Part Three of a series

Hundreds of children have passed through Luette Bowen's office during in her 25-plus years as a school psychologist. But one thing has remained constant: their need for help -- no matter what you call it.

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"It's the names [of the disorders] that have changed, not the kids," said Bowen, director of psychological services for Northgate School District. "I have the same problems referred to me today that I did in 1980," she said.

While current statistics might seem cause for alarm -- the U.S. Department of Health & Human Services estimates that one in five children has a diagnosable mental, emotional or behavioral disorder --Bowen emphasized that kids have always wrestled with anger control, stress and anxiety and persistent feelings of sadness.

But everyone may not be familiar with today's new labels.

For instance, the "hyper" child is now the child with attention-deficit hyperactivity disorder; that "troublemaker" today could be a kid with oppositional defiant disorder.

As for those reticent "nerds" everyone ostracized? They could be suffering from social phobia, a dehabilitating form of shyness.

"Children have been having trouble in school for a very long time," said Heidi Feldman, director of General Academic Pediatrics at the Children's Hospital of Pittsburgh and a nationally recognized leader in developmental-behavioral pediatrics, "so it's not like these kids didn't exist. What we didn't have was a medical approach to those issues."

So while the "intermittent explosive disorder" might sound new-age, the rage and volative behavior associated with the disorder is not.

What has changed, Feldman maintained, is that mental health professionals have gotten better at identifying those problems at an earlier age. Parents, too, are more aware of their rights and responsibilities in getting help for their children, whether it's counseling, medication or special education services under the Individuals with Disabilities Education Act.

The challenge in the medical community, Feldman said, is differentiating between kids' characteristics that fall within the "normal" end of the spectrum and those that allow them to be characterized as disorders.

"And oftentimes it's a tough call," she said.

Juvenile-onset bipolar disorder, commonly known as manic depression, is a case in point. Twenty years ago most people assumed the disorder rarely appeared in children, said Neal Ryan, a professor in child and adolescent psychiatry at the University of Pittsburgh School of Medicine.

"And now some studies suggest that it affects one percent of all children," he said, "so it's received a lot more attention." Some children are being diagnosed even at age 6 or younger, he said.

Obsessive-compulsive disorder, which is characterized by anxious thoughts or rituals you feel you can't control -- washing your hands over and over because you're obsessed with germs, for instance -- is another example.

In the '80s, people were told it was very rare in children, "so we didn't even think about it," said Boris Birmaher, a professor of psychiatry at Pitt's School of Medicine and director of the Child and Adolescent Mood and Anxiety Program at Western Psychiatric Institute and Clinic.

And if you assume children can't have a certain disorder, "you won't ask the right questions."

Yet today, said Birmaher, professionals believe 3 percent of children have OCD.

The big two: Stress and anxiety

Are a greater number of children being diagnosed with mental, emotional and behavioral disorders? It's hard to say.

The numbers have remained fairly constant over the years, according to Rolando Santiago, acting deputy director for the Evaluation, Child, Adolescent and Family branch of the federal Center for Mental Health Services. It's just that 30 years ago parents received little help in finding services for their children. As a result, many of these children were placed in institutions or ended up in the juvenile justice system.

"Many families had to relinquish custody for those kids to receive mental health services," she said.

Most professionals agree, though, that both children and their parents are more anxious today than they were a generation ago -- whether it's due to the pressures of single parenthood or two-income families, or events such as Col-umbine and September 11. Not surprisingly, some of the most common mental health problems kids are affected today with those related to stress and anxiety.

One study of 9- to 17-year-olds by the National Institute for Mental Health concluded that as many as 13 percent of young people each year experience an anxiety disorder. One in 10 children suffer from mental illness severe enough to cause some level of impairment, according to a 2001 U.S. Surgeon General's report.

"It's much more difficult for kids today," said Birmaher. "Their values are different and they're exposed to things easier and faster."

"A lot of children are bringing themselves up as the unit family dissolves, which can create pressure," said John Zbornik, school psychologist with the Lakewood City Schools in Lakewood, Ohio, who has studied math and reading anxiety disorders.

The trend toward high-stakes testing compounds that stress. "There's a lot more pressure on kids to perform," said Zbornik.

Feldman said that 30 years ago, even dropouts could earn decent living through skilled labor. Yet even though today's standards are higher, many schools have not changed their teaching styles or improved the classroom environment, she said.

And because most people are having smaller families, parents sometimes expect just one or two children to fulfill all their dreams.

"Kids have to be everything," she said.

Parents and teachers should become concerned when a child's disorder is so intense and long-lived that it affects his or her ability to learn or enjoy life.

Just because a child comes to school without his math book doesn't mean he has math anxiety, Northgate's Bowen points out. "It isn't just one test or episode. It's something that's sustained over time."

A good school-based team will look at past records, talk with teachers, and most important, observe the child over several weeks or months.

"The worst thing is to label a kid who doesn't need to be labeled," she said.

Still, according to the surgeon general's report, about 70 percent of children who suffer from a diagnosable disorder never receive help.

Part of the solution, Feldman said, is changing the way children with problems are educated. Regardless of whether a child is impulsive or shy, he or she experiences the same academic program, teaching style and supports as everyone else.

A better approach, she said, would be to tailor the classroom to the kids' characteristics. For instance, shy or anxious children could "warm up" in a classroom with a lot of support and attention before gradually being introduced to a larger classroom.

"It sounds so Mr. Rogers, but all children really do have a beautiful place inside and it's not what they do but who they are," said Feldman. "We want to get back in touch with that as parents and teachers."

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Tomorrow: Teaching about September 11.