The image we have of a mentally-ill person is that he or she runs around unkempt, if not naked, and speaks gibberish. That is not necessarily correct. Mental disorder covers a spectrum of symptoms, from the deranged person unable to care for himself or herself to the unreasonable, paranoid or socially offensive member of society. Most mental illnesses start in childhood. Around 20 per cent of children and adolescents (2-18 years) suffer from psychiatric disorders, which initially manifest with minor symptoms. Parents and caregivers ignore early symptoms, confident that the child will “grow out of it”. Even when symptoms are severe, obvious and socially embarrassing, parents are chary about seeing a psychiatrist because of the perceived social stigma attached to it. Undiagnosed and untreated, the illness becomes a full-blown disease by the time the patient becomes an adult. In children, the symptoms are often vague and difficult to classify as “abnormal”. Shyness, anxiety, speech peculiarities and temper tantrums may appear normal. Also in nuclear families, parents and grandparents may adjust to behaviour that is not normal. Any consistently inappropriate behaviour that occurs often, lasts a long time and repeatedly disrupts the child’s life or family should be taken seriously and investigated. The symptoms that should be taken seriously are hyperactivity with an inability to sit down and concentrate on any task, refusal to eat, difficulties in urination or passing motion, poor school performance, difficulty in sleeping, defying authority, refusing to attend school, outbursts of temper, disobedience, stealing, damaging property, poor social skills with no friends and having nightmares. The illness is already severe if the child hallucinates. Children who suffer from psychiatric problems like anxiety are socially withdrawn and nervous. They may avoid places or activities. ADHD (Attention Deficit Hyperactivity Disorder) affects 3-5 per cent of school children. It is commoner in boys. The symptoms are inattentiveness, overactivity, and impulsive or inattentive disruptive behaviour with or without learning disability. Autistic children withdraw into themselves, lack empathy, dislike or avoid physical contact and have poor language and communication skills. They cannot make friends. Meal times may become stressful because they refuse to eat. There may be extreme mood swings. The exact cause of mental illness is not known. It is probably the result of a combination of factors in a susceptible individual. It does tend to run in families, especially if many members have major or minor psychiatric illnesses. This may also be because a mentally ill parent cannot nurture a child appropriately. It does not, however, mean that children of parents with mental disorders will necessarily develop the disease. Chemicals called neurotransmitters convey signals from one brain cell to another and thereby control all brain activity. If the chemicals are not in proper proportion or sync, the imbalance can lead to symptoms of mental disorder. The imbalance may be hereditary or the result of an injury or illness. Stress in any form, either psychological (loss of a parent) or environmental (war or violence) can also affect the levels of these chemicals and precipitate mental illness. Children with psychiatric problems do not grow up and grow out of their illness. They require appropriate and timely treatment. Although more than 50 per cent of mental illnesses begin by the age of 14, it often stays undiagnosed. If the illness becomes worse, the child may be forced to drop out of school. He or she may have suicidal tendencies, may attempt suicide and actually succeed. The child may become dependent on drugs or alcohol and become sexually promiscuous. Adults can visit a doctor. Children, on the other hand, need to be taken to a doctor after parents recognise the symptoms. They need to be evaluated by a paediatrician and a child psychiatrist. Once a diagnosis has been made, a combination of behavioural therapy, psychotherapy and occupational therapy is used. Medication is required in certain children, but it needs to be used only as a last resort. Major psychiatric problems such as schizophrenia require appropriate medication. Children need a stable home environment to develop normally. They need adequate discipline. Winning your child’s affection by undermining the authority of the other parent or being overly indulgent is detrimental. It sends mixed signals to the child and leads to emotional conflict. Exercise is very important for mental and physical development. Structured outdoor activity for at least half an hour daily is required after the age of three. This helps to regulate neurotransmitters. Television viewing needs to be supervised as well as curtailed. The rapidly flashing images deplete neurotransmitter levels. Children should not watch programmes unsuitable for them as well as violent cartoons. Parents, spend an adequate amount of time with your child. This way you will immediately pick up on any problems. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in | 
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