5.3.2 Indications and Contraindications

5.3.2 Indications and Contraindications

Indications and Contraindications for Different Treatment Interventions

In child and adolescent psychiatry, various treatment interventions are utilized to address the diverse range of disorders that may be present. Each intervention has its own set of indications and contraindications, which should be considered when selecting the most appropriate treatment for a given individual. Below, we discuss the indications and contraindications for some common treatment interventions in child and adolescent psychiatry.

  1. Psychotherapy (e.g., Cognitive Behavioral Therapy, Family Therapy, Play Therapy):

Indications: Psychotherapy is indicated for a wide range of disorders, including anxiety, depression, ADHD, oppositional defiant disorder (ODD), conduct disorder, and trauma-related disorders. It is also appropriate for addressing relationship difficulties, self-esteem issues, and coping skills development.

Contraindications: Psychotherapy may not be suitable for children with severe intellectual disabilities, as they may not be able to fully engage in and benefit from the therapy process. Additionally, if a child is experiencing a psychiatric crisis, immediate stabilization and management should take precedence over therapy.

  1. Pharmacological Interventions (e.g., stimulants, antidepressants, antipsychotics):

Indications: Medications may be indicated for disorders such as ADHD (stimulants), depression (antidepressants), anxiety (anxiolytics), bipolar disorder (mood stabilizers), and psychosis (antipsychotics). They may also be used for symptom management in cases of severe aggression or irritability.

Contraindications: Some contraindications for medications include allergies, pre-existing medical conditions that may interact negatively with the medication, or a history of poor response or adverse effects to a specific drug. Additionally, medications should be used with caution in very young children or those with a high risk of medication misuse.

  1. Educational Interventions (e.g., Individualized Education Plans, Special Education Services):

Indications: These interventions are indicated for children with learning disorders, intellectual disabilities, ADHD, and other conditions that impact academic performance and functioning.

Contraindications: Educational interventions may not be necessary for children without academic difficulties or those who are already receiving appropriate accommodations and support.

  1. Speech and Language Therapy:

Indications: This intervention is appropriate for children with communication disorders, such as speech-sound disorders, language disorders, and social communication disorders.

Contraindications: Speech and language therapy may not be necessary for children without communication difficulties or those who have already achieved age-appropriate language skills.

  1. Behavioural Interventions (e.g., Parent-Child Interaction Therapy, Social Skills Training):

Indications: Behavioral interventions are indicated for a variety of conditions, including ADHD, ODD, conduct disorder, autism spectrum disorder, and anxiety disorders.

Contraindications: These interventions may not be suitable for children with severe intellectual disabilities or those who do not have the capacity to engage in and benefit from the therapy process.

  1. Occupational Therapy and Physical Therapy:

Indications: Occupational therapy is useful for children with motor, sensory, or developmental disorders, while physical therapy is helpful for those with physical disabilities or conditions affecting mobility and coordination.

Contraindications: Occupational and physical therapy may not be necessary for children without motor, sensory, or physical difficulties.

In conclusion, it is essential to consider the individual needs, strengths, and limitations of each child when selecting appropriate treatment interventions in child and adolescent psychiatry. Collaboration between healthcare professionals, parents, educators, and the child is critical to ensure that the selected interventions are tailored to the child’s unique circumstances and promote optimal outcomes.

Indications for Inpatient Care

Inpatient care is a specialized service provided by child/adolescent psychiatric units in the UK. Indications for inpatient care in child and adolescent psychiatry include situations where the child/adolescent is at risk of harm to self or others, where intensive support is needed to manage severe mental illness, where the child/adolescent requires a safe environment to undergo medication changes, and where other outpatient interventions have not been successful. Inpatient care may also be indicated for children/adolescents with acute symptoms of psychosis or bipolar disorder or those with severe self-harm or suicidal ideation. However, admission to inpatient care should be balanced against the potential disadvantages of hospitalization, including separation from family and community, stigma, and loss of routine and educational opportunities.

Inpatient care can provide a safe and therapeutic environment where a multidisciplinary team can assess, stabilize, and treat young people in crisis, provide intensive medication management, and engage families in treatment. However, the use of in-patient care for children and adolescents should be carefully considered as it may disrupt the young person’s education, development, and family relationships, and there are concerns about the potential adverse effects of institutionalization. Therefore, inpatient care should only be used as a last resort and should be supported by a comprehensive discharge and aftercare plan.

References:

  1. American Academy of Child and Adolescent Psychiatry. (2019). Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 58(2), 70-76.
  2. National Institute of Mental Health. (2016). Psychotherapies. Retrieved from https://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml
  3. Glick, B., & Matson, J. L. (2014). Treatment of autism spectrum disorders. In Handbook of mental health in children and adolescents (pp. 405-425). Springer, New York, NY.
  4. Le Grange, D., Lock, J., Loeb, K., & Nicholls, D. (2015). Academy for Eating Disorders position paper: the role of the family in eating disorders. International Journal of Eating Disorders, 48(5), 417-421.
  5. D’Amico, F., & Laloyaux, J. (2016). Art therapy with children and adolescents in CAMHS: a review of the literature. The Arts in Psychotherapy, 51, 68-74.
  6. Royal College of Psychiatrists. (2015). CR162: Admission to psychiatric inpatient units and wards. College Report. Retrieved from https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr162.pdf
  7. National Institute for Health and Care Excellence. (2016). Violence and aggression: short-term management in mental health, health and community settings. Clinical guideline CG25. Retrieved from https://www.nice.org.uk/guidance/cg25/chapter/1-Guidance#inpatient-care
  8. Department of Health. (2015). Mental health services: inpatient care for young people with acute mental health needs. Retrieved from https://www.gov.uk/government/publications/mental-health-services-inpatient-care-for-young-people-with-acute-mental-health-needs