Developmental Approaches to the Patient with Pediatric and Psychiatric Comorbidity

Abstract

Pediatric and psychiatric illness can combine in complex patterns, which have implications for diagnosis, treatment, and outcome. The knowledge base in pediatric psychiatry (child psychiatry as it applies to pediatric practice) has expanded considerably in the past two decades. The careful documentation of the epidemiology of comorbidity in cross-sectional and longitudinal studies in clinical and population-based samples is enabling us to shift our attention to the examination of developmental pathways and predictable patterns of relationships between pediatric and psychiatric illness. We describe a pragmatically based model for the clinician who works in the primary care setting. The model is based on the biopsychosocial model of disease. We enrich our perspective by adding the theoretical framework of developmental psychopathology, as it informs child psychiatric practice. Context, complexity, and continuity are concepts that can be easily accommodated within the synthetic framework of developmental theory. The approach of developmental psychiatry is particularly well suited to the diagnosis and treatment of the child or adolescent suffering from both pediatric and psychiatric illness, because it allows the integration of diverse data and accounts for complex clinical situations.