Child and Adolescent Psychiatry

34 Chapter 3

Comorbidity

Many individuals have multiple diagnoses. These are the common overlaps:

Anxiety

Depression

Hyperkinesis

Conduct

Age and gender Family income Maternal stress level

M

5–10

FM

11–15 GHQ-12

F

%

16

12

8

4

0

20

16

12

8

4

0

40

30

20

10

0

Verbal intelligence Specific learning disorder Neurodevelopmental

disorder

–1SDAverage+1SD No Yes

20

15

10

5

0

30

20

10

0

No Yes

40

30

20

10

0

INCOME

% %

% % %

% with ICD-10 diagnoses

Three-year follow-up

Over 2,500 individuals from the 1999 survey were reassessed three years on –

stratified sampling ensured that this follow-up sample included two-thirds of the

individuals who had a disorder in 1999, and a fifth of those without.

Persistence

A quarter of those with emotional disorders initially still had an emotional

disorder at follow-up with high persistence associated with high parental

stress levels.

Almost half of those with conduct disorders initially still had a conduct

disorder at follow-up. Greater persistence was associated with special

educational needs and high parental stress levels.

New onset of disorders

Onset of new emotional disorders was commoner in adolescents, and was

linked to physical illness and stressful life events.

Onset of new conduct disorders was commoner in boys, and was linked to

special educational needs, living with a step-parent and high parental stress

levels.

Use of services

Among the children and adolescents who had a disorder in 1999, just under half

were seen by specialist services for mental health problems over the next three

years, with some using multiple services; 25% had been seen by mental health

services, 25% by special educational services, 14% by social services, and 14% by

paediatrics.