Under the Hood

Pediatricians, Primary Care Physicians May Be Best Caretakers For Kids With Mental Health Needs

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Pediatricians may be equipped to care for children's mental health needs, from ADHD to anxiety. Pixabay, public domain

When we think of depression, anxiety, or other mental health problems, we often imagine the tired office worker crushed by the burden of responsibility — not the carefree toddler in daycare. It can be easy to overlook mental health issues in children, but it’s crucial to pay attention to them; mental illness in childhood can have lasting effects on social, financial, and emotional health later on.

A new study published in Pediatrics examines mental health in children — and how they’re getting treated for it. Interestingly enough, while adults are typically referred to therapists or psychiatrists for mental health needs, the study argues that pediatricians and primary care physicians are good starting points to care for a child’s mental health needs.

Some 35 percent of kids receiving mental health care had appointments only with their primary care physicians, the study found. 26 percent saw only psychiatrists, and 15 percent saw only psychologists or social workers. The results of the study indicate that most parents are turning to their child’s pediatrician to offer help when it comes to mental health issues like attention deficient hyperactivity disorder (ADHD) or anxiety disorders — and this is why the pediatrician’s role is so important.

The researchers examined data from 43,000 children in the U.S. aged 2-21 years between 2008 and 2011. Some 1,800 of these kids had a mental health problem, and out of that number, the majority were diagnosed with ADHD or anxiety disorders. About one in 10 kids in the U.S. have a mental health condition, and there simply aren’t enough child psychiatrists to treat them all, the researchers found.

“There just aren’t enough child psychiatrists in the United States to treat every child with a mental health condition,” Van Cleave told HealthDay. “Given that, any efforts to improve the quality of mental health care for children would be wise or appropriate to focus on improvements in primary health care, since that is where a lot of that care is happening.”

That’s especially true for kids with ADHD. The study found that 42 percent of children with ADHD were treated by their primary care providers, rather than psychiatrists or mental health providers.

“This finding likely reflects the fact that the American Academy of Pediatrics has urged primary care pediatricians to take an active role in the treatment of ADHD, and that clinical guidelines for pediatricians recommend that medication should be considered a first-line treatment for all youth with ADHD that are 6 years of age and older,” Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center of New York, told HealthDay.

While it may not seem as though primary care physicians are best suited for mental health needs, the reality is if they certainly can be. The American Academy of Pediatrics lists guidelines for ADHD, teen depression, and anxiety, and many pediatricians feel comfortable handling them.

“Primary care physicians provide a good home for children’s mental health conditions,” Van Cleave told LiveScience.

On a larger level, primary care physicians for adults should also feel more comfortable tending to patients’ mental health needs — at least initially — as many physical conditions are impacted by stress, depression, and anxiety. Integrating preventive care into the healthcare system will also require focusing more on patients' mental health when they visit their primary care doctors, rather than waving them away to be prescribed medications by psychiatrists.

Source: Van Cleave J, Wolraich M, et al. Pediatrics, 2015.

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