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Mental Disorders and Disabilities Among Low-Income Children (2015)

Chapter: Part II: Clinical Characteristics of Selected Mental Disorders

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Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Part II

Clinical Characteristics of Selected Mental Disorders

The Social Security Administration recognizes 11 different disorders in the mental health category that will qualify families of children and adolescents for disability benefits if they meet the Supplemental Security Income (SSI) program diagnostic or functional criteria. Part II of this report provides background information concerning the clinical characteristics of the mental disorders that most often form the basis for SSI childhood disability benefits. Information about these selected disorders is not comprehensive and is not intended to provide clinical guidance. Rather, the discussion of the clinical characteristics of selected mental disorders in the following chapters is tailored to address the objectives of the committee’s charge, which was to provide information on factors, such as diagnosis, treatment, and prognosis, which influence trends in the numbers of children who qualify for SSI disability benefits. This introduction provides background information relevant for interpretation of the chapters included in Part II of this report.

AGE OF ONSET OF SYMPTOMS VERSUS AGE OF DIAGNOSIS OF SYMPTOMS FOR MENTAL DISORDERS IN CHILDREN

Most mental disorders in children are diagnosed after they reach school age, and in the majority of cases they are not diagnosed for months or often years after the onset of symptoms (NRC and IOM., 2009). The age at which a child is formally diagnosed can vary depending on the mental disorder and on the circumstances in which symptoms of the mental disorder are manifested (e.g., at home, at school, or in a clinical setting).

Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

Conditions such as developmental difficulties, including autism spectrum disorder (ASD) and intellectual disability (ID), are more commonly diagnosed earlier in a child’s life, whereas conditions such as depression more commonly appear and are diagnosed in adolescence. Obtaining mental disorder diagnoses for children is complicated by a number of barriers. These include family recognition of the problem, concern about stigma, limited access to mental health services, costs associated with obtaining a diagnosis, and variations in diagnostic standards.

RISK FACTORS FOR MENTAL DISORDERS IN CHILDREN

Risks and correlates for mental disorders may be genetic, environmental, or a combination of both. These factors may include poverty, childhood trauma and adverse experiences (such as abuse and neglect, or living with an impaired parent), stressful and unstable living conditions, hunger and food insecurity, homelessness, obesity, sleep deprivation, exposure to neurotoxins, chronic illness, reduced access to health care services, adverse school experiences (such as bullying), and substance use. It should be noted that many of these factors are also risk factors for disability and poverty, thereby complicating analyses of risks. They are also factors that can interfere with access to and adherence to treatment for the conditions.

Because many of these factors are more prevalent in socioeconomically disadvantaged families, children living in inner cities and poor rural areas are more vulnerable to acquiring mental disorders and are less likely to be identified and treated at an early stage. Evidence is accumulating from animal and human studies that epigenetic changes to the expression of DNA as the result of stressful life exposures at various points—before conception (to either parent), during pregnancy (to the mother), or after birth (to the child)—can contribute to the risk for mental disorders. Similarly, resilience factors play a role in mental health outcomes. These factors can also be genetic, epigenetic, or environmental; examples include nurturing homes and school success. However, mental disorders generally have no laboratory test or biologic marker to guide diagnosis.

DIAGNOSIS AND CLASSIFICATION OF MENTAL DISORDERS IN CHILDREN

Diagnoses of mental disorders are made by a variety of health professionals. Many children are identified as needing mental health services as the result of an assessment by a child psychologist, psychiatrist, pediatrician, family physician, or counselor. Pediatricians and family medicine physicians are increasingly are making diagnoses such as attention deficit

Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

hyperactivity disorder (ADHD), and they are frequently the individuals who first identify severe behavioral disturbances.

There are no clear measures or standards for assessing the severity of mental disorders. Severity is in part contextual, with some environments and situations aggravating symptoms and interfering with coping. Other, more supportive contexts may reduce the severity and dysfunction of children with specific diagnoses.

Developmental issues may modify presenting manifestations and make diagnosis difficult. In fact, diagnoses may change with age, as the expression of each disorder evolves with a child’s maturation. Symptoms may wax and wane. In addition, the response to treatment varies from one point in a child’s development to another, and from one individual to another. Not infrequently, as the subsequent chapters in this report will attest, a child will have several concurrent or sequential mental diagnoses or may have a mental disorder co-occurring with a physical disorder. Those diagnoses that appear to be the main cause of impairment are usually described as a primary mental disorder and those that co-occur are labeled as secondary disorders.

Diagnoses are usually made using a complex set of criteria, which are set out in a series of manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. There have been multiple versions of the DSM, the most recent being the DSM-5, which was published in 2013 and which was preceded by the DSM-IV-TR (2000), the DSM-IV (1994), the DSM-III-R (1987), and the DSM-III (1980). The sets of criteria vary in substantial ways, and with a new diagnostic standard, changes in diagnostic categories will be encountered. Almost all of the criteria involve both a set of symptoms and some evidence of impairment, although not necessarily the level of impairment that would qualify for designation as severely or moderately impaired according to the SSI definitions. The SSI mental health listings for children are roughly based on the DSM-III. How the subsequent evolution of diagnostic criteria affected SSI determinations is unknown.

In interpreting the available data concerning children with mental health problems, it is important to understand the uses and limitations of a “primary diagnosis.” Diagnostic labels vary depending on their intended use (e.g., clinical, research, or public health). Official systems of diagnosis such as the DSM or the International Classification of Diseases are categorical in nature; either a child does or does not have a particular diagnosis (APA, 2013; WHO, 1992). As a practical matter, clinicians treat the individual and his or her presenting problems rather than the “diagnosis.” Diagnoses are provided to facilitate billing, and in the absence of a definitive laboratory or blood test, the accuracy of the label can vary tremendously. Nevertheless, there are some diagnoses that can be made

Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

more consistently (e.g., ASD, ID) and others that require multiple respondent perspectives (e.g., ADHD) to enhance accuracy. As a result of these issues, the concept of a “diagnosis” needs to be understood as an evolving phenomenon (Jensen and Hoagwood, 1997).

FUNCTIONAL IMPAIRMENT FOR CHILDREN WITH MENTAL DISORDERS

There can be a range of impairments within a diagnosis. For example, the level of impairment may be objectively measured in the case of intellectual disability (e.g., with an IQ test), but the determination will be more subjective in the case of ADHD. It must be noted that to qualify for SSI benefits, every condition or combination of impairments must meet the statutory and regulation-specified level of impairment. Furthermore, it must be emphasized that the prevalence of a diagnosis or condition is not the same as the prevalence of a disability related to that condition. For example, while several studies show that the frequency of ADHD diagnosis has increased in the population, there is simultaneous evidence that the prevalence of disability due to ADHD has decreased (Houtrow et al., 2014).

COMORBIDITY AND CO-OCCURING MENTAL DISORDERS IN CHILDREN

Mental disorders in children very frequently co-occur. The presence of one disorder may predispose the child to other problems. For example, a child with ADHD might also exhibit conduct problems. Similarly, in children with autism there is an increased risk of intellectual disability. Furthermore, in early childhood the impairments caused by speech, language, and communication disorders may not be distinguishable from autism or intellectual disability. Multiple co-occurring diagnoses may make treatment decisions more challenging.

Mental disorders and physical disorders may also co-occur. The high rates of co-occurring mental and physical health conditions with complicated causal connections are well documented, especially in adults (Druss and Walker, 2011). Having a disability increases the risk of mental health problems; and having a mental health disorder increases the risk of having health problems and that a health problem will be disabling (Honey et al., 2010). There are also numerous studies of comorbid physical and mental health problems in children. Data from Canada’s Bergen Child Study show increased rates of emotional and behavioral problems among children with various types of chronic health problems and an increased probability of psychiatric diagnoses (Hysing et al., 2009). Using data from the Neurodevelopmental Genomics Cohort Study, Merikangas and colleagues

Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

found that the prevalence of mental health disorders is higher among children with moderate to severe physical conditions compared to children without physical conditions or with mild physical conditions (Merikangas et al., 2015). Children enrolled in Medicaid with severe mental health problems were significantly more likely to have chronic physical health problems than other children (Combs-Orme et al., 2002). The presence of both physical and mental health problems were found to be negatively associated with general health status and functioning (Combes-Orme et al., 2002). In a study of Florida Medicaid-enrolled children, 35 percent of children with physical disabilities had mental health problems and 42 percent of children with mental health disabilities had other health problems (Boothroyd and Armstrong, 2005). The risk factors for having comorbid physical and mental health problems include poverty and social disadvantage (Honey et al., 2010). These children are at high risk for unmet needs which can further worsen their health and functioning (Boothroyd and Armstrong, 2005).

As noted in Chapter 2, the SSI data on comorbidity are unavailable. For the purposes of SSI determinations—and therefore for the purposes of this report—a single diagnosis is chosen as the primary cause of impairment. When there are multiple diagnoses that contribute to marked impairment, either physical or mental, the condition most easily assessed as meeting the standards of disability in the SSI system is frequently the one that is selected with the diagnosis. Due to the limitations of the SSI data, patterns of comorbidity within the SSI program cannot be assessed and compared to patterns of comorbidity observed in the general population.

LIMITATIONS IN OBTAINING ACCESS TO SERVICES FOR CHILDREN WITH MENTAL DISORDERS

As noted earlier, diagnoses are provided in part to facilitate access to services and billing for these services, as is exemplified by the Medicaid data reviewed in Parts III and IV of this report. However, access to services itself is influenced by a host of factors that are quite independent of diagnosis. These factors include recognition and activation by the parent or caregiver to seek out services, the availability of providers, adequate insurance coverage, and, importantly, the stigma associated with mental disorders. Thus, it is important to note, diagnosis is a necessary but not a sufficient step in improving children’s mental health outcomes.

TREATMENT OF MENTAL DISORDERS IN CHILDREN

The response to treatment is also highly variable for many of the mental disorders. Treatment modalities generally fall into two categories: behavioral therapies and medication. For a number of disorders, the use

Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

of both modalities may be superior to either alone in effecting a beneficial treatment response. There are many psychotropic medications, and, historically, treatment benefits have been identified by trying one or more drugs. A medication’s side effects not infrequently complicate and delay a beneficial response. The ability to predict a response and its timing or durability over time is limited. In cases in which there are benefits to treatment, a major determinant of the treatment outcomes is adherence to the prescribed therapy. Factors that interfere with adherence include the cost of the treatments, a lack of family organizational capacity, and the perception that the drugs produce adverse reactions.

Psychotherapy, including cognitive behavioral therapy, and parental education and therapy are often indicated. However, reimbursement for diagnosis or treatment by public or private third-party payers is often at a level that is not accepted by providers of mental health care, and many families are unable to afford these costs. There are many barriers to full participation in a therapeutic intervention. The mitigation of risk factors is often important for achieving therapeutic benefit, but families with limited resources are often unable to do what is necessary to reduce risk factors. This challenge for socioeconomically disadvantaged families is of particular concern for benefit programs such as the SSI, because the likelihood of improvement is reduced and the mental disorder–caused impairment is less likely to improve.

While effective treatments, as noted above, do exist for the majority of childhood mental disorders, few service providers have been trained to deliver effective and evidence-based services. Consequently, even if a child is diagnosed accurately and his or her family is able to overcome the many barriers to accessing services, the likelihood that he or she will receive an effective and evidence-based service is low. One study summarized this situation as a “20/20/2” problem: About 20 percent of children and adolescents will have a mental disorder during their lifetime; of those only 20 percent will be able to receive mental health care; and of those only 2 percent will receive an evidence-based service (HHS, 1999; New Freedom Commission on Mental Health, 2003; U.S. Public Health Service, 2000). Although actual estimates differ considerably depending on how the data are collected, there is broad consensus that most children are not treated and that, of the children who are treated, most are not receiving evidence-based treatment.

EFFECTS OF MENTAL DISORDERS IN CHILDREN

As a group, children and adolescents with mental disorders fall behind their peers in the areas of school success, social engagement, family integration, personal relationships, and ability to secure employment. Their problems may interfere substantially with family functioning, parental

Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

employment, and the coping ability of siblings. This adverse impact on the family is a barrier to providing for the needs of the child with a mental disorder. As youth move into adulthood, these mental disorders are often a barrier to achieving financial and functional independence. Many of these youth are placed in foster care or end up in the juvenile justice system. Neither system is well equipped to deal with the child’s mental disorder in an optimal fashion. For all of these reasons, many childhood mental disorders are lifetime problems, either recurrently or persistently.

In the general population, approximately half of all children with a psychiatric diagnosis will be free of their initial childhood difficulties by early adulthood, and many may be within the normal range in the areas of health, educational and career achievements, social functioning, and avoidance of criminal or dangerous behavior (Costello and Maughan, 2015). However, many childhood psychiatric disorders lower a young person’s chances of a normal life as an adult. Because these youths are more likely, once they reach adulthood, to experience a recurrence of the same disorder or the onset of a different one, the adult prevalence rate for mental disorders is higher among them than among adults with no psychiatric history. In addition, evidence is beginning to accumulate that, even in those grown youth with no adult diagnosis, having experienced a disorder in childhood or adolescence increases their risk of poor “real-world” outcomes in the areas of educational and work achievement, of conflicts with law enforcement and the legal system, of social isolation and suicidality, and of physical frailty and ill health. Children with high impulsivity have many problem behaviors, and as adults they are more likely to die young (before age 46) than children low on these measures, with the risk for children in the highest quartile of impulsivity and related externalizing behavior more than double that of children in the lowest quartile (Jokela et al., 2009). There are, however, very limited or no specific data on what proportion of children with mental health conditions meet the SSI’s level of impairment in childhood or on what the adult outcomes are for these children. Overall, one would expect their outcomes to be somewhat worse than the outcomes among all children who receive a psychiatric or mental health diagnosis because many of those children would not have met the level of impairment necessary to be eligible for the SSI benefits.

It is still unclear how often the untreated course of a disorder results in an acceptable outcome, e.g., how many adults with a history of childhood mental illness succeed in compensating for the ensuing functional disabilities. More than half of the children with psychiatric disorders identified in epidemiologic studies have received no specialty mental health care (Burns et al., 1995, 1997; Merikangas et al., 2010, 2011).

Environmental and contextual factors can have a significant effect on the identification, expression, and outcome of mental disorders in children.

Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

Adverse conditions can exacerbate and worsen outcomes for children; however, appropriate treatment and supports such as the SSI benefits enhance a child’s opportunity to succeed in school, participate in the community, and live a healthy life (Costello et al., 2010).

REFERENCES

APA (American Psychiatric Association). 2013. Diagnostic and statistical manual of mental disorders, 5th edition. Washington, DC: APA.

Boothroyd, R. A., and M. I. Armstrong. 2005. Comorbidity and unmet service needs among Medicaid-enrolled children with identified disabilities. Journal of Emotional and Behavioral Disorders 1(13):43–51.

Burns, B. J., E. J. Costello, A. Angold, D. Tweed, D. Stangl, E. M. Z. Farmer, and A. Erkanli. 1995. Childrens mental health service use across service sectors. Health Affairs 14(3):147–159.

Burns, B. J., E. J. Costello, A. Erkanli, D. L. Tweed, E. M. Z. Farmer, and A. Angold. 1997. Insurance coverage and mental health service use by adolescents with serious emotional disturbance. Journal of Child and Family Studies 6:89–111.

Combes-Orme, T., C. A. Heflinger, and C. G. Simpkins. 2002. Comorbidity of mental health problems and chronic health conditions in children. Journal of Emotional and Behavioral Disorders 10(2):116–125.

Costello, E. J., and B. Maughan. 2015. Optimal outcomes of child and adolescent mental illness. Journal of Child Psychology and Psychiatry 56:3324–3341.

Costello, E. J., A. Erkanli., W. Copeland, and A. Angold. 2010. Association of family income supplements in adolescence with development of psychiatric and substance use disorders in adulthood among an American Indian population. JAMA 303(19):1954–1960. doi: 10.1001/jama.2010.621.

Druss, B. G., and E. R. Walker. 2011. Mental disorders and medical comorbidity. The Synthesis Project: Research Synthesis Report (21):1–26.

HHS (U.S. Department of Health and Human Services). 1999. Mental health: A report of the Surgeon General. Rockville, MD: HHS, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

Honey, A., E. Emerson, G. Llewellyn., and M. Kariuki. 2010. Mental health and disability. In International Encyclopedia of Rehabilitation, edited by J. H. Stone and M. Blouin. http://cirrie.buffalo.edu/encyclopedia/en/article/305 (accessed on July 15, 2015).

Houtrow, A. J., K. Larson, L. M. Olson, P. W. Newacheck, and N. Halfon. 2014. Changing trends of childhood disability, 2001–2011. Pediatrics 134(3):530–538.

Hysing, M., I. Elgen., C. Gillberg., and A. J. Lundervold. 2009. Emotional and behavioural problems in subgroups of children with chronic illness: results from a large-scale population study. Child: Care, Health and Development 35(4):527–533.

Jensen, P. S., and K. Hoagwood. 1997. The Book of Names: DSM-IV in Context. Development and Psychopathology 9(2):231–249.

Jokela, M., J. Ferrie, and M. Kivimäki. 2009. Childhood problem behaviors and death by midlife: The British National Child Development Study. Journal of the American Academy of Child and Adolescent Psychiatry 48(1):19–24.

Merikangas, K. R., J. P. He, D. Brody, P. W. Fisher, K. Bourdon, and D. S. Koretz. 2010. Prevalence and treatment of mental disorders among U.S. children in the 2001–2004 NHANES. Pediatrics 125(1):75–81.

Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

Merikangas, K. R., J. P. He, M. Burstein, J. Swendsen, S. Avenevoli, B. Case, K. Georgiades, L. Heaton, S. Swanson, and M. Olfson. 2011. Service utilization for lifetime mental disorders in U.S. adolescents: Results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry 50(1):32–45.

Merikangas, K. R., M. E. Calkins, M. Burstein, J. P. He, R. Chiavacci, T. Lateef, K. Ruparel, R. C. Gur, T. Lehner, H. Hakonarson, and R. E. Gur. 2015. Comorbidity of physical and mental disorders in the neurodevelopmental genomics cohort study. Pediatrics 135(4): e927–e938.

New Freedom Commission on Mental Health. 2003. Achieving the promise: Transforming mental health care in America. Final report. DHHS Pub. No. SMA-0303832. Rockville, MD: HHS.

NRC and IOM (National Research Council and Institute of Medicine). 2009. Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: The National Academies Press.

U.S. Public Health Service. 2000. Report of the Surgeon General’s Conference on Children’s Mental Health: A national action agenda. Washington, DC: HHS.

WHO (World Health Organization). 1992. The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Geneva: WHO.

Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×

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Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
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Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
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Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
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Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
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Suggested Citation:"Part II: Clinical Characteristics of Selected Mental Disorders." National Academies of Sciences, Engineering, and Medicine. 2015. Mental Disorders and Disabilities Among Low-Income Children. Washington, DC: The National Academies Press. doi: 10.17226/21780.
×
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Children living in poverty are more likely to have mental health problems, and their conditions are more likely to be severe. Of the approximately 1.3 million children who were recipients of Supplemental Security Income (SSI) disability benefits in 2013, about 50% were disabled primarily due to a mental disorder. An increase in the number of children who are recipients of SSI benefits due to mental disorders has been observed through several decades of the program beginning in 1985 and continuing through 2010. Nevertheless, less than 1% of children in the United States are recipients of SSI disability benefits for a mental disorder.

At the request of the Social Security Administration, Mental Disorders and Disability Among Low-Income Children compares national trends in the number of children with mental disorders with the trends in the number of children receiving benefits from the SSI program, and describes the possible factors that may contribute to any differences between the two groups. This report provides an overview of the current status of the diagnosis and treatment of mental disorders, and the levels of impairment in the U.S. population under age 18. The report focuses on 6 mental disorders, chosen due to their prevalence and the severity of disability attributed to those disorders within the SSI disability program: attention-deficit/hyperactivity disorder, oppositional defiant disorder/conduct disorder, autism spectrum disorder, intellectual disability, learning disabilities, and mood disorders. While this report is not a comprehensive discussion of these disorders, Mental Disorders and Disability Among Low-Income Children provides the best currently available information regarding demographics, diagnosis, treatment, and expectations for the disorder time course - both the natural course and under treatment.

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