Who gets treated? Factors associated with referral in children with psychiatric disorders

There is evidence from several industrialized countries that only a small proportion of children with psychiatric disorders receive specialist treatment. It is unclear, however, why some disturbed children are brought for treatment while others are not. To examine this issue in one community, children aged 7 through 11 were screened for behavioral problems using the Child Behavior Checklist (CBCL); 89 treated and 126 nontreated children, all of whom scored in the clinical range (above the 90th percentile) on the CBCL, were compared on measures of psychopathology, environmental factors and adaptive functioning. All the children were assessed using the Diagnostic Interview Schedule for Children. There was no difference between the groups in the proportions receiving a psychiatric diagnosis, or in the proportions with more than one psychiatric disorder. The nontreated disturbed children were as likely as the treated ones to have attention deficit disorders, anxiety, and oppositional disorders, and to be failing in school. The treated children had more cases of conduct disorder and depressive disorders, and were more likely to be poor, male and black. Teachers reported twice as many behavioral problems in treated as in untreated children, suggesting that adults' discomfort with children's behavior may have been a more potent precipitator of referral than the children's failure to perform well at school. The findings suggest that many nontreated children may be no less impaired than those who receive treatment, and that other factors than severity of psychopathology may dictate which disturbed children receive mental health services.