Child and Adolescent Psychiatry
What the exam tests
Child psychiatry tests developmental context, collateral history, cross-setting impairment and cautious medication use. You must separate normal variation from disorder and involve parents, school and safeguarding.
Core rules
- Assess development, family, school, peers and trauma; obtain information from more than one setting.
- ADHD requires inattention and/or hyperactivity-impulsivity for at least six months, before age 12, in two or more settings, with impairment.
- Autism spectrum disorder involves persistent social communication deficits and restricted, repetitive behaviour, with early onset.
- Attachment disorders follow severe neglect; reactive attachment disorder shows inhibited, emotionally withdrawn behaviour, while disinhibited social engagement disorder shows indiscriminate friendliness.
- Depression can present with irritability; psychosis and bipolar disorder are rare before puberty and need careful differential diagnosis.
- Behavioural and family interventions precede medication where possible; monitor growth, blood pressure and metabolic effects.
Worked example
A 7-year-old is inattentive, loses things, cannot wait turns and runs around in class and at home; teachers and parents report six months of impairment. This meets ADHD criteria if symptoms began before age 12 and occur across settings. The reasoning is cross-situational impairment, not just high energy. Assess sleep, hearing, anxiety, trauma and learning problems before starting stimulants or behavioural parent training.
Traps that cost marks
Do not diagnose ADHD from school complaints alone. Do not miss hearing or language disorders, anxiety, trauma or abuse. Do not overdiagnose bipolar disorder from irritability. Do not start medication without baseline growth and cardiovascular monitoring.