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Abstract

Objective

The study compared use of specialty outpatient mental services among children ages six and seven and children ages eight through 12 and investigated predictors of differences in the patterns of service use by age.

Methods

Eligible children were first-time patients of clinics participating in the Longitudinal Assessment of Manic Symptoms who were between ages six and 12 and who were English speaking. Children who screened positive for symptoms of mania (N=1,124) were invited to participate, and families of 621 (55%) children consented. A matched sample of 86 children without a positive screen for mania also participated. Baseline interviews assessed sociodemographic characteristics of the child and family and the child’s functioning, diagnoses, and use of services.

Results

Of the 707 children, 30% were younger, and 50% used multiple types of specialty outpatient services. Younger children were more likely to be male, have Medicaid insurance, and have two parents with mental health problems. Use of multiple types of services was related to study site, high depression scores, fewer minor health issues, and fewer stressful life events among younger children and with parental stress, primary diagnosis, poor functioning, and not living with both parents among older children. Younger children were much more likely than older children to have used services before age six.

Conclusions

Younger children showed very early use of multiple types of services for mental health problems and a pattern of persistent impairment despite long-standing use of services. These data argue strongly for focusing on emotional and behavioral issues among young children.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services

Cover: Deep Cove Lobster Man, by N. C. Wyeth, ca. 1938. Oil on gessoed board (renaissance panel). Accession number 1939.16. Courtesy of the Pennsylvania Academy of Fine Arts, Philadelphia, Joseph E. Temple Fund.

Psychiatric Services
Pages: 1026 - 1033
PubMed: 24789735

History

Published in print: August 2014
Published online: 27 October 2014

Authors

Details

Sarah M. Horwitz, Ph.D.
Dr. Horwitz is with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (e-mail: [email protected]). Dr. Storfer-Isser is with Statistical Research Consultants, L.L.C., Schaumburg, Illinois. Ms. Demeter is with the Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, Ohio. Dr. Youngstrom is with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Frazier is with the Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland. Dr. Fristad, Dr. Arnold, and Dr. Axelson are with the Department of Psychiatry, Ohio State University, Columbus, where Dr. Fristad is also with the Division of Child and Adolescent Psychiatry. Dr. Birmaher is with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Kowatch is with the Department of Psychiatry, Nationwide Children’s Hospital, Columbus. Dr. Findling is with the Division of Child and Adolescent Psychiatry, Case Western Reserve University School of Medicine, Cleveland, and with the Department of Psychiatry, Johns Hopkins Children’s Center, Baltimore.
Amy Storfer-Isser, Ph.D.
Dr. Horwitz is with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (e-mail: [email protected]). Dr. Storfer-Isser is with Statistical Research Consultants, L.L.C., Schaumburg, Illinois. Ms. Demeter is with the Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, Ohio. Dr. Youngstrom is with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Frazier is with the Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland. Dr. Fristad, Dr. Arnold, and Dr. Axelson are with the Department of Psychiatry, Ohio State University, Columbus, where Dr. Fristad is also with the Division of Child and Adolescent Psychiatry. Dr. Birmaher is with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Kowatch is with the Department of Psychiatry, Nationwide Children’s Hospital, Columbus. Dr. Findling is with the Division of Child and Adolescent Psychiatry, Case Western Reserve University School of Medicine, Cleveland, and with the Department of Psychiatry, Johns Hopkins Children’s Center, Baltimore.
Christine Demeter, M.A.
Dr. Horwitz is with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (e-mail: [email protected]). Dr. Storfer-Isser is with Statistical Research Consultants, L.L.C., Schaumburg, Illinois. Ms. Demeter is with the Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, Ohio. Dr. Youngstrom is with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Frazier is with the Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland. Dr. Fristad, Dr. Arnold, and Dr. Axelson are with the Department of Psychiatry, Ohio State University, Columbus, where Dr. Fristad is also with the Division of Child and Adolescent Psychiatry. Dr. Birmaher is with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Kowatch is with the Department of Psychiatry, Nationwide Children’s Hospital, Columbus. Dr. Findling is with the Division of Child and Adolescent Psychiatry, Case Western Reserve University School of Medicine, Cleveland, and with the Department of Psychiatry, Johns Hopkins Children’s Center, Baltimore.
Eric A. Youngstrom, Ph.D.
Dr. Horwitz is with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (e-mail: [email protected]). Dr. Storfer-Isser is with Statistical Research Consultants, L.L.C., Schaumburg, Illinois. Ms. Demeter is with the Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, Ohio. Dr. Youngstrom is with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Frazier is with the Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland. Dr. Fristad, Dr. Arnold, and Dr. Axelson are with the Department of Psychiatry, Ohio State University, Columbus, where Dr. Fristad is also with the Division of Child and Adolescent Psychiatry. Dr. Birmaher is with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Kowatch is with the Department of Psychiatry, Nationwide Children’s Hospital, Columbus. Dr. Findling is with the Division of Child and Adolescent Psychiatry, Case Western Reserve University School of Medicine, Cleveland, and with the Department of Psychiatry, Johns Hopkins Children’s Center, Baltimore.
Thomas W. Frazier, Ph.D.
Dr. Horwitz is with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (e-mail: [email protected]). Dr. Storfer-Isser is with Statistical Research Consultants, L.L.C., Schaumburg, Illinois. Ms. Demeter is with the Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, Ohio. Dr. Youngstrom is with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Frazier is with the Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland. Dr. Fristad, Dr. Arnold, and Dr. Axelson are with the Department of Psychiatry, Ohio State University, Columbus, where Dr. Fristad is also with the Division of Child and Adolescent Psychiatry. Dr. Birmaher is with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Kowatch is with the Department of Psychiatry, Nationwide Children’s Hospital, Columbus. Dr. Findling is with the Division of Child and Adolescent Psychiatry, Case Western Reserve University School of Medicine, Cleveland, and with the Department of Psychiatry, Johns Hopkins Children’s Center, Baltimore.
Mary A. Fristad, Ph.D., A.B.P.P.
Dr. Horwitz is with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (e-mail: [email protected]). Dr. Storfer-Isser is with Statistical Research Consultants, L.L.C., Schaumburg, Illinois. Ms. Demeter is with the Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, Ohio. Dr. Youngstrom is with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Frazier is with the Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland. Dr. Fristad, Dr. Arnold, and Dr. Axelson are with the Department of Psychiatry, Ohio State University, Columbus, where Dr. Fristad is also with the Division of Child and Adolescent Psychiatry. Dr. Birmaher is with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Kowatch is with the Department of Psychiatry, Nationwide Children’s Hospital, Columbus. Dr. Findling is with the Division of Child and Adolescent Psychiatry, Case Western Reserve University School of Medicine, Cleveland, and with the Department of Psychiatry, Johns Hopkins Children’s Center, Baltimore.
L. Eugene Arnold, M.D.
Dr. Horwitz is with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (e-mail: [email protected]). Dr. Storfer-Isser is with Statistical Research Consultants, L.L.C., Schaumburg, Illinois. Ms. Demeter is with the Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, Ohio. Dr. Youngstrom is with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Frazier is with the Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland. Dr. Fristad, Dr. Arnold, and Dr. Axelson are with the Department of Psychiatry, Ohio State University, Columbus, where Dr. Fristad is also with the Division of Child and Adolescent Psychiatry. Dr. Birmaher is with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Kowatch is with the Department of Psychiatry, Nationwide Children’s Hospital, Columbus. Dr. Findling is with the Division of Child and Adolescent Psychiatry, Case Western Reserve University School of Medicine, Cleveland, and with the Department of Psychiatry, Johns Hopkins Children’s Center, Baltimore.
David Axelson, M.D.
Dr. Horwitz is with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (e-mail: [email protected]). Dr. Storfer-Isser is with Statistical Research Consultants, L.L.C., Schaumburg, Illinois. Ms. Demeter is with the Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, Ohio. Dr. Youngstrom is with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Frazier is with the Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland. Dr. Fristad, Dr. Arnold, and Dr. Axelson are with the Department of Psychiatry, Ohio State University, Columbus, where Dr. Fristad is also with the Division of Child and Adolescent Psychiatry. Dr. Birmaher is with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Kowatch is with the Department of Psychiatry, Nationwide Children’s Hospital, Columbus. Dr. Findling is with the Division of Child and Adolescent Psychiatry, Case Western Reserve University School of Medicine, Cleveland, and with the Department of Psychiatry, Johns Hopkins Children’s Center, Baltimore.
Boris Birmaher, M.D.
Dr. Horwitz is with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (e-mail: [email protected]). Dr. Storfer-Isser is with Statistical Research Consultants, L.L.C., Schaumburg, Illinois. Ms. Demeter is with the Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, Ohio. Dr. Youngstrom is with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Frazier is with the Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland. Dr. Fristad, Dr. Arnold, and Dr. Axelson are with the Department of Psychiatry, Ohio State University, Columbus, where Dr. Fristad is also with the Division of Child and Adolescent Psychiatry. Dr. Birmaher is with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Kowatch is with the Department of Psychiatry, Nationwide Children’s Hospital, Columbus. Dr. Findling is with the Division of Child and Adolescent Psychiatry, Case Western Reserve University School of Medicine, Cleveland, and with the Department of Psychiatry, Johns Hopkins Children’s Center, Baltimore.
Robert A. Kowatch, M.D., Ph.D.
Dr. Horwitz is with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (e-mail: [email protected]). Dr. Storfer-Isser is with Statistical Research Consultants, L.L.C., Schaumburg, Illinois. Ms. Demeter is with the Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, Ohio. Dr. Youngstrom is with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Frazier is with the Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland. Dr. Fristad, Dr. Arnold, and Dr. Axelson are with the Department of Psychiatry, Ohio State University, Columbus, where Dr. Fristad is also with the Division of Child and Adolescent Psychiatry. Dr. Birmaher is with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Kowatch is with the Department of Psychiatry, Nationwide Children’s Hospital, Columbus. Dr. Findling is with the Division of Child and Adolescent Psychiatry, Case Western Reserve University School of Medicine, Cleveland, and with the Department of Psychiatry, Johns Hopkins Children’s Center, Baltimore.
Robert L. Findling, M.D., M.B.A.
Dr. Horwitz is with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (e-mail: [email protected]). Dr. Storfer-Isser is with Statistical Research Consultants, L.L.C., Schaumburg, Illinois. Ms. Demeter is with the Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, Ohio. Dr. Youngstrom is with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Frazier is with the Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland. Dr. Fristad, Dr. Arnold, and Dr. Axelson are with the Department of Psychiatry, Ohio State University, Columbus, where Dr. Fristad is also with the Division of Child and Adolescent Psychiatry. Dr. Birmaher is with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Kowatch is with the Department of Psychiatry, Nationwide Children’s Hospital, Columbus. Dr. Findling is with the Division of Child and Adolescent Psychiatry, Case Western Reserve University School of Medicine, Cleveland, and with the Department of Psychiatry, Johns Hopkins Children’s Center, Baltimore.

Funding Information

National Institute of Mental Health10.13039/100000025: R01 MH073967
: RO1 MH073801
: RO1 MH73953
: RO1 MH073816

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