National Survey Tracks Rates of Common Mental
Disorders Among American Youth

Only about half of American children and teenagers who have certain mental disorders receive professional services, according to a nationally representative survey funded in part by the National Institute of Mental Health (NIMH). The survey also provides a comprehensive look at the prevalence of common mental disorders.

The results are part of the National Health and Nutrition Examination Survey (NHANES), a collaboration between NIMH and the National Center for Health Statistics of the Centers for Disease Control and Prevention. The survey conducted from 2001 to 2004 had 3,042 participants. These most recent results include data from children and adolescents ages 8 to 15, and were published online ahead of print December 14, 2009, in the journal Pediatrics.

“Data on the prevalence of mental disorders among U.S. youth have been varied, making it difficult to truly understand how many children and teens are affected,” said NIMH Director Thomas R. Insel, M.D. “These data from the NHANES survey can serve as an important baseline as we follow trends of mental disorders in children.”

In the study, the young people were interviewed directly. Parents or caregivers also provided information about their children’s mental health. The researchers tracked six mental disorders—generalized anxiety disorder (GAD), panic disorder, eating disorders (anorexia and bulimia), depression, attention deficit hyperactivity disorder (ADHD) and conduct disorder. The participants were also asked about what treatment, if any, they were receiving.

Overall, 13 percent of respondents met criteria for having at least one of the six mental disorders within the last year. About 1.8 percent of the respondents had more than one disorder, usually a combination of ADHD and conduct disorder. Among the specific disorders,

• 8.6 percent had ADHD, with males more likely than females to have the disorder;
• 3.7 percent had depression, with females more likely than males to have the disorder;
• 2.1 percent had conduct disorder;
• 0.7 percent had an anxiety disorder (GAD or panic disorder);
• 0.1 percent had an eating disorder (anorexia or bulimia).

“With the exception of ADHD, the prevalence rates reported here are generally lower than those reported in other published findings of mental disorders in children, but they are comparable to other studies that employed similar methods and criteria,” said lead author Kathleen Merikangas, Ph.D., of NIMH.

Those of a lower socioeconomic status were more likely to report any disorder, particularly ADHD, while those of a higher socioeconomic status were more likely to report having an anxiety disorder. Mexican-Americans had significantly higher rates of mood disorders than whites or African-Americans, but overall, few ethnic differences in rates of disorders emerged.

Merikangas and colleagues also found that overall, 55 percent of those with a disorder had consulted with a mental health professional, confirming the trend of an increase in service use for childhood mental disorders, especially ADHD. However, only 32 percent of youth with an anxiety disorder sought treatment, a finding consistent with other studies. Moreover, African-Americans and Mexican-Americans were significantly less likely to seek treatment than whites, reiterating the need to identify and remove barriers to treatment for minority youth, noted the researchers.

“Until now, there has been a dearth of reliable data on the magnitude, course and treatment patterns of mental disorders among U.S. youth,” said Dr. Merikangas. “When combined with data from other nationally representative surveys, the data will provide a valuable basis for making decisions about health care for American youth,” she concluded.

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What Conditions Can Coexist with ADHD?

Some children with ADHD also have other illnesses or conditions. For example, they may have one or more of the following:

• A learning disability. A child in preschool with a learning disability may have difficulty understanding certain sounds or words or have problems expressing himself or herself in words. A school-aged child may struggle with reading, spelling, writing, and math.
• Oppositional defiant disorder. Kids with this condition, in which a child is overly stubborn or rebellious, often argue with adults and refuse to obey rules.
• Conduct disorder. This condition includes behaviors in which the child may lie, steal, fight, or bully others. He or she may destroy property, break into homes, or carry or use weapons. These children or teens are also at a higher risk of using illegal substances. Kids with conduct disorder are at risk of getting into trouble at school or with the police.
• Anxiety and depression. Treating ADHD may help to decrease anxiety or some forms of depression.
• Bipolar disorder. Some children with ADHD may also have this condition in which extreme mood swings go from mania (an extremely high elevated mood) to depression in short periods of time.
• Tourette syndrome. Very few children have this brain disorder, but among those who do, many also have ADHD. Some people with Tourette syndrome have nervous tics and repetitive mannerisms, such as eye blinks, facial twitches, or grimacing. Others clear their throats, snort, or sniff frequently, or bark out words inappropriately. These behaviors can be controlled with medication.

ADHD also may coexist with a sleep disorder, bed-wetting, substance abuse, or other disorders or illnesses.

Provided by NIMH

Thomas E. Brown, Ph.D, is an assistant clinical professor of Psychiatry at the Yale University School of Medicine and the associate director of the Yale Clinic for attention and Related Disorders.

An expert on Attention deficit/Hyperactivity Disorder, Dr. Brown has presented papers, workshops and symposia at professional meetings throughout the world. Dr. Brown’s award winning website can be found at: www.drthomasebrown.com

Russell Barkley, Ph.D., discusses the recent advancements in understanding the nature and subtyping of ADHD as well as recent discoveries in what might cause the disorder and medications that might help treat ADHD.

by Thomas E. Brown, Philipp C. Reichel, Donald M. Quinlan, Yale University School of Medicine

Journal of Attention Disorders Online First, published on May 6, 2009 as doi:10.1177/1087054708326113

Objectives:

To demonstrate that high IQ adults diagnosed with ADHD suffer from executive function (EF) impairments that: a) can be identified with a combination of standardized measures and self-report data; and b) occur more commonly in this group than in the general population. Method: 157 ADHD adults with IQ ≥ 120 were assessed with 8 normed measures of EF– 3 index scores from standardized tests of memory and cognitive abilities, and 5 subscales of a normed self report measure of EF impairments in daily life. Results: 73% of subjects were significantly impaired on ≥ 5 of these 8 EF markers. On all 8 measures, incidence of these impairments was significantly greater than in the general population.

Conclusion:

High IQ adults with ADHD tend to suffer EF impairments that can be assessed with these measures; incidence of such impairments in this group is significantly higher than in the general population.

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