Should Kids Get Screened for Anxiety in School?

The Child Mind Institute is on a mission to make school mental health screenings as standard as eye exams.
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"Do you think he'll be anxious?" my husband said to me recently as we watched our toddler scale the couch, hug the cat, and then spin around and around on the living room floor until he fell on his butt in a fit of giggles.

"Um, no?" I said, hopefully. "Just look at him." After all, at 22 months, our boy is anything but anxious. In fact, he's so fearless that I've been considering making him wear a helmet to the playground.

But of course my husband isn't talking about our son at right this minute. He is talking about what he may be like next year, and the year after that, and in the years and years to come.

You see, we both descend from anxious stock—from the kind of people who avoid elevators and airplanes, and fear medical tests with an almost religious zeal. And as the senior health editor at Parents magazine (me) and a psychiatrist-in-training (my husband), we are also lucky enough to know the facts: 17.1 million children in this nation suffer from a serious mental health disorder, and anxiety disorders make up the biggest percentage (31 percent) of that number.

To put these figures in perspective, Dr. Harold Koplewicz, M.D., CEO of the Child Mind Institute in New York City, tells me: "There are 7 million kids in America who have asthma, there are 7 million who have a peanut allergy, and there are 200,000 with diabetes... When it comes to serious illness, mental health disorders are what kids are most likely to get." And parental worrying, Dr. Koplewicz says, is actually critical to curing. "We know that early identification is essential, and that early intervention works," he says, "It could change the trajectory of a child's life."

But worrying isn't all that has to happen. Dr. Koplewicz's vision for helping our kids requires looking beyond the home and the parents—to the school system. In honor of Mental Health Awareness Month and CMI's Speak Up for Kids Campaign, I spoke to Dr. Koplewicz, who is also a Parents advisor, about his ambitious plan.

Parents: On Tuesday the Child Mind Institute released its annual report on the state of children's mental health. What's your main message this year?

Dr. Harold Koplewicz: We have two: One, is that children with mental health and learning disorders face serious challenges and obstacles in school and most schools aren't equipped to evaluate or provide treatment. The other is that schools are the best place to provide change.

Why schools, and not, say, pediatricians' offices or mental health clinics?

HK: Historically schools are the place where you do hearing screenings and vision screenings, and where kids spend about 8 hours everyday for 253 days a year. That makes it very easy. Plus, pediatricians are under-paid, overworked and have to do a lot of interventions about physical health. Mental health always gets short shrift in their offices.

What in-school programs do you think have the most promise?

HK: One program is the Good Behavior Game. The game is for elementary school kids and it is a contest in which classrooms try to get points for good behavior. This game not only changes the behavior of the kids in the classroom, it actually has some very long-term effects. In first graders, the game actually has a 50 percent reduction in risk of drug abuse, a 35 percent reduction in risk of alcohol abuse and an almost 60 percent reduced risk in regular smoking,. How often does that happen, that a simple psychosocial intervention in first grade has a positive effect 5 and 10 years later?

Also, about 17 percent of schools currently have positive behavior and intervention support systems in place, meaning they positively reinforce kids who are doing on task behavior. So they'll say, "Thank you for sitting so nicely in your chair, or thank you listening to me," instead of "stop fidgeting. Can't you listen to me? You're not following my instructions." Those schools that have changed their culture have 33 percent fewer in-school suspensions. I think that's really worth expanding and continuing to investigate.

Are suspensions and expulsions a good measure of mental health?

HK: Well, they are definitely red flags. First, especially in nursery schools and elementary schools, they are red flags that the school's teachers haven't gotten the training needed to handle off-task behavior. But they should also be red flags for the parents to say, "Okay, how are we going to use this information wisely?" It is very hurtful and painful and humiliating to have your kid suspended and I think half the time that it is unnecessary. But I still think that in that moment, instead of blaming the school, parents should try to figure out how to make their child's life in school easier and more pleasant. And if there are no services available at the school—only a quarter of preschools have access to a psychologist or psychiatrist—that means going to talk to a psychiatrist or psychologist or other mental health professional.

Who needs to hear this message most?

HK: Every parent should be concerned about mental health, no matter how good the parent is. Parents don't make a kid psychiatrically ill. It's bad luck. But a parent could make a child who is ill have a much better life by getting them attention and treatment. And the school environment turns out to be one of the great places where interventions can make learning easier. At the end of the day, every parent wants his or her child to have academic achievement.

What action can parents take today to bring mental health services to their child's school?

HK: We want parents to walk into their child's school and say, bringing these programs here isn't just going to be good for my kid, it's going to be good for everybody. Mental health disorders are the most common disorders of childhood and therefore they may interfere in learning—not only for the child with the problem, but for everyone else who has been interrupted. We need parents and teachers to recognize this and see that sometimes money has to be spent.

Julia Edelstein is the senior health editor at Parents magazine.

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