Many Children with a Mental Health Condition Never See a Mental Health Professional

A new study, published in Pediatrics, finds that many children with ADHD are treated solely by primary-care providers (PCP), who may be more likely to prescribe medication rather than use behavioral therapy or other treatment strategies.

The study examined how children with mental health conditions, such as bipolar disorder, depression, or ADHD are treated in the United States. Researchers looked at data from the 2008-2011 Medical Expenditure Panel Survey (MEPS), an annual nationwide survey about health-care expenditures across the country. Researchers focused on children and young adults between the ages of two and 21 who had had outpatient visits for existing mental health problems. Researchers examined whether the children had visited a PCP, a psychiatrist, a psychologist, or a licensed social worker.

The results showed that 34.8 percent of children with mental health conditions saw only their PCP, with no consultation by a mental health professional. When the data was narrowed to children with ADHD, the number grew: approximately 42 percent saw only their PCP rather than a psychiatrist alone or a combination of health-care professionals. For the most part, the stats held up across racial and economic strata. However, children living at 100 to 200 percent of the poverty level were over three times as likely to see a PCP as they were a psychiatrist or other mental health specialist.

Regardless of the mental health condition being treated, PCPs were far more likely to prescribe medication. The children with ADHD who saw a PCP had a 73.7 percent chance of being prescribed stimulant or alpha agonist medication, compared to 61.4 percent of those being treated by a psychiatrist or behavioral therapist. In other words, the authors write, "children with ADHD seen by PCPs had 1.5 times the odds of receiving a medication than did children seen by psychiatrists." While medications are the first-line treatment for ADHD, they can’t treat every symptom, and they usually work best when combined with behavioral therapy and educational supports.

"There aren't enough child psychiatrists in the United States to treat every child with a mental health condition," , the senior author of the study. According to the most recent data, only about 8,000 child psychiatrists practice in the United States (along with another 600 developmental-behavioral pediatricians, who can also provide behavioral therapy to children with ADHD).

The researchers aren’t advocating for parents to switch their child’s ADHD treatment solely to a psychiatrist or social worker, which can be costly or not supported by health insurance. Rather, they write, “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.”

In other words, the study concludes, primary-care doctors who are properly trained in treating mental health conditions — including behavioral therapy techniques for ADHD — will be better suited to treat their patients effectively.