CHILDREN’S MENTAL HEALTH

Most are well aware of the moody, angst-ridden teenager, and it is this image that has been branded as the poster child for mental health awareness. But what precedes this adolescent stage? In early childhood development, the spotlight is often on the physical advancements and not the mental health development. The National Institute of Mental Health reports that at any one time, one in five children suffer from a mental disorder severe enough to cause impairment, citing affective disorders like Attention Deficit Hyperactivity Disorder, also known as ADHD or ADD, autism, bipolar disorder, borderline personality disorder, depressive and anxiety disorders, eating disorders, obsessive compulsive disorder and schizophrenia.

The causes of childhood mental health disorders result largely from biological as well as environmental factors including the death of loved ones, divorce or broken relationships, poverty-related stress, discrimination, sexual abuse, exposure to violence and other disasters. When left untreated, youth mental health disorders can lead to declining performance in school, substance abuse, violence and even suicide. David Fassler, M.D., chairman of the American Psychiatric Association’s Council on Children, Adolescents and their Families says, "The real tragedy is that most children and adolescents with psychiatric disorders still do not get the help they need. If left untreated, the physical, emotional, social and intellectual development of children with mental disorders will be severely stunted, if not crippled."

The cost of these untreated conditions weighs heavily on the child, parents and the health care system. They may also increase a child’s risk of coming into contact with the juvenile justice system.

For Rae Stevenson, being diagnosed with depression and schizophrenia at an early age was overwhelming. "My father didn’t know how to handle my symptoms; he thought it was because I was prepubescent."

But as Rae’s symptoms worsened, she started hearing unexplained voices, had visual hallucinations and had a propensity to defy authority.

"It is easy to overlook the seriousness of childhood mental disorders," states Dr. Fassler. It was only when Rae got in trouble with the law years later that she was taken in for an evaluation. As many as two-thirds of all young people with mental health problems are not getting the help they need.

Signs that a child is struggling vary in nature, but pay particular attention to children who are experiencing any of these warning signs: poor concentration and the inability to make decisions, racing thoughts, persistent nightmares, losing interest in things once enjoyed, feelings of worthlessness or excess anxiety, and hearing voices that cannot be explained. Older children may exhibit destructive behaviors such as abusing alcohol or other drugs, abusing or even killing animals, violating the rights of others or chronic law-breaking, participating in life-threatening activities, purging food, abusing laxatives or exercising obsessively, and fire-setting. It is important to pay attention to your child’s behavior at home even if he or she has no problems at school. Troubling behavior most always shows up at home first. According to the U.S. Department of Health and Human Services, children often have more than one disorder, ranging from mild to severe. These disorders vary in frequency as well as the age at which they appear.

"If a child is sad, restless, spending a lot of time alone, seems to have low self-esteem or is not as assertive in a group as you’d like them to be, it’s important to start a dialogue with that child," said Dr. Mark Collins, a child psychologist. "Ask them what’s going on."

Collins added that poor or deteriorating interpersonal relationships can be a sign of trouble.

"Is the child complaining a lot?" Collins said. "Angry outbursts? Unreasonably demanding? It’s important to confront this behavior head-on. I’m a big believer in modifying bad trajectories."

Autism, a brain development disorder, characterized by impaired communication and social interaction starts presenting before age 3. Children affected by attention deficit/hyperactivity disorder and childhood onset bipolar start presenting symptoms between the ages of 4 to 8. Eating disorders like anorexia nervosa and bulimia, anxiety and depressive disorders along with schizophrenia target the 9to 12 + year olds.

If it becomes evident that outside help is necessary, the next question is: How do you help your child? Family friends or religious advisers, pediatricians, mental health professionals, community or state agencies and police can all be of valuable assistance. It is imperative as parents to lend your child the utmost support in every aspect of treatment. By becoming an active participant in the treatment plan of your child, your input will be invaluable. When speaking to your child’s pediatrician or any other medical professional, be sure that you don’t minimize your concerns and/or downplay your child’s symptoms. Pediatricians have access to mental health experts who can help address your child’s symptoms.

When seeking help, it is important to assess your child’s situation, and to be aware of when and where to get help. Mild to moderate change in behavior and/or if you’re worried, but not alarmed, get a routine assessment done soon with either a pediatrician, mental health professional, school, family friend or community agent. Major changes in behavior, the inability of your child to cope without help or if you feel unable to cope, are considered urgent. Seek assistance with a pediatrician, mental health professional or the school within 48-72 hours. Severe, out-of-control or threatening behavior is an emergency. Get help with the hospital emergency department or police immediately.

"Parents should be active participants," Collins said. "It’s important to work with teachers and ask them ‘What’s my child like in school?’"

Dr. Karl Williams, chief executive officer of Harmony Healthcare, a primarily outpatient mental health facility, says there is a scarcity of providers and therapists in Las Vegas.

"We have a physician and therapist available for emergent situations," Williams said. "We also have a 24-hour hotline. We have a 24-hour team ready to go to an ER and help get a patient to the next level of care."

Some disorders like bipolar and schizophrenia are lifelong conditions that cannot be cured. They can, however, be managed through medication therapy in conjunction with routine visitations to psychiatrists and/or psychotherapy. Other disorders like autism, ADD/ADHD, anxiety, depression and obsessive-cumpulsive disorder may be treated with medication. Medications should be used as part of a comprehensive treatment plan, and only when their benefits outweigh the risks.

Psychiatrists recommend that for parents who have recognized symptoms of childhood mental disorders, have sought medical help and have consigned to a treatment plan including medication, to closely monitor medication for efficacy, adverse effects and ongoing needs. Talk regularly with your child’s teacher, physicians and caregivers about how your child is doing, especially when medication is first introduced, restarted or when the dose has changed. Find a school or classroom setting that the organization and structure are beneficial to your child. Help your child feel comfortable with his or hertreatment plan; he or she need to be aware of the value of it, and to know that it does not make them different from their peers. Lastly, applaud your child for improvements in behavior (developing social skills, better grades, etc.). Appreciate that these changes are the result of your child, and that therapy and medication only act as a conduit.

Rae, now a healthy 22 year old says, "Every child’s mental health is important. These problems are real, painful, and can be severe, but they are treatable with the cooperation of families and communities."

The Nevada Department of Child and Family Services operates nine locations, statewide that cater to the mental health services of children. Services include community-based outpatient services, residential and day treatment services and contracted services (NNCAS, SNCAS and Rural DCFS), and are individualized for each child and family.