Health Promotion and Prevention in Child and Adolescent Mental Health

O’LOUGHLIN, K.; ALTHOFF, R.R.; HUDZIAK, J.J. Health promotion and prevention in child and adolescent mental health. In: REY J.M. (org.). IACAPAP e-Textbook of Child and Adolescence mental Health. Geneva: IACAPAP, 2017

The perfect storm for positioning the field of child and adolescent mental health to the forefront of health care reform is upon us. If we embrace the power and scope of health promotion and illness prevention, our field will become central to the care and wellbeing of all children and families. Child and adolescent psychiatrists are the only physicians trained to understand the emotional and behavioral correlates of the structure and function of the developing brain. No other field combines classic medical training with an understanding of brain and behavior development from birth to age 24, the age span that defines the children and families we serve. Over the past two decades multiple domains in medical research have matured to the point that child and adolescent psychiatry is perfectly positioned to execute a paradigm shift in how our field is defined and practiced.

The change agents include rapid advances in the understanding of genetics (Rijlaarsdam et al, 2014), epigenetics (Weder et al, 2014), and structural (Ducharme et al, 2011) and functional (Stringaris et al, 2015) neuroimaging studies of large populations of children across development (Verhulst & Tiemeier,2015). This research allows our field to understand the unique vulnerabilities and opportunities that occur during the epoch of brain development. With the explosion of interest in, and evidence from the Adverse Childhood Experiences (ACEs) study, it is now clear that the same factors that place children at risk for anxiety, depression, and substance abuse also contribute to similarly elevated risk for obesity, diabetes, and hypertension (and many other general medical problems) (Felitti et al, 1998).

These data allow our field to rightly claim a special role in addressing and preventing the factors that precede the most common and costly of all medical illnesses, not just psychiatric illness. Another major advance exists in the area of health promotion. Cardiologists would never define themselves as physicians who only care for patients’ with end stage heart disease, rather cardiology is defined as a field that also has developed heart health promotion and illness prevention programs (e.g., through diet and exercise). This has led the rest of medicine to appreciate the importance of promoting cardiac health in all humans. Child and adolescent psychiatry should and can follow the same method. Modern neuroscience gives child and adolescent psychiatrists the opportunity to design brain health promotion programs from pregnancy to adulthood.

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