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.

Linda Dowdney's 6-year term as an Editor of Child Psychology & Psychiatry Review has come to an end, and she is stepping down. As her co-editor, I would like to pay tribute to her unstinting work. Linda became co-editor by joining Jonathan Hill at the end of 1992, taking over from Barbara Maughan. At that time the old ACPP Review & Newsletter appeared six times a year. However, it soon became obvious that it was worthwhile re-styling and upgrading the ACPP Review & Newsletter to a peer-reviewed journal, so Linda and Jonathan planned this together with the Council of the ACPP. Progress was slow, but finally in 1995 all was agreed. Jonathan Hill withdrew in 1995 and I took his place.

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.

The quality of collaborative links between the NHS and Social Services in the field of child mental health is dependent on the culture of co-operation set at the highest level of government. There needs to be an understanding of the different theoretical models that underpin working practices. The importance of personality factors, power struggles and misperceptions is highlighted. Constructive suggestions are made on how to ensure that collaboration works effectively.

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.

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.

In recent years there has been a growing interest in methods of eliciting children's views on factors influencing their lives. When children's views are sought it is important that this is done in a developmentally appropriate manner with instruments whose psychometric properties are known. The present review describes a variety of methods that have been used to evaluate children's satisfaction with services in education, paediatrics and mental health. The majority of the studies used self-completion questionnaires and provided only limited information on reliability. Means of establishing reliability and validity in research with children are discussed, as are the variables that have been found to correlate with child satisfaction.

As the ‘decade of the brain’ comes to a close, it is clear that the field of neuropsychology has made many vital contributions to evaluation, treatment, and research issues in child and adolescent health care. In the study of brain-behaviour relationships, the neuropsychologist plays a unique role. The practice of child neuropsychology is differentiated from adult work because developmental and environmental influences have a significant impact on practice. The various goals of the child neuropsychologist may include psychoeducational and neuropsychological assessment, the exploration of brain-behaviour relationships, consultation with a variety of professionals ranging from teachers to neurologists, and rehabilitation training. Advances in medical treatment have contributed to an expanding population of children and adolescents with neurological and/or neuropsychiatric concerns. New research in this field has also provided evidence of disordered or dysfunctional neurological systems in a number of childhood disorders and psychiatric conditions. This paper reviews some contributions that neuropsychology has made to the health care of children and adolescents in the past decade.

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.

The use of a standardised protocol for the pharmacological (using Selective Serotonin Re-uptake Inhibitors–SSRIs) and psychological treatment of 10 consecutive adolescent patients with Obsessional Compulsive Disorder is reported. The psychological treatment consisted of exposure to the feared stimulus and cognitive behavioural treatment of anxiety associated with this procedure. The results suggest that there are benefits from both pharmacological and psychological treatments. However, both treatments were difficult to implement. For the SSRIs, some patients reported disinhibition of mood swings and behaviour. For those patients who showed benefits from the pharmacological treatments, there appeared to be a decrease in willingness to attempt psychological methods. The psychological methods require considerable time, which may not be available in clinics, and substantial effort by the patients.

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.

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.

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 describes, in a humourous way, some of the frustrations, joys, pleasures and pains of a European psychologist working in a hospital in the People's Republic of China. It tells tales of families from distant fields in the remote hinterland and from the more urban communities and shows how these compare and contrast with similar situations in the U.K. Parents love their children whether in Guangzhou or Glasgow and this paper illustrates these cross-cultural connections.

This paper reviews the current position of the Milan Approach in the family therapy field. Over the past 20 years this approach has made a major contribution to the development of family therapy theory and practice in the U.K. However, the ideas have been modified in order to fit different client groups in a range of settings; until today, the Milan, or Post-Milan approach is an amalgam of the original concepts and new techniques. This paper describes the development of this approach and highlights the following topics as central to current thinking: language, power, narrative, family resilience, externalising, focusing on change, and solution focused approaches. Several techniques of the Post-Milan approach are demonstrated in a discussion of one case treated by the author.

The aim of this postal survey was to highlight differences in temperament and behaviour between 32 toddlers in Japanese families living temporarily in London and 36 in British families, all in London. Mothers completed questionnaires about demography, perinatal events, and their child's temperament and behaviour. UK toddlers were described as exhibiting fewer behavioural symptoms than Japanese toddlers. Significantly more of the Japanese toddlers scored above the cutoff on the Behaviour Check List, indicating higher levels of behavioural disturbance. An interesting item is ‘sleeping with parent’, which occurs commonly in Japanese families and is considered to be normal for that culture. On the Toddler Temperament Scale the Japanese toddlers proved more distractable and more intense than the UK toddlers when age had been allowed for. It was of interest that Japanese girls proved more distractable than Japanese boys and UK girls. Possible explanations for the differences are advanced.

There has been a resurgence of interest in the use of projective doll play techniques, partly arising out of the recognition of the sophistication of young children's play. This review considers a number of recent projective doll play innovations and evaluates the utility of these techniques for investigating young children's moral development, attachment beyond infancy, and for predicting behaviour problems. In addition, the use of these techniques with high-risk and clinical populations is described and a discussion of factors influencing the quality of projective play responses is presented.

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.

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.

Looking back, the 1980s was a decade of enlightenment and success in juvenile justice practice in this country; diverting youngsters away from the criminal courts and reducing the severity of response towards those who were prosecuted did not result in crime waves or public demand to stop this lenient treatment of the young. In the 1990s, the whole criminal justice system took a significant turn towards retribution and punishment. The movement may have been aimed initially at certain groups of criminals, particularly the persistent and serious, but swept all in its wake, including children aged 10–14 who were neither. There is little apparent appreciation of the damaging consequences of this trend, not only for individual children but also for the whole concept of childhood. There is now a wide discrepancy between the approach taken by the criminal and civil law towards children which current criminal justice policies indicate is to continue into the foreseeable future.