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05-06-13, 08:58 PM
Chapter 3: Children and Mental Health

1. Childhood is characterized by periods of transition
and reorganization, making it critical to assess the
mental health of children and adolescents in the
context of familial, social, and cultural
expectations about age-appropriate thoughts,
emotions, and behavior.

2. The range of what is considered “normal” is wide;
still, children and adolescents can and do develop
mental disorders that are more severe than the “ups
and downs” in the usual course of development.

3. Approximately one in five children and adolescents
experiences the signs and symptoms of a DSM-IV
disorder during the course of a year, but only about
5 percent of all children experience what
professionals term “extreme functional impair-

4. Mental disorders and mental health problems
appear in families of all social classes and of all
backgrounds. No one is immune. Yet there are
children who are at greatest risk by virtue of a
broad array of factors. These include physical
problems; intellectual disabilities (retardation); low
birth weight; family history of mental and addictive
disorders; multigenerational poverty; and caregiver
separation or abuse and neglect.

5. Preventive interventions have been shown to be
effective in reducing the impact of risk factors for
mental disorders and improving social and
emotional development by providing, for example,
educational programs for young children, parent-
education programs, and nurse home visits.

6. A range of efficacious psychosocial and
pharmacologic treatments exists for many mental
disorders in children, including attention-
deficit/hyperactive disorder, depression, and the
disruptive disorders.

7. Research is under way to demonstrate the
effectiveness of most treatments for children in
actual practice settings (as opposed to evidence of
“efficacy” in controlled research settings), and
significant barriers exist to receipt of treatment.

8. Primary care and the schools are major settings for
the potential recognition of mental disorders in
children and adolescents, yet trained staff are
limited, as are options for referral to specialty care.

9. The multiple problems associated with “serious
emotional disturbance” in children and adolescents
are best addressed with a “systems” approach in
which multiple service sectors work in an
organized, collaborative way. Research on the
effectiveness of systems of care shows positive
results for system outcomes and functional
outcomes for children; however, the relationship
between changes at the system level and clinical
outcomes is still unclear.

10. Families have become essential partners in the
delivery of mental health services for children and

11. Cultural differences exacerbate the general
problems of access to appropriate mental health
services. Culturally appropriate services have been
designed but are not widely available.

-Mental Health: A Report of the Surgeon General , P. 17-18