Many disorders seen in adults can occur in children.

However, there is a group of disorders usually first diagnosed in children. Table 7-1 lists these disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). This chapter reviews only the more common disorders.

Child psychiatric assessment requires attention to details of a child's stage of development, family structure and dynamics, and normative age-appropriate behavior. Consulting with parents and obtaining information from schools, teachers, and other involved parties (e.g., Department of Social Services/Youth Services) are essential to proper assessment.

Children, especially young children, usually express emotion in a more concrete (less abstract) way than adults. Consequently, child interviews require more concrete queries (Do you feel like crying? instead of Are you sad?). Playing games, taking turns telling stories, and imaginative play are often used to gain insight into the child's emotional and interpersonal life. During play, observations are also made regarding activity level, motor skills, and verbal expression. Children are much more Likely than adults to have comorbid mental disorders, making diagnosis and treatment more complicated.

The complexities of diagnosis in child psychiatry often require the use of psychological testing. Tests of general intelligence include the Stanford-Binet Intelligence Scale (one of the first intelligence tests developed and often used in young children) and the Wechsler Intelligence Scale for Children-Revised (WISC-R). The WISC-R is the most widely used intelligence test for assessing school-age children. It yields a verbal score, a performance score, and a fullscale score (both verbal and performance) or intelligence quotient (IQ).

There are many other tests and objective rating scales designed to measure behavior (e.g., impulsiveness, physical activity), perceptual-motor skills (by drawing people, placing pegs in appropriately shaped holes), and personality style (by describing what is happening in an ambiguous scene).

Because seizure activity or subtle electroencephalographic abnormalities are common in certain child psychiatric disorders, an electroencephalogram (EEG) may be warranted. The evaluation of mental retardation usually involves a search for possible causes.