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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
600
He
lpLin
e: 1
(800) 9
50-N
AM
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
ducation Program
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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2010
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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2010
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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2010
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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2010
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
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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
.
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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
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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.
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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