Mayo Clinic list helps spot mental illnesses in kids

  • Article by: JEREMY OLSON , Star Tribune
  • Updated: October 28, 2011 - 9:55 PM

Confusion by parents and doctors is a reason it came up with 11 clearly written "action signs."

The Mayo Clinic released a list of warning signs Friday showing whether children might have mental disorders -- a tool designed to ensure that parents and doctors catch mental illness early without alarming parents of healthy children.

The 11 "action signs" are written in everyday English instead of medical jargon, with language created through interviews with 6,000 U.S. parents and children.

"The child mental health field needed something like what cancer had done" with its seven warning signs of the disease, said Dr. Peter Jensen, a Mayo psychiatrist who led the creation of the list. "It needed some kind of crisp, easily understood messages that parents, teachers, health care providers could ... relate to."

The list, which is endorsed by the U.S. Surgeon General, the American Academy of Pediatrics, the National Alliance on Mental Illness and other groups, seeks to help parents differentiate normal childhood moodiness from abnormal levels of aggression, depression and hyperactivity.

Confusion by parents and doctors is one reason why more than half of children with serious mental disorders are untreated, according to estimates by the U.S. Surgeon General, and also why 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 or 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 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 "Feeling very sad or withdrawn" isn't enough, unless it has persisted for at least two weeks.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 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 new list wouldn't produce false positives in children whose misbehaviors were just the 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.

Stephanie Hendrickson of St. Louis Park said the list would be helpful. The fact that her adopted son suffered fetal alcohol effects made it easier to convince experts that his problems were due to a biological disorder, but there were still times when therapists only suggested changing parenting practices to help him.

"All parents feel that pressure of 'I'm messing my kid up,'" she said.

Now a parent educator for a west metro school district, Hendrickson said other parents have expressed the same frustration to her.

"When is this clinical?" she asked. "When is it not just a 3-year-old having a temper tantrum or being anxious about going to soccer? When does it become: I need to get some help?"

Easier for parents

Parental psychology influenced the list, which is being published in the journal Pediatrics. 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 associate the term with children.

The list will make it easier for parents to decide whether to seek help, 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.

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 said they hope the list will make it easier for teachers and doctors to believe parents when they express concerns, and for children to receive treatment.

"Children may go as long as 10 years without intervention," said Ruth Hughes of CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder). "Just think about what that time frame is in a child's life."

A speedy diagnosis can make a difference, Blau added. "We know when you intervene early ... that treatment is effective, that young people can and do recover from mental health conditions."

Jeremy Olson • 612-673-7744

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