Mental Health Disorders in Adolescents: A Guide for Parents, Teachers, and Professionals
reviewed by Alberto M. Bursztyn - March 01, 2013
Title: Mental Health Disorders in Adolescents: A Guide for Parents, Teachers, and Professionals
Author(s): Eric P. Hazen, M.D., Mark A. Goldstein, M.D., & Myrna Chandler Goldstein, M.A.
Publisher: Rutgers University Press, Piscataway
ISBN: 0813548942, Pages: 350, Year: 2010
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I began reading Mental Health Disorders in Adolescents with the critical expectation of a psychologist who often disagrees with psychiatrists approach to treating mental health conditions, an approach that relies almost exclusively on psycho-pharmacological interventions. However, I was soon abandoned that perspective; Hazen and his co-authors begin by clarifying their comprehensive approach to treatment, which includes psychotherapy as a potent and necessary adjunct to most psychiatric interventions. Although their understanding of mental illness is firmly grounded in the medical paradigm, and their interventions are consistent with that formulation, the authors are well informed about social and psychological development and value a collaborative, multidisciplinary menu of treatments.
Dispensing with professional language and obtuse academic arguments, the book accomplishes the task of speaking clearly to parents without being patronizing or intimidating. Writing from the vantage point of seasoned clinicians, the authors offer an accessible and useful guide to parents of psychologically troubled adolescents. Taking into account the enormous anxiety and turbulence that families experience when caring for an adolescent with mental illness, the authors provide factual information and an array of treatment choices about each diagnostic entity; including helpful suggestions for seeking help, accessing services, and obtaining insurance coverage.
Although the title suggests that the text is a guide for parents, teachers and professionals, parents are the intended audience. In fact most statements are addressed to them, for example: If you have doubts about your childs therapy, bring them up with the therapist (p. 50). This is not a shortcoming; in fact the books major strength is the recognition that parents of troubled adolescents need information and guidance as they enter the bewildering world of mental health care. Parents must make difficult and often costly choices as they navigate a challenging set of options, all while managing a stressful situation at home. The authors seek to empower parents to play the central role in their childs treatment as they work with various mental health professionals. They compare the treatment team to musicians in an orchestra.
each member having his or her own part to play. If the musicians have different ideas about the goal, the end result is disharmony. By knowing the various players a parent can more effectively play the role of conductor assuring that each person is playing his or her part and that all are working with the same overall plan in mind (p.24).
Obviously, this may not be a role that all parents can play, particularly considering that mental illnesses are often shared by children and parents and that the debilitating effects of managing a troubled teen at home may further impair their capacity to be effective conductors of a team self-assured and opinionated mental health professionals. Nevertheless, I value the authors perspective that parents must become informed and assertive in the quest for their childs best treatment options (Bursztyn, 2011).
Hazen, Goldstein and Goldsteins narrative is most sure-footed when describing psychiatric treatments and practices. This is clearly evident in the discussion of medication and the various outpatient and inpatient options. Regarding medications, they provide a refreshingly frank assessment of risks and note in one instance that there is limited evidence base for adolescent psychiatry (p. 35) evidence is primarily extrapolated from adult studies. Explaining the reasons for prescribing particular psychoactive medications, the authors clarify why a physician may choose a particular course of treatment over another; most helpful to parents is the clarification that frequent prescription changes is not advisable. They state:
Prescribers who are inexperienced or uncomfortable with managing psychiatric medications may have a disorganized approach to medication prescription. They may try one medication, give up on it too soon, try two medications at once, switch to something else because of side effects, then go back to the first medication but at a higher dose. This approach is not only messy, but potentially harmful (p. 62).
This strong caveat underlines the inexact nature of medicating mental illness; rather than burnish the mystique of psychiatric science, the authors urge parents to monitor and keep records of prescribers practices. Appendix B offers a helpful Treatment Organizer where parents can enter details about their childs treatment history that they can share with other providers.
The discussion on levels of care is particularly helpful to parents who may not be aware of the various treatment options for adolescents in psychiatric crisis. They describe the potential conflict between physicians recommendations and health insurance administrators who review the case. In plain language the authors indicate how health insurance companies limit physicians choices and restrict patients length of stay in residential settings, thus often undermining treatment. Parents are sometimes placed in the uncomfortable position of having to choose between enormous out of pocket expenses or dismissing the psychiatrists recommendations. The book offers suggestions to parents about how to advocate for more coverage, noting that the insurers rationale could be bewildering not only to the parents, but to the physician as well.
The presentation of psychotherapy lacked depth, but offered valuable information. For example, in searching for a therapist, the authors discuss the various qualifications and approaches associated with professionals who provide therapy, but underline that therapy is a relationship and goodness of fit is a matter of chemistry between the individual personalities. They point out that teens have a healthy skepticism of adults in general and therapists in particular (p. 45). The authors further describe the nature of the therapeutic process and the importance of confidentiality and patience. Although they identify reasons to discontinue treatment with a specific therapist, they do not mention the potential of therapy as a screen for acting out teens that mollify their parents by suggesting that they are addressing troubling concerns in therapy.
The coverage of specific mental health conditions includes chapters on: depression, bipolar disorder, anxiety, psychosis, substance abuse, ADHD, personality disorders, OCD, eating disorders, loss and trauma, dangerous behaviors, autism and school problems. The chapters are similarly organized, featuring an introduction, a case presentation, and a progression from diagnosis to different treatment options. All chapters conclude with a short narrative on prognosis and other concerns. They are easy to read and contain critical information for parental decision-making. Organizations, resources and additional readings are included in Appendix A.
Psychiatric illnesses often emerge during adolescence; untreated or misdiagnosed teens have poor prognoses and are likely to experience and create turmoil throughout their lives. Parents can play a central role in helping their troubled adolescents, but they are often worried, confused, and distressed, not knowing where to turn for help. I believe that Hazen and colleagues book is an essential tool for parents and I recommend it as a required text for all mental health professionals working with adolescents and their families. It does not have all the answers, but it certainly contains wisdom.
Bursztyn, A.M. (2011). Childhood Psychological Disorders: Current Controversies. Westport, CT: Praeger Books.