Prevalence and Impact of Parent‐Reported Disabling Mental Health Conditions Among U.S. Children

doi:10.1097/00004583-199905000-00023

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 38, Issue 5, May 1999, Pages 600-609

https://doi.org/10.1097/00004583-199905000-00023 Get rights and content

ABSTRACT

Objectives

To provide a current national profile of the prevalence and impact of parent-reported disabling mental health conditions in U.S. children.

Method

A cross-sectional descriptive analysis of 99,513 children younger than 18 years old included in the 1992–1994 National Health Interview Survey (NHIS). The response rate exceeded 94% in each year. Disability is defined as the long-term reduction in a child's ability to perform social role activities, such as school or play, as a result of his/her mental health condition.

Results

On average, 2.1 % of U.S. children were reported to suffer from a disabling mental health condition in 1992–1994. The most common reported causes of disability include mental retardation, attention-deficit hyperactivity disorder, and learning disabilities. While national prevalence estimates were produced for some low-prevalence conditions such as autism (38/100,000), for many specific diagnoses the reported prevalence rates were too low for accurate national population estimates using this data set. Logistic regression analysis demonstrates that prevalence of a disabling mental health condition was higher for older children; males; children from low-income, single-parent families; and those with less education. These conditions are also associated with high rates of special education participation (approximately 80%) and health system use.

Conclusions

The NHIS provides a useful and untapped resource for estimating the prevalence of disabling mental health conditions. These conditions are increasingly prevalent and have a profound impact on children and the educational and health care systems.

REFERENCES (50)

BJ Burns
Mental health service use by adolescents in the 1970's and 1980's
J Am Acad Child Adolese Psychiatry
(1991)
P Cohen et al.
Diagnostic predictors of treatment patterns in a cohort of adolescents
J Am Acad Child Adolesc Psychiatry
(1991)
P Cohen et al.
Child psychiatric diagnosis by computer algorithm: theoretical issues and empirical tests
J Am Acad Child Adolesc Psychiatry
(1987)
JV Lavigne et al.
Prevalence rates and correlates of psychiatric disorders among preschool children
J Am Acad Child Adolesc Psychiatry
(1996)
MN Sanford et al.
Ontario Child Health Study: social and school impairments in children aged 6 to 16 years
J Am Acad Child Adolesc Psychiatry
(1992)
TM Achenbach et al.
Epidemiological comparisons of Puerto Rican and US mainland children: parent, teacher and self-reports
J Am Acad Child Adolesc Psychiatry
(1990)
TM Achenbach et al.
Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity
Psychol Bull
(1987)
PF Adams et al.
Current estimates from the National Health Interview Survey, 1994. National Center for Health Statistics
Vital Health Stat
(1995)
J Anderson et al.
Emotional and behavioral problems
LY Aron et al.
Serving Children With Disabilities: A Systematic Look at the Programs
(1995)

M Bayley

Handicap and Community Care: A Study of Mentally Handicapped People in Sheffield

(1973)

H Birch et al.

Mental Subnormality in the Community: A Clinical and Epidemiologic Study

(1970)

HR Bird et al.

Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico

Arch Gen Psychiatry

(1988)

NA Brandenberg et al.

The epidemiology of childhood psychiatric disorders: prevalence findings from recent studies

J Am Acad Child Adolesc Psychiatry

(1990)

BJ Burns et al.

Children's mental health service use across service sectors

Health Aff

(1995)

BJ Burns et al.

Examining the research base for child mental health services and policy

J Ment Health Adm

(1990)

SB Campbell et al.

Follow-up of hard to manage preschoolers: adjustment at age 9 and predictors of continuing symptoms

J Child Psychol Psychiatry

(1990)

B Cooper et al.

The social-class background of mentally retarded children: a study in Mannheim

Soc Psychiatry

(1984)

EJ Costello

Primary care pediatrics and child psychopathology: a review of diagnostic, treatment, and referral practices

Pediatrics

(1986)

EJ Costello

Developments in child psychiatric epidemiology

J Am Acad Child Adolesc Psychiatry

(1989)

EJ Costello et al.

The Great Smoky Mountains Study of Youth: functional impairment and serious emotional disturbance

Arch Gen Psychiatry

(1996)

EJ Costello et al.

How can epidemiology improve mental health services for children and adolescents?

J Am Acad Child Adolesc Psychiatry

(1993)

EJ Costello et al.

DSM-III disorders in pediatric primary care: prevalence and risk factors

Arch Gen Psychiatry

(1988)

CM Drillien et al.

Studies in mental handicap, part I: prevalence and distribution by clinical type and severity of defect

Arch Dis Child Health

(1966)

GJ DuPaul

Parent and teacher ratings of ADHD symptoms: psychometric properties in a community-based sample

J Clin Child Psychol

(1991)

Cited by (64)

Risk factors for mental health diagnoses among children adopted from the public child welfare system
2012, Children and Youth Services Review
Citation Excerpt :
However, we need to be cautious that older adopted children do not have their behaviors unnecessarily labeled or interpreted as problematic due to their adopted status. It is unclear why white youth in our sample were more likely to have a diagnosis; however, this finding is consistent with some published studies in which African American and Hispanic children (Halfon & Newacheck, 1999; Pastor & Reuben, 2005) and children of color (Keller et al., 2001) demonstrated lower levels of psychiatric symptomatology than white children. Findings on the relationship between race and mental health symptoms are not universally conclusive.
Children awaiting adoption through the child welfare system often have “special needs,” or characteristics that make securing an adoptive home for them challenging. A subset of these youth experiences significant psychiatric symptomatology, which may pose a problem for the stability of the adoptive placement. Clinicians and policymakers require information about precursors to mental health difficulties in order to plan effectively for the placement of these children.
This study examines potential child and biological family risk factors for the presence of a DSM-IV mental health diagnosis among 368 children placed for adoption by a special needs adoption program between February 1997 and April 2005 using logistic regression within the Generalized Estimating Equations (GEE) framework. A significant proportion of the children and biological parents in our study experienced serious adversity prior to adoptive placement. Older age at adoptive placement, white race, male gender, having more than one placement, and a history of sexual abuse are significant predictors of the presence of a mental health diagnosis in the logistic regression model. Biological parent incarceration is significantly associated with the absence of a mental health diagnosis.
Adoptive placement is a key transition for youth who have often experienced significant loss and trauma prior to placement. Support of the adoptive family and youth can be critical to ensuring placement stability and may be especially salient for youth with documented mental health diagnoses and corresponding behavioral problems, which put children at increased risk for placement disruption. More work is needed to understand the interplay of risk and protective factors for mental health difficulties among youth adopted from the child welfare system, including how these are affected by child welfare policies, informal procedures, and resources to produce varying outcomes for children in peril.
The medical home as a mediator of the relation between mental health symptoms and family burden among children with special health care needs
2011, Academic Pediatrics
This study explores the role of medical home as a mediator of the relationship between emotional and behavioral difficulties among CSHCN and financial- and employment-related burden experienced by their families.
Data were obtained from the 2005–2006 NS-CSHCN, a nationally representative cross-sectional survey of 40 465 CSHCN. Family burden was measured using parent-reported financial problems and changes in family member employment resulting from the child’s needs. Emotional and behavioral symptoms were reported by parents using 3 binary items capturing difficulty with depression, anxiety, disordered eating, and emotional or behavior problems. Medical home was measured according to the framework of the American Academy of Pediatrics. Bivariate and multivariate analyses were used to explore the role of medical home in the relation between mental health symptoms and family burden.
A smaller proportion of CSHCN with emotional or behavioral difficulties had a medical home or related components compared to CSHCN generally, and a greater proportion of their families experienced burdens. Multivariate analyses showed that the mediated effect of care coordination on the relation between emotional or behavioral symptoms and family burden explained 18% to 35% of the total effect of these symptoms on financial problems and employment changes. Overall medical home access explained 16% to 28% of the total effect of symptoms on burden.
Medical home access, and care coordination in particular, may partially mediate the relation between emotional and behavioral symptoms and financial hardship. Future efforts to implement the medical home model may benefit from an increased focus on care coordination as a means of reducing these burdens.
Meeting children's basic health needs: From patchwork to tapestry
2010, Children and Youth Services Review
Few would deny that if a system were to be designed de novo to meet children's basic health needs, it would be radically different from the confusing and fragmented patchwork of programs in place today. While Medicaid and the Children's Health Insurance Program (CHIP), have improved access to care, increased use of health care services, and reduced unmet health needs for low-income children, the impact of these programs on the quality of health care, and on children's health outcomes is less certain. At the same time, the prevalence of childhood chronic illness is increasing, there is an “epidemic” of obesity, and sizeable increases in reported developmental and behavioral problems and mental health issues. Our existing system of care appears ill-equipped to respond to this changing epidemiology. Unmet needs for care in childhood represent “time-bombs,” likely to result in an explosion of chronic illness in mid-life. We propose a new approach to child health policy, based on the life course health development model in which health in childhood is regarded as a foundation for lifelong well-being. A new tapestry of comprehensive children's services, integrated across sectors, which fully address children's health needs and promote positive health, could set children on optimal health trajectories for life. This system could be a major component of the transformative change the nation is seeking to reduce health care costs and improve quality of life across the lifespan.
National comorbidity survey replication adolescent supplement (NCS-A): I. background and measures
2009, Journal of the American Academy of Child and Adolescent Psychiatry
Citation Excerpt :
The specific measures used to operationalize each construct were selected from reviews of the epidemiological, clinical, and developmental literatures and evaluations of existing instruments from epidemiological studies. The methodological work performed in preparation for the UNOCCAP study was of great value in this regard, as was the methodological work in a number of other studies, including the Methods for the Epidemiology of Child and Adolescent Mental Disorders study,10,64 the National Longitudinal Study of Adolescent Health,65 the NHIS,66 the National Health and Nutrition Examination Survey,24,67 the Ontario Child Heath Study and Follow-up Study,68 the National Longitudinal Survey of Children and Youth,69 the Great Smoky Mountain Study,6 and the Yale High Risk Study of Comorbidity of Anxiety and Substance Use Disorders.70 We also consulted with numerous experts on the selection of measures.
This article presents an overview of the background and measures used in the National Comorbidity Survey Replication Adolescent Supplement (NCS-A).
The NCS-A is a national psychiatric epidemiological survey of adolescents aged 13 to 17 years.
The NCS-A was designed to provide the first nationally representative estimates of the prevalence, correlates, and patterns of service use for DSM-IV mental disorders among U.S. adolescents and to lay the groundwork for follow-up studies of risk and protective factors, consequences, and early expressions of adult mental disorders. The core NCS-A diagnostic interview, the World Health Organization Composite International Diagnostic Interview, is a fully structured research diagnostic interview designed for use by trained lay interviewers. A multiconstruct, multimethod, and multi-informant battery was also included to assess risk and protective factors and barriers to service use. Design limitations due to the NCS-A evolving as a supplement to an ongoing survey of mental disorders of U.S. adults include restricted age range of youths, cross-sectional assessment, and lack of full parental/surrogate informant reports on youth mental disorders and correlates.
Despite these limitations, the NCS-A contains unparalleled information that can be used to generate national estimates of prevalence and correlates of adolescent mental disorders, risk and protective factors, patterns of service use, and barriers to receiving treatment for these disorders. The retrospective NCS-A data on the development of psychopathology can additionally complement data from longitudinal studies based on more geographically restricted samples and serve as a useful baseline for future prospective studies of the onset and progression of mental disorders in adulthood.
Intellectual disability and mental disorders in a US population representative sample of adolescents
2019, Psychological Medicine
Closing the opportunity gap for young children
2023, Closing the Opportunity Gap for Young Children

View all citing articles on Scopus

: Support for this research was funded by a grant from the Maternal and Child Health Bureau and the Health Resource Service Administration (grant MCJ-069500). Data were provided by the National Center for Health Statistics. The authors thank Dennis Cantwell, Marian Sigman, Kimberly Hoagwood, and Kelly Kelleher for their helpful comments in preparation of this manuscript, and Phinney Ahn for her research assistance.

View full text

Special SectionPrevalence and Impact of Parent‐Reported Disabling Mental Health Conditions Among U.S. Children

ABSTRACT

Objectives

Method

Results

Conclusions

J Am Acad Child Adolese Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Epidemiological comparisons of Puerto Rican and US mainland children: parent, teacher and self-reports

J Am Acad Child Adolesc Psychiatry

Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity

Psychol Bull

Current estimates from the National Health Interview Survey, 1994. National Center for Health Statistics

Vital Health Stat

Emotional and behavioral problems

Serving Children With Disabilities: A Systematic Look at the Programs

Handicap and Community Care: A Study of Mentally Handicapped People in Sheffield

Mental Subnormality in the Community: A Clinical and Epidemiologic Study

Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico

Arch Gen Psychiatry

The epidemiology of childhood psychiatric disorders: prevalence findings from recent studies

J Am Acad Child Adolesc Psychiatry

Children's mental health service use across service sectors

Health Aff

Examining the research base for child mental health services and policy

J Ment Health Adm

Follow-up of hard to manage preschoolers: adjustment at age 9 and predictors of continuing symptoms

J Child Psychol Psychiatry

The social-class background of mentally retarded children: a study in Mannheim

Soc Psychiatry

Primary care pediatrics and child psychopathology: a review of diagnostic, treatment, and referral practices

Pediatrics

Developments in child psychiatric epidemiology

J Am Acad Child Adolesc Psychiatry

The Great Smoky Mountains Study of Youth: functional impairment and serious emotional disturbance

Arch Gen Psychiatry

How can epidemiology improve mental health services for children and adolescents?

J Am Acad Child Adolesc Psychiatry

DSM-III disorders in pediatric primary care: prevalence and risk factors

Arch Gen Psychiatry

Studies in mental handicap, part I: prevalence and distribution by clinical type and severity of defect

Arch Dis Child Health

Parent and teacher ratings of ADHD symptoms: psychometric properties in a community-based sample

J Clin Child Psychol

Special Section
Prevalence and Impact of Parent‐Reported Disabling Mental Health Conditions Among U.S. Children