Reprinted from the Health District's quarterly publication mailed to district residents (Spring 2004)

It’s not unusual for 4-year-olds to break a toy. For Justin, breaking the windshield of his mother’s car was no child’s play. In a fit of rage, he hurled a plastic apple, shattering the glass right before his mother’s eyes as she drove.

For her, it was a dramatic realization that her son needed help.

“When he would rage, he would be so completely out of control,” his mother says.

Justin, now 9, was eventually diagnosed with bipolar disorder, a neurobiological brain disorder for which he is being treated. With medications, he is stable. He is not alone. More than one in six Colorado children age 8 and younger have emotional and behavioral problems serious enough to disrupt classrooms and distress teachers, a 2000 survey of early childhood programs found.

These problems manifest as depression, anxiety, attention deficit/hyperactivity disorder (ADHD), bipolar disorder and other illnesses. Often they are genetically based. Some are brought on or exacerbated by stress in families, or from abuse or trauma. Left untreated, these disorders put kids at risk for poor academic achievement and social adjustment, and make them more vulnerable to substance abuse and other problems later in life.

Better diagnoses and greater awareness have led to improved mental healthcare for

kids but alone can’t account for a growing prevalence in the diagnosis of mental health issues, including mood disorders such as depression, says Dr. Paula Riggs, child psychiatrist and clinical researcher at the University of Colorado Health Sciences Center.

“Children and adolescents today have a greater burden of stress and family disruption than in decades before,” she says.

The road from diagnosis to treatment is arduous. Telling a difficult temperament from a behavioral disorder can be tough for parents. And once a disorder is identified, parents struggle with acceptance – their own and that of family and friends.

Laura welcomed her son’s bipolar diagnosis as a way to finally get him help. But, like many parents of kids with mental health issues, the Fort Collins mother also felt guilt.

“When the doctor told me it wasn’t my fault, I was so relieved, I cried,” she says, recalling how others suggested she either “wasn’t tough enough” or “was too tough” in handling her son.

Parents do bear responsibility for getting help for their kids, but they shouldn’t shoulder blame.

“If a child has poor eyesight and stumbles into walls, that would be a problem – one that the parent didn’t cause,” says Dr. Tom Linnell, a Fort Collins psychologist who treats children.
“We would take the child to the doctor and get his vision corrected. The parent then would need to make sure the kid wears his glasses.”

Dealing with mental health issues is no different, he says.

Parents often broach the subject with their child’s pediatrician.

“We’re the most appropriate starting point,” says Dr. John Guenther of the Fort Collins Youth Clinic. “As primary-care doctors, we are attuned to a lot of stress that families are having. Examples are parents fighting or divorce, even things the family may not realize is stress, such as moving or starting school. A lot of mental health issues are integral to family environment.”

Identifying the issues involves talking with parents about a child’s developmental history and formal testing where appropriate, says Dr. Michael Griffith, one of two clinical psychologists at the youth clinic.

Parents, more and more, view a mental health specialist as a resource, he says. “Families clearly see the value of checking in with someone (much like they would with a physician during a well-child visit) and asking, ‘Is this normal?’ ”

Fear of having a child labeled with a diagnosis might discourage some parents. A label, if it’s accurate, however, can be helpful, says Dr. Linnell.

“It would give explanation to what’s going on and point the way to lots of resources and literature for parents on what to do,” he says. “A label might also open doors to services, like at school.”

Once a diagnosis is made, says Dr. Riggs, it is paramount for parents to ask questions of the specialist: How was the diagnosis reached? What are the treatment options? What is the risk-benefit of each option and what are the risks of not treating?

“It’s about dialogue between parents and providers and informed consent,” she says.

Some diagnoses in children respond well to medication, while others do not. Many might require a combination of medication and psychotherapy. Dr. Riggs suggests parents consult books and the Internet, in addition to seeking information from providers.

More work is needed to close gaps in access to mental healthcare, to integrate care systems among the medical and mental health professions, and to address insurance woes. But there is progress on the home front.

“The willingness of parents to bring kids for treatment has steadily increased,” Dr. Linnell points out. “Twenty-five years ago, we simply labeled lots of things as behavioral problems, like ‘That kid’s a bad kid.’ Now, we take a closer look. It’s a kid who’s suffering — from depression, anxiety or ADHD, for example.”

As for Justin’s future, his mother Laura can only ponder – and she does.

“I’ve had to re-evaluate my priorities. Suddenly, I’ve had to say: ‘He may not live’ – suicide is a real threat.

“My No. 1 priority is that he lives. You appreciate every day.”

Laura recalls one milestone in particular. On that day, she wrote on her calendar: “Justin said: I love you, Mom.”

“He was 7. It was the first time in his life he said that.”