Introduction

Child mental health can be defined as: ‘The optimal achievement of the child's developmental potential, intellectually, emotionally and behaviourally’. A variety of circumstances may inhibit or impair a child's optimal development. Identifying these risk factors at a sufficiently early stage to stop them affecting childhood mental health constitutes primary prevention. In relation to child mental health, primary prevention has been defined as: ‘The actual recognition of potential developmental and other problems and intervention to prevent the emergence of these problems as disabling disorders’ (Berlin, 1990). Before looking at risk factors, we will briefly identify some of the commoner child mental health problems.

The scope of childhood psychiatric disorder

Childhood mental health problems are conventionally divided into two broad groups: disorders of conduct or externalising problems, and disorders of emotion or internalising problems. Children whose behaviour concerns adults around them are often regarded as having a conduct disorder. Hyperactivity is usually put in the same group, probably because of its strong association with behavioural difficulties. Children with separation anxiety excessive for their age, phobias, obsessive–compulsive disorder, anorexia nervosa, depression, or somatic presentations of psychological disturbance are said to have an emotional disorder.

In addition to the two major groupings there are disorders affecting the social control of sphincters (enuresis and encopresis), and those affecting motor impulses such as tic disorders and Tourette's syndrome. There are problems associated with the sleep and feeding of young children and the rarer disorders of social and linguistic development, including the pervasive developmental disorders such as autism.