State of Child Mental Health 2014: Are Things Really So Bad?

"‘Cause the good ole days weren’t always good, and tomorrow ain’t as bad as it seems."
– Billy Joel, Keeping the Faith

From the popular press, it is easy to get the impression that children and adolescents are struggling more than ever. Between recent mass shootings, bullying induced suicide, so many arrests of child pedophiles, and astonishing statistics of child screen time, things can sound quite bleak for our newest generation. Even the mental health system designed to help these folks has been under intense fire, either for being completely inaccessible or for being too accessible to the point that every child who whines gets put on a medication.

These are legitimate concerns, but perhaps a longer perspective might be helpful for some context regarding how levels of problems now compare to the past. Good statistics have not been available for that long, but what we do know may be surprising to many.

Suicide. The rate of completed youth suicides (many mental health professionals now try to stay away from the phrase “successful” suicide for obvious reasons) has been steadily declining. The incidence rose steeply, especially for males, from the 1960s until the early 1990s and has been coming down ever since, according to the Centers for Disease Control (CDC).

Teen Pregnancy Rates. According to the government’s Office of Adolescent Health, the teen pregnancy rate among adolescent females has been cut in half from 1990 to 2012, across many different ethnic groups.

Delinquency. The number of youth who are incarcerated have dropped from a high of 381 per 100,000 in 1995 to 225 per 100,000 in 2010 according to a report by the Annie E. Casey Foundation.

Substance Use. The rate of smoking in teens is at an all-time low, according to the Monitoring the Future study that has surveyed substance use for decades. Cannabis use is also down from peaks in the 1970s, although has been trending up lately. Alcohol use in teens is also at historic lows, according to the National Institute of Drug Abuse.

Psychiatric Disorders. As has been well covered in many areas, including this blog, there have been significant increases in the rates of many psychiatric disorders, including ADHD, autism, and bipolar disorder. What is less clear, however, is the degree to which these numbers reflect an actual increase in behavior, higher detection rates, or even a lowering of the diagnostic threshold. A study by Achenbach and coworkers that looked at quantitative levels of child behavior problems using the same instrument over a 23 year time span found some increases in overall levels from the 1970s to the early 1990s but then levels began to fall by the end of the millennium.

Child Abuse and Bullying. Reports from the Crimes Against Children Research Center shows a steady decrease in the rate of child abuse since the early 1990s, particularly physical and sexual abuse as well as violent victimization at school. The reports utilize government data from the National Child Abuse and Neglect Data System.

Nobody should interpret this post as my belief that we don’t have serious problems to confront today in child mental health, but compared to other time periods (particularly the early 1990s for some reason), kids today are really not behaving that horribly and now doesn’t look like a horrible time to be a kid.

Reference

Achenbach, T.M., Dumenci, L., & Rescorla, L.A. (2003). Are American children's problems still getting worse? A 23-year comparison. Journal of Abnormal Child Psychology, 31, 1-11.

@copyright by David Rettew, MD

Image courtesy of John Churchman and www.brickhousestudios.com

David Rettew is author of Child Temperament: New Thinking About the Boundary Between Traits and Illness and a child psychiatrist in the psychiatry and pediatrics departments at the University of Vermont College of Medicine.

Follow him at @PediPsych and like PediPsych on Facebook.