Child and Adolescent Psychiatry
This domain tests developmental reasoning: symptoms must be judged against age, developmental stage and context, and information must come from more than one setting. Examiners reward evidence of collateral history from parents and teachers, and caution about medicating young people.
Core diagnostic rules
- ADHD: developmentally inappropriate inattention and/or hyperactivity-impulsivity for at least six months, present in two or more settings, with onset of several symptoms before age twelve and clear impairment. Rating scales from home and school support but do not replace clinical assessment.
- Autism spectrum disorder: persistent deficits in social communication and interaction plus restricted, repetitive behaviours or interests, with early onset and functional impact.
- Oppositional defiant disorder: a pattern of angry, defiant and vindictive behaviour without serious violation of others' rights. Conduct disorder adds aggression, destruction, deceit and serious rule violation.
- Separation anxiety disorder and school refusal: refusal is a symptom, not a diagnosis, and requires assessment for anxiety, bullying, learning difficulty and family factors.
- Adolescent depression: irritability may replace sadness; ask directly about self-harm and suicide.
Treatment rules
Behavioural parent training is first-line for ADHD in young children and is combined with medication in older children; methylphenidate is first-line, with monitoring of height, weight, blood pressure and tics. Atomoxetine is an alternative. For adolescent depression, fluoxetine with CBT has the best evidence; all antidepressants require close monitoring of suicidality in the early weeks. CBT is first-line for child anxiety, with an SSRI added if severe or unresponsive. Antipsychotics are not a first-line treatment for disruptive behaviour.
Worked example
A nine-year-old is described as inattentive only at school. Reasoning: symptoms confined to one setting may reflect a learning difficulty, hearing or vision problem, bullying, a chaotic classroom, or a specific anxiety rather than ADHD. Cross-situational impairment is a criterion, so the next step is psychoeducational assessment and observation rather than immediate medication.
Traps that cost marks
Diagnosing ADHD in a preschool child. Ignoring sensory or learning problems. Failing to assess for abuse and neglect. Using antipsychotics for behavioural control. Not monitoring growth and cardiovascular parameters on stimulants. Overlooking that a child's consent and confidentiality differ from an adult's.