If you’re anything like I was when my kids were starting primary school, it’s never crossed your mind that a child in his single digits could be clinically anxious or depressed. There is deceptively little public discourse about pediatric mental illnesses. I believe this is partly due to a collective blindness, in Western cultures, to “adult” ailments in young children, whom we wish to believe immune to the darkest aspects of life--and partly the consequence of a long-standing and pervasive stigmatization of people of all ages with mental illness. The statistics on pediatric and adolescent mental illness are sobering.
According to the National Alliance on Mental Illness (NAMI):
Four million children and adolescents in this country suffer from a serious mental disorder that causes significant functional impairments at home, at school and with peers. Of children ages 9 to 17, 21 percent have a diagnosable mental or addictive disorder that causes at least minimal impairment.
Half of all lifetime cases of mental disorders begin by age 14. Despite effective treatments, there are long delays, sometimes decades, between the first onset of symptoms and when people seek and receive treatment. An untreated mental disorder can lead to a more severe, more difficult to treat illness and to the development of co-occurring mental illnesses.
In any given year, only 20 percent of children with mental disorders are identified and receive mental health services.
I don’t mean to suggest that every kid with school anxiety, or every victim of bullying, is at risk for developing a clinically significant psychiatric disorder. But that doesn’t mean you shouldn't be paying close attention. Sometimes a stomach ache is just a stomach ache--but sometimes it’s a somatic response to a serious emotional dysregulation. If your child consistently displays any of these 5 behaviors once the school year has begun, it’s worth scheduling a meeting with her teacher, guidance counselor, or even her pediatrician--just to be on the safe side.
1. An all-consuming dread of school that seeps into other areas of life, interfering with functionality at home and in the community.
Look for things like striking personality changes or obsessive focus (perseveration) on one or two school-related topics--for example: recess, a particular peer, the cafeteria experience, or using the bathrooms at school. If he’s talking about something more frequently than makes sense, or with clear signals of emotional distress--hand-wringing, fidgeting, teariness--you should follow up. After all, you know your kid better than anyone. Start the ball rolling by touching base with people who can help you figure things out.
2. Chronic stomach pains or hypochondria. I doubt there is a child to be found, anywhere, who has not on one occasion or another presented with a stomach ache just before leaving for school. Malingerers? Possibly, some of them. But children’s somatic complaints always deserve to be taken seriously, because there is usually something going on behind them. Chronic stomach aches, for instance, can mean a lot of different things. Constipation is not unusual in young children--especially the ones who subsist on frozen waffles, pasta, and french fries. (N.B. This does not constitute any kind of admission on my part. Really and truly. Because I would NEVER have given in to my kids’ demands to dine solely on white foods. I always insisted on something pigmented gracing their plates. Even if that pigmented food ended up being chocolate.) But seriously, after ruling out medical causes of chronic somatic complaints, talk to the school counselor, or make a consultation with a therapist. Imagine being eight years old and facing every school day with that same internal maelstrom you feel at age 45, when your boss grimly invites you in for a one-on-one chat. While most school children overcome the anxiety that causes them to wake up each day with a stomach ache, some don’t--because the issues at play are complex, and liable to grow only more so if unaddressed. That kind of inner turmoil cannot be sustained without causing serious emotional damage.
3. Disrupted sleep patterns. Was your kid a champion night-time sleeper until she started second grade? Did he never, ever nap during the day since the age of 18 months, but now can’t stay awake after school in spite of a good ten hours of sleep at night? A lot of parents wrestle with their children’s sleep issues (not to mention their own!). A host of things could be responsible for troubled sleep, some physical, some emotional. If it lasts for more than a week or two, and there is no obvious cause, have the issue checked out. My rule of thumb has always been: start with the pediatrician, and if she finds no medical reason for the problem, approach the appropriate member of the school’s staff--or an outside mental health professional. Anxiety and depression often make their first appearance in response to school-related triggers--and an excess of either can impact sleep. Remember: a child who is chronically under- or over-slept is a child who’s not accessing his curriculum to his full capacity, OR his necessary social and life-skills experiences.
4. Too much time in the nurse’s office. Has the nurse’s office become your child’s second bedroom? It’s no secret that children dealing with emotional turmoil tend to end up in the nurse’s office. And if it’s once or twice a term, no big deal. Like their parents, kids sometimes need to take a “personal day”--even if it takes the form of an hour’s respite on a cool, Naugahyde bed under the sympathetic eye of the least stress-inducing person available. But if you’re receiving calls from the nurse on a daily basis, over an extended period of time, assume there’s a problem--and don’t ever assume your child’s school will act on it for you. The most important lesson my husband and I learned over many years of serious struggle was that, if an issue needed to be addressed, WE had to make it happen.
5. Talking about, writing about, or drawing dark topics and images. This may seem like a no-brainer, but we humans have evolved a wonderful capacity for self-deception. As my husband Lars likes to say, “Denial is not a river in Egypt.” True enough. Even if it feels like you can’t possibly deal with yet another problem, if your child is fixated on violent narratives, obsessively drawing or seeking out dark images, expressing fantasies or plans to harm himself or others, take it seriously. Get a referral for therapeutic services immediately. Yes, the availability, accessibility, and affordability of pediatric mental health care is outrageously inadequate (that is a post for another time--when you and I have a few hours to spare). Yes, it may take days and weeks of effort. You’ll lose those days and weeks and never get them back. But you will gain something priceless, if you summon your inner-bulldog and push relentlessly until you get your child the help he needs. School counselors can often help with referrals, and even bump your child up to the top of the waiting list, if the need is severe.
I know that accepting the possibility your child may have some sort of psychiatric disorder is acutely painful. I know the waters of Denial are delightfully refreshing. But there are crocodiles in those waters. I've encountered them while treading water there.
To end with a personal anecdote, some years ago, when my son Benjy was in fourth or fifth grade, he found a little animation program to use with his handheld gaming device. And he made a moving picture. It was brief; you had to pay close attention or it was over before it started. And it was drawn in such a way that you had to look closely to see what the action really was. The first several times he showed it to me I did not look closely enough. I thought I saw a stick figure standing and then falling down.
“How cool,” I said. (Oh, if only I could redo that moment!)
It was only after I stepped away from it for a whole day and he brought it back to me again that I saw what the vignette was actually about. Suicide. It was a male figure holding a gun to his head and blowing his brains out. When I saw it for what it was, I felt like I was drowning. When I could breathe again I got moving. And thank goodness I did.
Readers, feel free to tell your stories, or ask questions about how to navigate the crocodile-infested waters of parenting a child with mental illness.