Research in Child and Adolescent Mental Health

The European Society of Child and Adolescent Psychiatry (ESCAP), formerly the European Union of Pedopsychiatrists, was founded in 1960 to further knowledge and understanding in the field of child and adolescent psychiatry. This field includes emotional, psychosomatic and behavioural disorders, (including depression, anxiety and conduct problems), developmental disorders, such as autism, learning difficulties, and alcohol and drug problems in this age group. ESCAP is the only scientific organisation bringing together all European psychiatrists who practice with children and adolescents. It holds a regular conference, on this occasion to be held in Hamburg, Germany, in September, 1999, and publishes a quarterly professional, academic journal, ECAP (European Child and Adolescent Psychiatry).

The purpose of this declaration by ESCAP is to draw attention to the lack of resources for the conduct of research into child and adolescent psychiatric disorders. These disorders are the most common handicapping conditions in childhood. Epidemiological studies in different European countries suggest that around 10% of children and adolescents suffer from a psychiatric, developmental or learning disorder in any one year. These disorders have a major social and psychological impact on the child and family. The financial costs arising from their occurrence are considerable and fall not only on health, but also on social, education and voluntary services, and on the families themselves. For example, it has been estimated that conduct disorders, affecting around 5% of the child population, cost approximately 150,000 Euro per affected person during childhood, adolescence and early adult life. The personal suffering caused to children for example by depressive disorders (often with suicidal ideas and sometimes suicidal behaviour), eating disorders such as anorexia nervosa and bulimia, autism (with profound difficulties in communication and personal relationships), and mental retardation cannot be over-estimated.

Over recent years, and especially during the last twenty five years, there have been major advances in the understanding of child and adolescent psychiatric disorders. It has, for example, become apparent that many disorders of childhood, especially conduct disorders, but also depression and anxiety, frequently persist into adult life. Indeed, some adult psychiatric disorders, such as antisocial personality disorders, virtually always begin in childhood. The causes of some disorders have, to a considerable degree, been elucidated and we now know a great deal more about the way social and genetics factors interact to produce behaviour and emotional disorders. However, the gaps in our knowledge remain profound. For many disorders our understanding of causation remains limited. This is particularly true of depressive and anxiety disorders. There has been a very modest amount of research into the effectiveness of treatment, yet all are agreed that it is vital that the scarce resources that are available should provide treatment that is evidence-based. Evaluation of preventive initiatives has scarcely begun, although the social and financial rewards for successful prevention would be enormous.

The volume of financial support invested in European research into child and adolescent psychiatric disorders remains extremely low. Apart from the drug and alcohol field there appears to be no priority at all accorded in EC planning for research and development in child and adolescent psychiatry. National governments support studies to a variable extent, but, in general, there is a lack of financial and manpower resources to conduct research. ESCAP wishes to press the case for significantly more resources to be put into this important area of work.
More specifically, ESCAP strongly recommends:

1. Research into child and adolescent psychiatry identified as a priority area in the list of EC priorities for research.
2. Specific research support for studies into the treatment of childhood and adolescent depression, anxiety disorders, developmental disorders and conduct disorders.
3. Earmarked EC expenditure of 30 million Euro per annum for the next five years for the field of child and adolescent mental health research.
4. The commissioning by the EC of a review of existing research into child and adolescent psychiatric disorders currently being conducted in EC countries.
5. The establishment of EC training fellowships in child and adolescent psychiatry to increase the numbers qualified to conduct research in this field.