National Children's Mental Health Report Card

A national survey of 1,000 adults with children commissioned by the Child Mind Institute in 2011 investigated parents’ awareness of and concerns about psychiatric and learning issues in their children. The key findings were as follows:

• Nearly one in four parents, or 22%, reports being concerned about a child’s mental health.
• Children identified by their parents as having mental health issues show more than double the rate of problematic and dangerous behaviors—including alcohol and drug abuse, suspension from school, and suicide attempts—of children in the whole sample.
• While most parents with concerns sought treatment (87%), almost half (43%) waited more than a year and nearly a quarter (22%) waited more than two years to get help.
• The most common treatments were medication (50%) and psychotherapy (46%). Of those who received medication, 80% found it effective while only 50% found psychotherapy and other treatments effective.
• Of the parents who had concerns about a child’s mental health, 81% said they had talked to their pediatrician about them. Nearly half went to either their pediatrician (36%) or family doctor (11%) for treatment, while 38% who went to a psychologist and 24% went to a psychiatrist.
• While 97% of parents said mental health is as important as physical health, only 29% said their pediatricians asked them regularly about their child’s mental health.
• More than a third (40%) of respondents said they do not understand their mental health coverage; 43% believe the health care system doesn’t provide enough mental health coverage.

1. Nearly one in four parents are concerned about a child’s mental health.

The survey of 1,000 adults with children 2-24 years of age found that almost a quarter (22%) said they have had a child with mental health or behavioral issues.

By detailing the symptoms and behaviors that concerned them, the parents in the survey provide a snapshot of children who are displaying signs of psychiatric and learning difficulties, how their behavior differs from other children in the sample, and what parents are doing to get them help.

The reasons that parents most often “sought professional help” for their children included the following concerns:

• 22% impulsive or hyperactive
• 20% moody or sad
• 18% trouble academically
• 16% trouble paying attention
• 12% trouble interacting with friends, others
• 12% more disobedient than other children
• 11% breaking rules or getting into trouble
• 10% repetitive, rigid or strange behaviors

Of those parents who expressed concern about a child, 70% said the symptoms and behaviors affected the child’s “quality of life.”

The most common ways in which the child’s quality of life was impaired (multiple answers were accepted):

• 49% had difficulty making friends and socializing
• 25% became withdrawn or depressed
• 21% suffered academically
• 18% had trouble going about daily life
• 14% became very anxious

2. Children with mental health issues show more than double the rate of problematic and dangerous behaviors

Even more concerning, children identified by their parents as having mental health issues show more than double the rate of problematic and dangerous behaviors of all children in the sample.

• 20% had been suspended, compared to 9% of all children
• 19% had engaged in binge drinking, compared to 7% of all children
• 16% had repeated a year of school, compared to 7% of all children
• 16% had engaged in alcohol abuse, compared to 6% of all children
• 13% had school attendance problems, compared to 6% of all children
• 14% had been arrested, compared to 5% of all children
• 11% had been engaged in drug abuse, compared to 3% of all children
• 5% had engaged in self-mutilation, compared to 1% of all children
• 6% had made a suicide attempt, compared to 1% of all children

3. Most parents with concerns sought treatment, but almost half waited more than a year.

Of those parents who expressed concern about a child, 87% said they sought professional help at least once for that child. But 43% of parents say they waited more than one year during which children exhibited symptoms before seeking help. Nearly one quarter (22%) waited more than 2 years. The central reason why parents waited to get help was that they “didn’t think it was a problem” (40%).

The other reasons why parents waited to get help included:

• 9% I couldn’t get my child to go to services
• 7% I didn’t know where to go
• 5% It was too expensive
• 5% Services were not available in my community.
• 5% I was afraid they would recommend medication

Of those who sought help, 76% said they got a diagnosis.

• 58% were diagnosed with attention and behavior issues
• 16% with autism
• 10% bipolar
• 9% depression
• 8 % anxiety
• 6% learning disorder

4. The most common treatments were medication and psychotherapy, with medication reported as most effective.

Of those who sought professional help, 67% said they received “effective” treatment.

Half (50%) of those whose children received treatment said the treatment was medication, while 46% said they received psychotherapy, and 19% said they were prompted to make changes in the child’s lifestyle.

Most—85%—of the parents who sought help accepted the recommendations of the professional they saw. Of those who declined to pursue the treatment, more than half (55%) rejected medication, 10% psychotherapy, and 3% changes in lifestyle.

And yet of those who did go on medication, 80% said the medication was effective. Only half of those who received other forms of treatment found those treatments to be effective.

The most common reasons for rejecting medication were:

• 17% Side effects of the drugs
• 17% School feels should wait to see if the child improves before medication
• 13% I don’t believe in medication
• 10% I didn’t like what I read or heard about medication
• 10% I felt my child would be stigmatized as having a mental health problem

5. Pediatricians play key role

The survey highlighted the important role pediatricians play in identifying children with symptoms of psychiatric and learning disorders. Of parents who have concerns about a child, 81% said they had talked to their pediatrician about those mental health issues. Nearly half (47%) went to either their pediatrician (36%) or family doctor (11%) for treatment, rather than a mental health professional. Some went to a psychologist (38%) and 24% went to a psychiatrist. Pediatricians were also the top referral source, with 39% of parents saying they were referred to a clinician by their pediatrician.

6. Few pediatricians ask regularly about a child’s mental health.

While almost all parents (97%) said mental health is just as important as physical health, mental health screening does not seem to be a routine part of a pediatrician’s exam. Only 29% said that their pediatrician asked them regularly whether they had concerns about their child’s mental health.

7. Many parents are confused by their mental health coverage; nearly half believe the system doesn’t provide enough coverage.

The survey shows substantial confusion about insurance coverage for mental health treatment, with 40% of respondents reporting that they do not understand the mental health coverage that their health care plan offers. Though those who have a child with mental health issues are more knowledgeable about their level of coverage, still 1 in 5 (21%) said they do not understand the coverage that their healthcare plan provides.

Overall, only 1 in 3 (32%) said they believe that the “health care system provides enough mental health coverage”—43% said they believe there is not enough coverage, and 25% were not sure.

The survey, which interviewed a nationally representative sample of 1,000 adults with children (primary or co-caregivers of the children, including mothers, fathers, stepmothers, stepfathers, and grandmothers), was conducted with random digit dialing, and has a margin of sampling error of +/-3%. There were 14,697 refusals.

Overall, the sample was better educated and from a higher SES when compared to the US population. The rates of mental illness and problematic and risky behavior would likely be much higher if this sample were more representative and included more participants of a lower SES. A full demographic comparison will be provided upon request.

This survey captured parents’ assessment of the mental health and behaviors of one of their children. Therefore, the study should not be used to estimate the prevalence of mental health disorders in children, but how many parents are wrestling with these issues, and what they are doing to get help for their children.

Responses include parents’ concerns about children and adolescents. Hence, the statistics about risky behaviors (e.g. drug and alcohol abuse) were skewed by the younger children in the sample. If adolescents were broken out, we would expect the percentages of these behaviors to be higher.

1. With 22% of parents expressing concerns a child’s mental health, the issue calls for the urgency, funding, and public policy initiatives comparable to childhood illnesses like leukemia and diabetes.

2. Not addressing mental health issues puts children at risk for alcohol and drug abuse, problems in school, arrest, and harmful behaviors. Furthermore, we are placing additional and unnecessary burden on other systems, such as the juvenile justice system. Parents, teachers, and pediatricians need better tools to identify these disorders in their early stages and help link these children to effective treatment.

3. Since we know that early intervention leads to better outcomes, we should strive to close the gap between the appearance of symptoms and the pursuit of a diagnosis and treatment. Better education of parents, teachers, and pediatricians would enable them to recognize the signs and symptoms of mental health issues earlier.

4. Despite the widespread concern in our society about the use of psychotropic medication in children, 80% of parents in our sample whose children received treatment for mental health issues that included medication found it to be effective.

Only 50% of parents found other forms of treatment (e.g. psychotherapy) to be effective. Given that this does not match the levels of efficacy shown in studies of behavioral treatments often used to treat children in combination with or in lieu of medication, it suggests that more effort needs to be made to connect children to the most effective evidence-based behavioral treatments and care.

With only 67% of parents finding their child’s treatment to be effective, more needs to be done to connect parents, teachers, pediatricians, and mental health professionals to effective forms of treatment.

5. Given the key role pediatricians play in identifying children with mental illness, treating children with mental illness, and referring parents to other professionals for treatment, it is critical that pediatricians receive ongoing education about the latest advancements in the field and the most effective treatments.

6. With parents reporting that most pediatricians don’t take an active role in inquiring about the mental health of children, we need to urge pediatricians to include this screening as a regular part of a child’s annual checkup.

7. The confusion surrounding the provision of mental health care coverage in insurance plans suggests the need to better educate the public about their coverage. Furthermore, the lack of parity between physical and mental health care coverage needs to be rectified.