EDITORIAL

C hild and adolescent psychiatry has undergone some radical changes within the last few decades. The discipline covers a large field with many connections to adult psychiatry, paediatrics, obstetrics, neurology, general practitioners and the social system. In terms of research, the broad spectrum of topics is exemplified by the four papers on child and adolescent psychiatry in this issue of the Nordic Journal of Psychiatry (1 /4). One study by Savonlahti et al. deals with the relation between mother and infant, describing and analysing factors that promote and prevent the fine social tuning leading to a normal social functioning in children (1). This paper is an example of an important part of the research in infant psychiatry, both analysing relations and looking for risk and protective factors for deviant psychological development in the very small children (5). Another study, by Pelkonen & Marttunen, describes ‘‘a hot topic’’ in child and adolescent psychiatry these days: the diagnosis and treatment of depression in young children and adolescents (2). A number of studies have been performed in order to analyse the efficacy of medication and psychotherapy in children and adolescents with depression. Due to a low number of probands, heterogeneity, exclusion of comorbid conditions (i.e. the real-life patient), short observation time and a high placebo response rate, most of the studies are somewhat restricted in their conclusions. Although there has been a worldwide increase in the prescription of selective serotonin reuptake inhibitors (SSRIs) to children and adolescents, the Nordic countries are still reluctant using them (6). This is also reflected in the study by Pelkonen & Marttunen, which shows that Finland presumably is prescribing the lowest number (2). Throughout the Western world, including the Nordic countries, we have seen a large increase in the seeking of child psychiatric expertise and knowledge. Why is it so? First of all, child psychiatry has become less tabooed, parents and professionals are demanding specialized assessment and treatment of children, and there has been a great increase in the recognition of child psychiatric disorders within the general population. As a result of the ICD-10 and DSM-IV diagnostic systems, we have obtained better diagnostic possibilities in children and adolescents. Some have argued that society has become less tolerant, more attentive to possible problems, and less inclined to accept weaknesses. So, the increase in children referred for child psychiatric treatment may reflect cultural and social changes, that society has become more complex, and that the demands we enforce on our children have grown. Thus, the increase in eating disorders may reflect a cultural trend and an increase in demand of self-control; the increase in attention-deficit hyperactivity disorder (ADHD) may to some extent reflect a change of demands in the school system, a loosened family structure, a more complex society with bombardment of information, and demands of shift in attention. The increase in OCD and anxiety disorders may reflect the massive amounts of anxietyprovoking information we get nowadays from the mass media in combination with the above-mentioned factors. An actual increase in depression may be a result of genetic influence, better recognition, better diagnostics and better treatment offers. This change in clinical obligations also calls for intensified research activities in order to improve our understanding of causes for psychiatric disorders in childhood and in order to refine and improve our treatment offers. One must, therefore, call for an increase in allocation of research resources to the field of child psychiatry, basic research (such as brain research, imaging procedures, genetics, neuroimmunology, etc.) as well as clinical research (pharmacological treatment and psychotherapy, studies of course of disorders, clinical phenomenology and diagnostics). Topics for future research should be recognition of disorders in childhood and research in risk and resilience factors, genetics, and brain research. The treatment approach in child psychiatry must be more evidence based and we must, therefore, search for more specific and refined treatment strategies that take into account efficacy as well as side-effects.