Child and adolescent psychiatry
Encyclopedia
The branch of psychiatry
that specializes in the study, diagnosis, treatment, and prevention of psychopathological disorders of children, adolescents, and their families, child and adolescent psychiatry encompasses the clinical investigation of phenomenology, biologic factors, psychosocial factors, genetic factors, demographic factors, environmental factors, history, and the response to interventions of child and adolescent psychiatric disorders (Kaplan and Saddock).
as a special phase of life with its own developmental stages, starting with the neonate and eventually extending through adolescence. Kraepelin's psychiatric taxonomy published in 1883, ignored disorders in children.
Johannes Trüper founded a famous approved school on Sophienhöhe close to Jena in 1892 and was a co-founder of "Die Kinderfehler"(1896), one of the leading journals for research in pedagogy and child psychiatry in its time. The psychiatrist and philosopher Theodor Ziehen, regarded as one of the pioneers of child psychiatry, gained practical child psychiatric experience as a consultant liaison psychiatrist at the approved school which was run by Johannes Trüper. Wilhelm Strohmayer, another psychiatrist from Jena, also belongs to the founding fathers of child psychiatry in Germany with his book Vorlesungen uber die Psychopathologie des Kindesalters für Mediziner und Pädagogen (1910) which is based on his consultant work on Sophienhöhe.
As early as 1899, the term "child psychiatry" (in French) was used as a subtitle in Manheimer's monograph Les Troubles Mentaux de l'Enfance. However, the Swiss psychiatrist Moritz Tramer (1882–1963) was probably the first to define the parameters of child psychiatry in terms of diagnosis, treatment, and prognosis within the discipline of medicine, in 1933. In 1934, Tramer founded the Zeitschrift für Kinderpsychiatrie (Journal of Child Psychiatry), which later became Acta Paedopsychiatria. The first academic child psychiatry department in the world was founded by Leo Kanner
in 1930 under the direction of Adolf Meyer
at the Johns Hopkins Hospital
, Baltimore. Dr. Kanner was the first physician to be identified as a child psychiatrist in the US and his textbook, Child Psychiatry (1935), is credited with introducing the specialty to the academic community. The first use in English of the term "child psychiatry" occurred when Leo Kanner published his textbook under that name in the US in 1935. Academic child psychiatry in US was born at Johns Hopkins University
. Its founding father, Leo Kanner, a medical graduate of the University of Berlin, was brought to Johns Hopkins
by Adolf Meyer
in 1928. Eight years later, Kanner offered the first formal elective course in the subject here. But it wasn't until the 1960s that the first NIH grant to study pediatric psychopharmacology was awarded. It went to one of Kanner's students, Leon Eisenberg, the second director of the division.
The use of medication in the treatment of children also began in the 1930s, when Charles Bradley opened a neuropsychiatric unit and was the first to use amphetamine
for brain-damaged and hyperactive children.
Academic divisions of child psychiatry began to develop, particularly in the US, in the 1930s. The first "pediatric psychiatry clinic" was established in 1930 at Johns Hopkins Hospital
, Baltimore, headed by Leo Kanner
. In 1933, The Maudsley Hospital in London
opened a children's department under Mildred Creak, and research in child psychiatry began to increase. Similar overall early developments took place in many other countries. In the United States, child and adolescent psychiatry was established as a recognized medical speciality in 1953 with the founding of the American Academy of Child Psychiatry, but was not established as a legitimate, board-certifiable medical speciality until 1959.
The era since the 1980s flourished, in large part, because of contributions made in the 1970s, a decade during which child psychiatry witnessed a major evolution as a result of the work carried out by Michael Rutter
. The first comprehensive population survey of 9- to 11-year-olds, carried out in London and the Isle of Wight, which appeared in 1970, addressed questions that have continued to be of importance for child psychiatry; for example, rates of psychiatric disorders, the role of intellectual development and physical impairment, and specific concern for potential social influences on children's adjustment. This work was influential, especially since the investigators demonstrated specific continuities of psychopathology over time, and the influence of social and contextual factors in children's mental health, in their subsequent re-evaluation of the original cohort of children. These studies described the prevalence of ADHD (relatively low as compared to the US), identified the onset and prevalence of depression in mid-adolescence and the frequent co-morbidity with conduct disorder
, and explored the relationship between various mental disorders and scholastic achievemment.
It was paralleled similarly by work on the epidemiology
of autism
that was to enormously increase the number of children diagnosed with autism in future years. Although attention had been given in the 1960s and '70s to the classification of childhood psychiatric disorders, and some issues had then been delineated, such as the distinction between neurotic and conduct disorders, the nomenclature did not parallel the growing clinical knowledge. It was claimed that this situation was altered in the late 1970s with the development of the DSM-III system of classification, although research has shown that this system of classification has problems of validity and reliability. Since then, the DSM-IV and DSM-IVR have corrected some of the questionable parsing of psychiatric disorders into "childhood" and "adult" disorders, recognizing that while many psychiatric disorders are not diagnosed until adulthood, they may present in childhood or adolescence (DSM-IV).
of a child or adolescent starts with obtaining a psychiatric history
by interviewing the young person and his/her parents or caregivers. The assessment includes a detailed exploration of the current concerns about the child's emotional or behavioral problems, the child's physical health and development
, history of parental care (including possible abuse
and neglect), family relationships and history of parental mental illness. It is regarded as desirable to obtain information from multiple sources (for example both parents, or a parent and a grandparent) as informants may give widely differing accounts of the child's problems. Collateral information is usually obtained from the child's school with regards to academic performance, peer relationships, and behavior in the school environment.
Psychiatric assessment always includes a mental state examination of the child or adolescent which consists of a careful behavioral observation and a first-hand account of the young person's subjective experiences. The assessment also includes an observation of the interactions within the family, especially the interactions between the child and his/her parents.
The assessment may be supplemented by the use of behavior or symptom rating scales such as the Achenbach Child Behavior Checklist or CBCL, the Behavioral Assessment System for Children or BASC, Connors Rating Scales (used for diagnosis of ADHD), Millon Adolescent Clinical Inventory or MACI, and the Strengths and Difficulties Questionnaire or SDQ. These instruments bring a degree of objectivity and consistency to the clinical assessment. More specialized psychometric testing may be carried out by a psychologist, for example using the Wechsler Intelligence Scale for Children
, to detect intellectual impairment or other cognitive problems which may be contributing to the child's difficulties.
may be more useful. A case formulation is standard practice for child and adolescent psychiatrists and can be defined as a process of integrating and summarizing all the relevant factors implicated in the development of the patient's problem, including biological, psychological, social and cultural perspectives (the "biopsychosocial model
"). The applicability of DSM diagnoses have also been questioned with regard to the assessmment of very young children: it is argued that very young children are developing too rapidly to be adequately described by a fixed diagnosis, and furthermore that a diagnosis unhelpfully locates the problem within the child when the parent-child relationship is a more appropriate focus of assessment.
The child and adolescent psychiatrist then designs a treatment plan which considers all the components and discusses these recommendations with the child or adolescent and family.
s or professionals from schools, juvenile courts, social agencies or other community organizations.
Traditional deficit and disease models of child psychiatry have been criticized as rooted in the medical model
which conceptualizes adjustment problems in terms of disease states. It is said by these critics that these normative models explicitly characterize problematic behavior as representing a disorder within the child or young person and these commentators assert that the role of environmental influences on behavior has become increasingly neglected, leading to a decrease in the popularity of, for example, family therapy. There are criticisms of the medical model approach from within and without the psychiatric profession (see references): it is said to neglect the role of environmental, family, and cultural influences, to discount the psychological meaning of behavior and symptoms, to promote a view of the "patient" as dependent and needing to be cured or cared for and therefore undermines a sense of personal responsibility for conduct and behavior, to promote a normative conception based on adaptation to the norms of society (the ill person must adapt to society), and to be based on the shaky foundations of reliance on a classificatory system that has been shown to have problems of validity and reliability (Boorse, 1976; Jensen, 2003; Sadler et al. 1994; Timimi, 2006).
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
that specializes in the study, diagnosis, treatment, and prevention of psychopathological disorders of children, adolescents, and their families, child and adolescent psychiatry encompasses the clinical investigation of phenomenology, biologic factors, psychosocial factors, genetic factors, demographic factors, environmental factors, history, and the response to interventions of child and adolescent psychiatric disorders (Kaplan and Saddock).
History
An important antecedent to the specialty of child psychiatry was the social recognition of childhoodChildhood
Childhood is the age span ranging from birth to adolescence. In developmental psychology, childhood is divided up into the developmental stages of toddlerhood , early childhood , middle childhood , and adolescence .- Age ranges of childhood :The term childhood is non-specific and can imply a...
as a special phase of life with its own developmental stages, starting with the neonate and eventually extending through adolescence. Kraepelin's psychiatric taxonomy published in 1883, ignored disorders in children.
Johannes Trüper founded a famous approved school on Sophienhöhe close to Jena in 1892 and was a co-founder of "Die Kinderfehler"(1896), one of the leading journals for research in pedagogy and child psychiatry in its time. The psychiatrist and philosopher Theodor Ziehen, regarded as one of the pioneers of child psychiatry, gained practical child psychiatric experience as a consultant liaison psychiatrist at the approved school which was run by Johannes Trüper. Wilhelm Strohmayer, another psychiatrist from Jena, also belongs to the founding fathers of child psychiatry in Germany with his book Vorlesungen uber die Psychopathologie des Kindesalters für Mediziner und Pädagogen (1910) which is based on his consultant work on Sophienhöhe.
As early as 1899, the term "child psychiatry" (in French) was used as a subtitle in Manheimer's monograph Les Troubles Mentaux de l'Enfance. However, the Swiss psychiatrist Moritz Tramer (1882–1963) was probably the first to define the parameters of child psychiatry in terms of diagnosis, treatment, and prognosis within the discipline of medicine, in 1933. In 1934, Tramer founded the Zeitschrift für Kinderpsychiatrie (Journal of Child Psychiatry), which later became Acta Paedopsychiatria. The first academic child psychiatry department in the world was founded by Leo Kanner
Leo Kanner
Leo Kanner was a Jewish American psychiatrist and physician known for his work related to autism. Kanner's work formed the foundation of child and adolescent psychiatry in the U.S. and worldwide....
in 1930 under the direction of Adolf Meyer
Adolf Meyer
Adolf Meyer may refer to:*Adolf Bernard Meyer , German anthropologist and ornithologist*Adolf Meyer , Swiss psychiatrist*Adolf Meyer , German architect-See also:...
at the Johns Hopkins Hospital
Johns Hopkins Hospital
The Johns Hopkins Hospital is the teaching hospital and biomedical research facility of Johns Hopkins University School of Medicine, located in Baltimore, Maryland . It was founded using money from a bequest by philanthropist Johns Hopkins...
, Baltimore. Dr. Kanner was the first physician to be identified as a child psychiatrist in the US and his textbook, Child Psychiatry (1935), is credited with introducing the specialty to the academic community. The first use in English of the term "child psychiatry" occurred when Leo Kanner published his textbook under that name in the US in 1935. Academic child psychiatry in US was born at Johns Hopkins University
Johns Hopkins University
The Johns Hopkins University, commonly referred to as Johns Hopkins, JHU, or simply Hopkins, is a private research university based in Baltimore, Maryland, United States...
. Its founding father, Leo Kanner, a medical graduate of the University of Berlin, was brought to Johns Hopkins
Johns Hopkins
Johns Hopkins was a wealthy American entrepreneur, philanthropist and abolitionist of 19th-century Baltimore, Maryland, now most noted for his philanthropic creation of the institutions that bear his name, namely the Johns Hopkins Hospital, and the Johns Hopkins University and its associated...
by Adolf Meyer
Adolf Meyer
Adolf Meyer may refer to:*Adolf Bernard Meyer , German anthropologist and ornithologist*Adolf Meyer , Swiss psychiatrist*Adolf Meyer , German architect-See also:...
in 1928. Eight years later, Kanner offered the first formal elective course in the subject here. But it wasn't until the 1960s that the first NIH grant to study pediatric psychopharmacology was awarded. It went to one of Kanner's students, Leon Eisenberg, the second director of the division.
The use of medication in the treatment of children also began in the 1930s, when Charles Bradley opened a neuropsychiatric unit and was the first to use amphetamine
Amphetamine
Amphetamine or amfetamine is a psychostimulant drug of the phenethylamine class which produces increased wakefulness and focus in association with decreased fatigue and appetite.Brand names of medications that contain, or metabolize into, amphetamine include Adderall, Dexedrine, Dextrostat,...
for brain-damaged and hyperactive children.
Academic divisions of child psychiatry began to develop, particularly in the US, in the 1930s. The first "pediatric psychiatry clinic" was established in 1930 at Johns Hopkins Hospital
Johns Hopkins Hospital
The Johns Hopkins Hospital is the teaching hospital and biomedical research facility of Johns Hopkins University School of Medicine, located in Baltimore, Maryland . It was founded using money from a bequest by philanthropist Johns Hopkins...
, Baltimore, headed by Leo Kanner
Leo Kanner
Leo Kanner was a Jewish American psychiatrist and physician known for his work related to autism. Kanner's work formed the foundation of child and adolescent psychiatry in the U.S. and worldwide....
. In 1933, The Maudsley Hospital in London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
opened a children's department under Mildred Creak, and research in child psychiatry began to increase. Similar overall early developments took place in many other countries. In the United States, child and adolescent psychiatry was established as a recognized medical speciality in 1953 with the founding of the American Academy of Child Psychiatry, but was not established as a legitimate, board-certifiable medical speciality until 1959.
The era since the 1980s flourished, in large part, because of contributions made in the 1970s, a decade during which child psychiatry witnessed a major evolution as a result of the work carried out by Michael Rutter
Michael Rutter
For the motorcycle racer, see Michael Rutter Sir Michael L. Rutter is the first consultant of child psychiatry in the United Kingdom. He has been described as the "father of child psychology"...
. The first comprehensive population survey of 9- to 11-year-olds, carried out in London and the Isle of Wight, which appeared in 1970, addressed questions that have continued to be of importance for child psychiatry; for example, rates of psychiatric disorders, the role of intellectual development and physical impairment, and specific concern for potential social influences on children's adjustment. This work was influential, especially since the investigators demonstrated specific continuities of psychopathology over time, and the influence of social and contextual factors in children's mental health, in their subsequent re-evaluation of the original cohort of children. These studies described the prevalence of ADHD (relatively low as compared to the US), identified the onset and prevalence of depression in mid-adolescence and the frequent co-morbidity with conduct disorder
Conduct disorder
Conduct disorder is psychological disorder diagnosed in childhood that presents itself through a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated...
, and explored the relationship between various mental disorders and scholastic achievemment.
It was paralleled similarly by work on the epidemiology
Epidemiology of child psychiatric disorders
-Prevalence of mental illness:Epidemiological research has shown that between 3% and 18% of children have a psychiatric disorder causing significant functional impairment and Costello and colleagues have proposed a median prevalence estimate of 12%...
of autism
Autism
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...
that was to enormously increase the number of children diagnosed with autism in future years. Although attention had been given in the 1960s and '70s to the classification of childhood psychiatric disorders, and some issues had then been delineated, such as the distinction between neurotic and conduct disorders, the nomenclature did not parallel the growing clinical knowledge. It was claimed that this situation was altered in the late 1970s with the development of the DSM-III system of classification, although research has shown that this system of classification has problems of validity and reliability. Since then, the DSM-IV and DSM-IVR have corrected some of the questionable parsing of psychiatric disorders into "childhood" and "adult" disorders, recognizing that while many psychiatric disorders are not diagnosed until adulthood, they may present in childhood or adolescence (DSM-IV).
Developmental disorders
- Autistic spectrum disorders including Asperger's disorder
- Learning disorders
Disorders of attention and behaviour
- Attention deficit hyperactivity disorder
- Oppositional defiant disorderOppositional defiant disorderOppositional defiant disorder is a diagnosis described by the Diagnostic and Statistical Manual of Mental Disorders as an ongoing pattern of disobedient, hostile and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior...
- Conduct disorderConduct disorderConduct disorder is psychological disorder diagnosed in childhood that presents itself through a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated...
Mood disorders
- DepressionDepression (mood)Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...
- Bipolar disorderBipolar disorder in childrenBipolar Disorder , formerly known as "Manic Depression", is characterized by extreme changes in mood that range from depressive "lows" to manic "highs"...
Anxiety disorders
- Panic disorderPanic disorderPanic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks...
- PhobiasSpecific phobiaA specific phobia is a generic term for any kind of anxiety disorder that amounts to an unreasonable or irrational fear related to exposure to specific objects or situations...
- Obsessive Compulsive Disorder
Assessment
The psychiatric assessmentPsychiatric assessment
A psychiatric assessment, or psychological screening, is a process of way of gathering information about a person within a psychiatric service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for...
of a child or adolescent starts with obtaining a psychiatric history
Psychiatric history
A psychiatric history is the result of a medical process where a clinician working in the field of mental health systematically records the content of an interview with a patient...
by interviewing the young person and his/her parents or caregivers. The assessment includes a detailed exploration of the current concerns about the child's emotional or behavioral problems, the child's physical health and development
Child development
Child development stages describe theoretical milestones of child development. Many stage models of development have been proposed, used as working concepts and in some cases asserted as nativist theories....
, history of parental care (including possible abuse
Child abuse
Child abuse is the physical, sexual, emotional mistreatment, or neglect of a child. In the United States, the Centers for Disease Control and Prevention and the Department of Children And Families define child maltreatment as any act or series of acts of commission or omission by a parent or...
and neglect), family relationships and history of parental mental illness. It is regarded as desirable to obtain information from multiple sources (for example both parents, or a parent and a grandparent) as informants may give widely differing accounts of the child's problems. Collateral information is usually obtained from the child's school with regards to academic performance, peer relationships, and behavior in the school environment.
Psychiatric assessment always includes a mental state examination of the child or adolescent which consists of a careful behavioral observation and a first-hand account of the young person's subjective experiences. The assessment also includes an observation of the interactions within the family, especially the interactions between the child and his/her parents.
The assessment may be supplemented by the use of behavior or symptom rating scales such as the Achenbach Child Behavior Checklist or CBCL, the Behavioral Assessment System for Children or BASC, Connors Rating Scales (used for diagnosis of ADHD), Millon Adolescent Clinical Inventory or MACI, and the Strengths and Difficulties Questionnaire or SDQ. These instruments bring a degree of objectivity and consistency to the clinical assessment. More specialized psychometric testing may be carried out by a psychologist, for example using the Wechsler Intelligence Scale for Children
Wechsler Intelligence Scale for Children
The Wechsler Intelligence Scale for Children , developed by Dr. David Wechsler, is an individually administered intelligence test for children between the ages of 6 and 16 inclusive that can be completed without reading or writing...
, to detect intellectual impairment or other cognitive problems which may be contributing to the child's difficulties.
Diagnosis and formulation
The child and adolescent psychiatrist makes a diagnosis based on the pattern of behavior and emotional symptoms, using a standardized set of diagnostic criteria such as the Diagnostic and Statistical Manual (DSM-IV-TR) or the International Classification of Diseases (ICD-10). While the DSM system is widely used, it may not adequately take into account social, cultural and contextual factors and it has been suggested that an individualized clinical formulationClinical formulation
A clinical formulation is a theoretically-based explanation or conceptualisation of the information obtained from a clinical assessment. It offers a hypothesis about the cause and nature of the presenting problems and is considered an alternative approach to the more categorical approach of...
may be more useful. A case formulation is standard practice for child and adolescent psychiatrists and can be defined as a process of integrating and summarizing all the relevant factors implicated in the development of the patient's problem, including biological, psychological, social and cultural perspectives (the "biopsychosocial model
Biopsychosocial model
The biopsychosocial model is a general model or approach that posits that biological, psychological , and social factors, all play a significant role in human functioning in the context of disease or illness...
"). The applicability of DSM diagnoses have also been questioned with regard to the assessmment of very young children: it is argued that very young children are developing too rapidly to be adequately described by a fixed diagnosis, and furthermore that a diagnosis unhelpfully locates the problem within the child when the parent-child relationship is a more appropriate focus of assessment.
The child and adolescent psychiatrist then designs a treatment plan which considers all the components and discusses these recommendations with the child or adolescent and family.
Treatment
Treatment will usually involve one or more of the following elements: behavior therapy, cognitive-behavior therapy, problem-solving therapies, psychodynamic therapy, parent training programs, family therapy, and/or the use of medication. The intervention can also include consultation with pediatricians, primary care physicianPrimary care physician
A primary care physician, or PCP, is a physician/medical doctor who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis....
s or professionals from schools, juvenile courts, social agencies or other community organizations.
Training
In the United States, Child and adolescent psychiatric training requires 4 years of medical school, at least 3 years of approved residency training in medicine, neurology, and general psychiatry with adults, and 2 years of additional specialized training in psychiatric work with children, adolescents, and their families in an accredited residency in child and adolescent psychiatry. Child and adolescent sub-speciality training is similar in other Western countries (such as the UK, New Zealand, and Australia), in that trainees must generally demonstrate competency in general adult psychiatry prior to commencing sub-speciality training.Certification and continuing education
In the US, having completed the child and adolescent psychiatry residency and successfully passing the certification examination in general psychiatry given by the American Board of Psychiatry and Neurology (ABPN), the child and adolescent psychiatrist is eligible to take the additional certification examination in the subspecialty of child and adolescent psychiatry. Although the ABPN examinations are not required for practice, they are a further assurance that the child and adolescent psychiatrist with these certifications can be expected to diagnose and treat all psychiatric conditions in patients of any age competently.Shortage of child and adolescent psychiatrists
The demand for child and adolescent psychiatrists continues to far outstrip the supply worldwide. There is also a severe maldistribution of child and adolescent psychiatrists, especially in rural and poor, urban areas where access is significantly reduced. There are currently only approximately 6,500 practicing child and adolescent psychiatrists in the United States. A report by the US Bureau of Health Professions (2000) projected a need in the year 2020 for 12,624 child and adolescent psychiatrists, but a supply of only 8,312. In its 1998 report, the Center for Mental Health Services estimated that 9-13% of 9- to 17-year-olds had serious emotional disturbances, and 5-9% had extreme functional impairments. However, in 1999, the Surgeon General reported that "there is a dearth of child psychiatrists." Only 20% of emotionally disturbed children and adolescents received any mental health treatment, a tiny percentage of which was performed by child and adolescent psychiatrists. Furthermore, the US Bureau of Health Professions projects that the demand for child and adolescent psychiatry services will increase by 100% between 1995 and 2020.Cross-cultural considerations
Steady growth in migration of immigrants to higher-income regions and countries has contributed to the growth and interest in cross-cultural psychiatry. Families of immigrants whose child has a psychiatric illness must come to understand the disorder while navigating an unfamiliar health care system.Criticisms
Critics of psychiatry often argue that psychiatric diagnosis lacks "objectivity", particularly when compared with diagnosis in other medical specialties. However, when one examines interrater reliability—an important component of objectivity—the agreement among psychiatrists for several major psychiatric disorders are generally on a par with those in other medical specialties. Nonetheless, in psychiatry as in all of general medicine, there is an irreducible element of the subjective. That is part of the "art" of medical and psychiatric practice (Pies 2007).Traditional deficit and disease models of child psychiatry have been criticized as rooted in the medical model
Medical model
Medical model is the term cited by psychiatrist Ronald D. Laing in his The Politics of the Family and Other Essays , for the "set of procedures in which all doctors are trained." This set includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and...
which conceptualizes adjustment problems in terms of disease states. It is said by these critics that these normative models explicitly characterize problematic behavior as representing a disorder within the child or young person and these commentators assert that the role of environmental influences on behavior has become increasingly neglected, leading to a decrease in the popularity of, for example, family therapy. There are criticisms of the medical model approach from within and without the psychiatric profession (see references): it is said to neglect the role of environmental, family, and cultural influences, to discount the psychological meaning of behavior and symptoms, to promote a view of the "patient" as dependent and needing to be cured or cared for and therefore undermines a sense of personal responsibility for conduct and behavior, to promote a normative conception based on adaptation to the norms of society (the ill person must adapt to society), and to be based on the shaky foundations of reliance on a classificatory system that has been shown to have problems of validity and reliability (Boorse, 1976; Jensen, 2003; Sadler et al. 1994; Timimi, 2006).
See also
- Biological psychiatryBiological psychiatryBiological psychiatry, or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics and...
- Childhood psychiatric disorders
- Child psychopathologyChild psychopathologyChild psychopathology is the manifestation of psychological disorders in children and adolescents. Oppositional defiant disorder, attention-deficit hyperactivity disorder, and pervasive developmental disorder are examples of child psychopathology...
- Child and adolescent mental health servicesChild and Adolescent Mental Health ServicesChild and Adolescent Mental Health Services is a name for NHS-provided services for children in the mental health arena in the UK. In the UK they are often organised around a 4 Tiers system...
- Developmental disorders
- Medical modelMedical modelMedical model is the term cited by psychiatrist Ronald D. Laing in his The Politics of the Family and Other Essays , for the "set of procedures in which all doctors are trained." This set includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and...
- PsychiatryPsychiatryPsychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
- Anti-psychiatryAnti-psychiatryAnti-psychiatry is a configuration of groups and theoretical constructs that emerged in the 1960s, and questioned the fundamental assumptions and practices of psychiatry, such as its claim that it achieves universal, scientific objectivity. Its igniting influences were Michel Foucault, R.D. Laing,...
- Biopsychiatry controversyBiopsychiatry controversyThe biopsychiatry controversy is a dispute over which viewpoint should predominate and form the scientific basis of psychiatric theory and practice. The debate is a criticism of a claimed strict biological view of psychiatric thinking. Its critics including disparate groups such as the...
- Peter BregginPeter BregginPeter Roger Breggin is an American psychiatrist and critic of biological psychiatry and psychiatric medication. In his books, he advocates replacing psychiatry's use of drugs and electroconvulsive therapy with humanistic approaches, such as psychotherapy, education, and broader human...
- Controversy about ADHDControversy about ADHDThe causes, diagnosis, and the treatment of attention-deficit hyperactivity disorder have been the subject of active debate at least since the 1970s. For various reasons, ADHD remains one of the most controversial psychiatric disorders despite being a well validated clinical diagnosis...
- Rennie v. KleinRennie v. KleinRennie v. Klein was a case heard in the Federal District Court of New Jersey in 1978 to decide whether an involuntarily committed mental patient has a constitutional right to refuse psychiatric medication...
- right to refuse treatment
External links
- American Academy of Child and Adolescent Psychiatry
- International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP)
- European Psychiatric Association: Child and Adolescent Psychiatry
- NIMH Child Psychiatry Branch Homepage
- Encyclopedia Britannica
- Classification of psychiatric disorders in childhood and adolescence: building castles in the sand?
- Cultural Diversity in the Development of Child Psychopathology
- Resources For Outpatient Children's Mental Health Treatment