As a parent, you know instinctively what is important to meet your children’s physical needs, such as nutritious food and clean water, appropriate clothing for the season, adequate shelter, enough sleep and regular medical and dental care. However, identifying a child’s mental and emotional needs is not always as easy. Even if you know the red flags, it can be difficult to distinguish signs of a problem from normal childhood behavior (or misbehavior). Every child may display some “questionable” behavior at some point, so how do you know when a child’s actions have crossed the line as normal and become something more serious? Concerns about the stigma associated with mental illness, the use of certain medications and the cost of treatment also can be stumbling blocks that can prevent parents from seeking the help children may need to address mental or emotional problems. As a result, many children who could benefit from treatment don’t get the help they need.
John Damon, Chief Executive Officer of Mississippi Children’s Home Services and President of the National Association for Children’s Behavioral Health in Washington, D.C., spoke to Well-Being about the serious gap between children who need treatment for mental health issues and those who actually receive them.
“In this country, one in five kids has a significant mental health problem, explains Dr. Damon. “Unfortunately less than 20% of these young people get treatment. It’s important for parents to know warning signs to watch for in their children, but even then symptoms of mental illness can be difficult to identify.”
Warning signs to watch for
Mood changes. Look for feelings of sadness or withdrawal that last at least two weeks or severe mood swings that cause problems in relationships at home or school.
Intense feelings. Be aware of feelings of overwhelming fear for no reason – sometimes with a racing heart or fast breathing – or worries or fears intense enough to interfere with daily activities.
Behavior changes. This includes drastic changes in behavior or personality, as well as dangerous or out-of-control behavior. Fighting frequently, using weapons or expressing a desire to badly hurt others also are warning signs.
Difficulty concentrating. Look for signs of trouble focusing or sitting still, both of which might lead to poor performance in school.
Unexplained weight loss. A sudden loss of appetite, frequent vomiting or use of laxatives might indicate an eating disorder.
Physical harm. Sometimes a mental health condition leads to suicidal thoughts or actual attempts at self-harm or suicide.
Substance abuse. Some kids use drugs or alcohol to try to cope with their feelings. Look for signs of rapid change in behavior, change in peer group, or a sudden drop in grades.
By knowing the warning signs of mental illness in children, as a parent you are better prepared to recognize concerning behaviors and take action to help your child cope.
“It is important to recognize that children are not small adults,” Dr. Damon continues. “It may be difficult for them to verbalize how they feel, so paying attention to their behavior is critical. In other words, kids often express how they feel by how they act. They may just seem irritable or in a bad mood. However, irritability may be a sign of something more significant. Watch for changes in school performance. Do they seem to be worried or anxious? Are they having trouble sleeping, sleep more than usual or have bad dreams? Do they frequently complain of stomach aches or other physical symptoms? Younger children may express their strong emotions through temper tantrums. Older kids and teens may stop wanting to do things they once enjoyed and express feelings of hopelessness.”
“It’s important to remember that everybody has times of feeling up or down, but when the behavior is interfering with the functioning of daily life, it is more than the normal ebb and flow of emotions,” Dr. Damon adds. “We have to find a way to integrate primary care and mental health, so that a child’s emotional wellbeing is given equal parody with their physical wellbeing, instead of a last resort add on. We talk about anxiety, depression, suicide, dropout rates, and teen substance abuse as though they are separate issues from healthcare, but in reality they are a big contributor to the cost of healthcare, to say nothing of the impact they have on the lives of our young people.”
What should you do if you suspect your child is experiencing mental or emotional problems?
If you’re concerned about your child’s mental health, talk to your child’s primary care provider. Describe the behavior that concerns you. You might also talk to your child’s teachers, close friends or loved ones, or other caregivers to see if they’ve noticed any changes in your child’s behavior. It will be helpful to your child’s physician to have input from other adults who spend time with your child.
A child’s mental health condition is diagnosed and treated based on signs and symptoms and how the condition affects the child’s daily life. There are no simple tests to determine if something is wrong. To make a diagnosis, your child’s doctor might recommend that your child be evaluated by a specialist, such as a psychiatrist, psychologist, social worker, psychiatric nurse, mental health counselor or behavioral therapist.
Your child’s doctor or mental health provider will also look for other possible causes for your child’s behavior, such as a history of medical conditions or trauma. He or she might ask you questions about your child’s development, how long your child has been behaving this way, teachers’ or caregivers’ perceptions of the problem, and any family history of mental health conditions.
Diagnosing mental illness in children can be difficult because young children often have trouble expressing their feelings and normal development varies from child to child. Despite these challenges, a proper diagnosis is an essential part of guiding treatment.
As President of the National Association for Children’s Mental Health Dr. Damon is working with other mental health professionals to change the national dialogue and to stop the lack of parody between mental and physical health. One shining example of the work Dr. Damon and others are involved in is the effort being taken at Children’s of Mississippi at University Mississippi Medical Center in Jackson to integrate mental and physical health. It is one of the first sites in the nation to do so.
“We need to learn to give the same care and concern to our children’s emotional wellbeing that we do to their physical health,” Dr. Damon concludes. “We wouldn’t overlook a broken bone or, heaven forbid a diagnosis of cancer. If 1 in 5 children had cancer and yet less than 20% received treatment, we would be outraged. By the same token, we have to change the way we think about getting the care and treatment our children need for their mental health issues. Proactively addressing mental health needs results in happier, healthier, and more productive children.”
Foster good mental health in your kids.
Give children unconditional love.
• Love, security and acceptance should be at the heart of family life – Children need to know that your love does not depend on their accomplishments. Mistakes and/or defeats should be expected and accepted. Confidence grows in a home that is full of unconditional love and affection.
Nurture children’s confidence and self-esteem.
• Praise them – Encouraging children’s first steps or their ability to learn a new game helps them develop a desire to explore and learn about their surroundings. Allow children to explore and play in a safe area where they cannot get hurt. Assure them by smiling and talking to them often. Be an active participant in their activities. Your attention helps build their self-confidence and self-esteem.
• Set Realistic Goals – Young children need realistic goals that match their ambitions with their abilities. With your help, older children can choose activities that test their abilities and increase their self-confidence.
• Be Honest – Do not hide your failures from your children. It is important for them to know that we all make mistakes. It can be very re-assuring to know that adults are not perfect.
• Avoid Sarcastic Remarks – If a child loses a game or fails a test, find out how he or she feels about the situation. Children may get discouraged and need a pep talk. Later, when they are ready, talk and offer assurance.
• Encourage children – To not only strive to do their best, but also to enjoy the process. Trying new activities teaches children about teamwork, self-esteem and new skills.
Sources: Mental Health America; MayoClinic.org; American Psychological Association
Dr. John Damon is the Chief Executive Officer for Mississippi Children’s Home Services. Dr. Damon’s undergraduate degree is in psychology. He earned a Master of Arts in Marriage and Family Therapy and his Ph.D. is in Clinical psychology and completed his residency in Child Psychology at University of MS Medical Center. Damon is President of the National Association for Children’s Behavioral Health in Washington, D.C., and is past President of the Board of Directors for the Behavioral Health Society of the MS Hospital Association. He is currently serving on the MS Autism Advisory Committee and is Vice President of the MS Association for Child Caring Agencies.