Approved by Council, October 1986
To be reviewed
Child and adolescent psychiatry is a developmental psychiatry. It focuses not only on mental disorders but also on the complex interactions between human maturation and psychological adaption. Logically and scientifically, therefore, intrinsic deficits and developmental disabilities, including mental retardation, ought to be the responsibility of child and adolescent psychiatrists, who should be keenly interested in, trained bout and concerned with these conditions.
In fact, at psychiatry's beginning's, mental retardation was considered an integral part of the field. Psychiatrists provided the early foundation of enlightened, humanistic approaches to education and clinical care for retarded children. However, reflecting changes in society's attitude toward retarded persons, our profession virtually moved away from this field in the years that followed.
Recently child and adolescent psychiatrists have gradually renewed their concern with mental retardation. They have unfortunately tended all too often to view clinical work with developmentally disabled children as a specialized, even exotic area, of interest to only a small fraction of practioners. Training programs have stressed the teaching about various mental retardation syndromes, rather than skills in providing mental health services to mentally retarded persons. Many child and adolescent psychiatrists continue to subscribe to outdated notions that developmentally disabled persons cannot benefit from psychiatric services.
There are four important aspects of psychiatry's role in the field of mental retardation. First is the provision of clinical services. Mentally retarded persons constitute a relatively large and drastically underserved group, as far as psychiatric care is concerned. Further aggravating this problem is the fact that this population is at greatly increased risk for developing a full spectrum of mental disorders. Following the movement to deinstitutionalize retarded persons, it became clear that these mental disorders are the primary obstacle to the adaptation of many retarded persons to life in the communicty. Evidence shows that retarded individuals, just as the nonretarded ones, can benefit fron full range of psychiatric treatment modalities, both biological and psychological. Child and adloescent psychiatrists, by virtue of their training on bot psychological and biological aspects of human development, ought to be well prepared to provide such services to retarded children as well as adults. Likewise, there is a great need for administrative recognition of mental health needs of retarded persons and for the requirement for access to appropriate outpatient and inpatient treatment.
Second, child and aloescent psychiatrists have an important role in both primary and secondary prevention of mental disorders in this popoulation. For many retarded children, the early and judicious introduction of emotional supports for them and their families in addition to appropriate special education, reduces vulnerability to the emotional and behavioral disorders which so often complicate their lives. Developmentally disabled children, eben is they have a concurrent, severe mental disorder, are usually referred for their initial clincla evaluation to programs which may be expert at identifying the developmental disability, but are less equipped to recognize the concurrent emotional factors. The participation of child and adloescent psychiatrists in this early diagnostic stage will enable the early recognition of mental disorders, which could lead to remediative efforts preventing these disorders from becoming entrenched.
Third, child and adolescent psychiatrists should play a major research role, including clinical studies (such as epidemiology, diagnostic issues, treatment approaches and prevention) as well as basic research related to causes and pathogenesis is of both mental retardation and mental disorders in retarded persons.
Fourth, the training and learning opportunities in this field cannot be underestimated. A child and adloescent psychiatrist intraining can learn here about the effects of various handicaps (neurological and other) on human development, behavior, adaptation and psychopathology: about the interrelationships among chronic handicap, family development and society: and about how the developmental modifies the presentation of a mental disorder. Since mentally retarded children are served by many professionals, the child and adloescent psychiatrist in training has the opportunity to learn skills of collegially working within a n interdisciplinary team. All of the above skills are useful and necessary for any child and adolescnt psychiatrist, whether serving retatrded persons or not.
No discipline possesses all skills necessary to care for retarded persons thus none can claim an exclusive "ownership" of this interdisciplinary field. Thus child and adolescent psychiatrists, in their clinical, preventive, research and teaching roles, will function as members of an inters=disciplinary team of professionals.
Achievement of the above objectives will depend on adequate training. Most misconceptions about mental retardation and reluctancce to enter the developmental disabilities field are due to ignorance. Broader training not limited to traditional review of mental retardation syndromes, could include study of human development, diagnosis of mental disorders in retarded persons, and various treatment modalities. This training should be interdisciplinary and should provide opportunity to learn relevant knowledge and techniques of other disciplines, both medica (such as pediatrics) and nonmedical (such as psychology, special education, speech and langusge pathology and social service). Such trainiing models and curricula already exit and have proven to be effective.
In summary, knowledge of developmental disabilities is a necessary component of child and adloescent psychiatrist's competence, and providing clinical services to developmentally disabled persons and their families is an important responsibility of the child and adolescent psychiatrist.