Tags: In This Issue, Pediatric Health
How to Help Your Struggling Child
All kids have good days and bad days, but when negative emotions or behaviors interfere with everyday life, there may be a more serious issue. When parents have concerns about their children, they should not dismiss them.
"If they notice changes they may want to jot down notes for themselves," said Dr. Eric Scott, Professor of Clinical Psychology at Riley Hospital for Children. These notes can be helpful when doctors later ask questions about current and past symptoms.
When parents should be concerned
If a child's symptoms are disrupting normal activities, such as school, relationships with peers, eating, sleeping or the enjoyment of life, it is time to seek help from a professional.
Meeting with the pediatrician is the first step in reaching a diagnosis. The child's doctor can determine when physical complaints, such as headaches or stomachaches, are a medical concern or related to anxiety or depression. Pediatricians may refer the family to a psychiatrist, psychologist or a social worker.
Psychiatrists hold a medical license and have advanced training in formulating a diagnosis, developing a comprehensive treatment plan, prescribing medication and providing psychotherapy. Psychologists hold doctorate level degrees and are trained to provide various forms of individual therapy, such as cognitive behavioral therapy. Social workers may provide individual or family therapy.
Medical insurance usually covers at least part of the cost of mental health treatment. In Indiana, each county also has a community mental health center where services are provided with a sliding scale fee structure. Parents should be aware that because of a national shortage of child and adolescent psychiatrists, the average wait time to see a child psychiatrist is one to three months.
What to expect from therapy
Once help is sought, treatment will depend on the child's diagnosis and the severity of the problem. For instance, a child with obsessive compulsive disorder (OCD) may require two to three months of weekly visits to a psychologist and appointments with a psychiatrist so that cognitive behavioral therapy with exposure and response prevention can be completed and the need for medication can be evaluated. OCD is often associated with repeating certain rituals, such as excessive cleaning, tapping, arranging, checking, praying or concerns about health.
"We try to identify problem areas and children's skills to deal with them," said Scott. "We try to do time limited therapy." When therapy alone is not enough, medications may be needed.
Pros and cons of medication
Prescribing psychiatric medications is complicated since medications that ease some symptoms may come with significant or unknown side effects. The FDA has approved medications after twelve week clinical trials. Short term effects may be known, but long term risks are not. Some medications, like SSRIs have only been around for about 30 years. We don't know what effects they have on brain development or the endocrine system for instance. However, short term, potentially life-saving, benefits may outweigh risks.
"Medications should not be the first option," said Dr. Martin Plawecki, a Child Psychiatrist and Assistant Professor of Psychiatry at Riley Hospital for Children.
Dr. Harris adds, "Every professional has a personal style. I tend to be cautious in prescribing medications, weighing the risks versus the benefits in each case. The treatment decision should be a collaborative effort between psychiatrist, patient and family."
Pediatricians may feel comfortable treating some conditions that necessitate medication, such as ADHD, while collaborating with the school to institute accommodations for the child and monitoring for side effects related to weight, growth, heart rate and blood pressure. Indeed, 40 percent of visits to a pediatrician's office are for behavioral health concerns.
How treatment can help
The intended result of any treatment plan is an improvement in the child's ability to function and enjoy life. It is important to recognize a problem and seek help, so that the condition does not worsen and become a greater burden on the child and family.
When a child has emotional symptoms, mental health professionals assess whether the root of the problem is behavioral, the result of a disease, due to external factors in the child's life (such as divorce or a move to a new school) or related to dimensions of the child's personality.
For behavioral problems, such as lying, stealing or throwing tantrums, parents may learn new skills to manage their child's behavior, whereas other methods are recommended for other conditions. The hope is that patients will learn to manage their conditions so they can recognize symptoms and take appropriate actions should the problem recur.
Just as adults may experience bouts of depression or other mental disorders, children may also have mental health issues for a period of time in which treatment is needed, followed by long periods in which no treatment is needed.
"The goal is to become stable," said Plawecki, but he notes "a mental health provider may be part of their care indefinitely."
While some conditions require long-term treatment, therapy and/or medication are often quite effective in helping children to manage their disorders and to gradually resume normal activities. Some conditions improve as children mature, and the frequency of therapy may change as children learn skills to cope. Untreated mental health issues can be very distressing to children and families, but help is available to treat children's conditions and support their families.
Dr. Elana Harris is a Child Psychiatrist specializing in anxiety disorders, OCD and Tourette Syndrome. She also has a PhD in neuroscience. Susan Jacobs Jablow is a free-lance writer whose articles have appeared in more than a dozen publications.