Disparities in Pediatric Mental Health Development and Impacts to U.S. Healthcare
There is no health without mental health, a growing body of evidence indicates, yet resources to help facilitate and guide health policy to navigate this coordination of care is largely overlooked in our U.S. pediatric population. Childhood mental and developmental disorders are a complicated challenge to healthcare policy makers. Children with behavioral health issues are more likely to experience a compromised developmental trajectory with increased need for medical and disability services if not addressed. Childhood adversity and the perpetuating cycle of adverse events stems beyond the child’s control and is often a subset of inherited problems within the family structure. Approximately 15 million children in the United States – 21% of all children – live in families with incomes below the federal poverty threshold (NCCP).
Socioeconomic and repetitive factors such as poverty and violence perpetuate and force parents and children to both respond or react to each other’s behaviors – physically, physiologically and psychologically; however, the child is reacting to both their own fears and behaviors and responding to the stress of their parent’s reactions. When children are exposed to long term adverse events such as poverty, violence, repeated trauma or neglect, there is a higher likelihood of developing long term health conditions into adulthood. The onset of many adult mental and developmental disorders occurs in childhood.
Childhood adversity is a significant problem in the U.S., particularly for children growing up malnourished and who deal with the same behavioral health issues present in adult lives. Among adults in California, 61% reported adverse childhood experiences (ACEs). Those ACEs were associated with $10.5 billion in excess personal healthcare spending during 2013, and 434,000 Disability-Adjusted-Life-Years (DALYs) valued at approximately $102 billion dollars (Miller et al., 2020). In 2016, 34 million children age 0–17—nearly half of all US children—had at least one of nine ACEs, and more than 20 percent had two or more (Johnson et al., 2017). Children with multiple ACE scores access the healthcare system 2.5 times more often than people with lower or no ACE scores. The higher the ACE score in children, the higher potential an adverse effect can cognitively impair the child as they develop into adulthood.
Children younger than 18 years constitute approximately 25% of the US population and, as is often said, 100% of our future (Dziuban et al., 2017). Transition from pediatric to adulthood population and the role mental and physical health care has in development is critical. Nearly three-quarters of adult disorders have their onset or origins during childhood, becoming harder to treat and incurring ever-greater social, educational, and economic consequences over time (Wissow et al., 2016).
Consistent evidence to support the benefits in integrating mental and physical health for better clinical outcomes in pediatric populations lacks. Because population health data for pediatrics is not federally mandated by all payors for reimbursement as it is required for adult and Medicare populations – the expectations to produce clinical standards is overlooked. While adult primary care is derived from patient-specific interaction, independence and autonomy, health care systems miss the correlation between mental and physical health within the pediatric population and the long-term cost financially associated distinctively – missing that the two health conditions are at times interrelated and can coexist.
There are significant differences between adult and pediatric health care models, which may affect adherence by young adults with chronic diseases (Castillo & Kitsos, 2017). As children experience chronic stress, the amygdala and prefrontal cortex within the brain becomes overworked, altering neurochemistry during what should be a time of cerebral and physiological development. Because children are not cognitively wired to recognize or communicate danger at a young age, continuous triggers and stress to these areas of the brain create greater erosion in what are known as telomeres – effecting the areas responsible for cerebral and physiobiological development.
Research shows that young adults who repeatedly faced biological stress as children showed significant erosion of their telomeres – the protective caps on the ends of DNA strands that keep genome healthy and intact. Adults with adverse childhoods who showed eroded telomeres were more likely to develop chronic disease – making cells age faster, increasing the risk for cancer, heart disease, liver disease, pulmonary disease, auto-immune disease, and obesity.