Issues relating to the consent of individuals under 18 years of age in England and Wales are covered by the Family Law Reform Act 1969, the Children Act 1989, the Mental Health Act 1983 (to some extent) and case law. Legislation on the consent of minors to hospital admission and treatment is complicated and contradictory, leaving clinicians unsure when to rely on the consent of the minor or that of someone with parental responsibility. This article reviews the concept of the zone of parental control (ZPC), introduced in England in 2008. It argues that this concept is too vague and subjective to provide any clear guidance on who can give consent for a minor's admission and treatment.

Tourette syndrome is a complex neuropsychiatric disorder of juvenile onset, characterised by motor and phonic tics. It is associated with a number of comorbid psychiatric conditions and a reduced quality of life in the young person and with parenting stress, caregiver burden and psychopathology in the parents. The global prevalence (about 1%) is higher than previously thought, with a strong male preponderance. Evidence is emerging that Tourette syndrome is not a unified disorder; rather, it encompasses a number of subtypes, characterised by complexity of tics and the simultaneous presence of other behaviours or disorders. This article discusses the aetiology of the syndrome, and examines its clinical features and comorbid psychiatric conditions and psychopathologies. Assessment and diagnosis are also discussed. Psychoeducation is a cornerstone of management, augmented with behavioural and/or pharmacological treatments. Newer therapies, such as deep brain stimulation, offer tantalising possibilities, but further research is still needed.

The care of women with anxiety and depressive disorders in the perinatal period is complex. The literature in this field is vast and may be difficult for busy clinicians to keep abreast of. The first part of this article provides an overview of the potential risks and benefits of treatment options, including no treatment, at various stages in the perinatal period. The second part explores the frameworks which may assist clinicians in decision-making with their pregnant patients, including risk-benefit analysis, ethical considerations, evaluating capacity, and mental health legislation. The common pitfalls and limitations of these approaches are examined to guide good practice.

Obsessive–compulsive disorder (OCD) is one of the most debilitating psychiatric conditions in young people. In DSM-5 it is no longer characterised as an anxiety disorder, but instead is part of a group of ‘obsessive–compulsive and related disorders'. In the past 10 years, cognitive—behavioural therapy (CBT) has become well established as the first-choice treatment. This article explains some of the elements of CBT and describes new directions in research which might improve interventions.

The negative effects of parental mental illness on children are not dependent on the parent's diagnosis, but are related to that parent's behaviour, the responses of other key adults (both familial and professional), and the degree to which development of the child's resilience has been encouraged. Parental mental illness can be responsible for serious interruptions in a child's cognitive and emotional development, which in turn can have implications for their future mental health. Resilience can be promoted by relatively simple interventions, but these require the active participation of both adult- and child-focused professionals involved with the family, particularly those concerned with the parent's treatment.

Cognitive dysfunction is one of the major contributors to the burden of epilepsy. It can significantly disrupt intellectual development in children and functional status and quality of life in adults. Epilepsy affects cognition through a number of mechanisms in complex interrelationship. Cognitive deficits in epilepsy may be treated indirectly through aggressive seizure control using anti-epileptic drugs or surgery, and by treating comorbid conditions such as depression. The beneficial effects of reducing seizures may offset the adverse cognitive side-effects of these therapies. Direct treatment of cognitive impairment in epilepsy mainly involves memory rehabilitation. Other direct treatments are mostly experimental and their evidence base is currently poor.

Depression and anxiety are common in adolescents, but most affected will not get any formal help. Digital mental health technologies (i.e. resources and interventions to support and improve mental health) are a potential way to extend the reach and increase adolescents’ access to therapies, at a relatively low cost. Many young people can access the internet and mobile technologies, including in low- and middle-income countries. There has been increased interest in integrating technologies in a range of settings, especially because of the effect of the COVID-19 pandemic on adolescent mental health, at a time when services are under pressure. This clinical review gives an overview of digital technologies to support the prevention and management of depression and anxiety in adolescence. The technologies are presented in relation to their technological approaches, underlying psychological or other theories, setting, development, evaluations to date and how they might be accessed. There is also a discussion of the potential benefits, challenges and future developments in this field.

Compassion-focused therapy (CFT) is embedded in an evolutionary, functional analysis of psychopathology, with a focus on affiliative, caring and compassion processes. CFT has been applied in a number of adult settings, but its clinical applications in child and adolescent psychopathology and psychotherapy have not been systematically explored. This article describes the applications of CFT in paediatric populations. Specifically, the following developmental considerations are discussed: the unique importance of parent-child and attachment relationships for the development of self-compassion, being open to compassion from others and being compassionate to others; the potential effect of com passion training on the maturing brain (affective regulation systems); and the therapeutic targeting of shame and self-criticism to alleviate psychological distress and enhance the effectiveness of cognitive-behavioural interventions.

Most individuals who have lived in foster homes, residential care or adoptive families for substantial periods (‘people affected by public care or adoption’) show normal psychological adjustment as adults, although rates of mental disorders, hospital admission and suicide are increased. Research focusing on the experiences of this group of people can help professionals better understand their behaviour and attitude towards help. Psychiatric symptoms can be multifaceted, including complex trauma presentations. The specific mental health needs of this population are increasingly being recognised in child and adolescent mental health services but less so in adult services. In this article we describe life experiences of people affected by public care or adoption, examine the lifelong impact of these experiences on mental health and functioning, and offer practical suggestions for clinical work with them.

Dual diagnosis is one of several terms used to identify individuals diagnosed with a co-occurring mental disorder and substance use disorder. The existence of a dual diagnosis in adolescents is often associated with functional impairment in various life domains, causing physical health problems, relational conflicts, educational/vocational underachievement and legal problems. Dual diagnosis is difficult to treat and can result in tremendous economic burden on healthcare, education and justice systems. It is essential for clinicians caring for young people to be knowledgeable about dual diagnosis to ensure that it is identified early and treated. This article aims to provide an overview of dual diagnosis, increase its awareness and promote a realistic treatment approach.

Psychosis is a complex presentation with a wide range of factors contributing to its development, biological and environmental. Psychosis is a feature present in a variety of psychiatric disorders. It is important for clinicians to keep up to date with evidence regarding current understanding of the reasons psychosis may occur. Furthermore, it is necessary to find clinical utility from this knowledge so that effective primary, secondary and tertiary preventative strategies can be considered. This article is the first of a three-part series that examines contemporary knowledge of risk factors for psychosis and presents an overview of current explanations. The articles focus on the psychosis risk timeline, which gives a structure within which to consider key aspects of risk likely to affect people at different stages of life. In this first article, early life is discussed. It covers elements that contribute in the prenatal and early childhood period and includes genetic, nutritional and infective risk factors.

Current understanding of psychosis development is relevant to patients' clinical outcomes in mental health services as a whole, given that psychotic symptoms can be a feature of many different diagnoses at different stages of life. Understanding the risk factors helps clinicians to contemplate primary, secondary and tertiary preventive strategies that it may be possible to implement. In this second article of a three-part series, the psychosis risk timeline is again considered, here focusing on risk factors more likely to be encountered during later childhood, adolescence and adulthood. These include environmental factors, substance misuse, and social and psychopathological aspects.

The development of effective preventions for psychosis is hindered by conceptual challenges underlying diagnosis and the fact that few of the many biological risk factors identified to date are sufficiently well understood to form the basis of a targeted intervention. On the other hand, a great deal is known of the psychosocial conditions that increase the lifetime risk of most mental illnesses: surely enough to justify better resourcing of interventions focused on antenatal care and the emotional well-being of children from the early years through adolescence, where as much as a half of all mental ill health has its roots.

Autoimmune disorders in children and adolescents can have significant neuropsychiatric complications and there is growing interest in the association between autoimmune conditions and psychiatric syndromes, particularly in Down syndrome. Acute presentations with psychiatric symptoms require careful assessment in order to recognise and plan treatment of underlying autoimmune disease in collaboration with paediatric colleagues. Difficult treatment decisions arise in children with established autoimmune diagnoses and psychiatric symptoms that may be a result of neuroimmunological processes associated with their condition, psychiatric side-effects of drug treatments or psychopathology resulting from other factors in the history that may or may not have a direct relation to the autoimmune diagnosis. This article illustrates these complexities through discussion of specific autoimmune disorders and three case histories.

Adverse effects of psychotropic medication on breast-fed infants have not been studied in controlled and systematic research. Existing information comes from small case series and single case reports. These limited data confirm that psychotropics are excreted into breast milk and that the infant is exposed to them. In recent decades sufficient data have accumulated to allow psychiatrists to prescribe tricyclic antidepressants, selective serotonin reuptake inhibitors, conventional antipsychotics, carbamazepine and sodium valproate to breast-feeding mothers with safety. There are not sufficient data on atypical antipsychotics to allow women to breast-feed safely. Mothers on clozapine or lithium should not breast-feed. It is good practice to recommend that breast-feeding mothers requiring psychotropic medication be on a low dose of one single drug. Future research taking account of maternal mental health, psychopharmacological factors, infant physiological environment and individualised risk/benefit assessment will yield clearer responses to this complex issue.

Clinicians assessing children with autism are sometimes faced with a dilemma, especially if there is a definite or suspected history of abuse or neglect: is this autism or attachment disorder? This is important because the attachment disorders (reactive attachment disorder and disinhibited social engagement disorder) are thought to be caused by abuse or neglect, whereas autism is not. We discuss the Coventry Grid, a clinical tool aiming to aid differentiation between autism and attachment disorders. We examine the small body of empirical studies focusing on this differential diagnosis and find that the Coventry Grid can be regarded as an evidence-based tool. We also discuss preliminary findings regarding a relatively unstructured observational method involving two assessors who engage the child in jokes and playful social dilemmas, which might help clinicians elicit the information required to complete the Coventry Grid.

Mental illness in very young children is relatively rare and the number of 0- to 4-year-olds seen in secondary care psychiatric services has recently declined. Conceptualisation of mental illness in this age group is shifting towards a model that views disorders as part of the wider spectrum of diagnoses, rather than distinct, developmentally specific conditions. This article discusses the epidemiology of psychiatric illness in preschool children, evaluates assessment tools that have only recently been validated for use in secondary care and considers evidence of the efficacy and cost-effectiveness of early intervention using treatments encompassing pharmacological, psychological and social approaches.

Hallucinations (erroneous percepts in the absence of identifiable stimuli) are a key feature of psychotic states, but they have long been known to present in children with non-psychotic psychiatric disorders. Recent epidemiological studies of child populations found surprisingly high rates (about 10%) of hallucinatory experiences. These hallucinatory phenomena are most likely to occur in the absence of psychiatric disorder and are usually simpler, less elaborate and less distressing than those observed in children with psychiatric disorders. This article details the clinical assessment of hallucinations in children and adolescents, taking into account developmental considerations and paediatric organic associations. It describes hallucinations in young people with psychoses (schizophrenia spectrum and mood disorders) and non-psychotic psychiatric disorders (emotional and behavioural disorders), and it addresses therapeutic aspects.

Differentiating between autism spectrum disorder and attachment disorders such as reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) can be difficult. We comment on Davidson et al's article on this problem, note the dearth of validated assessment tools for RAD and DSED, and point to the utility of the Early Trauma-Related Disorders Questionnaire.

Internet gaming disorder (IGD) is a condition in which the individual is preoccupied with playing online video games and unable to regulate this behaviour, resulting in adverse physical and psychological consequences. Although there is some debate about whether IGD is an addiction or a coping mechanism, global evidence indicates that the condition is increasing in prevalence with recent advances in technology and its higher penetration into routine life. Male children and adolescents located in East Asian countries are at higher risk than others in the world. Attention-deficit hyperactivity disorder, depression and anxiety are typically associated with IGD. Given the continuing ambiguity regarding the diagnosis and screening tools for the disorder, it has become all the more relevant for mental health practitioners and academics to attend to this condition and develop evidence-based treatments. This review summarises both the existing evidence for the disorder and the debates that surround it.