The prognosis of the ''difficult'' child is extremely variable. Two ''difficult'' children exhibiting a similar clinical picture and sometimes sharing the same diagnosis can develop in two opposite directions: one will grow up to be a mentally healthy adult, free from the symptoms from which he suffered in childhood; the other will exhibit increasingly more symptoms, suffer from one or more disorders as described in this chapter, develop comorbid disorders, such as substance abuse, and later decline rapidly into a situation of significant social dysfunction.

The prognosis depends on several factors, including the diagnosis, the severity of the symptoms, the age of onset of the difficulties, the child's other characteristics (traits, tendencies, IQ, etc.), the interaction of the child with his/her family and the legitimization given him/her to function at different levels, the environmental demands, the support systems, the nature of individual and family coping, the nature of treatment and the response to it. Concerning pharmacological treatment, several factors are to be considered: the existence of an effective pharmacological treatment; the specific effectiveness for the individual child; whether the parents are prepared to give medication to their children. This last question may sound rather strange, but in many parts of the world there is a widespread apprehension regarding pharmacological treatment, accompanied by stigma and ignorance, so that even if there is an effective, available medication, parents refuse to administer it.

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