Program models for children wirh early onset of mental disorders
Schools are ideal places to establish child behavior and learn about their mental status. At the same time, they are places where programs are installed to ensure that children and teenagers are in their right state of mind to learn. These settings are responsible for shaping the children and adolescents’ relationships and other interactions, their academic achievements and all these are related to mental health. It is the role of the school counsellors, teachers and parents to work as a team towards the betterment of their children’s lives. High-income countries have expanded school-based mental programs that will increase the awareness of psychological disorders among children and seek to reinstate them to boost academic performance and allow for the best behaviors among children and adolescents. An excellent program is that which integrates neuroscientific information to understand the nervous system of an individual thus comprehend the impact of the mental disorders and what causes them. The paper will begin by discussing how a neuroscientific approach for mental health would look like and thereafter refer to a program on the early onset of children and adolescents and critique since it is not up to date with the neuroscientific information as its foundation.
First, it is important to understand what a neuroscientific approach looks like and what neuroscience deals with. Neuroscience is a branch of science that studies about the nervous system and combines other disciplines such as psychology, cytology, physiology and biology to understand the function of the neurons in humans. It also seeks to explain why the behaviors of neurons in the brains affect the behavior of people making them behave the way they do. The past few decades have experienced great advancements in neuroscience where professionals have been able to see an inside of a human brain through neuroimaging (Lambert, 2005). Even though the popularity of these advances have taken the world by storm, it is still sad that not much progress has been yielded in finding solutions for those who are mentally ill. Instead, therapy and counselling sessions are still the most utilized interventions that are used to attend children and adolescents with mental dysfunctions.
The director of the National Institute of Mental Health’s Research Domain Criteria Initiative, Sarah Morris, points out that much has to be done to increase the move towards the use of neuroscience in treating mental disorders especially in children and adolescents found in a school setting. One of the most famous models used to assess mental illnesses is the circuit method which has been in practice since the Freudian days (White, 2016). The circuit approach is neuroscientific because it sees the brain as a network of circuits and observes these circuits to study patients’ symptoms that will provide a basis for starting the treatment process. The model combines the traditional methods for diagnosing mental illness with the behavior and pattern of neurons to understand how a mental illness develops and progresses to the extent of impacting the child’s development (Luke, Miller & McAuliffe, 2019). The circuit approach focuses on the activities of thousands of neurons with each other through electrical signals. This neuroscientific approach goes beyond the usual diagnosis of mental illnesses where a therapist interviews a patient and goes ahead to study the inside of the brain to reveal what exactly root cause of mental disorders.
The reason why the circuit approach has been embraced in the field of mental health is its ability to take the scientific path for a more advanced diagnosis to arrive at concrete information about an illness. The goal is to eliminate the stigma faced by people suffering from mental illness as the public often view it as an individual failure and not a biological discourse. The world still have a long way to go and too much to learn before they accept that mental illness is not a weakness but rather its due to malfunctioning of some parts of the brain (Lambert, 2005). The study of the neurons will explain why some people suffer from different mental issues and thus be able to explain the defects that the neurons are causing in the brain making individuals behave in some abnormal ways compared to others (Luke, Miller & McAuliffe, 2019). Currently, the field of psychology fails to look at the brain when attempting to make a diagnosis and this is one mistake that these health practitioners are making. The same way a heart doctor looks at the heart when an individual complains of having pain or problems in the area is the same way that mental health professionals should look at the brain to establish a cause.
Leanne Williams is a neuroscientist at Stanford University and after leaving her work as a therapist, she delved into research of the brain. One thing she has realized is that the lives of all individuals will change if personalized neuroscience is applied on each patient (White, 2016). She is saddened that little has been done so far despite the full knowledge that neuroscience would inform the field of mental health and solve the problems that the field is currently grappling with. Williams currently works on a project known as the Research on Anxiety and Depression (RAD) which is funded by the National Institute for Mental Health (NIMH) (White, 2016). Williams is the first person to conduct a study that combines several neurobiological tests like brain scans with the social wellbeing of an individual to make accurate diagnoses and offer the right treatment to the patients with mental illnesses. She has made several trials with the key aim of finding the biological markers that distinguish different mental illnesses and points out the vitality of both neuroscientists and psychologists working together to find the ultimate treatment for these patients.
A neuroscientific approach would not take for granted the brain when making diagnosis but this has been happening daily. It is high time the brain was checked and several scans run to identify the behavior of the neurons ad how it is causing defects and this is through examination of the brain circuits. Williams give an example of a neuroscience approach when she did a test on 60 year old woman who had had panic episodes and depressions for the longest period. She was placed in a brain scanner at the university and she agreed to undergo the RAD test because she wanted to see inside her brain and probably understand what has been causing her troubles (White, 2016). A screen was placed in front of her face which has both sad and happy faces and the patient was required to press either of the buttons for happy and terrified faces. The tests were to be carried out during her entire time in the brain scanner and it was expected that each time, brain circuits would be activated. According to Williams, the many tests taken are supposed to exercise the brain.
Since Williams began her RAD project in Stanford, she has been performing tests to many participants with mental issues. These people have seen the need to personally study their brains with the help of a neuroscientist before a psychologist makes a diagnosis. During the tests, the participants are expected to give a swab of saliva (White, 2016). This practice is critical because it helps in genetic tests for investigating the antidepressant effectiveness and the how the brain circuits are affected by the differences in genetics. After the participants have conducted tests in the MRI machines, they later undergo evaluations by the psychologists.
When the tests come out, any abnormalities in the circuits are searched and then a meeting between the neuroscientist, the patients and a therapist is held. Here, possible interventions and treatments are discussed after the therapist defines the problems of the patients and are made to understand the functioning of their brains. Interventions such as psychotherapies, drugs or counselling are then offered depending on the extremity of the case. Follow up exercises are important for the participants to monitor progress and whether the treatments offered have positive impacts (White, 2016).
The information from the scans and the therapist’s diagnoses have been found to have more detailed information compared to when the therapist alone conducts the diagnosis. The research director at the Gronowski Center, Nancy Haugh, has reported improved treatment on the patients when the behavior of the neurons is studied (White, 2016). Haugh takes part in the RAD study and helps understand what is going on in the brains of their patients. Sometimes, before the brain scans are conducted, the patients are taken to the therapists first and after that, tests are conducted. Often, the results attained confirm the results that the psychologist had already conducted but in other cases, the results are different prompting other modes of treatment.
In the world today, over 500 million people suffer from mental disorders and more than half of these numbers are children and adolescents. School settings and learning institutions have become the hub of these mental illnesses as children and adolescents are exposed to extreme environments. The presence of school counsellors alone has not solved the issue making the mental disorders and the aggressive behaviors associated with them rampant. This causes low academic achievements in schools hence reduced productivity among the students. The existing models in schools where school counsellors are used only treat 30% of the problem and the 70% is left untreated leading to progression of the mental sicknesses (Lambert, 2005). During this time, the brain continues deteriorating explaining the extreme cases of mental issues among children.
Every patient ought to be treated differently because there is no definite treatment for the mental problems. Trial and error is what most doctors and therapists do in trying to find the right intervention for their patients and the individuals struggle with the adverse side effects of the new drugs they are given every time they visit the hospitals. According to the assistant professor of psychiatry and behavioral sciences at Stanford Medicine, Amit Etkin, new and advanced drugs will solve mental issues but the current problem is the absence of these medicines. This has made Etkin to go the neuroscientific way to seek further improvements in mental health (White, 2016). Etkin admits that neuroscience practices such as brain stimulation have resulted in positive results hence a platform for providing the treatment for cognitive disorders. Deep brain stimulation trigger the circuits that assists the neuroscientist understand the activities and the defects in the brain.
An active part in research as at now is brain stimuluses and activities like transcranial magnetic stimulations are the common ones, Etkin reports. He has confirmed that indeed, these are advances in the mental health field and if brain scans are used in children and adolescents, mental health professionals will be able to detect cognitive defects. As such children will immediately be placed in treatment before the inception of signs and symptoms (White, 2016). He says that the brain scans should be likened to cancer screenings or other tests done when checking for chronic diseases. If people could wait until they start experiencing the symptoms of cancer, then they would have waited for far too long and there are slim chances of coming out if. The same case should apply for mental illness such that early detection leads to prompt treatment.
Apart from the RAD, there is another trial, iSPOT-D, that is currently being conducted at the University of Texas Southwestern Medical Center which attempts to find biological markers. These markers are important in establishing the reaction between depression and anxiety disorders with treatment. Recently, a biomarker was identified by Helen Mayberg, a psychiatrist professor at the Emory University. The identification made headlines in the social media because this is one rare occurrence. This marker dictates the kind of treatment that best suits the depressed patient because not all need medication while others respond well to therapies. Having researched and found these possible outcomes, Mayberg is more than willing to delve more into neuroscience to solve mental issues. The world would be a better place if everyone thought of the brain when the issue of mental issues comes up instead of seeing it as the fault of the patient. Williams noticed that if the brain scans show low activity in the amygdala, then the best medication would be Zoloft and Prozac instead of Cymbalta and Effexor. The amygdala in the brain is responsible for emotions. In other words the right treatment for this condition is the Selective Serotonin reuptake inhibitor (SSRIs) and not the Serotonin–norepinephrine reuptake inhibitor (SNRIs).
The RAD study is the excellent approach where physicians will treat a depressed patient by running neurobiological tests to get more insight on what is going on so that appropriate treatment is provided. It is important to note that even though there are patients suffering from anxiety, depression and schizophrenia, every person will elicit distinct symptoms. Therefore, the causes of these disorders are distinct and should not be offered the same treatment but sadly, this has been taking place. Williams points out that the significance of the study is to classify the diagnoses into categories centered on the dysfunctions of the brain circuits. Just as there are trials and errors in the traditional methods of diagnoses, clinical trials should also be done to prove the effectiveness of neuroscience to treat mental illness and eventually shift from therapy to research.
The circuits from people with depression and anxiety are taken and then compared with circuits taken from healthy people. The comparison is important to look out for nonconformities between the two circuits which will in return provide a platform for making appropriate diagnoses. Neuroscientists like Williams assert that they are not only employing science to treat mental issues but are also trying to link it with the social life of the patients. They achieve this by researching the quality of life that the patients are living as well as their experiences in the work environment. The other thing they want to identify are the different ways used by these people to cope with emotions because all these reflect on how their brains functions and respond to the society in different ways.
Williams says that offering personalized psychiatry is critical in providing the right treatment for the patients. She adds that during her entire time as a neuroscientist, she has been able to create healthy relationships with clinicians who are constantly in contact with children and adolescents suffering from mental illnesses. Williams posit that the creation of these relationships has created a pool of ideas where the practitioners can meet and generate the right treatments for patients because of the efficient communication developed. She gives an example of how one worker who works in the engineering department experience difficulties concentrating at work if he does not have a nap. When Williams mapped the circuits in the brains of the engineer, she realized that when at rest he would have negative modes and this is attributed to the engineer’s ‘default mode’ circuit being on overdrive. As such he found himself depressed and could not pay attention when working.
Williams confirms that providing personalized treatment on every child and adolescent with neurological disorders might be difficult as at now but it is high time it was tried. She believes that the move towards a neuroscientific approach will solve the difficulties that arise with mental problems. The early onset of mental disorders in children and adolescents will come to an end if the neurological tests are done on young children. Suitable measures such as the use of antidepressant drugs or therapies will be employed before these children become adults. There are several neuroscientific tests that have been done and they are safe to be conducted in school settings.
The above discussion has provided a clear picture of what a neuroscientific-informed approach would look like. The many examples provided by different neuroscientists shows how much they are enthusiastic about applying neuroscience to solve complex mental issues. Young children and adolescents ought to be the main targets for neuroscientific approaches because they constitute a larger percentage of people suffering from mental illnesses. Psychologists, therapists, parents and doctors should ask themselves why the mental conditions keep coming back. This is because the appropriate treatment which in this case is neuroscience has not been fully embraced.
There are many school-based mental programs that have been put in place to help children and adolescents with early onset of mental disorders, early instances of aggressiveness and other neurological disorders in a school setting. The following discussion will be a critique of such a program because it is does not utilize neuroscientific information as its underpinning. The program in picture is the PAX Good Behavior Program which is one of the most utilized school-based prevention programs for children with mental illness.
The main goal of PAX GBG is to improve student attainment by ensuring that children are in their best mental state. The model is mostly used in middle childhood because it is believed that this is the age when children go to school and interact with other new children. Also, this is the right time for schools to begin addressing the importance of mental state to children. There is need for the implementation of tools that will ensure early intervention and to look out for any early signs and symptoms of mental illness and provide the necessary attention. The exact programs that schools should look for and employ are those that accommodate a full classroom and in addition, offer variety of mental health facilities that have impact on an individual child and that which can positively impact their development. However, more attention should be on those children with the risk of developing mental issues when they are still young.
The PAX GBG is a game played mostly by children in elementary schools to advocate and promote good behavior while decreases the unwanted ones. PAX has been used in several schools in the United States because it has been found to have positive results for instance; institutions which apply this program have noted that there is 45-90% decrease in bad behaviors and a 12% decrease in the urgency of special attention to children (Embry, 2002). Also, the percentage of children required to transfer has reduced to 30% which is a sign that children are at their best behaviors and are in the right mental state that boost academic attainment hence proper transition between classes (Embry, 2002).
The first limitation, however, is the fact that PAX GBG does not apply any science for early intervention of child mental issues. As earlier on discussed, a neuroscientific approach is that which involves brain scanning to check the behavior of circuits in individual people and thereafter present the results to a therapist who will then offer a prescription. Even though the PAX GBG model is used in elementary to curb disruptive behaviors in later life, it does don’t give an extensive explanation of how mental illness will be handled in this period (Embry, 2002). Since children and adolescents are the main targets, the PAX GBG would begin with examining the brains of children before enrolling them to school. Keeping these records will make teachers and school counsellors to understand their students and look out for any symptoms of mental illness.
PAX GBG has a long-term impact on the mental health on children especially those characterized by extreme aggression and anxiety disorders. The reason for this is that when these children play the PAX GBG when in their first grade, they adopt the best behaviors and learn to relate well with others. Therefore, as they advance in age, there is no need for them to be taken to special institutions since of the reduced levels of aggression, thus can relate well with others. Consequently, they are 20% less likely to develop mental disorders in their adulthood (Embry, 2002). One good thing with the program is that it leads to the total reductions of suicide attempts and thoughts.
The PAX GBG is an instance where children learn to work together in groups and assist one another when there are difficulties. Rewards are offered for good behaviors and punishment is presented when unwanted behaviors are realized. The reason why there are little or no cases of suicides and other personality disorders later in life in adolescents is attributed to this program. Children in this program are taught the significance of creating a positive future together and develop skills that are useful when they are adults (Embry, 2002). These skills are mostly behavioral, cognitive and emotional that will tune the child in the right path of happier and healthier lives.
Again, this program shows promising results in the lives of children as it seeks to prevent early onset on mental illnesses and other neurological disorders. However, it fails to provide a clear path for long-term results that will ensure that the child does not relapse or the mental illness will not occur. Unlike the neuroscientific approach where the cause of the problem is established from the brain scans and the neurological tests such as deep brain imaging, the PAX GBG only deals with the outside of the patient which neuroscience wants to eliminate. A neuroscientific approach does not simply make assumptions on the kind of treatment that is best for children. It is different from the PAX GBG approach because neuroscience attends to every patient individually through brain examination (Embry, 2002). Unlike PAX GBG where children and adolescents are placed in clusters and their behaviors monitored based on these groups, neuroscience conducts test in the brains of these patients and come up with the ultimate problem. PAX GBG places children in groups and provide communal treatment without acknowledging that children are different and what is best for one person may not work for the other individual.
The whole of Canada and the United States have stated that PAX GBG is one of the most operative schemes that teachers can utilize to boost long-term academic success on children. Apart from this, children are also safeguarded from the early onset of mental and neurological disorders as well as behavioral problems that will impact their later life. This is one milestone that the PAX GBG approach has succeeded to attain and it goes in line with the goal of the neuroscientific approach of preventing the onset of personality and neurological disorders (Embry, 2002).
The discussion has critiqued the PAX GBG program because there is no instance that it recognizes the use of neuroscience to tackle mental issues in children and adolescents. The approach only deals with children playing games with the aim of encouraging the best behaviors. Teachers should work in collaboration with the doctors who will in turn partner with neuroscientists to ensure that students receive the best care. However, before this is done, creation of awareness and sensitization is critical for all the parties involved so that they are aware of what exactly is taking place. As Williams admits, neuroscience will take mental health to the next step and within no time, reduction in early onset of mental disorders will be realized.
The reason why schools are the ideal places for creating sensitization is because of the different kinds of behaviors that are present in this environment. Therefore, it will be easy to treat each student singly other than viewing them as a whole. The importance of neuroscience is that the first step it makes before diagnosis is to monitor the nervous system and check for any defect. It is from the results attained that therapists can use them as foundation to treat the diseases before they advance. Provision of both the SSRIs and the SNRIs depends on what the neuroscientists find in the brain. Schools that are currently using PAX GBG should first conduct the tests on children still in elementary so that the game comes later after the problem in the brain has been established (Embry, 2002).
In conclusion, the paper has broadly discussed how a neuroscientific approach would look like and the need for the existing programs to adopt neuroscience in their approach. The PAX GBG is the program that is currently being recognized in several countries such as the United States, Canada and the whole of Europe. It has succeeded in instilling good behaviors and reducing unwanted ones because it is used during children’s early ages. However, its failure to utilize neuroscience as its platform is the reason why there are many cases of relapse in these children. The example of Williams has been used in this case to broaden the understanding of how a neuroscientific approach would help children with early onset in schools. Therefore, hospital practitioners ought to indulge in more research concerning the importance of neuroscience to treat children and adolescents. This should be done especially in public school settings where interactions are more and they are likely to get exposed to extreme conditions which will impact negatively on their mental health.
Lambert K. G. (2005). The clinical neuroscience course: viewing mental health from neurobiological perspectives. Journal of undergraduate neuroscience education : JUNE : a publication of FUN, Faculty for Undergraduate Neuroscience, 3(2), A42–A52.
Luke, C., Miller, R., & McAuliffe, G. (2019). Neuro-Informed Mental Health Counseling: A Person-First Perspective. Journal of Mental Health Counseling, 41(1), 65–79