Learning about mental illness
Mental health on one end and mental disorders on the other represent two poles of a health-illness continuum. The terms “problem behavior or emotional disturbances” are often used to describe a range between these two poles, where mental health is impaired but does not meet the criteria for a mental disorder. This section provides guidance on delineating health, abnormality, and disorder for common mental disorders in adolescence. Further knowledge of scientifically supported causes of specific disorders can help alleviate personal uncertainties and counteract processes of stigmatization. Such knowledge enables a better understanding of initially unusual behavior and facilitates communication with adolescents and colleagues. Additionally, familiarity with scientifically validated, effective interventions allows for referrals to appropriate resources that can initiate comprehensive diagnostic assessments and, if necessary, further psychotherapeutic or educational measures. The identification of early warning signs or relevant abnormalities holds great importance for schools and all stakeholders involved in education. The dissemination of knowledge in this section aims to raise awareness of existing psychological abnormalities, reduce stigma through communication, and initiate support.
Additional sources
The State of the world’s children 2021 (UNICEF, 2021)
Autism spectrum disorders
Describe
Unlike conditions such as depression or anxiety, individuals on the autism spectrum are born with this disorder, and there is no known cure. Autism is often referred to as a pervasive developmental disorder, showcasing distinct differences in brain function compared to neurotypical individuals. “Neurotypical” is a term used to describe individuals whose neurological development conforms to the “typical” pattern. In contrast, the term “neurodiverse” refers to individuals whose neurological functioning deviates from this typical pattern, such as people with autism spectrum disorders or ADHD. Diagnosis of an autism spectrum disorder requires the presence of symptoms across three key areas: social communication, social interaction, and repetitive and stereotypical behavior. However, these symptoms may vary from person to person, which is why we speak of a spectrum. Nonetheless, a common trait among individuals with autism is difficulty in social interaction, coupled with a strong preference for structure and predictability. In some countries, the abnormalities in social communication and interaction are now summarized and not separate entities anymore. However, we will describe them separately here.
Social communication characteristics: Language development may be delayed or entirely absent in individuals with autism spectrum disorders. However, if language is present, individuals with autism often demonstrate differences compared to neurotypical people in their communication. For instance, they may employ more neologisms, make socially inappropriate statements or pose inappropriate questions, and repetitively use the same words and phrases. Furthermore, there are disparities compared to neurotypical individuals in initiating and sustaining verbal exchanges. Frequently, small talk is reduced, and engaging in reciprocal conversations to maintain a dialogue is restricted. Additionally, individuals with autism often display diminished non-verbal communication, such as reduced nodding or shaking of the head, pointing to distant objects, or employing conventional gestures like waving or blowing a kiss. Moreover, in children on the autism spectrum, there is often a notable reduction in varied, spontaneous imaginative play.
Social interaction characteristics: Individuals with autism often show diminished non-verbal behavior to navigate social interactions. For instance, they may avoid or maintain limited eye contact. Additionally, social smile and facial expressions in general are frequently less pronounced compared to neurotypical individuals. Moreover, those on the autism spectrum often face challenges in forming and maintaining relationships with peers. They may show reduced interest in peers, and their response to others’ approaches may be negative at times. Furthermore, there may be a lack of shared joy, which can be observed in fewer offers to share belongings or a diminished inclination to share interests and joy with others. Individuals with autism also commonly demonstrate reduced reciprocity on social and emotional levels. For example, providing comfort to others may be infrequent, inappropriate, or non-intuitive. Additionally, interactions with adults may sometimes be reserved, and individuals with autism spectrum disorders may exhibit reduced interest in such interactions.
Repetitive, stereotypical behavior: Individuals with autism often develop unusual or highly intense interests, which they deeply engage in. Sometimes, they cling to actions or rituals that serve no function in themselves. Therefore, they frequently struggle with alterations in daily routines or changes in their environment. Moreover, those on the autism spectrum may display a predominant fixation on specific objects or non-functional aspects of items. Another notable distinction involves sensory peculiarities, which may encompass various senses such as reactions to auditory, visual, tactile, or olfactory stimuli. Some individuals with autism may react hyper sensitively to certain stimuli, experiencing discomfort, whereas others may be hyposensitive, demonstrating reduced perception. Additionally, they may exhibit repetitive motor movements with their hands or entire body on occasion.
Red flags/Warning signs: Absent or delayed language, difficulties in social interaction, repetitive and restricted behavior and interests, sensitivity to sensory stimuli, rigid thinking and behavioral patterns, developmental delays. It is important to note that the presence of some of these warning signs does not necessarily mean that a person has autism. A professional assessment and diagnosis by specialists such as pediatricians, psychiatrists, psychologists, or specialized therapists are required to accurately diagnose an autism spectrum disorder.
Frequency and consequences
Approximately 1 in 100 children worldwide is diagnosed with an autism spectrum disorder (ASD). There is a higher frequency of diagnoses among boys compared to girls. In childhood and adolescence, an autism spectrum disorder can lead to difficulties in school. Sensory overload in a classroom setting can result in difficulties with concentration. Individuals with autism spectrum disorders often experience increased challenges in interacting with others, particularly peers. These difficulties may manifest in various social situations, including communication, understanding nonverbal cues, and the ability to establish and maintain relationships. In addition to social challenges, individuals on the autism spectrum often experience significant perceptual differences in everyday life, such as sensory sensitivities that affect social situations. Coping with these perceptual differences is often a challenge for individuals with autism and can greatly impact their daily lives. Very frequently, autism spectrum disorders co-occur with other mental disorders, most commonly ADHD, obsessive-compulsive disorder, and anxiety disorders, as well as depression.
Understand
The exact causes of autism spectrum disorders have not been fully investigated and understood, but research suggests that a combination of genetic, environmental, and developmental factors plays a role. There is likely no single cause of autism, but rather a variety of factors that contribute to the development of the disorder through complex interactions. The most important part, however, is genetic predisposition. Environmental factors, on the other hand, play a more important role in terms of functional impairment and personal distress.
Support
Approaches to the treatment and support of autism spectrum disorders can be diverse and should be tailored to the individual needs of the affected person. Early diagnosis and intervention can positively impact the course of autism. Early interventions may include behavioral and communication therapies, as well as supportive measures aimed at promoting the development of social skills, communication, and self-help skills. Therapies such as Applied Behavior Analysis (ABA), cognitive behavioral therapy, and speech therapy can help improve social skills, communication, self-regulation, and other essential skills. Individually tailored educational plans and support services in schools can help facilitate the learning process for children and adolescents with autism. This may include providing support personnel, adjustments in the classroom, and promoting peer interactions. All interventions aimed at promoting well-being and facilitating coping with difficult situations from previous sections can have a protective effect. By offering individually tailored support that is aligned with the needs and strengths of the affected individual, these interventions can help strengthen resilience and develop positive coping strategies. By promoting social skills, self-regulation, communication, and self-help skills, they can help increase resilience to stress and challenges. Moreover, they can also enhance self-esteem and promote a sense of efficacy, which in turn contributes to improving mental health and overall well-being.
Exercise
Additional sources
Centers for Disease Control and Prevention (2022). Autism Spectrum Disorder (ASD). Retrieved from: https://www.cdc.gov/ncbddd/autism/facts.html
Keen et al. (2015). How well are children with autism spectrum disorder doing academically at school? An overview of the literature. Autism, 20(3), 276-294. doi: 10.1177/1362361315580962
Eating disorders
Describe
Eating disorders are serious mental illnesses that affect eating behavior and the perception of one’s own body. They can lead to significant health problems and greatly impact the lives of those affected. The most common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder. Despite their diversity, all eating disorders share some common features. First, disordered eating behavior is a central theme, which can manifest through unusual eating habits such as extreme calorie counting, excessive eating, or severely restricted food intake. These behaviors have serious effects on health, both physically and mentally. People with eating disorders often suffer from malnutrition, dehydration, heart problems, depression, and other mental health conditions. Another common feature is the distorted perception of one’s own body and weight. Affected individuals tend to perceive themselves as “overweight” or “unattractive”, regardless of their actual weight or appearance. This often leads to intense emotional distress, including anxiety, shame, guilt, and self-hatred. Eating behavior can frequently serve as a coping mechanism for these emotional issues. Finally, eating disorders significantly impair the individuals’ daily life. The constant focus on food, weight, and body image can cause considerable suffering and greatly hinder the adolescents# ability to work, attend school, engage in social relationships, and pursue personal development.
Thoughts: In eating disorders, the main thoughts of those affected often revolve around food, weight, body image, and gaining control. They may obsessively contemplate over calories, weight gain or loss, and constantly worry about what they should eat.
Feelings: Negative thoughts and a sense of rejection towards one’s own body are also common. These feelings are accompanied by guilt and shame towards one’s body, appearance, or eating behavior. Eating disorders can lead individuals to feel isolated. They often experience difficulty in maintaining social contacts. Many people with eating disorders experience feelings of sadness, negative feelings, or depression. These feelings can be intensified by the constant focus on food, weight, and body image, as well as the social withdrawal. Additionally, a low self-esteem is often reported.
Behaviors: Disordered eating behaviors can vary widely, from food refusal to uncontrollable binge eating, secretive eating, and neglecting personal interests. Often, those affected withdraw from family and friends. Perfectionistic tendencies and strict rules regarding eating behaviors reinforce this cycle of negative thoughts and emotions.
Body: In eating disorders, individuals may experience a range of physical sensations, including disrupted hunger and satiety feelings, nausea, digestive problems, dizziness, palpitations, physical weakness, hair loss, and sensitivity to cold. These sensations can be attributed to malnutrition, irregular eating, and excessive exercise.
Red flags/Warning signs: Warning signs for eating disorders may include changes in eating behavior, distorted body image, social withdrawal, mood swings, rigid eating rules, and excessive thoughts about food and weight.
Frequency and consequences
Eating disorders affect approximately 14 out of 1000 women and 5 out of 1000 men. They typically begin in adolescence. Eating disorders can have serious consequences for physical and mental health. They often lead to malnutrition and weight-related issues, including muscle atrophy, fragile bones, hair loss, and a weakened immune system. Additionally, eating disorders can result in the cessation of menstruation in women and loss of potency in men. Cardiovascular problems, such as arrhythmias and heart failure, are also common. Gastrointestinal problems, such as gastritis and ulcers, are another consequence. Furthermore, eating disorders can cause cognitive impairments and mental health issues such as depression and anxiety disorders. Social withdrawal, isolation, and relationship problems are common social consequences. Long-term, eating disorders can lead to life-threatening complications such as heart failure, kidney failure, and an increased risk of suicide.
Understand
It is important to note that eating disorders are not caused by a single factor but rather by a complex interplay of multiple factors. The exact causes can vary from person to person and are often the result of a combination of biological, psychological, and socio-cultural factors. Genetic predisposition plays a crucial role when it comes to the vulnerability of eating disorders. Studies have shown that individuals with family members who have been diagnosed with an eating disorder are at increased risk of developing one themselves. Additionally, hormonal, and neurochemical differences in the brain, particularly related to neurotransmitters such as serotonin and dopamine, can influence the risk of developing an eating disorder. Individual personality traits and psychological factors also play an important role. Childhood experiences, the presence of role models, parenting styles, and high achievement standards can increase the risk of eating disorders. Perfectionism, low self-esteem, a need for control, and impulsivity are examples of personality traits that may be associated with an increased risk of eating disorders. Furthermore, contemporary society and culture have a significant impact on the development of eating disorders. In particular, the portrayal of idealized body images in the media and on social platforms can lead to distorted body images and unrealistic beauty standards. The pressure to conform to body weight and appearance ideals, emanating from peer groups and society at large, can increase the risk of eating disorders.
Support
The treatment of eating disorders requires a holistic approach that considers various aspects of the condition and is individually tailored. Psychotherapy plays a central role in treating eating disorders, addressing underlying psychological issues and promoting healthy behaviors. The goal is to identify and change negative thought patterns and behaviors, as well as improve the relationship with food and one’s own body. Specialized clinics or counseling centers that focus on treating eating disorders provide comprehensive support, including diagnosis, counseling, therapy, and coping assistance. For severe cases of eating disorders, especially in acute life-threatening conditions such as severe underweight or dehydration, hospitalization or inpatient therapy may be necessary to ensure intensive medical care and monitoring. Additionally, nutrition therapy, conducted by qualified nutrition professionals such as dietitians or therapists, can help individuals to learn healthy eating habits, improve their relationship with food, and promote balanced nutrition. The aim is to establish healthy eating behaviors and combat malnutrition.
Exercise
Additional sources
National Institute of Mental Health (2024). Eating Disorders. Retrieved from: https://www.nimh.nih.gov/health/topics/eating-disorders
Internet addiction
Describe
Media addiction, also known as internet addiction or online addiction, refers to compulsive behavior in which an individual spends excessive amounts of time using digital media, particularly on the internet. This type of addiction can take various forms, including excessive use of social media, online gaming, streaming services, or other digital activities. Affected individuals invest an excessive amount of time in digital media usage and neglect important responsibilities such as work, school, social interactions, and personal duties. Despite intending to reduce time spent on digital media, individuals with internet addiction struggle to control it. Often, they spend more time on digital media than planned and increasingly need more time to experience the same satisfaction or thrill as before. This can lead them to turn to digital media more frequently, and their usage increases steadily.
Thoughts: Affected individuals are constantly preoccupied with their preferred medium. They can hardly concentrate on other thoughts and repeatedly feel the need to engage with digital media. Affected individuals may heavily rely on their online presence and success in social media for their self-worth. They constantly worry about how many likes, comments, or followers they have and feel inferior if they do not receive enough recognition. Similarly, digital media can serve as a means of escape from real problems or unpleasant emotions. Affected individuals may retreat into the virtual world to distract themselves and escape from stress or difficulties.
Feelings: Often, affected people experience a loss of control, where he or she feels unable to control media usage. This can lead to frustration, anxiety, and feelings of helplessness. The fear of missing out can lead affected individuals to constantly stay online and fear missing important events or news when offline.
Behavior: Affected individuals spend the majority of their time with media and neglect social relationships, hobbies, and other obligations. They have difficulty reducing their consumption and often conceal the extent of their usage. Affected people constantly seek excuses to be online and may display aggressive or angry behavior when denied access to digital media.
Body: Excessive use of digital media can cause various physical discomforts. Poor posture and hours of sitting in front of screens can lead to back and neck pain, tension, and other musculoskeletal complaints. Additionally, an inactive lifestyle due to excessive media use can increase the risk of weight gain. Conversely, neglecting meals can lead to weight loss. Prolonged staring at screens can also lead to eye discomfort such as dryness, irritation, blurred vision, and headaches, collectively known as “computer vision syndrome.”
Red flags/Warning signs: Warning signs for a pathological use of internet should alert to potential signs and symptoms indicating excessive use of digital media and potential addiction. These include behavioral changes such as increased interest in digital media, neglect of responsibilities and activities, withdrawal symptoms when restricting media consumption, problems in interpersonal relationships, health issues, uncontrollable behavior, withdrawal and isolation, as well as deception and lying about the extent of usage. It is important to take these warning signs seriously and take appropriate action early on to recognize and treat internet addiction. Professional help and support can assist in developing healthier habits and supporting the individual on the path to recovery.
Frequency and consequences
The estimated global prevalence of internet addiction is 6.0 percent. This excessive use of digital media can lead to serious consequences, including an increased risk of aggressive behavior with high consumption of violent content, as well as a deterioration in academic performance. Furthermore, psychological effects such as depression, anxiety disorders, social phobias, and sleep problems may arise. It is important to take the effects of excessive media use seriously and to take appropriate preventive and treatment measures in a timely manner.
Understand
The causes of internet addiction are diverse and can include biological, psychological, social, and environmental factors. These factors encompass a genetic predisposition, mental health issues such as depression or anxiety disorders, an environment that promotes excessive use of digital media, and personal factors such as stress management or the pursuit of reward and recognition. Excessive use of digital media can fulfill various psychological needs and serve as an escape from real-world problems. It provides an easy way to make new friendships and maintain social connections, which can be particularly appealing when interpersonal interaction in the real world is perceived as difficult. Additionally, playing digital games satisfies the need for challenge and reward, with successful gaming triggering the release of happiness hormones. These aspects contribute to increasing the appeal of digital media and promoting its excessive use, which, however, can simultaneously have negative impacts on real-life functioning and mental health.
Support
Individual or group therapy can help identify the underlying causes and triggers of excessive digital media use and develop healthy coping strategies. Cognitive behavioral therapy can be particularly useful in recognizing and changing problematic thought patterns and behaviors. Additionally, media literacy programs can help develop a better understanding of the impacts and risks of media use and learn strategies for responsible digital media use. Limiting access to digital media through time restrictions, installing blocking features, or creating media-free zones in the home can also help to reduce usage. Furthermore, promoting alternative activities and hobbies not associated with digital media can help decrease the time spent with digital media and foster interests in other areas of life.
Exercise
Additional sources
Lozano-Blasco, R., Robres, A. Q., & Sánchez, A. S. (2022). Internet addiction in young adults: A meta-analysis and systematic review. Computers in Human Behavior, 130, 107201. doi: 10.1016/j.chb.2022.107201
Despression
Describe
Depression in adolescents may resemble that of adults, but it can also manifest in increased irritability, mood swings, or physical complaints. Especially during puberty, it is often difficult to distinguish a depressive episode from age-typical emotional and mood fluctuations. The main symptoms are a sad mood, often accompanied by irritability in adolescents, loss of interest, and lack of energy or motivation. These symptoms do not necessarily occur all together and can vary in severity. It is typical to observe a change in behavior, meaning that the adolescent no longer finds joy in activities that used to bring pleasure or suddenly reacts strongly. Lack of motivation often manifests as spending hours “lying in bed,” being unable to muster the energy, or feeling exhausted after minor efforts.
Thoughts: Concentration problems or slowed thinking may manifest. Adolescents may have difficulty making decisions. Other notable aspects in thinking patterns include negative thought spirals about themselves, others, or the future. Adolescents with depression may often engage in thoughts about death or the meaninglessness of life. If adolescents intensely and possibly very specifically contemplate not wanting to live or wanting to end their lives, support should always be offered, or other individuals involved.
Feelings: Feelings of guilt are common, as well as feelings of worthlessness or loneliness. Many adolescents with depression also frequently experience anxiety.
Behavior: Strong irritability can lead to an increase in conflicts with peers, parents, or teachers. On the other hand, adolescents with depression often withdraw from groups or activities or hobbies. Many adolescents also appear either motorically restless or slowed down in their movements. Lack of drive can manifest in schoolwork being completed less reliably or a decline in performance.
Physical: On a physical level, depression is often accompanied by sleep disturbances, changes in appetite, headaches, or stomachaches.
In the differentiation between health, abnormality, and disorder, the intensity and frequency of behaviors play a role, as well as whether the adolescent or the environment suffers from them and whether he/she is impaired in coping with everyday tasks. Often there is a decline in academic performance, conflicts with peers, withdrawal from the peer group, or arguments at home that go beyond typical adolescent conflicts. For a precise differentiation, the assessment of specially trained child and adolescent psychotherapists or specialists in child and adolescent psychiatry is necessary.
Red flags / Warning signs: When adolescents express suicidal thoughts or plans, these expressions must be taken seriously in every case. Teachers should listen to the adolescent and involve other individuals for support (colleagues and, for example, the school psychological service). Assessment of suicidality is conducted by child and adolescent psychotherapists and child and adolescent psychiatrists. If an adolescent is in an acute crisis, an emergency medical service or ambulance is called (112). It is important not to leave the adolescent alone during the waiting period.
Frequency and consequences
3-7% of adolescents in Germany (and worldwide) are affected by depression. 5% of all individuals experience at least one depressive episode in their lifetime. From puberty onwards, more girls than boys become depressed. Depression often occurs in episodes. Hence it is also referred to as a depressive episode, with some individuals experiencing only one episode and others experiencing multiple episodes. Depression is associated with poorer academic performance, for example, due to concentration problems, because adolescents find it difficult to motivate themselves to complete tasks or prepare for exams, or because subjects that used to interest them no longer bring them joy. Physical symptoms such as sleep disturbances or lack of drive increase the risk of absenteeism. In the long term, the probability of poorer educational and career outcomes is increased for individuals with depression. Conversely, academic failures or school-related stress can be factors that contribute to the onset and maintenance of depression. Depression very often co-occurs with other mental disorders, most commonly with anxiety disorders.
Understand
Depression arises when many different stress factors come together. Vulnerability and stress are often discussed. Vulnerability describes vulnerabilities that the adolescent already brings with them. These can be genetic factors such as the presence or absence of certain chemical messengers in the brain, or psychological factors such as low self-confidence or negative or perfectionistic thought patterns. Social factors also play a role in the development of vulnerability; examples include the school environment or integration into the class community. Bio-psycho-social risk factors can increase vulnerability, while protective factors on these three levels can mitigate risks. Depression occurs when stressors are added to vulnerability. These are events that pose a particular challenge, such as exam periods, bullying, or the loss of a friendship. It is important to note that the individual interplay of these many factors leads to the development of depression, not a single factor. School-related factors that have been shown to be particularly relevant in terms of increasing the risk of depression include real or perceived academic problems, a negative classroom atmosphere, poor relationships with peers and teachers, bullying, and exclusion. In addition, various individual and familial factors influence. Accordingly, intervention can be targeted at various points in this framework, aiming both to reduce risk factors and stressors and, especially, to build protective factors and competencies that mitigate the effects of risks and stressors.
Support
Protective measures can be provided by all interventions from the previous and following sections (how to flourish, how to deal with difficult situations). They establish protective factors and thereby reduce vulnerability. However, there are times, situations, or structures that exceed the existing coping mechanisms or resources and, despite resilience being fostered, can lead to overwhelm and a depressive episode. Teachers can be an important first point of contact. They can describe their concerns and the behaviors they observe in a trusting conversation, thus conveying understanding and openness to the affected adolescents. Simply feeling seen can be experienced as support. Finding a balance between addressing concerns on one hand and respecting the privacy of adolescents on the other hand is often challenging for many teachers. Helpful tips for communicating with distressed students can be found on the project’s website schule.ich-bin-alles.de. Psychotherapeutic interventions for treating depression in adolescents often rely on the principles of cognitive-behavioral therapy. If outpatient psychotherapy is not sufficient, partial or full inpatient treatment can be arranged through the pediatrician or general practitioner. If adolescents and parents waive confidentiality, the teacher can make an important contribution to the diagnostic process. Additionally, communication between the school and clinic is advisable if the adolescents are educated in a clinic school as part of partial or full inpatient treatment.
Exercise
ADHD
Describe
The symptoms of ADHD are divided into two groups: attention problems and hyperactivity/impulsivity. Adolescents may exhibit the combined type of the disorder, which is referred to as ADHD, or they may only experience attention problems, known as ADD. Behaviors observed in the school environment and related to attention problems include easy distractibility, difficulty remembering instructions, initiating, organizing, or completing activities, and often struggling to maintain a consistent, steady work pace. Behaviors associated with hyperactivity and impulsivity include interrupting others, excessive talking, or excessive motor restlessness. In adolescence, motor restlessness tends to recede into the background, while impulsivity, especially verbal impulsivity, becomes more prominent. In addition to the described problems, difficulties in sustaining motivation and effort over longer periods are often evident. Many adolescents are initially enthusiastic but eventually encounter difficulties with prolonged implementation or staying on task. Particularly typical for ADHD in adolescence are aversions to mentally demanding tasks and difficulties with work and everyday organization. Assessing time intervals, planning activities over a longer period, or managing time is often challenging. There is controversial debate about whether difficulties in emotional regulation are also part of ADHD, or whether this problem is not part of the actual disorder but occurs frequently in conjunction with it.
Thinking: Primary features include easy distractibility and difficulty focusing on one thought. In conversations, this scattered thinking often manifests in descriptions that seem disjointed or in individuals jumping from one topic to another. Thinking frequently gets lost in trivial details, causing the essential aspects to be overlooked.
Feeling: Many adolescents experience strong emotional reactions to sensory stimuli, heightened emotional lability, or rapid mood swings. Waiting is often perceived as very stressful and akin to “torture.” When something exciting, stimulating, or new happens, adolescents with ADHD report a particularly high level of enthusiasm.
Behavior: Adolescents with ADHD may appear absent-minded or as if they are not listening. They may work slowly at times, appear disorganized, or fail to complete tasks. Even in everyday routines, a systematic approach is difficult. Due to impaired time perception and difficulty organizing work steps, individuals with ADHD are often tardy.
Body: Many adolescents with ADHD describe a strong inner restlessness. They may perceive their level of arousal as too high, as if they are “driven by a motor.”
When distinguishing between health, peculiarity, and disorder, the severity and frequency of behaviors play a role, whether the adolescent or the environment suffers from them, and whether he/she is impaired in coping with everyday tasks. Impairments typically occur during times of increased demands. For a precise distinction, the assessment of specifically trained child and adolescent psychotherapists or specialist physicians in child and adolescent psychiatry is necessary.
Red Flags/Warning Signs: Certain features seem to be particularly common in different age groups: Difficulty maintaining attention is a common symptom that frequently appears in studies. It has even been found to be associated with severe functional impairments in a recent study. In another analysis, it was found that this symptom, along with things like frequent forgetting of everyday tasks and losing objects, is particularly strongly associated with inattention. For the domain of hyperactivity and impulsivity, certain behaviors seem to be particularly alarming, such as difficulties in playing quietly, frequent restlessness, or standing up in inappropriate moments. It is also interesting to note that certain behaviors, such as frequent loss of objects or aversion to prolonged mental efforts, may indicate other disorders, such as problems in social behavior. Although further research is needed, these findings could help improve screening procedures and select interventions more effectively.
Frequency and consequences
Approximately 3-5% of adolescents in Germany and worldwide are affected by ADHD. When the gold standard of diagnosis is applied, ADHD has not become more common in the last 30 years and appears at comparable rates in epidemiological studies worldwide. Due to increased awareness and more reliable diagnostics, the disorder is generally better recognized in routine care today. There is no evidence to support the media’s often conveyed impression that ADHD is a fad diagnosis or a disease of civilization. Boys are affected twice as often as girls. ADHD is relatively stable in the course of development: 70–86% of all affected individuals continue to meet the diagnostic criteria in adolescence. The majority of adolescents with ADHD have additional mental health issues, with approximately 60% having multiple additional diagnoses. Oppositional or conduct disorders most commonly co-occur with ADHD. Conduct disorders are associated with an increased risk of alcohol, nicotine, drug use, gambling, and contact with the criminal justice system. ADHD is associated with an increased risk of accidents and suicide attempts. Anxiety disorders and depression also occur in about one-quarter of those affected by ADHD. There are also high rates of overlap with tics and autism spectrum disorders. An ADHD diagnosis increases the risk of grade repetition, the use of school-based and extracurricular learning support, and lower levels of educational attainment.
Understand
Nowadays, ADHD is understood as a disorder of neural development, meaning it is assumed that the brains of people with ADHD have specific peculiarities in certain areas and therefore function differently. Central to this are difficulties in executive functions, which act as an air traffic control system for monitoring and controlling incoming and outgoing information and cognitive resources. Particularly relevant in the educational context is working memory, which is responsible for holding information for processing for a short duration. For example, multi-step instructions require working memory capacity, as the information not only needs to be briefly remembered but also actively used and manipulated. Inhibition, as another aspect of executive function, describes the ability to interrupt and suppress a dominant action impulse. Cognitive flexibility, as the third central competence in the area of executive functions, is required when adapting one’s behavior to the demands of the situation, for example, when switching between instructions or changing behavior after correction by the teacher. Beyond executive dysfunction, attentional orientation in space or to important information is often impaired. This, too, can be linked to a different functioning of the brain. There is strong evidence that certain environmental circumstances increase the risk of ADHD. Some of these circumstances may even be direct causes, but for most, there is the possibility that they are related to genetic and environmental influences that are not necessarily specific to ADHD.
Support
Protective measures can be taken from all interventions mentioned in the previous sections (how to flourish, how to deal with difficult situations). They build up protective factors and thus reduce vulnerability. However, there are times, situations, or structures that exceed the available resources and, despite resilience being fostered, lead to overwhelm and a depressive episode. Teachers can be an important first point of contact. They can describe their concern and the behaviors they observe in a trusting conversation, thereby conveying understanding and openness to the affected adolescents. Even the feeling of being seen can be experienced as support. Many teachers find it challenging to strike a balance between addressing concerns on one hand and respecting the privacy of the adolescents on the other. Helpful tips for communicating with distressed students can be found on the project’s website schule.ich-bin-alles.de. Psychotherapeutic interventions for treating depression in adolescents often rely on the principles of cognitive behavioral therapy. If outpatient psychotherapy is not sufficient, a partial or full inpatient treatment can be initiated through the pediatrician or general practitioner. If adolescents and parents waive confidentiality, the teacher can make an important contribution to the diagnostic process. Additionally, it is advisable for there to be communication between the school and the clinic if the adolescents are being educated in a clinic school as part of partial or full inpatient treatment.
Exercise
Additional sources
Faraone et al. (2021). The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neuroscience and biobehavioral reviews, 128, 789–818. doi: 10.1016/j.neubiorev.2021.01.022
Anxiety disorders
Describe
Anxiety disorders in adolescence are mental health conditions that can significantly affect the lives of teenagers. They manifest through persistent, excessive fears or worries that impair normal functioning in various areas of life. Adolescents with anxiety disorders may experience symptoms such as panic attacks, social withdrawal, excessive worrying, physical discomfort, and avoidance behavior. These disorders can take various forms, including generalized anxiety disorder, social anxiety disorder, panic disorder, specific phobias, and obsessive-compulsive disorder (OCD). Timely diagnosis and treatment are crucial to help adolescents with anxiety disorders develop effective coping strategies and lead healthy, fulfilling lives.
Thoughts: People with anxiety disorders often struggle with an overwhelming flood of thoughts characterized by fear and worry. Their thoughts tend to focus on potential dangers, even in everyday situations, and they often envision worst-case scenarios. These constant thoughts can lead to self-criticism and self-condemnation for their fears. They may also tend to avoid situations that trigger their anxiety and try to control everything to manage their fears.
Feelings: Adolescents with anxiety disorders may experience a variety of emotions, including fear, worry, restlessness, helplessness, and physical symptoms such as palpitations or dizziness. These feelings can significantly impair daily life and lead to shame or guilt.
Behavior: Adolescents with anxiety disorders often exhibit specific behaviors to cope with their fears. This often includes avoiding situations or places that could trigger their anxiety and developing safety or control behaviors to feel safer. Some may withdraw and isolate themselves to avoid potential stressors, while others may engage in risky behavior to find temporary relief. It is important to understand that while these behaviors may bring temporary relief, they can exacerbate anxiety in the long run.
Body: Various physical symptoms can occur, including palpitations, shortness of breath, sweating, trembling, dizziness, gastrointestinal discomfort, headaches, and tingling or numbness. These symptoms can significantly impair daily life and cause additional anxiety. It is important to note that they are often part of the body’s physical response to anxiety.
Red flags/Warning signs: A person is said to have an anxiety disorder when their symptoms of anxiety are so severe that they impair normal functioning and do not respond appropriately to the situation. Warning signs for anxiety disorders may include excessive worrying, physical symptoms such as palpitations or shortness of breath, panic attacks, social withdrawal, control behaviors, sleep disturbances, concentration problems, unexplained physical complaints, behavioral changes, and persistent tension.
Frequency and consequences
The prevalence rates of anxiety disorders worldwide can vary depending on factors such as geographical location, cultural differences, diagnostic criteria used, and research methodologies employed. However, anxiety disorders are among the most common mental health disorders globally, affecting millions of people of all ages. According to the World Health Organization (WHO), anxiety disorders are estimated to affect approximately 3.6% of the global population. Anxiety disorders can have various consequences that significantly impact daily life. Affected individuals may struggle to function normally in different areas such as work, school, relationships, and leisure activities, as symptoms may hinder them from performing certain activities or maintaining social interactions. This can lead to social isolation and exacerbate feelings of loneliness. The constant emotional stress associated with anxiety disorders can also impair overall well-being and lead to depression or other mental health disorders. Additionally, physical symptoms of anxiety disorders such as sleep disturbances, muscle tension, and gastrointestinal problems can further compromise physical health. Individuals may heavily restrict their lives to avoid certain situations or objects, leading to feelings of helplessness. Furthermore, anxiety disorders can cause financial burdens, relationship difficulties, and self-esteem issues. Therefore, timely diagnosis and treatment are crucial to minimize the effects of anxiety disorders and improve quality of life.
Understand
The causes of anxiety disorders are multifaceted and may involve a combination of genetic, neurobiological, environmental, and life factors. Genetic predisposition may play a role, as anxiety disorders often run in families. Imbalances in brain neurotransmitters such as serotonin and noradrenaline may also be implicated. Traumatic experiences, abuse, or challenging life circumstances can increase the risk of anxiety disorders. Learning processes are also influential, as individuals may develop anxious responses to certain situations through direct experiences or observation of others. Personality traits such as low self-esteem or negative thinking patterns can also elevate the risk of anxiety disorders. Biological factors such as increased activity in certain brain regions may also contribute. It is important to emphasize that not all individuals with the same risk factors will develop an anxiety disorder, and the exact cause may vary from person to person. Early intervention and treatment are essential to reduce the effects of anxiety disorders and enhance quality of life.
Support
With anxiety disorders, there are various ways to find support and manage symptoms. A first step is seeking professional help from child and adolescent psychotherapists, psychiatrists, and psychologists who can provide an accurate diagnosis and recommend treatment options. Psychotherapy, such as cognitive behavioral therapy, can be effective in identifying negative thought patterns and developing coping strategies. Additionally, guided exposure therapy can reduce symptoms by confronting fears. In some cases, medications like antidepressants or anti-anxiety drugs may be helpful under medical supervision. A healthy lifestyle, including regular exercise, balanced nutrition, adequate sleep, and stress management, can also contribute to symptom relief. Furthermore, talking to family, friends, or participating in a support group can offer additional social support. Self-help strategies like breathing exercises, progressive muscle relaxation, and mindfulness practices can also be helpful. It’s important to address avoidance behavior and gradually confront anxiety-inducing situations. If anxiety disorders coexist with other health issues, it’s important to address them simultaneously. Every individual is unique, so it may be necessary to try different approaches to find what works best. Being patient and seeking professional support are important for developing effective coping strategies and improving quality of life.
Exercise
Additional sources
https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders