Estimating the Prevalence of Early Childhood Serious Emotional/Behavioral Disorders: Challenges and Recommendations

Cheryl Boydell Brauner, MPHa Cheryll Bowers Stephens, MD, MBAb An expanding literature base indicates the incidence and prevalence of emo tional/behavioral problems in young children is increasing. The U.S. Depart ment of Health and Human Services' (DHHS') 1999 report, Mental Health: A Report of the Surgeon General, estimates that at least one in five (20%) children and adolescents has a mental health disorder at some point in their life from childhood to adolescence.1 At least one in 10 (10%), or about 6 million people, has a serious emotional disturbance at some point in their life.1 On October 23-24, 2000, DHHS convened a multidisciplinary group of experts from fields including mental health, public health, and epidemiology. The group advised, "It is essential that the nation find ways to support emo tional health of our youngest children and their families through a continuum of comprehensive, individualized, culturally competent services that focus on promotion, prevention, and intervention." They also recommended steps to ensure the emotional health of infants not only to address school readiness, but to help families be stronger, supportive teachers for their children. Research highlights the importance of the first three years of life for school readiness, but also the important role that emotional health plays in preparing children to engage in cognitive tasks.2"5 Before there is thought and language, there is emotion, and it is this early affect within the context of the earliest relationships that forms the basis for all future development.6-8 Research has also shown that the emergence of early onset emotional/behavioral problems in young children is related to a variety of health and behavior problems in adolescence, not to mention juvenile delinquency, school drop out, etc.9-11 Families and communities, working together, can help children with mental disorders. A broad range of services is often necessary to meet the needs of these children and their families. However, in many communities, services for young people with serious emotional disturbances are unavailable, unaffordable, or inappropriate. An estimated two-thirds of the young people who need men tal health services in the United States are not receiving them.1 As a result, many children with mental health issues become involved with the juvenile

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