youths receive care from school personnel, juvenile justice officers, nurses, and pediatricians. We desperately need students to devote their careers to providing specialized mental health services to children and adolescents, either by delivering evidence-based treatment themselves or by removing sociocultural barriers to families’ access to high-quality care.
The Use of Medication
One of the greatest changes in the field of abnormal child psychology in the past 2 decades has been the increased use of psychotropic medication—that is, prescription medication used to treat behavioral, cognitive, or emotional problems. Approximately 7.5% of all school-age children and adolescents are taking at least one psychotropic medication at any point in time (Howie, Pastor, & Lukacs, 2014; Jonas, Gu, & Albertorio-Diaz, 2013).
The use of psychotropic medication varies as a function of children’s age (Figure 1.3). Medication is more frequently prescribed to adolescents than to prepubescent children. The greater use of psychotropic medication among adolescents likely reflects the greater overall prevalence of mental health problems in adolescents compared to younger children. Furthermore, adolescents’ mental health problems tend to be more severe and, consequently, may be more likely to require medication. Although young children are less likely to be prescribed medication than older children and adolescents, approximately 2% of preschoolers are taking at least one medication to manage a mental health problem (Chirdkiatgumchai et al., 2013; Fontanella, Hiance, Phillips, Bridge, & Campo, 2014).
Medication use also varies by gender. Regardless of age, boys are more likely to receive medication for psychological problems than girls. This gender difference in medication use reflects the fact that boys are approximately 3 times more likely than girls to be diagnosed with ADHD and to receive medication for that condition.
The percentage of youths receiving medication to treat psychological problems has more than doubled over the past 20 years. Interestingly, the percentage of children participating in psychotherapy, a nonmedicinal treatment, has remained relatively stable during this same time period (Olfson, Blanco, Wang, Laje, & Correll, 2014; Olfson, He, & Merikangas, 2013).
Two factors seem to be driving the overall rise in the use of psychotropic medication among children and adolescents. First, clinicians are getting better at recognizing mental disorders in youths. Second, physicians have more medication options for children now than 2 decades ago (Bowers, Weston, Mast, Nelson, & Jackson, 2020).
Interestingly, not all types of psychotropic medications have shown the same increase in popularity. Medications used to treat ADHD, such as Ritalin and Adderall, showed a dramatic increase in the past 2 decades. In contrast, medications used to treat anxiety disorders (i.e., anxiolytics) and thought disorders like schizophrenia (i.e., antipsychotics) have increased at a slower pace. Only one class of medication for children and adolescents has declined in popularity: antidepressants. In the 1990s, physicians began prescribing antidepressant medications, like Prozac, to youths with depressive symptoms. In 2004, however, the US Food and Drug Administration (FDA) issued a warning to physicians that youths prescribed antidepressants were significantly more likely to experience suicidal thoughts (4%) than youths with depression who took placebo (2%). Because of this warning, antidepressant prescriptions declined. Today, antidepressants are usually reserved for youths who show more serious depressive symptoms and who are not showing adequate improvement in psychotherapy (Friedman, 2014).
Figure 1.3 ■ Medication Use by Children and Adolescents
Note: Approximately 7.5% of youths use psychotropic medications at any point in time. Boys are more likely to use medication than girls and adolescents are more likely to use medication than prepubescent children (Howie et al., 2014).
Is medication overprescribed? To answer this question, researchers examined psychological problems and medication use in a large, nationally representative sample of adolescents (Merikangas & He, 2014). In the previous year, approximately 40% of adolescents experienced a mental health problem. However, only 14.2% of adolescents with mental health problems were prescribed medication. These findings challenge the widespread belief that psychotropic medication is overprescribed to youths. On the contrary, many children and adolescents who might benefit from medication never receive it.
Barriers to Treatment
Researchers and policy experts have identified several barriers to families’ access to high-quality mental health treatment (Garland et al., 2013; Santiago, Kaltman, & Miranda, 2013). First, economic barriers can limit children’s access to treatment. Psychotherapy, medication, and other forms of treatment can be expensive. Even families with private health insurance may be limited in the duration or type of treatment they can receive. Low-income families may face the additional challenge of obtaining treatment from a public social service system that is often overburdened and underfunded. Low-income parents also face practical barriers to treatment, such as finding time off work, transportation to and from sessions, and childcare for their other children.
Second, social–cultural factors might decrease a family’s willingness to participate in therapy. For example, some ethnic minority families may perceive psychological treatment to be ineffective or irrelevant to their immediate concerns. Instead of seeking psychotherapy or counseling, these families might consult with physicians, clergy, or elders in their community for treatment, advice, or support. Other parents from culturally diverse backgrounds might view therapies developed primarily for White, middle-class families as inapplicable to them. For example, some parents might disagree with therapists’ recommendation to avoid spanking children when they misbehave. Still other parents may be unable to find therapists who can communicate in their language (American Psychological Association, 2017b).
Even if families are able and willing to participate in treatment, they may be unable to find high-quality mental health services. As we will see, evidence-based mental health treatments are not available in many communities. For example, multisystemic therapy is an effective treatment for older adolescents with serious conduct problems. Many well-designed studies have shown multisystemic therapy to reduce adolescents’ disruptive behavior problems, improve their social and academic functioning, reduce their likelihood of arrest and incarceration, and save the community money (Dopp, Borduin, Wagner, & Sawyer, 2014; van der Stouwe, Asscher, Stams, Deković, & van der Laan, 2014). However, few clinicians are trained in providing multisystemic therapy, and it is available in only a small number of communities.
Third, there are simply not enough experts in child and adolescent mental health to satisfy the need for services. Our current mental health system is able to address the needs of only about 10% of all youths with psychological problems. Furthermore, only 63% of counties in the United States have a mental health clinic that provides treatment for children and adolescents (Cummings, Wen, & Druss, 2013). Youths who receive treatment are typically those who show the most serious distress or impairment. Youths with less severe problems, such as moderate depression, mild learning disabilities, or unhealthy eating habits, often remain unrecognized and untreated until their condition worsens. Inadequate mental health services are especially pronounced in disadvantaged communities.
Finally, stigma can interfere with children’s access to mental health treatment (O’Driscoll, Heary, Hennessy, & McKeague, 2012). Stigma refers to negative beliefs about individuals with mental disorders that can lead to fear, avoidance, and discrimination by others or shame and low self-worth in oneself (Corrigan, Bink, Schmidt, Jones, & Rüsch, 2016). Stigmatization of mental illness comes in many forms. During casual conversation, people use terms like crazy, wacked, nuts,
