AHRQ Views: Blog posts from AHRQ leaders
Embracing Evidence as a Central Strategy to Tackling Childhood Mental Illness
Every day, there is growing awareness of the impact and importance of mental health care for children.
Among the sobering realities: About one in five children and adolescents has one or more mental, emotional, or behavioral health disorders. One in eight is affected by a childhood anxiety disorder. And only one in five children with mental health problems receives needed services.
Referral and care for children with mental health conditions is complicated by a health care system that can be fragmented and inefficient. Time pressures compound potential gaps in knowledge or training among clinicians to identify, refer, or adequately treat these children.
These challenges are steep. And improvements will take time.
However, AHRQ has recently made noteworthy contributions to support ongoing efforts for better care. Consistent with the Agency's mission to build the evidence base about what works and doesn't work in providing care for people with a variety of health conditions, AHRQ has published four evidence reviews about treatments for children with mental health disorders. These evidence reviews provide comprehensive and foundational assessments of what is known about these critically important topics.
The reports were authored by AHRQ-funded scientific teams that are part of the Agency's Evidence-based Practice Center (EPC) Program. For 20 years, the EPC program has advanced the Agency's commitment to developing, synthesizing, and disseminating evidence to improve care.
These four reports have a number of features in common. In response to feedback from experts in the field, the reports identify key clinical questions that are critical to children and their mental health needs. The reports not only synthesize available evidence on interventions' effectiveness and harms, they also evaluate the strength of that evidence. And, importantly, the reports identify areas where more research is needed.
The clinical challenges related to mental health care are numerous and complex. In each case, the EPC reports summarize key findings on complex, yet clearly defined questions:
- Strategies to Improve Mental Health Care for Children and Adolescents assessed 16 strategies intended to help clinicians improve mental health care. The report cites evidence showing that financial incentives, such as pay-for-performance, can improve clinician competence in implementing evidence-based practices. Providing educational information alone may not be enough, but may improve outcomes when combined with clinician reminders.
- First- and Second-Generation Antipsychotics in Children and Young Adults: Systematic Review Update was commissioned in part in response to the rise in use of antipsychotics in children and young adults over the past 20 years, particularly among those who are publicly insured or living in foster homes. The report evaluated the effectiveness and harms of first- and second-generation antipsychotics for treating schizophrenia, bipolar disorder, attention deficit hyperactivity disorder, and other conditions. One notable conclusion: among second-generation antipsychotics, olanzapine was shown to be worse for weight gain and more likely to elevate body mass compared to risperidone, ziprasidone, and aripiprazole.
- Anxiety in Children evaluated the comparative effectiveness and harms of psychotherapy and medications for childhood anxiety disorders, including panic disorder, social anxiety disorder, phobias, generalized anxiety disorder, and separation anxiety. It found that cognitive behavioral therapy and the use of medications both reduce anxiety symptoms. The combination of medications and therapy is more effective than either treatment alone. The full report includes summaries of specific comparisons between medications and other treatments.
- Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Children and Adolescents found that, among children 7 to 17 years old, cognitive behavioral therapy may improve ADHD symptoms. The evidence also showed that child training (such as interventions aimed at improving organizational or social skills) and parent training (interventions to help parents deal with specific ADHD behaviors) improve ADHD symptoms but did not change academic performance. The evidence was insufficient on whether imaging or electroencephalograms were reliable to diagnose ADHD.
Each of these evidence reviews includes background on the topic, a description of the evidence, and a detailed account of the research analysis. Taken together, health care professionals can use this information to provide better care and improve health care decisionmaking for children and their caregivers.
AHRQ's EPC reports have addressed adult mental health challenges, as well. Other recent reviews include Diagnostic Accuracy of Screening and Treatment of Post–Acute Coronary Syndrome Depression: A Systematic Review and Treatment for Adults With Schizophrenia.
There is no doubt that caring for mental illness is challenging to health care professionals and families—particularly when conditions affect children. But AHRQ hopes that providing summaries and analyses of the growing body of evidence will help clinicians and families seek and provide better care.
Dr. Chang is Director of AHRQ's Evidence-Based Practice Center Program.