select search filters
briefings
roundups & rapid reactions
before the headlines
Fiona fox's blog
Reactions to a report on the currents trends in child mental health as published by NHS Digital.
Professor Tamsin Ford, Royal College of Psychiatrists, said:
“Some neurodevelopmental problems begin very early so some children age 2-4 did meet criteria for Autism Spectrum conditions and a few for ADHD.
“Behaviour disorders in this age group means extreme temper tantrums & severe disobedience- they had to be developmentally inappropriate, severe & persistent with evidence of distress or impairment to warrant a diagnosis.
“You would not expect this age group to experience depression- it is rare in primary school age children although rates climb rapidly through adolescence.
“But some do experience anxiety- particularly around separations from care givers – while not wanting to leave much on starting school or play group is normal at its most severe children cannot bear to be in a different room – so when it severely restricts the child’s experience of the world it becomes a clinical problem. We also assess feeding and sleeping problems which were similarly severe if a diagnosis was assigned.
“Most stroppy toddlers have good days & the terrible twos are short lived – for ODD (oppositional defiant disorder) you have severe problems (in number, at least 4 types of challenging behaviour) sustained over 6 months & causing distress or impact – so severity, persistence & impact.
“School age children have been surveyed before using the same measures – this shows a small increase in emotional disorders while ADHD and behaviour disorders occurred at similar rates. There are no comparable data on 2-4 year olds.”
Prof Andrea Danese, Professor of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King’s College London, said:
“The survey provides the best available data on prevalence and trends in mental health disorders in English children and adolescents. This is because, in contrast with other surveys, it assesses the prevalence of psychiatric disorders in the population as opposed to the prevalence of broader and less meaningful measures of distress or dissatisfaction. Furthermore, comparable assessment was undertaken in 5 to 15 year olds in 1999 and 2004 providing an opportunity to detect changes in the prevalence of psychiatric disorders over time. The survey also measure the risk and functional impairment associated with mental health disorders as well as the support provided by professionals.
“The findings are broadly consistent with similar data from British research cohorts of young people (e.g., ALSPAC Study; E-Risk Longitudinal Twin Study) and strengthen the notion that more than 1 in 10 young people (12.8%) meet criteria for a psychiatric disorder at any point in time. Among psychiatric disorders, emotional disorders (anxiety disorders, depressive disorders, and mania and bipolar affective disorder) showed the highest prevalence (8.1%). The survey also reveals that the overall prevalence of psychiatric disorders has increased only slightly in the past 12 years (1.5 percentage point), largely due to an increase in the prevalence of emotional disorders in both boys and girls. As in previous research, mental health disorders in modern England appear to be concentrated among children and young people who live in disadvantage socioeconomic conditions and experienced violence victimisation. Of note, mental health disorders, and particularly emotional disorders, were associated with much higher risk of self-injurious thoughts and behaviours (25.5% of 11 to 16 year olds with a disorder reported self-harm or suicide attempt compared to 3% of those without a disorder). Mental disorders were also associated with much higher risk of school exclusion (6.8% children with a disorder compared to 0.8% of those without a disorder). These findings highlight the significant burden of mental health disorders, and particular emotional disorders, in children and adolescents. The survey shows that these disorders are associated with significant distress, risk, and impairment in functioning among young people. Therefore, it is vital to support more research on the causes and treatments of these disorders.
“The survey shows that 1 in 2 young people with a mental health disorder had contact with teachers because of worries about mental health. However, only 1 in 5 young people with a mental health disorder had contact with a specialist mental health professional in a position to diagnose and treat the disorder, often only after a long waiting time. These findings make the case for an urgent need to increase funding to support recognition and treatment of these conditions – both within school and in child and adolescent mental health services (CAMHS).”
“There are some important differences in the assessment of pre-schoolers vs older children and adolescents. Crucially, the assessment is based solely on reports from parents rather than join parent / teachers’ reports or self-reports of adolescents. Furthermore, the measures used in pre-schoolers mainly capture behavioural (e.g., oppositional-defiant disorder) and neurodevelopment problems (e.g., autism spectrum disorder) rather than emotional disorders. Most of the diagnoses in pre-schoolers in this survey are accounted for by children with behavioural problems, neurodevelopment disorders, and other problems (e.g., sleeping disorder, feeding disorder, toileting disorder).
“Oppositional defiant disorder is a descriptive diagnosis characterised by temper outbursts, arguing with adults, disobedience, deliberately annoying others, passing on blame, being easily annoyed, resentful, spiteful and vindictive. Its use is in improving communication between professionals and planning treatment rather than identifying an homogeneous and biologically distinct disorder of the brain.
“The prevalence in this survey provides a lower bound of the variation because of several reasons. For example, the survey only had responses from 52% of young people they targeted, and we know from previous research that those who take part in such cross-sectional surveys tend to be, on average, healthier than those who do not; the survey only captured psychopathology at the time of assessment, and many young people with episodic conditions (including several emotional disorders) who might have met criteria for diagnosis in the recent past but not at the time of assessment would have not been captured. As such, the actual prevalence of psychopathology in the population of young people may likely be higher, possibly closer to 1 in 3 in older adolescents, as has been reported in longitudinal studies.”
Professor Terrie Moffitt, Chair in Social Behaviour & Development, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King’s College London, said:
“It’s important to understand that the absolute percentages of young people with disorders should be viewed with scepticism. These percentages should only be viewed as a lower bound. This is for several reasons.
“First, because only 52% of the families recruited agreed to take part. Studies with higher participation rates tend to also find higher prevalence rates of mental disorder.
“Second, because this is a one-off survey, in which people are asked about symptoms of mental illness after having just met the interviewer. Longitudinal studies, which interview families repeatedly over the years and win their trust and confidence, tend to find higher rates of mental disorders.
“Third, I was unable to find the length of the reporting period in the documents, but the percentage of children with disorder obviously must depend on the length of reporting period. The percentage of children having symptoms today is smaller than the percentage for the past month or the last six months, or the past year. Reporting period is a key bit of information.
“Fourth, this study is still diagnosing disorders as categories, as if each child either is sick or totally healthy. This is done in order to make the comparison back to 1999.
“However, other modern research in mental health has moved on to acknowledge that symptoms of mental disorders are found on a continuum in the population. This means that there are large percentages of children who had many symptoms and were not fully healthy, but who fell short of the cut-off count to meet the study’s diagnostic criteria. These children who are just under the cut-off are known to be at very high risk of developing a full impairing disorder in the near future. For these reasons, the prevalence rates reported will be under-counts, and they underestimate the size of the problem for Britain.
“That said, it is perfectly alright to use the percentages to make comparisons within the study. For example, comparing rates against prior years’ rates is legitimate, and shows a slight increase in problems of anxiety and depression. Also, comparing ethnic groups shows that white children in Britain have three times higher rates of disorder as compared to non-white groups. These are the statistics in the report that warrant public discussion.”
Dr Dennis Ougrin, Consultant Child and Adolescent Psychiatrist and Clinical Senior Lecturer, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King’s College London, said:
“There is an overall increase in the prevalence of mental disorders but not as large as many have predicted.
“The increase is almost entirely explained by an increase in the prevalence of emotional disorders, especially in girls.
“The gap between the mental health of white British children and other ethnic groups is widening.
“Children with mental disorders are heavier users of social media and are affected by the social media more significantly, than the children without mental disorders.
“The proportion of children with emotional disorders who report self-harm has increased substantially from 28% in 2004 to 34% in 2017. This could explain the overall increase in self-harm.”
“Including 2-4 year olds is a very useful addition that will hopefully highlight the importance of an early diagnosis as the issue here is that many disorders, such as Autism Spectrum Disorder, manifest themselves very early in life.”
Dr Michael Bloomfield, UCL Excellence Fellow, Translational Psychiatry Research Group Head and Honorary Consultant Psychiatrist, UCL, said:
“The reasons underlying increased rates of mental disorders in young people over the past twenty years are going to be complex, and this appears to be driven by increasing rates of emotional disorders. Adolescence is a critical period for a person’s development, particularly as our brains go through important changes during our teenage years. Since prevention is better than cure, it is really important for all of us in society to understand together why this is and start reducing the rates of mental disorders in young people. It is also important to highlight that child and adolescent mental health services up and down the country have received cut after cut to their resources in recent years. Young people experiencing mental disorders must have timely access to evidence-based psychiatric care which can include psychological and family therapies.”
Professor Craig Morgan, Professor of Social Epidemiology and Head of Department, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King’s College London, said:
“It is perhaps surprising, given the social changes in the past 13 years (e.g., rise in social media, austerity and rising inequality, etc.) that the overall prevalence of mental health problems among young people have remained relatively stable, with at most a slight increase among those aged 5 to 15 years
“This is especially so as many of the factors associated with an increased risk of mental health problems (e.g., social media use, cyber bullying, low socio-economic position, etc.) have increased in the past 13 years
“There are two observations from this:
Declared interests
Professor Craig Morgan: I lead a study of the development of adolescent mental health over time in south London – REACH: https://www.thereachstudy.com/)