Childhood mental health problems

Most common mental health issues encountered in 6 to 12 year olds
Reported by school psychologists

Anxiety - 73.1%
Challenging behaviour - 71.8%
Family/parenting concerns - 65.4%
Peer relationships - 59%
Anger and conflict - 55.8%
Bullying - 41.7%
Self esteem - 38.5%
Child safety and protection - 31%
Depression - 21.1%
Trauma - 19.2%

Challenging behaviour = Autism spectrum disorder, ADHD, oppositional disorder, learning difficulties and conduct disorder

Ref: [Inpsych - Bulletin of the Australian Psychological Society, June 2011]



My work with children has mainly been in the private practice setting. Children are brought to me by their parents usually. The list cited above would be quite similar to how I would rate the children I have seen over the years.

One thing that has always interested me in my work with children, and what this data supports, is the low rate of depression as compared to the other mental health problems presented. I have found this surprising as I expected it to be higher. I expected anxiety to be as high as it is but I also expected depression to be the same. Which it is not. The rate of depression is much lower.

Why I expected this is because with adults and adolescents they tend to be about the same.

Adults in Australia (Department of health and ageing statistics)
10% anxiety at some point in adult life
20% depression (6% major depression)

One needs to be careful with such statistics as they can vary quite considerably depending on how one defines depression and anxiety. However, it seems safe to say that in adults there are similar amounts of depression compared to anxiety unlike in childhood. They are at similar rates whereas in childhood that is not the case with anxiety being much more prevalent than depression. According to the research above anxiety is three to four times more prevalent than depression in children seeking help from school psychologists.



This of courses raises the question as to why this would be so. I don’t know of any explanation that has been given to answer this question. So I thought I might do some hypothesising of my own.

Anxiety in childhood
It could be that diagnosing depression in children is harder than in adults. Thus the rates of depression are higher in children but are not recognised because the children do not present to school psychologists with that difficulty. I suppose this could be the case but it seems a bit dodgy to me as depression is not that hard to diagnose. Even if the child does not report the problem emotions found in depression the body language of a depressed child is not that hard to detect. It would also seem reasonable that a depressed child is just as likely to report unpleasant emotions as an anxious child. Why should there be any difference between those two?

It seems more reasonable to me that childhood by its very nature is more likely to produce reactions of anxiety rather than depression, whereas in adulthood this is not the case. It is simply a matter of when god made us, she stuffed up. The way humans reproduce the species is by giving birth to very small versions of adults that take almost two decades to fully mature.

As adults it is easy to forget just how vulnerable a child is. A child is like living in the land of the giants. Take a minute to lie face up on the floor, get someone to stand over you and remind yourself of how a child sees her relationships with adults.




One of my favourite TV shows in childhood - Land of the giants.

This could partly explain why anxiety is the highest of all mental health issues in childhood. A child’s life is on the line each day. Its actual physical existence is out of its control and is determined by those adults around her. Indeed a threatening state of affairs even if the child is treated well. Those around it can kill it at any time and of course children don’t understand about laws against murder and so forth until much later in life.

It has been postulated that you can roughly determine the difference in strength between two people by taking the fourth power of the ratio of their heights.
Ref: [S. Gould. 1977. Ever Since Darwin. New York: W.W. Norton Company.]

The height of the average female is twice that of the average two year old so she is (24 = 16) sixteen times stronger than the child (2 to the power of 4). A very large difference in power and strength I think one could say. It has been postulated that around that age of 10 - 12 years is the first time where a child could probably start to look after itself in terms of acquiring the food and shelter necessary to live. Up until that time the child’s physical well being in terms of food and shelter is dependent on the adults around it. Of course the child knows that the adults can withdraw that food and shelter should they choose to do so.



Despite these physical threats we also have all the psychological causes of anxiety. If a child is psychologically abandoned in some way, which many are to varying degrees, anxiety is a common reaction to such abandonment. Children are much more psychologically dependent on those around them than adults are and thus anxiety may be more prevalent in childhood as a result.

Every parent also has a Child ego state of their own. Sooner or later there are going to be situations where their own Child ego state needs are going to take priority over the needs of their biological child. A classic example is post natal depression. In this case the mother’s own Child ego state needs may be to sleep for extended periods of time in bed as a consequence of the depression. When she does this her biological children’s psychological needs are secondary and thus anxiety can result when the children experience this psychological abandonment.

Finally normal human development requires the child to master scary developmental tasks. Most obviously the separations from mother and father. Such as going to school, handling difficult circumstances without mother’s help, getting a job and just becoming psychologically independent is an anxiety producing process.



There we have it. This could explain to some degree why childhood is more of an anxiety producing stage of human development as compared to adulthood. It does not seem possible to develop an argument for why childhood would be a more depression producing stage of development. Indeed the level of depression in childhood in the first piece of research cited put it at 21%. The statistics from the Department of health and ageing put the level of depression in adulthood at 20%. They are the same. Whereas anxiety in children seeking help was around 70% and in adulthood put around 10% of adults in general.

Nothing like a bit of hypothesising on a Friday!

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Three reaction to stress & suicide

Solutions to problems or high stress. It is generally acknowledged that the more a person is placed under stress the more they will revert to their childhood solutions to problems and the more they will regress, as it is known. This means they move from the Parent and Adult ego state into the Child ego state as is shown in the diagram 1 below.

Diagram 1

This illustration shows that as one is placed under more and more stress, the more they will revert to their early ways of thinking, feeling and behaving. The more childlike they will become in their thinking and behavior and the more obvious their early decisions become in how they behave. They move from their grownup Adult and Parent ego states into the Child ego state part of self. This is supported by research in neuro-psychology as is shown by Johnston (2009). When people are placed under stress they are less able to access the pre-frontal cortex of the brain which is associated with the more developed functions like problem solving, decision making and stress management. Instead people will tend to access the more primitive part of the brain in the amygdala.

When this happens the early decisions about how they should think and feel become more pronounced. These early decisions influence the current decision making much more than if the Parent and Adult ego states were fully operational. As a result one finds such people making decisions that may seem quite out of character for them Decisions can be made which seem odd and even bizarre based on the facts at the time because it is the early child like thinking that is dominating in the personality.

Generally there are regarded to be three main responses to high stress. In 1915 an American physiologist called Walter Cannon described the fight or flight response. This is a fundamental response to a threat or perceived attack where the person will either fight the attacker or flee from them. Since that time another response has been added and that is the freeze response where the person does not either attack back or flee they just freeze and end up doing nothing. This freeze response is seen as the ‘playing dead’ reaction. In the animal kingdom sometimes an animal will play dead so that its attacker thinks it is dead, becomes bored and then moves away. A good example of this is the mouse who is caught by a cat. It plays dead in the hope that the cat will tire of it all and become distracted onto something else.

Everyone has used all three at some time but we all will have one basic response that we use when there is a very high threat or very high level of stress. It is our last bastion when all other options have been tried. Our most basic response to stress of course will be the one that we decided upon as a young child and which fits most with our basic temperament. Our temperament will effect our decision making to varying degrees and thus will effect wether we choose fight, flight or freeze as our primary solution to problems and stress.

Fight, flight or freeze?

Below are some behavioral examples of how a person may respond to threat in each of the three ways.

Fight - this person may physically hit out (as can be the case in domestic violence), verbally hit out, fight for their rights, put in a complaint or sue somebody. In childhood this is the child who will hit out, shout in their defense, maybe break property or try and hurt the other person in some way. The primary response is to fight up against the adversary either overtly or covertly. When under great stress this person will tend to hit out at others physically or verbally. In childhood the child may voice disapproval at mother and father or seek to angrily get change in some way in the home. If mother and father are fighting the child may actually seek to intervene in some way between them.

Flight - This solution may include things like using alcohol, drugs or prescription medication. All these are a way of getting away from the problem as a means to solving it. The person who quits their job and simply goes elsewhere. Here one chooses to geographically relocate or to move away from the problem thus solving it in their mind. In childhood the youngster may display running away from home behavior or the child may go and hide under their bed as a response to stress in the home. Unlike the fighter this child does not seek to change the conditions in the home or express their disapproval instead they move away from the problem and wait for it to subside. They want to ‘slide under the radar’.

Freeze - In earlier times this person would have been diagnosed as having a nervous breakdown. In essence the person collapses in on self and goes into a state of incapacitation. They simply fall to the ground or crawl into bed and go into the fetal position. These days people go on stress leave from work, they may seek hospitalization, some can have panic attacks and agoraphobia which are both incapacitating conditions that can keep them home bound. In childhood the child just stands there and simply does not know how to respond. In the extreme they can loose bowel or bladder control. Whereas fight is primarily an angry response, freeze is mainly an anxiety response.

Suicide primarily is a flight response. One solves the problem by getting away from it and suicide does indeed do that. Interestingly enough in the histories of suicidal individuals it is not uncommon to hear of them report running away from home behavior which of course is the flight response as well. Most often if a child says they are going to run away from home, when asked where they are going to run to they has no answer. In essence the child is running away to oblivion.

Suicidal individuals are in a state of considerable distress and often confronted with some very difficult problem whether that be a recent event that has occurred or just an increasing state of malaise, melancholy and distress that has evolved over time. Thus they will act in more child like ways as mentioned before. When taking a client's history they reports flight as a main way of dealing with stress then this is another point to note when making a suicide risk assessment.

All people fight suicidal urges to some degree. If they did not then it would not be long before their did indeed die. If however the person has a primary flight response then they will be more willing to give up on the fight and take the flight solution of suicide. If the person has a strong fight response then you know they will be less likely to give up and make a serious suicide attempt. The no suicide contract can be particularly useful for this type of indidivual. They can use it as part of their fight response.

Counselling generally speaking is a fight response. Client's wish to identify the problem, find the cause of the problem and then change it rather than simply moving away from the problem. However this is not always the case. Some people will use counselling to identify the problem and then seek ways of getting away from it. Depending on what the problem is, either approach can be useful.

For instance if the client has a primary fight response and has a problematic relationship with mother they will tend to try and alter that relationship by changing self or by negotiation. Those with the flight response will not try so much to alter the relationship but will tend to take the solution of simply never seeing mother again. Some people come to counselling to get permission to do precisely that. To get approval from the counsellor and make a decision to terminate the relationship with mother. Obviously as a therapist it is conducive to work out which of these responses the client is essentially looking for.

Those with the flight response are much more likely to seek a purely medication approach to their problems of emotional distress. For instance the medication approach to depression is a example of a flight response. If it is found to be successful then that person would have little interest in seeking a counselling approach as well. On the other hand one not uncommonly meets clients who say they don't like taking medication as it does not solve the problem and they will seek to find the cause of the problem and try and remediate that.

Sometimes the fight response can be the problem in the itself. If the person has a toxic relationship with their mother that brings them great angst they can seek to change it. The problem with changing relationships is it usually requires both parties change. If mother refuses to then there is not much you can do about that. The person with the fight response will tend to continue to try to change the relationship (mother).

Sometimes it is very hard to accept

that things can not be changed

Some things you cannot change and the person with the fight response will have trouble identifying those times and will get stuck trying to change the unchangeable. The therapeutic goal in these circumstances is for the person to give up their fight which some can find very hard to do.

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