Breaking Barriers in Youth Mental Health: An Exclusive Interview with Dr. Himani Adarsh (Part-1)

Dr. Himani: Hello! I’m Dr. Himani Adarsh, I was born and brought up in a family of doctors. My educational journey begins with joining a school in the Jammu region. I was always interested in pursuing a career in the medical profession. I completed my MBBS from the University of Kashmir (Jammu & Kashmir). I became interested in the human mind and psychology during my internship at GMC, Jammu.

A major milestone for me was when I secured an MD seat at one of the prestigious institutes in India. I completed my MD in Psychiatry from PGIMER (Postgraduate Institute of Medical Education and Research), Chandigarh, in 2020. In 2021, I joined DM Child and Adolescent Psychiatry (CAP) in PGIMER and dedicated three years to gaining experience in this super specialty. Currently, I am a consultant psychiatrist at ClearMedi Bahara Multispeciality Hospital, Mohali. 

Dr. Himani: As a person, I have always found myself dwelling deep into the mysteries of the human mind and its enormous capabilities. So, when I was pursuing my M.D. in the field of psychiatry, I had ample opportunity to interact with people who were dealing with mental health issues. Over these 3 years of working with the mental health concerns of people from various domains, I started to realize that a majority of them were beginning to show some or the other issues in their childhood or adolescent years.

This period from birth to 18 years is a sensitive developmental period, and the more adverse childhood experiences, the more likelihood of developing psychiatric disorders over the years. For me, it was a fascinating observation. With the knowledge I acquired from my teachers and books, I decided to dedicate more years to understanding the developmental psychopathology of various disorders and how we can help prevent and manage them.

Dr. Himani: One important thing to consider is that our children and adolescents (0-18 years of age) are not simply a younger version of adults. They are wired differently than adults, but the irony is that they can suffer from psychiatric disorders as seen in adults, and on top of that there are some psychiatric disorders specifically seen in their age range. Childhood and adolescence mark significant transitions in physiological, cognitive, emotional, moral, social, and other domains. In India, a meta-analysis reported that the prevalence of child and adolescent psychiatric disorders in the community is around 6.46% (1 in 20), and in the school, it was found to be 23.33% (1 in 5).

The common psychiatric disorders seen in this population are anxiety disorders, depressive disorders, disruptive behavioral disorders (e.g., oppositional defiant disorder), obsessive-compulsive disorder, and substance use. There is a high prevalence of Neurodevelopmental disorders (eg: autism spectrum disorders [ASD], attention-deficit/hyperactivity disorder [ADHD], developmental learning disorders [DLDs], etc,.).

Dr. Himani: I am glad that you raised this question. Parents and caregivers play a crucial role in fostering and supporting a child's mental health. Their influence extends across emotional, social, cognitive, and physical development, shaping the foundation for the child’s well-being. They can provide a secure and stable home where children feel physically and emotionally safe. Show unconditional love, support, and encouragement. Spend quality time together, listen actively, and engage in meaningful conversations.

Parents can exhibit self-care and seek help when necessary to show that mental health is a priority. Validate their feelings and help them understand that all emotions are normal. Guide them in problem-solving and managing challenging emotions. Encourage healthy social connections and encourage healthy habits, including regular exercise, nutritious meals, and sufficient sleep. Limit excessive screen time and promote creative and outdoor activities. When parents and caregivers prioritize mental health and provide a supportive environment, children are better equipped to develop resilience, manage stress, and build a positive self-image.

Dr. Himani: Our life span is divided into periods, each with its problems of adjustment. When we use the word child, we generally include the stages of development from 4-12 years. For ages 1-3 years, the term toddler is used clinically. Mental health challenges in children and adolescents differ due to developmental, social, and biological factors unique to each stage. The brain is much more sensitive to experiences in the first few years of life than in later years.

A child has limited cognitive and communication abilities. They generally express their distress through changes in play, tantrums, regression (e.g., bedwetting), or attachment behaviors. In children, mental health issues may manifest through behavioral changes, difficulties with emotional regulation, or physical complaints (e.g., stomachaches, and headaches). In children, anxiety disorders, separation anxiety, behavioral disorders, and neurodevelopmental disorders are more common.

 Adolescence begins at 12 years of age. Adolescence is the greatest time of neural change and maturation, and it is a time of marked neurodevelopmental changes. The adolescent brain demonstrates increased reward-seeking behavior, risk-taking behaviors, and high peer affiliation. Adolescent mental health challenges often involve more complex emotions, self-identity concerns, and a greater capacity for abstract thinking, leading to mood disorders or social withdrawal.

For an adolescent Social and Environmental Influences play a major role, like peer relationships, social media, academic pressures, the desire for autonomy, and romantic relationships may impact mental health. Adolescents are at a higher risk of self-harm, suicidal ideation, and experimenting with substance use due to heightened impulsivity and exposure to stressors. The onset of psychiatric illness is common and often develops in children and adolescents.

Dr. Himani: In my experience, when I start working with a child or adolescent suffering from some mental health issues, I am not only dealing with a single client. I make sure to assess and manage the family as a whole. Particularly in India, family includes parents, grandparents, and other extended family members who play a crucial role in management. This is a challenging area because there is masked distress due to stigma, societal pressure, and boundaries within the extended family, which leads to the development of a therapeutic barrier with the therapist. So, the task here is to navigate through all these barriers and make the family understand the mental health needs of the new generation.

Dr. Himani: Overall, my work with children and young people is always full of rewarding experiences. However, one particular patient I worked with holds a special place in my journey as a child therapist. So, this 8-year-old girl suffered from an accidental traumatic complete amputation of her right hand, and reconstruction surgery was done at the central institute. This was a traumatic experience for her, and she started to exhibit symptoms of Post-traumatic stress disorder (PTSD) and was not cooperative in her rehabilitation/physiotherapy instructions being given by the treating team. Using a child-centered play therapy approach, I was able to rehabilitate her. Over a few months, she started cooperating with her physiotherapist, her self-esteem began to build up, and she started going to school and using her right hand more often. The girl and her parents are still in contact with me, and she is living a normal life now.

Dr. Himani: I believe that working in the mental health field has helped me develop both professionally and emotionally throughout the years. My interactions with patients, families, and colleagues are characterized by empathy, respect, and integrity. I have gained the skills of building rapport and establishing trust with children and adolescents, as well as their families, and this has been my biggest asset and has been instrumental in achieving positive outcomes.

Dr. Himani: It all starts with spending a good amount of time with the patient as well as their families. As a psychiatrist, we are well trained in taking a detailed history, which includes various aspects, like family history, antenatal/postnatal, developmental history, and symptomatology. In the case of school-age children, liaison with schoolteachers is also done. After that, a detailed mental status examination is conducted. Further to investigate some cases we decide on psychological tests (like IQ, Personality tests, etc,.).

We rule out other co-morbidities, including both medical and psychiatric disorders. Once a diagnosis is established then depending on the type of disorder the management plan is made and here it's important to keep the patient and parents in the loop. Psychiatric treatment primarily involves pharmacological (i.e., medications) and non-pharmacological (i.e., therapies) techniques. During the course of treatment, I always make time to meet with patients and their parents for follow-up meetings.

Dr. Himani: Differentiating between normal developmental stages and potential mental health concerns involves understanding typical developmental milestones. After that, one can see whether the behaviors or emotions deviate significantly in intensity, duration, or impact on functioning. In our D.M. training course, I underwent thorough academic and clinical training, which included studies related to normal development. Also, I was posted in the Pediatrics and Genetics department to understand more about the developmental aspects. Only once you gain knowledge about typical growth and development and its variants can you pick up the deviance from normal. It’s mandatory to ask the parents as well as observe different domains, like motor skills (gross and fine), social skills, emotional responses, cognitive milestones, and behavioral patterns according to the age of the patient. Behaviors and emotions that are the key indicators of mental health concerns are:

• Persistent over time (lasting weeks or months).

• Severe in intensity, impacting the child’s ability to function in daily life.

• Unusual for the child’s age or developmental stage (e.g., severe separation anxiety in a 10-year-old).

• Distress or dysfunction is observed across multiple settings (e.g., home, school, and social environments).