What are we talking about here and what’s the scope?
About one in five children in the U.S. suffers from some sort of emotional or behavioral condition, according to a new study led by the National Academy of Sciences (NAS). Among adults with confirmed illnesses, 50% were diagnosed before the age of 14 and 75% before 24. Worse than the money lost to mental illness is the joy lost to it. Epidemiologists speak of what are known as disability adjusted life years (DALYs) — years compromised or diminished by ill health. Among Americans under 25, mental disorders account for 30% of all DALYs; in the 14-to-25 group, it's 48%.
Some disorders begin in childhood and continue into adolescence and adulthood. Others go away or improve with age, and some begin later in life. Mental illnesses are usually caused by a combination of factors that fall into four broad categories: environmental, genetic, biological, and psychological Mental health screenings are a key part of youth mental health. Approximately 50% of chronic mental health conditions begin by age 14 and 75% begin by age 24. At the same time, the average delay between when symptoms first appear and intervention is 8-10 years. Mental health screenings allow for early identification and intervention and help bridge the gap.
Research has shown that targeting symptoms early leads to better outcomes. moment when parents should recognize their child’s behavior has surpassed the boundary of what all children do and has become sufficiently alarming to warrant a formal evaluation? There probably isn’t one. It is often a gradual awareness that And children often lack the vocabulary or developmental ability to explain their concerns.
The following disorders are common in childhood:
- Attention deficit hyperactivity disorder (ADHD)
- Eating problems
- Bathroom issues
- Feelings of sadness, or moodiness
- Disruptive behavior
- Learning disorders, such as dyslexia
- Involuntary movements, or tics
- Schizophrenia, or distorted thoughts and feelings
Why is this so challenging?
Children, however, are developing mentally and physically, and their behavior may be difficult to analyze. Actions such as anxiety, anger, and shyness can be a part of developmental growth or a temporary condition rather than an illness. When troubling behaviors occur over a period of time or in a way that disrupts daily life, they are considered symptoms of a disorder.
Initial diagnosis is based on reports of behavior from parents, caregivers, and teachers in order to understand how the child functions in different situations. Often a child will have a combination of two or more behaviors, such as anxiety and bedwetting.
Before seeking a formal mental health evaluation, parents may have tried to help their child by talking to friends, relatives, or the child’s school. They may try to discover whether others see the same problems and to learn what others suggest. Parents may feel that they also need help in learning better ways of supporting the child through difficult times and may seek classes to help them sharpen behavior management or conflict resolution skills.
Duration intensity age delays in normal development significant delays (six months or more) in language development, motor skills, or cognitive development should be brought to the attention of the child’s pediatrician.
Concerns about the stigma associated with mental illness, the use of certain medications, and the cost or logistical challenges of treatment might also prevent parents from seeking care for a child who has a suspected mental illness. And children often lack the vocabulary or developmental ability to explain their concerns.
Historically, many professionals have been cautious to have a child “labeled and judged” at an early age because children are in a developmental period. On the other hand, the earlier that parents and professionals can intervene in the life of a young child with delays in emotional and behavioral development, the better it is for both the child and the family. Children can develop all of the same mental health conditions as adults, but sometimes express them differently. For example, depressed children will often show more irritability than depressed adults, who more typically show sadness.
How does it work? What can we do?
A screening questionnaire called the Pediatric Symptom Checklist can help identify children ages 4-16 who are having major problems functioning in their daily life - at home, at school, with friends, in their activities, or with their mood is completed by parents, often while they're in the pediatrician's waiting room. The score helps the doctor decide which children and families may need more attention regarding emotional or behavioral concerns. It's used as a first step to alert the pediatrician that a problem may exist.
Diagnosis usually begins with a medical doctor who takes a lengthy history and examines the child to rule out physical reasons for the difficulties. A psychologist is trained to evaluate and diagnose mental illnesses but usually treats them through counseling or behavioral therapy. A psychiatrist is a medical doctor who can diagnose mental illnesses and write prescriptions for medication.
Modifications in a child’s routine at home or school may help to establish whether some "fine tuning” will improve performance or self-esteem.
A family doctor can rule out physical health issues, perform a basic mental health screening, and refer families to an appropriate child or adolescent psychologist, or psychiatrist. Also, many hospitals and most community mental health centers offer comprehensive diagnostic and evaluation programs for children and adolescents. Their well-being is so connected with that of the family, that services must be developed with and directed to the family as a unit. School districts also do mental health screenings during kindergarten roundup, Early and Periodic Screening, Diagnosis and Treatment (EPSDT).
Children can experience a range of mental health conditions, including:
- Anxiety disorders. Children who have anxiety disorders — such as obsessive compulsive disorder, post-traumatic stress disorder, social phobia and generalized anxiety disorder — experience anxiety as a persistent problem that interferes with their daily activities.
Some worry is a normal part of every child's experience, often changing from one developmental stage to the next. However, when worry or stress make it hard for a child to function normally, an anxiety disorder should be considered.
- Attention-deficit/hyperactivity disorder (ADHD). This condition typically includes symptoms in three categories: difficulty paying attention, hyperactivity and impulsive behavior. Some children with ADHD have symptoms in all of these categories, while others may have symptoms in only one.
- Autism spectrum disorder (ASD). Autism spectrum disorder is a serious developmental disorder that appears in early childhood — usually before age 3. Though symptoms and severity vary, ASD always affects a child's ability to communicate and interact with others.
- Eating disorders. Eating disorders — such as anorexia nervosa, bulimia nervosa and binge-eating disorder — are serious, even life-threatening, conditions. Children can become so preoccupied with food and weight that they focus on little else.
- Mood disorders. Mood disorders — such as depression and bipolar disorder — can cause a child to feel persistent feelings of sadness or extreme mood swings much more severe than the normal mood swings common in many people.
- Schizophrenia. This chronic mental illness causes a child to lose touch with reality (psychosis). Schizophrenia most often appears in the late teens through the 20s.
What are the warning signs of mental illness in children?
Warning signs that your child might have a mental health condition include:
- Mood changes. Look for feelings of sadness or withdrawal that last at least two weeks or severe mood swings that cause problems in relationships at home or school.
- Intense feelings. Be aware of feelings of overwhelming fear for no reason — sometimes with a racing heart or fast breathing — or worries or fears intense enough to interfere with daily activities.
- Behavior changes. These includes drastic changes in behavior or personality, as well as dangerous or out-of-control behavior. Fighting frequently, using weapons and expressing a desire to badly hurt others also are warning signs.
- Difficulty concentrating. Look for signs of trouble focusing or sitting still, both of which might lead to poor performance in school.
- Unexplained weight loss. A sudden loss of appetite, frequent vomiting or use of laxatives might indicate an eating disorder.
- Physical symptoms. Compared with adults, children with a mental health condition may develop headaches and stomachaches rather than sadness or anxiety.
- Physical harm. Sometimes a mental health condition leads to self-injury, also called self-harm. This is the act of deliberately harming your own body, such as cutting or burning yourself. Children with a mental health condition also may develop suicidal thoughts or actually attempt suicide.
- Substance abuse. Some kids use drugs or alcohol to try to cope with their feelings.
Mental health conditions in children are diagnosed and treated based on signs and symptoms and how the condition affects a child's daily life. There are no simple tests to determine if something is wrong. To make a diagnosis, your child's doctor might recommend that your child be evaluated by a specialist, such as a psychiatrist, psychologist, social worker, psychiatric nurse, mental health counselor or behavioral therapist.
Your child's doctor or mental health provider will work with your child to determine if he or she has a mental health condition based on criteria in The Diagnostic and Statistical Manual of Mental Disorders (DSM) — a guide published by the American Psychiatric Association that explains the signs and symptoms that mark mental health conditions.
Your child's doctor or mental health provider will also look for other possible causes for your child's behavior, such as a history of medical conditions or trauma. He or she might ask you questions about your child's development, how long your child has been behaving this way, teachers' or caregivers' perceptions of the problem, and any family history of mental health conditions.
Diagnosing mental illness in children can be difficult because young children often have trouble expressing their feelings, and normal development varies from child to child. Despite these challenges, a proper diagnosis is an essential part of guiding treatment.
Consult your child's doctor or mental health provider to determine what might work best for your child, including the risks or benefits of specific medications.
parents and children commonly experience feelings of helplessness, anger and frustration. Seek ways to relax and have fun with your child. Praise his or her strengths and abilities. Explore new stress management techniques, which might help you understand how to calmly respond to stressful situations.
Consider seeking family counseling or the help of support groups, too. It's important for you and your loved ones to understand your child's illness and his or her feelings, as well as what all of you can do to help your child.
To help your child succeed in school, inform your child's teachers and the school counselor that your child has a mental health condition. If necessary, work with the school staff to develop an academic plan that meets your child's needs.
If you're concerned about your child's mental health, seek advice. Don't avoid getting help for your child out of shame or fear. With appropriate support, you can find out whether your child has a mental health condition and explore treatment options to help him or her thrive.
What are the differences between testing, screening, assessment and evaluation?
Testing is a generic term that can be used in different places and often means that a professional, such as a teacher, pediatrician, counselor or special education consultant wants to learn more about your child. Testing can show a child’s strengths and weaknesses, and it can help diagnose a child, based on their symptoms. It can give us information about their intelligence and academics as well as behaviors that are a problem.
Screening is when several brief tests and/or instruments are used to identify children who may be at risk for certain mental health issues. For example, children in the juvenile justice system in Connecticut are screened for mental health issues to determine the types of services/supports they might need.
Assessment is a more comprehensive process that uses a series of different tests or instruments to help create a picture of your child. Assessment may look at specific areas such as your child’s educational needs, or your child’s psychological functioning. Assessments are often done by child psychologists, either individually or part of a team. Results of assessments can be used to determine the best level of care, the right services and help point to the needs of your child.
Evaluation is the most comprehensive. It may include screening testing and assessment as well as clinical interviews of you, your child, service providers and other adults in your child’s life. Evaluations often include gathering your child’s history and background and to know all the things that contribute to your child’s mental health issues. Often, a team of mental health professionals including psychiatrists, psychologists, social workers and other educational and mental health professionals will conduct evaluations. Results of an evaluation may be used by court systems, schools, state agencies and treatment providers to help find out the best services for your child. Family members should be an active part of an evaluation.