Increasing Core Competencies in Child and Adolescent Psychiatry

Worldwide, 10%–20% of children and adolescents experience mental disorders. Half of all mental illnesses begin by the age of 14 years and three-quarters by the mid-20s.[1] Child and adolescent psychiatry is an area who now needs our special attention. Child and adolescent psychiatry in India is going through a turmoil; other specialties such as pediatricians are venturing into child psychiatry disorders such as autism spectrum disorders, intellectual disabilities, learning disabilities, and attention deficit hyperactivity disorder which are traditionally considered the core area of psychiatry, covered in the core curriculum of psychiatry training for postgraduation in psychiatry as well as included in the 10^th revision of the International Statistical Classification (ICD-10) under psychiatric disorders. The clinical criteria of Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition and ICD-10 which psychiatrists are primarily trained in are used for clinical diagnosis of these conditions. Moreover, medications and therapies used for the treatment of comorbidities of these conditions are psychiatric medications.

The advent of pediatric psychopharmacology has enormously improved psychiatric care of children and adolescents;[2] however, there is hesitancy in the use of medication in children. Evidence-based pediatric psychopharmacology is essential for better care and avoiding legal issues. There is an enormous need for monitoring the long-term side effects of psychiatric drugs in the inherently vulnerable pediatric population. Clinicians and researchers should direct their attention toward the legal, ethical, and regulatory aspects of pediatric psychopharmacology.[3] Child and adolescent psychopharmacology needs a thorough understanding of pharmacodynamics and kinetics in children and adolescents, weight-based dosing, evidence base, and labeled use versus off-label use.

Research areas in child psychiatry in India remain mostly unexplored, especially developmental disorders.[4] Human resources and training issues for both psychopharmacological and psychosocial interventions for child and adolescent psychiatry will be of paramount importance.[5] Furthermore, there is a plethora of new research coming up of interventions in childhood psychiatric disorders, which needs to be translated into clinical care. Neurodevelopmental disorders require different skill sets which need additional training and supervision from child and adolescent psychiatry perspective; moreover, the psychiatric disorder can manifest in children and adolescents with varied clinical presentations and require a thorough understanding of clinical, diagnostic, and therapeutic aspects. Recent trends of stem cell therapy which are being practiced unregulated without sufficient scientific basis and doubtful intention are creating confusion and are exploitative in nature.

Considering this prevailing scenario, this supplement on child and adolescent psychiatry brought out by the Clinical Practice Guidelines Subcommittee of Indian Psychiatric Society lead by Chairperson Professor Shiv Gautam, Cochairperson Professor Ajit Avasthi, and Convener Professor Sandeep Grover is a welcome document.

The editorial team is happy to be associated with bringing out of this supplement on child and adolescent practice guidelines in India. We sincerely hope that it fulfills the needs and expectations of all psychiatrists working with children and adolescents.

Long live IPS!