MURRAY – There is a growing understanding of the need to address mental health issues in general, but particularly in children. A press conference on mental health awareness was held earlier this month during which Governor Andy Beshear ceremonially signed House Bill 44, a bill which allows school districts to include mental and behavioral health issues in attendance policies.
In her opening speech at the ceremony, Lieutenant Governor Jacqueline Coleman cited multiple studies suggesting mental health issues are growing among young people. She noted a 2018 CDC study revealed one in five children in the United States have a mental health disorder; however, only 20% of them sought out treatment with a mental health provider. Also in 2018, the Kentucky Youth Risk Behavior Survey (YRBS), a survey which is administered annually to randomly-selected middle and high school students in every state, showed 57% of 12- to 17-year-olds who had a major depressive episode did not receive treatment from a mental health provider.
“Other reports were published before the pandemic, and they showed us that students wanted help addressing and improving their wellness, but didn’t know how or where to get it and that stigma was a major barrier that came from many places including social media, friends, family, community, heritage, religion and many others,” Coleman said.
According to data published by the Kentucky Cabinet for Health and Family Services on state Medicaid recipients, attention-deficit/hyperactivity disorder (ADHD) is the most frequently diagnosed condition among children in the state; and that holds true for Calloway County as well. Four of the five medications most commonly prescribed to children in the county are treatments for mental health conditions, specifically ADHD and depression. Interestingly, a mental illness is among the top five diagnoses for adults in the county as well; generalized anxiety disorder is No. 2 for that group.
Katrina Coffelt, owner and founder of Bridges Family Center, LLC, is not surprised that ADHD is a more common diagnosis for kids and anxiety is more common for adults because there are similarities between ADHD and anxiety. In fact, she says the most reported reason most people begin therapy – either for themselves or a loved one – is for anxiety.
“Even someone who might have ADHD, they may not bring them to counseling for ADHD,” Coffelt said. “It’s far more likely that they are bringing them in because their kid’s anxiety has gotten out of control. If you talk to pediatricians, they would agree, the No. 1 reason they are referring them for counseling is going to be for anxiety.
“ADHD can have a lot of comorbidities involved, and, oftentimes, ADHD can be confused by anxiety as well. When you look at the actual criteria, they sound very different, like it should be an easy differentiation to make, but for a child who is experiencing anxiety, they can look very distracted; they can look very hyper at times; they can respond to those stressors in very different ways that can look and mimic the same symptoms as attention deficit disorder. Sometimes we are having misdiagnosis, I believe, with ADHD when, really, we might be looking at a diagnosis of anxiety.”
Coffelt would like to see the conversation around ADHD in kids change. There are a lot of misconceptions about the life trajectory of kids diagnosed with the condition. Fully acknowledging that ADHD can be debilitating, she noted, “It can also be an incredible thing. So many incredibly wonderful, creative, successful people have ADHD. I think when parents hear their kids have ADHD, it’s like a death sentence; like they’re never going to be successful because they’re never going to be good in school. … Yeah, it might cause some challenges in the general way that we do school, but here are all of the awesome things that we can do and the accommodations we can make that can be helpful, and, really, your child is not less successful than anyone else, they just may not go in the same direction.”
Changing the dialogue to frame the condition in a more positive light is important because there is more to having ADHD than just being hyper. Without diagnosis or treatment, ADHD can be very detrimental.
“One of the things I’ve always said we don’t talk about with ADHD is the depletion of self-worth because you feel like you fail all the time,” Coffelt advised. “When you have ADHD, there’s a constant sense of ‘I’m failing,’ and most people – kids and adults – are aware of when they’re ‘failing’ or not meeting that expectation; and that sense of not meeting expectations, at some point you (begin to think), ‘Well, I’m never going to.’ If you start to believe that about yourself, that’s a pretty depressing thought.”
While depression is not as commonly diagnosed in children, that does not necessarily mean that children do not suffer from depression. In fact, the 2018 YRBS revealed 30% of high school students reported feeling sad or hopeless to the point that they “stopped doing some usual activities,” and 15% had seriously considered suicide; the 2019 results showed an increase in those categories to 37% and 18%, respectively. Alarmingly, the 2019 results also showed that more middle schoolers considered suicide than high schoolers at 22%.
“Depression is definitely something that is more recorded in adulthood, but I think for a lot of childhood disorders you’re looking more at behavioral (issues),” she said. “Depression doesn’t always look ‘behavioral’ in the way that we think it does. It’s probably not that we have less people who struggle with depression in childhood; it’s just that the other diagnoses or symptoms are more prevalent, so that is what we are going to be addressing more than likely.
Coffelt says many people do not have a good grasp on what depression looks like in adults and are less aware of what it can look like in kids. In children, depression manifests in anger and being withdrawn.
“I think we categorically look at depression as this crying, weeping, laying in bed all day thing, and that’s not necessarily everyone’s experience of depression. … In children, it’s harder to see because their schedules are different; they’re basically forced through the criteria of everyday living; so, we’re not as able to see some of those behaviors as we would (otherwise). We’re more likely to diagnose depression in teenagers because they start to have independence and the ability to have willpower.”
We turn to professionals for our maintenance needs, whether regarding our bodies or our cars, because they are able to better identify potential problems and possess the tools and skills necessary to diagnose and address our needs. Given the common misconceptions about how symptoms of various mental illnesses manifest in different people, it is important to reach out to mental health providers for assistance and guidance.