Children's Mental Health: Current Challenges and a Future Direction

Mental Health Needs of Children

A Population Overview: The Extent of Need

One out of every five children has a diagnosable mental, emotional, or behavioral disorder.² Up to one in ten children suffer from a serious emotional disturbance.² However, seventy percent of children with a diagnosable disorder do not receive mental health services.⁴ In the National Action Agenda for Children's Mental Health, the U.S. Surgeon General warns that the nation is facing a public crisis in caring for children and adolescents with behavioral, psychological, and emotional problems. Estimates show that of the children who are receiving mental health services, 70-80% receive mental health care within the school.^5,6

Recent data not only points to exceptionally high levels of unmet need, but also to ethnic and racial disparities. Children in minority populations are less likely to have access to mental health services, and the care they receive is often of poorer quality.⁷ Hispanic young people are the least likely of all minority groups to access specialty mental health care, even though they and African American children have the highest rates of need.⁷

In addition to children identified with diagnosable mental health disorders, there are a large number of children at risk for future problems or who may need help for a behavioral, emotional or mental disorder but do not meet DSM-IV criteria.³ In many low-income populations the percent of children who are at risk for a mental health problem is greater than 50 percent.⁸ One study found that 32% of children living in poverty children had diagnosable mental health impairments. ⁹ By combining the 50% who are at risk and the 32% with diagnosable disorders, there are a great number of low-income children in need of mental health services. Yet, these children are in a population that often has less access to health services than wealthier peer groups, and are even less likely to receive indicated mental health care.

Many children and youth face complex environmental social issues that put them at risk for emotional, behavioral, and/or developmental disorders. Children living in poverty are affected by mental health disorders at a much higher and intense level than children in more affluent populations. This is often due to their living situation and their inability to access affordable services. Children who do not have mental health problems addressed have a diminished capacity to learn and benefit from the school environment.⁵ The following paragraphs describe in greater detail the types of mental disorders affecting children and youth.

Mental Disorders Affecting Children and Youth

Children and adolescents are affected by a wide spectrum of mental health disorders. Mental health disorders in this population can range from mild to severe conditions. Often a child may have more than one disorder.¹⁰ As seen in Table 1, mental health disorders are widespread in the child and adolescent population, yet the majority of children and adolescents with mental health disorders are not receiving treatment. The following are of some of the more common mental, emotional and behavioral disorders that affect children and youth.

Table 1:
Common Mental Health Disorders and the Number of Children and Youth Affected

Anxiety Disorders

Anxiety disorders are the most common mental health disorders affecting children and adolescents (see Table 1). This class of disorders includes phobias, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder and generalized anxiety disorder.¹⁰ All of these can affect a child's ability to learn and function in the school environment. A child with panic disorder may not be able to handle test taking, deadlines, and social pressures. A child with generalized anxiety disorder will worry about school in general, with stressing situations increasing the anxiety.^11,12 These disorders can be hard to diagnose, but they can be successfully treated with medication and counseling.

Conduct Disorder

Children and adolescents who act out feelings and impulses in destructive ways may have a conduct disorder. These children who are estimated to number 7 in 100 children disregard the rights of others and the basic rules of society by "lashing out" at peers, lying, committing vandalism and theft, and acting without concern for others.¹² The behaviors of children who are not diagnosed and treated become more severe as they reach adolescence.¹² By early diagnosis and intervention, along with therapy and medication, many of these children can control their conduct disorder and succeed in school.

Depression

Although depression has not always been considered a childhood disorder, recent studies have shown that depression affects a large number of children (see Table 1). Depression is diagnosed by a two week (or greater) change in emotion (sad/cries/hyperactive), motivation (schoolwork declines), physical well-being (appetite/sleep/health), and thoughts (hopeless/can't do anything right).^12,10 It is difficult to diagnose depression in a child, making it necessary to look at the change from behavior typical of a that child. Severe depression that goes undiagnosed and untreated may lead to suicide. In the 1999 YRBSS national survey 28.3% of students stated they had felt sad or hopeless almost everyday for two or more weeks in the previous 12 months.¹³ Of these students 14.5% had suicidal thoughts, 8.3% attempted to commit suicide, and 2.6% of those who attempted suicide received treatment from a doctor or nurse.¹³ It is possible to treat depression before it gets severe enough for suicidal thought, but first the children have to be identified.

Learning Disorders

Learning disorders, more commonly called learning disabilities, affect the way children and youth receive, process and express information. ¹⁰ They can range from mild language and reading problems to decreased mental capacity. Learning disorders make it difficult for a child to learn to read, spell, and do basic math. Early diagnosis and intervention allows the child to function and succeed at school.¹⁰ Failure to diagnose a learning disorder can leave a child far behind her peers academically and can lead to other mental disorders such as depression.

Attention Disorders

Children with attention disorders, such as attention deficit disorder (ADD) or attention deficit hyperactive disorder (ADHD), often have difficulty concentrating and focusing their attention in school, and can be impulsive and distractible.¹¹ Students diagnosed with AD/HD may be entitled to classroom accommodations, adaptations, modifications or other services if the condition has an adverse impact on educational performance. Attention disorders can be treated through medication, therapy, and learning skills.¹¹

Eating Disorders

A group of life threatening mental disorders that affect children and adolescents are eating disorders. The two most common forms of eating disorders are anorexia nervosa and bulimia nervosa. Children and adolescents with either disorder have low self-esteem, self worth, and body image.¹¹ Anorexic children do not maintain normal body weight, are afraid of gaining weight, yet do not believe they are underweight.¹⁰ Bulimic children appear to be of normal weight, however they binge and purge to prevent weight gain, abuse laxatives, and exercise obsessively.¹⁰ Eating disorders are difficult to treat and most people diagnosed with one always struggle to maintain a healthy eating lifestyle.

Substance Abuse

Statistics on rates of overall substance abuse is not readily available. The YRBSS study looks at alcohol and drug use but does not look at substance abuse diagnoses. It also only looks at individual substances and does not provide overall data on rates of substance abuse in youth. Use and abuse of alcohol and other drugs is common in adolescents. Fifty percent of all deaths from age 15 to 24 involve alcohol or drugs.¹² Warning signs of substance abuse in adolescents include a decline in school performance, new friends, delinquent behavior, and an erosion of family relationships.¹²

What can be done?

Mental health problems affect children's health, development, and learning capabilities. Statistics presented above show high rates of mental health disorders in children but treatments for many of these problems have been developed that can successfully address many of these disorders. Recognition of the extent of mental health problems in children and youth and the importance of getting more help to address these problems is recognized in Healthy People 2010.¹⁴ Some of the goals of Healthy People 2010 include decreasing the number of youth with untreated mental illness, decreasing youth suicides, and decreasing lost days of school due to somatic problems.¹⁴ By providing children and youth with mental health services, a portion of the goals outlined in Healthy People 2010 will be met.

Next: Organizing Mental Health Services For Children