A few weeks ago, I posted an Ask Aviva question about getting permission for a certain medication for a nine-year-old child with bipolar disorder. My answer addressed how to get permission, but one reader was shocked that a nine year old had been diagnosed with bi-polar. “Get a second opinion!” this reader advised, their underlying implication being ‘how on earth’ could any mental health professional think that an elementary school aged child could have this type of severe mental illness. While I fully support getting a second opinion and never rushing to a diagnosis, the difficult fact is that, yes, sometimes, pre-teen children are diagnosed and treated for mental illness, and the path to the diagnosis and subsequent treatment can be hell for the parents, the child, and the rest of the family.
A recent analysis of studies worldwide, puts the overall average incidence of mental health diagnosis at 13% for children ages 6-18, the main diagnoses being anxiety, hyperactivity/attention deficit, depressive and disruptive disorders. In Israel, on average ~150 children per year, ages 0-11, are hospitalized for mental health issues. Although overdiagnosis does occur, there are many instances and many cultural influences that can prevent diagnosis and adequate treatment.
This is a list of the most common diagnoses parents receive regarding their child’s mental health:
So, what should you do if you suspect your child is struggling with more than the usual frustrations of childhood? Who do you ask? Where do you go? What do you say?
STEP 1: If your child is in a kindergarten (גן 3, טרום טרום חובה) asking the ganenet for her opinion as for whether she notices any problems in a group setting is often a good start.
STEP 2: If you are worried that your child has an emotional or severe learning disorder, the gan psychologist (yep there is one) is the next stop. Ask the ganenet to set up an appointment for you to discuss your concerns.
STEP 3: If the ganenet mentions her concerns to you first, or if she agrees with your assessment, or your gut tells you something odd is going on with your child, ask the branch secretary to give you the forms to be evaluated at “merkaz hitpatchut hayeled” (child development center) which every kupah has. You will need a referral from your pediatrician or family doctor for this, plus completed questionnaires from the ganenet and from one parent. This appointment usually takes a few months to arrange so start early. Note: in some geographic areas, the development center may be a private service (or in a hospital) and you may need a hitchayvut, so ask the branch secretary first when you make an appointment.
STEP 4: At the center, you (and your child) will meet with a neurologist, occupational therapist, speech therapist, and sometimes a nurse. Make sure you get the reports in writing after the visit. This usually takes a few weeks. These health professionals will help you determine if your child has speech issues, learning challenges, or emotional struggles that may be negatively influencing his/her behavior.
STEP 5: If you feel that your child has an emotional disturbance (severe mood swings, alarming outbursts of anger, overwhelming tantrums or severe depression) contact the kupah psychiatrist in addition to the development center route. This is done by either getting a referral from your family doctor and making an appointment with a kupah child psychiatrist (again this could take a couple of months, so make it early. You can always cancel if the issue resolves itself) or making an appointment directly to a mental health clinic. The kupot websites have both of these services listed on their websites. If you are not satisfied with the service through these heavily subsidized options then you can always seek out private psychiatric/psychological/therapeutic treatment later.
STEP 6: It is always important to get a copy of the diagnosis report (ivchun) because you will need this in the future for bureaucratic and school-related reasons, in addition to pursuing actual therapy for your child in the future.
If your child has been hospitalized for a mental illness and/or is taking a medication for a mental health disorder and still has residual behavior that is difficult to control, you may be eligible to receive bituach leumi payments, as mental health illness is also recognized as a disability. Your first contact should be with your local Yad Mechavenet office, a private organization sub-contracted by bituach leumi to help you gather the correct information for your bituach leumi application. You can also contact the Shira Pransky Project, for subsidized assistance to apply online.