10.12.11

The Kids Mental-Health Crisis

With psychiatric and mood disorders in children a national concern, early detection and treatment can prevent deadly tragedies like the Arizona shooting, but there’s a startling lack of awareness, says Alizah Salario.

When Jared Loughner opened fire at a Tucson supermarket last winter—killing six, harming 14, and bruising the morale of an entire nation still healing from old wounds—the first question that came to mind left many onlookers baffled: Why did he do it?

Soon enough, bits and pieces about Loughner’s bizarre behavior emerged: the strange anti-government gripes, the creepy YouTube videos, and the reports from fellow community-college students who feared the 23-year-old formed a disturbing narrative about a young man who displayed escalating symptoms of mental illness. Loughner’s past raised another troubling question: Why didn’t he receive help?

The Child Mind Institute, a nonprofit devoted to children’s mental-health care, may have some answers. The findings in its 2011 National Children’s Mental Health Report Card confirm what many have long known: that psychiatric and mood disorders in children are extremely common, and the kids and adolescents who suffer from them are nearly twice as likely to abuse drugs and alcohol, struggle academically, and inflict self-injury than the general population. What’s more, there’s a startling lack of mental-health awareness among parents, educators, and pediatricians.

“The big message here is that it's [psychiatric and mood disorders] very common and it’s very real, and it affects the child’s ability to be successful,” said Harold S. Koplewicz, president of the Child Mind Institute and a leading child and adolescent psychiatrist. “This is a national problem, and something that we should monitor on a regular basis. This report card is barely passing.”

The institute surveyed 1,000 parents with children ages 2-24 years. Nearly a quarter of those surveyed (22 percent) said they had a child with a mental-health issue. Most expressed concern about their child’s hyperactivity, impulsive behavior, or moodiness; common diagnoses included depression, ADHD, and autism. Not surprisingly, the vast majority of parents felt that the issue negatively affected their child’s “quality of life.”

Approximately one in five children—more than 15 million in America alone—has a psychiatric disorder, and at least half of them will never receive help, according to the Child Mind Institute. So why aren’t more kids getting the services they need?

“There’s a bit of a societal invisibility,” said Sharon Foster, a clinical psychologist who specializes in the treatment of youth and family problems in San Diego. “Until somebody does something horrific that grabs the headlines, we don’t pay much attention to it.”

Because disorders that affect mood and emotion still carry a stigma, it’s not uncommon for parents to be blindsided, suggests Koplewicz. Most parents aren’t given yardsticks for developmentally appropriate behavior as they are for physical milestones like first steps and potty training.

“Unless we make behavioral development a part of education, a lot of times parents will be in the dark,” he said.

“As a parent, when someone says there’s something wrong with your child, you hear, ‘Oh, let’s just wait. Maybe it’s just a stage.’ Many families are afraid, and there’s this tendency to wait and see,” said Darcy Gruttadaro, director of the Child & Adolescent Action Center at the National Alliance on Mental Illness.

The idea of mental illness in children and young adults still gives many parents pause before they seek help. The report found that about half of parents surveyed waited more than a year after the onset of symptoms to raise their concerns with a professional (usually a pediatrician) and nearly a quarter waited more than two years.

“If you look back 50 years, people whispered cancer,” said Koplewicz. “I do believe that people still feel there’s a certain amount of weakness involved, that kids are relying on pills as a sort of crutch in a way we wouldn’t suggest with cancer, diabetes, epilepsy, or any other disease.”

The report card suggests that pediatricians play a crucial role in early detection. By routinely testing for mental illness just as they schedule immunizations and screen for physical conditions, doctors can detect psychiatric issues early on. Currently, the majority of primary-care physicians don’t ask regularly about a child’s mental health or include screenings as part of a routine checkup.

But pediatricians are only the first line of defense. Ongoing training for all professionals who work with children on a regular basis would also increase early detection. “Teachers need more training in signs and symptoms, and they need to be empowered to tell parents if a child’s behavior seems outside a typical range,” said Koplewicz. And raising awareness shouldn’t stop there.

“We have to think systemically,” said Foster. “We have to think of this as a public-health concern, the same way we would childhood obesity.”

The onset of psychiatric problems in adolescence presents different obstacles. Peers, not pediatricians, often are the first to detect behavior that falls outside the realm of “typical” for teens. “Peers have inclinations before others,” said Foster. “If peers are worried, then I’d be worried.”

That’s why without a peer group to raise the red flag, isolated or socially ostracized teens face a distinct challenge. Those who keep everything bottled up and fly under the radar are less likely to get help, making a support system especially important during adolescence.

More than 15 million children in America have a psychiatric disorder, and at least half of them will never receive help,

“If they can find a social niche where they’re accepted, it can provide them with something important. Because you know, we all need to belong,” said Foster.

Though mood and behavioral disorders are common, most are also very treatable, suggests Koplewicz. Successful treatment usually involves a combination of medication and psychotherapy. But not all therapy is created equal, he notes, and those proven effective tend to incorporate positive reinforcement and clear consequences. Koplewicz emphasizes the importance of therapies that engage the child and help parents move away from paradigms that are punitive or permissive and toward a more comprehensive model.

“It’s not treatment that goes on forever,” said Koplewicz. “It’s treatment that is very symptom-oriented. We’re trying to get the child out of the doctor’s office so they can live their life.”