The Mayo Clinic released a list of warning signs recently showing whether children might have mental disorders – a tool designed to identify undiagnosed children when they are most treatable without alarming parents of healthy children.
The 11 “action signs” are written in everyday English instead of medical jargon — for example, if a child experiences “sudden overwhelming fear for no reason, sometimes with a racing heart or fast breathing.”
The list is endorsed by the U.S. Surgeon General, the American Academy of Pediatrics, the National Alliance on Mental Illness and other groups.
“The child mental health field needed something like what cancer had done” with its seven warning signs for the disease, said Dr. Peter Jensen, a Mayo Clinic psychiatrist who led the creation of the action list. “It needed some kind of crisp, easily understood messages that parents, teachers, health care providers could … relate to.” The list seeks to help parents differentiate normal childhood moodiness from abnormal levels of aggression, depression and hyperactivity.
Here are the 11 warning signs parents should watch for:
- Feeling very sad or withdrawn for two or more weeks
- Seriously trying to harm or kill yourself, or making plans to do so
- Sudden overwhelming fear for no reason, sometimes with a racing heart or fast breathing
- Involved in multiple fights, using a weapon, or wanting badly to hurt others
- Severe, out-of-control behavior that can hurt yourself or others
- Not eating, throwing up or using laxatives to make yourself lose weight
- Intensive worries or fears that get in the way of daily activities
- Extreme difficulty in concentrating or staying still that puts you in physical danger or causes school failure
- Repeated use of drugs or alcohol
- Severe mood swings that cause problems in relationships
- Drastic changes in your behavior or personality
Confusion by parents and doctors is one reason why as many as half of children with serious mental disorders are untreated, according to estimates by the U.S. Surgeon General, and also why some healthy children are misdiagnosed with disorders they don’t have.
“We needed to do something to help flesh out people’s understanding about what it meant when a child really did have a problem,” said Gary Blau, a clinical psychologist with the U.S. Substance Abuse and Mental Health Services Administration. “It’s different than just being a phase of sort of the traditional ups and downs of growing up. There is a difference between that and having a significant mental health problem.”
The difference often is when behaviors last for a prolonged period of time or affect other people. “Feeling very sad or withdrawn” isn’t enough, unless it has persisted for at least two weeks. “Severe mood swings” alone aren’t a warning sign on the list unless they “cause problems in relationships.”
The list was tested against children with diagnosed mental disorders to see if it would accurately forecast their conditions. A resulting study found that many of these children wouldn’t be detected by the symptom list. On the other hand, the study found that the list wouldn’t mistakenly identify children whose behaviors were normal pangs of growing up.
“As we wrestled with that, we realized there would be a potential for confusion or even harm if parents were worried when they didn’t need to be worried,” Jensen said. “And so what we did was we erred on the side of making sure that this child really has a problem” if he meets any of the action list criteria.
A report in the journal Pediatrics lists the action signs and the science and psychology behind them. Jensen said the word suicide was replaced with “seriously trying to harm or kill yourself, or making plans to do so,” because parents didn’t necessarily identify the term with children.
The list will make it easier for parents to decide whether to seek help for their children, Jensen said, because they only need to answer “yes or no” to the action signs. They don’t need to evaluate whether their kids meet complex diagnostic criteria for mental disorders.
“If you have five or six or seven things to weigh, decisions are very difficult, but if you have a simple yes-no decision, it becomes much easier,” Jensen said. “That’s what the Cancer Institute did when they created warning signs like 20 pounds of unexplained weight loss” as a predictor of cancer.
Out of 15 authors of the report, Jensen and one other researcher reported financial relationships that could present conflicts of interest. Jensen has been a paid consultant for drugmakers Shire and Janssen-Ortho. While the list could certainly hasten the rate at which children receive psychiatric medication, Jensen said it was not developed with any corporate interests in mind.
Advocates for three national patient organizations spoke in favor of the action list. They said they hope it would make it easier for teachers and doctors to believe parents when they express concerns, and for troubled children to receive faster treatment.
“Children may go as long as 10 years without intervention,” said Ruth Hughes, the chief executive for CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder). “Just think about what that timeframe is in a child’s life.”
The “Action Signs” Project – Mayo Clinic Research Institute