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Impairing emotional outbursts, defined by extreme anger or distress in response to relatively ordinary frustrations and disappointments, impact all mental health care systems, emergency departments, schools, and juvenile justice programs. However, the prevalence, outcome, and impact of outbursts are difficult to quantify because they are transdiagnostic and not explicitly defined by current diagnostic nosology. Research variably addresses outbursts under the rubrics of tantrums, anger, irritability, aggression, rage attacks, or emotional and behavioral dysregulation. Consistent methods for identifying and assessing impairing emotional outbursts across development or systems of care are lacking.The American Academy of Child and Adolescent Psychiatry Presidential Task Force (2019-2021) conducted a narrative review addressing impairing emotional outbursts within the limitations of the existing literature and independent of diagnosis.Extrapolating from the existing literature, best estimates suggest that outbursts occur in 4%-10% of community children (preschoolers through adolescents). Impairing emotional outbursts may respond to successful treatment of the primary disorder, especially for some children with attention-deficit/hyperactivity disorder whose medications have been optimized. However, outbursts are generally multi-determined and often represent maladaptive or deficient coping strategies and responses.Evidence-based strategies are necessary to address factors that trigger, reinforce, or excuse the behaviors and to enhance problem-solving skills. Currently available interventions yield only modest effect sizes for treatment effect. More specific definitions and measures are needed to track and quantify outbursts and to design and assess the effectiveness of interventions. Better treatments are clearly needed.

Suicide rates continue to increase among children and adolescents in the United States, with suicide remaining the second leading cause of death for youth aged 10 to 24 years of age. Most studies of suicide among children and adolescents have not focused on youth of color because of research suggesting that suicide was a health threat for white youth. Research showing shifting trends in suicide for minoritized youth of color has increased national focus, revealing disparities in recognition and treatment of suicidal behaviors for racially and culturally diverse youth.

This chapter reviews the lives of the children affected by bipolar disorder and how it changed for the better. It acknowledges how sheer luck and a parent’s love can make a difference in a child’s life path. Kids with all kinds of mental illness being identified and treated earlier bring hope that they can be helped out of their harmful ruts. Moreover, the pandemic sparked unquestionable damage to the mental health of US children. The chapter tackles progress with policies in improving mental health support. It suggests focusing better on the bigger picture and thinking harder about broader, structural issues that have huge and inequitable impacts on mental health.

This chapter tackles psychotherapy as a method of treatment for bipolar disorder. It clarifies that medication is often not sufficient by itself, so psychotherapy will provide the greatest chance of lifelong success in treating the condition. Imaging studies have shown psychotherapy leads to physical changes in the brain. Moreover, bipolar disorder affects the person with the condition and their respective family. A therapist using cognitive-behavioral therapy challenges a patient’s unhealthy thinking patterns while simultaneously encouraging problem-solving skills and healthier choices. The chapter also explores other psychotherapy approaches such as interpersonal psychotherapy, dialectical behavior therapy, and family-focused treatment. It then covers the duration and side-effects of psychotherapy.

This chapter focuses on bipolar disorder that affects the lives of people. It starts with how taking care of children with bipolar disorder might take over a parent’s life. The characteristic definition of bipolar disorder ranges between mania and depression. Professional help is advised when red flags like bouts of explosive rage or repeated high-risk behavior have been recorded. The chapter explains the process of diagnosing bipolar disorder, especially when the condition is often mistaken for attention-deficit/hyperactivity disorder or schizophrenia. Moreover, bipolar disorder often exists side by side with other emotional and behavioral issues known as comorbid conditions or comorbidities. The chapter also highlights the role of biology in mood disorders.

This chapter introduces the concept of bipolar disorder found in adolescents. It defines bipolar disorder as a mood disorder of a potentially harmful variety of ordinary course of shifting attitudes and behavior. The disorder mostly consists of some degree of mania and alternates with cycles of depression or pervasive sadness. The chapter cites the increased demand for mental health care professionals, especially after the COVID-19 pandemic triggered traumas, frustrations, and social isolation. It suggests parents seek help with professional diagnosis and treatment if their child is suspected to have bipolar disorder. After all, bipolar disorder could potentially get worse when left undiagnosed and untreated.

If Your Adolescent Has Bipolar Disorder: An Essential Resource for Parents provides a definitive guide to understanding and getting effective help for adolescents with bipolar disorder. The guide is primarily designed for parents and other adults in contact with teenagers with bipolar disorder. Most current scientific expertise available today has been combined with no-nonsense, hands-on advice from parents who have faced their children’s bipolar disorder. The scientific expertise ranges between the newest treatments and medications and the latest research findings on bipolar disorder. If Your Adolescent Has Bipolar Disorder aims to provide information and tools parents need to aid teenagers to achieve the best possible outcome in coping with their condition.

Limited research has simultaneously focused on sociodemographic differences in who receives recommended adolescent depression screening in primary care and who endorses elevated depression and suicide risk on these screeners. We describe screening and risk rates in a large pediatric primary care network in the United States after the network expanded its universal depression screening guideline to cover all well-visits (i.e., annual medical checkups) for adolescents ages 12 and older.Between November 15, 2017 and February 1, 2020, there were 122,682 well-visits for adolescents ages 12-17 (82,531 unique patients). The Patient Health Questionnaire - Modified for Teens (PHQ-9-M) was administered to screen for depression.A total of 99,961 PHQ-9-Ms were administered (screening rate=81.48%). The likelihood of screening was higher among adolescents who were female, 12-14 years of age at their first well-visit during the study, White, Hispanic/Latino, or publicly-insured (i.e., Medicaid-insured). Additionally, 5.92% of adolescents scored in the threshold range for depression symptoms and 7.19% endorsed suicidality. Heightened depression and suicide risk were observed among adolescents who were female, 15-17 years of age at their first well-visit during the study, Black, Hispanic/Latino, attending urban primary care practices, or Medicaid-insured. Odds of endorsing suicidality were also higher among teens who identified as other races.Limitations related to data available in the electronic health record and reliance on data from a single hospital system are noted.Findings highlight misalignments in screening and risk status that are important to address to ensure more equitable screening implementation and health outcomes.

Youth exposure to ‘web of violence’ is associated with impairments in mental and physical health. The current study aimed to identify subgroups of violent events, such as maltreatment, bullying perpetration and peer victimization and explore how these relate to depressive symptoms, hopelessness, and impairment among a sample of clinically-referred youth. A sample of 151 adolescents between the ages of 12 and 18 years was evaluated at a mood disorders program in an outpatient hospital-based clinic. Cluster analysis was used to identify subgroups based on ‘web of violence’ experiences. Group differences were then analyzed by demographics and clinical variables. Overall, rates of exposure to maltreatment, peer victimization and bullying perpetration were high. Cluster analysis identified two subgroups of adolescents which can be characterized as low versus high exposure groups. The high exposure group reported more severe depressive symptoms, greater hopelessness, and more impairment than the low exposure group. Among this clinical sample, distinct subgroups of youth were identified that differed based exposure to maltreatment and peer fighting and victimization. Adolescents in the high exposure group showed significantly worse clinical outcomes compared to the low exposure group. These findings further highlight the importance of a comprehensive assessment for involvement in violence when evaluating adolescents with depression.

Adolescent suicidality (ie, suicidal ideation or attempts) is a major public health concern. Cyberbullying experiences and perpetration have become increasingly prevalent and are associated with mental health burden, but their roles as independent suicidality risk factors remain unclear. Data are needed to clarify their contribution to teen suicidality to inform suicide prevention efforts.To examine whether cyberbullying experiences and perpetration are distinct stressors divergent from other forms of peer aggression experiences in their association with suicidality in early adolescence.This cross-sectional analysis used data collected between July 2018 and January 2021 from the Adolescent Brain Cognitive Development (ABCD) study, a large, diverse sample of US children aged 10 to 13 years.Youth reports of cyberbullying experiences or perpetration.The main outcome was youth-reported suicidality (past or present, as reported in the ABCD 2-year follow-up assessment). Covariates included demographics, established environmental risk and protective factors for youth suicidality, psychopathology, and experiences or perpetration of offline peer aggression.A total of 10 414 ABCD participants were included in this study. Participants had a mean (SD) age of 12.0 (0.7) years and 4962 (47.6%) were female; 796 (7.6%) endorsed suicidality. A total of 930 (8.9%) reported experiencing cyberbullying and 96 (0.9%) reported perpetrating cyberbullying. Of the perpetrators, 66 (69.0%) also endorsed experiencing cyberbullying. Controlling for demographics, experiencing cyberbullying was associated with suicidality (odds ratio [OR], 4.2 [95% CI, 3.5-5.1]; P .001), whereas perpetrating cyberbullying was not (OR, 1.3 [95% CI, 0.8-2.3]; P = .30). Experiencing cyberbullying remained associated with suicidality when accounting for negative life events, family conflict, parental monitoring, school environment, and racial and ethnic discrimination (OR, 2.5 [95% CI, 2.0-3.0]; P .001) and when further covarying for internalizing and externalizing psychopathology (OR, 1.8 [95% CI, 1.4-2.4]; P .001). Both being a target and being a perpetrator of offline peer aggression were associated with suicidality (OR, 1.5 [95% CI, 1.1-2.0] for both), controlling for all covariates described earlier. Cyberbullying experiences remained associated with suicidality (OR, 1.7 [95% CI, 1.3-2.2]; P .001, controlling for all covariates) when included with offline peer aggression experiences and perpetration.In this cross-sectional study, experiencing-but not perpetrating-cyberbullying was associated with suicidality in early adolescence. This association was significant over and above other suicidality risk factors, including offline peer aggression experiences or perpetration. These findings can inform adolescent suicide prevention strategies, and they suggest that clinicians and educational staff working with this population should routinely evaluate for adolescents' experience with cyberbullying.

ObjectiveThe authors used multimodal data collected during pre/early-adolescence in research settings to predict self-report of past suicide attempt (SA) by mid-late adolescence in pediatric care settings. The study further aimed to determine types of data that contribute to the prediction; and to test generalizability of the prediction in an independent sample.MethodsThe authors applied machine learning methods on clinical, neurocognitive and geocoded neighborhood environmental data from the Philadelphia Neurodevelopmental Cohort study (PNC, Mean age 11.1, SD=2.2, 52.3% female and 51.4% Black participants) to predict SA reported ∼5 years later in a community pediatric clinic (n=922, 5.3% SA) or emergency department (n=497, 8.2% SA). The authors compared prediction performance when using all data versus individual data types, then used feature selection algorithms (Lasso, Relief and Random Forest) to identify important predictors and compared performance of models relying on feature subsets.ResultsIn the training dataset, SA prediction was good, reaching AUC=0.75, sensitivity/specificity 0.76/0.77 when relying on feature subsets identified using feature selection pipelines. Use of highest-ranking feature subsets from the training dataset yielded similar prediction in the testing dataset with AUC=0.74, sensitivity/specificity 0.66/0.70. Different algorithms showed different high-ranking features, but overall multiple data domains were represented among the highest-ranking predictors selected by each algorithm.ConclusionsThese findings provide evidence for feasibility of predicting youth SA using data collected at a single timepoint early in life in a diverse cohort. Results encourage incorporation of multiple data types including neurocognitive and geocoded environmental measures in machine learning SA prediction pipelines.

Standardized suicide risk assessment improves the detection of individuals at risk of suicide. We conducted a quality improvement initiative in a system of outpatient behavioral health practices affiliated with a free-standing children's hospital to implement standardized suicide risk assessment for new patients.Clinicians received education in suicide risk assessment and were trained to use an evidence-based suicide risk assessment tool, the Columbia Suicide Severity Rating Scale (C-SSRS). We standardized workflow processes and integrated the C-SSRS in the electronic health record with a feature to communicate instances of elevated risk across care teams through a problem list. We analyzed C-SSRS responses and adherence to standardized processes and compared the percentage of patients with a suicide-related item on the problem list before and after implementation. We assessed clinician knowledge through a survey. All patients with identified suicide risk received treatment to reduce their risk of suicide in the context of usual care.For 3,972 new patient visits occurring postimplementation (November 2016-December 2018), the average monthly adherence to the standardized process was 97.7%. The mean monthly incidence of nonspecific active suicidal thoughts was 16%, aborted suicide attempts were 2%, and actual suicide attempts were 3%. The mean monthly incidence of a suicide-related item documented on the problem list was 5.66% in the postimplementation period compared with 1.47% in the 1-year preimplementation. Clinicians demonstrated statistically significant increases in knowledge about suicide risk factors and assessment.Standardization of suicide risk assessment processes improved detection and documentation of suicide risk in a pediatric outpatient behavioral health setting.

Key Points Question Are there associations among attention-deficit/hyperactivity disorder (ADHD) pharmacotherapy, externalizing symptoms, and childhood suicidality (ie, ideation or attempts)? Findings In this cohort study of 11 878 children aged 9 to 10 years at baseline, externalizing symptoms showed expected associations with suicidality. ADHD pharmacotherapy was associated with less suicidality in children with externalizing symptoms, specifically among those with substantial symptoms burden, both at the baseline and 1-year follow-up assessment. Meaning These findings suggest that in children with substantial externalizing symptoms, ADHD medication use may be associated with less suicidality, in addition to its known clinical benefits in treating externalizing symptoms., This cohort study investigates the associations of attention-deficit/hyperactivity disorder (ADHD) medication with externalizing symptoms and childhood suicidality., Importance Childhood suicidality (ie, suicidal ideation or attempts) rates are increasing, and attention-deficit/hyperactivity disorder (ADHD) and externalizing symptoms are common risk factors associated with suicidality. More data are needed to describe associations of ADHD pharmacotherapy with childhood suicidality. Objective To investigate the associations of ADHD pharmacotherapy with externalizing symptoms and childhood suicidality. Design, Setting, and Participants In this cohort study, cross-sectional and 1-year-longitudinal associations were examined using data (collected during 2016-2019) from the Adolescent Brain Cognitive Development (ABCD) Study, a large, diverse US sample of children aged 9 to 11 years. Data analysis was performed from November to December 2020. Exposures Main and interaction associations of externalizing symptoms (hyperactivity ADHD symptoms, oppositional defiant, and conduct disorder symptoms) and ADHD medication treatment (methylphenidate and amphetamine derivatives, α-2-agonists, and atomoxetine) at baseline assessment. Main Outcomes and Measures Child-reported suicidality (past and present at baseline; current at longitudinal assessment). Covariates were age, sex, race/ethnicity, parents’ education, marital status, and concomitant child psychiatric pharmacotherapy (antidepressants and antipsychotics). Results Among 11 878 children at baseline assessment (mean [SD] age, 9.9 [0.6] years; 6196 boys [52.2%]; 8805 White [74.1%]), 1006 (8.5%) were treated with ADHD medication and 1040 (8.8%) reported past or current suicidality. Externalizing symptoms (median [range], 1 [0-29] symptom count) were associated with suicidality (for a change of 1 SD in symptoms, odds ratio [OR], 1.34; 95% CI, 1.26-1.42; P

Suicide rates continue to rise among children and adolescents; suicide is the second leading cause of death in the United States. Although research studies have identified factors associated with suicide risks for youths, none distinguishes those who have suicidal ideation from those who most likely will make an attempt or die by suicide. Most studies focus on psychiatric diagnoses associated with suicide risks. Recent studies suggest that cross-cutting symptom profiles may be a stronger predictor of risks for suicide than diagnosis. This article provides an overview of emotional dysregulation as it relates to suicidal ideation, intent, and behaviors for youth.

OBJECTIVE: Youth suicide rates in the United States have been increasing in recent years, especially in Black Americans, the reasons for which are unclear. Environmental adversity is key in youth suicidality; hence there is a need to study stressors that have a disproportionate impact on Black youths. We aimed to disentangle the unique contribution of racial/ethnic discrimination from other adversities associated with childhood suicidal ideation and attempts (suicidality). METHOD: We analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, which included a large, diverse sample of US children (N = 11,235, mean age 10.9 years, 20.2% Black), assessed for multiple environmental adversities including discrimination. Multivariate regression models tested the association of self-reported racial/ethnic discrimination with suicidality, covarying for multiple confounders including other discrimination types (toward non–US-born individuals, sexual orientation–based, and weight-based). Matched analyses contrasted effects of racial/ethnic discrimination and racial identity on suicidality. RESULTS: Black youths reported more discrimination and higher suicidality rates than non-Black youths. High racial/ethnic discrimination was positively and significantly associated with suicidality, adjusting for other discrimination types (odds ratio = 2.6, 95% CI = 2.1–3.2). Findings remained significant after adjusting for multiple suicidality risk factors. Once experienced, racial/ethnic discrimination was similarly associated with suicidality in White, Black, and Hispanic youths. Matched analyses revealed that racial/ethnic discrimination was associated with suicidality (relative risk = 2.7, 95% CI = 2–3.5), whereas Black race was not (relative risk = 0.9, 95% CI = 0.7–1.2). CONCLUSION: Racial/ethnic discrimination is disproportionately experienced by Black children, and is associated with preadolescent suicidality, over and above other adversities. Findings highlight the need to address discrimination as part of suicide prevention strategies. Cross-sectional design hampers causal inferences. Reprinted from J Am Acad Child Adolesc Psychiatry, Argabright et al., Association Between Discrimination Stress and Suicidality in Preadolescent Children, S0890–8567(21)01355-1, copyright 2021, with permission from Elsevier

In the recently published article "Mental Health in the Young Athlete" the following author name was inadvertently misspelled as Christine L. Master. The correct spelling of the author's name is: Christina L. Master as shown above.

Purpose of review The goal of the present paper is to provide a comprehensive overview of mental health concerns in young athletes, with a focus on common disorders, as well as population-specific risk factors. Recent findings Athletes experience similar mental health concerns as non-athlete peers, such as anxiety, depression and suicidal ideation, ADHD, eating disorders, and substance abuse. However, they also experience unique stressors that put them at risk for the development or exacerbation of mental health disorders. Student athletes have to balance academics with rigorous training regimens while focusing on optimal performance and managing high expectations. Physical injuries, overtraining, concussion, sleep disorders, and social identity are some of the factors that also impact the mental health of student athletes. Existing literature highlights the need to develop proactive mental health and wellness education for young athletes, and to develop services that recognize the unique needs of this population.

Environment (E) is pivotal in explaining variability in brain and behavior development, including suicidal ideation (SI) and behavior. It is therefore critical to systematically study relationships among environmental exposures (i.e., exposome) and suicidal phenotypes. Here, we evaluated the role of individual-level adversity and neighborhood environment and their interaction (E x E) in association with youth SI. Sample included youth (N = 7,054, ages 11–21) from the Philadelphia Neurodevelopmental Cohort, which investigated clinical phenotypes in a diverse US community population. We examined cross-sectional associations of environmental exposures with lifetime history of SI (n = 671), focusing on interactions between individual-level exposures to assaultive trauma (n = 917) and neighborhood-level socioeconomic status (SES) quantified using geocoded Census data. Models included potential confounds and overall psychopathology. Results showed that assaultive trauma was strongly associated with SI (OR = 3.3, 95%CI 2.7–4, p, Graphical abstract Image 1, Highlights • Environment (E) is key in shaping development of suicidal ideation (SI). • We integrated individual-level trauma exposure and neighborhood-level data on socioeconomic status (SES) in N=7,054 youths. • Trauma was robustly associated with youth SI in our cohort, while SES had no association with SI. • Only in youth with history of assaultive trauma, low SES was associated with lower SI rates (trauma by SES interaction). • Results suggest a stress inoculation effect that was shown in animal models, but has not been shown in human suicide research.

BackgroundAlthough there are extensive data on clinical psychopathology in youth with suicidal ideation, data are lacking regarding their neurocognitive function.AimsTo characterise the cognitive profile of youth with suicidal ideation in a community sample and evaluate gender differences and pubertal status effects.MethodParticipants (N = 6151, age 11–21 years, 54.9% females) from the Philadelphia Neurodevelopmental Cohort, a non-help-seeking community sample, underwent detailed clinical evaluation. Cognitive phenotyping included executive functioning, episodic memory, complex reasoning and social cognitive functioning. We compared participants with suicidal ideation (N = 672) and without suicidal ideation (N = 5479). Regression models were employed to evaluate differences in cognitive performance and functional level, with gender and pubertal status as independent variables. Models controlled for lifetime depression or general psychopathology, and for covariates including age and socioeconomic status.ResultsYouth with suicidal ideation showed greater psychopathology, poorer level of function but better overall neurocognitive performance. Greater functional impairment was observed in females with suicidal ideation (suicidal ideation × gender interaction, t = 3.091, P = 0.002). Greater neurocognition was associated with suicidal ideation post-puberty (suicidal ideation × puberty interaction, t = 3.057, P = 0.002). Exploratory analyses of specific neurocognitive domains showed that suicidal ideation-associated cognitive superiority was more prominent in post-pubertal males compared with females (Cohen's d = 0.32 and d = 0.11, respectively) across all cognitive domains.ConclusionsSuicidal ideation was associated with poorer functioning yet better cognitive performance, especially in post-pubertal males, as measured by a comprehensive cognitive battery. Findings point to gender and pubertal-status specificity in the relationship between suicidal ideation, cognition and function in youth.Declaration of interestR.B. serves on the scientific board and reports stock ownership in ‘Taliaz Health’, with no conflict of interest relevant to this work. M.A.O. receives royalties for the commercial use of the Columbia-Suicide Severity Rating Scale from the Research Foundation for Mental Hygiene. Her family owns stock in Bristol-Myers Squibb. All other authors declare no potential conflict of interest.

Adolescent depression is a prevalent condition that has been on the rise in recent years. The primary care setting is often the front line to mental health needs, specifically identifying and treating early depression. This review presents the current evidence base about adolescent depression, its identification, and treatment approaches. The US Preventive Services Task Force and American Academy of Pediatrics recommend universal screening for depression in adolescents in primary care settings. There are several depression screening measures that could be useful in primary care. Recommended treatment approaches which include therapy, medication, or a combination of the two are based on an adolescent’s presentation and degree of impairment. There is sufficient empirical evidence supporting use of three therapies and two Selective Serotonin Reuptake Inhibitors for adolescent depression. Currently, there are resources, screening measures, and research evidence available to adequately support pediatricians in the identification and treatment of adolescent depression.

Bullying involvement is a multidimensional issue and a significant concern for school-aged youth. However, research on bullying involvement within clinical samples is limited. The present study exa...

This article focuses on the cross-discipline training competencies needed for preparing behavioral health providers to implement integrated primary care services. After a review of current competencies in the disciplines of child and adolescent psychiatry, psychology, and social work, cross-cutting competencies for integrated training purposes are identified. These competencies are comprehensive and broad and can be modified for use in varied settings and training programs. An existing and successful integrated care training model, currently implemented at Children's Hospital of Philadelphia, is described. This model and the training competencies are discussed in the context of recommendations for future work and training.

Family cohesion and family conflict are important protective and risk factors respectively in the development of child psychopathology. Our study examines parent-adolescent discrepancy of the family environment constructs, family cohesion and family conflict, and their associations with adolescent impairment. The sample consists of 141 parent-adolescent dyads evaluated at an outpatient behavioral health clinic. The mean adolescent age is 14.8 (range 11–18) while the mean parent age is 48.9 (range 32–67). Findings show that adolescents report significantly less family cohesion but do not differ significantly in reports of family conflict. Greater family cohesion is associated with less adolescent impairment by multiple reporters. Nonetheless, greater family conflict is associated with more adolescent impairment by the same reporter. The results show that both adolescent and parent reports of family cohesion and conflict are important to consider when integrating information gathered in a clinical assessment.

Background Suicidal behavior is highly familial. Neurocognitive deficits have been proposed as an endophenotype for suicide risk that may contribute to the familial transmission of suicide. Yet, there is a lack of research on the neurocognitive functioning of first-degree biological relatives of suicide attempters. The aim of the present study is to conduct the largest investigation to date of neurocognitive functioning in community youth with a family history of a fatal or nonfatal suicide attempt (FH). Methods Participants aged 8-21 years from the Philadelphia Neurodevelopmental Cohort completed detailed clinical and neurocognitive evaluations. A subsample of 501 participants with a FH was matched to a comparison group of 3,006 participants without a family history of suicide attempt (no-FH) on age, sex, race, and lifetime depression. Results After adjusting for multiple comparisons and including relevant clinical and demographic covariates, youth with a FH had significantly lower executive function factor scores (F[1,3432] = 6.63, p = .010) and performed worse on individual tests of attention (F[1,3382] = 7.08, p = .008) and language reasoning (F[1,3387] = 5.12, p = .024) than no-FH youth. Conclusions Youth with a FH show small differences in executive function, attention, and language reasoning compared to youth without a FH. Further research is warranted to investigate neurocognitive functioning as an endophenotype for suicide risk. Implications for the prevention and treatment of suicidal behaviors are discussed.

Depression and human immunodeficiency virus disease are common co-occurring conditions among youth living with human immunodeficiency virus/AIDS. Depression serves as a risk factor for contracting the disease and for nonadherence to medications and adherence to safe sex practices. Although new infections are decreasing nationally, subpopulations of youths continue to have the highest rates of new infections, specifically ethnic and sexual minority youths. Depression contributes to poor health outcomes for youths with human immunodeficiency virus disease. Evidence-based psychotherapy and pharmacotherapy for depression are effective treatments. Integrated care with medical and mental health provides the best care for this population of youth.

Objectives: This presentation will focus on recent events and social factors that call for urgent changes in health care that will impact child and adolescent psychiatry Changing racial and ethnic demographics in the United States, increased recognition of racism and discrimination highlighted during the COVID-19 pandemic, and calls for action sparked by the very public murder of George Floyd and others, point to an urgent need for health care leaders to focus on diverse representation in medicine The goals of this presentation are to address barriers and facilitators for recruiting and retaining a diverse workforce in academic child and adolescent psychiatry programs and to describe effective methods for improving recruitment and retention of underrepresented minority trainees and faculty Methods: Recent relevant findings and insights from academic institutions and industries describing effective methods for addressing diversity and inclusion, and creating a diverse workplace that will attract the next generation of child and adolescent psychiatry leaders, will be discussed Examples of strategies for recognizing bias and addressing structural racism, barriers, and facilitators to recruitment and retention will be reviewed Results: Organizations and programs that develop focused strategies for increasing diversity have had some success A genuine commitment to recruit and develop diverse leaders, recognition of the benefits of workforce diversity, intentional and focused strategies for creating an inclusive environment, and recognition of structures that foster racism within institutions are required for developing successful strategies Conclusions: Approaches used to address racism and discrimination in child and adolescent psychiatry can be effective, only when combined with a strategy to achieve well-described and measurable objectives Implementation of successful strategies will require changes in current recruitment practices It will be imperative for child and adolescent psychiatry programs to respond to the shifting demographics of children and families in the United States by diversifying the leadership structures in their own programs, in order to recruit and retain the diverse workforce that will be needed to lead child and adolescent psychiatry into the future AC, ETHN, SP

OBJECTIVES: To examine agreement between parent and adolescent reports of adolescents’ suicidal thoughts and explore demographic and clinical factors associated with agreement in a large community sample. METHODS: Participants included 5137 adolescents 11 to 17 years old (52.1% girls; 43.0% racial minority) and a collateral informant (97.2% parent or stepparent) from the Philadelphia Neurodevelopmental Cohort. Families were recruited from a large pediatric health care network. Adolescents and parents completed a clinical interview that included questions about adolescents’ lifetime suicidal thoughts. RESULTS: Agreement was moderate for thoughts of killing self (κ = 0.466) and low for thoughts of death or dying (κ = 0.171). Discrepancies stemmed from both parental unawareness of suicidal thoughts reported by adolescents and adolescent denial of suicidal thoughts reported by parents. Fifty percent of parents were unaware of adolescents’ thoughts of killing themselves, and 75.6% of parents were unaware of adolescents’ recurrent thoughts of death. Forty-eight percent of adolescents denied thoughts of killing themselves, and 67.5% of adolescents denied thoughts of death reported by parents. Several demographic (eg, age) and clinical (eg, treatment history) characteristics were associated with agreement. CONCLUSIONS: Early identification and intervention hinge on reliable and valid assessment of suicide risk. The high prevalence of parental unawareness and adolescent denial of suicidal thoughts found in this study suggests that many adolescents at risk for suicide may go undetected. These findings have important clinical implications for pediatric settings, including the need for a multi-informant approach to suicide screening and a personalized approach to assessment based on empirically derived risk factors for unawareness and denial.

Although pediatric hospitals specialize in providing care to children and adolescents, at The Children's Hospital of Philadelphia (CHOP), our team has been providing behavioral health services for two unique parent populations-parents with a child in the Newborn Infant Intensive Care Unit and pregnant women carrying fetuses with specific birth defects and receiving prenatal care in the Center for Fetal Diagnosis and Treatment. A new training program was developed to expand the scope of pediatric psychologists' practice to include perinatal behavioral health services, specifically for these two unique parent populations served at CHOP. The program includes direct service provision for adult mental health concerns, as well as education and support to help families cope with the existing medical conditions. This article describes the training program and its implementation as a model of training for other pediatric hospitals. The roles of psychologists embedded in these units and hospital privileges are discussed.