Chapter

Prevention and treatment

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/9780199216697.003.0009

Series: International Perspectives in Philosophy & Psychiatry

Prevention and treatment

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Preventive activity in the field of the biopsychosocial disorders of childhood can, like other forms of medical prevention, be classified as follows.

♦ Primary prevention: action taken to prevent the development of the disorder in the first place, usually by removing the cause.

♦ Secondary prevention: action taken to identify the disorder at its onset, or as early as possible thereafter, so as to prevent extension and to minimise duration.

♦ Tertiary prevention: action taken to limit further avoidable disability arising from an established condition.

Rational prevention is made easier if there is good understanding of the factors that may be related to the development of disorders. The presence of a risk factor implies that the individual has an increased likelihood of developing a disorder. Protective factors are those that reduce an individual’s likelihood of developing the disorder in the presence of a risk factor (or conversely those that enhance resilience), and vulnerability factors are those that increase likelihood of disorder. Thus, for example, the presence of parental marital disharmony is a risk factor for conduct disorder. If a child at risk for this reason has a good relationship with an adult outside the family, this can act as a protective factor, and if the child is educationally delayed, this may increase the child’s vulnerability to develop such a disorder. Therefore action to reduce risk and vulnerability factors, and to enhance protective factors and resilience, may result in successful prevention. Although perhaps the major responsibility for prevention lies in social and educational policy areas, as far as health professionals are concerned the onus for prevention in this field is largely, although not entirely, on those working in primary health care, such as general practitioners, community health doctors, and health visitors. Therefore emphasis in this section will be on activities that these professionals can undertake. However, those involved in secondary care, such as paediatricians, psychologists, and psychiatrists can also undertake activities of major preventive significance, particularly if there is a focus on high-risk groups (Boyle and Offord 1990). Social policy measures of potential preventive significance will be discussed first.

Treatment methods in child and family psychiatry are scientifically less well established than in some, but by no means all, other branches of medicine. In particular, knowledge concerning the effectiveness of different types of treatment for particular disorders is often uncertain. Consequently, it is not surprising that treatment practice still varies quite widely from centre to centre. Nevertheless, much useful knowledge is available and the evidence base is increasing steadily (Hoagwood et al. 2001). This is as true for what does not work, as for what does (Turk 2005b). Further, although there is a need for far more evaluation of treatment methods in this field, there is already a substantial amount of evidence available concerning the effectiveness of different psychotherapy techniques for specific disorders (Fonagy et al., 2002a; Target and Fonagy, 2005; Weisz and Jensen 2001). In the following sections a number of methods of treatment are described, although it must be appreciated that many practitioners often use different forms of therapy in combination. In each case an attempt has been made to describe the form the treatment takes, the principles underlying it, indications and contraindications for its use, and evidence for its effectiveness. Some examples are given of its application in different types of facility: primary care, paediatric and psychiatric. For brevity, the case examples do not contain all relevant information. Names of children described, and some identifying data, have been altered to preserve anonymity.

Chapter.  29899 words.  Illustrated.

Subjects: Psychiatry

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