Organization - Child and Adolescent Psychiatry and Psychology Service

The Child and Adolescent Psychiatry and Psychology Service participates in the following Units:

The Service consists of two healthcare areas, a Working Group on Eating Disorders and an area of High Specialization for Autism Spectrum Disorders.

Child and Adolescent Hospital Psychiatry Section

All children with psychiatric disorders who require hospital care and who come from Barcelona Esquerra (Eixample Esquerra, Sants-Monjuich, Les Corts and Sarria-Sant Gervasi), from the Eixample Dreta, from Barcelona Litoral Mar (Ciutat Vella, Sant Marti, Sant Adrià del Besós), and from the territorial sectors of Badalona and Santa Coloma de Gramenet are treated in the hospital ward. The day hospital assists children and adolescents cared for at the CSMIJ in the Eixample and in the specific programs of the Service, as well as children under the age of 12 from all over Barcelona.

Section of the Center for Child and Adolescent Mental Health (CSMIJ) in the Eixample

The CSMIJ of the Eixample (there are approximately 40,000 children under 18 in this sector) has various mental health care programs, which have specific funding from the Catalan Health Service and have general and specific objectives. The main programs are: Healthcare Program for children under 12 years (PSP), Healthcare Program for Specific Treatments for Children and Youth (PATEI), Health and School Program, and Autism and Child Psychosis Assessment Program (UVAPI).

Eating Disorders (ED) Working Group

The Eating Disorders Working Group is part of the Child and Adolescent Psychiatry and Psychology Department in the Neurosciences Institute at the Hospital Clínic de Barcelona. It is made up of a multidisciplinary team that treats minors with severe eating disorders. It collaborates with other hospital departments such as Dietetics-Nutrition, Cardiology, Endocrinology and the CDB.

The group's main task is to improve the care of patients with severe EDs and their families, offering evidence-based treatments adapted to the different facilities available. It also carries out training and teaching activities. Some professionals in the group are part of different research groups, such as the Clínic Consolidated Group in Child Psychiatry and Psychology (GRUPPIC), the IDIBAPS Child Psychiatry and Psychology Group, the CCNIEC Research Group, and CIBERSAM, as well as international consortia such as ENIGMA.

Autism Spectrum Disorders (ASD) Working Group

The Autism Working Group at the Hospital Clínic is part of the Neurosciences Institute (ICN). It is made up of professionals from the SPPIJ, the Adult Psychiatry and Neurology Department, and the Anaesthesia, Genetics, Pharmacy and Neuroradiology Departments. The group specializes in comprehensive treatment of autism at all levels of care, mainly in children under 18 years of age. The recognized prevalence of autism in the region is between 1% and 1.5%.

The group is dedicated to improving care processes for people with autism at all levels, as well as carrying out teaching and research activities. Studies conducted include research on the aetiology of autism, new pharmacological targets, and psychological, social, and educational interventions.

Several members of this group have participated in advising on the development of actions in the Generalitat de Catalunya's Mental Health and Addiction Master Plan to improve care for autism. They are also part of international consortia such as EU-AIMS and ENIGMA-ASD.

Eating disorders

The Department’s Eating Disorders Unit treats patients diagnosed with severe eating disorders and also their families. We are a multidisciplinary team primarily focused on providing psychotherapeutic treatment based on scientific evidence, specifically Family-Based Therapy and Cognitive-Behavioural Therapy (CBT). In some patients, and depending on the comorbidities, treatment with Dialectical Behavioural Therapy and EMDR Therapy is also provided. There are three treatment options: intensive outpatient treatment, ED day hospital, and inpatient hospitalization, depending on the severity of the case. Moreover, the Unit’s professionals participate in continuing education and care coordination with the community, in order to manage case referrals.

Autism Spectrum Disorders

The SPPIJ offers all levels of care for autistic children and adolescents and their families. This ranges from collaboration with primary care in order to improve detection and diagnosis, to the Autism Reference Unit, which deals with the most complex cases. The assessment is carried out by specialists in the administration of standardized instruments at all of the Department’s care facilities. Intervention is individualized, in accordance with the clinical heterogeneity of autism, based on the principles of cognitive behavioural therapy and third-generation therapies, and focuses on the understanding of autistic symptomatology, the acquisition of adaptive skills in the environment and the approach to comorbidity. Etiopathogenic studies and neurological assessments are carried out in cases that require then, as well as specialized psychopharmacological treatment. There are also programmes for families at both outpatient and day hospital levels, and social intervention and advice on dependency assistance are offered to improve external support.

First Psychotic Episodes

Adolescent patients with a first psychotic episode are monitored by the Specific Care Programme for Incipient Psychotic Disorders (PAE-TPI) at the Eixample Child and Adolescent Mental Health Centre (CSMIJ), and may be admitted to the rest of the Department’s facilities (conventional hospitalization, home hospitalization, and day hospital). At the outpatient level, a cognitive-behavioural psychological approach is taken, involving cognitive and psychiatric and also social and community rehabilitation. Any comorbidities that may exist are taken into account, with treatment being offered in all areas of psychopathology and psychosocial complexity.

The Department conducts clinical research on patients with this diagnosis, both in terms of treatment (psychological, psychiatric) and helping to establish risk factors for developing this disorder (substance use, complications in pregnancy and childbirth, genetics, epigenetics, inflammation, etc.), prognostic markers and to unravel the mechanisms by which a first psychotic episode occurs (magnetic resonance imaging, brain neuroimaging and other biological markers determined through blood tests). Moreover, the Department trains other professionals in the healthcare network in the field of this disorder, and also participates in university teaching and supervising doctoral theses on this subject.

Furthermore, the Department conducts research studies on patients with a genetic risk of experiencing a first psychotic episode and a clinical risk of experiencing a first psychotic episode, in terms of brain neuroimaging, cognition, blood tests, and clinical assessment. In addition, it carries out group treatments to strengthen the protective mechanisms of these children and adolescents.

Obsessive-Compulsive Disorder (OCD) and Tourette Syndrome (TS)

The Obsessive-Compulsive Disorder (OCD) treatment programme for has a long tradition at the SPPIJ. It is a multidisciplinary programme specializing in the treatment of children and adolescents with highly complex OCD. In all cases, an assessment is carried out to determine the severity of the disorder and psychological and/or pharmacological intervention is initiated. The first-choice psychological therapy is Exposure with Response Prevention (ERP) and consists of helping patients to cope with their obsessions without performing their usual rituals. Intensive training is required with patients and their families, helping the latter to modify certain dynamics in which they usually accommodate the disorder. Interventions are usually individual, but recently, patient experiences have been implemented in which people who have been treated within the programme explain their experience to other patients. The OCD programme is heavily involved in research and has participated in several funded projects. Moreover, it is also involved in the training of other mental health professionals through expertise courses. 

The Tic and Tourette Syndrome Treatment Programme is a multidisciplinary programme for the assessment, diagnosis and intensive treatment of complex cases involving tics, Tourette syndrome and comorbid psychopathology. The programme offers a personalized treatment approach based on the severity of symptoms, comorbid conditions and preferences regarding pharmacological and/or psychological treatments. Each treatment plan starts with a psychoeducation module on managing the condition and its impact on family and school functioning. In selected cases, they offer an intensive programme of exposure therapy and response prevention and/or habit reversal therapy. In all cases, a family approach is taken and coordination with schools is carried out to plan for special educational needs. The team maintains close ties with the research project, offering patients the opportunity to participate in ongoing studies.

Addictive Behaviours 

The Addictive Behaviour Treatment Programme for Adolescents (UNICA-A) provides help for children and adolescents under the age of 18 with substance use disorders and behavioural addictions, and also offers assistance to their families. A multidisciplinary approach is taken with a motivational, systemic and cognitive-behavioural perspective on a longitudinal basis at various levels of care. At an outpatient level, individual and family visits are made on a regular basis, and intensively on a weekly or fortnightly basis within a dual pathology programme. At a hospital level, short stays are organized for detoxification. Finally, support is provided in the transition to adult mental health and addiction services in cases that require continued follow-up.

Clinical Assessment

At the Child and Adolescent Psychiatry and Psychology Department, comprehensive assessments are carried out of the mental health problems that come to their attention, based on clinical interviews with parents (or legal guardians), clinical questionnaires for parents and teachers, coordination with schools, observations of patient behaviour, and structured interviews or specific tests for the diagnosis of mental disorders, in order to reach the most accurate clinical judgment and be able to advise the best possible treatment. This clinical assessment usually takes 4-6 sessions.

Neuropsychological Assessment

Neuropsychology is the scientific discipline that studies the cognitive functions and their relationship to mental health disorders and/or neurological disorders. Neuropsychological assessment allows for more accurate approaches to problems in order to make differential diagnoses between certain mental disorders. It assesses intellectual capacity, attention functions, executive functions, language problems, and visual-spatial processing problems in patients attending the Child and Adolescent Psychiatry and Psychology Department, in order to better understand their information processing and personalize their psychological and/or psychiatric treatment as much as possible. The neuropsychological assessment lasts between 2-3 sessions, in order to adapt treatment as much as possible to the characteristics of each patient and try to obtain their maximum performance.

Psychopharmacological Therapy

The psychopharmacological approach tailored to the needs of each patient is one of the therapeutic approaches used in all of the Department’s healthcare facilities. They offer supervised monitoring of the doses of the different psychotropic drugs, as well as treatment with long-acting (depot) drugs to ensure optimal adherence and stability in treatment. They perform blood level analyses to assess the adherence, efficacy and safety of medication in those patients who require it. In addition, they monitor side effects such as extrapyramidal symptoms and metabolic syndrome, assessing factors such as weight, abdominal circumference, blood pressure and the necessary biochemical parameters.

Cognitive-Behavioural Therapy

Cognitive-Behavioural Therapy (CBT), or behaviour modification therapy, is the type of psychological therapy with the most scientific evidence for the vast majority of mental health disorders. It achieves a response to treatment of between 40 and 80%, with the highest rates in anxiety disorders, obsessive-compulsive disorder, depressive disorders, post-traumatic stress disorders, Tourette syndrome, attention deficit hyperactivity disorder, elimination disorders, childhood-onset behavioural disorders, and eating disorders. It is complemented by specific tools in the treatment of each mental disorder and, in recent decades, has evolved towards third-generation CBT, which includes therapeutic approaches from other schools and theoretical disciplines, such as attachment theory, humanistic approaches, neuroscience or systemic therapy. It most important therapeutic components are gradual exposure and habituation to feared stimuli, modification of maladaptive cognitive styles, stimulus control and contingency modification and reversal learning. Currently, transdiagnostic cognitive-behavioural therapeutic approaches or those based on the psychological processes of each patient are being developed. The Child and Adolescent Psychiatry and Psychology Department team applies this therapeutic approach as a basis for all its treatments.

Exposure and Response Prevention

Exposure and Response Prevention (ERP) is the psychological therapy that has proven most effective in childhood and adolescent obsessive-compulsive disorder, with treatment response rates of between 60 and 80%. It consists of gradual exposure and habituation to stimuli that trigger obsessive thoughts, while at the same time attempting not to perform the compulsion or ritual. In this way, the brain becomes desensitized and no longer needs to perform the compulsion as the only response to the discomfort generated by the obsession. ERP requires sessions led by a therapist, in addition to other exercises that must be done at home. The involvement of parents in EPR visits is essential in the treatment of this disorder in children and adolescents. EPR therapy has also been extended to the habituation of premonitory sensations of tics in Tourette Syndrome. 

Dialectical Behaviour Therapy

Dialectical Behaviour Therapy is a scientifically proven treatment indicated for adolescents and families with severe emotional dysregulation who exhibit suicidal behaviour, self-harm, and other problematic behaviours that affect the adolescent’s functioning. It is a therapy that combines an approach based on balancing the processes of acceptance and change. This programme offers individual and multi-family group psychotherapy. In multi-family groups, adolescents and primary caregivers are taught skills in mindfulness, tolerance of emotional distress, emotional regulation, personal effectiveness, and parent-child conflict resolution. The aim of the treatment is to learn new skills that enable the adolescent and the family to manage severe emotional dysregulation and reduce problem behaviours. It is a structured 16-week programme that requires a therapeutic commitment from the family and the adolescent.

EMDR Therapy

EMDR (Eye Movement Desensitization and Reprocessing) therapy is a scientifically proven, evidence-based type of psychological treatment divided into different phases and aimed at working with children and adolescents (as well as adults) and their families on strategies for emotional regulation and stabilization, as well as processing traumatic memories of situations we have experienced in the past. The aim is to repair the harmful effects in the form of symptoms and emotional distress derived from these memories and recollections. These psychological sequelae can continue to affect us even though time has passed since the situations that caused the damage occurred. Various strategies are used to carry out these procedures, including bilateral stimulation, which consists of stimulating the nervous system through different types of stimuli (e.g. eye movements) so that the system can unlock and work with these memories.

Systemic Family Therapy

The Child and Adolescent Psychiatry and Psychology Department offers systemic family therapy as an intervention to address selected clinical cases in which psychopathology in children and adolescents is associated with complex family situations and/or risk contexts. This therapy focuses on improving family dynamics and strengthening relationships between family members. It can address family restructuring, significant life events, and the individual adaptation processes of each member that may condition the family relational context. Through collaborative sessions, families are helped to develop effective communication and conflict resolution strategies, promoting an environment of support and mutual understanding. The aim is to promote positive and lasting changes that benefit both the child or adolescent and their family environment.

Therapeutic Groups

There are extensive studies that show that involving mothers and fathers in the treatment of children and adolescents improves the response to treatment. In addition, therapeutic groups provide therapeutic ingredients that do not exist in individual or single-family therapy, such as emotional support and problem-solving alternatives provided by people in similar situations and group cohesion. The Child and Adolescent Psychiatry and Psychology Department runs various psychotherapy groups in its different facilities, for patients (emotional regulation, anxiety management, addictive behaviours, attention strategies and impulse control), for mothers and fathers (psychoeducation for families of patients with autism spectrum disorders, attention deficit hyperactivity disorder or eating disorders) or for patients and families together (dialectical behaviour therapy, group analysis).