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OBJECTIVE: To evaluate stress and quality of life in parents of children with an intellectual disability (moderate-severe-profound), who attend a Child and Adolescent Mental Health Intellectual Disability Service (CAMHS ID), and to estimate the perceived levels of challenging behaviour and satisfaction with supports. METHODS: Data from children attending the service from 2014 to 2017, along with clinician and parent rating scales were collected. RESULTS: Most children had medical comorbidities, autism spectrum disorder (ASD), and challenging behaviours. Half had a diagnosis of a mental health disorder. Less than half received respite care. Challenging behaviours and ASD were found to be correlated with increased parental stress while perception of support was inversely correlated with stress. Intellectual disability, ASD, and parental stress were correlated with a decrease in perceived family quality of life. CONCLUSIONS: This study concurs with previous studies, outlining that parents of children with intellectual disability, in particular, where there is a diagnosis of comorbid ASD and challenging behaviour, experience increased psychological distress and lower quality of life.

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OBJECTIVE: This study was carried out to determine the prevalence of selective mutism (SM) in an urban school population and to assess comorbidity and family characteristics. METHOD: Teachers of primary schools, teaching children between the ages of four and 12, were sent a description of SM and asked to complete the selective mutism questionnaire (SMQ) if they believed a child in their class met criteria. Thirty-nine schools were sampled, covering a catchment area of 10,927 children. Children who screened positive on the SMQ were offered a full psychiatric assessment. Parent, child and clinicians completed various rating scales. RESULTS: A response rate of 100% from schools was obtained. The prevalence rate of SM was 0.18% (20/10927). fourteen (70%) attended for further evaluation. All children scored within the clinical range on the Clinical Global Assessment Scale (CGAS), indicating moderate to severe impairment. fifty percent (7) reported a family history of social anxiety disorder, and 43% (6) autistic spectrum disorders. CONCLUSION: This is the first Irish based prevalence study of SM. Results indicate that SM is not as rare as previously believed. Children with SM were found to have significant functional impairment along with a strong family history of anxiety and autism.

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Elective mutism is a rare disorder of communication, where the child speaks fluently in familiar situations, such as home, despite lack of speech in less familiar settings, for example school. A variety of temperamental and behaviour characteristics, co-morbid psychiatric conditions, neurodevelopmental delay and family factors have been associated with the disorder. EM children are described as excessively shy, withdrawn, 'slow to warm up', inhibited, often avoid eye contact, fear social embarrassment and experience significant separation anxiety, on separation from their attachment figures. Their behaviour is often perceived by others as controlling and oppositional. Onset of EM is typically in early childhood years. A number of constitutional and environmental factors have been considered in its onset, progression and response to intervention. Treatment is generally considered to be multimodal, and occurs in a variety of settings, including home and school. Longterm studies suggest that communication difficulties may extend into adulthood. In addition, outcome studies showing a high rate of phobic disorders suggest that EM may be a developmental precursor of adult social phobia. This article reviews the literature on EM, its presentation, aetiology, epidemiology and the various evidence based biopsychosocial treatments.

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OBJECTIVE: To evaluate the feasibility and effectiveness of group therapy for children with selective mutism and their parents. METHOD: Five children (mean age 6.1 years) with a diagnosis of selective mutism were administered group therapy over an 8-week period. Parents simultaneously attended a second group, aimed at providing education and advice on managing selective mutism in everyday situations, and in the school environment. RESULTS: At post-treatment, all children increased their level of confident speaking in school, clinic and community settings. Parents indicated a reduction in their own anxiety levels, from pre- to post-treatment on self-rating scales. CONCLUSIONS: Findings support the feasibility and effectiveness of group therapy for children with selective mutism and their parents.

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Selective serotonin reuptake inhibitor induced mania has been described in adults, and more recently in adolescents. To the authors' knowledge a case in pre-adolescents has not yet been published in the literature. The authors would like to report two cases of SSRI-induced mania. Both cases were pre-adolescent girls, A and B, who had a DSM-IV diagnosis of panic disorder, and were treated with paroxetine.

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OBJECTIVE: To evaluate the efficacy of "compliance therapy" for improving adherence to prescribed drug treatment among patients with schizophrenia. DESIGN: Randomised controlled trial. SETTING: Urban catchment area psychiatric service. PARTICIPANTS: 94 consecutive admissions of patients with schizophrenia, 56 agreed to participate. INTERVENTION: Compliance therapy and non-specific counselling, each consisting of 5 sessions lasting 30-60 minutes. MAIN OUTCOME MEASURES: Compliance with drug treatment at one year; attitudes to treatment, symptomatology, insight, and quality of life at one year; length of "survival" in the community, bed days, and rehospitalisation rates at two years. RESULTS: Compliance therapy did not confer a major advantage over non-specific therapy in improving compliance at one year (43% (12/28) v 54% (15/28), difference -11% (95% confidence interval -37% to 15%) or in any of the secondary outcome measures-symptomatology, attitudes to treatment, insight, global assessment of functioning, and quality of life. CONCLUSION: Compliance therapy may not be of benefit to patients with schizophrenia. Attitudes to treatment at baseline predicted adherence one year later and may be a clinically useful tool.

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