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Why Are Half of U.S. Kids With Mental Health Issues Not Getting Treatment?

MONDAY, March 29, 2021 (HealthDay News) -- Over half of high-risk children in the United States are not receiving behavioral health services critical to their mental, emotional and physical well-being, new research warns.

"It's a pretty simple and kind of widely agreed upon finding that there are a lot of at-risk kids, when you look at it in terms of adversities or symptoms, who aren't getting mental health services, behavioral health services, that would be of benefit to them," said study co-author David Finkelhor. He directs the University of New Hampshire's Crimes Against Children Research Center.

Lack of treatment for kids who struggle with depression, anxiety and/or several adverse childhood experiences is more severe among children of parents with only high school-level educations and children of color, with Black kids found to be the least likely to have access to behavioral health services.

"The implication is, we should really be doing a lot more to try and facilitate services for this segment of the population," said Finkelhor.

A noteworthy outlier in the study: High-risk children with nontraditional family structures were far more likely than their counterparts to have received mental health services.

For the study, the researchers examined the results from three national surveys of children's exposure to violence, which included nearly 12,000 kids aged 10 to 17 and caregivers of children aged 2 to 9. The team found that between 41% and 63% of high-risk youths surveyed went without any professional help.

The report was published online recently in JAMA Network Open.

This dearth of services can impact children long term, said Dr. Tarik Hadzic, a child, adolescent and adult psychiatrist in Los Angeles, who was not involved with the study.

"These are little kids. Half of this group [aged] 2 to 9 was ages 2 to 5," said Hadzic. "These are paramount times in the development of a child's brain, when an early intervention can have huge positive effects on appearance of both [mental health issues and adverse childhood experiences]. You can affect both mental and physical conditions later, because kids with untreated mental health conditions will go on to have more problems as adults."

In addition, he noted, nearly two-thirds of youths aged 10 to 17 with mental health issues and adverse childhood experiences didn't receive care, which can lead to other negative outcomes.

"That's really troubling as well," Hadzic said. "This includes adolescence, especially later adolescence, when they are more likely to be liable criminally for offenses, and more likely to engage in suicidal behavior, for example, leading to death. That's completely preventable. They're not being identified. I don't see them."

Missed diagnoses of conditions in kids of color is one issue, which was evident in another study published recently in JAMA Network Open. It showed disparities in the identification and treatment of attention-deficit/hyperactivity disorder in Asian, Black and Hispanic children. Lack of resources in lower-income communities, prior negative experiences with medical professionals, and historical malpractice against people of color are also factors.

To make matters worse, the surveys examined for the latest research were completed in 2008, 2011 and 2014. By several metrics, the COVID-19 pandemic period has been extremely difficult for children, and high-risk kids are likely bearing the brunt of the trauma.

"In my practice, I'm seeing far more kids and adolescents with worsening depression," Hadzic said. "Isolation is clearly a risk factor for depression. And now we have this, you know, rightfully-so instituted isolation because of the deadly pandemic, but a lot of kids are just basically cut off. And they're not finding digital interactions nearly as meaningful with their friends. So I do think that the pandemic is definitely making universal screening far more difficult. It's making identification of kids with [adverse childhood] events more difficult."

If professionals become more agile at identifying at-risk children, treatment can help affected kids considerably. Finkelhor and his colleagues have laid out suggestions on how to expand needed clinical contact.

"We need to train more people to provide these kinds of services," said Finkelhor. "We need to provide them in more convenient locations, like schools, and in conjunction with medical practices. We need to package them to make them a little bit less stigmatizing. We need to advertise some of the new procedures and techniques that we have. We need to make sure that the new and particularly the evidence-based services that are most effective are the ones that are being provided, and that everybody is trained up in them."

Finkelhor also advocated for the use of the arts and exercise to help children deal with depression, anxiety and trauma.

More information

Visit the U.S. Centers for Disease Control and Prevention for more on mental health in children.

SOURCES: David Finkelhor, PhD, professor, sociology, and director, Crimes Against Children Research Center, University of New Hampshire, Durham, N.H.; Tarik Hadzic, MD, PhD, child, adolescent and adult psychiatrist, Los Angeles; JAMA Network Open, March 15, 2021, online

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