THE PREVALENCE OF PSYCHIATRIC DISORDER IN CHILDREN AND ADOLESCENTS
In a survey of 52 studies, Roberts et al. (1998) found that the average prevalence of psychiatric disorder in children and adolescents was 15.8%, with a range of 11–22%.
Sawyer et al. (2000) surveyed a representative sample of 4500 Australian school children aged 4–17 years, using the Child Behavior Checklist (CBCL) (Achenbach, 1991), the Diagnostic Interview Schedule for Children (DISC-IV) (Shaffer et al., 2000), and the Child Health Questionnaire (CHQ) (Landgraf et al., 1996). Adolescents aged 13–17 years also completed the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Youth Risk Behavior System Questionnaire (YRBS) (Brener et al., 1995). Sawyer et al. found that 14.7% of children and 13.1% of adolescents were in the clinical range. Children and adolescents with mental health problems had a poorer quality of life, lower self-esteem, and worse school performance than those without such problems, and were a greater burden to their families. Adolescents with mental health problems reported high rates of suicidal behavior, smoking, drinking, and drug use. Few psychiatrically disturbed children were receiving any professional treatment, and those who did receive help usually obtained it from general practitioners, school counselors, or pediatricians. Very few had attended a specialized mental health service or clinician.
These sobering statistics indicate that, even if primary diagnostic and therapeutic services were effective, and even if the links between primary and specialized professional services were efficient, there are far too many seriously disturbed families for existing facilities to serve. Furthermore, there is little empirical support for different kinds of mental health treatment outside of laboratory studies (Weisz et al., 1995), and the dropout rate from community services is alarmingly high. For these reasons, the idea of prevention has been promoted. Prevention aims to avert or divert unfavorable developmental trajectories in such a way as to reduce the incidence or severity of psychopathology and promote mental health.
RISK FACTORS AND RESILIENCE
The risk factors known to be associated with later psychiatric disorders vary from biological (e.g., genetic or chromosomal abnormality; exposure to intrauterine toxins such as alcohol or nicotine; premature birth; exposure to toxins such as lead during early development; and chronic physical disability such as epilepsy or brain injury) and temperamental (e.g., behavioral inhibition or difficult temperament) to familial (e.g., parental depression, alcoholism and antisocial personality; disorganized infant–parent attachment; coercive childrearing; single-parent or blended families; marital discord and domestic violence; physical abuse, sexual abuse, and neglect), socioeconomic (e.g., poverty or membership in a disadvantaged minority group) and catastrophic (e.g., civilian disaster or war).
Protective factors counterbalance risk. It is known, for example, that an easy, likeable temperament, above-average intelligence, good support from at least one parent, a cohesive family environment, and social capital in the form of good schools, adequate community resources for sport and skill-building, and good employment prospects protect otherwise vulnerable individuals ...