The goal of the study was to ascertain the factor structure and prevalence of psychiatric disability in children and adolescents in relation to demographic variables and diagnosis. A representative sample of 1420 children (9–13 years) from 11 countries in North Carolina was followed for up to 6 years. Children and caretakers were interviewed with the Child and Adolescent Psychiatric Assessment, which generates DSM-IV diagnoses and includes a measure of disability secondary to psychological symptoms. Three broad areas of disability were identified (relating to family, school, and peers). School disabilities were more common in boys than girls, while the reverse was true of family disability. Effects of age were complex, and partially gender-differentiated. Children from minority ethnic groups had a higher overall prevalence of school disabilities, and were more prone than Whites to the disabling effects of disruptive behavior disorders. Anxiety disorders were as likely to result in disability as depressive disorders, and oppositional defiant disorders were more strongly associated with disability in some areas than was conduct disorder. The areas where disability is manifested are different depending on race, gender, age, and the type of disorder suffered. The implications of these findings for nosology and prevention are discussed.

The goal of this study was to investigate the variables that best predict functional impairment in children and adolescents. Two hundred and eight psychiatric and 129 pediatric children aged 7 to 17 years were assessed with measures of psychopathology, functional impairment, temperament, marital discord, educational style, coping, developmental milestones, stressful life events, medical history, school information, and family history of psychopathology. Multiple regression models adjusted by psychopathology were estimated. The global model, which included all the significant variables in partial models, revealed the following predictors of impairment: receiving review lessons, chronic disease or handicap, the presence of problems the child interpreted as stressful, late onset and long duration of psychopathological problems. These indicators could be useful for the proper identification of children with severe difficulties, in order to provide them with adequate psychological services.

In this selective review of recent research on internalizing disorders in childhood, we focus on four areas: the predictive validity of the diagnoses of depressive and anxiety disorders, rates of comorbidity, the chronology of onsets of the disorders of interest, and transmission of depressive and anxiety disorders in the pedigrees of affected individuals. To synthesize and reconcile findings in these four areas, we approach the information from a developmental perspective and assume that genetically driven biologic processes play a salient role in the expression of depressive and anxiety disorders in childhood. We also comment on the relevance of findings on children and adolescents to the field of depressive and anxiety disorders in adults and make recommendations for further research.