Dr. David Palmiter's Blog for Hectic Parents

About 14-22% of children in the United States suffer from a diagnosable psychological disorder. Add 20% to that number if you include youth who suffer at sub clinical levels. However, only about 20% of these children get effective care. And, even when they get it they’ve often had to suffer for years first. This occurs even though the research on the effectiveness of child psychotherapies is very positive. What would we conclude about our culture if this were true of our childrens’ dental health instead of their mental health?

I’m writing this blog entry to try to review key indicators of when a child might benefit from mental health services. There are four primary areas of functioning that one can consider: relationships with adults, relationships with peers, academics and mood.

Relationships with adults: The key issue is whether the youth gets along reasonably well with adults. Of course this includes parents/parent-figures and teachers. But it also includes coaches, extended family, bosses, etc. If the youth is frequently in conflict or frequently avoidant or detached from any significant type of relationship with adults, an evaluation may be warranted.

Relationships with peers: Kids need to be able to form friendships, and get along effectively, with other kids who are doing well. For example, if a teen’s close friendships are primarily with those who often get into trouble, abuse substances, or are significantly symptomatic, a significant problem may be present. Likewise, if a child or teen is avoidant, aggressive, controlling or otherwise routinely rejected or ignored by most other youth, this is of concern.

Academics: This is one of the trickier areas to describe tightly. The central issue here is not grades, though grades consistently falling in the C and lower range would generally indicate that a problem exists (assuming that the teaching and curriculum are appropriate). The central issue here is the youth applying herself or himself when she or he does not feel like it.  Developing this psychological muscle (i.e., task persistence when internal motivation is required) is one of the most important developmental tasks of childhood. So if a child is not applying herself or himself, or experiencing significant turmoil or failure in academic pursuits, an evaluation is likely warranted.

Mood: The key issue is whether or not the youth is content. Happiness is great. Contentment is the bar however. If the child is consistently sad, angry or anxious for a significant portion of his or her waking day, this is signaling a need for professional attention. It is often the case that a parent may be confused regarding what a child or teen is thinking or feeling. Thus, problems with sleep, appetite, concentration, connectedness with the world or physical activity can be signs of a problem. (There may also be absences of experiences of joy, but more for kids with depressive disorders than anxiety disorders. )

As I write this blog, there are 42 ways that youth can be diagnosed with a mental health disorder. So, this is hardly a comprehensive post. However, if a child is getting along well with others, is doing well in school and seems content, that child may be fine. The only significant area I’ve left out is experiencing success in one or more extracurricular pursuits. While a lack of positive experiences in the latter area is not, by itself, necessarily indicative of a problem, a child who lacks for such experiences may be more vulnerable to attacks on self-esteem.

I hope you will share this blog post with those who could use it. If you would like to read about common myths about mental health services, click here. For ideas on how to afford care click here. And, finally, to find a lean-mean-healing machine in your neck of the woods, click here.