Your Mentally Ill Child


            Mental illness is many things. Like physical illness,

mental illness can affect anyone and has many forms. The first important point to understand is
that mental illness is not just one illness but is many illnesses.

            It will help to think about it in this way. There is the part of your child that thinks and
understands. You can call this part the child's mind. There is the part that feels happy and sad,
frightened and calm, angry and joyful. You can call this part the emotions. Also there is the part
that does things and takes action based on what your youngster thinks and feels. You can call this
part behavior.

            What is mental illness? Your child's mind, emotions, and behavior normally work
together as a team. When children become mentally ill, the three members of the team stop
working together. They each start functioning independent of each other and your child cannot
get them to start working together again.

            Some kinds of mental illness affect the mind the most. Your youngster is unable to think
clearly and understand things the way they really are. The world becomes a strange and confusing
place for him.

            Other kinds of mental illness affect emotions more and other kinds affect behavior more;
but all types of mental illness affect a child's mind, emotions, and behavior to some extent and in
some way. When this happens, the young person finds it very hard to keep the three members of
the team under control and working together. Keep this problem of teamwork in mind as you
think about whether your child may be mentally ill.

Signs of mental illness

            For the most part, children who are not mentally ill never exhibit these signs. If you
notice any of these signs in your child, the first step is to talk with your family physician about
what you have observed. Your physician will probably suggest that you have your child
evaluated by a children's mental health specialist. It is important for you to follow whatever
recommendations you receive.

            Think about these questions. They highlight common signs of mental illness. As you
consider each question, ask yourself if your child ever exhibits the sign. If not, go to the next
question. If he sometimes has the problem, put a check mark beside the question and then go to
the next question. Step through the questions until you have thought about each question.

Does your child;

                        Have extreme mood swings? (His mood jumps from one extreme to the other and
he cannot control it.)

                        Vomit after eating or use laxatives to control his weight?

                        Go on extreme eating binges? (May or may not be unusually overweight.)

                        Starve himself?

                        Distrust everyone and think people are out to get him?

                        Have very strange thoughts and feelings he cannot understand or control?

                        Have extreme fears that keep him from doing things most people the same age do

                        Get extremely uncomfortable if someone gets close or touches him?

                        Urinate or defecate in his clothes? (This applies to children over eight or
nine-years-old and does not include wetting the bed.)

                        Cut or hurt himself on purpose?

                        Have an unusual interest in fire, watching fires, setting fires, and doing things
with fire?

                        Hear voices and see things others do not hear and cannot see?

Mood jumps from one extreme to the other and he cannot control it

            There are several reasons why it might be difficult for a child to control his mood and
emotions. Two of the most likely are being upset and excitement. Your child becomes upset or
excited and his emotions get a little out of hand. Nonetheless, he normally can settle down if
necessary, at least for a few minutes. With this sign, his mood jumping to the extremes needs to
be combined with an inability to control it before the behavior is significant.

            A potential cause of the sign is depression. A depressed child often does not behave like
adults expect depressed children to behave. They might think he would be in a down mood and
not very active. His depression may look like this but is just as likely to look quite differently.

            One aspect of depression in children fits this sign well. The child's moods and emotions
flip around unpredictably. For example, he may be very up and have a lot of energy and then
down and withdrawn, open and friendly and then very angry for no reason you can see. The
important thing is to see that he cannot stop the emotional turmoil by himself and needs
specialized help with his depression.

            Another cause of this sign is serious mental illness. If this is what is happening with your
child, you would likely see one or more of the other signs discussed here.

            Arguing and getting upset with your mentally ill child only makes things worse. It is not a
problem that has anything to do with discipline or willfulness. The youngster's emotions and
reactions really are out of control; and he cannot help it. Patience and tolerance are in order along
with a careful evaluation by your family physician. If this evaluation does not result in a referral
to a children's mental health specialist, you should consider the possibility of getting a second

Vomits after eating or uses laxatives to control his weight

            Vomiting after eating is most likely caused by a minor illness or intestinal problem. With
any sign, a physical problem may be all or part of the cause. Your child is much more likely to be
physically ill than mentally ill.

            When vomiting or laxatives are being used by a child to control his weight, he has a
serious problem. He may have thought of it by himself or may have picked the idea up from a
friend or something he read. The point is that the behavior is dangerous and is both physically
and psychologically unhealthy.

            The behavior is common enough that you need to watch for it whether you suspect the
problem or not. You should watch for:

                        Your child's most always using the bathroom immediately after or during meals.

                        Unpleasant or unusual odors in the bathroom or other rooms in your house.

                        Any hints or clues when he talks with you or with his friends.

                        Unusual body odor or bad breath.

                        Gray or darkening teeth.

                        Here is the point. The behavior can cause permanent physical damage and even
your child's death, if it goes to the extreme. You must talk with him about the problem even if
you do not think he has it. Talking about it will not give him the idea but will teach him about the
dangers so he is aware of them when he hears about the behavior at school or somewhere else.

            If you suspect that your child is or may be involved in the behavior, you need to talk with
him. Also, you must closely watch him for a couple of weeks. If your concerns are not satisfied,
you need to get him to a children's eating disorder specialist. You and he cannot handle this
problem without professional help. Even if the behavior seems to stop, keep an eye out. It is
likely to start back up.

Goes on extreme eating binges

            Like other signs of mental illness, this sign can have several causes. One likely cause is
depression combined with the child's nervousness and up-tightness. Eating is something to do
and a way of dealing with his nervous energy. Eating far too much is somewhat like a natural
tranquilizer that makes the young person a little drowsy and calmer.

            Another cause is part of an eating disorder called bulimia and is related to the last sign.
The child's weight likely is about right for his height and age; but nonetheless, he vomits to
control his weight. After eating, he purges or gets rid of what he has just eaten. As if trying to
make up for the purging, he eats huge amounts of food in one sitting. This is not just overeating.
In one sitting, the child may eat enough food to serve as normal meals for ten or twenty people.
Keeping food away from him or locking up the food usually does little good and may make
matters worse. The youngster needs specialized help immediately.

Starves himself

            First, dieting is never a good idea for a child under twelve or thirteen, unless directly
supervised by a physician. Even a day or so of eating little to nothing is dangerous for
pre-adolescent children. While the child's food is severely restricted, he does not grow. Even
worse, he may never make up for the time he was not growing. This is very serious. A young
child should never diet unless medically supervised. It is as simple as that.

            For a teenager, watching his weight is usually not a problem, although checking with a
physician is a good idea. An adolescent's eating little to nothing for a day or two once in a while
usually does not hurt anything; but be sure that the dieting is not extreme. Further, be sure it does
not go on for more than a couple days at a time and does not happen more than once in a while. If
your child has a weight problem, arranging for him to talk with his physician is the place to start.

            This sign is part of an eating disorder called anorexia and has little to do with dieting or
normal weight control. A child exhibiting this sign is starving himself. The first thing is that you
would notice is losing weight. Next, you would notice his getting thin and that he is eating little
to nothing. He might tell you that he is watching his weight, is not hungry, or does not feel well.
Whatever his reason is, he is not eating enough.

            Here is the hard part to understand. Even though your child is already thin, he thinks he is
fat or at least thinks he is overweight. How he looks to you does not fit with his perception of
himself. His self-perception is distorted or does not fit with how he really is. He has lost his
ability to judge himself and feels fat no matter what the truth is.

            If you see this sign in your child, his need for specialized help is urgent. You nor your
child can handle the problem without help. Just remember this. Your child can die from the
behavior. It does have to do with depression and low self-esteem; but it is much more
complicated. Specialized care is always necessary.

Mistrusts everyone and thinks people are out to get him

            Whether you should be concerned about this sign is a matter of how strongly and how
often you see the sign. Also, consider how you might feel were you your child. Maybe people
actually are not to be trusted and are out to get him. Your child may be right.

            It is not unusual for a child to feel used sometimes and to be somewhat leery of people. It
becomes a problem when he starts changing what he does or does not do, where he will and will
not go. It is a problem when it interferes with his normal, day-to-day activities. The problem gets
worse when the youngster thinks people are trying to hurt him and more so if he is not sure who
'they' are or if 'they' are not people who are likely to hurt him. For example, he might come to
believe most teachers or perhaps you are trying to control his mind or find a chance to kill him.

            Here is the central question. Are your child's fears far beyond anything real, beyond
reason, or quite weird? If so, he likely has a very serious mental illness-related problem and
needs psychiatric help.

Very strange thoughts and feelings he cannot understand or control

            Any child may need help understanding his thoughts and feelings. At times, he may need
extra understanding from his parents and time to talk about what is going on in his life. His
thoughts and feelings may seem strange to him and be hard for him to figure out; but you may
see them as little more than a part of growing up.

            There are two things that should cause you concern, though. If your child's thoughts and
feelings make him very uneasy and do not go away in a couple of weeks, counseling likely will
help. Also, if they make you very uncomfortable, your talking with your child's physician is wise.
If the thoughts and feelings are violent or destructive, it is a sign of anger and rage and is
something the child needs help with right away.

            If your child's thoughts and beliefs are quite strange or very out of the ordinary,
specialized mental health intervention is important. These kinds of thoughts and ideas might
include your child's thinking that he has special powers, that people are controlling his thoughts,
or other supernatural or far-out beliefs. Take time to be sure that he is not just pretending or
putting you on. Nonetheless, strange and uncontrolled thoughts and feelings can be a sign of
serious mental illness.

Extreme fears that keep him from doing things most children his age do easily

            Fear is a feeling every child has from time-to-time. Normal fears can be very strong and
make it hard for your child to handle the give-and-take of his days and weeks. Still, these fears do
not keep him from doing the kinds of things most children do. At the rough points, a little
understanding from you and a good pep talk are enough to get him to get on with getting on.

            Two types of fear are very serious, though. The first is fear of separating from home and
important adults. The second is less specific. It ranges from being afraid of some things and
situations to being afraid most of the time.

            Fear of separating is called separation anxiety. This is often seen as a fear of going to
school but comes up sometimes as a fear of being alone or of being left. Being afraid to go to
school is interesting. It looks like the child is afraid of going to school. There may be a good
reason to be afraid of something at school; but you need to be cautious about coming to the
conclusion that the problem is at school. Usually, school is not something children have any good
reason to fear. The truth likely is that he does not want to be away from home and fears the
separation. Your best choice is to get professional help for him. If he gets quick, specialized help,
three or four weeks of behavior therapy usually correct the problem.

            For your part, the main thing will be to calmly but firmly make him go to school. You
should take him if that is the only way to get him to go.

            Once in a while, a child develops extreme and very puzzling fears. What start out as
normal fears get so strong that they keep the child from doing normal kinds of things. Perhaps the
child may start being afraid of things that are not real. He might fear odd things like becoming
invisible, turning into a horse, being killed by rays from outer space, or something else just as
weird. These fears are likely signs of mental illness and need assessed by a children's mental
health specialist.

Trouble having people close or touching him

            This sign has to be extreme to be important. When it is, the child is mentally ill and needs
long-term treatment.

            Here is what you need to know. Usually, your child will be comfortable with touching,
hugging, and having people close to him. By eight or ten, he may like less of this type of
attention, especially from you. You will notice a lot of difference from child to child; and a
specific child may like this kind of attention some days and not others.

            Whether your child holds back or wants to be touched, when touching him or initiating
physical contact, ask yourself this. 'Does he really want to do this?' Unless you are sure he does,
take it very slowly and gently. The best approach is to stay close but let your child control the
touching, especially when it is a gesture of affection or just playful. He is the one to decide about
touching and who touches him.

            The best practice is to ask, 'Would you like a hug?' 'May I put my arm around you?'
'May I look at the bruise on your leg?' While you are still outside his room and without opening
his door, ask, 'May I come in to talk a minute?' If he says that they cannot, they should respect
his wishes.

Urinates or defecates in his clothes

            This is usually a serious problem sometimes caused by medical difficulties but more often
by emotional troubles. Keep in mind that a child ten or twelve-years-old sometimes might have
an accident. Even so, it is unlikely for children that old. If you see the sign in your child, a
physical examination is necessary. A real physical problem may be the cause.

            Here are a couple of important things to know. Even if the problem is emotional, it can
become physical if it goes on too long. Not regularly going to the bathroom causes physical
problems. This means the child needs medical care for the problem, even if the etiology is

            There is not much you can do to help except calmly have your child clean himself each
time he has trouble. Making any more of it will only make his problem worse.

            It is specifically important to separate bed-wetting from other difficulties and not attribute
undue seriousness to problems exhibited by kids under six or seven. Bed-wetting sometimes
follows from parent to child and has a genetic component. A small percentage of teens are
bed-wetters and do not have any significant problems. If you are concerned, consult with a
pediatrician about your child's behavior.

Cuts and hurts himself on purpose

            A child might cut or hurt himself and really just be fooling around; but it is unlikely.
Even then, it will happen once or twice and stop. If the cut or injury is more than minor or if the
behavior persists, the child has a problem.

            Talking with him about the behavior and listening carefully for other signs of
maladjustment will help. This is a very serious problem; and if it happens more than once or
twice, the young person needs a mental health evaluation. Also, look very closely for other signs
you may have overlooked. With emphasis, be sure that you do not accept the explanation you
may receive from others that he is doing it for attention. It is much more serious than that.

            Although self-mutilating behavior is most likely related to mental illness, it may have
other origins. For example, the behavior may be related to gang initiation activities or may be a
fad in which youngsters in an area are participating. Whatever the etiology, you need to pursue
the behavior until you understand the 'why' of it and until it stops.

A persistent interest in fire, watching fires, setting fires, and doing things with fire

            A child might like to build fires and watch a fire burning. At the same time, he
understands the danger and is careful. Also, fire is not something he thinks about much.

            A child who has a problem with fire has a much different set of thoughts and feelings
about fire. He thinks a lot about it and looks for chances to set fires, to watch fires, and to do
things with fire.

            Before ten or so, your child's playing with matches or lighters may cause a fire or get you
concerned in other ways; but typically, this is a behavior problem and not a sign of mental illness.
By ten to twelve, though, it is more than a behavior problem, although a simple accident can still

            If your child has a problem with fire, you can invest some effort in keeping matches and
lighters away from him and to take time to teach him safe use of matches and fire. Also, talking
with a fireman might have some educational value. Nonetheless, these activities should not be
used to frighten or scare your child. It is likely that he has other problems that may be less easy to

            Here is the important point. Getting angry with him or punishing him are likely only to
make his problems worse. For example, he may become more secretive, more clever at hiding the
behavior, and even more fascinated. Certainly, talking is important as is a warm, safe family
environment. Even so, specialized help is necessary.

Hears voices and sees things others do not hear and cannot see

            This sign is called hallucinating and can be caused by high fevers, drug reactions, or some
type of poisoning. If the sign suddenly appears, consider these possibilities first. They mean that
your child needs medical attention immediately.

            Your child may tell you about things that may seem like auditory or visual hallucinations
when they are only dreams. At other times, it just seems to him like something odd happened
when it did not. Any of these causes do not last long and do not recur. Even at that, you should
not just brush them off as unimportant. As with other signs, you should watch for additional
indicators of difficulty.

            When hallucinations are a sign of mental illness, they will happen from time-to-time.
Also, the child believes they are real. Usually, he will tell you about them, especially if you ask if
he is still hearing the voices or seeing the visions. If not, you can likely tell by watching him. You
will see he is watching the visions or listening to the voices.

            Let's finish consideration of mentally ill children by making this point one more time.
These signs are very serious. If you see any of them in your child, it is critical to get specialized
help. Your physician will help you get the help your child must have.

By Gary A. Crow, Ph.D. March 17, 2017