Serious Emotional Disturbance in Children and Adolescents: Opportunities and Challenges for Psychologists

Approximately 4.5 to 6.3 million children and adolescents in the United States have a serious emotional disturbance that undermines their present functioning and imperils their future. However, at least two thirds of young people with a diagnosable mental disorder receive no services at all. Responding to this unmet need, psychologists are assuming new roles in a changing mental health marketplace and are adopting new intervention strategies to work with these children, adolescents, and their families. This article addresses the scope of the problem, opportunities and challenges for practitioners, the larger context of professional practice, future directions, and suggestions for psychologists. Over a decade ago, I received a call from a single mother in my community. In a voice trembling with emotion, she told me that her 14-year-old daughter (I will call her Ellen) was hiding in the woods behind their home—terrified, confused, and very delusional. Refusing to come inside, Ellen would dart periodically into the busy highway adjacent to the property, clearly placing herself at risk. What should she do, this frantic mother beseeched me? What had happened to her daughter? In fact, her daughter was experiencing the first episode of a severe and persistent mental disorder. Admitted to the inpatient unit of a local mental health center, Ellen received a diagnosis of schizophrenia. For the next decade, she and her mother became travelers in a tangled mental health system that left them with a paralyzing sense of hopelessness and helplessness. Over these years, Ellen experienced multiple brief hospitalizations (the “inpatient revolving door”), received several diagnoses, and was given a plethora of medications. Much of her adolescence was spent in a fog of disabling symptoms and inappropriate treatments, profoundly disrupting all aspects of her life. For example, her high school years were marked by irregular attendance and a chaotic pattern of educational placements and plans that deflected Ellen far from her expected educational course. These years were also traumatic for her younger sister, Joyce, who felt her own needs were largely ignored in the midst of repeated family crises. Eventually, Ellen received an accurate diagnosis of bipolar disorder and began a multimodal treatment plan that included individual psychotherapy, family psychoeducation, and a moodstabilizing medication. Collaborating with Ellen’s psychiatrist, her psychologist offered psychosocial services for Ellen and her family and monitored the psychological effects and side effects of her medication. With appropriate treatment, Ellen began to come to terms with her disorder and to reconstruct her life. Although gratified by this positive outcome, Ellen and her family paid an enormous price for the shortcomings of the mental health system. In the current era, there is much reason to hope that, with an earlier diagnosis and more effective treatment, adolescents like Ellen will lose fewer irreplaceable years of their lives and that their families will receive the support and education they so urgently need under these circumstances.