In October 1993, two young and idealistic psychologists and an equally committed school psychologist opened Children’s Resource Group (CRG). Our mission was to “bridge the medical, educational and psychological needs of children.” At that time, we envisioned a practice that focused primarily on the evaluation of children and adolescents. We had anticipated that we would do the evaluations and design treatment plans. The evaluations would then be shared with parents, physicians, other mental health providers and schools and we would move on to the next evaluation. It quickly became evident, however, that those working with the children and adolescents we evaluated needed education about the child’s diagnoses, better understanding of how to intervene, and support in going forward. Thus, our services expanded to include psychotherapy, parent education seminars, medication management by psychiatrists and nurse practitioners, and educational support services.
There has been an explosion of research in all areas of mental health over the past 20 years, especially in childhood disorders. In the early 1990’s, we would hear parents, teachers and medical professionals say things like, “I don’t believe in ADD or ADHD,” as if it were a religion. Yet the research was telling us a great deal about this condition, how to treat it, and what the long-term outcomes would likely be if it went untreated. Since that time, the estimated incidence of ADHD has increased from 3% of the population to closer to 9%. Increasingly, adults are being treated for ADHD. The stigma of having a child with ADHD or having ADHD as an adult seems to be diminishing and we recognize that ADHD is not an excuse but an explanation for behaviors previously not understood.
In the late 1990’s and early years of the new millennium, the focus of research and controversy turned to Autism Spectrum Disorders (ASD). The inclusion of Asperger’s Disorder in DSM-IV broadened the spectrum of autism and resulted in increased awareness and emphasis on Autism. Medical and behavioral research blossomed in this area. There was a great deal of public education regarding ASD. Schools worked diligently to meet the needs of the expanding population and many services were developed to address the non-educational issues surrounding ASD. While having a child with an Autism Spectrum Disorder or having the condition as an adult is not easy, there are now more supports available and greatly improved understanding and acceptance of ASD in our society.
And just when we were starting to better understand ADHD and ASD, behavioral health professionals began to grapple with understanding the group of children and adolescents who demonstrated significant emotional instability. While professionals debated whether or not this group represented Childhood Onset Bipolar Disorder or some other condition, families suffered with the stigma of having children and adolescents who were “out of control” and schools struggled with addressing their educational needs. The recent publication of DSM-V provides a new diagnostic category for this group of children and adolescents, Disruptive Mood Dysregulation Disorder (DMDD). Over the next decade, we anticipate much better understanding and acceptance of mood regulation disorders and improved treatment.
The providers at CRG are clinicians, not researchers or academics. We constantly pursue the most current research and the best practices in treatment for behavioral health issues. Over the years, we have embraced the quotes of others to help us make our points and to support and encourage the families and those who work with our clients. Here are some of my personal favorites:
- “A good parent deals with the hand they are dealt.” – Dr. Harold Koplewicz
- “It is easy to know that something is not quite right. It is harder to know what is wrong.” – Dr. Bennett Leventhal
- “Children do well if they can.” – Dr. Ross Greene
- “You don’t have to believe in medicine for it to work.” – Dr. Thomas Brown
- “There are no easy answers to complex problems.” – Dr. Ernest Smith
- “A diagnosis is only the beginning of a lifelong journey for a family.” – Bonnie Smith, M.A.
In the first 20 years of CRG’s history, we have seen tremendous growth in the understanding and acceptance of a wide range of psychiatric and neurodevelopmental conditions. Parents have increasingly sought diagnosis and services for their children and adolescents. In doing so, they have often recognized similar or related issues in themselves and sought treatment. Individuals are more comfortable self-disclosing their own diagnoses, pursuing treatment, and seeking support groups. From 1993 to 2007, we saw increased emphasis on training of those who work with individuals with these conditions and increased services and supports. However, with the recent recession and depressed economy, we have seen services begin to shrink and reimbursement for behavioral health services decrease. Schools are no longer doing comprehensive evaluations and it is more difficult to qualify for special education services. This pull-back in funding and services will likely increase stigma over time. Without appropriate supports for treatment, those with neurodevelopmental and mental health disorders are likely to be perceived as a “burden.” This “burden” may lead to increased stigma.
Going forward, we at CRG and those of you committed to supporting individuals with neurodevelopmental and mental health diagnoses have a shared goal. We will need to make conscious efforts to continue to support the rights of these individuals; continue to demystify these diagnoses; and educate those around us about the positive outcomes associated with appropriate diagnosis, treatment, and support for all individuals. For an excellent “tip sheet” on debunking myths of mental illness in children, visit: http://www.childmind.org/en/posts/articles/2010-11-8-7-myths-about-child-mental-health. The National Alliance for Mental Illness is known for its programs and advocacy on behalf of those with mental illness and provides tips on fighting the stigma of mental illness at: http://www.nami.org/Content/Microsites270/NAMI_Howard_County/Home258/Multicultural_Action1/StigmaandMentalIllnessinDiverseCommunities.pdf.
As CRG moves into its third decade, we want to thank all of our current and former colleagues, as well as our medical, educational and community partners, for a great ride. And thanks to all of the individuals who have entrusted their care to CRG for sharing a part of their lives with us. We wish you all well!