H NDS-ONHealth

Health Wave Newsletter, May 2013

Visit us on our website at www.healthwaveinc.com

May is Mental Health Month

This newsletter summarizes the latest research and data from the National Institute of Mental Health, including some common questions and answers for parents and children.

Brain Development During Childhood and Adolescence

In recent years, powerful new imaging technologies and other approaches have allowed scientists to track the development of the brain during childhood. These studies offer a way to understand how the intellectual abilities and behavioral maturity of children at various ages are rooted in the developing brain. Studies of the developing brain also offer the best possibility for understanding the origins of mental illnesses. Research suggests that vulnerability to mental illnessand resilience is rooted in development. Both risk and resilience are shaped by genes and environment interacting together, through childhood and adolescence. Research can show how. In the 1980s and 1990s, national surveys revealed that many adults with mental illness recall having had their first symptoms in youth. Studies tracking the maturation of the brain showed that different parts of the brain grow at different times. There are growth spurts as well as periods of more gradual growth. Imaging studies have also shown that youth diagnosed with mental disorders show patterns of development different than in unaffected youth. Research in animals has shown that early experience has measurable effects on the brain and later behavior. Early experiences shape how the brain-based stress response system develops and can influence later stress resilience.

TODAY
Scientists are continually refining imaging techniques to provide more detailed information on brain development, even in very young children. Researchers are tracing how changes in the developing brain underlie milestones in a childs mental and physical abilities, and behavior. Scientists are conducting studies to determine what individual genes do in the brain and how changes in genes disrupt brain function. Research on early childhood stress is showing how early trauma can alter the brains stress response system and contribute to future risk of anxiety and mood disorders.

YESTERDAY
Thirty years ago, it was thought that children did not experience mood disorders like depression.

 Scientists are also studying how genes that convey vulnerability to stress may increase risk. Studies of how the environment can turn genes on and offa field called epigeneticsare providing clues to how early experience can have lasting effects on behavior, even across generations. Epigenetic changes are likely to be involved in the effects of the environment on development of the nervous system. Knowledge of epigenetic processes may offer targets for the development of new medications.

Prevalence and Use of Services

ANY DISORDER CHILDREN
50%_ 40%_ 30%_ 20%_ 10%_ 0%_
Lifetime Prevalence of 13-18 year olds Lifetime Prevalence

50%_
Lifetime Prevalence of a Severe Disorder

Sex

Age

40%_

13-14 years old 41.7

20%_ 10%_ 0%_

21.4

Demographics (for Lifetime Prevalence)

Sex: Not statistically di erent; Age: Statistically di erent; Race: Statistically signi cant di erences were found between non-Hispanic whites and other races
Merikangas KR, He J, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Study-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-989

TOMORROW
Ongoing research will clarify the relationship between genes and risk for mental illness. Rather than finding genes that cause a particular disorderfor example, a gene for bipolar disorderit is more likely that genes will be identified that contribute to behavioral, emotional, and social tendencies, including responses to stress. The mosaic of these traits will contribute to vulnerability or resilience to illness. Scientists are increasingly focusing on neural circuits in the brain and how they develop during childhood. Research will map neural circuits in the brain, clarify how genes and environmental factors shape them, and determine how they become disrupted in mental illness. One of the major goals of research is to identify biomarkers of disease to enable early and accurate diagnosis of mental illness. The genetics of mental illness is complex; still, knowledge of how genes shape brain function should make it possible to determine whether particular genes increase or protect against risk. Research also suggests that genes may help determine how a person will respond to treatment. Research on the effects of early stress on the brain will help inform efforts to support the healthy emotional and intellectual development of children.

Mental disorders are common among children in the United States, and can be particularly difficult for the children themselves and their caregivers. Approximately 20 percent (or 1 in 5) children, either currently or at some point during their life, have had a seriously debilitating mental disorder.

12 MONTH PREVALENCE FOR CHILDREN (8 to 15 years old)

ANY DISORDER 13.1% ADHD 8.6% MOOD DISORDERS 3.7% MAJOR DEPRESSION 2.7% CONDUCT DISORDER 2.1% DYSTHYMIA 1.0% ANXIETY DISORDERS 0.7% PANIC DISORDERS 0.4% GENERALIZED ANXIETY DISORDERS 0.3% EATING DISORDER 0.1%
Data courtesy of CDC

Approximately 13 percent of children ages 8 to 15 had a diagnosable mental disorder within the previous year. The most common disorder among this age group is attention-deficit/hyperactivity disorder (ADHD), which affects 8.5 percent of this population. This is followed by mood disorders broadly at 3.7 percent, and major depressive disorder specifically at 2.7 percent.

SERVICE USE FOR CHILDREN (8 to 15 years old)

Approximately half (50.6 percent) of children with mental disorders had received treatment for their disorder within the past year. There were some differences between treatment rates depending on the category of mental disorder. Children with anxiety disorders were the least likely (32.2 percent) to have received treatment in the past year. Females were 50 percent less likely than males to use mental health services, while 12-15 year olds were 90 percent more likely than 8-11 year olds to use mental health services. No differences were found between races for mood, anxiety, or conduct disorders. Mexican Americans and other Hispanic youth had significantly lower 12-month rates of ADHD compared to non-Hispanic white youth. Data courtesy of CDC

USE OF SERVICES FOR DEPRESSION

Percent Receiving Services
50% _ 40.3 40% _ 30% _ 20% _ 10% _ 0% _ 2004 2005 2006 2007 2008 37.8 38.9 38.9
Data courtesy of SAMHSA

MALES 46.0

43.3

30%_

The Substance Abuse and Mental Health Services Administration (SAMHSA) examines depression treatment among youth ages 12 to 17 each year through the National Survey on drug Use and Health (NSDUH). NSDUH's most recent data are for 2008 and show that 37.7 percent of youth with depression received treatment for their disorder.

15-16 years old 45.9

37.7

17-18 years old 54.5

FEMALES 46.7

Answers to Frequently Asked Questions About the Treatment of Mental Disorders in Children.

Q.What should I do if I am concerned about mental,

behavioral, or emotional symptoms in my child?

A.Talk to your child's doctor or health care provider.

Ask questions and learn everything you can about the behavior or symptoms that worry you. If your child is in school ask the teacher if your child has been showing worrisome changes in behavior. Share this with your child's doctor or health care provider.

Q.How are mental illnesses diagnosed in young children? A.Just like adults, children with mental illness are
diagnosed after a doctor or mental health specialist carefully observes signs and symptoms. Some primary care physicians can diagnose your child themselves, but many will send you to a specialist who can diagnose and treat children.

Q.How do I know if my child's problems are serious? A.Not every problem is serious. In fact, many
everyday stresses can cause changes in your child's behavior. For example, the birth of a sibling may cause a child to temporarily act much younger than he or she is. It is important to be able to tell the difference between typical behavior changes and those associated with more serious problems. Pay special attention to behaviors that include: Problems across a variety of settings, such as at school, at home, or with peers Changes in appetite or sleep Social withdrawal, or fearful behavior toward things your child normally is not afraid of Returning to behaviors more common in younger children, such as bed-wetting, for a long time Signs of being upset, such as sadness or tearfulness Signs of self-destructive behavior, such as headbanging, or a tendency to get hurt often Repeated thoughts of death.

Q.Are there treatment options for children? A.Yes. Once a diagnosis is made, your child's specialist will recommend a specific treatment. It is important to understand the various treatment choices, which often include psychotherapy or medication. Talk about the options with a health care professional who has experience treating the illness observed in your child. Some treatment choices have been studied experimentally, and other treatments are a part of health care practice. In addition, not every community has every type of service or program.

Q.Are there treatments other than medications? A.Yes. Psychosocial therapies can be very effective
alone and in combination with medications. Psychosocial therapies are also called "talk therapies" or "behavioral therapy," and they help people with mental illness change behavior. Therapies that teach parents and children coping strategies can also be effective.

Q.Does medication affect young children differently

than older children or adults?

A.Yes. Young children handle medications differently than older children and adults. The brains of young children change and develop rapidly. Studies have found that developing brains can be very sensitive to medications. There are also developmental differences in how children metabolize - how their bodies process - medications. Therefore, doctors should carefully consider the dosage or how much medication to give each child. Much more research is needed to determine the effects and benefits of medications in children of all ages. But keep in mind that serious untreated mental disorders themselves can harm brain development.

Q.Can symptoms be caused by a death in the family, illness in a parent, family financial problems, divorce, or other events?

A.Yes. Every member of a family is affected by

tragedy or extreme stress, even the youngest child. It's normal for stress to cause a child to be upset. Remember this if you see mental, emotional, or behavioral symptoms in your child. If it takes more than one month for your child to get used to a situation, or if your child has severe reactions, talk to your child's doctor.

Also, it is important to avoid drug interactions. If your child takes medicine for asthma or cold symptoms, talk to your doctor or pharmacist. Drug interactions could cause medications to not work as intended or lead to serious side effects.

Q.How do I work with my child's school? A.If your child is having problems in school, or if a
teacher raises concerns, you can work with the school to find a solution. You may ask the school to conduct an evaluation to determine whether your child qualifies for special education services. However, not all children diagnosed with a mental illness qualify for these services. Start by speaking with your child's teacher, school counselor, school nurse, or the school's parent organization. These professionals can help you get an evaluation started. Also, each state has a Parent Training and Information Center and a Protection and Advocacy Agency that can help you request the evaluation. The evaluation must be conducted by a team of professionals who assess all areas related to the suspected disability using a variety of tools and measures.

Sometimes, the whole family may need counseling. Therapists can help family members find better ways to handle disruptive behaviors and encourage behavior changes. Finally, support groups help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.

Q.Where can I go for help? A.If you are unsure where to go for help, ask your
family doctor. Others who can help are listed below. Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors Health maintenance organizations Community mental health centers Hospital psychiatry departments and outpatient clinics Mental health programs at universities or medical schools State hospital outpatient clinics Family services, social agencies, or clergy Peer support groups Private clinics and facilities Employee assistance programs Local medical and/or psychiatric societies You can also check the phone book under "mental health," "health," "social services," "hotlines," or "physicians" for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.
Health Wave Publishing Company 39 Davenport Street Stamford, CT 06902 Tel: 203-975-7810 or 800-374-7953 Fax: 203-975-7946 e-mail: hpwinfo@ healthwaveinc.com

Q.What else can I do to help my child? A.Children with mental illness need guidance and
understanding from their parents and teachers. This support can help your child achieve his or her full potential and succeed in school. Before a child is diagnosed, frustration, blame, and anger may have built up within a family. Parents and children may need special help to undo these unhealthy interaction patterns. Mental health professionals can counsel the child and family to help everyone develop new skills, attitudes, and ways of relating to each other. Parents can also help by taking part in parenting skills training. This helps parents learn how to handle difficult situations and behaviors. Training encourages parents to share a pleasant or relaxing activity with their child, to notice and point out what their child does well, and to praise their child's strengths and abilities. Parents may also learn to arrange family situations in more positive ways. Also, parents may benefit from learning stress-management techniques to help them deal with frustration and respond calmly to their child's behavior.