Child and Adolescent Psychiatry

Child and adolescent mental health represents a critical area of psychiatric practice, with many adult mental disorders having their onset in childhood or adolescence. Early identification and intervention significantly improves long-term outcomes.

ADHD (Attention-Deficit/Hyperactivity Disorder) is diagnosed using DSM-5 criteria requiring persistent inattention and/or hyperactivity-impulsivity that: is present in multiple settings (home and school), has onset before age 12, causes functional impairment, and is not better explained by another condition. Three presentations are specified: predominantly inattentive, predominantly hyperactive-impulsive, and combined. Non-pharmacological interventions (psychoeducation, parent training, environmental modifications, CBT for older children) are the recommended first-line treatment, particularly in younger children. In NZ, methylphenidate is funded through Pharmac following assessment and diagnosis by a paediatrician or child psychiatrist. A mandatory Pharmac ADHD audit ensures prescribing is appropriate and regularly reviewed. Atomoxetine and lisdexamfetamine are also funded but require special authority.

Autism Spectrum Disorder (ASD) presents with persistent deficits in social communication and interaction, and restricted, repetitive patterns of behaviour, interests, or activities. Early signs include limited joint attention, reduced gaze contact, absent babbling or words by 12 months, and social withdrawal. Formal diagnosis in NZ requires multidisciplinary assessment. Disability support services (Whaikaha — Ministry of Disabled People) may provide funded support once a formal ASD diagnosis is established.

Conduct disorder involves a persistent pattern of behaviour violating the rights of others or major societal norms (aggression, destruction, deceitfulness, serious rule violations). It is more common in males and associated with ADHD, trauma, and socioeconomic disadvantage. Untreated, conduct disorder is a risk factor for adult antisocial personality disorder.

Adolescent development is characterised by identity formation (Erikson's stage of identity vs role confusion), peer group importance, increased risk-taking behaviour (related to prefrontal cortex immaturity), and vulnerability to depression and anxiety. School refusal (emotionally based school non-attendance) may reflect separation anxiety, social anxiety, depression, bullying, or learning difficulties; management requires a school-family-clinician collaboration.

Child maltreatment recognition is a mandatory skill. Types include physical abuse, sexual abuse, emotional abuse, and neglect (the most common form). Warning signs include unexplained injuries, injuries inconsistent with developmental stage, delayed presentation, changing or implausible history, and pattern injuries (e.g., loop-shaped bruising from belt). In NZ, all health practitioners have a mandatory reporting obligation under the Oranga Tamariki Act 1989 (Children's and Young People's Well-being Act) to report concerns about children at risk of harm. The threshold is reasonable grounds to suspect — certainty is not required.