Mention the topic of kids and psychiatric medication, and certain buzzwords are likely to spring to mind: “overdiagnosed,” “overmedicated,” “overtreated.”

According to the often-repeated storyline about children and mental illness in the United States (and in countries like Canada and Australia, too), more kids are being diagnosed with more severe emotional and behavioral problems – and more are being treated with psychotropic drugs, even when their symptoms are relatively mild.

A new analysis in the New England Journal of Medicine challenges that narrative.

The study, which analyzed data from a large-scale national survey of U.S. parents, found that the percentage of children and teens with severe problems has actually dropped slightly since the mid-90s, from 12.8 percent to 10.7 percent.

Curiously, the analysis didn’t provide statistics about whether the percentage of kids with milder problems has increased or decreased. But it does seem to contradict several studies by the Centers for Disease Control and Prevention and other government agencies that have shown dramatic increases in the percentage of kids with mental illness.

The NEJM analysis also found that more kids with emotional and behavioral problems are getting help, but that the biggest increase in services occurred in kids with more severe impairment.

And “help” didn’t always mean medication, though some previous analyses, including one by this study’s main author, have suggested a relative decline in the percentage of both adults and children who receive therapy compared to drugs. Rather, the study found that use of both medication and therapy increased over time. That was true for kids with both milder and more severe impairment.

Overall, the percentage of all kids receiving meds approximately doubled between 1996 and 2012 – from 5.5 percent to 8.9 percent.

The study’s findings also question the oft-held assumption that vast numbers of kids with mild problems get medications. It found that kids with more severe illness were about five times more likely to be medicated compared to those with milder problems.

Despite an increase in service use, though, fewer than half of kids with severe problems received help of any kind as of 2012. For kids with milder impairments, the figure was just 1 in 10. People concerned about overtreatment might take that as a good sign, but it’s worth remembering that even minor problems can rapidly worsen as kids mature. A lot of children, it seems, are still falling through the cracks of our mental healthcare system.

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