Conceptual issues

Taking a population approach to child psychiatric disorder is relevant for several reasons. Child psychiatric disorders ('child' includes adolescents) are a common mental health problem at all stages of early development, and emotional and behaviour problems form the most common type of disability in childhood. Since their aetiology often includes environmental factors, mental health interventions are commonly targeted at the child's social and family environment rather than the individual child. Disruptive behaviour disorders are a cost to the welfare of other members of the community, both adults and children, and are expensive to contain. There is mounting evidence from developmental psychopathology that multiple childhood adversities and the presence of psychiatric disorder in childhood predict the presence of psychiatric disorder in adult life.(1) Thus attention to child mental health improves the chance of mental health in adult life. Furthermore, the same adversities associated with the development of psychiatric disorder in childhood also predict later social adjustment, as shown in the Newcastle 1000 Families Study.(2) To promote child mental health and reduce the amount of child psychiatric disorder in the population is therefore an important social task.

Furthermore, most children with psychiatric disorder will not be seen in treatment services and when they are, their condition has usually become chronic. It seems unlikely that, in the foreseeable future, services will ever be extensive enough in any country to treat all children with mental health problems. It may, therefore, be worth investing in prevention.

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