Psychiatry: disorder groups
Child & adolescent psychiatry
Child and adolescent psychiatry covers mental health from infancy to the late teens, working with children, families and schools. It is a recognised subspecialty, but every psychiatrist needs the basics because many adult illnesses begin in youth.
Depth by stage, Pre-U → Consultant (details)
What is it?
Children and teenagers can develop most of the same mental health problems as adults, but they show them differently. A child's development, family, school and peers are always part of the picture, so assessment includes parents, teachers and sometimes other agencies.
Common problems include anxiety, depression, self-harm, ADHD, autism, behavioural problems, eating disorders, school refusal, early psychosis and the effects of abuse or neglect. Around half of all lifetime mental disorders start by the mid-teens.
Child and adolescent psychiatrists work with paediatricians, clinical psychologists, occupational and speech therapists, teachers and social welfare officers. In Malaysia the number of such specialists is small relative to need.
Why does a psychiatrist need it?
Adult psychiatrists need to understand how illnesses begin and how childhood experiences shape adult problems, and they must recognise child protection concerns when adult patients are parents. Trainees complete a child and adolescent rotation, and some continue to a subspecialty fellowship.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalAwareLearns child development and family dynamics in behavioural science.
- ClinicalUnderstandsTakes developmental histories in paediatrics and recognises common child mental health problems.
- HousemanshipAwareRecognises child abuse warning signs and distress in paediatric patients.
- Medical officerUnderstandsAssesses adolescents in emergencies and adult patients' parenting and child safety concerns.
- Psych traineeAppliesCompletes a child and adolescent rotation and manages common conditions with supervision.
- Specialist / consultantAppliesGeneral consultants apply core skills; subspecialists (level 4) lead child and adolescent services.
What are the key topics?
Conditions
- Emotional disorders: anxiety, depression, OCD in children
- Self-harm and suicide risk in adolescents
- Disruptive behaviour and dissocial disorders (oppositional defiant, conduct)
- Neurodevelopmental disorders: ADHD, autism, intellectual disability
- Early-onset psychosis and bipolar disorder
- Eating disorders
- Elimination disorders (enuresis, encopresis)
- Attachment problems and effects of abuse and neglect
Assessment
- Developmental, family and school history
- Seeing the child alone and with parents
- Questionnaires such as the SDQ (Strengths and Difficulties Questionnaire)
- Liaison with schools and paediatricians
- Confidentiality, consent and the child's evolving maturity
- Child protection screening
Treatment
- Parenting programmes and family therapy
- CBT adapted for children and adolescents
- Medication with careful monitoring (e.g. SSRIs in adolescents, ADHD medication)
- School-based support and liaison with education services
- Inpatient and day-patient care for severe cases (limited in Malaysia)
Malaysian context
- Child Act 2001 and child protection procedures (e.g. hospital-based Suspected Child Abuse and Neglect, SCAN, teams)
- Social Welfare Department (JKM) role
- Special education and school counsellors
- Cultural factors: family hierarchy, academic pressure, help-seeking through religious channels
How is it learned and assessed?
- Behavioural science and paediatrics postings
- Child and adolescent psychiatry rotation in specialist training
- MMed Part II; MRCPsych Paper A (development), Paper B and CASC stations with parents
- Subspecialty fellowship training for those who specialise
Typical textbooks and resources
- Rutter's Child and Adolescent Psychiatry — Wiley-Blackwell
- Child and Adolescent Psychiatry — Robert Goodman & Stephen Scott, Wiley-Blackwell
- Shorter Oxford Textbook of Psychiatry — Oxford University Press
- IACAPAP Textbook of Child and Adolescent Mental Health — International Association for Child and Adolescent Psychiatry and Allied Professions (free online)
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
How is a child psychiatrist different from a child psychologist?
A child psychiatrist is a medical doctor who has specialised in psychiatry and then in children and adolescents; they can prescribe medication and manage medical issues. A clinical psychologist assesses and provides psychological therapy and testing but does not prescribe.
Do children get depression?
Yes. It may show as irritability, school problems, withdrawal or physical complaints rather than obvious sadness. It is treatable, and early help matters.