Healing Young Minds: Dr. Himani Adarsh on Childhood Trauma & Mental Health (Part - 2)

Dr. Himani: Children and adolescents can experience traumatic events in any form, and we generally use a broader term - Adverse childhood experiences (ACEs). ACEs include different forms of Abuse, Neglect, and Family dysfunctions. There is good evidence available that shows that ACEs lead to mental health conditions as well her chronic medical issues in the long term.

Mental health disorders are more likely to develop in those who have experienced multiple ACEs at an early age. When a child grows up in dysfunction and chaos or has experienced continuous abuse or neglect, there is an excessive and continuous stimulation of the stress response system which leads to brain changes, affecting behavior and physical health. ACEs have been linked to the development of anxiety disorders, mood disorders, defiance and conduct issues, substance use disorders, and high-risk sex behaviors.

Exposure to childhood trauma alters brain development and affects the immune and endocrine systems. The overall prevalence of chronic medical disorders like Obesity, HTN, Diabetes, heart-related conditions, and immune-related diseases have been reported more in adults with multiple ACEs.

Dr. Himani: I usually conduct interactive sessions with students and try to understand their needs, why they want to use digital media, and what purpose it serves them. Usually, common themes are gaming, seeing the exciting lives of social media bloggers, chatting with friends, and learning new things, like some DIYs. Assessment is done for any underlying issues, like low self-esteem, social anxiety, neglect, or any form of abuse in the family. Associated psychiatric disorders can lead the child to withdraw from social interaction and indulge more in the digital world. So, the first step in my clinical practice is to find and treat the underlying causes. Some strategies to promote responsible and mindful technology use are:

• Creating schedules for study, entertainment, and relaxation to prevent excessive screen use.

• Engaging in hobbies, physical activities, and face-to-face social interactions to complement digital activities.

• Since children pick up the same behavior from their parents, parents should make every effort to avoid using devices in front of them.

• Setting digital boundaries, like using features like app timers or parental controls if needed.

• Participating in family or group activities without devices to strengthen personal connections.

• No screen use after dinner.

• Take screen breaks during study sessions to rest your eyes and improve focus.

Dr. Himani: Pharmacological treatment of ADHD involves two types of psychotropics mainly, stimulants (Methylphenidate) and non- stimulant medications (Atomoxetine, etc,.). Depending on the age of the child, the severity of symptoms, and the associated psychiatric disorders and medical disorders, the decision is taken on which medication to start. In children they are generally prescribed according to the body weight and regular monitoring for the response as well as side effects is done.

Again, for Anxiety and Depression, we have different classes of medications, like SSRIs (selective serotonin reuptake inhibitors) and they are prescribed according to the type of the disorder. Psychoeducating the patient and the parents regarding the medication and regular monitoring for side effects proves to be beneficial in ensuring good adherence to the treatment and less chances of any adverse outcomes.

Dr. Himani: Psychotherapy is a type of mental health treatment where a therapist and a patient or family engage in therapeutic dialogues and interactions. Different types of psychotherapy involve different approaches, techniques, and interventions. As a therapist, we assess various factors like the type of disorder, the associated conditions, the willingness of the client/family to participate, the cognitive component, availability of time, and their personality traits before deciding to start someone on psychotherapy.

Some brief psychotherapeutic interventions can be done over a few weeks like rief intervention for alcohol problems. For severe mental illnesses such as depression, bipolar disorder, OCD, and phobic disorders there are different types of cognitive behavioral therapies, which are tailored for that particular disorder. The goal of CBT is to recognize and alter harmful thought patterns and behaviors. It also entails learning coping mechanisms and relaxation methods. For personality disorders, like borderline personality disorder we have well-designed dialectical behavior therapy (DBT), which mainly focuses on teaching mindfulness, distress tolerance, emotional regulation skills, and maintaining effective interpersonal relationships.

These therapies require skills on the part of the therapist, and commitment of client/family, and the sessions can last up to 12-24 weeks, depending on the factors I discussed above. I use DBT with my teenage clients, and the outcomes are great.

Dr. Himani: Our children and adolescents who are diagnosed with any form of disability are similar to other children; the only difference is that, due to some developmental issues, they become dependent on their needs in one or the other form. For supporting mental health in special needs children, I prefer using strength-based approaches. For an optimal outcome, we should focus on their abilities, talents, and achievements to build confidence and resilience.

We can facilitate connections with peers who share similar experiences to reduce isolation and foster belonging. A key aspect is to educate and empower caregivers by providing training and resources to families and educators to recognize mental health concerns and offer effective support. The aim is to create supportive environments where youth with disabilities feel valued and included in social, academic, and extracurricular activities.

Dr. Himani: The pandemic time was an overall stressful period for every human being. Especially, our young population was confined indoors, their routine was disrupted, and it led to an increase in screen media use. Limited social interactions and lack of peer engagement led to loneliness and emotional distress. They also observed illness and deaths in the family.

Fear of illness, uncertainty, and exposure to distressing news heightened anxiety levels. Increased exposure to family conflicts or financial hardships created additional emotional burdens. School-going children suffered academically also, and this affected their self-esteem. Despite these challenges, some children demonstrated resilience, particularly those with strong family support and access to mental health resources.

Dr. Himani: According to Operational Guidelines on School Health Programme, 2018: India is home to 47.3 crore children (0–18 years) comprising 39 percent of the country’s total population. At the school level, a program, intervention, or strategy can be applied that is specifically designed to influence students’ emotional, behavioral, and/or social functioning. One of the key strategies to reach children and adolescents is through schools. Schools can serve as an ideal platform to impart education on health issues, institute healthy behaviors, forge linkages with services, and reach parents and the community through the students.

Universal prevention can be provided for the whole-school student population to promote healthy social and emotional understanding and skills. The classroom curriculum should incorporate strategies like teaching social-emotional skills to decrease impulsive and aggressive behavior and increase social competence. Life skills training chapters can be included, which deal with teaching self-awareness, empathy, critical thinking, problem-solving, coping with stress and emotions, and effective communication skills, preparing and enabling one to cope with life’s challenges.

School teachers should be sensitized to various child and adolescent mental health issues, ways to work as gatekeepers for suicide prevention, and steps to conduct preliminary crisis intervention. Lastly, Parent-Teacher associations, offer the potential to create an environment of collaboration and cooperation.

Dr. Himani: Pharmacogenetics is an emerging field that analyzes a patient’s genetic makeup to predict how they metabolize and respond to medications. It helps tailor drug selection and dosing, reducing the risk of adverse effects and improving treatment efficacy. This is especially valuable in mental health, where responses to psychiatric medications can vary widely. By identifying genetic variations in enzymes like CYP450, it guides clinicians in prescribing safer, more effective treatments. Pharmacogenetic testing supports personalized medicine, optimizing outcomes for each individual.

Dr. Himani: Bullying has a significant negative impact on children's mental health, resulting in depression, anxiety, and low self-esteem, whether it occurs in person or online. It frequently results in sufferers feeling alone and powerless, especially in cases of cyberbullying where they believe there is no way out. Bullying if persists might affect academic achievement and result in school avoidance or dropout. Children may struggle with developing healthy relationships and experience trust issues. Bullying can lead to long-term psychological distress, suicidal thoughts, and committing suicide in extreme situations.

Schools can address bullying by implementing clear anti-bullying policies and educating students on its consequences. Foster a supportive environment by teaching kindness, empathy, and inclusion through social-emotional learning programs. Regular workshops should be arranged for students, staff, and parents to build awareness and equip them to handle bullying effectively. Peer mentorship can be encouraged, and safe reporting systems ensure students feel heard and protected.

Dr. Himani: In group therapy sessions, children and adolescents who have some common psychiatric issues are treated by the therapist. Group interventions are an easy way to provide treatment to a number of patients, thus saving time. Also, to create awareness about good mental health, teaching life skills, anger management, or sexual education, teaching in groups is an effective way. Group intervention can target specific issues like children at risk for aggressive behaviors, drug use, and delinquency.