Multisystemic therapy (MST) is a family- and community-based treatment that has successfully served as a clinical and cost-effective alternative to out-of-home placements (e.g. incarceration, psychiatric hospitalisation) for youths presenting serious clinical problems. MST clinical procedures and findings from MST outcome studies are reviewed. Several key features differentiate MST from prevailing mental health and juvenile justice practices and probably account for its relative success. These features include interventions that comprehensively address the known determinants of clinical problems, the provision of services in home and community settings to promote service access and ecological validity, and a philosophy that emphasises provider accountability for family engagement and outcomes.

Diagnosis of neurological conversion disorder is difficult. Considerable overlap in symptomatology occurs with progressive neurological degenerative disease, pervasive refusal syndrome, depressive illness, chronic fatigue syndrome, and other conditions. Conversion symptoms can also coincide with organic neurological disease. Successful management requires a sensitive, confident, multidisciplinary approach. Multiple or repeated investigations can be counterproductive in resolving symptoms. This report describes three children, one male and two female, aged between 9 and 10 years, who were referred for evaluation of progressive neurological symptoms. Each progressed to a completely dependent state within 8 weeks of referral, requiring nasogastric feeding and total assisted care. A convincing psychosocial trigger was not identified in any case. Improvement occurred only when investigations were ceased and rehabilitation commenced. Long-term follow-up has revealed an excellent outcome for all three children.

Difficult management issues, frequently involving many agencies, arise when psychotic adolescents need admission to hospital. We review the recent experience of a community-based adolescent team and identify factors that appeared to inhibit effective management at times when admission was necessary. Suggestions are made about how to develop the flexible arrangements necessary to facilitate appropriate management.

Most published questionnaires for infant sleep problems form part of general questionnaires looking at a wider range of infant behaviours. This paper evaluates the Infant Sleep Questionnaire (ISQ), a maternal self- report questionnaire designed specifically to assess sleeping behaviour in 12–18-month-old infants. The sensitivity and specificity of the ISQ as compared to maternal sleep diary measures is reported. The use of the ISQ for clinical and research purposes is discussed.

This paper is an account of child mental health services in a country that has undergone very rapid socioeconomic growth and change. Despite the economic wealth and the availability of funding, there are problems with human resources. Patterns of morbidity are similar to Western cultures, but attitudes to child mental health in the community are different. Such difficulties necessitate taking different approaches in service delivery. Child psychiatrists have to assume a variety of roles and working through the family seems to be surprisingly feasible and acceptable.

In a series of recent judgements the courts have authorised the treatment of adolescents against their will. What effect have these judgements and other legal developments had on the legal basis of medical treatment for children? How do they affect the professionals involved in decision- making? This article attempts to address the most commonly expressed concerns and queries about the changing legal context of work in the field of child mental health. It is based on the authors' discussions with professionals from backgrounds in health care, social care, and justice during training we have carried out with multidisciplinary and multiagency teams in England and Wales. For the purposes of this article, we will, in keeping with The Children Act 1989 (s105 (1)), use the term ‘child’ and ‘children’ to refer to everyone under 18 years old.

Re CB and JB (care proceedings: case conduct)[1998] 2 FCR 313 Family Division, Manchester. Wall J.

Care proceedings were brought in respect of twins who were born in February 1996. It was alleged that one of them had been the victim of two shaking episodes, whilst in the care of their parents. In February 1998, a care order was made and the children were freed for adoption. The facts of the case were very simple, the only factual issue being which parent had inflicted the child's injuries. Care proceedings were commenced in November 1996 and the substantive hearing took place in February 1998; a large number of expert opinions had been sought; the legal advisers had not worked towards clarifying the issues. The judge, Mr Justice Wall, was highly critical of the conduct of the case and made a number of recommendations.