SAN FRANCISCO, Jan. 9 (UPI) -- Something's rotten in the state of our children's mental health.
Mind-boggling trends are snaking their way into the record books, rattling the nation with reams of reports of nearly 14 million youngsters, some of them barely out of diapers, beset by a plethora of psychiatric disturbances.
In the absence of an objective medical or scientific test for their presence, and with bottom-line limits on access to specialists suited to make an often-difficult call, questions arise about the accuracy of and uniformity in detecting many of the emotional, mental and behavioral disorders springing onto pediatric patient charts.
The extent of missed diagnosis -- and its fallout -- remains largely conjecture, but few could argue current methods of separating the sick from the well are error-free.
The fault line seems to run on either side of the diagnostic fence, cracking with both overstatements and underestimates.
As one example, phenomenal spikes in the use of mind-altering drugs in children -- which skyrocketed 700 percent during the 1990s for behavioral conditions alone -- and widely varying treatment rates -- from 17 percent in Virginia to 3 percent in Utah for attention-deficit/hyperactivity disorder, or ADHD -- have led some skeptics to suspect a case of over-diagnosis.
On the other side of the diagnostic couch, investigations point to a latent laxness. Take a study published in the Archives of General Psychiatry in October 2005 that showed a mental disturbance was assessed only half the time in people ages 7 to 24 rushed to the hospital emergency department for self-inflicted injuries between 1997 and 2002.
The findings bring to light "substantial under-recognition of mental illness and likely inadequate referral for follow-up mental healthcare," the authors suggested. They called for additional research to illuminate the scope and cause of the shortcomings.
The urgency of following through was underscored with further analysis, which revealed a 22-fold leap in subsequent suicide rates among adolescent boys who on a previous occasion had deliberately ingested poison.
Adding to the pile of concerns, evidence mounts of inadequate or inappropriate treatment. As uncounted numbers of children are doled out drugs -- or doses -- they may not need, those requiring relief too often are left out in the therapeutic cold, the non-profit advocacy group Consumers Union reports in an evaluation of prescription drugs used to treat ADHD. The report was released in late 2005.
In a twist, the risk -- though flowing from divergent directions -- seems to transcend the economic divide.
"Inner-city children tend to be undertreated and not have access to mental healthcare facilities while in the wealthier suburban children, the drugs might be overused, and even in those communities there is a lack of specialty providers," says Donna Palumbo, associate professor of neurology and pediatrics. She is also director of the Strong Neurology ADHD Program, head of pediatric neuropsychology training at the University of Rochester School of Medicine and Dentistry in Rochester, N.Y., and principal investigator on a major, government-funded study of ADHD diagnosis and treatment in preschoolers.
Data are elusive on the number of children affected, but a clue emerges from a number of studies.
For example, a North Carolina survey of pediatricians showed a mere 2 percent of the estimated 6 million youngsters with significant emotional and behavioral disorders are seen by mental-health specialists.
Another study, by Northwestern University researchers, found of 4,939 disabled children with psychosocial problems, including depression, anxiety and hostility, only 42 percent received the services they required.
Other research raises concern among critics that even among the experts, there may be overzealous use of the prescription pad. For example, reports published in the Journal of the American Medical Association in 2000 and 2004 showed a mushrooming use in children as young as 2 of anti-depressants, which have been linked to increased risk of suicidal behavior in some adolescents, and other psychiatric drugs. Few such medicines have been approved by the Food and Drug Administration for use in children, and there is a paucity of studies showing their long-term effects on growing bodies and developing brains.
The risk of unwanted consequences is elevated by economic pressures that have shriveled the forces of specialists and the time allotted doctors for visits with and follow-up of their young patients. A study published in Pediatrics in September 2004 notes the average pediatric visit lasts 13 minutes.
"This country is in a crisis when it comes to children's mental healthcare," proclaims pediatric psychopharmacologist Ronald Brown. He is dean of the College of Health Professions, professor of public health, psychology and pediatrics at Temple University Health Sciences Center in Philadelphia and author of "Medications for Children: A Guide for the Practitioner" (Guilford Press).
"It's been a real issue, it's been ignored, and it needs to be dealt with," Brown asserts.
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