Can 20% of U.S. Kids Really Have Some Kind of Mental Health Disorder?
As many as 20 percent of American kids have a mental illness, says a recent report from the Centers for Disease Control and Prevention (CDC). That means 1 in 5 children in the U.S. have a mental health disorder, a figure that might sound inflated: is there something really, really wrong with children in the U.S., or with how Americans raise kids?
Conversely, the CDC’s findings have a positive approach, as they suggest that we are doing a better job at diagnosing children with mental health issues. The report also points out that, in 2010, suicide was the second leading cause of death among children aged 12-17 in the U.S. Identifying depression, anxiety or other conditions in kids is the first step to helping them and, even more, preventing the tragedy of a child taking her or his own life.
CDC Report on U.S. Kids’ Mental Health
The CDC reports that, among children aged 6-17 years, 3.5 percent have behavioral or conduct problems, 3 percent have anxiety disorders, just over 2 percent have depression, just over 1 percent are on the autism spectrum and a small percentage (0.2) have Tourette’s Syndrome. 11 percent of school-age children — and 1 in 5 high school-age boys — have a medical diagnosis of ADHD. Treating children with these disorders, via health care, hospitals, special education or juvenile justice, is estimated to cost $247 billion annually.
It is possible that there is a real, actual increase in the number of children with mental health disorders. The CDC notes other factors, though, including changes in policies and access to health care, that could influence a child being diagnosed with ADHD or another condition. As the report says, children with health insurance had a higher prevalence of ADHD, autism spectrum disorders (ASDs) and anxiety. Children without health insurance had lower rates of these and were more likely to be reported as having substance use disorders.
Education and economic levels were also found to be correlated to certain mental health conditions. The report found that, ”as household education decreased, the prevalence of parent-reported behavioral or conduct problems, depression, and anxiety increased.” In addition, households in more distressed economic circumstances had children with greater rates of these disorders, as well as ADHD and drug and cigarette use.
Race, ethnicity and economic circumstances were also linked to different rates of mental health disorders. For instance, ADHD was found to be lowest among Hispanic children, behavior or conduct problems were diagnosed at the highest rates among black non-Hispanic children and ASDs were found to be higher among white non-Hispanic children. Anxiety was more common among white non-Hispanic children than black non-Hispanic children.
Mental Health Disorders are Still Diagnosed By Observation, Not Biological Symptoms
These results reflect an ongoing challenge in diagnosing mental health disorders. In most cases, there are no actual biomarkers, no biological tests, that say, clear and simply, “you have ADHD.” ADHD, autism and depression are all diagnoses that are made based on the observations of psychiatrists and other medical professionals, with the input of parents and others to see if a child meets the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
The result can be what Dr. Joel Paris of McGill University calls “diagnostic epidemics.”
… “major depression” is a very disparate collection of signs and symptoms that cannot be used to determine the correct treatment. Bipolar disorder is being diagnosed in patients who do not have its classical features, and has even been applied to young children. Attention deficit hyperactivity disorder (ADHD) has no definite boundaries, and is being greatly over-diagnosed, both in children and adults. Autism spectrum disorders, once considered rare, are now being seen as among the most common of all conditions that professionals see.
To further complicate the matter, the very DSM criteria used to diagnose mental health disorders have just undergone a substantial revision that has been full of controversy. A number of conditions such as grief and what could be called tantrums in children now are listed in the new DSM-5.
The rise in prevalence rates could be the result of changes in the definition of the disorder or also changes in the public understanding of mental disorders. Better diagnosis has frequently been pointed out as a factor in the rise in the rate at which autism has been diagnosed, with rates now estimated to be as high as 1 in 100 or even 1 in 50.
Indeed, while my teenage son Charlie was dubbed “classically autistic” by clinicians, behavioral psychologists and teachers when he was young, I’ve now found myself being asked “does he just have autism”? After years of saying “yes,” my husband and I have begun to qualify saying that Charlie is autistic with statements such as “he doesn’t have actual seizures but” and “he does have abnormal EEGs.”
A German company, SAP, recently announced it wil be recruiting “hundreds” of autistic people, noting that they have a “unique talent for information technology.” But I don’t think that SAP is looking for an individual like Charlie. He can do more than many (including his parents) often realizes he can. But (after years of constant instruction) he does not read and seems more likely to end up with a job involving physical effort, such as recycling or janitorial work.
The DSM system is “flawed but necessary,” as Dr. Paris puts it; the manual gives clinicians a vocabulary of terms to use. What needs still to change is not asking whether or not someone has a clinician-diagnosed mental health condition but why we still attach so much stigma to mental illness and fear to get a child the help that can make a difference in her or his life.
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