By Sophia F. Dziegielewski, Ph.D., LCSW
It surprised many when Paula Caplan, a clinical and research psychologist wrote in The Washington Post that about half of all Americans can expect to get a psychiatric diagnosis in their lifetime (Caplan, 2012). Almost 44 million Americans being documented as having experienced some form of mental illness, last year alone (Rushlow, 2014). These numbers sound alarming and if we accept this as a statistic relative to adults, could this possibly include children and adolescents? Historically, it was believed by some experts that the possible immaturity of a developing brain could actually serve as a protective factor from the development of mental illness (Hayden & Mash, 2014). However, it appears that more recent studies and statistics have proved otherwise. When mental studies related to mental illness are applied to children it is estimated that 20-40% of children worldwide are affected by a mental disorder, and many more experience symptoms (Kessler, Avenevoli, Costello, et al., 2012).
With such a high prevalence and increasing numbers, it should come as no surprise that some researchers question whether these incidences of mental disorders are simply a product of our times (Ahn & Kim, 2008); or whether when applied to children and adolescents this can be viewed as a convenient way to account for personal behaviors or system factors such as “poor” parenting skills. For parents, trying to figure out what is a normal developmental response from your child or adolescent and what is indicative of something more makes you question this as well. It is normal to blame yourself and to question whether your parenting skills are at fault. This type of questioning of your own behaviors as a parent is healthy and shows that you want what is best for your child. This type of questioning will also help by providing incentive to learn more and explore ways of addressing problematic behaviors.
Furthermore, when it comes to a mental disorder and children, could this practice trend be related to insurance coverage and the need for practice reimbursement (Braun & Cox, 2005; Davis & Meier, 2001; Sadler, 2002)? Pomerantz and Segrist (2006) seemed to support this assumption as they found that the parent’s health insurance (or lack thereof) could be a factor as to whether the adult or child gets a mental health diagnosis and the supporting treatment is received. The dreaded question that many are afraid to ask is with further accessibility of insurance coverage for young adults, with the advent of the Affordable Health Care Act (ACA) (U.S. Department of Health and Human Services, Fact Sheet, 2012), could the actual numbers increase due to extended coverage on a parent’s insurance plan?
When considering your child, what is clear is that the controversy among professionals related to whether a child or adolescent actually has a mental disorder varies; how to best treat mental disorders among professionals can also vary; and, whether one has good health coverage could be a factor in securing adequate treatment. With all this said, not recognizing the problematic behaviors being exhibited along with the influences and resistances to avoid such a diagnosis –could clearly affect the individualized assessment and treatment to follow.
If your child or adolescent has been diagnosed with a mental illness, you may feel lost and confused. This is normal, as it is difficult to figure out the next steps. Although no one has all the answers, here are some suggestions for you to consider:
- Who has told you your child has a mental disorder? Is it a teacher? Ask the individual for specific behaviors that your child is experiencing to substantiate what they are saying?
- Is this individual qualified to make such a determination? For example, a teacher can document concrete behaviors but he/she is not trained to actually place a label on the child.
- Where are the behaviors occurring? Is it at home only, or at school only? With mental health conditions, it will always need to be clearly documented when the behaviors are occurring and how the child is responding. Pay careful attention to how these behaviors interfere with the completion of your child’s or adolescent’s routines or activities required for daily living. As a parent, you should also document the concerning behaviors that you see your child exhibiting. If you can keep a diary and simply write down the date, the time, the behavior, and, if you can remember, what happened right before the behavior and after the incident.
- Most importantly, don’t panic if you suspect your child has a mental illness and remember—you are not alone. Always seek a professional and get a complete, comprehensive assessment, which is the foundation for all helping activity designed to assist your child or adolescent. Mental health practitioners (also referred to as clinicians), such as psychiatrists, psychologists, psychiatric nurses, and social workers, remain the largest group of mental health providers and can help you interpret this information and determine how to address it. It is always a good idea to ask these professionals what experience they have with assessing and treating children and/or adolescents that suffer from similar concerns.
- Select a clinician who will be able to take the information gained in the mental health assessment and apply it to the resultant treatment planning and practice strategy that you will follow. Choose someone who you feel comfortable with and be sure to write down your questions in advance in case you get nervous and forget what to ask. When working specifically with children and adolescents, social workers and other mental health therapists clearly play a critical role in completing a comprehensive assessment and can offer suggestions on how to handle problematic behaviors that goes beyond what appears in the office.
The author, Sophia F. Dziegielewski, is a licensed clinical social worker and she hopes you find the suggestions outlined in this article helpful. They are not meant to preclude your seeking professional assistance and/or medical advice from a trained professional related specifically to your child or adolescent. For resources and referrals see website listing for local agencies and services.
Ahn, W., & Kim, N. S. (2008). Causal theories of mental disorder concepts. Psychological Science Agenda, 22(6), 3–8.
Braun, S. A., & Cox, J. A. (2005). Managed mental health care: Intentional misdiagnosis of mental disorders. Journal of Counseling and Development, 83, 425–433.
Caplan, P.J. (April 27, 2012). “Psychiatry’s bible, the DSM, is doing more harm than good.” The Washington Post, WP Opinions. Retrieved November 20, 2013 from: http://www.washingtonpost.com/opinions/psychiatrys-bible-the-dsm-is-doing-more-harm-than-good/2012/04/27/gIQAqy0WlT_story.html.
Davis, S. R., & Meier, S. T. (2001). The elements of managed care: A guide for helping professionals. Belmont, CA: Brooks/Cole.
Pomerantz, A. D., & Segrist, D. J. (2006). The influence of payment method on psychologists’ diagnostic decisions regarding minimally impaired clients. Ethics and Behavior, 16(3), 253–263.
U.S. Department of Health and Human Services. (2012). Fact sheet: The Affordable Care Act’s new patient’s bill of tights. Retrieved from http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs8.html.