When are mood swings, temper tantrums, and aggressive behavior the sign of pediatric bipolar disorder, and when are they just normal development? When is the desire to spend time alone a sign of shyness, and when is it a hallmark of early onset depression? How can a parent find the right expert to help him decide whether to treat his child with antidepressants that have been designed for and tested on adults, not children?
The difficulty in answering questions like these, according to experts at the National Alliance on Mental Illness (NAMI), is exacerbated by the inability of many children to describe or express their emotions, and the paucity of experts in pediatric psychiatry. Below, we've adapted NAMI's 10 steps to help parents and their health-care providers make an accurate diagnosis of mental illness.
1. Record keeping
Organize and keep accurate records related to your childs emotional, behavioral, social, and developmental history. The records should include observations of the child at home, in school, and in the community. They should be shared with the childs treating provider to help in making a diagnosis. The records should include the following information:
- Primary symptoms, behaviors, and emotions of concern
- A list of the childs strengths
- A history of when the child first talked, walked, and developed social skills
- A complete family history of mental illness and substance use disorders (many mental illnesses run in families)
- Challenges the child is facing with school, social-skill progression, developmental milestones, behaviors, and emotions
- The times of day or year when the child is most challenged
- Interventions and supportsincluding therapy, medication, residential or community services, hospitalization, and morethat have been used to help the child, and their effectiveness
- Settings that are most difficult for the child (e.g., school, home, social situations)
- Any major changes or stresses in the childs life (e.g., divorce, death of a love one)
- Factors that may act as triggers or worsen the childs behaviors or emotions
- Significant mood instability or disruptive sleep patterns
Families know their child best and their expertise is essential in securing an accurate diagnosis for their child.
2. Comprehensive physical examination
To make an accurate diagnosis, it is important to start the process with the child's primary care physician. A comprehensive physical examination should be done to rule out other physical conditions that may be causing a childs symptoms.
3. Co-occurring conditions
Your child should be evaluated for co-occurring conditions, like learning disabilities, sensory integration problems, and other physical and mental disorders that may cause behavioral problems or poor school performance. If you suspect that a co-occurring condition is affecting your childs ability to learn, ask the school to perform a psycho-educational evaluation.
4. Specialists in childrens mental health
After other physical conditions and learning disabilities are evaluated, it is time to meet with a qualified mental health provider. Your childs primary care physician may be able to refer you to a mental health professional. You can also ask for referrals from families involved with NAMI or other advocacy organizations. To find a child psychiatrist, visit the American Academy of Child and Adolescent Psychiatry website, and search under its child-and-adolescent-psychiatrist-finder tool.
5. The diagnostic and evaluation process
A medical diagnostic toollike a blood test, MRI scan, or X-raythat will identify mental illnesses in children has not yet been developed. Your childs diagnosis should be made based on professional observation and evaluation, information provided by your family and other experts, and the criteria found in the latest version of the Diagnostic and Statistical Manual of Mental Disorders. This evaluation should include a comprehensive look at all aspects of your childs life in school, with family and friends, and in the community. The provider who evaluates your child is likely to ask you to fill out a checklist that provides a detailed profile of your child and the challenges your child is facing.
6. Adjustments in the diagnosis
It may take several visits with a mental health professional before a diagnosis is made. The diagnosis may also change as new symptoms emerge or existing symptoms change. A diagnosis must be confirmed over time, and thus, an ongoing two-way communication between the treating provider and the family is necessary to track and monitor the childs condition and progress. Families should not hesitate to seek a second opinion if they are not confident in their childs evaluation and the diagnostic process. Getting a second opinion can be challenging because of the shortage of childrens mental health providers.
7. Effective interventions and outcomes
If a diagnosis continues to change or cannot be reached right away, it is still important to focus on effective interventions to address the childs symptoms. The goal should be to achieve the outcomes that are most important to the child and family.
8. Working with the school
Families should work with the school to identify effective interventions, accommodations, and supports that promote positive behaviors and academic achievement, and prevent challenging behaviors. Families should ask their childs treating provider to identify interventions that can be used at school and at home to help a child acquire positive behaviors and academic achievement.
9. Service and support options
Ask your childs treating provider to recommend effective psychosocial interventions, skills training, support groups, and other options that can help your child cope with symptoms and develop the skills necessary to ultimately lead a full and productive life.
10. The importance of families
Never underestimate the importance of working with other families. There are many seasoned families who have walked the walk and are happy to share their wisdom and experience with families attempting to secure an accurate diagnosis and effective services for their child.
For some children, having a diagnosis is scary, and they may be resistant to accept it. Others are relieved to know that what is happening to them is caused by an illness, that they are not alone, and that there are treatment options that can make them feel and do better. It is important to find ways to use the strengths and interests of your child to help him or her cope with difficult symptoms. Benefits are often derived from aerobic exercise, martial arts, music, and fine artswhatever it takes to provide your child with a therapeutic outlet. The diagnosis is one piece of a much larger puzzle.