A review of the changes in child psychiatry over the past two decades would suggest that although some minor shifts in attitude and orientation have occurred putting an emphasis on different issues, the practice has remained relatively unaffected apart from the trial of different therapeutic maneuvers. The minimal research that has emerged in this period has had little impact on the establishment of a scientifically based body of knowledge.
Child psychiatry remains as service oriented as ever and its training programs are designed to produce new service-oriented child psychiatrists to carry on the tradition. The therapeutic skills developed with experience are impressive although their efficacy remains to be rigorously evaluated. In fact, the art has flourished but the science has stood still. A tentative blueprint for future development is presumptuously offered although there is ground for skepticism, based on past performance, that this will bridge the chasm between the science and the art. Efforts of this nature, nevertheless, need to be made if this fragile discipline is to be salvaged from its present predicament.