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Dr. Harold Koplewicz

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Child Mental Health: 7 Common Myths

Posted: 09/14/10 08:00 AM ET

It is easy to empathize with suffering we can see: a child who lost hair in chemotherapy, for instance. The suffering of a child with psychiatric issues is far less obvious. Many children and teens with emotional problems keep their pain secret. Others express their feelings in risky or offensive ways. Due largely to stigma--fear, shame and misunderstanding about mental health disorders--the majority never receive clinical care.

Debunking myths about child mental health is critical to getting more children the help and understanding they deserve.

MYTH 1: A child with a psychiatric disorder is damaged for life.
A mental health condition is by no means an indication of a child's potential for future happiness and fulfillment. The most important thing to remember here is that early intervention can be very effective at preventing chronic, debilitating conditions. If parents and teachers recognize the early signs of a psychiatric disorder -- whether it's ADHD or depression or anxiety -- and get a child treatment, she has a much better chance of eliminating, or effectively managing, symptoms that would otherwise interfere with relationships and her ability to succeed at school and at work.

MYTH 2: Psychiatric problems result from personal weakness.
It can be difficult to separate the symptoms of a child's psychiatric disorder -- impulsive behavior, aggressiveness or extreme shyness, for example -- from a child's character. But a mental health disorder is an illness, just like diabetes or leukemia is not a personality type. By way of example, anorexic girls are often blamed for starving themselves, but the obsessive fears and distorted body image that drive their behavior have genetic and biological bases. We can't expect children and teens to have the tools to overcome anorexia (or any other psychiatric disorder) on their own, but they can absolutely recover with the help of their parents, clinicians and a carefully individualized treatment plan.

MYTH 3: Psychiatric disorders result from bad parenting.
While a child's home environment and relationships with his parents can exacerbate a psychiatric disorder, these things don't cause a disorder. Anxiety, depression and learning disorders -- indeed, the full range of mental health conditions -- often have biological causes. Parenting isn't to blame. But parents play a central role in a child's recovery. They provide support and care that is crucial to their child's treatment plan and future development.

MYTH 4: A child can manage a psychiatric disorder through willpower.
The key word here is disorder. A disorder is not mild anxiety or a dip in mood. It is severe distress and dysfunction that can affect all areas of a child's life. A heartbreaking number of parents resist mental health services for their children because they fear the stigma attached to diagnoses or see psychiatrists as pill-pushers. This is incredibly sad because kids don't have the skills and life experience to manage a condition as overwhelming as depression, anxiety or ADHD. They can benefit profoundly from the right treatment plan, which usually includes a type of behavioral therapy, and have their health and happiness restored.

MYTH 5: Therapy for kids is a waste of time.
Treatment for child mental health disorders isn't old-fashioned talk therapy. Today's best evidence-based treatment programs for children and teens use a cognitive-behavioral model: therapy that focuses on changing thoughts, feeling and behaviors that are causing them serious problems. This is solution-driven therapy, and it's a key component of some of the most exciting and innovative new treatments plans for kids. Research has shown that there's a "window of opportunity" -- the first few years during which symptoms of mental health disorders appear -- when treatment interventions are most successful. This means that early identification followed by therapeutic interventions can give kids the tools they need to decrease, or effectively manage, their symptoms before they experience the stigma and negative effects of a fully developed psychiatric disorder.

MYTH 6: Children are overmedicated.
Since so many public voices (many without authority or clinical experience) have questioned or decried the use of medications in the treatment of childhood psychiatric disorders, many people believe that psychiatrists simply prescribe medication to every child they see. The truth, however, is that good psychiatrists use enormous care when deciding whether and how to start a child on a treatment plan that includes medication -- usually along with behavioral therapy. Medication is not the norm. Approximately 20 percent of children and teens in America have psychiatric issues at any one time; only five percent of them take medication. We never doubt whether a child with diabetes or a seizure disorder should get medication; we should take psychiatric illness just as seriously. The larger problem is that millions of children who suffer from serious psychiatric problems never receive any help.

MYTH 7: Children grow out of mental health problems.
Children are less likely to "grow out" of psychiatric disorders than they are to "grow into" more debilitating conditions. Most mental health problems left untreated in childhood become more difficult to treat in adulthood. Since we know that most psychiatric disorders emerge before a child's 14th birthday, we should have huge incentive to screen young people for emotional and behavioral problems. We can then coordinate interventions while a child's brain is most responsive to change, and treatment is more likely to be successful. Left untreated, disorders often lead to substance abuse, difficulties with relationships and work, and brushes with the law.

Harold S. Koplewicz, M.D.
President, The Child Mind Institute
Director, Nathan S. Kline Institute for Psychiatric Research

The opinions expressed herein are solely my own as a child and adolescent psychiatrist and public health advocate.

 
 
 

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It is easy to empathize with suffering we can see: a child who lost hair in chemotherapy, for instance. The suffering of a child with psychiatric issues is far less obvious. Many children and teens wi...
It is easy to empathize with suffering we can see: a child who lost hair in chemotherapy, for instance. The suffering of a child with psychiatric issues is far less obvious. Many children and teens wi...
 
 
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LaurieAnn
Wake Up! Grow Up! Lighten Up!
08:27 PM on 09/19/2010
Children's mental health and developmental disorders (separate things but often occurring together) need to be taken seriously and well treated through a multi-modal approach.  I am absolutely there.  Having a child with autism, severe learning disabilities and depression I have seen first hand how important effective treatment can be.  I am however concerned that so many articles I read about children's mental health issues place a large focus on ADHD.  Though I understand that it falls within the realm of the Diagnostic and Statistical Manual I have never been under the impression that it is a mental illness, but rather a developmental/spectrum disorder in a manner such as autism.  Children with ADHD do certainly need appropriate therapies, however I think we do a disservice to children who have true mental illnesses by continuing to focus the discussion solely on ADHD.
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NoSandwiches
09:57 AM on 09/19/2010
Saw a kid at work making a pot of coffee at 4:45pm and when I commented on it, he said caffeine doesn't effect him because he can drink it all day and right before bedtime and it doesn't keep him awake. I said that sounds like ADHD to me, and he said "yeah, I was diagnosed with that as a kid but my mom didn't believe in medication." I looked at the coffee and said he's clearly self-medicating and he gave me a sheepish grin. Two days later he drove a forklift into a supporting pole and caused 38,000 dollars worth of damage to the building (he was fine.) Maybe if he actually had a prescription he would have been able to manage better.
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synaesthete
07:48 AM on 09/17/2010
IIRC, we're not even really sure what the causes are for a lot of psychiatric disorders; one medication may work for a certain patient, but not another with identical or near-identical symptoms. But to me, at least, it seems virtually impossible to definitely say whether medications are a good thing or not, given that there are at least three different theories on the biological mechanics behind schizophrenia (again, IIRC) despite the fact that there are pretty much universally accepted symptoms for diagnosis.

And even they are not really agreed on. Having attempted suicide twice in my teens and been to multiple therapists and psychiatrists in the past (costing my parents a fortune in medical bills), we have received multiple diagnoses for anything from depression to bipolar disorder to just going through a teenage phase. My father refused to allow me to be medicated, however. To this day I am unsure whether taking Lexapro would have prevented those suicide attempts (the first of which happened two months after I was prescribed the pills), or exacerbated them and the mood swings I've felt for a good chunk of my life.

I'm kind of a fencesitter for this one. I don't believe in medicating children unnecessarily, but then again, there may be cases that genuinely call for it.
12:40 AM on 09/17/2010
I'm late to this party, and probably no one will read this, but I'm absolutely stunned at the ignorance of the comments I've read so far.

If you have never suffered from a significant mental illness or had a close family member or friend who has, you have no business commenting. You "know" nothing.

There are bad mental health doctors and therapists out there, just like there are bad physical docs, businessmen, politicians, and every other sort of person -- parents included.

Untreated childhood mental illness does not go away. I got no drugs, no therapy, struggled through school and marriage and eventually landed in the hospital unable to function at all after spending several months obsessively walking and walking and walking, hoping I could walk myself out of my life. Has all the treatment I've gotten since been perfect? No. But way better than nothing. And I'm still alive.

I have known at least 8 people who have committed suicide during my lifetime -- nothing is more heartbreaking, especially when there is hope with treatment.

I currently volunteer with a therapeutic horseback riding center for the disabled -- it doesn't take much time with a child who is autistic to some degree or totally -- and I mean totally -- unable to concentrate for a minute to realize there's a problem.

If the body can break, so can the brain, and hence the mind. It's about kid's lives, not about Pharma. They need help!
11:03 AM on 09/17/2010
I read it and agree.
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SrAN
1st time proud pagan mom since May 16
07:24 AM on 09/16/2010
I was really hoping that this article was going to touch on the actual mental health myths our children face today. Anymore today mental disorders are dished out like candy to kids. Your two year old is having temper tantrums and won't listen to you, then he/she must have borderline personality disorder. Your teenager can't stop looking at girls and thinking about sex, don't blame it on the hormones he must have voyuerism or paraphilias. And instead of starting with talk therapy to see if this is just a normal process in their development let's give them medication because that is much easier and will help them become "normal" faster. I remember times like this when I was a kid 20 years ago when more and more children were diagnosed with ADD or ADHD and were prescribed ridlin at the drop of a hat. Childhood has been overloaded with thoughts of constant illness and parents have made their children hypochondriacs when it comes to physical and mental illnesses. These are the myths that we need to talk about.
12:14 PM on 09/16/2010
Mental illness needs to be taken seriously.There are plenty of websites and "psychologists" that don't believe in medication and chemical imbalance.Go find them.ADD and ADHD are over medicated, its not right to give kids speed for being kids. However a lot of these "severely ADHD" kids have actual, serious, mental illness.
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SrAN
1st time proud pagan mom since May 16
12:40 PM on 09/16/2010
I am not advocating for overlooking real mental illnesses. Having taught elementary school for a short time and having worked around children who are medicated for one thing or another I have seen that many of them honestly don't need it. The children just need someone to guide them and show them the right way to act.

There are definitely severe mental illnesses out there and the myths surrounding children with these illnesses need to be brough to light as well. I was just hoping that the author would point out that we do live in a society of helicopter parents who believe that any little tantrum or developmental behaviour can be treated with medication so their children can be "normal".
04:39 AM on 09/16/2010
The education of psychology as an asset of awareness to the significance of unity in the credibility of life as a meaning between common universal groups is a subject utilized by the global elite to managed the proceeds of slavery, instead of activating the credentials of empowerment to the meaning of 'Right' in the primary significance of the human condition.

The banking sector on this planet are a unified group of alien corrupters whose definition of health is not yours...as millions and billions are forced into an enforced poverty trap to cover the irresponsible conduct of their behavior. Banks were supposed to take responsibility as a principle aspect of their nature in representation of nature and health in the condition. The selfish nature of the small group of greed merchants imposing powers and acts of God upon ordinary people’s lives will do more psychological damage as conditions in poorer communities degrade, as stress, anger and low self esteem condition the mental condition of children.

The objective is to advance the life chances and credentials of their own groups whilst diminishing the credentials of others to use psychology through payments, like a big experiment in which they always remain buoyant in the ebb and flow of inequality to the masses, ruling the credentials of autonomy from the towers of their own appetites in the deception of power through controlled means and ends.

Equality is a natural condition, not an imposed system with no respect or truth to value.
03:12 AM on 09/16/2010
Great article! Thanks for posting this. People need to understand that individuals with mental disorders are no less deserving of treatment than people with physical problems.
03:22 PM on 09/15/2010
If the good doctor didn't placate parents and big pharma, we all know he wouldn't have his ivory tower position.

Anyone who wants to be part of our societal delusion that parents don't play a huge role in the psychological health of their kids ought to spend a day in any family or juvie court in the country. Short of that, talk to any caseworker at the CPS branch near you.
04:34 PM on 09/15/2010
@ohboy
I agree. Spend a day with families, and you'll see through a social workers eyes the HUGE connection between loving and supportive parenting and positive mental health. So too, absent, abusive, and neglectful parenting and the arising of negative mental health. In my world we call this "trauma" and it "counts" in the formation of mental illness.
04:48 PM on 09/16/2010
Beyond personal observation, there's a boatload of peer reviewed research that correlates healthy psychological outcomes with positive parenting, as well as the reverse. This Koplewicz guy is more PR than med.
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synaesthete
07:38 AM on 09/17/2010
I know many people who have loving families who have either committed suicide or are in the throes of a deep psychiatric disorder. My best friend's brother committed suicide at 18 despite having every possible advantage and quite possibly the most lovely, understanding parents I've ever met. Conversely, some of the kids I grew up came from very broken homes, and are patient, kind, and much more stable than I -- and I came from a comparatively intact family.

I, too, have seen an overall correlation between good parenting and stable mentalities, but a lot of my experience seems to suggest that there is a plethora of other causes and one's relationship with one's family need not necessarily dictate one's mental health.
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CAPTAINSKIPPY
02:02 PM on 09/15/2010
Good post - early intervention is better than late, as well as easier.
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omsandi
11:36 AM on 09/15/2010
They forgot Myth #8: "Childhood psychiatric disorders are legitimate if the U.S. Diagnostic and Statistical Manual says so." Shyness, tantrums, teen angst, thinking about sex too much, and binge eating are now considered "disorders" that they can write a prescription for. Your two-year-old is no longer going though his "terrible two's" - he is suffering from "Temper Dysregulation Disorder with Dysphoria." So forego the spanking and dole out the Paxil.
12:04 PM on 09/15/2010
Yes, in addition to the problem of over-medication, we also have disorder trigger finger. :)
10:05 AM on 09/15/2010
The consensus seems split between "YES, medication is the answer, and it has helped me a lot," and "NO, drugs are not the answer, there are plenty of other solutions (and causes) to consider."

As a clinical psychologist and life coach who works with chronically mentally ill populations, I can say that I agree with you BOTH. Yes, I have seen the "right meds" (important to note) really balance out a person's mood, and even make hallucinations stop, and yes I have also seen these same medications "zombify" someone, develop into dependence, and have more side effects than I care to count. What ends up happening in MANY cases, is you have 2-10 medications for one problem. When we cross this line too far, then we are in "over-medication" territory.

Here is the underlying issues:

1) There are psychological dis-eases, and brain diseases. They DON"T always go hand in hand. Sometimes we are treating trauma and poor self image with meds, and sometimes we are using therapy to treat a biological problem. We have to get clearer on the root cause before jumping to a remedy. "A pill for every problem" is a big problem.

2) A lot psychiatrists (especially those 50+ in age) are operating from a 19th century behaviorist ideology that reduces humans to symptoms and behaviors. The more holistic model of Psychiatry WILL look at things like nutrition, exercise, environment, selfcare,etc. Give them time, they will catch on!

-Patrick
http://www.patrickjkerwin.com
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teresa1960
07:16 AM on 09/15/2010
I will be speaking to a group of psychology students at our university next month on parenting a child with ADHD & ODD. I will talk about my journey with him from birth to present as he is now 14yrs old. I will discuss the identification process and the medications he was on from the ages of 4-12. I took him off meds 2 years ago and focused on nutrition. Since he's been off meds his teachers actually told me how much happier he was, and his behavior had improved (not removed totally) but they said he had more control. I always insisted the the ADHD medications made him much more hostile. Parenting these children is challenging to say the least but it takes a very engaged parent to support and guide these kids along.
I take pride in the fact that I chose my gut feelings over what doctors & teachers were trying to sell me.
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JTJMOMEDTEK
vote out global warming deniers
08:15 AM on 09/15/2010
Great for you!! I hope you can teach others to do the same. I have a friend who did that too and now her son is in his second year of college to become a history teacher.
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mombabytiger
Looking into the heart of an artichoke.
08:14 PM on 09/15/2010
I have a son with ODD and it is ruining our lives. I would give anything for a treatment - if it's a pill, fine.
10:44 PM on 09/15/2010
I have asperger but only know about it at my late 40s. My parents never treated me any special, so they never bothered to know my problem, just thinking I do not want to live like any other kids, thinking I was a bit different but nothing more.
I think I would have improved my life tremendously if only my family had taken the trouble to find out about me, and teach me what they know about life, because I needed that. So I ended up lonely and miserable.
Parents and other family members must actually, really be a good and friendly listener to help a child facing any kind of problem - whether mental or not. And also try giving good advise when needed, lovingly.
06:56 AM on 09/15/2010
Thank You. Especially #2 is important I think. Today everyone says that who is ill, out of work, poor, .... has only himself to blame. That thinking positive will eradicate all that magically. - I will not. The only thing positive thinking relieves is for heartless observers to feel compassion they do not WANT to feel.

Especially children are often driven into psychiatric problems when othery - even parents - tell them "it is all in your mind". If I hear that I always have the urge to kick them in the shins and say "it is ll in your mind".

Studies prove that the children who are most confident, healthy, mentally strong, and happy are the ones who get support. The LEAST healthy are the ones left to their own devices.
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Sam1jere
Open-minded, sports lover, Red
03:31 AM on 09/15/2010
I remember reading that children are only born with the fears of falling down and loud noise, with all others acquired from the immediate environment. Whether this is proven or yet another myth is beyond me.

Both parent and child are part of an experiment, crudely put, and that experiment is itself part of a journey. It is more of a tributary linking up eventually to this river we call life. Along the way would be expected bends, detours, obstacles of all kinds, linking up with other canals and so on.

It can never be exact science, and mostly seems to be a thankless effort. The best starting point is the home value system, from where a child's worldview and sense of morality is honed. Without this there can be no future adult. The adults themselves, who originate from childhood, must be vigilant to pick out anything that looks odd or out of place. Illness or deviant behavior falls here.

Observation itself is an amalgam of common sense, keenness, education, networking with others and just interest. An article such as this is a good starting point but this information and knowledge must extend to healthcare, the community level, education system and news media.

To me, such articles should receive more media attention than the antics of the political class. More forums must exist where debate on such knowledge can be further refined.

I've learned quite a bit from this piece. Thanks.
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Trittydi
Special on pap smears at Walgreen's this week ....
02:20 AM on 09/15/2010
Vitamin D supplementation is always worth considering for depression.

I have seen deeply depressed patients recover completely once their blood serum levels were normalized. Dr. Cannell over at The Vitamin D Council says we should aim for serum levels between 50 to 80 ng/ml. (Cancer survivors higher yet)

The incidence of chronic disease increases as we move away from the equator. Some depression can be completely cured with Vitamin D supplementation.
http://www.vitamindcouncil.org/depression.shtml

Consider having the child's blood serum levels tested. If you can't afford it (insurance companies often won't pay for it) - consider supplementing with 5,000 IU daily. If the child is younger than about 14-15 - 2-3000 IU a day is fine. But if they are seriously deficient their doctor might want to give them a single large dose to get started. But it MUST be Vd3 - VD2 is not the same.

If they can be tested you want to do it.

Pharmcology of Vitamin D
http://www.vitamindcouncil.org/vitaminDPharmacology.shtml

Story - VD2 vs. VD3 in a hospital situation:
http://heartscanblog.blogspot.com/search?q=d2+D3

Dr. Cannell - Water is more toxic than vitamin D3
http://www.youtube.com/watch?v=0oc2Od7Yytk&feature=related
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JTJMOMEDTEK
vote out global warming deniers
09:49 AM on 09/15/2010
OMG Thank you Thank you Thank You for validating everything I have been saying for years.
I wish I could fan you 100 times.
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Trittydi
Special on pap smears at Walgreen's this week ....
01:55 AM on 09/16/2010
Your welcome! I have been studying this for about a year now - and the word is getting out.
*
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LaurieAnn
Wake Up! Grow Up! Lighten Up!
08:37 PM on 09/19/2010
Thank you for this excellent information.