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Troubling tally of kids' mental disorders.

Troubling tally of kids' mental disorders

Two large surveys, one focusing on U.S. pediatric practice and the other sampling communities throughout Puerto Rico, indicate that a surprisingly large percentage of children -- about 1 in 5 -- have moderate to severe psychiatric disorders. The reports, both in the December ARCHIVES OF GENERAL PSYCHIATRY, reinforce similar estimates in recent studies in New Zealand and North America and suggest that many such children do not receive mental health care.

"Rates this high would clearly imply a major public health problem, if these disorders led to significant long-term impairment," write psychologist Elizabeth J. Costello of Duke University Medical Center in Durham, N.C., and her colleagues, who conducted the U.S. pediatric study. Unfortunately, they note, researchers know little about what happens to children with untreated psychiatric disorders they reach adolescence and adulthood.

Nevertheless, according to psychiatrist Hector R. Bird of Columbia University College of Physicians and Surgeons in New York City and his co-workers, their findings in Puerto Rico "indicate a major public health problem for the children in the island."

Costello and her colleagues studies 789 children aged 7 to 11 years visiting their pediatrician over a one-year period. Each child and his or her parent (usually the mother) filled out a standard questionnaire on the child's behavior problems and social skills. The children attended two medical centers run by a health maintenance organization. One is located in Pittsburgh and serves both affluent and poor families; the other serves a suburgan, mainly blue-collar population.

To estimate the occurrence of different psychiatric disorders, the experimenters interviewed 126 children with high scores for behavior and emotional problems, as well as their parents. They also interviewed another 174 children scoring in the normal range and their parents. A statistical analysis was used to calculate the prevalence of mental disorders in the entire sample.

Based on interviews with the child, the parent or both, 22 percent of the children had one or more psychiatric disorders. The most frequent diagnoses include phobias (such as intense fear of closed spaces or a variety of animals), oppositional disorder (persistent confrontations and temper tantrums aimed at parents, siblings and teachers), overanxious disorder (excessive worrying about future events and how one is viewed by others) and sepration anxiety (panic or anxiety when not at home or with parents).

The researchers say emotional and behavioral problems were the third most frequently occurring group of disorders among the children, behind respiratory problems and nervous system and sensory organ disorders, such as middle ear infections. Yet fewer than 4 percent of the study sample received a mental health referral from a pediatrician. This rate is consistent with that for psychiatric referals by pediatricians in general.

Only long-term studies of children with untreated mental disorders will allow researchers to develop screening measures to help pediatricians identify those children most in need of help, conclude the researchers.

Bird and his colleagues administered the same questionnaires used in Costello's study to 777 Puerto Rican children aged 4 to 16 and their mothers, all part of a random national sample. To establish specific diagnoses, the researchers re-interviewed children with high scores on the qustionnaire and a randomly selected group of those scoring in the normal range.

Nearly 16 percent of the children sufferred from moderate to severe psychiatric disorders, the researchers say. Diagnoses were roughly the same as those in Costello's study, although more cases of attention-deficit disorder (hyperactivity) turned up in Puerto Rico.

The data indicate that about 150,000 Puerto Rican children in the same age range have comparable mental disorders, the investigators maintain. Fewer than 10,000 children received mental health services during the eight months in which the survey was conducted, according to the Puerto Rico Division of Mental Health, in San Juan.
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Author:Bower, Bruce
Publication:Science News
Date:Dec 24, 1988
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