The following has been written for my local colleagues working in Child and Adolescent Mental Health Services (CAMHS), and our patients. The hope is to explain to young people and parents/carers that diagnoses and medications are not the only ways to receive help. We live in an increasingly medicalised world, and we need to keep a broader perspective on childhood distress.
The primary approach in managing emotional difficulties in young people, as well as adults (be it stress, anxiety, low mood, behavioural challenges) is through ‘Talking Therapies’. There are a range of these, (from individual, to family, to group based) and we need to take time to determine which type of these therapies might be suitable for each young person, and also where these should be delivered. There are many providers outside of CAMHS that can deliver such therapeutic approaches and it is not uncommon for us to recommend that help is received elsewhere.
Child and Adolescent Mental Health Services use a “bio-psycho-social” model of assessment and treatment. In short, this means that every assessment should consider the aspects which relate to brain development, emotional factors, and aspects to do with the child’s environment.
Commonly, what is needed is a change around the child, rather than a change within them. Parents/carers may need additional support in how to manage their own responses to the child’s distress.
It is especially important that we avoid “pathologizing” distress which might be situational (caused by modifiable factors in the child’s environment) and/or natural, for example a response to bullying, or bereavement. The child may need additional support at school, for example, to benefit their learning.
Families and young people may come to CAMHS expecting a “diagnosis”. They may leave from an appointment with a sense of disappointment if this has not been given. In all fields of medicine it is recognised that symptoms do not necessarily fit into diagnostic criteria. Many symptoms (abdominal pains, for example) will come and go. Particularly in children, who have developing brains, we may choose to watch and wait before giving a particular descriptive term, if at all. Labels can be damaging if they are seen to define a child. So, in CAMHS we make “needs based” plans, in the hope of being clear about how we might improve the quality of life for young people we care for.
Families may also hope that there might be a “medication” fix. This understandable. Medications can be life changing. However, it is important to note that in some difficulties, they will not play a role. For example, there is limited evidence base for the use of “psychotropic” medication in neurodevelopmental disorders such as Autism, unless there is an additional mental illness.
Regardless, it is most likely that before any medications are considered, the young person and their family will be advised to follow non-medication approaches (for example good sleep hygiene techniques).
All medications come with potential side effects, and some of those used in mental health, can cause a worsening of mood state. It is very unusual that medication is an appropriate first step. The National Institute of Clinical Excellence (‘NICE’) guidelines are followed closely in our team.
Connected Child Health 