Child and Adolescent Mental Health

The Importance of Development

Most common mental disorders, including those with the greatest morbidity, have an onset in childhood or adolescence (Kessler & Wang, 2008), with the peak incidence for common disorders occurring during adolescence (Paus, Keshavan, & Giedd, 2008). While some disorders (e.g., depression) typically develop during adolescence, others (e.g., attention deficit disorder) may have an earlier onset, but remain undiagnosed due to developmental context or limitations in screening and assessment. Childhood and adolescence provide critical periods for prevention, early detection, and intervention to promote child mental and behavioral health. Advances in brain imaging (Giedd J., Raznahan A., Alexander-Bloch A., Schmitt E., Gogtay N., & Rapoport J.L. ,2015), neuroscience (Casey, Getz, & Galvan, 2008; Luciana & Collins, 2012; Strang, Chein, & Steinberg, 2013) and behavioral science (Albert, Chein, & Steinberg, 2013; Smith, Chein, & Steinberg, 2013) have shown that there are critical environmental and genetic developmental influences on child and adolescent mental health, across biological, socioemotional, and behavioral domains ³. For example, early childhood is a period in which essential skills for self-regulation begin to develop (Berger, 2011; Diamond, 2013; Skinner & Zimmer-Gembeck, 2009), while adolescence is a period in which numerous risks become salient (National Research Council and Institute of Medicine, 2011), such as increased vulnerability to sensation-seeking, risk-taking behaviors, and susceptibility to peer influence. This can result in, among other things, enhanced vulnerability to substance use and addiction (Chambers, Taylor, & Potenza, 2003), including opioids (Wall et al., 2018). Moreover, research has identified multiple pathways and several risk factors leading to the development of mental and behavioral disorders in children and adolescents (Cross-Disorder Group of the Psychiatric Genomics Consortium, 2013; Frick, 2012; Latimer et al., 2012; Reiss, 2013). Disorder presentations are affected by biological determinants, environmental influences and genetics, including prenatal development and exposures and subsequent nutrition, in an interplay that is multi-determined and complex (Dunn et al., 2011; Tercyak, 2010). For example, research in epigenetics has shown that environmental and social factors (such as prenatal substance abuse, lead, pesticides, and other common, everyday exposures) alter gene expression, and experience interacts with genetic predisposition (Szyf, 2009). Clinicians and psychological scientists recognize that the etiological factors and behavioral expression of childhood disorders often overlap and interact, and co-morbidities are common. Some conditions, particularly developmental and intellectual disabilities, render children and adolescents vulnerable to under-diagnosis of co-morbid mental health and health problems (“diagnostic overshadowing”) (Matson & Williams, 2013).

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