Mental health treatment for kids – the role of pediatricians

Only 20 – 25 percent of children with mental disorders receive treatment, according to the U.S. Surgeon General. One reason is pediatricians don’t do as much as they could to spot problems early and connect children to treatment.

Only 20 – 25 percent of children with mental disorders receive treatment, according to the U.S. Surgeon General. One reason is pediatricians don’t do as much as they could to spot problems early and connect children to treatment. The American Academy of Pediatrics is now calling on its members to step up their efforts. (Photo: Flickr/MR38)

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The field of pediatrics has become good at reducing infectious disease and infant mortality. But today, pediatricians are being asked to pay more attention to children’s behavioral and mental development:

Berger: I think that pediatricians are truly the first line of defense, we’re the ones that parents are going to call first.

Eric Berger of Philadelphia’s Center City Pediatrics says parents are worried about disorders like ADHD, autism or anxiety:

Berger: Is the child learning to speak appropriately, is the child’s social interaction appropriate?

But pediatricians often prove to be poor sentries when it comes to mental health. A new joint report from the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry urges pediatricians to play a more active role in diagnosing and intervening with children who show signs of mental disorders.

Dr. Thomas McInerney, a lead author of the report, says pediatricians should approach mental health problems as they do other maladies, such as asthma or an upset stomach:

McInerney: In many cases the pediatrician is able to make diagnosis and do the treatment for children with mild to moderate conditions in medical disorders, and very similar could do the same thing for children with mental disorders as well.

This could be done in collaboration with a specialist, says McInerney.

Several obstacles stand in the way of this approach: a lack of training, a lack of slots for referrals and, importantly, a lack of reimbursement for the extra effort. Eric Berger knows this from experience:

Berger: A large portion of our patients have capitated insurances, that means that we are going to get paid the same $10 or $15 per month per patient whether we spend hours on the phone with them talking about different behavioral developmental problems or whether we see them once a year.

The money issue, combined with lack of training, can lead some pediatricians to downplay a child’s developmental challenges – even when there is cause for concern:

Clarke: saying things like, oh, he’ll grow out of it, or she’ll grow out of it, I wouldn’t worry about it too much right now…

Dr. Ann Marie Clarke is a corporate officer at SPIN, “Special People in Northeast”– which provides treatment for
people with disabilities. She says by the time she gets to see kids, their problems are often deep.

Clarke: The way the system is set up right now, a number of children don’t get services until their problems get to be so severe that they qualify for a diagnosis

And getting that diagnosis can be a daunting challenge. Pediatric mental health specialists are overrun with requests for appointments. Bob Mancuso of New Jersey says local hospitals quoted him wait times of up to 16 months when he wanted to have his son tested for autism.

Mancuso: Some advocates in the community told my wife to try calling in and crying, so we did that too, still couldn’t get in.

So the Mancusos ended up going “out of network” to get their son tested – and paid a large sum to do so. Only then did they get help dealing with his autism.

Eric Berger says pediatricians refer too many kids to specialists, instead of dealing with early signs and symptoms themselves.

Berger: So we end up creating a bottleneck for these providers where you have wait lists for two years often for kids that need help right away.

To get pediatricians more involved, The American Academy of Pediatrics has developed recommendations about improving screening, as well as training and insurance reimbursements.

Meanwhile, it’s been more than two years since the Mancusos first put their son’s name on waiting lists for evaluation. It’s good they didn’t wait for those call backs. Because none ever came.