Why Becomes What

We know that the number of mental health problems in children and adolescents has increased immensely over the last ten – fifteen years, and this increase has led to a mental health crisis in this age group.  We know that pediatricians are the “first line of defense” when it comes to all things physical with our children.  Pediatricians have been trained to treat our children’s colds, flu symptoms, ear infections, and bumps and scrapes, but they have not been well-trained to care for their mental health in a meaningful way. We know there are not enough pediatric therapists and psychiatrists to treat the number of children and adolescents who are among the increased number of pediatric patients suffering with mental health problems.  We also know that up until recent years, mental health was not a subject easily discussed, and so the topic was usually avoided.  Gradually, the conversation surrounding mental health has increased.  The last year in particular has shown a marked increase in the proliferation of articles and conversations about the importance of dealing with mental health.  It is finally being discussed, but people think that this mental health crisis has popped out of nowhere.

The American Academy of Pediatrics has stated, “Mental health disorders have surpassed physical conditions as the main source of impairments and limitations.  Pediatricians need to take on a larger role in addressing the mental health crisis. Yet a majority of pediatricians do not feel prepared to do so.” 

We could blame this crisis on the pediatricians, but mental health treatment was a very small part of their training.  We could blame it all on the pandemic, but we know the pandemic only accelerated the trajectory of the already existing mental health problem.  We could blame it on the chaotic world around us in which the actions of people and countries has caused anxiety in the calmest of adults.   But none of these reasons alone, nor all three together, fully answer the question of “Why?”.

Why has there been such an increase in mental health illness in children and teens?   

From time to time, I have listened to The Dailya podcast supported by The New York Times and hosted by Michael Barbaro.  Recently I heard a podcast, posted on August 30 of this year, entitled “Inside the Adolescent Mental Health Crisis.”  Michael Barbaro was interviewing a colleague, Matt Richtel, who has spent the last few years doing research (with full support from The New York Times) into the mental health crisis among adolescents.  One of the major issues he discussed is how puberty has affected the onset of mental health illness.

Richtel points out that around 1900, puberty arrived on average when a girl was 14 years of age and starting menstruation.  In today’s world, that girl is starting puberty and menstruation around age 12, or even earlier in some cases.  Boys are also going through a similar challenge at an earlier age than was previously the case.  We think of puberty as the beginning of sexual awakening, but it is much more than that.  The awakening is not only in our bodies, but also in our brains.  According to Richtel, it is our brains that have not developed fast enough to keep in lockstep with our bodies.  The brain cannot process, nor make sense of, all this new stimulation from the world around us. Sex and all things sexual are only part of the story. The world with its nuances and issues is a bigger part of the puberty experience. Richtel says that the brain of a 12year old is simply not developed enough to be able to process the quantity of new information being forced on it.  The brain of a 12year old has not caught up to the more quickly developing body, and the brain is not ready to cope with all this new available information .  The 12year old is able to access quickly, and without filters, so much information in our technologically driven world that the brain of this child can go into overload.  With this overload comes internal confusion, rumination, obsessive thinking, anxiety, depression, self-harm, suicidal ideation, aggression, and the list could continue.  So, our “Why?” now becomes “What?”.  What can we do to effectively confront this crisis?

Most logically, as a child’s or adolescent’s first-line-of-defense, pediatricians should get the extra training that is needed for them to feel more competent and comfortable treating the internal cuts and scrapes of mental health bruising.  Then we need more well-trained and qualified pediatric therapists and psychiatrists to pick up the baton and help the child to continue the healing process.  Although medications may play a part in the healing process as well, I do not believe that it is a total fix and certainly needs to be accompanied by a conversation with a doctor.  These experts in the field of mental health can do something that the medicines cannot do, and that is to acknowledge and validate the turmoil of emotions living inside these kids, and teach the young patient good coping skills that will be part of the child’s tool kit going forward.  

Resources.

National Alliance on Mental Illness

National Institute on Mental Health

Heads Together Mental Health

The Society of Clinical Child and Adolescent Psychology’s Effective Child Therapy website can help parents discern what mental health treatments have robust data behind them, and which are most strongly recommended for specific disorders. 

The American Psychological Association allows you to search by Zip code, patient age group, doctor or therapist specialty, type of therapy provided, insurance and telehealth participation, and whether there are openings for new patients. 

The Association for Behavioral and Cognitive Therapies’ search tool specifically helps locate psychologists, psychiatrists and clinical social workers who are trained (and ABCT-licensed) in the evidence-based cognitive and behavioral techniques most frequently cited by experts as beneficial for children. 

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