Prevention and Treatment
in
Child Psychiatry
Dr Finbarr O’Leary
Consultant Child and Adolescent
Psychiatrist
Multi – Axial Classification
• 1. psychiatric syndrome
• 2. specific developmental delays
• 3. intelligence
• 4. medical conditions
• 5. psychosocial situations
prevention
1. Primary prevention
stop the disorder occurring.
remove the cause
2. Secondary prevention
identify the disorder at onset
prevent extension
3. Tertiary prevention
limit disability from an established disorder
prevention
1. Primary prevention
health promotion
disease prevention
2. Secondary prevention
early identification
treatment
3. Tertiary prevention
rehabilitation
Treatment .v. Prevention
• Individual
• Group/population
• Referred
• Unreferred
• Problem
• ‘At Risk’
• Remedial
• Protective
• Restore
• Enhance
Prevention in Child Psychiatry
‘good enough parenting’
Best environment meets
needs of most
distressed infant
Worst environment
cannot meet needs of
healthy, easy going
infant
Prevention in Child Psychiatry
Public Policy
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1. poverty alleviation
2. neighbourhood unity
3. good housing
4. employment
5. child protection from abuse
6. accident prevention
7. quality of education
8. marital and family support
Prevention in child psychiatry
life cycle stages
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1. parenthood preparation
2. antenatal care
3. birth and neonatal period
4. preschool period
5. middle childhood
6. adolescence
Prevention in Child Psychiatry
Child Health Services
2nd and 3rd prevention
1. Physical and mental health needs of a
child are inseparable
2. Child must be seen in context of their
family
3. Parents need to be involved in decision
making
4. No one person or profession has all the
knowledge or skills
5. Voluntary support groups are helpful
Prevention in Child Psychiatry
Child Health Services
2nd and 3rd prevention
6. Seeing of a child and family not always needed.
Consultation to other professionals can be useful
• A. psychosocial ward rounds in paediatrics
• B. consultations to community care social
workers
• C. consultations to teachers in school
• D. consultations to residential homes
• E. consultations to any professional who has
child involvement (gp, phn, s/l therapist….)
Treatment in Child Psychiatry
• Assessment (history and mental state)
• Diagnosis (using multi-axial thinking)
• Treatment
Treatment Modalities
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1. behaviour therapy
2. individual psychotherapy
3. family therapy
4. group therapy
5. medication therapy
• Can be use alone or in combination
• Outpatient or inpatient
Medication Therapy
• Stimulants
• Serotonin Reuptake Inhibitors
• Neuroleptics - Major Tranquillisers
• Minor Tranquillisers
• Mood Stabilisers
• Hypnotics
Behaviour Therapy
• Definition of Behaviour ;
• ‘all activity of the organism beyond simple
physiological functions necessary to
sustain life’
Behaviour Therapy
• Yule 1980
• Guiding principle is that behaviour can be
modified by its consequences
Behaviour Therapy
• Yule 1980
• Reinforcer
• Any event which follows on from a
behaviour which increases the strength or
probability of the behaviour
Behaviour Therapy
• Yule 1980
• Reinforcer of Childhood?
• Attention
• Good or Bad
Behaviour Therapy
the
past
determines
the
future
Behaviour Therapy
AFTER
• What a parent does
a child
has behaved in a certain way is the most
important influence the parent has on how
that child will behave in the future