Early Mental Health Intervention Can Lead to Lifelong Success

Like physical illnesses, the sooner mental illness is diagnosed and treated, the better the outcomes

April 19, 2021

Did you know that 50% of all lifetime cases of mental illness begin by age 14?

Statistics like this make McLean Hospital clinicians, like Dana B. Sarvey, MD, want to spend every possible minute educating parents, pediatricians, and other adults who care for children about the importance of mental health and early intervention.

“Identifying mental health conditions early changes treatment outcomes,” said Sarvey. “The earlier you treat, the greater the impact can be.”

Sarvey, who serves as the associate medical director of McLean’s Belmont Adolescent Partial Hospital Program, pointed to studies showing that early diagnoses and interventions improve immediate outcomes. They also improve lifelong prospects for individuals with a range of mental health conditions.

“We know that more than half of all adults with a psychiatric disorder began to show signs of the condition while they are teenagers,” she stated. “We also know that how severe an illness becomes is often related to how early we see these signs.”

Sean: Quietly Struggling at 8 Years Old

As an 8-year-old, Sean was bright, gregarious, and athletically gifted. But he was also quietly struggling with anxiety.

He couldn’t understand why he was feeling this way. Instead of asking for help, he hid his symptoms from the adults in his life. By the time he was 13, he had his first intrusive thought—something he would later learn was obsessive compulsive disorder (OCD).

“The first time I had an intrusive thought—something that is common for people with OCD—I thought that my brain broke,” said Sean. “I was afraid to tell anyone.”

“Even though I knew my family loved me, I was worried they wouldn’t understand,” Sean said. “So I chose to live in silence.”

Girls head with technology graphics

According to Lisa W. Coyne, PhD, an expert in child and adolescent OCD, Sean’s experience is not abnormal.

“Although the signs are there if we look for them, so many of us as parents, teachers, coaches, and providers don’t realize what we are seeing until it becomes a crisis,” said Coyne. She noted that although the average age of onset for OCD is 8 years old, it takes most people many more years to be diagnosed.

“Adding to the complexity of OCD in children is that far too often, children and teens are afraid to talk to us about anything they perceive as being strange or different.”

According to both Sarvey and Coyne, creating an environment and developing a relationship where children and teens feel safe to express themselves—even if the topic is difficult—is key to building trust and being able to offer help.

Why Is Early Intervention So Important?

“The brain is an amazing organ and unlike some of our other body parts, is remarkably elastic—meaning it has the ability to change and adapt,” said Stephanie A. Maddox, PhD, McLean Hospital neuroscientist and co-founder of the hospital’s Brains Matter school outreach program.

The brain’s ability to be flexible—particularly the adolescent brain—is a key reason why early intervention is important and effective.

“Adolescence is an important window of opportunity for intervention, and early experiences can influence future outcomes,” explained Sarvey. She also noted that although brain development is something that is often thought of as something that happens when children are very young, neurons replicate rapidly before birth, and that extends into early childhood.

But the ‘pruning’ process—or the paring down of certain pathways and the reinforcement of others to accelerate nerve transmission—seems to play a major role in brain development during adolescence.

Sarvey explained that through childhood, the brain develops “in a predictable pattern from back to front.” This process has consequences when it comes to emotional and cognitive development.

Watch Now!

Dr. Lisa Coyne answers our questions about mental wellness for children and teens

The Teen Brain

The teenage brain is still developing, a process that will not end until the age of 25. Two key areas of the brain that are critical to understanding teen behavior are:

  • The limbic area, which consists of a set of structures in the midbrain and develops years before the frontal lobe. The limbic area regulates emotion and provides a feedback system for reward and motivation. It also helps process social interactions and forms memories.
  • The frontal lobe is the part of the brain that is most associated with organizing, planning, and judgment. Since this area is the last to develop, it is most susceptible to being influenced by environment and experience and less by genetics.

“There is a great deal of emotion-driven decision-making during adolescence,” said Sarvey, “think gas—without much in the way of brakes!”

In other words, a lot is going on in every teen’s brain.

Understanding these stages of brain development can have a major impact on how individuals respond to the symptoms of mental illness. “Adolescence is when certain psychiatric illnesses can impact the brain in a permanent way,” Sarvey said.

For example, substance use during adolescence can negatively affect the creation of essential pathways in the brain and can lead to abnormal reward responses. According to Sarvey, if the creation of these neural pathways goes awry, psychosis may be the result.

Shellye: My Family Thought I Was Seeking Attention

Shellye hit puberty earlier than most girls, which gave the bullies in 6th grade a reason to taunt her. Test anxiety turned into full-blown panic attacks.

Shellye’s family interpreted her visible anxiety and panic as her way of seeking attention. Their reaction, in turn, left Shellye feeling like a bad person.

By the time Shellye attended her first year of college, she had developed depression and was hurting herself (engaging in self-harm). “I knew I needed help,” she said.

Shellye admitted she was afraid to tell her parents because she didn’t want them to be mad at her. “I texted them to tell them what I was going through,” she explained.

They were upset and scared, but most importantly, they were supportive. “My mom immediately drove to pick me up at school and took me to the hospital, where I was able to get the help I needed.”

Shellye’s Story

Deconstructing Stigma participant Shellye

As a participant in McLean’s Deconstructing Stigma campaign, Shellye shares her journey with mental illness and recovery so that others recognize that they are not alone.

Deconstructing Stigma participant Shellye

How Treatment Can Change the Brain

Based on their knowledge of brain development, mental health clinicians and researchers have created and tweaked mental health treatments to be impactful during the teenage years.

For example, cognitive behavior therapy (CBT) helps encourage teens to exercise top-down regulation of their behavior. The therapy encourages the patient to shift from emotion-driven behaviors (via the limbic system) to a more careful appraisal of thoughts and emotions (via the frontal lobe) to change behaviors.

“Even though adolescents are at a small disadvantage when it comes to brain development, we can help them learn to use their frontal lobes,” Sarvey stated. CBT, she said, exercises the frontal lobes and encourages the use of that part of the brain. This can change neural pathways.

“CBT has been shown to be as effective as medication alone in studies examining treatments for adolescents with a diagnosis of major depression or an anxiety disorder,” she said.

In some cases, a combination of medication and psychotherapy may be more effective in “changing the brain.” The exact mechanism of action by which certain common medications used to treat depression and anxiety are effective in teens is still not fully understood, Sarvey reported.

However, “there is evidence that antidepressant medications can promote growth of new neurons in the brain.”

Sarvey cited recent studies suggesting that treatment with antidepressant medications creates changes in the adolescent brain. How so? By affecting how adolescents process their emotions. The most common of these medications are selective serotonin reuptake inhibitors (SSRIs).

When adolescents are depressed, Sarvey explained, “the physiology of their brain can change. It changes so that they have more selective processing of negative environmental cues. Treatment with an SSRI appears to normalize this process again, changing signaling in the brain.”

Shellye: A Few Months Later, I Was Already Improving

After a few months of treatment, including CBT and dialectical behavior therapy (DBT), Shellye saw major improvements in both her moods and thoughts. Today Shellye is a successful businesswoman who credits the treatment she received as a teen with providing her with the tools she needed for her journey to positivity, health, and success.

Help Your Child Feel Like a Kid Again

Teens in group therapy with clinician

McLean offers world-class treatment and support for children and teens who are struggling with mental health challenges. Call us today to find the care that’s right for your child.

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Teens in group therapy with clinician

But When Does a Young Person Need to Seek Care for Their Mental Health?

Adolescence is such a critical time in brain development, and early intervention can affect potential outcomes. Therefore, adolescents with symptoms should get help as soon as possible.

So how do parents, educators, and clinicians identify those who might need help?

“Adolescents tend to display moodiness as a part of their development,” Sarvey said. “Conflict can arise between parents and teens as teens test limits and navigate their desired separation and individuation from their family.”

However, Sarvey notes that when moodiness becomes the dominant symptom, often displayed when a teen exhibits sadness, irritability, or crying a lot of the time—and is paired with a change in behavior and functioning, such as a loss of interest in previously enjoyable activities or a shift in academic performance or attendance at school—it is time to seek professional help.

“I don’t want anyone else to feel like they are alone and can’t get help. Whether you’re eight, 18, or 80, treatment is available, and most importantly, it can be life-changing. – Sean, Deconstructing Stigma participant

“If you treat children and adolescents, they get better,” Sarvey shared. “Adolescents tend to be very open and flexible when it comes to treatment.”

This risk-taking behavior is used to one’s advantage with teens, she said. Teens may be more likely to take a risk with treatment. Based on the wiring of their brain, this can also help them get better faster.

Unfortunately, not every teen or young adult who needs treatment gets it. “At least one in five adolescents has a diagnosable mental illness. But only one-third of those have received treatment,” Sarvey said. “That has to change.”

“Good public outreach and collaboration with pediatricians, schools, parents, and others who engage with adolescents regularly is a good way to promote mental health screening and make referrals for support at a younger age,” Sarvey stated. She cited efforts like McLean Hospital’s Deconstructing Stigma campaign, which fights misconceptions about mental illness, as a way to encourage young adults to seek help for their symptoms.

She also suggested teens and parents take advantage of tools and resources. Some are available through the National Institute of Mental Health and the American Academy of Child and Adolescent Psychiatry.

Overall, Sarvey emphasized the importance of getting treatment for mental health issues, no matter what a person’s age.

“Though adolescence is an important time for intervention, any age is a good age to start treatment,” she said. “Brain development happens along a continuum, and it continues for much of our lifetime.”

Sean: Together, We Figured It Out

Sean continued to live with the symptoms of anxiety, panic, and OCD throughout his teens—affecting his grades and his social life. Eventually, Sean’s mental illness became debilitating and led him to contemplate ending his own life.

Sean ultimately decided to tell his father about what he was experiencing. When recounting the conversation, he admitted he didn’t know how his father would react.

“I told him, ‘Dad, you know I’ve been struggling. But I need help,’” Sean said. “He told me he loved me, and that together, we would figure it out.”

Today, Sean is an accomplished artist and mental health advocate who speaks openly about his experience growing up with mental illness. “I don’t want anyone else to feel like they are alone and can’t get help,” he said. “Whether you’re eight, 18, or 80, treatment is available, and most importantly, it can be life-changing.”