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Vol. LXIII, No. 13
June 24, 2011

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Experts Answer Questions on Children’s Mental Health Day

At NIMH’s Children’s Mental Health Day event are (from l) moderator NIMH director Dr. Thomas Insel and panelists Drs. Jay Giedd, Danny Pine, Ellen Leibenluft and Ben Vitiello.
At NIMH’s Children’s Mental Health Day event are (from l) moderator NIMH director Dr. Thomas Insel and panelists Drs. Jay Giedd, Danny Pine, Ellen Leibenluft and Ben Vitiello.
One of the take-away messages of a recent NIMH-sponsored webcast on children’s mental health was that studying mental health and development in children is important not only to improving the lives of children, but also for understanding the roots of adult illness and how it can be prevented. The webcast took place on Children’s Mental Health Day, May 3, and featured a panel of NIMH scientists whose research has focused on brain development and mental health in children. Scientists answered questions from an audience gathered in a Bldg. 31 conference room and over 400 participants online nationwide.

The panel members’ research has helped demonstrate that mental illnesses are common in children, but has also shown that children are markedly resilient; most of those with problems in childhood will grow up to be healthy adults. NIMH director Dr. Thomas Insel moderated the discussion with panelists Dr. Jay Giedd, Dr. Danny Pine, Dr. Ellen Leibenluft and Dr. Ben Vitiello.

Giedd has done long-term studies of children and adolescents using non-invasive brain imaging, genetic studies and behavioral tests to track the growth of the young brain and investigate the relationship between brain development, behavior and mental illness. He opened by noting that one of the key ideas emerging from their work is the possibility of harnessing the plasticity of the brain at this age—its capacity for change—to support or restore health. Also, it is the path or trajectory of development, Giedd said, not the size or function of any one part of the brain, that separates health from illness.

A central focus of Pine’s research has been anxiety disorders in youth. Mental disorders, he said, are common in children—occurring in as many as 20 to 30 percent—but researchers are beginning to be able to identify which children have problems that will persist and which will recover more readily.

Work on anxiety suggests that resilient children are those who, while anxious, face their fears rather than avoid them. This provides the basis of one approach to therapy, which involves having a child do the things that scare him or her, in manageable doses, similar to treatment of anxiety disorders in adults. A goal of continued research is to understand more about the biological bases of anxiety disorders and use that information to target new treatments.

Leibenluft addressed childhood bipolar disorder, which has become a more common diagnosis in recent years. Just because a child is irritable, she said, does not mean that he or she has bipolar disorder. These children have a disorder, but it is likely that it can be helped with treatment that is less toxic than those used for bipolar disorder, so the distinction is important. The manic phase of bipolar disorder—a speeding up of thoughts and activity—is central to diagnosis.

Vitiello said that as a result of many recent studies in children, we have much more information—specific to children—on treatments. In the past, treatment of children was often based on information derived from adults. For attention deficit hyperactivity disorder, stimulants are effective and behavior therapy is helpful for some but not all children. Some studies suggest that controlling ADHD can decrease the risk of substance abuse.

All four speakers commented on questions from the audience:

  • Right now imaging is a useful research tool, but is not yet useful as a diagnostic tool.
  • The line between health and illness is not distinct. There is a huge range of normal behavior; one measure of whether difficult behavior represents an illness is whether the behavior prevents a child from engaging in the normal activities of youth, like going to school. A pediatrician can be helpful in making an assessment.
  • Genetics play a role in mental illness, but they do not determine who will become ill. Environment is very important. Animal research has shown that the same gene can be beneficial or harmful depending on the environment. Although bipolar disorder is strongly associated with genetic inheritance, the vast majority of children of parents who are bipolar will not have the disorder.
  • For many disorders, both talk therapy and medications can be helpful. The use of medication gets more controversial in very young children. There is information from research on medication use in older children, but not enough yet on the very young.
The speakers emphasized that mental illnesses are complex disorders; studies of the brain are only beginning to scratch the surface of what we need to know to understand them. NIHRecord Icon

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