Child and Adolescent Psychiatry
What this domain tests
This domain tests developmental thresholds, the two-setting rule for ADHD, first-line psychosocial treatment, and safety monitoring in young people. Examiners also probe normal variation versus disorder.
Core rules and concepts
- ADHD: symptoms before age 12, at least six inattentive or hyperactive-impulsive symptoms (five for age 17 and over), for six months or more, in two or more settings with impairment. Preschool children receive parent behaviour training first; stimulants are first-line from age six.
- Autism spectrum disorder: persistent deficits in social communication and interaction plus restricted, repetitive patterns, with support-level specification; early intervention improves outcome.
- Tic disorders: behavioural treatment (CBIT) first; alpha-2 agonists; antipsychotics only for severe impairment.
- Adolescent depression: fluoxetine is the best-evidenced agent; monitor for suicidal ideation and activation closely after starting.
- Eating disorders: anorexia nervosa in adolescents is managed with family-based treatment alongside medical stabilisation.
Worked example
An 8-year-old is inattentive and fidgety at school and at home, symptoms since age 5, with normal vision and hearing. Two settings, onset before 12 and impairment are satisfied - ADHD, combined presentation. Parent training and school liaison come first, with stimulant medication if impairment persists.
Traps that cost marks
- Diagnosing ADHD when onset is after age 12.
- Missing hearing or vision problems, sleep apnoea or abuse as explanations.
- Starting an SSRI in a young child without close monitoring and clear indication.