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Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities
adolescent risk factors and specific MEB disorders. For example, parental depression greatly increases the likelihood of a child’s being depressed; similarly, the risk of schizophrenia or other major mental disorders is much higher among those with parents or siblings who have the disorder (see Chapter 4).
The antecedent history of the disorder and its developmental link totarget risk factors should be adequately described. Although the origins of most MEB disorders and problems are still incompletely understood, the temporal relationship between early behavioral phenotypes and DSM-IV diagnosable conditions has been documented extensively. There are valuable models of how antecedent risk factors relate to the onset of these disorders. The taxonomy of these disorders, although less precise than physical disorders, has also been standardized using DSM criteria. Perhaps most importantly for this discussion, many risk factors for MEB disorders are measurable with scientifically verified assessment tools, facilitating the linkage of their recognition to the onset of later MEB disorder outcomes. While protective factors are less thoroughly documented than are risk factors, they can be recognized in some cases and associated with mental health outcomes.
There should be an effective intervention to address the identifiedrisks or early symptoms and signs of the MEB disorder. Early preventiveintervention should lead to better outcomes than treatment after onset. We note first that there are treatments available for most MEB disorders. However, the effectiveness of these treatments is highly variable. However, if these disorders can be prevented or delayed, a much larger benefit can be obtained than through early treatment. Parental concern about young children’s behavior is a strong risk factor for later emergence of MEB disorders meeting DSM-IV criteria (Perrin and Stancin, 2002). There is some evidence that reduction of risk or presymptomatic intervention prevents, delays, or modifies disorder symptoms. As discussed in Chapter 7, recognition of the risk for depression has led to interventions that reduce the incidence of the full-blown disorder. Interventions for families struggling with divorce have been protective for downstream MEB disorders in the children (see Box 6-9). School or community-wide interventions following a catastrophic event appear to reduce the occurrence of posttraumatic stress disorder (PTSD) in young people (Layne, Saltzman, et al., 2008). Many more such examples could be cited and undoubtedly will surface in the future. The ability to screen for adverse events or conditions has led to effective early interventions in several but not all situations.
Prodromal identification of behaviors or biomarkers for schizophrenia could provide an intervention advantage; studies are suggestive but not yet