PEDIATRICS Vol. 70 No. 6 December 1982, pp. 883-894
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Prevention of Children's Psychosocial Disorders: Myth and Substance

Michael Rutter MD, FRCP, FRCPsych1

1 The Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London

A critical appraisal of primary prevention of children's psychosocial disorders indicates that our knowledge on this topic is limited and that there are few interventions of proven value. Nevertheless, there are possibilities for effective prevention. Myths associated with unwarranted claims for the value of prevention are reviewed in terms of unproven assumptions that: (1) prevention cuts costs; (2) prevention in childhood will improve adult health; (3) improved living standards will reduce mental illness; (4) sensible interventions can only be beneficial; (5) providing people with information leads to preventive action; (6) the main issue in prevention is implementing what we know; (7) the best approach is to tackle the basic cause; and (8) the crucial issue is to identify that one basic cause. Principles of causation are discussed and a model of causative influences is used to consider potentially effective primary prevention policies with respect to those directed at (a) individual predisposition; (b) ecologic factors; (c) influences on opportunity and situation; and (d) current stresses and strengths. It is concluded that a good deal is known about risk factors and the areas in which primary prevention might be effective, but that less is known concerning precisely how to intervene in order to bring about the desired results. There is a potential for effective primary prevention but, so far, it remains largely unrealized.

Key Words: primary prevention • child psychiatric disorder • ecology • evaluation • principles of causation

Submitted on November 24, 1981
Accepted on February 22, 1982




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