Childhood mental illness affects the child, family and community.  Estimated cost= $247 billion per year (NRCIM, 2009)  13%- 20% of children in the U.S.A, experience a mental disorder in a given year (NRCIM, 2009)  Prevalence appears to be increasing

 Mental Disorders results in difficulties:  At home  With peers  At school (Schieve, Boutlet, and Kogan, 2007)  With chronic health conditions (diabetes, asthma, epilepsy) NRCIM, 2009  Continuation of mental health issues in adulthood (NRCIM, 2009)  And are associated with:  Substance abuse  Criminal behavior  High risk taking behavior (Copeland, et. al, 2007)

 Approximately 40% of children with one mental disorders have at least one other mental disorder (U.S. Department of Health and Human Services, 2010)

 ADHD  ODD and CD  RAD  ASD  PTSD  OCD  Mood Dsrds  Depression  Bipolar

Diagnostic Criteria  “A persistent pattern of inattention and/or hyperactivity- impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):”  Inattention  Hyperactivity and impulsivity  6 + symptoms for at least 6 months and is inconsistent with developmental level  Must be present before age 12, interfere with life functioning, symptoms are present in 2 or more settings

 Special issues  Unintentional injuries, ER visits, drug and alcohol abuse ( Charach, et. al, 2011)  More common with boys, lower income, white non-Hispanics and black non-Hispanics (NHIS)  Prevalence  8.4 % of Parents in 2011 reported that they had been told kid has ADHD (NHIS)  Treatment options:  Medications and/or behavioral intervention therapies (CDC, 2013)

 ODD is not a “earlier, milder form” of CD (Ddiamantopoulou, 2011)  ODD often proceeds CD, but ODD does not consequently “cause” CD  ADHD, CD, and ODD are often comorbid (CD paper reference)

 Pattern of:  angry/irritable mood  argumentative behavior  vindictiveness  At least 6 months  At least 4 symptoms  With at least one non-sibling person  Behavior doesn’t occur due to substance abx, psychosis, etc. & doesn’t meet Disruptive mood dysregulation disorder

 Pattern of behavior that violates the basic rights of others OR major age- appropriate societal norms are violated  At least 3 symptoms over 12 months  At least one criterion present in the past 6 months  Aggression to people and animals  Destruction of property  Deceitfulness or theft  Serious Violation of rules  Specify: With limited pro-social emotions

ODDCD  Onset usually preschool  3.3% prevalence (DSM V)(concurrent with other research from NSCH)  Male  as early as preschool  usually diagnosed middle childhood/middle adolescents  prevalence median range of 4% (DSM V)

A. Pattern of inhibited, emotionally withdrawn behavior toward CG shown by: Minimally seeks or responds to comfort when distressed B. Social and emotional disturbance characterized by at least 2: A. Minimal social responsiveness B. Limited positive affect C. Episodes of unexplainable irritability, sadness, or fearfulness that are evident during nonthreatening interactions with CGs

A. Child has experienced a pattern of extremes of insufficient care: A. Neglect of basic emotional needs B. Repeated changes of PCG (i.e. Foster care) C. Rearing in settings that prevent formation of attachment (i.e. Institutions) B. Insufficient care caused disturbance in behavior C. Not ASD D. 9 months to 5 years old

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 Young children who were exposed to abuse and neglect  Prevalence is unknown  Prevalence in severely neglected children only 10% (DSM V)  One study found 2.4% of children to be insecurely attached (Minnus, et al., 2009)  Comorbidity of language and cognitive delays as well as depressive symptoms

 OHpU OHpU

 Most recent data shows prevalence of 3.9 % of kids 3-17 having ever been diagnosed (CDC, 2013)  Adolescent girls more likely (CDC, 2013)  Symptoms can appear at any age but likely onset is puberty (DSM-V)

 In 1996 was 1.3 /10,000 U.S. children and  In 2004 rose to 7.3/10,000  BPD-related discharges also increased four-fold among adolescents.  BPD-related hospitalization was more prevalent among female adolescents and adults, while male children had larger risk than females.  “Children’s BPD diagnoses tended not to specify a prevailing mood state” (Blader and Carlson,2007) More volatile behavior changes

 Males have earlier onset (25% before age 10)  25% of all cases start before 14 years old

 See handout….

Blader, J. Ph.D. and Carlson, G. (2007) Increased RRates of Bipolar Disorder Diagnoses among U.S. Child, Adolescent, and Adult Inpatients, Biol Psychiatry. 62(2): 107–114.Published online 2007 February 16. doi: /j.biopsych Charach, A., et al. (2011) Childhood attention- deficit/hyperactivity disorder and future substance use disorders: comparative meta-analysis. Journal of American Academy of Child Adolescent Psychiatry

National Research Council and Institute of Medicine. (2009). Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Washington, DC: The National Academic Press. Schieve, LA, Boulet, SL, Kogan MD, et al. (2011). Parenting aggravation and autism spectrum disorders. Disability Health Journal. American Academy of Child and Adolescent Psychiatry. (2005). Practice Parameter for Assessment and Treatment of Children and Adolescents with reactive attachment disorder of infancy and early childhood. 44:11

US Department of Health and Human Services. Health Resources and Services Administration, Maternal and Child Health Bureau. (2010). The mental and emotional well-being of children: a portrait of states and the nation. Center for Disease Control and Prevention (2013). Mental Health Surveillance Among Children- United States, Minnus. H, et al., (2009). An exploratory study of the association between reactive attachment disorder and attachment narratives in early school-age children. Journal of Child Psychology and Psychiatry. 50(8),931–942.

CDC; National Center for Health Statistics. National Health Interview Survey. (2012). Available at Copeland, W., et al., (2007). Childhood psychiatric disorders and young adult crime: a prospective, population-based study. American Journal of Psychiatry Diamantopoulou, S, et. al, (2011).The parallel development of ODD and CD symptoms from early childhood to adolescence. European Child Adolescent Psychiatry. 20:301–309