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The article reports on the changes in academic staffing in 24 university departments of pediatrics where undergraduates are taught in various regions of the U.S. Although there has only been a 7.2% decline in academic staff, among lecturers there has been a 26% reduction. In an accompanying perspective, a Professor urges young pediatricians to participate in established research networks. A Division Director for a group of 18 faculty and fellows who conduct clinical and health services research, and more recently as Vice Chair of Academic Affairs.

This paper unpacks the legacy of racism and white supremacy in American child psychiatry, connecting them to current racist inequities, to reimagine an antiracist future for the profession, and to serve all children's mental health body and soul. History reveals how child psychiatry has neglected and even perpetuated the intergenerational trauma suffered by minoritized children and families. By refusing to confront racial injustice, it has centered on white children's protection and deleted their role in white supremacist violence. An antiracist future for the profession demands a profound historical reckoning and comprehensive reimagining, a process that this paper begins to unfold., Competing Interests: Disclosure The authors have no conflicts of interest to disclose. They collectively contributed hundreds of hours and centuries of lived experience. In the process, they endured retraumatization while confronting white supremacist violence and risking censure from their employers and institutions for their unapologetic, transparent approach. The emotional, intellectual, and physical toll of this labor on their bodies cannot be quantified. The only remuneration they received for their free labor was support from one another. While invaluable, this is also unacceptable. The motivation for their unpaid contribution is that it serves as an impetus and mandate to fund long overdue and desperately needed anti-racism initiatives in American child psychiatry., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: Qualitative research methods are based on the analysis of words rather than numbers; they encourage self-reflection on the investigator's part; they are attuned to social interaction and nuance; and they incorporate their subjects' thoughts and feelings as primary sources. Despite appearing well suited for research in child and adolescent psychiatry (CAP), qualitative methods have had relatively minor uptake in the discipline. We conducted a qualitative study of CAPs involved in qualitative research to learn about these investigators' lived experiences, and to identify modifiable factors to promote qualitative methods within the field of youth mental health. Methods: We conducted individual, semi-structured 1-h long interviews through Zoom. Using purposive sample, we selected 23 participants drawn from the US (n = 12) and from France (n = 11), and equally divided in each country across seniority level. All participants were current or aspiring CAPs and had published at least one peer-reviewed qualitative article. Ten participants were women (44%). We recorded all interviews digitally and transcribed them for analysis. We coded the transcripts according to the principles of thematic analysis and approached data analysis, interpretation, and conceptualization informed by an interpersonal phenomenological analysis (IPA) framework. Results: Through iterative thematic analysis we developed a conceptual model consisting of three domains: (1) Becoming a qualitativist: embracing a different way of knowing (in turn divided into the three themes of priming factors/personal fit; discovering qualitative research; and transitioning in); (2) Being a qualitativist: immersing oneself in a different kind of research (in turn divided into quality: doing qualitative research well; and community: mentors, mentees, and teams); and (3) Nurturing: toward a higher quality future in CAP (in turn divided into current state of qualitative methods in CAP; and advocating for qualitative methods in CAP). For each domain, we go on to propose specific strategies to enhance entry into qualitative careers and research in CAP: (1) Becoming: personalizing the investigator's research focus; balancing inward and outward views; and leveraging practical advantages; (2) Being: seeking epistemological flexibility; moving beyond bibliometrics; and the potential and risks of mixing methods; and (3) Nurturing: invigorating a quality pipeline; and building communities. Conclusions: We have identified factors that can support or impede entry into qualitative research among CAPs. Based on these modifiable findings, we propose possible solutions to enhance entry into qualitative methods in CAP (pathways), and to foster longer-term commitment to this type of research (identity). [ABSTRACT FROM AUTHOR]

Objective: A new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child and adolescent psychiatry (CAP) educators and medical student educators in psychiatry. This paper outlines the task force design and strategic plan to address the long-standing dearth of CAP training for medical students., Method: The CAPME ADMSEP Task Force, formed in 2010, identified common challenges to teaching CAP among ADMSEP's CAPME Task Force members, utilizing focus-group discussions and a needs-assessment survey. The Task Force was organized into five major sections, with inter-organizational action plans to address identified areas of need, such as portable modules and development of benchmark CAP competencies., Results/conclusion: The authors predict that all new physicians, regardless of specialty, will be better trained in CAP. Increased exposure may also improve recruitment into this underserved area.

Objective: Pediatric bipolar disorder (PBD) reflects shifts in conceptualizing bipolar disorder among children and adolescents since the mid-1990s. Since then, PBD diagnoses, predominantly in the United States, have increased dramatically, and the diagnosis has attracted significant controversy. During the same period, psychiatric theory and practice has become increasingly biological. The aim of this paper is to examine the rise of PBD in terms of wider systemic influences., Method: In the context of literature referring to paradigm shifts in psychiatry, we reviewed the psychiatric literature, media cases, and information made available by investigative committees and journalists., Results: Social historians and prominent psychiatrists describe a paradigm shift in psychiatry over recent decades: from an era of "brainless psychiatry," when an emphasis on psychodynamic and family factors predominated to the exclusion of biological factors, to a current era of "mindless psychiatry" that emphasizes neurobiological explanations for emotional and behavioral problems with limited regard for contextual meaning. Associated with this has been a tendency within psychiatry and society to neglect trauma and attachment insecurity as etiological factors; the "atheoretical" (but by default biomedical) premise of the Diagnostic and Statistical Manual of Mental Disorders (3rd and 4th eds.); the influence of the pharmaceutical industry in research, continuing medical education, and direct-to-consumer advertising; and inequality in the U.S. health system that favors "diagnostic upcoding." Harm from overmedicating children is now a cause of public concern., Conclusion: It can be argued that PBD as a widespread diagnosis, particularly in the United States, reflects multiple factors associated with a paradigm shift within psychiatry rather than recognition of a previously overlooked common disorder.

This paper reviews access, outcomes, and quality in the children's mental health system. We contend that a major focal point of future reforms should be at the organization level of care delivery. We identify five areas for intentional policy action to better infuse quality into the system. We also call for building upon the momentum of recent high-visibility reform proposals and for renewed advocacy to advance quality-linked perspectives into the children's mental health system beyond its focus on children with severe emotional disturbances.

Aim: The purpose of this review is to report on existing literature regarding children and adolescents younger than 16 years of age experiencing a first-episode psychiatric disturbance. Rather than providing a comprehensive list of service implications, this paper identifies some of the gaps in knowledge and practice to encourage ongoing analysis regarding better practices for early intervention for children and adolescents experiencing a first-episode psychiatric disturbance. Methods: A search was conducted to identify key evidence-based literature published from 1985 to 2007 discussing various aspects of child and youth mental health in Canada, the USA, the UK, Australia and New Zealand. The review also included ‘grey’ literature. Categories of information include diagnoses, pharmacological and non-pharmacological treatment, prevalence, environmental and other risk factors, and demographic variables. Results: Understanding first-episode psychiatric disturbance for patients under the age of 16 years is limited because of a scarcity of controlled studies focusing on this population. Programme evaluations are sparse, perhaps because of the small number of specialized units servicing this population. It may be helpful to enlist early intervention psychosis programmes that have been successful in assisting young people aged 16–24 in the development of better practices and care outcomes for younger age groups. Conclusions: The authors highlight information that has the potential to assist in optimizing care for those youth younger than 16 years experiencing or exhibiting signs of a first-episode psychiatric disturbance. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to explore the rapid rise in the diagnosis of bipolar disorder (BD) in the paediatric, particularly pre-pubertal, age group, in the USA over the past decade and to look at associated controversies. Conclusions: There has been a very marked rise in the diagnosis of BD among pre-pubertal children, and to a lesser extent adolescents, in the USA since the mid 1990s. The rise appears to have been driven by a reconceptualizing of clusters of emotional and behavioural symptoms in the paediatric age group by some academic child psychiatry departments, most notably in St Louis, Boston and Cincinnati. There is controversy in both the academic literature and public media centring on diagnostic methods, epidemiological studies, adverse effects of medication including media-reported fatalities, and pharmaceutical company influence. With some exceptions, the traditional view of BD as being very rare prior to puberty and uncommon in adolescence appears accepted beyond the USA, though whether this is changing is as yet uncertain, and thus there are implications for Australian and New Zealand child and adolescent psychiatry. [ABSTRACT FROM AUTHOR]

Youth violence in the United States has emerged as a major concern for communities, policymakers and community researchers. This paper reports on the efforts of a child mental health clinic to build a community consensus around addressing violence that affects youth and all members of the community. We describe and give case examples regarding our approach to acquiring the perspectives of the community, particularly that of youth, discuss key themes and implications that emerged from our work, and offer preliminary recommendations for designing a youth violence prevention initiative in a disenfranchised community. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper outlines the structure of the Pediatric Psychiatry Crisis Service at New York Presbyterian Hospital, a service that provides twenty-four hour emergency psychiatric evaluation and intervention to children, adolescents and families in northern Manhattan. Structure and staffing of the service, usage of the service and the presentation of three cases addressing high, moderate and low risk crisis patients are discussed. Finally, future challenges facing the Crisis Service are addressed. [ABSTRACT FROM AUTHOR]

This article explores a series of papers Anna Freud wrote in the 1970s, which constitute her history of child psychoanalysis. It notes her purposes-theoretical, clinical, and institutional-for reviewing this history and then focuses on three themes that she stressed. First, she emphasized that the "widening scope of psychoanalysis" had been both tremendously fruitful and perplexing as it revealed areas-such as the developmental pathologies-for which theory and technique lag. Second, she underscored the way child analysis had been extended from pathology to the theory of normal development, particularly by adding child observation to its research methods. Third, she noted how child analysis has often been hampered by reductionist thinking, and she made a plea for complexity: for considering all metapsychological frameworks and all developmental lines, and for articulating a complexly grounded diagnostic.

This paper examines the ethical principles governing research in child and adolescent psychiatry. The guidelines for protection of children and adolescents are research subjects are discussed. These include the principle of nonmaleficence and beneficence (the risk-benefit ratio), the principle of autonomy (informed consent and confidentiality), and the principle of justice (fair distribution of benefits and burdens of research). In the light of recent national efforts to help promote responsible research practice, the ethical standards relating to the protection of scientific integrity as well as research advocacy, training, and stewardship are also discussed.

This paper discusses some recent developments in the law which affect the practice of child psychiatry. New areas of professional liability are reviewed including the legal responsibility of the psychiatrist for "negligent" evaluations. Also discussed is the impact of child abuse legislation upon the standard of care in child psychiatry. The increasingly important role of psychiatrists in the legal system is viewed as a trend which will place the profession at greater risk of civil liability in the future. The need for generally accepted guidelines for conducting specialized evaluations is emphasized.

Occupational therapy is in need of role clarification within the specialty of child psychiatry. The literature reveals that occupational therapy is often undelineated or unrecognized by child psychiatry, has limited efficacy research, and may be at risk for losing its practice with children hospitalized for psychiatric disturbances. This paper outlines steps for the formulation of a specialized role for occupational therapy within this specialty. The Model of Human Occupation (Kielhofner, 1985) is suggested as a basis for conceptualizing this role. A clinical study focused on the evaluation of adaptive functioning with use of the Vineland Adaptive Behavior Scales (Sparrow, Balla, & Cicchetti, 1984, 1985) is presented as an example of a way in which occupational therapy can provide assessment data valuable to the interdisciplinary clinical team. The role of occupational therapy in both short-term and long-term hospitalization of children with psychiatric disturbances is described.

Explanations for the etiology of incest can be grouped into four general categories. Although some authors believe that one of the explanations is persuasive for most or all cases of incest, it appears that there is empirical and case report support for all four explanations. In this paper, it is suggested that assessing family will provide valuable guidelines for determining the most appropriate legal and therapeutic interventions for that family. [ABSTRACT FROM AUTHOR]

Sexual abuse, the fasters growing type of abuse complaint, often raises issues concerning the credibility of individual allegations. This paper discusses historical, developmental, and societal factors affecting children's credibility and recommended assessment methods that maximize a child's capacity to relate his or her experience. Clinical factors leading to false allegations are discussed. [ABSTRACT FROM AUTHOR]

The article discusses on the contributions of Adolf Meyer to the idea of mental hygiene as ideal for public health in the U.S. Meyer's endeavors had helped to lay the foundations of the movement and its evolvement into national recognition. In addition, Meyer compared the growth of the idea of mental hygiene in children with the development of psychiatry. He also made biology the assimilator of both viewpoints pf psychiatry and pediatrics by pointing out that it emphasized all the facts of child life in a natural setting.

The article discusses several opportunities for educating the U.S. nursing workforce to prepare them for the early identification and intervention of mental health disorders in children. Under the Patient Protection and Affordable Care Act (PPACA) Public Law 111-148, funding for the primary care workforce would be increased, allowing various entities to develop programs that teach provision of primary care. The Pediatric Nursing Alliance (PNA) aims to address a number of areas that impact quality care of children and families, including access, advocacy and education for pediatric nurses.

Objectives: Mental health disorders (MHDs) are major public health concerns with increasing risk of morbidity and mortality among children. Oral health problems (OHPs) are receiving attention as associated comorbidities. This study assessed the burden of oral health problems in children aged 3–17 years with MHD in the United States. Methods: Cross sectional analyses was performed using the National Survey of Children's Health database 2016–2017 containing information of 60,655,439 children. Weighted survey binomial logistic regression generating odds ratio for association between MHD and OHP were calculated. Weighted dose–response models captured incremental effects of MHD severity on oral health conditions. Population attributable risk (PAR) to quantify proportions of potentially avertable OHP as a result of intervention targeted at different levels of MHD severity were estimated. Results: Prevalence of OHP among those with any MHD was 22.5 percent. Children with MHD were more likely to be non‐Hispanic White, living in poorer households, and having private health insurance P < 0.001. Dose–response analyses showed children with mild MHD were 85 percent more likely [OR = 1.85 (95% CI: 1.47–2.32)], and those with moderate/severe MHD 93 percent more likely (OR = 1.93, 95% CI: 1.50–2.49) to experience OHP, compared to children without MHD. Population attributable risk (PAR) revealed that if mild and moderate/severe MHD were improved by 75 percent, OHP would be averted in 152,206 children with mild and 255,851 with moderate/severe MHD, respectively. Conclusion: Our results suggest that disparities persist among the pediatric population with MHD who suffer OHP in the United States. [ABSTRACT FROM AUTHOR]

Proponents of day treatment for children and adolescents assert that this mode of intervention is a viable alternative to hospitalization based on both treatment and cost effectiveness. Preliminary studies on treatment effectiveness are beginning to appear in the literature. This paper focuses on the relative cost difference of treating children and adolescents in a day-treatment program vs three inpatient-hospital settings. The study finds that the populations in the two settings are similar with regard to demographic and diagnostic characteristics and that day treatment is significantly less costly on a daily basis. A conservative conclusion, based on the findings reported, is that over the course of treatment partial hospitalization is equal or less costly than hospitalization. The authors conclude that further research exploring both treatment efficacy and cost effectiveness is in order to define what role day treatment should serve in the continuum of mental health-care services for children and adults.

News media and advocacy groups have brought to public attention a disturbing number of recent deaths proximal to the use of physical restraints. This paper examines the evidence indicating that use of these procedures can be dangerous to patients; explores the theoretical basis and practical application of restraints; and argues not only that their use may be unethical as a therapeutic intervention, but that it may have constitutional implications. [ABSTRACT FROM AUTHOR]

Throughout its history, American child psychiatry has been a hospitable specialty for women physicians. In its early years when practitioners were often steeped in psychoanalysis and influenced by theorists such as Anna Freud, many leaders within the field were women. By the 1960s and 1970s, child psychiatry was moving away from analysis and towards more research-based practice. The biography of an important leader in this area, New York University's Stella Chess, illustrates the mechanism of that transformation and the role of ideas about mothers and working women. Chess, along with her husband and collaborator Alexander Thomas, gathered data to disprove the popular notion that mothers were to blame for children's behaviour problems and demonstrated instead that issues resulted from a poor fit between a child's temperament and his/her environment. Chess not only demanded that facts support theory, but also used her own parenting experiences and common sense to guide her work. [ABSTRACT FROM AUTHOR]

Abstract. Psychosocial problems of children have received increasing attention in the pediatric literature, but it remains unclear to what extent psychiatric services are available and used for the treatment of these problems. This paper examines the utilization of psychiatric services by children over an 18-year period in Monroe County, NY, where a psychiatric case register monitors utilization since 1960. Reporting to the register is estimated at more than 90% of utilization for the child population. By 1977, the last year for which reasonably complete data are available, enough information had accumulated to study the lifetime utilization of all children up to 17 years of age. During the last three years of the study period, the lifetime prevalence of illness treated in psychiatric facilities including private psychiatrists' offices was 3% for children aged 5 to 9 years, 5.5% for children aged 10 to 14 years, and 7.3% for those aged 15 to 17 years. The incidence of newly recognized and treated illness was approximately .7% per year in the age range 5 to 14 years and 1.0% for those aged 15 to 17. Community mental health centers brought a marked increase in treated incidence especially for the nonwhite population. Utilization rose during the first 15 years of the study period and reached a plateau by the mid-1970s. Two interpretations of this stabilization of utilization are offered. The first one suggests that needs and utilization are still increasing, but that this rise is masked in the data by a drop in reporting providers. The second interpretation suggests that supply and demand for services have become balanced since the establishment of four community mental health centers. Pediatrics 70:790-801, 1982; mental health, psychiatric... [ABSTRACT FROM AUTHOR]

The article offers information on the American Academy of Child and Adolescent Psychiatry (AACAP) award opportunities in the U.S. The AACAP Irving Philips Award for Prevention recognizes a psychiatrist of child and adolescent psychology. The AACAP Norbert and Charlotter Rieger Psychodynamic Psychotherapy Award recognizes a paper that addresses the use of psychodynamic psychotherapy. The AACAP Junior Investigator Award offers 30,000 dollars to child and adolescent psyciatry junior faculty.

Purpose: The Conners Rating Scales are widely used in research and clinical practice for measuring attention deficit/hyperactivity disorder (ADHD) and associated problem behaviors, but country-specific norms are seldom collected. The current study presents the standardization of the Swedish Conners 3VR Rating Scales. In addition, we compared the Swedish norms to those collected in the U.S. and Germany. Material and methods: The study included altogether 3496 ratings of children and adolescents aged 6-18 years from population-based samples. Results: The scores obtained for the Swedish Conners 3VR showed satisfactory to excellent internal consistency for most subscales and excellent test-retest reliability. Across-informant correlations were modest. Cross-country comparisons revealed that aggression symptoms rated by teachers and ADHD symptoms rated by parents differed between Sweden, Germany and the U.S. Executive functioning deficits also varied as a function of rater and country, with German and Swedish teachers reporting increasing behavior problems with age, whereas a decrease was observed in the U.S. For some subscales, the observed cross-cultural differences were large enough for a child to be classified as being within the normal range (t-score <60) in one country and within the clinical range (t-score>70) in another country. Conclusion: The present study shows that the Swedish adaptation of the Conners 3VR provides consistent and reproducible scores. However, across-informant ratings were only modest and significant cross-cultural differences in scoring were observed. This emphasizes the need for multi-informant assessment as well as for national norms for rating instruments commonly used within child and adolescent psychiatry research and clinical settings. [ABSTRACT FROM AUTHOR]

At the fall component meetings of the American Psychiatric Association in Arlington, Va., September 13-16, 2017, the APA councils heard reports from their components. Following are summaries of the activities of the councils and their components. [ABSTRACT FROM AUTHOR]

Interest in providing integrated psychological and medical services in pediatric primary care is growing rapidly. Efforts to incorporate psychological services into primary care settings are leading to new models and innovative approaches to evaluation and treatment in a variety of settings. Presently, there is a need to expand the empirical base for such work and to critically evaluate what is being done. The introduction to this special section discusses some of the background for the development of integrated care, and provides some context for the articles that follow. These articles address issues related to screening in integrated pediatric primary care, the variety of services provided in the context of integrated primary care, and outline the competencies needed for providing high-quality care in such settings. Suggestions for future research directions are provided. [ABSTRACT FROM AUTHOR]

Children with emotional and behavioral problems (EBP) may have a negative effect on their mothers' earnings because they require additional time for treatment. On the other hand, children with EBP require additional financial resources, which may increase their mothers' earnings through an increase in work activities. This study examined the impact of children's EBP on parental earnings, while accounting for omitted variable bias. This study found significant reductions of single mothers' wage rate/annual earnings if their children have EBP. Conversely, children's EBP increased their married mothers' hourly wage. These results have important implications in terms of public policy such as the Affordable Care Act (ACA) of 2010 in terms of expanding health insurance coverage to children with EBP to have access to appropriate treatment. [ABSTRACT FROM AUTHOR]

This article focuses on mental health problems of children. One in ten children in the United States suffers from mental health problems that affect their lives. The surgeon general has specifically called on pediatricians to improve screening and referral for child mental illness. In response to this national call, numerous studies have examined mental health screening in pediatric practices. However, little has been written about realities of implementing an integrated model of primary care and mental health. The departments of child psychiatry and pediatrics must work together in a coordinated fashion to address the social and emotional needs of children.

Background The accuracy of any screening instrument designed to detect psychopathology among children is ideally assessed through rigorous comparison to 'gold standard' tests and interviews. Such comparisons typically yield estimates of what we refer to as 'standard indices of diagnostic accuracy', including sensitivity, specificity, positive predictive value ( PPV), and negative predictive value. However, whereas these statistics were originally designed to detect binary signals (e.g., diagnosis present or absent), screening questionnaires commonly used in psychology, psychiatry, and pediatrics typically result in ordinal scores. Thus, a threshold or 'cut score' must be applied to these ordinal scores before accuracy can be evaluated using such standard indices. To better understand the tradeoffs inherent in choosing a particular threshold, we discuss the concept of 'threshold probability'. In contrast to PPV, which reflects the probability that a child whose score falls at or above the screening threshold has the condition of interest, threshold probability refers specifically to the likelihood that a child whose score is equal to a particular screening threshold has the condition of interest. Method The diagnostic accuracy and threshold probability of two well-validated behavioral assessment instruments, the Child Behavior Checklist Total Problem Scale and the Strengths and Difficulties Questionnaire total scale were examined in relation to a structured psychiatric interview in three de-identified datasets. Results Although both screening measures were effective in identifying groups of children at elevated risk for psychopathology in all samples (odds ratios ranged from 5.2 to 9.7), children who scored at or near the clinical thresholds that optimized sensitivity and specificity were unlikely to meet criteria for psychopathology on gold standard interviews. Conclusions Our results are consistent with the view that screening instruments should be interpreted probabilistically, with attention to where along the continuum of positive scores an individual falls. [ABSTRACT FROM AUTHOR]

IMPORTANCE: Psychiatric disorders and comorbidity are prevalent among incarcerated juveniles. To date, no large-scale study has examined the comorbidity and continuity of psychiatric disorders after youth leave detention. OBJECTIVE: To determine the comorbidity and continuity of psychiatric disorders among youth 5 years after detention. DESIGN, SETTING, AND PARTICIPANTS: Prospective longitudinal study of a stratified random sample of 1829 youth (1172 male and 657 female; 1005 African American, 296 non-Hispanic white, 524 Hispanic, and 4 other race/ethnicity) recruited from the Cook County Juvenile Temporary Detention Center, Chicago, Illinois, between November 20, 1995, and June 14, 1998, and who received their time 2 follow-up interview between May 22, 2000, and April 3, 2004. MAIN OUTCOMES AND MEASURES: At baseline, the Diagnostic Interview Schedule for Children Version 2.3. At follow-ups, the Diagnostic Interview Schedule for Children Version IV (child and young adult versions) and the Diagnostic Interview Schedule Version IV (substance use disorders and antisocial personality disorder). RESULTS: Five years after detention, when participants were 14 to 24 years old, almost 27% of males and 14% of females had comorbid psychiatric disorders. Although females had significantly higher rates of comorbidity when in detention (odds ratio, 1.3; 95% CI, 1.0-1.7), males had significantly higher rates than females at follow-up (odds ratio, 2.3; 95% CI, 1.6-3.3). Substance use plus behavioral disorders was the most common comorbid profile among males, affecting 1 in 6. Participants with more disorders at baseline were more likely to have a disorder approximately 5 years after detention, even after adjusting for demographic characteristics. We found substantial continuity of disorder. However, some baseline disorders predicted alcohol and drug use disorders at follow-up. CONCLUSIONS AND RELEVANCE: Although prevalence rates of comorbidity decreased in youth after detention, rates remained substantial and were higher than rates in the most comparable studies of the general population. Youth with multiple disorders at baseline are at highest risk for disorder 5 years later. Because many psychiatric disorders first appear in childhood and adolescence, primary and secondary prevention of psychiatric disorders offers the greatest opportunity to reduce costs to individuals, families, and society. Only a concerted effort to address the many needs of delinquent youth will help them thrive in adulthood. [ABSTRACT FROM AUTHOR]

Background: School mental health services are important contact points for children and adolescents with mental disorders, but their ability to provide comprehensive treatment is limited. The main objective was to estimate in mentally disordered adolescents of a nationally representative United States cohort the role of school mental health services as guide to mental health care in different out-of-school service sectors. Methods: Analyses are based on weighted data (N = 6483) from the United States National Comorbidity Survey Replication Adolescent Supplement (participants' age: 13–18 years). Lifetime DSM-IV mental disorders were assessed using the fully structured WHO CIDI interview, complemented by parent report. Adolescents and parents provided information on mental health service use across multiple sectors, based on the Service Assessment for Children and Adolescents. Results: School mental health service use predicted subsequent out-of-school service utilization for mental disorders i) in the medical specialty sector, in adolescents with affective (hazard ratio (HR) = 3.01, confidence interval (CI) = 1.77–5.12), anxiety (HR = 3.87, CI = 1.97–7.64), behavior (HR = 2.49, CI = 1.62–3.82), substance use (HR = 4.12, CI = 1.87–9.04), and eating (HR = 10.72, CI = 2.31–49.70) disorders, and any mental disorder (HR = 2.97, CI = 1.94–4.54), and ii) in other service sectors, in adolescents with anxiety (HR = 3.15, CI = 2.17–4.56), behavior (HR = 1.99, CI = 1.29–3.06), and substance use (HR = 2.48, CI = 1.57–3.94) disorders, and any mental disorder (HR = 2.33, CI = 1.54–3.53), but iii) not in the mental health specialty sector. Conclusions: Our findings indicate that in the United States, school mental health services may serve as guide to out-of-school service utilization for mental disorders especially in the medical specialty sector across various mental disorders, thereby highlighting the relevance of school mental health services in the trajectory of mental care. In light of the missing link between school mental health services and mental health specialty services, the promotion of a stronger collaboration between these sectors should be considered regarding the potential to improve and guarantee adequate mental care at early life stages. [ABSTRACT FROM AUTHOR]

Using data from the Client/Patient Sample Survey, a nationally representative study of outpatient mental health service utilization, the prevalence and correlates of psychotropic medication receipt for youth who live with families and in foster care are compared. The medication rate is similar for both groups, with slightly more than one-third of youth treated with medication. Additionally, when medication is prescribed, it is the sole intervention provided for close to one half of each group, and the distribution of other services received (such as clinical case management and collateral services) is similar, regardless of living situation. However, the predictors of medication use differ for the two groups. Among foster care youth, only presenting problems of depressed mood, being withdrawn, and suicidality significantly increase the odds of medication; among youth with families, sociodemographic characteristics (male gender), and a range of clinical factors (disruptive behavior disorder, presenting problems of hyperactivity and sleep disturbance, prior mental health service receipt, and inpatient or residential care referral sources) increase the likelihood of medication. The conclusion that distinct sets of factors predict medication for the two groups was reinforced by results of multivariate analyses; foster care status moderates the association between medication receipt and only one of the correlates examined (gender). Implications, limitations, and areas for future research are presented. [ABSTRACT FROM AUTHOR]

Purpose - Historical studies of the expert management of childhood in Australia often make passing reference to the establishment of child guidance clinics. Yet beyond acknowledgement of their founding during the interwar years, there has been little explication of the dynamics of their institutional development. The purpose of this article is to examine the introduction of child guidance in Australia against the backdrop of the international influences that shaped local developments. Design/methodology/approach - The article investigates the establishment of child guidance clinics in Melbourne and Sydney in the 1930s. In doing so, it explores the influence of American philanthropy, the promise of prevention that inspired the mental hygiene movement, and some of the difficulties faced in putting its child guidance ideals into practice in Australia. Findings - American philanthropy played an important role in the transnational carriage of ideas about mental hygiene and child guidance into Australia. However, it was state support of child guidance activities that proved critical to its establishment. In addition to institutional developments, what also emerges as important in the 1930s is the traction gained in the broader realm of ideas about "adjustment" and mental health, particularly in relation to the efficacy of early intervention and multidisciplinary approaches to treating problems of childhood. Originality/value - In tracing its early development, the article argues for the importance of understanding child guidance not only in terms of its administrative successes and failures, but also more broadly in terms of how early intervention as an influential mode of thought and practice took root internationally. [ABSTRACT FROM AUTHOR]

The authors make the case for the inclusion of cognitive enrichment programs in early mainstream education that should be designed to eliminate the early discrepancies in children's cognitive abilities and prevent later learning disabilities and achievement gaps. Following a review of the literature on existing early cognitive enrichment programs and their effects with cognitive impaired children and children with special needs, the authors present the theoretical and programmatic features of Feuerstein's 3-year basic program, along with a brief description of its different modules. The authors also provide a summary of all the available evidence of the program's effectiveness, including the results of 3 evaluation studies of pilot projects in the United States. The article culminates in an appeal for rigorous research on the feasibility and effects of programs in mainstream education for early cognitive enrichment and prevention of learning problems, including research on the effects of Feuerstein's Instrumental Enrichment-Basic (FIE-B) program. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the structure, process, and outcomes of emergency department (ED) psychiatric services that are available to children who present with behavioral health problems. The author designed and employed a 33-item survey for data collection. All nonfederal EDs in one southeastern state ( N = 68) were solicited to participate. Descriptive analyses including ANOVAs, t tests, and chi-squares summarized sample characteristics and group differences by ED pediatric psychiatric service (EDPPS) arrangement. Thirty-four hospitals participated, sharing similar organizational characteristics with nonresponders except that participating hospitals were significantly more likely to have inpatient psychiatric services. The survey successfully captured data confirming that EDs use a range of strategies to manage children with behavioral health problems, raising concerns about the suitability of such service variation. These results highlight the need for further research that examines the association of EDPPS structure and process with patient and organizational outcomes to inform quality improvements in pediatric behavioral healthcare. [ABSTRACT FROM AUTHOR]

Background: In 2003, the National Institute of Mental Health funded the Child and Adolescent Psychiatry Trials Network (CAPTN) under the Advanced Center for Services and Intervention Research (ACSIR) mechanism. At the time, CAPTN was believed to be both a highly innovative undertaking and a highly speculative one. One reviewer even suggested that CAPTN was "unlikely to succeed, but would be a valuable learning experience for the field." Objective: To describe valuable lessons learned in building a clinical research network in pediatric psychiatry, including innovations intended to decrease barriers to research participation. Methods: The CAPTN Team has completed construction of the CAPTN network infrastructure, conducted a large, multi-center psychometric study of a novel adverse event reporting tool, and initiated a large antidepressant safety registry and linked pharmacogenomic study focused on severe adverse events. Specific challenges overcome included establishing structures for network organization and governance; recruiting over 150 active CAPTN participants and 15 child psychiatry training programs; developing and implementing procedures for site contracts, regulatory compliance, indemnification and malpractice coverage, human subjects protection training and IRB approval; and constructing an innovative electronic casa report form (eCRF) running on a web-based electronic data capture system; and, finally, establishing procedures for audit trail oversight requirements put forward by, among others, the Food and Drug Administration (FDA). Conclusion: Given stable funding for network construction and maintenance, our experience demonstrates that judicious use of web-based technologies for profiling investigators, investigator training, and capturing clinical trials data, when coupled to innovative approaches to network governance, data management and site management, can reduce the costs and burden and improve the feasibility of incorporating clinical research into routine clinical practice. Having successfully achieved its initial aim of constructing a network infrastructure, CAPTN is now a capable platform for large safety registries, pharmacogenetic studies, and randomized practical clinical trials in pediatric psychiatry. [ABSTRACT FROM AUTHOR]

This study presents a large rnulticenter cohort of children with cerebral venous thrombosis from 5 centers in the United States and analyzes their clinical findings and risk factors. Seventy patients were included in the study (25 neonates, 35%). The age ranged from 6 days to 12 years. Thirty-eight (55%) were younger than 6 months of age, and 28 (40%) were male. Presenting features included seizures (59%), coma (30%), headache (18%), and motor weakness (21%). Common neurological findings included decreased level of consciousness (50%), papilledema (18%), cranial nerve palsy (33%), hemiparesis (29%), and hypotonia (22%). Predisposing factors were identified in 63 (90%) patients. These included infection (40%), perinatal complications (25%), hypercoagulable/hematological diseases (13%), and various other conditions (10%). Hemorrhagic infarcts occurred in 40% of the patients and hydrocephalus in 10%. Transverse sinus thrombosis was more common (73%) than sagittal sinus thrombosis (3 5%). Three children underwent thrombolysis, 15 patients received anticoagulation, and 49 (70%) were treated with antibiotics and hydration. Nine (13%) patients (6 of them neonates) died. Twenty-nine patients (4 1%) were normal, whereas 32 patients (46%) had a neurological deficit at discharge. Seizures and coma at presentation were poor prognostic indicators. In conclusion, cerebral venous thrombosis predominantly affects children younger than age 6 months. Mortality is high (25%) in neonatal cerebral venous thrombosis. Only 18 (25%) patients were treated with anticoagulation or thrombolysis. [ABSTRACT FROM AUTHOR]

Focuses issues related to the delivery of mental health services to children and adolescents in the U.S. Problems with the identification of mental health needs and appropriate delivery services; Impact on the failure to meet the mental health treatment needs of children; Predictions for an adverse consequences when these children reach adulthood.

Adolescent refugees are a traumatized, vulnerable group of arrivals to America who lack experience with or interest in psychiatric care. Testimonial psychotherapy's unique focus on transcribing personal, traumatic events for the altruistic purpose of education and advocacy make it an acceptable interaction by which to bridge the cultural gap that prevents young refugees from seeking psychiatric care. The theoretical basis for testimony is discussed. Testimonial psychotherapy has been used with adult refugees, but not with adolescents. This article describes the testimonial process with three Sudanese adolescents (the so-called 'Lost Boys'), which appeared feasible and safe. An efficacy study is underway. [ABSTRACT FROM AUTHOR]

Until the 2001 Surgeon General's report there had been no acknowledgment of the need for a national plan for research priorities to improve services and reduce illness burden for children and adolescents with severe mental disorders. Barriers to services among those in need include individual and family factors, and clinician and service system factors. Additionally, little reserch is available on the impact of major policy reforms on children's ability to obtain efficacious care. Critical research gaps exist in a number of areas with the prevention and early intervention area representing a particularly important missed opportunity. [ABSTRACT FROM AUTHOR]

The admission of a child to a psychiatric unit is difficult for parents. While many articles about admissions can be discovered in the literature, few address the process of admission. A grounded theory study was undertaken to describe and explain the relationships that develop between parents and nurses in child psychiatric units. The crucial nature of the admission process was discovered and is the focus of this article. Theoretical sampling was used. Data were collected by interviewing parents and the nursing staff working with the parents. In addition, participant observation was used. Data were analyzed using the constant comparative method. Parents often came to the unit expecting to be blamed for their child's problems. When nurses responded with reassurance and caring, the parents' engagement was enhanced. During admission, expectations of parents and nurses influenced the relationship. In addition, the study discovered ways that nursing routines influence the relationship during the admission period. [ABSTRACT FROM AUTHOR]

The case records of 849 children, seen at the University of Michigan Children's Psychiatric Hospital have been examined to determine which factors are associated with hospitalization. Of all variables considered, diagnosis proved to be the single best predictor of hospitalization. This relationship was moderated by age, sex, social class, and the presence or absence of environmental stress. Of note was the decreased likelihood of hospitalization among 11-12 year old children with psychotic disorders, and the decreased likelihood for children with psychophysiologic disorders to be hospitalized at the 13 and older age group. Environmental stress was most strongly associated with children hospitalized with developmental and psychophysiologic disorders. Sex was not associated with the hospitalization status of children with personality disorders, while girls were more likely than boys to be hospitalized with psychophysiologic and developmental disorders, and boys more likely to be hospitalized with neurotic and psychotic disorders. Finally with respect to social class, there was an increased likelihood of hospitalization for those with personality and psychotic disorders as social class fell from managerial to blue collar to unskilled/unemployed. A curvilinear relationship between social class and hospitalization was found for those with psychophysiologic disorders. [ABSTRACT FROM AUTHOR]

The article presents an examination of the role of adult siblings in care-giving for the severely mentally ill. Care in the community has become the dominant policy choice for dependent populations in the United States in recent decades. Community care means that disabled populations including the mentally ill, physically disabled, infirm elderly, and other dependent groups should live in their own residences and communities rather than in institutional settings. In this cross-sectional analysis mothers provide the most care for the seriously mentally ill. However, over time parents will die or become too disabled to provide assistance to their seriously mentally ill children. Because the majority of the seriously mentally ill do not have families of procreation, the role of primary caretaker must transfer to siblings if the person is not to become either totally isolated or a ward of the state.