Understanding child and adolescent psychiatry

Child and adolescent psychiatrists assess, diagnose and treat children up to the age of 18 who have mental health and psychological problems. Dr Derek Blincow is a leading child and adolescent psychiatrist and here he explains the types of disorders he treats and why children and adolescents can be prone to such disorders.

What are the main disorders treated within adolescent psychiatry?

Children show a wide range of difficulties that can be assessed and, where appropriate, diagnosed and a treatment plan formulated after an initial consultation. Often children can be helped through pastoral support and counselling. Schools increasingly offer this. However, when problems persist despite the best efforts of the family and the school, then it is always worth assessing for any underlying disorder. The basic rule is that, when a child shows a persisting dysfunctional pattern, then early assessment and treatment is key.

Younger children can show adult disorders but there is a range of disorders that are specific to childhood, behaviour problems for example and some types of anxiety disorders. Children can also manifest their difficulties in varying ways, through regression, sleep and eating problems, bodily complaints or in terms of peer relationships.

In adolescence, mental health difficulties become more common and their nature changes. Adolescence is an increasingly stressful phase of human development. There is no doubt that adolescent disorders are increasing. Greater numbers are struggling with emotional disorders, such as anxiety and depressive disorders, which are the commonest manifestation. Often those who have managed up to that time start to be severely handicapped by crippling social anxiety. Sometimes this is associated with a depressive disorder if the level of their anxiety undermines normal, everyday functioning. Sleep can be disturbed as can appetite but often the first problem is that the adolescent can withdraw from those around them and possibly also from school. They may hurt themselves. They may harbour self-destructive thoughts.

Common too are eating disorders. These include bulimia where there the regulation of eating is disturbed without significant weight loss or anorexia, where weight loss can be profound. Anorexia is particularly important to detect early as the younger a person and the less severe the disorder, the better the outlook with treatment. Although there is a significant morbidity and even a high mortality with anorexia, early detection and treatment dramatically reduces the risk longer term and often leads to a complete recovery.

Also important to mention is that a number of adolescents start to show emotional problems at that age because they have as yet undiagnosed developmental conditions, such as attention deficit disorder. This and other developmental conditions, for example autistic spectrum disorder, predispose to a great deal of emotional turmoil in adolescence and these children are at much greater risk for suffering from the disorders that are described above.

Less common but very important to treat at this age is obsessive-compulsive disorder, which can often be accompanied by body dysmorphic disorder, where the adolescent feels they or some part of themselves is too conspicuous and should be changed.

What considerations have to be made when treating adolescent patients?

It cannot be emphasized how important early detection of such disorders is in adolescence. There are good treatments for these conditions and applying them in a timely way leads to much improved outcomes.

Adolescence is a time of major change, physically, hormonally and in terms of brain development. At no time in your life, except as an unborn child or tiny infant, is there so much brain growth and transformation. Adolescent brains are therefore both vulnerable to injury but also very responsive to repairing any damage if the right remedies are applied.

For parents who are concerned about their child’s mental health, what should they do?

Adolescence is also a time when children become significantly more private in their thoughts and feelings and independent of their parents. However, there is still a great deal that parents can offer in terms of supporting and being actively engaged in the treatment plan. With early onset anorexia, for example, family work is by far the most effective treatment. With any disorder, however, parents and carers need to be involved in the assessment and, to some degree, in the treatment for all of the disorders mentioned here.

What role does family play in adolescent psychiatry? What is family therapy?

Family therapy is a specific treatment approach where family members will look with a therapist at processes within the family that may be generating or maintaining symptoms and also, vitally, how those processes might change to allow for recovery and growth. Family therapy is often not as intensive as individual therapy because what goes on between sessions is as important as what is transacted when the family is actually in the therapeutic session. So, a family might meet monthly with a therapist to work at a problem rather than weekly, as many individual therapies require.

If you are concerned about a loved one or family member, make an appointment with a specialist.