Child and Adolescent Mental Health

How Can I Tell If My Child Needs Help?

It is often difficult to know if a child needs help. Parents may be so involved with their children that they may be unable to tell if a child is having problems. Divorce, death of a family member, moving, change or loss of parent's job, illness in the family, and going to a new school may all cause stress for children – but also for parents.
When deciding whether your child needs help, keep in mind that an appropriate reason to consider treatment for a child is if he or she is generally unhappy.
You may want to find help for your child if any of the following warning signs have been present for a period of time.

Warning Signs:

  • Displays unusual changes in emotions or behavior.
  • Has no friends or has difficulty getting along with other children.
  • Is doing poorly in school, misses school frequently, or does not want to attend.
  • Has lots of minor illnesses or accidents.
  • Is very anxious, worried, sad, scared, fearful, or hopeless.
  • Cannot pay attention or sit still; is “hyper.”
  • Is disobedient, aggressive, irritable, and excessively angry; often screams or yells at people.
  • Does not want to be away from you.
  • Has frequent, disturbing dreams or nightmares.
  • Has difficulty falling asleep, wakes up during the night, or insists on sleeping with you.
  • Becomes suddenly withdrawn or angry.
  • Refuses to eat.
  • Is frequently tearful.
  • Hurts other children or animals.
  • Wets the bed after being toilet-trained.
  • Suddenly refuses to be alone with a certain family member, friend, or acts very disturbed when he or she is present.
  • Displays affection inappropriately or makes unusual sexual gestures or remarks.
  • Talks about suicide or death.
  • Has unexplained decline in schoolwork and excessive absences.
  • Neglects appearance.
  • Has marked changes in sleeping and/or eating habits.
  • Runs away.
  • Has frequent outbursts of anger.
  • Defies authority, is truant, steals and/or vandalizes.
  • Excessively complains of physical ailments.
  • Uses or abuses drugs or alcohol
  • Some of these problems may be helped by working with a teacher, counselor or school psychologist. Help can also come from concerned family members.

It is normal for parents to experience guilt feelings because their child is having emotional or behavioral problems. But a child’s problems may not be caused by the home or school. A tendency to have certain emotional or behavioral problems can be inherited.
Also, it is possible that problems may be caused by changes within a child’s brain or body, so the child should always have a complete medical examination.

When in doubt, consult an expert. It is better to “over-react” than to ignore problems until they are extremely serious.

Children’s Mental Health Problems

The following are the different types of children’s mental health problems: Adjustment Disorders describe behaviors children may have when they are unable, for a time, to adapt to stressful events or changes in their lives (such as moving, death in family, divorce). They may have difficulty in school or social situations, or they may have physical symptoms with no medical cause. Symptoms usually start within three months of the stressful event, and last up to six months. Attention Deficit Disorder (ADD) – is the inattentiveness that creates challenges for children in school and other activities that require focus, but does not necessarily involve disruptive or hyperactive behavior. Disruptive Behavior Disorders include some of the more common disorders of childhood, including Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder.

Attention Deficit Hyperactivity Disorder (ADHD) is a pattern of behavior combining inattention, distractibility, impulsivity, and hyper-activity that usually appears in a child before the age of seven. Children with these disorders behave in ways that interfere with social situations, such as the classroom, playground, and family. Some children with ADHD have secondary disorders such as learning disabilities, conduct disorders, opposite-ional disorder, or depression.

Oppositional Defiant Disorder (ODD) – hostile and defiant behavior lasting at least 6 months, in which a child manifests at least four of the following behaviors: often loses temper, argues with adults, actively defies or refuses to comply with adults' requests or rules, deliberately annoys people, blames others for his or her mistakes or misbehavior, is often touchy or easily annoyed by others, is often angry and resentful, and is often spiteful or vindictive.

Conduct Disorder: Children with conduct disorders may refuse to follow rules at home or in school, become truant, delinquent, or even violent. A supportive behavioral intervention program is a key part of a treatment program for such youth.

Anxiety Disorders are a group of disorders (separation anxiety, avoidance disorder, phobias, fear of school, eating disorders, panic disorder, obsessive-compulsive disorders, post-traumatic stress disorder), in which anxiety is the main symptom. Anxiety disorders may show up as physical symptoms (headaches, stomachaches), as disorders in conduct (refusal to go to school), or as inappropriate emotional responses (crying, giggling). Eating Disorders are illnesses that cause a person to adopt harmful eating habits. They are most common among teenage girls and women, and frequently occur along with other psychiatric disorders such as depression and anxiety disorders. The poor nutrition associated with eating disorders can harm organs in the body and, in severe cases, lead to death. The two most common types of eating disorder are anorexia nervosa and bulimia nervosa.

Anorexia a life-threatening eating disorder that is characterized by self-starvation and excessive weight loss. The disorder is diagnosed when a person weighs at least 15 percent less than his or her normal body weight. Extreme weight loss in people with anorexia nervosa can lead to dangerous health problems and even death. People with anorexia nervosa have intense fears of becoming fat and see themselves as fat even when they are very slender. These individuals may try to correct this perceived "flaw" by strictly limiting food intake and exercising excessively in order to lose weight.

Bulimia -- a person suffers from bulimia if he or she experiences the following binge-purge symptoms at least twice a week for three months: (a) Eating much more food than usual, in just a short time -- especially snacks or other foods high in calories; this is called a binge, and while it lasts, the person feels like their eating is out of control. (b) After a binge, using aggressive purging tactics to try to prevent gaining weight from all the food just eaten; this can include making oneself vomit or take laxatives, diuretics, enemas or other medications, or fasting or excessive exercise as part of this harmful strategy. (c) Thoughts about bodyweight and shape dominate how the person feel about him- or herself over all.

Mood Disorders are disturbances in a child's mood which are not due to other physical or mental illnesses. Bi-polar disorder (manic-depression) and childhood depression (major depression) are examples of mood disorders. Mood disorders generally respond to medication.

Mania symptoms may include inflated self-esteem; decreased need for sleep while feeling full of energy; loud and rapid speech that is difficult to interrupt; continuous flow of speech with abrupt changes of topic; distractibility; restlessness; increased sociability; disorganized, flamboyant or bizarre activities; and rapid shifts of elevated mood to anger or depression.

Depression: Symptoms may include sadness, loss of interest in usual activities, big changes in sleep and eating habits, feelings of worthlessness and hopelessness, difficulties in thinking or concentrating, alcohol or drug abuse, and suicidal thoughts or recurring thoughts of death. Pervasive Developmental Disorders are disorders in which the brain has difficulty processing information. There are distortions, deviations and delays in the development of social and motor skills, language, attention, perception, and reality testing.

Autistic spectrum disorder begins during infancy or childhood. The infant with autism may lack a social smile, avoid eye contact, and fail to cuddle. The child fails to develop the usual bonding with parents and other people, fails to develop normal language, and may use nonverbal commands in place of speech.

Schizophrenia is a serious mental illness characterized by loss of contact with the environment and by personality changes. Hallucinations and delusions often are symptoms of this disorder, which frequently show up in young adulthood, although the symptoms may also occur at a younger age.

How Do I Choose a Mental Health Professional for a Child?

A mental health professional for your child should be warm and caring and still be professional and objective. Parents and children should begin to feel comfortable after several sessions, though both may be anxious, frightened, angry or resistant to treatment at the beginning.

Effective mental health professionals are trained to anticipate and work with those emotions so that open communication can be established. To select a mental health professional, you may want to talk to more than one person to.

How Do I Talk to My Child’s School/Teacher about Mental Health Needs?

You don’t have to talk to the school at all, but if you choose to, you can talk to the child’s teacher, school counselor, or administrator about how the school might support the child in the school setting.

Public schools are required to make changes to help every child be successful in school. Parents may ask for an educational assessment to determine how the child’s mental health needs might be impacting the child’s ability to successfully learn. A child may be eligible for Section 504 services or IDEA services based upon that assessment. These services are not provided to “label” a child, but to be sure that a child is being taught and supported in a way that will help the child be most successful.

How Does Therapy Work for Children?

When your child is in therapy, the relationship between the mental health professional and the child is the same as it would be with an adult, but you, as the parent, will be involved as an interested third party. Early in therapy, you and the therapist should be able to identify the child's main problems and set goals to solve them. There are many therapeutic techniques that are used with children. A common technique is play therapy, which gives children a more natural means to communicate with adults. By using games, dolls, and art, the child is often able to express difficult emotions.

Older children with better communication skills may be able to talk more directly with the mental health professional. The counselor or therapist may suggest other family members come for a number of sessions to help understand how the family works as a system. He/she may suggest new ways to relate to your child at home. Most mental health professionals periodically request that the entire family participate in structured family therapy meetings. These meetings are not held to place blame or criticize parents or other siblings, but to help understand how the family communicates and works together, help the child learn to communicate effectively with parents and siblings, and help parents and other siblings understand how to help and support the child. It is important for everyone, if possible, to participate in these meetings. It may take time for your child to get comfortable in therapy. Just as with adults and adolescents, problems may become worse before they get better. Try to get your child to stick with therapy until he/she feels comfortable. However, if the child really seems to distrust the therapist after some time, it is a good idea to look for someone else.

It is as important in child therapy as it is in adult therapy for the parent periodically to evaluate the progress of the treatment and the relationship with the therapist. After your child has been in therapy for a while, ask yourself the following questions to determine if therapy is working. If the answer to most of them is "yes," then you should be confident that therapy is helping. If the answer to most of them is "no," then you may want to get a second opinion from another therapist and consider making a change in your child's treatment.
  • Does our child seem comfortable with the therapist?
  • Is there open communication between the therapist and us, the parents?
  • Has the therapist diagnosed the problem our child is having?
  • Has the therapist identified our children’s strengths?
  • Are the therapist and our child working toward the goals we set together?
  • Has our relationship with our child improved?
  • Are we, the parents, being given guidance to work on our child’s problem and increase his/her strengths?

What About Adolescents?

When adolescents are involved in therapy, they can and should speak for themselves. Parents may or may not be included in the therapy sessions, or may be encouraged to participate in family therapy or group sessions. Therapy with a peer group is helpful for teens with some type of mental health problems.
The adolescent and the therapist should discuss what each expects to accomplish. In addition to mental health therapy sessions, treatment for substance abuse may be necessary in order to address mental health problems. The entire family may be asked to participate in a number of sessions to help understand how the family communicates, works together, and how they can assist with the adolescent's problems. It is important for parents to understand that there may be certain aspects of the therapy that should remain confidential between the mental health professional and the adolescent. Before treatment begins, the parents, the adolescent, and the therapist should come to an agreement as to what information will be disclosed to the parents.

It is just as important in adolescent therapy as it is in adult therapy to periodically evaluate the progress of the treatment and the relationship with the therapist. Once your adolescent has been in therapy for a while, ask yourself the following questions to see if you believe therapy is working.

If you answer "yes" to most of them, then you can be confident that therapy is helping. If you answer "no" to most of them, then you may want to get a second opinion from another therapist and consider making a change in your adolescent's treatment.

  • Is our adolescent more positive about therapy?
  • Has the therapist diagnosed the problem and are the two of them working toward treatment goals that include our adolescent’s strengths?
  • Is our adolescent becoming free from any use or addictions to drugs and/or alcohol?
  • Has our relationship with our adolescent improved?
  • Is there communication between the therapist and us, the parents?

How Do I Know When My Child or Adolescent Can Stop Therapy?

Your child may be ready to stop therapy when he/she:
  • Is generally happier, more expressive and cooperative, and less withdrawn.
  • Is doing better at home and in school.
  • Is making friends.
  • You understand and have learned how to deal more effectively with those factors that led to the problems for which you sought help.
  • Is functioning better at home and in school
Sometimes, ending therapy will be an anxious time for children and parents. Problems may reappear temporarily. The mental health professional should be available to provide counsel and support for a period of time after your child is finished with therapy. It is a good idea to allow some time to adjust before considering going back into therapy.
You and your child may benefit from support groups (see the Finding HELP Phone List).

If a decision is made to seek professional help, it is very important that the adolescent be aware of choices and be involved in making a plan.

Services for Children and Adolescents

Parents of children and adolescents with emotional problems need to know what the full range of services for their children should be. Following is a set of ideal options ranging from home-based services to the most restrictive hospital setting. Ask your pediatrician, child's school counselor or your local Family Guidance Center (look under “Children and Teen Services” in the Finding HELP Phone List) for help finding and arranging for the services described below.

Similar to the adult model, many children, adolescents, and their families are effectively served by outpatient office-based assessment and therapy services. Often times these services occur after school, in the evenings or during weekends at a time convenient for families and the therapist.

24-Hour Access And Crisis/Suicide Line

This "hotline" can be used by anyone at any time. It offers support, counseling, and referral services to help with the crisis. 808-832-3100 (Oahu) / 800-753-6879 (Neighbor Islands). This service includes Crisis Mobile Outreach as well as Crisis Stabilization. It serves children, youth, and adults.

Care Coordination

For families who do not have private insurance coverage, but may have QUEST or Medicaid, and for those who have no insurance, there are state funded Family Guidance Centers within each Community Mental Health Center to assist families in receiving the appropriate outpatient treatment or other referral for children and adolescents. (See Finding HELP Phone List under “Children & Teen Services”). Each youth served here is assigned a Care Coordinator, who helps the youth obtain and helps coordinate the mental health services needed. The Care Coordinators are located in the Family Guidance Centers mentioned above.

Community-Based Outpatient Treatment

Outpatient treatment usually means that the child lives at home and receives psychotherapy at a local mental health clinic or from a private therapist. Sometimes psychotherapy is combined with a home intervention and/or a school-based special education program. Outpatient therapy may involve individual, family, or group therapy, or a combination of them. Outpatient therapists often work with the child’s pediatrician, if medication is involved.

Home Intervention

The purpose of the home-based model of treatment is to provide intensive in-home crisis intervention for those children with the most serious problems, in order to keep them from being placed outside their homes, away from their families. Such programs are directed toward managing crises and teaching families new ways of resolving problems to prevent future crises.

Successful home intervention programs have therapists available to families 24 hours a day for 4 to 6 weeks. During this period, families receive regular training sessions in their homes and may call on the therapists for help any time a crisis arises. The therapist can provide behavior interventions, client-centered therapy, values clarification, problem solving, crisis intervention, and assertiveness training. They also help with home management and budgeting skills, advocacy, and referral for legal, medical, or social services.

Intensive home-based treatment helps make a more accurate assessment of the child and of the family's functioning. This treatment also makes it easier for the therapist to show and develop new behaviors in the child's normal environment. Therapists can directly observe the treatment plan and revise it when needed.

School-Based Services

Schools must provide appropriate special education and related services for children who are identified as having an emotional impairment that is impacting their ability to learn effectively. For qualifying children, school staff and parents write an Individualized Education Program (IEP), which specifies the amount and type of special education the child requires, the related services the child may need, and the type of placement which is suitable for teaching the child. Special education services are specifically educational in nature. While these educational services may be helpful to the emotionally challenged child, a more complete treatment program may also be needed, such as psychotherapy services. Special education services must be provided at no cost to parents. The IEP must be revised at least every year, with parents participating in the revision.

If your child has emotional or behavioral problems that upset their school attendance or performance, talk to the teacher, counselor, and/or principal of your child's school (public or private) and ask for an evaluation of your child. If you think your child would benefit from special education and mental health services, ask your local public school for a "Request for Evaluation" Form and related information leaflets and brochures. Private school students can be evaluated by the public school they would have attended.
If mental health and other support services are needed for your child, a case manager should be assigned to help you and your child find and use all the services that may be needed (e.g., education, mental health, vocational). A school counselor can assist. For information assistance, look in the Finding HELP Phone List under Children & Teen Services. Special Parent Information Network (SPIN) on all the islands, the Learning Disabilities Association or, in Waianae, Legal Services for Children may be helpful.

Community-Based Day Treatment (Community-Based Instruction)

Community based instruction is the most intensive nonresidential type of treatment. It has the advantages of allowing the child to live at home, while bringing together a bro-ad range of services designed to strengthen the child’s school performance and improve family functioning. The specific features vary from one program to another, but may include some or all of the following components:

  • Special education, generally in small classes with a strong emphasis on individualized instruction.
  • Psychotherapy, which may include both individual and group sessions.
  • Family services, which may include family psychotherapy, parent training, brief individual therapy with parents, help with specific tangible needs such as transportation, housing, or medical attention.
  • Vocational training.
  • Crisis intervention.
  • Skill building with an emphasis on interpersonal and problem-solving skills and practical skills of everyday living.
  • Behavior modification.
  • Recreation therapy, art therapy, and music therapy to aid social and emotional development.
  • Drug and/or alcohol counseling.
  • Children participate in a day treatment
Program for 6 hours a day. Lengths of stay are usually one school year, but can be shorter or longer.

Some of these community-based instruction programs are physically located on a school site where they may have a wing of their own that includes classrooms and office space. Other day programs are provided in community agencies, or on the grounds of a private clinic or hospital.

Out-Of-Home Treatment Programs

Out-of-home treatment programs are provided only when a child cannot be safely treated in their own home, and involve the use of therapeutic foster homes, group homes, or community based residential treatment. This type of treatment is provided when there is a need to bring about a total change in the child's environment.
Therapeutic foster homes. Foster home placement is, in many ways, a “natural” approach to treatment because it provides a family unit, which is the normal developmental situation for a child. A therapeutic foster home will provide additional components beyond the nurturing characteristics of a well-organized family. These additional components may include special training for the foster parents in behavior modification and crisis intervention, plus treatment supports, including psycho-therapy and case management. These specialized foster homes usually foster one to two children at a time.
Therapeutic group homes. Group home placement is somewhat more restrictive than foster care, since the living situation is not as “natural.” Group homes provide family-style treatment in a more struc-tured setting than the natural environ-
ment. Treatment usually involves a co-mbination of evaluation, psychotherapy, use of behavior modification, and supervised social/peer development.
Residential treatment centers. Reside-ntial treatment centers provide round-the-clock treatment and care for children with the most serious emotional challenges who need continuous supervision, treatment, and often times, medication. Residential treatment centers provide on-site education, psychiatric services, and crisis response.
Many of these centers focus on a particular treatment philosophy. Gene-rally, residential centers base their treatment on the premise that the child's total environment must be structured in a therapeutic way. Some concentrate on behavior modification programs which function both in the classrooms and in the treatment units as well. Others use an individualized, patient-centered app-roach. Some treatment centers are set up to deal specifically with alcohol and drug related problems.

While residential treatment centers have academic programs, a great deal of attention is focused on the child's emotional problems, regardless of whether these problems are associated with academic matters. Considerable time and effort are spent on group and individual therapy and therapeutic social activities. Residential care tends to be the most restrictive type of treatment, attempted after other, less intensive, forms of treatment have been tried and have failed, or when a child has violated the law and has been ordered by the court to a particular facility.

Hospital Based Care. A psychiatric hospital is a medical facility whose emphasis is on medical solutions to mental problems. Psychiatric hospitals tend to use medications, and other physiological treatment interventions. Those hospitals which serve children must provide educational opportunities for them, but the main focus of these facilities is not academics, but intensive treatment stabilization and discharge to a less restrictive, longer term treatment program.

Respite Services

Respite Services give families (natural, adoptive or extended) temporary relief from caring for a child or teen who is receiving mental health services through a family guidance center or a private mental health provider. Contact your local Family Guidance Center for more information.

Finding Help for Adolescents

Emotionally disruptive or unsettling behavior in adolescents may be related to the physical and psychological changes taking place. This is a time when young people are often troubled by sexual identity and very concerned with physical appearance, social status, parents’ expectations, and acceptance from peers. Young adults are establishing a sense of self-identity and shifting from parental dependence to independence.

A parent or concerned friend may have difficulty deciding what “normal behavior” is and what may be signs of emotional or mental health problems. The checklist below should help you decide if an adolescent needs help. If more than one sign is present, or lasts a long time, that may indicate a more serious problem.

The mental health professional you choose for your adolescent should have expertise in dealing with the unique problems of adolescence. You should feel comfortable with the therapist and feel that you can establish open communication, and that you can get your questions answered. However, your adolescent may not feel comfortable with the therapist, or may be hostile to him/her.

Warning Signs That Your Teen May Need Help

If you are a parent or other caregiver of a teenager, pay attention if your teen:Is troubled by feeling:
  • very angry most of the time, cries a lot or overreacts to things; ·
  • worthless or guilty a lot;
  • anxious or worried a lot more than other young people;
  • grief for a long time after a loss or death;
  • extremely fearful-has unexplained fears or more fears than most kids;
  • constantly concerned about physical problems or appearance;
  • frightened that his or her mind is controlled or is out of control.
  • Experiences big changes, for example:
  • does much worse in school;
  • loses interest in things usually enjoyed;
  • has unexplained changes in sleeping or eating habits;
  • avoids friends or family and wants to be alone all the time;
  • daydreams too much and can't get things done;
  • feels life is too hard to handle or talks about suicide;
  • hears voices that cannot be explained.
  • Is limited by:
  • poor concentration; can't make decisions;
  • inability to sit still or focus attention;
  • worry about being harmed, hurting others, or about doing something "bad";
  • the need to wash, clean things, or perform certain routines dozens of times a day;
  • thoughts that race almost too fast to follow;
  • persistent nightmares.
  • Behaves in ways that cause problems, for-example:
  • uses alcohol or other drugs;
  • eats large amounts of food and then forces vomiting, abuses laxatives, or takes enemas to avoid weight-'gain;
  • continues to diet or exercise obsessively although bone-thin;.
  • often hurts other people, destroys property, or breaks the law;
  • does things that can be life threatening.

Medications for Child and Adolescent Mental Health Problems

Medication can be an effective part of the treatment for several psychiatric disorders of childhood and adolescence, but this often raises many concerns and questions in both the parents and the youngster.

The physician, preferably a psychiatrist or a pediatrician working in close collaboration with a psychiatrist, who prescribes medi-cation should be experienced in treating psychiatric illnesses in children and adolescents. He or she should fully explain the reasons for medication use, the benefits of the medication, potential side effects or dangers, and other treatment alternatives. Psychiatric medication should not be used alone. The use of medication should be part of a comprehensive treatment plan, usually including psychotherapy and parent guidance sessions.

Before recommending any medication, the child/adolescent psychiatrist will interview
the youngster and make a thorough diagnostic evaluation. In some cases, the evaluation may include a physical exam, laboratory tests, other medical tests such as an electrocardiogram (EKG) and consu-ltation with other medical specialists. As each youngster is different and may have individual reactions to medication, close contact with the treating physician is recommended.

Do not stop or change a medication without speaking to the doctor.

Children’s Mental Illnesses That Are Prescribed Medications

  • Bedwetting -- if it persists after age five and causes serious problems in self-esteem and social interaction.
  • Anxiety -- if it keeps the youngster from normal daily activities.
  • Attention deficit hyperactivity disorder (ADHD), described earlier.
  • Obsessive-compulsive disorder -- recurring obsessions (troublesome and intrusive thoughts) and/or compulsions (repetitive behaviors or rituals such as hand washing, counting, and checking to see if doors are locked) which are often seen as senseless and which interfere with a child’s daily functioning.
  • Depression -- lasting feelings of sadness, hopelessness, unworthiness and guilt, inability to feel pleasure, a decline in schoolwork and changes in sleeping and eating habits.
  • Eating disorder -- either self-starvation (anorexia) or binge eating and vomiting (bulimia), or a combination of the two.
  • Bipolar (manic-depressive) disorder -- periods of depression alternating with manic periods, which may include irritability, "high" or happy mood,
  • behavior problems, staying up late at night, and grand plans.
  • Psychosis -- symptoms include irrational beliefs, paranoia, hallucinations (seeing things or hearing sounds that do not exist), social withdrawal, extreme stubbornness, and deterioration of personal habits. May be seen in developmental disorders, severe depression, schizo-affective disorder, schizophrenia, and some forms of substance abuse.
  • Autism Spectrum Disorder (or other pervasive developmental disorder such as Asperger's Syndrome) -- characterized by severe deficits in social interactions, language, and/or thinking or ability to learn, and usually diagnosed in early childhood.
  • Severe aggression -- which may include violence, property damage, or self-abuse, such as head banging or cutting.
  • Sleep problems -- symptoms can include insomnia, night terrors, sleep walking, fear of separation, and anxiety.
  • Types Of Medications
  • Stimulant Medications: are often useful as part of the treatment for attention deficit hyperactive disorder (ADHD) and include Dextroamp-hetamine (Dexedrine, Adderal),
  • Methylphenidate (Ritalin), and Pemo-line (Cylert).
  • Antidepressant Medications: are used in the treatment of depression, school phobias, panic attacks, and other anxiety
  • Do not stop or change a medication without speaking to the doctor.
  • disorders, bedwetting, eating disorders, obsessive-compulsive disorder, perso-nality disorders, posttraumatic stress disorder, and attention deficit hype-ractive disorder. See page 12.
  • Antipsychotic Medications: Antipsy-chotic medications can be helpful in controlling psychotic symptoms (delusions, hallucinations) or disorganized thinking. These medications may also help muscle twitches ("tics") or verbal outbursts as seen in Tourette's Syndrome. They are occasionally used to treat severe anxiety and may help in reducing very aggressive behavior. For examples of antipsychotic medications, See page 12.
  • Mood Stabilizers and Anticonvulsant Medications: may be helpful in treating manic-depressive episodes, excessive mood swings, aggressive behavior, impulse control disorders and severe mood symptoms in schizoaffective disorder and schizophrenia. Lithium (lithium carbonate, Eskalith) is an example of a mood stabilizer. Some anticonvulsant medications can also help control severe mood changes, such as Valproic Acid (Depakote, Depakene), Carbamazepine (Tegretol), Gabapentin (Neurontin), and Lamotrigine (Lamictil).
  • Anti-anxiety Medications: may be helpful in the treatment of severe anxiety. See page 11 for examples.

When prescribed appropriately by an experienced psychiatrist (preferably a child and adolescent psychiatrist) and taken as directed, medication may reduce or eliminate troubling symptoms and improve daily functioning of children and adolescents with psychiatric disorders.

Questions to Ask

Evaluation and monitoring by a physician is essential. Parents and guardians should be provided with complete information when psychiatric medication is recommended as part of their child's treatment plan. Children and adolescents should be included in the discussion about medications, using words they understand. The prescribing physician should be told of all other medications and/or addictive substances being taken by the child. By asking the following questions, children, adolescents, and their parents/ caretakers will gain a better understanding of psychiatric medications:
  • What is the name of the medication? Is it known by other names?
  • What is known about its helpfulness with other children who have a similar condition to my child?
  • How will the medication help my child? How long before I see improvement?
  • When will it work?
  • What are the side effects which commonly occur with this medication?
  • What are the rare or serious side effects, if any, which can occur?
  • What is the recommended dosage? How often will the medication be taken?
  • Are there any laboratory tests (e.g. heart tests, blood test, etc.) which need to be done before my child begins taking the medication, or while he/she is taking the medication?
  • When prescribed appropriately by an experienced psychiatrist (preferably a child and adolescent psychiatrist) and taken as directed, medication may reduce or eliminate troubling symptoms and improve daily functioning of children and adolescents with psychiatric disorders.
  • Will a child and adolescent psychiatrist be monitoring my child's response to medication and make dosage changes if necessary? How often will progress be checked and by whom?
  • Are there any other medications or foods which my child should avoid while taking the medication?
  • Are there interactions between this medication and other medications (prescription and/or over-the-counter) my child is taking?
  • Are there any activities that my child should avoid while taking the medication? Are any precautions recommended for other activities?
  • How long will my child need to take this medication? How will the decision be made to stop this medication?
  • Does my child's school nurse, teacher, or principal need to be informed about this medication?
Treatment with psychiatric medications is a serious matter for parents, children and adolescents. Parents should ask these questions before their child or adolescent starts taking psychiatric medications. Parents and children/adolescents need to be fully informed about medications. If, after asking these questions, parents still have serious questions or doubts about medication treatment, they should feel free to ask for a second opinion by a child and adolescent psychiatrist.

Topics Include

  • How Can I Tell If My Child Needs Help?
  • Warning Signs
  • Children’s Mental Health Problems
  • How Do I Choose a Mental Health Professional for a Child?
  • How Do I Talk to My Child’s School/Teacher about Mental Health Needs?
  • How Does Therapy Work for Children?
  • What About Adolescents?
  • How Do I Know When My Child or Adolescent Can Stop Therapy?
  • Services for Children and Adolescents
  • 24-Hour Access And Crisis/Suicide Line
  • Care Coordination
  • Community-Based Outpatient Treatment
  • Home Intervention
  • School-Based Services
  • Community-Based Day Treatment (Community-Based Instruction)
  • Out-Of-Home Treatment Programs
  • Respite Services
  • Finding Help for Adolescents
  • Warning Signs That Your Teen May Need Help
  • Medications for Child and Adolescent Mental Health Problems
  • Children’s Mental Illnesses That Are Prescribed Medications
  • Types Of Medication
  • Questions to Ask
© Mental Health America of Hawaii
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