The results of a new study on the prevalence of pediatric mental health disorders and treatment should cause every American to sit up and take notice. Publishing in JAMA Pediatrics this month, researchers from the University of Michigan used a nationwide survey asking 46.6 million parents with children and teenagers 6 to 17 years old whether their child had ever been given a mental health diagnosis — depression, anxiety, and ADHD are examples — and, if so, had they received treatment or counseling from a mental health professional?

— In 2016, nationwide, 7.7 million children had been diagnosed with at least one mental health condition. That is 16.5% — 1 out of every 6 — of American youths.

— Some states did better than others. Hawaii had the lowest prevalence (7.6%) of reported pediatric mental health diagnoses; Maine had the highest (27.2%).

Half of the children and teenagers who currently (in 2016) had a mental health condition received NO treatment or counseling from a mental health professional such as a psychiatrist, clinical psychologist, psychiatric nurse, or clinical social worker in the preceding 12 months.

— Again, the differences among the 50 states were striking: The District of Columbia was best, having the lowest percentage (29.5%) of children and teens who had not received professional attention from a mental health provider for their mental health diagnosis; North Carolina came in last, with 72.2% reporting not having received treatment or counseling.

— Children from poor households or those with a single mother were 40% more likely to have a mental health condition compared to children from more affluent homes or those with two parents.


Even more concerning, there is a good chance that the mental health picture for children and teenagers is even worse than it appears from this study. The stigma of mental illness may cause parents to shy away from seeking evaluations or treatments for their kids’ worrisome moods or behaviors. Also, insufficient insurance coverage and prohibitive out-of-pocket expenses may also lead to underreporting of mental health disorders. According to Dr. Edith Bracho-Sanchez, access to mental health services might be the biggest obstacle of all for children and families who need help:

According to data from the American Academy of Child and Adolescent Psychiatry, the majority of the country faces a severe shortage of practicing child and adolescent psychiatrists, with fewer than 17 providers available per 100,000 children.

This means many families face long wait times, which can in turn lead to worsening of the underlying mental health condition in the child and an eventual need for more treatment sessions than if the condition had been addressed in its early stages, Mautone explained.

The available qualified providers face another challenge: communicating with other systems caring for children.

There are many systems in this country aimed at caring for children, Robles-Ramamurthy said, including the education system, the health care system, the juvenile justice system and the child welfare system.

“All of these systems that are supposed to be caring for children often times are not talking to each other,” she said. “A lot of times kids fall through the cracks and families are not getting the appropriate support they need,” she added.


And there is one more reason that mental illness in children and teenagers goes underreported: Primary care physicians who take care of the young like pediatricians and family medicine doctors are far more likely to competently diagnose and treat mental health conditions themselves, without the need to consult a mental health professional for assistance except for their most difficult-to-manage patients. Additionally, pediatricians are less likely to ascribe a diagnosis such as ADHD as a mental health disorder, so parents might not see it as such either.

With so many children and teenagers suffering psychologically, perhaps we need to stop and ask ourselves as parents, as doctors, and as a society: “What are we doing wrong?”


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