When it comes to pediatric mental health, one of the most important aspects to treating people is the beginning.
From screenings and diagnoses, to medication and therapy, it can be overwhelming and scary.
One in 10 children under the age of 18 is experiencing some impairment because of their behavioral health.
That could include a wide range of problems, from depression and anxiety, even just sleeping disorders or hearing loss; all issues that, if not diagnosed, can end up not just changing the child’s life, but actually changing their brain.
“As they get older, those changes become less plastic and more solid, and that’s when we start to see kids that grow up to act on some of those impulses,” explained pediatrician Michelle Fiscus, and past president of the Tennessee Chapter of the American Academy of Pediatrics.
“Everything we see with chronic disease, addiction, is related to mental health in one way or another,” she said.
“Whenever we hear about young people doing mass shootings or who commit suicide or who commit some sort of heinous crime, my first thought is, ‘What happened to that child? What kind of adverse childhood experience did they encounter?'” Dr. Fiscus said. “In order for us to get ahead of those chronic disease conditions we see in adults, we have got to think of mental health or brain health.”
That’s why she said early diagnosis is so important, but still, there are no quick fixes.
“Sometimes we have parents who will come into our offices and say, ‘My son Johnny is in real trouble at school, the school is talking about expelling him, or he’s going to fail this year.’ In trying to help, sometimes a physician will prescribe a medication for that child when really that may not be the thing that’s in their best interest,” Dr. Fiscus said.
She said throwing medication at the problem can sometimes have the opposite intended effect on the child.
“If you take a child like that who is anxious and put them on one of the routine medications that we use on something like ADHD, you make matters worse,” she said.
Instead, doctors should focus on getting to the cause of the problem.
“What has Johnny’s experience been in his life? Did he have trauma? Did he lose a parent? Is there substance abuse in the home, or domestic violence, or has he been bullied or is there a family history of mental health issues?”
She continued, “Many times that’s just a child that needs structure or more parent-child interaction or a different school situation, not a child that needs to be medicated. If you have a child under the age of five and under that needs to be the last thing you are thinking about is putting the child on medication.”
Here are some signs parents should be looking for at home, that are age-specific.
For example, if a teenager is extremely irritable, and not just your average irritable teenage behavior.
“They’ve lost contact with friends, they’re giving away possessions that are important to them or they don’t want to go to school and their grades are dropping,” said Dr. Fiscus.
Sometimes, substance abuse, depression or anxiety can be the reason for those behaviors.
In younger children, acting out can be a warning sign.
“If Suzy hit someone or is crying a lot in school, can’t stay in their seat or can’t concentrate, you want to think about anxiety disorders in children that manifest in learning disabilities,” Dr. Fiscus explained.
Problems sleeping can also be a red flag.
“We see a lot of children who come in with ADHD who are actually horrible snorers and have sleep apnea, and when you treat sleep apnea they get a good night sleep and their inattention symptoms go away,” said Dr. Fiscus.
Dr. Fiscus said parents shouldn’t hesitate to ask for help, but unfortunately many do because there is still such a stigma surrounding mental health in children.
“Getting kids into early intervention, screening early, having parents not have fear about going to their child’s physician, about addressing their child’s mental health concerns. If a parent goes to their pediatrician and says, ‘I’m concerned about my child’s behavior,’ our impulse is not going to be to shame the parent or to call DCS or to try to get the child into the correction system, our path is to help that child.”
Dr. Fiscus said the bottom line is this, “If you suspect something just isn’t right with your child, you are probably correct, and you should take your child to the pediatrician as soon as possible. If a specialist or psychiatrist is needed, the pediatrician can help make that referral.”
Pediatricians start screening for substance abuse issues and depression at age 12. Before that, doctors focus on developmental milestones and behavioral health.