The current epidemic of mental distress in children and teens is shedding light on how poorly we address mental health in this country. My hope is that a more holistic approach to our emotional wellbeing becomes the standard of care as a result of this crisis but in the meantime there are many options for taking an integrative approach to mental health.
The CDC defines mental health disorders as “critical changes in the way children behave, learn, or deal with their emotions which can lead to distress and affect their cognitive functioning and behaviors” (Okwori, 2022).
Reading this definition makes it obvious why the pandemic has increased rates of mental health concerns, but the number of kids and teens who were dealing with mental health disorders was already rising before the dawn of COVID-19. “ In 2019, 13 percent of adolescents reporting having a major depressive episode, a 60 percent increase from 2007” (Richter, Times, It’s Life or Death: the mental health crisis among U.S. Teens, 2022). A 2018 study found that anxiety disorder diagnoses had increased by 17% in the five years prior.
These rates also do not include children who do experience symptoms of anxiety or depression but haven’t sought help or medical advice for their concerns. Researchers have not been able to identify a clear cause for these increasing numbers.
A paper published this year exploring the prevalence of mental health disorders in children and adolescents in the U.S. was based on data from the 2018 National Survey of Children’s Health. The survey asked families if children had ADHD, a behavior disorder, anxiety or depression. Each of these conditions was found, not surprisingly, to be higher in older age groups. Diagnosing mental health disorders can be challenging in very young children and given that these diagnoses are most commonly assigned during primary care visits, which are notoriously short, there can likely be some discrepancy between DSM V criteria and the diagnosis a child or even young adult may receive. A diagnosis may change as a child grows and develops. But we do know that when anxiety develops in young children, it generally persist through life.
We also know that there can be a genetic predisposition to a child developing anxiety. How parents demonstrate handling stressful situations, combined with genetic influences, can contribute to symptoms of anxiety. The uncertainly of these times in which we are living is impacting our stress levels. Children are trying to make sense of the world but anxiety can develop when they witness the stress of their family members.
A Naturopathic Perspective
As a naturopathic doctor, I have seen benefit in working with children who start to exhibit symptoms of anxiety. Though they may not yet fit the criteria for an official diagnosis, we can begin to support their mental health with cofactors needed in neurotransmitter production and with a homeopathic intake to support them energetically. A homeopathic intake involves discussing how they respond to stressors in their lives and this can segue to a conversation about how to support healthy feelings of attachment. In his book, “The Power of Showing Up,” Daniel Siegel outlines the importance of feeling seen, safe, soothed and secure, in order to develop secure attachments. These foundational aspects of the parent-child relationship can, of course, be complicated by developmental phases, life circumstances and world events. Sometimes taking a holistic approach involves treating all members of the family.
Researchers speculate that factors for increased rates of mental illness may include increased screen time and loneliness that relates to less connections to others; decreased sleep and exercise; and hormonal changes related to earlier puberty. Working with a ND often includes conversations about lifestyle changes such as increasing time outdoors, optimizing sleep hygiene and grounding to help regulate circadian rhythms. For those going through puberty, testing hormones may provide insights into opportunities for hormone balancing.
In a recent article in the nytimes, school counselors commented how they’ve seen teens struggle socially in the past year and have found some adolescents preferring screen time to real life activity. These are signs of emotional dysregulation and can be addressed with a holistic approach. As emergency rooms fill with teens in crises, it’s important to remember that we do not need to wait till a child is in crises to begin addressing mental health concerns. Looking for imbalances early on may help to determine a treatment approach that decreases the likelihood of more emergent symptoms.
When young people struggle to cope with life challenges, this creates stress in the body. Stress causes the adrenal glands to release cortisol which can disrupt blood sugar regulation and sleep and can impact the function of the immune system. While our bodies are made to handle certain amounts of stress, if young people are struggling regulating emotions or are exhibiting more impulsivity, these may be signs that they are experiencing a stress injury and need support.
Taking a holistic approach at this time has a number of benefits. It teaches young people that there are things they can do to feel better. Whether it’s coping skills, breathing techniques, supplement support or taking a break from screens, *the process of learning what tools help will service them for their whole lives*. Learning mindfulness exercises that help to shift one’s mindset teaches young people the power of their self-agency which can be used not only for their mental health but for their physical well-being and executive functioning.
An Integrative Approach
For some, pharmacological treatment may be necessary. NDs are trained to check for interactions with medications and complementary recommendations can strengthen the effectiveness of any treatment plan and provide opens for when and if a young person and their family decide to discontinue medical treatment.
For kiddos who not yet need drug treatment, creating a multi-pronged plan, in conjunction with talk therapy, is also a more robust approach than relying on one single modality. If we acknowledge what we do and do not know about mental health, it becomes obvious that effective long-term solutions to mental health challenges must involve various treatment strategies that help individuals meet the myriad of environments and challenges that they will encounter in life.
The researchers who authored this paper did find that coordinating medical and mental healthcare improved treatment outcomes and decreased caretaker stress. From a naturopathic perspective this is a key point. Of course coordinating between medical and mental health care is important! What may be even better is working with a practitioner who has training in both medical and mental health and can provide treatment suggestions informed by a holistic approach. Of course access to this type of integrative care is limited by a lack of equitable insurance coverage. Insurance companies don’t want to pay for prevention and so concerns escalate to crises before an insurance company will pay.
Issues with insurance coverage are also limiting the ability of families to find therapists and to found suitable treatment centers after hospitalization. It’s heartbreaking that insurance companies factor so significantly int0 our ability to address the mental health crisis. While insurance companies are concerned with profits, poorly paid school counselors are trying to keep up with the demands of their district as many positions remain unfilled due to an inadequate number of counselors to fill the positions that exist.
Talking About the Tough Stuff
A recent article in the times points out how the role of school counselors has changed over the last twenty years “from mostly providing academic guidance to teaching social-emotional learning to the whole school.” Because there are clear associations between the mental health of children and their caregivers, it can be beneficial for the whole family to discuss this concepts at home. Normalize creating space to experience your feelings. Do not shame anyone for having feelings. As a caretaker, bring awareness to your feelings of anxiety or depression and realize that your experience with these symptoms may influence how your young ones respond to stressors. Have conversations about coping mechanisms and self-care practices for each family member. Talk about *neuroplasticity* and how research has shown we can change our thinking patterns which can influence how we feel. And prioritize getting the care needed through primary care, mental health counseling and holistic approaches to health.
In a recent article in the Atlantic, the author points out that while preventing anxiety disorders is a worthwhile objective, the sensation of anxiety is one that we all must experience. Given that anxiety is a universal phenomenon, it’s important to normalize this for children and teach them to tolerate the discomfort. This idea further supports the need for a holistic approach to mental health. There is a continuum between life discomforts and diagnosable disorders and an integrative approach to mental health helps to shed light on an individual’s unique continuum. As a child grows and their continuum of mental health shifts, a supply of coping skills and a range of treatment options will provide the options they need to not only avoid crisis, but thrive in an uncertain world.
Julian, K. (May 2020). Childhood in an anxious age and the crisis of modern parenting. The Atlantic.
Okwori, G. (2022). Prevalence and correlates of mental health disorders among children & adolescents in U.S. Children and Youth Services Review. 136.
Richter, M. (April 23 2022). ‘It’s Life or Death’: The mental health crisis among U.S. teens. NY Times.