SURVEY OF DIFFICULT TO CONTAIN AND TREAT CHILDREN AND ADOLESCENTS

Child psychiatrists and paediatricians are faced by a number of distur bed children and adolescents who become a major treatment challenge du e to a combination of their dangerous and/or disruptive behaviour and the unavailability of resources. Paediatricians and psychiatrists in o ne regional health area were questioned about the number of such child ren and adolescents under 18 years of age seen over a 20 month period. The response rate was 44% (86/194 specialists approached). A total of 72 children and adolescents were identified. For a health district wi th a total population of 200 000, this represents nearly five children (about one of these identified by paediatricians and one with associa ted learning disability). The majority of cases were adolescents with chronic problems (over one month's duration) but most cases reported b y paediatricians were acute in preadolescents. Conduct disorders, auti stic spectrum, and psychotic disorders were the most common clinical p roblems. Seriously disruptive behaviour had been present in two thirds and marked problems with behaviour that was a physical risk to others and to the self were present in over half and nearly a third of cases respectively. Services had been universally stretched by these childr en's difficulties. Clinicians thought the needs of these children woul d have been best met either through psychiatric day hospital type faci lities or in combined paediatric/child psychiatric inpatient units.