Children and mental illness
With patience and treatment, kids can lead the happy lives you envision for them
Friday, December 21, 2007
During the summer of 2003, my then 7-year-old son Daniel developed unusual behaviors that made me vaguely uneasy.
He became a picky eater, so obsessed with money he stole our spare change and his incessant rocking cracked several kitchen chairs.
Then one morning, I discovered that during the night, he had wrapped a blanket ribbon tightly around his neck. After my panic woke him, Daniel replied, "I don’t want to live anymore."
His pediatrician immediately sent us to Children’s Memorial Hospital, the beginning of an emotional roller coaster ride that included several hospitalizations and misdiagnoses.
When a pediatric neurologist diagnosed a seizure disorder, which can cause psychiatric symptoms, treatment for it was the dawn of Daniel’s healing.
Our experiences are not unique.
Kids’ mental illness on the rise
Mental illness in children younger than age 14 is on the rise for two reasons, says Dr. Joyce Anderson, a psychiatrist with the mental health division of the Illinois Department of Human Resources. One, health professionals are better at finding it. And two, children today are more stressed than those of previous generations, causing or unmasking the mental illness.
Unfortunately, Anderson says skilled pediatric mental health professionals are few, especially in non-urban areas. And most psychiatric medications are designed for adults, not children.
Even actually assessing young children’s mental health is tricky since they are still developing their ability to distinguish fantasy from fact. That is partly why certain disorders, such as bipolar or schizophrenia, are not accurately diagnosed until adolescence, unlike the more common oppositional or defiant behavior and attention deficit disorder.
"In normal childhood development, a child’s ability to move precedes his ability to talk," Anderson says. "That is why behavior, the child’s primary mode of communication, is what he will use first to express distress. Even at age 10 or 12, when emotionally challenged, children may regress to earlier, disruptive behavior patterns."
When behavior is extreme
Raise a red flag when a child’s emotional behavior really stands out from other children. Extremes of behavior—very agitated and aggressive to very quiet and withdrawn—should be checked out with the child’s pediatrician, the health professional most familiar with your child’s development.
Lemont pediatrician Dr. Ken Porter advises parents to seek emergency help whenever there is a potential for harm to their child. "I think most general pediatricians would do the same if a child is experiencing extremely psychotic behavior, hallucinations or bizarre self-injurious behaviors, such as cutting and head banging," Porter says.
Otherwise, Porter first tries to determine if there is a physical cause for a child’s odd behavior, particularly a new behavior. If the physical exam is normal, Porter may refer the child to a child psychiatrist.
"Parents know their children better than anyone ever will and I have learned that when a parent is telling me something is just not right, it usually is not right," Porter says.
"But parents are not always good at determining what that something is and the child may not be able to communicate it very well, either."
Depending upon the diagnosis, Porter himself may monitor any prescribed medication, something more pediatricians today are doing simply because there is no one else to do it.
Porter has seen clinical depression in children as young as 3, especially when there is a strong family history, although the symptoms for it may be different. Adults may appear sad and withdrawn. Children may exhibit signs of attention deficit disorder or other behavior disorders.
Treatment can help most kids
The good news is that children, overall, respond very well to treatment.
"Children are very plastic, very moldable," Porter says. "They do grow out of many disorders, everything from allergies to seizures. I never tell parents that this is forever because we know well that children are wonderful at proving us wrong."
Libertyville pediatric neurologist Dr. Abrar Arshad says he sees children when pediatricians suspect some form of abnormal functioning within the child’s brain or when there are significant delays in a child’s development, especially in speech.
After neurological examination and laboratory tests to rule out metabolic disorders, Arshad may order other tests, such an MRI or CT scan to view the brain or an EEG to measure the brain’s electrical activity to diagnose or rule out a seizure disorder.
"There is good evidence that some of these kids who have attention problems have some type of chemical imbalance or abnormal brain activity that contribute to their developmental problems and that should definitely be ruled out," Arshad says.
"But in the majority of kids, we don’t find that. We are diagnosing more pervasive development disorders and autism, but we don’t find any significant abnormalities that cause them."
Even when a physical cause is present, treating the problem may still require a team effort by a pediatrician, pediatric neurologist, child psychiatrist and child psychologist.
Yet, psychotherapy may be more challenging with children than it is with adults simply because they are less able to communicate their needs and feelings and to make connections between their behavior and issues occurring in their lives, says Hinsdale child psychologist Dr. William Melon.
"Young children don’t really have the ability to think back and reflect," Melon says.
Other challenges occur when the child has multiple problems. For instance, a child may need speech therapy in addition to psychotherapy.
"It’s like trying to teach a child who needs glasses to read," Melon says. "No matter how hard you try to teach him, he still needs the glasses."
Parents can help figure things out
When assessing a child, Melon may talk at length with the parent to gather information about the child’s medical history and environment. They may also complete a number of forms about the child’s behavior. Perhaps there is unusual stress occurring in the child’s environment or parents are unintentionally reinforcing the child’s negative behavior.
Melon may also talk with the child, but the less verbal the child is, the more Melon may use other strategies to help the child communicate what is going on inside as well as to replicate as much as possible situations at home, school or play.
For instance, Melon may play a game with a child and observe the child’s reaction when he wins or loses. Or opportunities for therapy with the child may occur as they play together with puppets and farm animals, Melon says.
One child may have farm animals behave roughly. Another child may choose the larger animals as helpers to the smaller ones.
"What works for one child will not necessarily work for another one," Melon says. "Sometimes a child gets better no matter what therapy is used. But if anything I am doing is not helpful, then I talk with the parents about why I think they should pursue other avenues and refer them to someone else."
When it’s your own child
Finding the right help for your child isn’t any easier for those who have some basic insight into the problem. Early childhood educator Evelyn Polk of Chicago found that out the hard way when she learned her then 7-year-old son had ADHD.
"By about the age of 2, he was not on the same development continuum as the other kids I worked with," Polk says. "One of the biggest differences was hypolexia—he was literally reading before he was walking. He didn’t play with other kids his age, he had a hard time concentrating and he got very frustrated with things. What would be a five-minute tantrum for other kids could last all day for him."
With her background, she felt she should have known what was wrong. "I felt like such a failure as a parent. It was a big ‘Aha!’ moment in my life when we had a name for it, that we had something we could fight, that I could do research and find out what that meant."
But even once a child receives proper treatment, you may need to address the very real stigma that accompanies mental illness, Polk says.
"Although people can accept a physical illness in a child, like diabetes, it can be very hard for them to accept that a child can have a mental illness. It’s easier to blame parents for not being good parents," Polk says.
"People should know that these are real and treatable disorders in both children and adults. Having one is not a death sentence or a sentence to a horrible life. People can live successful lives once they are diagnosed and treated."
Denise M. Baran-Unland is a mom and freelance writer living in Channahon.