It is apparent to anyone who works with children that available US child and adolescent mental health services are woefully inadequate to meet the needs of children and their families.
Consider the numbers1:
Three decades ago, in 1980, the Graduate Medical Education National Advisory Committee recommended that by 1990 the number of child psychiatrists should be increased to 8,000 to 10,000, and a decade later, in 1990, the Council on Graduate Medical Education (COGME) projected that 30,000 child and adolescent psychiatrists would be needed by 2000
Mental health providers, other than child and adolescent psychiatrists, are important resources as providers for pediatric patients, but psychologists, social workers, and therapists with experience and expertise in treating children are not available in sufficient numbers or in all communities. Pediatricians, then, are the professionals to whom families often turn for recognition and diagnosis of psychosocial problems, and sometimes for their management as well.
In this month's issue, W. David Lohr, MD, and Joshua T. Honaker, MD, describe the pathology and evaluation of aggression in children. Their discussion of developmental context and the importance of recognizing aggression as a component of other conditions such as attention-deficit/hyperactivity disorder and autism provide a framework for the evaluation of this very common and troubling behavior. They guide the reader through working with and interviewing the children and their families to formulate a treatment plan.
In next month's issue, they will describe options for management by professionals and parents. Their combined expertise as a child and adolescent psychiatrist (Lohr) and a pediatrician (Honaker provide clear, authoritative, and practical guidance for pediatricians.
Between 2004 and 2011, the number of child psychiatry residents in the United States increased from 723 to 853, and 10 new training programs were accredited. That's certainly good news. But pediatricians will remain an essential resource for child and adolescent mental health diagnosis and management, despite these increases. These articles by Lohr and Honaker will enhance readers' comfort with this responsibility.
American Academy of Child and Adolescent Psychiatry. Resources for primary care: AACAP workforce fact sheet. http://aacap.org/cs/root/legislative_action/aacap_workforce_fact_sheet Revised September 15, 2011. Accessed March 16, 2012.