Sunday, September 14, 2003
By Claudia Kalb
Sept. 22 issue — Tyler Whitley, 7, is 4 feet 4 inches and weighs 75 pounds. He has blond hair, blue eyes, a generous spirit—and bipolar disorder, a serious mental illness. Highly irritable and angry one minute, he’ll be laughing hysterically the next. Grand illusions kick in: he can leap to the ground from the top of a tall tree or jump from a grocery cart and fly. And then there are the heart-wrenching bouts of depression, when Tyler tells his parents, “I should never have been born. I need to go to heaven so people can be happy.”
IF ONLY TYLER could be happy every day of his life. The sobering reality is that mental illnesses, from depression to autism, do strike children. And they strike hard. In the United States, one in five children and adolescents has a mental disorder that causes at least some impairment. Many have more than one. The good news: kids’ mental health is finally getting some attention. The Office of the Surgeon General has called for increased awareness and improved services for kids. Advocacy groups are battling stigma and demanding better detection. Scientists are learning more about genetic and environmental triggers—and about what the disorders look like in children, and how to treat them. “We’ve made major progress in the last 30 years,” says Dr. Daniel Pine of the National Institute of Mental Health, but “we cannot ignore the fact that we have serious work to do.”
The challenges are staggering. While pediatricians and school officials are at the front lines of children’s health, not all are trained to see the warning signs. In kids, symptoms of mental disorders can be nonspecific—stomachaches and irritability—and can blur from one disorder to the next. Parents and teachers often can’t tell the difference between a normally rambunctious child and one who may be seriously ill. As a result, less than 20 percent of children with mental illnesses get the care they need. “The myth is it’s a phase, they’ll grow out of it,” says Anne Marie Albano of the NYU Child Study Center. “A lot of them don’t.”
Mental-health professionals worry over how to treat their smallest patients: How young is too young to make a diagnosis? Are children being labeled and medicated too quickly? Are psychotropic drugs, most of which have not been specifically tested in kids, safe and effective? Researchers are working on the answers. The disorders, in the meantime, are very real. Left untreated, they can lead to academic failure, substance abuse and even suicide, the third leading cause of death in kids 10 to 19. Says Darcy Gruttadaro of the National Alliance for the Mentally Ill: “We’re talking about very serious consequences.”
Anxiety disorders affect 13 percent of kids between 9 and 17. The category includes an array of conditions, from obsessive compulsive disorder (OCD) to social anxiety. OCD is among the easiest to spot. A child with the disorder might wash his hands repeatedly or perform a ritual—counting to 25 every time he gets on the bus. In very rare cases, children contract sudden and intense bouts of OCD from strep infections, but in general the condition appears to be triggered by a mix of genes and environment. One of the unique and challenging characteristics: “Kids know what they’re doing doesn’t make sense,” says NIMH’s Dr. Susan Swedo, “and they hide it from their parents.”
Every parent knows about separation anxiety, and it’s perfectly normal in infants and toddlers. But when a 9-year-old begins to fear that her mother is going to die and refuses to go to school, the condition may warrant treatment. Kids with social anxiety disorder want to avoid school for a different reason: they worry intensely about being judged. Even the simplest tasks, like eating in the cafeteria, can bring on intense embarrassment and sweating.
Not all anxiety is so specific. Kids who worry excessively about everything, from homework to earthquakes, may fall into the category of generalized anxiety disorder (GAD). One of the telling traits is incessant fears about the future. Like other anxiety disorders, which often clump together in kids and can be linked to depression, GAD must interfere significantly in a child’s life and last for at least six months in order to fit the official psychiatric diagnosis. Treatment consists of cognitive behavioral therapy (coping strategies for parents and kids) and, in some cases, medication (typically antidepressants).
DEPRESSION AND BIPOLAR DISORDER
Depressed kids don’t necessarily look like depressed adults: they’re often irritable, rather than sad and withdrawn. Experts are now hunting for the disease’s earliest footprints. In a study of preschoolers 3 to 5, Dr. Joan Luby of Washington University School of Medicine in St. Louis identified depression through play. Luby had children watch two puppets discuss their emotions, then asked the kids to point to the one that sounded most like them. The study found that depressed kids showed far less pleasure in play and some explored themes of death. “Preschoolers are inherently joyful beings,” says Luby. Too often, “parents don’t consider that a child is depressed.” No one is suggesting that preschoolers be given Prozac (box, page 70). But given the disease’s chronic effects, early recognition could ward off problems down the line.
Bipolar disorder, an ongoing cycle of depression and mania, used to be thought of as a disease that began in early adulthood. But psychiatrists are now detecting it much earlier, especially in kids with a family history since the disorder is so highly heritable. “These kids have always been there,” says Martha Hellander of the Child & Adolescent Bipolar Foundation, an online support group. “They just haven’t been properly identified.” The illness is often confused with attention deficit hyperactivity disorder, but bipolar kids are more prone to elated moods, grandiose thoughts and daredevil acts. While bipolar adults have fairly well-marked periods of depression and mania, kids may have more rapid cycles. First-line treatment: mood stabilizers, and possibly antipsychotic or anticonvulsant drugs. “When children get properly treated, they feel better,” says Dr. Jean Frazier of McLean Hospital in Belmont, Mass. “Parents will say, ‘I finally have my child back’.”
Concentration problems and hyperactivity can be symptoms of diagnosable disorders. ADHD, the most well known, affects 3 percent to 5 percent of school-age children, the majority of them boys. No, bad parenting isn’t the cause, says Stephen Hinshaw, a child psychologist at the University of California, Berkeley. “Parents cause ADHD largely from the genes they pass on.” While critics worry about an ADHD epidemic, experts say the condition may be underdiagnosed, especially in girls who are more likely to be daydreaming than hyperactive. The consequences can be disastrous: poor school performance, low self-esteem and substance abuse.
Oppositional defiant disorder can look like ADHD, and some kids have the inflammatory mix of both. But kids with ODD aren’t necessarily inattentive. Instead, they exhibit a relentless and extreme pattern of defiance, anger and lashing out. The aggression is even more pronounced in a condition called conduct disorder, which tends to be diagnosed later, as kids enter adolescence. These children are not only unruly, they destroy property, harm animals and beat up other kids. While stimulants may be prescribed for ADHD, there are no specific drug classes for ODD and conduct problems. Behavioral therapy, including parent training programs, can make a world of difference.
There’s still a long way to go in the quest to conquer children’s mental illnesses. Tyler Whitley’s mom, Leah, is taking it one step at a time. Early on, doctors said Tyler’s moodiness was “just a little boy being a little boy.” Finally, after several difficult years of searching for answers, her otherwise sweet and funny son has received a proper diagnosis. “This illness is nightmarish,” says Whitley, but “with the help of our doctors, treatment and family support, we can get through it.” And maybe one day Tyler can experience the happiness he—and every other child—deserves.
With Joan Raymond © 2003 Newsweek, Inc.