Children with psychiatric problems go on to be at greater risk of health, legal, financial and social problems, finds a prospective study published in JAMA Psychiatry.

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Even if children grew out of psychiatric disorders, a variety of adulthood problems persisted.

The higher likelihood of problems in adulthood remained even if the children’s psychiatric disorders did not persist into adulthood. The same was true even if they did not meet the full diagnostic criteria for a disorder.

The study of 1,420 individuals from 11 predominantly rural counties in North Carolina was conducted by William Copeland, PhD, of Duke University Medical Center in Durham, NC, and coauthors.

They report on how common childhood psychiatric disorders become adverse functional outcomes in adulthood. The children were assessed six times between the ages of 9 and 16 years.

The children were examined for common psychiatric diagnoses and “subthreshold” psychiatric problems – falling short of the full criteria for diagnosis, with the following results:

  • A common behavioral or emotional disorder at some point in childhood or adolescence was diagnosed in 26.2%
  • Subthreshold psychiatric problems were displayed by 31%
  • Children who never met the criteria for a disorder or subthreshold problem represented 42.7%.

About a fifth of the participants who never had a psychiatric disorder or symptom impairment below threshold levels in childhood reported an adverse outcome as an adult.

By contrast, 41.5% of participants who had childhood subthreshold problems, and 59.5% of those that had a childhood psychiatric disorder, reported adverse outcomes as adults.

Participants with a childhood disorder had six times higher odds of at least one adverse adult outcome compared with those participants with no history of psychiatric problems. A childhood disorder also gave nine times higher odds of two more adverse outcomes.

“Common childhood psychiatric disorders are costly, impairing and often a source of great distress for the child and a burden to others,” the authors say, adding:

“Many children will experience impairing psychiatric problems over the course of their childhood. These common early disorders are often associated with a disrupted transition to adulthood, even if the psychiatric problems do not persist into adulthood and even if the problems do not meet full criteria for a psychiatric disorder.”

The authors warn that “with each additional exposure to childhood psychiatric problems, the prognosis becomes more dire. If the goal of public health efforts is to increase opportunity and optimal outcomes, and to reduce distress, then there may be no better target than the reduction of childhood psychiatric distress – at the clinical and subthreshold levels.”

An editorial commenting on the study is published in the same issue of the journal, written by Benjamin Lahey, PhD, of the University of Chicago, IL.

Dr. Lahey says there are a number of possible causal links between psychopathology in childhood and psychopathology in adulthood. The two could have different causes, “but experiencing mental health problems in childhood may directly or indirectly increase the risk for adult psychopathology.”

Or: “It is possible that some or all of the causes of psychopathology across the lifespan operate in early life.”

Finally, it is possible that the “predictive association between child psychopathology and adult psychopathology could reflect chronic or intermittent exposures to conditions that give rise to psychopathology when encountered across a lifespan.”

Dr. Lahey concludes:

Unfortunately, there currently is little empirical basis for choosing among [these possibilities]. Thus, the extant studies of the predictive association between child and adult psychopathology raise as many questions as they answer.

Fortunately, the unanswered questions are clear, extremely important and answerable if the right kinds of prospective studies are conducted.”