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Child psychiatry is a specialty of psychiatric medicine, and is more often called child and adolescent psychiatry. Its focus is on treating, from multiple perspectives, both children and teens suffering from mental illnesses, learning disorders or impairment, or other conditions. Though this area of medicine is now a widely accepted discipline and subspecialty of psychiatry, it wasn’t until the second half of the 20th century that the idea of creating separate specialization designation gained strength. Today a person who is a child psychiatrist often has more training that a doctor who is a licensed as a psychiatrist without specialty.
The emphasis in psychiatry is on treatment and diagnosis of mental disorders, but this is viewed in a slightly different way in child psychiatry. Treating children or adolescents is not seen as analogous to treating adults. People in the process of still developing their bodies, minds, and attitudes about the world, are very different than people who have already grown up. Those objecting to this premise might watch the behavior of a pre-teen and compare it to that of someone in her twenties; it’s very clear behaviors of the two people observed are usually not the same.
Therefore, one question child psychiatry might ask is: “How do expressions of mental illness differ in children and adults?” Understanding this difference helps to identify how symptoms of mental illness manifest in children. In turn, this helps to create diagnostic standards that can be used after assessment to give opinions on what mental disorders might exist, if any.
Determining treatment after diagnosis creates a similar set of questions. Whether treatment is some form of therapy or medication, it has to be focused on how to heal children instead of adults. The same drug doses don’t work, the same forms of therapy may not work and new modalities have to be explored that create the most effective treatments for kids and teens. The extra years of specialization help child psychiatrists learn and explore these modalities so that they are expert in diagnosing and treating the population they serve.
It’s common to think of those in child psychiatry as practicing with individuals or families only, but people in this field could work in a number of different areas. They may be employed in education in public or private schools, they could teach, they staff institutions children occupy, or they might do research, which is vital to acquiring more knowledge in this field. Child psychiatrists may also participate in other areas such as the field of forensics, or they could be employed by child protective agencies as consultants or investigators.
The field also works closely with other specialists. Not all child psychiatry clinicians give mental health counseling, for instance. Yet they may recommend it for their patients and would work closely as part of a treatment team that included a therapist. Any form of pediatrics or pediatric specialty could be part of a treatment team too, especially when a child may have diverse mental, medical, and physical needs.
Those interested in specializing in child psychiatry do have a great deal of training to complete. After a four-year degree, people spend four years in medical school and internship. They will then complete three years of residency in general psychiatry and two more in child psychiatry. Sometimes residencies are constructed in slightly different ways. Periodic continuing education is likely to be required to maintain board certification or licensure.
I was in college with a girl who went into child psychiatry. We stayed friends after college and we discussed some of her training and how modern medicine approaches mental illness in children.
She was treating a girl who exhibited every feature of bipolar disorder, but at 10, was too young for an "official" diagnosis. Because of this, she had to fight with her patient's insurance company to pay for the medication that would help the girl. The insurance company said she was too young for it, but she had been doing very well on the samples my friend had in her office. She finally prevailed, but it was a long, hard slog.
Obviously, mental illness treatment differs between adults and children, but so does counseling and therapy.
Kids may be very literal a lot of the time, but when discussing uncomfortable subjects, they may also be very oblique and/or figurative. This is why child psychiatrists use models, dolls, art therapy and similar treatment models to help children process with bad things that have happened to them, and come to terms with these events. You can't just always ask a child what someone did to them. You have to approach it from the back way to get the answer.
A child psychiatrist is skilled in using these methods to help children work through issues and to help treat mental illness.
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