Children’s mental health covers a wide range of disorders. Some, such as ADHD and autism, tend to manifest themselves when children are young, while others, such as depression and addiction, are more likely to appear during the teenage years. Some respond readily to treatment or tend to improve as children grow older, while others, such as autism, are much more intractable.

Moreover, children’s mental and behavioral disorders may be detected and treated in any number of settings, from a pediatrician’s or psychologist’s office to schools to the juvenile justice system. This heterogeneity points to one of the problems Alison Cuellar finds with the United States’ approach to children’s mental health. Policies and programs to help children with mental disorders are fragmented and lack coordination, funding follows idiosyncratic rules, and all of this makes prevention programs hard to deliver.

Another problem, Cuellar writes, is that treatment often focuses on controlling symptoms in the present rather than on long-term life chances. Treatments and programs that reduce children’s symptoms don’t necessarily lead to long-term gains in areas like education and employment; that is, even children whose treatment is deemed successful may fare more poorly in life than children without mental disorders. Thus Cuellar recommends that we evaluate whether treatment for at least some disorders should focus less on relieving symptoms and more on educational achievement and overall functioning.

Another question for which policy makers in particular need the answer is whether our resources are best spent on programs that focus on detecting and treating individual children with mental health problems or on programs that focus more broadly on preventing mental health problems among populations of children who are likely to have high rates of mental disorders—for example, minority children who live in disadvantaged neighborhoods.


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pp. 111-134
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