We compared children aged 7-12 years referred to child psychiatrists by general practitioners (GPs) with community control children matched for the presence of psychiatric disorder. Referral status in psychiatrically disturbed children was linked to male sex, severity of the disorder, mental problems in the mothers, high levels of psychosocial stress in the family, and less support from extended families. For the whole group of referred children, the referral was associated with high antisocial scores on parental questionnaires, with parental reports of problems in controlling the children, and of high levels of stress felt in relation to them. In addition, parents of referred children were in disadvantaged socioeconomic groups.

A substantial minority (23%) of children between 7 and 12 years of age attending general practice were found to have psychiatric disorders. Disturbance was slightly more frequent in girls than in boys, and emotional disorder was the most common diagnosis. Psychiatric disorder was associated with psychological disadvantage (broken homes, the child had lived away from the family, family history of psychiatric disorder) and with current high levels of parental stress in relation to their children. Disturbed children tended to present with symptoms of anxiety, bed-wetting, hayfever, nosebleeds or scabies. Amongst a subsample of children consulting in general practice, psychiatric disorder may be a relevant factor contributing to somatic consultation.

SUMMARY Detailed interviews with parents of 128 children aged 7 to 12 years consecutively referred to general paediatric clinics identified psychiatric disturbance in 36 (28%) of the children. Emotional disorders were the commonest psychiatric diagnoses (present in two thirds); less frequent diagnoses were conduct disorders (5/36, 14%), mixed conduct/emotional disorders (six, 17%), and hyperkinetic-syndrome (three, 8%). Disturbance was related to level of energy, with disturbed children being described significantly more frequently as 'bounding with energy' or conversely 'tired and apathetic'. Psychosocial problems (broken homes, mentally distressed mothers, family stress including financial stress and marital difficulty) were also increased in the disturbed group, but most of all these mothers reported feeling stressed in relation to the children.Psychiatric disorders, particularly emotional disorders, are common associated problems in paediatric referrals. Family stress, specially that focused on parenting, is likely to be an important factor contributing to disturbed children's consultations in general paediatric clinics.Child mental health problems are a common reason for consultation in general paediatric clinics. They have been reported as the main reason for attending in between 5 to 10% of children in several surveys. '-There are indications that childhood psychiatric morbidity may also be present as an associated or background factor in children with somatic presentations,6 but recognition of these behavioural problems by physicians is probably limited.7 In contrast with the work done in adult medical patients, which has documented psychiatric morbidity in between a quarter and 40% of medical patients and physician recognition rates of between 40-50%,8 these issues have received little direct research attention in the paediatric literature.More information on the frequency, nature, and associations of childhood psychiatric morbidity among paediatric patients is clearly necessary if these problems are to be recognised and attended to, if appropriate, in paediatric clinics.Two studies have used child behavioural questionnaires completed by parents in children attending general paediatric clinics and reported high rates of psychological deviance in over 35% of children.9 10

Children 7 to 12 years of age were asked to indicate events they had experienced in the previous three months in a questionnaire devised for the study. Most children were able to complete the questionnaire and reported positive and negative events, the most common themes being personal achievement, illness-related events and problems in relationships. The agreement between parents and child reporting of individual events was uneven and children reported more events than parents. Psychiatrically disturbed children noted an excess of negative and loss events and children attending paediatric clinics reported fewer events, particularly fewer positive happenings, than non-attending primary school children. A child Life Events questionnaire may be of use to explore disturbed and ill children's perception of their lives.