More Children are Developing Psychosocial Problems, Physicians Say

Dramatic increase to be documented in Pediatrics

June 05, 2000

A study showing a dramatic increase in the number of children with behavioral and emotional problems - and contending that psychosocial problems are becoming the centerpiece of pediatric primary care for school-age children - will be published in the June issue of the journal Pediatrics.

The study examined the changes in identification of psychosocial problems in children between 1979 and 1996, and the results are alarming.

The number of children diagnosed with behavioral or emotional problems in 1979 was 6.8 percent, but more than doubled to 18.7 percent by 1996.

"In short, psychosocial problems are becoming the centerpiece of pediatric primary care for school-age children," says study co-author Thomas McInerny, M.D., associate chair for clinical affairs at the University of Rochester's Children's Hospital at Strong, and a member of the Pediatric Research in Office Settings group.

McInerny isn't a stranger to this kind of research. In 1979, he was a member of a team that determined that nearly 7 percent of children in Rochester, N.Y., had behavioral or emotional problems. More than 18,000 children were involved in that study, the results of which were published in Pediatrics in 1984.

In 1996, McInerny collaborated with Kelly Kelleher, M.D., M.P.H., of the University of Pittsburgh, to form another team that replicated the study on a nationwide basis. The study included 395 community-based pediatricians and family practitioners, and more than 21,000 children.

The results of the 1996 study validate a cutting-edge prediction made in a 1975 book titled "Child Health and the Community," written by Robert Haggerty, M.D., then-chairman of the department of pediatrics at Children's Hospital at Strong. At that time, he termed behavioral and emotional issues the "new morbidity" for children.

"Bob Haggerty was right all those years ago," McInerny says. "Psychosocial problems are the most common chronic condition for pediatric visits, eclipsing asthma and heart disease. They are also among the most disabling of pediatric conditions accounting for one-third of all missed school days among adolescents."

Physicians involved in the 1996 study believe that the increase in single-parents families and the rising number of children in poverty are mostly to blame for the increased number of children with psychosocial problems.

Between 1979 and 1996, the number of children seen for primary-care visits who were not living with both parents increased from 15 percent to 21 percent. In both studies, these children were more likely to have a psychosocial problem.

In addition, the percentage of children enrolled in Medicaid almost tripled between 1979 and 1996. The study's authors say "this was likely due to a significant expansion of Medicaid populations nationally, combined with growth in the number of children living in poverty since 1979."

McInerny says the results of the study should serve as a wake-up call.

"This study tells us that we need to give people studying to be pediatricians more training in diagnosing behavioral and emotional problems," McInerny says. "It also tells us that we need more child and adolescent psychiatrists and psychologists, because there just aren't enough of them."

"Most importantly, though, this study should encourage us to find out why there has been such an increase in behavioral and emotional problems, and what we can do to reverse the trend," he adds.

There are ways to help children avoid developing psychosocial problems, McInerny says. He used the trauma of a divorce as an example.

"There will always be some marriages that end in divorce, but at least if parents are going to divorce, they can learn to do it in a way that doesn't put tremendous pressures on the kids," he says. "We've got to find ways to make these types of events less traumatic."

The study was supported by grants from the National Institute of Mental Health, the Health Resources and Services Administration Maternal and Child Health Bureau, and the Staunton Farm Foundation.

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