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This chapter focuses on the philosophical and ethical issues that arise in the field of child and adolescent psychiatry. The chapter is divided into four main sections. The first covers ethical concerns about recent trends in the treatment of child and adolescent psychiatric disorders; the second covers more general approaches to understanding the duties of physicians in diagnosing and treating the mental health problems of children and youth; the third discusses some of the debate over theories of the psychological development and the nature of the child's mind; and the fourth and final section briefly addresses how some issues in the debates over the definition of mental disorder and the foundation of nosology play out in the case of disorders of children and youth.

This chapter examines the emergence of child psychiatry in England during the 1840s. It discusses Leonard Guthrie's book Functional Nervous Disorders in Childhood where he highlighted the enormous changes that took place in the final decades of the 19th century when there was a preoccupation with the ‘mind of the child’. It also discusses the novels that influenced Guthrie's interpretation of the problem concerning the study of the child of the mind. These are George Eliot's The Mill on the Floss and Charlotte Brontë's Jane Eyre.

This chapter shows how child guidance became a highly technical medical specialty during the 1930s. Originally conceived as “common-sense psychiatry,” the evolution of child guidance into a uniquely American child psychiatry began in 1927, when the Commonwealth Fund abandoned its bold effort to prevent juvenile delinquency and adult neurosis and psychosis. Its new goal was to transform child guidance clinics into psychotherapeutic centers for the treatment of limited numbers of children, and child guidance into a medical specialty. It was not until 1959, however, that the American Psychiatric Association formally designated child psychiatry a subspecialty of psychiatry. To accomplish its new goals the Commonwealth Fund changed its own program and encouraged the clinics to change theirs. Instead of limiting its function to the diagnosis of children's problems and relying on community social agencies to use environmental manipulation to help troubled children, it urged the clinics to provide direct psychotherapy by a child guidance team.

This chapter analyzes the Yale Longitudinal Study (YLS)—which documented the early and middle childhood years of a dozen children in New Haven County, Connecticut—within the context of other similar studies that were carried out during the middle decades of the twentieth century. It shows how the YLS became a popular tool for many practitioners in the field of child psychiatry from the 1950s through the mid-1970s when investigating children's cognitive, social, and emotional development. It also examines the role played by the YLS in the transformation of research on children within the mental sciences in the post-World War II era. The chapter argues that longitudinal research was embraced by child psychiatrists because it offered a means of accurately documenting the psychological phenomena involved in child development, including ego formation, development of individuality, and mother-child interactions.

This chapter examines discourses concerning child insanity in England during the 19th century. After Charles Darwin's publication of On the Origin of Species, the ideas of inheritance came to play an increasingly large role in psychiatric discourse. The common simile, that a child is like an animal, took on new literal forms. The first major statement on child insanity during this period came from Henry Maudsley's The Physiology and Pathology of the Mind. This was one of the first accounts that placed childhood mental disorders in an evolutionary perspective.

This chapter discusses nineteenth-century literature in the field of psychiatry, which was limited almost entirely to the study of “insanity” in adults. What sparse comments there were on mental illness in children almost always came from Europeans. Americans contributed only four of the fifty-five titles cited in an 1883 review of the literature on childhood insanity, and none of the four dealt specifically with childhood mental illness. According to psychiatrist Eli Rubenstein, this “is the story of an entire era in America prior to 1900....Original research is rare...there is no discovery or theory of great fundamental importance to child psychiatry. No research today stems from the work of any of these early writers.” In Europe, Emil Kraepelin's famous classification of mental diseases was restricted to adults, and the renowned texts by Kraepelin and Eugen Bleuer included nothing on emotional disorders of childhood.

Child and adolescent psychiatry is the medical specialty that works with children, young people, and families with emotional and behavioural problems. As children and young people are still developing and grow–ing, their emotional wellbeing and functioning needs to be thought about in this context, making it different from adult psychiatry. Communication with people of all ages is vital within the specialty and information from a wide variety of sources, including parents or carers, school, and peers, is used to inform the clinical picture, in addition to history-taking and direct observations of the child’s behaviour. Play is often used to understand younger children’s thoughts and feelings. In theory, the specialty covers children and young people from birth up to the teenage years, although different services cover slightly different age ranges. The spectrum of difficulties covered within the specialty include psy–chiatric disorders also seen in adults (such as psychosis); problems spe–cific to the age group (such as separation anxiety); lifelong conditions which start in childhood (such as ADHD); and conditions that may pre–sent in different ways in childhood or adolescence (such as phobias). Approaches to treatment include psychopharmacological interven–tions, and numerous therapeutic modalities including family therapy and CBT, which can be modified for different age groups. Most work is community based, although there are specialist inpatient units which offer on-going educational opportunities to young people who need the intensive support and risk reduction of a hospital admission. Work tends to be done within MDTs using a range of knowledge and expertise to offer the most appropriate care.

This chapter examines discourses concerning childhood passion in England during the 19th century. During this period, passion carried a rich overlay of meanings and the passionate child was a typological projection from religious and education discourse which was to play a crucial role in the development of child psychiatry. Most children's literature published during this period focused on the child who gave way to passion. Examples of these are Reverend Carus Wilson's The Children's Friend and the works of Jane Eyre and George Eliot.

This chapter describes how the Hull House residents and Chicago clubwomen led the campaign to establish the first juvenile court in the nation in 1899. Ten years later they arranged for an investigation into the causes of juvenile delinquency by neurologist William Healy, who conducted a five-year clinical study of 823 children and youth referred to the Chicago court. Healy's research, supported by Chicago philanthropist Ethel Dummer, was published as The Individual Delinquent. As David Rothman has commented, it is hard to imagine a title more expressive of progressive thinking. A classic in its own time, The Individual Delinquent helped launch the child guidance movement of the 1920s, which led ultimately to the emergence of a unique American child psychiatry.