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Capacity and Competence in Child and Adolescent Psychiatry

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Abstract

Capacity and competence in the field of child and adolescent psychiatry are complex issues, because of the many different influences that are involved in how children and adolescents make treatment decisions within the setting of mental health. This article will examine some of the influences which must be considered, namely: developmental aspects, the paradoxical relationship between the need for autonomy and participation and the capacity of children, family psychiatry, and the duty of care towards children and adolescents. The legal frameworks relevant to consideration of consent and competence will be briefly considered, as well as some studies of children's consent, participation and competence. A case vignette will be used as a focus to consider the complexity of the issue of competence in child and adolescent psychiatry, in the particular mental disorder of anorexia nervosa.

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REFERENCES

  • Alderson, P. and Montgomery, J. (1996) Health Care Choices. Making Decisions with Children.London: Institute for Public Policy Research.

    Google Scholar 

  • Anderluh, M.B., Tchanturia, K., Rabe-Hesketh, S., and Treasure, J. (2003) Childhood Obsessive Compulsive Personality Traits in Adult Women with Eating Disorders: Defining a Broader Eating Disorder Phenotype. American Journal of Psychiatry 160(2), 242–247.

    Google Scholar 

  • American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4 Edition.Washington, DC.: American Psychiatric Association.

    Google Scholar 

  • Bastien, R.T. and Adelman, H.S. (1984) Noncompulsory versus Legally Mandated Placement, Per-ceived Choice, and Response to Treatment among Adolescents. Journal of Consulting and Clinical Psychology 52, 171–179.

    Google Scholar 

  • Billick, S.B., Edwards, J.L., Burgert, W., Serlen, J.R., and Bruni, S.M. (1998) A Clinical Study of Competency in Child Psychiatric Inpatients. Journal of the American Academy of Psychiatry and Law 26(4), 587–594.

    Google Scholar 

  • Billick, S.B., Burgert, W., Friberg, G., Downer, A.V., and Bruni-Solhkhah, S. (2001) A Clinical Study of Competency to Consent to Treatment in Pediatrics. Journal of the American Academy of Psychiatry and Law 29, 298–302.

    Google Scholar 

  • Bulik, C.M., Sullivan, P.F., Fear, J.L., and Joyce, P.R. (1997) Eating Disorders and An-tecedent Anxiety Disorders: A Controlled Study. Acta Psychiatrica Scandinavica 96, 101–107.

    Google Scholar 

  • Cascardi, M., and Poythress, N (1997) Correlates of Perceived Coercion during Psychiatric Hospital Admission. International Journal of Law and Psychiatry 20, 445–458.

    Google Scholar 

  • Cases (2004) Health Care Analysis 12, 269–270.

    Google Scholar 

  • Casimir, K.C., and Billick, S.B. (1994) Competency in Adolescent Inpatients. Bulletin of the American Academy of Psychiatry and Law 24,19–29.

    Google Scholar 

  • Degner, L., and Sloan, J. (1992) Decision Making during Serious Illness: What Role do Patients Really Want to Play? Journal of Clinical Epidemiology 45, 941–950.

    Google Scholar 

  • De Winter, M., Baerveldt, C., and Kooistra, J. (1999) Enabling Children: Participation as a New Perspective on Child-health Promotion. Child, Care, Health and Development 25,15–25.

    Google Scholar 

  • Dippold, I., Wiethoff, K., Rothärmel, S., Wolfslast, G., Konopka, L., Naumann, A., Keller, F., and Fegert, J.M. (2003), Dass Ich Verbessert werde mit Therapie”—Kenntnisse und Unkenntnisse Minderjähriger Patienten bei Behandlungsbeginn. In U. Lehmkuhl (Hg.) Ethische Grundlagen in der Kinder-und Jugendpsychiatrie und Psychotherapie.Göttingen: Vandenhoeck & Ruprecht.

    Google Scholar 

  • Fairburn, C.G., and Harrison, P.J. (2003) Predictors of Mortality in Eating Disorders. Archives of General Psychiatry 60(2), 179–83.

    Google Scholar 

  • Fegert, J. M. (2003) Ethical and Legal Issues in Treatment of Schizophrenic Patients with Neuroleptics in Childhood and Youth. Nervenheilkunde2/03, 75–79.

    Google Scholar 

  • Fegert, J. M., Späth, K., and Salgo, L. (Hg.) (2001) Freiheitsentziehende Maßnahmen in Jugenhilfe und Kinder-und Jugendpsychiatrie. Votum Verlag.

  • Fornari, V., Kaplan, M., and Sandberg, D.E. (1992) Depressive and Anxiety Disorders in Anorexia Nervosa and Bulimia Nervosa. International Journal of Eating Disorders 12(1), 21–29.

    Google Scholar 

  • Godart, N.T., Flament, M.F., Perdereau, F., and Jeammet, P. (2002) Comorbidity between Eating Disorders and Anxiety Disorders: A Review. International Journal of Eating Disorders 32(3), 253–70.

    Google Scholar 

  • Godart, N.T., Flament, M.F., Lecrubier, Y., and Jeammet, P. (2000) Anxiety Disorders in Anorexia Nervosa: Co-morbidity and Chronology of Appearance. European Journal of Psychiatry 15,38–45.

    Google Scholar 

  • Grisso, T., and Appelbaum, P. S. (1998) Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals. Oxford: Oxford University Press.

    Google Scholar 

  • Hoge, S., Lidz, C., Eisenberg, S., Gardner, W., Monahan, J., Mulvey, E., Roth, L., and Bennett, N. (1997) Perceptions of Coercion in the Admission of Voluntary and Involuntary Psychiatric Patients. International Journal of Law and Psychiatry 20, 167–181.

    Google Scholar 

  • Jarry, J.L., and Vaccarino, F.J. (1996) Eating Disorder and Obsessive-compulsive Disorder: Biochemical and Phenomenological Commonalities. Journal of Psychiatry and Neurosciences 21(1), 36–48.

    Google Scholar 

  • Kaser-Boyd, N., Adelman, H.S., and Taylor, L. (1985) Minors' Ability to Identify Risks and Benefits of Therapy. Professional Psychology 16, 411–417.

    Google Scholar 

  • Kaufmann, N.H., and Flekkoy, M.G. (1998) Participation Rights of the Child: Psychological and Legal Considerations. Children's Legal Rights Journal18,15–29.

    Google Scholar 

  • Lating, J.M., O'Reilly, M.A., and Anderson, K.P. (2002) Eating Disorders and Posttraumatic Stress: Phenomenological and Treatment Considerations using the Two-factor Model. International Journal of Emergency Mental Health4(2), 113–8.

    Google Scholar 

  • Murch, M., and Thorpe, L.J. (1997) The Development of the Family Justice System in England and Wales: Past, Present and Future. In Salgo, L. (Ed.) The Family Justice System. Past and Future, Experiences and Prospects. (pp. 5–34). Collegium Budapest, Workshop Series No. 3, Budapest.

  • O'Brien, K.M., and Vincent, N.K. (2003) Psychiatric comorbidity in anorexia and bulimia nervosa: Nature, prevalence, and causal relationships. Clinical Psychology Review 23(1), 57–74.

    Google Scholar 

  • Ondrusek, N., Abramovitch, R., Pencharz, P., and Koren, G. (1998) Empirical Examination of the Ability of Children to Consent to Clinical Research. Journal of Medical Ethics 24(3), 158–165.

    Article  Google Scholar 

  • Paul, M., Foreman, D. M., and Kent, L. (2000) Out-patient Clinic Attendance Consent from Children and Young People: Ethical Aspects and Practical Considerations. Clinical Child Psychology and Psychiatry5(2), 203–211.

    Google Scholar 

  • Pawluck, D. E., and Gorey, K.M. (1998) Secular Trends in the Incidence of Anorexia Nervosa: Integrative Review of Population-based Studies. International Journal of Eating Disorders 23, 347–352.

    Google Scholar 

  • Peterson, C.G., and Siegal, M. (1999) Cognitive Development and the Competence to Consent to Medical and Psychotherapeutic Treatment. In C.G. Peterson and M. Siegal (Eds.), (pp. 257–281). Cognitive Development and the Competence to Consent

  • Piaget, J. (1986) Judgement and Reasoning in the Child. New York: Harcourt Brace and Co.

    Google Scholar 

  • Perrin, E.C., Sayer, A.G., and Willett, J.B. (1991) Sticks and Stones may Break my Bones... Reasoning about Illness Causality and Body Functioning in Children who have a Chronic Illness. Pediatrics 88, 608–619.

    Google Scholar 

  • Rastam, M., Gillberg, C., and Wentz, E. (2003) Outcome of Teenage-onset Anorexia Nervosa in a Swedish Community-based Sample. European Child and Adolescence Psychiatry 12(Suppl 1), I78–I90.

    Google Scholar 

  • Rothärmel, S., Wolfslast, G., and Fegert, J.M. (1999) Informed Concent, ein Kinderfeindliches Konzept? Medizinrecht7, 293–298.

    Google Scholar 

  • Roth, E.A., and Roth, L.H. (1984) Children's Understanding of Psychiatric Hospitalization. American Journal of Psychiatry 141, 1066–1070.

    Google Scholar 

  • Salgo, L. (Ed.) (1997) The Family Justice System. Past and Future, Experiences and Prospects. (153 p.). Collegium Budapest Workshop, Series No. 3, Budapest.

  • Schulze, U., Mehler-Wex, C., Remschmidt, H., Herpertz-Dahlmann, B., and Warnke, A. (2002) Children in the Drive for Thinness. How Early Anorexia Nervosa modifies Development. MMW Fortschr Med. 144(38), 28–30.

    Google Scholar 

  • Serpell, L., Livingstone, A., Neiderman, M., and Lask, B. (2002) Anorexia Nervosa: Obsessive-compulsive Disorder, Obsessive-compulsive Personality Disorder, or Neither? Clinical Psychology Review 22(5), 647–669.

    Google Scholar 

  • Steinhausen, H.C. (2002a) The Outcome of Anorexia Nervosa in the 20th Century. American Journal of Psychiatry 159(8), 1284–3129.

    Google Scholar 

  • Steinhausen, H.C. (2002b) Anorexia and Bulimia Nervosa. In M. Rutter and E. Taylor (Eds.), Child and Adolescent Psychiatry. Oxford: Blackwell Publishing.

    Google Scholar 

  • Strober, M., Freeman, R., and Morrell, W. (1997) The Long Term Course of Severe Anorexia Nervosa in Adolescents: Survival Analysis of Recovery, Relapse and Outcome Predictors over 10–15 Years in a Prospective Study. International Journal of Eating Disorders 22, 339–360.

    Google Scholar 

  • Sullivan, P.F., Bulik, C.M., Fear, J., and Pickering, A. (1998) Outcome of Anorexia Nervosa: A Case-control-study. American Journal of Psychiatry 155(7), 939–946.

    Google Scholar 

  • Tan, J. O. A., and Jones, D. P. H. (2001) Children's Consent. Current Opinion in Psychiatry 14, 303–307.

    Google Scholar 

  • Tates, K., and Meeuwesen, L. (2000) 'Let Mum Have Her Say': Turntaking in Doctor-parent-child Communication. Patient Education and Counseling 40, 151–162.

    Google Scholar 

  • The Children Act 1989 (c.41)(1989). London: HMSO.

  • UN Convention on the Rights of the Child, United Nations (1989).

  • Weithorn, L.A., and Campbell, S.B. (1982) The Competency of Children and Adolescents to Make Informed Treatment Decisions. Child Development 53(6), 1589–1598.

    Google Scholar 

  • Wiethoff, K., Dippold, I., Rothärmel, S., Wolfslast, G., Konopka, L., Naumann, A., Keller, F., and Fegert, J.M. (2003) “Ich Dürfte Ja Nichts Sagen, Ich Musste Hier Rein”—Bedingungen und Folgen der Stationären Aufnahme aus der Sicht Minderjähriger Patienten. In U. Lehmkuhl (Hg.), Ethische Grundlagen in der Kinder-und Jugendpsychiatrie und Psychotherapie.Göttingen: Vandenhoeck and Ruprecht.

    Google Scholar 

  • Wittchen, H.U., Nelson, C.B., and Lachner, G. (1998) Prevalence of Mental Disorders and Psycho-logical Impairments in Adolescents and Young Adults. Psychological Medicine 28, 109–126.

    Google Scholar 

  • Zenz, G. (1997) The Chaos of Legal Representation: A Challenge for the Family Justice System. In The Family Justice System. Collegium Budapest, Workshop Series No. 3, 110–117.

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Authors and Affiliations

  1. The Oxford Centre for Ethics and Communication in Health Care Practice (The ETHOX Centre), Division of Medicine, University of Oxford, Old Road Campus, Old Road, Headington, Oxford, OX3 7LF, United Kingdom

    Jacinta O. A. Tan

  2. Universitätsklinikum Ulm, Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Steinhovelstrasse 5, 89075, Ulm, Germany

    Jorg. M. Fegert

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  1. Jacinta O. A. Tan
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  2. Jorg. M. Fegert
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Tan, J.O.A., Fegert, J.M. Capacity and Competence in Child and Adolescent Psychiatry. Health Care Analysis 12, 285–294 (2004). https://doi.org/10.1007/s10728-004-6636-9

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