Changes in referral patterns to outpatient child and adolescent psychiatric services from 2005-2018.

There has been a steep increase in referrals to child and adolescent psychiatric (CAP) services across Western countries. To fit CAP services to the increasing demand, it is important to gain more knowledge about the background for the increase in referrals and to investigate changes in referral patterns over time.
Cross-sectional observational study comparing referrals to outpatient CAP services from 2005, 2010 and 2018 to the only CAP center in the North Denmark Region.
There was a 3.9 times increase in referrals from 2005 to 2018. Referrals for disorders with onset in early childhood (primarily autism and ADHD/ADD) increased from 2005 to 2010 but decreased from 2010 to 2018. There was an increase in the proportion of referrals for emotional disorders from 2010 to 2018. The proportion of girls referred for disorders with onset in early childhood increased from 2005 to 2018. The referral age for these disorders remained relatively high, and this was most pronounced for girls.
There has been significant changes in the referral pattern to outpatient CAP services. The increasing referral rates for girls for disorders with onset in early childhood could indicate improved ability in primary settings to recognize these symptoms in girls. However, late referral to CAP services for these disorders remains an issue. Educational services play an increasing role in referring children for these disorders, and it is important to ensure that they have the competences to identify children in need of assessment by CAP services.