Child Psychiatry
and fantasy life, for example by asking for three magic wishes.
The assessment should be completed with a physical examination and by speaking to other informants involved with the child or family, such as the family doctor, school teacher, educational psychologist, or social services. Investigations may be performed, most commonly intelligence tests and tests of academic attainment, such as standardized reading tests.
Pervasive Developmental Disorder (Autism)
Autism is severe disorder that begins early in life and is apparent by the third birthday. It is characterised by a failure to make social relationships, poor language development and resistance to change with limited and repetitive behaviours and interests. These children fail to notice or respond to other people’s emotions or social signals. They do not adapt their behaviour appropriately to new environments, and are very restricted in their play, rarely engaging in make-believe play. Typically, they will choose unusual non-soft toys and may become attached to a particular object and refuse to be separated from it. Some will have very limited language skills, and those skills that are present will generally not be used in social conversation with others. Three quarters have significant mental retardation.
Autism has a prevalence of 4 in 10,000 and is three times more common in boys than girls. It is associated with brain damage in some cases and genetic factors are thought to play an important role in the aetiology. There are no specific treatments available. The families require a great deal of support and counseling, and behaviour problems may be managed with behavioural therapy. The outcome is generally poor, with only 15% ever achieving independent functioning.
0-1 year
Totally dependent Rapid motor development – walking by one year Attachment behaviour from 7 months
1-2 years
Begins to talk Dry by day Temper tantrums Separation anxiety
2-5 years
Complex language skills Sociable Development of sexual identity Identification with parents Beginning of conscience formation Vivid fantasy life See themselves as the centre of their world
5-10 years
Well-defined identity as a girl or boy Able to separate well from mother Personality attributes acquired by the end of this period persist into adulthood
Adolescence
Puberty – 11 to 13 years in girls and 13 to 17 years in boys Establishment of personal identity Establishment of autonomy from parents Learning to work and develop skills to become self supporting Peer group relationships are very important
Table 2 Normal childhood development
Specific Developmental Disorders
In these disorders, specific skills such as reading, spelling, arithmetical skills, and language are disturbed. The problems are present from early childhood. In order to make a diagnosis of specific developmental disorder, acquired brain trauma or disease must be excluded and the child must have had reasonable opportunities to acquire these skills at home or school. The causes of the specific developmental disorders are not known for sure but are thought to stem from abnormalities in cognitive processing. They are all much more common in boys than girls.
Specific reading disorder is particularly common, with a prevalence of 5-10%. Typical reading problems include distortions or additions of words or parts of words, slow reading rate and loss of place in the text. Although specific reading disorder is not due to inadequate schooling, truancy is a common consequence of the academic difficulties. Conduct disorders and specific reading disorder frequency co-exist.
Hyperkinetic Disorder
In America this is known as attention deficit hyperactivity disorder (ADHD). The main features of the disorder are overactivity, restlessness, short attention span, distractibility and impulsive behaviour. These children are often clumsy, accident prone and get into trouble with parents and teachers because they act without thinking. Other children will often avoid them and they can become socially isolated.
Symptoms are usually present from an early age, but it is most commonly diagnosed in 6 to 9 year olds in whom there is a prevalence of about 8%. It is 3 times more common in boys than girls. Many causes have been suggested, from genetic factors to allergies and poor parenting. This is one of the very few childhood psychiatric conditions that is treated with medication. Amphetamine-like stimulates are used, such as methylphenidate, which have the paradoxical effects of reducing activity levels and improving attention. This results in improvements in academic performance and development of friendships. Behavioural therapy, using a system of