Vol 11, N°1 Child and Adolescent Psychiatry
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I n t h i s  i s s u e... Child psychiatry is perhaps the most challenging subspe- cialty within our field. Clinicians and researchers must confront a variety of problems. Their patient is a moving target—always  growing,  developing,  and  changing. Generalizations made about a 5-year-old population (in fact rarely studied) may not apply to a 10-year-old, and even less so to a 15-year-old. Epidemiology, diagnosis, treatment, and neurobiology must use a developmental perspective that recognizes the importance of vulnerabil- ity, change, and maturation during childhood and ado- lescence. Furthermore, many of the disorders that are common  in  young  people  have  been  defined  and described on the basis of their presentation in adults, despite the fact that we all recognize that children are not miniature adults. In fact, this issue illustrates this par- ticular problem very well. All of the disorders discussed, apart from autism spectrum disorders, are defined and described in the “adult” section of the American Psychi- atric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV): bipolar disorder, unipolar depression, obsessive-compulsive disorder, sleep disor- ders, post-traumatic stress disorder, and anorexia ner- vosa. The need to decide how well these definitions and descriptions apply to children and adolescents is a persis- tent theme in this issue, as is the need for more research on this topic. Likewise, treatment protocols appropriate for adults clearly cannot be easily extrapolated to children and adolescents. We know far too little about when and how to intervene, as well as the benefits and risks of early intervention. One thing is certain: although children are not small adults, they will all become adults. The chal- lenge of reducing the global burden of mental illness must begin with high-quality diagnosis and treatment of children and adolescents. This issue helps to address that challenge. The issue begins with a State of the art overview of the epidemiology   of   childhood   disorders   by   Kathleen Merikangas, Erin Nakamura, and Ronald Kessler (p 7). As they point out, these disorders contribute heavily to the global burden of disease in and of themselves. Beginning with a description of basic epidemiologic concepts such as incidence and prevalence, they go on to summarize our current state of knowledge about the disorders that are most common in children and adolescents. While the epidemiology of adult disorders has received substantial attention and acquired a solid database, data of compa- rable quality do not as yet exist for children and adoles- cents. Information about the epidemiology of mental ill- nesses in children under 6 is especially limited. What existing data do demonstrate, however, is that “classic” childhood disorders are relatively common (eg, attention deficit hyperactivity disorder [ADHD], conduct disorder), but that many “adult” disorders are also common (eg, depression, anxiety disorders). Furthermore, the costs associated with these disorders are substantial, and yet the services provided are insufficient. Only about half of children and adolescents with mental disorders receive mental health services, even in developed nations such as the US and the UK. Many experts are dissatisfied with the current methods for classifying and diagnosing men- tal illnesses in young people, since they fail to account for the high rates of comorbidity and the possibility that some disorders are characterized by overlapping dimen- sions of psychopathology. Two papers emphasizing Translational research  echo themes expressed by Merikangas et al, particularly the importance of conceptualizing childhood disorders with dimensional approaches. James Leckman, Michael Bloch, and Robert King (p 21) provide an elegant example of these approaches in the study of childhood obsessive- compulsive disorder (OCD), which affects approximately 1% to 3% of children and adolescents. Although OCD is described as a unitary nosological entity in DSM-IV  and the World Health Organization's ICD-10 Classification of Mental and Behavioral Disorders. Clinical descriptions and diagnostic guidelines (ICD-10), multiple factor ana- lytic studies have suggested instead that it is comprised of four factors or dimensions in both children and adults: forbidden thoughts, symmetry, cleaning, and hoarding. Leckman et al discuss the power of this dimensional approach, in combination with a developmental and neurobiological perspective. For example, imaging stud- ies  suggest  that  different  neural  networks  may  be involved in the different dimensions, while different genes may be implicated for them at the molecular level. Taking a slightly different perspective, Joseph Buxbaum (p 35) focuses specifically on genetic etiologies of the autism spectrum disorders (ASD). In an interesting and comprehensive summary of our knowledge to date, he broadens the concept of ASD by describing its potential overlap with other rarer conditions such as Rett's syn- drome or 22q13 deletions. This article will be particular- ly useful for those readers who wish to become more familiar with cutting-edge genomics and genome-wide