He has been referred to as "Dr. Kids." Whenever someone is looking for an expert in child and adolescent psychiatry, his name immediately pops up. His expertise is regularly tapped by APA, the Mental Health America (NMHA), the National Institute of Mental Health (NIMH), and the American Academy of Child and Adolescent Psychiatry (AACAP).

In recognition of his efforts on behalf of young children and adolescents with behavioral, mental, and emotional disorders, the NMHA presented its Green Ribbon Award to Fassler last month at a press briefing on childhood depression.

"Disorders like depression can begin very early in life," Fassler told Psychiatric News. "We see infants who suffer from depression; we certainly see 3- and 4-year-olds who are dealing with depression."

He noted that depression is far less frequent in younger children, but it can and does occur. The incidence increases throughout adolescence, he said.

Fassler believes that psychiatrists and other mental health professionals are getting better at recognizing the signs and symptoms of depression in younger children. "This is critically important," he said, "because the earlier these kids get help, the less likely they are to have long-term, ongoing difficulties."

Because depression may present differently in the young, it is also critical that a thorough diagnostic work-up occur by a well-qualified mental health professional. "It can’t be done," said Fassler, "in a 15-minute office visit. AACAP says a comprehensive evaluation takes several hours and may require more than one visit."

Diagnosis is especially difficult in that for most children, the first health care professional they see is a pediatrician or general practitioner. According to Fassler, many pediatricians are perfectly competent to diagnose and treat these illnesses, but "the pediatricians that I have talked to say they haven’t had the training or experience, so they feel uncomfortable doing so." This fact is echoed in national surveys that have shown that most pediatricians still refer patients for psychiatric evaluation.

"Unfortunately," said Fassler, "child and adolescent psychiatry is still one of the most underserved medical subspecialties." Because of the short supply of child psychiatrists, practices across the country, including Fassler’s in Burlington, Vt., collaborate with pediatricians to do initial evaluations, then refer back to the pediatrician to manage ongoing care.

The key for parents, said Fassler, is to make sure that children get to a competent mental health professional who has specific expertise and experience in diagnosing and treating childhood mental illness, like depression.

"We’ve learned some good lessons," said Fassler. "Kids are not just little adults. They express things differently. But, similarly, we need to know how kids respond to treatment. We need to know more about dosing and combination therapy."

Fassler noted that while more research data on these and other questions is needed, so is more extensive education.

Through AACAP and NIMH, conferences and training symposia have been held to help educate medical professionals on the differences of childhood psychiatric disorders.

"We are just now," said Fassler, "starting to get some of the data and information that we need to understand how these disorders present in young children."