They Usually Don’t “Grow Out of It” – Dale Mortimer, M.D.

Is your child or grandchild not working up to his or her potential academic and social ability? Are teachers complaining that the child is too social, too easily distracted, immature for his or her age, or not working up to his or her academic ability? Surveys have found that at any given time, about 20% of children and adolescents between the ages of 9 to 17 will have a diagnosable mental disorder (– not a mental illness, but a mental disorder. There is an important difference!). Unfortunately, only one–fifth of these youngsters (that is, 20% of 20% = 4% of all youths) are ever identified or treated for their mental disorder.

Many mental disorders have a strong heritable component. If, as children, on or both parents were profoundly and impairingly shy (i.e., as in social anxiety disorder – which is a very common mental disorder), then their own children are at a greatly increased likelihood of themselves being profoundly shy – including being very reluctant to ask for help from a classroom teacher. If a parent’s elementary school teachers complained (– that is, several decades ago when the parent was a child) that the student needed to be neater, improve his or her organization, “socialize less,” improve academic effort, be more consistent (i.e., comments typical of those with attention deficit/hyperactivity disorder), then the parent’s own children are at a substantially greater likelihood of having similar impairing problems with motivation and planning as well. Problems such as these begin in childhood, and often continue through adolescence into adulthood. That is, for many kids and teens, – despite what the pediatrician might say – They Simply Don’t “Outgrow It.” And as we learn from watching various space launches from Cape Canaveral, the longer it takes to identify and correct a rocket that is veering further and further off–course, the more difficult and expensive it is then, to get the rocket back on target.

Furthermore, without early and effective treatment, these mental disorders such as social anxiety disorder and attention–deficit/hyperactivity disorder can result in very bad outcomes. The 1999 Youth Risk Behavior Surveillance of high school students found that during the twelve months prior to the survey: 19% seriously considered attempting suicide; 14% made a suicide plan; 8% attempted suicide; and 2% of suicide attempts required medical attention. The most worrisome ”take–home message” of this study was that the majority of the parents were completely unaware of their child’s self–destructive thoughts and plans.

Although one would think that teachers would be in a highly advantageous position to readily identify youth who could benefit from psychiatric assessment and treatment, most – if not all –  school districts have formally forbidden teachers and other school staff from encouraging parents to pursue a psychiatric assessment for their struggling child or adolescent.

Primary care physicians (i.e., pediatricians and family medicine physicians) are also in an advantageous position to identify, treat, or appropriately refer distressed children and adolescents with academic, behavioral or emotional problems to seasoned child & adolescent psychiatrists in the community (i.e., me!). However, surveys consistently find that up to 80% of youth with mental disorders are never identified with these problems by their primary care physicians.

Since a primary care physician’s ability to identify psychiatric problems is more likely to occur during longer office visits, and since most primary care physicians have signed managed care contracts ( – the result of which is that pediatricians needing to see more children and adolescents per hour (typically 5 children/adolescents per hour) in order to financially compensate for the reduced insurance reimbursements), then problem–detection, early recognition, and treatment of psychiatric problems in children and adolescents is not likely to happen – at least not without some extra help.

Screening instruments can provide the primary care physician with the opportunity to efficiently recognize problems and to start treatment – preferably at an early and maximally effective point in the youngster’s life trajectory. Early recognition – at a point before significant and/or permanent damage is done to a child’s life trajectory – is both prognostically better for the child and economically better for the family and the family’s funding sources (e.g., wealthy grandparents and/or and medical insurance).

Developed by child psychiatrist and pediatrician Michael Jellinek, M.D., the Pediatric Symptom Checklist screening instrument can be used to improve the likelihood of identifying those children and adolescents between the ages of 4 and 16 years old who are having significant problems with school, friendships, family relationships, mood, and/or general medical conditions. The good news is that the Pediatric Symptom Checklist screening instrument was intentionally not copy–righted, so I can copy this to my website.

Scoring and interpretation of the Pediatric Symptom Checklist is as follows:

An elevated score on the Pediatric Symptom Checklist is something that the youngster’s primary care physician should want to know about – and then address within the context of the youngster’s particular medical and psychosocial situation. With the youngster’s problem successfully identified, the primary care physician can then refer the family to a medical specialist (e.g., a brilliant but yet humble child & adolescent psychiatrist in solo private practice in Vancouver, WA) for a thorough evaluation – and for treatment if warranted.

Child & adolescent psychiatrists are those physicians who are the most highly trained in the medical assessment and treatment of children and adolescents who have disorders affecting mood, behavior, thinking, memory, motivation, or academic performance.

If your child, your adolescent, grandchild – or your student – is having impairing psychosocial problems, please don’t ignore them because…they usually don’t “outgrow it.”