APA Expert Opinion
An APA expert answers common questions about mental health

This month, David Mrazek, M.D. APA member and psychiatrist at the Mayo Clinic in Rochester, Minn., and chair of APA’s Council on Children, Adolescents, and Their Families.

My child seems really out of sorts.  How often do children to have mental health problems? 

Similar to adults, children and teens can suffer from mental health disorders that interfere with how they think, feel and act.  Studies show that one in five children and adolescents may have a diagnosable mental disorder.

Though it seems obvious, try talking to the child or teen and ask if there is anything bothering him or her.  If the child or teen denies that anything is wrong and begins to act in a more normal manner again, continue to be watchful of any unusual behavior which may return.  Also, consider your family history – does anyone have a history of a mood or psychiatric disorder?  If a child or teen is exhibiting symptoms, it is important to seek help. When untreated, mental health disorders can adversely impact the child’s school and family life.  A mental health provider, such as a child and adolescent psychiatrist, will be able to diagnose a mental illness and provide you with treatment options.

If my child might be suffering from depression, what are some of the warning signs I should look for?

Depression, one of the two main mood disorders, can sometimes be difficult to see in children, especially children who are going through puberty.  Teenagers can appear irritable or angry when they are really feeling sad or bored.  With these behaviors can come a loss of interest in favorite activities, in being with friends or in doing things they used to enjoy.  There may also be changes in sleeping, energy level and appetite.  A parent may notice a decrease in work or school performance (e.g., it may take the child or teenager longer to do the same amount of work).  Thoughts of suicide or suicide attempts may also be present in a child or teen suffering from depression.  The important thig to know is that children can and do suffer from depression, but safe, effective treatments are available.

A student at my son’s high school committed suicide.  How should I answer questions my son may have about this tragedy?

It is important for your son to know that you or someone he trusts is available to talk. Adolescence can be a turbulent time. Teenagers deal with a vast array of new experiences during this transitional period, and a considerable number of young people are dealing with depression, an illness with significant long-term consequences, including an increased risk for suicide.

Teens need is to be reassured that they have someone to whom they can turn—be it family, friends, school counselor, physician, or teacher—to discuss their feelings or problems. It must be a person who is very willing to listen and who is able to reassure the individual that it is normal to be angry, confused and sad about this tragedy.

In short, simply taking the time to talk to teenagers about their emotions or problems can help. Let them know help is available.

You can find out more about teen suicide, its warning signs and how to prevent it here.

My child is a bit more active than other children his age.  Does this mean that he has attention-deficit/hyperactivity disorder (ADHD)?

Not necessarily.  Most young children are very active in their early years.  The main features of ADHD include hyperactivity, impulsiveness and an inability to sustain attention or concentration.  These and other symptoms occur at levels far more severe than typically found in children of similar ages and developmental levels.  If you have concerns as to your child’s behavior and he is displaying some of these features, or if you would like more information on ADHD, you should consult your pediatrician or mental health professional.

My daughter is going to summer camp. I was thinking I should give her a break from her medication. Could this create any problems?

If your child has been diagnosed with depression, attention-deficit/hyperactivity disorder (ADHD) or another illness, it's important to work with your child's physician before stopping or starting any medication.  Many studies have demonstrated the importance of keeping a child on medication and on schedule year round as the best way to manage symptoms. In general, symptoms don't take a break and so neither should effective treatment of those symptoms.

If you want to change medications or try reducing the dose you should discuss it with the doctor before making any changes in the dose of your child's medication. Going off medication when a child is at camp and away from parents and her physician is generally not a good idea.  Also, some parents report that a “medication vacation” hurts the child's routine, has a yo-yo effect, or makes the child feel more awkward about their treatment. In the worst cases, if the child's symptoms return full-force, they can feel like a failure.

You can find out more summer camp tips for parents here.

I have heard about the FDA and “black box” warnings on psychiatric medications for children.  Where can I find more information on this?

The American Psychiatric Association (APA), in conjunction with several allied groups, launched a comprehensive Web site, www.ParentsMedGuide.org, in early 2005.  In light of the great deal of information released regarding antidepressants and children, the ParentsMedGuide helps parents understand the information that is available, so that they can make an informed decision about getting the most appropriate care for their child.  The key thing to know about the FDA warnings is that they also acknowledge the risk of not treating depression because, after all, it is untreated depression that carries the greatest risk.  Medications, when part of a comprehensive treatment plan customized to the needs of the child and family, can and do help kids.

How would I find a child psychiatrist?

There are many ways – referrals from your family physician or other parents – but one great way is through the American Academy of Child and Adolescent Psychiatry (AACAP), a voluntary membership organization with over 7,000 of the nation’s child and adolescent psychiatrists, many of whom are also APA members.  You can visit their Web site, www.aacap.org, to find more information on child and adolescent psychiatrists.  When you are ready to locate a doctor in your area, you may search their public psychiatrist finder for a doctor using your own specific search criteria. 

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