Mental Disorders

Children's mental health problems have emerged from a long history of misunderstanding and neglect to become the central concern of an active group of researchers and practitioners. The last few decades of the twentieth century witnessed an explosion of knowledge about the nature of disorders that affect children, their frequency of occurrence, their developmental course, and the effectiveness of treatments.

In both children and adults, mental disorders typically are defined in one of two ways: as a category or along a dimension. Categorical approaches are typified by the American Psychiatric Association's diagnostic criteria, as published in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. The definitions of mental disorders in the DSM-IV are characterized predominantly by symptom criteria for diagnoses, as well as by taking into account impairment and, for some disorders, age of onset. For this approach, clinical interviews are the typical measurement.

In contrast to categorical approaches, dimensional approaches emphasize symptoms along a continuum from none or few symptoms to clinically significant levels of symptoms. The dimensional approach is typically measured by reliable and valid questionnaires administered to parents, teachers, or the children under study, with lists of behaviors that the respondent indicates as being characteristic of the child, sometimes or somewhat characteristic, or not characteristic of the child. Children are assigned a score along the continuum or are indicated as exceeding, or not, an empirically established cutoff for clinically significant levels of behavior problems or, at the next lower level, of borderline significance.

The mental disorders that children can develop are commonly divided into two groups: disruptive or externalizing behavior disorders (e.g., attention-deficit hyperactivity disorder, conduct problems) and emotional or internalizing behavior disorders (e.g., anxiety, depression). In addition, children also can develop other disorders that do not fit into this classification system, such as autism, schizophrenia, and eating disorders.

An important perspective within which to understand children's mental disorders is development. By its nature, children's behavior fluctuates over time. One of the biggest challenges for parents and practitioners is to distinguish between normal developmental changes and the emergence of a disorder (atypical changes). Development is also an important consideration in determining whether early signs of a disorder will emerge as a full-blown disorder, develop into a different disorder, or resolve into healthy functioning.

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