It’s difficult to hide: multiple slash marks on the forearm. Many try to cover-up the painful reminders of a very bad day while some tell me openly all of the details. Either way these are the patients that are amongst the most distressing to me as a doctor and as a mother.  And at the same time they are the most intriguing. They almost all say the same thing: they were not trying to kill themselves…but they cut themselves for other reasons.

Cutting is one type of “non-suicidal self-injury” (NSSI). In teens, NSSI most often involves cutting, but also can be burning themselves or banging their heads. Cutting is usually done on the arms, stomach, or thighs with a sharp object like a razor blade, knife, or scissors. To parents it may be out of the expected, but it’s usually not out of the blue. 

NSSI is an outward sign of an inward pain. Teens often cut themselves in response to emotional pain or distress. When they cut, they feel a rapid physical release of emotional pain that is otherwise too difficult to tolerate. Surprisingly, studies have shown that people who self-injure have little or no physical pain even when tissue damage is severe.  After cutting, they still feel badly, but they feel calmer and better able to manage their feelings.  It often begins as an impulse, but cutting can quickly become a habit that is difficult to stop.   

Today’s guest blogger Carol Caruso is a member on the National Alliance on Mental Illness board of directors and the executive director of NAMI PA Montgomery County. She talks more today how they help families who contact NAMI for help.

Parents faced with a sudden change in their child’s behavior are often at a loss -- what to do or where to turn for help. Their once bright, active and well-adjusted youngster may suddenly become moody, lose interest in friends and activities, and start to fail in school.  In other cases, their child may have just received a mental health diagnosis and parents do not know what it means when it comes to the course of treatment and prognosis.

At NAMI, we receive many calls from parents asking for resources, support and guidance. We’ve helped parents deal with some of the most common mental illnesses experienced by children and adolescents, which include attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD), major depression and early onset bipolar disorder.  

A third of children diagnosed with attention-deficit/hyperactivity disorder still have ADHD in adulthood, and more than half had another psychiatric disorder, found a study released online today in Pediatrics.

The study looked at 232 adults from Rochester, Minn., who were diagnosed with ADHD as children in the late 1970s and early 1980s, and compared them to adults who did not have a childhood ADHD diagnosis. Of the children with ADHD, almost 30 percent met the criteria for adult ADHD at age 27.

Nearly 57 percent of adults with childhood ADHD had another psychiatric disorder as adults, these included alcohol dependence or abuse, antisocial personality disorder, other substance abuse or dependence, generalized anxiety disorder, and current major depressive episode. Suicide was nearly 5 times higher among childhood ADHD cases compared to those children without ADHD.

This is the first in an ongoing series that will examine mental illness in teens. Blog contributor Rima Himelstein, M.D., a Crozer-Keystone Health System pediatrician and adolescent medicine specialist, opens the series with how to recognize signs of depression in teens. In the following weeks, we'll go more indepth into how depression can accompany other mental illness, treatment options available for teens, and the risks for not treating depression such as suicide.

Teen depression is a problem with many faces. I learned this from my patients.

What type of treatments help kids who have witnessed shootings, been caught in a storm, or who have been abused themselves? What treatments help kids cope with a serious illness? What treatments have serious side effects? Therapists deal with these issues every day and desperately need help in deciding what to do for their young patients suffering from post-traumatic stress disorder symptoms.

A review was published in Pediatrics earlier this week that looked at 6,647 studies that asked the question “what helps kids after a terrible thing has happened?”. The government-sponsored review concluded that there was insufficient hard evidence on the best interventions to help kids who experience PTSD.

This review first points out how difficult it is to do a study with a vulnerable population. Results can be biased, families can drop out, the clinics might not gather the right data, and often everyone gets treated so its difficult to compare treatments. Often results are biased in favor of the treatment under study. Thus, out of the 6647 papers reviewed, only 25 were found worthy of a further look and evaluation of their results. Of those 25 unbiased papers, 22 had sufficient data for analysis.

By Rima Himelstein, M.D.

The first time I met my 16-year-old patient, she hadn’t had a period for 14 months. For the past year, she had felt moody, had difficulty concentrating, and had experienced “hot flashes” and “night sweats.” This teenager was a competitive volleyball player with Olympic aspirations. She exercised every day and lost 20 pounds over the prior six months. She didn’t eat very much, but at night she often dreamed about food. Luckily, she hadn’t had any bone fractures … yet.

My patient was experiencing the Female Athlete Triad, a disorder that has three related parts: 

1. Low energy availability from disordered eating
2. Menstrual problems
3. Low bone mineral density for the patient’s age

By Katherine K. Dahlsgaard, Ph.D.

American children receive over 30 shots for vaccinations during the course of their lives.  That doesn’t include Novocain shots at the dentist’s office and injections to draw blood for tests. Yet In a recent study, 63% of children reported mild-moderate fears of receiving shots (as did about 24% of adults). Estimates vary, but studies have suggested 2-8%of children have injection phobias (i.e., extremely intense fears combined with high anticipatory anxiety that results in impairment in everyday living).

While intense fears may need counseling, parents can help kids overcome mild to moderate fears with these steps: 

1. Do not wait until the day of the doctor’s appointment to surprise your child with the news that he’ll be getting a shot. Many parents do this, reasoning that if they tell their child in advance, “he will worry about it all week.” However, NOT telling your child in advance a) suggests that YOU think shots are so overwhelming and awful that he should, too, and b) denies your child a chance to develop and practice a good coping plan.
2.  Tell him about the shot matter-of-factly, modeling calm behavior. If he expresses distress, you can empathize and reassure him that it’s a normal reaction: “I understand that you’re nervous – lots of people don’t like shots.”
3.  Do not overly reassure your child (“It’ll be okay! It’ll be okay!”) or tell him, “Don’t worry – it won’t hurt.” First, shots do hurt, which he already knows. Second, the greater purpose here is to help him realize he can act bravely even when things are painful.

By Sari Harrar

Reports surfaced this week that the US Food and Drug Administration is investigating a heart attack and five deaths -- including that of a Maryland teenager-- “associated” with highly-caffeinated Monster Energy Drink. But months earlier, Yale University’s Rudd Center for Food Policy and Obesity released a report warning that energy drink makers are aggressively targeting pre-teens and teens via Facebook, Twitter and YouTube, with campaigns and come-ons parents may never see.

Parents want better labeling and stronger regulations for these drinks, which are often sold in large cans and contain caffeine as well as stimulants like guarana and taurine.  A  June 2012 survey of 985 parents found that:

• 86% think energy drinks should report caffeine content on the label.
• 85% think energy drinks should carry warning labels about risk for “adverse effects.”
• 78% think energy drinks should not be marketed to kids or teens.
• 74% think energy drinks shouldn’t be sold to kids or teens.