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Depressed Kids Less Likely Than Disruptive Ones to Get Mental Health Services

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Nov. 16, 1999 (Atlanta) -- Children who misbehave regularly are more likely to receive mental health services at school than children suffering from depression, according to a recent study. Researchers who did the study, published in a recent issue of the Journal of the American Academy of Child & Adolescent Psychiatry, suggest that children with depression probably don't get help because their parents don't recognize the symptoms. Another likely reason: parents and school personnel are more likely to intervene when a child is disruptive than when he or she appears depressed.

"It's very easy for depressed children to fade into the wallpaper, but they are as seriously disturbed as children who misbehave," researcher Hector R. Bird, MD, tells WebMD. Bird's report analyzes the most recent data from the National Institute of Mental Health on treatment -- and access to treatment -- of children with mental disorders. Bird is a professor of clinical psychiatry at Columbia University College of Physicians and Surgeons in New York City.

Currently, 75% of U.S. children using mental health services get the help at school, and for many, school services are the only care they receive. The report is one of few that looks at patterns of usage of mental health services in children with depression or conduct disorders such as attention deficit hyperactivity disorder (ADHD).

The researchers found that parents were more apt to see a need for mental health services for children with disruptive disorders than for those with depression. On the other hand, children were more likely to see a need for mental health services for depression than for disruptive conduct disorder.

Both findings are disturbing, say psychiatrists. "[T]his latest report confirms the [inadequate] attention and services for children with depression when compared with those with ... conduct disorders," Jeff Q. Bostic, MD, EdD, writes in a separate article accompanying the report. "Perhaps even more troubling, while juveniles with depression recognized their need for mental health services, their parents and teachers frequently were unaware of the child's depression."

Based on the report's findings, the researchers promote expanding and improving school-based mental health services. "Schools provide a single point of access to services in a non-threatening atmosphere, and thus reduce the barriers to children['s] receiving help for emotional, behavioral, and drug-related problems," they write.

Bird offers an extra note of caution for doctors treating children for disruptive disorders: Be sure you test thoroughly to confirm that the behavior disorders aren't being caused by underlying depression -- which is sometimes the case. "I think the likelihood is that a child may misbehave because of underlying depression," Bird tells WebMD. "These things are so closely linked, and ... sometimes if [doctors] treat the depression, the behavior disorders will go away as well."

Future studies should be done to determine whether depression leads to conduct disorders or vice versa, Bird adds.

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