Long considered banal, the psychic disorders of children and adolescents are nowadays increasingly thought of as a major public health issue. Three reasons explain this change in opinion: the prevalence of this type of disorder; the inadequate treatment it receives; the long-term consequences
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Long considered banal, the psychic disorders of children and adolescents are nowadays increasingly thought of as a major public health issue. Three reasons explain this change in opinion: the prevalence of this type of disorder; the inadequate treatment it receives; the long-term consequences of such disorders for young patients. As far as their prevalence is concerned, it is around 20%, the most common ones being anxiety disorders (12%), closely followed by behavioural disorders (10%). As to their life-span prevalence, it has been estimated that in the United States 49% of children between the ages of 4 and 18 fill at least once the criteria for a DSM-IV diagnosis. Moreover, the co-occurrence of conduct disorders, anxiety disorders and depression disorders appears to be very high. None of these disorders receives adequate treatment. In Geneva, the number of consultations for such disorders is about 10%, which is high compared to the rate in the USA (2–3%), but still not satisfactory. This is important, since disorders of this type tend to persist in childhood rather than to go into spontaneous remission and since they are often the forerunners of psychic disorders in adulthood. Indeed, the long-term prognosis about serious disorders is subject to reservations, with up to 50 to 100% of cases still presenting disorders long after the initial diagnosis. This is particularly true of pervasive development disorders and schizophrenia, but also for behavioural disorders, including conduct disorders, oppositional disorders and ADHS. Emotional disorders, including problems related to anxiety and depression, are considered to have a more positive prognosis than behavioural disorders, but their tendency to spontaneous remission is now called into question. Whereas separation anxiety and simple phobia, observed in very young children, usually disappear, the emotional disorders of older children–hyperanxiety disorders, social phobia, obsessional-compulsive disorders and depression-tend to persist. Finally, they have important repercussions at different levels: firstly, in terms of stress, and high personal and family suffering during both childhood and adulthood; secondly, in terms of the psycho-social consequences concerning schooling and professional training on the one hand, and their repeated recourse to the medical and/or social services on the other hand, with major socioeconomic consequences for part, if not all, of their lives. This means that we, therefore, need to take a closer look at the short-term but also the longterm efficiency of the different types of treatment available today: medicinal, psycho-analytical, cognitive- behavioural, and to evaluate them through research.
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