June 5, 2000 -- The number of children with psychological, emotional, and developmental problems has grown dramatically in recent years, say researchers from the University of Pittsburgh. They suggest that the rise in poverty and single-parent households may be partly to blame.
"We conducted a national study and found that psychosocial problems in children essentially tripled between 1979 and 1996," says Kelly J. Kelleher, MD, MPH, whose research was published in the journal Pediatrics. "Physicians are frankly being overwhelmed by the large number of children with behavior and developmental problems now coming into their practices." Kelly is the Staunton professor of pediatrics and psychiatry at the University of Pittsburgh School of Medicine.
Although increases were found in nearly all types of psychological problems, the biggest came in the area of attentional problems, such as ADHD. Children in single-parent households, those receiving Medicaid, and older boys were most likely to have psychosocial problems, the researchers found.
In 1996, the research team asked almost 400 pediatricians and family doctors to gather data on more than 21,000 children, ages 4 to 15. Their responses were compared to information collected in 1979 on 18,000 children from Rochester, N.Y. In 1979, the researchers found about 7% of children had psychosocial problems, while by 1996, this had increased to about 19% -- almost one child out of five.
The physicians noted many different sorts of problems, ranging from trouble adjusting to stresses -- such as moving, divorce or death -- to learning problems, lying and stealing, and mental illness. The greatest problem was ADHD, which was found 1% of the time in 1979 and increased to 9% in 1996.
"Our data suggest a large part of this increase in childhood problems is due to the explosion in low-income Medicaid patients, and the fairly significant rise in single-parent households," Kelleher says.
One expert who was not involved in the study notes that there are probably two explanations for its findings: not only is the incidence of psychosocial problems increasing, but health care professionals also are becoming more sophisticated at diagnosis. "I think it's a combination of the two," says psychologist James Ewell, PhD., "but undeniably, today there is much more training and awareness about children's emotional and psychosocial problems." Ewell is a psychologist in private practice in Eugene, Ore.
What can parents do to help their children deal with these problems?
First, be alert for signs of potential problems, Ewell says. "Be aware of changes in behavioral patterns -- notice if the child is more isolated, less interested in activities they used to enjoy," he says. "Problems such as depression may first show themselves in children in the form of anger, sullenness."
Other warning signs, he says, are problems with other children; feedback from teachers or other professionals at school; and trouble reading. Parents also should be concerned if a child is easily distracted and has trouble concentrating, or has an unusual fascination with violent themes, guns and bombs, or hurting younger children or animals
What steps can a parent take? "The pediatrician is one of the first places to go," Ewell says. "Consult the child's teacher to find out what counseling or other support services are available in the school district."
Frances Page Glascoe, PhD, says free developmental, behavioral, and mental health screenings are available through the public schools. "If the child is not yet enrolled, seek your local Child Find coordinator under the Individuals with Disabilities Education Act." Glascoe, who was not involved in the study, is adjunct associate professor of pediatrics at Vanderbilt University School of Medicine in Nashville and editor of Ambulatory Child Health: The Journal of General Community and Social Pediatrics.
Another resource is your local Yellow Pages. Look for listings under "counselors," "psychologists," and "mental health services."
The researchers who did the current study note that "brief and rare visits" to doctor's offices may not be the best way to deal with children's emotional and psychological problems. Instead, they say, different forms of care may be needed, from mental health professionals, patient advocates, home visitors, and/or support groups.
"We need continuous, team-based care," says J. Lane Tanner, MD. "Parents ought to band together to demand pediatric care that doesn't just focus on each acute episode of illness. We need care that looks at the child's developmental potential, rather than just maintaining physical health." Tanner is director of the division of behavioral and developmental pediatrics at the University of California San Francisco School of Medicine.
The research was funded by grants from the National Institute of Mental Health, the Health Resources and Services Administration Maternal and Child Health Bureau, and the Staunton Farm Foundation of Pittsburgh.
- New research shows that the number of children with emotional and developmental problems has nearly tripled in the past two decades.
- According to researchers, this trend can be partly explained by the rise in single-parent households and the increased number of children on Medicaid.
- Parents should be alert to any changes in behavior that may be a sign of a problem, such as children becoming more isolated or losing interest in activities they used to enjoy.