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Behind the headlines of pediatric mental health issues

Worsening mental health among children and teens has captured headlines, but data indicate a larger picture of neurological damage. Workforce shortfalls cause long wait times for appointments, insurance reimbursement policies mean many costs are borne by families, and research into causes is lacking.

Young Americans suffer from anxiety and depression at an ever-increasing rate, a trend that began before the coronavirus-related lockdowns. According to the Child and Adolescent Health Measurement Initiative, children ages 2 through 17 suffered from anxiety at a rate of 2.9 percent in 2007, rising to 8.96 percent in 2016 and to 12 percent in 2022. Pediatric depression saw a similar rise, from 2 percent in 2007, to 4.42 percent in 2016 and 5.7 percent in 2022.

Anxiety and depression are not the only neurological conditions on the rise in young people. The incidence of developmental delay was 3.2 percent in 2007, and increased to 6.34 percent in 2016 and 7.6 percent in 2022. Speech disorders affected 3.7 percent of children in 2007, rising to 7.31 percent in 2016 and 9.1 percent in 2022. Attention-deficit disorder/attention-deficit-hyperactivity disorder had a survey prevalence of 6.4 percent in 2007, a figure that rose to 9.44 percent in 2016 and 10.2 percent in 2022.

Shortage of providers

Some school districts are coping with the increase in mental health problems by contracting with service providers to bring care into schools. The Press previously described the Student Assistance Program in the Bethlehem Area SD, as well as the wellness centers located in district schools. Liberty HS principal Harrison Bailey III noted that children seeking care outside the school district may struggle to find mental health care providers, or be placed on long waiting lists for appointments.

This discrepancy between population health care needs and the capacity of the physician workforce to meet these needs is often the focus of articles on pediatric mental health. Connie Garner, former policy adviser to Sen. Edward Kennedy and current consultant at Foley Hoag LLP, told the Press that she believes more training for primary care providers in mental health issues will improve patients’ access to care. She also suggests that an increase in reimbursement rates for psychiatrists will encourage more medical students to enter the field of mental health.

Unfortunately, the number of doctors entering the workforce every year is limited by the fact that the federal Medicare program funds all medical residencies, with a cap of 100,000 slots per year, a figure that has not changed since 1997. An increase in the number of medical schools or the size of medical school classes may increase the number of medical students in the U.S., but the hard limit on residencies means that there is also a hard limit on how many doctors become qualified to practice each year. Financial incentives could, however, bring more doctors who have trained outside the U.S. into the country.

Finding the right provider - and enough time for testing and diagnosis

Psychiatry isn’t the only field in which the number of providers is not keeping pace with the magnitude of the patient population. Some children’s neurological problems have behavioral manifestations, but are best diagnosed and treated by neurologists, or in partnership with neurologists.

Melissa Wright, M.D., is a pediatric neurologist at the University of Utah, with both clinical and research responsibilities. Like most pediatric neurologists, she sees patients with a wide variety of symptoms, from suspected absence seizures to chronic headaches to more complex issues.

Wright offers an example of two common problems, seizures and ADHD, with diagnostic and treatment complexity. “Sometimes it’s complicated,” Wright tells the Press, because teachers and families may suspect that a child has ADHD because of learning difficulties, but families notice that the child also has staring episodes, “and we find that they’re having frequent absence seizures.” Determining how much, if any, of the patient’s problem is ADHD-related can be challenging; treating the patient’s seizure disorder has its own path of root cause analysis and finding the right medication regimen.

Although Wright recognizes that neurologists have expertise in brain health that PCPs do not, she notes that a major restriction on PCPs is time. Pointing out that pediatric neurology patients may have very complex presentations, or complicated psychosocial situations that affect provision of care, she says that the typical 15-minute PCP appointment is likely not long enough to give family doctors or pediatricians enough time to delve into these patients’ problems. When a PCP writes a referral, shortages of pediatric neurologists affect families’ access to specialized care.

Another issue that affects some families is reimbursement for testing and coverage of prescription medication.

“Full neuropsychiatric testing for kids is a four-hour process of going through different domains of learning, which can tell us the patterns of a child’s learning challenges, or help us see a neurological profile,” Wright says, “and families are sometimes told it won’t be covered by insurance.” She also notes that she spends more time than she ever expected trying to get insurance approval for medications that her patients need.

As a doctor at a major academic medical center, Wright is not under the type of revenue-generation pressure that some of her peers in private practice face. She is often able to make time – or take personal time – to help patients and their families secure school-based accommodations. “For headache patients,” she explains, “I have to write 504s for them to be able to have water bottles and to be able to go to the bathroom and take medication.” (A 504 plan is an accommodation for a student with a disability, mandated by Section 504 of the Rehabilitation Act of 1973.) “Every single week in my clinic,” she says, “I talk to families about navigating school.” She observes that many PCPs may not have the time to work with families in this way.


causes of a range

of problems?

Given the parallel rise of many brain-related health problems, from ADHD to depression to developmental delay, it’s easy to wonder whether there is an environmental factor or factors affecting today’s young people.

“I get asked that a lot,” Wright says, “and the short answer is, we just don’t have enough research yet.” She mentions, as a point of comparison, that multiple sclerosis has a genetic component – people with a first-degree relative with MS are more likely to develop the condition – and an environmental component – low vitamin D levels and obesity are risk factors for pediatric-onset MS. However, she notes, MS is a well-defined condition. “When it’s harder to define the condition, such as speech disorder, it’s harder to do these wide-scale studies” that uncover environmental causes.

To dig into just one environmental contaminant that has become increasingly widespread over the past few decades, we spoke with Stephanie Seneff, a senior research scientist at the MIT Computer Science and Artificial Intelligence Laboratory.

Seneff has a bachelor’s degree in biology with a minor in food and nutrition, as well as a master’s degree, an engineering degree, and a Ph.D. in electrical engineering and computer science. She has published dozens of papers on increasingly prevalent chronic illnesses, as well as articles and presentations on the health effects of nutritional deficiencies and environmental toxins.

Seneff has extensively studied glyphosate, the active ingredient in the herbicide sold as the brand Roundup. Many of the genetically modified crops grown in the U.S. are resistant to glyphosate, designed to be sprayed multiple times during the growing season with large doses of Roundup without dying. Other crops that are not “Roundup-Ready,” such as oats and wheat, are sprayed with glyphosate at harvest time to dry them rapidly.

One neurological problem that has risen at the same time as glyphosate usage is sleep disorder. Seneff testified at a 2014 Pa. General Assembly hearing on genetically modified organisms that this increase may be because the synthesis of melatonin, a natural sleep-regulating hormone, is downstream from the shikimate pathway, which glyphosate disrupts. Roundup specifically targets the shikimate pathway in order to kill weeds. Although human cells do not use this pathway, commensal bacteria in the human gastrointestinal tract do rely on it for a crucial function: synthesizing three aromatic amino acids, tyrosine, tryptophan and phenylalanine.

Other researchers, including Tatyana Strekalova of Oxford University, have described the biological mechanisms by which deuterium – a naturally occurring isotope of hydrogen – disrupts pathways used for serotonin transport in the body. Serotonin is a key neurotransmitter involved in mood regulation. In a 2015 paper, Strekalova and colleagues showed that deuterium prevalence in drinking water in the United States is correlated with the prevalence of depression.

Seneff expands on this finding by describing a chain of events, starting with glyphosate damage, that could be preventing people from properly metabolizing deuterium.

“The research literature on both soil bacteria and the common gut microbe E coli has shown that glyphosate suppresses many microbial enzymes in the class of enzymes called dehydrogenases. Research has also shown that glyphosate suppresses two very important human dehydrogenases - glucose 6 phosphate dehydrogenase and succinate dehydrogenase. Dehydrogenases (both human and microbial) play a crucial role in supplying the mitochondria with deuterium-depleted protons. Deuterium (heavy hydrogen, a natural element) is extremely damaging to the ATPase pumps in the mitochondria, causing them to become inefficient at producing ATP and to release reactive oxygen species that damage the tissues. Mitochondrial dysfunction is associated with many chronic diseases, including many neurodevelopmental and neurodegenerative diseases.”

In other words, dehydrogenases could ensure that mitochondria aren’t overloaded with deuterium, but because glyphosate suppresses dehydrogenases, the deuterium is left to damage the mitochondria, resulting in a host of downstream damage. This damage could include depression, as Strekalova argues.

Noting that “Glyphosate usage on core crops in the United States has increased over time in step with the steady rise in prevalence of a long list of chronic conditions, including depression, Alzheimer’s disease, autism, ADHD and sleep disorder,” Seneff tells the Press, “I suspect that glyphosate’s disruption of mitochondrial function is a major factor explaining a potential causal relationship between glyphosate and these conditions.”

Between the shortage of neurologists and psychiatrists, insurance limits on reimbursement for neuropsychiatric testing and medications, PCPs’ time constraints, the increasingly widespread use of agricultural chemicals, and the challenge of defining and funding studies of environmental factors for neurological disorders, meeting pediatric mental health needs will continue to be a challenge.

001: (PHOTO COURTESY OF THE UNIVERSITY OF UTAH). Dr. Melissa Wright is a pediatric neurologist. She notes that untangling the neurological and behavioral components of children's health problems can be complicated.
Press PHOTO COURTESY OF PLUS COMMUNICATIONS Connie Garner is a policy adviser focused on health care. She suggests that improving psychiatrists' pay will increase the size of the workforce.
003: (PHOTO COURTESY OF CHELSEA GREEN PUBLISHING) Dr. Stephanie Seneff is a senior research scientist at MIT. She suggests that the widespread use of glyphosate may be responsible for the increase in many chronic human diseases, including depression.
Press illustration courtesy CDC Anxiety and depression are not the only neurological conditions on the rise in young people.