Millions of Teens are Suffering Needlessly

Jan 12, 11 8:48 AM

Two recent studies in the Journal of the American Academy of Child and Adolescent Psychiatry remind us of a critically important problem in the United States: millions of youth are suffering from mental health disorders for which they receive no care.

The first study, whose first author is NIH researcher Dr. Kathleen Ries Merikangas, reports on results from a large national survey of over 10 thousand adolescents. Similar to findings from multiple regional studies that came before it, the researchers found that 22.2% of the teens were suffering from severe impairment or distress, while 49.5% were “…affected by at least one class of (mental health) disorder….” The rates for the four most common types of disorders were as follows: anxiety disorders (31.9%), behavioral disorders (19.1%), mood disorders (14.3%) and substance abuse disorders (11.4%). Some rates for specific disorders were as follows: ADHD (8.7%), Oppositional Defiant Disorder (12.6%) and eating disorders (2.7%). Anxiety disorders had the youngest average age of onset (age 6) while mood disorders had the highest rates of severe impairment (11.2%). The abstract for this October, 2010 article can be found here.

The second study, which had the same first author, examined rates of mental health service usage for over 6 thousand adolescents from the same data set as the first study.  Also similar to multiple regional studies that came before it, the researchers found that 63.8% of teens with a mental health disorder received no care for such. As is consistent with findings in clinical practice, the kids who were most likely to get care were those suffering from ADHD (59.8%) and behavioral disorders (45.4%). Only 17.8% of the teens suffering from the most prevalent category, anxiety disorders, got care. Moreover, only 37.7% and 15.4% of teens suffering from mood and substance abuse disorders, respectively, received care. Even among those considered to be in a severe category, less than half received care (47.4%). Finally, and quoting from the authors: “Of adolescents with mood disorders, Hispanics and non-Hispanic Blacks were much less likely than Whites to report having received mental health treatment, and a similar pattern was observed for Hispanic youth with anxiety disorders.” The abstract for this January, 2011 article can be found here.

Please also note that even when kids get care, they often have been suffering for years before they get the care or the care they receive is truncated. For instance, in the second study above it was found that one half of those who received care for ADHD, behavioral disorders or substance abuse disorders “…received six or fewer lifetime outpatient mental health visits…” What would we think about ourselves as a culture if the same statistics applied to our kids’ dental health?

Want to take some action steps? This is what you can do:

√ Educate yourself. I have written several blog posts to help:

• Signs that a kid needs mental health services.

• Seven common myths about counseling.

• Affording mental health care.

Please also see my Twitter posts or the mental health links on my website for a stream of related information.

√ Ask your pediatrician to consider screening for mental health problems in her or his practice. One tool that is available, that is easily administered and is free to download, is the Pediatric Symptom Checklist. Click here to obtain it.

√ Take your child for a mental health  evaluation if you suspect that she or he could benefit. To find a clinician near you click here. Don’t let your baby be one of the millions of youth in this country who suffer needlessly.

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A Happiness Ritual: Practice Acts of Kindness

Jan 1, 11 4:33 PM

Want a new ritual for 2011? Consider developing a kindness practice.  Those who develop such a practice have been found to experience multiple benefits:

√ Perceiving others in a more positive and empathic light.

√Experiencing fewer negative thoughts.

√ Viewing oneself more favorably.

√ Establishing deeper social connections.

√ Experiencing a “helper’s high.”

One way to start a kindness practice to establish one day a week as your kindness day. This can be done as a family or individually. Here are some ideas to get you started:

• Leave extra money in the coffee line to pay for the person behind you.

• Shovel a neighbor’s driveway.

• Volunteer at a local soup kitchen.

• Hand write a thank you note.

• Send an e-card to lift someone’s spirits (e.g., www.123greetings.com).

• Give a cleaning person at your job or school a thank you gift for his or her service.

• Let someone ahead of you in the line at the grocery store.

• Befriend and visit someone who lives in a nursing home.

• Befriend and support a child who is struggling financially (e.g., www.childrensinternational.com).

• Adopt a soldier as a pen pal (i.e., www.adoptaussoldier.org).

• Cut coupons and leave them on top of the related product at the grocery store.

• Put extra change in a vending machine that you use.

• Put a full load of coins in the meter before you leave your parking spot.

While there are just a few ideas listed here, there are many Internet resources available to support a kindness practice (e.g., www.helpothers.org, www.randomactsofkindness.org and www.daretobeanangel.com), as well as books (e.g.,  The How of Happiness by  Sonja Lyubomirsky and The Power of Kindness by Piero Ferrucci).  Finally, please see my previous blog entry on how to make and keep New Years Resolutions.

Good luck to you as you develop a kindness practice. Also, if you think of some creative ideas for practicing kindness please consider posting them here.

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Gratitude Letters

Nov 13, 10 4:30 PM

Gratitude letters can promote closeness and happiness in families. Let me describe what such a letter is and then describe how such might be used within a family.

Gratitude letters are usually around 300 words in length, but can be as long as you’d like. The letter is written directly to a family member (i.e., in the first person). To be more personal, write it out by hand. The letter should express only positive thoughts and feelings that you have regarding the person and should not include direct or indirect statements regarding how the person may have let you or someone else down or how the other person might improve as a person. Try to include examples of specific things the person has done or said that cause you to feel gratitude; these examples can be recent or from a long time ago. When it’s time to share the letter do so by reading it to the family member; don’t chicken out and hand it over for the other person to read. You may start to tear up or get emotional. That’s okay (you’ll probably find you’re not the only one). When you’re finished give it to the other person. Allow the positive moment to linger as long as the other person likes (i.e., some of us, though we enjoy it, may start to feel a little uncomfortable with the intimacy that can emerge); in other words, the other person decides when to end the moment or change the topic.

There are a number of ways such letters can be introduced into your family. The first way is for you to start doing the exercise unilaterally for any and all members of your family. If you chose this method don’t announce your agenda in advance; just spring it on the other person. It is also important to not do this with the hope or expectation that the other person will reciprocate.

Another method is to agree, as a family, that you will all do this exercise. The first step is to pick the person who will be the first “victim” (i.e., the one who everyone will write about first) and pick a day and time by which the letters are to be completed and read. You may need to stay after some kids to make sure they do their part; the recipient of the letter should not be the one to do this reminding (if you’re a single parent, ask a relative or friend to do this for you). If a given child is in 4th grade or younger, or has some interfering disability, you can be flexible regarding the length. For children who cannot write, but who are old enough to understand the concept, ask for a gratitude picture instead (if a given child needs it, it’s okay to provide a little help, but do this as sparingly as possible lest the recipient conclude it’s more your work). When the assigned day and time comes around, take turns reading your letters (/showing your pictures) all-together as a family. After everyone is finished, go with any urges to hug and cry and express love and joy. After the first recipient’s turn is finished, assign who the next recipient will be and so on and so forth. When I’ve helped families to do this, we’ve usually spaced the turns one week apart, though you can do it at whatever pace feels right for you.

This experience is usually very positive for families, and often to a surprising degree. (If this is not the case for you and your family, I would wonder if this is a symptom worthy of attention.) You can also find a lot of satisfaction in writing gratitude letters for others towards whom you have unexpressed gratitude, be it ancient or recent. If you’d like to make this a regular self-improvement project, write and execute one a month, at least until you run out of people. You might also encourage others in your family to try writing letters for people outside of your family. Such a practice focuses our minds on positive truths and stands to promote happiness.

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Is your kid getting enough sleep?

Oct 16, 10 9:15 AM

For many of us, a typical school night resembles a circus with the clowns’ hair on fire. There is way too much to do and not enough time to do it all. Because of this it may be tempting to try to make more time by pushing our kids’ bedtime back. After all, there has to be give somewhere and, while we might not like seeing our kid tired the next day, we know he or she can always catch up later.  Right?

Well, unfortunately, research suggests that even one hour of lost sleep can have a dramatic and negative impact on a child’s or a teen’s functioning the very next day. Before summarizing some of this research, let me share the nightly doses of sleep recommended by the National Sleep Foundation:

1-3 years old:            12-14 hours

3-5 years old:            11-13 hours

5-12 years old:          10-11 hours

Teens:                       8.5-9.25 hours

One of the best parenting books I’ve ever read is Nurture Shock (read my blog entry on my top three favorite books for parents by clicking here). According to the authors, the following number among the consequences when our children do not get enough sleep:

• For every hour of lost sleep, a child loses seven IQ points the next day.

• When kids get less sleep, their bodies respond in a manner that maximizes the production of fat and minimizes its breakdown.

• Sleepy kids are more lethargic and less active the next day.

• A complete night’s sleep is needed in order to properly remember newly learned academic material.

• Children with deprived sleep are more likely to remember negative rather than positive events.

• Children who are tired have a more difficult time thinking flexibly the next day.

To review related findings from the National Sleep Foundation click here.

I realize that messages like this are difficult to hear as it is so challenging to fit it all in. Moreover, our children often resist our efforts to get them to bed on time, adult leaders of extracurricular activities often seem unaware of these issues when they schedule late night events and kids sometimes find it difficult to fall and stay asleep. (To review strategies for promoting a good night’s sleep in your child click here.) But, for now, I believe we all do well to realize the importance of our kids getting a good night’s sleep.

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Signs that a Kid Needs Mental Health Services.

Sep 28, 10 8:19 PM

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.

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Affording Mental Health Care

Sep 14, 10 8:34 PM

This entry reviews the cost issues affiliated with mental health care.  While paying a provider for counseling can be expensive, it need not be. Some thoughts to help:

• Many health insurance policies cover some portion of the cost. Often a client is left with only a small copay. Moreover, with the signing into law of the Mental Health Parity and Addiction Equity Act, many policies have expanded their coverage of mental health services.

• Monies spent on counseling are usually considered a medical expense and so may be deductible from your taxes..

• If you have a university in your region with a graduate program in the mental health professions (e.g., clinical psychology, psychiatry, etc.), they may have an outpatient training clinic that offers services at a very low cost. In these clinics those working towards advanced degrees often provide the care under the supervision of experienced faculty. For instance, I direct such a clinic and our most common fee is $10/visit.

• Most people do not live far from a community mental health center. These centers receive public funding to support their charter. Therefore, many of them will offer services on a sliding scale or otherwise arrange for flexible payment plans. If you’re unsure where the one by you is, call up any psychologist in the yellow pages and ask.

• There are a number of charitable organizations that sponsor mental health services on a sliding or a reduced fee scale (e.g., Catholic Charities, Jewish Social Services, etc.). In all of the instances that I know of, one need not belong to the sponsoring religious group in order to get care.

• If you or a loved one suffer from a chronic medical or psychiatric problem you may qualify for support from social security. To find out more be in touch with an attorney that specializes in disability applications, your local community mental health center or your state’s mental health or disability offices.  Other programs may also be available if you cannot afford health insurance.

• Many providers may be willing to reduce their fee if you can show cause. I would not ask for this up front. But, after the evaluation is concluded, and the provider has come to know you and your circumstances, it never hurts to ask. The large majority of the thousands of mental health professionals I’ve met over the years are a mission-driven lot who care deeply about what they do. To find such a person near you, click here.

In factoring cost issues please also consider what it would be worth to be free of the problems that are having you consider getting care. What would it be worth to be free of depression, to have your child stop acting defiantly or be free of anxiety, to have your marriage healed, etc.? Imagine life with troubling mental health burdens either eliminated or controlled; then ask yourself what that would be worth?

For my post about common myths about counseling click here.

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Resources for Suicide Prevention

Sep 9, 10 7:34 PM

As this month is suicide prevention month, I am guest blogging at the American Psychological Association’s Blog http://www.yourmindyourbody.com. My post regards suicide prevention in youth. Click here to read it.

I also did a live radio interview, on the same topic, for the Harrisburg, PA PBS radio station. To listen to it, click here.

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Top Three Books I’d Recommend for Parents

Aug 30, 10 9:42 PM

Parenting books are legion. However, many of them either do not have a credible scientific basis or overstate the importance of their recommendations. So, I thought it might be interesting to propose the top three books I’d suggest parents read, at least until mine is available in early 2011 😉 Today, these are my three picks:

NurtureShock. If there were one chapter I’d have every parent, coach, school administrator, teacher, pediatrician, and those who serve children and teenagers read, it would be “the lost hour,” which is contained within. The mounting research on the importance of sleep is well articulated here. As the available evidence suggests that a majority of our children and teenagers do not get enough sleep, this is a very important read. However, this is hardly the only valuable chapter as the rest of the book contains important, research-based findings that may sagely inform parenting strategies.

Sh*t My Dad Says. A hilarious read, this book initially shocks the parent-reader as the father’s insights and counsel are usually wrapped in spicy invectives. However, the parent-reader also gets the sense that the father was engaged enough, and in love enough, with his boy to realize “good enough parenting,” at least. So often we parents conceive of ourselves as sculpting our kids personalities and outcomes, fretting over this and that error. However, the available evidence suggests that we are more like shepherds and that our efforts, while critically important, are hardly exclusively determinative of how our kids turnout. This book reminds us of that important truth.


The How of Happiness. This book effectively reviews the current scientific literature on how to engender happiness. (Spoiler alert: only about 40% of our happiness is under our direct control.) On a short list of evidence-based strategies we parents can pursue to promote our childrens wellness is our own wellness. While this book does not articulate an exclusive list of strategies, it does a yeoman’s job of reviewing the high points.

What are your thoughts? What three books would you have parents read and why?

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Three Key Ways Teachers Can Promote Resilience

Aug 27, 10 8:42 AM

As our nation begins transitioning back to school, and because teachers are one of our most important collaborators in raising our children, I thought I’d devote this entry to teachers.

In my years of working collaboratively with teachers I have become a big fan of the profession. Just as I find most parents love their kids more than their own lives, I find that most teachers are in the game because they wish to make an important difference in the lives of kids. Their primary motivation is not money–if so a teacher has had bad career counseling–it is mission. For this reason, I would like to offer the top three things I wish teachers would remember, or realize, when trying to teach our kids.

You have the power to make significant and life-long contributions to your students.

In case studies of children who have faced adversity, but who came out on the other side of it well adjusted, a teacher is often sited as having made a critically important contribution. Those benefited by the teachers’ gifts don’t necessarily recall the academic content that was covered, but they recall the human investment. “Mr. Roberts was the first one who ever believed in me.” “Mrs. Johnson reached out to me when I was at my lowest.” “Ms. Jackson never gave up on me even though I was a real pain.” As someone who both named his only son after a teacher, and who also teaches, I can tell you that it need not take much time and energy to have a tremendous impact. Sharing a lunch, writing a note, arranging for a little tutoring, etc. can make a mighty difference, though it may not be obvious. For instance, I once discovered that I student of mine had laminated a complimentary sticky note I attached to a report she wrote; I learned about this months later when she told me that she read it whenever she needed a boost.

You can serve a pivotal role in helping students to identify their strengths.

Their are at least two reasons why knowing one’s strengths is important: such is pivotal to the formation of a positive self-esteem and knowing one’s strengths aides in effective educational and vocational planning. That said, many kids (and adults) do not know their top strengths and may even find the concept foreign. Teachers have many opportunities to either mirror kids strengths back to them or to assist kids in identifying their top strengths. The former can happen simply by expressing thoughts you have about any special abilities a student is showing. It can also happen by putting a kid on display for a positive contribution. The teacher I mentioned I named my son after, upon having seen me perform in a school play, wrote my name on the board the next Monday morning; he noted it was there in order to recognize an outstanding performance. Though I probably sat their without much of an expression on my face, that simple gesture made my month.

Teachers can help identify top strengths by encouraging exploration of uncharted interests in a student’s life. Unimpeded, and assuming basic conditions for growth are in place, trees grow their branches around obstacles towards the light. Unimpeded, and assuming basic conditions for growth are in place, children grow their interests and behaviors towards their competencies. Teachers might also encourage students to fill out instruments which can aide in developing theories about their top strengths (e.g., the VIA Signature Strengths Survey for Children, StrengthsExplorer, etc.).

You can teach students that how we think has a much greater influence over how we feel than what actually happens.

As any case study of a famous, popular and wealthy person who committed suicide can illustrate, more determinative of mood is what we make of what happens in our lives, not what actually happens. As just one example, consider the script: crisis = pain + opportunity. A crisis is like a siamese twin. Resilient minds are not in denial about the pain that is attached to unfortunate twists of fate. However, they then go on to look for the opportunity that is always attached. Teachers can encourage their students to learn this truth by providing examples. This agenda could be incorporated into many lesson plans (e.g., in English students could read stories with this lesson; in history students could hear examples of this formula; in many academic classes satisfaction and new skill sets are borne out of the pain involved in certain mental pursuits, etc.). And, when bad things happen in students’ lives advisers can encourage, after the pain has been given its due, the search for the opportunity imbued within, perhaps while also providing personal illustrations.

In closing I salute you for your mission, especially when you execute it well on those days when no adults are watching and dialing it in would be all so easy to do. And, remember, if you have children who are not responding to your efforts, an army of qualified mental health professionals is dispersed across our country. To find such a person in your vicinity, click here.

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Communicating with Kids About Financial Stress

Aug 16, 10 12:15 PM

In today’s economy families commonly need to cut back or make significant changes in how they live. Many parents find themselves wondering how to discuss these changes with their children. Experienced child psychologists know that once you’ve seen one family you’ve seen one family. For this reason, there is no counsel or set of  procedures that can be universally applied. However, it is possible to provide some general guidelines to address common questions.

Is it possible to hide our financial stress from our kids?

Probably not. Most of us tend to show our vulnerabilities more when we’re stressed; smokers tend to smoke more; people in troubled marriages argue more; people inclined towards impatience yell more, etc. A young child, sensing these changes, can become fairly upset and believe that he is at fault unless a parent provides some degree of clarity.

Should I lie to my child about what is going on in order to protect her?

We parents love our kids so much that it can make us crazy (i.e., we’re parent-lunatics—my post on this topic can be found here). So, the motivation to give false assurances is certainly understandable. However, it would generally be a mistake to assert something we do not believe. While doing this in the short run can seem humane, it can damage our credibility in the long run. And, as is the case in adult relationships, credibility can be a difficult thing to recapture. Moreover, kids can usually tell when something is wrong.

What should I tell my child about what is going on?

The younger or the more psychologically vulnerable the child, the more selective I might be in what I share. The older the child, and the more that he is thriving, the more open I might be. A central parental goal is to help my child to learn how to cope well with stress. It’s useful for kids, through the course of development, and in doses that they can handle, to be exposed to a wide variety of stresses so that they can learn how to cope effectively. Yet we parent-lunatics, because we can’t bear to see our kids hurting, sometimes deprive them of such valuable learning opportunities. Then, when they’re on their own, they may experience a diminished ability to respond to multiple kinds of stress and challenges (e.g., many freshmen arrive on college campuses with a compromised capacity to make effective decisions when stressed).

Can you give me an example of what I might say to a younger or a more vulnerable child regarding the significant financial pressures we’re facing?

Let’s say that you’ve been downsized and you’re going to have to move out of your house if you can’t land a new job in three months. I probably would not tell an eight year old that the mortgage is in danger. I would, however, tell that child about the job change, because Dad is going to be home more, or someone else might let it slip. It’s like sex education: you want as much information coming from you as possible. However, a child is like a bridge that’s still being built. How much weight he can handle changes over time (i.e., we don’t want to take a caravan of heavy trucks across a bridge that’s not completed if we can avoid it). If there are serious issues that would significantly stress or frighten a young child, I’m probably would not share that information until I have to.

What would you say to a healthy, older teenager about that same situation?

I might say to the teen, “I need to tell you something troubling. I got laid off. I’m not quite sure what’s going to happen and what kinds of changes we might have to go through together. I’m somewhat worried and sad about all of this, but I’m also confident in my abilities and our abilities as a family. I just thought that you’re old enough to hear about this straight up.” Such disclosures can promote closeness with a teen and affirm that you recognize her growing maturity. Then, there is the follow up opportunity to model how to cope well with stress. I can’t tell you the number of times, in my practice, that a teen has expressed surprise to learn that her parent was previously dumped by a significant other (this happens in the context of the teen being devastated by such a loss in his or her own life). We’re often not used to telling our kids about our vulnerabilities and failings, even though doing so can help them in many ways (for my humorous blog entry on this topic click here).

What do I do about the shame and guilt that I feel that I’m not able to give my kids as many things, and as many experiences, as I could in the past?

I’d suggest trying to redirect the mental energy you are putting into guilt and shame into thinking through the following formula: crisis = pain + opportunity; a related corollary is that as the pain rises so too usually does the opportunity. Maybe we can’t go to the shore this year. But, maybe we can spend more time hanging out at a neighborhood pool together. Maybe I can’t buy the top-of-the-line sneakers, but I can start to collaboratively consider whether chasing expensive corporate branding is good for us.

In closing I can share that our research makes it clear that one of the most important things our kids need from us is undivided and positive attention. The things we purchase sometimes own us more than we own them, so reduced questing for material possessions may actually  be offering us the opportunity to create deeper and better bonds with our kids. Required is love, creativity, flexibility, presence and persistence. Not required is money and Ralph Lauren (well, except in his family).

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