This annual report - Taranaki District Health Board

[34] have made further contributions to the understanding of the operation of risk andprotective factors for child and adult mental disorders.The development of classification systems, including the American PsychiatricAssociation’s DSM-III (published in 1980) and the World Health Organization’s ICD-9(published in 1978) have improved clinicians’ abilities to make diagnostic distinctions, [324]but there is continuing debate about the validity of some diagnostic criteria and the manydiagnostic sub-categories in the current DSM-IV and ICD-10 classifications (which result ina significant proportion of patients seeming to have multiple disorders) [332].Since the 1970s there has been an increasing recognition of the relationship betweenbrain development and mental disorders. Both schizophrenia [333] and autism [334] arenow considered to be neurodevelopmental disorders. Much research has been done onthe genetics of mental disorders. A large number of twin, adoptee and family studies haveshown that genetic influences operate in almost all forms of mental disorder albeit tovarying degrees [335]. The development of technology to identify individual susceptibilitygenes has made it possible to study gene-environment interactions [336,337] and thereare increasing numbers of studies finding evidence of gene–environment interactions inpsychiatry and in other branches of medicine.An example of gene-environment interaction is provided by the Dunedin longitudinal studywhich found that a functional polymorphism in the promoter region of the gene encodingthe neurotransmitter metabolising enzyme monoamine oxidase A (MAOA) moderated theeffect of child maltreatment on the chances of the child becoming a violent adult.Maltreated children whose genotype conferred low levels of MAOA expression developedconduct disorder and anti-social personality more often and were more likely to commitviolent crimes as adults than children who were maltreated but had a high-activity MAOAgenotype [337,338].Bronfenbrenner’s ecological theory of human development has led to the appreciation thatthere are influences beyond the family which have effects on child development andpsychopathology [339]. This has led to new directions in research and findings about theelements in larger social structures and societies that are vital for children to fulfil theirdevelopmental potential.In the last few decades there have been innovations in psychotherapy [340], cognitivebehavioural therapy [341], parenting programmes [342,343] and family therapies [344].The beneficial effects of pharmacological treatment for ADHD, first reported in 1937 [345],have been confirmed by numerous studies (including many randomised controlled trials)since methylphenidate was released for commercial use in 1957 [337,346].The advances in the understanding of the causes and treatments of childhood mentaldisorders have come from research in many different fields, including psychology,sociology, genetics and other non-psychiatric disciplines [324]. It is hoped that as thegeneral public becomes more aware of these advances there will be less stigmatisation ofthose with mental disorders and so a major barrier to mental health service access andutilisation will be removed [347].Child Mental Health Services in New ZealandBackgroundIn New Zealand, in the later decades of the 20 th century, child and youth mental healthservices (CAMHS) were not seen as a high priority and service development occurred inan ad hoc fashion throughout the country. Two key reports commissioned by the Ministryof Health in 1995, the McGeorge Report [348] and the Stocktake of Services [349] noted asignificant shortage of child and youth mental health services and considerable variabilityin regard to how services were provided and who received them [350].The Mental Health Commission’s 1999 review of child and youth mental health servicesfound a shortage of staff with experience in child and youth mental health across allprofessional disciplines and noted that there was no coordinated national plan to addressIn-Depth Topic: Mental Health Issues in Children - 369