In today’s second segment of our Winter 2014 blog series Including Kids and Teens With Mental Illness at Church, we’ll take a closer look at some of the relationship barriers families experience when children or teens have a significant mental health condition.

The kids and families we serve in our child and adolescent psychiatry practice are extremely vulnerable to a vicious cycle of escalating social isolation, perpetuated by the nature of the conditions they experience, their propensity to misinterpret the thoughts and reactions of other people and the stigma associated with mental illness. Allow me to explain…

Kids and teens with many common mental health conditions often talk or act in a manner that rubs their peers or adults in their life the wrong way. For example, a child with ADHD too impatient to follow the rules of a game or experiencing challenges with anger management and emotional self-regulation will often find themselves removed from the birthday party circuit and with a limited range of options for after-school play. A bright kid with an autism spectrum disorder might irritate peers when they talk incessantly about football statistics or their favorite movie. Friends of a teen with anxiety may stop texting or calling if their friend repeatedly declines invitations to parties, dances or activities where large groups of kids gather. Over time, kids with common mental health conditions and their families are less likely to have as many friends, and as a result, as many opportunities to be invited to vacation Bible school, retreats and mission trips.

A second component to the snowballing social isolation kids and families experience when impacted by mental illness involves their propensity to misperceive in an inappropriately negative manner how they’re perceived by others. Kids with anxiety disorders appear in many instances to have a biological predisposition to overestimate the extent of danger or risk in a new situation. They are prone to make grossly inaccurate assumptions about how they’re perceived by other people that frequently lead to patterns of avoiding situations, activities and relationships that would otherwise be pleasurable. This is the premise behind the effectiveness of cognitive-behavioral therapy for kids with anxiety disorders and depression…addressing the misperceptions that underlie dysfunctional patterns of behavior is essential in overcoming anxiety and the social isolation that frequently contributes to depression.

The third component to our negative cycle is stigma. There are two relevant types of stigma I’d like to address in the context of this discussion.

Kids with mental health diagnoses are especially vulnerable to self-stigmatization. Here’s a great paper on self-stigmatization from one of the two universities where I teach that explains this concept in depth as it pertains to kids who are prescribed medication for their mental health condition. Teens are especially prone to internalizing cultural stigma regarding mental illness. The need to receive treatment for mental illness frequently reinforces their negative self-image, and they will often go to great lengths to hide from others their need to take medication. This also helps to explain why the explosion in use of medication for ADHD coincided with the development of longer-acting pills that eliminated the need for kids to stand in line every day at lunchtime at the nurses’ office or principal’s office.

Kids with the conditions we’re discussing get picked on…a lot. Kids who become the targets of bullying are frequently those who stand out to peers as having more subtle differences. For example, there’s evidence kids with Asperger’s Disorder are significantly more likely to be bullied than kids with autism who also have intellectual disabilities. Society is making progress in addressing discrimination against persons who are obviously disabled, but kids with mental health-related issues seem like fair game to peers.

The vast preponderance of the kids I see are terrified by the prospect of being viewed as “different” by peers and often reject any type of help or assistance with the potential for drawing undesired attention to themselves. The immediate area in which I practice has several truly outstanding school systems that attract families of kids with special education needs because of the quality of support services they provide. Conservatively, I’d say half my patients with special education needs refuse much needed support services because they don’t want to be seen walking into the classroom where small group instruction is provided, or have to explain to their friends why they take their tests in a separate room or get extended time for their tests.

This is why we can’t expect to set up a “special needs ministry” or “disability ministry” and expect kids and teens with mental illness, trauma or developmental disabilities to come. Kids with these conditions (and their families) will FLEE from any ministry initiative that has the potential to draw attention to their differences.

We’ll discuss strategies for overcoming all of the barriers to church involvement for kids and families impacted by mental illness as we approach the conclusion of our series.

Next: Overcoming the social communication barrier
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Confused about all the changes in diagnostic terminology for kids with mental heath disorders? Key Ministry has a resource page summarizing our recent blog series examining the impact of the DSM-5 on kids. Click this link for summary articles describing the changes in diagnostic criteria for conditions common among children and teens, along with links to other helpful resources!