Paediatric psychopharmacology: special considerations
varies in children, increasing during the first year (or family history of Tourette syndrome), autism
and gradually falling until puberty. spectrum disorders, and severe mental retardation
(Table 46.2).
Protein-binding and volume of distribution: These
differ in children, affecting pharmacokinetics by Antipsychotics
modifying the fraction of drug that is active Second-generation antipsychotics (SGAs): These
(unbound) [6]. are prescribed most frequently, and include risperi-
done, quetiapine, aripiprazole, olanzapine, ziprasi-
Incomplete maturation of neurotransmitter done and amisulpride. They are dopamine receptor
system: The noradrenergic system does not fully blockers (hence they reduce positive symptoms
develop anatomically and functionally until early but can produce extrapyramidal symptoms and
childhood [7]. This may be one of the reasons hyperprolactinaemia) and 5HT-2A receptor
for poor antidepressant response in childhood blockers.
depression.
• Risperidone is the most used SGA; it is a potent
Cardiotoxicity: The rates of maturation of the dopamine D2 receptor blocker (hence produces
sympathetic and parasympathetic system vary, hyperprolactinaemia) and can lead to extrapyra-
although vagal and sympathetic modulations midal symptoms.
follow a similar pattern. This may lead to accen-
tuation of the relative loss of vagal modulation • Quetiapine is an effective SGA with a moderate
associated with tricyclic antidepressants [8]. effect on weight; it usually needs to be taken
at least twice daily because of relatively weak
MEDICATIONS receptor binding.
The dose ranges of the majority of psychotropics • Ziprasidone is the only SGA that is weight neu-
used in children and adolescents, with their main tral; however, it has a greater impact on cardiac
indications, are shown in Table 46.1. rhythm and the QTc interval.
Stimulants • Clozapine is used in those with resistant psy-
Stimulants have been used for decades and good choses or tardive dyskinesia, but can lead to
research evidence exists for their short-term use neutropenia, sialorrhoea and significant weight
in ADHD. More recently, various stimulant deliv- gain.
ery systems have been developed – the osmotic
controlled-release system (OROS), Concerta XL; • Olanzapine is used less in children and ado-
the wax matrix-based beaded system, Metadate lescents because of the propensity to weight
CD or Equasym XL; Focalin XL; the patch release gain and metabolic syndrome. Evidence from
system, Daytrana, etc. – resulting in long-acting adults suggests that clozapine, olanzapine and
preparations that make it possible to avoid the low-potency conventional antipsychotics such as
administration of medication in school, reducing chlorpromazine are associated with an increased
stigmatization and embarrassment. risk of insulin resistance, hyperglycaemia and
type 2 diabetes mellitus.
The release systems and preparation of stim-
ulants (proportion of immediate release vs slow • Aripiprazole is a dopamine partial agonist or
release) allows the tailoring of the long-acting dopamine stabilizer and also has actions at 5HT-
preparations to suit individual children [9]. 2A and D3 receptors, and partial agonism of
Stimulants are contraindicated in schizophrenia, 5HT-1A receptors. Symptoms may improve in
hyperthyroidism, cardiac arrhythmias, angina the first week, but it is recommended to wait 4–6
pectoris and glaucoma, and in patients with a weeks to determine efficacy, owing to the phar-
history of hypersensitivity. Stimulants can be used macokinetics of the drug. The mean elimination
with caution in hypertension, depression, tics half-life of aripiprazole is 75 hours, and 94 hours
for the major metabolite, dihydro-aripiprazole.
Little published evidence exists on its use in
managing non-psychotic disruptive behaviour in
developmental disorders, although clinical expe-
rience suggests that very small doses (2–5 mg
daily) are sufficient (Table 46.3).
288
Approaches to intervention
Table 46.1 Dose range of psychotropic medication used in children and adolescents.
Drug Dose range Target symptoms
Stimulants 5-60 mg/day Inattention, hyperactivity, impulsivity, and
Methylphenidate IR behavioural problems related to ADHD
18-72 mg/day
Concerta XL 10-60 mg/day
Equasym XL 10-60 mg/day
Medikinet Retard 2.5-40 mg/day
Dexamfetamine
Non-stimulant 1-1.2 mg/kg body weight/day
Atomoxetine
Tricyclic antidepressants <6 years: 10-20 mg/day Bedwetting, hyperactivity, impulsivity,
Imipramine, desipramine inattention
>6 years: 10-75 mg/day
Clomipramine 10-200 mg/day Obsessions, compulsions
SSRls
Fluoxetine 10-60 mg/day Depression (only fluoxetine approved),
Fluvoxamine 50-300 mg/day obsessions and compulsions (high doses may
Sertraline 25-150 mg/day be needed), self-injurious behaviour, and
Paroxetine 10-60 mg/day anxiety-related aggression in autism spectrum
Citalopram 10-60 mg/day disorder (low doses)
SNRI 37.5-150 mg/day Symptoms of ADHD in adults
High doses - psychosis, (hypo)mania
Venlafaxine Pre-pubertal: 0.5-8 mg/day Low doses (<1/3 of dose for psychosis) - tics,
Antipsychotic medication severe aggression and self-injury; risperidone
Haloperidol Post-pubertal: 1-16 mg/day in ASD with ADHD
50-600 mg/day
Clozapine∗ 0.25-6 mg/day Epilepsy, symptoms and prophylaxis of bipolar
Risperidone 2.5-20 mg/day illness
Olanzapine 25-300 mg/day
Quetiapine 1-15 mg/day Epilepsy, akathisia, sleep disorders
Aripiprazole (continued overleaf )
Anti-epileptic medication 5-10 mg/litre (serum level)
50-100 mg/litre (serum level)
Carbamazepine 0.5-4 mg/day
Sodium valproate
Clonazepam
289
Paediatric psychopharmacology: special considerations
Table 46.1 (continued)
Drug Dose range Target symptoms
Other
Lithium carbonate 0.4-1.0 mEq/litre (serum Bipolar disorder, aggression in the learning
level) disabled, augmentation in depression
Clonidine 0.05-0.4 mg/day Hyperactivity, impulsivity, inattention,
insomnia, tics, oppositionality, aggression in
ASD
Buspirone 10-45 mg/day Anxiety, hyperactivity, aggression
Melatonin 0.5-9 mg/day
Naltrexone 12.5-50 mg/day Sleep problems
Severe resistant self-injurious behaviour in
ASD
ADHD, attention-deficit hyperactivity disorder; ASD, autism spectrum disorder; SNRI, serotonin-norepinephrine reuptake inhibitor;
SSRI, selective serotonin reuptake inhibitor.
∗Only for psychosis and tardive dyskinesia.
Table 46.2 Specific side effects of stimulants.
Side effect Precautions Comment
Seizure No evidence of decreasing If seizures appear or worsen, change to
Growth retardation seizure threshold; can be used dexamfetamine; avoid atomoxetine
in well-controlled epilepsy
Advisable not to start stimulants in
Reduced height and weight children who are short or biologically
centiles possible over time predisposed to short stature
Cardiovascular Increases heart rate and blood High risk in those with structural cardiac
problems pressure - monitor regularly defects; monitor with ECG. Avoid
Adderall in cardiac high-risk groups
Abuse potential Possible abuse of stimulants by
others with access Self-initiated increase in dose by
emotionally unstable patients with
Psychotic symptoms Can induce or worsen psychotic substance use disorders is possible, and
experience should be monitored; atomoxetine,
bupropion or Concerta XL, (drug-delivery
system makes it difficult to abuse) can be
used
Avoid in those who have first-degree
relatives with a psychotic disorder or in
children who have psychotic or
quasi-psychotic experiences;
atomoxetine, tricyclic antidepressants,
clonidine, bupropion or risperidone can
be used
ECG, electrocardiography.
290
Approaches to intervention
Table 46.3 Specific side effects of selected psychotropic medication.
Drug Precautions Side effects
Non-stimulant Contraindicated in Growth retardation: reduction of two to
Atomoxetine hepatic impairment, three percentiles in mean height, and
(noradrenaline reuptake glaucoma, uncontrolled some weight loss
inhibitor) seizures, or a history of
hypersensitivity to drug; Seizure liability: not to be used in patients
Tricyclic antidepressants use with caution in with uncontrolled seizures, and should be
Imipramine, amitriptyline, hypertension, discontinued in those who develop or have
nortriptyline, tachycardia, an increased frequency of seizures
desipramine, cardiovascular problems,
clomipramine and patients with long Cardiovascular: increases heart rate (by
Newer antidepressants QT interval or family increasing noradrenergic tone) and small
SSRIS: fluoxetine, history of QT increase in blood pressure; QT interval
fluvoxamine, sertraline, prolongation, or prolongation
paroxetine, citalopram, cerebrovascular disease
escitalopram Suicide risk: monitor for signs of
SNRI: venlafaxine Use has declined due to depression, suicidal thoughts and
NRI: reboxetine, concerns of cardiac behaviour∗
mirtazapine arrhythmias and case
reports of sudden death Liver dysfunction: severe liver
injury—rare. Abnormal liver enzymes are
It is currently advised more common. Discontinue on first
that children or symptom or sign of liver dysfunction, e.g.
adolescents being pruritus, dark urine, jaundice, right upper
started on, or dose being quadrant tenderness or unexplained
increased of, flu-like symptoms
antidepressants should
be monitored closely for Cardiotoxicity, danger of accidental or
emergence or worsening intentional overdose, troublesome
of suicidal ideation or sedation, anticholinergic side effects,
behaviour lowered seizure threshold
Antidepressant-related suicidal ideation
and behaviour: consistently there has been
increased suicidal ideation with use of
antidepressants in childhood depression.
This has to be balanced with genuine
suicidal risk in untreated severe
depression†
Antidepressant-induced behavioural
activation: increased motor activity,
restlessness, excitability and impulsivity
that occurs usually early in treatment and
may be reduced by using the MED
principle; managed by reducing the dose,
and with a benzodiazepine for a few days
(continued overleaf )
291
Paediatric psychopharmacology: special considerations
Table 46.3 (continued)
Drug Precautions Side effects
Antipsychotic medication
FGAs: haloperidol, Monitor movement Extrapyramidal side effects such as
chlorpromazine disorders at baseline and tardive dyskinesia are more common in
regularly during FGAs. Aripiprazole and clozapine are
SGAs: risperidone, treatment useful in those who require antipsychotics
olanzapine, quetiapine, but have developed tardive dyskinesia
aripiprazole, ziprasidone, Monitor weight, waist
clozapine circumference, and BMI Hyperprolactinaemia: common with
at baseline and every 6 risperidone and FGAs
weeks; serum prolactin,
fasting lipids, fasting Risk of weight gain and metabolic
cholesterol, fasting dysfunction:
glucose, and liver
function tests at baseline High—clozapine, olanzapine
and every 6 months. Be
cautious if there is a Moderate— risperidone, quetiapine
family history of obesity,
dyslipidaemia, Low—amisulpride, aripiprazole,
early-onset ziprasidone
hypertension,
cardiovascular disease, Treatment of SGA-induced metabolic
cerebrovascular accident dysfunction: preventive healthy lifestyle
or diabetes counselling; regular monitoring of body
weight and metabolic variables;
cognitive-behavioural therapy and
motivational interviewing to address
unhealthy diet, physical inactivity, and
smoking; metformin therapy may become
necessary in severe cases
FGA, first-generation antipsychotic; MED, minimum effective dose; NRI, norepinephrine reuptake inhibitor; SGA,
second-generation antipsychotic; SNRI, serotonin-norepinephrine reuptake inhibitor; SSRI, selective serotonin
reuptake inhibitor.
∗A black box warning exists as a result of analyses showing more frequent suicidal ideation in clinical trials of
children treated with atomoxetine [10].
†In December 2003, the Committee on Safety of Medicines concluded that the evidence was adequate to establish
effectiveness only for fluoxetine in the treatment of depressive illness in children and adolescents, and advised
against the use of the other SSRIs [11]. The US Food and Drug Administration has insisted on black box warnings
for all SSRIs regarding the possibility of suicide-related behaviour as a side effect in children [12].
Mood stabilizers • Lamotrigine is especially useful when significant
Carbamazepine, sodium valproate, lamotrigine, depressive symptoms exist in bipolar disorder.
lithium carbonate and SGAs are mood stabilizers. Valproic acid markedly increases the half-life
of lamotrigine and the likelihood of developing
• Sodium valproate or valproic acid is the most severe drug rashes including Stevens–Johnson
used mood stabilizer and is best avoided in girls syndrome. Lamotrigine is to be started at very
of child-bearing age due to its teratogenic effects, low doses (as low as 5 mg/day) and increased
as well as possible side effect of polycystic ovar- slowly over a couple of months.
ian disease.
As antipsychotics, antidepressants and anti-
• Lithium use warrants regular blood level moni- manic agents are more closely associated with the
toring, which is often a problem in children.
292
Approaches to intervention
development of obesity and sexual/reproductive but they remain at present a promise for the future.
adverse events in African American patients, prac- Please see Chapter 41. A holistic biopsychoso-
titioners need to carefully weigh the risks/benefits cial formulation and management of the child’s
of prescribing psychotropic agents to African problem is essential as psychopharmacotherapy is
American children, taking into consideration only part of a package of care. Use of the MED
pre-existing/comorbid conditions or individual principle assists in titrating initial dose increments
risk factors for adverse reactions, especially when to the expected target dose based on treatment
multiple medications are prescribed [13]. response and emergent adverse effects. Paediatric
pharmacovigilance for psychotropic agents and
DRUG INTERACTIONS true long-term studies on efficacy and side effects
are essential. Evidence on treatment impact on
Detailed reviews of the cytochrome P450 enzyme comorbid disorders, cost-effectiveness and impact
system in children and guidelines for the prediction on quality of life is sparse and urgently needs to
of drug–drug interactions are available [14,15]. be addressed. Until such detailed data become
It is advisable to look through this list before available, it is safe to assume that paediatric pop-
prescribing concomitant medication. Terfenadine, ulations are at least as, or more, vulnerable to
ketoconazole, azetamazole and erythromycin, if adverse effects as adults.
co-administered with selective serotonin reuptake
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[15] Oesterheld JR, Shader RI. (1998) Cytochromes:
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294
Index
Index
action clonidine 290
infancy 19 haloperidol 289
lithium 290
adolescence risperidone 145
cultural influences 15 SSRIs 289
expressing grief in bereavement 93 alcohol 202
fostering resilience 78, 83 alcohol abuse 5
definition of resilience 79 alcohol use during pregnancy 155
mobilizing resilience 81–2 alkyl nitrate use 202
policy and practice 79–81 allele, definition 27
social and emotional development (SED) 57, amphetamine use 202
59 amygdala
social-cognitive development 62 impact of childhood mistreatment 121
mentalizing 63–4 anger
mentalizing in mid-adolescence 64–5 first year of life 42–3
anomalous parenting behaviours 88
adoption and fostering 100 anorexia nervosa (AN) 194, 278–9
adopted from care 101–2 binge-purging subtype (AN-BP) 194
foster children 100–1 restrictive subtype (AN-R) 194
infancy 100 anterior cingulate cortex (ACC) 123
treatment considerations 102–4 antisocial behaviour
interventions for attachment difficulties 103 maltreated children 117
antisocial personality disorder (ASPD) 219
adrenocorticotropic hormone (ACTH) 108 anxiety 277–8
affective social processes prevention programmes 75
anxiety disorders 169, 173
infancy 19 aetiology
age of mother 5 genetics 170
agreeableness 218 life events 171
aggression neurobiology 171
parent–child interactions 171
conduct disorder 175, 176 social adversity 171
in the home 251 temperament 170
problematic SED 60 assessment 171–2
resulting from bereavement 92 diagnosis 169–70
resulting from maltreatment 124 epidemiology 170
sibling influences 10
treatment 287
atypical antipsychotics 178
buspirone 173
buspirone 290
Child Psychology and Psychiatry: Frameworks for practice, Second Edition. Edited by David Skuse, Helen Bruce,
Linda Dowdney and David Mrazek.
2011 John Wiley & Sons, Ltd. Published 2011 by John Wiley & Sons, Ltd.
295
Index
anxiety disorders (continued) diagnostic classification 224–5, 226–7
prevention 173 epidemiology 153–4
prognosis 172 management 156
treatment 172 treatment 156
cognitive behavioural therapy (CBT) 172
family therapy 173 medication 156–7
medication 173 non-stimulants 158
other psychotherapies 172–3 other interventions 159
psychosocial interventions 158
arginine vasopressin (AVP) 108 school interventions 158–9
aripiprazole 288, 289 stimulants 157–8
attention skills
bipolar disorder 212 development from birth to five years 35–6
arousal authoritarian parenting style 4
authoritative parenting style 4
infancy 19 autism spectrum disorders (ASDs) 141
array-based comparative genomic hybridization aetiology 142
assessment and investigation 144
(aCGH) 39–40 associated disorders 142
Asperger syndrome 142 course and prognosis 145
Assessment Checklist for Children (ACC) 101 diagnosis 142–3
parental concerns 143
maltreated children 102 differential diagnosis 143–4
atomoxetine management and intervention 144
medication 144–5
attention deficit hyperactivity disorder practice points 145
(ADHD) 156, 158 prevalence 141–2
avoidant personality disorder 220
attachment 14–15 Avoidant type attachment 86, 87
attachment behaviour 85, 90
base pair (bp), definition 27
interventions 89 behavioural disorders 175, 178
fostered and adopted children 90, 103
preventive 89–90 aetiology 176–7
definition 175
maltreated children 102 epidemiology 176
variations in attachment prevention and treatment 177–8
subtyping 175–6
causes of variation 86–8 benzodiazepines
consequences 89 anxiety disorders 173
disorders 89 bereaved children 92, 95
normative patterns 86 assessments
attachment bond 85
attachment theory at death 96
definition 85–6 immediately after death 97
Attachment, Self-Regulation and Competency longer term 98
pre-death 96
(ARC) framework 103 short term 97
attention expressing grief 92
adolescence 93
infancy 18 early childhood 92
neuropsychological assessment 236, 240 middle childhood 92–3
attention deficit hyperactivity disorder (ADHD) factors influencing outcome 94
interventions
143, 153
aetiology 154–5
clinical course 159
cognitive and neurobiological correlates 155
diagnostic assessment 155
child information and observation 155–6
information from parents 155
key areas 155
physical examination 156
report from school 156
296
Index
help for parents 95 attention deficit hyperactivity disorder
needs of children 94 (ADHD) 156
role of professionals 95
service for children 95 buspirone 290
theoretical and cultural influences 94 anxiety disorders 173
psychopathology 93
resilience and positive outcomes 93 cannabis use 202
understanding of death 92 carbamazepine 289
Binge Eating Disorder (BED) 194 catechol O-methyltransferase (COMT)
biological influences see genetic and biological
attention deficit hyperactivity disorder
influences on children (ADHD) 154
bipolar disorder 210
COMT gene 25
see also depression cerebellum
assessment 211
clinical characteristics 210–11 impact of childhood mistreatment 121–2
diagnostic classification 225–6 child abuse see maltreated children
diagnostic criteria 210 child protection 119
differential diagnosis 211 childcare, professional 5–6
epidemiology 211 Children’s Yale–Brown Obsessive Compulsive
longitudinal course and prognosis 211–12
suicide risk 212 Scale (CY-BOCS) 162
treatment 212 chronic fatigue syndrome (CFS) 148
citalopram 289
acute phase 212–13
depressive phase 213 somatization and somatoform disorders 151
psychological treatments 213–14 clomipramine 289
refractory cases 214
body mass index (BMI) 197, 198 autism spectrum disorders (ASDs) 145
borderline personality disorder (BPD) 219 obsessive–compulsive disorder (OCD) 165,
Bowlby–Ainsworth model of attachment 14
brain 166
impact of childhood mistreatment on clonazepam 289
clonidine 290
development 121
amygdala and hippocampus 121 attention deficit hyperactivity disorder
corpus callosum and other white matter (ADHD) 156
122 – 3 clozapine 288, 289
prefrontal cortex and cerebellum 121–2 cocaine use 202
impact of childhood mistreatment on function cognitive behavioural therapy (CBT) 265, 269
123 adopted or fostered children 103
event-related potential (ERP) studies 123–4 anxiety 75
fMRI studies 123 anxiety disorders 172
regions involved in mentalizing 62–3 attention deficit hyperactivity disorder
Brazelton Behavioural Assessment Scale 70
brothers and sisters see siblings, effect on (ADHD) 158
basic premises 265–7
development 9
bulimia nervosa (BN) 194, 279 core steps 266
key childhood cognitions 266
non-purging subtype (BN-NP) 194 bereaved children 93
purging subtype (BN-P) 194 depression 74
bullying 6 developmental considerations 267
siblings 11 eating disorders 199
bupropion obsessive–compulsive disorder (OCD) 163–5
recent advances 267–9
stress 112
substance misuse 206
cognitive development
birth to five years 36–9
community influences on children 6
297
Index
competitiveness epidemiology 187
middle childhood 58–9 management 189
managing associated comorbidities 189–90
complex condition, definition 27 outcomes 189
complicated traumatic grief (CTG) 93, 94 parental 4–5
comprehension strategies 48 preventing relapse 190
concerta XL 289 prevention programmes 74
conduct disorder (CD) 175 desipramine 289
development
aetiology 176–7 birth to five years 32
definition 175
epidemiology 176 clinical decision-making and developmental
prevention and treatment 177–8 delay 37–8, 39
subtyping 175
configurations of risk 7 developmental domains 33–9
conscientiousness 218 developmental examination 32–3
copy-number variations (CNVs) 24 diagnosis and management 40
autism spectrum disorders (ASDs) 142 indicators of abnormal development 32,
definition 27
corpus callosum (CC) 37 – 8
impact of childhood mistreatment 122–3 medical investigations 39–40
corticotropin-releasing hormone (CRH) 108 physical examination 39
co-sleeping 15 first year of life 41–2, 43–4
crying crying 42
first year of life 42 fear 43
cultural influences on children 13, 16 smiling 42
see also ethnicity surprise, anger and sadness 42–3
adolescence 15 developmental domains 33
childhood and parenting across cultures attention skills 35–6
cognitive development 36–9
13 – 14 drawing 34, 35
development niche and ecocultural pathways gross motor 33
imitating and copying cube models 34, 35
13 language and communication 34, 36
infancy object concepts and relationships 34, 35
play and social behaviour 34–5, 37
attachment 14–15 visual, eye-hand coordination and problem
co-sleeping 15
developmental stages 14 solving 34
neurobehavioural development 20–1 developmental examination 32
parental involvement in play and learning
history-taking 32–3
15 observation and interactive assessment 33
mental health 15–16 dexamfetamine 289
middle childhood 15 attention deficit hyperactivity disorder
cytochrome P450 2D5 gene 263
poor substrate metabolizers 263 (ADHD) 156, 157
ultra-rapid substrate metabolizers 263 diagnostic classification 224–5
deficits in attention, motor skills and perception ADHD 224–5, 226–7
(DAMP) 143 bipolar disorder 225–6
current issues 226
deletion mutation, definition 27 disruptive disorders 227
dependent personality disorder 220–1 progress 227
depression 187, 278 self-injury 227
diploid number, definition 27
see also bipolar disorder disinhibited behaviour 102
aetiology 187–8 Disorganised type attachment 86, 87
diagnosis 189
298
Index
divorce of parents 5 neuropsychological assessment 236–7, 243
DNA 23–4 expressive language 46
expressive SLI (E-SLI) 182
definition 27 expressive–receptive SLI (ER-SLI) 182
genomic regulation 24–5 extraversion 218
genomic variation 24 eye movement desensitization and reprocessing
drug abuse 5
dyslexia 134–5 (EMDR)
dyspraxia 143 adopted or fostered children 103
stress 112
eating disorders
adolescence family and systemic influences on children 3–4
assessment 197 changing family patterns 5
cognitive behavioural therapy (CBT) 199 separation and divorce 5
diagnosis and classification 194–5 single parents and step parents 5
epidemiology and aetiology 195 childcare and schooling 5–6
formulation 196 culture 13–14
future directions 199 parental involvement in play and learning 15
management 196 parent and family characteristics 4–5
medical aspects 197–8 siblings 8
psychiatric aspects 198–9 adjustment 10
risk factors 195 development of social understanding 9–10
risk factors, high 196 individual relationships 9
infancy 128, 132 intervention programmes 11
assessment 130, 131 parent–child relationships 9
diagnosis 129–30 peers 10–11
presentation 128–9 social and environmental factors
risk evaluation 130–2 multiple stressors 6–7
treatment 132 neighbourhood and community contexts 6
poverty and social disadvantage 6
Eating Disorders Examination (EDE) 195
Eating Disorders Not Otherwise Specified family therapy assessment 255, 258
definition 255
(EDNOS) 194 general principles 256
ecstasy use 202 goals 256–7
education process 257–8
research assessment tools 258
maltreated children 117 types 255–6
electroconvulsive therapy (ECT)
family-focused therapy (FFT) 213
bipolar disorder 213 fear
emotional abuse of children 115
emotional development see social and emotional first year of life 43
feeding disorders see eating disorders
development (SED) fluoxetine 289
encopresis 278
epigenetic variation 26 anxiety disorders 173
autism spectrum disorders (ASDs) 145
definition 27 depression 189
equasym XL 289 somatization and somatoform disorders 151
ethnicity 16 fluvoxamine 289
anxiety disorders 173
see also cultural influences on children obsessive–compulsive disorder (OCD) 166
mental health 15–16 fostering see adoption and fostering
event-related potential (ERP) fragile-X syndrome 142
maltreated children 123–4 FRIENDS for life 75
obsessive–compulsive disorder (OCD) 163,
299
165
executive function
Index
friendships cultural influences
role of child’s siblings 10–11 attachment 14–15
co-sleeping 15
Functional Family Therapy (FFT) 273 developmental stages 14
parental involvement in play and learning 15
gene chip, definition 28
gene, definition 27 eating disorders 128, 132
general ability assessment 130, 131
diagnosis 129–30
neuropsychological assessment 236 presentation 128–9
generalised anxiety disorder 169 risk evaluation 130–2
genetic and biological influences on children 23, treatment 132
27 neurobehavioural development 18, 21
gene numbers 23–4 capacities 18–19
genomic regulation mechanisms 24–5 culture 20–1
glossary of terms 27–9 Mutual Regulation Model (MRM) 19–20
individual genome mapping 26–7
sources of variation 24 promoting mental health
susceptibility to psychiatric disorders assessment 69–70
definition 68
epigenetic variation 26 factors 69
gene–environment interactions 25 families with indicated additional needs 70–1
genome-wide association studies 25–6 importance of infancy 68–9
genome, definition 28 universal interventions 70
genome-wide association study, definition 28
genotype, definition 28 social and emotional development (SED) 57
glue misuse 202 social cognition 51–2
infant attachment classification profiles 87
hallucinogen use 202 influences on children’s emotional and
haloperidol 289
haploid number, definition 28 behavioural development 3
headaches 148 culture 13, 16
heterotypic continuity 85
high-altitude adaptation through parental adolescence 15
childhood and parenting across cultures
practices 20–1
hippocampus 13 – 14
development niche and ecocultural pathways
impact of childhood mistreatment 121
histrionic personality disorder 220 13
Human Genome Project, definition 28 infancy 14–15
hyperactivity 154 mental health 15–16
hyperkinetic disorder 154 middle childhood 15
hypothalamic–pituitary axis (HPA) 68 family and systemic 3–4
changing family patterns 5
bereaved children 93 childcare and schooling 5–6
psychophysiological response to stress 107, 108 parent and family characteristics 4–5
resilience 79 social and environmental factors 6–7
genetic and biological 23, 27
imipramine 289 gene numbers 23–4
impulsivity 154 genomic regulation mechanisms 24–5
inattention 154 glossary of terms 27–9
indels 24 individual genome mapping 26–7
indicated prevention programmes 73 sources of variation 24
indulgent parenting style 4 susceptibility to psychiatric disorders 25–6
infancy siblings 8
adjustment 10
adoption and fostering 100 development of social understanding 9–10
300
Index
individual relationships 9 Life Story Book 103
intervention programmes 11 literacy disorders see also language
parent–child relationships 9
peers 10–11 acquiring literacy skills 135
inhibited behaviour 102 assessment 137–8
insecure attachments 86, 87
insertion mutation, definition 28 diagnostic components 138
interactive behaviour scales 87 identification 137
interventions, systemic and family approaches definition 134–5
nature of impairment 135–6
276 preschool to adolescence 136
eating disorders risk factors 136
teaching techniques 138–9
anorexia nervosa (AN) 278–9 lithium carbonate 290, 292
bulimia nervosa (BN) 279 looked-after children (LAC) 100–1
emotional problems
anxiety 277–8 maltreated children 102, 114, 119–20
depression 278 brain function differences 123
encopresis 278 event-related potential (ERP) studies 123–4
suicidal behaviour 278 fMRI studies 123
externalizing disorders clinical implications 124–5
ADHD 276 epidemiology 114
adolescent conduct problems 276 harm to the child 116–17
adolescent substance misuse 277 antisocial behaviour 117
multi-dimensional treatment foster care educational progress and employment 117
mechanisms 116
(MDTFC) 277 mental health 117
transferability of treatment approach impact on brain development 121
amygdala and hippocampus 121
277 corpus callosum and other white matter
nature of evidence 279 122 – 3
IQ prefrontal cortex and cerebellum 121–2
autism spectrum disorders (ASDs) 143 intervention 118
neuropsychological assessment 234–5 aims 118
child protection 119
ketamine use 202 immediate treatment 118–19
treatment for the effects and future
lamotrigine 292 prevention 119
language 45 recognizing maltreatment 117–18
tiers of concern 118
see also literacy disorders; specific language role of genetic influences 124
impairment (SLI) social and family factors 114–16
types of maltreatment 114, 115
atypical development 48–9
development from birth to five years 34, 36 maternal sensitivity scales 88
future directions for study 49 maternal smoking during pregnancy 155
milestones of speech and language medication
development 47 attention deficit hyperactivity disorder
neuropsychological assessment 236, 239 (ADHD) 156–7
phases of development 47–8
processes and components of development autism spectrum disorders (ASDs) 144–5
obsessive–compulsive disorder (OCD) 165–6
45 – 7 psychotropic 261
large families, effect on children 5
late talkers 48 national differences in prescription policies
learning 261 – 2
cultural influences
parental involvement in play and learning 15
301
Index
medication (continued) naltrexone 290
narcissistic personality disorder 220
somatization and somatoform disorders 151 neglect of children 115
stress 112 neighbourhood influences on children 6
medikinet retard 289 neurobehavioural development in infancy 18, 21
memory
neuropsychological assessment 236, 238 capacities 18–19
mental health culture 20–1
cultural influences on children 15–16 Mutual Regulation Model (MRM) 19–20
maltreated children 117 neuropsychological assessment 229, 233, 234, 237
mental health, promoting informal 233
childhood 72 information gathering 230
issues 230
anxiety prevention programmes 75
depression prevention programmes 74 environmental influences 230
future developments and challenges 75–6 informal observations 230–1, 232
prevention programmes 72–4 setting and task characteristics 231–2
infancy justification 234–5
assessment 69–70 knowledge base and competencies 230, 231
definition 68 measurement considerations 235
factors 69 developmental 235
families with indicated additional needs failure route 235
psychometrics 235–6
70 – 1 necessity 234
importance 68–9 specialist assessment 236
universal interventions 70 attention 236, 240
mental state examination (MSE) 247 executive function 236–7, 243
metatonin 290 general ability 236
methylation (genes), definition 28 language 236, 239
methylphenidate 289 memory 236, 238
attention deficit hyperactivity disorder motor skills 236, 242
social cognition 237
(ADHD) 156, 157 spatial ability 236, 241
microarray, definition 28 theoretical background
middle childhood assessment 229
child neuropsychological assessment model
cultural influences 15
social and emotional development 56, 57, 58–9 230
developmental model 229–30
addressing problems 60 neuroticism 218
consequences of problems 60 NICU (Neonatal Intensive Care Unit) Network
migraine headaches 148
modafinil Neurobehavioural Scale (NNNS) 19
attention deficit hyperactivity disorder nucleotide, definition 28
(ADHD) 156 obsessive–compulsive disorder (OCD)
monoamine oxidase A (MAOA) aetiology 162
assessment
MAOA gene 25, 124 comorbidities 163
aggression resulting from maltreatment 124 differential diagnosis 162
distress of obsessions and compulsions 163
mothers, young 5 phenomenology of obsessions and
motor skills compulsions 162
prevalence 161
development from birth to five years 33, 34 prognosis and ongoing care 166
neuropsychological assessment 236, 242
multi-dimensional treatment foster care
(MDTFC) 277
Multisystemic Therapy (MST) 273–4
mutation, definition 28
Mutual Regulation Model (MRM) 19–20
302
Index
symptoms 161 personality
threshold of ordinary rituals 162 childhood traits with adult outcomes 217–18
treatment 163 definition 217
development 217
medication 165–6
NICE stepped-care model 164 personality disorder 221
understanding 163 assessment
obsessive–compulsive personality disorder antisocial personality disorder (ASPD) 219
avoidant personality disorder 220
(OCPD) 221 borderlinel personality disorder (BPD) 219
olanzapine 288, 289 childhood personality 218
dependent personality disorder 220–1
bipolar disorder 212 diagnostic issues 218–19
openness 218 histrionic personality disorder 220
opiate use 202 narcissistic personality disorder 220
oppositional defiant disorder (ODD) see obsessive–compulsive personality disorder
(OCPD) 221
behavioural disorders paranoid personality disorder 219
oxycarbazepine personality disorder not otherwise specified
(NOS) 221
bipolar disorder 212 schizoid personality disorder 219
schizotypal personality disorder 219
panic disorder 170 definitions
paranoid personality disorder 219 personality 217
parenting 3–4 temperament 217
adoption and fostering 103 personality disorder not otherwise specified
anomalous parenting behaviours 88 (NOS) 221
changing family patterns 5
pharmacogenetics, definition 28
separation and divorce 5 pharmacogenomics
single parents and step parents 5
characteristics of parent and family 4–5 beyond CYP2D6 263–4
childcare and schooling 5–6 cytochrome P450 2D5 gene 263
cultural influences 13–14
parental involvement in play and learning 15 poor substrate metabolizers 263
relationships with and among siblings 9 ultra-rapid substrate metabolizers 263
styles of parenting 4 definition 262
parenting programmes for conduct problems 274 future expectations 264
effectiveness phenotype, definition 28
social learning approaches 274 phobias 170
youth interventions 274 physical abuse of children 115
evidence linking parenting to child play
cultural influences
psychopathology 271 parental involvement in play and learning 15
mediators of change 274 development from birth to five years 34–5, 37
role of therapist skill 274 middle childhood 58
social learning theory 271 polymorphisms 24
Positive Parenting Programme 177
child-centred approach 271–2 post-traumatic stress disorder (PTSD)
features 272 children bereaved by parent murder or suicide
imposing clear commands 272–3
increasing desirable child behaviour 272 93
reducing undesirable child behaviour 273 mistreatment during childhood
youth interventions 273
family-based 273 impact on hippocampus 121
multicomponent 273–4 stress response 109
paroxetine 289 poverty 6
participatory action research (PAR) project 80–1
perceptual reasoning (PR) factor 235
303
Index
prefrontal cortex (PFC) 62–3 research examples
impact of childhood mistreatment 121–2 abuse or neglect 282
mentalizing in adolescents 63–4 long-term outcomes 283–4
mixed diagnoses 283
preschool
social and emotional development (SED) 57 psychotropic medication 261
national differences in prescription policies
psychiatric disorder assessment 261 – 2
children and adolescent interviews 246–8
mental state examination (MSE) 247 quetiapine 288, 289
observations 246 bipolar disorder 212
constructing a formulation 249
family interviews 246 reactive attachment disorders (RADs) 89
necessity 245 reading comprehension 135
other sources of information 249 reading problems see literacy disorders
parent/carer interviews 248 rearrangement (chromosomes), definition 29
important information 248 receptive language 46
physical examination and investigations 248–9 relaxation therapy 151
scope 245–6 resilience 79
psychological assessment 251, 253 bereaved children 93
biopsychosocial model 252–3 mobilizing 81
main systems 252
models 251–2 project implementation 82
psychological testing 253–4 project summary 81–2
policy and practice 79–81
psychological first aid 112 Resistant type attachment 86, 87
psychometric testing ribosome, definition 29
risperidone 288, 289
interpretation of scores 235–6 bipolar disorder 212
reliability and validity 235 rivalry
psychopharmacology, special paediatric middle childhood 58–9
RNA 24–5
considerations 286, 293 definition 29
art of medication prescription 287
drug interactions 293 sadness
ethical issues 293 first year of life 42–3
factors in children 287
schizoaffective disorder (SA) 214
absorption and hepatic metabolism 287 schizoid personality disorder 219
cardiotoxicity 288 schizotypal personality disorder 219
fat distribution 287–8 school-based prevention programmes 74
incomplete maturation of neurotransmitter schools 6
secure attachments 86, 87
system 288 selective prevention programmes 73
protein binding and distribution volume 288 selective serotonin reuptake inhibitors (SSRIs)
judicious prescribing 286
medications 288 anxiety disorders 173
antipsychotics 288 autism spectrum disorders (ASDs) 145
mood regulators 292–3 bipolar disorder 213
non-stimulants 291 depression 189
stimulants 288, 290 obsessive–compulsive disorder (OCD) 165–6
multimodal treatment package 286 somatization and somatoform disorders 151
non-licensed psychotropic medication 287 stress 112
symptom-based strategy 286–7 separation anxiety disorder 169
psychotherapeutic approaches 281, 284 separation of parents 5
basic premises of psychodynamic approach 281
evidence base 281–2
potential adverse effects of treatment 284
304
Index
sertraline 289 imposing clear commands 272–3
anxiety disorders 173 increasing desirable child behaviour 272
obsessive–compulsive disorder (OCD) 166 reducing undesirable child behaviour 273
social phobia 169–70
sexual abuse of children 115 social skills training
Short OCD Screener (SOCS) 161 attention deficit hyperactivity disorder
siblings, effect on development 8
(ADHD) 158
adjustment 10 social understanding
bullying 11
development of social understanding 9–10 role of siblings 9–10
individual relationships 9 sodium valproate 289, 292
intervention programmes 11
parent–child relationships 9 bipolar disorder 212
peers 10–11 somatization and somatoform disorders 147
single parents 5
single-nucleotide polymorphisms (SNPs) 24 associated features
definition 29 comorbidity 148
sisters and brothers see siblings, effect on educational concerns 149
family factors 149
development 9 personality features 148
sleep precipitating factors 148
states in infancy 19 clinical characteristics 147–8
small inferring RNA (siRNA) 29 diagnostic assessment 149
smiling differential diagnosis 150
future directions 152
first year of life 42 prevention 152
smoking 202 referral to mental health clinics 150
smoking, maternal 155 treatment effectiveness 151
sociability of humans 62–3 treatment effectiveness
social and emotional development (SED)
legal considerations 151
contributing factors 59 treatment planning 150
positive 59
problematic 59–60 family work 151
medication 151
middle years 56 programme 150
addressing problems 60 school 150–1
consequences of problems 60 spatial ability
neuropsychological assessment 236, 241
preschool 56–8 specific language impairment (SLI) 135
social cognition 51 aetiology 181
biological bases 181
individual differences 53–4 cognitive bases 182
origins 54 environmental influences 182
associated developmental problems 183–4
infancy 51–2 definition 180–1
neuropsychological assessment 237 developmental progression of language skills
young children 52–3
social disadvantage 6 183
social interactions distinctive features 182–3
first year of life 41–2, 43–4 implications 184
types 182
crying 42
fear 43 middle childhood 182
smiling 42 specific learning difficulty (SLD) 234
surprise, anger and sadness 42–3 step parents 5
social learning theory 271 stress
typical format
child-centred approach 271–2 assessment 110–11
features 272
305
Index risk associated with self-harm 191
treatment 191–2
stress (continued) surprise
first year of life 42–3
trauma interview 111 systems biology, definition 29
definition 107
developmental issues 108 temperament
differential diagnosis 111 definition 217
epidemiology and history 109
management and treatment 111 tension headaches 148, 151
threat appraisal 171
immediate measures 111 threat attention 171
psychopathology 110 tobacco use 202
psychophysiological response 107 toddlerhood 14
delayed reaction to an event 107–8 social and emotional development (SED) 57
longer-term effects 108, 109 translation (genetics), definition 29
reactions in children 109–10 tricyclic antidepressants (TCAs)
risk and resilience 109
substance misuse 201, 207 attention deficit hyperactivity disorder
aetiology 203 (ADHD) 156
comorbid mental health problems 203
assessment 203–5 somatization and somatoform disorders 151
investigations 206 Tummy Time 21
mental and physical examination 205–6 Turner syndrome 142
protective factors 205
risk factors 205 uninvolved parenting style 4
classification and interventions 204 universal prevention programmes 73
consequences and features 203
definition 201–3 venlafaxine
epidemiology 201 depression 189, 289
treatment 206
evidence base 206–7 Webster–Stratton Incredible Years Programme
role of CAMHS 207 177
suicidal behaviour 278
assessment 191 Wechsler Intelligence Scale for Children
bipolar disorder 212 (WISC-IV) 234–5
course 191
epidemiology 190 well-being see mental health, promoting
management 191 word recognition 135
precipitating factors 190–1
predisposing factors 190 young mothers 5
prevention 192
ziprasidone 288
306