Introduction to the Special Series on Child and Adolescent Mental Health1

Article Outline

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Current estimates indicate that as many as one in five youngsters will experience a psychiatric disorder at some point before adulthood. Oftentimes, these disorders will run a chronic course into adulthood, resulting in significant distress and impairment for both the affected child and their loved ones. Given the high prevalence rate of child psychiatric problems and their associated impairment, the past decade has witnessed a great expansion in the study and treatment of pediatric psychiatric conditions. Despite this, effective treatment is not fully utilized, certain disorders are not readily and accurately diagnosed, and referrals are often directed to professionals who may not be adequately equipped or trained to handle certain disorders. With the expansion of the nursing role within health care, it is clear that nurses have an increasingly important role in care of youth, both within and outside of psychiatric care centers. Yet, few nurses outside of the mental health arena have specialized knowledge about evidence-based mental health care of children and adolescents. As a result, the dissemination of appropriate care has lagged, resulting in considerable morbidity and functional impairment that is related to the presence of a psychiatric disorder.

With this in mind, the articles contained in this special section review the state of the knowledge about the phenomenology and treatment of psychiatric conditions commonly encountered by nurses, capturing the complexities of each disorder while highlighting the appropriate treatment approaches to facilitate optimal outcomes. Given that nurses are often the first providers to encounter children experiencing these challenging conditions, we are particularly pleased with the way that these articles present information about a broad range of topics including clinical presentation, assessment, etiology, and perhaps most importantly, evidence-based treatment.

Breitenstein et al. open by describing the nature and treatment of childhood disruptive behavior disorders. These disorders are common and without effective treatment and can be very costly to families and to the overall society. In their article on mood disorders, Lack and Green present the nature and evidence-based treatment of pediatric major depression, dysthymia, and bipolar disorder. Both of these disorders are highly prevalent among children and adolescents and associated with a number of deleterious outcomes. Lack and Green provide an excellent presentation related to the intricacies of treatment, both psychotherapeutic and pharmacologic, and how the practicing nurse can integrate this information into the care of pediatric patients with mood disorders.

Keeley and Storch describe the nature, epidemiology, assessment, and treatment of a range of pediatric anxiety disorders. One of the most prevalent forms of childhood and adolescent psychopathology, the varied anxiety disorders, can be tremendously impairing. Unfortunately, these disorders, perhaps more than any of the other psychiatric conditions, are often underdetected given patient secrecy and that these symptoms often do not create the same level of disruption as other disorders such as the oppositional defiant disorder or attention deficit hyperactivity disorder. In their article, Keeley and Storch highlight the importance of complete treatment, which includes psychological and pharmacological approaches, and the role of the nurse in providing care.

In a series of two articles, Inglese reviews the nature and role of the nurse in the assessment and treatment of youth with autism. Over the past decade, rates of autism and related spectrum disorders have increased exponentially; thus, undersItanding presenting features of this disorder and its treatment is critical for the practicing nurses. The Inglese articles are particularly noteworthy for the manner in which they present the intricacies of autism spectrum disorders and review the multitude of modalities that are used in its treatment.

Finally, Silvan et al. reports on a qualitative study that examines how parents from different racial/ethnic groups understand two commonly used parent-rating scales of child emotional and behavioral functioning, namely the Child Behavior Checklist and the Eyberg Child Behavior Inventory. Understanding how people from varied backgrounds view available measures has important implications for ensuring accurate assessment of symptoms and for monitoring treatment progress.

Each of the articles contains a wealth of knowledge that is relevant for the practicing nurse, regardless of specialty. Perhaps the greatest contribution of this series, however, is the easy-to-grasp manner that information is disseminated. It is our hope that the reader is left to consider issues inherent to the effective care of youth with psychiatric disorders. Considering the critical role that nurses play in the well-being of youth and their families, it is crucial for nurses and other mental health professionals to collaborate not only in patient care but also in the education of other professionals about their own disciplines. With this in mind, our hope is that this will help to broaden views, serve as a bridge between the nursing and mental health disciplines, and stimulate additional collaboration and scholarship between these fields on effective interventions for childhood psychiatric disorders.