Amy’s* jaw was black and blue, but she hadn’t been in an accident. Instead, the 15-year-old, who has cerebral palsy (CP) and is nonverbal, had been punching her own chin — but why? Her family, along with Dr. Elizabeth Barkoudah, and her colleagues in the Cerebral Palsy and Spasticity Center at Boston Children’s Hospital, searched for answers. “We thought we had considered everything,” says Barkoudah. Yet a slew of approaches — from a full-body workup to a special brace aimed at preventing the teen from hitting herself — proved fruitless.
After months of investigating, the team finally discovered the trigger for Amy’s self-harm: Her mother had just had new baby and she was having trouble adjusting to this change. “She was feeling anxious because of that,” explains Dr. Barkoudah. “Yet her mental health hadn’t been at the forefront of anyone’s thought process.”
Different symptoms in kids
That’s something that Dr. Barkoudah and her colleagues hope to change. “The CP community isn’t well aware of how much anxiety and depression these kids experience because they often can’t tell us directly,” she says. Yet children with CP — or any neurodevelopmental disability, for that matter — aren’t that different from their peers. In fact, children in general can exhibit symptoms of anxiety, depression and other mental health concerns very differently than adults.
For example, children are less likely to understand the concept of anxiety or depression. Instead of verbalizing their feelings, they may express them through their behavior. Parents, teachers and other caregivers should keep an eye out for such signs, which can range from defiance to problems sleeping. However, in children with CP, these changes are apt to be interpreted as symptoms of pain or other physical issues.
Communicating without words
When clinicians do identify signs of mental health concerns in children, their first inclination may be to recommend therapy as this is a mainstay of treatment. But this approach isn’t without challenges for nonverbal children. “I’m more flexible about prescribing a course of antidepressants or anti-anxiety medication in these cases,” says Dr. Barkoudah. “When a child’s medical diagnosis leaves them fewer options for treatment, medication can be helpful.”
That was the case for Amy, who experienced a dramatic improvement after she started taking an antidepressant. Other children may benefit from non-pharmaceutical approaches, depending on their unique situation. The key, says Dr. Barkoudah, is to be aware that your child may be expressing their emotions in ways you might not expect, and to seek professional help if you suspect a problem. “Not everyone fits a textbook definition of anxiety or depression,” she says. “Your child may be trying to tell you something without using words.”
*Patient’s name has been changed.
Learn about the Cerebral Palsy and Spasticity Center.