PROS Pearls:

*Today's pediatricians, families and children appear to be facing an increasing number of psychosocial problems, when compared with families almost 20 years prior.

*The comparison suggests an almost threefold increase in such problems as identified by clinicians. From 1979 to 1996, clinicians-identified psychosocial problems increased from 6.8% to 18.7% of all pediatric visits among 4- to 15-year-olds.

*The increases were associated with increases in the proportions of single-parent families and Medicaid enrollment. The authors explored but ultimately discounted a number of different other possible explanations for the increases, including: 1) differences in clinician-patient familiarity between the two study samples, 2) differences in clinician characteristics, 3) increased recognition due to better training in behavioral problems, and 4) patient demographics (especially important in light of the geographic differences of the two studies).

*The authors found increases in all categories of psychosocial problems except for mental retardation. Showing the greatest absolute increase was the proportion of visits by children noted to have attention deficit/hyperactivity problems (AHPs), which jumped from 1.4% to 9.2%. The increase in AHPs had a significant impact on the overall increase. However, even without AHPs, the 1996 sample had nearly twice as many psychosocial problems as the 1979 sample.

*The authors conclude that any true increases in psychosocial problems are likely due to the adverse changes that have occurred in the social condition of children and families.