Child Psychology and Psychiatry

Dr. David Skuse is Head of Behavioural and Brain Sciences at the UCL Institute of Child Health and an Honorary Consultant in Developmental Neuropsychiatry at Great Ormond Street Hospital for Children.Dr. Helen Bruce is a Consultant Child and Adolescent Psychiatrist for East London NHS Foundation Trust, Honorary Senior Clinical Lecturer at Barts and the London School of Medicine and Dentistry, and Senior Teaching Fellow at the Institute of Child Health, UCL. Dr. Linda Dowdney is a Consultant Clinical Psychologist and Associate Fellow of the British Psychological Society.

• Notes on Contributors xxiiiSection 1 Developing Competencies1a: Contextual Influences Upon Social and Emotional Development 11 Family and Systemic Influences 3Barbara MaughanFamily Relationships and Parenting 3Parent and Family Characteristics 5Sibling Relationships 5Changing Family Patterns 6Parental Separation and Divorce 6Childcare and Schooling 6Wider Social and Environmental Influences 7Poverty and Social Disadvantage 7Neighbourhood and Community Contexts 8Multiple Stressors 8References 82 Child Development and Cultural Considerations in Clinical Practice 11Ruma Bose and Sanjida SattarIntroduction 11Developmental Niche and Eco-Cultural Pathways 11Childhood and Parenting Across Cultures 12Infancy 12Developmental Stages 12Attachment 12Parental Involvement in Play and Learning 13Middle Childhood 13Adolescence 14Culture and Disability 14Ethnicity and Mental Health 14Conclusion 15References 153 Neurobehavioural Development in Infancy: The Buffering and Transducing Role of the Mother/Caretaker–Infant Dyad 17Cindy H. Liu and Ed TronickIntroduction 17Infant Neurobehavioural Capacities 17Culture 18Mutual Regulation and Buffer–Transducer Models 20Conclusion 21References 224 Genetic and Biological Influences 25David H. SkuseIntroduction 25How Many Genes Are There? 26Sources of Genomic Variation 28Mechanisms of Genomic Regulation 29Mechanisms Influencing Neurodevelopmental Integrity 30Measuring Genetic Susceptibility to Psychiatric Disorders 30Gene–Environment Interactions 30Genome-Wide Association Studies (GWAS) 31Epigenetic Variation 32Future of Psychiatric Genetics: Precision Medicine 32Conclusions 33References 34Section 1b: General Patterns of Development 375 Clinical Evaluation of Development from Birth to 5 Years 39Ajay Sharma, Tony O’Sullivan and Gillian BairdChild Development and Neurodevelopmental Disorders 39History-Taking 41Observation and Interactive Assessment 42Developmental Domains 42Gross Motor 42Visual Behaviour, Eye–Hand Coordination and Problem-Solving 43Early Visual Behaviour 43Eye–Hand Co-Ordination 43Object Concepts and Relationships 44Imitating and Copying Cube Models 44Drawing 45Language and Communication 46Play and Social Behaviour 46Development of Attention 46Cognitive Development 46Clinical Decision-Making and Severity of Developmental Delay 48Physical Examination 49Planning Medical Investigations and Making Diagnosis 50Further Reading 516 Emotional Development in the First Year of Life 53Howard SteeleIntroduction 53Infant Emotional Expression 53The Development of Infant Emotional Expressions 54Crying 54Smiling or Joy 55Surprise, Anger and Sadness 55Fear 55Infant Detection of the Emotional Expressions of Others 56The Interactive Context 57References 577 Young People with Learning Disabilities 59David DossetorIntroduction 59The Changing Context 59Human Rights, Equity of Access to Services and Social Inclusion 59Assessment and Intervention 60Quality of Life, Developmental and Mental Health Factors 60Child and Family Factors 63Educational and Service Influences 63Types of Intervention 64The Development of Services 65Conclusion 66References 67Internet Resources 688 Language Development 71Thomas Klee and Stephanie F. StokesProcesses and Components of Language Development 71Milestones of Speech and Language Development 73Developmental Phases 73Atypical Language Development 75Future Directions 75References 75Internet Resources 769 Development of Social Cognition 77Virginia SlaughterEarly Social Cognition 77Social Cognition in Preschool and Beyond 78Individual Differences in Social Cognition – Implicationsfor Children’s Social Lives 79Individual Differences in Social Cognition – Where Do They Come From? 80References 8110 Social and Emotional Development in Middle Childhood 83Alan CarrIntroduction 83The Preschool Years 83Middle Childhood 85Adolescence 86Factors Contributing to SED 86Positive SED 86Problematic SED 87Consequences of SED Problems in Middle Childhood 87Addressing SED Problems 88References 8811 Social-Cognitive Development During Adolescence 91Sarah-Jayne BlakemoreHumans Are Exquisitely Social 91The Social Brain 91Development of Mentalizing During Adolescence 91Online Mentalizing Usage is Still Developing in Mid-Adolescence 93References 95Section 2 Promoting Well-being 9712 Attachment in the Early Years: Theory, Research and Clinical Implications 99Pasco FearonWhat is Attachment? 99Attachment Variations and Their Measurement 100Causes of Variation in Attachment 100Attachment Disorders 103Consequences of Variations in Attachment 103Interventions 104Preventive Interventions 104Interventions with Fostered and Adopted Children 104Conclusions 105References 10513 Promoting Infant Mental Health 109Christine PuckeringWhy the Early Years Matter 109Pregnancy and the Perinatal Period 110Intervention 111Antenatal and Postnatal Interventions 111Intervention During Early Childhood 112The Need for Supportive Services 113Primary Health Care Services 113The Role of Child Mental Health Services 113References 11314 Promoting Children’s Well-Being: The Prevention of Depression and Anxiety 117Paul StallardPrevention 117School-Based Prevention 119Depression Prevention Programmes 119Anxiety Prevention Programmes 120Future Developments and Challenges 121References 12215 Fostering Resilience in Adolescents 125Angela VealeIntroduction 125What Do We Mean by Resilience? 125Agency in Resilience 126Mobilizing Social Networks to Foster Coping and Resilience 126Implications for Policy and Practice 127Mobilizing Resilience: An Illustrative Example 127Summary of the Project 127Implementing the Project 129Conclusion 130References 13116 Sexual Orientation, Sexual Health and Gender Dysphoria 133Justin WakefieldIntroduction 133Sexual Orientation 133Defining Sexual Orientation and Its Importance in Clinical Evaluation 133An Overview of the Literature Relating Sexual Orientation and Mental Health 134Understanding the Associations Between SexualOrientation and Mental Health 134Intervening to Prevent Adverse Mental Health Outcomes 134Sexual Health 135The Influence of Mental Health on Sexual Behaviour 135The Influence of Mental Health Treatment on Sexual Behaviour 136Clinical Implications 136Gender Dysphoria 136Diagnostic Issues 136Epidemiology 136Aetiology 137Clinical Management in Childhood 137Clinical Management in Adolescence 137Non-specialist care 137Specialist Care 138Summary 138References 13817 Child Users of Online and Mobile Technologies – Risks, Harms and Intervention 141Peter K. Smith and Sonia LivingstoneAggressive Risks: Cyber-Aggression and Cyberbullying 142Sexual Risks: Pornography, Sexting, Stranger Danger 142Trends Over Time 143The Harm Associated with Mobile and Online Risk 144Aggressive Risks and Harm 144Sexual Risks and Harm 145Factors that Increase Risk of Harm or Protect Against Them 145Interventions 145Challenges to Research 145Policy Implications 146References 146Internet Resources 148Section 3 The Impact of Trauma, Loss and Maltreatment3a: Trauma and Loss 14918 Children Bereaved by Parent or Sibling Death 151Linda DowdneyChildren’s Understanding of Death 151How Children Express Grief 151Early Childhood 151Middle Childhood 152Adolescence 152Resilience and Positive Outcomes in Bereaved Children 152Psychopathology in Bereaved Children 152Prolonged Complex Bereavement 153Hypothalamic–Pituitary–Adrenal Axis (HPA) Dysregulation 153What Influences Child Outcome? 153Interventions with Bereaved Children 154Theoretical and Cultural Influences 154What Do Bereaved Children Need? 154What is Helpful for Parents? 155Services for Bereaved Children 155The Role of Professionals 155Conclusions 157References 157Internet Resources 159For Families 159Resources for Schools and Teachers 159Advice on Different Faith and Belief Communities 15919 Stress and Reactions to Stress in Children 161David TrickeyReactions 161Cognitive Model of PTSD 163Evidence-Based Interventions 164Conclusion 165References 16520 Children’s Developing Sense of Moral Agency, and the Disruptions Associated with War Exposure 167Cecilia WainrybThe Development of Moral Agency 167Challenges Posed by Exposure to War 168Numb Agency 168Imbalanced Agency 169Essentialized Agency 170Conclusions 171References 172Section 3b: Maltreatment 17521 Child Maltreatment 177Danya GlaserIntroduction 177The Nature of Maltreatment 177Epidemiology 177Social and Family Factors 179The Harm to the Child 179Psychosocial Development 180Educational Progress and Employment 181Recognition of Maltreatment and Assessment of Harm and Need 181Professional Response to Child Maltreatment 182Treatment and Future Prevention 183Conclusion 184References 18422 The Neuroscience and Genetics of Childhood Maltreatment 187Eamon McCrory, Vanessa B. Puetz and Essi VidingThe Impact of Maltreatment on Brain Development 187Structural Differences 188Subcortical Structures: The Hippocampus and Amygdala 188Cortical Structures: The Prefrontal Cortex and Cerebellum 188Corpus Callosum and Other White Matter Tracts 189Functional Differences 190FMRI Studies 190Event-Related Potential (ERP) Studies 190The Role of Genetic Influences 191Clinical Implications 191References 192Section 4 Atypical Development in Children and Adolescents 19523 Autism Spectrum Disorder – An Evolving Construct 197William MandyThe Dimensionality of ASD 198The Fractionation of the Autism Triad 198The End of Asperger’s Disorder 199Gender Differences in ASD 199Higher Social Motivation 200Distinct Pattern of Risk for Co-Occurring Conditions 200A Better Capacity to Camouflage and Compensate for Autistic Difficulties 200Conclusions 201References 20124 Attention Deficit Hyperactivity Disorder 203Antonio Muñoz-Solomando and Anita ThaparDefinition 203Epidemiology 205Aetiology 205Cognitive and Neurobiological Correlates 205Diagnostic Assessment 206Information from Parents 206Child Information and Observation 207Report from School or Other Informants 207Physical Examination 207Treatment 207Pharmacological Intervention 207Stimulants 208Non-Stimulants 209Other Medications 209Psycho-Social Interventions 210School Interventions 210Other Interventions 210Clinical Course 211References 21125 Anxiety Disorders in Children and Adolescents 215Aaron Vallance and Elena GarraldaDiagnostic Features 215Epidemiology 217Aetiology 217Temperament 217Genetic Factors 217Environmental Factors and Parent–Child Interactions 218Neurobiology/Neuropsychology Factors 218Respiratory Dysregulation 219Assessment 219Prognosis 219Treatment 220Cognitive Behavioural Therapy (CBT) 220Pharmacotherapy 221Conclusion 224References 22426 Childhood Behavioural Disorders 227Graeme Lamb and Ramya SrinivasanIntroduction 227Diagnostic Classifications and Subtyping 227Epidemiology 229Aetiology 229Prevention and Treatment 230Conclusion 232References 23227 Depression and Suicidal Behaviour 235Julia Gledhill and Matthew HodesIntroduction 235Depressive Disorder 235Epidemiology 235Aetiological Factors 236Diagnostic Assessment 237Outcome 237Management 237Initial Assessment 237Treatment 238Managing Associated Co-Morbidity and Risk Factors 238Preventing Relapse 238Suicidal Behaviour 238Epidemiology 238Aetiological Factors 239Predisposing Factors 239Individual 239Family 239Wider Environment 239Precipitating Factors 239Risk Associated with Self-Harm 240Course 240Management 240Type of Assessment 240Treatment 241Prevention 241References 24228 Eating Disorders in Adolescence 245Dasha NichollsDiagnosis and Classification 245Epidemiology and Aetiology 246Managing Eating Disorders 248Medical Aspects 248Psychiatric Aspects of Management 250Key Messages and Future Directions 251References 25129 Emerging Personality Disorder 255Eileen VizardDefinitions 255Temperament 255Personality 255Childhood Personality Traits and Adult Outcomes 255Relevant Neuroscience Findings 257Personality Assessment and Personality Disorderin Clinical Practice 257Why Assess Childhood Personality? 257Diagnostic Issues 258Conclusions 260References 26130 Literacy Disorders 263Valerie Muter and Margaret J. SnowlingDefinition, Incidence, Persistence and Co-occurrence 263Acquiring Literacy Skills 264The Nature of Impairment in Children with Literacy Disorders 264Patterns of Impairment from Preschool to Adolescence 265Assessing Literacy Disorders 266Teaching Children with Literacy Disorders 268References 26931 Challenges in Child and Adolescent Obsessive Compulsive Disorder 271Elaine Chung, Anup Kharod and Isobel HeymanThe ‘Hidden Problem’ 271When Do Ordinary Childhood Rituals Become OCD? 272Aetiology 272Assessment of the Young Person with Possible OCD 272Differential Diagnosis and Identifying OCD 272Phenomenology of Obsessions and Compulsions 273Obsessions May Cause More Distress Than Compulsions 273Co-Morbidities 273Treatment 274Young People Becoming Experts 274Cognitive Behavioural Therapy 274Anxiety 274OCD as An ‘Intruder’ 275Medication 276Prognosis and Ongoing Care 277References 277Further Reading 279Internet Resources 27932 Medically Unexplained Symptoms/Functional Symptoms in Children and Adolescents 281Eve McAllister, Laura Markham, Anna Coughtrey and Isobel HeymanIntroduction 281Epidemiology 282Factors Relevant to the Development, Severity and Persistence of FS 282Course of Illness 283Assessment 284Treatment 285Effectiveness of Psychological Treatment 285Psychopharmacological Treatment 286Current Challenges and Future Directions 286References 28833 Paediatric Bipolar Disorder 291Anthony JamesIntroduction 291Diagnostic Criteria 291Differential Diagnosis 292Epidemiology 293Assessment 293Prodrome and Longitudinal Course 294Suicide 294Treatment 295Acute Phase 295Treatment of Depression in Bipolar Disorder 296Longer-Term Treatment 296Psychological Interventions 296References 29634 Early Intervention in Psychosis 299Paolo Fusar-Poli and Giulia SpadaIntroduction 299Early-Onset Psychosis 299The Psychosis Prodrome 300The Clinical High-Risk State 300Detecting the Clinical High-Risk State 300The BS Approach 301The UHR Approach 301Using High-Risk Criteria with Children and Adolescents 303Transition to Psychosis 303Intervention 304Future Directions 305References 30535 Developmental Language Disorder 307Gina Conti-Ramsden and Kevin DurkinWhat is Developmental Language Disorder? 307What Causes DLD? 308Biological Bases of DLD: Genetic and Neurobiological Factors 308Cognitive Bases of DLD: Non-Linguistic and Linguistic Factors 309Environmental Influences 309What Types of Language Difficulties Do Children with DLD Have? 309Distinctive Features of Language in DLD 310Developmental Progression of Language Skills in DLD 310Associated Developmental Problems and Outcomes 311Implications 311References 312Internet Resources 31336 Substance Misuse in Young People 315K. A. H. Mirza, Roshin M. Sudesh and Sudeshni MirzaIntroduction 315Epidemiology 315Defining Substance Misuse in the Young: A DevelopmentalPerspective 317Definitions 317Alternative Classifications in Young People 317Aetiology: Risk and Protective Factors 320Antecedent and Co-Morbid Mental Health Problems 320Consequences and Associated Features of Substance Misuse 321Clinical Assessment 322Treatment 322Evidence Base for Treatment 322Role of Child and Adolescent Substance Mental Health Services (CAMHS) 323Conclusions 323References 324Appendix 36.1 Clinical Assessment 326Mental State Examination and Physical Examination 326Investigations 327Section 5 Assessment and Approaches to Intervention 32937 New Perspectives on the Classification of Child Psychiatric Disorders 331Elena GarraldaIntroduction 331The Modern Area of Classification of Psychiatric Disorders 331Classification in Child and Adolescent Psychiatry 332Child and Adolescent Psychiatric Disorders in DSM 5 and asProposed for ICD 11 333The Neurodevelopmental Disorders 333Autistic Disorders 333Developmental Language or Communication Disorders 334The Classification of Disruptive, Dissocial and Conduct Disorders 334Future Approaches to Classification 335Classification and Child and Adolescent Mental Health Practice 335Final Considerations 336References 33638 Paediatric Neuropsychological Assessment: Domains for Assessment 339Jane Gilmour and Bettina HohnenIntroduction 339Why Undertake a Specialized Neuropsychological Assessment? 339When is a Specialized Neuropsychological Assessment Justified? 339Measurement Considerations 340Developmental Considerations 340Be Sure of Why the Child Fails a Task – What is Their Route to Failure? 340Psychometrics 341Reliability and Validity 341Interpreting Scores 341Domains of Specialist Assessment 341General Ability 341Memory 347Language 347Attention 349Spatial Ability 349Motor Skills 349Executive Function 349Social Cognition 350Conclusions 350References 35139 Cognitive Behavioural Therapy for Children and Adolescents 355Cathy Creswell and Thomas G. O’ConnorBasic Premises of the CBT Approach and its Administration 356Developmental Considerations 357Recent Advances and Future Directions for CBT for Children and Adolescents 358Conclusion 360References 360Further Reading 36240 Psychodynamic Psychotherapy for Children and Adolescents 363Eilis KennedyIntroduction 363Basic Premises of a Psychodynamic Approach 363The Evidence Base for Psychodynamic Child Psychotherapy 364Examples of Research with Children and Young People Presenting with Various Clinical Problems 364Children Who Have Experienced Abuse 364Internalizing and Externalizing Disorders 364Disruptive Behaviour Disorders 364Internalizing Disorders 364Mixed Diagnoses 365Young People with Poorly Controlled Diabetes 366Long-Term Outcomes 366The Anna Freud Centre Long-Term Follow-up Study 366Potential Adverse Effects of Treatment 367Conclusion 367References 36741 Systemic and Family Approaches to Intervention 371Philip MessentIntroduction 371Externalizing Disorders 371Attention Deficit Hyperactivity Disorder (ADHD) 371Conduct Problems in Adolescence 372Substance Misuse in Adolescence 372Emotional Problems 372Anxiety 372Depression 373Self-Harm and Attempted Suicide 373Eating Disorders 373Adolescent Anorexia Nervosa 373Obesity 374First Episode Psychosis 374A Different Sort of Evidence 374References 37542 Mentalization 379Dickon BevingtonIntroduction 379Definition 379Development 380Relevance 381Applications 381The Mentalizing Stance 381Specific Interventions 382Mentalization-Based Treatment 382MBT-Families 382Adaptive Mentalization-Based Integrative Treatment (AMBIT) 383References 38443 Parenting Programmes for Conduct Problems 387Stephen Scott and Sajid HumayunEvidence Linking Parenting to Child Psychopathology 387Programmes for Children Based on Social Learning Theory 387Format of a Typical Social Learning Programme 388Teaching a Child-Centred Approach 388Increasing Desirable Child Behaviour 389Imposing Clear Commands 389Reducing Undesirable Child Behaviour 389Interventions with Youth 389Family-Based Interventions 390Multi-Component Interventions 390Effectiveness 391Social Learning Approaches 391Youth Interventions 391Mediators and Moderators of Change 391Dissemination: The Role of Therapist Skill 391Conclusion 392References 39244 Paediatric Psychopharmacology – Special Considerations 395Paramala Santosh and Rakendu SurenIntroduction 395Information to Assist Judicious Prescribing 395Medication as a Part of Multi-Modal Treatment Package 396Symptom-Based Pharmacotherapeutic Strategy 396The Art of Prescribing Medication 396Use of Non-Licensed Psychotropic Medication 397Factors Affecting Pharmacotherapy in Children 397Medications 398Stimulants 399Antipsychotics 399Second-Generation Antipsychotics (SGAs) 399Mood Stabilizers 403Disruptive Mood Dysregulation Disorder (DMDD) 403Drug Interactions 404Ethical Issues in Paediatric Psychopharmacology 404Conclusion 404References 40445 Paediatric Liaison 407Peter HindleyOverview 407Paediatric Liaison and Child and Adolescent Mental Health Emergencies 407Paediatric Liaison and the Mind–Body Interface 408Paediatric Liaison: Management, Commissioning and Value for Money 410Conclusions 410References 41146 Promoting Educational Success: How Findings from Neuroscience can Guide Educators to Work Optimally with the Brain 413Bettina HohnenEducation and Neuroscience: The Debate 413Neuro-Myths 413Optimum Context for Learning: A Neuroscientific Model 414Background to Brain Development 414Level 1 415Level 2 415Level 3 416Level 4 416Level 5 416Level 6 416Developmental Changes in the Brain: The Case of Adolescence 4161. Reward 4172. Regulation 4173. Relationships 4174. Creativity and Higher-Order Thinking 417References 41847 Continuities and Discontinuities in Youth Mental Healthcare 421Helen Bruce and Linda DowdneyIntroduction 421Service Characteristics 421Client Characteristics 422Ways Forward 423Evaluation of Transition Outcomes 424Conclusions 424References 425Internet Resources 426Youth mental health support 426For Professionals and Commissioners of Services 42748 The Children and Young People’s Improving Access toPsychological Therapies (CYP IAPT) Programme in England 429Peter Fonagy, Kathryn Pugh and Anne O’HerlihyIntroduction 429Challenges Facing CAMHS 429Implementation 430Partnerships and Collaboratives 430Implementation Initiatives 430Training Initiatives 431User Participation Initiatives 431Monitoring User Participation and Training Initiatives 431Service Development Outcomes 432Evaluation 432Improved Access and Efficiency 432Evidence-Based Interventions 432ROM and User Engagement 433Challenges to Implementation 433Future Directions 433References 433Internet Resources 435Index 437