Psychiatric Genomic Dilemmas In Adolescence

Abstract

Advances in genetics, data analysis technologies, and the practice of precision medicine are slowly entering the field of psychiatry and raise hopes for better diagnosis, prevention, and treatment of psychiatric disorders. As genetic testing for predispositions to and diagnosis of psychiatric disorders is developed, children may be a particular target group. Studies indicate that parents desire to learn all about their children’s genetic make-up–primarily out of a sense of responsibility to care for their children but also due to curiosity–and that testing laboratories and pharmaceutical companies are already invested in marketing their products in this area. Use of genetic tests in children may be motivated further by the fact that many psychiatric conditions begin in childhood and adolescence, although the social, healthcare, and income costs associated with psychiatric disorders endure well beyond childhood.However, the prospect of psychiatric genetic testing of children, especially asymptomatic children in research settings, and return of secondary genomic findings to them and their families raise unique dilemmas. How should we balance parents’ informational interests and children’s right (not) to know? What should the response be to genetic results indicating predispositions to psychiatric conditions (e.g., schizophrenia, substance use disorders)? Should the answers to these questions turn on the availability of effective preventive measures? And who should decide?These challenges are exacerbated for adolescents (ages >13), who are legal minors but whose decision making capacity can often resemble that of adults. The unique characteristics of adolescence further pull the discussion in two conflicting directions. On the one hand, adolescents are engaged in a search for individual identity, in planning for the future, and in individuating from their families, which suggest the value of granting them greater control over decisions regarding genetic testing. On the other hand, adolescents often manifest greater impulsivity and tendencies to engage in risky behaviors and to be influenced by peer pressure, which suggest that their decision-making capacity may be compromised. This may have particular implications for psychiatry: studies suggest that the majority of teens with substance abuse issues began using drugs or alcohol as a result of peer pressure, and that the use of such substances increases the risk for other psychiatric conditions (e.g., schizophrenia). Whether adolescents would resist such pressures in light of psychiatric genetic testing results is unknown, but important to explore.This presentation will review existing studies relating to the psychiatric genetic testing of adolescents and consider the ethical and social challenges that arise, in particular: adolescents’ preferred decision-making roles; types of primary and secondary genomic findings to be returned; impact of psychiatric genetic knowledge on the adoption of prevention measures; and genomic privacy among family members. In addition, suggestions for future research will be considered.