Advances in the diagnosis and treatment of children with serious mental illness.

As a nation, we are becoming aware that a significant number of children develop severe neuropsychiatric disorders. Unfortunately, knowledge of DSM-IV criteria does not always help the child and family social worker identify children with these disorders. Early onset schizophrenia, bipolar disorders, and severe depression can cause child behaviors that differ markedly from symptoms manifested by adults with serious mental illness. This article provides specific information for screening and treating children who develop long-term neuropsychiatric disorders. any parents and child care service providers have never seen a youth with serious mental illness. As a result, .they often do not know when or how to request appropriate preventive, emergency, or psychiatric inpatient assistance. Furthermore, requesting psychiatric evaluations for a child can be intimidating. This is particularly true if the parent feels disenfranchised, stressed, lacks insurance coverage, suffers from a mental illness or addiction, or has only limited child development knowledge. In addition, parents who believe that their child's problems will spontaneously improve with increasing age may delay or resist suggested mental health interventions. As a result, discovering untreated children with serious mental disorders commonly falls on the shoulders of child and family welfare social workers. This creates highly technical and at times stressful screening, community education, and referral responsibilities for the worker. Obviously, an inability to identify and provide differential interventions for seriously mentally ill clients will have a negative impact on the children and families. Therefore, recognizing how children's neuropsychiatric symptoms mimic or differ from adult behavioral indicators is a crucial skill that must be developed by professionals. This article presents a compilation of biopsychosocial research documenting the epidemiology and biological nature of serious child mental illness. In addition, it describes how DSM-IV symptoms in children differ from adult criteria and offers concrete diagnostic and treatment suggestions. Unfortunately, orchestrating diagnostic assessments and comprehensive biopsychosocial treatment plans for young clients is extremely difficult. Treatment and community service planning is complicated and complex for several reasons: Neuropsychiatric disorders present in children are similar to those found in adults, but the symptoms of these disorders may be different in children than in adults. Children have difficulty communicating internal experiences, sensations, perceptions, emotions, and thoughts. Medication and psychosocial intervention effectiveness is less researched for children than for adults. Community mental health workers are often less experienced in diagnosing and treating children with serious neuropsychiatric problems. Community services and family support programs are often aimed at older adolescents and young adults. Clinicians and community agencies have difficulty accessing research findings that are rapidly changing the knowledge base concerning children with serious mental illness. Therefore, these "special needs" children will largely be incorrectly diagnosed and underserved unless social workers purposefully internalize a framework for identifying early onset schizophrenia and mood disorders. Schizophrenia Even though schizophrenia most often occurs in late adolescence, it can also strike very young children. Furthermore, over 50% of these children will experience neuropsychiatric symptoms and require medication treatments throughout their lives. Asarnow et al. [1994] found that 61% of children with early onset schizophrenia maintained the same diagnosis through adolescence and young adulthood. Psychotic symptoms in young children are often preceded by numerous behavioral disturbances, developmental lags, and "soft" neurological signs. The actual DSM-IV schizophrenia symptoms can develop in a slow insidious process over many years or suddenly appear without warning. …