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Diane Kelly Andreou, MD, is a clinical psychologist and director of the Boys Town Center Behavioral Health Clinic in South Florida. She is also the mother of a teenager. She is very interested in providing quality interventions to ensure that today's children become successful adults.  
Our children and adolescents are facing a mental health crisis. They sleep less and are less physically active and spend less time in person with their friends than previous generations. The pandemic has intensified these factors. Mental health during childhood and adolescence includes reaching developmental milestones, developing social skills, learning to regulate emotions, succeeding in school, and learning to cope with challenges. Mental and behavioral disorders cause distress and can significantly change behavior, the way of learning and managing emotions.  
A common childhood mental health problem is anxiety. Anxiety is not a disorder; Fears and worries, such as the dark, storms, or an upcoming exam, are typical during childhood. When fears and worries interfere with school, family life, and relationships, an anxiety disorder may occur.
Here are some ways anxiety can interfere with functioning:    
* Fear of being away from parents, excessive crying or worry at the thought of separation, and fear regarding the health or safety of the parents.
* Having an extreme fear of a specific thing or situation.
* Being afraid of school or situations where there are people.
* Having many worries such as the future, school or bad things happen.
* Having repeated episodes of sudden, intense fear and physical symptoms such as shortness of breath, rapid heartbeat, dizziness, tremors, or sweating.
Many children have no words to express their anxiety symptoms.
Fear or worry may take the form of trouble sleeping or going to bed alone, fatigue, irritable/grumpy mood, difficulty concentrating, refusal at school, or stomach aches or headaches. Many anxious children are calm, obedient, and eager to please others. Anxiety can benefit from behavioral and cognitive-behavioral therapy. 

Another common childhood disorder is Attention Deficit Hyperactivity Disorder (ADHD). It is a persistent pattern of behaviors that interfere with development or functioning in different settings, such as home and school. Children with ADHD often have other problems, such as speech and language delays, poor writing, social rejection, and learning difficulties. Symptoms of inattention include careless errors, difficulty sustaining attention, poor follow-through, avoidance of tasks that require sustained mental effort, loss of items needed for tasks, and distraction. Hyperactive/impulsive behaviors include fidgeting, leaving seat frequently, excessive talking, blurting out responses, difficulty taking turns, and interrupting. ADHD can benefit from behavior management strategies at home and behavioral interventions and adaptations at school. Behavioral intervention is often combined with medication. Almost everyone has mood swings. Many may experience sadness with losses or setbacks. Depression interferes with the ability to sleep, eat, and handle daily responsibilities at home, school, or work. It can occur at any age, but it often first appears in the teens or early 20s.

In the case of children and adolescents, the following behaviors may be symptoms: 
* Persistently feeling (for more than 2 weeks) sadness, irritability or hopelessness.
* Not being interested in doing the things you previously enjoyed.
* Having changes in appetite (loss of appetite or eating too much) or not  achieve the expected weight gain.
* Sleeping too much or not being able to sleep.
* Suffer changes in energy level, fatigue, laziness, tension, restlessness.
* Present feelings of worthlessness or guilt. 
* Present difficulty concentrating, paying attention and making decisions.
* Thinking repeatedly about  death or  in agony.
* Self-injuring or displaying self-destructive behavior.
Major depression can lead a child or adolescent to think about suicide.
Sadness is not always observed by others. Irritability, withdrawal, and lack of motivation may be more apparent. Interventions help control mood and distress, manage eating, sleep, and activity, and improve social support.
Suicide is the second leading cause of death from early adolescence to young adulthood and most who attempt suicide have shown early warning signs before their attempt. The signs include:
* Make direct or indirect threats, spoken, sent by text message or posted. Take statements such as "I'm going to kill myself" seriously, even if someone says they are joking or "didn't mean it." Passive statements like "they'd be better off without me" should also be taken seriously.
* Have made a previous attempt. The risk of another attempt is significantly higher in the year following an attempt.

* Suffer from behavioral changes. Worry about death, lack of interest in activities, lethargy, [changes] in eating and sleeping patterns, and withdrawal.
* Depression that regularly presents itself more as irritability than sadness.
* Plan death or have a defined plan. Access to a means to carry out the suicide. Give away all belongings. Show sudden, brief energy and encouragement once someone feels they have peace or comfort in their plan.
* The phenomenon of suicide contagion. There is evidence that media coverage of suicide leads to a higher rate of subsequent suicides. Factors such as repetition of information, sensationalism surrounding suicide with excessive detail and imagery, and glorification of the positive side of suicide (sadly, including the person's positive traits) can increase risk.
Without early diagnosis and treatment, children with mental disorders can have problems at home, at school, and in building relationships. These problems can continue into adulthood. Treatment in childhood or adolescence can prevent more serious or long-lasting problems.
Dr. Diane Kelly Andreou is a clinical psychologist and director of the Boys Town Center Behavioral Health Clinic in South Florida. She is also the mother of a teenager. She is very interested in providing quality interventions to ensure that today's children become successful adults.  

We thank the Children's Services Council for allowing us to use this article from their Family Resource Guide publication.

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