Search This Blog

Monday, May 25, 2015

The Surprising News about Children's Mental Health

From the Psychology Today Blog
"Fulfillment at Any Age"

By Susan Krauss Whitbourne Ph.D.
May 23, 2015

New research suggest today’s kids are in pretty good psychological shape.

If you believe what you read in the media, you’d say today’s children and teens are heading toward greater depression, anxiety and attentional problems. We hear about drastic rises in rates of autism, attention deficit hyperactivity disorder, depression and even bipolar disorder, thought at one time only to affect adults.

The rise in rates of psychological disorder among the 18-and-under’s was attributed, to differing degrees, by everything from helicopter parents and exposing them as infants to vaccines. According to such explanations, not borne out by science, parents who either try too hard to prevent their children from exposure to the ills of the world are actually making them psychologically and physically more fragile.

A perhaps more cynical interpretation of the supposed trends in higher rates of mental illness in the young looks at ulterior motives for children to be overdiagnosed. Some charge that the pharmaceutical companies fund the research that justifies the need for more children to have medications prescribed for their hyperactivity or depression. Pediatric mental healthworkers become overly zealous to diagnose and then treat symptoms that may not truly represent an underlying psychiatric condition.

Many in the field of child mental health believe it is better to take such an overly cautious approach and to err on the side of intervention. This would be a reasonable argument if it were not for the fact that the intervention typically does take the form of medications when, in many more cases, behavior therapy would be both safer and more effective.

Enter into this debate the results of a May, 2015 article published in the Journal of the American Medical Association and expertly summarized by the New York Times mental health journalist, Benedict Carey. As stated by the study’s lead author, Columbia University’s Mark Olfson:

“Some observers worry that psychotropic and other mental health treatment of young people with less impairing conditions has increased disproportionately as a result of the recent broadening of conceptualizations of child and adolescent psychiatric disorders” (p. 2030).

To find out whether, in fact, youth are being over-diagnosed and hence over-treated, Olfson and his team analyzed survey results from over 53,000 6-17 year-old participants tested over three time periods within the years 1996–2012.

You might wonder how mental health information could be obtained from children as young as 6. Unique to the study, part of the Medical Expenditure Panel Surveys (MEPS) conducted by the Agency for Healthcare Research and Quality, data were obtained not from physicians or other raters, but from parents.

The reports you’ve been hearing about in the press about increases in ADHD, autism or other mental health disorders come from the CDC, which asks parents whether they’ve been told by a health professional that their child has such a disorder. The Olfson group’s mental health data are based on a rating scale in which parents themselves report on their children’s behavior.

The scale, known as the Columbia Impairment Scale (CIS) asks parents to indicate how much of a problem (from 1 to 4) their children have in each of these areas:
  • 1.) Getting along with [his/her] mother
  • 2.) Getting along with [his/her] father
  • 3.) Feeling unhappy or sad
  • 4.) [His/Her] behavior at school
  • 5.) Having fun
  • 6.) Getting along with other adults
  • 7.) Feeling nervous or afraid
  • 8.) Getting along with brothers and sisters
  • 9.) Getting along with other kids
  • 10.) Getting involved in activities like sports or hobbies
  • 11.) [His/Her] schoolwork
  • 12.) [His/Her] behavior at home
  • 13.) Staying out of trouble

As you can see from these items, the CIS covers a broad range of behaviors and can be applicable both to young children and teens. Also, the CIS doesn’t ask parents to diagnose their children or to report on whether their children actually have received a diagnosis, as I noted above.

On this 1-4 point scale per item, the maximum score would be 52. A CIS score of greater than or equal to 16 was used as the cutoff point for severe mental impairment, meaning that the parent could note extreme problems in 4 of these questions, or a milder level in a wider range.

It’s important to note that although the CIS doesn’t provide a diagnosis, it does correlate highly with a more structured diagnosis using the current psychiatric system in the US, the DSM.

Now, on to the results. Across the periods of 1996-98, 2003-05, and 2010-12, the percent of 6-17 year-olds with severe mental impairment declined from nearly 12.8%, to 11.9% and finally to 10.7% in the most recent testing. This is a drop of 2 percentage points, which is both statistically and meaningfully significant.

Every subgroup declined, but there were consistently higher rates of reported impairment in boys, adolescents (vs. children), and non-Hispanics.

These findings show that children and teens are, in fact, becoming mentally healthier in terms of the actual behavior their parents observe. It’s possible, of course, that parents are biased reporters, but it’s not clear why they would be more likely now than 20 years ago to see their children in a more positive light.

However, there’s a large disparity between reports of children’s distress and their use of mental health services. Across the board, parents today report that their kids are more likely now to receive psychotherapy (6%) than in the past (4%). However, they are also more likely to report the use of psychotropic medications, especially stimulants, which rose from 4 to 6.6% over the past 20 years. This occurred regardless of the level of impairment that parents reported in their kids.

Proportionately, children and teens with more severe impairment received more mental health interventions across the 20-year period of the study. However, looking at the absolute changes in mental health service use, it was kids with less severe impairment who showed the largest increase. This means that parents are more likely now than in the past to seek help for their children even if they perceive their problems to be less than severe.

The mental health service use is the good news-bad news part of the study. It’s encouraging that severe mental illness is decreasing among the young, good that parents are seeking treatment, but problematic when kids with less than severe problems are receiving medication. Another piece of bad news is that, as the authors point out, only 25% of children with severe problems receive psychotherapy.

The upshot of the study, for parents, is that by using measures such as the CIS, they can evaluate their own children’s needs. Although teens are less likely than kids to report their problems to their parents, by being sensitive to your children’s experience in these crucial areas, you can help steer them toward appropriate intervention.

We can hope that this intervention will increasingly rely less on meds as the public increasingly learns about the benefits of psychotherapy, across all age groups.

No comments:

Post a Comment