Published: 01/12/2005 Volume 115 No. 5984 Page 28

Advice from the National Institute for Health and Clinical Excellence that psychotherapy should be the first-line treatment for children suffering a psychiatric disorder was not actually a ringing endorsement of these services.

The announcement was arguably more driven by fears about antidepressants, which have been linked with an increased suicide risk.

In the US, the Food and Drug Administration has added a warning to antidepressants about the risks for children and adolescents, emphasising the need for close monitoring.

In response, the American Psychiatric Association said antidepressants save lives, and that the largest threat to a depressed child's well-being is to receive no care at all. The American Academy of Child and Adolescent Psychiatry argued the labelling would frighten and confuse parents.

In other words, a right old muddle has merely been made murkier, with parents rendered more confused than ever by official bodies.

Children and young people may present to services with physical conditions because they lack the confidence or language to describe their emotional distress. One UK study, for example, found that 38 per cent of 1316-year-olds going to a GP had a clinical psychiatric disorder in the previous year, but only 2 per cent actually presented with a psychological complaint.

A 2004 survey of British school children conducted by the Tavistock Clinic and University College London, found that one in four probably needed professional psychological help.

A team at the Institute of Psychiatry at King's College London has examined whether children are more psychiatrically disturbed than past generations. Research on 30,000 young people showed a more than doubling in adolescent behavioural problems over the last 25 years, affecting males and females, all social classes and all family types.

What to do about troubled children is becoming a national emergency, but not one that is gaining the recognition it deserves.

Dr Raj Persaud is consultant psychiatrist at South London and Maudsley trust and professor for public understanding of psychiatry.