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Principles of treatment in child and adolescent psychiatry

Once a comprehensive assessment has been completed, the child and parents need to be involved in drawing up a treatment plan. The successful rate of treatment will depend on the extent to which they feel their wishes, fears and anxieties have been addressed during the initial meetings. It is useful for the therapists and the family/child to set out some targets for what will be seen as a successful outcome of treatment.

Diagnostic labels are helpful if parents and the child have an understanding of the criteria used for making a diagnosis and its potential for treatment. Caution needs to be exercised, however, as diagnostic labels can be seen as stigmatizing and parents often withdraw from treatment for fear of being ‘labelled’. Diagnosis has potential benefits as it is a concise way in which information, regarding the nature, origin and prognosis for a particular child, can be conveyed. It also allows for special provisions to be made to meet the child’s needs (special school, statementing). Clinical governance, the framework through which NHS organizations are held accountable for the quality of services, has emphasized the need for evidence-based practice. The National Institute for Clinical Effectiveness has produced guidelines for the diagnosis and management of ADHD with particular reference to the use of stimulants (Techology Appraisal Guidance No. 13 National Institute for Clinical Excellence).

There is fairly strong evidence of efficacy for the use of medication in hyperkinesis, parent training in conduct disorders and family therapy in the treatment of anorexia in adolescents. Behaviour treatments for soiling and enuresis have also been found to be effective. On the other hand, there is very little evidence that the use of tricylics in adolescent depression and social skills’ therapy in clinic settings for peer relationship problems are effective.

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