Evaluating Behavioral Problems in the Pediatric Clinic

Published in Dome - November 2016

When Johns Hopkins pediatric psychiatrist Rheanna Platt meets with Latino children grappling with behavioral problems, she often ponders: Could the ways their parents adjust to life in America be playing a role?

That’s hard to tell but needs to be known. Current psychosocial research on U.S. immigrants is scant, she says, and studies of Latino families even rarer. Yet more than 80 percent of Johns Hopkins Bayview Medical Center’s pediatric patients and 45 percent of its obstetric patients are Latino. Anecdotes from the medical center’s pediatric social workers attest to traumatic events in these parents’ countries of origin and discrimination locally. Such devastating experiences, she says, likely trickle down emotionally to the children.

Platt has found a prime opportunity to learn more about the lives of Latino parents: well-baby visits. “Parents may neglect their own health, but most bring their children for the requisite six visits during the first year of life,” she says.

In 2015, with psychiatric researcher Elisabet Arribas-Ibar, Platt launched a study of 100 parents of the youngest children—newborns to age 5—to examine possible mental health risk factors and physical symptoms they might display.

Using surveys, in-depth interviews and childhood records, Platt and Arribas-Ibar gathered data on immigration status, health care access and risk factors, based on experience. They also explored parental stress that surfaces in the pediatric primary care setting. Finally, the study aimed to gauge the willingness of parents to meet as a group to discuss risk factors and mental health.

Their findings have identified a host of stressors for these parents. Chief are financial struggles, documentation status, fear of violence and relationship discord. Health problems like obesity and asthma may complicate matters, says Platt.

Among the patients who come to the pediatric clinics and are referred to community psychiatry’s Latino Family Clinic, those with learning disruptors like ADHD are common.

Over time, Platt often sees relationships between older children and parents deteriorate. “Many Latino parents,” she says, “have trouble advocating for their children’s needs in the school setting because of language barriers.” In families where parents sent hard-earned money back home for years before their children immigrated, tensions can mount. She notes that it’s not uncommon to hear parents, their resentment bubbling up, ask a struggling adolescent, “How can you be depressed after everything we’ve done for you?”

Though many Latinos are beginning to tap the hospital’s adult health seminars and social services—three Spanish-speaking therapists are available at Johns Hopkins Bayview’s pediatric clinics—“lots of folks are afraid to do so or don’t know where to turn,” Platt says.

All the mothers interviewed for the study expressed interest in an intervention within the pediatric primary care setting—encouraging news, says Platt, as the survey showed a high prevalence of symptoms like anxiety, PTSD and depression in those with minimal social support.

“Our best hope,” Platt says, “is to learn more about Latino parents’ struggles and design programs to promote their well-being—and in turn, their children’s.”