The Shifting Rates of Youth Psychiatric Diagnoses

Key points

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• Rates of psychiatric disorders can vary considerably across time.

• A new study tracked the relative rates of various psychiatric disorders in youth from 2013 to 2021.

• Some diagnoses, such and anxiety and depression, became more common while others, like bipolar disorder, fell.

• What is behind these trends isn't exactly clear but it's important to investigate further.

The rates of various psychiatric diagnoses as applied to children and adolescents can change quite a bit over time for various reasons. There is much debate about the increased prevalence of diagnoses such as autism and ADHD over the past 30 years or so. In the 1990s and early 2000s, there was also a dramatic and controversial increase in the number of youth being diagnosed with bipolar disorder in part due to a shift in how the disorder was conceptualized by mental health professionals.

What have been some of the latest trends in diagnoses? There have been hints from different sources about these. Certainly there is the sense that depression and anxiety have been increasing. At the same time, there is also the impression that some “externalizing disorders,” characterized by aggression, breaking rules, and defiance may be decreasing for the current generation that seems more likely to spend time quietly in their room on their phone than pushing limits and defying rules.

To get a better sense of recent trends, a team of researchers well known for examining different shifts in mental health behaviors and treatments examined millions of mental health records from youth all over the country who received services at publicly funded treatment services from the years 2013 to 2021.

The main finding was that there were indeed some major changes in the rate of various diagnoses being applied across the study period, but the direction of these changes varied considerably from diagnosis to diagnosis. Perhaps the most striking change was that the percentage of bipolar disorder diagnoses dropped from 10% to 1.3% across the study period. Those externalizing disorders like oppositional defiant disorder (ODD) and conduct disorder also fell significantly.

Going in the other direction were diagnoses related to mood and anxiety. The percentage of diagnoses related to anxiety conditions rose from 9.6% to 19.2%, while depressive and trauma-related disorders also increased, particularly for adolescents.

The most common diagnosis assigned was ADHD at around 27% but, surprisingly, no major trends in either direction occurred.

This study, unfortunately, was not equipped to evaluate why these trends were occurring, as there are many factors that could be contributing to these shifts including:

• True changes in the number of youth struggling with these conditions.

• Changes in the way diagnostic criteria are being applied and interpreted by mental health professionals.

• Change in the demographics of youth presenting to publicly-funded clinics versus other types of treatment facilities.

For example, right when this study period began in 2013, a new version of the Diagnostic and Statistical Manual (DSM), which lists the official criteria for various mental health conditions, was published. One of the big changes to DSM-5 was the inclusion of a new diagnosis called Disruptive Mood Dysregulation Disorder (DMDD), which was intentionally created as an alternative to bipolar disorder for youth who presented more with chronic dysregulation rather than clear cycles of depression and mania. This new diagnosis could have been one of the reasons the rate of bipolar disorder dropped, although unfortunately the study didn’t track DMDD diagnoses.

It is inevitable that some folks will interpret these fluctuations as evidence that the diagnoses aren’t “real” in the first place. In my view, this would be an inaccurate conclusion based on the data. At the same time, however, it is important not to get too swept up in the labels we apply imperfectly and focus on what meaningful changes are occurring and why.

Perhaps, for example, it is true that youth really are feeling more stressed and less hopeful than they did in the past. Perhaps it is also true that youth are less inhibited about acknowledging this and seeking help than were previous generations. These two trends together could produce the increased rates of mood and anxiety diagnoses we are seeing.

As for bipolar disorder, it is likely that many folks will be glad to see the rate of diagnosis dropping, but what does this really mean? Is this trend translating into changes in important areas like medication usage or is it just swapping one name for another?

Much follow-up research is needed, but it is clear that the landscape of youth mental health is continually changing and we need to try and be as aware as possible about this shifting environment.

Note: This article originally appeared on Psychology Today.