Pediatric Mental Disorders

Does my child need a psychiatric evaluation?

It can be devastating to learn that your child is physically sick. But discovering that he suffers from a mental disorder adds another layer of confusion and anxiety. Mental disorders are not as well understood as physical disorders, and it is only recently that they have begun to be openly discussed. Add the fact that new diagnoses come up seemingly weekly, along with all the misinformation about the medications used to treat mental disorders, and you have some very confused and worried parents.

You may wonder, aren’t mental disorders only the domain of adults? Unfortunately, no. It might be helpful to consider the numbers. There are approximately 75 million children and teenagers in the country. About one in five young people younger than 18 is thought to suffer from a bona fide mental disorder. That is at least 15 million of our youth. The majority of young people with mental disorders suffer from some form of anxiety (separation fears, panic disorder, obsessive-compulsive disorder), disruptive behavior disorders (attention deficit disorder, oppositional defiant disorder, conduct disorder), and mood disorders (depression, bipolar disorder).

It’s natural to ask ourselves as parents, “What went wrong?” and, “Could I have prevented this from happening?” This is a difficult issue, as there is evidence that mental disorders usually stem from a combination of sources. The truth is no one really knows the exact cause of mental disorders. However, there are at least four factors— two internal and two external— that contribute to some degree in their development.

Internal Causes

  1. Genes: There is evidence of some psychiatric problems running in families, but not as much as some may think.
  2. Neurotransmitter Chemicals: These chemicals in our nervous system are concerned with the transmission of nervous impulses and have been implicated as being out of balance in the bodies of those with a mental disorder. This has never been proven, and no chemical imbalance has ever been shown to be a direct cause of a mental disorder despite many specialists saying so. These neurotransmitters are often identified as being the chemicals which psychotropic drugs act upon. Maybe someday we will know more about the details of these neurotransmitters, as well as if and how they cause mental disorders. But for now, we have to be content with knowing that many of them are treatable.

External Causes

  1. Severe Trauma: Physical or sexual abuse, neglect, or other severe events, such as losing one’s family members, are known to contribute to a higher rate of mental disorder. The majority of victims of these events don’t necessarily develop a mental disorder.
  2. Parenting: Parents or caregivers influence a child’s development. And while we do know that parents’ ways often lend to a child’s behavior, there is still not ample evidence to absolutely correlate a particular parenting style with the development of a specific disorder.

At some point you might find it necessary to get a psychiatric evaluation for your child. The suggestion might come from a teacher, a therapist, or even you. You can usually find a child and adolescent psychiatrist through a pediatrician, school personnel, clergy, or a friend whose child has also needed help. If all else fails, call a local mental health association or hospital for direction. If a consultation seems necessary, the psychiatrist usually sees the parent(s) before seeing the child.

During the initial sessions with a psychiatrist, you are asked many questions about why you are seeking consultation for your child. The doctor covers the patient’s behavior, moods, learning, thinking, family relations, physical health, current medications, unusual habits, isolation, anger, anxiety, regression to immature behaviors, interpersonal difficulties, behavioral problems at home or school, or self-destructive behaviors. The physician then asks about your potential problems, the family constellation, and other siblings who might have issues. A history of previous therapies, medications, and possible hospitalizations will be asked for, as well.

By the end of what might seem an exhaustive questioning period, the psychiatrist has a good idea about the child and members of the family. At this point, you might simply get reassurance that the problem seems minor, if not just a passing phase, and be given some informed advice to help clear the road of your child’s development. You will be asked to call back and give the doctor a follow up. At other times, the psychiatrist may decide that it is necessary to see the child on an ongoing basis.