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Peter Szatmari

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When we first discovered that more than 20 per cent of our youth had a significant mental-health problem, in a study that looked at more than 3,000 randomly selected children and adolescents from different communities across Ontario, we didn't believe our own results.

Those of us on the team, including Dr. Dan Offord (sadly, now deceased) and Dr. Mike Boyle of McMaster University, tried to disprove the figures among ourselves and rule out all the mistakes we might have made.

But the Ontario Child Health Study (OCHS) held up: We couldn't find any real errors, and in the time since, the landmark study on the prevalence of mental-health problems in children and youth has been replicated elsewhere in North America and Europe.

That shocking figure – one that we seem to have grown immune to – includes chronic and severe problems, as well as the mild transient problems that are likely to go away on their own. If we take away the milder cases, we can conclude that 10 to 15 per cent, approximately one in 10 children or youth, suffer from more chronic challenges. Yet there remains a reluctance to accept the magnitude of the problem. Why is it that people don't really appreciate the scope and burden of mental-health challenges among children and youth? Here are two of the biggest reasons:

Severity of symptoms

One thing the OCHS taught us was that parents, teachers and the children themselves often disagreed on the presence or severity of a problem. Teachers might say a child was very overactive, while the parents might say that this problem was quite mild. The child often reported symptoms of sadness and anxiety that were not intuited by the parents. And family doctors often missed those telltale signs, too. If a parent took a child to the family doctor for an "emotional" problem, we learned the doctors would often not agree that there was a problem and would chalk it up to "being a boy," or "it's normal," or that the parent was "too concerned."

Even more striking was that parents and teachers often did not think a child might have a "mental-health problem" even if they described many symptoms and behaviours consistent with a significant challenge. Parents might see symptoms of sadness, irritability, crying and poor school performance, yet not recognize that this might represent an important mental-health problem.

It is clear that as a society we have a very low level of mental-health literacy. We all have a hard time distinguishing the ups and downs of typical development from the telltale signs of a disorder or illness – even medical professionals fall into this trap.


People often ascribe mental-health problems to other causes: "Oh, he's just spoiled," "He's looking for attention," "He's a bad kid." Or they blame the parents to explain away the distress that the child is experiencing. I will never forget one child who was a frequent visitor to the emergency room for very aggressive behaviour and persistent, severe temper tantrums. The health professional who was working up the case for me summarized the problem by saying that "the boy was only looking for attention," as if that was the child's fault, as if he wanted to be that way.

Kids don't want to be bad and they don't want to get into trouble. Some lack the skills to regulate their emotions and if that difficulty in regulation is persistent and severe, then it is a sign of a health problem, just like high sugar levels or a high temperature. When difficult behaviour in our children and youth is interpreted as a moral failing, then stigma has blinded us to thinking of this in a health framework and taking appropriate action.

But you know your kid best. If you are worried that he or she is having a problem, ask your family doctor for a full mental-health checkup, or ask the child's teacher for his or her perspective. In my next column, I will talk more about how to differentiate between the typical ups and downs of development and a real mental-health challenge.

Dr. Peter Szatmari is chief of the Child and Youth Mental Health Collaborative at SickKids, CAMH and the University of Toronto.

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