**8. Acknowledgment**

The research was supported by the Deutsche Forschungsgemeinschaft (DFG; German Research Foundation, HA 1400/14-1-4) and the Jacobs Foundation, Zürich (Switzerland). I am very grateful to the families for participating in the studies and to Mrs Joswig-Gröttrup and Mrs Hamilton Kohn, Jugendamt der Stadt Braunschweig, Department of Preschools, as well as to all preschool teachers for their very good cooperation. My warmest thanks also to Dr. Kurt Hahlweg, PhD Frank C. Verhulst and Dr. Nina Heinrichs for their comments on earlier versions of this manuscript.

#### **9. References**

156 Epidemiology Insights

Furthermore, a teacher perspective could add valuable information about problem behaviour at school, which might possibly result in reports of more externalizing problems. Due to principles of data collection, frequent change of teachers, and the transition from kindergarten to primary school it was only possible to obtain the parental report. For international comparison of the results, the age at school entry in Germany,

To sum up, the study contributes to a more complete understanding of externalizing behaviour problems and their continuity from kindergarten to primary school. The results point to the need for early child psychiatric research on child mental health beginning in infancy and the preschool years. The development of problem behaviour in specific clinical or risk groups may differ from the pattern found in the present data. An increased utilization of child mental health services by older children, who already show disturbances in the preschool years, has important implications for early preschool recognition of child mental health problems and indicates the need for the prevention and development of a differentiated delivery of child mental health services. Clinicians working in primary care, day care, or school systems need to be attentive to opportunities for early detection and intervention regarding preschoolers' externalizing behavioural problems, particularly since efficacious prevention and treatment exists for the psychopathology of young children (e.g.

Since the first child psychiatric epidemiological studies in the 1950´s and 1960´s, epidemiological research has provided a wealth of empirical findings that may aid develop strategies for improving the mental health outcomes of children. Descriptive epidemiological data on prevalence rates, historical trends, and outcomes of mental health problems can help planning mental health services for children and provide evidence for setting priorities when resources are limited. Etiologic epidemiological research forms the basis for prevention interventions by unravelling the causative mechanisms in the development of psychopathology. Clinical epidemiological strategies are important for more evidence-based approaches to diagnostic assessment and intervention strategies, and outcome research may help improving the quality of mental health services. Finally, more efforts should be put into improving partnerships between epidemiological researchers and prevention specialists and between epidemiological researchers and policy-makers for improving strategies for preventing and treating mental health

The research was supported by the Deutsche Forschungsgemeinschaft (DFG; German Research Foundation, HA 1400/14-1-4) and the Jacobs Foundation, Zürich (Switzerland). I am very grateful to the families for participating in the studies and to Mrs Joswig-Gröttrup and Mrs Hamilton Kohn, Jugendamt der Stadt Braunschweig, Department of Preschools, as well as to all preschool teachers for their very good cooperation. My warmest thanks also to Dr. Kurt Hahlweg, PhD Frank C. Verhulst and Dr. Nina Heinrichs for their comments on

generally at the age of 6 years, needs to be taken into account.

Weisz et al., 2005).

**7. Conclusion** 

problems in children.

**8. Acknowledgment** 

earlier versions of this manuscript.


The Epidemiology of Child Psychopathology: Basic Principles and Research Data 159

Frick, P. J., Lahey, B. B., Loeber, R., Tannenbaum, L., van Horn, Y., Christ, M. A. G. et al.

Grietens, H., Onghena, P., Prinzie, P., Gadeyne, E., van Assche, V., Ghesquiere, P. &

Hahlweg, K., Heinrichs, N., Kuschel, A., Bertram, H. & Naumann, S. (2010) Long-term

Harland, P., Reijneveld, S. S., Brugman, E., Verloove-Vanhorick, S. P. & Verhulst, F. C. (2002)

Heinrichs, N. (2006) The effects of two different incentives on recruitment rates of families

Ivanova, M. Y., Achenbach, T. M., Rescorla, L. A., Harder, V. S., Ang, R. P., Bilenberg, N. et

Javo, C., Ronning, J. A., Heyerdahl, S. & Rudmin, F. W. (2004).Parenting correlates of child

Jensen, P. S., Rubio-Stipec, M., Canino, G., Bird, H., Dulcan, M., Schwab-Stone, M. E. &

Keiley, M. K., Bates, J. E., Dodge, K. A., & Pettit, G. S. (2000). A cross-domain growth

Loeber, R., Burke, J. D., Lahey, B. B., Winters, A. & Zera, M. (2000). Oppositional defiant

Moffitt, T. E. (2003). Life course persistent and adolescence-limited antisocial behavior: A 10-

*Journal of Abnormal Child Psychology,* Vol.28, 161-179, ISSN 0091-0627 Kraemer, H. C., Yesavage, J. A., Taylor, J. L., & Kupfer, D. (2000). How can we learn about

*Adolescent Psychiatry*, Vol.3, 1569-1579. ISSN 0890-8567

*of Psychiatry*, Vol.157, 163-171, ISSN 0002-953X

Vol.13, No.4, 319-340, ISSN 0272-7358

*Health,* Vol.4, No.14, ISSN 1753-2000

1018-8827

0890-8567

8827

8567

095X

*Behavioral Assessment*, Vol.*26*, 137–146, ISSN 0882-2689

(1993). Oppositional defiant disorder and conduct disorder: A meta-analytic review of factor analyses and cross-validation in a clinic sample. *Clinical Psychology Review,* 

Hellinckx, W. (2004). Comparison of mothers', fathers', and teachers' reports on problem behavior in 5- to 6-year-old children. *Journal of Psychopathology and* 

outcome of a randomized controlled universal prevention trial through a Positive Parenting Program: Is it worth the effort? *Child and Adolescent Psychiatry and Mental* 

Family factors and life events as risk factors for behavioural and emotional problems in children. *European Child & Adolescent Psychiatry*, Vol.11, 176–184, ISSN

into a prevention program. *Journal of Primary Prevention*, Vol.27, 345-365, ISSN 0278-

al. (2010). Preschool psychopathology reported by parents in 23 societies: Testing the seven-syndrome model of the Child Behavior Checklist for ages 1.5-5. *Journal of the American Academy of Child & Adolescent Psychiatry,*Vol.49, No.12, 1215-1224, ISSN

behavior problems in a multiethnic community sample of preschool children in northern Norway. *European Child & Adolescent Psychiatry*, Vol.13, 8–18, ISSN 1018-

Lahey, B. (1999). Parent and child contributions to diagnosis of mental disorder: Are both informants necessary? *Journal of the American Academy of Child and* 

analysis: Externalizing and internalizing behaviors during 8 years of childhood.

developmental processes from cross-sectional studies, or can we? *American Journal* 

and conduct disorder: A review of the past 10 years. Part I. *Journal of the American Academy of Child & Adolescent Psychiatry,* Vol.39*,* 1468-1484, ISSN 0890-

year research review and research agenda. In B. B. Lahey, T. E. Moffitt & A. Caspi

age 12. *Journal of Child Psychology and Psychiatry*, Vol.47, No.8, 791–800, ISSN 0021- 9630


Conners, C. K. (1997). *Conners' Rating Scales-Revised*. Multi-Health Systems, ISBN 978-

Costello, E. J., & Angold, A. (2006). Developmental epidemiology. In D. Cicchetti & D. J.

Costello, E. J., Egger, H., & Angold, A. (2005). 10-Year Research Update Review: The

De Los Reyes, A. & Kazdin, A. E. (2005). Informant discrepancies in the assessment of

Duhig, A. M., Renk, K., Epstein, M. K. & Phares, V. (2000). Interparental agreement on

Döpfner, M., & Lehmkuhl, G. (1998). *DISYPS-KJ. Diagnostik-System für psychische Störungen* 

Döpfner, M., Breuer, D., Wille, N., Erhart, M., & Ravens-Sieberer, U. (2008). How often do

Döpfner, M., Görtz-Dorten, A., & Lehmkuhl, G. (2008). Diagnostik-System für

Egger, H. L. & Angold, A. (2006). Common emotional and behavioral disorders in preschool

Ferdinand, R. F., Visser, J. H., Hoogerheide, K. N., van Der Ende, J., Kasius, M. C., Koot,

Fombonne, E. (2002). Case identification in an epidemiological context. In M. Rutter & E.

*Psychology: Science and Practice*, Vol.7, 435–453, ISSN 0969-5893

9630

0033-2909

0158046396, North Tonawanda, NY

Huber, ISBN 978-3456830063, Bern

*Psychology*, Vol.47, 313–337, ISSN 0021-9630

70, ISSN 1018-8827

Bern

0021-9630

0865428805, Oxford, England

John Wiley & Sons, ISBN 978-0471237365, New Jersey

*Psychiatry*, Vol.44, No.10, 972–986, ISSN 0890-8567

age 12. *Journal of Child Psychology and Psychiatry*, Vol.47, No.8, 791–800, ISSN 0021-

Cohen (Eds.), *Developmental Psychopathology: Theory and method* (2nd ed., pp. 41-65).

Epidemiology of Child and Adolescent Psychiatric Disorders: I. Methods and Public Health Burden. *Journal of the American Academy of Child & Adolescent* 

childhood psychopathology: a critical review, theoretical framework, and recommendations for further study. *Psychological Bulletin*, Vol. 131, 483–509, ISSN

Internalizing, Externalizing, and Total problems: A meta-analysis. *Clinical* 

*im Kindes- und Jugendalter nach ICD-10 und DSM-IV* [DISYPS-KJ. Diagnostic system for psychiatric disorders in children and adolescents in ICD-10 and DSM IV].

children meet ICD-10/DSM-IV criteria of attention deficit-/hyperactivity disorder and hyperkinetic disorder? Parent-based prevalence rates in a national sample results of the BELLA study. *European Child & Adolescent Psychiatry,* Vol.17, No.0, 59-

Psychische Störungen im Kindes- und Jugendalter nach ICD-10 und DSM-IV, DISYPS-II. [DISYPS-II. Diagnostic system for psychiatric disorders in children and adolescents in ICD-10 and DSM IV 2nd Edition]. Huber, ISBN 978-1111155401,

children: Presentation, nosology, and epidemiology. *Journal of Child Psychiatry and* 

H. M. & Verhulst, F. C. (2004). Improving estimation of the prognosis of childhood psychopathology: Combination of DSM-III-R/DISC diagnoses and CBCL scores. *Journal of Child Psychology and Psychiatry*, Vol.45*,* No.3, 599-608, ISSN

Taylor (eds.), *Child and Adolescent Psychiatry* (pp 52-69), Blackwell, ISBN 978-


The Epidemiology of Child Psychopathology: Basic Principles and Research Data 161

Schaeffer, C. M., Petras, H., Ialongo, N., Poduska, J., & Kellam, S. (2003). Modeling growth

Schonberg, M. A. & Shaw, D. S. (2007). Do the predictors of child conduct problems vary by

Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH

Shaffer, D., Lucas, C. P. & Richters, J. E. (1999). *Diagnostic Assessment in Child and Adolescent* 

Shaw, D. S., Gilliom, M., Ingoldsby, E. M., & Nagin, D. S. (2003). Trajectories leading to

Spoth, R. & Redmond, C. (2000). Research on family engagement in preventive

van Lier, P. A. C., van Der Ende, J., Koot, H. M. & Verhulst, F. C. (2007). Which better

Verhulst, F. C. (1995). The epidemiology of child and adolescent psychopathology: Strengths

Verhulst, F. C. & Koot, H. M. (1992). *Child Psychiatric Epidemiology: Concepts, Methods and* 

Verhulst, F. C. & Koot, H. M. (1995). *The epidemiology of child and adolescent psychopathology.* 

Verhulst, F.C., van der Ende, J., Ferdinand, R. F. & Kasius, M. C. (1997). The prevalence of

Waddell, C., Offord, D. R., Shepherd, C. A., Hua, J. M. & McEwan, K. (2002). Child

Wadsworth, M. E. & Achenbach, T. M. (2005). Explaining the link between low

practice. *Journal of Primary Prevention,* Vol.21*,* 267-284*,* ISSN 0278-095X Tolan, P. H. & Dodge, K. A. (2005). Children´s mental health as a primary care and concern.

*Psychology and Psychiatry,* Vol.48, No.6, 601-608, ISSN 0021-9630

*American Psychologist*, Vol.60, 601–614, ISSN 0003-066X

*Findings.* Sage, ISBN 978-0803939974, Newbury Park

*Psychiatry*, Vol.54, 329-336, ISSN 0003-990X

Oxford University Press, ISBN 978-0192623409, Oxford

*Psychopathology.* Guilford Press, ISBN 978-1572305021, New York

*Psychology,* Vol.39, 1020–1035, ISSN 0012-1649

38, ISSN 0890-8567

0192623409, Oxford

ISSN 0703-7437

1153, ISSN 0022-006X

1649

*Family Psychology Review*, Vol.10, 101–136, ISSN 1096-4037

in boys' aggressive behavior across elementary school: Links to later criminal involvement, conduct disorder, and antisocial personality disorder. *Developmental* 

high- and low-levels of socioeconomic and neighborhood risk? *Clinical Child and* 

Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. *Journal of the American Academy of Child and Adolescent Psychiatry, 39*, 28-

school-age conduct problems. *Developmental Psychology,* Vol.39, 189–200, ISSN 0012-

interventions: Toward improved use of scientific findings in primary prevention

predicts conduct problems? The relationship of trajectories of conduct problems with ODD and ADHD symptoms from childhood into adolescence. *Journal of Child* 

and limitations. In F. C. Verhulst & H. M. Koot (Eds.), *The epidemiology of child and adolescent psychopathology* (pp. 1–21). Oxford University Press, ISBN 978-

DSM-III-R diagnoses in a national sample of Dutch adolescents. *Archives of General* 

psychiatric epidemiology and canadian public policy-making: The state of the science and the art of the possible. *Canadian Journal of Psychiatry,* Vol.47, 825-832,

socioeconomic status and psychopathology: Testing two mechanisms of the social causation hypothesis. *Journal of Consulting and Clinical Psychology*, Vol.73, 1146–

(Eds.), *Causes of conduct disorder and juvenile delinquency* (pp. 49-75). Guilford Press, ISBN 978-1572308817, New York


Moffitt, T. E., Caspi, A., Rutter, M., & Silva, P. A. (2001). *Sex differences in antisocial behavior:* 

Nagin, D. S. & Tremblay, R. E. (1999). Trajectories of boys' physical aggression, opposition,

Nock, M. K., Kazdin, A. E., Hiripi, E. & Kessler, R. C. (2007). Lifetime prevalence, correlates,

Palfrey J. S., Tonniges, T. F., Green, M., & Richmond, J. (2005). Introduction: addressing the

Patterson, G. R., DeBaryshe, B. D., & Ramsey, E. (1989). A developmental perspective

Plück, J., Döpfner, M., Kuschel, A., Heinrichs, N., Denner, C. & Schmeck, K. (under review).

Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The

Ravens-Sieberer, U., Wille, N., Erhart, M., Bettge, S., Wittchen, H.-U., Rothenberger, A. et al.

Rescorla, L., Achenbach, T., Ivanova, M. Y., Dumenci, L., Almqvist, F., Bilenberg, N., et al.

Rescorla, L., Achenbach, T. M., Ivanova, M. Y., Dumenci, L., Almqvist, F., Bilenberg, N., et

Roberts, E. E., Attkisson, C. C. & Rosenblatt, A. (1998). Prevalence of psychopathology

Robins, L. N., & Rutter, M. (1990). *Straight and devious pathways from childhood to adulthood*.

Rutter, M., Tizard, J. & Whitmore, K. (1970). *Education, health and behaviour.* Longman, ISBN

*von Klein- und Vorschulkindern (CBCL/1½ - 5; C-TRF1½ - 5).* 

*American Journal of Psychiatry,* Vol.164, 942–948, ISSN 0002-953X

Cambridge University Press, ISBN 0521010667, Cambridge, UK

delinquency. *Child Development,* Vol.70, 1181–1196, ISSN 0009-3920

ISBN 978-1572308817, New York

No.7, 703-713, ISSN 1469-7610

0031-4005

ISSN 1018-8827

142, ISSN 1063-4266

9780582320987, London

953X

Vol.75, No.2, 351–358, ISSN 0022-006X

The Free Press, ISBN 978-0521427395, New York

066X

(Eds.), *Causes of conduct disorder and juvenile delinquency* (pp. 49-75). Guilford Press,

*Conduct disorder, delinquency, and violence in the Dunedin Longitudinal Study*.

and hyperactivity on the path to physically violent and nonviolent juvenile

and persistence of oppositional defiant disorder: Results from the National Comorbidity Survey Replication. *Journal of Child Psychology and Psychiatry,* Vol.48,

millennial morbidity-the context of community. *Pediatrics,* Vol.115, 1121-1123, ISSN

on antisocial behavior. *American Psychologist,* Vol. 44, 329–335, ISSN 0003-

*Zur Reliabilität und faktoriellen Validität der Fragebögen für Eltern und ErzieherInnen* 

worldwide prevalence of ADHD: A systematic review and metaregression analysis.

(2008). Prevalence of mental health problems among children and adolescents in Germany: results of the BELLA study within the National Health Interview and Examination Survey. *European Child & Adolescent Psychiatry,* Vol.17, Suppl. 1, 22-33,

(2007a). Behavioral and emotional problems reported by parents of children ages 6 to 16 in 31 societies. *Journal of Emotional and Behavioral Disorders*, Vol.15, No.3, 130–

al. (2007b). Epidemiological comparisons of problems and positive qualities reported by adolescents in 24 countries. *Journal of Consulting and Clinical Psychology*,

among children and adolescents. *American Journal of Psychiatry, 155*, 715-725. ISSN 0002-


**9** 

*Colombia* 

**Epidemiology of Tics** 

Blair Ortiz, William Cornejo and Lucía Blazicevich

*Child and Adolescent Diseases Research Group PEDIACIENCIAS* 

Tics are the most frequent movement disorders during childhood; their highest prevalence occurs at scholar and adolescence-ages. Most tics are transient but some of them become

Moreover, some tics are related to disorders with significant impact, like attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive (OCD) and affective disorders. Epidemiological studies are the initial approach to diagnose them and properly begin

In this chapter, we explained the clinical bases of tics, review the more representative epidemiological studies that assess the prevalence of tics and make a critical standpoint of

**2.1 Definition of tics and their practical ways to characterize them since clinical view**  As we described elsewhere, tics are defined as "sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations"and have clinical concerns1.Tics are likely to differ in terms of the body location, number, frequency, complexity, intensity or forcefulness, noticeable and resulting social consequences2. Intervals between tics can range from seconds, hours or even days. The forcefulness with which a tic is performed can range from slight and barely noticeable to intense and obvious. Over time, the frequency and intensity of tics may wax and wane and maybe influenced by a variety of internal and external stimuli including private events, contextual variables and social reinforcement

Tics can also vary considerably in their complexity. Tics that involve the contraction of a single muscle group are typically referred as simple tics and those that involve the contraction of multiple muscle groups are typically considered complex. Simple tics are typically of very short duration (*i.e.* 1 second) and include such behaviors as eye blinking; jerking of the face, head, torso, or limbs; coughing; sniffing; throat clearing and making singles syllable sounds. Complex tics are often sustained for longer durations or occur in paroxysms and can include virtually any orchestrated pattern of behavior otherwise

chronic having educational, familial and social negative implications.

these studies about epidemiology applicable to clinical practice.

**1. Introduction** 

treatment.

**2. Content** 

contingencies3.

*Universidad de Antioquia, Child Neurology Group,* 

Weisz, J. R., Sandler, I. N., Durlak, J. A. & Anton, B. S. (2005). Promoting and protecting youth mental health through evidence-based prevention and treatment. *American Psychologist*, Vol.60, 628-648, ISSN 0003-066X
