Early screening can play a critical role in pediatric mental health

Edited for clarity.

Contemporary Pediatrics®:

Hi, and thank you for joining us. I'm Joshua Fitch with Contemporary Pediatrics®.

Thomas R. Young, MD

I'm Tom Young. I the founder and chief medical officer of Proem Behavioral Health.

Contemporary Pediatrics®:

Dr. Young, thank you so much for taking the time to join us. Today we're discussing how critical early intervention is related to pediatric mental health. Now of course, in multiple facets of pediatric care early intervention is crucial. With a pediatric mental health crisis still current, what can early intervention do for this population just on a general sense, and can you speak to how important it really is?

Young:

It's critical really, Joshua. The issue of children's mental health really does sort of begin the whole journey of an individual in their mental health process throughout life. As we understand today, for example, serious mental illness, which includes things like schizoaffective disorder, and schizophrenia, all are originally manifest during the early teen years and into middle teens and early 20s. Early recognition of these severe mental illnesses by pediatricians in conjunction with parents and schools and others who are involved can markedly reduce the long-term outcome for these people. That changes an entire societies issue with mental health. It reduces jails, it reduces severe hospitalization. Unfortunately, in the US, the average length of time it takes from the first onset of a symptom early in adolescent years, until they're actually even diagnosed correctly in this country, is about 10 years. Those 10 years are lost to the ability to change the trajectory of that disorder. So that's not just including the adolescent lost years for other disorders that occur that can be recognized early on. So adolescence, as much as we talk about it and late childhood, if you will, are critical, critical years for the entire lifetime of that individual.

Contemporary Pediatrics®:

With that being said, Dr. Young, early intervention is critical for all mental health challenges and children, but what are some of the most important disorders? Or what disorders does early intervention help the patient the most? Are they all equal? Can you speak to that a little bit?

Young:

I don't think they're all equal. I think it's, it's really hard, Joshua, to be able to save to somebody that's not as important as this because it's your child, but if we think for example, those disorders, which can lead to significant risks of things like suicide, for example, late adolescent onset of bipolar disease, other disorders of thinking, that can occur, those become very critical for the for the child or adolescent at that time, and may be life threatening at times. Other disorders, early recognition of disorders like eating disorders, anorexia, bulimia, can be critically important to short term as well as long term health of an adolescent. So those are high risk disorders. disorders, which lead to early onset exploration with drugs can be high risk. Kiddos who are really quite anxious, will often turn to self treatment. Again, recognizing that anxiety for what it is and beginning to address it can reduce the need for the individual, the child or adolescent, to find their own resolution, and often we see that in early onset addiction. It's really not [that] they're an addicted person, they're a person looking for their own cure, if you will. So I think all of those kinds of disorders are really critical because they can provide current high risk behaviors.

Contemporary Pediatrics®:

Now, of course, you mentioned the delay in diagnosis being a huge contributor to this issue we're seeing. How can a general practice pediatrician, given that information, kind of insert themselves, can they do that? Oftentimes, correct me if I'm wrong, it's referred to a specialist. How can this kind of change the dynamic given those severely long wait times that directly have an impact on the child?

Young:

Well, I think that's a great question because we do have issues with access and accessibility, and I separate those two. So I do appreciate from the primary care pediatricians point of view. The reality is they may perceive themselves as being less equipped, but they are equipped to do I think some of the things. First off, that's early assessment screening, asking routine questions and sort of making it okay, for particularly early tweens, [11- and 12-year-olds] to be able to talk about something that's bothering are asking about it. So the very behavior of a pediatrician asking those early onset questions. So early screening, early continued screening, in other words, don't ask when they're 11 and never ask again. Ask at 11, ask at 12. Some of the things that we know about early screening tools, the ability to take certain tools and move to the next step. For example, if you're not, you may not be a pediatrician that does, you know, adolescent counseling, but you can be the pediatrician that gets the right diagnosis and gets them on the right path early on. I'll give you the example: If I do screening, and I have a child that comes up and screens positive for anxiety, I can do the next step, which is to sort out what type of anxiety fairly easily because then I can make the right either medication decision, or the right medic treatment decision, or the right referral decision more quickly. The quicker these kiddos get into treatment, the more likely they are to get well sooner, and the more likely they are to not lose out on those things that go on during adolescence. Children and adolescents who sort of lose out on being an adolescent, because of a mental health disorder, have lost a huge sort of growth step, a huge developmental step. If I am strange, as an adolescent, and I have no friends, I've lost sort of the dynamic growth that occurs when you start developing friendships, and understand inner relationships with other people. I've missed out on that. And you can't go back and get that later. So there's a whole lot of reasons to sort of find out what's going on early and quickly.

Contemporary Pediatrics®:

Obviously, pediatric mental health has been at the forefront, of course, the American Academy of Pediatrics, deeming it a mental health crisis in 2021. Over these last couple years, with the attention so focused on pediatric mental health, what steps have you noticed in the right direction, and how can they be further taken?

Young:

Well, I think a lot of a lot has gone on, I think the pandemic across all age brackets, and everyone in this country and probably worldwide... We've all noticed that and we've all seen that. I think pediatricians have brought that to the forefront. Primary care doctors, primary nurse practitioners, all who provide care to children, have noticed that. I think they're getting better at screening. I think that's step number one, I think we're seeing more screening, I think we're certainly seeing more pediatricians and pediatric groups, looking for solutions, to add to their practices that provide either the technology or education for them to be able to do that. So I think that's there. I get a lot of questions out just in the real world from parents now, this happens to me, probably every other day. There'll be a conversation, and parents seem to be talking about it more. So I think we're seeing what I would call maybe a reduction in the stigma, and I think that's a good thing that's happened, I think, by engendering conversation in the public engendering conversations and families having teens talking about it to teens. I still do a great deal of practice in sort of the high school and collegiate space, and the teens talking to other teens is now more common. I think that is all sort of a reflection of the fact that it's been front and center in people's minds for the last two to three years, really for the first time, and it's been okay. I think the pandemic if it did nothing else made it okay to talk about, okay to say "I have that feeling," okay to be cognizant of how I feel, at all those adolescent levels, and I consider really through the college age, 20, 21, 22, those are adolescents. That's still brain changing brain growth, developmental years. So we're seeing more talk about that more understanding of that and I think that's a great thing. Absolutely great. Continue that. Pediatrician feel more comfortable. Ask those questions. Make that part of your of your world, even for the younger kiddos. We're seeing advances and things like autism, advances in early diagnoses of other disorders. As practitioners, having come originally from the primary care world, being a practitioner and not being afraid of some of those things that we face, and understanding that there's things we can do and understanding there's referral, just keep up the great work. I mean, that's really what we have to do is just keep advancing and keep the topic in front of us. So I think things are better.