The Wall Street Journal
* JUNE 1, 2010
By SHIRLEY S. WANG
Pediatricians should screen children for possible mental health issues at every doctor visit, according to new, extensive recommendations a national pediatrician group issued Tuesday.
These doctors also should develop a network of mental-health professionals in the community to whom they can send patients if they suspect a child needs further evaluation, according to the task force on mental health convened by the American Academy of Pediatrics. The recommendations were made in a series of reports published in a supplement to the journal Pediatrics.
In recent years, pediatricians and mental health professionals have been calling for increased attention to mental health in primary-care settings because of growing rates of disorders in children such as attention-deficit hyperactivity disorder, autism and anxiety.
At the same time, there is a shortage of child mental-health experts, particularly psychiatrists. While 21% of U.S. children and adolescents have a diagnosable mental illness, only one-fifth of that group receives treatment, according to the academy.
"You can't be in community practice and not see kids who come in regularly with depression, anxiety, etc.," says James Perrin, a task force member and pediatrics professor at Harvard Medical School. "You can't say, 'Not my problem.'"
The new recommendations are more extensive and detailed than previous ones. In 2009, the pediatricians group called for more training and more attention to mental health concerns, and fewer barriers to collaborating with mental-health specialists. Now, it is recommending that pediatricians systematically ask the parent or child at every visit about how the child is getting along with other kids their age and whether they are happy.
In addition, at certain critical ages where disorders may become noticeable—such as 18 months and 2 years for autism, a condition characterized by social impairment and language problems—pediatricians should go through a more-detailed checklist of symptoms designed to give them a sense of whether "I need to be more or less worried about this child," Dr. Perrin says.
Increasing evidence suggests children fare better if they receive early intervention for behavioral and mental-health problems. And if parents have regular conversations with pediatricians about mental health from the time their children are young, they may feel more comfortable bringing up future concerns, making the pediatricians' office "user-friendly for kids' mental health issues," Dr. Perrin says.
David Fassler, a child and adolescent psychiatrist in Burlington, Vt., and treasurer at the American Psychiatric Association, who wasn't involved in the new recommendations, calls the report "helpful and comprehensive." Implementation will be a challenge, he says. Doctors' time with patients is limited, and some pediatricians don't have much mental-health expertise.
The pediatrics academy plans to add screening measures to their website to help pediatricians with evaluation. "If we really want pediatricians to focus more time and attention on the mental-health needs of children and adolescents, we need to ensure that they have appropriate training, adequate reimbursement and timely access to consultation and ongoing treatment for their patients," Dr. Fassler said in an email.
Alain LeGuillou, a private-practice pediatrician in Larchmont, N.Y., says he thinks it's important and feasible to identify which children need further evaluation for mental-health concerns. He aims to refer them to specialists as soon as possible and is expanding his network with mental-health professionals in the community. "We don't have to wait to have a perfect diagnosis," said Dr. LeGuillou, who has been a pediatrician for 15 years. "As soon as we see a milestone that's off, a behavior that's changing or some parenting that's inappropriate, then I tend to refer quickly."