Child and Adolescent Psychiatry: Development, Context, and Caution
Questions require developmental framing: symptoms must be judged against age-expected behavior. Know the presentation of autism spectrum disorder (social communication deficits, restricted interests), ADHD (inattention, hyperactivity, impairment across settings), and disruptive behavior disorders. Mood and anxiety disorders occur in youth but may present as irritability or somatic complaints. Trauma and maltreatment must be considered. Psychopharmacology in youth demands caution: stimulants for ADHD with growth and cardiovascular monitoring, SSRIs (notably fluoxetine and escitalopram) for depression and anxiety, and antipsychotics reserved for specific indications with metabolic monitoring.
Traps
- Applying adult criteria without developmental adjustment.
- Missing that irritability can signal depression or mania, not just oppositionality.
- Overlooking school and family context in impairment assessment.
- Ignoring black-box warnings and the need for informed consent with caregivers.
Rule of thumb
Ask: is the behavior deviant for age, impairing across settings, and persistent? Worked example: a 7-year-old with inattention at school but no home impairment and normal development may not meet ADHD criteria; gather collateral from teachers before diagnosing.