Parents and Teachers as A

llies

Recog

niz

ing E

arly

-onset M

enta

l Illness in

Child

ren a

nd A

dole

scents

1.26N

AM

I Basics E

ducation Program

2010

1

By J

oyce

Bu

rlan

d, P

h.D

., Na

tion

al D

irecto

r N

AM

I Ed

uca

tion

, Tra

inin

g a

nd

Pe

er S

up

po

rt Ce

nte

r

Fo

urth

Ed

ition

, 20

09

©2

00

9 N

AM

I

Pare

nts

and T

eachers

as A

llies: R

ecogniz

ing E

arly

-onset M

enta

l Illness in

Child

ren a

nd A

dole

scents

© 2

009 b

y N

AM

I, The N

atio

nal A

lliance o

n M

enta

l Illness.

All rig

hts

reserv

ed.

The N

atio

nal A

lliance o

n M

enta

l Illness (N

AM

I) is th

e n

atio

n's

larg

est g

rassro

ots

me

nta

l health

org

aniz

atio

n d

edic

ate

d to

impro

vin

g th

e liv

es o

f indiv

iduals

and

fam

ilies a

ffecte

d b

y m

enta

l illness. N

AM

I has o

ver 1

,100 a

ffiliate

s in

com

munitie

s

acro

ss th

e c

ountry

who e

ngage in

advocacy, re

searc

h, s

upport a

nd e

ducatio

n.

Mem

bers

of N

AM

I are

fam

ilies, frie

nds a

nd p

eople

livin

g w

ith m

enta

l illnesses

su

ch a

s m

ajo

r depre

ssio

n, s

chiz

ophre

nia

, bip

ola

r dis

ord

er, o

bsessiv

e-

com

puls

ive d

isord

er (O

CD

), panic

dis

ord

er, p

osttra

um

atic

stre

ss d

isord

er

(PT

SD

) and b

ord

erlin

e p

ers

onality

dis

ord

er.

NA

MI

3803 N

. Fairfa

x D

r.,

Arlin

gto

n, V

A 2

2203

ww

w.n

am

i.org

(703) 5

24-7

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lpLin

e: 1

(800) 9

50-N

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I (6264)

Parents and Teachers as A

llies

Recogniz

ing E

arly

-onset M

enta

l Illness in

Child

ren a

nd A

dole

scents

1.27N

AM

I Basics E

ducation Program

2010

Introduction

On Jan. 3, 2001, the Surgeon G

eneral of the United States released a report

stating that 12 percent of American children under the age of 18 have a

diagnosable mental illness. A

lthough welcom

e as a wake-up call to the nation,

this belated recognition of children in crisis is not likely to come as new

s tothe m

illions of parents and teachers who are struggling every day to help these

distressed youngsters.

The burden of coping w

ith serious mental illness am

ong our youngest andmost vulnerable citizens has long been assigned to the institutions of hom

eand school. D

ue to the neglect in establishing appropriate resources and servicesfor ch

ildren

with

mental illn

esses, paren

ts and teach

ers have, by d

efault,

become prim

ary providers. Schools now exist as de facto

mental health

systems for these troubled children, and hom

e is the principal refuge for care.Largely unprepared for this responsibility, unrecognized and certainly unsung,parents and teachers are the frontline allies in the battle to avert the devastationof long-term

mental illness am

ong our nation's youth.

Acknow

ledging and strengthening this alliance between hom

e and school is agoal of the utm

ost necessity. The m

ain hope for children at risk for seriousmental illness lies in early detection and the fact that childhood is the m

ostintensely w

atched developmental period in life. Parents and teachers are

children’s closest observers. Problems first surfacing at hom

e are often am

plified in the school setting; by law, schools provide the critical link betw

eena child in crisis and referral for evaluation. W

ith early recognition, accuratediagnosis and appropriate treatm

ent, young people with m

ental illness can behelped—

forestalling years of suffering by these children and their families.

This m

onograph was prepared to help parents and teachers identify

the key warning signs of early-onset m

ental illness among this population. It

focuses on the specific, age-related symptom

s of mental illness in youngsters

which m

ay differ from adult criteria for diagnosis. T

his is not to suggest that, ontop of everything else, parents and teachers becom

e diagnosticians and therapists, but they m

ust be grounded in a common know

ledge base and unitedin their w

illingness to recognize and confront mental illness w

hen it exists.

32

Tab

le o

f Co

nte

nts

Intro

ductio

n3

Beco

min

g a

llies: R

ecko

nin

g w

ith d

iffere

nt p

ers

pectiv

es

4

Th

e h

eart o

f the m

atte

r: Child

ren ro

bb

ed

of c

hild

ho

od

5

Keys to

early

reco

gnitio

n a

nd

treatm

ent

6

Learn

ing

and

wo

rkin

g to

geth

er a

s a

llies

7

Sig

ns o

f early

-onset m

enta

l illnesses in

child

ren a

nd

ad

ole

scents

:

Atte

ntio

n-d

efic

it /hyp

era

ctiv

ity d

iso

rder (A

DH

D)

8

Op

po

sitio

nal d

efia

nt d

iso

rder (O

DD

) and

co

nd

uct d

iso

rder (C

D)

11

Majo

r dep

ressio

n13

Early

-onset b

ipo

lar d

iso

rder

16

Anxie

ty d

iso

rders

18

Anxie

ty d

iso

rders

in a

do

lescence

20

Child

ho

od

-onset s

chiz

op

hre

nia

21

Ad

ult-o

nset s

chiz

op

hre

nia

22

Ob

sessiv

e-c

om

puls

ive d

iso

rder (O

CD

)23

Un

ders

tand

ing

fam

ily re

actio

ns to

menta

l illness

24

Navig

atin

g th

e re

ferra

l pro

cess a

s a

llies

28

Stre

ng

thenin

g th

e a

lliance: H

ow

NA

MI c

an h

elp

29

1.28N

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I Basics E

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2010

transition, leaving parents and teachers adriftin the turbulence of old-versus-new

andtried-versus-true.

Consequently, those attem

pting to buildalliances m

ay come from

a number of

perspectives. Many parents and teachers

understand that serious mental illness in

children is a neurobiological disorder; many

do not. Some do not hesitate to identify

these disorders and seek immediate

treatment; others are exceedingly reluctant to do so. Professional opinion is still

split between traditional beliefs that bad or m

isguided parenting accounts for children’s disturbed behavior and the acceptance of the new

scientific findingsthat m

ental illness in children is a real disease that requires medical

treatment. T

he quotes on page 4 are typical examples of the difficulties faced in

an era of scientific change: the concerned teacher wondering how

to approach theparents, the w

orried mother frustrated by not getting through to the teacher.

To deal with these strains, parents and teachers need only to focus on their

highest calling: helping the troubled child. Whatever the cause of the profound

distress they see, they are the principal early warning team

. They w

itness theproblem

and can help children at risk get a psychiatric evaluation. Acting

quickly and decisively will lead to treatm

ent that will save these children’s

childhoods and spare their adult lives.

Th

e H

eart o

f the M

atte

r:

Ch

ildre

n R

ob

bed

of C

hild

ho

od

“What I rem

ember m

ost is the suffering. Kids are supposed to be happy.

Boy, that’s a joke. I was depressed for years and felt totally odd and

isolated, almost despised. G

rowing up w

as a really miserable experience

until I got help.” — A young m

an in therapy, recalling his childhood

There is now

compelling evidence that m

ental illnesses in children do occur,that untreated m

ental illness places children at risk of developing the most

This sum

mary account of the sym

ptoms of m

ental illness in children and adolescents—

and a discussion of the issues these disorders raise for parentsand teachers—

is intended to provide an educational tool for advancing mutual

understanding and communication. It is designed to travel on a tw

o-way

street: for teachers to use and give to parents and for parents to use and give toteachers.

It may be that nature, in its w

isdom, has singled out these tw

o primary

custodial human netw

orks for the job of identifying children at risk, knowing

that the vigilant eye of parents and teachers will sound the first alarm

when a

child fails to thrive. This booklet pays tribute to all those w

ho are dedicated tothis task.

Be

co

min

g A

llies:

Re

cko

nin

g w

ith D

iffere

nt P

ers

pectiv

es

“There’s a child in m

y class who I think has sym

ptoms of psychiatric illness.

It’s not just his behavior; it seems to be som

ething deeper. I don’t know how

to help him, how

to approach his parents or where to refer them

for help.This is som

ething that everyone is reluctant to discuss. I care very much

about this child and fear if we don’t get him

some help soon, w

e may lose

him.”

— A teacher in R

hode Island

“My son is a constant horror-show

at home. H

e does things that are way

beyond our control despite everything we do to help him

. His school

performance is a disaster. I know

something is really w

rong with him

, but Ican’t get his teachers at school to recognize he’s got a m

ental illness. They

say it’s a “behavioral disorder” and that we should go to parenting class.”

— A m

other in Virginia

An im

mediate problem

in strengthening parent-teacher alliances to serve children w

ith serious mental illnesses is the unsettled nature of the subject

itself. The top

ic of mental illn

ess comes load

ed with

baggage—stigm

a, misin

formation

, blaming—

which

silences an

d divid

es us. In

addition,

knowledge about the neurobiology of m

ental illnesses in children is in rapid

54

…know

ledge about theneurobiology of m

entalillnesses in children is inrapid transition, leavingparents and teachersadrift in the turbulenceof old-versus-new

andtried-versus-true.

1.29N

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How

ever, none of those environmental events cause

mental illness. E

arly-onsetmental illness is a biological given, and this is a case w

here children are challenged by a chem

ical disturbance in their brains that controls their behaviorand underm

ines their ability to deal with their w

orld, whatever it m

ay be.Environm

ental stress can trigger the onset of mental illness and certainly m

akethe experience w

orse for children; their parents, socioeconomic status or degree

of chaos at home, for exam

ple, do not cause their illnesses.

The problem

is, of course, identifying which set of behavior disturbances are

which. Is the child spinning out of control a candidate for therapy and fam

ilycounseling or does the behavior represent sym

ptoms of a m

ental illness that will also require close psychiatric supervision and treatm

ent? This is a call only

a qualified child psychiatrist should make. M

edicating a child whose problem

s can be effectively rem

edied by therapy alone is as clinically misguided as

denying medication to the child w

hose condition cannot improve w

ithout it.

Unhappily, because m

ental illness in children is often not well-recognized,

children with m

ental illness are more likely to be diverted into counseling than

medical treatm

ent. Any child w

ith persistentbehavioral difficulties should have a

psychiatric evaluation. Verifying clinical symptom

s is basic, but doctors alsolook for a group of clinical features that have particular diagnostic significance:intensity, duration and level of distress. C

hildren with untreated serious m

entalillness suffer constant, unrelieved m

isery. Therapy m

ay help the child and support the fam

ily, but it has little impact on severe illness-driven

behaviors. Parents and teachers must w

atch for early signs of severity and disability so they can speed the referral to a qualified psychiatrist. For childrenwith m

ental illness, this step is the threshold to recovery and hope.

Learn

ing

an

d W

ork

ing

To

geth

er a

s A

llies

“I had a big discussion with m

y daughter’s teacher. She thought it was

wrong to saddle Becky w

ith a psychiatric label. I told her, ‘What difference

does it make? She’s already been labeled a rotten kid. W

hat could be worse

for Becky than that?’” — The father of a 14-year-old

debilitating forms of illness and that the im

pact of untreated mental illness on

their growing years is devastating. W

hen children have neurobiological sym

ptoms that they cannot control, childhood becom

es a painful ordeal. All the

building blocks children need to prepare themselves for adulthood are kicked

out from under them

. Many of their sym

ptoms cause poor functioning in

school; they fall behind, can’t compete, fail. Behaviors driven by their

symptom

s are unpleasant and irritating; they become lightening rods for

criticism, ridicule and rejection. In the starkest sense, untreated m

ental illness isa thief of childhood. It steals aw

ay every benefit this precious span of developm

ent confers on growing children.

When consequences this serious threaten a child’s potential and effective

medical and therapeutic treatm

ents are at hand to stabilize a child’s life, delaying effective rem

edies for any reason can comprom

ise a child’s entirefuture. Parents and teachers m

ust be empow

ered as allies to confront any and all conventions standing in the w

ay of early recognition and immediate

treatment of childhood m

ental illnesses.

Ke

ys to

Early

Rec

og

nitio

n a

nd

Tre

atm

en

t

“I’m so thankful w

e finally got to see a psychiatrist. When he told m

eM

ichael had obsessions because of an illness in his brain, everything fellinto place. I suddenly thought of the w

hole animal kingdom

and what it

would m

ean for a bird to have a bum w

ing. I figure wing is to bird as

brain is to boy. We have to treat M

ichael’s brain.” — The m

other of a 9-year-old

It is normal for all grow

ing children to be reactive to stresses in their environment

and to express their feelings in behavior disturbances. Many children struggle

with poverty, deprivation and abuse, and m

any must get through traum

atic periods of loss or fam

ily instability. Children can have difficulties w

hen they shiftfrom

one developmental stage to another or find that academ

ic and social challenges are just too m

uch for them at a given point. Parents and teachers w

itnessa range of environm

ental stressors that can cause children to act out, rebel and showdisturbed behavior.

76

1.30N

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This dad is reporting from

his unique position in his child’s private w

orld. On the

public side of the child’s life, the teacher isweighing the social cost of a psychiatric

diagnosis. The father has an “insider” view

,which the teacher in the classroom

may not

have. He know

s that, given the state ofdem

oralization he sees in his child at home,

nothing must stand in the w

ay of seekinghelp for her. W

ith shared insight, parent andteacher can becom

e allies for action.

Maintaining tw

o-way com

munication

between the public and private parts of a

troubled child’s life is absolutely essential forteachers and parents to gain the inform

ation necessary for early intervention onthe child’s behalf. Behaviors a teacher sees frequently in school m

ay not occur athom

e; behaviors seen at hom

e may n

ot happen at sch

ool. In th

e privacy of

hom

e, child

ren are m

ore likely to express h

ow terrible they feel; in school, the

teacher will pick up on heightened sym

ptoms caused by the stress of required

work and negative encounters w

ith peers. It is impossible to p

ut th

ese separate

pieces of a child’s experience into a meaningful w

hole unless parents and teachers w

ork together. As allies, they can identify the early w

arning signs ofmental illness and becom

e a singularly effective early-intervention team.

Inthe sum

maries that follow

, the symptom

s of early-onset m

ental illn

essesin ch

ildren

are followed by th

e symptom

s for adolescen

ts. In th

e case ofchild

ren under age 13, every effort has been m

ade to describe behaviors com

monly seen in school and to include typical observations from

parents in thehom

e.

Sig

ns o

f Early

-on

set M

en

tal Illn

ess

in C

hild

ren

an

d A

do

lescen

ts

Atten

tion-Deficit/H

yperactivity D

isorder(ADHD)

ADHD is a neurobiological disability in children and adolescents that is highly

heritable and can have lifelong consequences. More com

mon in boys than

98

There is now

compelling

evidence that mental

illness in children doesoccur, that untreated mental illness places

children at risk of developing the m

ost debilitating form

s of illness and that the im

pactof untreated m

ental illnesson their grow

ing years isdevastating.

girls, ADHD occurs in one of every 20 children. It is not caused by bad

parenting nor do these children lack intelligence or discipline—they sim

plycann

ot sustain

the focu

s need

ed to com

plete tasks ap

prop

riate for their age

and in

telligence. A

s a result, ch

ildren

with

ADHD seem

unable to beh

ave or follow

the rules other children take in stride. They characteristically perform

better one-on-one than they do in groups. For a diagnosis of ADHD, the core

symptom

s of inatten

tion, im

pulsivity, h

yperactivity an

d low

tolerance

of frustration

must be p

resent in

a child

for at least six mon

ths an

d cau

se clin

ically significan

t impairm

ent in

two or m

ore settings. (T

hese ch

ildren

typically act worse in school than they do at hom

e.) For many children, the

key identifier for ADHD is the early age of onset, before age seven.

Inattentive Type•can

’t pay atten

tion to d

etails; are often cau

ght d

aydream

ing

•avoid, dislike or are reluctant to engage in activities that require sustained attention

1.31N

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ADHD in

Adolescen

ceAlthough hyperactivity frequently dim

inishesin the teenage years as the older child is ableto exercise m

ore self-control, if ADHD

remains untreated it can rebound in adult-

hood. More than half of those w

ith ADHD in

their young years will continue to have

difficulty as teenagers; poor school perform

ance, difficulty with peer

relationships and low self-esteem

are com

mon. A

teen with A

DHD and a history of co-occurring conduct disorder

and oppositional defiant disorder is at high risk for continued antisocial behavior and m

ay be frequently dismissed and suspended from

school. The

school dropout rate for this group is 12 times greater than the rate am

ong teenswho are not affected by A

DHD.

•high rate of conduct disorder: 50 percent

•high risk for alcohol use, drug abuse and early sm

oking•increased antisocial behavior and delinquency

•inattentive type, m

ore common in girls; boys “blow

off” school, act im

pulsively, “can’t get it together,” feel persistently restless•school failure; dow

nward social drift to “outcast” school groups;

low self-esteem

Opposition

al Defian

t Disord

er (ODD) an

d Conduct D

isorder (C

D)

These d

isruptive m

ental d

isorders in

volve child

hood

disob

edien

ce that

grossly violates accepted behavioral norms for children. T

his is the child who,

beyond all understanding, refuses to cooperate or a child who relishes playing

a destructive, villainous role with others. A

gain, boys with this disorder out-

number girls. C

ore symptom

s are inflexibility in ODD and physical aggression

and cruelty in CD. A

lthough it seems inconceivable, children as young as age

three can display symptom

s of these disorders. Genetically vulnerable, these

children are often at high risk because of disadvantages such as poverty, abuseand neglect but they can also com

e from stable hom

es. Because these childrenare so relentless and show

so little remorse over their destructive actions,

attempts to control or discipline them

tend to make them

even more defiant. It

is difficult not to spot these disorders. Children w

ith such extreme antisocial

11

10

•are highly distractible, forgetful, absent-m

inded, careless, disorganized•often do not finish school w

ork (work m

ay be full of mistakes,

turned in late or not at all)•don’t listen to or follow

through on instructions

Hyperactive/Im

pulsive Type•display extrem

e physical agitation; fidget, squirm, can’t stay seated or

remain still

•constantly interrupt and speak out of turn; talk excessively; disrupt the classroom

•are “on the go” and act as if “driven by a m

otor”•intrude on others; resort to even m

ore inappropriate behavior when

reprimanded

Com

bined Type•most com

monly, a m

ix of inattentive and hyperactive/impulsive sym

ptoms

Observations from

Hom

e•report that sym

ptoms have been persistent since early childhood;

the illness didn’t come on suddenly, but som

ething was “off”

from the very beginning

•describe the child as never slow

ing down, as exhausting and dem

anding or, conversely, “clueless” w

ith “head in the clouds”•may m

isread the child as bad or not bright or wonder w

hy the child is alw

ays in trouble at school

Co-occurring D

isordersMore than

one-half of children with A

DHD have at least one other m

ajor child

hood

disord

er: 40 percen

t have op

position

al defian

t disord

er; 25 percent have conduct disorder; 30 percent have anxiety disorders; one-thirdhave d

epression

. Some ch

ildren

with

ADHD m

ay be in early stages

of bipolar d

isorder, w

hich

shou

ld be ru

led ou

t before any stim

ulan

ts or antidepressants are prescribed. T

hese medications can trigger m

anic and psychotic episodes in children w

ith bipolar disorder(see page 16).

Problems surfacing at

home are often am

plifiedin the school setting; bylaw

, schools provide thecritical link betw

een achild in crisis and referral for evaluation.

1.32N

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antisocial behaviors that “up the ante” indanger to others. T

here is also a late-onsetform

of conduct disorder, starting after age10, in w

hich a child will becom

e aggressiveand antisocial as a prim

ary way of interacting

with others. Because these children frighten

and alienate their classmates, they can

become loners w

ho feel they have nothing tolose by acting w

orse.

•truancy, school failure, frequent expulsion from

school•reckless, accident-prone behavior

•low

self-esteem covered by a cocky or “tough” dem

eanor•early sexual activity

•early drug and alcohol abuse

•sociopathic behaviors causing serious harm

to others, such as physical abuse, intim

idation and rape•frequent encounters w

ith the criminal justice system

Major D

epression

in Child

renIt is now

known that children can experience serious depression but, for m

anyyears, the “state of childhood” w

as thought to provide immunity from

profounddespair. C

hildren with clinical depression signal their distress very differently

than adults and do not meet the established adult criteria for diagnosis.

Consequently, w

hat is now identified as a m

ood disorder affecting 2 percent ofchildren and 8 percent of adolescents has largely been undiagnosed or misdiagnosed. Spotting childh

ood depression

requires kn

owing th

e uniqu

eways ch

ildren

express th

e depression

they feel. T

he core sym

ptom

is not

sadness, bu

t irritability and aggressiveness. T

he mood disturbance also

frequently plays out in imagined body pain

s and a n

oticeable drop

in sch

oolperform

ance. A

noth

er key indicator is th

e abruptness of beh

avior change:

a sociable, likeable child

who is d

oing w

ell suddenly develops problems w

ithpeers and ignores schoolw

ork. Early detection and treatm

ent are essential to prevent a chronic and relapsing course of illness, w

hich is the prognosis forearly-onset depression in children.

behaviors are the bane of school and home. T

hey are literally tragedies-in-the-making, and early intervention

is critical for everyone involved.

Oppositional D

efiant Disorder (w

illful behaviors):•negative, hostile, defiant behavior; w

ill not comply w

ith requests made by adults

•persistent arguing w

ith adults; belligerent, obstinate•intense rigidity and inflexibility; feel entitled to m

ake unreasonable dem

ands•touchy, resentful, spiteful; blam

e others when apprehended

Conduct D

isorder (intentional behaviors):•aggression and cruelty tow

ard people and animals; bullying w

ith bats, pipes, w

eapons•destructiveness (setting fires, defacing or destroying property)

•deceitfulness (lying, stealing, “conning”)

•disobedience (truancy, running aw

ay from hom

e)•lack of rem

orse for antisocial behaviors

Observations from

Hom

e•get angry and exasperated w

ith the child who w

on’t ever obey or cooperate (O

DD)

•are shocked, horrified and em

barrassed by the child’s sadistic behaviors (CD)

•feel frightened and intim

idated and worry constantly about danger of

injury to siblings (CD)

•are overw

helmed by criticism

from fam

ily and friends •report that the m

any suspensions from school add to their burdens at hom

e•can’t take the child anyw

here; feel ostracized and housebound

Co-occurring D

isorders:Fifty percent of children w

ith ODD have A

DHD; 40 percent w

ith CD have

ADHD and alm

ost as many have depression.

Opposition

al Defian

t Disord

er/Conduct D

isorder in

Adolescen

ceA child w

ho is a tragedy-in-the-making at age 7 w

ill, without treatm

ent, pose a

consid

erable threat to society at age 15. B

igger, stronger, con

dition

ed

by years of oppositional resistance and bullying, this teenager will persist in

13

12

Medicating a child w

hoseproblem

s can be effectively rem

edied bytherapy alone is as clinically m

isguided asdenying m

edication to thechild w

hose conditioncannot im

prove without it.

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•show

extreme irritability, aggressiveness, com

bativeness•feel m

ad all the time, sullen, groundless; have anxious com

plaints about headaches, stom

achaches; may have extensive m

edical evaluations that find no cause for these sym

ptoms (this is often the only significant

diagnostic identifier)•experience drop in grades; w

on’t do homew

ork; refuse to go to school; feel extrem

e anxiety about tests•develop negative self-judgem

ent, are down on them

selves; believe they are w

eird, ugly, dumb, picked-on; have thoughts of death

•are hypersensitive to criticism

•overreact to disappointm

ent and frustration; become tearful, give up easily

•becom

e unable to have fun, withdraw

, mope, w

on’t join in activities•becom

e lethargic, apathetic, dispirited; have difficulty with sleeping,

oversleeping; can’t get up in the morning and are sleepy in school

•one-third show

psychotic features of depression: hallucinations (seeing/hearing

things), delusions (false beliefs) or paranoia (suspiciousness)

Observations from

Hom

e•say nothing ever pleases the child; child seem

s to “hate himself and

everything else;” report the well-adjusted child they are fam

iliar with

“went som

ewhere,” that they have a “totally different kid;” sadness and

confusion at this sea change in their child•adm

it that this child is no fun and is hard to like•observe that the child tries to “put on a good face” in public and displays the w

orst of the symptom

s at home

Co-occurring D

isordersOne-third of children ages six through 12 diagnosed w

ith major depression

will develop bipolar disorder w

ithin a few years (see page 16). M

ood disordersand anxiety disorders co-exist at every age level.

Major D

epression

in Adolescen

ceThere is a m

arked increase in the incidence of depression in the teenage years,with a peak of onset at age 15. In this age group tw

ice as many girls are affected

as boys. Because older children are more adept at hiding behaviors they fear w

illmake them

lose face, depression in teens can be masked by outstanding school

performance, school leadership and “ideal behavior.” O

ther adolescents with

15

14

depression who cannot rely on popularity or academ

ic performance to disguise

their condition try not to attract attention at school. A recent com

prehensivescreening of high school students for depression found that half of those w

ho qualified for referral and treatm

ent were not know

n to school psychologists orsocial w

orkers as being in need of help. Depression in adolescents can be detected

by talking to the teenager and watching behavior patterns closely. Fam

ily input iscritical because m

any of the symptom

s occur at home, w

hen peers are out of sight.

•feel sad, hopeless, em

pty; crying in class•appear lethargic, slow

-moving, sleepy; conversely, inability to control

hyperactivity may signal depression

•develop extrem

e sensitivity in interpersonal relationships; are highly reactiveto rejection or criticism

; “drop” friends they’re having problems w

ith•are irritable, grouchy; prefer to sulk and cannot be cajoled into a better m

ood•overreact to disappointm

ent or failure; often take months to recover

from setbacks

•feel restless and aggressive; becom

e antisocial (lie to parents, cut school, shoplift)

•think they are different, no one understands, “everyone” looks dow

n on them•becom

e more and m

ore isolated from fam

ily and schoolmates; often

shift down to an out-of-the-m

ainstream peer group or “hang out”

exclusively with one friend

•becom

e self-destructive; at high risk of “self-medicating” w

ith drugs and alcohol

•stop caring about their appearance

•com

monly have m

orbid imaginings and thoughts of death

Co-occurring D

isordersFifty percent of adolescents w

ith major depression also have an anxiety

disorder that existed before the onset of the depression. Anxious states increase

the risk of suicide.

Ninety percent of adolescents w

ho commit suicide have a psychiatric diagnosis of

mood disorder and alcohol/substance abuse. W

hile suicide in children under theage of 12 is rare, it is the third-leading cause of death am

ong adolescents ages 15to 19. G

irls have a higher rate of attempted suicide; boys com

plete more

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school•describe rages as seizures: “w

ild-eyed,” violent tantrums of kicking,

hitting, biting, screaming foul w

ords, thrashing that lasts for hours•note child has serious sleep disturbance: hard to rouse, gains energythrough the day and “bounces off the w

all” by end of school day•report extrem

e physical sensitivity: clothes must feel “just right,” food

temperature m

ust be “just right”•say child acts w

orse at home than at school

Co-occurring D

isordersThe developm

ent of bipolar disorder in children may involve clusters of

symptom

s at various ages that look like ADHD, O

DD, C

D and depression.

A careful, differential diagnosis m

ust be made so that children w

ith bipolar disorder w

ill not be given stimulant or antidepressant m

edications which can

trigger manic and psychotic episodes in vulnerable children.

Bipolar D

isorder in

Adolescen

ceThe on

set of bipolar d

isorder in

adolescen

ce can be a d

evastating

setback. Talents and strengths the child developed while grow

ing up are swept

away, leaving the teenager stranded and dislocated at a critical stage of

maturation. R

eckless behaviors driven by mania bring painful, em

barrassingnotoriety w

hile depressive episodes make active participation in school life

almost im

possible. In adolescence, this illness can strike with great severity w

ithpronounced psychosis and grandiose delusions. A

lesser state of elation (hypom

ania) can persist, making the adolescent feel all-pow

erful and invincibleand unlikely to heed advice from

adults. Teens with this illness are at high risk

for drug and alcohol addiction and it doesn’t take long for them to get a

reputation for incorrigible wildness. H

owever, they do feel genuine rem

orse fortheir destructive actions even though they are likely to repeat them

.

Manic Phase•difficulty sleeping; high activity level late at night

•increased goal-setting and unrealistic expectations (boasting of becom

ing a rock star w

hen they can’t sing or a prominent “big shot” w

hen they are failing at school)

•very rapid and insistent speech

suicides and are at highest risk if they drink heavily. Suicide is a tragic, avoidable consequence of m

ood disorders, which—

when recognized—

are high

lytreatable.

Early-on

set Bipolar D

isorder

This m

ood disorder can involve sharp swings from

episodes of manic “highs” to

periods ofdepressive “low

s” or a mixed state in w

hich manic energy com

bines with the depressed m

ood. In children, the scientific basis of this diagnosis isstill evolving. Tw

o cornerstones for diagnosis now used are 1) the presence of a

strong family history of bipolar disorder and 2) an early-onset sym

ptom

pattern that is unique to this age group. There is a grow

ing number of

accounts of families w

hose children are struggling with a form

of “pediatricmania” in w

hich mood shifts occur repeatedly throughout the day and the

child is caught in long periods of ultra-rapid mood cycling. T

hese parentsreport that they cope w

ith frequent, severe, prolonged, explosive rages at home

as well as unpredictable, aggressive, oppositional spells that sw

ing back to thechild’s “other” upbeat m

ood. Silly and full of energy one mom

ent, the childwill suddenly becom

e angry, disruptive and defiant. These children are often

charming, funny, verbally and artistically gifted and bright. T

hey can also bebossy, intrusive, insistent and obnoxious.

•hair-trigger arousal system

is set off by the slightest irritant or change•overreaction takes the form

of irritable, oppositional, negative behavior•multiple m

ood shifts; the child acts like two different people (angel/devil)

•usually rage is controlled in school, in front of classm

ates•hyperactivity: highly distractible, inattentive; decreased need for sleep

•grandiose behavior: tell the teacher how

to run the class or harass the teacher in an attem

pt to take over the class •overt hypersexual activities and com

ments in the classroom

•great sensitivity to tem

perature and often heat-intolerant•insatiable craving for carbohydrates and sw

eets•

psychotic episodes of auditory hallucinations (common); m

ay not be reported

Observations from

Hom

e•report that the child w

as “always different” w

ith ragged sleep cycles, night terrors, violent nightm

ares; first reaction to any request is “no!”•say child typically has severe separation anxiety; w

ill refuse to go to

17

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These ch

ildren

canbe rude and noncom

pliant when trying to avoid encounters

that trigger anxiety. How

ever, they generally shun the spotlight and “hide out”on the fringes of the group.

Separation Anxiety (childhood version of panic disorder)

•intense anxiety at being separated from

parents; overwhelm

ing hom

esickness when apart

•worry that parents w

ill die; clinging to the parent and following parent

from room

to room•refusal to sleep alone and w

ill not go on sleep-overs•claim

s of sickness to avoid going to school (sick feelings disappear if they stay hom

e)

Overanxious D

isorder (childhood version of generalized anxiety disorder)•global, excessive w

orry about school, how they look, standing w

ith friends, etc.

•dread they w

ill do things wrong; perfectionist; re-do w

ork•excessive seriousness, uptight, unsure feelings, hypersensitivity to criticism

•deafness to reassurances; continual w

orry, even though school work is excellent

“Avoidant” D

isorder (childhood version of social phobia)•acute shyness and discom

fort in social situations•restriction of social contacts exclusively to close fam

ily mem

bers•fear of being singled out, judged, evaluated, called on in class

•possibly phobic about specific situations (eating in private, using public bathroom

s)

Observations from

Hom

e•report w

orry and concern over repeated absences from school

•report that “m

eltdowns” occur w

hen they try to force activities which

generate anxiety•find them

selves in a catch-22; accommodating anxious behaviors risks

school failure, yet insisting on attendance and social contact means the

child continually falls apart

Co-occurring D

isordersMood disorders and anxiety disorders co-exist at every age.

•all-or-nothing m

entality (if not exactly their way, it’s w

orthless)•spending sprees (running up large credit card bills over the phone)

•aggressive, touchy, irritable, “in-your-face” m

anner•reckless driving; drinking and driving; repeated car accidents

•hypersexuality, provocativeness; lack of concern for harm

ful consequences•lying and m

aking up stories; sneaking out of class; sneaking out of houseat night to party

•psychotic episodes: delusions (false beliefs), hallucinations (seeing/hearingthings), paranoia (suspiciousness); m

ay have romantic delusions about

teachers

Depressive Phase•crying; catastrophizing (gloom

and doom)

•moodiness, irritability (picks fights w

ith others)•trem

endous fatigue, oversleeping, lethargy; carbohydrate cravings•insecurity, separation anxiety, low

self-esteem•school avoidance; feigning sickness to stay hom

e; constant physical com

plaints•self-isolation; pushing people aw

ay•suicidal thoughts and attem

pts

Co-occurring D

isordersNinety four percent of adolescents w

ith bipolar disorder have symptom

s of A

DHD.

Anxiety D

isorders

Anxiety disorders cause extrem

e discomfort and unease in situations generally

regarded as unthreatening. To children dealing with anxiety, m

any normal

events and expectations arouse intense dread and worry. A

nxiety disorders arethe m

ost common m

ental illnesses among children and adolescents. T

he forms

of this disorder in children are separation anxiety (terror at being apart from a

parent), “over-anxiousness” (excessive, unwarranted w

orrying) and social phobia (severe shyness and avoidance of social contact). T

he effects of thesedisorders are so constrictive and p

aralyzing th

at the ch

ild often

shrin

ks fromcon

tact with

the ou

tside w

orld. Pred

ictably, a key warn

ing sign

of anxiety

disord

ers is missin

g school. C

ontin

uou

s absences w

ith th

e child

called in

sick in th

e morn

ings occu

r frequently an

d m

ay lead to an

attendance review

.

19

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21

Child

hood

-onset Sch

izophren

iaNo m

ore devastating mental illness exists than schizophrenia, a chronic brain

disorder marked by delusions and hallucinations in the acute stage and by

apathy, withdraw

al and lack of motivation in the residual stage. Fortunately, the

childhood form of this illness is rare, affecting one in 40,000 children under the

age of 15. Unfortunately, the early expression of this disorder is extrem

ely severe,involving significant abnorm

ality in brain structure and causing pronounced disruption in brain developm

ent. The defining sign of childhood schizophrenia is

the slow gradual em

ergence of psychotic symptom

s as well as their persistence

after the onset of the illness. Because the onset process is so protracted, ancillarysigns of detection are useful; early-onset schizophrenia is often preceded bydevelopm

ental disturbances such as lags in motor and speech/language

development; poor functioning in attention, m

emory and decision-m

aking andgrade failure. C

hildhood-onset schizophrenia is rarely observed before the age offive and can be differentiated from

autism by this later age of onset.

•early pattern of inhibition, w

ithdrawal and sensitivity

•problem

s with conduct disorder

•anxious and disruptive in social settings

•poor m

otivation and follow-through

•school failure or required placem

ent in special education•

inability to make friends; disinterested in form

ing relationships•

confusion about what is real: hearing voices of som

eone not there(hallucinations) or sense of being follow

ed or threatened (delusions and paranoia)

•show

ing no emotion; speaking rarely; sitting still for long periods

of time

•inappropriate expression of em

otion (laughing at sad events)•

little or no eye contact; little expression of body language

Observations from

Hom

e•

report that the child hears voices saying bad things about him or her or

stares at things that are not there•

worries that the child show

s no interest in making or having friends and

prefers isolation to any involvement in social activities

•say that odd behaviors are not lim

ited just to certain situations but arepervasive in every realm

of the child’s life

Anxiety D

isorders in

Adolescen

ceThe onset of anxiety disorders in adolescence reaches its peak in the

mid-teen years and often occurs after a loss or change in the teenager’s life. T

hehigh rate of illness in this population is doubly unfortunate because teens w

ithanxiety disorders cannot calm

themselves dow

n and are highly susceptible toalcohol and drug addiction. T

hese substances initially act to reduce anxiety andare frequently used as a form

of self-medication. A

t this older age, adolescentswill have heart-stopping panic attacks or becom

e confirmed “w

orry warts” or

literally shut down all com

munication and interaction due to social phobia.

Symptom

s of anxiety disorders in teens are similar to those experienced by

adults. This illness results in a sense of forced, inescapable isolation and feelings

of failure. Older children w

ith anxiety disorders know their reactions are

excessive and unreasonable, but they are powerless to change them

.Consequently, they suffer constant dem

oralization and low self-esteem

.

Panic Disorder

•palpitations, pounding heart, rapid heartbeat; chest pain and discom

fort; shortness of breath•sw

eating, trembling, shaking;

•feeling of choking, nausea and dizziness

•feelings of unreality

•fear of dying, losing control or “going crazy”

Social Phobia (Social Anxiety D

isorder)•fear of specific social or perform

ance situations•dread of being hum

iliated or embarrassed by doing som

ething wrong in

front of others•avoidance of feared situations or enduring them

with intense

distress(exposure can trigger panic attacks)

Social Phobia (Generalized)

•fears include m

ost social situations•inability to initiate or m

aintain conversation; getting them to talk is like

“pulling teeth”•fear of participating in sm

all groups•fear of speaking to authority figures

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•inability to relate to others or understand the basics of reciprocal relationships

•lack of insight that one is ill

•poverty of speech; brief, laconic replies and decrease in fluency of speech

Observations from

Hom

e•

report that a high-functioning teenager is “falling apart” and becoming

unrecognizable to family and friends or that a shy, reclusive child is

getting dramatically m

ore so and is doing unpredictable, bizarre things•

say they feel engulfed by fear and panic, that something is going terribly w

rong

Obsessive-C

ompulsive D

isorder (O

CD) in

Child

ren an

d Adolescen

tsThis chronic illness involves the recurrence of senseless, intrusive, continuous,

anxiety-producing thoughts and impulses (obsessions) w

hich children attempt to

ward off w

ith rigidly patterned, irrational behaviors (compulsions). A

lmost as

common as A

DHD, this illness affects m

ore than one million children and

adolescents, with boys tw

ice as likely to experience this illness as girls.Sym

ptoms can start as early as ages 3 or 4, but the peak age for onset is age 10.

Younger children may not interpret their odd, stereotyped behaviors as unusual:

to them, they are just “absolutely necessary.” Blocking or preventing their

compulsive responses can trigger violent tantrum

s. Older children w

ill oftenbecom

e exhausted in an effort to hide their condition from peers. In this illness,

there is a striking similarity of sym

ptoms am

ong children and adults, with 50

percent of adults with O

CD reporting their conditions started before the age

of 15.

Obsessions•fear of contam

ination, dread of germs

•fixation on lucky/unlucky num

bers•fear of catastrophic danger to self or others (fire, death, illness)

•need for sym

metry and exactness (objects or furniture m

ust be placed“just so”)

•excessive doubts

•forbidden, aggressive or perverse sexual thoughts and im

pulses

•describe that the child appears “blank” all the tim

e: delays answering

questions, doesn’t respond at all or frequently asks for statements to be

repeated

Adult-on

set Schizop

hren

iaThe average age of onset of the adult form

of schizophrenia is 18 for youngmen and 25 for young w

omen. H

owever, m

any teenagers of both gendersreport that onset sym

ptoms of schizophrenia started in their latter years of high

school. This illness is far m

ore common than childhood schizophrenia; it strikes

one out of 100 people and it ranks among the top 10 causes of disability in

developed countries worldw

ide. Consequently, early detection and treatm

entprovide the best chance for im

mediate stabilization and reduction of long-term

disability. Adult schizophrenia com

monly begins w

ith an acute psychoticepisode w

hich follows a “prodrom

al” period of progressive breakdown. T

heresidual sym

ptoms of the illness can severely lim

it the functional capacity ofyoung people struggling w

ith this brain disorder and the early years of illnessare m

arked by repeated bouts of psychosis, hospitalization and risk of suicide.

Prodromal O

nset Symptom

s•

persistent, uncontrollable crying not linked with any recognizable source

of sadness •

agitation and precipitous weight loss; sudden lack of attention to hygiene

•withdraw

al and isolation, “holing-up;” marked decline in scholastic

performance

•odd sensory experiences; odd beliefs and rituals

•feelings of cosm

ic importance (om

nipotence) or intense religiosity•

suspiciousness; fear of being watched or disliked by peers (paranoia)

Acute “Positive” Sym

ptoms (B

ehaviors “added to” the personality by the illness)•

delusions (false beliefs) and hallucinations (seeing/hearing things not there)•

grossly disorganized behavior, bizarre actions and incoherent speech•

bizarre body postures; pacing, rocking, grimacing; extrem

e negativism

Residual “N

egative” Symptom

s (A

ttributes “taken from” the personality by the illness)

•flat, blunted em

otional responses; total absence of spontaneity•

lack of motivation; inability to initiate and persist in goal-directed activities

23

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feelings that are normal responses to traum

a. This process is described in m

uch ofthe professional literature on fam

ily coping and adaptation to mental illness. T

hechart on page 27 lists the various stages that m

ark the path parents typically follow

.

The teacher’s com

ment on page 24 relates to stage one. O

ut of ignorance, fearor dread at w

hat mental illness m

eans for them, parents initially cling to any

alternative explanation, particularly those that seem to prom

ise a solution thatdoes not require taking the child to a “shrink.” T

his stage often blends with the

anger of stage two (W

hy him? W

hy her? Why us?) and frustration that the child

can’t simply “self-correct” so there w

on’t bea problem

.

The follow

ing suggestions, based on needs parents identify, are guidelines forteachers w

orking to engage parents in the early stages of emotional turm

oil overtheir child’s m

ental illness.

Here’s w

hat teach

ers can do:

•Rem

ove feelings of blame.Parents are hounded by constant feelings of

guilt and are hypersensitive to any indication that they are the cause oftheir child’s illness. Parents report that being blam

ed for their child’s problem

scares them aw

ay and makes them

defensive and distrusting. It ishelpful for the teacher to offer direct com

ments such as “you are not to

blame if your child has a m

ental illness” or “I know how

difficult thingsmust be at hom

e, but that’s because of the strain you’re under. It does notcause m

ental illness.”

•Acknow

ledge denial and anger as normal.Let parents know

that youbelieve anyone facing this crisis w

ould react similarly and that their

hesitation and frustration are absolutely understandable.

•Com

municate em

pathy and compassion for the parents’ dilem

ma.A

warm

, accepting attitude goes a long way tow

ard building trust.

•De-stigm

atize mental illness.C

ompare m

ental illnesses to other childhood illnesses like juvenile diabetes and epilepsy. Stress that thousands of children w

ith mental illness are under the care of

Com

pulsions•ritual hand-w

ashing, showering, groom

ing, cleaning•repetitive counting, touching, getting up and dow

n, going in and out,writing/erasing/rew

riting•continuous checking and questioning; arguing, hoarding or collecting

Observations from

Hom

e•report they m

ust cooperate with com

pulsive rituals to placate the child and avoid confrontations and tantrum

s•say the child is often too exhausted to play or join in fam

ily activities•express bew

ilderment and anger at child’s inability to control irrational

behaviors•disclose that ritual com

pulsions swam

p home life but are m

ore subdued in public

Co-occurring D

isorders •twenty percent of individuals w

ith OCD also have m

otor tic disorders•twenty to 40 percent of adolescents w

ith eating disorders have OCD

•adolescents w

ith OCD are at high risk for depression

Un

ders

tan

din

g F

am

ily R

eactio

ns to

Men

tal Illn

ess

“This m

ust be terribly tough on them, but the hardest part for m

e is when

parents balk at getting a psychiatric consultation.They know

their childhas a serious problem

but drag their feet about doing what’s necessary. I

don’t know how

to reach them w

hen this happens.” — A sixth-grade teacher

The path from

onset to acceptance of mental illness in a child is a long and difficult

process. Many parents are able to take decisive steps right aw

ay, but it is notuncom

mon for parents to resist accepting w

hat feels like a life sentence of disability for their child.

Parents describe this experience as a “triple-wham

my:” a fam

ily crisis, a marital

crisis and a personal crisis. From thousands of testim

onies heard in family support

groups, it is evident that parents go through a predictable emotional cycle of

25

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Pre

dic

tab

le S

tag

es o

f Em

otio

nal R

eactio

ns a

mo

ng

Fam

ily M

em

bers

Dealin

g w

ith M

en

tal Illn

ess

(Adapted from

the NAMI Fam

ily-to-Family education program

)

I.DEALING W

ITH THE CATAST

ROPHIC EVENT

Crisis/Sh

ock:feeling overw

helmed, dazed. “W

e don’t know how

to deal with it.”

Denial:

A protective response. W

e “normalize” w

hat is going on, find reasons forwhat is happening that don’t involve m

ental illness. We decide all this is not really

serious or there is a perfectly logical explanation for these events or it will pass...or

all three.

Hoping-again

st-Hope:The daw

ning of recognition and the hope that this is not alife event, that som

ehow everything w

ill magically go back to norm

al.

Need

s:*Su

pport *C

omfort *E

mpath

y for confusion

*Help

finding resou

rces *Early in

tervention

*Progn

osis *Empath

y for pain

*NAMI

II.LEARNING TO COPE: “G

OING THROUGH THE M

ILL”

Anger/G

uilt/R

esentm

ent:We start to “blam

e the victim,” insisting that the child

should “snap out of it.” We harbor trem

endous guilt, fearing that it really is ourfault. W

e torment ourselves w

ith self-blame.

Recogn

ition:The fact that a m

ental illness happened to someone w

elove

becomes a reality for us. W

e know it w

ill change our lives together.

Grief:W

e deeply feel the tragedy of what has happened to the child w

ho is stricken.We grieve that our future together is uncertain. T

his sadness does not go away.

Need

s:*Vent feelin

gs *Keep

hope *E

ducation

*Self-care *Netw

orking

*Skill training *L

etting go *C

o-operation

from system

*NAMI

III.MOVING IN

TO ADVOCACY: “C

HARGE!”

Understan

ding:W

e gain a solid, empathic sense of w

hat our child is experiencing.We gain real respect for the courage it takes for our child to cope w

ith this illness.

Acceptance: Yes, w

e finally say, bad things do happen to good people. It’s nobody’sfault. It is a sad and difficult life experience, but w

e will hang in there and m

anage.

Advocacy/A

ction:We can now

focus our anger and grief to advocate for othersand fight discrim

ination. We join public advocacy groups. W

e get involved.

Need

s:*A

ctivism *R

estoring balan

ce in life *R

esponsiven

ess from system

*NAMI

psychiatrists and that treatment is highly effective. E

mphasize that m

oreand better research is underw

ay to ensure safe, appropriate medications

for children.

•Emphasize that early intervention and treatm

ent are essential protectivesteps for their child.E

xplain that taking this action will lesson the

severity of the illness and will keep the child from

developing more

serious forms of the illness in later years. Stress that treatm

ent works, that

giving children appropriate medication enables them

to regain lost groundand realize their potential. Tell them

a psychiatrist is the individual bestqualified to m

ake this determination.

•Be particularly sensitive to parents w

ith special needs and concerns.Be

aware of the special needs of single parents, w

orking mothers, parents

living at poverty levels and parents of different cultures.

•Provide parents w

ith resources: Tell them education is the key to

understanding.Give them

this Parents and Teachers as Allies

booklet.Encourage them

to contact the local or state NAMI organization for

information about referrals, support groups and education classes. U

rgethem

to attend so they can get the support they need for themselves.

27

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We w

ill someday live in a w

orld where screening for m

ood disorders and other m

ental illness in young people will be an accepted, custom

ary proced

ure. U

ntil th

at time, ch

ildren

and ad

olescents w

ill not receive th

e critical early in

tervention

they d

eserve unless p

arents an

d teach

ers unite

to identify m

ental illn

ess and to “d

ouble-team

” the ch

ild in

to the

approp

riate treatment.

As guardians of their children’s future, parents m

ust take the responsibility foreducating every im

portant adult in their child’s home and school life. A

s mentors of these children's potential, teachers need to educate every person

in the child’s world at school w

ith power over treatm

ent choice. This is w

hy parents and teachers constitute the prim

ary, indispensable alliance. They are

not ju

st the first lin

e of defen

se, they are often

the only

line of defense.

Stre

ng

then

ing

the A

llian

ce: H

ow

NA

MI C

an

Help

NAMI is the largest grassroots organization in the nation dedicated to im

provingthe lives of individuals and fam

ilies affected by mental illness. T

he four pillars ofNAMI’s m

ission—support, education, advocacy and research—

are carried out bythousands of N

AMI m

embers w

ho serve in their communities as support group

leaders, family and consum

er contacts, teachers and advocates. This netw

ork ofexperienced volunteers can be an invaluable source of help for parents and teachers in their quest for inform

ation, education and support. Connecting w

iththis pow

erful grassroots know-how

will greatly reduce the doubt, isolation and

shame parents feel. K

ey resources offered by many N

AMI affiliates are:

•NAMI B

asics:a six-w

eek, peer education course taught by trained NAMI

mem

bers. The curriculum

is designed for parents and caregivers of children and adolescents w

ith mental illnesses.

www.nam

i.org/basics

•NAMI P

arents an

d Teach

ers as Allies:a tw

o-hour, in-service programfor school professionals and fam

ilies designed to help them better

understand the early warning signs of m

ental illnesses in children andadolescents and how

best to communicate w

ith families and intervene.

Na

vig

atin

g th

e R

efe

rral P

rocess a

s A

llies

“If the truth be told, I’m not given m

uch leeway to be proactive about

early intervention. One supervisor told m

e it’s not my job to identify

mental illness. Som

e administrators w

ith the final say always settle for

talk therapy and won’t go the m

edical route. Getting appropriate

psychiatric treatment usually m

eans I have to buck the whole system

.”— A high school teacher in Verm

ont

If medals w

ere minted for rising above the call of duty as an educator, they

would certainly go to the legions of teachers w

ho dotake action to identify

children with m

ental illnesses and press for effective psychiatric treatment. In

most school system

s today, a referral to a psychiatrist is a long-delayed, laststep

in a series of team m

eetings and administrative review

s that typically lead to anevaluation by a psychologist or social w

orker. While these m

ental health professionals can ably provide support and counseling, they are rarely trainedto recognize m

ental illness in children and they are not permitted to

prescribe medication. H

owever, a psychiatric evaluation generally w

ill not bepursued unless these evaluators recom

mend it.

The m

ost effective way to put a child on a fast track to see a child

psychiatrist is for the parentsto take the initiative, find the doctor, get the

diagnosis and present the school with m

edical evidence that their child has amental illness. If a child psychiatrist cannot be located in their geographical

area, parents should seek help from a neurologist or pediatrician. For fam

ilieswho cannot afford these options or are apprehensive about them

, the teachercan start the process for the child to be identified by school authorities as astudent w

ith an “emotional behavioral disorder” (E

BD). C

lose collaborationduring the review

process means the teacher can help the parents understand

why they m

ust advocate for a medical evaluation every step of the w

ay.

29

28

If medals w

ere minted for rising above the call of duty as an educator,

they would certainly go to the legions of teachers w

ho do take action toidentify children w

ith mental illnesses and press

for effective psychiatrictreatm

ent.

1.41N

AM

I Basics E

ducation Program

2010

For more inform

ation about the in-service program or to learn how

tobring it to your school visit w

ww.nam

i.org/CAACor contact N

AMI

National at (703) 524-7600.

•NAMI C

hild and Adolescent A

ction Center:Provides public health educa-

tion, brochures and fact sheets about early-onset mental illnesses in children

and adolescents, produces family guides and resources packets and publishes a

quarterly magazine, N

AMI Beginnings, for caregivers and professionals w

howork w

ith children. The Center also provides technical assistance to N

AMI

state and affiliate leaders on issues impacting children and adolescents w

ithmental illness and their fam

ilies. www.nam

i.org/CAAC

•The N

AMI F

amily-to-F

amily E

ducation Program:a 12-w

eek, peer education course taught by trained N

AMI m

embers in 48 states. A

lthoughthe curriculum

covers only mental illnesses diagnosed in adults, the course is

appropriate for families of teenagers w

ho have adult disorders. The course is

also available in Spanish in select communities. w

ww.nam

i.org/family

•NAMI Su

pport G

roups:Local group m

eetings in towns and cities across

the nation, these confidential gatherings of caregivers in need offer ahaven of understanding based on lived experience w

ith mental illness.

Additional support groups are offered for individuals w

ho live with m

en-tal illness. N

AMI C

onnection, support groups for individuals for mental

illness, are also offered in select communities. w

ww.nam

i.org/connection

•NAMI H

elpLine:A toll-free service providing support, referral and

information. O

ver 60 fact sheets on a variety of topics are available alongwith referrals to N

AMI’s netw

ork of local affiliates in communities across

the country. Information and referrals are also offered in Spanish.

1 (800) 950-NAMI (6264) or info@

nami.org.

•www.nam

i.org:A source of inform

ation about all facets of NAMI

advocacy at the national and state levels; current information on research;

basic information about m

ajor mental illnesses, new

est medication

strategies, discussion groups and best treatment practices.

31

30

To order this booklet, please visit the NAMI Store at w

ww.nam

i.org/store.

NO

TE

S

1.42N

AM

I Basics E

ducation Program

2010

As guardians of their children’s future, parents m

usttake the responsibility for educating every im

portantadult in their child’s hom

e and school life. As m

entors ofthese children’s potential, teachers need to educate everyperson in the child’s w

orld at schools with pow

er overtreatm

ent choice.

1.42 (a)N

AM

I Basics E

ducation Program

2010

3803 N. Fairfax D

r., Arlington, VA

22203(703) 524-7600 • H

elpLine: 1 (800) 950-6264www.nam

i.org

1009

1.42 (b)N

AM

I Basics E

ducation Program

2010