Adolescent Psychiatry Services Research Articles

The Role of Nurse Practitioners in Meeting the Need for Child and Adolescent Psychiatric Services: A Statewide Survey

The high prevalence of child and adolescent mental health disorders coupled with shortages in age-appropriate mental health services pose a significant problem likely to be exacerbated over time. A survey was designed to identify the current status of and need for child and adolescent psychiatrists (CAPs) and mental health services, as well as strategies and recommendations to address identified needs in the state of New York. Key informants from each county and New York City were surveyed by telephone (N = 58). Most respondents identified a shortage of child and adolescent psychiatry services and reported that when CAPs are unavailable, nurse practitioners (NPs) are currently among the top four professional groups who prescribe and/or monitor psychotropic medication. Almost half of the respondents (48%) identified employing NPs with advanced certification in child and adolescent psychiatry as a promising strategy to improve access to care. Addressing the shortage of CAPs can provide an opportunity for the nursing profession to advance its role in the provision of mental health services to youth.

Child and adolescent psychiatry services in low- and middle-income countries

The theme in this issue concerns the interface between child psychiatric services in low- and middle-income countries and the availability of such services in higher-income countries. In neither context are such services ideal, and resources are relatively slim when compared with demand. The key issues are discussed in three terms: first, of the need for nations to have a general statement of child and adolescent mental health policy (Shatkin et al); second, of the need to establish international child and mental health research networks to foster research in low- and middle-income countries (Erlich & Plener); and third, of the circumstances that exist for providing such support to children in one such country, Pakistan (Khan et al).

Academic Training in a Child and Adolescent Psychiatry Fellowship: A Curriculum Based on Leadership Experience

The authors describe how one child and adolescent psychiatry fellowship program responded to emerging trends in clinical practice which increasingly demand that child and adolescent psychiatrists lead their colleagues through instruction and supervision. Data from surveys of recent graduates of child and adolescent training programs were reviewed and the trends were identified. The authors describe the Academic Chief Fellow rotation, which was designed for the fellows to enhance their academic skills by teaching, guiding, and supervising their junior colleagues. The authors describe the implementation of the new rotation and discuss the fellows' response. They also detail the responses of the medical students and residents who rotated on the child and adolescent psychiatry service under the Academic Chief Fellow. Greater experience in teaching and supervising others can be meaningfully integrated into existing child and adolescent psychiatry fellowship curricula. Other outcomes may include greater medical student and general psychiatry resident satisfaction with their child and adolescent psychiatry rotation and greater interest among medical students in child and adolescent psychiatry as a career.

The Mental Health of Asylum-seeking and Refugee Children and Adolescents Attending a Clinic in the Netherlands

We investigated the sociodemographic and clinical characteristics of asylum-seeking and refugee children and adolescents referred to a child and adolescent psychiatry service in the Netherlands. Children with families and unaccompanied minors were compared. Unaccompanied minors had significantly higher frequencies of symptoms and psychiatric disorders than the children with families, both considered a high-risk population for mental health problems.

A developmental approach to violence, hostile attributions, and paranoid thinking in adolescence

Research within the area of paranoid thinking has focused primarily on adults and has only recently looked at the effects during the critical life stage of adolescence, with even less research in the context of the juvenile justice system. This article aims to explore the relationship between antisocial behaviour in adolescence and the development of paranoid thinking, set within wider contexts that surround the juvenile justice system. The information presented is drawn from both the current research and the clinical experiences of those working in adolescent forensic psychiatry services. The relationships with other disorders such as conduct disorder, ADHD, PTSD, and depression are also explored.

Differences between prepubertal- versus adolescent- onset bipolar disorder in a Spanish clinical sample

To examine patients attended and diagnosed with bipolar disorder (BD) at a child and adolescent psychiatry service; to record age of diagnosis and age of onset, and to study clinical differences between prepubertal and adolescent onset groups. All patients currently attended for BD type I, type II or non specified BD were reviewed and divided into two age groups: prepubertal onset (beginning before age 13) and adolescent onset (beginning at or above age 13). The sample were 43 patients with BD. Fourteen (32.6%) with prepubertal onset and 29 (67.4%) with adolescent onset. Time between onset of symptoms and diagnosis was longer in the prepubertal onset group (1.2 years versus 0.8 years respectively, P = .05). Patients with prepubertal onset BD more frequently presented previous symptoms such as irritability and conduct problems and had a higher rate of comorbidity (more frequently attention-deficit/hyperactivity disorder-ADHD). The adolescent onset group more often presented psychotic symptoms. The clinical characteristics of patients with bipolar disorder differ according to whether onset is prepubertal or adolescent.

Videoconferencing in child and adolescent psychiatry in Finland – an inadequately exploited resource

To assess the current role of videoconferencing and the purposes for which it has been used in child and adolescent psychiatry in Finland, we sent a 16-item questionnaire to all providers of child and adolescent psychiatry services in specialised health care in Finland, i.e. the 42 child and adolescent units in 21 hospital districts. All service providers responded. The responses to both open-ended and structured questions were analysed manually and classified quantitatively and qualitatively. Use of videoconferencing was reported by 16 of the 21 hospital districts in Finland. Videoconferencing had been used for more than 5.5 years in only three hospital districts, for 3-5 years in 14 units and for 1-3 years in six units. Videoconferencing was used for clinical work in 12 and for distance education in another 12 hospital districts. Videoconferencing was used weekly for clinical work and for supervision by two districts; it was used for education by three districts. Although the workers' experiences of and attitudes towards videoconferencing were favourable, it has not been widely used in child and adolescent psychiatry. The implementation of videoconferencing seems to depend more on the activity of service providers than on the number of people involved.

Outcome of children with school refusal

To assess prospectively the psychiatric diagnostic status, psychosocial correlates, and short-term outcome of youngsters with school refusal. Thirty-three subjects (8-16 years) presenting with school refusal to a tertiary Child and Adolescent Psychiatry service were evaluated. Instruments administered at baseline and after 3 months (including an outcome measure at 3 months) were: The Missouri Assessment of Genetics Interview for Children (MAGIC) to ascertain psychiatric diagnoses, a modified version of Parent Interview Schedule (PIS), and the Children's Global Assessment Scale (CGAS). Twenty-nine subjects (87.9%) had a psychiatric diagnosis at baseline. Depressive disorder (63.6%) was commonest followed by specific phobias (30.3%). Psycho-social factors influenced school refusal in a majority (87.9%). Twenty of the thirty subjects (66.6%) who could be followed-up had returned to school. Psychiatric diagnosis persisted in 16 subjects. Younger age, being last-born, no or one diagnosis, and good baseline functioning predicted a favorable outcome. Psychiatric morbidity is high in a clinic population of youngsters with school refusal. It is associated with temperamental, family, and other environmental adversities. Short-term outcome in these children is largely favourable in terms of return to school and global functioning.

Datapoints: Recent Trends in Suicide Among U.S. Adolescent Males, 1992-2001

Back to table of contents Previous article Next article ColumnsFull AccessDatapoints: Recent Trends in Suicide Among U.S. Adolescent Males, 1992-2001Jeffrey A. Bridge, Ph.D., Rémy P. Barbe, M.D., and David A. Brent, M.D.Jeffrey A. BridgeSearch for more papers by this author, Ph.D., Rémy P. BarbeSearch for more papers by this author, M.D., and David A. BrentSearch for more papers by this author, M.D.Published Online:1 May 2005https://doi.org/10.1176/appi.ps.56.5.522AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In the United States black youths have historically had lower suicide rates than white youths, but the gap has been narrowing because of an increase in the suicide rate among young black males (1).Using the mortality database from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (2), we determined trends in suicide deaths between 1992 and 2001 for white males and black males aged 15 to 19 years. Trends in suicide were estimated by using negative binomial rate regression analyses.As Figures 1 and 2 show, the overall suicide rate among white males decreased by an average of 3.9 percent annually (p<.001). The firearm suicide rate decreased by 6.6 percent annually (p<.001), and the rate of suicide by other means decreased by 3.9 percent annually (p=.002). However, there was an annual increase of 3.2 percent for suicide by suffocation (mostly hanging) (p<.001). In contrast, the overall suicide rate among black males decreased by 7.3 percent annually (p<.001), and nearly all the decrease was explained by a 10.2 percent annual decrease in the firearm suicide rate (p<.001).Possible explanations for the recent decline in the youth suicide rate include the enactment of gun laws intended to keep firearms from youths (3) and the increasing use of selective serotonin reuptake inhibitors in the treatment of pediatric depression (1).The firearm suicide rate has fallen substantially in recent years among both white and black adolescent males. This decline may be part of an overall downward trend in firearm deaths (2). The recent increase in suffocation suicides among white male teenagers may indicate that method-specific substitution is occurring. Our data underscore the need for health care providers to assess the availability of lethal means, and the risk for their use, and to make recommendations for their removal or safe storage.AcknowledgmentsThis research was supported in part by grants K01-MH-69948, T32-MH-18951, and P30-MH-66371 from the National Institute of Mental Health and by a grant from the University Hospitals of Geneva.The authors are affiliated with the division of child and adolescent psychiatry at the University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, Pennsylvania 15213-2592 (e-mail, [email protected]). Dr. Barbe is also with the child and adolescent psychiatry service at the University Hospital of Geneva in Switzerland. Harold Alan Pincus, M.D., and Terri L. Tanielian, M.A., are editors of this column.Figure 1. Suicide completion rates among white males aged 15 to 19 years, 1992-2001Figure 2. Suicide completion rates among black males aged 15 to 19 years, 1992-2001

Child and adolescent psychiatry workforce: a critical shortage and national challenge.

Despite the decades-long projection of an increasing utilization of child and adolescent psychiatry services and an undersupply of child and adolescent psychiatrists, the actual growth and supply of child and adolescent psychiatrists have been very slow. Inadequate support in academic institutions, decreasing graduate medical education (GME) funding, decreasing clinical revenues in the managed care environment, and a devalued image of the profession have made academic child and adolescent psychiatry programs struggle for recruitment of both residents and faculty, although child and adolescent psychiatry has made impressive progress in its scientific knowledge base through research, especially in neuroscience and developmental science. While millions of young people suffer from severe mental illnesses, there are only about 6,300 child and adolescent psychiatrists practicing in the United States. There is also a severe maldistribution of child and adolescent psychiatrists, especially in rural and poor, urban areas where access is significantly reduced. By any method of workforce analysis, it is evident that there will continue to be a shortage of child and adolescent psychiatrists well into the future. Medical/psychiatric educators have a mission to encourage medical students and general psychiatry residents to enter child and adolescent psychiatry and provide crucial mental health care and health care advocacy for our country's youngest and most vulnerable citizens. This article stems from the work of the American Academy of Child and Adolescent Psychiatry Task Force on Work Force Needs, which led to its 10-year recruitment initiative.

Bilingual Children Referred for Psychiatric Services: Associations of Language Disorders, Language Skills, and Psychopathology

To investigate (1) the prevalence of language deficits and disorders and (2) the relationship of bilingual language skills and psychopathology, in Spanish-English bilingual children referred for child and adolescent psychiatry services. Bilingual language skills, emotional/behavioral problems, sociodemographics, immigration variables, and nonverbal IQ were studied in 50 consecutively referred children. Estimated prevalence was high for language deficits (48%) and disorders (41%), with most cases (>79%) being of the mixed receptive-expressive type. In children with clinically significant emotional/behavioral problems, bilingual language skills were strongly and inversely correlated with problem scores, particularly global problems (r = -0.67, p < .001); social, thought, and attention problems (r > or = -0.54; p < .004); delinquency (r = -0.66, p < .001); and aggression (r = -0.52, p < .01). These correlations remained significant after IQ adjustment. Prior findings from monolingual children were confirmed in this bilingual sample, namely (1) the high prevalence of mixed receptive-expressive and other language disorders and delays and (2) the close tie between poor language skills and emotional/behavioral problems. The data strongly suggest the clinical importance and feasibility of language assessment and the significance of receptive problems in bilingual children referred for psychiatric services. A safe approach is to fully assess language skills, rather than misattributing these children's language delays to normal bilingual acquisition processes.

Juvenile homicide offenders: 10 years' experience of an adolescent forensic psychiatry service

Psychosocial characteristics were retrospectively studied in 46 juvenile perpetrators of homicide who had been referred to an adolescent forensic service in a 10-year period. Results of analysis were compared with a sample of 106 fire-setters referred to the same service. The profile of British homicidal juveniles is similar to that cited in the American literature in that the majority are male and come from disturbed family backgrounds. Compared with a delinquent sample of fire-setters, however, significantly more homicidal juveniles were male and had a history of frequent changes of schools, alcohol abuse and alcohol intoxication at the time of the offence. By contrast, when compared with delinquent juveniles, significantly fewer of the homicidal juveniles suffer from psychotic illness and are known to professional services prior to referral to the service. In a discriminant analysis a history of psychosis, being in care, alcohol intoxication at the material time and prior psychology contact were the most significant variables predicting group membership for homicidal and fire-setting delinquents. Abused homicidal youths do not differ markedly from those who do not suffer abuse but are characterized as coming from families with higher rates of paternal psychopathology. Prevention needs to focus on issues such as quality of parenting and alcohol abuse.

Developmental Disability and Behaviour

Back to table of contents Previous article Next article Book Forum: Child PsychiatryFull AccessDevelopmental Disability and BehaviourMARK H. FLEISHER, M.D., MARK H. FLEISHERSearch for more papers by this author, M.D., Omaha, Neb.Published Online:1 Jul 2001https://doi.org/10.1176/appi.ajp.158.7.1175AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In this book the editors and contributors have created a very useful review of the important topic of challenging pediatric behaviors. They have assembled an expert group of authors from the fields of child and adolescent psychiatry, pediatric neurology, clinical psychology, neuropsychology, psychotherapy, and community-based pediatric services. The authors write with the clarity and insight that is produced by substantial clinical and teaching experience.The book begins with excellent introductory chapters on disabilities and the management of problem behaviors. The best and most useful chapters that follow review behavior in young people with hearing and visual impairment, traumatic brain damage, behavior analysis, neuropsychological testing, therapeutic interventions for neuropsychiatric disorders, medication management, and psychotherapy for children with developmental disabilities. All of the chapters are well written and provide useful information for clinicians.In a review book such as this it may be surprising to see chapter titles on Rett syndrome and Landau-Kleffner syndrome. Clearly it could be argued that the book would be stronger if it had devoted chapters specifically to some of the more common developmental disorders such as autism or Down’s syndrome. But the contributors use these syndromes to discuss broader behavioral issues and also to highlight distinct or dissimilar features between Rett syndrome and autistiform behaviors as well as the gait and motion symptoms of cerebral palsy.Similarly, the chapter on behavioral aspects of Landau-Kleffner syndrome is constructed to discuss that syndrome and other behavioral presentations as well. Among the primary topics discussed are attention deficit hyperactivity disorder, autistic spectrum disorders, sleep disturbances, aggression, and problematic seizure behavior.A chapter covering ambulatory electronic monitoring in sleep disorders may be a bit eclectic but is nevertheless useful and well written. Sleep disorders seem to be generating more clinical and research interest relative to developmental disabilities, and this chapter will add to our understanding of this topic.It should be iterated that this is an overview of pediatric disorders of development and associated behaviors. It is not meant to explore this large and complex topic comprehensively. Additionally, the editors and some of the other chapter authors recognize that there is no international agreement on terminology, and they are careful to point out the differences. There are several examples of the effort to clarify these confusing conflicts. Internationally it is more common to see the term “mental retardation,” as opposed to “learning disability,” which is the common phrase in the United Kingdom. In the United States, “learning disability” refers to a specific problem of knowledge acquisition within an overall picture of normal intelligence. It can be a maddening discussion, but it is nevertheless necessary for the international community of clinicians, researchers, and authors to communicate effectively.This book has been thoughtfully written and constructed to appeal to the clinical professional who cares for or who has a special interest in pediatric disorders of behavior and development. It will also be especially useful for teachers, psychiatrists, psychologists, and neurologists as an overview text or for use in the instruction of professionals in training.Edited by Christopher Gillberg and Gregory O’Brien. London, Mac Keith Press (New York, Cambridge University Press, distributor), 2000, 189 pp., $64.95. FiguresReferencesCited byDetailsCited ByNone Volume 158Issue 7 July 2001Pages 1175-1176 Metrics History Published online 1 July 2001 Published in print 1 July 2001

Juvenile homicide offenders: 10 years' experience of an adolescent forensic psychiatry service

Psychosocial characteristics were retrospectively studied in 46 juvenile perpetrators of homicide who had been referred to an adolescent forensic service in a 10-year period. Results of analysis were compared with a sample of 106 fire-setters referred to the same service. The profile of British homicidal juveniles is similar to that cited in the American literature in that the majority are male and come from disturbed family backgrounds. Compared with a delinquent sample of fire-setters, however, significantly more homicidal juveniles were male and had a history of frequent changes of schools, alcohol abuse and alcohol intoxication at the time of the offence. By contrast, when compared with delinquent juveniles, significantly fewer of the homicidal juveniles suffer from psychotic illness and are known to professional services prior to referral to the service. In a discriminant analysis a history of psychosis, being in care, alcohol intoxication at the material time and prior psychology contact were the most significant variables predicting group membership for homicidal and fire-setting delinquents. Abused homicidal youths do not differ markedly from those who do not suffer abuse but are characterized as coming from families with higher rates of paternal psychopathology. Prevention needs to focus on issues such as quality of parenting and alcohol abuse.

Comorbidity in juvenile obsessive-compulsive disorder: a report from India.

Using minimal exclusion criteria, to assess systematically the psychiatric comorbidity in children and adolescents with obsessive-compulsive disorder (OCD) and compare the findings with those of previous studies. Fifty-four children and adolescents who satisfied DSM-III-R criteria for OCD were assessed using a structured interview schedule, the Children's version of the Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and the questionnaire for tic disorders. All 54 subjects were recruited from the Child and Adolescent Psychiatry (CAP) services of the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, South India. Diagnoses were determined consensually after a review of all the available data. Comorbidity was found in 69% of the sample: 22% were diagnosed with disruptive disorders; 20% met criteria for mood disorders; 19% had anxiety disorders; and 17% had tic disorders. Only 1 subject had bipolar disorder, and none had psychosis. The rates for individual diagnoses--in particular, the rates for disruptive disorders, bipolar disorder, and psychosis--were considerably lower than those reported in previous studies. Patterns of comorbidity in this study differed from those previously reported. Novel patterns of comorbidity with disruptive disorders, bipolar disorder, and psychosis reported in a few recent studies were not replicated in this study. These differences are probably due to different ascertainment methods. Comorbidity needs to be assessed in large epidemiological samples before definite associations can be made between certain comorbid disorders and juvenile OCD.

Zoophilia in young sexual abusers

Zoophilia or bestiality is a rare paraphilia which has received little attention in recent psychiatric literature. We describe a cohort of seven patients who were referred to a tertiary child and adolescent psychiatry service specializing in the assessment and treatment of young abusers. On the basis of the available material, we highlight the importance of enquiring into this type of behaviour and consider its implications for the risk assessment and treatment of young sex abusers.

Child and adolescent self-poisoning: service-related characteristics

This study presents the pattern of assessment and 6-month out-patient attendance of 54 children and adolescents who took an overdose over a 12-month period, and were assessed by a district child and adolescent psychiatry service. Attempts were precipitated by arguments (67%) or school-related stressors (19%). In 70.4% of cases, analgesic tablets were used. A psychiatric disorder was present in 51% of the cases. At 6 months, 13% of the patients were still attending for follow-up, while three children (5.5%) had taken a second overdose. Admission to a paediatric ward can facilitate the initiation of treatment. Child mental health services should aim at providing prompt assessment, good communication with other agencies, and follow-up arrangements, particularly with high-risk young people and their families

The British approach to child and adolescent psychiatry: A course for Russian postgraduates

A two week course in Child and Adolescent Psychiatry was given in St. Petersburg as part of the partnership between the City's Child and Adolescent Psychiatry Service and Division of Child and Adolescent Psychiatry at Leicester University Medical School. In such a short course, it was necessary to focus on areas of particular importance to Russian practice. Areas chosen were: assessment and interviewing skills, psychosomatic concepts, mental retardation, suicide and self harm, attachment, behaviour therapy and adolescent problems. The course also offered practical demonstrations with Russian families. The response was favourable but assessment of how much the course added to knowledge was difficult.

A substance misuse clinic for adolescents

We describe the operation of a substance misuse clinic for adolescents as a Joint venture between a voluntary organisation ‘Streetwise’ and the Adult Substance Misuse Services and Child and Adolescent Psychiatry Services in Newcastle upon Tyne. A number of issues are discussed relevant to improving clinical services for adolescent substance misusers.

Riding the storm

A few months ago I was beaten about by a patient. Outside the hospital I was shouted at, screamed at, kicked, and punched. I had my spectacles on and my hands were full. This young woman had been threatening my life for some days. Luckily, she was not carrying a weapon. Eventually I retreated between cars into the road and she came at me again. I did not retaliate. After a few more blows I was able to make my escape. The young woman (I will call her Carol) had been difficult through childhood, and a pattern of self destructive behaviour began in earnest after puberty. There had been occasional violence, mainly towards inanimate objects. She abused solvents, took alcohol to excess, smoked cannabis, cut her wrists, and took overdoses. She had managed to achieve one or two GCSEs. She was keen on art, particularly drawing. Nevertheless, by school leaving age she had exhausted the patience of her family, who evicted her. Long term outpatient contact and one or two admissions under the child and adolescent psychiatry service probably reduced the extent of her acting out, but also left in Carol a potent residue of antipathy to authority figures and institutions. Her acts of deliberate self harm tended to be public and demonstrative: the police were often involved. Her appearances in the accident department were frequent. When she turned 17 she came to the adult services …