Childhood mental illness

sad child image

By Kelli Miller
WebMD Health News

Childhood mental illness is a public health crisis that needs increased awareness and intervention, according to a report released today by the Child Mind Institute, a nonprofit that focuses on mental health care for children. “The Children’s Mental Health Report” reveals that more kids are living with a psychiatric disease than cancer, diabetes, and AIDS combined. And yet, few are getting the help they need – making them more likely to drop out of school, abuse drugs and alcohol, and get tangled in the juvenile justice system. Harold Koplewicz, MD, the institute’s co-founder and president, talks about the key findings and what parents can do to keep their kids healthy.

Q: What is most significant finding in the Children’s Mental Health Report?

A: It’s the number of children in the United States who are suffering from these disorders. The fact is, 17.1 million young people up to the age of 18 have or have had a diagnosable psychiatric disorder. These are the most common conditions of childhood and adolescence. To give you some reference, there are 7.1 million American kids who have asthma. There are 200,000 American kids under the age of 20 who have diabetes. There are 7 million American kids who have peanut allergies. And yet we have 17.1 million young people with a diagnosable psychiatric disorder. This is a true public health crisis. I think the other important issue is that more than two-thirds of these kids don’t get help.

Q: Are there more kids with these illnesses than in the past?

A: No, I don’t think so. Let’s take obsessive-compulsive disorder, for example. (It) was thought in the 1980s to (affect) 1 percent of the children that came to a psychiatric clinic. So that’s 1 in 100 of psychiatrically ill children. Today, we recognize it’s 3 percent of the general population, or 3 in 100 of children in general. How did that happen? Did it go into the water? Is it something in the electrical wires? How could you have such a massive increase?

What happened were two things. A medication came out called anafranil that turned out to be incredibly effective in treating kids with (mental health) disorders. Then, a group of psychologists developed a treatment program called exposure response prevention, which was incredibly effective in treating OCD (obsessive-compulsive disorder) symptoms. Then people started talking about it. A woman named Judy Rapoport from the National Institute on Mental Health wrote a book called The Boy Who Couldn’t Stop Washing. So, all of a sudden, you have two effective treatments and some public awareness, and people came out of the closet. When they were told they could treat it, they were no longer ashamed of it. With a lot of these diseases, people try to keep to themselves. They are holding back. They don’t want people to know how much they are suffering.

Q: Why do you think stigma remains around mental health?

A: One of the biggest problems we have is that we do not have a blood test or an objective test that finds that someone has the illness. We still make the diagnosis the way we did for years with heart disease. We take a history — we say if your chest hurts and the pain is radiating down your left arm, you might be having a heart attack. Now, we have measurements and tools that can measure (heart problems). In psychiatry, however, we are looking at behavior. We look to see if kids are behaving in a certain way that is different from normal. We ask, ‘How severely different is it than what we consider normal?’ I think also as parents, when we don’t understand something, we are ashamed of it, and we feel guilty about it, and so we deny that fact that our kids have it. We are so willing to say ‘Oh, they are just being a boy,’ or, ‘They are just a moody teenager.’ We are not embracing the fact how real, common, and treatable these conditions are, which is contributing to the public health crisis.

Q: How can parents recognize that their children have a mental health disorder?

A: The most important thing is, the parents have to know their kids. They have to recognize what their appetite, sleep pattern, social activities, and academic performance are like. When there are changes in that behavior, that should be a red flag. It’s important to consider that there is a general discrepancy between a parent’s and child’s report on the degree and nature of the illness. Children report more illness about themselves than their parents report about them, particularly if they are anxious or depressed. Parents don’t see the symptoms as often as the child does. That means if a parent sees a change, they shouldn’t wait. It’s most likely more severe than they suspect. (A child does not naturally talk) about how worried, sad, or irritable they are.

Q: What happens when a child with mental illness is not treated?

A: I think the worst thing that that can happen to a child is they can have damage to their self-esteem. They start feeling ‘less than’ or inadequate. That happens if they are put in situations where they don’t have the skills to succeed or to thrive. If we pretend that a child doesn’t have a problem, and yet they can’t sit still or pay attention as long as other kids, or they can’t pick up the language the way everyone else can, or they’re so anxious that they can’t concentrate, we put children into a real-life situation on a daily basis where they are feeling truly inadequate. They become demoralized. They want to avoid that situation.

That, in my opinion, is what contributes to the high rate of academic failure and school dropouts that occurs with kids who have a psychiatric diagnosis. Seventy percent of the youth in juvenile justice settings have a psychiatric diagnosis. We know that left untreated, kids start feeling bad, and when someone feels bad in a situation they try to avoid it. Once you start avoiding school you are more at risk for bad things happening to you.

Q: Your report recommends using medications in combination with psychotherapy as the most effective way to treat mental illness in kids. What would you say to parents who may be reluctant to put their child on medication?

A: I think if you read the report very carefully, we are talking about medication for very specific disorders. We are talking about medication for ADHD, depression, and anxiety disorders. What’s really interesting is we are using data from national studies that compared medication to other things, whether it’s a placebo or specific talk therapy like cognitive behavioral therapy or a combination of talk therapy with medication. So parents who read this will be better informed about how well this works.

For instance, look at the treatment for anxiety. We show that combination therapy effectiveness after 12 weeks is 81 percent using Zoloft along with cognitive behavioral therapy. Therapy and Zoloft alone are about the same, 60 percent and 55 percent. But at 36 weeks later, each one (is about the same) rate. Combination therapy, behavioral therapy alone, and Zoloft alone come to 83, 80, and 82 percent. So a parent looks at this and says “OK, my kid can get better in 12 weeks if he uses the medication and the behavioral therapy. If we wait long enough, behavioral therapy alone will get us to the same treatment (success) rate.”

But how much longer do you want your kid to suffer? During the first few weeks when the kid isn’t well, he won’t be attending school (and) he might not be able to sleep in his own bed. At least now, parents have the ability to look at this report and understand the effectiveness of … evidence-based treatments. The Child Mind Institute doesn’t accept money from the pharmaceutical industry, which I think puts us in a very unique position. So when we are telling you some of the most effective treatments are medicine, we, as physicians and clinicians are talking about what we know from nationally federally funded studies. Not studies funded by the drug companies.

Q: What else should parents know about mental health treatment?

A: Sometimes, a child will need more than just therapy and one medicine. You might need two medicines. Some of these are hard conditions to treat. I think for parents who are concerned about using medication, they need to have an understanding of medicine works. Medicine seems to give a quicker response, and gets your kid less symptomatic, faster. But by no stretch of the imagination is medicine a magic bullet. Cognitive behavioral therapy can really make a world of difference in the long run for these kids.

Q: Finding help for a child can be difficult, time consuming and expensive, as many providers do not take insurance. What can be done to make this easier for parents?

A: We have produced a guide online called Parents’ Guide to Getting Good Care. I wouldn’t hire an architect, for example, without a guide. And yet parents are so worried and distressed when they finally decide to get mental health care for their kids, they don’t do the due diligence process that we think is necessary. So we’ve created a guide that gives parents the right questions to ask. It describes the difference between the types of mental health professionals. The guide also helps them find the right person to help their child in their neighborhood. There is also a symptom checker on our web site that gives them some idea of what may be troubling their child. This is where parents really need help. They need to understand when their child is in trouble and they have to make sure they are getting their kids truly effective treatment.

Parents have a hard job. Definitely part of the requirement of being a good parent is to not to deny when you see symptoms. In the hopes that you want your kids to be healthy, sometimes we tend to look the other way. But this is really one of those times when looking the other

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