Study: Kids' stress cited as disorders increase

Aug. 19--American children are experiencing a higher rate of neurological-development and mental health disorders and behavioral problems than they did a decade ago, with a surprisingly high increase among children from more affluent households.

But the good news is that children now face fewer physical disabilities than a decade ago, according to a health-data analysis conducted by Children's Hospital of Pittsburgh of UPMC researchers and published in the September issue of Pediatrics.

The unexpected spike in neurological and mental disorders, especially among advantaged children, could reflect greater awareness of such conditions, better diagnostic procedures and more available mental health services for children, the study suggests.

But it also could reveal that children nowadays face lives filled with daily stressors, environmental exposures and health challenges, among other dietary and risk factors that are harming mental development and behavior.

Stressful exposures, obesity among pregnant women and the daily onslaught of scary news, among other factors, could help explain the ever higher rates of autism spectrum disorders, childhood anxiety, attention deficit and hyperactivity disorder (ADHD) and depression.

"Our study can't tell how or why this has occurred, but we have educated guesses," said Amy Houtrow, chief of Children's division of pediatric rehabilitation medicine and the study leader.

Those guesses, she said, include shifts in the way disorders are diagnosed, the well-documented increases in autism cases, heightened public awareness of such disorders, and the need for specific diagnoses before children can qualify for early intervention or other mental health services.

"I think what the study does is set the stage to dig deeper -- to look for the reasons for the trends," Dr. Houtrow said.

"In this study, we found that physical disabilities are decreasing. This is a very positive finding. But the increase in disability due to neurodevelopmental and mental health problems is concerning.

"If parents are worried about how their child is functioning, they should bring it to the attention of their health-care provider," she said.

Kenneth W. Norwood Jr., chairman on the American Academy of Pediatrics'Council of Children with Disabilities, said the study helps confirm the steady increase in neurological- development and mental health disorders and behavioral problems he and other doctors have witnessed in patients over the years.

It's more than just awareness and diagnostic tools.

"We have to be open to the real possibility that these increases in developmental and behavioral problems are truly increasing in frequency, and if that is the case, then we need to do some soul-searching," he said.

"I'm convinced it's a little bit of both. We have better identification of these disorders, but some of these disorders are increasing in prevalence, and if you look at the data over the last couple of decades, increases in childhood anxiety have been occurring since World War II.

"People are under stress," he said. "The world has changed."

The Children's Hospital analysis found that the number of children with neurological- developmental and mental health disabilities rose 21 percent between 2001 and 2011.

But physical disabilities, including asthma, have declined during the same period by 12 percent.

Children living in poverty still have the highest rates of mental and physical disabilities. But children in more socially advantaged households, with incomes 400 percent of the federal poverty level, showed a surprisingly high 28.4 percent increase in disabilities from mental health, neuro-developmental and behavioral disorders.

The study is based on the National Health Interview Survey, conducted by the U.S. Centers for Disease Control and Prevention, of children from birth to 17. It included evaluations of each child's ability to perform activities at home and school.

Children, especially those in more socially advantaged households, may be diagnosed more readily for neurological disorders such as autism or mental health disorders, because of better access to health services and increased parental awareness of such disorders.

But environmental exposures, obesity in pregnancy and the persistent stress of the American lifestyle also help to explain the increase. During his career, Dr. Norwood said, he has witnessed notable increases in autism and childhood anxiety, along with an ever-larger prevalence of ADHD and childhood depression.

"The big gorilla out there is stress," he said. "This is a very important study because of all of that. Now I think studies need to be designed to better understand why these disorders are increasing in prevalence."

David Templeton: dtempleton@post-gazette.com or 412-263-1578.

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