Mental health diagnoses are common in children. According to the National Institute of Mental Health, symptoms of disorders such as depression, anxiety, social phobia, obsessive-compulsive disorder (OCD), bipolar disorder, and schizophrenia typically get their start in childhood:

Like adults, children and teens can sometimes experience intense emotions as they get older or go through stressful or traumatic events in their lives. For example, it is common for children to feel anxious about school or friendships, or for teens to have short periods of depression after a death in the family.

Mental disorders are different. They can cause ongoing, severe symptoms that affect how a child feels, thinks, acts, and handles daily activities, such as going to school, sleeping, or eating. It is important to know the signs and seek help if needed.

 

In 2013, the Centers for Disease Control and Prevention issued the first-ever report on the prevalence of pediatric mental health disorders. The report highlights the impact of mental health problems on children, families, and communities, making them an important public health issue:

Mental health is important to overall health. Mental disorders are chronic health conditions that can continue through the lifespan. Without early diagnosis and treatment, children with mental disorders can have problems at home, in school, and in forming friendships. This can also interfere with their healthy development, and these problems can continue into adulthood.

 

Key findings from the CDC report among children ages 3-17 include:

  • Millions of American children live with depression, anxiety, ADHD, autism spectrum disorders, Tourette syndrome or a host of other mental health issues.
  • ADHD was the most prevalent current diagnosis among children aged 3–17 years.
  • The number of children with a mental disorder increased with age, with the exception of autism spectrum disorders, which was highest among 6 to 11 year old children.
  • Boys were more likely than girls to have ADHD, behavioral or conduct problems, autism spectrum disorders, anxiety, Tourette syndrome, and cigarette dependence.
  • Adolescent boys aged 12–17 years were more likely than girls to die by suicide.
  • Adolescent girls were more likely than boys to have depression or an alcohol use disorder.

 

Pediatricians are often the first providers to address mental health concerns in their patients. After a thorough gathering of pertinent history and a focused physical examination, we often refer our patients to mental health professionals such as psychologists, therapists, licensed counselors, or social workers. If we feel a child would benefit from medication, or if a child has a complicated history, a referral to a psychiatrist would be indicated. (An exception might be ADHD. Most pediatricians are comfortable assessing, diagnosing, and treating ADHD without psychiatric input.)

Medications, however, are often not the first-line treatments for many mental health disorders. Instead, as Dr. Megan A. Moreno points out in JAMA Pediatrics, therapy is:

Therapy can help children and teenagers develop problem-solving skills and deal with stress. It can be beneficial for children or teenagers who are dealing with personal issues, such as bullying, or family issues such as divorce, as well as for problems at school such as a sudden drop in grades, learning, or attention problems (such as attention-deficit/hyperactivity disorder). Therapy is often an important part of treatment for teenagers with certain medical conditions such as depression, anxiety, and eating disorders and can be a helpful part of a treatment team for children or teenagers dealing with the stress of an ongoing or chronic illness. A mental health therapist can be a valuable partner in your child or adolescent’s health care team. In some cases, your pediatrician may recommend working with a therapist. In other cases, you as a parent may choose to seek a therapist to help your child.

 

Dr. Moreno considers some questions parents might ask to help them find the right therapist for the situation. Once an initial appointment is made, patients and families need to realize that therapy takes time and requires patience:

In the first few visits of therapy, the therapist will spend some time getting to know your child. In many cases, therapists will spend some time with your child or teenager alone at each visit. Most therapists today use cognitive behavioral therapy (also called CBT) to help children and teens build skills and strengths to address the condition they are facing. Because therapy often involves practicing skills, your child or teen may be asked to do “homework” in between sessions. Your role as a parent can be to support your child in going to therapy, offer praise when your child practices skills they are learning, and do check-ins with the therapist on how things are progressing. Most therapists cannot prescribe medicine but may work with your pediatrician if medication is recommended. You can provide permission to the therapist to communicate with your pediatrician so that your health care team is able to provide the best care for your child.

 

The providers at Pediatric Alliance have been strong advocates for improving access to appropriate and effective mental health care for children and families. Some mental health disorders are preventable; practically all are treatable. We all must be up to the challenge to find the resources necessary to help people — children, adults, families, communities — who are suffering.

 

(Google Images)