How Many Children Need Mental Health Treatment and Get It?

Photo by D Sharon Pruitt

There's more evidence that many children have a mental health disorder and not enough get help. The first representative survey of children in the United States found that 13% of children ages 8 to 15 had at least one psychiatric disorders during one year. The data comes from the National Health and Nutrition Examination Survey (NHANES), a collaboration between the National Institute of Mental Health (NIMH) and the National Center for Health Statistics of the Centers for Disease Control and Prevention. Over 3,000 children were evaluated in person, and their primary caretakers were interviewed by telephone shortly afterward. Along with diagnostic questions, the degree of impairment in daily life was assessed in such areas as family and peer relationships and in school performance. The children and their caretakers were also asked whether help was sought in the past year at a hospital, clinic, or professional's office for the child's symptoms.

The percentage of children who met diagnostic criteria for the following disorders is listed from most to least common.

• Attention-deficit Hyperactivity Disorder (ADHD)  8.6%
• Depression (Major Depression or Dysthymia)  3.7%
• Conduct Disorder   2.1%
• Anxiety (Generalized Anxiety Disorder or Panic Disorder)  0.7%
• Eating Disorder (Anorexia or Bulemia)   0.1%

Similar to the results of other studies, boys were twice as likely as girls to have ADHD. Girls were twice as likely as boys to have one of the two types of depression. There was no difference between boys and girls in the other disorders. The rates of depression and conduct disorder were higher in young adolescents ages 12-15. All but the anxiety disorders were reported more often in poor children. Higher rates of the two types of anxiety disorders were found in children from higher income families.

Only half of the children with diagnosed disorders sought help for their symptoms in the past year. Children with disruptive behavior (ADHD and Conduct Disorder) were most likely to seek treatment. Only a third of children with an anxiety disorder received services. The children with more severe symptoms were only slightly more likely to get help. There was no information reported about type (medication, therapy, or both), length (one or more visits), or response to treatment. As a result, we don't know how many children were receiving adequate treatment.

How do the current study's estimates differ from older findings? As I noted in Children's Access to Mental Health Care, the Surgeon General's 1999 Report on Mental Health found that 1 in 5 children and adolescents had a diagnosable mental illness. This was a higher rate (20%) than is found in the NHANES study (13%). The difference is likely due to the broader range of disorders included in the Surgeon General's report.

The major strength of the NHANES study is that it provides the first estimates of the overall prevalence of specific mental disorders in children in the United States. Because the researchers used a standardized method of diagnosing the children, the results can be directly compared with local and international studies that use the same criteria. As the lead author Kathleen Merikangas, Ph.D. concludes, "Until now, there has been a dearth of reliable data on the magnitude, course and treatment patterns of mental disorders among U.S. youth. When combined with data from other nationally representative surveys, the data will provide a valuable basis for making decisions about health care for American youth."

Merikangas, K., He, J., Brody, D., Fisher, P., Bourdon, K., & Koretz, D. (2009). Prevalence and Treatment of Mental Disorders Among US Children in the 2001-2004 NHANES PEDIATRICS, 125 (1), 75-81 DOI: 10.1542/peds.2008-2598