Child Psychiatry is a medical specialty, which aims to study the mental development of children and adolescents. To detect, treat and rehabilitate deviations, as well as intervene directly or indirectly in the child’s environment so that, in as harmonious and healthy a way as possible enable the child to become a mentally healthy adult.
After basic training in Medicine, this specialty requires a specific training in other areas. A Child Psychiatrist studies Paediatrics, General Psychiatry, including a vast and diversified study ranging from genetics, sociology, ethology, neurology, developmental psychology, psychoanalysis, systemic theories and communication theories, behaviour and psychopharmacology, among others.
A psychiatric consultation is in part similar to any other medical consultation (clinical history, observation, diagnosis and therapeutic orientation), but with some particularities, since it is at the same time diagnostic and therapeutic.
It needs a space that guarantees privacy and comfort, with the necessary equipment for a brief neurological examination, materials necessary to interact with the child (paper, pencils, toys, books), but it is above all the doctor and the patient relationship / commitment, which is the fundamental instrument in the diagnosis and treatment of the child.
It requires time, time of the parents, time of the child and of the therapist, and the motivation to create an effective therapeutic alliance. A first consultation rarely takes less than two hours, where it is essential to assess expectations and motivations, clarify the problem, demystify prejudices against mental problems, understanding what type of help is most needed. Depending on the situation, there are several ways of approaching the situation. It may begin with seeing only the parents or guardians or only the child or adolescent or in including other adults with a significant role in the life of the child or adolescent This is essential to guarantee confidentiality and trust.
The necessity for complementary examinations is rare, but sometimes psychological or psychopedagogical assessments are necessary. Occasionally more specific tests are needed such as an EEG or brain CT Scan or MRI is warranted.
Medication is rarely needed although necessary in specific cases (psychotic situations, some behaviour problems, attention deficit and hyperactivity, more severe depressions, etc.).
The understanding and involvement of the family / parents is fundamental, with whom the doctor should discuss the necessary medication, where they become important as co-therapists in the process.
Follow-up treatment may include individual therapy, with the family, cognitive-behaviour psychotherapy, school intervention, psychomotor therapy, individual or group, or other medical specialty.
There may be extremely serious situations that justify an in-patient admission in a specific unit or that may require the intervention of medical-legal services or the protection of children when at risk.
The results of Psychiatric treatment are not always noticed immediately and are difficult to assess by the co-morbidity and coexistence of risk and protective factors in all situations. It is always multidisciplinary teamwork involving the participation of the family and the school or other institutions and specialties, in order to be able to interconnect all those involved. By creating new insights into the problems the solutions will lead to the balanced development of the child, often modifying transgenerational patterns of pathology and promoting an adjusted behaviour with the consequent improvement of the child, family, and social well-being.