Child and Adolescent Psychiatry
Developmental framework
Assessment in children is developmental and multi-informant - history from parents/carers and school is essential, and the child's own account must be obtained where possible. Know normal developmental milestones (language, social, motor) as the baseline against which abnormality is judged.
High-yield conditions
- ADHD: inattention and/or hyperactivity-impulsivity, onset before 12, present in ≥2 settings, impairing. First-line: behavioural parenting interventions in young children, stimulants (methylphenidate) or atomoxetine as pharmacotherapy.
- Autism spectrum disorder: persistent deficits in social communication plus restricted/repetitive behaviours, early onset. Distinguish from social anxiety and attachment difficulties.
- Conduct disorder vs oppositional defiant disorder (ODD is less severe, no rights violation).
- Tic disorders and Tourette syndrome (motor + vocal tics >1 year).
- Separation anxiety, school refusal, and selective mutism.
- Adolescent depression and self-harm: assess risk and safeguarding.
Traps
- Diagnosing ADHD without evidence of cross-situational impairment.
- Missing safeguarding concerns (abuse, neglect) presenting as behavioural change.
- Forgetting that early-onset schizophrenia is rare; prodromal social withdrawal is more often ASD, depression or trauma.
- Assuming children metabolise drugs like adults - dosing is weight-based and monitoring differs.
Rule of thumb
When a child's behaviour changes abruptly, ask what changed in the environment (home, school, abuse, bullying) before assigning a primary psychiatric diagnosis.