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In the light of recent guidance published by The National Institute for Health and Clinical Excellence (NICE) on the diagnosis and management of attention deficit disorders in children, young persons and adults, Gill Salmon, a consultant Child and Adolescent Psychiatrist based in Swansea, South Wales, and Amanda Kirby, Professor of Developmental Disorders in Education based at the University of Wales, Newport, give an overview of the rationale for involving teachers in the assessment of children with AD/HD and the development and implementation of subsequent educational interventions. They also review the resulting training implications; explore some of the obstacles to multi-agency, multi-disciplinary working; and examine how current special educational needs policy goes hand-in-hand with the tiered approach to provision of child and adolescent mental health services in offering a graduated response to these children.

Attention deficit hyperactivity disorder is a highly heritable medical condition which mainly affects school-aged children although it is increasingly being recognized in adults. The exact cause remains unknown, but the condition responds well to evidence-based interventions. [ABSTRACT FROM AUTHOR]

In the light of recent guidance published by The National Institute for Health and Clinical Excellence (NICE) on the diagnosis and management of attention deficit disorders in children, young persons and adults, Gill Salmon, a consultant Child and Adolescent Psychiatrist based in Swansea, South Wales, and Amanda Kirby, Professor of Developmental Disorders in Education based at the University of Wales, Newport, give an overview of the rationale for involving teachers in the assessment of children with AD/HD and the development and implementation of subsequent educational interventions. They also review the resulting training implications; explore some of the obstacles to multi-agency, multi-disciplinary working; and examine how current special educational needs policy goes hand-in-hand with the tiered approach to provision of child and adolescent mental health services in offering a graduated response to these children. [ABSTRACT FROM AUTHOR]

Attention deficit hyperactivity disorder (ADHD) is commonly comorbid with movement difficulties, including developmental coordination disorder (DCD). Compartmentalised service provision may result in children with ADHD not being screened, and assessed if necessary, for DCD and vice versa. In this study, 69 children attending an ADHD clinic were screened for movement problems, using the parent-completed Movement Assessment Battery for Children Checklist (Henderson and Sugden 1992). The results showed that 19% of the children with ADHD were defined as having a 'movement problem', with a further 16% defined as 'at risk'. This paper discusses the results of the study and the implications for paediatric occupational therapy. [ABSTRACT FROM AUTHOR]

The Community Intensive Therapy Team (CITT) has been operating since 1998. It was developed to cater for the needs of patients with complex difficulties referred to a specialist Child and Adolescent Health Service (CAMHS) in South Wales, UK. The patients served by the CITT are comparable with patients who might be referred for admission to an inpatient unit and include patients with eating disorders, psychosis, affective disorders, adjustment disorders or repetitive self-harm. The theoretical model used is based on a biopsychosocial model which aims to empower and support family members. The philosophy of the CITT is to work with the child and family in their own environment, tailoring the therapy to the needs of all concerned. CITT makes use of the strengths within the patient, the family and extended family, the agencies already involved and the environment. Since its introduction, the CITT has been able to manage all the complex referrals made to it from the generic Tier 2/3 CAMHS teams it serves, with minimal recourse to inpatient beds. [ABSTRACT FROM AUTHOR]

This article summarizes the rationale for multi-agency working when assessing children and young people with suspected neurodevelopmental disorders such as attention-deficit hyperactivity disorder, developmental coordination disorder and autistic spectrum disorders. Details of referral pathways that have been drawn up for each separate disorder are given and the process through which multi-agency agreement was reached is described. Key features thought to be common to all three pathways are discussed and factors thought to have contributed to successful multi-agency working highlighted. The work is described in the context of existing national policy documents in the UK. [ABSTRACT FROM AUTHOR]

This qualitative study aims to explore the types and purpose of discourse emerging when professionals from a Child and Adolescent Mental Health Service meet with professionals from other agencies to discuss cases. The aim reflects current political and contextual agendas influencing agencies to work more closely together and obstacles to achieving this goal highlighted in the literature such as the need for agencies to develop a common language to discuss children of concern. Data were collected through eight audio-taped meetings involving CAMHS and members of other agencies such as social services and education. A thematic analysis identified nine themes, defined according to their discourse type, including: single agency discourse; case complexity discourse and multi-agency discourse. Results indicate that agencies are hindered from working more closely together and developing a common language for use in multi-agency meetings, because they tend to have different understandings of the terminology used and a common consensus about language and meaning is not usually negotiated within the meeting. There is a need for greater awareness amongst staff from different professional groups and agencies that meaning given by one group will often need to be clarified by others and assumptions about common understandings should not be made. [ABSTRACT FROM AUTHOR]

This article reviews the literature on bullying with particular reference to associated psychiatric symptoms and presents data and case examples from an inpatient and outpatient adolescent service and a school for emotionally and behaviourally disturbed children (EBD school). Bullying or its effects do not seem to be a distinguishing factor among those admitted to an adolescent unit. In the outpatient group, however, being bullied is frequently a factor in the presentation of adolescents to psychiatric services, with depression being the diagnosis in over 70% of cases. In contrast, bullies and bully/victims were most likely to present with conduct disorders, which were frequently co-morbid with hyperkinetic disorder/attention deficit hyperactivity disorder (ADHD). Unsurprisingly, regardless of whether bully, victim, bully/victim or neither, the most common psychiatric diagnosis of the EBD school pupils who were interviewed was that of conduct disorder. This was sometimes co-morbid with AD(H)D but also seen alongside generalized anxiety disorder and major depressive disorder. In an adolescent unit and in an EBD school, being bullied or a bully is an important factor associated with psychiatric symptomatology and should be regarded as a substantial mental and public health issue. [ABSTRACT FROM AUTHOR]

Three female patients with schizophrenia who originally presented with a diagnosis of anorexia nervosa are described. Some of the links between psychosis and eating disorders are then explored, particularly with regard to the possible role of the 5-HTlc receptor. [ABSTRACT FROM AUTHOR]

Bullying is common in schools and is often seen as an inevitable part of school life. Children who are bullied tend to be more anxious and insecure than their peers. We report the case of a 13-year-old boy who was bullied from the age of 9 and presented to the local Child and Adolescent Mental Health Team (CAMHS) with a psychotic depression. Clinical improvement and re-integration into school was achieved by use of psychotropic medication and work on building self-esteem so that the patient could assert himself, both with peers and adults. There is evidence suggesting that children and adolescents who are bullied have increased rates of referral to the CAMHS, particularly with symptoms of depression. (Int J Psych Clin Pract 2000; 4:73-75). [ABSTRACT FROM AUTHOR]

Presents a story of a psychiatrist who occasionally gets summoned for medical emergency situations.

This paper discusses the research supporting the use of multi-source feedback (MSF) for doctors and describes the mini-Peer Assessment Tool (mini-PAT), the MSF instrument currently used to assess trainees in child and adolescent psychiatry. The relevance of issues raised in the literature about MSF tools in general is examined in relation to trainees in child and adolescent psychiatry as well as the appropriateness of the mini-PAT for this group. Suggestions for change including modifications to existing MSF tools or the development of a specialty-specific MSF instrument are offered., Competing Interests: Declaration of interest None.