The long-term outcome for emotional and behavioural problems

Long-term outcome of psychological problems in childhood is important in a variety of ways including understanding disease entities, managing treatment and implementing research. It is of particular importance to courts in cases involving children. Judges have the unenviable task of determining best action for the future of children. Research is now available showing linkages between childhood and adult disorder but also revealing increasing complexity of factors determining outcome. A model of child to adult continuity can be constructed showing linkages between genetic influence, intrauterine environment, perinatal risks, early upbringing and lifetime risk and resilience influences. Known continuities of behaviours are traced from child to adult life. The presentation is intended to give a glimpse of some of the data available to assist in decision-making. Childhood determination of disorders such as schizophrenia may enable treatment to prevent further damage. Exciting developments particularly in genetics and functional imaging, will radically improve data over the next few years, possibly challenging currently held beliefs. At present expert witness contribution is under challenge but knowledge of the continuities can save court time, help prevent future heartache for vulnerable children, and later cost to the taxpayer.