I think one of the most difficult parts of my job as a psychiatrist is telling parents and their children that they are not responsible for their illness.
Children with emotional and behavioral problems continue to face significant stigma. Many in the medical community refer to them as “diagnostic and therapeutic orphans.” Unfortunately, access to high-quality mental health services remains difficult for many people.
An accurate diagnosis is the best way to tell whether a person will respond well to treatment; but this can be much more complicated than it seems.
I have written three textbooks on medication use in children and adolescents with emotional and behavioral problems. I know this is never a decision to be taken lightly.
But there is reason to hope. Although it is not possible to medically diagnose any psychiatric condition, dramatic advances in brain imaging, genetics, and other technologies are helping us objectively identify mental illnesses.
Knowing the signs of sadness
We all experience sadness and anxiety occasionally, but persistent problems may be a sign of a deeper problem. Ongoing problems with sleeping, eating, weight, school, and pathological self-doubt may be symptoms of depression, anxiety, or obsessive-compulsive disorder.
It can be difficult to distinguish normal behavior from problem behavior. Emotional and behavioral problems may also vary with age. For example, in pre-adolescent children, depression occurs equally in boys and girls. However, during adolescence, 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 members are not responsible for their mental illness. This is partly because there are no available objective markers of psychiatric illness and it is difficult to detect precisely. Imagine diagnosing and treating cancer based on history alone. Unbelievable! But that’s exactly what mental health professionals do every day. This can make it difficult for parents and their children to accept that they have no control over 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 have your child evaluated by a licensed mental health professional who is experienced in diagnosis and treatment. This is especially important when considering medications that affect the child’s brain.
Characterizing patients is becoming easier thanks to recent advances in genetics, neuroimaging, and mental health science. New technologies may also make it easier to predict who is more likely to respond to a particular treatment or experience the drug’s side effects.
Our laboratory has utilized brain MRI studies to help uncover the anatomy, chemistry, and physiology underlying OCD. This repetitive, ritualistic illness—though sometimes used among ordinary people to describe someone who is nervous—is actually a serious and often devastating behavioral disorder that can paralyze children and their families.
Thanks to the recently introduced advanced, high-field brain imaging techniques such as fMRI and magnetic resonance spectroscopy, we can actually measure children’s brains to see areas of malfunction.
For example, we found that children ages 8 to 19 with OCD were unable to receive a “completely clear signal” from a part of the brain called the anterior cingulate cortex. This signal is essential for you to feel safe and secure. So, for example, people with OCD may keep checking to see if the door is locked or wash their hands repeatedly. There are striking brain abnormalities that return to normal with effective treatment.
We also started a pilot study with a pair of identical twins. One has OCD, the other does not. We found brain abnormalities in the affected twin but not in the unaffected twin. More research is clearly warranted, but the results fit the pattern we found in larger pre- and post-treatment studies of children with OCD 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 be able to identify children at increased genetic risk for psychiatric diseases such as bipolar disorder and schizophrenia.
New, more sophisticated brain imaging and genetics technology actually allows doctors and scientists to see what’s going on in a child’s brain and genes. For example, using MRI, our laboratory discovered that the brain chemical glutamate, which acts as the brain’s “light switch,” plays a critical role in childhood OCD.
When I show parents their child’s MRI brain scans, they often tell me they are relieved and reassured that they “can see it.”
Children with mental illness continue to face tremendous stigma. Families often fear that others will find out if they are hospitalized. They may be hesitant to tell schools, employers, or coaches about the child’s mental illness. They often fear that other parents will not allow their child to spend too much time with a child who has been labeled as mentally ill. Terms like “psychopath” or “going mental” continue to be part of our everyday language.
The example I like to give is epilepsy. Epilepsy once had all the stigma that mental illness has today. In the Middle Ages, it was believed that a person was possessed by the devil. Later, more advanced thought said that people with epilepsy were crazy. Who else other than a crazy person makes every part of his body tremble or urinates and defecates on himself? Most patients with epilepsy were confined to 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 determined not only the diagnosis but also the appropriate treatment.
This is the goal of modern biological psychiatry: to unlock the mysteries of the brain’s chemistry, physiology, and structure. This could help better diagnose and precisely treat childhood-onset mental illnesses. Knowledge always heals, informs and defeats ignorance and stigma.
This article is republished from The Conversation, an independent, nonprofit news organization providing facts and authoritative analysis to help you understand our complex world. Written by David Rosenberg Wayne State University
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David Rosenberg receives funding from the Children’s Hospital Foundation of Michigan, Detroit, MI, and a grant from the National Institute of Mental Health (R01MH59299).