A survey of pediatricians indicates that 15 percent of the children they
see in their practices have moderate to mild behavioral problems, but many say
they feel unprepared to diagnose and treat these disorders adequately.
The disorders they diagnosed frequently or occasionally, usually with the
help of standardized instruments such as questionnaires, were
attention-deficit/hyperactivity disorder (ADHD), depression, and anxiety.
Forty-seven pediatricians in primary care practices in North Carolina were
interviewed by researchers at Wake Forest University Baptist Medical Center.
The results were published in the September Pediatrics.
Pediatricians in general are treating more children with psychiatric
problems as the result of chronic underfunding of the public mental health
system and a shortage of children's mental health specialists, said lead
author Jane Williams, Ph.D., and her colleagues.
The pediatricians said that in the area of mental disorders, they most
frequently diagnosed and treated ADHD, and expressed a high level of comfort
with making the diagnosis, the authors stated.
There was more variation in the pediatricians' diagnosis and treatment of
anxiety and depression. Slightly fewer than half of the pediatricians said
they frequently diagnosed the mood disorders. Those who prescribed for these
disorders generally relied on selective serotonin reuptake inhibitors
"Pediatricians' comfort level in diagnosing anxiety in particular was
strongly related to their prescribing SSRIs," the authors reported.
They noted that the diagnosis and treatment of ADHD has shifted primarily
to pediatricians, and the diagnosis of depression and anxiety in children is
shifting to them gradually as well.
The problem this situation raises is that pediatricians reported feeling
inadequately prepared in medical school and residency training to treat
children with psychiatric disorders, in particular anxiety and depression, and
to choose appropriate medications, the authors said.
Their discomfort with prescribing newer drugs for depression and anxiety
will undoubtedly increase with the recent controversy about increased suicide
risk in children who take SSRIs (see
The vast majority (96 percent) of pediatricians reported that they provided
psychoeducation for children with behavioral problems. This included
supportive counseling, education for coping with ADHD, behavior modification,
and/or stress management, Williams and her team reported.
The pediatricians they surveyed "expressed the greatest interest in
receiving education about psychopharmacology, diagnosis and treatment of
depression and anxiety, and updates on ADHD, the authors stated. "The
pediatricians were not interested in receiving education about several
high-prevalence disorders they don't often diagnose or treat including conduct
disorder and substance abuse."
An abstract of the article, "Diagnosis and Treatment of
Behavioral Health Disorders in Pediatric Practice," is posted online at<pediatrics.aappublications.org/cgi/content/abstract/114/3/601>.▪