The following information comes from the National Institute of Mental Health and has been modified to be applicable to homeschool settings.
Research shows that half of all lifetime cases of mental illness begin by age 14. Scientists are discovering that changes in the body leading to mental illness may start much earlier, before any symptoms appear.
Through greater understanding of when and how fast specific areas of children’s brains develop, we are learning more about the early stages of a wide range of mental illnesses that appear later in life. Helping young children and their parents manage difficulties early in life may prevent the development of disorders. Once mental illness develops, it becomes a regular part of your child’s behavior and more difficult to treat. Even though we know how to treat (though not yet cure) many disorders, many children with mental illnesses are not getting treatment.
This fact sheet addresses common questions about diagnosis and treatment options for children with mental illnesses. Disorders affecting children may include anxiety disorders, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, bipolar disorder, depression, eating disorders, and schizophrenia.
Q. What should I do if I am concerned about mental, behavioral, or emotional symptoms in my child?
A. Talk to your child’s doctor or health care provider. Ask questions and learn everything you can about the behavior or symptoms that worry you. If your child is in any co-op classes ask the teacher if your child has been showing worrisome changes in behavior. Share this with your child’s doctor or health care provider. Keep in mind that every child is different. Even normal development, such as when children develop language, motor, and social skills, varies from child to child. Ask if your child needs further evaluation by a specialist with experience in child behavioral problems. Specialists may include psychiatrists, psychologists, social workers, psychiatric nurses, and behavioral therapists.
If you take your child to a specialist, ask, “Do you have experience treating the problems I see in my child?” Don’t be afraid to interview more than one specialist to find the right fit. Continue to learn everything you can about the problem or diagnosis. The more you learn, the better you can work with your child’s doctor and make decisions that feel right for you, your child, and your family.
Q. How do I know if my child’s problems are serious?
A. Not every problem is serious. In fact, many everyday stresses can cause changes in your child’s behavior. For example, the birth of a sibling may cause a child to temporarily act much younger than he or she is. It is important to be able to tell the difference between typical behavior changes and those associated with more serious problems. Pay special attention to behaviors that include:
- Problems across a variety of settings, such as at your homeschool co-op, at home, or with peers
- Changes in appetite or sleep
- Social withdrawal, or fearful behavior toward things your child normally is not afraid of
- Returning to behaviors more common in younger children, such as bed-wetting, for a long time
- Signs of being upset, such as sadness or tearfulness
- Signs of self-destructive behavior, such as head-banging, or a tendency to get hurt often
- Repeated thoughts of death.
Q. Can symptoms be caused by a death in the family, illness in a parent, family financial problems, divorce, or other events?
A. Yes. Every member of a family is affected by tragedy or extreme stress, even the youngest child. It’s normal for stress to cause a child to be upset. Remember this if you see mental, emotional, or behavioral symptoms in your child. If it takes more than one month for your child to get used to a situation, or if your child has severe reactions, talk to your child’s doctor.
Check your child’s response to stress. Take note if he or she gets better with time or if professional care is needed. Stressful events are challenging, but they give you a chance to teach your child important ways to cope.
Q. How are mental illnesses diagnosed in young children?
A. Just like adults, children with mental illness are diagnosed after a doctor or mental health specialist carefully observes signs and symptoms. Some primary care physicians can diagnose your child themselves, but many will send you to a specialist who can diagnose and treat children.
Before diagnosing a mental illness, the doctor or specialist tries to rule out other possible causes for your child’s behavior. The doctor will:
- Take a history of any important medical problems
- Take a history of the problem – how long you have seen the problem – as well as a history of your child’s development
- Take a family history of mental disorders
- Ask if the child has experienced physical or psychological traumas, such as a natural disaster, or situations that may cause stress, such as a death in the family
- Consider reports from parents and other caretakers or teachers.
Very young children often cannot express their thoughts and feelings, so making a diagnosis can be challenging. The signs of a mental illness in a young child may be quite different from those in an older child or adult.
As parents and caregivers know, children are constantly changing and growing. Diagnosis and treatment must be viewed with these changes in mind. While some problems are short-lived and don’t need treatment, others are ongoing and may be very serious. In either case, more information will help you understand treatment choices and manage the disorder or problem most effectively.
While diagnosing mental health problems in young children can be challenging, it is important. A diagnosis can be used to guide treatment and link your child’s care to research on children with similar problems.
Q. Will my child get better with time?
A. Some children get better with time. But other children need ongoing professional help. Talk to your child’s doctor or specialist about problems that are severe, continuous, and affect daily activities. Also, don’t delay seeking help. Treatment may produce better results if started early.
Q. Are there treatment options for children?
A. Yes. Once a diagnosis is made, your child’s specialist will recommend a specific treatment. It is important to understand the various treatment choices, which often include psychotherapy or medication. Talk about the options with a health care professional who has experience treating the illness observed in your child. Some treatment choices have been studied experimentally, and other treatments are a part of health care practice. In addition, not every community has every type of service or program.
Q. What are psychotropic medications?
A. Psychotropic medications are substances that affect brain chemicals related to mood and behavior. In recent years, research has been conducted to understand the benefits and risks of using psychotropics in children. Still, more needs to be learned about the effects of psychotropics, especially in children under six years of age. While researchers are trying to clarify how early treatment affects a growing body, families and doctors should weigh the benefits and risks of medication. Each child has individual needs, and each child needs to be monitored closely while taking medications.
Q. Are there treatments other than medications?
A. Yes. Psychosocial therapies can be very effective alone and in combination with medications. Psychosocial therapies are also called “talk therapies” or “behavioral therapy,” and they help people with mental illness change behavior. Therapies that teach parents and children coping strategies can also be effective.2
Cognitive behavioral therapy (CBT) is a type of psychotherapy that can be used with children. It has been widely studied and is an effective treatment for a number of conditions, such as depression, obsessive-compulsive disorder, and social anxiety. A person in CBT learns to change distorted thinking patterns and unhealthy behavior. Children can receive CBT with or without their parents, as well as in a group setting. CBT can be adapted to fit the needs of each child. It is especially useful when treating anxiety disorders.
Additionally, therapies for ADHD are numerous and include behavioral parent training and behavioral classroom management. Visit the NIMH Web site for more information about therapies for ADHD.
Some children benefit from a combination of different psychosocial approaches. An example is behavioral parent management training in combination with CBT for the child. In other cases, a combination of medication and psychosocial therapies may be most effective. Psychosocial therapies often take time, effort, and patience. However, sometimes children learn new skills that may have positive long-term benefits.
Q. What special challenges can homeschool co-ops or outside classes present?
A. If your child is in a homeschool co-op or taking some classes at public or private school, each school year might bring a new teacher and new schoolwork. This change can be difficult for some children. Inform any new teachers that your child has a mental illness when he or she starts school or moves to a new class. Additional support will help your child adjust to the change.
Q. What else can I do to help my child?
A. Children with mental illness need guidance and understanding from their parents and teachers. This support can help your child achieve his or her full potential and succeed in school. Before a child is diagnosed, frustration, blame, and anger may have built up within a family. Parents and children may need special help to undo these unhealthy interaction patterns. Mental health professionals can counsel the child and family to help everyone develop new skills, attitudes, and ways of relating to each other.
Parents can also help by taking part in parenting skills training. This helps parents learn how to handle difficult situations and behaviors. Training encourages parents to share a pleasant or relaxing activity with their child, to notice and point out what their child does well, and to praise their child’s strengths and abilities. Parents may also learn to arrange family situations in more positive ways. Also, parents may benefit from learning stress-management techniques to help them deal with frustration and respond calmly to their child’s behavior.
Sometimes, the whole family may need counseling. Therapists can help family members find better ways to handle disruptive behaviors and encourage behavior changes. Finally, support groups help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.
Q. How can families of children with mental illness get support?
A. Like other serious illnesses, taking care of a child with mental illness is hard on the parents, family, and other caregivers. Caregivers often must tend to the medical needs of their loved ones, and also deal with how it affects their own health. The stress that caregivers are under may lead to missed work or lost free time. It can strain relationships with people who may not understand the situation and lead to physical and mental exhaustion.
Stress from caregiving can make it hard to cope with your child’s symptoms. One study shows that if a caregiver is under enormous stress, his or her loved one has more difficulty sticking to the treatment plan.4 It is important to look after your own physical and mental health. You may also find it helpful to join a local support group.
Q. Where can I go for help?
A. If you are unsure where to go for help, ask your family doctor. Others who can help are listed below.
- Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
- Health maintenance organizations
- Community mental health centers
- Hospital psychiatry departments and outpatient clinics
- Mental health programs at universities or medical schools
- State hospital outpatient clinics
- Family services, social agencies, or clergy
- Peer support groups
- Private clinics and facilities
- Employee assistance programs
- Local medical and/or psychiatric societies.
You can also check the phone book under “mental health,” “health,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.