Children. The word evokes images of happy, playful, carefree youth. But the reality is that millions of American children suffer from mental health problems, and many don’t get the care they need. This not only creates challenges in childhood, but can have dire consequences later in life for these children and for the country as a whole — especially when it comes to disruptive behavior disorders.
Children with disruptive behavior disorders, oppositional defiant disorder and conduct disorder, account for more than half of those referred for mental health services. These childhood disorders are characterized by behaviors including frequent temper tantrums, fighting, arguing, and defiance towards authority figures. Children with these problems often find themselves in conflicts with peers, family members, and other adults.
Left untreated, disruptive behavior disorders significantly increase the risk for substance use, violent behaviors, victimization, incarceration, and even premature death. According to the latest research, an estimated 50 to 75 percent of youths who move through the juvenile justice system could be diagnosed with a mental health disorder.
Disruptive behavior disorders can be difficult to identify, because it can be hard for parents to know which behaviors are a normal part of growing up and which are the sign of something more serious. Normal development means becoming more independent, which means more conflict with others. Many children and adolescents with disruptive behaviors are often misdiagnosed with another disorder such as ADHD because the symptoms are similar.
Misdiagnoses often result in children receiving no treatment at all or being prescribed medication instead of psychosocial therapy — the scientifically recommended form of treatment for disruptive behavior disorders. In addition, children with these disorders may benefit from care even though their symptoms may not meet the specific criteria for a diagnosis. The one thing that is clear is that the danger of no treatment or inadequate care is potentially disastrous.
Untreated or mistreated, disruptive behavior disorders may spiral into worsening symptoms; unintended side effects such as problems with sleeping, anxiety, and mood swings; and serious unresolved behavioral problems. Unfortunately, these usually lead to punishment from authority figures or from the juvenile justice system instead of treatment. The cost to society of untreated disruptive behavior disorders is enormous. For one thing, these disorders place significant strain on parental mental health. One study found that a diagnosis of operational defiant disorder was the most significant predictor of caregiver strain. Other studies show that prolonged parental stress can lead to other mental health disorders such as anxiety and depression.
Aside from the emotional burden placed on families, there is a significant financial burden created for schools, for public health agencies, and for society. One study estimates that we could save up to $2.3 million per child by implementing successful interventions for high-risk youth who demonstrate disruptive behaviors. Additionally, research suggests that through early identification and treatment in children, we could reduce the frequency of criminal offenses and reduce the number of children who enter the juvenile justice system.
Early intervention can have lasting beneficial effects. An evidence-based update recently published in the Journal of Clinical Child and Adolescent Psychology shows that the most effective ways to treat disruptive behavior disorders are with group therapy focused on parents’ behaviors and with individual therapy involving the child and his or her parent(s). These therapies place parents in an active role in their child’s treatment and give them the tools they need to serve as their child’s best advocate and guide their behavior during everyday interactions.
We can see the tragic effects of improperly treating disruptive behavior disorders and other mental health disorders at an early stage — in daily crime reports, in the chaos of the juvenile justice system, and in the mental health crisis in our prisons.
But getting these children the treatment they need is easier said than done. That’s because of the shortage of qualified mental health providers and the difficulty of identifying symptoms and making the right diagnosis. Moreover, there is general misunderstanding of the causes of disruptive or antisocial behaviors in children, which can result from family influences, an unstable home environment, and other factors. On top of these daunting challenges, the mental health and research communities are under constant threat of cuts to funding for research and treatment, further endangering future scientific breakthroughs that will benefit at-risk children.
Cutbacks in funding of mental health care, which are outlined in the House of Representatives’s American Health Care Act, will drastically reduce access to behavioral health coverage not only for children but for every American in need of care. This bill allows states to refuse mental health coverage for its residents, and those with preexisting conditions could be left without any coverage whatsoever. Additionally, cuts in mental health research could stall our burgeoning understanding of how best to treat these conditions.
As a nation, we need to bolster our efforts to discover and use evidence-based treatments for mental health issues — not cut back. The future of this research is essential to preventing chronic mental illness, crime, and violence throughout the child’s lifespan, and it must begin early in life. What could be more important?
Andres De Los Reyes, Ph.D., is associate professor of psychology at the University of Maryland at College Park and the editor-in-chief of the Journal of Clinical Child and Adolescent Psychology. Steve S. Lee, Ph.D., is a child clinical psychologist, president-elect of the Society of Clinical Child and Adolescent Psychology, and associate professor in the Department of Psychology at University of California, Los Angeles.