Survey results suggesting that pediatricians are more comfortable identifying–but not treating–most children's mental health problems are consistent with previous findings, a leading child and adolescent psychiatrist says.
“With the exception of attention-deficit/hyperactivity disorder, most pediatricians have limited training and experience in the diagnosis and treatment of child psychiatric disorders,” Dr. David Fassler, also a clinical professor of psychiatry at the University of Vermont, Burlington, said in an interview. “For this reason, we're seeing an increased emphasis on programs designed to enhance access to timely and appropriate consultation services.”
The results, based on a survey of Cleveland-area primary care pediatricians and child and adolescent psychiatrists, showed that ADHD was the only psychiatric condition for which most of the respondents thought pediatricians should be responsible.
“The willingness of pediatricians to accept the responsibility for identifying children's mental health problems is encouraging,” researchers led by Dr. Amy Heneghan of the department of pediatrics at Case Western Reserve University, Cleveland, reported (J. Dev. Behav. Pediatr. 2008;29:262-9). “It is an important first step toward reducing the morbidity, mortality, and costs associated with an inadequate and dysfunctional child mental health system.”
In 2005, Dr. Heneghan and her associates mailed a survey to 338 primary care pediatricians and 75 child and adolescent psychiatrists who practice in the Cleveland area.
Each respondent was asked the same three questions about ADHD, depression, behavioral problems, learning disabilities, anxiety disorders, substance abuse, and eating disorders:
▸ How strongly do you agree or disagree that pediatricians should be responsible for identifying this problem?
▸ How strongly do you agree or disagree that pediatricians should be responsible for treating or managing this problem?
▸ How strongly do you agree or disagree that pediatricians should be responsible for referring this problem?
Researchers scored each response on a 3-point Likert scale, with the choices being disagree, neutral, or agree.
Each respondent also was asked 13 questions about barriers for pediatricians in their identification, referral, and treatment of childhood mental health problems, such as lack of time for treating them and lack of training for identifying them. Researchers scored these responses on a 5-point Likert scale, with the choices being strongly disagree, disagree, neutral, agree, or strongly agree.
Another part of Dr. Heneghan's survey asked respondents to share their opinions about the availability of children's mental health services. The final analysis included responses from 132 primary care pediatricians and 31 child and adolescent psychiatrists.
Dr. Heneghan and her associates reported that with the exception of ADHD, most of the respondents in both groups agreed that pediatricians should be responsible for identifying and referring but not treating child mental health problems. For example, while less than 20% of respondents in both groups agreed that pediatricians should be responsible for treating depression, behavioral problems, learning disabilities, anxiety disorders, substance abuse, and eating disorders, 86% of primary care pediatricians and 57% of child and adolescent psychiatrists agreed that pediatricians should be responsible for treating ADHD.
More than 70% of respondents in both groups agreed that a lack of mental health services was a barrier for primary care pediatricians, but child and adolescent psychiatrists were significantly more likely than pediatricians to agree that pediatricians' lack of training in identifying childhood mental health problems was a barrier (70% vs. 47%, respectively).
Both groups strongly agreed that long waiting periods to see referred mental health providers, lack of time to treat mental health problems, and lack of qualified providers to refer to were barriers for pediatricians.
Dr. Fassler said that in his practice, child and adolescent psychiatrists are now providing on-site consultation to seven pediatric groups. He also pointed out that Massachusetts has a “well-regarded statewide initiative that includes telephone consultation with face-to-face backup, as needed.”
In addition, he said, other states have developed innovative telemedicine programs to provide such services. “I don't think pediatricians will ever be treating the full range of child psychiatric disorders,” Dr. Fassler said. “But they clearly are and should be critical members of the treatment team.”
The study was funded by the Woodruff Foundation and the Annie E. Casey Foundation.