This is part two of a series on youth mental health in Oklahoma. Read the first part of the series here.
Isolated. Overwhelmed. Confused. Parents of children with mental health conditions shoulder heavy emotions, maybe no more so than at the beginning of a child’s journey into treatment and recovery. In truth, they aren’t as alone as they feel: according to the National Institute of Health, as many as one in five children have a mental health condition. The lack of awareness, education and access to resources has created a staggering stigma for these children and their families.
“Years ago, I would have had no problem telling people I have hypothyroidism but I was less likely to tell them I take an antidepressant,” said Lori Wharton, a board member of Mental Health Association Oklahoma and frequent speaker on mental health. “Now I’m open that I have Generalized Anxiety Disorder. I have people come up to me after I speak and say ‘I’m going to start talking about it, too.’ I feel like I’m giving them some freedom and some peace.”
That was not the case for Wharton when her then-12-year-old daughter’s depression and anxiety culminated in two suicide attempts. Because early intervention is key to successful treatment, Wharton works tirelessly to connect other families to mental health resources. Mental health conditions present in a variety of ways in children, from anxiety and depression to Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder (ADHD). According to the Oklahoma Department of Mental Health and Substance Abuse Services, of the more than 40,000 Oklahoma County children with a mental health condition in 2015, only 24 percent received services.
“Intervening at the right time and with the right treatment can make a big difference to the person this child becomes and the quality of life this child will have,” said Dr. Naveena Boindala, child and adolescent psychiatrist for INTEGRIS Mental Health, Spencer.
For Boindala, the primary factor in determining a treatment plan is how much the mental health condition is affecting a child’s sense of who they are.
“Children are constantly in the process of figuring out their identity,” said Boindala, “asking themselves questions like: ‘Am I a good kid? Am I lovable? What am I good at? Is the world a good place? Can I trust people?’”
If a child’s untreated mental health condition leads to behavior problems, she might assume she is a bad kid, isn’t smart or that others don't like her.
“If this child thinks this about themselves for long enough, they start to believe it,” said Boindala.
Often before parents seek mental health treatment for their child, they must first come to terms with the condition for themselves.
“I fear that stigma for my kids and I think every parent does,” said Jenna Cunningham, whose sons deal with anxiety. “You have to let it be and know it’s okay as long as we are working toward finding a solution.”
Treating mental health conditions
As Wharton explored the treatment options for her daughter, she quickly learned patience would be essential in helping her get better.
“The expectations were to get a therapist and medication and things will get better,” said Wharton. “Those were unrealistic expectations. Just like you might see several general physicians to make a decision, it’s even more like this with a counselor or psychiatrist. You have to find the right fit.”
Wharton’s daughter tried a handful of medications before the family settled on what was best for her. Though mental health conditions often have a higher chance of recovery if treated with therapy and medication in tandem, the type of treatment for each child is highly variable. Parents and medical professionals consider the cause of the mental health condition, family history and the child’s response to therapy. While psychologists like Dr. Lisa Marotta in Edmond don’t prescribe medication for their patients, through testing and symptom severity, Marotta helps parents determine when medication may be recommended.
“I typically make a referral for additional evaluation, be it academic, emotional, sensory or medical, and add this data to the overall treatment plan to help parents make an informed choice,” said Marotta. “A psychiatrist, developmental pediatrician or primary care physician will take testing and recommendations under consideration in a parent meeting to provide additional information about the risks and benefits of medication. An informed parent is a child’s best advocate.”
In therapy sessions, Marotta guides patients to break the cycle of negative self-talk and learn to remain hopeful even when life feels difficult. She helps her young patients with anxiety, depression and behavior challenges understand their symptoms and then identify and express their feelings.
“Counseling empowers the client to listen and respond appropriately to ‘gut feelings’ to navigate more comfortably through life,” said Marotta.
Patients learn techniques for relaxation, conflict management, anger and stress management, assertiveness and other social skills to build healthy relationships. Marotta helps family members develop strategies that promote good mental health at home.
“When parents bring their child into services and participate in treatment, they are modeling for their child that it is acceptable to seek counseling when they have symptoms,” said Marotta. “Once symptoms are improved the task of counseling is to build lifestyle changes in the child and family that will help support mental health and resilience.”
When Marotta’s patients “graduate” from therapy, they identify symptoms together that would indicate they should return.
“If symptoms return, additional support and fine tuning of emotional coping skills are often all that are required to help get young people back on track,” said Marotta.
That same focus on supporting the family is paramount at Red Rock Behavioral Sciences’s Planet Rock in Oklahoma City, where a multidisciplinary group of clinicians diagnose children with mental health conditions, provide therapy to develop healthy coping strategies and prescribe medication if needed. By engaging parents and teaching them the coping mechanisms their children are learning, Dr. Wana Ellison and staff empower families to discuss and encourage strong mental health at home, from improving nutrition to understanding mindfulness.
“We can train our brain to think healthy,” said Ellison, chief operating officer of outpatient offices for Red Rock Behavioral Sciences. “We can learn and practice cognitive processing and become our own therapist when we beat ourselves up or have little hope for the future.”
Because Cunningham’s sons’ anxiety is directly related to dyslexia and school performance, their family has employed reading therapy to combat the dyslexia, in turn reducing their anxiety. When Cunningham’s oldest son started pre-k, he experienced profound anxiety, including severe nausea that sent him to the bathroom most days before school.
“At school he’s a star pupil with no behavioral issues,” said Cunningham, whose son innately hid his symptoms at school. “He was very social and a smart kid. Everything appeared normal except this severe stress before school.”
Their older son’s anxiety was nearly debilitating when he was officially diagnosed with dyslexia in the second grade. As intake specialist of the ReadWrite Center, where her sons receive reading therapy, Cunningham learned that dyslexia and anxiety often go hand in hand.
“They know they’re bright and should be getting what the rest of their peers are getting,” said Cunningham. “They know ‘kids are reading higher levels and faster than me.’”
While reading therapy focuses on providing the boys tools to manage dyslexia, it also involves talk therapy, mindfulness and decreasing negative self-talk. After a month of reading therapy, Cunningham noticed a significant decrease in her oldest son’s anxiety, though it still peaks during state testing. Her younger son no longer gives up when work gets difficult, but his anxiety occasionally presents as physical ailments. He worries that if he can’t perform well at school, his teacher will see him having a hard time and think he’s stupid.
“The irrational thinking is a vicious cycle,” said Cunningham. “When you go to school and your anxiety is high, it’s harder to perform. If you can’t calm down to do your school work, you don’t perform well. Then it reiterates to your brain all the negative things it was telling you.”
Making mental health a priority at home
In one of the treatment rooms at Planet Rock, a large image of trees spans one wall, with a couch opposite where patients can recline. They practice deep breathing or mindfulness techniques so when they encounter a trigger in the outside world, they can close their eyes, remember the image and calm their body’s natural responses. Ellison said techniques like deep breathing, studying a favorite picture or listening to music help ground kids in the present, focus and break the cycle of worrying about the future.
She also recommends teaching children a “body, mind and spirit check,” where children mentally scan their whole body to determine what feels out of place and how to correct it. Like when Cunningham’s son worries about school performance, Ellison urges parents to employ the modulating effect to exchange worries for positivity.
“When we are angry, sad, mad or happy, pay attention to that feeling and measure it on a scale of one through 10,” said Ellison. “Use self-talk to decrease the negative and increase the positive. Our brain can train those unhealthy feelings and we can realize our feelings will subside.”
When kids tend toward absolute thoughts like “I am worthless” or “I never do anything right,” which often lead to isolation or even self-harm, Planet Rock therapists teach them to challenge and replace those unhealthy thoughts with truth.
“Ask yourself, ‘Am I always worthless and will I never have worth?’” said Ellison. “By challenging and replacing that unhealthy thought, even by a small margin, the negative feelings and unhealthy behavior can decrease.”
Relaxation techniques are another popular tool for children with mental health conditions. Cunningham has found guided meditation videos on YouTube especially helpful when one of her sons developed insomnia about a month prior to state testing.
“He’d lay down and his brain would just go and go,” said Cunningham. “He’d ask things like, ‘What if I fail? Do colleges see these test scores?’ The videos have been a saving grace at nighttime.”
Cunningham taught her sons their minds can play mean tricks on them, and how to recognize those tricks. Now reading above his grade level, her oldest son still has messages of failure and uncertainty playing in his head.
“We identify the fear and understand that it’s a real fear by not downplaying it,” said Cunningham. “Then we talk about the tools they have that can help them when they feel this way. Sometimes they need to take a break and relax so they can find those tools.”
Like Ellison recommended, Cunningham asks them what they know about themselves to be true, like the fact they are both succeeding in reading therapy or that they can spell difficult words even when it doesn’t come naturally. In the Cunningham household, they give their boys’ anxiety a name, like Roger or Fred, and they might say, ‘I can see Roger is really getting to you today.’
“It becomes a separate function of themselves,” said Cunningham. “It helps them to identify that it’s not who they are.”
Perhaps the best things parents can do at home with kids with mental health conditions are to listen without judgment and embrace and honor their kids’ feelings. Wharton urges all parents to talk to their children about typical sadness versus depression, or typical worries versus anxiety. When her daughter was undergoing treatment for depression, she journaled about her feelings and experiences.
“She couldn’t verbalize them, but she could write them and then share with me,” said Wharton.
Support for the caretakers
The stress and worry of caring for a child with a mental health condition, and its ever-changing nature, takes a toll on parents’ emotional and physical well-being.
“Anxiety may present in a different way today than tomorrow or the next day,” said Cunningham. “I’m constantly reevaluating, ‘Are you really sick or is this anxiety? Does your stomach really hurt or did something happen at school today?’ It’s constant and overwhelming.”
Because mental health conditions tend to run in families, it’s not uncommon for a child’s symptoms and treatment to bring parents face-to-face with similar struggles.
“Parents need to take care of their mental health,” said Wharton, who acknowledged she had been living with undiagnosed General Anxiety Disorder. “I lost myself in it all. I had to get myself help so I could help my daughter.”
After years of uncertainty, misdiagnoses and multiple medications, when Loren Lewis’ son was diagnosed with paranoid schizophrenia in his 20s, she felt both a sense of relief and of worry.
“Now you know why your loved one is acting this way,” said Lewis, volunteer sponsorship officer for the Edmond/North OKC branch of National Association of Mental Illness. “But it’s extremely stressful because you’re constantly monitoring behavior for whatever is going to happen next. You can’t let your guard down.”
Though Lewis said for many parents the signs and symptoms of mental health conditions appear so gradually they can be mistaken for a typically moody teenager, her son’s shift in behavior was dramatic. Even with the support of professionals, his delusional behavior, communication with imaginary people and suicide attempts leave Lewis overwhelmed and exhausted. The support groups provided by NAMI, which are free to the public, are of great comfort to the family. Lewis has received advice on doctors, counselors and books to read. In addition to support groups, NAMI offers education and advocacy programs to these families and the public.
“Knowing you’re not alone and getting it off your chest is a huge relief,” said Lewis. “The help the other families give is invaluable.”
Fighting the stigma starts at home
“So often we as parents look at our kids and expect perfection,” said Cunningham. “We think how they are is a reflection of who we are, but that’s not always true.”
That mindset can lead parents to normalize or ignore signs of mental health conditions in children. The longer a mental health condition remains untreated, the higher the risk a child will develop habits of behaving and thinking that negatively affect their social behavior, learning ability and very identity. Marotta acknowledges it can be confusing for parents to know when to seek help, but that all parents should know the signs and symptoms of mental health conditions in children and call the child’s pediatrician with initial concerns.
“Intervention at the early stages of symptoms results in less emotional impact and fewer negative coping habits,” said Marotta.
Children with mental health conditions are at increased risk for adult disorders, substance addiction and suicide. Combating those negative risks, and early identification of symptoms, starts at home.
“Parent-child communication is a foundational skill for managing stress,” said Marotta. “When the message is that it is okay to express your feelings and seek help or support when it is needed, many of the small problems of childhood can be resolved without intervention. Open communication also makes intervention easier for those bigger mental health challenges.”