Chapter 14 Child and adolescent psychiatry: General principles

Abstract

Child psychiatry is the medical speciality that provides assessment and treatment for children and adolescents who have mental health problems. These problems include major mental illness beginning early in life as well as delays and deviations in children's development, emotional state, and behavior. The prevalence of mental health disorders in children and adolescents is approximately 20%. This chapter has provided an overview of many of the general principles that inform practice in child psychiatry. In order to understand the etiology and possible solutions to children's mental health problems, child psychiatrists use not only the medical model of disease but also other theoretical framework such as analytical theories, behavioral principles, attachment theory, and systemic thinking. Decision making is informed by a detailed understanding of normal and abnormal child development from infancy through to adolescence. A thorough assessment in child psychiatry requires that detailed information must be gathered from the child, family members, and school staff. Children should be given the opportunity to talk by themselves at some point during the assessment. Talking and interacting with children of all ages in order to facilitate free communication is a core skill in child psychiatry. Theoretical understanding of child development, social behavior, and psychological defense mechanisms assists the practitioner in this. Physical examination, medical investigations, and psychometric testing all augment the clinical interviews. The whole assessment allows the clinician to develop a differential diagnosis and an etiological formulation, both of which will guide intervention. Child psychiatrists use the full range of behavioral, psychological, and pharmacological interventions available in adult psychiatry. Research is beginning to inform evidence-based practice, and there is a growing interest in preventative work. Child psychiatric interventions can be helpful in the management of children who have chronically ill physical health. All child psychiatrists need to be aware of how child abuse may manifest in developmental, emotional, or behavioral problems of childhood, and they must practice within local child protection guidelines. Focused therapeutic work may help some children who have been victims of child abuse.