Mental Health Disabilities in Children Up 21% in 10 Years

Marcia Frellick

August 18, 2014

Although the number of children with physical disabilities has decreased 12% over the course of a decade, the number who have disabilities related to any neurodevelopmental or mental health condition has increased by 21%.

That growth, reported in an article published in the September issue of Pediatrics, has pushed the overall prevalence of childhood disability up by 16% between 2001-2002 and 2010-2011. As of 2011, 6 million children in the US were living with a disability.

Those living in poverty continue to have the highest rates of disability, at 102.6 cases per 1000 people, but unexpectedly, those living in households with incomes more than 4 times the federal poverty level saw the largest increase, at 28.4% during the 10-year period, according to the report. Children living in households with incomes less than the federal poverty level saw only a 10.7% rise in the rate of disability during those years.

Lead author Amy Houtrow, MD, PhD, MPH, from the Departments of Physical Medicine and Pediatrics, University of Pittsburgh in Pennsylvania, said that although the study was not designed to determine the reasons for the increase, the authors suspect from the parents' reports that some of the drivers include less stigma associated with mental health conditions, more awareness of disorders by parents and physicians, and more willingness by physicians to diagnose conditions.

Dr. Houtrow told Medscape Medical News that willingness to diagnose may be even greater for advantaged families (those with 2-parent households and higher education and income levels), who may push harder to get services and may be perceived by the physician as more persuasive.

"To get certain services in the school or community, you have to have a diagnosis.... From a parent standpoint, it's beneficial to get your kid services," she said.

More Autism Classifications

She added that awareness of autism also likely is contributing to the increase.

"Decades ago, a child might have had substantial cognitive disabilities and abnormal behaviors that didn't get diagnosed as something specific, and now that we're understanding the neurobiology around autism, more children are being classified that way," she said.

Diagnoses of attention-deficit/hyperactivity disorder are also on the rise, which may be pushing up the numbers because school-related difficulties would qualify children with the disorder under the parameters of disability, she said.

The authors analyzed data from the National Health Interview Survey, conducted annually by the Centers for Disease Control and Prevention. This is the only nationwide survey that collects data on demographic characteristics, disability status, and health care use of the noninstitutionalized US population.

Children were considered disabled if they experienced any of the following because of a chronic condition:

  • limits on play activities other children are doing (<5 years old),

  • need for help with basics such as eating, bathing, dressing, and getting around the home (age 3+ years),

  • difficulty walking without equipment (age <18 years),

  • difficulty remembering (age <18 years), and

Dr. Houtrow said she sees the upward trend of mental health disabilities continuing and hopes the study results will heighten the awareness of parents, schools, and healthcare providers to watch for signs so that children have every chance to succeed.

"We saw a big rise among kids getting diagnosed under the age of 6 from this data. If we look at it from one angle, that seems tragic, but from another angle, it might be that we're catching things sooner," she said.

Dr. Houtrow was funded by the National Institutes of Health National Institute Child Health Development, Rehabilitation Medicine Scientists Training Program. One coauthor was funded by Department of Health and Human Services, Maternal and Child Health Bureau, National Institutes of Health. The other authors have disclosed no relevant financial relationships.

Pediatrics. 2014;134:530-538.

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