close   X

11/24/14blog post

why are we seeing an increase in these patients?

In the ICU the closest I get to caring for children with psychiatric or developmental disorders are mostly teenagers that have overdosed on medications with subsequent medical symptoms or young toddlers and middle school children with violent behavior that require close monitoring until definitive placement or therapy is established.

One CDC study found an increase of almost 21 percent from 2001-2011 in mental health conditions and neurodevelopmental disability in children while physical disabilities decreased by almost 12 percent in the same time frame.

Unfortunately as we track these types of admissions over the past 10 years or so, we are seeing a significant increase of these patients and one has to ask themselves why?

  • Are we more aware of specific diagnosis in the medical community where in the past we tended to ‘bulk everyone into one group’?
  • Does this greater awareness, mean we are connecting kids with resources and therefore more recognized in the health care system?
  • Have parenting styles changed? Single parent homes? Grandparents or extending family raising children?
  • Are we less tolerant of ‘normal childhood behavior’ and look for a quick fix with medications?
  • Are the children being exposed to more information that is not age appropriate? Is there less supervision of our children?
  • Does the technology exposure have any role?

I would argue all of the above.

Another recent study from this summer states the CDC has been monitoring the prevalence of ADHD diagnosis in children 4 to 17 years old and use of medications since 1997. There has been a steady increase in both in recent years. The data about preschoolers really worried me. When I trained in general pediatrics 14 years ago, behavior modification and education (of parents) of normal behavior to expect in this age group was the first line of therapy. The CDC data now suggests that a high number of children are receiving ADHD medications.

  • With 5.6 percent of our children diagnosed with ADHD, 74 percent of them were receiving medications and 44 percent were receiving psychological services
  • Among 2-3 year olds the data showed a prevalence of 1 percent with ADHD diagnosis with 46 percent of the children on medications and 45 percent receiving psychological services

An interesting finding of the study found a 28 percent increase in mental and developmental disability in children living in households with incomes at or above 400 percent the poverty level. This is the first time since 1957 that the prevalence rose more among socially ADVANTAGED families. Overall, children living in poverty have the highest disability rates.

  • Do families with increased incomes have better health insurance?
  • Better access to diagnostic services and resources?
  • Better understanding/acceptance of diagnosis?

Certainly there are situations where medications are the answer. In the end, this data suggests that we can’t replace good parenting with medications.

Our children need to be under almost constant supervision and we need to be cognizant of what they are exposed to in school, with friends, at home and in the privacy of their rooms.