Attention-deficit/hyperactivity disorder is the most prevalent mental disorder in children under aged 18 years in the United States, followed by depression, behavioral or conduct problems, anxiety, substance-use disorders, autism spectrum disorders, and Tourette syndrome, according to a report issued May 16 by the Centers for Disease Control and Prevention.
Millions of children in the United States have mental disorders, which are "a substantial public health concern with considerable associated costs to individuals, families, and society," concludes the report, titled "Mental Health Surveillance Among Children in the United States – 2005-2011." The report estimates that 20% of the children in the United States have mental disorders; the prevalence of mental disorders is increasing; and about $247 billion is spent on mental health in children annually.
Dr. David Fassler
This is the first CDC report to track the number of children (under age 18 years) in the United States who have a specific mental disorder, defined as "serious deviations from expected cognitive, social, and emotional development." The definition includes conditions that meet DSM-IV-TR criteria or criteria in the International Classification of Diseases. The report is published as a supplement to the May 17 Morbidity and Mortality Weekly Report (MMWR 2013;62 [Suppl. 2]:1-35).
"This is an important and helpful report," Dr. David Fassler, a child psychiatrist in Burlington, Vt., said in an interview. "Consistent with previous findings, it demonstrates that nearly one child in five has signs and symptoms of a significant psychiatric illness in any given year.
"The report also confirms that the prevalence of these disorders appears to be increasing, although the authors note that this finding may be due to changes in case definition, public perception, or policies regarding access to health care."
Furthermore, he predicted that the data in the report would be useful to parents, advocates, legislators, regulators. The findings "underscore the growing need for enhanced access to comprehensive mental health and substance abuse treatment services for children, adolescents and families," added Dr. Fassler, clinical professor of psychiatry, University of Vermont, Burlington.
The findings of the report were based on data from different national surveys and studies in the United States. The proportion of children affected by the outcomes studies varied by the condition, the survey and age group, the authors said, but they "begin to illustrate the impact of mental disorders among children."
Among the findings was that, in any given year, 13%-20% of children have a mental disorder. Among current diagnoses of mental disorders reported by parents of children aged 3-17 years, attention-deficit/hyperactivity disorder (ADHD) was the most common, at almost 7%. The next most common were behavioral or conduct problems (3.5%), anxiety (3%), depression (2.1%), autism spectrum disorders (ASDs) (1.1%), and Tourette syndrome (0.2% among children aged 6-17 years).
In addition, almost 5% of adolescents aged 12-17 years reported having an "illicit drug use disorder" in the past year, and 4.2% had an alcohol abuse disorder in the past year.
In 2010, suicide was the second-leading cause of death among children aged 12-17 years. Among people aged 10-19 years, the suicide rate was 4.5 suicides/100,000 people. About 8% of adolescents aged 12-17 years said that they had at least 14 "mentally unhealthy days in the past month."
The authors also found that all demographic groups were affected by mental disorders, but the estimated prevalence varied among racial and ethnic groups. For example, the prevalence of ADHD was lowest among Hispanic children and behavioral or conduct problems were the highest among black non-Hispanic children. ASDs "tended to be higher" among white non-Hispanic children, and white non-Hispanic children were affected by anxiety more than were black non-Hispanic children.
In addition, anxiety, ADHD, and ASD were more common among children who had health insurance.
The authors concluded that surveillance "is a critical first step in the public health approach to mental health among children," and that surveillance data "can help prioritize areas for research on risk and protective factors and provide empirical evidence to develop effective interventions that can prevent mental disorders and promote mental health."
The authors of the report are from the CDC, the Health Resources and Services Administration, the National Institute of Mental Health, and the Substance Abuse and Mental Health Services Administration.
The report complements a 2011 CDC report on mental illness in adults.