Chapter 30
Child & Adolescent Psychiatry
261
, Chapter 30: Child & Adolescent Psychiatry
Introduction
Child and Adolescent Mental Health Services (CAMHS) cater for children and adolescents.
In Ireland some CAMHS services see people up to 17 years, some cover up to 18 years and others still
only up to 16 years (though generally these services continue to treat young people who are still attending
CAMHS at the time that they turn 16 years but they do not take new referrals of those over 16 years).
Assessments involve a more detailed evaluation of particular areas than in an adult psychiatry assessment.
These include a detailed school history, developmental history, a family interview and collateral information
obtained from a child’s school with regards to academic performance, peer relationships and behaviour in the
school environment.
Services include:
o School assessment (i.e. assessment in the school of the individual)
Meeting between personnel from CAMHS and a child’s school (e.g. teachers, school psychologists
and guidance counsellors).
During these meetings, a more detailed picture of the child or adolescent can be obtained
within the environment of the school.
The needs of the child or adolescent are reviewed and highlighted.
Appropriate interventions developed on an ongoing basis with regular meetings.
Student academic records and a background history of mental health related problems are reviewed
for more in-depth assessment and analysis.
Observation of the child in the classroom setting reveals information about their strengths and
difficulties.
o Day hospital
Includes a mix of occupational therapy, various treatment programmes such as group therapy, social
skills, etc, and an educational focus.
The day hospital service caters for those individuals who require more in-depth assessment and a
more comprehensive treatment than can be offered in the general outpatient setting but do not
require inpatient treatment.
o Outpatient clinic
The duration and frequency of the outpatient visits are determined on an individual basis.
Younger children may be assessed in the presence of their parent.
o Inpatient care
The goals of the treatment plan and the length of time expected to achieve these goals should be
discussed with the parents. Parents should understand that hospitalisation will be one phase in the
treatment process and that their active involvement in the treatment is expected to continue.
Differences between child and adolescent psychiatry and adult psychiatry
The child’s existence and emotional development depends on their family or caregivers.
The developmental stages are very important in the assessment and diagnosis in child and adolescent
psychiatry.
Use of psychopharmacotherapy is less common in child and adolescent psychiatry.
Children are less able than adults to express themselves in words.
Disorders of psychological development
ICD-10 classification
1. Specific developmental disorders of speech and language
A. Specific speech articulation disorder.
B. Expressive language disorder.
C. Receptive language disorder.
D. Acquired aphasia with epilepsy (Landau Kleffner syndrome).
2. Specific developmental disorders of scholastic skills
A. Specific reading disorder.
B. Specific spelling disorder.
C. Specific disorder of arithmetical skills.
D. Mixed disorder of scholastic skills.
3. Specific developmental disorder of motor function
4. Mixed specific developmental disorders
5. Pervasive developmental disorders
A. Childhood autism.
B. Atypical autism.
C. Rett’s syndrome.
262
, D. Other childhood disintegrative disorder.
E. Overactive disorder associated with mental retardation and stereotyped movements.
F. Asperger’s syndrome.
1. Specific developmental disorders of speech and language
Note: these conditions are more common in males than females.
A. Specific speech articulation disorder
ICD-10 criteria
The child’s use of speech sounds is below the appropriate level for his/her mental age.
There is a normal level of language skills.
B. Expressive language disorder
ICD-10 criteria
The child’s ability to use expressive spoken language is below the appropriate level for his/her mental age.
Language comprehension is within normal limits.
C. Receptive language disorder
ICD-10 criteria
The child’s understanding of language is below the appropriate level for his/her mental age.
In almost all cases, expressive language is markedly disturbed.
Abnormalities in word-sound production are common.
D. Acquired aphasia with epilepsy (Landau Kleffner syndrome)
ICD-10 criteria
A disorder in which the child, having previously made normal progress in language development, loses both
receptive and expressive language skills but retains general intelligence.
Onset of the disorder is accompanied by paroxysmal abnormalities on the EEG and in the majority of cases also
by epileptic seizures.
Typically the onset is between the ages of 3-7 years.
2. Specific developmental disorders of scholastic skills
Note: these conditions are more common in males than females.
A. Specific reading disorder
ICD-10 criteria
The child’s reading performance is significantly below the level expected on the basis of age, general
intelligence and school placement.
B. Specific spelling disorder
ICD-10 criteria
The child’s spelling performance should be significantly below the level expected on the basis of his/her age,
general intelligence and school placement.
C. Specific disorder of arithmetical skills
ICD-10 criteria
The child’s arithmetical performance should be significantly below the level expected on the basis of his/her
age, general intelligence and school placement.
D. Mixed disorder of scholastic skills
ICD-10 criteria
Both arithmetical and reading or spelling skills are significantly impaired.
The disorder is not solely explicable in terms of general mental retardation or inadequate schooling.
3. Specific developmental disorder of motor function
ICD-10 criteria
The child’s motor co-ordination on fine or gross motor tasks should be significantly below the level expected
on the basis of his/her age and general intelligence.
The difficulties in co-ordination should have been present since early development (i.e. they should not
constitute an acquired deficit) and they should not be a direct result of any defects of vision or hearing or of any
diagnosable neurological disorder.
263
Child & Adolescent Psychiatry
261
, Chapter 30: Child & Adolescent Psychiatry
Introduction
Child and Adolescent Mental Health Services (CAMHS) cater for children and adolescents.
In Ireland some CAMHS services see people up to 17 years, some cover up to 18 years and others still
only up to 16 years (though generally these services continue to treat young people who are still attending
CAMHS at the time that they turn 16 years but they do not take new referrals of those over 16 years).
Assessments involve a more detailed evaluation of particular areas than in an adult psychiatry assessment.
These include a detailed school history, developmental history, a family interview and collateral information
obtained from a child’s school with regards to academic performance, peer relationships and behaviour in the
school environment.
Services include:
o School assessment (i.e. assessment in the school of the individual)
Meeting between personnel from CAMHS and a child’s school (e.g. teachers, school psychologists
and guidance counsellors).
During these meetings, a more detailed picture of the child or adolescent can be obtained
within the environment of the school.
The needs of the child or adolescent are reviewed and highlighted.
Appropriate interventions developed on an ongoing basis with regular meetings.
Student academic records and a background history of mental health related problems are reviewed
for more in-depth assessment and analysis.
Observation of the child in the classroom setting reveals information about their strengths and
difficulties.
o Day hospital
Includes a mix of occupational therapy, various treatment programmes such as group therapy, social
skills, etc, and an educational focus.
The day hospital service caters for those individuals who require more in-depth assessment and a
more comprehensive treatment than can be offered in the general outpatient setting but do not
require inpatient treatment.
o Outpatient clinic
The duration and frequency of the outpatient visits are determined on an individual basis.
Younger children may be assessed in the presence of their parent.
o Inpatient care
The goals of the treatment plan and the length of time expected to achieve these goals should be
discussed with the parents. Parents should understand that hospitalisation will be one phase in the
treatment process and that their active involvement in the treatment is expected to continue.
Differences between child and adolescent psychiatry and adult psychiatry
The child’s existence and emotional development depends on their family or caregivers.
The developmental stages are very important in the assessment and diagnosis in child and adolescent
psychiatry.
Use of psychopharmacotherapy is less common in child and adolescent psychiatry.
Children are less able than adults to express themselves in words.
Disorders of psychological development
ICD-10 classification
1. Specific developmental disorders of speech and language
A. Specific speech articulation disorder.
B. Expressive language disorder.
C. Receptive language disorder.
D. Acquired aphasia with epilepsy (Landau Kleffner syndrome).
2. Specific developmental disorders of scholastic skills
A. Specific reading disorder.
B. Specific spelling disorder.
C. Specific disorder of arithmetical skills.
D. Mixed disorder of scholastic skills.
3. Specific developmental disorder of motor function
4. Mixed specific developmental disorders
5. Pervasive developmental disorders
A. Childhood autism.
B. Atypical autism.
C. Rett’s syndrome.
262
, D. Other childhood disintegrative disorder.
E. Overactive disorder associated with mental retardation and stereotyped movements.
F. Asperger’s syndrome.
1. Specific developmental disorders of speech and language
Note: these conditions are more common in males than females.
A. Specific speech articulation disorder
ICD-10 criteria
The child’s use of speech sounds is below the appropriate level for his/her mental age.
There is a normal level of language skills.
B. Expressive language disorder
ICD-10 criteria
The child’s ability to use expressive spoken language is below the appropriate level for his/her mental age.
Language comprehension is within normal limits.
C. Receptive language disorder
ICD-10 criteria
The child’s understanding of language is below the appropriate level for his/her mental age.
In almost all cases, expressive language is markedly disturbed.
Abnormalities in word-sound production are common.
D. Acquired aphasia with epilepsy (Landau Kleffner syndrome)
ICD-10 criteria
A disorder in which the child, having previously made normal progress in language development, loses both
receptive and expressive language skills but retains general intelligence.
Onset of the disorder is accompanied by paroxysmal abnormalities on the EEG and in the majority of cases also
by epileptic seizures.
Typically the onset is between the ages of 3-7 years.
2. Specific developmental disorders of scholastic skills
Note: these conditions are more common in males than females.
A. Specific reading disorder
ICD-10 criteria
The child’s reading performance is significantly below the level expected on the basis of age, general
intelligence and school placement.
B. Specific spelling disorder
ICD-10 criteria
The child’s spelling performance should be significantly below the level expected on the basis of his/her age,
general intelligence and school placement.
C. Specific disorder of arithmetical skills
ICD-10 criteria
The child’s arithmetical performance should be significantly below the level expected on the basis of his/her
age, general intelligence and school placement.
D. Mixed disorder of scholastic skills
ICD-10 criteria
Both arithmetical and reading or spelling skills are significantly impaired.
The disorder is not solely explicable in terms of general mental retardation or inadequate schooling.
3. Specific developmental disorder of motor function
ICD-10 criteria
The child’s motor co-ordination on fine or gross motor tasks should be significantly below the level expected
on the basis of his/her age and general intelligence.
The difficulties in co-ordination should have been present since early development (i.e. they should not
constitute an acquired deficit) and they should not be a direct result of any defects of vision or hearing or of any
diagnosable neurological disorder.
263
