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The British Child and Adolescent Mental Health Survey 1999: The Prevalence of DSM-IV Disorders
Open accessAbstract
Objective To describe the prevalence of DSM-IV disorders and comorbidity in a large population-based sample of British children and adolescents.Method Using a one-phase design, 10,438 children were assessed using the Development and Well-Being Assessment (DAWBA), a structured interview with verbatim reports reviewed by clinicians so that information from parents, teachers, and children was combined in a manner that emulated the clinical process. The authors' analysis examined comorbidity and the influence of teacher reports.Results The overall prevalence of DSM-IV disorders was 9.5% (95% confidence interval 8.8-10.1%), but 2.1% of children were assigned "not otherwise specified" rather than operationalized diagnoses. After adjusting for the presence of a third disorder, there was no longer significant comorbidity between anxiety and conduct disorder or attention-deficit/hyperactivity disorder (ADHD), or between depression and oppositional defiant disorder. A comparison of the disorders in children with and without teacher reports suggested that the prevalence of conduct disorders and ADHD would be underestimated in the absence of teacher information.Conclusions Roughly 1 in 10 children have at least one DSM-IV disorder, involving a level of distress or social impairment likely to warrant treatment. Comorbidity reported between some childhood diagnoses may be due to the association of both disorders with a third. Diagnoses of conduct disorder and ADHD may be missed if information is not sought from teachers about children's functioning in school.
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“the DSM diagnostic criteria for adolescent MDD have low diagnostic validity and specificity, resulting in unclear diagnostic boundaries especially with regard to generalized and social anxiety”
From Feasibility and preliminary efficacy of a novel RDoC-based treatment program for adolescent depression: "Training for Awareness Resilience and Action" (TARA)-A pilot study (2017) · cites this paper as [10]
Experimental — accuracy not yet measuredIn the citing paper
“Findings indicate that children exposed to early adverse childhood experiences in general [22] and more specifically children placed in foster care have a heightened risk of attachment difficulties [23,24].”
From Mental disorders in foster children: a study of prevalence, comorbidity and risk factors (2013) · cites this paper as [23]
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“The low prevalence of parent-reported ADHD diagnosis is consistent with other UK studies [45] and studies in Scandinavia [46].”
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Self-citationPrevalence of Psychiatric Disorders Among Children of Different Ethnic Origin
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“This prevalence estimate is comparable to the prevalence observed in another study conducted in the Netherlands (Verhulst, van der, Ferdinand, & Kasius, 1997) and to the prevalence estimates in other countries ( Ford, Goodman, & Meltzer, 2003; Bilenberg, Petersen, Hoerder, & Gillberg, 2005).”
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“[15] in the British Mental Health Survey, a fifth of psychiatric cases had non-operationalised or ‘not otherwise specified’ disorders.”
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Self-citationZur Epidemiologie psychischer Störungen im Kindes- und Jugendalter
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Adolescents’ Mental Health at School: The Mediating Role of Life Satisfaction
Cavioni, V., Grazzani, I., Ornaghi, V., Agliati, A., & Pepe, A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.720628 · Cited by 139
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MethodInfluentialObesity impairs academic attainment in adolescence: findings from ALSPAC, a UK cohort
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“smaller if only major depressive disorder (MDD) is regarded (Cohen et al., 1993; Costello et al., 1996; Ford et al., 2003 ).”
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“The initial validation of the DAWBA involved a study of both a community and a clinic sample [13] and the instrument has been used ever since in various epidemiological studies in Britain [7], Brazil [6], Bangladesh [24], Norway [15] and Russia [14].”
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Is ADHD a valid diagnosis in adults? Yes
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“85% for girls, for a sample of over 10,000 children aged from 5 to 15 years in 1999.(15) Although a systematic review of research between 1978 and 2005 found no differences between European and US rates of ADHD,(13) more recent studies sampling parent reports found that in the USA between 2008 and 2010, 6.”
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Prevalence of Psychiatric Disorders among Children and Adolescents in Northeast China
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“ADHD and behavior disorders, and between depression and some behavior disorders [20].”
BackgroundResultInfluentialThe prevalence of DSM-IV psychiatric disorders among 7–10 year old Yemeni schoolchildren
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“Although the previous validation of the DAWBA in Arabic did not examine ADHD diagnoses separately from other externalizing disorders [3], it is reassuring that the prevalence and gender ratio of ADHD in this study are in line with those reported by studies using the same measures in Brazil and Britain [12, 13], allowi…”
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“The most frequently diagnosed disorders can be divided into two broad categories, namely emotional disorders such as anxiety disorders and depression, and behavioral disorders such as attention-deficit and disruptive behavior disorders (see also Ford et al. 2003).”
BackgroundAre ADHD Symptoms Associated With Delay Aversion or Choice Impulsivity? A General Population Study
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“An experienced clinician combined all information about symptoms and their impact using a computerized heuristic to make standardized diagnoses of childhood psychiatric disorders.(71)”
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“In the present study, the threshold for impairing FSS was determined by the following: (1) ‘a medium amount’ of distress and/or social impairment corresponding to the threshold in the DAWBA measures [ 21 ], and/or (2) hospitalisation and/or at least three doctors’ visits and/or (3) at least 1 week absence from day-car…”
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InfluentialGroup therapy for anxiety in children with autism spectrum disorder
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BackgroundPsykiske lidelser i Norge : et folkehelseperspektiv
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“Such increased severity of early onset depression is also reflected in the fact that within child and adolescent samples, depression is often comorbid with other disorders; more than a third of these young people have a disruptive behavioural disorder, anxiety disorder or both [12, 13].”
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“A 5% threshold was chosen to be comparable to estimated prevalence rates of ADHD in the United Kingdom of 4% for males and 1% for females (Ford et al., 2003 ) while also ensuring an adequate sample size for the analyses.”
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“DSM-IV diagnoses are assigned by integrating the parent, youth and teacher reports on symptoms and impairment as extensively described (Ford et al., 2003).”
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Recent trends in UK child and adolescent mental health
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Self-citationThe sleep patterns and problems of clinically anxious children
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“The prevalence of children who had one or more psychiatric comorbidities in our study is very similar to those observed in southeastern Brazil (21 %), England (22 %) and the United States of America (20 %) [11, 15, 38].”
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“Recent epidemiological studies show that up to 5% of youths suffer from anxiety complaints that are severe enough to interfere with their daily functioning [1, 2].”
BackgroundBeyer, T., Postert, C., Müller, J. M., & Fürniss, T. (2012) · Child Psychiatry & Human Development · doi:10.1007/s10578-012-0282-5 · Cited by 77
The prevalence of mental health problems in Ethiopian child laborers
Fekadu, D., Alem, A., & Hägglöf, B. (2006) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2006.01617.x · Cited by 76
Booth, J. N., Tomporowski, P. D., Boyle, J. M. E., Ness, A., Joinson, C. J., Leary, S. D., & Reilly, J. J. (2013) · Mental health and physical activity · doi:10.1016/j.mhpa.2013.09.002 · Cited by 92
Allen, M. S., & Vella, S. A. (2015) · Mental Health and Physical Activity · doi:10.1016/j.mhpa.2015.10.002 · Cited by 75
The impact of recurrent abdominal pain: predictors of outcome in a large population cohort
Ramchandani, P. G., Fazel, M. S., Stein, A. L., Wiles, N., & Hotopf, M. H. (2007) · Acta Paediatrica · doi:10.1111/j.1651-2227.2007.00291.x · Cited by 75
“This is a structured questionnaire that combines parental (usually mother) and teacher questionnaires to generate DSM-IV psychiatric diagnoses (13).”
BackgroundJohnson, S. J., Hollis, C. P., Marlow, N., Simms, V., & Dieter Wolke, C. (2014) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.12360 · Cited by 75
Koenen, K. C., Moffitt, T. E., Caspi, A., Gregory, A. M., Harrington, H., & Poulton, R. (2008) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.117.2.460 · Cited by 76
Charman, T., Ricketts, J., Dockrell, J. E., Lindsay, G., & Palikara, O. (2014) · International Journal of Language & Communication Disorders · doi:10.1111/1460-6984.12116 · Cited by 86
“…and IQ and emotional and behavioural problems in our sample was not strong (with the exception of poor language abilities being associated with higher levels of problem in the ASD but not the LI group), and contrary to that seen in the general child psychopathology field (Ford et al., 2003).”
Attentional control and psychopathological symptoms in children
Muris, P., Mayer, B., van Lint, C., & Hofman, S. (2008) · Personality and Individual Differences · doi:10.1016/j.paid.2008.01.006 · Cited by 74
Canals, J., Morales-Hidalgo, P., Jané, M., & Doménech, E. (2018) · Journal of Attention Disorders · doi:10.1177/1087054716638511 · Cited by 71
“, 2015; Willcutt, 2012) but higher than other international and national results in preschool samples, which report rates of 2% to 4% (Bufferd et al., 2011; Egger & Angold, 2006; Ezpeleta et al., 2014; Ford et al., 2003; Gudmundsson et al., 2013; Surén et al., 2012; Wichstrøm et al., 2012).”
ResultRooney, R., Hassan, S., Kane, R., Roberts, C. M., & Nesa, M. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.09.005 · Cited by 73
Calam, R. M., Gregg, L., & Goodman, R. (2005) · Psychosomatic Medicine · doi:10.1097/01.psy.0000151490.77622.37 · Cited by 73
Self-citationAnxiety Disorders Among Children and Adolescents
Chiu, A. W., Falk, A. E., & Walkup, J. T. (2016) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20150029 · Cited by 73
Bosch, R., Pagerols, M., Rivas, C., Sixto, L., Bricollé, L., Español‐Martín, G., Prat, R., Ramos‐Quiroga, J. A., & Casas, M. (2021) · Psychological Medicine · doi:10.1017/s0033291720005115 · Cited by 74
Woo, B. S. C., Ng, T., Fung, D. S. S., Chan, Y. H., Lee, Y. P., Koh, J. B. K., & Cai, Y. (2007) · PubMed · Cited by 71
Vuijk, P., van Lier, P. A. C., Crijnen, A. A. M., & Huizink, A. C. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.11.003 · Cited by 71
“Prevalence rates of clinically elevated levels of anxiety and depression in children and early adolescents range from 2% to 4% (Costello et al., 2003; Ford et al., 2003).”
BackgroundThe Validity of the DSM-IV Subtypes of Attention-Deficit/Hyperactivity Disorder
Woo, B. S. C., & Rey, J. M. (2005) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.2005.01580.x · Cited by 74
“Although prevalence of ADHD as a whole decreases with increasing age [7,47,48], prevalence of ADHD-I may increase [46].”
BackgroundRåstam, M., Täljemark, J., Tajnia, A., Lundström, S., Gustafsson, P., Lichtenstein, P., Gillberg, C., Anckarsäter, H., & Kerekes, N. (2013) · The Scientific World Journal · doi:10.1155/2013/315429 · Cited by 70
Minor depression in adolescence: Phenomenology and clinical correlates
Sihvola, E., Keski‐Rahkonen, A., Dick, D. M., Pulkkinen, L., Rose, R. J., MARTTUNEN, M. J., & Kaprio, J. A. (2006) · Journal of Affective Disorders · doi:10.1016/j.jad.2006.06.019 · Cited by 70
“Existing literature suggests a comorbid pattern of anxiety and depressive disorders (Axelson and Birmaher 2001; Essau, 2003), depression and conduct disorder (Ford et al., 2003) and oppositional defiant disorder and depression (Angold and Costello 1993).”
InfluentialJohnson, S. J., Hollis, C. P., Hennessy, E., Kochhar, P., Dieter Wolke, C., & Marlow, N. (2010) · Archives of Disease in Childhood · doi:10.1136/adc.2010.194795 · Cited by 71
Christiansen, H., Kis, B., Hirsch, O., Philipsen, A., Henneck, M., Panczuk, A., Pietrowsky, R., Hebebrand, J., & Schimmelmann, B. G. (2011) · European Psychiatry · doi:10.1016/j.eurpsy.2009.12.024 · Cited by 76
“Prevalence rates show that more males than females are affected by ADHD [18,17,21], and females show significantly less disruptive behavior, but more internalizing problems such as depressive and anxiety symptoms that are closely related to poor self-concept [19].”
BackgroundColonnesi, C., Napoleone, E., & Bögels, S. M. (2014) · Journal of Personality and Social Psychology · doi:10.1037/a0035561 · Cited by 73
Prevalence and characteristics of depressive disorders in early adolescents in central Norway
Sund, A. M., Larsson, B. S., & Wichstrøm, L. (2011) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/1753-2000-5-28 · Cited by 69
“Concern has also been raised in Europe [16] and in the USA [17] as to whether depressed adolescents in the general population have access to and receive proper mental health care.”
BackgroundResultInfluentialBrady, A. M., Deighton, J., & Stansfeld, S. A. (2020) · Development and Psychopathology · doi:10.1017/s0954579420000206 · Cited by 81
Heritability of Anxious-Depressive and Withdrawn Behavior
Lamb, D. J., Middeldorp, C. M., van Beijsterveldt, C. E. M., Bartels, M., van der Aa, N., Polderman, T. J. C., & Boomsma, D. I. (2010) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2009.11.014 · Cited by 69
“Coorbidity within anxiety disorders and comoridity of anxiety disorders with depression is requent in both children and adults.(7-11) Research uggests that this may be due to common, mostly enetic, risk factors.”
Huntley, Z., Maltezos, S., Williams, C., Morinan, A., Hammon, A., Ball, D., Marshall, E. J., Keaney, F., Young, S., Bolton, P., et al. (2012) · BMC Psychiatry · doi:10.1186/1471-244x-12-223 · Cited by 72
“6% [1].”
Dismantling the bidirectional relationship between paediatric sleep and anxiety
Leahy, E., & Gradisar, M. (2012) · Clinical Psychologist · doi:10.1111/j.1742-9552.2012.00039.x · Cited by 69
Depression in paediatric chronic fatigue syndrome
Bould, H., Collin, S. M., Lewis, G., Rimes, K. A., & Crawley, E. M. (2013) · Archives of Disease in Childhood · doi:10.1136/archdischild-2012-303396 · Cited by 68
“High rates of depression in CFS/ME suggest that it is important for clinicians to consider comorbid depression in children with a diagnosis of CFS/ME.”
Background
Metadata
- Authors
- FORD, T., GOODMAN, R., & MELTZER, H.
- Affiliations
- King's College London (GB)
- Office for National Statistics (GB)
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2003-10
- Volume
- 42
- Issue
- 10
- Pages
- 1203-1211
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2057670386
- Cited by
- 1,227
- References
- 37
- Citations by year
- 2026: 7 · 2025: 14 · 2024: 18 · 2023: 25 · 2022: 33 · 2021: 40 · 2020: 54 · 2019: 44 · 2018: 53 · 2017: 59 · 2016: 75 · 2015: 88 · 2014: 102 · 2013: 84 · 2012: 103
- FWCI
- 32.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Leicester Research Archive (University of Leicester) (submittedVersion)
- Funders
- Wellcome Trust
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Keywords
- child and adolescent mental health, DSM-IV disorders, prevalence, comorbidities, conduct disorder, attention deficit hyperactivity disorder, anxiety disorders, depression, oppositional defiant disorder, teacher reports, Development and Well-Being Assessment, school functioning
- MeSH terms
- Adolescent, Mental Disorders, Child, Child, Preschool, Female, United Kingdom, Health Surveys, Humans, Male, Mental Health, Social Behavior, Comorbidity, Prevalence, Diagnostic and Statistical Manual of Mental Disorders
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