Good diagnosis should not to be confused with "labeling," according to Peter Jensen, M.D., who demonstrated at a recent conference how a correct diagnosis can forever change the course of a child’s life.

Jensen, director of the Center for the Advancement of Children’s Mental Health (CACMH) at Columbia University, said that youngsters with attention deficit/hyperactivity disorder are usually diagnosed with a second disorder—such as oppositional defiant disorder (ODD), conduct disorder (CD), anxiety disorder, or depression.

Jensen, who spoke to the National Consortium for Child and Adolescent Mental Health Services in Arlington, Va., last month, has a wealth of experience from his years at NIMH researching disorders of childhood and adolescence such as ADHD. He responded to the popular criticism of psychiatrists as "labeling" children and argues that only with sound diagnosis can clinicians predict the course of illness, as well as which treatments can help.

The National Consortium for Child and Adolescent Mental Health Services celebrated 30 years of advocacy for the youth of America at its quarterly meeting last month. The consortium convened a team of multidisciplinary members unified in purpose—to improve mental health services for children and adolescents. In attendance were consortium members who represented diverse organizations such as the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, and the American Psychological Association. The meeting took place at the headquarters of the National Alliance on Mental Illness (NAMI).

Presenting findings from a landmark study on ADHD, the NIMH Multimodal Treatment Study for Children With Attention Deficit/Hyperactivity Disorder (MTA Study), Jensen said that children with different diagnoses responded very differently to several modes of treatment.

"When treated without medications, kids with ADHD alone really had no benefit at all from the very best behavioral treatment on the planet," said Jensen. The same held true for children with ADHD and CD or ODD. However, those children with ADHD and anxiety did exceptionally well with behavioral therapy alone or medication alone. They did not do any better with the combined treatments, he said. The youngsters who had all the diagnoses that the study covered—ADHD, ODD, CD, anxiety, and depression—responded very well to the combined treatments.

Jensen found marked contrast between these treatments and business-as-usual care in the community. "High-quality medicine practices, as done in the MTA study, are more effective than medication practices in the community, where children are usually not carefully monitored and are not given adequate doses or three-times daily dosing—which is preferable, and where there is little contact between the doctor and the teachers."

Now that he is director of CACMH, Jensen will be able to "put science to work," the center’s motto. CACMH recently formed a partnership with NAMI in which Jensen and researchers at CACMH will work with NAMI to get the research about the best treatments available for children and adolescents with mental illness to policymakers and lobbyists. The lobbyists, in turn, will fight to make these high-quality treatments available to those who need them.

CACMH was developed this past May to bring the newest methods for the assessment and treatment of children’s mental disorders into the daily practices of pediatricians, psychiatrists, mental health care professionals, and educators.

Another speaker at the consortium meeting was Rolando Santiago, Ph.D., of the Child and Adolescent Family Branch of the Center for Mental Health Services (CMHS).

According to Santiago, the Comprehensive Community Mental Health Services for Children and Their Families Program is making a difference for children and adolescents with serious emotional disturbances. The "systems of care" program is now operating in 43 states. The systems or programs in each community are compared not only with one another, but also with the non-CMHS-funded care for children and adolescents in each community.

After one year in the program, behavioral and emotional problems in the 1,385 children enrolled in the program decreased by 17 percent. Clinical functioning also improved. After one year of receiving services, more than twice as many children had scores below 40 on the Child, Adolescent, and Functional Assessment Scale (CAFAS) than at intake. Children whose scores were below 40 are no longer considered to be clinically impaired. In addition, school performance for children in the program increased, with the number of children with average or above-average grades increasing by 11 percent after a year.

Mohammad Shafii, M.D., an APA member and chair-elect of the consortium, praised the group’s goals. "The consortium seeks to bring mental health services to the forefront of the nation’s attention," he said. "There is a feeling of collegiality and of transcending individual interests of the individual organizations for the betterment of child and adolescent mental health."

Shafii emphasized the importance of training future generations of child and adolescent psychiatrists, allocating more funding toward research for children and adolescents, and encouraging young psychiatrists to go to academic settings and do clinical work and research.