Adolescent Mental Health Disorders

  • Michelle Chaney
  • Suni Jani
  • Julia Shekunov
  • Tanishia Choice


The occurrence of mental health disorders in adolescents is common with lifetime prevalence of any disorder being 46.3 % among 13–18 year olds. The most frequent diagnoses are ADHD followed by depression and other mood disorders. Pediatricians are often the “front line” for screening, diagnosing, and managing many of these adolescents. This chapter will review evaluation and management strategies of the three most common mental health disorders seen in adolescents in primary care. Appropriate treatment strategies of these disorders in primary care and criteria for referral to specialized mental health care treatment will also be discussed.


ADHD Depression Anxiety Evaluation and management Primary care Medication treatment 


  1. American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:894–921.CrossRefGoogle Scholar
  2. American Academy of Child and Adolescent Psychiatry. Bipolar disorder: parents’ medication guide for bipolar disorder in children and adolescents. 2010.
  3. American Academy of Pediatrics, Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128:1007–22.Google Scholar
  4. American Psychiatric Association and American Academy of Child and Adolescent Psychiatry in consultation with a National Coalition of Concerned Parents, Providers, and Professional Associations. (2010). The use of medication in treating childhood and adolescent depression: information for patients and families.
  5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association; 2013. 20 Oct 2015.Google Scholar
  6. Beidel DC, Alfano CA. Child anxiety disorders: a guide to research and treatment. New York: Taylor & Francis; 2011.Google Scholar
  7. Biederman J, Mick E, Faraone SV, Spencer T, Wilens TE, Wozniak J. Pediatric mania: a developmental subtype of bipolar disorder? Biol Psychiatry. 2000;48:458–66.CrossRefPubMedGoogle Scholar
  8. Birmaher B, Brent D, et al. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry. 2007;46(11):1503–26.CrossRefPubMedGoogle Scholar
  9. Brotman MA, Schmajuk M, Rich BA, et al. Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children. Biol Psychiatry. 2006;60:991–7.CrossRefPubMedGoogle Scholar
  10. Brown RT, Amler RW, Freeman WS, et al. Treatment of attention-deficit/hyperactivity disorder: overview of the evidence. Pediatrics. 2005;115:e749–57.CrossRefPubMedGoogle Scholar
  11. Cheung AH, Zuckerbrot RA, Jensen PS, et al. Guidelines for adolescent depression in primary care (GLAD-PC): II. Treatment and ongoing management. Pediatrics. 2007;120:e1313–26.CrossRefPubMedGoogle Scholar
  12. Cheung AH, Dewa CS, Levitt AJ, et al. Pediatric depressive disorders: management priorities in primary care. Curr Opin Pediatr. 2008;20:551–9.CrossRefPubMedGoogle Scholar
  13. Clark M, Jansen K, Cloy A. Treatment of childhood and adolescent depression. Am Fam Physician. 2012;85:442–8.Google Scholar
  14. Costello EJ, Erkanli A, Angold A. Is there an epidemic of child or adolescent depression? J Child Psychol Psychiatry. 2006;47:1263–71.Google Scholar
  15. Crawley SA, Caporino NE, Birmaher B, et al. Somatic complaints in anxious youth. Child Psychiatry Hum Dev. 2014;45:398–407.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Cummings C, Fristad M. Pediatric bipolar disorder: recognition in primary care. Curr Opin Pediatr. 2008;20:560–5.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Drake KL, Ginsburg G. Family factors in the development, treatment, and prevention of childhood anxiety disorders. Clin Child Fam Psychol Rev. 2012;15:144–62.CrossRefPubMedGoogle Scholar
  18. Dunsmore JC, Booker JA, Ollendick TH. Parental emotion coaching and child emotion regulation as protective factors for children with oppositional defiant disorder. Soc Dev. 2013;22:444–66.CrossRefGoogle Scholar
  19. DuPaul GJ, Gormley MJ, Laracy SD. Comorbidity of LD and ADHD: implications of DSM-5 for assessment and treatment. J Learn Disabil. 2013;46:43–51.CrossRefPubMedGoogle Scholar
  20. DuPaul GJ, Pinho TD, Pollack BL, et al. First-year college students with ADHD and/or LD: differences in engagement, positive core self-evaluation, school preparation, and college expectations. J Learn Disabil. 2015. pii: 0022219415617164 [Epub ahead of print].Google Scholar
  21. Farchione TR, Birmaher B, Axelon D, et al. Aggression, hostility, and irritability in children at risk for bipolar disorder. Bipolar Disord. 2007;9:496–503.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Geller DA, March J. Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Focus. 2012;10:360–73.CrossRefGoogle Scholar
  23. Geoffroy MC, Boivin M, Arseneault L, et al. Associations between peer victimization and suicidal ideation and suicide attempt during adolescence: results from a prospective population-based birth cohort. J Am Acad Child Adolesc Psychiatry. 2016;55:99–105.CrossRefPubMedGoogle Scholar
  24. Goldenring JM, Rosen DS. Getting into adolescent heads: an essential update. Contemp Pediatr. 2004;21:64–90.Google Scholar
  25. Hoge EA, Ivkovic A, Fricchione GL. Generalized anxiety disorder: diagnosis and treatment. BMJ. 2012;345:e7500.CrossRefPubMedGoogle Scholar
  26. Hughes CW, Emslie GJ, Crismon ML, et al. Texas children’s medication algorithm project: update from Texas consensus conference panel on medication treatment of childhood major depressive disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:667–86.CrossRefPubMedGoogle Scholar
  27. Kendall PC, editor. Child and adolescent therapy: cognitive-behavioral procedures. New York: Guilford Press; 2011.Google Scholar
  28. Kim YS, Koh YJ, Leventhal B. School bullying and suicidal risk in Korean middle school students. Pediatrics. 2005;115:357–63.CrossRefPubMedGoogle Scholar
  29. Klein D, Myhre K, Ahrendt D. Bullying among adolescents: a challenge in primary care. Am Fam Physician. 2013;8:87–92.Google Scholar
  30. Kodish I, Rockhill C, Ryan S, et al. Pharmacotherapy for anxiety disorders in children and adolescents. Pediatr Clin North Am. 2011;58:55–72.CrossRefPubMedGoogle Scholar
  31. Leenarts LE, Diehle J, Doreleijers TA, et al. Evidence-based treatments for children with trauma-related psychopathology as a result of childhood maltreatment: a systematic review. Eur Child Adolesc Psychiatry. 2013;22:269–83.CrossRefPubMedGoogle Scholar
  32. Lereya ST, Copeland WE, Costello EJ, et al. Adult mental health consequences of peer bullying and maltreatment in childhood: two cohorts in two countries. Lancet Psychiatry. 2015;2:524–31.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Lewandowski RE, Acri M, Hoagwood K, et al. Evidence for the management of adolescent depression. Pediatrics. 2013;132:e996–1009.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Maynard BR, Heyne D, Brendel KE, et al. Treatment for school refusal among children and adolescents: a systematic review and meta-analysis. Research on Social Work Practice. 2015. doi: 10.1177/1049731515598619.
  35. McClellan J, Kowatch R, Findling RL, Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:107–25.CrossRefPubMedGoogle Scholar
  36. McLean CP, Asnaani A, Litz BT, et al. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res. 2011;45:1027–35.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Mendlowicz MV, Stein MB. Quality of life in individuals with anxiety disorders. Am J Psychiatry. 2000;157:669–82.CrossRefPubMedGoogle Scholar
  38. Merikangas KR, He J-P, Burstein M, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49:980–9.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Muris P, Ollendick TH. Children who are anxious in silence: a review on selective mutism, the new anxiety disorder in DSM-5. Clin Child Fam Psychol Rev. 2015;18:151–69.CrossRefPubMedGoogle Scholar
  40. Nansel TR, Overpeck M, Pilla RS, et al. Bullying behaviors among US youth: prevalence and association with psychosocial adjustment. JAMA. 2001;285:2094–100.CrossRefPubMedPubMedCentralGoogle Scholar
  41. Perrin JM, Friedman RA, Knilans TK, Black Box Working Group; Section on Cardiology and Cardiac Surgery. Cardiovascular monitoring and stimulant drugs for attention-deficit/hyperactivity disorder. Pediatrics. 2008;122:451–3.CrossRefPubMedGoogle Scholar
  42. Pilkington K, Kirkwood G, Rampes H, et al. Homeopathy for anxiety and anxiety disorders: a systematic review of the research. Homeopathy. 2006;95:151–62.CrossRefPubMedGoogle Scholar
  43. Roza SJ, Hofstra MB, van der Ende J, et al. Stable prediction of mood and anxiety disorders based on behavioral and emotional problems in childhood: a 14-year follow-up during childhood, adolescence, and young adulthood. Am J Psychiatry. 2003;160:2116–21.CrossRefPubMedGoogle Scholar
  44. Scheeringa MS, Zeanah CH, Cohen JA. PTSD in children and adolescents: toward an empirically based algorithm. Depress Anxiety. 2011;28:770–82.CrossRefPubMedGoogle Scholar
  45. Schulte EE. Learning disorders: how pediatricians can help. Cleve Clin J Med. 2015;82(11 Suppl 1):S24–8.PubMedGoogle Scholar
  46. Singh T. Pediatric bipolar disorder: diagnostic challenges in identifying symptoms and course of illness. Psychiatry. 2008;5:34–42.PubMedPubMedCentralGoogle Scholar
  47. Smoller JW, Tsuang MT. Panic and phobic anxiety: defining phenotypes for genetic studies. Am J Psychiatry. 1998;155:1152–62.CrossRefPubMedGoogle Scholar
  48. Southammakosane C, Schmitz K. Pediatric psychopharmacology for treatment of ADHD, depression, and anxiety. Pediatrics. 2015;136:351–9.CrossRefPubMedGoogle Scholar
  49. Stevens JR, Wilens TE, Stern, TA. Using stimulants for attention-deficit/hyperactivity disorder: clinical approaches and challenges. Prim Care Companion CNS Disord. 2013;15:PCC.12f01472.Google Scholar
  50. Testa A, Giannuzzi R, Daini S, et al. Psychiatric emergencies (part III): psychiatric symptoms resulting from organic diseases. Eur Rev Med Pharmacol Sci. 2013;17 Suppl 1:86–99.PubMedGoogle Scholar
  51. Van Meter AR, Burke C, Kowatch RA, et al. Ten-year updated meta-analysis of the clinical characteristics of pediatric mania and hypomania. Bipolar Disord. 2016;18:19–32.CrossRefPubMedGoogle Scholar
  52. von der Embse N, Barterian J, Segool N. Test anxiety interventions for children and adolescents: a systematic review of treatment studies from 2000–2010. Psychol Sch. 2013;50:57–71.CrossRefGoogle Scholar
  53. Williams JH, Veeh CA. Continued knowledge development for understanding bullying and school victimization. J Adolesc Health. 2012;51:3–5.CrossRefPubMedGoogle Scholar
  54. Wolitzky-Taylor K, Bobova L, Zinbarg RE, et al. Longitudinal investigation of the impact of anxiety and mood disorders in adolescence on subsequent substance use disorder onset and vice versa. Addict Behav. 2012;37:982–5.CrossRefPubMedPubMedCentralGoogle Scholar
  55. Zuckerbrot RA, Cheung AH, Jensen PS, et al. Guidelines for adolescent depression in primary care (GLAD-PC): I. Identification, assessment, and initial management. Pediatrics. 2007;120:1299–312.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Michelle Chaney
    • 1
  • Suni Jani
    • 1
  • Julia Shekunov
    • 1
  • Tanishia Choice
    • 1
  1. 1.Child and Adolescent Psychiatry Service, Department of PsychiatryMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

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