As a psychiatrist, I find that one of the most difficult parts of my job is telling parents and their children that they are not responsible for their illness.
Children with emotional and behavioral problems still suffer from significant stigma. Many in the medical community call them “diagnostic and therapeutic orphans.” Unfortunately, access to quality mental health care remains elusive for many.
An accurate diagnosis is the best way to determine whether someone will respond well to treatment, although that can be much more complicated than it sounds.
I have written three textbooks on the use of medications in children and adolescents with emotional and behavioral problems. I know this is never a decision to make lightly.
But there is reason for hope. Although medically unable to diagnose any psychiatric condition, dramatic advances in brain imaging, genetics and other technologies are helping us objectively identify mental illness.
Knowing the signs of sadness
We all experience sadness and anxiety at times, but persistent problems can be a sign of a deeper problem. Persistent problems with sleeping, eating, weight, school, and pathological self-doubt can be signs of depression, anxiety, or obsessive-compulsive disorder.
Separating normal behavior from problematic behavior can be a challenge. Emotional and behavioral problems can also vary with age. For example, depression in pre-adolescent children occurs equally in boys and girls. During adolescence, however, rates of depression increase much more dramatically in girls than in boys.
It can be very difficult for people to accept that they – or their family member – are not responsible for their mental illness. This is partly because there are currently no objective markers of psychiatric disorders, making them difficult to diagnose. Imagine diagnosing and treating cancer based on history alone. Unimaginable! But that’s exactly what mental health professionals do every day. This can make it more difficult for parents and their children to accept that they have no control over the situation.
Fortunately, there are now excellent online resources that can help parents and their children screen for common mental health conditions such as depression, anxiety, panic disorder and more.
The most important thing is to make sure your child is evaluated by a licensed mental health professional who has experience diagnosing and treating children. This is especially important when considering medications that affect the child’s brain.
Recent advances in genetics, neuroimaging, and mental health science are making it increasingly easy to characterize patients. New technologies can also make it easier to predict who is more likely to respond to a particular treatment or experience side effects from medications.
Our laboratory has used brain MRI studies to help unlock the underlying anatomy, chemistry, and physiology underlying OCD. This repetitive, ritualistic illness—although sometimes used among laypeople to describe someone who is tense—is actually a serious and often devastating behavioral illness that can paralyze children and their families.
Using advanced high-field brain imaging techniques – such as fMRI and magnetic resonance spectroscopy – that have recently become available, we can actually measure children’s brains to see defective areas.
For example, we found that children ages 8 to 19 with OCD never get the “completely clear signal” from a part of the brain called the anterior cingulate cortex. This signal is essential to feel safe and secure. That’s why people with OCD, for example, keep checking whether the door is locked or washing their hands repeatedly. They have striking brain abnormalities that appear to normalize with effective treatment.
We also started a pilot study with identical twins. One has OCD, the other doesn’t. We found brain abnormalities in the affected twin, but not in the unaffected twin. Further research is clearly warranted, but the results fit the pattern we found in larger studies of children with OCD before and after treatment, compared to children without OCD.
Exciting brain MRI and genetic findings are also reported in childhood depression, non-OCD anxiety, bipolar disorder, ADHD, and schizophrenia, among others.
Meanwhile, the field of psychiatry continues to grow. For example, new techniques may soon identify children with an increased genetic risk of psychiatric disorders such as bipolar disorder and schizophrenia.
New, more advanced brain imaging and genetic technology allows doctors and scientists to see what is happening in a child’s brain and genes. For example, using MRI, our lab discovered that the brain chemical glutamate, which serves as the brain’s “light switch,” plays a crucial role in OCD in children.
When I show families their child’s MRI brain scans, they often tell me that they are relieved and reassured “to be able to see it.”
Children with mental illness still face enormous stigma. When families are hospitalized, they often fear others will find out. They may be hesitant to let schools, employers or coaches know about a child’s mental illness. They often worry that other parents will not want to let their children spend too much time with a child who has been labeled as mentally ill. Terms like ‘psycho’ or ‘mental’ continue to be part of our everyday language.
The example I like to give is epilepsy. Epilepsy once had the stigma that mental illness has today. In the Middle Ages people were considered possessed by the devil. Then more advanced thinking said people with epilepsy were crazy. Who else would tremble or urinate and defecate all over their body except a crazy person? Many patients with epilepsy were locked up in insane asylums.
Then in 1924, psychiatrist Hans Berger discovered something called the electroencephalogram (EEG). This showed that epilepsy was caused by electrical abnormalities in the brain. The specific location of these abnormalities dictated not only the diagnosis but also the appropriate treatment.
That is the goal of modern biological psychiatry: to unlock the mysteries of brain chemistry, physiology and structure. This can help better diagnose and accurately treat childhood mental illness. Knowledge heals, informs and defeats ignorance and stigma every time.
This article is republished from The Conversation, an independent nonprofit organization providing facts and trusted analysis to help you understand our complex world. It was written by: David Rosenberg, Wayne State University
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David Rosenberg receives funding from the Children’s Hospital of Michigan Foundation, Detroit, MI, and a grant from the National Institute of Mental Health (R01MH59299).