By the time parents find us at the Boston or Worcester PAL office, their child usually has a lengthy list of mental health diagnoses. Part of what might prompt that first call is the sense of panic or desperation a parent feels just reading and trying to absorb what this list means. The more diagnoses, they reason, the worse off my child must be. When we get to the part of the call where the list is recited, the diagnoses often are overlapping, repetitive or seem to have evolved something like this: first there was ADD, then depression was added and later someone diagnosed (and added) bipolar disorder. Anxiety or a sleep disorder was thrown into the mix along the way. On top of all that, no diagnoses whatsoever have been eliminated.
This experience is what I call the “morphing” diagnosis. Remember those 90s videos or TV ads where one face was blended into the next and the next? Wikipedia calls morphing “a special effect that changes one image into another through a seamless transition.” Thus, the ADD child is changed into the depressed child and then into the bipolar child while the parent tries to understand what is taking place.
This is a very common experience. And it happens to a lot of families. According to the U.S. Surgeon General, mental health disorders occur in about 20% of children in any given year and about 5 million children and teens have a serious or significant mental health need that interferes with their daily life at home, at school or in the community. Their families are usually trying to figure out what is going on, hoping that a clear diagnosis will open the doors to services that their child needs. They find out that there isn’t a diagnostic tool like a blood test or an x ray and identifying what’s going on can be tricky. Piecing the picture together usually relies on the observations of teachers, family members, doctors and others and their observation skills can vary greatly.
But finally someone does arrive at a diagnosis. Then maybe another. And a different therapist or someone during a hospital stay adds yet another. Parents often ask, If no one can agree on my child’s diagnosis, then how can I ever decide on what treatments or services he (or she) needs?
Treatments for children’s mental health disorders are being studied and evaluated with the goal of matching the most effective treatment to a specific mental health disorder. We are hearing more and more these days about “evidence based practices” in the children’s mental health system. It conjures up the feeling that science and precision will be applied to matching the “right” treatment to any child with a mental health disorder. There is already strong evidence that certain medications are effective for children with ADHD and cognitive behavioral therapy is a promising treatment for children with anxiety or depression.
But therein lies the rub. An accurate picture of what is going on for a child with mental health needs is required in order to choose an effective treatment. Therapists sometimes refer to the “art” of diagnosing and in the next breath outline the science of evidence based practice. Perhaps this reflects where we are in the children’s mental health world. Maybe it is morphing too — from a denial not too long ago that children’s had mental health disorders; to a recognition that adult treatments can be ineffective and even unsafe for children; to an interest in studying what truly works for children, youth and their families.
In the meantime, I think we’ll just keep answering those calls.