Children’s Mental Health: Pattern of referral, distribution of disorders and service use in child psychiatry outpatient setting

Objective: To determine the pattern of referrals, socio-demographic factors, frequency of psychiatric diagnosis, and help offered to children presenting in Child Psychiatry Department outpatient clinic of a tertiary care hospital in Lahore. Methodology: A cross sectional study of children attending child psychiatry outdoor in a tertiary care hospital in Lahore was conducted. Following informed consent from the parent/ legal guardian, 1000 consecutive new referral to the department were assessed by interviewing the parent and the child. A Structured proforma was used for data collection. ICD-10 criteria were used for the diagnosis of psychiatric illness. Record was made of the interventions offered to the child family. Results: Total sample size was 1000 children with predominant male gender (65%) and mean age of 8.46 (S.D 4.51).More than half (54.5%) of the children in our sample were not enrolled in school and 19% had family history of psychiatric illness. Among the various sources of referral, self-referral was the highest (84.7%) followed by referral from Pediatrics (8.4%). Psychiatric diagnosis observed were Speech Related Difficulties {including speech delay, articulation problems and specific developmental delays of speech language} (46.5%) , Learning Disability (43.3%), Behavior Problems (26.3), Epilepsy (12.6%), Dissociative Disorders (10.1%), Attention Deficit Hyperactivity Disorder (4.5%), Autism (3.2%), Depression(2.4%), Anxiety(1.7%), Psychosis (1%) and Tics (1%). Co-morbidities were found in 44.7 percent of the children. The various interventions offered included medications, referral to psychologist (for family therapy and individual work), play therapist and speech therapist. Conclusion: Majority of children presenting to the child psychiatry clinic have multiple and complex needs due to high frequency of learning disabilities and co morbidities. The findings illustrate the importance of multidisciplinary approach and to assess the different dimensions of psychopathology in children for future service planning.