Wednesday, August 10, 2011

A Growing Concern in US Children

From Medscape Psychiatry > Findling on Psychiatry

Robert L. Findling, MD
Posted: 08/01/2011

 Dr. Robert Findling - director of the Division of Child and Adolescent Psychiatry at University Hospitals Case Medical Center and professor of psychiatry and pediatrics at Case Western Reserve University.

In this posting I would like to talk about a paper that was just published in the journal Pediatrics. Boyle and colleaguesdescribed the results of a study that focused on examining the childhood prevalence of developmental disabilities in the United States.
In my opinion, there are 2 key take-home messages from this paper.

The first is that from 2006 to 2008, about 1 out of 6 youngsters in the United States were reported to have a developmental disability. In addition, the number of youngsters with developmental disabilities reflected a greater prevalence than had previously been noted. This is important because these children require more educational and health-related services than youngsters who are developing typically.

Let's discuss how the authors came to these results. First, they looked at data regarding children between the ages of 3 and 17 years of age, a reasonably broad range. In addition, the authors focused on the years from 1997 to 2008. Diagnosis was based on parent report, which is an important consideration, and no formal diagnostic methodology per se was used.

A key strength to this paper is that the data came from the National Health Interview Survey and were gleaned from about 120,000 children. As far as diagnosis is concerned, the parents were simply asked whether or not a doctor or a healthcare professional had told them that their child had one of several developmentally based conditions. These conditions included ADHD [attention-deficit/hyperactivity disorder], autism, mental retardation, and learning disabilities, but also surveyed were conditions such as seizures, hearing loss, and blindness.

Of note, the overall prevalence of developmental disabilities increased with time during the 12-year period, from approximately 12.8% to 15%. That is a pretty big number.
The increases in prevalence of ADHD and autism were noteworthy. The prevalence of autism grew the most, with ADHD having the second greatest increase in prevalence. This report compliments other data that suggest that the rate at which developmental disabilities are being diagnosed in children is certainly increasing over time. The numbers also suggest that demands on educational systems will grow and already are growing. Similarly, because these youngsters are vulnerable, their greater healthcare needs must also be met.
I am both a pediatrician and a child psychiatrist and I recognize that these children's needs are sometimes split between mental health and pediatric professionals. As the number of children with these developmental disabilities rises, one might surmise that child psychiatrists and pediatric professionals will either collaborate more closely or that psychiatrists who have pediatric training may be particularly well suited to meet these youngster's medical needs. Certainly, this seems to be the case, as the number of these youngsters grows, their service needs also seem to be growing.

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