This annual report - Taranaki District Health Board

IN-DEPTH TOPIC: MENTAL HEALTH ISSUES INCHILDRENIntroductionGood mental health is essential to overall good health and wellbeing for people of all ages.Mental illness is a major contributor to the burden of ill health in New Zealand and in otherdeveloped countries [319,320]. In the widely cited 2004 World Health Organization report:The Global Burden of Disease: 2004 Update, unipolar depression was listed as the leadingcause of lost years of healthy life in high income countries [320]. A 2007 review of theevidence from epidemiological surveys found that about half of all lifetime mental disordersbegin by the mid-teens and three-quarters by the mid-20s [321].The 2011 report from the Prime Minister’s Chief Science Advisor, Improving the Transition:Reducing Social and Psychological Morbidity During Adolescence, noted that earlychildhood is a critical period for the development of executive functions and self-controland that evidence from longitudinal studies, including the Christchurch Health andDevelopment Study and the Dunedin Multidisciplinary Health and Development Study,indicates that young children who exhibit antisocial, defiant, dishonest, disruptive oraggressive behaviour are at risk of poor outcomes in adult life including criminality,substance abuse, mental, physical and dental health problems, teen parenthood, poorparenting practices and domestic violence [322]. The Royal College of Psychiatrists hasstated that improving mental health early in life would improve physical health, reducehealth-risk behaviour and inequalities, and increase life expectancy, economic productivity,social functioning and quality of life [323].With these issues in mind, this in-depth topic explores mental health issues for childrenaged 0–14 years. It begins with a brief overview of the history of child psychiatry andconcepts of child mental disorder. It then reviews the provision of child mental healthservices in New Zealand and considers some of the mental health and other issuesassociated with children in out of home care. The following sections cover theepidemiology and the evidence base for the management of some of the most commonpaediatric mental health diagnoses: attention deficit hyperactivity disorder (ADHD) andoppositional defiant disorder/conduct disorder. The final section offers an overview of thedeveloping field of infant mental health.Historical Background to Child Mental HealthChild Psychiatry has been a recognised specialty since the mid-20 th century [324]. Childpsychiatry, like general psychiatry, has its intellectual and scientific foundations in severaldisciplines: psychology, paediatrics, education and social work [325]. The debate about therelative importance of biological determinism (nature) and environment (nurture) for childmental health has continued from the beginnings of the profession to the present.The scientific study of normal child development was pioneered in the United States by G.Stanley Hall [326]. Once normal child development was well described and there was anunderstanding of the normal capabilities of children at different stages, it became possibleto more accurately recognise and describe deviations from normal childhood emotions andbehaviour.Bowlby’s work on the effects of maternal deprivation led to an awareness of theimportance of children developing selective attachments in early life and the ways in whichthese provide the foundation for all kinds of later social relationships [327,328,329]. Theclassic longitudinal study Deviant Children Grown Up, a 30-year follow up of 536youngsters seen in a child guidance clinic in St Louis in the 1920s, plus a control group of100 chosen from school records of the same period, demonstrated the links betweenconduct problems in childhood and antisocial personality disorder in adulthood [330]. Laterlongitudinal studies including two New Zealand studies in Dunedin [331] and ChristchurchIn-Depth Topic: Mental Health Issues in Children - 368