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.

Prompt and accurate diagnosis of Munchausen's syndrome by proxy is essential in order to minimise the risk of iatrogenic and parentally-induced harm to the child. However, inaccurate diagnosis of MSBP may have devastating consequences for the child, family and professionals involved. ‘Psychiatric’ Munchausen's syndrome by proxy, which involves the presentation of signs and symptoms suggestive of a psychiatric disorder in the child, is even more difficult to diagnose and requires an unbiased and full assessment by the appropriate multidisciplinary team.

There is much wisdom in these two essays on dyslexia, by Snowling and by Coltheart and Jackson, as well as a useful and informative summary of many key research findings. Given the fact that debates about the diagnosis and concept of dyslexia have been running for at least the last 40 years (see e.g. Rutter, 1969), and given the immense amount of high-quality empirical research that has been conducted (see e.g. Bryant & Bradley, 1985; Goswami, 1994; Rispens, van Yperen, & Yule, in press), it might be expected that most of the main controversies ought to have been resolved by now. But they have not, as is apparent from the contrasting positions adopted in this forum. It might be hoped that, at least, any well-informed dispassionate reviewer should be able to arbitrate and so decide which view is most valid. Unfortunately, even that is not readily possible. A key problem is that the two papers seem to be starting from different premises and, thereby, tackling a somewhat different issue.

This study reports on a nation-wide survey of a randomly selected group of child psychiatrists and examines their prescribing practices for a wide range of psychotropic medication in a wide range of disorders. Despite 98% of the sample valuing medication as a treatment modality, one third of clinicians prescribed rarely or not at all. More than three-quarters felt insufficiently competent in this area, a finding which was significantly associated with less frequent or no prescribing. Half of the sample believed that if they were better informed they would prescribe more and 91% requested regular psychopharmacology seminars.

Infant Observation is a valuable training experience for workers in child and adolescent mental health, helping both to conceive the infantile experience of the children under their care, and to understand the parents' accounts of a child's history. It is an experience that gives trainees a unique opportunity to observe the development of an infant, systematically and practically from birth, in the child's natural setting, thus facilitating the acquisition of a meaningful understanding of how human relationships emerge and develop. Infant Observation gives the trainee a clear focus on the baby and his family, whilst remaining as a participant observer, and spontaneously encouraging problem-free talk.

This paper presents an analysis of the first 81 cases seen in the recently established assessment service for children with autism and related disorders in Southampton. The children presenting for assessment are described in terms of a number of biographical, educational, behavioural, and medical features and the characteristics of our sample are compared with published findings. The future development of the service is considered in the light of current developments and common features and concerns of the families seen.

This paper describes the care arrangements made for children when their mothers are admitted to psychiatric hospital. It also describes at admission, and at 3 months follow-up, the views and opinions of mothers and carers with regard to the admission, its impact on the family, and the service received. It was found that children are predominantly cared for within their family when their mother is admitted to hospital, and that mothers and carers are concerned about the impact of the admission and its associated problems.

A postal questionnaire survey of senior clinical psychologists, child psychiatrists and community paediatricians in the Trent region (85% response) revealed that a total of 826 new ADHD cases were seen over the index period, 1997–1998. Approximately a third of these were adolescents. Wide variations in individuals' clinical caseloads, both within and between professional groups, were revealed. No respondent could identify any local formal transitional arrangements or adult services for older ADHD cases. This would suggest that there is a pressing need to establish such services for patients with ADHD irrespective of their age.

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.

As sustained methylphenidate becomes available in the United Kingdom, there is likely to be considerable demand related to the difficulties that frequently arise with standard methylphenidate due to the need for midday doses at school, as well as the pronounced ‘on/off’ therapeutic effects sometimes seen with multiple doses. This article briefly discusses longer acting stimulants, reviews the available literature, anticipates possible problems in the use of slow release methylphenidate, and presents clinical guidelines for its use.

This article analyses assessment procedures for young offenders aged 10 to 17 years who receive a police Final Warning or appear before Youth Courts in England and Wales. Members of Youth Justice Teams (YOTs) use detailed ‘Asset’ forms to collate information about the background, education, life-style and personal characteristics of the young people. The replies are scored to indicate the risk of further offending and the YOTs make their recommendations for intervention. The author points out that punishment has to be proportional to the crime but many young people and their families require long-term help if they are to be diverted from crime.

Personal construct psychology is presented and its application within a school setting is described. Using case material derived from working with an 11-year-old pupil displaying highly disruptive behaviour, the strengths and limitations of this approach are illustrated. Personal construct psychology can increase pupil and teacher understanding of behavioural difficulties and lead directly to individualised strategies for successful intervention.

Although research has demonstrated the differential influence of schools on children's psychosocial adjustment, the influence of radical legislative changes since 1979 is less clear. Evidence of a sharp rise in exclusions and in referral for special educational needs is contrasted with evidence that behaviour in most schools is good, and with data showing a steep reduction in the number of pupils leaving school with no qualifications. It is argued that these reforms have improved overall standards and may thereby have contributed positively to the mental health of many vulnerable children. However, the way they have been implemented has undermined teachers in some schools and, as a result, pupils there experience education as an additional source of stress rather than of stability and support.

The Revised Children's Manifest Anxiety Scale is a widely used assessment tool, but it is questionable whether the North American norms are applicable to a British population. The scale was administered to 575 English children aged 8–12 years. Means were computed by age and gender and compared to the published North American norms. English males reported less anxiety than American males in most age groups, while 8-year-old English girls reported less anxiety than 8-year-old American girls. The language used in the Scale caused some difficulties, suggesting that the Scale might be better used in a structured interview rather than as a self-completion questionnaire.

I have what I consider to be a healthy scepticism regarding new assessment instruments. Many of these are announced with great enthusiasm but fairly rapidly disappear or are used mainly by those who have developed them and by their associates.

Although the tone of the paper by Gowers et al. (2000) seems rather strong on enthusiasm and perhaps a little lacking in its critical view, I do have great respect for colleagues associated with development of HoNOSCA and other respected colleagues talk well of it. Clearly, it deserves careful scrutiny. For me relevant questions include: ‘Is it easy to use?’, ‘Is it useful in terms of describing a patient population?’ and ‘Is it useful in looking at outcome?’

This paper outlines current legislation and Code of Practice on the identification, assessment and special provision for children with special educational needs in England and Wales. It then highlights the proposals for changes presented in the consultation documents for new legislation and a revised Code of Practice. Changes include simplifying the process of identification and assessment, a greater emphasis on early identification, intervention and integration in mainstream schools, improving the training of teachers and learning support assistants, giving a voice to children themselves and a greater emphasis on collaborative partnership between schools, local educational authorities and parents. The positive advances and some concerns are discussed.

Needs assessment is a frequently used term by all agencies involved in the welfare of children and adolescents, and is a key method in health service planning (Stevens & Raftery, 1994). However, there is often a lack of clarity about the meaning of the phrase ‘needs assessment’ (Cohen & Eastman, 1997). In addition, for CAMHS services there are few established research or clinical instruments to assess the needs of individuals. This review sets out first to describe some key concepts and issues and, second, to describe the development of a needs assessment instrument for adolescents with complex and multiple problems, and how such an instrument can be used in clinical and research settings.

Many studies have demonstrated the short-term efficacy of stimulant drugs in decreasing the symptoms of Attention Deficit Hyperactivity Disorder (ADHD). However, long-term studies have not shown a similar effect. In this study, we report an audit of the medium-term outcome of 50 children with ADHD referred to a mental health service and treated with stimulants for at least 6 months. A poor outcome group was identified consisting of 30% of the children. As a group, they received a significantly higher dose of stimulant. More studies, with prospective design, are required to examine the medium-term outcome of children with ADHD on medication.