INTERNATIONAL ASSOCIATION FOR CHILD AND ADOLESCENT PSYCHIATRY AND ALLIED PROFESSIONS • ASSOCIATIONINTERNATIONALE DE PSYCHIATRIE DE L’ENFANT, DE L’ADOLESCENT, ET DES PROFESSIONS ASSOCIEES • ASOCIACIÓN
INTERNACIONAL DE PSIQUIATRÍA DEL NIÑO Y EL ADOLESCENTE Y PROFESIONES AFINES • 国际儿童青少年精神医学及相关学科协会 • ASSOCIAÇÃO INTERNACIONAL DE PSIQUIATRIA DA INFÂNCIA E ADOLESCÊNCIA E PROFISSÕES AFINS •JM Rey’s IACAPAP
TextbookofChild and Adolescent
Mental HealthEditors
Joseph M. Rey & Andrés Martin1Knowledge is the enemy of disease... Applying what we know already will havea bigger impact on health and disease than any drug or technology likely to be
introduced in the next decade.
(Pang et al The Lancet, January 28, 2006).

Mental illnesses are different to most other illnesses. The overwhelming burden ofmental illnesses falls upon the young.
(Healthcare Information for All 2015).

Supporting the mental health of children and adolescents should be seen as astrategic investment that creates many long term benefits for individuals, societies
and health systems.
(WHO, 2005).

JM Rey’s IACAPAP TextbookofChild and Adolescent
Mental Healthii©2020 International Association for Child and Adolescent Psychiatry and Allied Professions,IACAPAP, Geneva.
JM Rey’s IACAPAP Textbook of Child and Adolescent Mental Health

ISBN: 978-0-646-57440-0

This publication is intended for professionals training or practicing in mental health and not for
the general public.
This is an open-access publication under the Creative Commons Attribution Non-commercialLicense. Use, distribution and reproduction in any medium are allowed without priorpermission provided the original work is properly cited and the use is non-commercial.
The opinions expressed are those of the authors and do not necessarily represent the views of
IACAPAP or the editors.
This publication seeks to describe the best treatments and practices based on the scientificevidence available at the time of writing as evaluated by the authors and may change as a resultof new research. Readers need to apply this knowledge to patients in accordance with theguidelines and laws of their country of practice. Some medications may not be available in somecountries and readers should consult the specific drug information since not all the unwanted
effects of medications are mentioned.
Organizations, publications and websites are cited or linked to illustrate issues or as a source offurther information. This does not mean that authors, the editors or IACAPAP endorse theircontent or recommendations, which should be critically assessed by the reader. Websites may
also change or cease to exist.
Unless stated otherwise, the case vignettes are fictional and seek to highlight specific issues,
although they are based on the authors’ clinical experience.
Suggested citation: Rey JM & Martin A (editors). JM Rey’s IACAPAP e-Textbook of Childand Adolescent Mental Health. Geneva: International Association for Child and Adolescent
Psychiatry and Allied Professions 2020.

iii

INTERNATIONAL ASSOCIATION FOR CHILD AND ADOLESCENT PSYCHIATRY AND ALLIED PROFESSIONS • ASSOCIATIONINTERNATIONALE DE PSYCHIATRIE DE L’ENFANT, DE L’ADOLESCENT, ET DES PROFESSIONS ASSOCIEES • ASOCIACIÓNINTERNACIONAL DE PSIQUIATRÍA DEL NIÑO Y EL ADOLESCENTE Y PROFESIONES AFINES • 国际儿童青少年精神医学及相关学科协会 • ASSOCIAÇÃO INTERNACIONAL DE PSIQUIATRIA DA INFÂNCIA E ADOLESCÊNCIA E PROFISSÕES AFINS •JM Rey’s IACAPAP
TextbookofChild and AdolescentMental HealthE dito rsJoseph M Rey M D , P h D , F RAN ZCP & A n d r e s M a r ti n M D ,Editorial Advisory Board

Associate Editors
Julie Chilton MD

Thomas M Achenbach PhD

David Cohen MD, PhD (version in French)

Daniel Fung MD

Flávio Dias Silva MD, MSc (version in Portuguese)
Priscille Gerardin MD, PhD (version in French)Olayinka Omigbodun MBBS, MPH,

Hesham Hamoda MD, MPH (version in Arabic)

FMCPsych, FWACP

Nguyen Thi Hue MD (version in Vietnamese)

Luis A Rohde MDTakahiko Inagaki MD (version in Japanese)

Chiara Servili MD, MPH

Matías Irarrázaval MD, MPH (version in Spanish)

Garry Walter MD, PhD, FRANZCP

Daniel Martínez Uribe (version in Spanish)

Jing Liu MD
Dmytro Martsenkovskyi MD (version in Russian)Suaad Moussa (version in Arabic)
Cesar Soutullo MD, PhD
Paz Toren MD,MHA (version in Hebrew)
Florian Daniel Zepf MD
iv

2020 EDITION
Foreword by Professor Daniel Fung, President of IACAPAP
2018-2022(Click images to watch)

Preface by Professor Joseph

Preface by Professor Andres

M Rey, Editor

Martin, Editor

The Journey of a Thousand MilesBegins With a Single Step

A Zoomed Prefacev

FOREWORD TO THE 2012 EDITIONA Child and Adolescent Mental Health Guide in Every PALM
An electronic textbook on child and adolescent mental health (CAMH) that is free ofcharge and downloadable is now available on the website of the International Association
for Child and Adolescent Psychiatry and Allied Professions (IACAPAP). It is based onbest clinical practice, reflects the latest research, will be updated regularly and strives to beculturally sensitive.This feat clearly reveals the commitment of IACAPAP to make knowledge
about CAMH widely available, whilst advocating for access to quality CAMH care globally.
This e-book is a joint venture between child and adolescent psychiatrists and allied
professionals in better-resourced parts of the world and the awfully few CAMH professionals
in resource-poor regions working together. This arrangement fulfils another of IACAPAP’s
objectives of facilitating partnerships between developed and developing countries for thepurpose of education and training, encouraging learning and growth on both sides andhelping to reduce the disparity in accessibility of CAMH resources.
On the 6th of December 2010, the IACAPAP Bureau received a proposal fromProfessor Joseph Rey for the creation of an electronic book for CAMH to be launched at theParis Congress in July 2012. We were thrilled about the leap forward this project could meanfor CAMH worldwide. At the same time, it seemed a nearly impossible task. Now we canlook back with amazement. We are fully aware that this innovation was primarily achieved
with the sacrifice, doggedness, brilliance and sometimes sharpness of Professor Rey, theEditor. Seemingly impossible tasks need unusual interventions to bring them to fruition.
We were also conscious of the urgent need to have this project completed becausea majority of the health professionals in the areas of the world where more than 80%of children and adolescents live have had no formal CAMH training. This book is an
excellent starting point to ensure that no health professional who has to care for children isleft without CAMH information. I have witnessed, first-hand, the difficulty of obtaining
CAMH textbooks in developing countries due to high costs of purchase and difficulties
with shipping. I have also experienced the pressure involved in having to loan a CAMH
textbook for just a few days or having to make photocopies of portions of books in orderto obtain needed information for patient care, research and training. This e-book will bringtremendous relief to CAMH professionals caught in this kind of web. Estimates suggestthat there are now almost 6 billion mobile phone subscribers, a figure that would include amajority of the world’s population. Most of the growth in the subscriber base has come fromthe developing world. This e-book enables IACAPAP to put current information on bestpractices for CAMH into the palm of every health professional.
Finally, with a comprehensive textbook for CAMH in the palm of every CAMH
professional around the world, children, adolescents and their families can have better
CAMH care. Change has definitely come to the world of CAMH through access toIACAPAP’s new e- textbook of Child and Adolescent Mental Health; a truly welcomechange!
Olayinka Omigbodunvi

PREFACE TO THE 2012 EDITION
One of IACAPAP's commitments is to ensure that child and adolescent mental healthworkers everywhere in the world have access to the best up-to-date information to treat theirpatients.Thus IACAPAP provides regular world congresses, a parallel book series, educationalcourses in disadvantaged regions, the Donald F Cohen fellowship program, and the Helmut
Remschmidt research seminars. This book is a further contribution in this undertaking.
IACAPAP’s electronic book brings together available technologies and resources tomake learning more accessible, more efficient and more fun. For example, readers of thechapter on normal development can click and watch no less than the famous developmental
psychologist, Jean Piaget, explain and illustrate his theories of cognitive development. While
reading the chapter on other substances of abuse, view a clip from Samson and Delilah, anAustralian feature film which graphically depicts the deleterious effects of petrol sniffing inan aboriginal teenager. Learn how to identify and rate the early manifestations of autism bywatching a series of video clips, or listen to lectures by the best experts, or view video clips
that can be used to educate parents and patients. The most recent and authoritative practiceguidelines, free-to-use rating scales and questionnaires and the full text of hundreds of key
publications are only a click away from your screen (text in blue signals a hyperlink). In ourcase, we are privileged to have not only a variety of media forms but also highly instructive
text, but what you have on your screens today is only the beginning, a beta version, askeleton: much flesh is to be added yet.
What comes next? Apart from updating the book every year, specialized chapters
dealing with specific issues will be added to make the textbook increasingly morecomprehensive. This may include, for example, chapters dealing with specific treatments,
both psychological and pharmacological, and chapters about illnesses and problems not yet
covered in this edition such as HIV/AIDS and PTSD.
How can you contribute to this project? You can provide feedback about specificchapters: what is useful and what is not; which aspects are not well described; important gaps
and issues not discussed; errors; and information about specific needs or problems in yourcountry or culture that should be mentioned. All these comments will be sent to contributors
who will be asked to take them on board for the new editions. You may also suggest topics forchapters as well as the names of experts who could write them. Regrettably, the book is only
available in English and, so far, the included resources in other languages are very few. Soplease alert the editor about resources in languages other than English.
Much remains to be done, but IACAPAP is committed to continue supporting thisproject to which so many people have selflessly contributed. I thank the IACAPAP Executive
for their support and foresight, particularly the president, Professor Olayinka Omigbodun.
Many busy experts from the five continents have contributed chapters and responded
creatively to the demands made on them, for which I am grateful. I also thank the Editorial
Advisory Board and the Associate Editors—who helped with some of the sections—for theiradvice and suggestions. Of these, Professors Garry Walter and Florian Daniel Zepf deserve
special mention. Dr Jenny Bergen and Helen Rey assisted with the more unrewarding tasks ofproof reading and in many other practical ways. Finally, Josephine Pajor-Markus helped withdesign and layout and Sherri Corrie made it easy to deal with website issues.
Joseph M Reyvii

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