When are mood swings, temper tantrums, and aggressive behavior the sign of pediatric bipolar disorder, and when are they just normal development? When is the desire to spend time alone a sign of shyness, and when is it a hallmark of early onset depression? How can a parent find the right expert to help him decide whether to treat his child with antidepressants that have been designed for and tested on adults, not children?
The difficulty in answering questions like these, according to experts at the National Alliance on Mental Illness (NAMI), is exacerbated by the inability of many children to describe or express their emotions, and the paucity of experts in pediatric psychiatry. Below, we've adapted NAMI's 10 steps to help parents and their health-care providers make an accurate diagnosis of mental illness.
1. Record keeping
Organize and keep accurate records related to your child's emotional, behavioral, social, and developmental history. The records should include observations of the child at home, in school, and in the community. They should be shared with the child's treating provider to help in making a diagnosis. The records should include the following information:
- Primary symptoms, behaviors, and emotions of concern
- A list of the child's strengths
- A history of when the child first talked, walked, and developed social skills
- A complete family history of mental illness and substance use disorders (many mental illnesses run in families)
- Challenges the child is facing with school, social-skill progression, developmental milestones, behaviors, and emotions
- The times of day or year when the child is most challenged
- Interventions and supports—including therapy, medication, residential or community services, hospitalization, and more—that have been used to help the child, and their effectiveness
- Settings that are most difficult for the child (e.g., school, home, social situations)
- Any major changes or stresses in the child's life (e.g., divorce, death of a love one)
- Factors that may act as triggers or worsen the child's behaviors or emotions
- Significant mood instability or disruptive sleep patterns
2. Comprehensive physical examination
To make an accurate diagnosis, it is important to start the process with the child's primary care physician. A comprehensive physical examination should be done to rule out other physical conditions that may be causing a child's symptoms.
3. Co-occurring conditions
Your child should be evaluated for co-occurring conditions, like learning disabilities, sensory integration problems, and other physical and mental disorders that may cause behavioral problems or poor school performance. If you suspect that a co-occurring condition is affecting your child's ability to learn, ask the school to perform a psycho-educational evaluation. Slideshow: Symptoms of Mania and Depression
4. Specialists in children's mental health
After other physical conditions and learning disabilities are evaluated, it is time to meet with a qualified mental health provider. Your child's primary care physician may be able to refer you to a mental health professional. You can also ask for referrals from families involved with NAMI or other advocacy organizations. To find a child psychiatrist, visit the American Academy of Child and Adolescent Psychiatry website, and search under its child-and-adolescent-psychiatrist-finder tool.
5. The diagnostic and evaluation process
A medical diagnostic tool —like a blood test, MRI scan, or X-ray—that will identify mental illnesses in children has not yet been developed. Your child's diagnosis should be made based on professional observation and evaluation, information provided by your family and other experts, and the criteria found in the latest version of the Diagnostic and Statistical Manual of Mental Disorders. This evaluation should include a comprehensive look at all aspects of your child's life in school, with family and friends, and in the community. The provider who evaluates your child is likely to ask you to fill out a checklist that provides a detailed profile of your child and the challenges your child is facing.
Continue Reading: 5 More Ways to Get Your Child the Right Diagnosis
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