Although an oversimplification, childhood psychopathology can be divided into a few basic categories:

• Externalizing problems are overt misbehaviors such as aggressiveness, angry outbursts, argumentativeness (oppositionality), disruptiveness, and significant rule violations.  They cause distress to others in the child’s environment.
• Internalizing difficulties are less obvious and include depression, anxiety, phobias (including pathological school avoidance), excessive worrying, social withdrawal and psychophysiological (physical) reactions such as gastrointestinal disturbances and headaches.  Other social problems may include difficulties with peer interactions, inability to interpret social cues, lack of social skills and peer rejection.
• Autistic spectrum disorders, including Asperger’s Disorder.  These conditions involve impaired interpersonal functioning and various atypical features in the child’s development.
• More serious mental illnesses involve such difficulties as poor contact with reality, extreme mood swings, paranoia, and auditory and visual hallucinations.  These symptoms are relatively rare in childhood though they do occur. They are less rare in adolescence. Such difficulties are very worrisome when observed, and require prompt clinical attention.
• Attention deficit hyperactivity disorder (ADHD) and learning disabilities are well known but still often go undiagnosed (though over-diagnosis of ADHD also is a concern).  While the hyperactive child often is detected due to the disruptive nature of his or her behavior, the child with a subtle disorder of attention, language, learning, organization, or arousal frequently may not be recognized unless evaluated professionally.

Children who exhibit any of these symptoms may be candidates for mental health referral.  It is common for children to manifest more than one mental health condition simultaneously.  Children who function poorly at home or school, who are unmanageable, seriously unhappy or chronically upset, can most likely be seen as fitting into one or more of the above-mentioned broad categories.  Key symptoms to watch for include (but are not limited to) excessive crying, sadness, anger, aggressiveness, argumentativeness, defiance, fatigue, sleep disturbance, clinging to adults, worrying, withdrawal, irrational health concerns, confusion, inappropriately high or low activity level, distractibility, problems focusing attention, impulsivity, lying, stealing, unusual sexual or other preoccupations, and significant academic underachievement. If common-sense interventions do not result in satisfactory resolution, it is in the child’s interest to be evaluated by a skilled mental health specialist.

While generally not applicable to very young children, the potential for substance abuse presents a worrisome concern for everyone involved with children.  Statistics on American high school students’ drug and alcohol use are striking.  It appears that youngsters develop peer group identification and lifestyle choices during the middle-school years, and substance abuse behavior can begin at that time, and occasionally even earlier.  Serious substance abuse problems typically result in significant behavioral or emotional symptoms. Some of these symptoms resemble or are identical to those observed in other emotional disorders. One should be alert to disruptions of energy level, wake-sleep cycle and appetite; in addition, a precipitous decline in academic performance, deterioration in logical thinking, disorientation or dramatic personality change should be evaluated promptly.

Children do not exist in a social vacuum.  Their home and school environments influence them powerfully.  Family problems, marital difficulties and hardships and stresses can all contribute to emotional and behavioral difficulties in children.  Also, children who have experienced or witnessed significant trauma often develop emotional and behavioral difficulties requiring professional intervention.

It is critically important to examine the role of school on a child’s emotional wellbeing.  Children struggling with undetected or untreated learning disabilities, ADHD, or other cognitive issues, those suffering peer rejection, and those whose educational programs are not appropriate to their needs are among youngsters at risk for developing adjustment difficulties in school.  It is important to remain alert to these possibilities, and if they are present, to develop school-based strategies to assist the child.  Implementation of an appropriate IEP or 504 Plan, and various other interventions can be critically important.  Many mental health professionals who work with children are familiar with these issues; and some psychologists specialize in conducting evaluations, including detailed psychological and educational testing, to evaluate the nature of a child’s school-based and/or learning problems.  Spectrum clinicians are very sensitive to these issues, are available to conduct testing quickly, and have helped many families along the process.   Once the difficulties are understood, specific plans for intervention can be formulated and implemented.  It often is important that the treating professional establish and maintain open communication with the school (with parental permission), so that school-based symptoms can be targeted therapeutically.

Therapeutic work with children and adolescents spans an enormous range of approaches and techniques.  Young children often are seen in play therapy, in which play interaction is used as a medium of observation and communication with the child.  Older children and adolescents often participate in more conventional talking psychotherapeutic methods, similarly to adults.  A wide range of behavioral techniques are employed with children, depending on the underlying diagnosis and difficulty, and often significant work is done with the parents, who then implement behavioral and other techniques in the home environment.  Family psychotherapy, involving sessions that include multiple family members, can sometimes be helpful as well.  In addition to psychotherapy, some children can benefit from the use of psychotropic medications.  The use of medication with children must be approached with great care, and is of course undertaken only when the child’s parents desire this approach, and only after the potential therapeutic benefits and side effects have been discussed.

Children and adolescents are not just “little adults”.  Diagnostic and treatment methods with this population often differ considerably from adult work, and must be informed by specific understanding of child development and related issues.  Spectrum Behavioral Health counts among its clinical staff a number of professionals who specialize primarily in working with youngsters, and who are ready to assist with the problems than can arise with this age group.