Chapter

Introduction

Jeremy Turk, Philip Graham and Frank C. Verhulst

in Child and Adolescent Psychiatry

Fourth edition

Published on behalf of Oxford University Press

Published in print February 2007 | ISBN: 9780199216697
Published online February 2013 | e-ISBN: 9780191754333 | DOI: http://dx.doi.org/10.1093/med/9780199216697.003.0001

Series: International Perspectives in Philosophy & Psychiatry

Introduction

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More than most branches of medical practice child and adolescent psychiatry, increasingly described as child and adolescent mental health, is difficult to define. Central foci of the subject are the developmental, behavioural, and emotional disorders of childhood and adolescence. Many include “psychosomatic” physical symptoms, such as non-organic headache, stomach pains, and fatigue, in which stress or other environmental factors appear to play important causative and perpetuating roles. Delays and deviations in development, as well as general and specific learning problems, lie in the borderland of child psychiatric practice; educational and social services are often in the vanguard in providing support and services for affected individuals and their families. Environmental factors are often important in causation, and they are often, but by no means always, accompanied or followed by significant emotional and/or behavioural disturbance. Conversely, the importance of “constitutional” biological factors, in particular genetic factors, is increasingly being recognized. Most specialists in this field recognize the need for a biopsychosocial approach to child and adolescent mental health.

Children's development is inextricably interwoven with parental and carer quality of care, failures of parenting and caring, and other possible acts of commission and omission. Thus fostering of parenting skills is often seen as an integral part of child psychiatric practice. Indeed, there are some child and adolescent psychiatrists who prefer to see themselves as family psychotherapists and perceive most, if not all, child mental health problems as being attributable to distortions or deficits in either parenting ability or familial interpersonal interactions. This can often be a helpful approach, but it is important to acknowledge that, although children's problems can often be formulated in terms of interactions between the child, the family, and the wider environment, in a significant number of cases (as in childhood autism for example) a serious primary disturbance does indeed lie within the child. This will of course interact critically with prevailing familial and other social factors.

Defining the territory of child psychiatry in this way makes it clear that most professional assessment and treatment of child psychiatric disorders is carried out by non-psychiatrists, and often not even by medically qualified professionals. These include family doctors, paediatricians, and clinical medical officers, as well as psychologists (clinical and educational), nurses, social workers, nursery staff, and teachers. Situations which call for the particular skills of a child psychiatrist (Graham 1984) will vary. Generally, psychiatrists are most likely to be appropriately involved where the disorder is severely disabling, handicapping, and persistent, with significant degrees of functional impairment in development and quality of life. With training, other medical and non-medical professionals can be effective in assessing and treating problems in this field of work. This book aims to enable these individuals, as well as mental health professionals, to carry out these tasks more effectively.

An important characteristic of child psychiatric disorders is the degree to which they affect different aspects of the child's and the family's lives. The family of a seriously disturbed child requires the services of many different professionals, drawn especially from health, education, and social welfare services. An important principle of practice involves the need for all practitioners, no matter to which discipline they belong, to respect the contribution that others make, to be aware of the point at which another discipline may need to be involved, to acknowledge when a professional with a different background, training, and even perspective may know better than you, and to maintain as close communication with other disciplines as is compatible with professional confidentiality and the highest ethical standards.

Chapter.  19438 words. 

Subjects: Psychiatry

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