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The earliest intervention

Sophie McNamara
Med J Aust
Published online: 21 May 2012

Child and adolescent psychiatrists work with whole families to treat — or prevent — mental health problems.

One of the most appealing aspects of child and adolescent psychiatry, according to specialists in the field, is the chance to intervene at the earliest stages of burgeoning mental health problems.

In some cases the work of child and adolescent psychiatrists is preventive, stopping mental health problems from developing in vulnerable children.

Dr Sally Tregenza, director of advanced training in child and adolescent psychiatry in South Australia, decided to specialise in the field after enjoying a 6-month placement as a registrar.

“I found there was more of a sense of hopefulness with young people. I liked that early intervention could have a longer impact by preventing mental health problems”, she says.

Dr Tregenza also appreciated that child and adolescent psychiatry is one of the more flexible specialties. “Given that we’re so focused on developing relationships between children and parents or caregivers, it’s quite an understanding profession when it comes to supporting working parents”, she says.

Child and adolescent psychiatrists often work with the child’s family, school and community, in addition to the child themselves. Dr Tregenza says this adds another layer of complexity and challenge to the specialty, which she enjoys.

The specialty also involves considerable interaction with other medical and allied health professionals, such as paediatricians and psychologists, so prospective trainees need to enjoy teamwork. It suits doctors who are interested in understanding development and why we become the people we become, says Dr Tregenza.

“You also need to have a sense of playfulness; working with young children can be a lot of fun”, she says.

Professor Philip Hazell, director of advanced training in child and adolescent psychiatry at the Royal Australian and New Zealand College of Psychiatrists, agrees that working with young people can be great fun. He says the specialty suits doctors who like psychiatry, but who also enjoyed their paediatric terms.

“Most children and adolescents have really interesting stories to tell and it’s enjoyable trying to make a connection with them and understand their experience of the world so far.”

Professor Hazell says child and adolescent psychiatrists need to be dynamic in their interactions with colleagues and patients. He says they also need to be able to tolerate more uncertainty than most other doctors.

“Many of the manifestations aren’t yet fully formed in young people. Often, we’re not quite sure where it’s going and you have to sit with that ambiguity and communicate that to families and other health professionals”, he says.

Professor Hazell has witnessed tremendous changes in the specialty since he started out in the early 1980s. He decided on the specialty after a supervisor advised him that it was the area of psychiatry where “all the action” would be in the next 20 years. However, not everyone shared this view at the time.

“Back in the early 80s the general attitude was that it was a backwater discipline, that it was just ‘people doing nice things with sad kids’. It wasn’t taken particularly seriously.”

He has enjoyed seeing the accumulation of evidence for childhood mental health disorders and their treatments. Now there is good science underpinning many of the treatments, both psychosocial and pharmacological.

However, scientific understanding is still growing rapidly in the field, which means there are plenty of opportunities for child and adolescent psychiatrists to get involved in research. Professor Hazell says the research community is well connected internationally and very supportive of early career researchers. Two organisations he recommends for their mentoring opportunities for young doctors are the American Academy of Child and Adolescent Psychiatry (www.aacap.org) and the International Association of Child and Adolescent Psychiatry and Allied Professions (www.iacapap.org).

Training as a child and adolescent psychiatrist

After completing 3 years of basic training in psychiatry through the Royal Australian and New Zealand College of Psychiatrists, trainees can enter Advanced Training in Child and Adolescent Psychiatry. Entry into advanced training is based on an interview and completion of all the requirements of basic training. The 2-year advanced training program includes goals such as achieving clinical competency in infant, child and adolescent psychiatry, skills in advocacy on behalf of children, and the ability to show leadership in promoting mental health in children. Professor Hazell says that although entry into psychiatry training is not particularly competitive, it can be difficult to secure a place in some of the more popular training posts.

Perinatal and infant psychiatry

Advanced trainees in child and adolescent psychiatry also need to gain clinical experience in infant mental health. Perinatal and infant psychiatrists work with infants and their families, with a focus on the importance of the attachment relationship between parent and child.

Dr Anne Sved Williams is a perinatal and infant psychiatrist based at the Women’s and Children’s Hospital in Adelaide. She works with pregnant women in the hospital and new mothers in the psychiatric inpatient unit. She is also involved in screening women for antenatal and postnatal depression and managing community referrals from general practitioners and others.

“I love that it’s the earliest intervention in mental health … there are so many important parts of development in the first 2 years of life, so it’s an opportunity to help things go the best way possible”, she says.

  • Sophie McNamara


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