Here's a health headline that you may find surprising: For the first time, the top five disabilities among American children are all mental, behavioral or developmental conditions, not physical disabilities.
That was the subject of an intriguing article in the July 18 issue of the Journal of the American Medical Association. Citing government statistics, it offered this list of the "leading causes of limitation in usual activities due to chronic conditions in U.S. children'':
1. Speech problems
2. Learning disability
3. Attention-deficit hyperactivity disorder (ADHD)
4. Other emotional, mental and behavioral problems
5. Other developmental problems
You have to go all the way down to No. 6 to find a physical issue: asthma and other breathing problems.
An optimist might conclude that we're doing better at preventing and managing physical problems that used to top the list.
Certainly medicine and public health have made important gains. Yet overall, in 2008 almost 8 percent of children had some kind of a disability that limits them in some way — quadruple the rate reported in 1960, the article says. So it's not necessarily the case that physical ailments have plummeted.
I called Dr. Mark Cavitt, director of pediatric psychiatry at All Children's Hospital in St. Petersburg, to get his take on a trend with which he is well familiar.
He explained that the line between "physical health issues'' and "mental health issues'' can be faint indeed. For instance, many conditions that fit into the "mental health'' category are disorders of brain development.
He reminded me of the enormous increase we've seen in autism — earlier this year, a new study found that 1 in 88 children is somewhere on the autism spectrum.
"So it shouldn't be that surprising that other neurodevelopmental disorders are on the rise,'' he noted.
What's going on?
The article cites a bunch of possibilities, from an increase in premature births leading to developmental problems, to exposure to toxins, to better diagnostic tools, to more awareness among pediatricians and parents.
Many of these conditions, such as autism, can be quite apparent. Others, such as depression, may be more subtle. So it may be tempting and even soothing to regard at least some of this as hypervigilant types slapping labels on kids who are maybe a little quirky.
The article does suggest that at least some of the trouble is "savvy parents demanding a diagnosis of ADHD for children struggling at school in order to improve academic performance with stimulant medication and special accommodations.''
That's a topic for another day. But I suspect that more parents are deeply reluctant to medicate their children, or even accept that they may have a problem.
In the next week, kids will be starting school, a setting where behavioral and emotional problems can really stick out. So some parents may hear from concerned teachers or administrators. Some concerns will be well-founded; others not so much.
If I received such a call, I hope I would react like Ellen Mejias, the Land O'Lakes mom in our cover story today who went to her 6-year-old daughter's classroom to see for herself why the teacher was so worried.
Although there may be numerous appropriate ways to address a child's mental health problems, knee-jerk denial isn't one of them. You'd never allow a child with a physical ailment to suffer; kids with mental health troubles deserve the same swift compassion.
Looking the other way only makes things worse.
"In every one of those disorders (in the top 5), the earlier the intervention, the better the recovery,'' Cavitt said.
But early detection and treatment means not just parental savvy, but also access to well-trained health care providers, and the funds to pay them.
"We have excellent treatments for most of these disorders, but we don't necessarily have wide dissemination of these interventions,'' said Eric Storch, a University of South Florida psychologist who is investigating new therapies for children with obsessive-compulsive disorder.
Despite the prevalence of mental health issues in children, "our research funding is paltry, it's embarrassing,'' he said. The result: "We're intervening late in the cycle,'' Storch said.
"We have a saying: 'Little kids, little problems; big kids, big problems,' " he told me.
"That may be simplistic, but the point is that prevention is the ideal, or at least early intervention.''
Charlotte can be reached at [email protected] or (727) 893-8425. Follow her on Twitter: @SuttonTimes.