Child and adolescent psychiatry (or pediatric psychiatry) is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.
Classification of disorders
There are many classifications of disorders. Developmental disorders include autism spectrum disorder and learning disorders, and some attention and behaviors disorders are attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder. Childhood schizophrenia is an example of a psychotic disorder. Major depressive disorder, bipolar disorder, persistent depressive disorder, and disruptive mood dysregulation disorder are under the classification of mood disorders.
A wide range of disorders that are classified as eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder (ARFID), and pica. Some anxiety disorders are panic disorder, phobias, and Generalized anxiety disorder. Lastly, substance use disorders can be specified to specific substances, such as alcohol use disorder or cannabis use disorder.
Disorders are often comorbid. For example, an adolescent can be diagnosed with both major depressive disorder and generalized anxiety disorder. The incidence of psychiatric comorbidities during adolescence may vary by race, ethnicity and socioeconomic status, among other variables.
Clinical practice
Assessment The psychiatric assessment of a child or adolescent starts with obtaining a psychiatric history by interviewing the young person and his/her parents or caregivers. The assessment includes a detailed exploration of the current concerns about the child's emotional or behavioral problems, the child's physical health and development, history of parental care (including possible abuse and neglect), family relationships and history of parental mental illness. It is regarded as desirable to obtain information from multiple sources (for example, both parents, or a parent and a grandparent), as informants may give differing accounts of the child's problems. Collateral information is usually obtained from the child's school with regard to academic performance, peer relationships, and behavior in the school environment.Rutter, Michael and Taylor, Eric. Chapter 2, Clinical assessment and diagnostic formulation. In Rutter and Taylor (2002)
Psychiatric assessment always includes a mental state examination of the child or adolescent which consists of a careful behavioral observation and a first-hand account of the young person's subjective experiences. This assessment also includes an observation of the interactions within the family, especially the interactions between the child and his/her parents.Angold, Adrian. Chapter 3, Diagnostic interviews with parents and children. In Rutter and Taylor (2002)
The assessment may be supplemented by the use of behavior or symptom rating scales such as the Achenbach Child Behavior Checklist or CBCL, the Behavioral Assessment System for Children or BASC, Conners Comprehensive Behaviour Rating Scale (used for diagnosis of ADHD), Millon Adolescent Clinical Inventory or MACI, and the Strengths and Difficulties Questionnaire or SDQ. While these instruments bring a degree of objectivity and consistency to the clinical assessment,Verhulst, Frank and Van der Ende, Jan. Chapter 5, Rating scales. In Rutter and Taylor (2002) the diagnosis of ADHD requires confirmation by a clinician experienced in evaluating youth with and without ADHD, who supplements the findings with input from parents, teachers, and the youth themselves.
More specialized psychometric testing may be carried out by a psychologist, for example using the Wechsler Intelligence Scale for Children, to detect intellectual impairment or other cognitive problems which may be contributing to the child's difficulties.Sergeant, Joseph and Taylor, Eric. Chapter 6, Psychological testing and observation. In Rutter and Taylor (2002)
Diagnosis and formulation The child and adolescent psychiatrist makes a diagnosis based on the pattern of behavior and emotional symptoms, using a standardized set of diagnostic criteria such as the Diagnostic and Statistical Manual (DSM-V) or the International Classification of Diseases (ICD-11). While the DSM system is widely used, it may not adequately take into account social, cultural and contextual factors and it has been suggested that an individualized clinical formulation may be more useful. A case formulation is standard practice for child and adolescent psychiatrists and can be defined as a process of integrating and summarizing all the relevant factors implicated in the development of the patient's problem, including biological, psychological, social and cultural perspectives (the "biopsychosocial model"). The applicability of DSM diagnoses have also been questioned with regard to the assessment of very young children: it is argued that very young children are developing too rapidly to be adequately described by a fixed diagnosis, and furthermore that a diagnosis unhelpfully locates the problem within the child when the parent-child relationship is a more appropriate focus of assessment.
The child and adolescent psychiatrist then designs a treatment plan that considers all the components and discusses these recommendations with the child or adolescent and family.
Treatment Treatment will usually involve one or more of the following elements: behavior therapy,Herbert, Martin. Chapter 53, Behavioural therapies, in Rutter and Taylor (2002) cognitive-behavior therapy,Brent, David, Gaynor, Scott and Weersing, Robin. Chapter 54, Cognitive-behavioural approaches to the treatment of depression and anxiety. In Rutter and Taylor (2002) problem-solving therapies,Compas, Bruce, Benson, Molly et al. Chapter 55, Problem-solving and problem-solving therapies, in Rutter and Taylor (2002) psychodynamic therapy, parent training programs,Scott, Stephen. Chapter 56, Parent training programmes, in Rutter and Taylor (2002) family therapy,Jacobs, Brian and Peaarse, Joanna.Chapter 57, Family therapy, in Rutter and Taylor (2002) and/or the use of medication.Heyman, Isobel and Santosh, Paramala. Chapter 59, Pharmacological and other physical treatments, in Rutter and Taylor (2002) The intervention can also include consultation with pediatricians,Rauch, Paula and Jellinek, Michael. Chapter 62, Paediatric consultation, in Rutter and Taylor (2002) primary care physiciansGarralda, Elena. Chapter 65, Primary health care psychiatry, in Rutter and Taylor (2002) or professionals from schools, juvenile courts, social agencies or other community organizations.Nicol, Rory. Chapter 64, Practice in non-medical settings, in Rutter and Taylor (2002)
In a review of existing meta-analyses and disorders on the four most frequent childhood and adolescent psychiatric disorders (anxiety disorder, depression, ADHD, conduct disorder), only for ADHD was the use of medication (stimulants) considered to be the most efficacious treatment option available. For the remaining three disorders, psychotherapy is recommended as the most effective treatment of choice. A combination of psychological and pharmacological treatments is an important option in ADHD and depressive disorders. Treatments for ADHD and anxiety disorders produce higher effect-sizes than do interventions for depressive and conduct disorders.
A 2025 systematic review reinforced the effectiveness of psychosocial interventions for treating disruptive behaviors in youth, especially those involving parental participation. These approaches outperformed usual care in preschool and school-aged children. While medications such as stimulants and antipsychotics offered modest improvements in select cases, they carried a higher risk of side effects, and long-term comparative effectiveness remains unclear. A 2026 systematic review found that in children and adolescents diagnosed with anxiety or depression, mindfulness-based programs probably reduce depression symptoms slightly in the short term but do not appear to improve anxiety.
Training In the United States, Child and adolescent psychiatric training requires 4 years of medical school, at least 4 years of approved residency training in medicine, neurology, and general psychiatry with adults, and 2 years of additional specialized training in psychiatric work with children, adolescents, and their families in an accredited residency in child and adolescent psychiatry. Child and adolescent sub-speciality training is similar in other Western countries (such as the UK, New Zealand, and Australia), in that trainees must generally demonstrate competency in general adult psychiatry prior to commencing sub-speciality training.
Certification and continuing education In the US, having completed the child and adolescent psychiatry residency, the child and adolescent psychiatrist is eligible to take the additional certification examination in the subspecialty of child and adolescent psychiatry from the American Board of Psychiatry and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP). Although the ABPN and AOBNP examinations are not required for practice, they are a further assurance that the child and adolescent psychiatrist with these certifications can be expected to diagnose and treat all psychiatric conditions in patients of any age competently. Training requirements are listed on the web site of The American Academy of Child & Adolescent Psychiatry.AACAP
Shortage of child and adolescent psychiatrists in the United States
The demand for child and adolescent psychiatrists continues to far outstrip the supply worldwide. There is also a severe maldistribution of child and adolescent psychiatrists, especially in rural and poor, urban areas where access is significantly reduced. A report by the US Bureau of Health Professions (2000) projected a need by the year 2020 for 12,624 child and adolescent psychiatrists, but a supply of only 8,312. In its 1998 report, the Center for Mental Health Services estimated that 9-13% of 9- to 17-year-olds had serious emotional disturbances, and 5-9% had extreme functional impairments. In 1999, however, the Surgeon General reported that "there is a dearth of child psychiatrists." Only 20% of emotionally disturbed children and adolescents received any mental health treatment, a small percentage of which was performed by child and adolescent psychiatrists. Furthermore, the US Bureau of Health Professions projects that the demand for child and adolescent psychiatry services will increase by 100% between 1995 and 2020. More recent estimates from AACAP indicate that as of 2024 there are approximately 10,000 practicing child and adolescent psychiatrists in the United States against a demand that continues to exceed supply; the shortage is estimated at more than 8,000 practitioners needed to meet current mental health needs of children and adolescents.
Cross-cultural considerations Steady growth in migration of immigrants to higher-income regions and countries has contributed to the growth and interest in cross-cultural psychiatry. Families of immigrants whose child has a psychiatric illness must come to understand the disorder while navigating an unfamiliar health care system.Wintrob R. Cross-cultural psychiatry. Psychiatric Times. 2010;27:27.Measham T, Guzder J, Rousseau C, Nadeau L. Cultural considerations in child and adolescent psychiatry. Psychiatric Times. 2010;27:38-40.
Criticisms
Subjective diagnoses