About twenty percent of children and adolescents in the United States — that’s roughly fifteen million kids — have a diagnosable mental health condition. Odds are, you know one, or have one, yourself: a child who struggles to control their emotions and behaviors, or has a hard time in school or relating to others.
Whatever happened to our free-spirited, happy, socially adjusted, emotionally stable children and adolescents, you might ask. They still exist. But it’s a widely accepted fact in psychiatry and clinical psychotherapy that children and adolescents are dealing with an increased number of educational, social, emotional, familial, and environmental stressors than in previous eras.
This sometimes leads to substance abuse, which affects about half of high-school seniors. Many of these same high-school seniors have traumatic histories (witnessing abuse, being abused, and so on), and many are at an increased risk for substance abuse, mental health challenges, and social challenges. To make matters worse, children and adolescents who have traumatic histories and who have experimented with an illicit drug also have an increased risk for sexually-transmitted diseases, smoking, and even obesity, all of which are all leading causes of death.
And there’s more. Children and adolescents who are of color and/or who come from lower socioeconomic backgrounds face even more challenges in accessing mental health services. As a therapist working with this population, I frequently see that children of color and children who come from families with less money are disproportionately disenfranchised in the mental health system.
For decades, the focus of mental health attention and research has been on adults. As a result, we, as a society and as a group of professionals, lack knowledge (and research) on how to best identify and treat childhood psychopathology, primarily psychotic disorders such a schizophrenia, trauma, suicide, and self-injurious behaviors. Now, Jess Shatkin, an associate professor of child and adolescent psychiatry and pediatrics at NYU, has written Child & Adolescent Mental Health: A Practical, All-in-One Guide. Shatkin not only recognizes that child and adolescent mental health is an overlooked topic and receives very little to no press, but he also recognizes that we are overdue for a clinical resource specifically geared toward child and adolescent statistics, research, and treatment.
The book highlights the mental, emotional, and behavioral challenges faced by young people today. One major challenge is the lack of available therapists, social workers, and psychiatrists who specialize in this population. As Shatkin writes, “the United States Federal Bureau of Health Professions has named child and adolescent psychiatry as the most underserved of all medical specialties.”
Sadly, child and adolescent psychiatry and clinical psychotherapy tend to provide very little financial stability for healthcare practitioners, which probably relates to the shortage of professionals in the field. Shatkin explains that “children represent an underserved and disenfranchised group with no voice of their own when it comes to policy and organizational decision-making” — and to make matters worse, the stigma of mental health and psychiatric treatment continues to be a huge barrier for many families.
Shatkin’s book is, on the one hand, comprehensive, with a review of common psychiatric concerns such as schizophrenia, mood disorders, substance-abuse disorders, eating disorders, anxiety disorders, disruptive-behavior disorders, autism-spectrum disorders, and intellectual disabilities. However, there are some drawbacks to his guide. Some readers might perceive the book as only catering to the socially-acceptable constructs of mental illness. Shatkin’s main goal seems to be supporting the complex and sometimes disliked DSM.
Readers may also see the book as overly black-and-white, skipping over the grey areas of mental health: reactive-attachment disorder or adolescents who exhibit borderline personality traits; access to fair mental health treatment; cultural barriers in diagnosing a mental illness; medication management and why some medications are not effective for some people, even in high doses. About these, Shatkin does not help much. If I were a desperate parent seeking information about my child’s severe bipolar disorder, for example, which tends to be very resistant to high amounts of Geodon or Abililfy after repeated trials, I would probably find this book quite detached from the complex issues my child and I were facing.
That said, as a therapist with a specialization in child and adolescent mental health, I was quite ecstatic to receive an all-in-one book that functions like a demographically-targeted DSM. Shatkin provides hardcore facts and current research, and can help clinicians who need a quick reference guide.
Child & Adolescent Mental Health: A Practical, All-in-One Guide
W. W. Norton & Company, June 2015
Paperback, 512 pages