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New Mayo guide helps parents spot teens' mental disorders

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The Action Signs Project
This file photo is from The Action Signs Project, a toolkit to help parents, educators and health professionals identify children at behavioral and emotional risk.
Photo courtesy of The Action Signs Project

A new tool kit to help identify children with mental health disorders was published Friday by Mayo Clinic — 10 years after the U.S. Surgeon General put out the call for a set of easily identifiable mental health warning signs for youth. 

It took that decade for researchers to sift through all the studies, and interview more than 6,000 families and children, in their quest to figure out the easiest way to identify the most serious mental health disorders.

The report identifies 11 signs that require immediate action. They include severe mood swings that cause problems in relationships, intense worries or fears that get in the way of daily activities, sadness that lasts more than two weeks, or sudden and overwhelming fear brought on for no apparent reason.

Dr. Peter Jensen, a Mayo professor of psychiatry and one of the authors of the new guidelines, said the family interviews were especially helpful because they revealed the disconnect that often occurs between what a child says and how a parent interprets that message. 

"When you knock on doors you ask a parent, 'Has he ever talked about wanting to kill himself or made a plan to do so?' Four or 5 percent of parents will say yes. But then when you follow up, 'Has he seen anyone for that,' they'll say no two out of three times," Jensen said.

Jensen said part of the problem is that parents don't always recognize when the threats or behaviors their children display aren't normal. 

The 11 action steps listed in Mayo's tool kit are designed to make these situations very clear. For example a child who has severe Attention Deficit/Hyperactivity Disorder is described in these 17 words: "extreme difficulty in concentrating or staying still that puts you in physical danger or causes school failure".  

"Once you describe them that way, then it's pretty easy to say, 'Yeah, I guess he is that way and he did fail,' or 'Yeah, he's running out in front of cars. I guess that's pretty clear,'" Jensen said.

The Mayo tool kit project received substantial funding from the federal government's Substance Abuse and Mental Health Services Administration. 

Gary Blau, a clinical psychologist who is chief of the administration's Child, Adolescent and Family Branch, said 50 percent of serious mental health conditions manifest themselves by the age of 14. He said that's why the new "action signs" need to be distributed widely in an attempt to reach anyone who works with children on a daily basis.

"About one in 10 youngsters has a serious mental health condition that impairs their functioning in either home or school or in the community. So we're talking about a large part of our population," he said.

The tool kit can't get out soon enough for Sandra Spencer, executive director of the National Federation of Families for Children's Mental Health. Besides helping parents, Spencer thinks many family physicians and pediatricians would benefit from reading the 11 action signs. 

She speaks from personal experience. When her son was a preschooler in the mid 1990s, he began acting out. Spencer shared all of his behavioral problems with her son's pediatrician over the years, but she said the doctor never seemed to know what to make of the behavior.

"It was very frustrating for many years to know that this wasn't typical and to feel like I wasn't being heard and to understand that the pediatrician didn't know enough either," she said.

Her son was eventually diagnosed with bipolar disorder when he was a teenager. Spencer said her son lost a lot of potentially good years because no one was helping him.

"It really impedes everything. It affects their education. They don't learn as well. They get behind in school. They have social issues. They don't meet friends. They don't get along with people," Spencer said. "It really gets worse as the child goes on when they don't get the help, the treatment, the diagnosis and everything they need." 

Mayo researchers say that their 11 action signs won't be able to identify every child with a mental health problem. In order to make the tool kit easy to use, they acknowledge that it isn't as comprehensive as they would prefer. But they estimate that the tool kit will identify at least half of the children who are currently undiagnosed. 

Here are the signs parents should look for:

• Feeling very sad or withdrawn for more than two 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.

• Involvement in many fights, using a weapon, or wanting to badly 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.

• Intense worries or fears that get in the way of your 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.