CHILD PSYCHIATRY

branch of medicine that is concerned with the study and treatment of the mental, emotional, and behavioral disorders of childhood. Child psychiatry has been recognized as a division of the field of psychiatry and neurology since the mid-1920s. By about the mid-1950s the American Board of Psychiatry and Neurology officially had recognized the field and defined training and certification requirements for this subspecialty. Subdivisions within the field include infant psychiatry and adolescent psychiatry. Because the child is living through active and critical phases of development, the approach to the diagnosis and treatment of children's mental and emotional disturbances is necessarily different from that employed with adults. Personality is being molded and changed as the child grows, and so it is essential that the child psychiatrist have extensive knowledge of the developmental stages of personality. Although many of the general principles relating to the therapy of adult psychological disorders apply to child psychiatry, a major distinction is that the child psychiatrist must obtain much critical information on the child's behaviour from the adults who have been in frequent or close contact with the child-parents, pediatrician, psychologist, teacher, or social workers. For the most part, child psychiatry is concerned with the study and treatment of behaviour disorders and emotional problems that affect children. The emotional maladjustments of children frequently are characterized by anxiety reactions. They may include habit disorders-such as nail-biting, thumb-sucking, bed-wetting, and temper tantrums-and conduct disorders-such as extreme aggressiveness, lying, stealing, destructiveness, fighting, fire setting, cruelty, and running away from home. Among infants, deprivation of mothering or problems in the infant's relationship with the mother may lead to withdrawn behaviour, continuous crying, inability to eat, insomnia, and physical or mental retardation or both. In the last half of the 20th century, child abuse and neglect have been seen as a significant factor in childhood disorders. As in the treatment of adult patients, psychiatric treatment of children requires determination of any genetic, constitutional, or physical factors that have contributed to the disturbance. It is also essential that the parent-child relationship be assessed for its contribution to the disturbed behaviour. Where parental actions are disruptive or disturbing-as, for example, in relationships coloured by alcoholism, hostility, cruelty, neglect, overprotection of the child, or excessive ambitions for and expectations of the child-it is common to find behaviour disorders in the children involved. The existence of neurotic, psychotic, or psychopathic conditions in the parents often contributes to a faulty parent-child relationship. The death or loss of a parent may also have a lasting effect on a child's emotional growth. Another source of personality problems may be the child's relationship with brothers and sisters. Child psychiatry usually involves some form of family therapy. School experiences also can create personality problems. Many children exhibit conduct and learning disturbances because they are emotionally, temperamentally, or intellectually unable to learn. Children with perceptual difficulties such as dyslexia, for example, may fail to learn to read or to develop reading skills appropriate to their age level. As a consequence, they often become frustrated and anxious over their failure to meet the standards of their family and their class. Most therapeutic techniques used with adults are also employed with children, as well as more specialized methods such as play therapy. In the latter, play activities are used as the primary basis for communication between the child and the psychotherapist. Play activities enable children to express their feelings, thoughts, wishes, and fears more freely and easily than they are able to do through purely verbal communication.