A model for primary care child and adolescent mental health (CAMH) services is presented, the overall goal of which is to reduce population burden of CAMH problems. The theoretical orientation of the model is based on ecological systems theories. Features of the model include: local population outcome measures; small area service focus; primary-care-based CAMH specialists; a locally comprehensive service framework based in primary care (schools and general practices); and an explicit process of community engagement. The model is illustrated by reference to a primary care CAMH service (currently the subject of a controlled trial) in Flintshire, North Wales.

We argue against defining dyslexia as requiring by definition the presence of demonstrable phonological difficulty, and also against defining it in relation to exclusion criteria. Instead, we suggest that what matters is evaluating any child's set of reading subskills against age-related norms for those subskills. We also argue that in considering the causes of reading difficulty it is essential to distinguish between proximal cause (some abnormality in the information-processing system that the child is using to read) and distal cause (the reason for this system being abnormal). The same proximal cause (e.g. poor phonic knowledge) can be the product of different distal causes in different children (e.g. the distal cause might be constitutional, environmental, or educational).

Non-attendance for first outpatient appointments at Child Mental Health Clinics is a common problem affecting efficient use of resources, as well as staff morale. This study demonstrates that requiring families to confirm that they want an appointment, in order to receive one, significantly improves the attendance rate for first appointments, compared to two other commonly used procedures: a reminder letter before the appointment is sent, and a standard appointment letter. Furthermore, this procedure did not appear to reduce accessibility to the service.

This review examines some of the definitional issues of attention and the related constructs of working memory and executive control. Measurement approaches to two attention elements, inattention and impulsivity, which are relevant to the diagnosis of attention deficit hyperactivity disorder, are also explored. Features of Stroop and Stroop-like tasks, continuous performance tests, and assessment paradigms that have a volitional or motivational aspect, such as delay of gratification, are highlighted. The conclusions emphasise the multidimensional nature of attentional constructs and the care that must be taken when attempting to measure a single attentional element.

The incidence of food refusal associated with illness is reviewed, not illness by illness, but according to those factors that affect the ability to eat; normal learning about eating, aversive learning about eating, regulation of appetite, children's cognitions about foods, and parental anxiety about intake. Diseases affecting the major organs are likely to generate food refusal based on at least one of these factors, if not all of them. However, some minor disease processes can also have a major impact on food acceptance. Child temperament also affects food acceptance and may interact with the disease process to produce food refusal.

It is only relatively recently that Post Traumatic Stress Disorder (PTSD) has been recognised in children. Controlled treatment outcome studies of childhood PTSD are scarce, but those that exist indicate that Cognitive Behaviour Therapy (CBT) is an effective intervention. In this article, we briefly describe PTSD in children and outline some behavioural and cognitive models of the disorder. Derived from these models, prolonged therapeutic exposure and cognitive restructuring as part of a CBT package are then described. In practice, effective therapy will include more than exposure-based work, and additional procedures, including work with parents, are highlighted. While CBT is the treatment of choice of PTSD in childhood, there is an urgent need for further treatment outcome studies.

Despite agreement that children's social functioning may be the best indicator of current and future behavioural and emotional problems, its measurement is under-developed. Measures of social functioning and psychopathology remain entangled, although this may be less critical clinically than in research. Confusion in terminology and definition is highlighted and clarified by tracing diverse but converging areas of research. Current measurement needs and approaches are presented along with six measures—each suited to different assessment needs. It is suggested that the next generation of instrument developers make use of findings from studies of social competence and motivation, focusing not only on social skills and deficits but also on beliefs and goals that lead to adaptive and maladaptive functioning.

This paper concentrates on children's play during school breaktimes. Though neglected by researchers, it is one of the few occasions when children can play and interact in a relatively safe environment, free of adult control. The paper reports on a recent programme of research at the University of London Institute of Education. There are signs that the prevalence of a negative view about breaktime in schools is leading to more deliberate management and supervision of breaktimes, and a reduction in duration. Breaktime can be a time when aggression, teasing, and bullying take place, but this paper also reviews positive aspects of peer relations and games at breaktime, including opportunities for friendship development, social competence, and peer culture. An important challenge facing schools is achieving a balance between control over pupil behaviour, while facilitating pupil independence and social development.

Multisystemic therapy (MST) is a highly individualised family- and home-based treatment that has successfully served as a clinically effective and cost-effective alternative to out-of-home placements (e.g., incarceration, psychiatric hospitalisation) for youth presenting serious clinical problems. MST clinical procedures are reviewed and two extensive case summaries are used to explicate the MST intervention process for treating serious antisocial behaviour and modifications in that process needed to safely and effectively serve youth presenting psychiatric emergencies.

Obsessive-compulsive disorder (OCD) is estimated to affect between 0.5% and 2% of children and adolescents. The majority of clinical cases has both obsessions and compulsions. Depression, anxiety and tic disorders are common comorbid diagnoses, and assessment can therefore be complex. Several theories have been proposed for the aetiology and maintenance of the disorder, including cognitive-behavioural and neuropsychiatric theories. Cognitive-behavioural and pharmacological treatments are both probably efficacious therapies for children and adolescents but further research is needed to compare these treatments with each other, and to examine the use of combination therapies in controlled trials.

Professionals working in child and adolescent mental health services are increasingly encouraged to examine the evidence underlying their clinical practice. Embracing evidence-based practice can present difficulties, as barriers to changing practice exist. These difficulties are examined, along with the meaning of evidence-based practice in a multidisciplinary speciality, and the potential benefits that develop from it.

Hyperactivity is a potentially confusing concept with different terminology and history in Europe and the U.S.A. There is a certain amount of suspicion among U.K. practitioners as to whether it is appropriate to recognise it as a primary condition. Perhaps because of this, assessment procedures vary between practitioners and centres. Using our experience of running a specialist overactivity and attention disorders clinic (now defunct) at St George's Hospital, London we draw together recommendations for the assessment of this serious clinical problem.

There is growing interest in the provision of health services that are sensitive to the needs of diverse ethnic groups. This paper examines ethnic diversity of attenders at a Child and Adolescent Psychiatric Clinic and how these groups differ in terms of referral route, reason for referral, psychiatric diagnosis and school report of difficulties. Service access relative to the distribution of the local population is assessed. Modification of OPCS categories provides additional useful information. The findings are relevant for the planning and provision of child and adolescent psychiatric services in a highly diverse population.

This paper offers a critical assessment and some illustrations of an anthropological approach to the study of children's play. It argues that universal definitions of play are problematic and that therefore attention should be paid to the local definitions of play operative in any culture. This includes, importantly, the meanings that children attribute to and generate through their play. Drawing on ethnographic fieldwork the paper illustrates just one aspect of children's play: the different ways in which play facilitates power relations to be articulated, upheld, and challenged. In this sense play is revealed to be far from a frivolous activity. Instead, it is a serious medium through which children conduct their social affairs.

All families have attachments; some may be secure, others insecure, and family and marital therapists inevitably have to relate to these. This paper discusses ways in which the therapist can establish a temporary secure base within therapy, which helps families to feel safe enough to explore new ways of relating. The overall aim is to help them to create a more secure family or couple base at home, from which they can explore new solutions during and after therapy. A new school of therapy is not proposed as therapists can also use their own approaches when a secure therapeutic base is established.

This paper discusses the difficulties researchers are likely to encounter when assessing the self-concept of children with Down syndrome. It describes four potentially appropriate assessment methods: projective techniques, nonverbal and/or pictorial techniques, construct generation techniques, and topological techniques. The paper concludes that methods based on the Pictorial Scale of Perceived Competence and Social Acceptance (Harter & Pike, 1984) and personal construct psychology offer the most appropriate means for assessing the self-concept of children with Down syndrome.

Recruiting subjects for follow-up studies in child abuse raises ethical dilemmas. This paper examines the effects of the ethical stance taken in a study of a community sample of sexually abused children. The ethical code adopted required strict confidentiality and active consent to be interviewed from both child and carer, based on full information about the research objectives and method. The response rate was very low. A less rigid stance, which might have resulted in a larger sample, was considered inappropriate. Nevertheless, the quantitative and qualitative data yielded findings of interest to practitioners. Suggestions for future research practice are presented.

HoNOSCA is a timely newcomer to the field of Child and Adolescent Mental Health Services (CAMHS) research. In its short life it has already been thoroughly and successfully evaluated. Its user-friendliness has made it acceptable and even popular in routine clinical practice. It was central to clinical data gathering for the recent national survey of CAMH provision in the UK (Audit Commission, 1999). What are the reasons for its popularity? What are its limitations? And what about possible future uses?

The facts of the Bulger case and its legal consequences, in particular the judgements of the European Court of Human Rights (ECHR), are summarised. A review of the literature on child homicide indicates that this continues to be rare, can neither be predicted nor prevented, and suggests that the future outlook for such offenders may be good. The recommendations of a committee set up by Justice (1996) for changes in legislation and procedures concerning children who have killed, are congruent with the European Court's judgements, but still woefully at odds with public attitudes.

This study investigated possible associations between ethnic background of referred children and non-attendance, referrer type, problem type, age and gender. The sample consisted of 769 children offered outpatient appointments. Ethnic background influenced referrer type. Over-referrals against expectations were: White children more by GPs than expected, Black and South Asian children by specialist doctors, Black children by education services and Mixed Race children by social services. There was neither a significant difference in ethnic background between attendees and non-attendees nor were gender, age or problem types related to ethnic group. Clinicians should be aware that referral routes may appropriately, or inappropriately, be different for different ethnic groups. Differences found may be due to genuine variations in morbidity, thus leading to presentation to different referrers.