Prevalence and treatment of mental, behavioral, and developmental disorders in children with co-occurring autism spectrum disorder and attention-deficit/hyperactivity disorder: A population-based study.

There is a lack of nationally representative studies examining the co-occurrence of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children. This study examines comorbid mental, behavioral, and developmental disorders (MBDDs) and associated treatment modalities for children with co-occurring ASD and ADHD. Cross-sectional analyses were conducted using data from the pooled 2016-2018 National Survey of Children's Health (sample n = 102,341). Nationally representative prevalences were estimated for sociodemographic variables, comorbidities, psychotropic medication, and behavioral treatment. We assessed multivariable associations between co-occurring ASD + ADHD and MBDDs, use of psychotropic medication, and receipt of behavioral treatment after adjustment for sociodemographic confounders. Compared to children with ASD without co-occurring ADHD, children with ASD + ADHD had higher prevalence of most MBDDs, including anxiety (AOR 4.03 [95% CI 2.77, 4.87]), depression (AOR 3.08 [95% CI 1.77, 5.36]), behavior or conduct problems (AOR 4.06 [95% CI 2.72, 6.06]), and other mental health conditions. Similarly, compared to children with ADHD without ASD, children with ASD + ADHD had higher odds of anxiety (AOR 3.49 [95% CI 2.65, 4.61]), depression (AOR 1.67 [95% CI 1.21, 2.29]), behavior or conduct problems (AOR 2.31 [95% CI 1.68, 3.17]), and other mental health conditions. Children with ASD + ADHD were significantly more likely to take psychotropic medication than children with ASD without ADHD. Among children with ASD + ADHD, males had higher odds of receiving behavioral treatment, whereas older children and adolescents were more likely to take psychotropic medication. A multidisciplinary approach is necessary to support the complex needs of these children.

Correlates of Suicide Attempts in Filipino Youths: An Analysis Based on the 2015 Global School-Based Student Health Survey.

There is a lower incidence of suicide in the Philippines compared to other developed/developing countries, but the trend has been increasing. This study aims to identify the correlates of suicide attempts in Filipino youth using the World Health Organization's 2015 Global School-Based Health Survey. All schools in the Philippines with grades 7-10 were included. A stratified sampling design was used, and participants were randomly sampled. Of the 8,761 students who participated in the survey, 16.2% have attempted suicide at least once in the past 12 months. The factors that increased the risk of suicide attempts include female gender, being physically attacked, getting bullied, feeling lonely, poor sleep, having few close friends, smoking, alcohol use, less physical activity, use of amphetamine/methamphetamine, and less parental supervision. The use of methamphetamine/amphetamine is the single best risk factor of suicide attempts among Filipino youth with OR= 4.6; 95% CI [3.8, 5.6].

Call for Improvements to Federal Child and Adolescent Psychiatry Workforce Projection Methods.

For several decades, national surveys and reports have well documented the serious, growing, and unmet need for mental and behavioral health services among children, adolescents, and young adults (C/A/YA) in the United States.1-3 Moreover, shortages and maldistribution of child and adolescent psychiatrists have been repeatedly reported.4,5 This scarcity is especially concerning given that in 2017, an estimated 44% of child and adolescent psychiatrists were age 55 and older.6 The American Academy of Child and Adolescent Psychiatry (AACAP) and other mental and behavioral health organizations have consistently advocated for substantially expanding the child and adolescent psychiatry workforce through loan relief and other mental and behavioral health workforce programs serving C/A/YA.7-11 Despite this, national projections of the future child and adolescent psychiatry workforce, produced by the federal Health Resources and Services Administration (HRSA) for the first time in 2018, estimated an oversupply of child and adolescent psychiatrists in the United States by 2030.12 Moreover, these projections also found a surplus of school counselors, social workers, and psychiatric nurse practitioners, all of whom play a role in serving C/A/YA with mental and behavioral health conditions.13.

Sample Core Competencies in Child and Adolescent Psychiatry Training: A Starting Point.

In an effort to improve the preparedness of residents to address health care needs, the Accreditation Council for Graduate Medical Education mandated that all Residency Review Committees (RRCs) incorporate the general competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice into their requirements. In response, the Psychiatry RRC mandated that child and adolescent psychiatry programs develop one competency for each of the six areas, effective January 1, 2001. To assist in this effort, the Work Group on Training and Education of the American Academy of Child and Adolescent Psychiatry has developed sample core competencies for each area. These samples are meant to serve as potential models for consideration by training programs as they develop criteria tailored to their program's unique resources and needs.

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.

Assessment of competency in child and adolescent psychiatry training.

OBJECTIVE: Residency training programs in all areas of medicine are required to identify core competencies expected of all graduates and develop methods to assess and ensure attainment of these competencies. To assist with this process for residency programs in child and adolescent psychiatry, the Work Group on Training and Education of the American Academy of Child and Adolescent Psychiatry has developed several principles of the assessment process and compiled a variety of assessment methodologies for use in assessing competency. The principles of assessment include 1) residents should share responsibility for assessment; 2) assessment should be an open, ongoing and predictable process; 3) a wide range of evaluators should be utilized in the process; 4) residents should demonstrate competency in a variety of formats; 5) the goal is for 100% of residents to achieve core competencies. METHODS: Sample methods of assessment are provided in the report with special attention to how the method could be used in child and adolescent psychiatry. CONCLUSION: A multi-method, multi-evaluator for process of assessment is recommended.