Health Check

    Our Kids and Mental Wellness

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    When Cheryl Ratcliff’s son Tim was seven years old, he was convinced his Superman cape would allow him to fly and leapt off the roof of a building. He also had periods two to three days when he would go without sleep, followed by a depression so deep that he talked about suicide. The moods changed quickly. “It was like a light switch going on and off,” Cheryl said. She told her pediatrician she knew something was wrong. Tim was diagnosed with attention deficit hyperactivity disorder and put on the drug Ritalin. But, Cheryl felt something more serious was happening with Tim. She continued to try to get his doctor to listen, but her concerns were brushed off.

    Bela Sood, MD, is medical director of VCU Medical Center’s Virginia Treatment Center for Children and chair of the division of child and adolescent psychiatry. She says, “In trying to decide if your child has a serious problem, ask yourself, ‘Is this a departure from the child’s usual personality, his baseline personality? Is the behavior different from other children his age?’”

    She also suggests looking at your child from a developmental perspective. Some problems are purely developmental in nature and normal for that age. For example, toddlers have separation anxiety and hyperactivity issues, but if activity level is so high he can’t sit still for a minute, then that may indicate a problem. Children five to seven have issues of developing a separate self from their parent. Teens have completely different issues of hormonal changes and body chemistry.

    Dr. Sood recommends that parents educate themselves on developmental steps and what is typical. However, she adds, “If you have a child that talks about death a lot, is obsessed with negative thoughts, or has an internal feeling of sadness that continues, these can be serious and need to be checked out.”

    In Tim’s case, his behaviors were not at all typical for a child his age, and his symptoms got worse. At ten, Tim locked himself in his room. He had a knife and he threatened suicide. His mother told of the night, in desperation, when she broke down a door and got the knife away from her son. Fearful for his life, she took him to a hospital. “I could not believe that I was checking my son into a psychiatric hospital.” He was there for ten days. In the hospital, they took him off all medications and he went into a full-blown rage. The hospital stay allowed the doctors to observe Tim and adjust his medications. Finally, his mother got a firm diagnosis from a child psychiatrist. Tim had bi-polar disorder.

    Nearly ten years ago, one of the problems Cheryl Ratcliff faced in getting help for her son was that pediatric psychiatrists were rare. Dr. Sood says going to a psychiatrist today is accepted and it should not be an embarrassment. “It is important to go to as competent a professional as possible, a psychologist or psychiatrist with expertise in working with children.” She adds, “It may seem radical, but it pays to interview the doctor before you bring your child in as a patient. Ask who he typically treats. Feel free to ask about his training and experience.” To get a list of psychiatrists who treat children, see the website of the American Academy of Child and Adolescent Psychiatry.

    Asking your child’s teachers what they see is also a good idea according to Dr. Sood. Have there been changes in behavior? Are there differences between him and other children his age? Teachers see many kids at the same age level and can spot dissimilarities. They can also tell you about how well your child gets along with other children.

    Medications are an important component in treatment and therapy for mental disorders today. While there are numerous new medications on the market, their effect on children and teens may be different than on adults. Dr. Sood says, “The problem is that there are not a lot of clinical trials with children.” So, unless a doctor has had a lot of experience in medicating children, he may not be able to do this precisely. Again, is your doctor trained in the treatment of children? Anti-depressant medications, in particular, may be helpful, but there is increased concern that these drugs sometimes cause suicidal ideation and attempts. The FDA has posted a black-box warning on antidepressants stressing that if your child or teen is taking them, you must watch carefully for increased signs of suicidal thought or deeper depression. The American Medical Society, as Dr. Sood mentioned, suggests that many FDA approved medications are approved for adults or teens but have not been tested on children, particularly pre-schoolers.

    Cheryl finally located the right pediatrician who prescribed the proper medications for Tim. She found that structure and stability were key to helping him. She says, “They say that puberty either makes children with bi-polar disorder much worse or better. In his case, Tim has stabilized and gotten much better as he went through puberty.” Now at 17, his mom says he is able to do well in his studies, making A’s and B’s, and he has a few good friends. He is able to interact socially in a more positive way and enjoys school. “For the first time in his life, I believe he can be a successful adult,” says his mother.

    Cheryl has this message for parents: “It’s not your fault and do not be ashamed of your child’s illness. When your child is born you want him to be perfect – but he is my flesh and blood. I have stood by him and I think that’s been critical to his survival.”

    Dr. Sood says, in trying to decide whether your child has a problem, go with your gut feeling. She respects parents’ abilities to know their children. And, if you feel your child has a problem, do not hesitate to get help. Again, she recommends finding a child-trained, experienced psychiatrist or psychologist, a professional with experience in treating children.