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INTRODUCTION

Emotional and behavioral health is an integral component of children’s health, lifetime well-being and adjustment, educational attainment, and ability to thrive in all functional domains. It is strongly associated with physical health and resilience in the face of psychosocial or biological adversity. By contrast, behavioral and emotional problems predict or negatively influence the course of pediatric illness.

The significance of emotional and behavioral health problems in pediatrics is underscored by the prevalence of mental health disorders in children. One in 5 children presents with a serious and persistent mental health disorder. The prevalence increases to one-third for the nearly 25% of children in the United States exposed to 2 or more adverse childhood experiences (ACEs), which include physical, emotional, or sexual maltreatment, or chronic or severe medical conditions. (For further discussion of ACEs, see Chapter 28.)

Suicide, the most tragic correlate of mental health disorders, is the second leading cause of death in youth ages 15 to 24 years, accounting for 3 times more deaths than all childhood malignancies or heart conditions combined and more than 20 times the deaths attributable to diabetes in this age group. More ominously, the number of completed suicides appears to be increasing in at least some pediatric populations. Between 1999 and 2014, completed suicides in girls 10 to 14 years old tripled, the largest percent increase in deaths by suicide in any age group.

Other mental health disorders also show increases in prevalence, notably autism, which according to the Centers for Disease Control and Prevention, has gone from 1 in 100 at the beginning of this decade to 1 in 68. Similar increases are noted in adolescent depression and anxiety disorders.

Even more significantly, there is a growing appreciation of the profound lifetime consequences and the cost to both the individual and to society of childhood mental disorders in terms of poor educational attainment and significantly increased risk for substance abuse and dependency, incarceration, violence toward both self and others, and poor health. Pediatric mental health disorders shape dysfunctional and maladaptive developmental and neurodevelopmental trajectories not only by impairing the acquisition of cognitive and social skills but also, more subtly, by negatively impacting caretakers’ ability to provide the very developmental opportunities that underlie healthy adjustment and resilience.

Thus, pediatric mental health disorders lead to chronic lifetime psychopathology and poor health. For example, Winning et al showed that even after 50 years, mental health disorders in childhood were still associated with significantly increased cardiovascular morbidity and mortality. Not surprisingly, the Institute of Medicine’s 2015 report stated that “in the United States, mental and behavioral disorders are the largest contributors to years lived with disability. They are also co-morbid with medical conditions and costly to the health care system and society.” This report, however, noted a “quality chasm” between the number of individuals afflicted with mental health disorders and the availability and ...

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