As an organized branch of medicine, the field of child psychiatry is a relatively recent discipline with its origins in the popularization of the child guidance (aka mental hygiene/health) movement, mid-twentieth century.
Child behavior was deemed abnormal and, in accordance with Freudian psychoanalysis in vogue at the time, was due to the child’s mother. The nature versus nurture debate had its day and has since remained relatively dormant.
Today’s psychiatry is focused instead on finding a biological basis for mental illness through technological advancement. This has shifted the dominant paradigm from psychological theory to psychopharmacology
The interaction between a child’s mind/brain and their environment
The complicated mind/brain interaction with the internal physical and the external environment, adds much confusion to finding a cause or cure for mental illness.
Contemporary academic psychiatry studies the potential determinants and interactions of the myriad of influences that shape human development and behavior. Attempts are made to relate mental disorder to an underlying genetic or neurobiological mechanism. This instills hope that soon you may ask for a blood test for depression or a pill for fixing autism. We are not there yet as a field and this also means that we may not have a clear answer for why your child appears to have behavioral difficulties.
I recognize this can be frustrating for everyone involved. There is some thought that psychiatric conditions could be due to a cumulative threshold effect, meaning if traumatic stress should occur during early childhood (e.g. divorce or death of a loved one), this may pose a risk of mental illness later in life, often depending upon certain factors such as the strength and stability of parental attachment and bonding with the child at the time lead up to, during and after the event.
Nature vs nurture
This brings us back to the nature versus nurture argument as it seems likely both are at play within a complex mix of related factors. It is clear many children are resilient and although one may have a stressful life event take place and have no lasting psychological/emotional/ behavioral effects, another child may have a similar stressful life event and for reasons that remain to be understood, this child may go on to develop a severe and persistent mental illness.
It is plausible that nurture (i.e. the community, school, home, family, peers, teachers and primary caregivers) and nature (i.e. biology, genetics and heritability) are interacting during critical developmental periods resulting in different behavioral outcomes. This suggests it is equally as important to look at ways to prevent illness onset and the promotion of mental health.
Not all child misbehavior is a disorder and not all behavior deserves medication. Every child has strengths to support and reinforce, as well as limitations they can learn to improve upon.
My approach to child psychiatry is finding what tools work best for you and your child in allowing full expression of their inner thoughts, feelings and experiences to help develop a skill set that will empower you as the parent to help your child reach their full developmental potential.