Child Psychiatry

Child psychiatry, or medically based treatment of children's mental disorders, did not become prevalent until the 1900s. Before then, treatment of children had a long and varied history. Children with mental disorders have been blamed, tortured and ostracized for their behavior. The general zeitgeist of each time period was reflected in the treatment of its children.

In ancient Greece, children were cared for relatively well. The emphasis on intellectual and physical strength led people to educate their children, giving them knowledge and skills. Yet, unfortunate children who had mental or physical limitations were publicly tormented.

During the Roman Empire, poor children received harsh treatment. Their families often chose to sell, abandon or murder them, depending on their value to the family. Wealthy children were given education in athletics, poetry and art.

The Middle Ages were a particularly bad time for children. Any paintings of that time depicting children show that they were considered mini-adults, wearing adult clothing and displaying adult mannerisms. Adults were not concerned about children's development or education. Children were abandoned, sold into slavery or sent to work 13 hours a day. Girls were often forced into marriage in their pre-adolescent stage. Child mortality was high, and unwanted children were usually murdered.

Renaissance sensibility increased humanity toward children. Still, children with mental illness were considered possessed by the devil. Mortality rates were high, and child abuse was widespread. By the late 1600s in Europe, parents started to show affection toward their children and encourage their healthy development. Colonial Americans held on to the old ways, beating and starving their children, and legally putting them to death for stubbornness.

In the 18th century, children continued to work long hours, but a bill was submitted in the United States that limited the number of hours a child aged 9 to 18 could work. At the same time, publications about child development encouraged parents to use toys and games to foster the intellectual and physical growth of children.

The 1800's brought publications about child development from the medical field. They created an environment of improved child welfare. For the first time, hospitals developed interventions for children's mental conditions. Dorothea Dix lobbied state legislature, and succeeded in having them open 30 mental hospitals. At the same time, G. Stanley Hall of the Illinois Society of Child Study researched and published data about stages of development. The passage of laws about compulsory education led to the development of special education programs for children with mental limitations.

Child mental health treatment centers and child protective laws were innovations of the late 1800s. Lightner Witmer established the first psychology clinic in 1896 at the University of Pennsylvania. For the first time, childhood difficulties were assessed, treated and studied. By 1932, there were more than 200 child guidance clinics in America. While they were originally intended to treat juvenile offenders, they developed into treatment centers for all children.

By 2000, most child guidance clinics had been integrated into general community mental health clinics. Institutions offered numerous training programs for child psychology and specializations in child psychiatry.

Child psychiatry was first described in terms of diagnosis and treatment by Moritz Tramer, a Swiss doctor who founded the Journal of Child Psychiatry. At first, the nature vs. nurture argument was used to explain the course of psychopathology. Later on, the field incorporated Freud's psychoanalytic theory and Bowlby's attachment theory.

Psychopharmacology with children lacks a strong history of research. Children absorb, metabolize and eliminate drugs at different rates, so medications have to be calibrated according to weight and age. After puberty, the changing rates of metabolism make standardizing doses difficulty. Furthermore, some researchers have ethical reservations about testing medications on children.

In the 1930s, Benzedrine, a stimulant, became the first mental drug to be studied on children. It was widely used throughout the 1940s to improve school performance, but was replaced in popularity by Methylphenidate, or Ritalin, in the 1950s and 1960s. Stimulants continue to be the psychotropic drugs most frequently prescribed to children.

Neuroleptics, also known as antipsychotic agents, have been used since the mid-1960s. Major tranquilizers are used to treat hyperactivity and aggression. Side effects such as sedation and tremors are common, so these are best used in severe cases of psychosis.

Antidepressants have been used since the 1960s to treat children who display depression and anxiety. Despite their efficacy, they can be dangerous to adolescents, who become more prone to suicide during the initial phase of antidepressant use.

Child Psychiatry: Selected full-text books and articles

Ethical Issues in Mental Health Research with Children and Adolescents By Kimberly Hoagwood; Peter S. Jensen; Celia B. Fisher Lawrence Erlbaum Associates, 1996
Is There a Need for Observationally Based Assessment of Affective Symptomatology in Child and Adolescent Psychiatry? By Kaminer, Yifrah; Feinstein, Carl; Seifer, Ronald Adolescence, Vol. 30, No. 118, Summer 1995
Advanced Abnormal Child Psychology By Michel Hersen; Robert T. Ammerman Lawrence Erlbaum Associates, 2000 (2nd edition)
Librarian’s tip: Chap. 12 "Psychopharmacological Treatment"
Handbook of Infant, Toddler, and Preschool Mental Health Assessment By Rebecca DelCarmen-Wiggins; Alice Carter Oxford University Press, 2004
Librarian’s tip: Chap. 7 "Psychiatric Diagnosis in Preschool Children" and Chap. 12 "The Preschool Age Psychiatric Assessment (PAPA): A Structured Parent Interview for Diagnosing Psychiatric Disorders in Preschool Children"
The Bi-Personal Field: Experiences in Child Analysis By Antonino Ferro; Elizabeth Bott Spillius Routledge, 1999
Thinking about Children By D.W. Winnicott; Ray Shepherd; Jennifer Johns; Helen Taylor Robinson; Harry Karnac Addison-Wesley Pub., 1996
Librarian’s tip: Chap. 22 "Child Psychiatry: The Body as Affected by Psychological Factors [ca. 1931]," Chap. 27 "Training for Child Psychiatry: The Paediatric Department of Psychology [1961]," and Chap. 31 "Child Psychiatry, Social Work, and Alternative Care [1970]"
A Century of Psychiatry By Hugh Freeman Mosby, 1999
Librarian’s tip: "Environmental Influences on Child Psychiatry" begins on p. 81, and "Child Psychiatry since the 1980s" begins on p. 314
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