When does a child need help?
If behavior often disrupts regular activities, it's time to consult a professional
Every child has a tantrum now and then. Most children can at one time seem listless, or unhappy, or furious. And some children even resist going to school and act out once they are there. Are these behaviors normal or instead evidence of a simmering mental illness?
Child psychiatrists say most of these actions don't signal trouble. But how can a parent tell when perplexing or volatile behavior is a phase and when it's a sign of a psychiatric disorder? Experts say a key clue of trouble is when normal daily activities are disrupted for a long period. For example, most young children are naturally very social animals who thrive on hugs, attention, and conversation. When they don't, this may indicate a deeper problem.
What about mood swings? Again, examine their severity. "Many children have rituals; many children have tantrums," says Richard Sarles, a professor of child and adolescent psychiatry at the University of Maryland School of Medicine. "And many parents see this as a passing phase. But the basic question is: Is this interfering with the child's life?" It may be cause for concern if the tantrums consistently last over an hour and a half or if the child has not substantially out-grown tantrums by elementary school. Is there a loss of enjoyment of favorite activities, persistent sadness, even talk of death or suicide? Some of this behavior could signal the need for a thorough evaluation by a trained specialist.
Nearly every child gets the blues. But about 5 percent of children and adolescents suffer from clinical depression, especially those who are under stress, have experienced loss, or who have a family history of depression. A child who was once cheerful and involved with friends may become withdrawn and listless. Adolescents who are depressed often self-medicate with drugs or alcohol. Most confusing for parents, a child may be severely depressed but not act "sad," instead causing trouble at school or at home. Other signs that may indicate professional help is necessary:
Anxiety. Being anxious is part of being human and part of being a child. But some anxiety goes beyond normal worry, involving constant fears about safety, worries about things before they happen, panic at separation, and trouble sleeping or nightmares.
Attention deficit hyperactivity disorder. By far the most common disorder among children, ADHD has been diagnosed in about 2 million school-age children. The disorder involves a triad of symptoms: an inability to sustain attention, difficulty in controlling impulsivity, and, sometimes, hyperactivity.
Obsessive-compulsive disorder. Washing hands repeatedly, being unable to shake persistent and disturbing thoughts, and constantly checking something over can be signs of OCD. This disorder is seen in as many as 1 in 200 children and adolescents. Oddly, symptoms can worsen after a strep infection.
Oppositional defiant disorder. "I wanna do it myself" is a phrase that most parents hear with a mixture of pleasure and annoyance. But it can go overboard into chronic refusal to comply with even simple requests. Any authority figure can be the target--parents, teachers, or a baby sitter--and the pattern is one of active defiance and hostility. Five percent to 15 percent of children have ODD. The best treatment tends to be a parenting style that involves working around the conflict.
Observations from parents, teachers, and caregivers are crucial to help psychiatrists understand children who may have mental illnesses. These are clinical diagnoses, which means, as Sarles points out, "There is no good blood test, no EEG or CT scan or MRI of the brain to diagnose these disorders in children."
Where to get information
A number of resources exist online for those concerned about children's mental health. The best is the Web site of the American Academy of Child and Adolescent Psychiatry, which contains plenty of practical information and resources--www.aacap.org.
Other helpful sites include:
A.N.S.W.E.R. Adolescents Never Suicide When Everyone Responds: www.teenanswer.org
American Society for Adolescent Psychiatry: www.adolpsych.org
Autism Society of America: www.autism-society.org
Caring for Every Child's Mental Health Campaign: www.mentalhealth.org/child/
Child & Adolescent Bipolar Foundation www.cabf.org
Federation of Families for Children's Mental Health: www.ffcmh.org
Depression and Bipolar Support Alliance: www.DBSAlliance.org
Depression and Related Affective Disorders Association: www.med.jhu.edu/drada
National Alliance for the Mentally Ill: www.nami.org
This story appears in the November 11, 2002 print edition of U.S. News & World Report.
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