Last year, the Children’s Hospital Association, American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the U.S. Surgeon General declared national emergencies of child and adolescent mental health. The crisis had been brewing for decades but became more apparent with the pandemic as uncertainty, isolation and disruptions to routine and support systems took hold.
“When a child has significant and persistent impairment in multiple areas of their life due to strong distressing emotions, disruptive behaviors or other behavioral concerns, or is having trouble managing distressing thoughts or worries, this often qualifies as a mental health condition,” said Dr. Nasuh Malas, M.D., M.P.H, director of pediatric consultation-liaison psychiatry and service chief for child psychiatry at University of Michigan Health C.S. Mott Children’s Hospital.
These declarations set the stage for what has amounted to a large-scale effort to address child and adolescent mental health in primary care.
“Early intervention can provide meaningful support,” said Malas.
Screening in a primary care setting also creates an opportunity to normalize discussions of emotional and behavioral health and prevent further symptoms and the resulting impairment of function that can happen when a mental illness gets worse.
Make sure when your kids are heading in for their well child visit, they are also being asked about mental health.
Anxiety is kids’ biggest challenge
According to Malas, anxiety is the number one mental health concern kids (and caregivers) bring up to providers, though incidences of other mental illnesses are also increasing.
Anxiety is an innately human experience that may allow us to complete tasks or achieve a high-quality performance when we feel it in small, brief doses – such as stress before a test or speaking with new people.
Usually, this feeling subsides quickly. But when it does not, and the distress is persistent and impacts several areas with reduced functioning, the person likely needs professional support. This may mean counseling/therapy and adjusting demands on them or changing their routine.
In children, mental health challenges including anxiety can result in displays of strong emotions (sadness, loneliness, irritability, outbursts, severe anger or rages, withdrawal), physical changes (muscle tension, headaches, abdominal pain, restlessness, feelings of one’s heart racing and sweating), and may translate to a variety of behaviors including avoidance, tearfulness, withdrawal from activities, panic, aggression, or expressions of fear.
Family histories and personal experiences also play a role, with children of parents with mental health conditions more likely to also suffer from them, and kids who have survived traumatic events being at-risk, too.
Malas stresses that the role of primary care providers is paramount in identifying youth with mental health conditions.
Pediatric guidelines on suicide, depression and anxiety evaluation and management can help bring awareness of ways to prevent, identify and treat mental health conditions early in a child’s life, before they have had major impact on its quality.
How caregivers can help
Kellie Cripe, LMSW, of Ypsilanti, who has experience in child maltreatment, crisis intervention, trauma therapy and management consulting, offers the following advice for parents and caregivers looking to provide support to kids.
“I think it is imperative to start building that comfort level at a very young age,” Cripe said. “Making sure your children know how to identify their emotions and can talk about them is key. As caregivers, we also need to recognize kids’ expression of emotions may have an underlying meaning. For example, a child who acts out in what appears to be anger may be scared and not know how to express that fear. Also, consider the developmental level of your child, and set your expectations accordingly.”
Cripe also reminds caregivers that one of the most important factors in resilience is having at least one close, positive relationship with a parent or other safe adult. This person can also include their primary care doctor.
– Practice your own coping skills so you can model them for your child but also to demonstrate how valuable and important these skills are.
– Offer opportunities to talk privately at a time when the child can listen with full attention and in a space that feels safe and comfortable.
– Create time to engage in meaningful activities to highlight your child’s strengths or provide opportunities for conversation.
– Reach out to community support if the child’s emotions or behaviors are growing more impairing for the child.
– If a child has been diagnosed with a mental illness, it never hurts for parents or caregivers to also receive help and support.
Community mental health resources for local kids and teens
National Alliance on Mental Illness (NAMI) also has a resource page for teens and young adults.