An important change in ICD-11 is the lifespan approach, whereby previous child and adolescent disorders have been amalgamated with adult disorders. There have been changes in the definition/descriptions of neurodevelopmental and disruptive disorders, some of which may have an impact on service development.

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.

There is a growing research interest in childhood hallucinations aspredictors of psychotic states. This work appears to have limited directrelevance for clinical child psychiatric practice, but it highlights thecontinuing relevance of research into precursors of psychotic states andinto the determinants of clinically relevant hallucinations in children.

In 2009, a conference at Imperial College London brought together experts on the primary care provision of child and adolescent mental health. The following paper highlights various themes from the conference, and particularly focuses on general practice. Despite international and national guidance, child and adolescent mental health provision in primary care is limited in the UK and globally. We argue that primary care services are in fact well placed to assess, diagnose, and manage child and adolescent mental health problems. The barriers to such provision are considered from the perspective of both service users and providers, and the possible ways to overcome such challenges are discussed. The paper is informed by various epidemiological and intervention studies and comparisons between different countries and health systems are explored.

We studied patterns of psychophysiological (skin conductance, heart rate) reactivity to sounds and to situations with varying emotional and alerting connotations in child psychiatric out-patients and in healthy controls. Children with emotional disorders were particularly reactive to situations with aversive components, while conduct disorder subjects showed increased reactivity to pleasant situations and decreased responses to neutral but high-intensity stimulation and to withdrawal of stimulation in silence periods. The results indicate patterns of biological reactivity which may underlie different psychiatric disturbances in children.

Outcome auditing of specialist child and adolescent mental health services (CAMHS) is now well under way internationally. There is, however, debate about objectives and tools. A case is made for the achievable goal of enhancing service accountability through user satisfaction information and clinician-rated contextualised measures of improvements in symptoms and impairment.

We examined the use of a staff-completed measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), to record mental health problems in adolescents in local authority secure accommodation. It proved possible to train staff and implement completion of the HoNOSCA on 64 consecutive admissions. Interrater reliability was high. The HoNOSCA identified high levels of psychological problems on admission (mean 18.5, s.d.=5.5). Follow-up HoNOSCA ratings proved sensitive to change; however, correlation between HoNOSCA and adolescent-completed questionnaires was poor. We concluded that HoNOSCA can be helpful in documenting mental health problems among young people admitted to secure local authority units.

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.

Epidemiological research has revealed that psychiatric disorders in children and adolescents are common, persistent and handicapping. Only 1 in 10 of those with a disorder is seen in specialist mental health services. However, the majority of children and adolescents see their general practitioner (GP) every year. Although the majority present with physical complaints, there are indications that rates of psychiatric disorder in those attending are increased and that psychiatric disorder is associated with increased consulting. These findings raise questions about the role of primary care in the promotion and management of mental health in young people.

The assessment and treatment of somatisation in childhood require explicit recognition that many families frequently hold strong belief in the presence of physical disorders. Engaging the family, recognising and focusing on their beliefs and concerns, and paediatric/psychiatric liaison are usually required. Our knowledge on the management of children with somatisation is largely based on clinical reports but a number of open trials and methodologically increasingly stronger studies show that somatisation can respond to family treatments involving cognitive-behavioural techniques as well as to sensitive, psychologically sound advice by paediatricians. Antidepressants should be considered when there are comorbid mood disorders.

Epilepsy in childhood may alter family relationships but the relevance of these changes for the increased rates of psychopathology has been little investigated. This study uses maternal expressed emotion (EE) to examine family relationships of children with epilepsy and the association with high risk for psychiatric disorder. EE was assessed using the Camberwell Family Interview carried out with the mothers of 22 schoolchildren with chronic epilepsy who were attending a general hospital outpatient clinic. Sixteen of these children had similarly aged healthy siblings who served as controls. High risk for psychiatric disorder in the children and mothers was assessed using behavioural, mood, and self-esteem questionnaires completed by mothers, teachers, and children. It was found that mothers showed significantly more emotional overinvolvement and a trend for more hostility towards their children with epilepsy than towards sibling controls. For the 22 children with epilepsy, maternal emotional overinvolvement was not associated with child behavioural deviance. High levels of criticism and, to a lesser extent, hostility did show associations with child behavioural deviance, and the strongest links were between maternal criticism and maternal rated antisocial and overactive behaviour in the child. Fewer positive comments by mothers towards the children were associated with child emotional symptoms and lower self-esteem in a number of areas. This study suggests that further research could consider the appropriateness of psychological intervention for families in which mothers are critical and hostile and whose children show antisocial behaviour.

A 13–year-old boy developed severe kleptomania after a depressive illness. This was a response to psychological trauma, and appeared in the context of a probable ‘lethargic’ encephalitic process.