Child and Adolescent psychiatry - Dirk van West
1. Introduction
• Specificity of Child and Adolescent Psychiatry
o Children and (young) adolescents usually do not seek help themselves for their
problems.
o Children and adolescents depend on their family and their functioning is often
directly related to the family situation.
o Information from several informants is strongly taken into account when assessing
problems in children and adolescents.
o Children and adolescents are biologically and psychosocially immature.
o The level of development of the children or adolescent determines the manner of
communication (importance of communication skills!).
o Intervention techniques and the organization of care for children and adolescent
differs from those for adults.
• Definition psychiatric disorders in Children or Adolescents
o Not age appropriate
o Could not not be adjusted
o Impairment of general functioning and “burden” (itself and/or environment)
o Stagnation in his/her development
o Biopsychosocial approach
o Developmental psychopathology
• Categorical approach – DSM-5
o Three sections
▪ General introduction
▪ 20 main categories
▪ Categories “under study” (internet gaming disorder, non suicidal self-injury)
o No multi-axial system
o New categories
▪ DMDD: disruptive mood dysregulation disorder
▪ MND: minor neurocognitive disorder
▪ BED: binge eating disorder
o Disappeared:
▪ Asperger
• Dimensional approach
o Explanatory diagnostics
o Cut-off point normal – abnormal
Mild Moderate Severe
1
,• Child and adolescent psychiatric assessment (CAPA)
o Informant
▪ Parents
• Reason for referral
• Developmental anamnesis
o Pregnancy/birth
▪ Somatic condition, medicins, smoking and drug
(ab)use mother, birth complications and postnatal
condition of the child, prenatal stress, psychosocial
circumstances of the mother and her family
o First months
▪ Quality of child-parent relationship (attachment:
veilig, angstig-vermijdend, angstig-afwerend of
geseorganiseerd), child’s temperament, psychosocial
circumstances
o Motor development
o Language and speech
▪ Semantic problems
▪ Morphologic problems
▪ Pragmatic problems
o Maturation of bladder control
o Attachment and social relations
o Life events
o Cognitive, emotional, social and somatic functioning during
lifespan
• Child and family anamnesis: interaction child-parent, relation
parents, family activities
• Current functioning of the child/adolescent
▪ Children and adolescents
• > 16 jaar: jongere kan zelfstandig hulp zoeken: oordeelsbekwaam
• Cognitive development
o Testing intellegence (IQ)
o School progress testing (LVS)
• Social development
• Emotional development
• Somatic development
o Developmental neurological research
▪ “soft signs” (walking on tiptoe, hypotonic)
▪ “minor physical anomalies” (hypertelorism,
deformed ears)
▪ Teachers
• School progress
• Behaviour class and playground
• Relation child/adolescent-teacher and child/adolescents vs peers
▪ Clinicians
2
, o Diagnostic methods
▪ Questionnaires
• Reliability
o Test-retest reliability
o Interrater reliability
• Validity
o Content validity
o Construct validity
o Criterion validity
▪ Interview
▪ Observational methods
• Child and Adolescent Psychiatric Disorders
o Developmental disorders
▪ ADHD
▪ ASS
▪ Disorders of speech, language and communication
▪ Disorders of motor development
▪ Learning problems
o Externalizing disorders
▪ Oppositional defiant disorder (ODD)
▪ Conduct disorder (CD)
o Internalizing disorders
▪ Mood disorders
▪ Anxiety disorders
o Eating disorders
▪ Anorexia nervosa
▪ Boulimia nervosa
▪ Binge eating disorder
o Others
▪ Emotion regulation disorders
▪ Attachment disorder
▪ Selective mutism
2. Developmental disorders
2.1. ADHD
• Persistent pattern of inattentions and/or hyperactivity – impulsivity that interferes with
functioning or development
• Primary features
o Cluster of three symptoms
▪ Inattention
• Focused attention
• Divided attention
• Sustained attention
▪ Hyperactivity
▪ Impulsivity
3
, • Clinical manifestation (DSM 5)
o Inattention:
▪ Fail to pay attention to details or make careless mistakes in schoolwork
▪ Have trouble staying focused in tasks or play
▪ Appear not to listen, even when spoken to directly
▪ Have difficulty following through on instructions and fail to finish schoolwork
or chores
▪ Have trouble organizing tasks and activities
▪ Avoid or dislike tasks that require focused mental effort, such as homework
▪ Lose items needed for tasks or activities, for example toys, school
assignments, pencils
▪ Be easily distracted
▪ Forget to do some daily activities, such as forgetting to do chores
o Hyperactivity and impulsivity:
▪ Often fidgets with or taps hand or feet, or squirms in seat
▪ Often leaves seat in situations when remaining seated is expected
▪ Often runs about or climbs in situations where it is not appropriate
(adolescents or adults may be limited to feeling restless)
▪ Often unable to play or take part in leisure activities quietly
▪ Is often “on the go” acting as if “driven by a motor”
▪ Often talks excessively
▪ Often blurts out an answer before a question has been completed
▪ Often has trouble waiting their turn
▪ Often interrupts or intrudes on others (e.g. butts into conversations or
games)
• Clinical manifestation – additional features
o Duration: symptoms were present for the last 6 months
o Age of onset: before age 12 years
o Pervasiveness: present in 2 or more settings (home, school/work, friends,…)
o Impairment: symptoms interfere or reduce the quality of social, school or work
functioning
o Exclusion: symptoms are not better explained by another medical disorder
• Developmental psychopathology
o Preschoolers
▪ Reduced intensity and duration of playing
▪ Motor hyperactivity
▪ Associated problems:
• Developmental deficits
• Oppositional defiant behaviour
• Problems social development
o Primary school
▪ Distractibility
▪ Motor hyperactivity
▪ Impulsive behaviour
▪ Disruptive behaviour
4
1. Introduction
• Specificity of Child and Adolescent Psychiatry
o Children and (young) adolescents usually do not seek help themselves for their
problems.
o Children and adolescents depend on their family and their functioning is often
directly related to the family situation.
o Information from several informants is strongly taken into account when assessing
problems in children and adolescents.
o Children and adolescents are biologically and psychosocially immature.
o The level of development of the children or adolescent determines the manner of
communication (importance of communication skills!).
o Intervention techniques and the organization of care for children and adolescent
differs from those for adults.
• Definition psychiatric disorders in Children or Adolescents
o Not age appropriate
o Could not not be adjusted
o Impairment of general functioning and “burden” (itself and/or environment)
o Stagnation in his/her development
o Biopsychosocial approach
o Developmental psychopathology
• Categorical approach – DSM-5
o Three sections
▪ General introduction
▪ 20 main categories
▪ Categories “under study” (internet gaming disorder, non suicidal self-injury)
o No multi-axial system
o New categories
▪ DMDD: disruptive mood dysregulation disorder
▪ MND: minor neurocognitive disorder
▪ BED: binge eating disorder
o Disappeared:
▪ Asperger
• Dimensional approach
o Explanatory diagnostics
o Cut-off point normal – abnormal
Mild Moderate Severe
1
,• Child and adolescent psychiatric assessment (CAPA)
o Informant
▪ Parents
• Reason for referral
• Developmental anamnesis
o Pregnancy/birth
▪ Somatic condition, medicins, smoking and drug
(ab)use mother, birth complications and postnatal
condition of the child, prenatal stress, psychosocial
circumstances of the mother and her family
o First months
▪ Quality of child-parent relationship (attachment:
veilig, angstig-vermijdend, angstig-afwerend of
geseorganiseerd), child’s temperament, psychosocial
circumstances
o Motor development
o Language and speech
▪ Semantic problems
▪ Morphologic problems
▪ Pragmatic problems
o Maturation of bladder control
o Attachment and social relations
o Life events
o Cognitive, emotional, social and somatic functioning during
lifespan
• Child and family anamnesis: interaction child-parent, relation
parents, family activities
• Current functioning of the child/adolescent
▪ Children and adolescents
• > 16 jaar: jongere kan zelfstandig hulp zoeken: oordeelsbekwaam
• Cognitive development
o Testing intellegence (IQ)
o School progress testing (LVS)
• Social development
• Emotional development
• Somatic development
o Developmental neurological research
▪ “soft signs” (walking on tiptoe, hypotonic)
▪ “minor physical anomalies” (hypertelorism,
deformed ears)
▪ Teachers
• School progress
• Behaviour class and playground
• Relation child/adolescent-teacher and child/adolescents vs peers
▪ Clinicians
2
, o Diagnostic methods
▪ Questionnaires
• Reliability
o Test-retest reliability
o Interrater reliability
• Validity
o Content validity
o Construct validity
o Criterion validity
▪ Interview
▪ Observational methods
• Child and Adolescent Psychiatric Disorders
o Developmental disorders
▪ ADHD
▪ ASS
▪ Disorders of speech, language and communication
▪ Disorders of motor development
▪ Learning problems
o Externalizing disorders
▪ Oppositional defiant disorder (ODD)
▪ Conduct disorder (CD)
o Internalizing disorders
▪ Mood disorders
▪ Anxiety disorders
o Eating disorders
▪ Anorexia nervosa
▪ Boulimia nervosa
▪ Binge eating disorder
o Others
▪ Emotion regulation disorders
▪ Attachment disorder
▪ Selective mutism
2. Developmental disorders
2.1. ADHD
• Persistent pattern of inattentions and/or hyperactivity – impulsivity that interferes with
functioning or development
• Primary features
o Cluster of three symptoms
▪ Inattention
• Focused attention
• Divided attention
• Sustained attention
▪ Hyperactivity
▪ Impulsivity
3
, • Clinical manifestation (DSM 5)
o Inattention:
▪ Fail to pay attention to details or make careless mistakes in schoolwork
▪ Have trouble staying focused in tasks or play
▪ Appear not to listen, even when spoken to directly
▪ Have difficulty following through on instructions and fail to finish schoolwork
or chores
▪ Have trouble organizing tasks and activities
▪ Avoid or dislike tasks that require focused mental effort, such as homework
▪ Lose items needed for tasks or activities, for example toys, school
assignments, pencils
▪ Be easily distracted
▪ Forget to do some daily activities, such as forgetting to do chores
o Hyperactivity and impulsivity:
▪ Often fidgets with or taps hand or feet, or squirms in seat
▪ Often leaves seat in situations when remaining seated is expected
▪ Often runs about or climbs in situations where it is not appropriate
(adolescents or adults may be limited to feeling restless)
▪ Often unable to play or take part in leisure activities quietly
▪ Is often “on the go” acting as if “driven by a motor”
▪ Often talks excessively
▪ Often blurts out an answer before a question has been completed
▪ Often has trouble waiting their turn
▪ Often interrupts or intrudes on others (e.g. butts into conversations or
games)
• Clinical manifestation – additional features
o Duration: symptoms were present for the last 6 months
o Age of onset: before age 12 years
o Pervasiveness: present in 2 or more settings (home, school/work, friends,…)
o Impairment: symptoms interfere or reduce the quality of social, school or work
functioning
o Exclusion: symptoms are not better explained by another medical disorder
• Developmental psychopathology
o Preschoolers
▪ Reduced intensity and duration of playing
▪ Motor hyperactivity
▪ Associated problems:
• Developmental deficits
• Oppositional defiant behaviour
• Problems social development
o Primary school
▪ Distractibility
▪ Motor hyperactivity
▪ Impulsive behaviour
▪ Disruptive behaviour
4
