Pediatric Insomnia.

Insomnia is the most common sleep disorder among all ages; unfortunately, however, child and adolescent insomnia is infrequently addressed. Given the importance of adequate sleep for proper brain development, pediatric populations are particularly vulnerable to the negative effects of insomnia. Therefore, proper clinical assessment and treatment of pediatric insomnia is crucial. This article is the result of a comprehensive literature review and serves as a guide to the disorder and how it presents differently across child development.

Myths and Evidence Regarding Melatonin Supplementation for Occasional Sleeplessness in the Pediatric Population.

Occasional sleeplessness in children is common, with as many as 25% of all healthy children experiencing a problem sleeping at some point over the course of their childhood. Occasional sleeplessness is poorly understood, has a significant impact on quality of life in children and their families, and is often challenging to manage. There is substantial evidence supporting the safe and effective use of the widely available dietary supplement melatonin for children with chronic conditions. This article summarizes the views expressed in a recent Consensus Panel meeting convened to evaluate the use of melatonin in children, as well as the published scientific literature related to the effectiveness and safety of melatonin, with a focus on occasional sleeplessness in healthy children. We provide an evidence-based framework for the implementation of a standard process to effectively manage occasional sleeplessness in children and adolescents. Unsubstantiated concerns in the past may have limited melatonin's use in children with conditions for which the supplement may support a better sleep pattern and, by doing so, may help to improve quality of life. Melatonin dietary supplements using high quality standards may be provided to children together with cognitive-behavioral therapy after proper sleep evaluation and after improved sleep hygiene, family education, and sleep diary activities have failed to resolve sleep difficulties. [Pediatr Ann. 2021;50(9):e391-e395.].

Pediatric Insomnia.

Insomnia is the most common sleep disorder among all ages; unfortunately, however, child and adolescent insomnia is infrequently addressed. Given the importance of adequate sleep for proper brain development, pediatric populations are particularly vulnerable to the negative effects of insomnia. Therefore, proper clinical assessment and treatment of pediatric insomnia is crucial. This article is the result of a comprehensive literature review and serves as a guide to the disorder and how it presents differently across child development.

Mental Health Promotion and Disease Prevention: It's About Time.

Over the past decade, our field has observed rapidly rising rates of mental illness in children and adolescents. The numbers are sobering. Nearly 50% of teens 13 to 18 years of age meet DSM criteria for at least 1 disorder and 27.6% meet criteria for a "severe disorder."1 Adverse childhood experiences affect more than 50% of children and predispose these individuals to not only academic and behavioral problems throughout their youth, but also future physical disability, such as obesity, hypertension, and diabetes, as adults.2 By 14 years of age, accidents, suicide, and homicide assert themselves as the leading causes of death among our youth, accounting for more than 85% of the mortality among teens and young adults and holding fast to that ranking until 35 years of age.3 Most addictive behavior starts in adolescence, accounting for the 3 greatest causes of preventable death-smoking, obesity, and alcohol abuse-that take the lives of approximately 1 million adults in the United States annually.4 In addition, if there were ever a statistic to be held on the tip of every psychiatrist's tongue, it would be that 50% of all mental illnesses begin by 14 years of age and 75% begin by 24 years.5.

Exploring Interventions for Sleep Disorders in Adolescent Cannabis Users.

This review summarizes the available literature on the intersection of adolescent cannabis use and sleep disturbances, along with interventions for adolescent cannabis users who suffer sleep impairments. Adolescents are susceptible to various sleep disorders, which are often exacerbated by the use of substances such as cannabis. The relationship between cannabis and sleep is bidirectional. Interventions to improve sleep impairments among adolescent cannabis users to date have demonstrated limited efficacy, although few studies indicating the benefits of behavioral interventions-such as Cognitive Behavior Therapy for Insomnia or Mindfulness Based Stress Reduction-appear promising in the treatment of sleep disorders, which are present for users of cannabis. Further research is necessary to elucidate the precise mechanisms by which cannabis use coexists with sleep impairments, along with effective interventions for those users who suffer sleep difficulties.

Impact of a sleep course on sleep, mood and anxiety symptoms in college students: A pilot study.

OBJECTIVE: To examine the impact of a sleep course on sleep-related behaviors, mood, and anxiety in college students. PARTICIPANTS: Participants were 145 students enrolled in either the sleep course (n = 70) or a psychology course (n = 75); data were collected in September 2014, November 2014, and February 2015. METHODS: Sleep characteristics and symptoms of depression and anxiety were assessed using validated questionnaires and sleep logs. Linear, logistic and proportional odds regression models were used to test course effects. RESULTS: In November, sleep course students reported significant differences in sleep hygiene (SHI; p < .001), perceived sleep latency (PSQI; p < .05), and circadian sleep phase (MEQ; p < .05), compared to controls. In February, the sleep course students maintained most of the aforementioned gains and reported fewer symptoms of depression (CES-D; p = .05) and anxiety (BAI; p < .05). CONCLUSIONS: These positive preliminary results indicate that focused education has the potential to improve sleep among college students.

Almost Psychiatry: The Impact of Teaching Child and Adolescent Mental Health Studies to Undergraduate College Students.

OBJECTIVE: The Child and Adolescent Mental Health Studies (CAMS) program is housed in a Liberal Arts undergraduate college of a large research university. Psychiatrists, clinical psychologists, and social workers at the university's medical center teach the courses. The purpose of this study is to evaluate the extent to which CAMS encourages graduates of the program to pursue a career in child and adolescent mental health (CAMH). METHODS: In 2015-2016, graduates of the CAMS program were invited to participate in a mixed methods study. In addition to statistical analyses, qualitative thematic analyses were performed to interpret free-text responses. RESULTS: Forty-five percent (314/702) of invited graduates completed the online survey. Interviews were conducted with 11% (34/314) of participants by study staff over the phone. Quantitative results suggested that 81% (149/185) of participants enrolled in educational programs after graduation due to an interest in CAMH. A significantly higher proportion of the total sample (t = 3.661, p < .001) reported that they changed their career goals while undergraduate students compared to those who did so after graduation. Results of qualitative interviews with 34 participants uncovered five key themes unique to CAMS that may explain the program's influence on graduates' career choices and career development: practitioners-as-instructors, instructor mentorship, novel course content, experiential learning opportunities, and career training and skills. CONCLUSIONS: Quantitative and qualitative results indicated that teaching college undergraduate students about CAMH encourages them to set career goals within the field. These findings suggest the utility of implementing similar programs at other undergraduate colleges.

Psychiatry's Next Generation: Teaching College Students About Mental Health.

OBJECTIVE: The authors describe an integrated area of study for undergraduate college students that targets an increase in knowledge of mental health issues in children, adolescents, and emerging adults; encourages mental health service utilization on college campuses; and exposes young minds to the possibilities of working with children and adolescents in the mental health field. METHODS: An overview of the program is provided, including the resources required to oversee and manage the program, student requirements, a description of the role that clinicians and researchers play as the program faculty, and an explanation of the tuition model. RESULTS: The program currently includes 40 courses with an annual enrollment of over 3000 students, resulting in departmental revenues that currently exceed $11 million per year. Student evaluations of the courses are very positive, and in a program survey students reported that their participation in the program had a positive impact on their life (84.2%) and impacted their career choice (60.2%). CONCLUSIONS: The benefits of the program include a valuable outreach to college students regarding the importance of seeking help for mental health issues, a positive influence on early career decision-making, opportunities for clinical and research educators to develop their scholarly areas of interest, and a significant source of departmental discretionary revenues.

Video-teleconferencing with medical students to improve exposure to child and adolescent psychiatry.

OBJECTIVE: The chronic workforce shortage in child and adolescent psychiatry (CAP) remains a germane issue that has been difficult to deal with effectively. Collaboration between medical schools without sufficient CAP resources and those with enough to share may help improve interest in the field. METHOD: This lecture series piloted a collaborative effort between CAP residents from a Midwest academic center and student-led interest groups from two osteopathic medical schools. CAP residents led nine interactive lectures with medical students on relevant topics, using video-teleconferencing. Baseline and follow-up surveys were used to assess attitudes and responses to the lecture series. RESULTS A group of 175 students completed the baseline survey; 43 students completed the follow-up survey; 21 of 43 (48%) reported that the lectures would positively influence their career choice toward CAP. CONCLUSION: Interactive lectures via video teleconferencing demonstrated potential to improve medical students' exposure to CAP, and they were well received in this initial pilot study.

The use of herbal medications and dietary supplements by people with mental illness.

This study examined the relationship between herbal medication and dietary supplement (HMDS) use and mental health characteristics. Data are drawn from a national household survey of the United States' civilian, non-institutionalized population (N = 9,585). Psychiatric medication and HMDS use, psychiatric diagnoses and treatment needs, utilization and satisfaction were assessed. Compared to non-users, HMDS users were more likely to perceive themselves as having mental health needs, to have received mental health and primary care treatment, and to be dissatisfied with their overall healthcare. Psychiatric medication use was not related to HMDS use, and in multivariate analyses, HMDS use was associated with perceived mental health needs. Differences in use of specific HMDS between those with and without a psychiatric disorder were also examined. The use of HMDS warrants particular attention in persons with perceived mental health problems as these individuals may be turning to HMDS use for treatment of their symptoms.

Parasomnias and movement disorders in children and adolescents.

Childhood parasomnias and movement disorders arise from a variety of etiologic factors. For some children, psychopathology plays a causal role in sleep disorders; in other cases, recurrent parasomnia episodes induce psychopathology. Current research reveals complex interconnections between sleep and mental health. As such, it is important that clinicians consider the impact psychiatric disorders have on childhood parasomnias. This article describes common parasomnias and movement disorders in children and adolescents, with emphasis on psychologic and behavioral comorbidities.

The Child and Adolescent Mental Health Studies (CAMS) Minor at New York University.

OBJECTIVE: The authors describe the Child and Adolescent Mental Health Studies (CAMS) undergraduate college minor at New York University. METHODS: The authors detail the development, structure, and operation of the CAMS minor. They describe the importance of identifying program goals, building coalitions, creating an advisory board, selecting teaching materials and instructors, and establishing a viable financial model. RESULTS: The authors present student evaluations from the first course, which demonstrate great satisfaction with the program. CONCLUSION: The successful development of the CAMS minor demonstrates that Schools of Medicine (more specifically, the departments of Psychiatry and Child and Adolescent Psychiatry) can have a positive impact on undergraduate student education, which may later translate into an increased number of students who consider entering medical school and child psychiatry.

Child and adolescent mental health policy worldwide: an update.

Few countries worldwide maintain policies specifically designed to address the mental health needs of children and adolescents. Yet policies are essential to guide the development of systems of care, training programmes for practitioners, and research endeavours. Without policy, there is no clear pathway for programme development, no specific commitment from government, no expression of governance, no guide to support funding, and no clarification of who exactly is responsible for providing services to children and adolescents. In 2004, we published a report aimed at identifying child and adolescent mental health policies worldwide (Shatkin & Belfer, 2004). The present review expands upon that report and provides an up-to-date assessment of these policies.

The Global Absence of Child and Adolescent Mental Health Policy.

BACKGROUND: Few policies designed specifically to support child and adolescent mental health exist worldwide. The absence of policy is a barrier to the development of coherent systems of mental healthcare for children and adolescents. METHOD: This study collected data on existing policies from international databases, WHO headquarters in Geneva, Switzerland, and in consultation with experts in child and adolescent psychiatry from around the world. A set of criteria for ranking the adequacy of these policies was developed. RESULTS: Though no single country was found to have a mental health policy strictly pertaining to children and adolescents alone, 35 countries (corresponding to 18% of countries worldwide) were found to have identifiable mental health policies, which may have some beneficial impact on children and adolescents. Though little has been achieved worldwide in this area, there has been a significant degree of movement towards policy development in the past 10 years. The policies identified vary greatly in terms of their provisions for delivering services, initiating research, training professionals, and educating the public. CONCLUSIONS: The development of mental health policies is feasible and would substantially aid in the expansion of service systems, the institutionalisation of culturally relevant data gathering, and the facilitation of funding.

Atomoxetine for the treatment of pediatric nocturnal enuresis.

Current treatments for pediatric nocturnal enuresis rely upon the use of behavioral interventions, such as enuresis alarms, and pharmacological interventions, such as antidiuretic hormone analogs, tricyclic antidepressants, and anticholinergics. However, a considerable number of patients do not respond fully to any of these interventions, in spite of optimal behavioral management and medication dosing. This report describes 4 children with attention deficit hyperactivity disorder (ADHD) comorbid with nocturnal enuresis. Each child was treated with atomoxetine for ADHD and experienced serendipitous resolution of enuresis.