Table Of ContentP
Primary Child and Adolescent Mental Health Volume I r
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A PRACTICAL GUIDE a
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Second Edition y
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Volume I:Overview • General issues h
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Rewritten with the new primary care environment in mind, this greatly expanded and updated d
edition of Child Mental Health in Primary Careextends the structured approach of the first a
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edition to adolescent mental health. As in the first edition, Primary Child and Adolescent Mental
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Healthcovers each problem in a uniform way, offering definitions, assessment outlines, detailed
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management options and indications for referral. Numerous case examples further illuminate
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aspects of many conditions. o
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Comprehensive and practical, the forty-eight chapters of Primary Child and Adolescent Mental s
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Healthcover the full range of difficulties and disabilities affecting the mental health of children e
and young people. The book is divided into three volumes, and can either be read from cover to n
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cover or used as a resource to be consulted for guidance on specific problems.
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This book is vital for all healthcare professionals including general practitioners, health visitors e
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and other staff working in primary care to assess, manage and refer children and adolescents
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with mental health problems. School medical officers, social workers and educational a
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psychologists, many of whom are in the frontline of mental health provision for children and H
young people, will also find it extremely useful. e
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Reviews of the first edition Other books of related interest Primary
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'This very comprehensive and detailed book THE OTHER SIDE OF ADHD e
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provides the tools for primary care health Attention Deficit Hyperactivity Disorder o
professionals not only to assess a child's exposed and explained n Child and Adolescent
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needs but in many cases also to implement Angela Southall
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an initial package of care.' d
JUST FOR NURSES LISTENING TO CHILDREN AND YOUNG itio Mental Health
PEOPLE IN HEALTHCARE CONSULTATIONS n
'I have no reservation in recommending the Edited by Sarah Redsell and Adrian Hastings
book to all people working with children and
families in any capacity. An important training DIFFICULT CONSULTATIONS WITH AQ
text for a variety of professions. A very ADOLESCENTS lisoue A PRACTICAL GUIDE
effective text to be used in daily practice for Chris Donovan and Heather Suckling nn
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quick reference.' with Zoe Walker, Janet Bell, Tami Kramer a S
CHILD AND ADOLESCENT MENTAL HEALTH and Sheila R Cross viep
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'This book is well produced and clearly INCREDIBLY CARING (DVD) Jede
written. A useful book for anyone interested or Department for Children, Schools and Families nr,
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involved with children.' FAMILY PRACTICE yu
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'I looked through the book again and again urith Quentin Spender
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but could not find anything missing.' ha
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K28202 y, Alison Davies Volume I
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Child Mental Health in
Primary Care
Quentin Spender, Niki Salt,
Judith Dawkins, Tony Kendrick and Peter Hill
Forewords by
David Hall
Professor of Community Paediatrics
Institute of General Practice and Community Health Trust
Sheffield
and
Jackie Carnell
Director
Community Practitioners’ and
Health Visitors’ Association
Cartoons © 2001 Dave Colton www.cartoonist.net
Chapter 3 © 2001 Sangeeta Patel
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742
© 2001 by Quentin Spender, Niki Salt, Judith Dawkins, Tony Kendrick and Peter Hill
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Contents
Forewords v
Preface viii
List of contributors ix
Part 1 Introduction 1
1 Assessment in child mental health 3
2 Referral, consent and confidentiality 15
3 Cultural and ethnic issues 35
Sangeeta Patel
Part 2 Problems that may present at any age 47
4 Temperament and resilience 49
5 Disorders of language and social development 57
6 Behaviour problems 67
7 Family issues 91
8 Separation, divorce and reconstituted families 101
9 Chronic paediatric illness 111
10 Effects of parental mental illness on children and families 115
11 Child abuse 121
12 Sexualised behaviour 135
13 Post-traumatic stress disorder and adjustment disorder 139
14 Death, dying and bereavement 143
15 Imaginary friends, voices and psychosis 149
Part 3 Problems that may present in the first few years 155
16 Postnatal depression 157
17 Crying and colic 169
18 Feeding problems in pre-school children 179
19 Sleep problems 189
20 Breath-holding 199
21 Head-banging and body-rocking 201
Part 4 Problems that may present in school-age children 205
22 Attention-deficit hyperactivity disorder 207
23 Specific and generalised learning disability 229
iv Contents
24 Bullying 237
25 Enuresis 243
26 Faecal soiling/encopresis 251
27 Obsessive-compulsive disorder 257
28 Anxiety, worry, fears and phobias 261
29 School refusal 265
30 Recurrent abdominal pain 271
31 Physical presentations of emotional distress 277
32 Tics and Tourette’s syndrome 281
Part 5 Problems that present mainly in adolescence 287
33 Depression 289
34 Overdose and other self-harm 297
35 Eating disorders 305
36 Chronic fatigue syndrome 315
37 Substance misuse 321
Part 6 Detailed treatment options 325
38 Behavioural techniques for use by enthusiastic professionals
in primary care 327
39 Formulary 349
Foreword
I saw my first child psychiatry case as a second year medical student. A mother brought
her three-year-old son to the clinic, with the apparently trivial complaint that he was
taking things out of her handbag. It took the psychiatrist just a few moments to ascertain
that his father was in Wandsworth gaol for burglary, and his mother was convinced that
the boy was already embarking on a life of crime. I was deeply impressed. I know now
that few cases are so purely psychological and that few are so easily solved, but most
paediatric problems have a psychological dimension. Unless these are addressed, the
consultation will fail to satisfy either parents or the child.
Every primary care physician and every paediatrician must be familiar with the
psychological problems and psychosomatic disorders of childhood. This knowledge is
not an optional extra, but an essential part of everyday practice. Without it, many
opportunities will be lost to relieve anxiety, intervene promptly for serious problems, and
avoid unnecessary investigations for non-existent organic disease.
I have over the years accumulated a large collection of books on child psychiatry and
psychology, but until now I had never found one that I could confidently recommend to
our junior doctors training for general practice or paediatrics. I wanted one that offered
a theoretical basis for its approach, without being too abstruse; a common sense approach
that recognised the realities of clinical consultations; some guidance as to what is or is
not suitable for the non-specialist to tackle without referral; and short snappy chapters
that could be accessed quickly. At last, here is a book that matches that specification.
The Audit Commission recently reviewed services for child mental health problems
across the country and revealed some very disturbing facts. Most striking was the
remarkable disparity between districts in the provision made for these children. There is
an obvious need for greater investment in this area. But part of the reason for the
inadequacy of services and the long waiting lists is the tendency to refer every problem
straight to the child psychiatry team, without considering if there might be a solution
that could be applied by the non-specialist. If general practitioners and general paedi-
atricians equip themselves with the basic skills and knowledge outlined in this book,
the rate of referral will go down, parents and children will be more satisfied, and the
specialist teams will be able to concentrate on those more complex, baffling or intract-
able cases that really need their skills.
Every trainee in general practice and in paediatrics should buy this book, read it, and
read it again. And those whose job it is to teach them will need a copy as well.
David Hall
Professor of Community Paediatrics
Institute of General Practice and Community Health Trust
Sheffield
November 2000
Foreword
The recent strong emphasis by government ministers on the importance of primary
care, as outlined in the NHS Plan and the White Paper Saving Lives, Our Healthier
Nation, provides the perfect backdrop for this excellent book Child Mental Health in
Primary Care.
Having read this book with great interest, I am convinced that it will quickly become
a standard text for health visitors, school nurses and community practitioners because
of the wide and embracing scope adopted by the distinguished band of contributors and
through the excellent use of case studies.
Having had more than 20 years’ experience in this field, both as a health visitor and
now as a manager, I know that child mental health issues are ones on which primary
care professionals spend much time and energy. And it is by tackling these issues in a
sensitive way that many long-term problems affecting the child and family can be
overcome.
Children develop at a bewilderingly fast rate. The contributors cover the problems that
may arise in the early years, through to the school-age years when, for example, bullying
may occur, and on to the emotional minefield of ‘being a teenager’, when depression,
substance abuse and eating disorders could come to the fore. With the aid of case studies,
the book lays out strategies that could be adopted to resolve the child’s distress and
provide support structures for the family as a whole. It also approaches cultural and
ethnic issues, appropriate for a multi-cultural society.
The book’s common sense and straightforward direction can only inspire confidence
in the health professional, many of whom are hard-pressed with giant caseloads to deal
with. It will contribute to greater understanding and this in turn will facilitate smoother
team work within the primary care setting. The more that health visitors are able to
understand the complexity of child mental health issues, the fewer the families that will
need to be referred to the specialist services.
I know, remembering my days as a health visitor, that I would have greatly appre-
ciated and benefited from having a book such as this on my desk. It is comprehensive,
easy-to-read and thankfully free from the liberal use of jargon that sometimes bedevils
such publications.
The excellence of this book, however, can’t disguise the fact that the campaign for
enough resources to sustain and develop work in this field must continue. Under the NHS
Plan, more money and more staff are promised and this is to be greatly welcomed. But
there will be the inevitable struggle by competing priorities for their share of additional
resources, and those of us working in primary care must be conscious of this.
Foreword vii
I was pleased to have been asked to write this foreword as the subject goes to the very
core of what we, at the Community Practitioners’ and Health Visitors’ Association,
believe in and promote on a daily basis. Every health professional working in primary
care is well advised to study this book at some stage, preferably sooner rather than later.
It will increase their circle of knowledge.
Jackie Carnell
Director
Community Practitioners’ and
Health Visitors’ Association
November 2000
Preface
This book aims to help general practitioners, health visitors and other professionals
working in primary care settings to assess, manage and refer children and adolescents
with mental health problems. Recent reorganisations in the health service in the UK
have encouraged the provision of services at the primary care level, rather than
exclusively within specialist services. Some parts of the book may also be useful for
school medical officers, social workers and educational psychologists, many of whom are
in the front line of mental health provision for children and young people.
The book is composed mainly of chapters with a uniform structure that is designed to
emphasise what can realistically be done in primary care. Each of these chapters starts
with an introduction, including definitions, and then proceeds to an outline of assess-
ment, followed by management options, and finally indications for referral. The
introductory chapters give an overview of general themes. Illustrative case examples are
included in almost all chapters, and most of these examples are based on real individual
cases, or amalgams of several cases.
We often use the terms ‘child or ‘children’ to refer to both children and adolescents. In
most places we refer to the child as ‘he’, except when the condition in question is more
common in girls. A single parent is usually referred to as ‘she’, but the comments should
be taken to include single fathers.
We are grateful to a number of colleagues who have advised us about the content of
some of the chapters. These include Professor David Candy, Deborah Fulford, Dr Pat
Hughes, Ann Kimber, Karen King, Dr Rebecca Park, Dr Josephine Richards, Julia Robb,
Dr Andrew Singleton, Dr Jean Sherrington and Dr Jeremy Turk.
QS, NS, JD, TK, PH
November 2000
List of contributors
Judith DawkinsMBBSBSCMRCPSYCH Sangeeta Patel MRCGPMA
Senior Lecturer in Child and Adolescent General Practitioner
Psychiatry Balham, London, UK
St George’s Hospital Medical School
Clinical Lecturer
London, UK
Department of General Practice and
Consultant in Child and Adolescent Primary Care
Psychiatry St George’s Hospital Medical School
Surrey Hampshire Borders NHS Trust London, UK
Guildford, UK
Niki Salt MBBSDCHMRCP(PAEDIATRICS) MRCGP
General Practitioner
Thurleigh Road Group Practice
Peter Hill MAFRCPFRCPSYCHFRCPCH
Professor of Child and Adolescent London, UK
Psychiatry
Hospital for Sick Children Quentin SpenderMBBSDCHMRCP
Great Ormond Street (PAEDIATRICS) MRCPSYCH
Senior Lecturer in Child and Adolescent
London, UK
Psychiatry
St George’s Hospital Medical School
London, UK
Tony Kendrick BSCMDMRCPSYCHFRCGP
Professor of Primary Medical Care Consultant in Child and Adolescent
Medical School, University of Psychiatry
Southampton Sussex Weald and Downs NHSTrust
Southampton, UK Chichester, UK
