A study was conducted to investigate reductions in the numbers of social work posts located within Child and Adolescent Mental Health Services in the UK. Results suggested that reductions in posts noted in earlier studies are continuing. Interviewees' ideas about factors contributing to the survival of such posts are summarised. The significance of the loss of posts is discussed, with an account of changing ideas about the role of social workers within CAMHS teams, and of an audit undertaken of one service lacking such a post. Conclusions are drawn concerning ways of ensuring the preservation of such posts.

The incidence of food refusal associated with illness is reviewed, not illness by illness, but according to those factors that affect the ability to eat; normal learning about eating, aversive learning about eating, regulation of appetite, children's cognitions about foods, and parental anxiety about intake. Diseases affecting the major organs are likely to generate food refusal based on at least one of these factors, if not all of them. However, some minor disease processes can also have a major impact on food acceptance. Child temperament also affects food acceptance and may interact with the disease process to produce food refusal.

It is widely argued that a more general ‘genetic literacy’ of the public is required so that appropriate use is made of the new human genetic technologies, such as DNA testing, and there is effective public participation in debates about the regulation and development of new technologies. Despite a century of popularisation and school education in Mendelian genetics, public understanding remains very limited. An hypothesis is put forward that suggests that the limited public understanding results from the existence of a lay understanding of inheritance that conflicts with the scientific account of Mendelian genetics and impedes its uptake. It is further proposed that the lay understanding of inheritance is derived by children from a developmentally earlier social understanding of kinship relations. Given that the lay knowledge of inheritance is grounded in social concepts of kinship that are sustained by every day social activities and relationships, it may be particularly resistant to change. A test of the hypothesis is described and evidence relating to the development of concepts of inheritance and family in children is discussed.

The child and adolescent version of the Health of the Nation Outcome Scales (HoNOSCA) represents the first attempt at a routine outcome measure for Child and Adolescent Mental Health Services in the U.K. Extensive field trials suggested that the scales were both acceptable to clinicians from the various disciplines working in this area and also valid and reliable. A growing number of services are now using the scales in audit and research, supported by the national HoNOSCA base that provides training and co-ordinates further developments.

A model for primary care child and adolescent mental health (CAMH) services is presented, the overall goal of which is to reduce population burden of CAMH problems. The theoretical orientation of the model is based on ecological systems theories. Features of the model include: local population outcome measures; small area service focus; primary-care-based CAMH specialists; a locally comprehensive service framework based in primary care (schools and general practices); and an explicit process of community engagement. The model is illustrated by reference to a primary care CAMH service (currently the subject of a controlled trial) in Flintshire, North Wales.

As sustained methylphenidate becomes available in the United Kingdom, there is likely to be considerable demand related to the difficulties that frequently arise with standard methylphenidate due to the need for midday doses at school, as well as the pronounced ‘on/off’ therapeutic effects sometimes seen with multiple doses. This article briefly discusses longer acting stimulants, reviews the available literature, anticipates possible problems in the use of slow release methylphenidate, and presents clinical guidelines for its use.

There are at least 50000 refugee children and adolescents in the UK, mostly living in London. These young people and their families will have been exposed to high levels of violence, disruption of social life and losses, all of which will increase their risk for psychiatric disorders. Up to 40% may have psychiatric disorders, mostly depression, posttraumatic stress disorder and other anxiety related difficulties. Multi-agency support to refugee youngsters and families is important. Some refugee children and adolescents will require help from specialist mental health services that will need to be flexible in view of the refugees' cultural diversity, mobility and the need for the full range of treatments. Special efforts are required to reach this vulnerable group, and links with social services and schools in particular should be considered.

Despite growing discussion of the potential benefits of openness in relation to children conceived by donated gametes, the majority of parents do not intend to tell a future child about his/her origins. As a result little is actually known about the experiences and concerns of families who do choose openness. This is a descriptive study of 83 DI Network members who did intend to or had told a child conceived, using donor insemination, about his/her origins. Quantitative and qualitative data focused on their concerns and experiences of telling. Health professionals face the challenge of providing the opportunity for discussion of these issues both before treatment and afterwards during childhood.

Prompt and accurate diagnosis of Munchausen's syndrome by proxy is essential in order to minimise the risk of iatrogenic and parentally-induced harm to the child. However, inaccurate diagnosis of MSBP may have devastating consequences for the child, family and professionals involved. ‘Psychiatric’ Munchausen's syndrome by proxy, which involves the presentation of signs and symptoms suggestive of a psychiatric disorder in the child, is even more difficult to diagnose and requires an unbiased and full assessment by the appropriate multidisciplinary team.

Body Dysmorphic Disorder (BDD) is an excessive preoccupation with an imagined, or real, slight defect in normal physical appearance. The disorder, which usually begins during adolescence, tends to be chronic, and probably is much more common than is usually thought. This review presents an overview of the available scientific literature of BDD. It provides information about historical aspects, epidemiology, clinical features, aetiology, and instruments for assessing BDD. The relationship of BDD with other psychiatric disorders such as depression, obsessive-compulsive disorders, anxiety disorders, schizophrenia, eating disorders and personality disorders is discussed. Aetiological theories, including psychological and neurobiological explanations, are reviewed. Finally, psychopharmacological and psychotherapeutic treatment approaches are presented with special regard to treatment with serotonin-reuptake inhibitors, behavioural therapy and cognitive-behavioural therapy.

This paper describes the care arrangements made for children when their mothers are admitted to psychiatric hospital. It also describes at admission, and at 3 months follow-up, the views and opinions of mothers and carers with regard to the admission, its impact on the family, and the service received. It was found that children are predominantly cared for within their family when their mother is admitted to hospital, and that mothers and carers are concerned about the impact of the admission and its associated problems.

A postal questionnaire survey of senior clinical psychologists, child psychiatrists and community paediatricians in the Trent region (85% response) revealed that a total of 826 new ADHD cases were seen over the index period, 1997–1998. Approximately a third of these were adolescents. Wide variations in individuals' clinical caseloads, both within and between professional groups, were revealed. No respondent could identify any local formal transitional arrangements or adult services for older ADHD cases. This would suggest that there is a pressing need to establish such services for patients with ADHD irrespective of their age.

Infant Observation is a valuable training experience for workers in child and adolescent mental health, helping both to conceive the infantile experience of the children under their care, and to understand the parents' accounts of a child's history. It is an experience that gives trainees a unique opportunity to observe the development of an infant, systematically and practically from birth, in the child's natural setting, thus facilitating the acquisition of a meaningful understanding of how human relationships emerge and develop. Infant Observation gives the trainee a clear focus on the baby and his family, whilst remaining as a participant observer, and spontaneously encouraging problem-free talk.

There is growing interest in the provision of health services that are sensitive to the needs of diverse ethnic groups. This paper examines ethnic diversity of attenders at a Child and Adolescent Psychiatric Clinic and how these groups differ in terms of referral route, reason for referral, psychiatric diagnosis and school report of difficulties. Service access relative to the distribution of the local population is assessed. Modification of OPCS categories provides additional useful information. The findings are relevant for the planning and provision of child and adolescent psychiatric services in a highly diverse population.

The education of children with behavioural difficulties is under scrutiny from various quarters. The provision of specialised school environments is being questioned, at the same time as there is pressure to minimise the exclusion of disruptive pupils. This study looked at the rate of psychiatric disorder that was prevalent in a school for emotionally and behaviourally disordered (EBD) pupils, and found, using DSM III-R criteria, that 24% of the sample had depression, 11% had overanxiousness, and 70% had a diagnosis of Attention Deficit Disorder with Hyperactivity (ADHD). Educational attainment assessment showed that 75% had a reading age that was at least 2 years below their chronological age. These results suggest that such settings are dealing with a very disturbed group of youngsters.

This review describes the current situation with regard to diagnostic instruments for Asperger syndrome. The paucity of such instruments, and the lack of adequate standardisation data amongst the few that do exist, represent a serious omission for both clinicians and researchers. The major problem limiting the development of effective diagnostic or screening instruments is the confusion inherent in ICD-10 and DSM-1V systems in differentiating autism from Asperger syndrome. In the absence of clear and clinically satisfactory diagnostic criteria, efforts to develop valid assessment instruments may be attempting to put the horse before the cart!

Cognitive behavioural approaches have been used in the treatment of adult depression for many years, with much evidence of effectiveness. The paper discusses issues in the applicability of these techniques in interventions with depressed children and adolescents. Different models of CBT are discussed and a typical programme described using a case example. Work with parents, carers and other significant adults is emphasised.

Multisystemic therapy (MST) is a highly individualised family- and home-based treatment that has successfully served as a clinically effective and cost-effective alternative to out-of-home placements (e.g., incarceration, psychiatric hospitalisation) for youth presenting serious clinical problems. MST clinical procedures are reviewed and two extensive case summaries are used to explicate the MST intervention process for treating serious antisocial behaviour and modifications in that process needed to safely and effectively serve youth presenting psychiatric emergencies.

I have what I consider to be a healthy scepticism regarding new assessment instruments. Many of these are announced with great enthusiasm but fairly rapidly disappear or are used mainly by those who have developed them and by their associates.

Although the tone of the paper by Gowers et al. (2000) seems rather strong on enthusiasm and perhaps a little lacking in its critical view, I do have great respect for colleagues associated with development of HoNOSCA and other respected colleagues talk well of it. Clearly, it deserves careful scrutiny. For me relevant questions include: ‘Is it easy to use?’, ‘Is it useful in terms of describing a patient population?’ and ‘Is it useful in looking at outcome?’

Needs assessment is a frequently used term by all agencies involved in the welfare of children and adolescents, and is a key method in health service planning (Stevens & Raftery, 1994). However, there is often a lack of clarity about the meaning of the phrase ‘needs assessment’ (Cohen & Eastman, 1997). In addition, for CAMHS services there are few established research or clinical instruments to assess the needs of individuals. This review sets out first to describe some key concepts and issues and, second, to describe the development of a needs assessment instrument for adolescents with complex and multiple problems, and how such an instrument can be used in clinical and research settings.