Youth Mental Health Care Is Vital. And Hard to Access.
The youth mental health crisis is acute among teens with ADHD, according to a recent ADDitude survey that found half of caregivers have sought care during the pandemic but faced common barriers.
As the youth mental health crisis escalates, so too does demand for mental health services. Supply simply can’t accommodate the new demand, so many children and teens with mental, emotional, and behavioral disorders are struggling to access care.
More than half of neurodivergent youth have sought mental health care for the first time in the last few years, according to a recent ADDitude survey wherein 62% of caregivers said it was “difficult” or “very difficult” to access mental health care due to challenges such as prohibitive wait times, scheduling conflicts, and lack of accessibility.
Barriers to Care
Two-thirds of children with ADHD are currently receiving mental health care, according to the 1,187 caregivers who completed the ADDitude survey in August and September. Many parents reported barriers to care that made it challenging to secure services for their child.
“While I have good insurance, many of the mental health practitioners are limited to talk therapy and not employing practices such as EMDR,” said Kate, parent to a young adult with ADHD, anxiety, and depression in Kansas. “Mental health care is extremely expensive. If you have acute emergency mental health care needs, you face dropping $3,000 to $5,000 to get in at the ER. The other alternative is a long waiting list. In the meantime, your child suffers. It’s a nightmare.”
Long wait lists for in-network providers lead many to pay for services out-of-pocket. Caregivers reported wait times ranging from a few months to a few years, and more than 40% reported insurance and cost barriers.
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“Does this insurance have these providers? What will it cost without insurance when there are none?” asked the parent of a teenager with ADHD who rated her child’s mental health as “poor.” “And trying to provide healthy, palatable foods for a sort of picky eater without a job is hard on the wallet. Getting specific prescriptions that cost a lot isn’t easy, either. At moments, it makes the mentally healthier want to lay down and die.”
Though seemingly worsened by the pandemic, long wait times existed long before March 2020. According to the American Psychological Association (APA), only 4,000 out of 100,000 U.S. clinical psychologists specialize as child and adolescent clinicians.1 Time barriers have been, and continue to be, the norm.
“We were unable to reach our therapist once the pandemic started, and then the practice became so busy that they could no longer provide services,” wrote the mother of an 11-year-old with ADHD and anxiety in Pennsylvania. “[Our son] has not received services in three years. We have reached out to a different practice, but the wait time for a new appointment is more than 10 months long.”
One Australian parent, like 121 other respondents, said that securing access to mental health care was easy. Finding a well-equipped provider who could understand and effectively treat their child’s eating disorder, anxiety, and depression was not.
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“Accessing therapy is easy but keeping therapists who don’t leave or finding one who engages well with my daughter and her temperament is difficult,” the parent wrote. “The process of telling her story again and again to new counselors is a big hurdle. Engaging with a stable, mature, and experienced counselor is the challenge, plus affordability.”
More than half of respondents encountered scheduling or appointment conflicts (55%) or a lack of accessibility (50%).
“There is no one within two hours of us who treats ADHD, treats children under 12 years old, accepts Medicaid, and has availability,” wrote Jessika, the mother of an 11-year-old boy with ADHD in Maine.
Mental Health Treatments and Interventions
Of the neurodivergent youth with access to care, more than three quarters are currently taking medication. Medication was among the most useful treatment options according to caregiver ratings, as was exercise, which was most often rated as “helpful” or “very helpful.”
“The things [our son is] doing now, like exercise and mindfulness, are things he’s doing on his own to improve himself,” said one parent of a young adult with ADHD in New York. “This is a result of individual and family therapy he received in the past, which he resented at the time, but which he now says saved his life. He uses what he learned then to apply himself now. To us, this is miraculous.”
Previous research suggests sedentary behavior is associated with an increased risk of depression as children age.2 While exercise can help lessen the risk of depressive symptoms, the pandemic’s social distancing, increased screen time, and remote learning environments have not promoted physical activity.
Individual therapy was the most popular treatment option among respondents. More than 90% of youth with access to care are currently receiving individual therapy or have in the past two to three years. Sleep changes and family therapy were rated least helpful by caregivers.
Numerous respondents said getting their child to follow through with treatments or interventions was admittedly difficult. It’s not uncommon for adolescents to refuse help due to feelings of embarrassment and shame.
“[Our daughter] is dead set against medications, counseling, and actually anything that could be beneficial for her mental health,” said the mother of a teenager with anxiety and depression. “She tends to be stubborn and obstinate about any of it. She seems to withdraw more instead of being open to help of any kind.”
A System That Needs Fixing
Many parents feel hopeless in the face of a crisis they’re not equipped to solve on their own. This includes Breanne, who says the mental health system is “quite broken” for her daughter with an eating disorder, oppositional defiant disorder, and ADHD.
“There are too many barriers: waitlists, personal opinions… Real help only kicks in when your child is actively suicidal.”
When children can’t access proper treatment interventions, the consequences extend well into adulthood.
“My child is affected because her mom was terminated from her 20-year career for asking for accommodations due to her ADHD,” wrote the parent of an 8-year-old child with ADHD, anxiety, and learning disabilities. “Now, her mom has lost everything and can’t afford many things. Just getting basic needs is difficult enough, so doctor appointments take a backseat to the basic needs like food, job, utilities.”
“Another barrier is lack of trust. I don’t see that parents have sufficient assistance when dealing with their own disability… They need all kinds of mental, social, and financial assistance, and there is none.”
Youth Mental Health Care and ADHD: Next Steps
- Join Us! Mental Health Out Loud Event on Eating Disorders in Teens
- Read: Special 2022 Mental Health Report from ADDitude
- Read: Two Years Inside a Pandemic: A COVID Timeline of ADHD Brains in Distress
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View Article Sources
1Abramson, A. (2022, January 1). Children’s mental health is in crisis. Monitor on Psychology, 53(1). https://www.apa.org/monitor/2022/01/special-childrens-mental-health
2Kandola, A., et al. (2020). Depressive symptoms and objectively measured physical activity and sedentary behaviour throughout adolescence: a prospective cohort study. The Lancet Psychiatry, 7(3), 262 – 271. https://doi.org/10.1016/S2215-0366(20)30034-1