Stigma Interferes With Mental Health Treatment for Kids

AMERICA HAS COME A LONG way in recognizing the burden caused by childhood mental health conditions in recent decades. Still, far too many children and adolescents fail to get the help they need due to ongoing stigma and barriers in accessing mental health treatment. Sadly, one of the most potent stigmas is against the use of sometimes lifesaving medications.

Childhood mental health disorders are real. Half of all adult mental health disorders begin by age 14, and 75 percent are evident by age 24. One in every 5 children is living with a serious mental health condition.

Untreated, these disorders have dire consequences. Approximately 50 percent of students age 14 and older with a mental illness drop out of high school. Ninety percent of all suicides are due to treatable mental health conditions. Suicide is the second leading cause of death in teens and young adults. For those who do get help, the average delay from the onset of symptoms is eight to 10 years.

Now, research clearly shows that medication can be an effective part of treatment for many psychiatric disorders. But mention medication as a part of the treatment plan, and you are often met with parental concern, public uproar and that old, stubborn stigma.

A recent study in the Journal of Child and Adolescent Psychopharmacology takes a careful look at how we prescribe psychotropic medications to young people and offers up some insights as to how we, as a society, can help kids get better care. The authors focus on three major classes of medications: antidepressants, stimulants and antipsychotics. Here are some takeaways:

ADHD is still under-medicated. Stimulant prescriptions peak between ages 5 to 11, which is in line with the developmental onset of ADHD. But older children also struggle with ADHD; Sultan and colleagues show that 3.7 percent of older children fill prescriptions for stimulants, which is well below the 8.6 percent national community prevalence estimate of ADHD. Stimulant prescriptions fall to 2.4 percent and 1.6 percent in teens and young adults, respectively, falling below the prevalence estimates for ADHD for these age groups. Not all patients with ADHD require medications for treatment. But these numbers are still quite low, even when we take only moderate to severe cases into account, which clearly benefit from psychostimulants.

Anxiety and depression are under-medicated. Antidepressants are prescribed for many mental health disorders, with depression and anxiety disorders being some of the most common. The study shows that 1 percent of older children and 2.8 percent of adolescents receive prescriptions for antidepressant medications — quite low when prevalence estimates show that 5 percent of teens suffer from depression and 15 to 20 percent have an anxiety disorder.

Pediatricians aren’t comfortable with these medications. Most antidepressant prescriptions written for children originate from psychiatrists; family doctors write about 12 percent of them. Given the high number of adolescents with depression and anxiety, limited access to mental health services and the consequences of untreated depression, this is a critical barrier to care. This is likely due to unease in diagnosing and treating depression for pediatricians, who have nevertheless shown they can become more comfortable treating other psychiatric disorders like ADHD.

Psychiatric medications are essential for youth with impairing mental health disorders like depression, anxiety, autism, bipolar disorder, psychosis, eating disorders and emotional dysregulation. Medications can help manage truly painful symptoms and, in concert with therapy and other support services, help young people develop skills and get better.

Like most pharmaceutical drugs, psychiatric medications have side effects and risks. Depending on the class of medication, these can include weight gain, trouble sleeping, movement disorders and lethargy, among others. These side effects can be unsettling — but we must all be mindful about the potential risks of withholding effective treatments because we’d prefer our children not experience them.

Famously, antidepressants have been linked to increased suicidal ideation in some cases. But untreated depression is linked to completed suicide. These disorders are real and serious — and often more dangerous than the side effects of the medications we use to treat them.

A child’s sense of self is being shaped as he or she experiences these precious years. Having a mental health disorder during childhood throws off the normal biological, emotional and social developmental trajectory and can cause lifelong damage. Fight the stigma, and give children the care they need and deserve.

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