September is National Suicide Prevention Month and it can make the difference in someone’s life to have emotional and mental health support with access to the resources they need. Being open to mental health education and counseling as well as finding the right medication or treatment is key. Often, parents can be hesitant to have their child on psychiatric medication. Cook Children’s psychiatrists are answering parents’ questions and raising awareness to help alleviate stigma and treatment for children.

What are mental health conditions?

Depression, ADHD, anxiety and behavior problems are the most common mental disorders found in children. According to the U.S. Centers for Disease Control and Prevention (CDC), “Mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions, causing distress and problems getting through the day.”

Kristen Pyrc, M.D., Medical Director of Psychiatry Outpatient Services and the Partial Hospitalization Program at Cook Children’s, said they diagnose mental health conditions when they are limiting a child or teen’s functioning.

“Worries, sadness, and anger are all normal emotions, but we become concerned when a kid’s sadness or anxiety keeps them from doing things that bring them joy, or things they need to do to take care of themselves like attending school, showering and interacting with friends,” she said.

How can mental health conditions be treated? 

Both counseling and medication can be used to treat a child with a mental health condition that affects their everyday life, but parents are often hesitant about having their child try medication.

“I’ve found medication and counseling to be equally effective for a child with anxiety and depression, but the combination of both gets kids better faster and safer,” Dr. Pyrc said.

Akemi Watkins, M.D., in Cook Children's Behavioral Health also recommends medication when needed. “If a child has moderate to severe depression or anxiety, we’ll recommend starting medication because current evidence suggests that a combination of medication and therapy is more effective than medication or therapy alone.”

Why are parents hesitant about their child taking medication?

Many parents are concerned with their child taking psychiatric medication because of potential side-effects, medication dependency, the stigma associated with it and even their own experience with mental health medications. The cost of prescription medications, especially name brand, can also be a major hurdle.

If a parent is questioning their child trying medication, Dr. Pyrc recommends, “Consider the risk of not treating anxiety, depression and ADHD, and whether that keeps them from reaching their full potential.”

Is it possible to get financial help to access medication?

The cost of medication often prevents parents from having their child try it. Name-brand prescriptions, especially when they are new to the market, are also out of most people’s price range.

Both Dr. Pyrc and Dr. Watkins help patients have access to their medication by finding similar, lower cost medications and recommending ways to find more affordable pricing.

“GoodRx can help you find the lowest cost pharmacy in your area,” they said. Dr. Pyrc also tells patients about CostPlus Drug Company which has many psychiatric medications at much lower costs that can be mailed.

How can we make taking medication a routine?

Helping a child get used to a new daily routine of taking medication can be challenging. Dr. Pyrc advises “habit-stacking” to make it easier.

“It means ‘stack on’ taking medication to something that you already do every day. Most people brush their teeth twice a day, so getting into the habit of taking medication after brushing your teeth is easier than trying to remember to take it at noon,” she said.

Setting phone notifications can also be helpful and Dr. Watkins advises the parent or guardian to be responsible for dispensing medication for safety reasons.

Medication Success Stories

Both Dr. Pyrc and Dr. Watkins have seen a lot of success stories when children and teens find the right medication.

“One of my favorite memories was a 1^st grader who had ADHD and got into trouble at school every day to the point that he did not want to go to school,” Dr. Pyrc shared. “After we started medication, he brought me his behavior log that had a smiley face for good behavior every day. I still remember the look on his face glowing with pride, and honestly, that is why I do my job.”

Dr. Watkins also experienced seeing her patients’ overall well-being and mental health improve.

“I had a teenage patient with depression and anxiety, and she was started on sertraline,” Dr. Watkins said. “After getting to a therapeutic dose, she was less socially isolated, less overwhelmed with anxiety and said that she was having fewer days where she felt depressed. She felt more motivated to attend school and her grades eventually improved as her depression and anxiety improved.”

Additional Support

When parents are still debating whether or not to have their child or teen try a psychiatric medication, Dr. Pyrc recommends they visit with their pediatrician who can help them understand what is “normal” or if something does need to be addressed. She also recommends researching the American Academy of Child and Adolescent Psychiatry (AACAP) to learn more about anxiety, depression, ADHD, sleep disorders and Autism in the AACAP Parents’ Medication Guides.

Raising a child who struggles with their mental health can be scary, challenging and confusing. The ACEs Task Force of Tarrant County developed a video series called The Roadmap for Children’s Mental Health to help families navigate this health issue.

On this episode of Raising Joy, we are joined by Dr. Brian Dixon from Mindful – a psychiatric practice based in Fort Worth and Frances Wampler from the Center for Children’s Health led by Cook Children’s. Dr. Dixon and Wampler share the mission behind these videos, and how Wampler’s own experience with her child informed the project.

If your child is struggling with their emotions and you don’t know where to turn, this episode is a great start.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

When your child is struggling with their mental health, it can be difficult to know where to turn. Nationwide, waitlists for appointments with child psychologists and psychiatrists can be months long. As a result, pediatricians have become the first line of defense for families who need support.

Alice Phillips, M.D., wears many hats at Cook Children’s. She’s the Board Chair of Cook Children’s Physician Network and Medical Director of Ambulatory Quality. Dr. Phillips is also a pediatrician at Cook Children’s Pediatrics Cityview, and has seen mental health concerns in her practice increase dramatically over the past 26 years. On this episode of Raising Joy, Dr. Phillips talks to us about the role of pediatricians in the mental health crisis and the growing number of tools in their toolbox to help children.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Lisa Elliott, a licensed psychologist and clinic manager of Cook Children’s Behavioral Health in Denton, says some children may threaten suicide in an attempt to get attention or others may be struggling with depression.

“But it doesn’t matter,” Elliott said. “You must take the threat very seriously. If a child is talking about suicide, get help immediately. It’s critical not to ignore this cry for help regardless of their reasons.”

Following a suicide in the community, parents should take the time to talk to their kids.

“Use it as an opportunity to discuss their possible feelings of grief or confusion and be a listening ear and support them,” said Joy Crabtree, a licensed psychologist and clinic manager for Southlake and Northeast Clinic. “Additionally, parents can ask their child if they have ever had any extreme feelings of sadness or thoughts about hurting themselves. If current feelings about wanting to hurt themselves are acknowledged, parents should let their therapist or psychologist know right away. If they do not have a therapist or psychologist, or they are not available, they should be taken to a local mental health facility or hospital emergency room for an evaluation.”

Research has found that about 90 of people who die by suicide experience mental illness.

Elliott says teens with chronic illness, such as depression, are no different than any other child and generally want to be treated just like any other kid. But they should receive professional help and be assessed for anxiety and depression.

“Parents should watch for any change in mood like sadness, depression, hopelessness, irritability, anger and hostility,” Elliott said. “You may see more tearfulness and changes in activity level. Watch for more withdrawal from friends and family, change in friends and loss of interest in activities once enjoyed.”

Elliott says warning signs of teen suicide include:

1. Increased use of alcohol/drugs
2. Preoccupied with death (writing, drawings)
3. Talking about feelings of hopelessness
4. Talking about being a burden to others
5. Telling loved ones goodbye
6. Decline in performance
7. Giving prized possessions away
8. Isolating and withdrawing
9. Acting highly anxious or agitated
10. Acting reckless and taking risks
11. Rages
12. Changes in sleeping and/or eating
13. Dramatic changes in personality and/or appearance

If you feel your child needs help, please call 682-885-3917 for a referral into Cook Children’s Psychology department.

Both can be a self-destructive losing battle.

Guilt is a negative emotion and often unhealthy – it can make anyone unhappy, dissatisfied and unproductive. For parents, guilt comes in all forms and I can especially relate to working moms. After all, I’m one myself. According to AmericanProgress.org women make up half of the workforce in the U.S.

Care.com found that 80 percent of working moms feel stressed about balancing child care, work, home and relationships.

It's important to understand there are a multitude of reasons why a mom is in the workplace. Some women may be the sole or primary breadwinner, others work because they can't afford child care and some work because they know that working will help them be a better parent.

It's critical for us as women and mothers not to pass judgement, but rather be supportive of all working women regardless of whether they are an employed mom or a stay at home mom. All mothers are working mothers!

But for the purposes of this article, I will focus on helping employed moms feel better about their decision to work. Often that requires us to look at the definition of what being a good mother is - a good mother is not determined by the number of hours we spend with our children. It's more about ensuring our children that they are wanted, valued and loved.

Working moms, by their example alone, can teach their children the value of hard work, ambition, independence and self-reliance.

The struggle that many working moms ask of themselves, me included, is there a way to balance work and being a mom? While it's a challenge, there are some things that working moms can do to help.

1. First and foremost is to realize we can’t do it all! We absolutely have to let go of some things, especially the unrealistic expectations. It's important to identify every household member’s needs and obligations and to realistically prioritize them. By changing our expectations, we can change other’s expectations of us.
2. We are bombarded with “expert” advice on what we “should” do to be a “good parent.” The bar that has been set for defining what a good parent should do is often ridiculously high and unrealistic. It is critical to remember we do not have to have gourmet meals on the table every night to qualify that we meet the good parent standard. What is most important, as noted previously is to make sure our children know they are very much wanted, loved and valued.
3. We have to enlist everyone’s cooperation and assign responsibilities, even to our children provided they are developmentally appropriate. When our kids were of school age, my husband and I shared the carpool responsibilities, as well as household duties.
4. When we are with our children it's very important to be present and intentional with them. Remove or minimize distractions, be engaged and interested in them. Set aside special time with each child, even if it's a few minutes a day. My son who is a grown man still talks about our hot chocolate/coffee stops as I would take him to elementary school.
5. Create special family activities that nurture each other, but create activities that fit into your schedule and budget. This might be a family board game night, baking cookies or reading a book together. Children also deeply value traditions – creating your own traditions with each child and as a family are very important.
6. Working moms often feel guilty about working and want to make their children happy. Our goal as parents is to raise our children to be responsible adults, which means we set realistic expectations, we assign responsibilities and chores, we follow through with consequences and we teach life lessons.
7. Learn how to set boundaries and how to express those boundaries in a kind way. It’s Ok if you can’t attend every PTA or school function during the day. Communicate that you would love to help and then provide for them the manner in which you can help and in that communication, include your time constraints.
8. Forgive yourself if something does not get accomplished or completed in the manner you had desired. By accepting responsibility and being flexible you are setting an example for your child that we all make mistakes, but we need to be accountable and responsible for them.
9. Create time for yourself and take care of yourself. You will not be good for anyone if you do not take care of yourself.
10. Utilize resources and supports. One of your best resources and support systems are other mothers. Find a local support group on the web or create one with your friends and/or co-workers who can share tips with and/or ask for help and ideas. Find daycares/providers that will assist with homework. Share carpooling responsibilities with other parents. Hire trusted and competent high school or college students to help with facilitating transportation to other activities.

Consider all of these options to help relieve the stress and provide more quality time with your children.

Remember what is most critical is to ensure our children that they are wanted, valued and loved, while raising them to be responsible adults.