Signs that your teen might be on an unhealthy path

Eating Disorder

Writer: Rachel Ehmke

Clinical Expert: Allison Dubinski, LCSW

https://www.youtube.com/watch?v=N7PTi5RTVkE

What You'll Learn

- What are common signs of eating disorders in teenagers?

- What kinds of eating disorders do teenagers experience?

- What should parents do if a child might have an eating disorder?

Quick Read

Most teenagers worry about how they look. It can be hard to tell the difference between normal behavior and a possible eating disorder. Here are the signs that a teenager might be dealing with an eating disorder.

First, kids with eating disorders have very unrealistic views of their bodies. Even if everyone else says they look great or even too skinny, they think they’re too fat. They also care more than other kids about how they look and feel like their self-worth is very closely tied to their weight and appearance.

Teenagers with eating disorders also have extreme eating habits. They might eat way too little, which is the main symptom of anorexia nervosa. Kids with anorexia are often high achievers trying to be perfect, and their weight can get very low. It can be hard to spot because these kids are often successful and popular.

Other kids with eating disorders eat way too much. In bulimia nervosa, they eat a lot all at once, which is called binging. Then, some kids with bulimia get rid of the food by throwing up, taking laxatives, or exercising a lot. This is called purging. They might be a normal weight or even overweight.

Many teenagers are good at hiding their eating disorders, but big changes in weight, eating habits, or exercise habits are often signs of trouble. If you think your child might have an eating disorder, get help from a doctor right away. Untreated eating disorders can be very dangerous, but treatment helps a lot. In particular, family-based treatment (FBT) has been shown to help kids get healthier quickly while staying at home with family.

All teenagers worry about their appearance. Self-esteem can be precarious during adolescence, and body consciousness comes with the territory. But if you’ve noticed that your child is fixated on weight, you’re probably worried. So what is the difference between normal behavior and behavior that might indicate an eating disorder?

- Distorted Body Image: While other people see a normal (or painfully skinny) kid, teenagers with eating disorders look into the mirror and see a different person entirely. They have a distorted perception of their own appearance, and no amount of reassurance from family and friends—all of them saying, “You’re not fat”—will change that conviction.

- Fixated on Appearance: Young people who develop eating disorders are extraordinarily focused on their appearance as a measure of self-worth. While other kids tend to stake their identities on their interests and accomplishments, these teenagers have their emotions, and their lives, wrapped up in thoughts of food and appearance.

- Extreme Dieting: Anorexia nervosa, the most common eating disorder, is self-imposed starvation, usually by a young woman who is otherwise high-functioning. Personality types more likely to develop the disorder include athletes, perfectionists, and over-achievers. They are driven to maintain a dangerously low body weight because of a distorted self-image. Detecting anorexia can be very difficult because it typically affects high-performing kids.

- Overeating: Kids with bulimia nervosa, the other most common eating disorder, indulge in periodic and usually secretive binges. Many kids with bulimia say they feel out of control during their binges and describe them as “out of body experiences.” To compensate, many will purge afterward or diet strenuously. Teenagers with the disorder may be very influenced by body ideals perpetuated in media and popular culture. It can be difficult to diagnose the disorder because people with bulimia can have a normal body weight or may even be overweight.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

What signs to look for

Kids with eating disorders often try to keep their unhealthy eating habits and behaviors a secret, but there are still some signs that parents might notice.

Signs of anorexia

- Losing weight unexpectedly and/or being dangerously thin (Despite their extreme thinness, kids with anorexia usually don’t think that they are unhealthy and actually want to lose even more weight.)

- Obsessing over calorie counts, nutritional facts, and diets

- Spending many hours exercising to burn off calories

- Skipping meals

- Avoiding eating socially

- Irregular periods, thinning hair, and constant exhaustion

Signs of bulimia

- Exercising excessively or using diet pills or laxatives

- Going to the bathroom immediately after meals

- Spending a lot of time in the bathroom

- Having a sore throat, sore knuckles, discolored teeth, and poor enamel

- Hoarding food in her room

- Having large amounts of food that go missing at home

Preventing Eating Disorders

Eating disorders can affect all kinds of kids for all kinds of reasons. Still, there things you can do to help your child build a healthy relationship with food and eating and reduce the risk that they might develop an eating disorder.

- Try to establish healthy eating habits. Make a routine of eating healthy, balanced meals as a family.

- Discuss foods in terms of how healthy they are, not how “good” or “bad” they are.

- Don’t criticize your child’s weight or appearance. Adolescence is a difficult time for most kids, and it’s essential to provide them with a nurturing and supportive environment.

- Some kids are more likely than others to develop eating disorders. Be extra vigilant if you have a family history of eating disorders or if you know that your child is under extreme pressure to look a certain way.

Treating Eating Disorders

Eating disorders in children are very serious and can be deadly, but they’re also treatable. If you think your child has an eating disorder, you should contact a doctor for help immediately.

Hospitalization is sometimes necessary, but for many kids with eating disorders, the recommended treatment involves staying at home and recovering under their family’s care. Family-based treatment (FBT) coaches parents on guiding their child’s recovery and evidence shows that it helps kids return to a healthy weight more quickly than other treatments. Enhanced cognitive behavioral therapy (called CBT-E) and adolescent-focused therapy (called AFT) have also been shown to be effective in many cases, though they generally work more slowly than FBT.

Eating Disorder https://standingabovethecrowd.com/?p=16589

James Donaldson on Mental Health - What Is an Eating Disorder and When to Worry

Signs that your teen might be on an unhealthy path

Eating Disorder

Writer: Rachel Ehmke

Clinical Expert: Allison Dubinski, LCSW

https://www.youtube.com/watch?v=N7PTi5RTVkE

What You'll Learn

- What are common signs of eating disorders in teenagers?
- What kinds of eating disorders do teenagers experience?
- What should parents do if a child might have an eating disorder?

Quick Read

Most teenagers worry about how they look. It can be hard to tell the difference between normal behavior and a possible eating disorder. Here are the signs that a teenager might be dealing with an eating disorder.

First, kids with eating disorders have very unrealistic views of their bodies. Even if everyone else says they look great or even too skinny, they think they’re too fat. They also care more than other kids about how they look and feel like their self-worth is very closely tied to their weight and appearance.

Teenagers with eating disorders also have extreme eating habits. They might eat way too little, which is the main symptom of anorexia nervosa. Kids with anorexia are often high achievers trying to be perfect, and their weight can get very low. It can be hard to spot because these kids are often successful and popular.

Other kids with eating disorders eat way too much. In bulimia nervosa, they eat a lot all at once, which is called binging. Then, some kids with bulimia get rid of the food by throwing up, taking laxatives, or exercising a lot. This is called purging. They might be a normal weight or even overweight.

Many teenagers are good at hiding their eating disorders, but big changes in weight, eating habits, or exercise habits are often signs of trouble. If you think your child might have an eating disorder, get help from a doctor right away. Untreated eating disorders can be very dangerous, but treatment helps a lot. In particular, family-based treatment (FBT) has been shown to help kids get healthier quickly while staying at home with family.

All teenagers worry about their appearance. Self-esteem can be precarious during adolescence, and body consciousness comes with the territory. But if you’ve noticed that your child is fixated on weight, you’re probably worried. So what is the difference between normal behavior and behavior that might indicate an eating disorder?

- Distorted Body Image: While other people see a normal (or painfully skinny) kid, teenagers with eating disorders look into the mirror and see a different person entirely. They have a distorted perception of their own appearance, and no amount of reassurance from family and friends—all of them saying, “You’re not fat”—will change that conviction.
- Fixated on Appearance: Young people who develop eating disorders are extraordinarily focused on their appearance as a measure of self-worth. While other kids tend to stake their identities on their interests and accomplishments, these teenagers have their emotions, and their lives, wrapped up in thoughts of food and appearance.
- Extreme Dieting: Anorexia nervosa, the most common eating disorder, is self-imposed starvation, usually by a young woman who is otherwise high-functioning. Personality types more likely to develop the disorder include athletes, perfectionists, and over-achievers. They are driven to maintain a dangerously low body weight because of a distorted self-image. Detecting anorexia can be very difficult because it typically affects high-performing kids.
- Overeating: Kids with bulimia nervosa, the other most common eating disorder, indulge in periodic and usually secretive binges. Many kids with bulimia say they feel out of control during their binges and describe them as “out of body experiences.” To compensate, many will purge afterward or diet strenuously. Teenagers with the disorder may be very influenced by body ideals perpetuated in media and popular culture. It can be difficult to diagnose the disorder because people with bulimia can have a normal body weight or may even be overweight.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

What signs to look for

Kids with eating disorders often try to keep their unhealthy eating habits and behaviors a secret, but there are still some signs that parents might notice.

Signs of anorexia

- Losing weight unexpectedly and/or being dangerously thin (Despite their extreme thinness, kids with anorexia usually don’t think that they are unhealthy and actually want to lose even more weight.)
- Obsessing over calorie counts, nutritional facts, and diets
- Spending many hours exercising to burn off calories
- Skipping meals
- Avoiding eating socially
- Irregular periods, thinning hair, and constant exhaustion

Signs of bulimia

- Exercising excessively or using diet pills or laxatives
- Going to the bathroom immediately after meals
- Spending a lot of time in the bathroom
- Having a sore throat, sore knuckles, discolored teeth, and poor enamel
- Hoarding food in her room
- Having large amounts of food that go missing at home

Preventing Eating Disorders

Eating disorders can affect all kinds of kids for all kinds of reasons. Still, there things you can do to help your child build a healthy relationship with food and eating and reduce the risk that they might develop an eating disorder.

- Try to establish healthy eating habits. Make a routine of eating healthy, balanced meals as a family.
- Discuss foods in terms of how healthy they are, not how “good” or “bad” they are.
- Don’t criticize your child’s weight or appearance. Adolescence is a difficult time for most kids, and it’s essential to provide them with a nurturing and supportive environment.
- Some kids are more likely than others to develop eating disorders. Be extra vigilant if you have a family history of eating disorders or if you know that your child is under extreme pressure to look a certain way.

Treating Eating Disorders

Eating disorders in children are very serious and can be deadly, but they’re also treatable. If you think your child has an eating disorder, you should contact a doctor for help immediately.

Hospitalization is sometimes necessary, but for many kids with eating disorders, the recommended treatment involves staying at home and recovering under their family’s care. Family-based treatment (FBT) coaches parents on guiding their child’s recovery and evidence shows that it helps kids return to a healthy weight more quickly than other treatments. Enhanced cognitive behavioral therapy (called CBT-E) and adolescent-focused therapy (called AFT) have also been shown to be effective in many cases, though they generally work more slowly than FBT.

Eating Disorder https://795569.us22.myftpupload.com/james-donaldson-on-mental-health-what-is-an-eating-disorder-and-when-to-worry-2/

James Donaldson on Mental Health - Understanding the rising suicide risk among Black youth

by Nationwide Children's Hospital

edited by Stephanie Baum, reviewed by Andrew Zinin

Suicide rates among Black youth have risen sharply in recent years, surpassing those of other racial and ethnic groups. In 2023, it was the third leading cause of death for Black youth aged 10–24 years. However, research examining factors contributing to suicide in this population remains limited.

A study published in JAMA Network Open and led by Cynthia Fontanella, Ph.D., principal investigator for the Center for Suicide Prevention and Research at Nationwide Children's Hospital, is the first large-scale study to examine multi-level risk and protective factors for suicide among Medicaid-enrolled Black youth with a lifetime mental health diagnosis.

"We focused on a Medicaid population because Black youth are disproportionately covered by Medicaid compared to other child populations," says Dr. Fontanella. "They often face social and economic challenges that impact both health and health care navigation. This study allowed us to gain a deeper understanding of intragroup patterns with the hope of more targeted suicide prevention strategies."

The study included 875 Black youth aged 9–24 years who died by suicide between January 1, 2010, and December 31, 2019. Each suicide case was matched with 10 living controls (8,750 individuals) on age, sex and state. There was a total of 9,625 individuals, with 6,950 of them being males. All cases and controls were Medicaid-enrolled and had a documented lifetime mental health diagnosis.

The study found factors associated with increased odds of suicide included:

- Depression and schizophrenia/psychosis diagnoses
- Prior deliberate self-harm
- Prior psychiatric acute care
- Brain injury
- Exposure to violence
- Family relational problems
- Foster care and disability status
- Living in an urban community or in a county with a moderate to high socially vulnerable index—these counties face significant challenges due to poverty, low education, high unemployment, inadequate transportation or crowded housing.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

The highest risk for suicide for Black youth was prior deliberate self-harm (56.4%). According to Dr. Fontanella, timely assessment and continuous follow-up after deliberate self-harm are crucial to decreasing the risk of suicide.

"Research shows that one of the highest risk periods for suicide in all youth is after hospitalization for psychiatric care," says Dr. Fontanella. "We need to target these critical periods. In a previous study, we found that kids that received a timely follow-up after hospitalization were significantly less likely to die by suicide. However, there are huge disparities in race. Black youth were less likely to receive follow-up, putting them at a greater risk."

Protective factors associated with decreased odds of suicide included diagnoses of anxiety and developmental disorders and living in a county with moderate to high rates of religious institutions.

"Community involvement and religiosity were found to be important protective factors for Black youth," says Dr. Fontanella. "This was a big finding. There is very little research looking at the direct impact of religion in these communities, so this is a definite area for further research. Learning what interventions are effective in this population, including culturally tailored interventions and psychosocial interventions are crucial."

https://795569.us22.myftpupload.com/james-donaldson-on-mental-health-understanding-the-rising-suicide-risk-among-black-youth/

by Nationwide Children's Hospital

edited by Stephanie Baum, reviewed by Andrew Zinin

Suicide rates among Black youth have risen sharply in recent years, surpassing those of other racial and ethnic groups. In 2023, it was the third leading cause of death for Black youth aged 10–24 years. However, research examining factors contributing to suicide in this population remains limited.

A study published in JAMA Network Open and led by Cynthia Fontanella, Ph.D., principal investigator for the Center for Suicide Prevention and Research at Nationwide Children's Hospital, is the first large-scale study to examine multi-level risk and protective factors for suicide among Medicaid-enrolled Black youth with a lifetime mental health diagnosis.

"We focused on a Medicaid population because Black youth are disproportionately covered by Medicaid compared to other child populations," says Dr. Fontanella. "They often face social and economic challenges that impact both health and health care navigation. This study allowed us to gain a deeper understanding of intragroup patterns with the hope of more targeted suicide prevention strategies."

The study included 875 Black youth aged 9–24 years who died by suicide between January 1, 2010, and December 31, 2019. Each suicide case was matched with 10 living controls (8,750 individuals) on age, sex and state. There was a total of 9,625 individuals, with 6,950 of them being males. All cases and controls were Medicaid-enrolled and had a documented lifetime mental health diagnosis.

The study found factors associated with increased odds of suicide included:

- Depression and schizophrenia/psychosis diagnoses

- Prior deliberate self-harm

- Prior psychiatric acute care

- Brain injury

- Exposure to violence

- Family relational problems

- Foster care and disability status

- Living in an urban community or in a county with a moderate to high socially vulnerable index—these counties face significant challenges due to poverty, low education, high unemployment, inadequate transportation or crowded housing.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

The highest risk for suicide for Black youth was prior deliberate self-harm (56.4%). According to Dr. Fontanella, timely assessment and continuous follow-up after deliberate self-harm are crucial to decreasing the risk of suicide.

"Research shows that one of the highest risk periods for suicide in all youth is after hospitalization for psychiatric care," says Dr. Fontanella. "We need to target these critical periods. In a previous study, we found that kids that received a timely follow-up after hospitalization were significantly less likely to die by suicide. However, there are huge disparities in race. Black youth were less likely to receive follow-up, putting them at a greater risk."

Protective factors associated with decreased odds of suicide included diagnoses of anxiety and developmental disorders and living in a county with moderate to high rates of religious institutions.

"Community involvement and religiosity were found to be important protective factors for Black youth," says Dr. Fontanella. "This was a big finding. There is very little research looking at the direct impact of religion in these communities, so this is a definite area for further research. Learning what interventions are effective in this population, including culturally tailored interventions and psychosocial interventions are crucial." https://standingabovethecrowd.com/?p=16584

James Donaldson on Mental Health - Questions to Ask a Doctor Prescribing Medication to Your Child

Tips for minimizing side effects and getting good results

Photo by Pixabay on Pexels.com

Writer: Hannah Sheldon-Dean

Many children with mental health challenges can benefit from taking medication, usually in combination with therapy. But finding the right medication and dosage takes time, and side effects can sometimes be a problem. That’s why kids who take medication should always be closely monitored by a doctor.

It’s important to find a doctor or psychiatrist who has experience using medication to treat the kind of issues your child is experiencing. The goal should be to find a provider who is thoughtful and well-informed, and who you and your child will be comfortable working with long-term. Your child’s doctor should be available to work with you until the medication is successful and be able to monitor your child as they change and grow.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Above all, you want to work with professionals who communicate effectively with you, listen to your concerns and answer your questions. Here are some questions that anyone prescribing medication to your child should be able to answer:

- What is the generic name of this medication, and what do we know about how the active chemical ingredient works?
- What are the alternative medications, and why did you choose this one?
- If it’s effective, what will this medication do for my child?
- How do you arrive at the best dosage for this medication?
- How long does it take to work?
- What are the potential side effects?
- How will you measure the effectiveness of the medication?
- What kind of monitoring will you do while my child is on the medication?
- What’s the research on this medication?
- How many patients have you treated with this medication?
- How long should my child continue to take this medication?
- If we choose to stop using the medication, how slowly must it be discontinued, and how do you monitor that tapering-off process?

Knowing what you don’t want in a doctor can be as important as knowing what you do want. If the doctor proposes medication for your child without giving you a clear diagnosis, you should look elsewhere. Trying medications to see if they work can lead to inappropriate and ineffective treatment. Decisions about medication should be based on your child’s diagnosis, not the other way around. Look for a different doctor if yours says something like: “If this works, we’ll know more about what to diagnose.”

Another sign of possible trouble is if your child is struggling and your clinician is adding one medication after another. That approach makes it easy to lose track of what’s effective and what’s not. When kids are given medications to alleviate side effects of other medications, it may be time to get a second opinion.

Photo by Pixabay on Pexels.com https://795569.us22.myftpupload.com/james-donaldson-on-mental-health-questions-to-ask-a-doctor-prescribing-medication-to-your-child-2/

Tips for minimizing side effects and getting good results

Photo by Pixabay on Pexels.com

Writer: Hannah Sheldon-Dean

Many children with mental health challenges can benefit from taking medication, usually in combination with therapy. But finding the right medication and dosage takes time, and side effects can sometimes be a problem. That’s why kids who take medication should always be closely monitored by a doctor.

It’s important to find a doctor or psychiatrist who has experience using medication to treat the kind of issues your child is experiencing. The goal should be to find a provider who is thoughtful and well-informed, and who you and your child will be comfortable working with long-term. Your child’s doctor should be available to work with you until the medication is successful and be able to monitor your child as they change and grow.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Above all, you want to work with professionals who communicate effectively with you, listen to your concerns and answer your questions. Here are some questions that anyone prescribing medication to your child should be able to answer:

- What is the generic name of this medication, and what do we know about how the active chemical ingredient works?

- What are the alternative medications, and why did you choose this one?

- If it’s effective, what will this medication do for my child?

- How do you arrive at the best dosage for this medication?

- How long does it take to work?

- What are the potential side effects?

- How will you measure the effectiveness of the medication?

- What kind of monitoring will you do while my child is on the medication?

- What’s the research on this medication?

- How many patients have you treated with this medication?

- How long should my child continue to take this medication?

- If we choose to stop using the medication, how slowly must it be discontinued, and how do you monitor that tapering-off process?

Knowing what you don’t want in a doctor can be as important as knowing what you do want. If the doctor proposes medication for your child without giving you a clear diagnosis, you should look elsewhere. Trying medications to see if they work can lead to inappropriate and ineffective treatment. Decisions about medication should be based on your child’s diagnosis, not the other way around. Look for a different doctor if yours says something like: “If this works, we’ll know more about what to diagnose.”

Another sign of possible trouble is if your child is struggling and your clinician is adding one medication after another. That approach makes it easy to lose track of what’s effective and what’s not. When kids are given medications to alleviate side effects of other medications, it may be time to get a second opinion.

Photo by Pixabay on Pexels.com https://standingabovethecrowd.com/?p=16580

James Donaldson on Mental Health - Why Do Black Children With Autism Get Diagnosed Late?

Exploring the many barriers faced by Black parents who seek early intervention for their child

Photo by Nicholas Githiri on Pexels.com

Writer: Faith Wilkins

Clinical Expert: Alana E. Telesford, PhD

What You'll Learn

- Why do Black children with autism receive a late diagnosis?
- How do pediatricians contribute to the late diagnosis of Black children with autism?
- How can Black parents overcome barriers to diagnosis and care?
- Quick Read
- Full Article
- What role do primary healthcare providers play?
- How might evaluations serve as a barrier?
- How does stigma affect diagnosis and access to care?
- How can parents overcome these barriers to diagnosis and care?
- What are healthcare professionals doing to tackle this issue?

According to one of the largest U.S. studies to date on the topic, Black children, on average, don’t get diagnosed with autism spectrum disorder (ASD) until three years after their parents have initially voiced concerns to their pediatrician. This automatically places them behind the curve, as they miss out on the many positive effects of early intervention services.

Given the longstanding history of implicit bias and racism within the healthcare system, Black parents may be reluctant to bring up their concerns to their child’s doctor. In fact, many parents have reported their pediatrician to be dismissive or quick to blame disruptive behaviors on poor parenting or harmful stereotypes. Additionally, pediatricians may not recognize ASD symptoms due to a lack of experience. Some doctors only receive a small amount of training on autism during their medical education.

Doctors may opt to take the “wait and see” approach to developmental monitoring, which can result in the child going through multiple rounds of evaluations before diagnosis. Black children are also often misdiagnosed with mood disorders first, further prolonging the process.

To avoid this, parents need to determine whether their child’s doctor is knowledgeable about autism. But many Black parents have described being unable to do so, as they had never heard about ASD and didn’t recognize the signs. Stigma has been cited as one of the main reasons that Black people may fail to acquire mental health information and resources. This is due to the historical misdiagnosis and mistreatment of Black people struggling with mental health issues. Many within the Black community are reluctant to talk about their own mental health struggles. This can lead parents to feel isolated and afraid of judgment, preventing them from seeking a diagnosis for their child.

But it’s important that parents educate themselves on autism and continue to advocate for their child. Foundations such as The Color of Autism and Autism in Black provide helpful information and support for the families of Black children with ASD. And if pediatricians still advise against further evaluation, parents can go to their state’s Early Intervention website to request an evaluation. Parents don’t need to go through pediatricians for a medical diagnosis. They can go to a clinician or any other autism testing agency.

And as research on the importance of autism training within the healthcare system continues to gain traction, there’s hope that more of an effort will be made to educate doctors on how to detect early signs of autism in children across multiple racial/ethnic groups.

Black children withautism spectrum disorder (ASD) continue to be at a disadvantage in terms ofdiagnosis and access to care. According to one of the largest U.S. studies to date on Black parents seeking an ASD diagnosis for their child, Black children don’t receive a diagnosis until three years, on average, after their parents have voiced their initial concerns about atypical behaviors. Even after receiving a diagnosis, they continue to face obstacles in nearly every aspect of care and treatment.

This automatically places Black children behind the curve, as evidence of the importance of early diagnosis and intervention for children with ASD continues to emerge. Early intervention has proven to be critical for the development ofcognitive and language skills, often resulting in a better long-termprognosis for kids with ASD. The disorder is often characterized by poor behavioral regulation, which can have negative effects on social functioning and academic achievement further down the road. With early intervention, a child’s triggers for behavioral dysregulation can be monitored and targeted with therapy. Kids who’ve received this type of care early on in their development have displayed a reduction in hyperactivity and improvement in their ability to manage everyday tasks and adapt to different social situations.

When children receive a late diagnosis, they miss out on a critical form of treatment. This could have lasting negative effects on their social, academic, and future professional development.

What role do primary healthcare providers play?

The healthcare system has a longstanding history of implicit bias and racism, resulting in a lingering sense of medical mistrust within the Black community. To this day, Black women are more than twice as likely to die from pregnancy complications than their white counterparts, regardless of socioeconomic status or educational level. Therefore, parents might be hesitant to even bring up their concerns with their child’s pediatrician.

 “Sometimes families experience either shame about asking for help or a sense of hopelessness. They feel like, ‘Well, even if I ask, I’m not going to get the supports that I need,’” explains Alana Telesford, PhD, a psychologist who specializes in autism.

According to studies that examine the experiences that Black parents have with their children’s primary care providers, these fears have proven to be warranted. Families often report their child’s doctor to be dismissive of their concerns, blaming disruptive behaviors on poor parenting or the harmful stereotype of Black children having a propensity for misbehaving. Other parents have described being accused outright of exaggerating to game the system and receive free government-issued services.

But another reason that doctors may fail to recognize the signs of ASD is that they don’t have the expertise. As Dr. Telesford points out, “Not everyone’s a specialist in developmental differences or autism, especially with young kids. Some pediatricians only get a small amount of training in autism during their medical education. So, if a family really has a concern, I think they also need to evaluate how well their pediatrician understands autism.”

How might evaluations serve as a barrier?

Many doctors opt to take the “wait and see” approach to developmental monitoring, which can also result in the child going through multiple rounds of evaluation before settling on a diagnosis. The current literature isn’t clear about why Black children are more likely than white children to be asked to endure more evaluations than usual. But scientists and health care professionals have a few possible reasons for this. For starters, the framework for ASD evaluations relies heavily on research that’s historically used white middle-class kids as their subjects, making it more difficult for clinicians to detect symptoms of autism in Black children. This can also lead to children being misdiagnosed with a mood disorder, further delaying the process. Additionally, shortages in trained professionals within the community can force parents to look outside their initial healthcare system for evaluations. This can be not only time-consuming but also expensive, posing yet another obstacle for lower-income families.  

Dr. Telesford describes the process as confusing and overwhelming for parents, especially for those who are seeking a first-time diagnosis. “There are so many steps involved. There’s a lot of paperwork, scheduling of different appointments, interacting with multiple healthcare professionals in a whirlwind sort of way.”

This can be especially frustrating for parents who aren’t familiar with the process and do not have a supportive pediatrician. Parents have reported having a much easier time with the evaluation process when their doctors clearly explain what’s going on, offer advice, and keep up with the child’s progress. Unfortunately, it can be a struggle to find doctors who are both willing and have the expertise to do this, even more so for Black parents.  

It’s also important to note that a medical diagnosis is different from an educational classification. Schools might take a medical diagnosis into consideration, but they will most likely require their own process of testing to determine special-education eligibility. The criterion for eligibility varies from state to state. And it’s this eligibility that will allow children to access the services they need within the school system.

“This process must be very parent-driven,” says Dr. Telesford. “So, if a parent has a report from a medical setting, they have to go to the school and formally request, ‘I want my child to be evaluated. This is the data I have.’”

How does stigma affect diagnosis and access to care?

To evaluate if their pediatrician has a firm understanding of autism and its symptoms, parents need to be knowledgeable about the disorder themselves. Many Black parents of children who’ve received a late diagnosis have reported that they had never heard of ASD before and didn’t know what to look for. Had they known, they would have pushed back when their doctor either dismissed their concerns or told them to wait until their child was older.

Stigma has been cited as one of the main reasons why Black people in particular fail to seek proper treatment or resources, regardless of socioeconomic status. Historically, Black people struggling with mental health issues have been more likely to be misdiagnosed, criminalized, or even killed rather than treated with care. As a result, many hesitate to talk about difficulties with mental health for fear of being misunderstood or judged. And for a lot of elder members of the community, mental health struggles are still seen as a sign of weakness or a lack of discipline.

“Families often fear that seeking a diagnosis will cause harm to their child, worrying that teachers, clinicians, or even other family members will make negative assumptions about their child based on the label. They also fear that their own parenting skills will be brought into question,” Dr. Telesford acknowledges.

Black parents are often made to feel isolated, and even if their child’s doctor or teacher raises concerns about early developmental delays, they might be reluctant to follow up in fear of their child receiving the “label” of having a mental health disorder. They decide to wait, resulting in their child either receiving a diagnosis later in life or never getting one at all.

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How can parents overcome these barriers to diagnosis and care?

The most important thing for parents to do is to educate themselves on autism spectrum disorder (ASD) and continue to advocate for their child, advises Dr. Telesford. Foundations such as The Color of Autism and Autism in Black provide helpful information and support for the families of Black children with ASD.

And if their pediatrician advises against further evaluation, she wants families to know that they have every right to request the evaluation anyway. “Because really, that determination of whether they need the support or not should be made by the Early Intervention team.”

Each state has its own federally mandated Early Intervention program. Pediatricians can refer patients for an evaluation, but parents can also go to their state’s Early Intervention website for more information on the process and to request an evaluation.

Parents should also be aware that they do not need a referral from their pediatrician to seek a medical diagnosis for their child.

According to Dr. Telesford, “A lot of families who I see have pediatricians who aren’t concerned. But they’ve decided to seek help anyway. So going to an agency outside of your PCP’s referral and outside of the school system, if you can access that, is something that’s also encouraged. You don’t need a referral from your PCP to come to us or go to any other autism testing agency.”

Having social support ? from family members, community members, or trusted friends ? can also play an important role in the seeking of care. Families are more likely to seek care if they are given an exact agency or provider to go to whom a trusted person in their life has worked with or heard of, says Dr. Telesford. “Additionally, families caring for multiple children may not be able to bring their child in for an appointment if they have a younger sibling at home who also requires care or an older sibling who needs transportation to and from school or extracurriculars.

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