Mental health: Children on the edge

More than one million children are suffering from mental disorders severe enough to require treatment, doctors say.

Rising divorce rates, increased drinking among young people and competitive pressures are among the factors behind the trend, with both sexes and all social classes affected. But a shortage of specialists and widespread stigmatisation of those with mental problems means many children are denied help or face long waits for treatment.

A report by the British Medical Association's Board of Science, published yesterday, said one in 10 children between the ages of one and 15 had a mental health disorder - ranging from sleep problems to excessive temper tantrums and depression.

The sharpest increase has been in behavioural disorders which have doubled in the past 30 years leading to a spread of stealing, lying and disobedience. More than 700,000 children are affected severely enough by behavioural disorders to require treatment, which disrupts school classes and family life,

The proportion of boys with conduct disorders has risen from 7.6 per cent in 1974 to 16 per cent in 2004. Among girls, the proportion has risen from 6 per cent in 1974 to 7.9 per cent in 2004, but experts say girls may be under-diagnosed.

Attention deficit disorder - the symptoms of which include restlessness, overactivity and difficulty concentrating - affects a further 5.1 per cent of boys and 0.8 per cent of girls.

David Skuse, professor of brain and behavioural science at the Institute of Child Health, London, said the biggest increase had been in "non-aggressive" conduct disorders - stealing, lying and disobedience - rather than in fighting and bullying whose prevalence had remained steady. Speaking at the launch of the BMA's report, Professor Skuse said: "There does appear to have been a real increase [in disorders] that is not due to increased recognition of the problem or biased referral. The reasons are likely to be complex and are likely to affect children as a whole rather than subgroups."

Conduct disorders are defined as bad behaviour that is out of the ordinary and seriously breaks accepted rules, lasting for at least six months. It includes severe temper tantrums beyond the age at which they would be expected, severe and persistent disobedience, defiant provocative behaviour, excessive fighting, bullying and cruelty to others or to animals.

The increase in the past 30 years has been concentrated in non-aggressive conduct disorders. Girls are increasingly affected. Only one in three children excluded from school for bad behaviour is referred for treatment.

Professor Skuse said: "Research over the past decade suggests [conduct] problems are equally common in girls - but they manifest themselves in different ways. It may be that we are failing to identify certain disorders that are hidden in the population but are important because they are linked with functional impairment."

The report, Child And Adolescent Mental Health - A Guide For Healthcare Professionals, reveals that wealth and privilege are no defence against mental disorders but poverty and deprivation increase the risks.

Although 16 per cent of children from families with a weekly household income of less than £100 suffered from mental health disorders, that is a smaller number than the 5 per cent affected in families with a weekly income above £600 a week. There are four times more wealthy households with an income above £600 a week than poor households with an income below £100 a week.

Vivienne Nathanson, head of science at the BMA said: "There is a huge need for robust measures to ensure children and adolescents are able to cope. Children from deprived backgrounds have a poorer start in life on many levels but without good mental health they may not have a chance to develop emotionally and reach their full potential."

Poor diet and unhealthy lifestyles increase the risk of mental disorders but little is known about their impact. Dr Nathanson said: "Healthcare professionals are realising just how important diet and exercise are in preventing mental health problems and it is vital more research is carried out. Anecdotal evidence suggests behaviour and concentration deteriorate with processed sugary food."

Avis Johns of YoungMinds, the mental health charity, said: "The majority of adults with mental illness are able to trace their symptoms back to childhood. It is essential we act now to prevent generations of children being blighted."

The Department of Health said there had been a 40 per cent increase in staff working in child mental health since 2002 and a similar increase in the patients treated. More than £300m was invested in the past three years.

Lisa Alexander, 27, and Christopher Harris, 9: 'The biggest problem is the lack of help'

"My son is nine years old and has a severe case of autism. Everything was fine at first, and then at 18 months he started to lose the use of language and it was clear he wasn't developing at the speed of his peers. He was diagnosed with the disorder, which is more common than people think.

"The biggest problem for children with behavioural problems and their parents is the lack of help when they have incidents. Sometimes Christopher, or Junior as we call him, gets sensory overload and just stops in his tracks. He is already eight and a half stone so I can't move him, and as a single mum it can be quite difficult.

"Recently I took him and my daughter, Monet, four, out on their scooters. Half way down the path something must have affected Junior and he got off his scooter and sat in the middle of the pathway. He was so agitated and I was on my own with him. It took 90 minutes to get him back to the car. Now I tend to go out with other parents whose children have autism so we can help each other.

"When Junior has had an episode like getting very distressed I have had to call 999. But all they can do is give him a bed in a paediatric unit, which is not addressing the problem. GPs don't have any specialist knowledge in the area and all they do is refer you on to someone else which can take weeks.

"I am on the parents council for the organisation Contact a Family and I teach a course for parents whose children have disabilities. I know I am lucky because I get to speak to people like social services and get what I need for myself and Junior, but plenty of people are not. The main thing is that the children don't need to change, but society needs to."

Caron Kemp