Reduction is Found in Severe Mental Illness Among the Young

New  York Times
May 20, 2015
Reduction is Found in Severe Mental Illness Among the Young

Dr. Christoph Correll, Professor of Psychiatry, Hofstra North Shore-LIJ School of Medicine

The rate of severe mental illness among children and adolescents has dropped substantially in the past generation, researchers reported Wednesday, in an analysis that defies public perceptions of trends in youngsters’ mental health.

The new report, published in The New England Journal of Medicine, comes at a time of fierce debate over the rates and treatment of childhood mental disorders. Critics argue that modern psychiatry is over-diagnosing and treating an increasing number of the worried well or merely quirky.
Child psychiatrists insist that while some children may be given treatments they do not need, the larger problem is that youngsters who could benefit from treatment too often do not get it.

Rate of Autism Diagnoses Has Climbed, Study FindsMARCH 29, 2012 More fundamentally, experts said, the new analysis exposed gaps in scientists’ grasp of mental health trends, especially when it comes to young people. Without a good handle on baseline levels of severe pediatric mental disorders, policy makers and research-funding organizations lack a good guide to targeting their resources, these experts said.
“Right now we have all these different agencies doing surveys, each using a different method,” said Kathleen Merikangas, chief of the National Institute of Mental Health’s in-house genetic epidemiology research program. “It’s a nightmare. We need to do better.”

Previous surveys, by the Centers for Disease Control and Prevention and other agencies, have found increases in conditions like autism and attention deficit disorder that are so large that some doctors have been skeptical. The new report found increasing rates of treatment, as well as a falling rate of serious impairment across the board.

“This study shows that the extremely high rates of childhood mental disorder reported by the C.D.C. and others result from flawed assessment methodology that includes many kids who have very mild impairment or no impairment at all,” said Dr. Allen Frances, a professor emeritus of psychiatry at Duke University.

The C.D.C. said it stood by its surveys and noted that it did not look directly at degrees of impairment but “broadly looked at selected mental disorders and other indicators of mental health,” said Britanny Behm, an agency spokeswoman, in an email.

Other experts cautioned that the new analysis may underestimate the rates of severe mental problems, particularly among teenagers, but some nonetheless agreed with Dr. Merikangas and Dr. Frances that mental health monitoring has not been done carefully enough.

In the study, researchers analyzed mental disability in 53,622 youngsters aged 6 to 17, based on ratings provided by parents. The parents scored their children on a so-called impairment scale.

The scale asks, for instance, how much of a problem a child has with “Feeling unhappy or sad?” “Having fun?” “Getting along with other kids?” “Feeling nervous or afraid?” The scale had 13 items in all, and parents assigned each one a “0,” for no problem, up to “4,” for a “very big problem.” Children whose scores were 16 or higher qualified as severely impaired. The data was drawn from in-depth household surveys performed by the Agency for Healthcare Research and Quality.

Continue reading the main story Between 1996 and 2012, the percentage of children and teenagers in that severe category dropped to 10.7 percent from 12.8 percent. That is a 16 percent decrease, and it was entirely unexpected, said Dr. Mark Olfson, of Columbia University, the study’s lead author. “The finding is robust and real and challenges the prevailing stereotype that young people are somehow more vulnerable to mental problems,” said Dr. Olfson. His co-authors were Dr. Benjamin Druss of Emory University and Dr. Steven Marcus, of the University of Pennsylvania.

In contrast to the new study, many government surveys have suggested that there were increases in the prevalence of serious mental disorders among children and teenagers.

One recent survey reported that rates of attention deficit disorder, the most common childhood mental health problem, rose to 10 percent from 7 percent between 2003 and 2010 and suggested an underlying rise in prevalence. Another report that came out in 2013 estimated that 13 percent to 20 percent of young people had mental disorders considered “serious deviations from cognitive, social and emotional development.” It concluded that prevalence of these conditions was increasing. And prevalence estimates for autism spectrum disorders increased to one in 88 from one in 110 from 2006 to 2008.

Dr. Olfson said that his study did not investigate why the prevalence of severe problems might have changed. Yet several explanations are plausible, he said. One is that the current generation of parents is doing something right, despite lingering worries about “helicopter parenting,” permissiveness, and video games. Another is that children with severe problems are increasingly likely to get psychiatric care earlier.
The new study found that the overall rate of young people being treated for a mental disorder increased, to 13 percent from 9 percent. But the steepest increases in use of mental health services were among the most impaired — to 44 percent in 2012 from 26 percent in 1996.

“While many parents still wait too long before bringing in their kids for evaluation and treatment, I nevertheless sense that parents are becoming better informed about mental health care options for their children,” said Dr. Christoph Correll, a professor of psychiatry at Hofstra North Shore-LIJ School of Medicine, who was not involved in the study.

Dr. Merikangas said that, public perceptions notwithstanding, rates of severe childhood disorders like attention deficit disorder, anxiety and depression tend to be stable, not on the rise. Rates of autism have increased in the last few decades, but there is debate over the extent of the increase.

But she also cautioned that ratings from parents, like those the new study used, are more reliable for younger children than for teenagers. “I think it’s important to keep in mind that there are some problems teenagers develop, like substance abuse, eating disorders and even depression, that parents are often not capable of recognizing,” she said.

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