Primary Prevention in Child and Adolescent Psychiatry-An Overview

By Lai, K. Y. C. | Hong Kong Journal of Psychiatry, September 2000 | Go to article overview

Primary Prevention in Child and Adolescent Psychiatry-An Overview


Lai, K. Y. C., Hong Kong Journal of Psychiatry


ABSTRACT

Although primary prevention has been a concern among child mental health professionals for many years, progress in the field has been slow and is fraught with conceptual and methodological difficulties. The aim of this paper is to provide an overview of the topic, highlight some of the more consistent findings, and make suggestions about future development. While it is now generally agreed that intensive primary prevention programmes targeting high risk pre-school children and starting early in the child's life can be effective, much less is known about programmes targeting older children. There is also growing evidence that the participation of the child alone in these programmes--without changing the social context with which the child is in touch everyday--is insufficient to produce sustained improvements. Further development in the field should be guided by a better understanding of the risks and protective mechanisms, and how these affect the child's outcome. In Hong Kong, where child psychiatric morbidity is comparable to that of the West and there are only limited treatment resources, primary prevention needs to be systematically developed as a matter of urgency.

Key words: Child Psychiatry; Effectiveness; Primary Prevention; Protective Mechanisms

INTRODUCTION

It is now well recognised that the community prevalence of child and adolescent psychiatric disorders ranges between 15% and 20%, the commonest of which are disruptive behaviour disorders and emotional disorders. However, few of these children are known to either mental health or social work professionals--1 in 10 in the Isle of Wight study1 and 1 in 6 in the Ontario Child Health Study.2 The remaining majority are not below 'case' level, and intervention is warranted. Many factors contribute to the discrepancy between those in need and those receiving help. The lack of resources is only one factor and, even if treatment for all those in need could be offered, not all children and their families would be willing to accept mental health services. Moreover, those willing to receive treatment may not be the most severely impaired. (3)

Once a disorder is established, there is a great deal of suffering for the child, the family, and others in the wider social context such as peers, teachers, and society in general. While promising treatment strategies, with at least demonstrable short-term benefits, are now accumulating for some disorders, it is also clear that not all children will respond. (4,5) Motivation of the family and the degree of psychopathology within the family are crucial factors for predicting continuation and success with treatment. Children do not grow out of their problems and it is well known that continuities exist between childhood and adult psychopathologies, particularly for antisocial behaviours, conduct disorder, (6) and depression. (7) Rutter pointed out that continuities exist not only at the symptom level but also in the individual's style of dealing with life circumstances, which increase the risk of morbidity.6 Nevertheless, continuities are not inevitable, and can be altered by subsequent positive experiences.

In light of these concerns, the possibility of preventing some of the more common disorders has been an issue with mental health professionals for many years. Unfortunately, progress in the field has been slow. Although much has been published on the topic, there are relatively few well-established findings. Reasons for the slow progress are the difficulties associated with the planning and evaluation of preventive research. Firstly, if primary prevention is defined as intervention before the onset of symptoms, the arbitrary nature of the thresholds for diagnosing some of the disorders makes it hard to distinguish between primary and secondary preventive efforts. Secondly, a programme's stated targets and goals may not be backed by sound theories, for although risk factors, and more recently, protective factors can be readily listed, the underlying mechanisms leading to dysfunction or protection are still poorly understood. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Primary Prevention in Child and Adolescent Psychiatry-An Overview
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.