Hats off to The Duchess of Cambridge for her remarkable vision in seeing that the future for all children, and thus our societies, lies in their having a strong foundation in emotional and mental health - and her determination to make that happen.
Did you know that 50% of all mental conditions appear before the age of 14? That 75% appear before the age of 24? We are talking about depression, eating disorders, ADHD, anxiety and PTSD (trauma) disorders, and more severe conditions like bipolar disorder (manic-depression) and schizophrenia. Unless properly detected and effectively treated these conditions handcuff a child's social, emotional and scholastic development and pirate away a more successful future.
As a public health doctor and psychiatrist, my job is to identify how we can enable more youth, in this case those with problems, be identified and receive effective services. In this post, I will focus on two ways this can be done: First, by detecting emotional troubles in youth 5-12 (the age group that Young Minds Matter is focused upon) in the principal sites where we find them and their families, namely in pediatricians'/GPs' offices and in schools. Second, by illustrating with examples what we can do, especially involving their families who are often the first to see troubles and best able to powerfully and positively impact their kids.
Pediatricians and GPs routinely monitor a child to ensure she or he is progressing along the normal development steps like walking, talking, and socializing with others; they also monitor blood sugar and weight (particularly body mass index or BMI, a measure of weight and height) to try to detect pre-diabetes and intervene before the illness sets in. As adults, we are familiar with this process - called screening - for example for high blood pressure and lipid (cholesterol) levels. There are very reliable and commonly used screening tests for emotional and behavior problems in youth as well.
One very good example of a screening tool is the Pediatric Symptom Checklist*. This checklist focuses on emotional and physical health and can be done in fewer than five minutes and scored in half that time; it is used with youth 4-16 and completed by a parent (or a youth for older adolescents). Either 17 or 35 questions ask that items be checked that "best describes your child", such as "Complains of aches and pains", "Less interested in school", "Worries a lot", "Feels hopeless", "Distracted easily", "Takes unnecessary risks", "Blames others for his or her troubles", and "Takes things that do not belong to him or her". Each item is marked "Never, Sometimes, Often" thereby offering a picture of severity and allowing for scoring along a frequency gradient.
Another good example is the Child Behavioral Check List (CBCL). This screening test has versions for children 1.5-5 and for those 6-18; it is completed by a parent or teacher (for the second version). It takes a bit longer to fill out because it covers more areas of a child's life. These include the youth's involvement in sports, hobbies, organizations; the child's friendships and academic performance; and a set of questions (not true, somewhat/sometimes true or very/often true) such as "argues a lot", "fears going to school", "refuses to talk", "headaches, nausea, stomachaches", "nightmares", "accident prone", "too shy or timid", "strange ideas", "vandalism", and "worries".
There are many other screens available to use for different age groups or settings, or that specifically focus on areas of concern, such as ADHD, depression, anxiety and eating disorders. What is most relevant is that we have tools that can help a family, doctor, teacher and even older youth reliably identify problems -- the essential first step to their remediation. It is also critical that services be readily available since identifying a problem without providing access to good treatment adds to the suffering of all involved and is, in fact, clinically irresponsible. We would not detect diabetes, asthma or anemia and then not treat it. The same standard practices of screening and intervening also must exist for emotional and behavioral problems in youth.
A fine example of intervention in pediatric and general practices is Dr. David Kolko's work on behavioral problems in youth*. His work focused on ADHD, anxiety and behavior problems using a PSC-17 screen with 5-12 year olds and their caregivers. Kolko employed a team approach with a care manager and on-site behavioral health services (including therapy and medication) working together with the pediatrician and nursing staff for 6-12 sessions. Some US states (Massachusetts and New York, for example) have developed excellent teaching, consultation and referral programs in which child psychiatrists offer ongoing services to pediatricians, their practices, and the youth and their families they serve.
Starting even earlier with youth in schools in the USA is done by ParentCorps, developed by Dr. Laurie Miller Brotman. This evidence-based program is embedded into schools and has operated successfully in high poverty areas in NYC as part of early childhood education. ParentCorps seeks to "...strengthen home-school connections and help teachers and parents provide high-quality environments that are safe, predictable and nurturing -- to ensure that all students develop the social, emotional and behavioral regulation skills that are the foundation for learning."
Other school interventions, especially for latency and early adolescent youth, involve providing mental health services in school-based health clinics. This arrangement not only offers convenience it helps lessen stigma.
The greatest gift we can give young people is the opportunity for a future. We all have so much to gain from investing in the social and emotional development of the next generation. The Duchess is pointing the way. We would be wise to follow her lead.
Young Minds Matter is a new series designed to lead the conversation with children about mental and emotional health, so youngsters feel loved, valued and understood. Launched with Her Royal Highness, the Duchess of Cambridge, as guest editor, we will discuss problems, causes and most importantly solutions to the stigma surrounding the UK's mental health crisis among children. To blog on the site as part of Young Minds Matter email firstname.lastname@example.org
* PSC-17 or 35; Www.massgeneral.org/psychiatry/service/PSC.home_aspx; Jellinek MS, Murphy JM, Little M, Pagano ME, Comer DM, Kelleher KJ. Use of the Pediatric Symptom Checklist to screen for psychosocial problems in pediatric primary care: a national feasibility study. Arch Pediatr Adolesc Med. 1999;153(3):254-260
* Kolko et al: Collaborative Care Outcomes for Pediatric Behavioral Health Problems, PEDIATRICS, Vol 133, No 4, April 2014
About the author:
The opinions expressed herein are solely my own as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.
My book for families who have a member with a mental illness is The Family Guide to Mental Health Care (Foreword by Glenn Close) -- is now available in paperback. I am completing a book about some secrets of psychiatric practice.
My website is www.askdrlloyd.com