June 6, 2000,in the Miami Herald
Today's kids more disturbed than in '79, pediatricians sayBY CHRISTINE MORRIS
Emotional and behavioral problems in children visiting pediatricians' offices soared between 1979 and 1996, according to a study released Monday.
Psychosocial problems were found in 6.8 percent of children ages 4 to 15 visiting pediatricians or family doctors in 1979.
That jumped to 18.7 percent of children in 1996, according to the study in the June issue of the journal Pediatrics.
Increases in poverty and single-parent households are partly to blame, the researchers found.
``We have to ask what's going on with our society that we're seeing so much more of this,'' said Dr. Thomas McInerny of the Department of Pediatrics at the University of Rochester Medical Center, one of the study's authors. ``Families are stressed, children are stressed now more than they were 20 years ago. How can we help reduce that stress and support families and children better?''
Some of the largest increases reported were in attention deficit and hyperactivity problems. They accounted for 1.4 percent of the visits in 1979 and 9.2 percent in 1996.
Significant increases were also found in anxiety and depression, from a negligible amount in '79 to 3.6 percent in '96.
``These are important findings,'' said Dr. Alan Delamater, director of clinical psychology in the Department of Pediatrics at the University of Miami School of Medicine. ``They really do call attention to the fact that there are a lot of children out there with problems, and there aren't a lot of easy ways for them to get fixed.''
Pediatricians have always functioned as gatekeepers, the first place that parents go for help, Delamater said.
Although the researchers said improved pediatrician awareness was not the cause of the increases, Delamater said the fact is that these doctors are getting better at identifying emotional and behavioral problems -- and that's good news.
``I train pediatricians in development and behavior of kids,'' Delamater said. ``Family practice doctors are more tuned in to this area and see it as something they need to deal with.''
The authors compared data from a 1979 survey of 30 pediatricians in the Rochester, N.Y., area with results of a 1996 study of 395 pediatricians nationwide.
More than 21,000 patients were involved.
The research was sponsored in part by the National Institute of Mental Health.
Children enrolled in Medicaid and children in single-parent homes were more likely to have emotional problems, the study found.
Fifteen percent of patients in the 1979 study lived in single-parent homes, compared with 22 percent in the 1996 study.
Just 6 percent of the earlier patients were on Medicaid, compared with 18 percent of the 1996 patients.
The study also found pediatricians were more likely to identify such problems in patients they knew.
``That talks a lot about the importance of continuity of care, of having patients be able to see the same physician over and over,'' McInerny said.
Pediatricians often underestimate the severity of emotional problems, Delamater said.
They have little time to evaluate the child's situation, let alone give advice for complex behavioral problems.
``Pediatricians and other physicians who care primarily for children need to have training in identification and treatment of behavioral and emotional problems,'' said McInerny, who directed the 1979 study and was an investigator in 1996.
The American Academy of Pediatrics recently mandated training for all pediatric residents in the development and behavior of children, Delamater said.
Paying for mental-health care is often a barrier. Many insurance plans do not cover psychological testing and treatment for such problems as attention deficit disorder and autism, Delamater said.
Copyright 2000 Miami Herald