Childhood mental illness

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Hi everyone! This is Deborah Shelton. Welcome to this live web chat on childhood mental illness, our first chat in March. We will be getting underway in a minute. In the meantime, you can start posting your questions. Special note: Please do not e-mail questions to my personal e-mail as I will not be checking e-mail during this chat. Back in a flash!

Hello again! Thank you for tuning in to this chat on childhood mental illness, a topic of great importance and concern to us all. Childhood mental illness occurs in about 20 percent of U.S. children during any given year, and almost 5 million children have a mental illness serious enough to interfere with daily life, according to the U.S. Surgeon General.

Research shows that while half of all lifetime cases of mental illness begin by age 14, changes in the body leading to mental illness may start much earlier, even before symptoms appear, according to the National Institute of Mental Health.

Joining us today are two experts in their fields. The internationally renowned Dr. Bennett Leventhal is a professor of child and adolescent psychiatry and vice-chair of the department of child and adolescent psychiatry at New York University. He also is deputy director of research at the NYU Child Study Center.

Welcome Dr. Leventhal.

Thanks. It is good to be here. I look forward to chatting with you all

Dr. Lynn Wegner is a professor of pediatrics, and developmental and behavioral pediatrics at the University of North Carolina, Chapel Hill. She also is a consultant to the American Academy of Pediatrics Task Force on Mental Health.

Thank you being here.

I am very pleased to be with you today and I look forward to the questions!

Thank you for the question. Ashley.

This is a terrific question because we know that the best treatment for mental health is generally good health. This means good nutrition, exercise and a broad variety of healthy experiences. Even for children who have psychiatric disorders, these fundamentals of good heath and development are essential in supporting all therapies.

I think the media has an obligation to avoid sensationalism -especially when children and adolescents are alleged perpetrators of incidents. Too often I read off the cuff assessments of their mental status that are not at all substantiated by professional assessment. I also think balanced reporting of perspectives and correct facts is essential!

The problem of heavy metals is very complex but important. Some heavy metals occur in nature and in our bodies. Indeed, some, in small quantities are essential for normal functioning so to remove them can actually adversely affect health. On the other hand, some heavy metals and, especially those that are in excess of safe limits can contribute to a broad spectrum of heath problems. Good doctors carefully examine all patients for all possible causes of symptoms. And, it is important to do a careful history and examination before starting treatment -including looking for all sorts of intoxications and infections.

A question for Dr. Wegner: Where should parents turn if they think their child is showing signs of mental illness?

I think this ties in a little with the previous question. The first step is to take your child to their medical provider. A review of the child’s history, physical exam and-if indicated- specific laboratory tests to confirm or eliminate an organic cause of the child’s emotional/behavioral changes. After this appointment, the medical provider should refer to a professional to answer additional questions: a child psychiatrist, developmental/behavioral pediatrician, neurodevelopmental disabilities pediatrician, child psychologist.

Great question. That’s something a lot of parents want to know.

While we are awaiting an answer, here’s a resource: The American Academy of Pediatrics provides information to parents about raising emotionally healthy children and coping with common behavioral and mental health conditions and stressful life situations at http://www.aap.org/healthtopics/behavior.cfm.

This is a very broad question because there a many psychiatric illnesses that are as diverse in cause and symptoms as are any other medical conditions. However, the starting point for deciding if a disorder is appearing is a parent or teacher concern that a child is not doing as well as he or she might – parents and teachers are often the most sensitive observers of children and detectors of problems. But what are the most common problems we see in young children are fears and excessive worries, behaviors problems and delays in social and emotional development. Each of this may indicate a significant problem that merits careful examination by skilled clinicians. Most importantly, if a parent has concern, he/she should ask a professional to help them understand the meaning of the symptom or behavior.

Welcome Ms. Lemke. Ms. Lemke is president of the Illinois Children’s Health Care Foundation.

Tammy, thanks for the tough question which, as you know, has been a focus of considerable discussion. First of all, mental health is one element of overall health. Secondly, mental health encompasses the full spectrum of emotional, cognitive and behavioral functioning. Therefore, children’s mental health is a healthy child operating in an healthy environment with a healthy brain that supports adaptive cognitive, social and emotional functioning that allows them to adapt successfully to the various experiences that they face in their environment.

We have several excellent questions and comments in line. We will be getting to them shortly. Stand by!

Prevention is always a goal and, while it seems obvious, prevention requires that all concerned about a child and children makes sure the child get has not only good overall health, nutrition and medical care but also a broad spectrum of social and physical experiences that foster healthy development. This means, good parenting, good neighborhoods, good schools, good friends, good food and good healthcare.

Our apologies for a brief technical difficulty. Here is Dr. Wegner’s response:
Risperdal is an atypical antipsychotic medication with very specific indications for children. Children 6 and older with self and other-directed aggression may properly be prescribed this medication for those behaviors. Adolescents 12 and older with properly diagnosed bipolar depression and mania may also properly be prescribed Risperdal for the manic symptoms. If the pediatrician is prescribing for those conditions, and it will usually be in conjunction with care by a mental health physician, then the answer is “Yes”.

There are significant side-effects to these medications and the child should be seen regularly for monitoring of these side-effects. One we are particularly concerned about is premetabolic syndrome -and significant weight gain. The other is the mergence of unusual body movements. Some of these side-effects may go away if the medication is stopped, but not always. Parents should have a clear understanding of potential risks and benefits before they give their child ANY medication!

Paranoid schizophrenia is a very serious complex psychiatric illness. While it is genetic, it is not always inherited by all offspring. Because schizophrenia is a complex disorder, it is best to have this discussion with a genetics counselor who can asses the entirety of your family’s risk for developing schizophrenia and refer you to the correct resources for monitoring and early intervention. A good place to start is with your pediatrician who will send you to a geneticist or genetics counselor.

For more information about children and mental illness, go to the National Institute of Mental Health at http://www.nimh.nih.gov.

A learning disability is not a mental illness -even though it is listed in the DSM-IV-TR. A learning disability is the failure to master an academic skill despite having intelligence in an average range, no problems with vision, hearing, or physical concerns and exposure to appropriate instruction. Having said that, children who have identified learning disabilities may show c0-morbid emotional conditions. These are distinct conditions.

ADHD is a very real medical condition that is characterized by inattention, impulsivity and difficulty organizing one’s behavior and environment. It appears that several areas of the brain are involved in ADHD but especially the pre-frontal cortex of the brain (the part of the brain on top of where our eyes are located.) This part of the brain is responsible for “executive functioning” that is planning and organizing behavior. So, children with ADHD really have a disruption in brain activity. It is not just an energetic or bored child. However, some children are just energetic and bored. So, there must be a careful evaluation to distinguish the two. Proper treatment is necessary for ADHD, and environmental and behavioral interventions will be necessary for both children.

If you have a question for one or both of our experts, we are taking them live online now.

Children from lower socioeconomic circumstances are “At Risk” for all sorts of problems, not just mental disorders. This is because they tend to have less access to general healthcare, less access to good nutrition, less access to good schools, less access to good professionals, like you and are often in environments with greater risk of toxic exposure and trauma/violence. As a result, children in these environments are more likely to have all sorts of illnesses and developmental problems. BUT, risk does not mean certainty. And RISK does not mean that these problems cannot be prevented. These children from disadvantaged communities can be helped when they are provided the necessary resources for health development.

Question from Sandy P: My g-dson has been suffering with behavioral issue/mental illness for almost ten[…] years. He is now 18 and cannot function on his own. He has been dx with bipolar disorder (most recently) which gave me hope of improvement, and has been taking Lithium in addition to anti-depressents and anti-anxiety meds — with no significant signs of improvement yet. I am beginning to lose hope that he will ever function. I know this is an unfair question, but, I am looking for hope. Do you see cases where children make marked improvements as they reach adulthood and/or find the right meds? He cannot function in school and has seen many psychiatrists, therapists, etc. THanks.

I am so glad he has a grandmother who loves him do much and is so concerned! That is a very strong point for him -take a bow.

Having said that, this is more than a medication issue. How are his academic skills, pre-vocational skills, interpersonal skills, self-help skills? Being able to function adaptively for the developmental stage is very important and so making sure all these areas have been assessed and interventions offered, if needed, could also be helpful.

Is he receiving any type of supportive therapy such as cognitive/behavioral therapy? Is the family getting family-focused therapy?

There are medications being developed all the time and so I would not become discouraged. This is a very serious and complex disorder and improvements may be subtle and slow in emerging.

Excellent question. Parents struggle with knowing the difference between typical teenage angst and mental illness.

While many adolescents have periods of frustration and sadness from time-to-time, this is not at all the same as Depression. Major Depression is a very serious but common disorder that can begin in adolescence. It is characterized by serious persistent and profound feelings of sadness, including crying, feelings of hopeless and helplessness and difficulty experience pleasure from the things that previously gave the adolescent pleasure. These intense feelings can include significant suicidal ideations and behaviors. Typically developing adolescents can develop depression but it is an illness, not the periodic frustrations and disappointment associated with growing up.

PTSD in children -especially very young children -can look like hypomania. In the past we were very careful to identify a life-threatening event to the patient, but now we know that observers to a violent event -life-threatening-can also demonstrate behaviors consistent with PTSD. This is something we always keep in mind -especially in children who live in high-crime neighborhoods or who have family members with disregulatd and violent behaviors.

This is an important question. It can be a challenge to distinguish normal behavior from real problems and your question goes right to this point. First of all, you have already indicated that this is a problem for you and your family, so you should seek the advice and guidance of your pediatrician or family doctor. secondly, a child who is angry and irritable more than half the time, is a child who is struggling and unhappy. He is not only not doing well in his family but he is probably struggling elsewhere. He needs some help. But, should you worry? I think you should be concerned for you child and get busy getting him help but this behavior and his problems might be quite amenable to intervention – and, the earlier the intervention, the more likely you are to prevent complications.

For more information: National Federation of Families for Children’s Mental Health has resources at http://www.ffcmh.org/

The family is a very important system for a child and any management of the child should include the family. Some therapists are more skilled in family work -for example , specially trained social workers.

Bipolar disorder is very, very rare in young children. However, there are many reasons why a child has repeated episodes of irritability and mood dysregulation. These children still need treatment by skilled professionals but the usual treatments for bipolar disorder are not likely to beneficial for them. A strong family history of bipolar disorder may be a strong indicator of risk but absent that, it is likely that other conditions may account for symptoms that are often confused with bipolar disorder

This sounds very complicated -but not unexpected -given the increase in co-morbid conditions with ADHD. This child would benefit -if he hasn’t already -by seeing a professional with specific expertise in diagnosing PDD-NOS and who also will take a close look at his developmental skills -specifically language and fine motor skills.

The hour flew by once again. Thanks to our chatters for talking with us. And thanks also to our experts for taking time out of their busy days to answer questions.

Thanks for the excellent questions. It was a privilege to chat with you.

Thanks for including me today. What a stimulating discussion!

Come back next week for a discussion with Chicago Tribune health reporter Judy Graham who will talk to experts about transitioning patients from hospital to home.
Goodbye!