The Child is Father to the Man
By Harold S. Koplewicz, M.D.
Mental illness has a negative impact on many aspects of our lives, no matter our age. It can manifest itself through troubled behavior, such as withdrawal, aggression, temper outbursts, poor school performance; through troubled feelings, for example fearfulness, worries, depression, and through troubled thinking, such as poor judgment, irrational beliefs. However, it is often difficult for parents and school professionals to judge the needs of a child for mental health intervention. This genuine dilemma stems from several sources. For one, most of children’s problems are not strikingly abnormal; rather, they are exaggerations of what we rightfully consider normal. We all get inattentive, restless, cranky, nervous, or blue at times. At what point do these common behaviors and feelings cause concern for our children? Another cause for dismissing or minimizing problems is the expectation that children go through phases, and that current problems are temporary and will pass.
How can we tell when our children need mental health intervention? Several rules of thumb help in determining the need for seeking professional attention for a child. How much do the problems impact on the child’s quality of life? Do they restrict activities that other children her age typically engage in, such as enjoyment of playdates, sleepovers, family activities, social interactions with children his age, looking forward to fun activities? Children spend much of their time in school, so we want to know whether the child is flourishing in this important social and learning environment. Do the child’s academic accomplishments match her intellectual ability? Finally, does the child experience unhappiness or misery on a consistent basis?
Importance of Childhood Mental Health for Adult Adjustment. Children’s mental health problems afflict the child, the family, as well as children’s schoolmates. For anyone who has lived with a child who experiences difficulty, it is easy to appreciate the importance of helping children, and to wish for the search for the best treatments possible. Our children’s happiness and success are clearly a priority. Besides the desire for immediate relief, there are other reasons for us to be concerned. Over the past 10 years, we have accumulated information about the importance of child mental illness on adjustment in adulthood. We now have evidence documenting that trouble in childhood is not regularly a passing phase or a stage. Indeed, for many, the child is father to the man.
We now understand that severe anxiety in childhood is a harbinger of depression and anxiety in later life, that learning disorders don’t just go away, that ADHD places children at risk for antisocial or criminal behavior and substance abuse, that depressed adolescents will much more likely struggle with depression in adulthood than their non-depressed peers. In fact, all adult chronic mental disorders start in childhood. This is not to say that all affected children become affected adults, but they are much more likely to be so than other children.
Importance of Treatment and Prevention. The negative consequences of child mental disorders has made the need for effective treatments all the more important. We have also learned a lot about treatment over the past 10 years. We now have treatments that work in many instances and that hold the hope of reversing ill-fated trajectories from childhood, adolescence into adulthood. Prevention efforts are just beginning, but hold promise.
Yet, most children, in fact the overwhelming majority, do not receive treatment. Many factors account for this sad state of affairs. There is a dearth of mental health professionals well-trained in diagnosis and knowledgeable about a variety of treatments. Cost is also a factor. But, in addition, stigma about mental illness is alive and well. Seeking help is still viewed as shameful, as defining parents as failures, and is pejorative toward the child. We face multiple challenges in reversing these barriers to caring for our children. The focus of this issue of Education Update on children’s mental problems sends the right message. It is a step toward keeping us informed and for us to be diligent in our support to parents and teachers. It also reminds us that we need to enlist the interest of our political representative so that the needs of children are met.#
Dr. Harold S. Koplewicz is the Founder and Director of the NYU Child Study Center.
