Is Your Child’s ‘Won’t’ Really a ‘Can’t’?

Where to find help when your child’s behavioral problems need medical care.
The 8-year old child who can’t sit still and pay attention in school, the child who shrinks away and can’t speak in a room full of people, and the teenager who can’t get out of bed in the morning to go to school–these are all behaviors that can frustrate helpless parents. But it’s very possible that your child isn’t being disobedient, rude, or lazy: When a child won’t do something, it may very well be because he can’t. 
These behaviors may all be symptoms of behavioral disorders such as ADHD, anxiety, or depression. Elementary-aged children are hardwired to please adults, so if they are consistently displaying displeasing behavior, it may be beyond their control. Parents and teachers should respond to this “can’t” behavior with help, not with punishment. 
“There has been a lot of evolution in understanding,” of childhood behavioral health, James Parles, M.D., of Three Village Behavioral Medicine in Stony Brook, says. “There’s a greater recognition that behavior problems often have roots in a disorder, rather than just bad behavior.” 
In the past, doctors would treat mental illnesses on a basic level, and anything more complicated would be referred to a specialist. “The result being that lots of kids were not identified as having mental health problems, they were just ‘bad students,’ or ‘difficult kids’.” 
Everybody has bad days, but when things aren’t going well and they don’t right themselves, then the ability to function well and the quality of life suffers. It’s time to see a doctor when the situation is consistently negative, according to Dr. Parles. Children with mental or behavioral disorders are more prone to a variety of physical symptoms that don’t seem to have disease correlation—chronic headaches, stomachaches, fatigue, weight loss, binge eating, and weight gain. In these cases, the likelihood of an underlying mental disorder or illness behind these “won’t” behaviors is substantial.
However, the ability for families to find mental and behavioral care for these health issues that is both high quality and affordable can be difficult. Dr. Parles calls this the pediatric public health problem of our time, one that is going largely unaddressed by the healthcare system in this country.  He sees an opportunity to do better. As a general pediatrician, Dr. Parles wants parents to know that their family’s pediatrician can treat ADHD, anxiety, and depression with medications, and can refer children to therapists and councilors. 
It’s important for patients and parents to understand the role of a generalist, versus a specialist. Major mental illness–such as bipolar disorder, psychosis, and severe treatment-resistant depression–requires treatment from trained psychologists and psychiatrists. However, there’s a large number of children and teenagers with less-serious disorders, and Dr. Parles says, there simply aren’t enough childhood mental health specialists to care for all these issues—which can be treated in a pediatrician’s office. 
With consistent care that is well coordinated between pediatricians and the appropriate mental health specialists, a large majority of children with chronic disorders can get much better, quickly. And when your child’s quality of life is suffering, getting a positive prognosis is paramount. Involving your pediatrician can quickly get you child a diagnosis and treatment plan, and turn your child’s “can’t” into “can.”