Researchers have found that approximately 35% of children who are being treated for mental health issues are seeing only their primary care physicians, compared with 26% who are treated only by psychiatrists and 15% who only see psychologists or social workers.
Cari Nierenberg, writing for LiveScience, reports that these findings focus on the part primary-care physicians play nationally in the care of children with mental health conditions. The study was published online in the journal Pediatrics.
The study’s leader, Dr. Jeanne Van Cleave, a pediatrician at Mass General Hospital for Children in Boston, says that one in 10 children of school-age in the US has a mental health condition, yet there are not enough child psychiatrists to treat these kids. Because of this shortage, many pediatricians have become more involved in children’s mental health identification and management.
To find out more about outpatient mental health services for children nationwide, the scientists analyzed information from about 43,000 children in the US ages 2 to 21 between the years 2008 and 2011.
Of the 1,800 children who were identified as having a mental health condition in the past year, attention-deficit/hyperactivity disorder (ADHD) and anxiety/mood disorders made up the majority of the outpatient care given.
The study did not include data concerning mental health services provided at schools, in the juvenile justice system and at child welfare agencies. It also did not include information about children who might have mental health conditions but have not sought help.
According to the study, about 74% of kids with ADHD were prescribed a medication by their family physician, and 60% of children who had anxiety and mood disorders were as well. For both of these conditions, primary care providers more often put their young patients on mood-altering medications than would child psychiatrists. Van Cleave explained that this might occur because child psychiatrists may be more likely to see the more difficult mental health cases or they might see a child who did not respond positively to a prescribed drug.
She added that recent guidelines for ADHD and teenage depression that have been released by the American Academy of Pediatrics make pediatricians more comfortable dealing with most cases of ADHD and anxiety disorders. Still, the study identified areas where primary physicians could do a better job of coordinating with child psychiatrists, psychologists, and social workers.
Four out of 10 kids with ADHD are treated by their pediatrician without any interchange with a mental health professional, writes Dennis Thompson of HealthDay.
“There just aren’t enough child psychiatrists in the United States to treat every child with a mental health condition,” Van Cleave said. “Given that, any efforts to improve the quality of mental health care for children would be wise or appropriate to focus on improvements in primary health care, since that is where a lot of that care is happening.”
The research team used data from the Medical Expenditure Panel Survey, which is an ongoing federal survey used to assess the use and cost of US health care. Forty-two percent of children with ADHD were seen by primary-care physicians, but these doctors saw fewer kids with anxiety or mood disorders. Three-quarters of ADHD children in the care of their pediatrician were being given medicine, while only 61% who were being cared for by a psychiatrist were prescribed medication.
“This finding likely reflects the fact that the American Academy of Pediatrics has urged primary care pediatricians to take an active role in the treatment of ADHD, and that clinical guidelines for pediatricians recommend that medication should be considered a first-line treatment for all youth with ADHD that are 6 years of age and older,” said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center of New York in New Hyde Park, N.Y., who was not involved in the study.