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Child and Adolescent Psychiatry
The branch of psychiatry that specializes in the study, diagnosis, treatment, and prevention of psychopathological disorders of children, adolescents, and their families. Child and Adolescent Psychiatry encompasses the clinical investigation of phenomenology, biologic factors, psychosocial factors, genetic factors, demographic factors, environmental factors, history, and the response to interventions of child and adolescent psychiatric disorders (Kaplan and Saddock).

History
An important antecedent to the specialty of child psychiatry was the social recognition of childhood as a special phase of life with its own developmental stages, starting with the neonate and eventually extending through adolescence. Kraepelin's psychiatric taxonomy published in 1883, ignored disorders in children. Johannes Trüper founded a famous approved school on Sophienhöhe close to Jena in 1892 and was a co-founder of "Die Kinderfehler"(1896), one of the leading journals for research in pedagogy and child psychiatry in its time. The psychiatrist and philosopher Theodor Ziehen regarded as one of the pioneers of child psychiatry, gained practical child psychiatric experience as a consultant liaison psychiatrist at the approved school which was run by Johannes Trüper. Wilhelm Strohmayer, another psychiatrist from Jena, also belongs to the founding fathers of child psychiatry in Germany with his book "Vorlesungen uber die Psychopathologie des Kindesalters für Mediziner und Pädagogen"(1910) which is based on his consultant work on Sophienhöhe. As early as 1899, the term 'child psychiatry' (in French) was used as a subtitle in Manheimer's monograph Les Troubles Mentaux de L'Enfance. However, the Swiss Moritz Tramer (1882-1963) was probably the first to define the parameters of child psychiatry in terms of diagnosis, treatment, and prognosis within the discipline of medicine, in 1933. In 1934, Tramer founded the Zeitschrift für Kinderpsychiatrie (Journal of Child Psychiatry), which later became Acta Paedopsychiatria. The first academical child psychiatry department in the world was founded by Leo Kanner in 1930 under the direction of Adolf Meyer at the Johns Hopkins Hospital, Baltimore. Dr. Kanner was the first physician to be identified as a child psychiatrist in the US and his textbook, Child Psychiatry (1935), is credited with introducing the specialty to the academic community. The first use in English of the term "child psychiatry" occurred when Leo Kanner published his textbook under that name in the USA in 1935. Academical child psychiatry in US was born at Johns Hopkins University. Its founding father, Leo Kanner, a medical graduate of the University of Berlin, was brought to Johns Hopkins by Adolf Meyer in 1928. Eight years later, Kanner offered the first formal elective course in the subject here. But it wasn't until the 1960s that the first NIH grant to study pediatric psychopharmacology was awarded. It went to one of Kanner's students, Leon Eisenberg, the second director of the division.

The use of medication in the treatment of children also began in the 1930s, when Charles Bradley opened a neuropsychiatric unit and was the first to use amphetamine for brain-damaged and hyperactive children.

Academic divisions of child psychiatry began to develop, particularly in the USA, in the 1930s. The first 'pediatric psychiatry clinic' was established in 1930 at Johns Hopkins Hospital,Baltimore, headed by Leo Kanner. In 1933, The Maudsley Hospital in London opened a children's department under Mildred Creak, and research in child psychiatry began to increase. Similar overall early developments took place in many other countries. In the United States, Child and Adolescent Psychiatry was established as a recognized medical speciality in 1953 with the founding of the American Academy of Child Psychiatry, but was not established as a legitimate, board-certifiable medical speciality until 1959.

The era since the 1980s flourished, in large part, because of contributions made in the 1970s, a decade during which child psychiatry witnessed a major evolution as a result of the work carried out by Michael Rutter. The first comprehensive population survey of 9-to 11-year-olds, carried out in London and the Isle of Wight, which appeared in 1970, addressed questions that have continued to be of importance for child psychiatry; for example, rates of psychiatric disorders, the role of intellectual development and physical impairment, and specific concern for potential social influences on children's adjustment. This work was influential, especially since the investigators demonstrated specific continuities of psychopathology over time in their subsequent re-evaluation of the original cohort of children (unsurprisingly since the environments that nurtured their emotional and developmental difficulties remained largely unchanged). It was paralleled by similarly work on the epidemiology of autism that was to enormously increase the number of children diagnosed with autistism in future years. Although attention had been given in the 1960s and 1970s to the classification of childhood psychiatric disorders, and some issues had then been delineated, such as the distinction between neurotic and conduct disorders, the nomenclature did not parallel the growing clinical knowledge. It was claimed that this situation was altered in the late 1970s with the development of the DSM-III system of classification, although research has shown that this system of classification has problems of validity and reliability. Since then, DSM-IV and DSM-IVR have corrected some of the questionable parsing of psychiatric disorders into "childhood" and "adult" disorders, recognizing that while many psychiatric disorders are not diagnosed until adulthood, they may present in childhood or adolescence (DSM-IV).

Practice
The child and adolescent psychiatrist uses a knowledge of biological, psychological, and social factors in working with patients. Initially, a comprehensive diagnostic examination is performed to evaluate the current problem with attention to its physical, genetic, developmental, emotional, cognitive, educational, family, peer, and social components. The child and adolescent psychiatrist arrives at a diagnosis and diagnostic formulation which are shared with the patient and family. The child and adolescent psychiatrist then designs a treatment plan which considers all the components and discusses these recommendations with the child or adolescent and family. An integrated approach may involve individual, group or family psychotherapy; medication; and/or consultation with other physicians or professionals from schools, juvenile courts, social agencies or other community organizations. In addition, the child psychiatrist is prepared and expected to act as an advocate for the best interests of children and adolescents. Child and adolescent psychiatrists perform consultations in a variety of settings (schools, juvenile courts, social agencies).

Training
Child and adolescent psychiatric training requires 4 years of medical school, at least 3 years of approved residency training in medicine, neurology, and general psychiatry with adults, and 2 years of additional specialized training in psychiatric work with children, adolescents, and their families in an accredited residency in child and adolescent psychiatry.

Certification and Continuing Education
In the US, having completed the child and adolescent psychiatry residency and successfully passing the certification examination in general psychiatry given by the American Board of Psychiatry and Neurology (ABPN), the child and adolescent psychiatrist is eligible to take the additional certification examination in the subspecialty of child and adolescent psychiatry. Although the ABPN examinations are not required for practice, they are a further assurance that the child and adolescent psychiatrist with these certifications can be expected to diagnose and treat all psychiatric conditions in patients of any age competently.

Shortage of Child and Adolescent Psychiatrists
The demand for child and adolescent psychiatrists continues to far outstrips the supply worldwide. There is also a severe maldistribution of child and adolescent psychiatrists, especially in rural and poor, urban areas where access is significantly reduced (Academic Psychiatry 2003). There are currently only approximately 6,500 practicing child and adolescent psychiatrists in the United States. A report by the U.S. Bureau of Health Professions (2000) projected a need in the year 2020 for 12,624 child and adolescent psychiatrists, but a supply of only 8,312. In its 1998 report, the Center for Mental Health Services estimated that 9-13% of 9- to 17-year-olds had serious emotional disturbances, and 5-9% had extreme functional impairments. However, in 1999, the Surgeon General reported that "there is a dearth of child psychiatrists." Only 20% of emotionally disturbed children and adolescents received any mental health treatment, a tiny percentage of which was performed by child and adolescent psychiatrists. Furthermore, the U.S. Bureau of Health Professions projects that the demand for child and adolescent psychiatry services will increase by 100% between 1995 and 2020.

Criticisms
Critics of psychiatry often argue that psychiatric diagnosis lacks “objectivity,” particularly when compared with diagnosis in other medical specialties. However, when one examines interrater reliability—an important component of objectivity—the agreement among psychiatrists for several major psychiatric disorders are generally on a par with those in other medical specialties. Nonetheless, in psychiatry as in all of general medicine, there is an irreducible element of the subjective. That is part of the “art” of medical and psychiatric practice (Pies 2007). Traditional deficit and disease models of child psychiatry have been criticised as rooted in the medical model which conceptualises adjustment problems in terms of disease states. It is said by these critics that these normative models explicitly characterise problematic behavior as representing a disorder within the child or young person and these commentators assert that the role of environmental influences on behaviour has become increasingly neglected, leading to a decrease in the popularity of, for example, family therapy. There are criticisms of the medical model approach from within and without the psychiatric profession (see references): it is said to neglect the role of environmental, family, and cultural influences, to discount the psychological meaning of behaviour and symptoms, it promotes a view of the "patient" as dependent and needing to be cured or cared for and therefore undermines a sense of personal responsibility for conduct and behaviour, it also promotes a normative conception based on adaptation to the norms of society (the ill person must adapt to society), and is based on the shaky foundations of reliance on a classificatory system that has been shown to have problems of validity and reliability (Boorse, 1976; Jensen, 2003; Sadler et al. 1994; Timimi, 2006).

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