Oxford Handbook Of Psychiatry

Pedopsychiatry

Introduction:

Psychiatric disorders presenting in childhood are distinct from those of adults because they arise in complex and intimate family relationships, and are influenced by the stage of child development. The children also present particular challenges for evaluation and treatment. The psychiatric disorders that present in childhood or adolescence are listed in Table 1.

• Pervasive Developmental Disorders
• specific developmental disorders
• hyperkinetic disorders
• Conduct disorders
• Affective disorders
• psychiatric aspects of child abuse
• Elimination Disorders

  Table 1 Classification of psychiatric disorders of childhood and adolescence

Normal early childhood development

Some characteristics of normal development of the child are presented in Table 2. It is essential to consider the developmental stage of the stage of the child during a psychiatric evaluation, as what is accepted as normal at a would be abnormal to another.

experiences of early childhood play a significant role in determining what type of person we become as adults. The role of parents is central in this. The child with the parents (or parent) who are loving and tolerant, yet able to establish and implement clear and reasonable limits is likely to develop high self-esteem and secure attachment to parents who provide a model for secure attachments to others in later life. The theory of "attachment" was first described by John Bowlby in the 1950s. It derives from his study of young children separated from their mothers at the hospital. attachment behavior begins at around 7 months and consists of clinginess and unwillingness to be separated from the primary caregiver, usually the mother. It serves to strengthen the bond between mother and child and has the function of the evolution of the protection of children against predators. A child is securely fastened in position to use the mother as a secure base from which to explore the outside world can begin, and will also be able to react well with separations of short duration. If the attachment is precarious, because the parent does not meet children's needs for attention or detention, or is inconsistent, the child will be challenged to explore and separation. This pattern of insecure attachment may persist throughout life, which affect adult relationships.

Assessment of children

How a psychiatric history is taken and that the child is considered dependent on age, confidence and language skills of the child. Much of the story will come from parents and children who are ready to separate from their parents can then be seen alone. It is generally preferable to see adolescents alone and before their parents to establish a relationship of trust with them. The interview should take place in a relaxed and friendly, with toys and drawing materials provided for children under 10 years.

The history should include the following:

• Presentation of the complaints described by both the parent and child. It is important to carry the child to ask about the complaint to gently, after winning their trust and talk about neutral topics.
• recent behavior or emotional difficulties, including general relationships of health, mood, sleep, appetite, elimination, antisocial behavior, life and play fantasy and behavior in school.
• Personal history, pregnancy, birth, milestones (motor, speech, feeding, toilet training, social behavior), medical history, separation from parents, schools attended and progress in them.
• Family structure and function of construction of a genogram i.