Sir, – Children and adolescents are referred to Child and Adolescent Mental Health Services (Camps) because they present with emotional and behavioural problems that may represent psychological or psychiatric difficulties.
Thorough assessments of presenting symptoms involves gathering information from young person and family and, with consent, collateral information from educators and other involved professionals. The use of standardised rating scales, looking at specific symptom profiles, complements the clinical interview, as do indicated physical examination and investigation. Only then can it be determined if the presenting symptoms meet diagnostic criteria for a psychiatric disorder.
The treatment of psychiatric disorders in children and adolescent involves not just consideration of diagnosis but also an appreciation of the severity of symptoms at assessment and an understanding of how those symptoms impact on social, emotional and academic functioning.
The treating doctor needs to be cognisant of any co-existing learning and speech and language needs the young person may have and the support available within the family system for the treatment suggested.
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A severely depressed adolescent may be relieved to be prescribed antidepressant as a first-line treatment: their mood may be so low that engaging in psychotherapy is not possible for them at this time.
Dr Gavin and colleagues (Letters, February 7th) highlight the dangers of undervaluing the role of medication in treating certain conditions. I echo these concerns.
But evidence-based treatments are not limited to medication. Sometimes non-pharmacological evidence based interventions are not offered because they are not appropriate for that young person at that point in time. Sometimes they are not offered because they are not available. How many of the service users in South Kerry were offered evidence-based non-pharmacological interventions but refused?
How many children and adolescents with autism spectrum disorder, which is not an illness, were offered the appropriate services from psychology, speech and language therapy and occupational therapy in Community Network Disability Teams in Kerry before they reached the door of Camhs? – Yours, etc,
Dr MARIA DUNNE,
Dublin 4.
Sir, – Sheila Wayman’s important article “Mentally ill Irish children ‘more likely to be underprescribed’ than over-prescribed medication” (February 5th) countered a lot of the misinformation which has been circulating since the over-prescribing scandal broke at South Kerry Camhs.
An appropriate dosage of Rispiridone is one of the very few evidence-based treatments for certain conditions associated with autism in certain autistic people – and I speak as the mother of one such person.
What has not been reported, however, is the fact that the HSE’s Camhs service does not treat autism on its own. Those autistics who are treated by Camhs “get in” because of associated conditions such as attention deficit hyperactivity disorder (ADHD) or anxiety.
I have actually heard a mother give thanks for her autistic child’s ADHD because it meant he was treated by Camhs.
This false division of the related conditions seems to be based on an antiquated division between “psychiatric” and “disability” service users, although in most cases there is no such clear distinction.
Quite where the parents of autistic children are meant to turn if they don’t happen to also carry a label which grants entry to Camhs is an open question as no clear pathway to treatment exists. – Yours, etc,
VICTORIA WHITE,
Dublin 14.