Child psychiatry Prof.elham Aljammas oct 2015

The practice of child psychiatry differs from that of adult psychiatry in 5 ways: Children seldom initiate the consultation. The child’s problems may reflect the problems of other people. The child’s stage of development must be considered. Children are generally less able to express themselves in words. The emphasis of treatment is different.

Normal development

The first year of life: 3 wks / smiles at faces 6 months / selective smiling 8 months / fear of strangers Shortly after 8 months / separation anxiety. Bowlby (1980) attachment and bonding. By the end of the first year, the child should have formed a close and secure relationship with the mother or other close carer. There should be an ordered pattern of feeding and sleeping. Learn about simple causal and spatial relationships. By the end of the first year, they enjoy making sounds and may say “mama”, “dada”, and perhaps one or two other words.

Normal development Year 2 Children begin to wish to please their parents and appear anxious when they disapprove. They begin to learn to control their behavior. By now, attachment behavior should be well established. Temper tantrums occur, particularly if exploratory wishes are frustrated. These tantrums don’t last long, and should lessen as the child learns to accept constraints. By the end of second year the should be able to put two or three words together as simple sentence.

Pre-school years (2-5 years) Social development occurs as child learn to live within the family. Further increase in intellectual abilities, (language). Identify with parent. Concentration increase gradually. Fantasy life is rich. Transitional objects. Sexual identity. Defense mechanism develop. Ride a tricycle help to dress and undress recall part of a story sing a song Temper tantrum gradually disappear before school.

Normal development Middle childhood: Learn to cope with school. Learn to read and write. Acquire numerical concepts. Social behavior develop further.

Adolescence Self-awareness increase. Consider where they want to go in life. Some experience emotional turmoil and feel alienated from their family. Peer group importance. Interest in other sex.

Developmental psychopathology

The influence of genes: Susceptibility genes have been identified for autism, ADHD, and specific reading disorder. Genes may indirectly cause stressful life events, for example they may control personality traits of impulsiveness and irritability that lead to repeated break down of relationships.

Developmental psychopathology The influence of the environment: Poor parental care and risk of depression (caring relations with other people may protect, yet this experience is not always protective, it does not reduce the risk of depression following child abuse).

Developmental psychopathology Changes in hormones: in newborn the hypothalamo-pituitary-adrenal system is highly responsive. It becomes progressively less responsive over the next 2 years. And there is some evidence that this change is greater in securely attached than in insecurely attached infants (Gunnar, 1998). These differences in responsiveness could be relevant to the development of psychopathology.

Developmental psychopathology The dividing line between normal and abnormal: Many childhood disorders are at the extreme of a continuum of a normal behavior. Despite this we need yes or no answers regarding treatment, so a cut-off point should be set.

Developmental psychopathology Continuities and discontinuities: Overactivity and difficulties is management in 3 years of age is associated with offending in adulthood (Stevenson and Goodman 2001). Anxiety in childhood is less likely to persist in adulthood.

Classification of psychiatric disorder in children and adolescents Adjustment reactions; Pervasive developmental disorders; Specific developmental disorders; Conduct (antisocial or externalizing) disorder; AHDH; Emotional (neurotic or internalizing) disorders; Symptomatic disorders.

Epidemiology Behavioral and emotional disorders are common in childhood. Rates in different developed countries are similar, also similar to developing countries. In the UK, the prevalence of child psychiatric disorder in ethnic minority groups are similar to that in the rest of population.

Epidemiology The landmark study was carried out more than 30 years ago in the Isle of Wight in the UK, concerned with the health, intelligence, education, and psychological difficulties in all the 10 and 11 years old attending state schools in the island- a total of 2193 children (Rutter et at., 1970). The one year prevalence of rate of psychiatric disorder was about 7%, with the rate in males being twice that in females.

Epidemiology ( the landmark study) Conduct disorders were 4 times more frequent among boys than girls, whereas emotional disorders were more frequent in girls in a ratio of almost 1.5:1 There was no correlation between psychiatric disorder and social class, but the prevalence increase as intelligence decrease. It was associated also with physical handicap and esp. with evidence of organic brain damage.

Epidemiology ( the landmark study) There was also strong association between reading retardation and conduct disorder. In 1975, Rutter et at., done another study in London and rates of all types of disorders were twice of those in the Isle of Wight. The results of the landmark study were confirmed in subsequent studies carried out in different countries.

Epidemiology ( the landmark study) Evidence about adolescence was provided originally by a 4 years follow-up of the Isle of Wight study (Rutter et al., 1976) At the age of 14, the 1 year prevalence rate of significant psychiatric disorder was about 20%

Epidemiology In the UK there is evidence of a substantial increase in conduct and emotional problems in adolescents over the past 25 years (Collishaw et al., 2004)

Epidemiology Variations with gender and age: Before puberty, disorders are more frequent overall among males than among females; after puberty, disorders are more frequent among females.

Epidemiology More freq. in femalesEqualMore freq. in males Depression after pubertyDepression before puberty PDD Specific phobiasSchool refusalSpecific developmental disorders Eating disordersSelective mutismHyperactivity disorders Daytime enuresisOppositional-defiant disorder Deliberate self-harm after puberty Conduct disorder Juvenile delinquency Nocturnal enuresis Tic disorder suicide

Epidemiology Disorders which usually begins after puberty: Depressive disorder Mania Psychosis Agoraphobia and panic Eating disorders Substance abuse Deliberate self-harm Suicide and Juvenile delinquency.