Practically no one expects a child to be intentionally harmed physically, sexually or emotionally, but it happens every day. Experts have for years concluded that child abuse, in general, often leads to mental disorders that affect behavior, self esteem, identity, and social and cognitive development.
Recognizing the need for increased child mental health services, the Los Angeles County Board of Supervisors is focusing more attention on this youthful community which can sometimes be forgotten because of the huge number of daily cases of child abuse officials must deal with not only locally, but across the nation.
Led by Supervisor Michael Antonovich (Fifth District), the board of supervisors recently approved additional mental health funding to expand the county’s capacity to serve children. This includes providing more financial resources for the Children’s Center of the Antelope Valley, 45111 Fern Ave., Lancaster, and also for Counseling 4Kids, located in Burbank and in Torrance. These agencies provide vital mental health services to child victims of abuse, children at risk of abuse and their families, as well as youth in the foster care system.
Improving the ‘parent-child’ relationship
The Children’s Services Center provides child abuse treatments, parent-child therapy sessions, a family preservation module, family support services and, importantly, an “enriched” play program to allow youngsters who may live in an abusive environment to enjoy being a child without the overhanging threat of physical, mental or sexual abuse.
The federal Centers for Disease Control and Prevention (CDC) last summer released a report describing mental disorders among children as “serious changes” in the way they typically learn, behave or handle their emotion. Such symptoms of mental disorders are said to usually begin in early childhood, although some of the disorders may develop throughout the teenage years. These disorders can be treated and managed says experts—provided they are identified early—and if parents, doctors and the typical support group such as teachers, coaches, counselors and therapists communicate freely with one another and are closely involved in the child’s treatment.
Without early diagnosis and treatment, it is widely believed that children with mental disorders may have problems at home, in school and in forming relationships. An undiagnosed mental illness can also interfere with a child’s healthy development and if not addressed, problems can continue into adulthood. The National Research Council and Institute of Medicine in 2011 gathered findings from a number of previous studies and reported that 13 to 20 percent of American children—irrespective of sex, race or ethnicity—will experience a mental disorder in any given year. That’s about one in five children exhibiting a form of mental illness.
About $260 billion is spent yearly on childhood mental disorders, according to a 2013 report by National Resource Council Institute of Medicine.
“One of our responsibilities is to open the lines of communication between parent and child,” said Sue Page, executive director of the Children’s Services Center of the Antelope Valley. The center offers a number of services designed to address early signs of childhood mental illness. “We provide support for parents to make changes. Our in-home counselors work with parents to prevent possible child abuse. We’re there to help kids who often can be the most vulnerable members of the community.”
Early monitoring is key
Experts recommend a relatively new method of identification of childhood mental illness called “public health surveillance” (the collection and monitoring of information about health among the public over time) which may be a positive first step to better understanding childhood mental disorders and the promotion of children’s mental health services. Such ongoing and systematic monitoring of mental health and resulting disorders can reportedly help to increase understanding of the mental health needs of children. This process can also inform research on the factors that increase risk and promote prevention, determine which programs are effective at preventing childhood mental disorders, and also monitor progress to determine if treatment and prevention efforts prove effective.
The CDC report revealed some key findings about mental disorders affecting children and teens aged 3 to 17 years. Among them: millions of American children live with depression, anxiety, ADHD (Attention Deficit Hyperactivity Disorder), autism spectrum disorders, and Tourette syndrome.
ADHD is the most prevalent diagnosis among the 3- to 17-year-old group. Boys were more likely than girls to have ADHD, behavioral or conduct problems, autism spectrum disorders, anxiety and even the tendency to begin smoking.
Adolescent boys ages 12 to 17 years were more likely than girls to attempt or commit suicide, while adolescent girls were more likely than boys to suffer from depression and begin to use alcohol.
Statewide, more than 300,000 children between the ages of 4 and 11 years needed mental health care in 2014. The UCLA Center for Health Policy Research reported last year that early intervention in children is a “critical step” in reducing the severity of mental health problems in adulthood.
“Without early assessment, you miss warning signs, as well as opportunities to intervene,” said Dr. Imelda Padilla-Frausto, a researcher at the center and lead author of the study. “Waiting can lead to more serious problems later.”
Effects of Proposition 63
California lawmakers have been working for a decade to help stem the growing tide of [progressive] mental illness. In 2004, voters passed Proposition 63 which resulted in the Mental Health Services Act. That statewide measure led to L.A. County’s “Prevention and Early Intervention” plan that today promotes awareness and prevention of various stigma associated with mental illness and also provides a platform for insuring that youth are included in the socialization process of each local community. Last year, the County received $40.9 million to better facilitate its services to not only adults suffering from mental illness, but also to increase its outreach services and to improve methods of identification of mental illness in children and adolescents.
The county is also working with First 5 LA in its Parent-Child Interaction Therapy program. This “evidence-based” program is designed for children ages 2 to 5 years identified with externalized “acting out” behaviors and places emphasis on improving the quality of the parent-child relationship and current parent-child interaction patterns. This program has been successfully used to help young children who may have serious behavioral problems such as aggressiveness, defiance, temper tantrums and oppositional behaviors. The program has been documented as effective in reducing incidences of low to moderately severe physical abuse cases involving young children. The program is reported to be most effective with stressed, “overwhelmed” parents by developing positive reinforcement within the parent-child relationship.
Early assessment is reported to be one of the best ways to identify initial signs of mental illness. Researchers at the Stanford University School of Medicine participated in a study that followed 543,000 children for 11 years, in an effort to learn more about the “… potential associations between individual, family and neighborhood factors” and psychiatric disorders in children and adolescents. The youth were measured for internalizing psychiatric disorders (anxiety and mood) and various “externalizing” disorders which may refer to ADHD and other conduct disorders. Their findings, along with those of participating institutions including Lund University in Sweden and Virginia Commonwealth University, revealed that more than 26,000 children developed a psychiatric disorder, with at least 29 percent of the cases attributed to the child’s family and 5 percent attributed to so-called “neighborhood deprivation.” This refers to the relation between certain neighborhoods and health-related resources (i.e. availability of fresh fruits and vegetables at a supermarket). When coupled with prior research conducted by the Robert Wood Johnson Foundation, the Stanford team posits that this type of deprivation can increase the cases of Type 2 diabetes and incidences of major depression as the affected child grows older.
Benefits of good nutrition, exercise
“The estimated risks and random effects [of undiagnosed mental illness] indicate that children are strongly affected by both their family and neighborhood environments,” said Jan Sundquist, the lead researcher of the multi-national study. The report further revealed that external factors can have a measurable effect on a child’s mental well-being. Early familial nurturing, good nutritional habits and regular physical activity may have more of an influence on mental stability than was previously believed. “Environmental factors can account for as much as six to eight times as much of the total variation in psychiatric disorders,” Sundquist explained. “Our findings call for policies to promote mental health [strategies] that consider potential influences from children’s family and neighborhood environments.”
Two additional reports by the U.S. Surgeon General and the New Freedom Commission on Mental Health each suggest that through appropriate identification, evaluation and treatment, children and adolescents living with mental illness can lead productive lives. But it is vital that mental illness be identified early. Unfortunately, both groups found that the “overwhelming majority” of children with mental illness are not be identified because of lack of access to treatment or support systems and thus have a “…lower quality of life.”
The National Alliance on Mental Illness (NAMI) reported in 2013 that, nationally, about 4 million children and adolescents suffer from a “serious” mental disorder that causes significant functional impairment at home, at school and with peers. Of children ages 9 to 17 years, 21 percent have a diagnosable mental or addictive behavior that causes at least minimal impairment. The NAMI report also indicated that half of all adult cases of mental illness begin at age 14. There are effective treatments, but there are also long delays—sometimes decades—between the first onset of childhood mental disorder(s) and the time when these persons seek help. In any given year, only 20 percent of children with a mental disorder are identified and receive mental health services.
Dr. Luis Ramirez, clinical director of patient services at the Antelope Valley children’s center, believes that short-term psycho-therapy sessions that correspond with the center’s evidenced-based program have realized positive results in transforming many of his charges into future, active members of the community. “Our outcome measures have allowed us to successfully serve and treat such children. Our clinicians will carefully review a case for six months all the time monitoring symptoms. We’ve had great success in identifying traits of early mental illness. For the past 30 years, all of this is possible because of the assistance and support of the community.”
Suicide rising among children
Suicide is reportedly the third leading cause of death in youth ages 15 to 24. The NAMI report indicated that more teenagers and young adults die from suicide than from the combined mortality resulting from cancer, heart disease, AIDS, birth defects, stroke, pneumonia and influenza.
School failure is another important factor in relation with child/adolescent mental illness. About 50 percent of students age 14 years and older who are living with a mental illness drop out of high school, representing the largest drop-out rate of any disability group. As well, the NAMI report revealed that youth with identified but untreated mental disorders wind up in jail or prison. The report found that 65 percent of boys and 75 percent of girls in juvenile detention have at least one mental illness. “We are incarcerating youth living with mental illness—some as young as 8 years old—rather than identifying their conditions early and intervening with appropriate treatment,” the report stated.
