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
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