Child psychiatry I

Child psychiatry I


The psychiatric disorders that present in childhood are distinct from those in adults because they arise within complex and intimate family relationships, and are influenced by the developmental stage of the child. Children also present special challenges for assessment and treatment. The psychiatric disorders that present in childhood or adolescence are listed in Table 1.


Table 1 Classification of psychiatric disorders of childhood and adolescence






image Pervasive developmental disorders

image Specific developmental disorders

image Hyperkinetic disorders

image Conduct disorders

image Emotional disorders

image Psychiatric aspects of child abuse

image Disorders of elimination



Normal childhood development


Some of the features of normal child development are shown in Figure 1. It is essential to consider the developmental stage of the child during a psychiatric assessment, as what is accepted as normal at one stage would be abnormal at another.


image

Fig. 1 Normal childhood development.


Early childhood experiences play an important role in determining what type of person we become in adulthood. The role of parents in this is central. The child with parents (or parent) who are loving and tolerant, yet able to set and enforce clear and reasonable limits is likely to develop a high self esteem, and secure attachment to the parents that will provide a template for secure attachments to others in later life. The theory of ‘attachment’ was first described by John Bowlby in the 1950s. It derived from his study of young children separated from their mother in hospital. Attachment behaviour begins at around 7 months and consists of clinginess and unwillingness to be separated from the main carer, usually mother. It serves to strengthen the bond between mother and child and has the evolutionary function of ensuring the child is protected from predators. A securely attached child is able to use the mother as a safe base from which exploration of the outside world can begin, and will also be able to cope well with brief separations. If the attachment is insecure, because the parent fails to respond to the child’s need for attention or holding, or is inconsistent, the child will have difficulty exploring and separating. This pattern of insecure attachment may persist throughout life, affecting adult relationships.



Assessment of children


The way in which a psychiatric history is taken and the child is examined will depend upon the age, confidence and language skills of the child. Much of the history will come from the parents, and children who are prepared to separate from their parents can then be seen alone. It is usually best to see adolescents alone and before their parents in order to establish a trusting relationship with them. The interview should take place in a relaxed and friendly atmosphere, with toys and drawing materials provided for children less than 10 years.


The history should include the following:


image Presenting complaint – described by both the parent and child. It is important to lead up to asking the child about the presenting complaint gently, after gaining their confidence and talking about neutral topics.

image Recent behaviour or emotional difficulties – including general health, mood, sleep, appetite, elimination, relationships, antisocial behaviours, fantasy life and play, and school behaviour.
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Jul 12, 2016 | Posted by in PSYCHIATRY | Comments Off on Child psychiatry I

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