Mental health care in the early stages of life is of great importance due to both its influence on the development of children and adolescents and also its long-term consequences.1 However, child psychiatry has not always been seen as important and the first works that focused exclusively on it were written in the 1880s by Hermann Emminghaus, Pièrre Filibiliou and Paul Moreau de Tours.2 In 1907 Augusto Vidal Perera published the Compendium of Child Psychiatry. This author stressed that child psychiatry should also deal with mood alterations and not only with mental deficiency. Child psychiatry appeared at the crossroad between paediatrics, psychiatry and pedagogy. In 1909 José Sarmiento and in 1917 Gonzalo Rodríguez Lara also published their works on mental disorders in childhood.
The first specific centres that were developed for these age groups combined clinical and pedagogical perspectives, the latter being particularly relevant2,3 Vidal Perera opened his clinical pedagogical practice in Barcelona in 1904. In 1907 the brothers Francisco and Amador Pereira opened a similar practice in Madrid and in 1915 José Córdoba Rodríguez founded the Pedagogical Medical Institute for children and adolescents in Barcelona. In 1919, Joan Alsina Melis founded the Municipal School for the handicapped in Vallvidrera with a capacity for a hundred children. Child psychiatry gradually became consolidated in Europe between the 1920s and 1940s and the first specialists who were dedicated exclusively to children and adolescents appeared at this time. A Chair of Child Psychiatry was created in Paris in 1925 and the first conference devoted to the specialty was held in 1937. In Spain, the first issue of the journal Arxius de Psicologia i Psiquiatria Infantil [Archives of Child Psychology and Psychiatry] was published in Barcelona in 1933; it was a publication of the Juvenile Court of the city. It was the successor of the journal Infantia Nostra (Fig. 1) which was founded in 1903 by Agustí Bassols Prim. That same year Moritz Tramer, Professor of Psychiatry at the University of Bern, founded another journal dedicated to child psychiatry called Zeitschrift für Kinderpsychiatrie and Leo Kanner published his book Child Psychiatry, which became a reference of the subject at that time. Another work that should be highlighted is Tramer's Manual of Child Psychiatry, Puberty and Adolescence.2 In 1934, thanks to the initiative of Jerònim de Moragas Gallisá, the first children's neuropsychiatry clinic was created in Barcelona as part of the Psychotechnical Institute of the Autonomous Government of Catalonia [La Generalitat]. It was directed by Emili Mira (Fig. 2). Other institutions that opened in those years include the clinic La Sageta founded by Emili Mira and Jerònim de Moragas and the Torremar Institute for poor and mentally handicapped children founded by Luis Folch Torres in Vilassar de Dalt (Barcelona) and later continued by his son Lluis Folch Camarasa. Gradually, the number of doctors and pedagogues who dedicated themselves exclusively to children and adolescents increased with names like Agustín Serrate Torrente in Zaragoza or Carlos Vázquez Velasco and Diego Gutiérrez Gómez in Madrid. In 1941 the Child Psychiatry Unit of the Hospital de Sant Pau in Barcelona was created. In 1945 Solé Segarra inaugurated the first Neuropsychiatry Service and Dispensary as part of the Chair of Paediatrics at Hospital Clínic de Barcelona. In addition, in Madrid during this time the “Fray Bernardino Alvarez” Pedagogical Medical Institute, directed by Francisco Mendiguchía, was created for minors with mental disabilities.
In the 1950s, specific scientific associations of child psychiatry emerged in different countries. The Spanish association of child psychiatry was founded by a group of doctors committed to the needs of children and adolescents in 1950 and its first president was José Córdoba. It was called the Society of Child Neuropsychiatry. Later it would be renamed the Spanish Association of infant-Juvenile Psychiatry (AEPIJ) and later as the Spanish Association of Child and Adolescent Psychiatry (AEPNYA). The first conference of the association was held in Barcelona at the Casal del Médico in 1952. From then on, scientific events were organized periodically and the association participated in international conferences on the specialty. In this decade, the Union of European Paedopsychiatrists (UEP) was also created, which is currently called the European Society of Child and Adolescent Psychiatry (ESCAP), as well as the American Academy of Child and Adolescent Psychiatry (AACAP). In 1978 the Child Psychiatry Section was initiated within the Spanish Association of Paediatrics and in 1981 the Spanish Society of Child and Adolescent Psychiatry and Psychotherapy (SEPYPNA) was established. Recently, the name of the Spanish Association of Child and Adolescent Psychiatry has been changed to the Spanish Association of Psychiatry of Childhood and Adolescence, although the acronym AEPNYA has been maintained.
During the 1960s and 1970s more child psychiatry units began to be created, such as the one inaugurated by Agustín Serrate in the Ramón Rey Ardid Chair of Psychiatry in Zaragoza in 1967. Likewise, new children's psychiatric hospitals were also established in these years, although they were largely dedicated to children with mental retardation. These hospitals include the Rodríguez de Miguel in Zamora, El Pinar in Teruel founded in 1970 and The Atalaya Children's Psychiatric Sanatorium founded in Ciudad Real in 1971. In Málaga, Miguel de Linares created the Psychopedagogical Institute “Dulce Nombre de María”. Also, during this time, child psychiatry units and sections were created in the new general hospitals, such as the unit that Flora Prieto directed at La Paz Hospital in Madrid. Psychiatric consultations were also carried out in specific units and sections of the paediatric department at the Gregorio Marañón General University Hospital, under the direction of María Jesús Mardomingo, and at the Vall d’Hebron Hospital in Barcelona under the direction of Josep Tomás. Likewise, different child psychiatry units and sections began operating in the adult psychiatry services of clinical hospitals such as those of Zaragoza, Valencia, Seville, Valladolid, Santiago and Barcelona. In the 1980s, Ferran Angulo was appointed Head of the Child Psychiatry Service at Sant Joan de Déu Children's Hospital in Barcelona and Josep Toro was appointed Head of the Section at Hospital Clínic de Barcelona. In terms of training, in 1972 Julián de Ajuriaguerra, director of the Psychiatric Hospital of Bel-Air (Geneva), collaborator of Piaget, who had a remarkable influence on Spanish child psychiatry, published his “Manuel de Psiquiatrie de l’Enfant”. In the 1970s, Jaime Rodríguez Sacristán, at the University of Seville, obtained the Chair of Child Psychiatry. Moreover, a child psychiatrist, Edelmira Domènech, obtained the Chair of Psychopathology dedicated to children and adolescents within the Faculty of Psychology of the Universitat Autònoma de Barcelona (UAB).
From the 1990s to the present, these and other practices in child psychiatry were consolidated and gradually became units, sections and services that have formed a network of care specific to the specialty. However, this occurred with much disparity in the different communities, as reported in the White Paper on Child and Adolescent Psychiatry published in 2014 by the Chair of Child Psychiatry of the Alicia Koplowitz Foundation whose director was Celso Arango.4
In undergraduate education, only a few medical schools have a specific subject on child and adolescent psychiatry. After finishing medicine, although there are different postgraduate courses, the training received during residency and later on has not been the same for all specialists who treat children and adolescents in Spain. In most European countries, child and adolescent psychiatry has been recognized as a specialty distinct from adult psychiatry and specific training has been established. This specialty was not recognized in Spain for many years and there was only a mandatory training of four months during the psychiatric residency. Child psychiatry associations have been working for years to develop the specialty and after several attempts it was recognized with the Royal Decree of Truncation of 2014 in which the specialty of Child and Adolescent Psychiatry was created within Psychiatry. However, this decree was not finally accepted and it was not until August 2021 that the Royal Decree establishing the title of specialist in Child and Adolescent Psychiatry was finally approved, as well as some modifications in the training of the specialty of general Psychiatry. A five-year training as a resident internal doctor was established with two years of common training and three years of specific training in General Psychiatry or Child and Adolescent Psychiatry. It is to be hoped that this will lead, in addition to an homogeneous training, to the further development of units and services.
Recognition of the importance of research into early mental health has also increased in recent decades as it allows studies to be carried out on different disorders without the influence of years of evolution or successive treatments. Moreover, there is a large distance between the practising clinics and the research,5 which can be improved by harmonizing the training. Other benefits that can be obtained from good training are a greater professional identity because professionals will have voluntarily decided to dedicate themselves to this specialty, will prioritize their own healthcare networks and will belong to specific associations, thus enhancing knowledge in this area.
