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 xxiii

Section 1 Developing Competencies

1a: Contextual Influences Upon Social and Emotional Development 1

1 Family and Systemic Influences 3
Barbara Maughan

Family Relationships and Parenting 3

Parent and Family Characteristics 5

Sibling Relationships 5

Changing Family Patterns 6

Parental Separation and Divorce 6

Childcare and Schooling 6

Wider Social and Environmental Influences 7

Poverty and Social Disadvantage 7

Neighbourhood and Community Contexts 8

Multiple Stressors 8

References 8

2 Child Development and Cultural Considerations in Clinical Practice 11
Ruma Bose and Sanjida Sattar

Introduction 11

Developmental Niche and Eco-Cultural Pathways 11

Childhood and Parenting Across Cultures 12

Infancy 12

Developmental Stages 12

Attachment 12

Parental Involvement in Play and Learning 13

Middle Childhood 13

Adolescence 14

Culture and Disability 14

Ethnicity and Mental Health 14

Conclusion 15

References 15

3 Neurobehavioural Development in Infancy: The Buffering and Transducing Role of the Mother/Caretaker–Infant Dyad 17
Cindy H. Liu and Ed Tronick

Introduction 17

Infant Neurobehavioural Capacities 17

Culture 18

Mutual Regulation and Buffer–Transducer Models 20

Conclusion 21

References 22

4 Genetic and Biological Influences 25
David H. Skuse

Introduction 25

How Many Genes Are There? 26

Sources of Genomic Variation 28

Mechanisms of Genomic Regulation 29

Mechanisms Influencing Neurodevelopmental Integrity 30

Measuring Genetic Susceptibility to Psychiatric Disorders 30

Gene–Environment Interactions 30

Genome-Wide Association Studies (GWAS) 31

Epigenetic Variation 32

Future of Psychiatric Genetics: Precision Medicine 32

Conclusions 33

References 34

Section 1b: General Patterns of Development 37

5 Clinical Evaluation of Development from Birth to 5 Years 39
Ajay Sharma, Tony O’Sullivan and Gillian Baird

Child Development and Neurodevelopmental Disorders 39

History-Taking 41

Observation and Interactive Assessment 42

Developmental Domains 42

Gross Motor 42

Visual Behaviour, Eye–Hand Coordination and Problem-Solving 43

Early Visual Behaviour 43

Eye–Hand Co-Ordination 43

Object Concepts and Relationships 44

Imitating and Copying Cube Models 44

Drawing 45

Language and Communication 46

Play and Social Behaviour 46

Development of Attention 46

Cognitive Development 46

Clinical Decision-Making and Severity of Developmental Delay 48

Physical Examination 49

Planning Medical Investigations and Making Diagnosis 50

Further Reading 51

6 Emotional Development in the First Year of Life 53
Howard Steele

Introduction 53

Infant Emotional Expression 53

The Development of Infant Emotional Expressions 54

Crying 54

Smiling or Joy 55

Surprise, Anger and Sadness 55

Fear 55

Infant Detection of the Emotional Expressions of Others 56

The Interactive Context 57

References 57

7 Young People with Learning Disabilities 59
David Dossetor

Introduction 59

The Changing Context 59

Human Rights, Equity of Access to Services and Social Inclusion 59

Assessment and Intervention 60

Quality of Life, Developmental and Mental Health Factors 60

Child and Family Factors 63

Educational and Service Influences 63

Types of Intervention 64

The Development of Services 65

Conclusion 66

References 67

Internet Resources 68

8 Language Development 71
Thomas Klee and Stephanie F. Stokes

Processes and Components of Language Development 71

Milestones of Speech and Language Development 73

Developmental Phases 73

Atypical Language Development 75

Future Directions 75

References 75

Internet Resources 76

9 Development of Social Cognition 77
Virginia Slaughter

Early Social Cognition 77

Social Cognition in Preschool and Beyond 78

Individual Differences in Social Cognition – Implications

for Children’s Social Lives 79

Individual Differences in Social Cognition – Where Do They Come From? 80

References 81

10 Social and Emotional Development in Middle Childhood 83
Alan Carr

Introduction 83

The Preschool Years 83

Middle Childhood 85

Adolescence 86

Factors Contributing to SED 86

Positive SED 86

Problematic SED 87

Consequences of SED Problems in Middle Childhood 87

Addressing SED Problems 88

References 88

11 Social-Cognitive Development During Adolescence 91
Sarah-Jayne Blakemore

Humans Are Exquisitely Social 91

The Social Brain 91

Development of Mentalizing During Adolescence 91

Online Mentalizing Usage is Still Developing in Mid-Adolescence 93

References 95

Section 2 Promoting Well-being 97

12 Attachment in the Early Years: Theory, Research and Clinical Implications 99
Pasco Fearon

What is Attachment? 99

Attachment Variations and Their Measurement 100

Causes of Variation in Attachment 100

Attachment Disorders 103

Consequences of Variations in Attachment 103

Interventions 104

Preventive Interventions 104

Interventions with Fostered and Adopted Children 104

Conclusions 105

References 105

13 Promoting Infant Mental Health 109
Christine Puckering

Why the Early Years Matter 109

Pregnancy and the Perinatal Period 110

Intervention 111

Antenatal and Postnatal Interventions 111

Intervention During Early Childhood 112

The Need for Supportive Services 113

Primary Health Care Services 113

The Role of Child Mental Health Services 113

References 113

14 Promoting Children’s Well-Being: The Prevention of Depression and Anxiety 117
Paul Stallard

Prevention 117

School-Based Prevention 119

Depression Prevention Programmes 119

Anxiety Prevention Programmes 120

Future Developments and Challenges 121

References 122

15 Fostering Resilience in Adolescents 125
Angela Veale

Introduction 125

What Do We Mean by Resilience? 125

Agency in Resilience 126

Mobilizing Social Networks to Foster Coping and Resilience 126

Implications for Policy and Practice 127

Mobilizing Resilience: An Illustrative Example 127

Summary of the Project 127

Implementing the Project 129

Conclusion 130

References 131

16 Sexual Orientation, Sexual Health and Gender Dysphoria 133
Justin Wakefield

Introduction 133

Sexual Orientation 133

Defining Sexual Orientation and Its Importance in Clinical Evaluation 133

An Overview of the Literature Relating Sexual Orientation and Mental Health 134

Understanding the Associations Between Sexual

Orientation and Mental Health 134

Intervening to Prevent Adverse Mental Health Outcomes 134

Sexual Health 135

The Influence of Mental Health on Sexual Behaviour 135

The Influence of Mental Health Treatment on Sexual Behaviour 136

Clinical Implications 136

Gender Dysphoria 136

Diagnostic Issues 136

Epidemiology 136

Aetiology 137

Clinical Management in Childhood 137

Clinical Management in Adolescence 137

Non-specialist care 137

Specialist Care 138

Summary 138

References 138

17 Child Users of Online and Mobile Technologies – Risks, Harms and Intervention 141
Peter K. Smith and Sonia Livingstone

Aggressive Risks: Cyber-Aggression and Cyberbullying 142

Sexual Risks: Pornography, Sexting, Stranger Danger 142

Trends Over Time 143

The Harm Associated with Mobile and Online Risk 144

Aggressive Risks and Harm 144

Sexual Risks and Harm 145

Factors that Increase Risk of Harm or Protect Against Them 145

Interventions 145

Challenges to Research 145

Policy Implications 146

References 146

Internet Resources 148

Section 3 The Impact of Trauma, Loss and Maltreatment

3a: Trauma and Loss 149

18 Children Bereaved by Parent or Sibling Death 151
Linda Dowdney

Children’s Understanding of Death 151

How Children Express Grief 151

Early Childhood 151

Middle Childhood 152

Adolescence 152

Resilience and Positive Outcomes in Bereaved Children 152

Psychopathology in Bereaved Children 152

Prolonged Complex Bereavement 153

Hypothalamic–Pituitary–Adrenal Axis (HPA) Dysregulation 153

What Influences Child Outcome? 153

Interventions with Bereaved Children 154

Theoretical and Cultural Influences 154

What Do Bereaved Children Need? 154

What is Helpful for Parents? 155

Services for Bereaved Children 155

The Role of Professionals 155

Conclusions 157

References 157

Internet Resources 159

For Families 159

Resources for Schools and Teachers 159

Advice on Different Faith and Belief Communities 159

19 Stress and Reactions to Stress in Children 161
David Trickey

Reactions 161

Cognitive Model of PTSD 163

Evidence-Based Interventions 164

Conclusion 165

References 165

20 Children’s Developing Sense of Moral Agency, and the Disruptions Associated with War Exposure 167
Cecilia Wainryb

The Development of Moral Agency 167

Challenges Posed by Exposure to War 168

Numb Agency 168

Imbalanced Agency 169

Essentialized Agency 170

Conclusions 171

References 172

Section 3b: Maltreatment 175

21 Child Maltreatment 177
Danya Glaser

Introduction 177

The Nature of Maltreatment 177

Epidemiology 177

Social and Family Factors 179

The Harm to the Child 179

Psychosocial Development 180

Educational Progress and Employment 181

Recognition of Maltreatment and Assessment of Harm and Need 181

Professional Response to Child Maltreatment 182

Treatment and Future Prevention 183

Conclusion 184

References 184

22 The Neuroscience and Genetics of Childhood Maltreatment 187
Eamon McCrory, Vanessa B. Puetz and Essi Viding

The Impact of Maltreatment on Brain Development 187

Structural Differences 188

Subcortical Structures: The Hippocampus and Amygdala 188

Cortical Structures: The Prefrontal Cortex and Cerebellum 188

Corpus Callosum and Other White Matter Tracts 189

Functional Differences 190

FMRI Studies 190

Event-Related Potential (ERP) Studies 190

The Role of Genetic Influences 191

Clinical Implications 191

References 192

Section 4 Atypical Development in Children and Adolescents 195

23 Autism Spectrum Disorder – An Evolving Construct 197
William Mandy

The Dimensionality of ASD 198

The Fractionation of the Autism Triad 198

The End of Asperger’s Disorder 199

Gender Differences in ASD 199

Higher Social Motivation 200

Distinct Pattern of Risk for Co-Occurring Conditions 200

A Better Capacity to Camouflage and Compensate for Autistic Difficulties 200

Conclusions 201

References 201

24 Attention Deficit Hyperactivity Disorder 203
Antonio Muñoz-Solomando and Anita Thapar

Definition 203

Epidemiology 205

Aetiology 205

Cognitive and Neurobiological Correlates 205

Diagnostic Assessment 206

Information from Parents 206

Child Information and Observation 207

Report from School or Other Informants 207

Physical Examination 207

Treatment 207

Pharmacological Intervention 207

Stimulants 208

Non-Stimulants 209

Other Medications 209

Psycho-Social Interventions 210

School Interventions 210

Other Interventions 210

Clinical Course 211

References 211

25 Anxiety Disorders in Children and Adolescents 215
Aaron Vallance and Elena Garralda

Diagnostic Features 215

Epidemiology 217

Aetiology 217

Temperament 217

Genetic Factors 217

Environmental Factors and Parent–Child Interactions 218

Neurobiology/Neuropsychology Factors 218

Respiratory Dysregulation 219

Assessment 219

Prognosis 219

Treatment 220

Cognitive Behavioural Therapy (CBT) 220

Pharmacotherapy 221

Conclusion 224

References 224

26 Childhood Behavioural Disorders 227
Graeme Lamb and Ramya Srinivasan

Introduction 227

Diagnostic Classifications and Subtyping 227

Epidemiology 229

Aetiology 229

Prevention and Treatment 230

Conclusion 232

References 232

27 Depression and Suicidal Behaviour 235
Julia Gledhill and Matthew Hodes

Introduction 235

Depressive Disorder 235

Epidemiology 235

Aetiological Factors 236

Diagnostic Assessment 237

Outcome 237

Management 237

Initial Assessment 237

Treatment 238

Managing Associated Co-Morbidity and Risk Factors 238

Preventing Relapse 238

Suicidal Behaviour 238

Epidemiology 238

Aetiological Factors 239

Predisposing Factors 239

Individual 239

Family 239

Wider Environment 239

Precipitating Factors 239

Risk Associated with Self-Harm 240

Course 240

Management 240

Type of Assessment 240

Treatment 241

Prevention 241

References 242

28 Eating Disorders in Adolescence 245
Dasha Nicholls

Diagnosis and Classification 245

Epidemiology and Aetiology 246

Managing Eating Disorders 248

Medical Aspects 248

Psychiatric Aspects of Management 250

Key Messages and Future Directions 251

References 251

29 Emerging Personality Disorder 255
Eileen Vizard

Definitions 255

Temperament 255

Personality 255

Childhood Personality Traits and Adult Outcomes 255

Relevant Neuroscience Findings 257

Personality Assessment and Personality Disorder

in Clinical Practice 257

Why Assess Childhood Personality? 257

Diagnostic Issues 258

Conclusions 260

References 261

30 Literacy Disorders 263
Valerie Muter and Margaret J. Snowling

Definition, Incidence, Persistence and Co-occurrence 263

Acquiring Literacy Skills 264

The Nature of Impairment in Children with Literacy Disorders 264

Patterns of Impairment from Preschool to Adolescence 265

Assessing Literacy Disorders 266

Teaching Children with Literacy Disorders 268

References 269

31 Challenges in Child and Adolescent Obsessive Compulsive Disorder 271
Elaine Chung, Anup Kharod and Isobel Heyman

The ‘Hidden Problem’ 271

When Do Ordinary Childhood Rituals Become OCD? 272

Aetiology 272

Assessment of the Young Person with Possible OCD 272

Differential Diagnosis and Identifying OCD 272

Phenomenology of Obsessions and Compulsions 273

Obsessions May Cause More Distress Than Compulsions 273

Co-Morbidities 273

Treatment 274

Young People Becoming Experts 274

Cognitive Behavioural Therapy 274

Anxiety 274

OCD as An ‘Intruder’ 275

Medication 276

Prognosis and Ongoing Care 277

References 277

Further Reading 279

Internet Resources 279

32 Medically Unexplained Symptoms/Functional Symptoms in Children and Adolescents 281
Eve McAllister, Laura Markham, Anna Coughtrey and Isobel Heyman

Introduction 281

Epidemiology 282

Factors Relevant to the Development, Severity and Persistence of FS 282

Course of Illness 283

Assessment 284

Treatment 285

Effectiveness of Psychological Treatment 285

Psychopharmacological Treatment 286

Current Challenges and Future Directions 286

References 288

33 Paediatric Bipolar Disorder 291
Anthony James

Introduction 291

Diagnostic Criteria 291

Differential Diagnosis 292

Epidemiology 293

Assessment 293

Prodrome and Longitudinal Course 294

Suicide 294

Treatment 295

Acute Phase 295

Treatment of Depression in Bipolar Disorder 296

Longer-Term Treatment 296

Psychological Interventions 296

References 296

34 Early Intervention in Psychosis 299
Paolo Fusar-Poli and Giulia Spada

Introduction 299

Early-Onset Psychosis 299

The Psychosis Prodrome 300

The Clinical High-Risk State 300

Detecting the Clinical High-Risk State 300

The BS Approach 301

The UHR Approach 301

Using High-Risk Criteria with Children and Adolescents 303

Transition to Psychosis 303

Intervention 304

Future Directions 305

References 305

35 Developmental Language Disorder 307
Gina Conti-Ramsden and Kevin Durkin

What is Developmental Language Disorder? 307

What Causes DLD? 308

Biological Bases of DLD: Genetic and Neurobiological Factors 308

Cognitive Bases of DLD: Non-Linguistic and Linguistic Factors 309

Environmental Influences 309

What Types of Language Difficulties Do Children with DLD Have? 309

Distinctive Features of Language in DLD 310

Developmental Progression of Language Skills in DLD 310

Associated Developmental Problems and Outcomes 311

Implications 311

References 312

Internet Resources 313

36 Substance Misuse in Young People 315
K. A. H. Mirza, Roshin M. Sudesh and Sudeshni Mirza

Introduction 315

Epidemiology 315

Defining Substance Misuse in the Young: A Developmental

Perspective 317

Definitions 317

Alternative Classifications in Young People 317

Aetiology: Risk and Protective Factors 320

Antecedent and Co-Morbid Mental Health Problems 320

Consequences and Associated Features of Substance Misuse 321

Clinical Assessment 322

Treatment 322

Evidence Base for Treatment 322

Role of Child and Adolescent Substance Mental Health Services (CAMHS) 323

Conclusions 323

References 324

Appendix 36.1 Clinical Assessment 326

Mental State Examination and Physical Examination 326

Investigations 327

Section 5 Assessment and Approaches to Intervention 329

37 New Perspectives on the Classification of Child Psychiatric Disorders 331
Elena Garralda

Introduction 331

The Modern Area of Classification of Psychiatric Disorders 331

Classification in Child and Adolescent Psychiatry 332

Child and Adolescent Psychiatric Disorders in DSM 5 and as

Proposed for ICD 11 333

The Neurodevelopmental Disorders 333

Autistic Disorders 333

Developmental Language or Communication Disorders 334

The Classification of Disruptive, Dissocial and Conduct Disorders 334

Future Approaches to Classification 335

Classification and Child and Adolescent Mental Health Practice 335

Final Considerations 336

References 336

38 Paediatric Neuropsychological Assessment: Domains for Assessment 339
Jane Gilmour and Bettina Hohnen

Introduction 339

Why Undertake a Specialized Neuropsychological Assessment? 339

When is a Specialized Neuropsychological Assessment Justified? 339

Measurement Considerations 340

Developmental Considerations 340

Be Sure of Why the Child Fails a Task – What is Their Route to Failure? 340

Psychometrics 341

Reliability and Validity 341

Interpreting Scores 341

Domains of Specialist Assessment 341

General Ability 341

Memory 347

Language 347

Attention 349

Spatial Ability 349

Motor Skills 349

Executive Function 349

Social Cognition 350

Conclusions 350

References 351

39 Cognitive Behavioural Therapy for Children and Adolescents 355
Cathy Creswell and Thomas G. O’Connor

Basic Premises of the CBT Approach and its Administration 356

Developmental Considerations 357

Recent Advances and Future Directions for CBT for Children and Adolescents 358

Conclusion 360

References 360

Further Reading 362

40 Psychodynamic Psychotherapy for Children and Adolescents 363
Eilis Kennedy

Introduction 363

Basic Premises of a Psychodynamic Approach 363

The Evidence Base for Psychodynamic Child Psychotherapy 364

Examples of Research with Children and Young People Presenting with Various Clinical Problems 364

Children Who Have Experienced Abuse 364

Internalizing and Externalizing Disorders 364

Disruptive Behaviour Disorders 364

Internalizing Disorders 364

Mixed Diagnoses 365

Young People with Poorly Controlled Diabetes 366

Long-Term Outcomes 366

The Anna Freud Centre Long-Term Follow-up Study 366

Potential Adverse Effects of Treatment 367

Conclusion 367

References 367

41 Systemic and Family Approaches to Intervention 371
Philip Messent

Introduction 371

Externalizing Disorders 371

Attention Deficit Hyperactivity Disorder (ADHD) 371

Conduct Problems in Adolescence 372

Substance Misuse in Adolescence 372

Emotional Problems 372

Anxiety 372

Depression 373

Self-Harm and Attempted Suicide 373

Eating Disorders 373

Adolescent Anorexia Nervosa 373

Obesity 374

First Episode Psychosis 374

A Different Sort of Evidence 374

References 375

42 Mentalization 379
Dickon Bevington

Introduction 379

Definition 379

Development 380

Relevance 381

Applications 381

The Mentalizing Stance 381

Specific Interventions 382

Mentalization-Based Treatment 382

MBT-Families 382

Adaptive Mentalization-Based Integrative Treatment (AMBIT) 383

References 384

43 Parenting Programmes for Conduct Problems 387
Stephen Scott and Sajid Humayun

Evidence Linking Parenting to Child Psychopathology 387

Programmes for Children Based on Social Learning Theory 387

Format of a Typical Social Learning Programme 388

Teaching a Child-Centred Approach 388

Increasing Desirable Child Behaviour 389

Imposing Clear Commands 389

Reducing Undesirable Child Behaviour 389

Interventions with Youth 389

Family-Based Interventions 390

Multi-Component Interventions 390

Effectiveness 391

Social Learning Approaches 391

Youth Interventions 391

Mediators and Moderators of Change 391

Dissemination: The Role of Therapist Skill 391

Conclusion 392

References 392

44 Paediatric Psychopharmacology – Special Considerations 395
Paramala Santosh and Rakendu Suren

Introduction 395

Information to Assist Judicious Prescribing 395

Medication as a Part of Multi-Modal Treatment Package 396

Symptom-Based Pharmacotherapeutic Strategy 396

The Art of Prescribing Medication 396

Use of Non-Licensed Psychotropic Medication 397

Factors Affecting Pharmacotherapy in Children 397

Medications 398

Stimulants 399

Antipsychotics 399

Second-Generation Antipsychotics (SGAs) 399

Mood Stabilizers 403

Disruptive Mood Dysregulation Disorder (DMDD) 403

Drug Interactions 404

Ethical Issues in Paediatric Psychopharmacology 404

Conclusion 404

References 404

45 Paediatric Liaison 407
Peter Hindley

Overview 407

Paediatric Liaison and Child and Adolescent Mental Health Emergencies 407

Paediatric Liaison and the Mind–Body Interface 408

Paediatric Liaison: Management, Commissioning and Value for Money 410

Conclusions 410

References 411

46 Promoting Educational Success: How Findings from Neuroscience can Guide Educators to Work Optimally with the Brain 413
Bettina Hohnen

Education and Neuroscience: The Debate 413

Neuro-Myths 413

Optimum Context for Learning: A Neuroscientific Model 414

Background to Brain Development 414

Level 1 415

Level 2 415

Level 3 416

Level 4 416

Level 5 416

Level 6 416

Developmental Changes in the Brain: The Case of Adolescence 416

1. Reward 417

2. Regulation 417

3. Relationships 417

4. Creativity and Higher-Order Thinking 417

References 418

47 Continuities and Discontinuities in Youth Mental Healthcare 421
Helen Bruce and Linda Dowdney

Introduction 421

Service Characteristics 421

Client Characteristics 422

Ways Forward 423

Evaluation of Transition Outcomes 424

Conclusions 424

References 425

Internet Resources 426

Youth mental health support 426

For Professionals and Commissioners of Services 427

48 The Children and Young People’s Improving Access to

Psychological Therapies (CYP IAPT) Programme in England 429

Peter Fonagy, Kathryn Pugh and Anne O’Herlihy

Introduction 429

Challenges Facing CAMHS 429

Implementation 430

Partnerships and Collaboratives 430

Implementation Initiatives 430

Training Initiatives 431

User Participation Initiatives 431

Monitoring User Participation and Training Initiatives 431

Service Development Outcomes 432

Evaluation 432

Improved Access and Efficiency 432

Evidence-Based Interventions 432

ROM and User Engagement 433

Challenges to Implementation 433

Future Directions 433

References 433

Internet Resources 435

Index 437