Glossary - Mental Illness Affecting Children and Adolescents


        Children and adolescents are as likely to suffer from mental illnesses as adults. However, some mental illnesses are more likely to affect children and adolescents, and some manifest themselves differently in children than they do in adults. You should, of course, discuss your child’s diagnosis in detail with his or her doctor. The definitions below offer only the most basic facts about an illness, additional details are available through the index to the Sheppard Pratt at Ellicott City web site, www.TaylorHealth.com.


Alcohol and Drug Abuse
        Teens (and adults) abuse drugs and alcohol because they are addicted to them, because they are “self-medicating” or numbing the emotional pain of another mental illness (e.g., depression), because of peer pressure, or for many other reasons. One of the easiest ways to define alcohol or drug dependency is a need to take the drug to feel “normal.” Withdrawal symptoms may occur if the alcohol or drug is taken away. Abuse of drugs and alcohol often occurs for some time before dependence sets in. Typical warning signs include:
       A drop in school or work performance
       Deterioration of family relationships
       Isolation
       A marked change in dress or appearance
       A change in groups of friends
       Physical changes, such as red eyes, persistent cough, or difficulty sleeping
       Delinquent or illegal behavior, and thefts to obtain money for drugs
Frequently the problems start gradually, often with “social” use of alcohol and tobacco, with an insidious increase in the use and abuse of a variety of substances, each of which may have serious effects on the mind and body, although the involved individual typically will deny that anything is wrong or defend their use of these substances. In addition to alcohol and nicotine, the most frequently abused drugs are marijuana, cocaine, PCP (phencyclidine), LSD (lysergic acid diethylamide), heroin, Ecstasy, mushrooms, amphetamines and other stimulants, and “downers” which include barbiturates and a variety of sedatives. Inhalants are another form of abuse that can have serious or fatal consequences. Any of a variety of volatile compounds with strong odors are inhaled to “get high.” Individuals often think their minds are functioning better on these drugs and any attempt to operate machinery or a vehicle can lead to serious injury or death due to poor judgment and slowed coordination and reaction times. 

Anorexia Nervosa
        A refusal to eat a balanced diet resulting in a loss of at least 25 percent of body weight is indicative of a mental illness, especially if there is no known physical illness accounting for the inability to maintain a normal weight for height and age. The disorder most often strikes teenage girls who have low self-esteem and an irrational belief that they are fat, regardless of how thin they become. Without treatment, the self-induced starvation can lead to death. Also see Bulimia, below.

Anxiety
        Young people suffer from three major types of anxiety disorder;
       Separation Anxiety: Excessive anxiety about those to whom the youth is attached, most often parents. Symptoms include a reluctance or refusal to go to school in order to stay home with the attachment figure and an unrealistic fear or worry that something will happen to the parent. Although it usually begins between the ages of 6 and 12, it can develop suddenly during teenage years.
       Avoidant Disorder: An excessive avoidance of contact with people for at least six months – to the extent that it interferes with social functioning, peer relationships, and satisfying relationships with family members and friends – may indicate the need for a professional evaluation of your child’s mental health.
       Overanxious Disorder: Excessive worrying or fearful behavior that does not focus on a specific situation or object and that persists for at least six months. Signs include an unrealistic worry about future events, an excessive need for reassurance, an inability to relax, and frequent physical complaints, such as headaches or stomachaches.

Occasionally young people develop other anxiety disorders such as Obsessive Compulsive Disorder, Phobias or Panic Disorder which are described elsewhere under the Illness Info section of this web site.

Attention Deficit Hyperactivity Disorder (ADHD)
        Youngsters (and adults) suffering from ADHD are excessively impulsive, have serious trouble paying attention, and find it difficult to focus on a task. They are often oppositional and have difficulty changing tasks to do what is needed or expected. They are easily distracted and often cannot organize work or cooperate in sports. This illness is ten times more common in boys than in girls, and it typically develops by the age of three. A variety of treatments are effective for ADHD, including stimulants such as Ritalin (methylphenidate), Adderal (amphetamine salts), and others. An antidepressant, Wellbutrin (bupropion) may also be effective and can have several advantages compared to the stimulants in that it is not addictive, does not suppress growth, and generally has fewer side effects compared to the stimulants.

Bulimia
        Another eating disorder primarily affecting girls, bulimia is characterized by a compulsion to binge (eat a large amount of food rapidly, usually in less than two hours) and then to purge (rid oneself of the food) by self-induced vomiting or the use of laxatives. Weight can fluctuate by as much as ten pounds during binge-and-purge cycles. Girls who suffer from bulimia are aware that their eating patterns are abnormal and they fear being unable to stop eating voluntarily. Binges are usually followed by a depressed mood and self-disgust. Bulimia leads to dehydration, hormonal imbalance, tooth and gum disease, and the depletion of important minerals, and it can have serious consequences for the adolescent’s later physical development.

Certificates
        When a person presents a danger to themselves or others and requires hospitalization for a psychiatric illness, but is unwilling or unable to agree to become a patient voluntarily, physicians can evaluate the patient and arrange for involuntary hospitalization. In Maryland (laws vary from state to state) two physicians or a physician and one psychologist listed in the National Register of Psychologists and licensed in Maryland may sign the certificates which require the person to be hospitalized. Once hospitalized the patient will be evaluated and treated. The doctors must have examined the patient within the week prior to signing the certificate. If the patient is not released he or she will have a Hearing with an Administrative Law Judge and an attorney ( A Public Defender will be appointed if necessary.). The Hearing will take place within the first 10 days of hospitalization, although the patient may agree once to a one week postponement of the hearing. If the Judge rules that all the criteria are met, the person becomes an Involuntary Patient, committed to the hospital for up to six months and can only be released by the treating doctor or by an appeal through the courts. Link to Emergency Petition

Conduct Disorder
        A repetitive and persistent destructive or hostile behavior pattern that violates the rights of others or deviates significantly from age-appropriate norms and rules may be diagnosed as conduct disorder. The conduct is far more serious than ordinary mischief and is often dangerous to the child or to others. Teenagers with a conduct disorder usually have trouble at home and/or school, are often sexually active at a young age; they may runaway from home, set fires, or commit crimes. Conduct disorder may be a manifestation of an underlying depression and is often accompanied by drug and alcohol abuse.


Delirium
        A clouding of consciousness with fading in and out of clear perception of reality is know as delirium and may be due to drug abuse, head trauma or a serious physical illness.

Depression
        A disturbance in mood lasting at least two weeks and characterized by sadness, hopelessness, and irritability may be much more serious than just “the blues.” Depression usually includes at least four of these symptoms:
       Change in appetite
       Change in sleeping patterns
       Loss of interest in activities formerly enjoyed (anhedonia)
       Loss of energy; fatigue
       Feelings of worthlessness, helplessness or inappropriate guilt
       Inability to concentrate or think; indecisiveness
       Recurring thoughts of death; threatened or attempted suicide

Seeking professional evaluation and assistance immediately whenever suicide is a concern can be lifesaving. 


Eating Disorders
        See Anorexia Nervosa and Bulimia.

Emergency Petition
        If a person presents a danger to themselves or others and is unwilling or unable to see a physician to be evaluated, any concerned person can seek an Emergency Petition to require the person to be evaluated for possible treatment. In Maryland (laws vary from state to state) a licensed physician who has examined the patient, or a police officer who observes the dangerous behavior, may sign the Emergency Petition, and the police are authorized to take the person to the nearest appropriate emergency room for evaluation for up to 30 hours. If a physician or police officer is not able to observe the dangerous behavior, the concerned person, often a friend or family member, can inform the police they wish to petition the court. (Although difficult, this can be done in off hours.) If the judge is satisfied that a dangerous situation exists an Emergency Petition will be authorized by the judge so that the individual can be located and picked up by the police to be taken to an emergency room for evaluation. If the evaluating doctors in the emergency room believe the patient meets the criteria, they will arrange for the patient to be hospitalized by filling out two physician’s certificates. Link to physician’s certificates

Involuntary Commitment or Involuntary Patient
        When a person presents a danger to themselves or others and requires hospitalization for a psychiatric illness, but is unwilling or unable to agree to become a patient voluntarily, physicians can evaluate the patient and arrange for involuntary hospitalization. In Maryland (laws vary from state to state) two physicians or a physician and one psychologist listed in the National Register of Psychologists and licensed in Maryland may sign the certificates which require the person to be hospitalized. The doctors must have examined the patient within the week prior to signing the certificate. Once hospitalized the patient will be evaluated and treated. If the patient is not released he or she will have a Hearing with an Administrative Law Judge and an attorney ( A Public Defender will be appointed if necessary.). The Hearing will take place within the first 10 days of hospitalization, although the patient may agree once to a one week postponement of the hearing. If the Judge rules that all the criteria are met, the person becomes an Involuntary Patient, committed to the hospital for up to six months and can only be released by the treating doctor or by an appeal through the courts. Link to Emergency Petition

Manic Depression
        Wide mood swings from extreme elation to severe depression that occur in cycles may signal a manic-depressive disorder. During the manic phase teens are hyperactive and become overly involved in activities that often have painful consequences. They talk loudly, change topics abruptly, and may go days without sleep or getting hungry; the may be very irritable and anger easily. Most manic depression begins before the age of 30, with the first signs of mood swings often appearing in the teens. Current treatments are highly effective in treating this disease. More subtle forms of mania, known as hypomania may initially appear as highly productive activity until things get out of hand.

Patient’s Rights
        The child, adolescent or adult patient has a right to be informed about his or her treatments and illness. Generally even involuntarily hospitalized patients accept appropriate treatments for their illness once they are explained to them. However the patient has a right to refuse treatment. Unless a patient presents an immediate danger to himself, herself or others in the hospital or certain circumstances exist, they should not be required to take medications or treatments they refuse. An adult patient in Maryland (laws vary from state to state) who has been certified and had a Medication Panel can, however, be required to take psychiatric medications that are needed.

Physician’s Certificates
        When a person presents a danger to themselves or others and requires hospitalization for a psychiatric illness, but is unwilling or unable to agree to become a patient voluntarily, physicians can evaluate the patient and arrange for involuntary hospitalization. In Maryland (laws vary from state to state) two physicians or a physician and one psychologist listed in the National Register of Psychologists and licensed in Maryland may sign the certificates which require the person to be hospitalized. The doctors must have examined the patient within the week prior to signing the certificate. Once hospitalized the patient will be evaluated and treated. If the patient is not released he or she will have a Hearing with an Administrative Law Judge and an attorney ( A Public Defender will be appointed if necessary.). The Hearing will take place within the first 10 days of hospitalization, although the patient may agree once to a one week postponement of the hearing. If the Judge rules that all the criteria are met, the person becomes an Involuntary Patient, committed to the hospital for up to six months and can only be released by the treating doctor or by an appeal through the courts. See Emergency Petition


Psychosis 
        A psychotic disorder is a severe mental disorder characterized by an extreme impairment in the person’s ability to think, respond emotionally, remember, communicate, or understand reality. Someone who is psychotic often has hallucinations (seeing or hearing things that don’t exist) or may regress into behavior appropriate for a much younger child. A psychosis greatly interferes with meeting the ordinary demands of life and usually requires close medical supervision and evaluation to determine if it is due to a physical or emotional problem, or alcohol or drug abuse.

Schizophrenia
        A psychotic disorder lasting more than six months, schizophrenia is accompanied by disturbances in thoughts, feelings, behavior, and the use of words. Symptoms may include inappropriate emotions and false beliefs or delusions, including paranoia, such as “they are plotting against me.” Three-quarters of schizophrenics develop the disease between the ages of 16 and 25. Hallucinations of hearing voices or seeing things that are not there may be experienced.


Self-Help Groups
        Another kind of group that is becoming increasingly common is the self-help group. Although not led by a professional therapist, the groups are therapeutic because members – usually ex-patients or the family member of people with various illnesses– provide continuing support as well as comfort in knowing that they aren’t alone in the problems they face. These groups also serve other important functions. Families working together can more effectively serve as advocates for needed research and hospital and community treatment programs. Ex-patients as a group may be better able to dispel stigma and draw public attention to such abuses as discrimination against the formerly mentally ill.
        Family and peer support and advocacy groups are now very active and provide useful information and assistance for patients and families of patients with schizophrenia and other mental disorders.
        The National Alliance for the Mentally Ill is composed exclusively of family groups, with 550 of them as of the end 1985 and adding about 150 to 200 new groups each year. The National Mental Health Association, the nation’s oldest and largest non-governmental citizen’s voluntary organization, is concerned with all aspects of mental disorders and mental health. The National Mental Health Consumers’ Association, a network of self-help organizations across the country, now has about 150 affiliates and operates a Self-Help Clearinghouse. The Depression and Related Affective Disorders (DRADA) support groups are composed of people interested in help with various forms of Bipolar disorder and depression and has many free support groups, especially in the Maryland area where it started. Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Gamblers Anonymous (GA) are for individuals with these respective problems; each offers multiple free self-help meetings in a variety of locations and times throughout the country. Al-Anon, Nar-Anon and Gam-Anon are for the respective family members of those afflicted with these addictions. Alateen is for teenagers with addictions issues, especially alcoholsm.

        The National Alliance for the Mentally Ill
        1901 North Fort Myer Drive, Suite 500
        Arlington, VA 22209
        www.nami.org

        National Mental Health Association
        1021 Prince Street 
        Alexandria, VA 22314-2971
        www.nmha.org

        The National Mental Health Consumers’ Association
        311 South Juniper Street, Room 902
        Philadelphia, PA 19107

        www.Mentalhealth.org - Knowledge Exchange Network

        www.MentalHelp.net

        Depression and Related Affective Disorders Association (DRADA) 
        Meyer 3-181, 600 North Wolfe Street 
        Baltimore, MD 21287-7381 
        Phone: (410) 955.4647 - Baltimore, MD 
        (202) 955.5800 - Washington, D.C. 
        E-mail: drada@jhmi.edu
        http://www.med.jhu.edu/drada

        Alcoholics Anonymous / AA
        General Service Office
        P.O. Box 459, Grand Central Station
        New York, New York 10163
        (212) 870-340
        www.AA.org
        www.AlocholicsAnonymous.org

        Narcotics Anonymous / NA
        World Service Office 
        PO Box 9999 
        Van Nuys, CA 91409 
        Phone: (818) 773-9999 
        FAX: (818) 700-0700
        www.NA.org

        Gamblers Anonymous
        Gamblers Anonymous
        International Service Office
        P.O. Box 17173, Los Angeles, CA 90017
        (213) 386-8789 - Fax (213) 386-0030
        www.gamblersanonymous.org

        Al-Anon
        Al-Anon Family Group Headquarters, Inc.
        1600 Corporate Landing Parkway
        Virginia Beach, VA 23454-5617
        757-563-1600, Fax 757-563-1655
        E-mail WSO@al-anon.org
        www.alanon.org

        Nar-Anon
        National Phone Number: 888/765-4885
        Maryland Number: 410/876-4316

        Gam-Anon
        Gam-Anon International Service Office, Inc.
        PO Box 157
        Whitestone, NY 11357
        718-352-1671 phone
        718-746-2571 fax
        www.Gam-anon.org


Voluntary Minor 
        A parent or guardian in the state of Maryland can authorize the psychiatric hospitalization and treatment of a child or adolescent under the age of 18 by signing a Voluntary Minor Agreement form at an appropriate hospital. If the child meets hospital admission criteria and is accepted by the admitting physician, the child can be required to be hospitalized even if he or she does not wish to be admitted. The parent or guardian agrees to work with the treatment team to allow the child to remain in treatment until the doctor believes it is appropriate to release the patient. If the parent or guardian who signs the patient in wishes to discharge the patient earlier, they must give the hospital a 3 day or 72 hour written notice. The treating physician may seek physician’s certificates to require the patient to remain in the hospital if he or she believes releasing the patient could present a danger to the patient or someone else. Usually parents and the treatment team will agree on the patient’s release date and appropriate aftercare treatment once the patient is in the community. If a parent or guardian is not available or if the adolescent is over the age of 16 and is not willing to sign a voluntary agreement, hospitalization can be sought through Emergency Petition and/or Physician’s Certificates.
        See Physician's Certificates and Emergency Petition.


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