When a child is diagnosed with a mental health disorder, it is a frightening and confusing experience both for the child and his or her parents. By the time the child has received a clinical identification of an emotional or mental program, there has been a time of confusion, frustration, and anger that has already occurred prior to the new label. Parents can be both relieved, to have a name for the there child's problem, and upset, to hear that their child has a disorder.
This can become more complicated when mental health professionals use
large, undefined words to describe a child's problem. This use of psychological and diagnostic terminology can make parents feel stupid or foolish, so much so, that they may be afraid to ask what it all means. The result is parents who feel as if they are a failure. They may also feel powerless to cope with their child's mental health disorder.
Child Development and Diagnosis
Understanding the role that child development plays in childhood mental health disorder will help parents understand how it is diagnosed. Child development provides a standard that the parent and the professional can use to assess and diagnose a childhood mental health disorder. Although child development differs from one child to the next, all children go through similar stages.
Children grow at unique rates: physically, emotionally, socially, and mentally. One child may excel in the area of social skills and lack physical grace. Another child may have superior coordination but poor academic proficiency. Development is a fluid process, carrying the child along at different paces. The magic of this fluidity is that children will "catch-up" to other children if they have minor delays. Usually, no outside help is needed in these cases. Another child, with larger discrepancies, will need interventions to "catch-up" to their peers. On the ladder of child development, these latter children will need a "leg up" in order to reach the next step of development. That is where parents and professional, working together, come in.
Another developmental issue occurs when a disorder, in one area of a child's development, affects other areas of functioning, in the child's development. For example, a child experiencing depression (an emotional developmental area) may have physical complaints (i.e., headaches, stomachaches, or fatigue), academic difficulties (poor grades, no motivation) and social skills deficits (few friends, withdrawn, antisocial). It is important that the mental health professional pays attention to developmental variations and helps the parent understand how one area can affect another.
Finally, child development is dynamic and purposeful. Children have a natural curiosity and an even wider capacity for growth and change. This is good news for parents. This capacity allows children to regenerate and heal from childhood traumas that lead to disorders. It is the ally parents and professionals count on to make effective interventions and allow the child to have a normal, healthy life. What this means, in the area of childhood mental health disorders, is that children and their disorder, can change over time. In fact, they are developmentally driven to change. It is the parents and the professional's job to help steer children in the right directions.
A "Tangled Ball of String"
The origins of childhood mental health disorders are complex. In some cases, such as Post-Traumatic Stress Disorder, cause is fairly straightforward. A child is a victim or witness of a crime or severe accident, shows signs of sleep disturbances, nightmares, and flashbacks, and is given the proper diagnosis (in this case PTSD). Other disorders are not so clear. They are clouded by biological, familial, cultural, interpersonal, and socioeconomic factors, all of which might play a part in the child's diagnoses. A good metaphor for this complexity is a large, tangled ball of string. It is hard to know on which part of the string to pick at to untangle the ball. It might require that you work on various parts of the string, at multiple angles, to unravel the problem.
One important string, connected to the well being of the child, is his or her family. Disorders affect members of the family and are affected by those same members. This is why professionals will say that the family is a system and that the treatment for the disorder may require that all members of that family system be involved, even if they do not have the disorder. As such, the family system may increase or decrease the symptoms of the childhood mental health disorder; much the way a heating systems thermostat regulates the room's temperature. Too hot and the heat shuts off. Too cold and the heat turns on.
Conversely, family members can be affected by another member's mental health disorder. A common example occurs when one child in a home takes a large chunk of a parent's time and energy (not to mention finances) to help the child cope with his of her disorder, leaving the other children in the home feeling ignored. Resentment, anger, and aggressive behaviors are typical in siblings of children with mental health disorders and often, must be addressed by the professional working with the family.
DSM-IV: The Diagnoses Bible
When professionals diagnose a child, they use a book called the Diagnostic and Statistical Manual of Mental Disorders (or DSM). The book is divided into sections for adult mental health disorders and "disorders usually first evident in infancy, childhood, or adolescence." Professionals use this book to communicate with one another (and insurance companies) about childhood mental health disorders. It is a classification system for understanding and labeling the defining features of childhood mental health disorders.
The DSM defines a mental health disorder "as a clinically significant behavioral and psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one of more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom."
Stated simply, a mental health disorder is a problem that affects a child's ability to function in his or her world. An important note, made by the DSM, is that a classification is not about classifying the person or child by his or her mental health disorder. This clarification can have profound effects on the self-image of the child. Being a problem and having a problem are very different things and create very different reactions from others.
Mental health professionals make a diagnosis, based on the classifications listed in the DSM, on five axes or levels of diagnoses. Axis I is used for Clinical Disorders or Other Conditions That May Be a Focus of Clinical Attention. Axis II is used for the listing of Personality Disorders and Mental Retardation. Axis III describes the General Medical Conditions. Axis IV is used for Psychosocial and Environmental Problems. And Axis V is the Global Assessment of Functioning. This multiaxial system provides for a comprehensive format for organizing and describing a child's disorder.
Information and Support
Perhaps the most important thing a parent can do when their child has been diagnosed with a mental health disorder is to get as much information on the topic as possible and find a support group for parents of children with this diagnosis. This will reduce a lot of the anxiety and myths about the diagnosis.
Parents can find information by taking a ride to their local library, searching their local bookstores, and browsing the Internet. At first, parents will fell overwhelmed or even refuse to look at the information. This is normal and will usually pass with time. If a parent chronically refuses to look at any information on the topic they may need the help and support of other parents to deal with this frightening change in their lives. Don't try to force or guilt a parent into research their child's diagnosis. Compassion and patience is needed at this time.
Support groups are helpful to parents of children diagnosis with a mental health disorder. These groups can help normalize the diagnosis by parents who "have already been there and done that" with the diagnosis. They can help the new parent advocate for their child's rights with the schools and health agencies. They are available to for hold up and sustain the parent when the emotional burden becomes too great to bear on their own.
Working with a Professional
Most likely a parent will work with the professional that diagnosed his or her child. But when this is not the case, for instance when the child has been diagnosed by a school psychologist or general, family physician, the parent will have to find a qualified professional that they feel comfortable with.
Parents should ask the referring professional for recommendations on who can help treat the child and the family. Parents can also talk to members of their support groups and review the materials they have gathered online and offline as to the most appropriate type of interventions and therapists for their child's diagnosis. If parents have no particular names to contact, look in the local listings for professionals in the parents living area and contact two or three likely candidates. Ask to interview one or two that appear knowledgeable and experienced with the child's disorder. The decision of a professional working with a child is not an easy one and should be considered patiently and wisely. Take time to research location, price, availability, and background. Feel free to ask for references. This involves a child's well being and should be handled carefully. Once a professional has been chosen, work closely with that person on the needs of the child. Every professional has a different way of handling parent/child interaction and consultations in therapy. Some will meet individually with parent and child. Others will want to meet together. Talk about the reasoning behind both approaches. Either way, parents need to be involved as they are the central agents in their child's life.
Having a child diagnosed with a mental health disorder is a crushing experience, even in the best of circumstances and with the best of medical and therapeutic help. Parents will need to understand all of the issues that are involved with the child's disorder, including development, diagnosis, and treatment techniques. Finding information, support, and a qualified professional will be helpful as parents navigate the stormy waters of diagnosis and treatment. With this help, they should be able to find calmer and safer times in their lives.
About the Author
Ron Huxley is a licensed child and family therapist in Fresno, California. His web site offers parents free advice, resources, and tools for coping with mental health disorders and other difficult parenting issues. Ron is available for private consultation and seminars on parenting and mental health issues. You can contact him at firstname.lastname@example.org
* Diagnostic And Statistical Manual Of Mental Disorders - Fourth Edition (1994). American Psychological Association, Washington, D.C.