Introduction Jane Meschan Foy, MD “The book aims to boost reader confidence and capacity through reinforcement of sound, intuitive pediatric approaches and full realization of the prime pediatric advantage: a trusting therapeutic relationship with patients and their families.” During the past 2 decades, the mental health specialty system has focused its efforts and resources on children and adolescents with severely impair- ing mental disorders. Pediatric clinicians often comanage or complement the mental health specialty care of these patients while independently managing the care of others with common less impairing mental disor- ders. Many excellent psychiatry textbooks provide guidance to clinicians on the assessment and treatment of children and adolescents with diag- nosable mental disorders. This book, by contrast, aims to help pediatric clinicians provide mental health care, not just for the 13% to 20% of children and adolescents with diagnosable disorders1 but also for those who may not, and hopefully will not, cross any diagnostic threshold for a mental disorder. They include the estimated 19% of children who have impairment caused by mental health symptoms in the absence of a diagnosable condition.2 Some of these chil- dren and adolescents may become adults before their symptoms reach the threshold for a diagnosis in fact, of people diagnosed as having a mental disorder as adults, approximately half began experiencing symptoms by the age of 14 years.3 A longitudinal study has shown that adults who, as children, had a subthreshold mental health condition (ie, impairment without a diagnosable disorder) have 3 times the odds of 1 adverse outcome in health, legal, financial, or social functioning, compared with peers without any mental health condition during childhood, and 5 times higher odds of 2 or more adverse outcomes, even after controlling for childhood psychosocial hardships and adult-onset psychiatric conditions.4 Clearly, children and adolescents with subthreshold symptoms deserve attention and care. 00-MHCC_fm.indd 13 4/5/18 12:06 PM
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