by As a psychiatrist, I find that one of the hardest parts of my job is telling parents and their children that they are not to blame for their illnesses.
There continues to be a significant stigma attached to children with emotional and behavioral problems. Many in the medical community refer to them as “diagnostic and therapeutic orphans.” Unfortunately, for many, quality mental health care remains inaccessible.
Accurate diagnosis is the best way to determine whether or not someone will respond well to treatment, although that can be a lot more complicated than it seems.
I have written three textbooks on the use of medication in children and adolescents with emotional and behavioral problems. I know this is not a decision to take lightly.
But there is reason for hope. Although no psychiatric condition can be medically diagnosed, significant advances in brain imaging, genetics and other technologies are helping us to objectively identify mental illness.
I know the signs of grief
We all experience sadness and worry from time to time, but persistent problems may be a sign of a deeper issue. Persistent problems with sleep, eating, weight, school and pathologic self-doubt may be symptoms of depression, anxiety or obsessive-compulsive disorder.
Separating normal behavior from problem behavior can be challenging. Emotional and behavioral problems can also change with age. For example, depression in pre-adolescent children occurs equally in boys and girls. During adolescence, however, rates of depression increase much more among girls than boys.
It can be very difficult for people to accept that their mental illness is not to blame for them – or their loved ones. This is partly because there are currently no objective markers for psychiatric illness, making it difficult to pin down. Imagine diagnosing and treating cancer based on history alone. Unbelievable! But that is exactly what mental health professionals do every day. This can make it harder for parents and their children to accept that they are not in control of the situation.
Fortunately, there are now excellent online tools that can help parents and their children screen for common mental health issues such as depression, anxiety, panic disorder and more.
Most important of all is to make sure the assessment is done by a licensed mental health professional experienced in the diagnosis and treatment of children. This is especially important when considering medications that affect the child’s brain.
Thanks to recent developments in genetics, neuroimaging and mental health science, it is becoming easier to characterize patients. New technologies may also make it easier to predict who is more likely to respond to a particular treatment or to cope with the side effects of a medication.
Our lab has used brain MRI studies to help unravel the basic anatomy, chemistry and physiology underlying OCD. This repetitive, ritualistic illness – though sometimes used in layman’s terms to describe someone who is upright – is a serious and often devastating behavioral illness that can paralyze children and their families.
Through sophisticated high-field brain imaging techniques – such as fMRI and magnetic resonance spectroscopy – that have recently become available, we can actually measure the child’s brain to see areas of dysfunction.
We found, for example, that children between the ages of 8 and 19 with OCD do not receive the “all clear signal” from a part of the brain called the anterior cingulate cortex. This sign is necessary to feel safe and secure. This is why, for example, people with OCD may keep checking that the door is locked or washing their hands over and over again. They have striking brain abnormalities that seem to normalize with effective treatment.
We have also started a pilot study with identical twins. One has OCD and the other does not. We found brain abnormalities in the affected twin, but not in the unaffected twin. More studies are clearly needed, but the results fit the pattern we have found in larger studies of children with OCD before and after treatment compared to children without OCD.
Brain MRI is exciting and genetic findings are also being 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 be able to identify children at increased genetic risk for psychiatric illnesses such as bipolar disorder and schizophrenia.
New and more sophisticated genetics and brain imaging technology allows doctors and scientists to see what is going on in a child’s brain and genes. For example, using MRI, our lab discovered that the brain chemical glutamate, which acts as the brain’s “light switch,” plays a critical role in childhood OCD.
When I show families their child’s MRI brain scans, they often tell me that they are relieved and relieved “to be able to see it.”
There continues to be a huge stigma attached to children with mental illness. Often when they are in hospital, families are afraid that others will find out. They may be reluctant to inform schools, employers or coaches about a child’s mental illness. They are often afraid that other parents will not want to allow their children to spend too much time with a child who is labeled mentally retarded. Terms such as “psycho” or “mentally” remain part of our everyday language.
The example I like to give is epilepsy. Epilepsy has had all the stigma associated with mental illness today. In the Middle Ages, one was considered possessed by the devil. Then, a more advanced idea said that people with epilepsy were crazy. Who else would shake all over their body or urinate and defecate themselves but a crazy person? Many patients with epilepsy were locked up in lunar asylums.
Then in 1924, psychiatrist Hans Berger discovered something called the electroencephalogram (EEG). This showed that the epilepsy was caused by electrical abnormalities in the brain. The specific location of these abnormalities led not only to the diagnosis but to the appropriate treatment.
That is the goal of modern biological psychiatry: to unlock the mysteries of brain chemistry, physiology and structure. This can help to accurately diagnose and treat childhood mental illness. Knowledge cures and overcomes ignorance and stigma every time.
This article is republished from The Conversation, a non-profit, independent news organization that brings you reliable facts and analysis to help you make sense of our complex world. 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).
