Help End School Violence: NAMI Calls for Routine Screening of Children for Mental Illness Early Warning Signs Listed

Posted on March 13, 2001

From Columbine to Santee…Violence in America's schools is no longer rare; it's epidemic. The public is outraged, parents are grieving, and fingers are pointed at the availability of guns, at broken families, at peer pressure, or at a pervasively violent culture. But no matter what experts may say, we all should know at least one thing instinctively: 14 and 15 year olds who resort to violence may be suffering from more than just alienation.

As the mother of a son with schizophrenia, and a former classroom teacher, I earnestly hope the epidemic of school violence forces us to confront the fact that, contrary to some popular misconceptions, children and adolescents do develop diagnosable and treatable mental illnesses. Early diagnosis, appropriate intervention and treatment can save lives.

At a time when preventable tragedies seem to occur almost weekly, early screenings for mental illness should be mandatory. Learning the signs and symptoms of mental illness should become part of all teacher and counselor training curricula. In addition, parents, coaches and friends should all learn to recognize where normal adolescent development ends, and mental health problems begin.

Too often, children with mental disorders go undiagnosed. Family doctors rarely ask about mental health problems. Routine mental health screenings, which should begin at an early age, rarely are performed. Unfortunately, it may be the stigma of mental illness that keeps doctors and parents from even talking about real problems. Even if mental illness is suspected, school personnel too often blame the parents.

But the U.S. Surgeon General has called for a war against stigma, greater education of both parents and teachers, and routine assessments of children and adolescents. Even in cases where young people choose not to kill their peers, suicide today remains the third-leading cause of death for youth, ages 15 to 24.

Detection of mental illness is not a new science. Tools exist, and as responsible adults and caring friends, we must learn to use them. NAMI and the Center for the Advancement of Children's Mental Health at Columbia University are working hard to introduce a program called DISC-the Diagnostic Interview Schedule for Children-to communities around the country

David Shaffer, MD, chief of the Division of Child Psychiatry at Columbia Presbyterian Medical Center, is a firm believer in the help that the DISC offers. Dr. Shaffer has been outspoken on the connection between mental health problems in young people and school failure, substance abuse and even suicide. He insists that doctors and parents need more information to recognize and treat serious depression and the early-onset of manic depression and schizophrenia.

These tools are available today. They can help to prevent additional tragedies like Columbine or Santee. As a parents or teachers, it is imperative that we ask whether our schools, physicians, and communities are using them. The price of silence is too great, and the price of neglect is unconscionable.

WARNING SIGNS OF TROUBLE

The following recommendations are derived from the pamphlet "Help and Hope: Caring for Your Children's Mental Health," (pp. 5-7) published by NAMI and the Center for the Advancement of Children's Mental Health at Columbia University.

Children Of Elementary School Age

• Difficulty in going to sleep or taking part in activities that are normal for the child's age or refusal to go to school on a regular basis.
• Frequent, unexplainable temper tantrums.
• Hyperactive, behavior-fidgeting or constant movement beyond regular playtime activities.
• A steady and noticeable decline in school performance.
• A pattern of deliberate disobedience or aggression.
• Opposition to authority figures, and little or no remorse for breaking rules or norms.
• Persistent nightmares.
• Poor grades in school despite trying very hard.
• Pronounced difficulties with attention, concentration or organization.

Pre-Teens And Adolescents

• Sustained, prolonged negative mood and attitude. Often accompanied by poor appetite, difficulty in sleeping, or thoughts of death.
• Opposition to authority, truancy, theft, vandalism, and consistent violation of the rights of others.
• Abuse of alcohol, drugs, and/or heavy tobacco use.
• Intense fear of becoming obese with no relationship to actual body weight, constant dieting, restrictive eating habits, purging food or vomiting.
• Frequent outbursts of anger or inability to cope with problems and daily activities.
• Marked change in school performance.
• Marked changes in sleeping and/or eating habits.
• Persistent nightmares or many physical complaints.
• Threats of self-harm or self-injury; harm or violence toward others.
• Sexual acting out.
• Threats to runaway.
• Strange thoughts and feelings and unusual behaviors.

Parents usually are the first to recognize that a child has a problem. As a first step, they should seek to validate concerns by talking with teachers, day-care or after-school providers, or anyone else who interact with their child on a regular basis.

If a child exhibits any of the above warning signs, talk with the child's regular doctor. If he or she shares your concerns, ask for a referral to a psychiatrist or other mental health professional. A psychological assessment may be needed to determine how best to help the child.

Beware of any assessment that "it's just a phase." Get a second opinion. Not all pediatricians or family physicians may recognize symptoms of mental illnesses. If necessary, ask for consultation with a developmental pediatrician. If you think your child has a problem, trust your instincts.

Self-injury, talk of suicide, or actual violence require immedite attention. If necessary, take your child to an emergency room for a psychiatric assessment to be done.