, as well as apply enough sternness and include questioning methods like explaining ‘why’ to help children realise the consequences and understand their wrongdoings. Expectations may be expressed firmly but they need to be kind and realistic. 
  • Cultivate Self-confidence and Nurture High Self-esteem: When children receive the unconditional love that they need, their self-confidence will spike and their excitement to explore will increase. With different activities, they experience first-hand different situations and conditions within the safe environment that allows them to gain confidence in completing different tasks. It is important for parents to encourage and support this curious attitude, rather than over-protect and limit them from exploration. Success and failure will start to stem, and this is where a child’s exploratory efforts will have them further grow into the process of becoming, with a sense of control and resilience. 

Protect the Innocent Minds of Children

To ensure good mental health in children, our responsibility as parents and adults is to always try our level best in paying close attention to any behaviour or mood changes, and always check up on your children when they are feeling down. 

Never brush away when they inform you that they have issues, as early and reliable recognition and the provision of effective treatments and care can assist in maintaining optimal functioning of their proper selves. During the early phases of indicated illness, risk factors have to be identified so that strategies to support recovery and well-being could be implemented, thus reducing the likelihood and severity of disruption during their lifetime.

Should you need to check with a mental health specialist, or a certified psychologist on the potential signs that you think may be red flags for mental health issues, WhatsDoc is able to assist, providing a safe and secured platform for consultations.

References:

https://www.straitstimes.com/singapore/important-that-singapore-steps-up-efforts-to-protect-mental-health-of-children-early

https://adelphipsych.sg/common-mental-health-issues-among-kids-in-singapore/#:~:text=Depression%20Among%20Children%20and%20Teens,through%20as%20they%20grow%20up.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429973/

https://www.imh.com.sg/uploadedFiles/Newsroom/News_Releases/SMHS%202016_Media%20Release_FINAL_web%20upload.pdf

https://www.suss.edu.sg/blog/detail/calling-for-help-our-children-s-mental-health

https://www.sbcc.sg/mental-health-kids/

https://www.owis.org/blog/mental-health-of-children-in-light-of-the-covid-19-pandemic-why-its-important-to-check-in

https://www.who.int/activities/Improving-the-mental-and-brain-health-of-children-and-adolescents

https://acamh.onlinelibrary.wiley.com/doi/10.1111/camh.12426

https://www.todayonline.com/singapore/gen-z-faces-different-forms-stress-may-be-more-anxious-depressed-others-them-says-imh-ceo

https://www.mentalhealth.gov/basics/what-is-mental-health

https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/mental-illness-in-children/art-20046577

https://www.cdc.gov/childrensmentalhealth/basics.html