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A Parents' Guide to Childhood Mental Health Disorders: Understanding Diagnosis

By Ron Huxley, LMFT

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When a child is diagnosed with a mental health disorder, it is a frightening and confusing experience both for the child and his or her parents. This can become more complicated when mental health professionals use large, undefined words to describe a child's problem. This use of psychological and diagnostic terminology can make parents feel stupid or foolish, so much so, that they may be afraid to ask what it all means. The result is parents who feel as if they are a failure. They may also feel powerless to cope with their child's mental health disorder.

Introduction

This guide is intended to help parents with the complex issue of childhood mental health disorders. Specifically, it is designed to help parents be more knowledgeable about and make decisions regarding their child's mental health disorder.
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The information here touches on only part of the complex issue of childhood mental health disorders. For the sake of simplicity, much was left out to keep the information focused on the needs of parents. In addition, not all researchers and clinicians agree on the best way to understand and treat childhood mental health disorders. As such, I can only write about what has worked for myself, as a professional, and what appears to be most helpful for the parents I have worked with. For a greater discussion on childhood mental health disorders, please join the free Parents Work Bench at http://www.egroups.com/list/parents_work_bench or mailto:parents_work_bench-subscribe@egroups.com

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Children grow at unique rates: physically, emotionally, socially, and mentally. One child may excel in the area of social skills and lack physical grace. Another child may have superior coordination but poor academic proficiency. Development is a fluid process, carrying the child along at different paces. The magic of this fluidity is that a child will "catch-up" to other children if they have minor delays. Usually, no outside help is needed in these cases. Another child, with larger discrepancies, will need interventions to "catch-up" to their peers. On the ladder of child development, these latter children will need a "leg up" in order to reach the next step of development. That is where parents and professional, working together, come in.



Child Development and the Diagnoses of Childhood Mental Health Disorders

Understanding the role that child development plays in childhood mental health disorder will help parents understand how it is diagnosed. Child development provides a standard that the parent and the professional can use to assess and diagnose a childhood mental health disorder. Although child development differs from one child to the next, all children go through similar stages.

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Another developmental issue occurs when a disorder, in one area of a child's development, affects other areas of functioning, in the child's development. For example, a child experiencing depression (an emotional developmental area) may have physical complaints (i.e., headaches, stomachaches, or fatigue), academic difficulties (poor grades, no motivation) and social skills deficits (few friends, withdrawn, antisocial). It is important that the mental health professional pays attention to developmental variations and helps the parent understand how one area can affect another.

Finally, child development is dynamic and purposeful. Children have a natural curiosity and an even wider capacity for growth and change. This is good news for parents. This capacity allows children to regenerate and heal from childhood traumas that lead to disorders. It is the ally parents and professionals count on to make effective interventions and allows the child to have a normal, healthy life. What this means, in the area of childhood mental health disorders, is that children and their disorder, can change over time. In fact, they are developmentally driven to change. It is the parents and the professional's job to help steer children in the right directions.

A more detailed look at child development at different ages and stages can be found by going to http://parentingtoolbox.com/hand/development.html

A "Tangled Ball of String"

The origins of childhood mental health disorders are complex. In some cases, such as Post-Traumatic Stress Disorder, cause is fairly straightforward. A child is a victim or witness of a crime or severe accident, shows signs of sleep disturbances, nightmares, and flashbacks, and is given the proper diagnosis (in this case PTSD). Other disorders are not so clear. They are clouded by biological, familial, cultural, interpersonal, and socioeconomic factors, all of which might play a part in the child's diagnoses. A good metaphor for this complexity is a large, tangled ball of string. It is hard to know on which part of the string to pick at to untangle the ball. It might require that you work on various parts of the string, at multiple angles, to unravel the problem.

One important string, connected to the well being of the child, is his or her family. Disorders affect members of the family and are affected by those same members. This is why professionals will say that the family is a system and that the treatment for the disorder may require that all members of that family system be involved, even if they do not have the disorder. As such, the family system may increase or decrease the symptoms of the childhood mental health disorder, much the way a heating systems thermostat regulates the rooms temperature. Too hot and the heat shuts off. Too cold and the heat turns on.

Conversely, family members can be affected by another member's mental health disorder. A common example occurs when one child in a home takes a large chunk of a parents time and energy (not to mention finances) to help the child cope with his of her disorder, leaving the other children in the home feeling ignored. Resentment, anger, and aggressive behaviors are typical in siblings of children with mental health disorders and often, must be addressed by the professional working with the family.

DSM-IV: The Diagnoses Bible

When diagnosing a child, mental health professionals use a book called the Diagnostic and Statistical Manual of Mental Disorders, now in the fourth edition (or DSM-IV). The book is divided into sections for adult mental health disorders and "disorders usually first evident in infancy, childhood, or adolescence." Professionals use this book to communicate with one another (and insurance companies) about childhood mental health disorders. It is a classification system for understanding and labeling the defining features of childhood mental health disorders.

The DSM-IV defines a mental health disorder "as a clinically significant behavioral and psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one of more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom (1)."

Stated simply, a mental health disorder is a problem that affects a child's ability to function in his or her world. An important note, made by the DSM-IV, is that a classification is not about classifying the person or child buy his or her mental health disorder. This clarification can have profound effects on the self-image of the child. Being a problem and having a problem are very different things and create very different reactions from others.

Mental health professionals make a diagnosis, based on the classifications listed in the DSM-IV, on five axes or levels of diagnoses.

Axis I is used for Clinical Disorders or Other Conditions That May Be a Focus of Clinical Attention.

Axis II is used for the listing of Personality Disorders and Mental Retardation.

Axis III describes the General Medical Conditions.

Axis IV is used for Psychosocial and Environmental Problems.

Axis V is the Global Assessment of Functioning.

This multiaxial system provides for a comprehensive format for organizing and describing a child's disorder.

While there has been criticisms about the use of the DSM-IV, it is not within the scope of this guide to discuss it. Emphasis is given to parents who need to know what a professional is referring to and using in the diagnosis of their child.

Reference:
1. Diagnostic And Statistical Manual Of Mental Disorders - Fourth Edition (1994). American Psychological Association, Washington, D.C.

More Details about The Parenting Toolbox here. Ron Huxley is the author of the book "Love & Limits: Achieving a Balance in Parenting." Visit his website at The Parenting Toolbox and get expert advice on anger management, mental health, and parenting issues.

Anthony Kane, MD

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