Peril and Promise: Teens, Tech, and America's Mental Health Crisis.

Advances in Internet technologies have implications for the health and development of children and adolescents with potential for both beneficial and harmful outcomes. Similar technological advances also impact how psychiatrists deliver mental health care in clinical settings. Internet tech adds complexities to psychiatric practice in the form of electronic health records, patient portals, and virtual patient contact, which clinicians must understand and successfully incorporate into practice. Digital therapeutics and virtual mental health endeavors offer new treatment delivery options for patients and providers. Some have proven benefits, such as improved accessibility for patients, but all require provider expertise to utilize.

Individual Affirming Care: Psychological and Social Approaches to Trans and Gender-Diverse Youth.

Clinicians working with youth encounter transgender and gender-diverse youth and play a role in supporting the psychological and social well-being of youth and their families. Mental health clinicians start with a thorough assessment, development of a biopsychosocial formulation of the youth, and a collaborative treatment plan. Determining if the youth meets diagnostic criteria for Gender Dysphoria and identifying comorbid mental health diagnoses inform recommendations for psychiatric medication management, individual and/or family therapy interventions, and/or referrals to medical or surgical colleagues. Supporting development of a coherent identity narrative and healthy interpersonal attachments with others is an important goal of treatment interventions.

Considering "Spheres of Influence" in the Care of Lesbian, Gay, Bisexual Transgender, and Queer-Identified Youth.

Working with lesbian, gay, bisexual transgender, and queer-identified (LGBTQ) youth can present a uniquely challenging opportunity for clinicians given the rapidly changing landscapes of gender and sexuality and deficits in training and education. The goal of this article is to provide the most up-to-date trends and advances in the mental health care of LGBTQ youth to empower clinicians in delivering evidence-based care. We adapt the "Spheres of Influence" model to challenge the clinician to think more globally about our interventions. When LGBTQ youth are supported at every sphere, we give them the best chance to survive and thrive into adulthood.

Dialog Across Cultures: Therapy for Diverse Families.

Child and adolescent psychiatrists (CAPs) work at the intersections of families, cultures, and systems, which affect engagement in care, assessment, and treatment planning. There are several practical strategies that CAPs can apply to practice cultural humility, to join with families, to facilitate difficult conversations and to work through misalignment. Culturally inclusive family-based care can promote greater understanding and lead to stronger outcomes with families as well as help mitigate mental health impact of structural racism and social inequities.

Editorial: Did Goldilocks Have It Right? How Do We Define Too Little, Too Much, or Just Right?

Clinicians, teachers, and parents alike have long lamented screen time and its developmental and psychological implications, particularly as access to digital devices, games, and online platforms has become ubiquitous. In 2018, 95% of US teens reported having access to a smartphone, and 45% reported being online "almost constantly."1 Parental and expert concerns include displacement of important activities such as sleep and exercise, Internet or video game addiction, negative social experiences such as cyberbullying, and worry that excessive use may cause or worsen mental health symptoms such as depression.23 Research on the subject is challenging, as associations between device use and psychological functioning are likely multifactorial and nonlinear and therefore difficult to elucidate from small samples or samples that are lacking in rich covariate data. In addition, the rapid pace of technological change makes studying and reporting on these phenomena challenging as studies may be out of date before they are even published.

Problematic Internet Use and Associated High-Risk Behavior in an Adolescent Clinical Sample: Results from a Survey of Psychiatrically Hospitalized Youth.

Problematic Internet use (PIU) is a growing clinical concern to clinicians working in adolescent mental health, with significant potential comorbidities like depression and substance use. No prior study has examined associations between PIU, high-risk behavior, and psychiatric diagnoses specifically in psychiatrically hospitalized adolescents. Here, we analyzed how PIU severity correlated with preadmission Internet habits, psychiatric symptoms, and high-risk behavior in this unique population. We hypothesized that as the severity of PIU increased, so would endorsement of mood symptoms, engagement in risky behaviors, and chances of having comorbid mood and aggression-related diagnoses. We performed a cross-sectional survey on an adolescent psychiatric inpatient unit in an urban community hospital in Massachusetts. Participants were 12-20 years old (n = 205), 62.0 percent female, and of diverse racial/ethnic backgrounds. Relationships between PIU, high-risk symptoms, diagnoses, and behaviors were performed both using chi-square tests and determining Pearson correlation coefficients. Two hundred five adolescents participated in the study. PIU severity was associated with being female (p < 0.005), sexting (p < 0.05), cyberbullying (p < 0.005), and increased suicidality within the last year (p < 0.05). Adolescents with aggressive and developmental disorders, but not depressive disorders, also had significantly higher PIU scores (p ≤ 0.05). In our sample of psychiatrically hospitalized adolescents, PIU severity was significantly associated with both serious psychiatric symptoms and high-risk behaviors, including those related to suicide. Our findings may improve safety assessments in this vulnerable adolescent population by identifying comorbid risks associated with problematic digital media use.

Relationship Between Adolescent Suicidality, Self-Injury, and Media Habits.

Media has changed the daily lives of most Americans, especially adolescents. The interplay between development and media habits is complex. There is a link between excessive media use and risk-taking behaviors, with an alarming increase in adolescent nonsuicidal self-injury, suicidal behavior, and completed suicide. The link is complex and not necessarily causal. Clinicians should routinely take a media history that distinguishes types and extent of use, content, and psychological impact. Media is a significant part of adolescents' lives and exploring their engagement with media is a critical piece of the initial assessment, risk assessment, and ongoing treatment.

Gender Incongruity in Children With and Without Disorders of Sexual Differentiation.

Access to the Internet and recent major media coverage has contributed to an increased societal awareness of the variations of gender identity. There are two sets of clinical guidelines primarily used by practitioners who care for transgender adolescents and adults. Although these guidelines have been tremendously helpful for the management of transgender adolescents, those working in the field recognize the limitations of firm recommendations with a population that is so heterogeneous. This article will summarize current recommendations for the management of children and adolescents with gender incongruence and suggest ways in which we might vary from the current guidelines.