“There is no health without mental health”.

This statement from the World Health Organization emphasises how mental health involves everybody. Mental health – the way we think or feel about ourselves and what is going on around us, and how we cope with the stresses of life – affects our sense of wellbeing as well as our physical health. In this sense everyone has mental health. Good mental health is vital for learning and life. Children who are mentally healthy are better equipped to meet life’s challenges. They also learn better and get on better with others. Good mental health helps children enjoy and benefit from their everyday experiences, have positive relationships with their families, friends and school staff, and contribute to their community in ways that are appropriate for their age. Good mental health in childhood provides a foundation for positive mental health and wellbeing, now and into the future. Having good mental health does not mean never having worries or feelings of distress. Everyone goes through ups and downs which can affect the way they feel and behave. Feeling worried, sad, frustrated or angry are all normal emotions. Mentally healthy children are able to use positive coping skills appropriate to their age to manage feelings and deal with difficulties. They develop helpful coping skills as part of their normal development and are not held back by emotional or behavioural problems.

Mental health difficulties

Mental health difficulties affect approximately 14 per cent, or one in seven, of Australian children. Most people will experience mental health difficulties at some point in their life, including children. It’s normal to go through a period of difficulty and then improve. At these times, children will benefit from support from the important adults in their lives. But, sometimes, mental health difficulties in children can be ongoing and can interfere with many aspects of their life.

Mental health difficulties affect children’s emotions and behaviour, and can cause concern for the child, parents and carers, and also the child’s school. Other terms for mental health difficulties include mental health problems and emotional/behavioural problems. In some cases when difficulties are persistent and/or severe they may be diagnosed as a ‘mental disorder’ by a mental health professional. 

Attention Deficit Hyperactivity Disorder (ADHD), anxiety and depression are examples of common mental health difficulties in primary school-aged children. Diagnosis is based on established international criteria that define specific sets of symptoms and behaviours for each disorder. For a diagnosis to be made, the symptoms must be severe enough to cause distress and interfere with the child’s ability to get on with everyday activities and enjoy life. 

Because mental health difficulties can place enormous stress on children and families, professional help can be a useful aid. However, children with mental health difficulties often do not receive appropriate professional support for a number of reasons, such as parents not knowing where to go for help. One of the major aims of KidsMatter Primary is to make information about children’s mental health and ways to get help available to parents, carers and school staff so that children experiencing mental health difficulties can receive appropriate treatment. 

Identifying children’s mental health difficulties early and providing helpful professional support can make a significant difference to children’s lives. It can help to resolve mental health difficulties before they become worse, improving the quality of life for children and their families. Early recognition and effective responses are important and provides children with skills for positive coping that have lifelong benefits for their mental health and wellbeing. The earlier in life difficulties are addressed, the better chance a child has at reducing the impact on their long-term mental health and wellbeing.

What kinds of mental health difficulties do children experience?

Children’s mental health difficulties are generally classified as being one of two types: ‘internalising’ and ‘externalising’. Children with internalising difficulties show behaviours that are inhibited and over-controlled. They may have a nervous or anxious temperament and be worried, fearful and/or withdrawn. Children with externalising difficulties show behaviours that are under-controlled. They may have a more challenging temperament, shown in impulsive or reactive behaviour. 

Sometimes this pattern can lead to difficulties with attention, aggression or oppositional behaviour. Externalising behaviours cause difficulties for others as well as for the children themselves. It is not uncommon for children to show behaviours associated with both internalising and externalising patterns of behaviour. 

The typical features associated with each pattern are summarised below. Features associated with children’s ‘internalising’ difficulties include:

  • nervous/anxious temperament
  • excessive worrying
  • pessimistic thinking
  • withdrawn behaviour
  • peer relationship difficulties (eg can be isolated).

Features associated with children’s ‘externalising’ difficulties include:

  • challenging temperament
  • reduced problem-solving skills
  • attention difficulties, hyperactivity
  • oppositional behaviour (eg doesn’t like to be told what to do; won’t follow rules)
  • aggressive behaviour. 

Children with ADHD often show severe externalising difficulties. Children with other serious behaviour problems also show externalising patterns of behaviour, such as persistent aggression. Children with severe internalising difficulties may be diagnosed with an anxiety disorder or with depression.

Is a diagnosis necessary?

A diagnosis is a medical label that helps mental health professionals make sense of the child’s symptoms. Diagnosing a child with a mental health difficulty can help to decide what treatment is needed. However, making an accurate diagnosis can sometimes be difficult. This is because children’s growth and development varies from one child to another and an individual child may show some symptoms of a mental health difficulty but not others. 

For families it can often be a relief to have a name for what is wrong. A diagnosis helps them to explain why their child behaves as he or she does. However, it is important to recognise that a diagnostic label merely describes a pattern of common symptoms. Even though a child may be diagnosed with a particular mental health difficulty (sometimes referred to as a disorder) it remains very important to recognise his or her strengths and meet his or her individual needs. 

What causes children’s mental health difficulties?

Understanding what causes children’s mental health difficulties is complex. Unlike some medical conditions that have a direct cause (eg the flu is caused by a virus), mental health difficulties are considered to be caused by multiple factors that interact in different ways depending on the individual child, family and social circumstances. 

The diagram below shows some of the biological, psychological and social factors that influence children’s mental health. Any one of these factors can have either a positive or negative influence on a child’s mental health. For example, self-esteem may be high or low, family circumstances may be positive or difficult, and both may vary at different times.

Risk and protective factors for children’s mental health

One way to understand mental health in children is through risk and protective factors. A number of specific factors have been identified through research that increase the risk of children experiencing poor mental health. Other factors have been identified as having a protective effect. Protective factors act to strengthen children’s mental health and wellbeing, making them less likely to develop mental health difficulties. They help to balance out the risk of developing mental health diffi culties and build resilience; the ability to cope with life’s difficulties.

The diagram above shows some key examples of risk and protective factors that influence children’s mental health. It is important to note that just because a child is exposed to mental health risk factors, it does not mean he or she will experience mental health difficulties. However, when multiple risk factors are present this likelihood is significantly increased. The relationship between risk and protective factors is complex. However, it is known that reducing risk factors and building protective factors in children has a positive effect on their mental health and wellbeing. KidsMatter Primary works to strengthen children’s protective factors during their primary school years to improve their mental health and wellbeing.

What to expect in a mental health assessment

Whether or not a diagnosis is made, it is necessary to get an accurate picture of what the difficulties are before effective professional support can be provided. This information is gathered by conducting a mental health assessment. The mental health assessment occurs at a consultation meeting in which a mental health professional (or sometimes a team) looks into the child’s difficulties, background and current needs. Sometimes more than one meeting is required. The mental health professional is likely to ask questions about the child’s early history, progress and difficulties at school, and the family situation. He/she will want to know such things as: 

  • in what situations the problems occur
  • how the child gets on with other children and family members
  • whether there are learning difficulties
  • the child’s strengths and interests.

You may be asked to complete questionnaires that will enable your child’s behaviours to be compared with others of the same age. You might be asked to keep a record of your child’s behaviour for a period to help the mental health professional get an accurate picture of the extent of your child’s difficulties. Recording your observations can also help you to get a clearer picture about your child’s difficulties. The information you provide at the assessment meeting is considered confidential. It cannot be shared with anyone else without your permission. All of the information gathered in the assessment will help the mental health professional understand the difficulties and the way your child and family has tried to manage it up until now. Based on this understanding he or she will decide what kind of professional support will be most appropriate.

Professional support

After the assessment has been completed, the mental health professional will evaluate your child’s difficulties and consider his or her strengths and needs. The mental health professional will discuss a plan for professional support with you and may recommend support (such as counselling) for:

  • the child on their own 
  • the child in a group of children with similar difficulties
  • the family as a whole
  • parents and carers to help with understanding and 
  • managing your child’s behaviours

You are entitled to ask questions too. You might like to ask:

  • What is the evidence that the professional support will be useful for my child?
  • What other options are available? 
  • How will I be involved with my child’s support?
  • How will I know if the professional support is working?
  • How long should it take before I see an improvement?
  • If my child needs medication, are there any side effects I should be aware of?

Professional support for mental health difficulties can often require learning new skills and new patterns of relating to others. This takes time. Progress should be reviewed regularly with the mental health professional or with your referring doctor to make sure the professional support is effective.

Mental health professionals who may help with children’s difficulties

School psychologist/school counsellor

Talk with your child’s school about the possibility of seeing the school psychologist or counsellor. School psychologists and counsellors provide assessment and support for children with mental health diffi culties. They advise parents and carers and school staff about helping individual children and may recommend specialist services outside the school. 

General practitioner (GP)

Your family doctor will give advice and help you decide whether further investigation and treatment is needed. A doctor’s referral is needed to be able to claim the Medicare rebate for mental health treatment from other professionals.

Other mental health professionals who can help

Paediatrician

Paediatricians are doctors who specialise in treating children. They consider what is developmentally appropriate behaviour for children at different ages to determine if the diffi culty relates to physical or mental health. 

Psychiatrist

Psychiatrists are doctors who have undertaken additional training to become specialists in mental illness. 

Psychologist

Psychologists provide assessment and treatment for a range of mental health diffi culties. They do not prescribe medication but offer a range of other professional supports, such as counselling. 

Social worker

Social workers help individuals with mental health difficulties to resolve associated psychosocial problems and improve their quality of life. 

Occupational therapist

Occupational therapists are trained to assist people to overcome limitations caused by injury or illness, mental health difficulties or developmental delay. 

Mental health nurse

Mental health nurses specialise in working with people experiencing mental health difficulties.

See also:

How mental health difficulties affect young children

Children and hardship

Should I be concerned: Suggestions for families

Should I be concerned: Suggestions for schools and early childhood services