Child and adolescent psychiatry

A branch of psychiatry that specialises in work with children, teenagers, and their families.

History
An important antecedent to the specialty of child psychiatry was the social recognition of childhood as a special phase of life with its own developmental stages, starting with the neonate and eventually extending through adolescence. As early as 1899, the term 'child psychiatry' (in French) was used as a subtitle in Manheimer's monograph Les Troubles Mentaux de L'Enfance. However, the Swiss Moritz Tramer (1882-1963) was probably the first to define the parameters of child psychiatry in terms of diagnosis, treatment, and prognosis within the discipline of medicine, in 1933. In 1934, Tramer founded the Zeitschrift für Kinderpsychiatrie (Journal of Child Psychiatry), which later became Acta Paedopsychiatria. The first use in English of the term "child psychiatry" occurred when Leo Kanner published his textbook under that name in the USA in 1935.

The use of medication in the treatment of children also began in the 1930s, when Charles Bradley opened a neuropsychiatric unit and was the first to use amphetamine for brain-damaged and hyperactive children.

Academic divisions of child psychiatry began to develop, particularly in the USA, in the 1930s. The first 'pediatric psychiatry clinic' was established in 1930 in Baltimore, headed by Leo Kanner. In 1933, The Maudsley Hospital in London opened a children's department under Mildred Creak, and research in child psychiatry began to increase. Similar overall early developments took place in many other countries.

The era since the 1980s flourished, in large part, because of contributions made in the 1970s, a decade during which child psychiatry witnessed a major evolution as a result of the work carried out by Michael Rutter. The first comprehensive population survey of 9-to 11-year-olds, carried out in London and the Isle of Wight, which appeared in 1970, addressed questions that have continued to be of importance for child psychiatry; for example, rates of psychiatric disorders, the role of intellectual development and physical impairment, and specific concern for potential social influences on children's adjustment. This work was influential, especially since the investigators demonstrated specific continuities of psychopathology over time in their subsequent re-evaluation of the original cohort of children (unsurprisingly since the environments that nurtured their emotional and developmental difficulties remained largely unchanged). It was paralleled by similarly work on the epidemiology of autism that was to enormously increase the number of children labeled as autistic in future years. Although attention had been given in the 1960s and 1970s to the classification of childhood psychiatric disorders, and some issues had then been delineated, such as the distinction between neurotic and conduct disorders, the nomenclature did not parallel the growing clinical knowledge. It was claimed that this situation was altered in the late 1970s with the development of the DSM-III system of classification.

Criticisms
Traditional deficit and disease models of child psychiatry are based on the medical model which conceptualises adjustment problems in terms of disease states. That is, it explicitly characterises problematic behavior as representing a disorder within the child or young person. There are increasing criticisms of this approach: it is said to neglect the role of environmental, family, and cultural influences, to discount the psychological meaning of behaviour and symptoms, it promotes a view of the "patient" as dependent and needing to be cured or cared for and therefore undermines a sense of personal responsibility for conduct and behaviour, it also promotes a normative conception based on adaptation to the norms of society (the ill person must adapt to society), and is based on the shakey foundations of reliance on a classificatory system that has been shown to have problems of validity and reliability. It is well known that diagnostic validity and reliability is questionable in the case of adults and these difficulties are even more acute in the case of child and adolescent emotional and developmental difficulties. Although supporters argue that board certification process ensures that child psychiatrists use a bio-psycho-social approach to understanding and treating ALL of the child and adolescent psychiatric diagnosis. In addition, the diagnostic criteria used is consistent with the DSM-IV-TR which unifies most views in order to do research.

References & Bibliography


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