Young kids battling mental health issues are on the rise

The need for mental health services is on the rise for elementary-aged children, according to Pamela Brown, executive director of the Anne Arundel County Partnership for Children, Youth and Families.

In kindergarten classes around Anne Arundel County, more teachers are dealing with students who bite, throw chairs, can't relate socially and can't focus on their work.

In emergency rooms, nurses are shocked at the increasing number of children arriving with mental health issues — and the number of parents who don’t know how to help.

Mental healthWBrown recently wrote the county’s Community Health Needs Assessment, which found public mental health services for children ages 6 to 12 increased by 14.5 percent from 2012 to 2014. The assessment was a joint undertaking led by the Anne Arundel County Department of Health, Anne Arundel Medical Center and University of Maryland Baltimore Washington Medical Center.

“It runs the gamut from the behavioral issues all the way up to things for which you really need intervention from a mental health expert,” Brown says.

Mental health professionals say they’re seeing a similar trend across central Maryland, with children as young as age 2 receiving services.

“We are seeing children, even younger and younger children, needing mental health services,” says Susan Perkins-Parks, director of the behavior management clinic at Kennedy Krieger Institute in Baltimore. “We get referrals from day care centers and preschool programs where people aren’t able to manage those kids.”

Experts say potential reasons range from improved awareness of mental health and access to services to issues like bullying, family stress, and academic and social pressures.

To address the increase, local and state leaders are working to fund additional mental health services. But for parents, experts say the first steps are identifying early warning signs and discovering where to go for help.

Recognizing a problem

Bryce Greenberg was a “perfect” baby, says his mother, Tracy Greenberg. Yet when he turned 18 months old, his behavior started to change.

“He began having night terrors,” says Greenberg, of Potomac. “They’re basically like nightmares on steroids.”

When Greenberg enrolled her son in music and “Mommy and Me” classes, she noticed the differences even more.

“He never would sit in the circles. He didn’t really want to participate in a lot of the activities,” she says. “He would just kind of do his own thing.”

Still, plenty of toddlers don’t like to sit, and many can be oppositional, Greenberg says. In the following years, Bryce stopped napping, became hard to soothe and began displaying violent behaviors. When kindergarten hit, that’s when Greenberg knew Bryce needed help.

“Kindergarten I can remember vividly,” Greenberg says. “At that age, things that were not typical — throwing chairs, refusal and not doing any work.”

As Bryce aged, the violence progressed. At times, he would bang his head against the wall for an hour. Doctors diagnosed him with attention deficit hyperactivity disorder (ADHD) and eventually with bipolar disorder and anxiety.

Less stigma

Mental illness is defined by the National Alliance on Mental Illness as a condition affecting a person’s thinking, feeling or mood. About half of all mental health conditions begin by age 14, the alliance says.

One of the main reasons more people are seeking mental health care for young children is the stigma around it has declined, says Dr. Meena Vimalananda, medical director of Sheppard Pratt’s child and adolescent services in Towson and Ellicott City.

“There is a greater awareness of mental health services in recent years,” she says. “These are legitimate illnesses. This is not something to be ashamed of, and it can be treated.”

Passage of the Affordable Care Act also boosted access to mental health clinicians, experts say.
But just what are the issues driving more parents to seek mental health care for their kids?

“The truth is, we don’t really know,” Brown says. “We’ve got a whole lot of educated guesses.”

Rising stress levels

Stress may be one possible reason for the increase in mental health needs.

“You get more and more families where two parents are working, and they’re working very long hours,” Brown says. “There’s stress in the household.”

That stress can be compounded by children’s pressures, both in and out of school, says Gina Richman, director of the child and family therapy clinic at Kennedy Krieger Institute.

“Kids have a lot of needs,” she says. “If something doesn’t go well, kids really take that very seriously, very personally — if they don’t have the right friends at school, if they don’t get invited to birthday parties, if they don’t get on a sports team. There’s a lot of pressure on these kids, and I think there’s a lot of pressure on parents. There’s not a lot of flexibility for them to work out a lot of these kinds of things when they come up in a very busy household.”

Military families often face added stress, such as parents being deployed or families having to move every few years, says Jennifer Crockett, director of training at Kennedy Krieger Institute’s Department of Behavioral Psychology.

“Children express that in different ways,” she says. “A 6-year-old is going to be really noncompliant and oppositional. A 12-year-old, you may see it more with how they’re interacting with their peers and forming social bonds. It’s not as if the children are necessarily showing signs of PTSD (post-traumatic stress disorder). They’re showing signs of disruption in their world.”

The recent recession may have also had an impact on the rising need, Brown says.

“Children were babies during that stress and during the anxiety and during that depression,” she says. “What we do know is that 0 to 5 is the most important time in terms of brain development, in terms of social and emotional learning.”

When a parent loses a job or can’t afford to pay the mortgage and the family home goes into foreclosure, adults aren’t the only ones affected, Brown says.

“If you think of the stress people were under during the recession ... stress is never just [on] the parents,” she says. “Stress feeds the children, too.”

Other possible culprits

Bullying is another potential reason mental health experts say they are seeing more young children.

“There was a time when kids were being bullied at school, and that was considered the norm,” Vimalananda says. “Not so much anymore. People are realizing the deep wounds and scars and that they should seek help.”

Technology may even play a role, as children are not learning the same social and emotional cues through human interaction as they did before smartphones and tablet devices were invented, Brown says.

“Young children learn to self-calm by a whole lot of touch and cues from mothers and others,” Brown says. “They weren’t getting that.”

Parents and children are not engaging each other in play and eye contact when their focus is on their phones, she says.

While reasons for the increase may vary, the sum result is the same for this age group, Brown says.

“Children cannot settle down at school,” she says. “So they go to school, and they’re not ready to learn. They’re not ready to sit in a classroom.”

Click next below for warning signs of mental health issues.

Sad studentWarning signs of mental health issues

Refusal to do school work is a common warning sign — especially if the child was once a focused student, Vimalananda says. It's a problem if a focused, well-adjusted child stops speaking, interacting or doing work, she says.

“Schools are usually good at picking up on the differences,” she says.

Other early warning signs include children spending more time alone in their rooms and becoming more withdrawn, agitated or argumentative, Richman says. In addition, many children experiencing mental health issues have trouble falling asleep and say they don’t want to go to school at all.

“We have one boy, he’s about 12, and every time something goes wrong at school he either threatens to kill somebody at the school or to kill himself and then immediately gets out of school for a week,” Richman says.

Often, the intention is not to inflict harm, but just to get out of the classroom.

“We want to get to what is alarming him,” Richman says. “A lot of these kids are making very dramatic responses to exit quickly out of situations. I never saw that before.”

Help and resources

At both Kennedy Krieger Institute and Sheppard Pratt, experts work with children and their families to identify behavioral and mental health issues and then design treatment plans.

Kennedy Krieger has five outpatient behavioral psychology programs for children, while Sheppard Pratt has a range of outpatient services, as well as a 16-bed inpatient unit in Towson for children ages 4 to 12.

Local health departments also offer mental health services for children. If parents have concerns about their child’s mental health, experts say to start with the family pediatrician. The pediatrician can evaluate the child and then refer families to a behavioral or mental health professional.

School guidance counselors are another good resource, especially if families are trying to determine if a child’s behavior is changing at school, Parks says.

Many local providers, however, have long waiting lists for services. That’s why county and state leaders are working to boost funding for mental health.

Last year, the Anne Arundel County Partnership for Children, Youth and Families and the Anne Arundel County Mental Health Agency received a $4 million, four-year federal grant to add a mobile crisis team just for the public school system. The team, which includes a mental health expert, social worker and case manager, responds to mental health issues in the schools, interacting with both the child and the family. If the family agrees to work with the team, members will manage all mental health care and follow-up.

In January, Arundel Lodge in Edgewater opened the Marcus Youth and Family Center, which provides services to children between the ages of 4 and 17 experiencing mental illness or substance abuse.

At press time, Congress was also considering the Mental Health in Schools Act, which would provide funding for public schools nationwide to partner with local mental health professionals. The plan is to establish on-site mental health care services for students.

Greenberg supports the act, saying the earlier mental health issues can be addressed, the better.
“I’d love to see more screening and early intervention,” she says.

Hopeful outcome

Early intervention, including guidance and hospitalization at Sheppard Pratt, helped Bryce get to where he is today, Greenberg says.

“He’s a teenager now, and he’s doing better than he’s ever done because we did get him help, and we did all the right things,” she says.

Instead of throwing chairs as he did in kindergarten, Bryce now takes deep breaths or breaks when he needs time away from his schoolwork at The Frost School, Sheppard Pratt’s special education school in Rockville. He recently joined the swim team and gets together with friends every week at the local trampoline park.

“Mental illness is a lifelong illness, but that doesn’t mean you can’t be in recovery and you can’t be stable,” Greenberg says. “By no means is it the end of the world if you have a child who’s going to have a mental illness. ... There is hope, and things do get better.”

By Allison Eatough