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m I made the 4th reference repeat in the text
I added some historical context of Chicago in 1980s, I added some information on the development of IJR from the creation of the first Juvenile Court and corrected the error that Dr. Healy was a psychiatrist - he was a neurologist.
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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.<ref>{{Citation |last=Gerhard |first=Uwe-Jens |coauthors=Schönberg, Anke and Blanz, Bernhard |year=2008 |title=Johannes Trüper--mediator between child and adolescent psychiatry and pedagogy |journal=Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie |volume=36 |issue=1 |pages=55–63 |url=https://www.researchgate.net/publication/5374193_Johannes_Trper--mediator_between_child_and_adolescent_psychiatry_and_pedagogy |accessdate=2008-07-04 |doi=10.1024/1422-4917.36.1.55}}</ref>
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.<ref>{{Citation |last=Gerhard |first=Uwe-Jens |coauthors=Schönberg, Anke and Blanz, Bernhard |year=2008 |title=Johannes Trüper--mediator between child and adolescent psychiatry and pedagogy |journal=Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie |volume=36 |issue=1 |pages=55–63 |url=https://www.researchgate.net/publication/5374193_Johannes_Trper--mediator_between_child_and_adolescent_psychiatry_and_pedagogy |accessdate=2008-07-04 |doi=10.1024/1422-4917.36.1.55}}</ref>


In 1899, Nobel Prize winning social worker Jane Addams helped to start the world's first Juvenile Court in Chicago, Illinois <ref name=ijr> Beuttler, Fred and Bell, Carl (2010). For the Welfare of Every Child – A Brief History of the Institute for Juvenile Research, 1909 – 2010. University of Illinois: Chicago </ref> In 1909, the Juvenile Psychopathic Institute (JPI), the world's first child guidance clinic, is founded in Chicago, and Mrs. Ethel Dummer provides funding for five years. <ref name=ijr> Beuttler, Fred and Bell, Carl (2010). For the Welfare of Every Child – A Brief History of the Institute for Juvenile Research, 1909 – 2010. University of Illinois: Chicago </ref> Psychiatrist William Healy, M.D., its first director, is charged with not only studying the delinquent’s biological aspects of brain functioning and IQ, but also the delinquent’s social factors, attitudes, and motivations, thus it was the birthplace of American child psychiatry <ref> Schowalter, John E. (2000). Child and Adolescent Psychiatry Comes of Age, 1944-1994. In Menninger RW and Nemiah JC (Eds). American Psychiatry After World War II – 1944 – 1994. Washington, D.C.: American Psychiatric Press, p. 461 – 480 </ref>. These studies determined that there was no relationship between biological heredity and criminality. In 1917, the State of Illinois took over the funding for the Juvenile Psychopathic Institute (JPI) and in 1920, the State of Illinois creates the Department of Public Welfare and changes the name of JPI to the Institute for Juvenile Research (IJR). <ref name=ijr> Beuttler, Fred and Bell, Carl (2010). For the Welfare of Every Child – A Brief History of the Institute for Juvenile Research, 1909 – 2010. University of Illinois: Chicago </ref> IJR's goal was to develop an understanding of the causes of behavioral disturbances in youth by doing research and providing service to delinquent youth while also developing prevention strategies to prevent delinquency. IJR researchers Shaw and McKay <ref> Shaw, C.R., McKay, H. (1942). Juvenile delinquency and urban areas. Chicago: University of Chicago Press </ref> noted delinquency was less due to biological, ethnic, or cultural factors and more due to social disruption eroding formal and informal social control in specific transitional neighborhoods ("delinquency areas") in a city. In an effort to prevent delinquency, the Chicago Area Project was born, and designed to create social fabric in "delinquency areas." In 1990, the Institute for Juvenile Research became a part of the Department of Psychiatry, College of Medicine, University of Illinois at Chicago. <ref name=ijr> Beuttler, Fred and Bell, Carl (2010). For the Welfare of Every Child – A Brief History of the Institute for Juvenile Research, 1909 – 2010. University of Illinois: Chicago </ref>
Before 1871, the year of the Chicago fire, Chicago’s population was 300,000 people. Twenty years after the Chicago fire in 1891, Chicago’s population was a little over a million people. By 1910’s Chicago's population had risen to over two million, and by the mid 1920’s the population was three million. This growth was driven by European immigration resulting in over 70% of Chicago’s population being either foreign-born or first-generation immigrant. <ref name=ijr> Beuttler, Fred and Bell, Carl (2010). For the Welfare of Every Child – A Brief History of the Institute for Juvenile Research, 1909 – 2010. University of Illinois: Chicago </ref> Because times were hard, parents were working overtime to scrape out a living, and children, who had to work to contribute to the family’s livelihood, were “ill-fed, ill-housed, ill-clothed, illiterate, and wholly untrained and unfitted for any occupation." <ref> Kelley, Florence and Stevens, Alzina P. (1895). Wage-Earning Children. In Jane Addams, Hull House Maps and Papers. New York: Thomas Y. Crowell & Co., pp. 49-76 [http://media.pfeiffer.edu/lridener/DSS/Addams/hh3.html] </ref> The results were many families, who, due to being disrupted by poverty and unfamiliar community circumstances as result of immigration were not able to properly care for their children. The reality that the new European immigrants were not doing well was also found in the extraordinarily high rates of European immigrant’s domestic violence in Chicago from 1875 to 1920. <ref> Addler, Jeffery S. (2003) "We’ve got a right to fight: We’re married”: Domestic homicide in Chicago, 1975 – 1920. The Journal of Interdisciplinary History, 34 (1): 27 – 48 </ref> Accordingly, in 1889, Nobel Prize winning social worker, Jane Addams (1860–1935) founded Hull House on Chicago’s Near West Side as a social settlement house “to aid in the solution of the social and industrial problems which are engendered by the modern conditions of life in a great city.” She observed “Children over ten years of age were arrested, held in the police stations, tried in the police courts. If convicted they were usually fined and if the fine was not paid sent to the city prison. However, often they were let off because justices could neither tolerate sending children to Bridewell nor bear in themselves guilty of the harsh folly of compelling poverty-stricken parents to pay fines. No exchange of court records existed and the same children could be in and out of various police stations an indefinite number of times, more hardened and more skillful with each experience.” <ref> Addams, Jane. (2004). My Friend, Julia Lathrop. University of Illinois Press: Champlain, IL, p. 133 </ref> In an effort to distinguish between criminality and juvenile delinquency, in 1899, Jane Addams and her female colleagues helped to start the world's first Juvenile Court in Chicago, Illinois <ref name=ijr> Beuttler, Fred and Bell, Carl (2010). For the Welfare of Every Child – A Brief History of the Institute for Juvenile Research, 1909 – 2010. University of Illinois: Chicago </ref>

Ten years later, in 1909, these foresighted women established the Juvenile Psychopathic Institute (JPI) in Chicago, the world's first child guidance clinic, and Mrs. Ethel Dummer provides funding for five years. <ref name=ijr> Beuttler, Fred and Bell, Carl (2010). For the Welfare of Every Child – A Brief History of the Institute for Juvenile Research, 1909 – 2010. University of Illinois: Chicago </ref> Neurologist William Healy, M.D., its first director, is charged with not only studying the delinquent’s biological aspects of brain functioning and IQ, but also the delinquent’s social factors, attitudes, and motivations, thus it was the birthplace of American child psychiatry <ref> Schowalter, John E. (2000). Child and Adolescent Psychiatry Comes of Age, 1944-1994. In Menninger RW and Nemiah JC (Eds). American Psychiatry After World War II – 1944 – 1994. Washington, D.C.: American Psychiatric Press, p. 461 – 480 </ref>. These studies determined that there was no relationship between biological heredity and criminality. In 1917, these innovative women convinced the State of Illinois to take over the funding for the Juvenile Psychopathic Institute (JPI), and in 1920, the State of Illinois creates the Department of Public Welfare and changes the name of JPI to the Institute for Juvenile Research (IJR). <ref name=ijr> Beuttler, Fred and Bell, Carl (2010). For the Welfare of Every Child – A Brief History of the Institute for Juvenile Research, 1909 – 2010. University of Illinois: Chicago </ref> IJR's goal was to develop an understanding of the causes of behavioral disturbances in youth by doing research and providing service to delinquent youth while also developing prevention strategies to prevent delinquency. IJR researchers Shaw and McKay <ref> Shaw, C.R., McKay, H. (1942). Juvenile delinquency and urban areas. Chicago: University of Chicago Press </ref> noted delinquency was less due to biological, ethnic, or cultural factors and more due to social disruption eroding formal and informal social control in specific transitional neighborhoods ("delinquency areas") in a city. In an effort to prevent delinquency, the Chicago Area Project was born, and designed to create social fabric in "delinquency areas." In 1990, the Institute for Juvenile Research became a part of the Department of Psychiatry, College of Medicine, University of Illinois at Chicago. <ref name=ijr> Beuttler, Fred and Bell, Carl (2010). For the Welfare of Every Child – A Brief History of the Institute for Juvenile Research, 1909 – 2010. University of Illinois: Chicago </ref>


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''.<ref>{{Citation |last=Manheimer |first=Marcel |year=1900 |title=Les troubles mentaux de l'enfance (review) |journal=Journal of Mental Science |volume=46 |pages=342–343 |doi= 10.1192/bjp.46.193.342 |postscript=. |issue=193}}</ref> 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''.<ref>{{Citation |last=Eliasberg |first=WG |year=1964 |month=July |title=In memoriam: Moritz Tramer M.D.(1882-1963) |journal=American Journal of Psychiatry |volume=121 |pages=103–4 |pmid=14154770}}</ref> The first academic child psychiatry department in the world was founded in 1930 by [[Leo Kanner]] (1894&ndash;1981), an Austrian émigré and medical graduate of the University of Berlin, under the direction of [[Adolf Meyer (psychiatrist)|Adolf Meyer]] at the [[Johns Hopkins Hospital]], Baltimore.<ref name=jhh>[http://www.hopkinsmedicine.org/Psychiatry/child_adolescent/ Child and Adolescent Psychiatry at The Johns Hopkins Hospital]</ref> 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 both the specialty and the term to the Anglo-phone academic community.<ref name=jhh/> In 1936, Kanner established the first formal elective course in child psychiatry at the John Hopkins Hospital.<ref name=jhh/> In 1944 he provided the first clinical description of early infantile [[autism]], otherwise known as Kanner's Syndrome.<ref>{{citation|last=Neumärker|first=K.-J.|title=Leo Kanner: His Years in Berlin, 1906&ndash;24. The Roots of Autistic Disorder|journal=History of Psychiatry|year=2003|volume=14|pages=205&ndash;208|doi=10.1177/0957154X030142005|issue=2|pmid=14518490}}</ref>
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''.<ref>{{Citation |last=Manheimer |first=Marcel |year=1900 |title=Les troubles mentaux de l'enfance (review) |journal=Journal of Mental Science |volume=46 |pages=342–343 |doi= 10.1192/bjp.46.193.342 |postscript=. |issue=193}}</ref> 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''.<ref>{{Citation |last=Eliasberg |first=WG |year=1964 |month=July |title=In memoriam: Moritz Tramer M.D.(1882-1963) |journal=American Journal of Psychiatry |volume=121 |pages=103–4 |pmid=14154770}}</ref> The first academic child psychiatry department in the world was founded in 1930 by [[Leo Kanner]] (1894&ndash;1981), an Austrian émigré and medical graduate of the University of Berlin, under the direction of [[Adolf Meyer (psychiatrist)|Adolf Meyer]] at the [[Johns Hopkins Hospital]], Baltimore.<ref name=jhh>[http://www.hopkinsmedicine.org/Psychiatry/child_adolescent/ Child and Adolescent Psychiatry at The Johns Hopkins Hospital]</ref> 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 both the specialty and the term to the Anglo-phone academic community.<ref name=jhh/> In 1936, Kanner established the first formal elective course in child psychiatry at the John Hopkins Hospital.<ref name=jhh/> In 1944 he provided the first clinical description of early infantile [[autism]], otherwise known as Kanner's Syndrome.<ref>{{citation|last=Neumärker|first=K.-J.|title=Leo Kanner: His Years in Berlin, 1906&ndash;24. The Roots of Autistic Disorder|journal=History of Psychiatry|year=2003|volume=14|pages=205&ndash;208|doi=10.1177/0957154X030142005|issue=2|pmid=14518490}}</ref>

Revision as of 22:28, 3 April 2013

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).

History

An important antecedent to the specialty of child (pediatric) psychiatry was the social recognition of childhood as a special phase of life with its own developmental stages, starting with the neonate and eventually extending through adolescence.[1] Kraepelin's psychiatric taxonomy published in 1883, ignored disorders in children.[2]

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.[3]

Before 1871, the year of the Chicago fire, Chicago’s population was 300,000 people. Twenty years after the Chicago fire in 1891, Chicago’s population was a little over a million people. By 1910’s Chicago's population had risen to over two million, and by the mid 1920’s the population was three million. This growth was driven by European immigration resulting in over 70% of Chicago’s population being either foreign-born or first-generation immigrant. [4] Because times were hard, parents were working overtime to scrape out a living, and children, who had to work to contribute to the family’s livelihood, were “ill-fed, ill-housed, ill-clothed, illiterate, and wholly untrained and unfitted for any occupation." [5] The results were many families, who, due to being disrupted by poverty and unfamiliar community circumstances as result of immigration were not able to properly care for their children. The reality that the new European immigrants were not doing well was also found in the extraordinarily high rates of European immigrant’s domestic violence in Chicago from 1875 to 1920. [6] Accordingly, in 1889, Nobel Prize winning social worker, Jane Addams (1860–1935) founded Hull House on Chicago’s Near West Side as a social settlement house “to aid in the solution of the social and industrial problems which are engendered by the modern conditions of life in a great city.” She observed “Children over ten years of age were arrested, held in the police stations, tried in the police courts. If convicted they were usually fined and if the fine was not paid sent to the city prison. However, often they were let off because justices could neither tolerate sending children to Bridewell nor bear in themselves guilty of the harsh folly of compelling poverty-stricken parents to pay fines. No exchange of court records existed and the same children could be in and out of various police stations an indefinite number of times, more hardened and more skillful with each experience.” [7] In an effort to distinguish between criminality and juvenile delinquency, in 1899, Jane Addams and her female colleagues helped to start the world's first Juvenile Court in Chicago, Illinois [4]

Ten years later, in 1909, these foresighted women established the Juvenile Psychopathic Institute (JPI) in Chicago, the world's first child guidance clinic, and Mrs. Ethel Dummer provides funding for five years. [4] Neurologist William Healy, M.D., its first director, is charged with not only studying the delinquent’s biological aspects of brain functioning and IQ, but also the delinquent’s social factors, attitudes, and motivations, thus it was the birthplace of American child psychiatry [8]. These studies determined that there was no relationship between biological heredity and criminality. In 1917, these innovative women convinced the State of Illinois to take over the funding for the Juvenile Psychopathic Institute (JPI), and in 1920, the State of Illinois creates the Department of Public Welfare and changes the name of JPI to the Institute for Juvenile Research (IJR). [4] IJR's goal was to develop an understanding of the causes of behavioral disturbances in youth by doing research and providing service to delinquent youth while also developing prevention strategies to prevent delinquency. IJR researchers Shaw and McKay [9] noted delinquency was less due to biological, ethnic, or cultural factors and more due to social disruption eroding formal and informal social control in specific transitional neighborhoods ("delinquency areas") in a city. In an effort to prevent delinquency, the Chicago Area Project was born, and designed to create social fabric in "delinquency areas." In 1990, the Institute for Juvenile Research became a part of the Department of Psychiatry, College of Medicine, University of Illinois at Chicago. [4]

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.[10] 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.[11] The first academic child psychiatry department in the world was founded in 1930 by Leo Kanner (1894–1981), an Austrian émigré and medical graduate of the University of Berlin, under the direction of Adolf Meyer at the Johns Hopkins Hospital, Baltimore.[12] 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 both the specialty and the term to the Anglo-phone academic community.[12] In 1936, Kanner established the first formal elective course in child psychiatry at the John Hopkins Hospital.[12] In 1944 he provided the first clinical description of early infantile autism, otherwise known as Kanner's Syndrome.[13]

From its establishment in February 1923, the Maudsley, a London-based postgraduate teaching and research psychiatric hospital, contained a small children's department.[14] Similar overall early developments took place in many other countries during the late 1920s and 1930s.[citation needed] 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.[15][16]

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.[citation needed] 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.[12]

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.[17] 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.[18]

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.[citation needed] 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.[citation needed] Since then, the DSM-IV[19] and DSM-IVR have altered some of the parsing of psychiatric disorders into "childhood" and "adult" disorders, on the basis that while many psychiatric disorders are not diagnosed until adulthood, they may present in childhood or adolescence (DSM-IV).[citation needed]

Classification

Developmental disorders

Disorders of attention and behaviour

Psychotic disorders

Mood disorders

Anxiety disorders

Eating disorders

Gender identity disorder

Clinical practice

Assessment

The psychiatric assessment 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.[20]

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.[21]

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.[22] 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.[23]

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)[24] or the International Classification of Diseases (ICD-10).[25] 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 formulation may be more useful.[26] 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").[27] 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.[28]

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,[29] cognitive-behavior therapy,[30] problem-solving therapies,[31] psychodynamic therapy,[32][33] parent training programs,[34] family therapy,[35] and/or the use of medication.[36] The intervention can also include consultation with pediatricians,[37] primary care physicians[38] or professionals from schools, juvenile courts, social agencies or other community organizations.[39]

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.[citation needed] 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, the child and adolescent psychiatrist is eligible to take the additional certification examination in the subspecialty of child and adolescent psychiatry from the American Board of Psychiatry and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP).[40] Although the ABPN and AOBNP 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. Training requirements are listed on the web site of The American Academy of Child & Adolescent Psychiatry.[41]

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.[42] 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.[citation needed]

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.[43][44]

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 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

References

General references

  • Rutter, Michael (2002), Child and Adolescent Psychiatry, Blackwell, ISBN 0-632-05361-5 {{citation}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

Notes

  1. ^ Kuczaj, Stan A. (1991). Developmental psychology: childhood and adolescence. New York: Macmillan Pub. Co. ISBN 0-02-377010-4.
  2. ^ Kanner, Leo (July 1960), "Child Psychiatry: Retrospect and Prospect", American Journal of Psychiatry, 117 (1): 15–22
  3. ^ Gerhard, Uwe-Jens (2008), "Johannes Trüper--mediator between child and adolescent psychiatry and pedagogy", Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 36 (1): 55–63, doi:10.1024/1422-4917.36.1.55, retrieved 2008-07-04 {{citation}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  4. ^ a b c d e Beuttler, Fred and Bell, Carl (2010). For the Welfare of Every Child – A Brief History of the Institute for Juvenile Research, 1909 – 2010. University of Illinois: Chicago
  5. ^ Kelley, Florence and Stevens, Alzina P. (1895). Wage-Earning Children. In Jane Addams, Hull House Maps and Papers. New York: Thomas Y. Crowell & Co., pp. 49-76 [1]
  6. ^ Addler, Jeffery S. (2003) "We’ve got a right to fight: We’re married”: Domestic homicide in Chicago, 1975 – 1920. The Journal of Interdisciplinary History, 34 (1): 27 – 48
  7. ^ Addams, Jane. (2004). My Friend, Julia Lathrop. University of Illinois Press: Champlain, IL, p. 133
  8. ^ Schowalter, John E. (2000). Child and Adolescent Psychiatry Comes of Age, 1944-1994. In Menninger RW and Nemiah JC (Eds). American Psychiatry After World War II – 1944 – 1994. Washington, D.C.: American Psychiatric Press, p. 461 – 480
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  12. ^ a b c d Child and Adolescent Psychiatry at The Johns Hopkins Hospital
  13. ^ Neumärker, K.-J. (2003), "Leo Kanner: His Years in Berlin, 1906–24. The Roots of Autistic Disorder", History of Psychiatry, 14 (2): 205–208, doi:10.1177/0957154X030142005, PMID 14518490
  14. ^ Evans, Bonnie; Rahman, Shahina; Jones, Edgar (2008-12-01), "Managing the `unmanageable': interwar child psychiatry at the Maudsley Hospital, London", History of Psychiatry, 19 (4): 454–475, doi:10.1177/0957154X08089619
  15. ^ "About Us". AACAP. Retrieved 25 March 2011.
  16. ^ Kutchins, Herb; Kirk, Stuart A. (1992). The selling of DSM: the rhetoric of science in psychiatry. New York: A. de Gruyter. ISBN 0-202-30431-0.{{cite book}}: CS1 maint: multiple names: authors list (link)
  17. ^ Green, Jonathan; Yule, William (2001), "Foreword", in Jonathan Green and William Yule (ed.), Research and Innovation on the Road to Modern Child Psychiatry: Festschrift for Professor Sir Michael Rutter, London, p. vii{{citation}}: CS1 maint: location missing publisher (link); Stevenson, Jim (2001), "The Significance of Genetic Variation for Abnormal Behavioural Development", in Jonathan Green and William Yule (ed.), Research and Innovation on the Road to Modern Child Psychiatry: Festschrift for Professor Sir Michael Rutter, London, p. 20{{citation}}: CS1 maint: location missing publisher (link)
  18. ^ Rutter, Michael (1990), Chapter 7, Isle of Wight Revisited, Twenty-five years of child psychiatric epidemiology. In Annual Progress in Child Psychiatry and Child Development. Chess, Stella and Herzig, Margaret (eds), Psychology Press, ISBN 978-0-87630-602-4
  19. ^ Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Washington DC: American Psychiatric Association, 1994
  20. ^ Rutter, Michael and Taylor, Eric. Chapter 2, Clinical assessment and diagnostic formulation. In Rutter and Taylor (2002)
  21. ^ Angold, Adrian. Chapter 3, Diagnostic interviews with parents and children. In Rutter and Taylor (2002)
  22. ^ Verhulst, Frank and Van der Ende, Jan. Chapter 5, Rating scales. In Rutter and Taylor (2002)
  23. ^ Sergeant, Joseph and Taylor, Eric. Chapter 6, Psychological testing and observation. In Rutter and Taylor (2002)
  24. ^ American Psychiatric Association (2000), Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition, American Psychiatric Publishing, ISBN 978-0-89042-025-6
  25. ^ International Classification of Diseases (ICD), World Health Organisation, retrieved 2008-07-02
  26. ^ Rousseau, Cécile (2008), "DSM IV, Culture and Child Psychiatry", Canadian Academy of Child and Adolescent Psychiatry, 17 (2): 69–75, PMC 2387108, PMID 18516309 {{citation}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  27. ^ Winters, Nancy (2007), "The Case Formulation in Child and Adolescent Psychiatry", Child and Adolescent Psychiatric Clinics of North America, 16 (1): 111–132, doi:10.1016/j.chc.2006.07.010, PMID 17141121 {{citation}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  28. ^ Egger, Helen (2009), "Psychiatric assessment of young children", Child and Adolescent Psychiatric Clinics of North America, 18 (3): 559–580, doi:10.1016/j.chc.2009.02.004, PMID 19486838 {{citation}}: Unknown parameter |month= ignored (help)
  29. ^ Herbert, Martin. Chapter 53, Behavioural therapies, in Rutter and Taylor (2002)
  30. ^ Brent, David, Gaynor, Scott and Weersing, Robin. Chapter 54, Cognitive-behavioural approaches to the treatment of depression and anxiety. In Rutter and Taylor (2002)
  31. ^ Compas, Bruce, Benson, Molly et al. Chapter 55, Problem-solving and problem-solving therapies, in Rutter and Taylor (2002)
  32. ^ Lieberman A.F., Van Horn P., Ippen C.G. (2005). "Towards evidence-based treatment: Child-parent psychotherapy with preschoolers exposed to marital violence". Journal of the American Academy of Child and Adolescent Psychiatry. 44: 1241–1248.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  33. ^ Schechter DS, Willheim E (2009). "When parenting becomes unthinkable: Intervening with traumatized parents and their toddlers". Journal of the American Academy of Child & Adolescent Psychiatry. 48 (3): 249–254.
  34. ^ Scott, Stephen. Chapter 56, Parent training programmes, in Rutter and Taylor (2002)
  35. ^ Jacobs, Brian and Peaarse, Joanna.Chapter 57, Family therapy, in Rutter and Taylor (2002)
  36. ^ Heyman, Isobel and Santosh, Paramala. Chapter 59, Pharmacological and other physical treatments, in Rutter and Taylor (2002)
  37. ^ Rauch, Paula and Jellinek, Michael. Chapter 62, Paediatric consultation, in Rutter and Taylor (2002)
  38. ^ Garralda, Elena. Chapter 65, Primary health care psychiatry, in Rutter and Taylor (2002)
  39. ^ Nicol, Rory. Chapter 64, Practice in non-medical settings, in Rutter and Taylor (2002)
  40. ^ "Specialties & Subspecialties". American Osteopathic Association. Retrieved 18 September 2012.
  41. ^ AACAP
  42. ^ Thomas, Christopher (2006), "The continuing shortage of child and adolescent psychiatrists", Journal of the American Academy of Child and Adolescent Psychiatry, 45 (9): 1023, doi:10.1097/01.chi.0000225353.16831.5d, PMID 16840879 {{citation}}: More than one of |pages= and |page= specified (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  43. ^ Wintrob R. Cross-cultural psychiatry. Psychiatric Times. 2010;27:27.
  44. ^ Measham T, Guzder J, Rousseau C, Nadeau L. Cultural considerations in child and adolescent psychiatry. Psychiatric Times. 2010;27:38-40.

External links

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