Children's Mental Health Awareness and Screenings

Approximately 20% of children and adolescents in the U.S. have a diagnosable mental health disorder — more than the total number of children with cancer, diabetes and AIDS combined. Suicide is the leading cause of death in Colorado for kids ages 10 to 14, an all-time high, and Colorado has the ninth-highest suicide rate in the nation.

Half of all lifetime cases of mental health issues begin by age 14, but on average, eight to 10 years pass before children access services. More than half (55%) of the youth in Colorado with mental health concerns are not receiving mental health treatment. Youth experiencing both mental health concerns and severe functional impairment are even less likely to receive treatment — their treatment rate is just 22%.

Untreated mental health concerns are associated with lower academic achievement, poor health outcomes, increased legal trouble, greater family conflict and poorer social functioning during childhood and into adulthood.

Screening for pediatric mental health concerns

Standardized mental health screenings are critical to identify youth needing support. Research has shown that relying solely on clinical judgment positively identifies only 30% of clinical patients, whereas providers identify 70% of patients when using a validated screening measure. Pediatric providers should consider having all patients complete a brief behavioral health screening at their well-child visits. Many are effective and available for free:

• The Pediatric Symptom Checklist, or PSC-17, is a widely used universal screener that the National Quality Forum has endorsed as a national standard of care. A positive score of 15 or greater indicates the presence of possible mental health concerns and the need for further evaluation by a qualified mental health provider.
• The Patient-Reported Outcomes Measurement Information System, or PROMIS®, provides a wide range of narrow-band measures that providers can use when they suspect a specific disorder, such as anxiety or depression.
• For ADHD, use the Vanderbilt ADHD Rating Scales.
• There are three autism spectrum disorder screeners: The Modified Checklist of Autism in Toddlers, or M-CHAT, for ages 16 to 30 months; Childhood Autism Spectrum Test for ages 4 to 11 years; and the Autism Spectrum Quotient for ages 12 to 15 years.
• For behavioral health concerns, use the Strengths and Difficulties Questionnaire.
• For eating disorders, use the Eating Attitudes Test, or EAT-26.

Treatment recommendations for pediatric mental health

Empirical evidence shows that psychological interventions provided by trained pediatric mental health providers are especially effective in reducing mental health concerns in youth. This is particularly true when treatment is timely. Early intervention can change the trajectory of the child's emotional and behavioral development, thereby preventing possible lifelong mental health concerns.

Evidence-based interventions for children and adolescents include behavior therapy, cognitive behavioral therapy, dialectical behavior therapy and acceptance and commitment therapy. Parent involvement in treatment is critical to ensuring positive patient outcomes.

When medical providers identify mental health concerns, it's important to destigmatize these concerns with the family. Emphasize that mental health concerns are common and that seeking support for these concerns promotes overall health and well-being.

If providers feel a referral for psychiatric evaluation and treatment is appropriate, Children's Hospital Colorado's Pediatric Mental Health Institute provides evidence-based, family-focused comprehensive mental health services. For more information, call 720-777-6200.

Additional pediatric mental health resources

• Children's Colorado’s mental health research
• Colorado Department of Human Services' behavioral health services finder
• Society of Clinical Child & Adolescent Psychology's guide to evidence-based therapy approaches
• Consortium for Science-based Information on Children, Youth, and Families
• American Academy of Child & Adolescent Psychiatry