Abstract
The last 20 years have witnessed a remarkable increase in clinical interest and research in child and adolescent psychiatry. Books, new specialist journals and publications in general psychiatry journals have mushroomed. This has been especially evident in Australia and New Zealand. For example, none of the 36 papers (excluding editorials, comments and case reports) published in the Australian and New Zealand Journal of Psychiatry in 1980 referred to child and adolescent psychiatry. In the year 2000, almost one-quarter (23 of 104 papers) dealt with child and adolescent psychiatry topics. By comparison, 11% (16 of 151) of papers published in 1980 in Archives of General Psychiatry referred to child and adolescent psychiatry; the proportion for the year 2000 was 12% (12 of 101 articles). The data in these journals may not represent the real world situation. However, this information is consistent with our impression that Australia and New Zealand, despite lagging behind in the amount of research and scholarship in child and adolescent psychiatry two decades ago, are making up for lost ground. Indeed, they now seem to match countries with more established scholarship in this field in the quality and proportion of psychiatric research published.
The reasons for the growth in interest in child and adolescent psychiatry are varied. However, the most important may be the realization by clinicians and policy makers that mental disorders often have their origin or onset during childhood and adolescence, and are frequent and handicapping in this age group. As a recent report of the Surgeon General of the United States of America put it [[1]]: The nation [[US]] is facing a public crisis in mental health for infants, children and adolescents. Many children have mental health problems that interfere with normal development and functioning. In the United States, one in 10 children and adolescents suffer from mental illness severe enough to cause some level of impairment. Yet, in any given year, it is estimated that about one in five children receive mental health services. Unmet need for services remains as high now as it was 20 years ago. Recent evidence compiled by the World Health Organization indicates that by the year 2020, childhood neuropsychiatric disorders will rise proportionately by over 50%, internationally, to become one of the five most common causes of morbidity, mortality, and disability among children.
This situation is similar to that reported in the child and adolescent component of the Australian National Survey of Mental Health and Wellbeing [[2]]. Accordingly, to reduce the burden of mental illness, prevention and early intervention must be a priority during this developmental period [[3,4]]. This also makes the need for research even more compelling. This Symposium is an acknowledgement by the Journal of the progress in our discipline and provides an opportunity to showcase some of the advances in theory, clinical practice and service delivery.
The classification of mental disorders is evolving. Clinicians and researchers are now realizing that the focus on ever-smaller categorical groups brought about by DSM-III, DSM-III-R and DSM-IV may have considerable practical problems and other approaches may be more useful to pursue [[5]]. Tom Achenbach, a pioneer in this field, describes some of these issues in his article and emphasizes that both categorical and dimensional views of psychiatric disorder can coexist in practice and complement each other [[6]]. Our understanding of the very nature – and substrate – of mental illness has been enhanced by the new imaging technologies. In their paper, Rapoport et al. summarize research using these technologies on changes in the brain over time in children suffering from schizophrenia and from attention deficit hyperactivity disorder [[7]]. The contribution of Dr Rapoport's team is changing the way we conceptualize those troublesome conditions. Steinhausen and Metzke [[8]], for their part, focus on the measurement of impairment, another aspect of considerable practical importance.
A picture of child and adolescent psychiatry in 2001 would be incomplete without mentioning the advances brought about by the large prospective studies. Three of the best known have been undertaken in this region: the Christchurch Health and Development Study (CHDS), the Dunedin Multidisciplinary Health and Development Study, and the Australian Temperament Project (ATP). Fergusson and Horwood's paper [[9]] not only illustrates the advantages and cost–benefit of long-term projects of this kind but also summarizes the large contribution made by the CHDS to mental health research. Many readers will be surprised by the range of topics addressed. These vary from lead exposure and intelligence to the effect of sexual orientation on mental health. Such a wealth of information condensed in one article is rare. Prior et al. [[10]] present some of the specific data that can be obtained in prospective studies using information from the ATP. They report on the links between temperament during infancy and behavioural and emotional problems later on. Their findings have obvious implications for prevention. Garralda's paper [[11]] addresses another subject with practical and everyday relevance, the role of general practitioners in the treatment of children and adolescents with mental health problems. Meeting the demand for treatment is indeed a challenge the world over [[1]], not least because there are few professionals at all levels with the knowledge and skills to deal with these problems. General practitioners can thus play an important role and Garralda's paper highlights some of the difficulties and advantages of this work.
Any Symposium can provide but a glimpse of a field and its progress. It would be impossible to cover all the topical areas. Further, it is evident that much work remains to be done in our subspecialty. However, it is also clear that we have much to celebrate. Far from dragging the chain, child and adolescent psychiatry – locally and abroad – emerges as a front-runner in many areas of research and service provision. We thank our contributors for helping to convey that message, and trust that you enjoy their papers and scholarship.