Child and adolescent psychiatry

What is it?

According to AACAP: a child and adolescent psychiatrist is a "physician who specialises in the diagnosis and treatment of disorders of thinking, feeling and/or behaviour affecting children, adolescents and their families". MedlinePlus (types of health care providers) states that psychiatry deals with "emotional or mental disorders", and that a primary care provider may refer the patient to specialists when needed. MedlinePlus (children's mental health) stresses the importance of recognising and treating mental illnesses in children early, because if they develop they become a normal part of the child's behaviour and are harder to treat.

Conditions it covers

According to AACAP these doctors treat conditions including: autism spectrum disorders, attention-deficit/hyperactivity disorder (ADHD), learning difficulties, developmental and cognitive delay, mood disorders, disruptive mood dysregulation disorder, depressive and anxiety disorders, substance dependence, and conduct disorders. NIMH states that many mental disorders may begin in childhood, examples being anxiety disorders, ADHD, depression and other mood disorders, eating disorders and post-traumatic stress disorder, and among its topics for children and adolescents it also lists autism spectrum and bipolar disorder.

Signs that may warrant assessment according to NIMH: in younger children: frequent tantrums or extreme irritability most of the time, or frequent fear or anxiety, or frequent complaints of stomach aches or headaches with no known medical cause, or constant movement and inability to sit quietly, or sleeping too much or too little and frequent nightmares, or difficulty making friends, or declining grades, or repeating actions or checking things many times for fear that something bad will happen. In older children and adolescents: loss of interest in things they used to enjoy, low energy, disturbed sleep, periods of very high energy and activity with a much reduced need for sleep, spending increasing time alone, dieting or excessive exercise or fear of gaining weight, self-harming behaviours, smoking or drinking alcohol or using drugs, risky or destructive behaviour, thoughts of suicide, or saying that someone is controlling their mind or that they hear what others do not. MedlinePlus adds signs including: problems in more than one setting (school, home, peers), changes in appetite or sleep, social withdrawal, returning to the behaviours of younger children such as bed-wetting, and repeated thoughts about death.

Related pages on this site: depression, psychiatry, paediatrics and family medicine. AACAP lists depressive disorders among what this specialty treats, and states that training passes through general psychiatry, that there are programmes combining paediatrics and psychiatry, and that access to the doctor is through paediatricians, family doctors and others; NIMH states to start by talking to the paediatrician or family doctor. Disorders that have no pages on the site are not linked here.

Common tests and procedures

According to NIMH, a comprehensive assessment of a child's mental health usually includes: an interview with the parents to discuss the child's developmental history, temperament, relationships with friends and family, medical history, interests, abilities and any previous treatment; gathering information from school such as standardised test results, behaviour reports, strengths and difficulties; and interviewing the child when needed for testing and behavioural observation. MedlinePlus states that the doctor or mental health specialist considers the child's signs and symptoms, medical history and family history. AACAP states that the diagnostic examination takes into account physical, genetic, medical, developmental, emotional, cognitive, educational, family, peer-relationship and social aspects.

Treatment: according to NIMH may include psychotherapy (sometimes called talk therapy) with several approaches, including structured therapies directed at specific conditions, medicines that depend on the diagnosis and may include antidepressants, stimulants or mood stabilisers and are often used with psychotherapy, as well as family counselling and parent support programmes. AACAP states that the integrated approach may include individual, group or family psychotherapy, medicines, and consultation with specialists from schools and others. The plan is chosen with the treating doctor, and no medicine is started, stopped or changed without a specialist.

When to see one

According to NIMH: if behavioural signs and symptoms appear that last weeks or months and interfere with the child's daily life at home, at school or with friends, a health professional should be contacted; you can start with the paediatrician or health care provider and ask for a referral to a mental health specialist with experience in assessing and treating children. AACAP lists signs that warrant a psychiatric assessment, including: a marked decline in school performance, severe anxiety shown by refusing to go to school, sleep or take part in usual activities, persistent disobedience or aggression (longer than 6 months), frequent unexplained temper tantrums, marked changes in sleeping or eating habits, depression shown by persistent negative mood, severe mood swings, repeated use of alcohol or drugs, intense fear of obesity unrelated to actual weight with excessive dieting, self-harm or threats of harming oneself or others, and strange thoughts, beliefs or behaviours.

According to AACAP this doctor can be reached through paediatricians, family doctors, school counsellors, hospitals and others, and these doctors provide consultations in several settings including primary care and schools. Referral to the specialist is usually decided by the primary care provider according to the condition (MedlinePlus). Imminent danger, however, does not wait for a referral: seek emergency help immediately.

Common questions