Ways to Approach Mental Health
It is often difficult for parents to see the forest for the trees. That is, people tend to recall major, cataclysmic behavioral “events,” as opposed to being objective and stepping back to notice a trend or cycle of symptoms. Some parents may also struggle with issues of guilt or denial. This is where consulting with a professional will be of great value.
Finding a Psychiatrist
The challenge may be finding a clinician who is abreast of recent “best practice” trends (what is presently acknowledged as the “right,” or respectful, approach) and does not buy into stereotypes that your child's behavior results from being a kid with Asperger's. As with seeking the initial diagnosis for Asperger's, you may encounter difficulty in locating a psychiatrist who meets this criterion. This is where networking with other parents or Asperger's/autism organizations in your area may be helpful. As before, be prepared to travel, especially if you live in a rural area and resources are sparse.
Alert
There's a phrase used to describe untreated mental health issues:“The longer the needle plays on the record, the deeper the groove becomes.” Some parents become oblivious to the obvious because of their guilt or denial. If you believe that your child demonstrates highly unusual or out-of-control behaviors, please actively seek timely clinical support.
Preparing for the First Visit
If you believe your child is experiencing a mental health issue, prepare yourself and your child for the appointment with the psychiatrist just as you would for the appointment to interview for a diagnosis (review these steps in Chapter 3). In addition, it will be of greatest benefit to a psychiatrist if you come prepared to discuss symptoms and not behaviors. This text has provided you with the language used to describe symptoms — euphoric mood, grandiosity, and the like. This is language a good doctor will recognize and understand.
You know your child best; a psychiatrist is especially vulnerable to whatever you do and say. After all, unless you have a previously established rapport, she's meeting you and your child for the first time. You have an obligation to your child to be direct and concise and to stay focused on discussing symptoms. When you enter a doctor's office venting with lots of storytelling about how difficult it was last weekend when your child trashed the house, punched his sister, and threw a TV out a second-story window, you are discussing behaviors. It may be natural to want to do this, especially with someone whom you hope will understand, validate your experience, and provide you with answers. However, in describing behaviors, you've just significantly broadened the doctor's challenge; the previously listed “behaviors” can crosswalk to dozens of potential diagnoses. When this occurs, you risk your doctor “falling back” on ascribing stereotyped diagnoses like schizophrenia, borderline personality disorder, obsessive-compulsive disorder, oppositional defiant disorder, or intermittent explosive disorder.
You can prepare for an initial appointment with a psychiatrist by doing the following:
Organize your child's symptoms as best you can by breaking them into categories for depression or bipolar to start.
After listing out the previous two, list symptoms of anxiety and PTSD.
Keep everything brief and concise — to one page if possible. Use numbered or bulleted entries so your doctor can easily scan the information.
Be prepared to discuss your family's mental health history (including alcohol and substance abuse) and any cycles you have noted in your child.
Do not provide the doctor with anything more than what she is requesting, but be prepared to offer it if she does.
Become educated about medications traditionally used to treat mood disorders, like lithium, Depakote, and Tegretol, and other newer mood stabilizers such as Lamictal, Zyprexa, Trileptal, Neurontin, and Topomax. (Be wary of antipsychotic medications except for short-term use in extreme, out-of-control instances.)
Ensure that you have a way that your child will either participate in a gentle, respectful discussion with the doctor, or ensure that there is someone with whom your child can stay in a waiting area while you discuss specifics that may be very upsetting for your child to hear.
Essential
It may be a distinct and profound relief for your child to realize that what has been compelling him to “be bad” isn't his fault. Remember the circular wheel of the self-fulfilling prophecy? Self-loathing, guilt, and remorse can become its lubricant. Wherever possible, partner with your child to educate him while gently encouraging him to exert control over his mental illness to the best of his ability.
Consider Short-Term Hospitalization
If your child's symptoms manifest in extreme, violent behavior that causes him to seriously endanger himself or others, you may also need to carefully weigh the option of a short-term commitment to a psychiatric hospital in order to keep him and your family safe. The goal of a short-term hospitalization is to stabilize the child as soon and as safely as possible prior to discharge back to his family. There, he may receive observation and treatment in a controlled environment. The treatment may include medication to stabilize him and help him to feel level again.
In gaining control over violent behavior, antipsychotic medications will likely be prescribed. Such medications are usually strong sedatives, intended to “slow down” the child so that he will be manageable and less of a threat to himself and others. Such antipsychotic medications may include Thorazine (chlorpromazine), Mellaril (thioridazine), Serentil (mesoridazine), Prolixin (fluphenazine), Stelazine (trifluoperazine), Haldol (haloperidal), and Loxitane (loxapine). It is not usual for such powerful drugs to be used to treat children, and their sedative effect in your child may be alarming. Be mindful that such drugs should be temporary until the mood-stabilizing medications take effect. Your role as a strong advocate for your child is to be educated about the names of medications, the reason for their prescription, their duration and desired effects, and any adverse side effects. This is not a time to be shy, self-conscious, or feel inferior — don't be afraid to ask and re-ask important questions or to request a second opinion if you are feeling dissatisfied. If you suspect your child is experiencing mental health issues, it is imperative that you take proactive action to address them before the situation escalates into a severe crisis.
