June 1, 2016  — Categorized in: ,

#WriteOnSarah: Mental Illness in Children – Invisible Until You Look

WORRY0011451454310Sarah Vander Schaaff is a writer, blogger and a mother of two from New Jersey, who has struggled with Obsessive-compulsive disorder for as long as she can remember. Her courageous column in the Washington Post (“Obsessive –compulsive disorder nearly ruined her life”, January 4th) received international attention for its honesty and openness. This is the first blog in a regular series for Sarah who will write about the mental health challenges we all face in day to day life.

Childhood is supposed to be easy, right?

As a mother, and someone interested in the mental health of families, I think childhood is tough. It’s full of vulnerable moments. I heard a good description recently from Kevin Kling:

Remember being a kid? We danced with all we have. We wore Superman outfits to the grocery store. As children we are closer in time to the Creator.”

It seems there’s an inherent conflict in being that receptive to life and so dependent on others. When you add the physical and psychological changes that come with each year, it’s no surprise children confront mental health challenges that are just as real and painful as those we grown-ups face.

In fact, over half of all lifetime cases of mental illness begin by age 14, according to the National Institute of Mental Health. And anxiety, which is common among children, can be identified at very young ages. Researchers at the University of British Columbia asked parents of kindergarteners: Is your child more shy or anxious than other children his or her age? Is your child more worried than other children his or her age?

If parents answered “yes” to either question, there was a high degree of predictability that the child would develop an anxiety disorder, according to the article in Canada’s Globe and Mail published in 2012.

But the process of seeing signs and seeking outside help is not always clear. Parents whose children suffer from anxiety often have it themselves. And children who are anxious to please are not disruptive in the classroom. But I think one of the biggest challenges is that we see so much of our children’s behavior as a reflection of our parenting skills. Sometimes, we need to expand our view.

I asked a mom to explain how she came to understand the signs of anxiety in her daughter.

“I guess the question is when did I start to acknowledge that she had “anxiety” and was more than just a normal worrier.

She was always hyper-aware, even as an infant, and as soon as she could communicate that she was afraid of something she did. For example, when I left a room, she became clingy, afraid that I would never come back.  Or when she saw a green-faced witch on a TV show, she was afraid that it was going to come “get her.”

But, at that time we felt that her worries were within normal limits. It wasn’t until elementary school that her fears and worries seemed irrational…beyond what I felt was “normal.” Having suffered with anxiety myself, I was acutely aware of her suffering and the snowball-effect.  But I wasn’t immediately sure how to help without making her worry more.

We sought out a cognitive therapist and she was immensely helpful. She taught me coping strategies and I shared them with my daughter. For example, when my daughter is in the midst of an anxiety spiral because she can’t fall asleep, I ask her, “What’s the worst that will happen if you can’t fall asleep?” She answers, “I’ll be tired tomorrow.” I say, “What happens if you’re tired tomorrow?” She answers, “I won’t get my work done at school or I’ll be too tired to be a good student in class and will fail my math test.” I respond with “What happens if you fail your math test?”… and so on.

Basically, she realizes that the world won’t end if she doesn’t sleep. This works like a charm every time! I hope that one day she will get to a point of being able to have this conversation with herself (without my help), but for right now…I’m happy with these small successes.”

Dr. Jess Shatkin, Professor of Child and Adolescent Psychiatry and Pediatrics at NYU School of Medicine and Vice Chair for Education at The Child Study Center at NYU, created a breakdown of four key factors for distinguishing normal worry from an Anxiety Disorder in children:

  1. Object: Is this something a child of this age should be worrying about?
  2. Intensity: Is the degree of distress unrealistic given the child’s developmental stage and the object/event?
  3. Impairment: Does the distress interfere with the child’s daily life?
    • Social functioning: unable to make friends
    • Academic functioning: failing classes
    • Family functioning: creating conflicts, limiting family choices
  4. Ability to Recover/Coping Skills: Is the child able to recover from distress when the event is not present?
    • Tend to worry about future occurrences of event/object
    • Distress occurs across multiple settings

In 2013, the CDC published an overview of Mental Health Surveillance among children. They estimate that 13%-20% of children living in the US experience a mental disorder in a given year and found evidence of an increase in hospitalizations.

In a time when we are greatly concerned for our children’s ability to thrive in the global economy and shifting American landscape—with headlines announcing national anxiety, increased substance abuse, and lost productivity—let’s look at this finding:

…mental disorders in children are associated with an increased risk for mental disorders in adulthood…”

Like the parents of those kindergartners surveyed, we need to take an honest look at our children, recognize their very real symptoms of mental illness, and find the experts who can help them manage.

So much of mental illness is invisible. It’s up to us to start looking.


If you have a question or topic you’d like to discuss with @writeonsarah, please email writeonsarah@dev-mha-vibrant.pantheonsite.io or leave a comment below.

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