ADHD, anxiety, depression—these are serious mental disorders that affect people everywhere, especially children. How to diagnose, treat and prevent these disorders in our kids is a heated topic with opinions all over the spectrum. Medication? No medication? Therapy? What kind of therapy? These are tough questions many parents find themselves asking in the face of a child who is depressed, anxious or suffering from ADHD.
I recently sat down with an expert on this topic–clinical social worker and psychoanalyst Erica Komisar. Erica specializes in counseling parents of children with mental disorders. Her book Being There: Why Prioritizing Motherhood in the First Three Years Matters is an excellent resource for all parents and talks about the importance of parent-child attachment in order to prevent mental disorders and mental illness. You can listen to the full conversation here.
In our conversation, I wanted to get to the bottom of this question: Are we over-diagnosing and overmedicating our kids? (Spoiler alert: we are.)
Erica says she estimates about one in five children today are medicated for mental disorders, but many of them shouldn’t be. That number is much higher than when I was in residency in the 1980s and the number seems to only be growing. Erica says there are a few things to contribute to this rise in diagnoses and medication use.
M: In your book, you emphasize the importance of a parents’ presence in his or her child’s life. Do you think there’s a link between parents not spending enough time with their kids and some of these issues that you’re seeing?
E: It’s a combination of being there physically but also being there emotionally. And yes, I was seeing a connection between deprioritizing children and also adolescents. We prioritize other things. We live in a very free society, an individualistic society…all good things that mean we pursue what is good for us. But children really need us in a very intense way for them to be emotionally healthy. They’re not born emotionally healthy or with the ability to regulate their emotions or become resilient to stress in the future, and they’re not born being emotionally secure. They’re born with the capacity for being emotionally secure, but it really requires that interaction with their parents.
Children really need us in a very intense way for them to be emotionally healthy. They’re not born emotionally healthy or with the ability to regulate their emotions or become resilient to stress in the future, and they’re not born being emotionally secure.
M: So how should we treat anxiety, depression, and ADHD in kids?
E: First, a proper evaluation.
What the research shows is most children in America don’t even have a proper evaluation before they’re treated. Parents will go first to their pediatrician and pediatricians are prescribing first these medications without even sending them on to mental health care specialists.
A lot of what we are seeing in terms of anxiety is that we live in a much more stressful society for children. The expectations are greater. There’s a real emphasis on cognitive development over social-emotional development. Children can’t be children. All of these things are what I would call psychosocial stressors. What’s going on at home? What’s going on at school? Does the child have a learning issue? Those questions can only be asked in a proper evaluation person to person.
Second, the first line of defense should always be play therapy and parent guidance, and if that alone doesn’t work then you would talk about maybe medication but certainly, medication is the last resort in all cases.
M: What specific things can parents do to help prevent anxiety, depression, and ADHD in their kids?
E: The environment is stressful, but what helps children to deal with the environment are a few things. One – is that they can regulate their emotions. And two – is that they are resilient to stress, and those two things are built like building the foundation of a house in the early years. So I would say if you have young children under the age of five, more is more [as far as how] emotionally and physically available you are to them.
Parents are like the digestive system for children’s emotions. Whatever emotions they have, parents interpret those emotions, they help sooth those emotions, they basically help to regulate children’s emotions from the outside in, and it’s only after a child’s first few years that a child can internalize the ability to regulate their own emotions. So one of the most important preventative things is to be as present as possible both physically and emotionally for your children and that helps with the emotional regulation from moment to moment.
I learned so much from my conversation with Erica. I highly recommend you listen to our full conversation on my podcast here.