When Mental Illness Strikes Children

Think "mentally ill," and an adult probably comes to mind.
Butmental illness strikes kids, too. Judith Rapoport, M.D., Chief of
Child Psychiatry at the National Institute of Mental Health, is on the
front trees of the battle against mental illness among children. Lately,
she has found new reasons to hope for better treatment--and someday even
prevention--of these life-disrupting disorders.

NANCY K. DESS: Is childhood mental illness more prevalent than
historically thought?

JUDITH RAPOPORT: Yes. Up to 11% of children whose parents have no
psychiatric diagnosis experience depression, anxiety, autism and so on.
With psychiatrically disturbed parents, the numbers are even
higher.

NKD: One of your interests is childhood obsessive-compulsive
disorder (OCD). What is that?

JR: With both childhood and adult OCD, thoughts and habits run wild
and interfere with normal life. Contamination and danger are major
themes. A boy may wash his hands 100 times after touching a doorknob. One
man felt sure that he had hit someone with his car and drove up and down
the road looking for the body.

NKD: Why does OCD exist?

JR: The answer starts with a question: "What's the normal function
of the brain system that goes bad?" We speculate that such systems have
adaptive evolutionary roles. Contamination concerns may derive from an
innate "program" related to "soiling the nest" and controlling grooming
behaviors. A flaw in how the brain regulates these behavioral routines
results in OCD symptoms.

KD: Besides the genetic component, what else does OCD
involve?

JR: Intriguing recent research looks at how childhood OCD might
arise from streptococcal infection, which causes an autoimmune response
in the brain. Put into social context, the implications are profound: If
ritualistic behaviors from an early age were relatively common, they
could, over time, be integrated into the culture. This work is generating
fascinating new ideas about how infectious agents, neurobiology and
culture may jointly shape rituals, ceremonies and other
traditions.

KD: Let's turn to childhood onset schizophrenia. What have you
learned so far?

JR: First, it is rare, much rarer than OCD or depression. In eight
years, we've found 55 eases. Yet it is important because it may give
clues as to what's going on in the more common later onset schizophrenia,
just as studying childhood diabetes led to breakthroughs in understanding
diabetes at all ages. We hope our study will help us find the cause of
schizophrenia, perhaps someday enabling us to prevent it. Overall,
childhood onset schizophrenia is very similar to severe adult onset
schizophrenia. Both are characterized by pervasive, serious disturbances
in thought, emotions and behavior. We do see a higher rate of genetic
markers with childhood onset. We are working hard in this area and are
still looking for people with onset of psychotic symptoms before their
13th birthday, to whom we provide excellent evaluation and
hospitalization, as needed.

NKD: What should parents, teachers and concerned others watch
for?

JR: With OCD, a change in habits--such as increased bathroom time
and chapped hands--can be a clue. With schizophrenia, the child may lose
interest in friends and have odd ideas and, later, hallucinate. But since
healthy children also can develop new habits or hallucinate, concerned
parents should seek out a good evaluation.

NKD: Is there hope for these children?

JR: Yes. New drugs have greatly improved life for many children
with various psychiatric disorders. But behavior therapy and family
counseling are valuable complements to drug therapy. With OCD, for
instance, counseling can reduce problematic avoidant behavior. Social
support is important, too: Parents who've become advocates for
schizophrenic children have mobilized neighborhoods and schools so that
their children can be part of a caring community--something everyone
needs.

Adapted by Ph.D.

Nancy K. Dess, Ph.D., is a professor of psychology at Occidental
College and senior scientist at the American Psychological Association in
Washington, D.C.