Mental health disorders are the most common diseases of childhood.

Of the 74.5 million children in the United States, an estimated 17.1 million have or have had a psychiatric disorder1 — more than the number of children with cancer, diabetes, and AIDS combined.2 Half of all psychiatric illness occurs before the age of 14, and 75 percent by the age of 24.

In spite of the magnitude of the problem, lack of awareness and entrenched stigma keep the majority of these young people from getting help.3 Children and adolescents with psychiatric illness are at risk for academic failure, substance abuse, and a clash with the juvenile justice system — all of which come at a tremendous cost to them, their families, and the community.

This is a public health crisis that must be addressed.

The Child Mind Institute Children’s Mental Health Report brings together the most up-to-date information on child and adolescent mental health, based on findings from the most reliable and comprehensive studies. The report covers:

  • The commonness of childhood mental illness

  • The gap between illness and care

  • The cost to society of ignoring children’s mental health

  • The effectiveness of treatment

We cannot deny that childhood mental illness is real and common. For millions of children, treatment can be transformative—but not nearly enough have access to care. Our nation must make a commitment to better training, robust research initiatives, and expanded public education efforts. Only then will we honor the promises we make to our young people.

It is our hope that this report will spark conversations — from kitchen tables to the halls of Congress — so that many more children will get the help they need to live healthy lives.

(1) Merikangas 2010; Kessler 2005

(2) Cancer.gov http://www.cancer.gov  Diabetes.org http://www.diabetes.org  AIDS: CDC http://www.cdc.gov

(3) Surgeon General’s Report, 1999; Merikangas 2011

Childhood Mental Illness Is Common

While statistics on the number of children and adolescents who have mental illness vary depending on what you measure, one large and well-designed study shows that:

0
%

of kids 2-17 have a current psychiatric diagnosis based on parent reports in telephone interviews.

How many kids are we talking about?

The US Census estimates that in 2015 there are 74.5 million children under 18. Of these we estimate that:

0
 million

young people have or have had a diagnosable psychiatric disorder.

This estimate is extrapolated from Census data and prevalence numbers reported for the NCS-A, GSMS, NHANES, and an analysis of early-childhood severe emotional disturbance by Brauner (2006).

Costello E, Mustillo S, Erkanli A, Keeler G, & Angold A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry.60(8):837-844. doi:10.1001/archpsyc.60.8.837. Merikangas, K., Hep, J., Burstein, M., Swanson, S., Avenevoli, S., Cui, L., Benejet, C…Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). Journal of American Academy of Child and Adolescent Psychiatry. 49(10): 980-989. doi: 10.1016/j.jaac.2010.05.017 Brauner, C. B., & Stephens, C. B. (2006). Estimating the Prevalence of Early Childhood Serious Emotional/Behavioral Disorders: Challenges and Recommendations. Public Health Reports, 121(3), 303–310. Merikangas, K. R., He, J.-P., Brody, D., Fisher, P. W., Bourdon, K., & Koretz, D. S. (2010). Prevalence and Treatment of Mental Disorders Among US Children in the 2001–2004 NHANES. Pediatrics, 125(1), 75–81. doi:10.1542/peds.2008-2598

What are the most common psychiatric disorders in childhood?

with severe impairment

These estimates are based on diagnostic interviews done by professionals with a large, representative sample of young people ages 13–18.

Merikangas, K., Hep, J., Burstein, M., Swanson, S., Avenevoli, S., Cui, L., Benejet, C…Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). Journal of American Academy of Child and Adolescent Psychiatry. 49(10): 980-989. doi: 10.1016/j.jaac.2010.05.017

How Many Kids Have an Autism Spectrum Disorder?

0
%

This estimate is based on retroactive chart review of almost 364,000 8-year-old children.

CDC Autism and Developmental Disabilities Monitoring (ADDM) Network 2010 survey)

0
%

This estimate is based on diagnostic interviews done by professionals with a sample of 55,000 young people ages 7-12.

Kim, Y., Leventhal, B., Koh, Y., Fombonne, E., Laska, E., Lim, E., …Grinker, R. (2011). Prevalence of autism spectrum disorders in a total population sample. American Journal of Psychiatry. 168(9). doi: 10.1176/appi.ajp.2011.10101532

4.5 times as
many boys
as girls
have autism

Age 6

median age of onset

Anxiety Disorders

Age 11

median age of onset

ADHD and Behavior Disorders

Age 13

median age of onset

Mood Disorders

Age 15

median age of onset

Substance Use

These estimates are based on diagnostic interviews done by professionals of a large, representative sample of young people ages 13–18. Anxiety disorders include generalized anxiety disorder, social anxiety disorder, specific phobias, panic disorder, PTSD, and separation anxiety disorder. Behavior disorders include ADHD, oppositional defiant disorder, and conduct disorder. Mood disorders include major depressive disorder, dysthymia, and bipolar disorder I and II.

Merikangas, K., Hep, J., Burstein, M., Swanson, S., Avenevoli, S., Cui, L., Benejet, C…Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). Journal of American Academy of Child and Adolescent Psychiatry. 49(10): 980-989. doi: 10.1016/j.jaac.2010.05.017

ADHD: How many kids are getting diagnosed?

42%
increase

The percentage of US children (ages 4-17) who had been diagnosed with ADHD by a health care provider, as reported by parents in phone interviews:

Center for Disease Control and Prevention (CDC). (2007). National Survey of Children’s Health. Retrieved from: http://www.nschdata.org/

ADHD: How many kids are getting treated with medication?

28%
increase

The percentage of US children (ages 4-17) taking stimulant medication for ADHD, as reported by parents in phone interviews.

Center for Disease Control and Prevention (CDC). (2007). National Survey of Children’s Health. Retrieved from: http://www.nschdata.org/

More than twice as many boys as girls (ages 4-17) are diagnosed with and medicated for ADHD.

5.5%

girls currently diagnosed with ADHD

3.7%

girls currently taking ADHD medication

12.1%

boys currently diagnosed with ADHD

8.4%

boys currently taking ADHD medication

Center for Disease Control and Prevention (CDC). (2007). National Survey of Children’s Health. Retrieved from: http://www.nschdata.org/

Average Age of ADHD Diagnosis

The average age of diagnosis varies depending on the severity of symptoms.

Age 8

for children with

mild ADHD

Age 7

for children with

moderate ADHD

Age 5

for children with

severe ADHD

Visser, S., Danielson, M., Bitsko, R., Holbrook, J., Kogan, M., Ghandour, R.,…Blumberg, S. (2014). Trends in the parent-report of health care provider-diagnosed and medicated Attention-Deficit/Hyperactivity Disorder: United States, 2003-2011. Journal of the American Academy of Child & Adolescent Psychiatry. 53(10): 34-46. doi: 10.1016/j.jaac.2013.09.001

States vary dramatically in the number of ADHD diagnoses.

Highest: Kentucky

0%

Lowest: Nevada

0%

The geographic variation is even more dramatic in the percentage of kids who get ADHD medication.

Highest: Louisiana

0%

Lowest: Nevada

0%

These estimates are based on parent reports in phone interviews.

Visser, S., Danielson, M., Bitsko, R., Holbrook, J., Kogan, M., Ghandour, R.,…Blumberg, S. (2014). Trends in the parent-report of health care provider-diagnosed and medicated Attention-Deficit/Hyperactivity Disorder: United States, 2003-2011. Journal of the American Academy of Child & Adolescent Psychiatry. 53(10): 34-46. doi: 10.1016/j.jaac.2013.09.001

Millions of Children Are Not Getting Help

Specialists and Training Are in Short Supply.

Association of American Medical Colleges (2014). 2014 Physician Specialty Data Book. Retrieved from: https://members.aamc.org/eweb/upload/14-086%20Specialty%20Databook%202014_711.pdf; Substance Abuse and Mental Health Services Administration (2013). Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues. Retrieved from: https://store.samhsa.gov/shin/content/PEP13-RTC-BHWORK/PEP13-RTC-BHWORK.pdf

0

Number of practicing school psychologists in the US.

0

Current estimated shortage of practicing school psychologists.

Michael J. Curtis, Sawyer A. Hunley, Elizabeth Chesno Grier. “The status of school psychology: Implications of a major personnel shortage.” Psychology in the Schools. Volume 41, Issue 4, pages 431–442, April 2004 DOI: 10.1002/pits.10186

1 :
0

Ratio of school psychologists to students

Charvat, J. (2005). NASP Study: How many school psychologists are there? NASP Communique. 33(6).

0

Number of clinical child psychologists

Estimate based on APA membership records

Who doesn't get treatment?

Access to treatment varies dramatically by disorder

40% of youth with diagnosable ADHD

Merikangas, K. R., He, J., Burstein, M. E., Swendsen, J., Avenevoli, S., Case, B., … Olfson, M. (2011). Service Utilization for Lifetime Mental Disorders in U.S. Adolescents: Results of the National Comorbidity Survey Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 32–45. doi:10.1016/j.jaac.2010.10.006

60% of youth with depression

Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of findings. Retrieved from: http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf

80% of youth with a diagnosable anxiety disorder

Merikangas, K. R., He, J., Burstein, M. E., Swendsen, J., Avenevoli, S., Case, B., … Olfson, M. (2011). Service Utilization for Lifetime Mental Disorders in U.S. Adolescents: Results of the National Comorbidity Survey Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 32–45. doi:10.1016/j.jaac.2010.10.006

In Merikangas, treatment use includes seeing a psychiatrist or being hospitalized; seeing another doctor or going to the emergency room; speaking with a counselor; attending a support group; interacting with the juvenile justice system; and receiving school-based services.


In the NSDUH, a person accessed treatment if they “saw or talked to a medical doctor or other professional or used prescription medication.”

Early anxiety leads to later psychiatric disorder.

Childhood anxiety predicts later:

Panic attacks

Depression

Separation anxiety disorder

Conduct disorder

Social phobia

Suicidality

Bittner, A., Goodwin, R. D., Wittchen, H. U., Beesdo, K., Höfler, M., & Lieb, R. (2004). What characteristics of primary anxiety disorders predict subsequent major depressive disorder?. The Journal of Clinical Psychiatry, 65(5), 618-26.

Untreated Mental Illness Hurts All of Us

Suicide

0

adolescents commit suicide every year.

http://www.cdc.gov/violenceprevention/pub/youth_suicide.html

0

are hospitalized for self-injury.

http://www.cdc.gov/violenceprevention/pub/youth_suicide.html

0
%

of young people who commit suicide have a psychiatric illness.

Shaffer, D., & Craft, L. (1999). Methods of adolescent suicide prevention. Journal of Clinical Psychiatry. 60.(2).

Lost Productivity and Law Enforcement

$
0
 Billion

The cost of lost productivity and crime spending related to mental illness in Americans under 24.

National Research Council and Institute of Medicine. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People. Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, Editors. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

Mental Illness in Youth Involved in the Juvenile Justice System

0
%

of youth in juvenile justice settings meet criteria for a psychiatric diagnosis.

Shufelt, J. & Cocozza, J. (2006). Youth with mental health disorders in the juvenile justice system: Results from a multi-state prevalence survey. Prepared by: National Center for Mental Health and Juvenile Justice.

Mental Illness in the Justice System

Young people who don't get treatment for mental illness are at higher risk for incarceration as adults—and most mental illness in this population is not identified until people are incarcerated. Our jails are serving as de facto hospitals now.


More than half of inmates in the correctional system have a mental health problem

A mental health problem is defined either by having a history in the year before incarceration of being diagnosed, hospitalized or treated for a mental disorder, or by meeting DSM4 criteria for a disorder based on a diagnostic interview.

James, D., and Glaze, L. (2006). Bureau of Justice Statistics Special Report: Mental Health Problems of Prison and Jail Inmates. Retrieved from: http://www.bjs.gov/content/pub/pdf/mhppji.pdf

Many inmates were found to have symptoms of a mental health problem with no history of previous diagnosis or treatment.

0
%

estimated to have a diagnosable mental illness

James, D., and Glaze, L. (2006). Bureau of Justice Statistics Special Report: Mental Health Problems of Prison and Jail Inmates. Retrieved from: http://www.bjs.gov/content/pub/pdf/mhppji.pdf

Inmates who have mental health problems are more likely than other inmates to have disciplinary problems while they are incarcerated.

James, D., and Glaze, L. (2006). Bureau of Justice Statistics Special Report: Mental Health Problems of Prison and Jail Inmates. Retrieved from: http://www.bjs.gov/content/pub/pdf/mhppji.pdf

Percent charged with violating prison rules

Inmates with mental health problems
Inmates without mental health problems

Early Identification and Treatment Can Turn Lives Around

Large randomized, controlled studies show a high response rate for treatments for psychiatric disorders, including anxiety, depression, and ADHD.

The most effective treatments for children with anxiety

The definitive, federally funded clinical trial of treatments for kids with anxiety disorders showed that a combination of cognitive behavioral therapy (CBT) and antidepressant medication (a selective serotonin reuptake inhibitor, or SSRI, called sertraline, or Zoloft) is the most effective acute or short-term treatment.

Effectiveness after 12 Weeks

0%

Combination
therapy

0%

CBT
alone

0%

Medication
alone

Longer Term: By 36 weeks of treatment, the response rates for the combined treatment remained the same, but response rates for treatment with medication alone and CBT alone caught up.

Effectiveness after 36 Weeks

0%

Combination
therapy

0%

CBT
alone

0%

Medication
alone

Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., … Kendall, P. C. (2008). Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety. The New England Journal of Medicine, 359(26), 2753–2766. doi:10.1056/NEJMoa080463

The most effective treatments for children with OCD

The definitive, federally funded trial of treatments for children with OCD found that the combination of medication (an SSRI called sertraline, or Zoloft) and cognitive behavior therapy (CBT) has the highest response rate.

12-Week Results

0%

Combination
therapy

0%

CBT
alone

0%

Medication
alone

Is CBT effective for younger children with OCD?

A later study of younger children (ages 5-8) evaluated the effectiveness of family-based CBT involving exposure and response prevention, comparing it to a family-based relaxation treatment that served as a control.

Response Rates at 14 Weeks

0%

Family-based
CBT

0%

Family-based relaxation
therapy

Freeman, J., Garcia, A., Benito, K., Conelea, C., Sapyta, J., Khanna, M., … Franklin, M. (2012). The pediatric obsessive-compulsive disorder treatment study for young children (POTS Jr): Developmental considerations in the rationale, design, and methods. Journal of Obsessive-Compulsive and Related Disorders, 1(4), 294–300. doi:10.1016/j.jocrd.2012.07.010

The most effective treatments for children with depression

The definitive, federally funded clinical trial of treatments for adolescents with depression showed that a combination of antidepressant medication (fluoxetine) and cognitive behavioral therapy (CBT) is more effective than either fluoxetine or CBT alone.

Rate of Improvement After 12 Weeks

0%

Combination
therapy

0%

CBT
alone

0%

Medication
alone

Over time the response rates of all three treatments rose, but the gap between them narrowed.

Rate of Improvement After 36 Weeks

0%

Combination
therapy

0%

CBT
alone

0%

Medication
alone

Treatment for Adolescents With Depression Study (TADS) Team. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) Randomized Controlled Trial. JAMA. 292(7):807-820. doi:10.1001/jama.292.7.807

Do antidepressant medications increase the risk of suicide?

Government studies suggest that SSRIs may increase suicidal thinking and behavior. However, there does not appear to be a link to completed suicide. For example, in a study comparing prescription rates of SSRIs in different counties from 1996 to 1998, suicide rates were lower where prescription rates were higher.

Gibbons R., Hur K., Bhaumik D., & Mann J. (2005). The relationship between antidepressant medication use and rate of suicide. Archives of General Psychiatry. 62(2):165-172. doi:10.1001/archpsyc.62.2.165.

A later study examined the suicide rate after regulators issued public health warnings in the US and the Netherlands.

  • 22% decline in SSRI prescriptions for youths in both countries.
  • 49% increase in youth suicide rate between 2003 and 2005 in the Netherlands.
  • 14% increase in youth suicide rates between 2003 and 2004 in the US, the largest year-to-year change in suicide rates in this population since the CDC began collecting suicide data in 1979.

Gibbons R., Brown C., Hur K., Marcus S., Bhaumik D., Erkens J., Herings R., Mann J. (2007). Early evidence on the effects of regulators’ suicidality warnings on SSRI prescriptions and suicide in children and adolescents. American Journal of Psychiatry. 164(9):1356-63). Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/17728420

The most effective treatment for children with ADHD

Stimulant medication significantly reduces symptoms of ADHD for most kids.

0
%

get a benefit from a single stimulant medication.

Spencer et al (1996). Pharmacotherapy of Attention-Deficit Hyperactivity Disorder Across the Life Cycle. Journal of American Academy of Child and Adolescent Psychiatry, 35(4): 409-32.

0
%

get a benefit when more than one stimulant medication is tried.

Hinshaw, SP and Scheffler, RM (2014. The ADHD Explosion. Oxford University Press; Barkley, R. Treating Children and Adolescents with ADHD: An Overview of Empirically Based Treatments.

The definitive, federally funded 14-month clinical trial of treatments for ADHD showed that:

  • Medication is significantly more effective in reducing ADHD symptoms than behavioral treatment.
  • Adding behavioral treatment to medication does not make it more effective in reducing ADHD symptoms.
  • Combined medication and behavioral treatment worked better to improve related areas of functioning that are problematic for kids with ADHD — oppositionality, anxiety, academic achievement, social skills, parent-child relations.
  • The kids in the combined treatment group were able to take lower doses of medication to see the desired effect than the medication-alone kids.

MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56(12), 1073.

Later evaluations of the kids who had participated in the study, after the 14-month treatment period ended, found that the differences between the groups diminished until they disappeared at 36 months. After the study, participants were in what’s called “community care,” which means that medications are given without the careful monitoring done during the study—and many stopped taking them. The conclusion is that if ADHD medication treatment is to be effective, there has to be an active approach to dosing and use of the meds.

Molina et al (2009). The MTA at 8 Years: Prospective Follow-up of Children Treated for Combined-Type ADHD in a Multisite Study. Journal of the American Academy of Child & Adolescent Psychiatry, 48(5) 484–500.

Does taking stimulant medication for ADHD increase a child’s risk of later substance abuse?

  • Research shows that children with ADHD are more likely than other children to develop substance use disorders.

    Lee, S. S., Humphreys, K. L., Flory, K., Liu, R., & Glass, K. (2011). Prospective Association of Childhood Attention-deficit/hyperactivity Disorder (ADHD) and Substance Use and Abuse/Dependence: A Meta-Analytic Review. Clinical Psychology Review, 31(3), 328–341. doi:10.1016/j.cpr.2011.01.006

  • However, children who are treated with stimulant medication for ADHD are not at higher risk for substance use disorders than those with ADHD who have not taken medications.

    Humphreys, K., Eng, T., & Lee, S. (2013). Stimulant medication and substance use outcomes: A meta-analysis. JAMA Psychiatry, 70(7), 740-749.

Treating Autism

There are three kinds of interventions that have been shown to help children with autism: behavioral interventions to improve communication and cognitive skills, structured educational models that help with learning, and medications that help with problematic behavior.


The American Academy of Child and Adolescent Psychiatry (AACAP) recommends that patients have access to an intervention called Applied Behavioral Analysis, particularly a version called Early Intensive Behavioral Intervention.

ABA techniques have been repeatedly shown to have efficacy for specific problem behaviors, and ABA has also been found to be effective as applied to academic tasks, adaptive living skills, communication, social skills, and vocational skills.

— AACAP

AACAP also says children on the spectrum have benefitted from a structured educational approach with explicit teaching.

Efficacy has been shown for two of the structured educational models, the Early Start Denver Model (ESDM) and the Treatment and Education of Autism and related Communication handicapped Children program (TEACCH).

— AACAP

Medication has also been show to help with behaviors like irritability, aggression, self-injury, and tantrums.

Combining medication with parent training is moderately more efficacious than medication alone for reducing serious behavioral disturbance and modestly more efficacious for adaptive functioning.

— AACAP

Volkmar et al., (2013). AACAP Practice Parameter. Retrieved from: https://www.aacap.org/App_Themes/AACAP/Docs/practice_parameters/autism.pdf