Evidence indicates an overrepresentation of youth with co-occurring autism spectrum disorders (ASD) and gender dysphoria (GD). The clinical assessment and treatment of adolescents with this co-occurrence is often complex, related to the developmental aspects of ASD. There are no guidelines for clinical care when ASD and GD co-occur; however, there are clinicians and researchers experienced in this co-occurrence. This study develops initial clinical consensus guidelines for the assessment and care of adolescents with co-occurring ASD and GD, from the best clinical practices of current experts in the field. Expert participants were identified through a comprehensive international search process and invited to participate in a two-stage Delphi procedure to form clinical consensus statements. The Delphi Method is a well-studied research methodology for obtaining consensus among experts to define appropriate clinical care. Of 30 potential experts identified, 22 met criteria as expert in co-occurring ASD and GD youth and participated. Textual data divided into the following data nodes: guidelines for assessment; guidelines for treatment; six primary clinical/psychosocial challenges: social functioning, medical treatments and medical safety, risk of victimization/safety, school, and transition to adulthood issues (i.e., employment and romantic relationships). With a cutoff of 75% consensus for inclusion, identified experts produced a set of initial guidelines for clinical care. Primary themes include the importance of assessment for GD in ASD, and vice versa, as well as an extended diagnostic period, often with overlap/blurring of treatment and assessment.
Autism Spectrum Disorder/psychology , Gender Dysphoria/psychology , Adolescent , Delphi Technique , Female , Guidelines as Topic , Humans , Male
Some individuals with Tourette syndrome (TS) have severe motoric and vocal tics that interfere with all aspects of their lives, while others have mild tics that pose few problems. We hypothesize that observed tic severity reflects a combination of factors, including the degree to which dopaminergic (DA) and/or noradrenergic (NE) neurotransmitter systems have been affected by the disorder, and the degree to which the child can exert cognitive control to suppress unwanted tics. To explore these hypotheses, we collected behavioral and eyetracking data from 26 patients with TS and 26 controls between ages 7 and 14, both at rest and while they performed a test of cognitive control. To our knowledge, this is the first study to use eyetracking measures in patients with TS. We measured spontaneous eyeblink rate as well as pupil diameter, which have been linked, respectively, to DA and NE levels in the central nervous system. Here, we report a number of key findings that held when we restricted analyses to unmedicated patients. First, patients' accuracy on our test of cognitive control accounted for fully 50% of the variance in parentally reported tic severity. Second, patients exhibited elevated spontaneous eyeblink rates compared to controls, both during task performance and at rest, consistent with heightened DA transmission. Third, although neither task-evoked pupil dilation nor resting pupil diameter differed between TS patients and controls, pupil diameter was positively related to parentally reported anxiety levels in patients, suggesting heightened NE transmission in patients with comorbid anxiety. Thus, with the behavioral and eyetracking data gathered from a single task, we can gather objective data that are related both to tic severity and anxiety levels in pediatric patients with TS, and that likely reflect patients' underlying neurochemical disturbances.
The clinical treatment of children and adolescents with gender dysphoria is still a controversial issue. The aim of this study was to get an overview of the knowledge and experience of international experts and to highlight shared views as well as differences in theoretical convictions and treatment approaches. Half-structured, guide-line based interviews were carried out with international experts in the field. The interviews were analyzed using qualitative content analysis (Mayring, 2010).
Cross-Cultural Comparison , Gender Identity , Transsexualism/therapy , Adolescent , Child , Child, Preschool , Cooperative Behavior , Education, Nonprofessional , Female , Gonadal Steroid Hormones/therapeutic use , Humans , Interdisciplinary Communication , Interview, Psychological , Male , Practice Guidelines as Topic , Psychosexual Development , Psychotherapy , Puberty/drug effects , Puberty/psychology , Sex Counseling , Surveys and Questionnaires , Transsexualism/diagnosis , Transsexualism/psychology
BACKGROUND: Full recovery from injury may be hindered by both physical ailments and psychologic distress. Little information is available on the psychologic response of children to physical trauma, although long-term dysfunction may result if psychologic needs are not identified and addressed. This study examined the prevalence and correlates of posttraumatic stress disorder (PTSD) symptoms in children and adolescents after an acute traumatic event resulting in mild to moderate physical injury. We were also interested in analyzing the discrepancies between parent/child reporting of the child's PTSD symptomatology. Because of the paucity of research evaluating interventions for pediatric PTSD, and as a secondary objective for this study, we collected preliminary data on the effectiveness of a single-session art therapy intervention designed to reduce PTSD symptoms. METHOD: From July 1998 through October 2000, 83 children/adolescents between the ages of 7 and 17 and their caregivers were interviewed within 24 hours of hospital admission and assessed for PTSD symptomatology, trauma history, and other measures of child and family functioning. Interviews were repeated at 1 month, 6 months, and 18 months after the initial hospitalization. Patients with at least mild symptomatology at the initial interview were randomized to receive either an art therapy intervention or standard hospital services alone. RESULTS: A total of 69% of children were found to have at least mild PTSD symptoms at baseline, 57% at 1 month, 59% at 6 months, and 38% at 18 months postinjury. Younger age and the severity of parental PTSD symptoms were correlated with symptom presence in children. Parents initially underreported their child's symptom severity when compared with the child's report, but assessments converged over time. The art therapy intervention showed no sustained effects on the reduction of PTSD symptoms. CONCLUSION: The presence of PTSD symptoms in children after traumatic injury is very high. Parental distress and characteristics of the family environment appear to be more relevant to the presence of child symptoms than the family make-up, course of hospitalization, or extent of the child's injuries. Parents may not initially recognize the degree to which their children experience such symptoms. The high presence of symptoms in this population underscores the need for treatment efficacy studies and parent/medical staff education in identification of PTSD.
Child, Hospitalized/psychology , Parents/psychology , Stress Disorders, Post-Traumatic/diagnosis , Wounds and Injuries/psychology , Adolescent , Adult , Art Therapy , Child , Female , Humans , Injury Severity Score , Longitudinal Studies , Male , Prevalence , Treatment Outcome , Wounds and Injuries/pathology
Munchausen Syndrome by Proxy , Pediatrics , Child , Child Custody , Child of Impaired Parents/psychology , Deception , Guidelines as Topic , Hospitals/standards , Humans , Liability, Legal , Munchausen Syndrome by Proxy/diagnosis , Munchausen Syndrome by Proxy/epidemiology , Munchausen Syndrome by Proxy/legislation & jurisprudence , Munchausen Syndrome by Proxy/therapy , Pediatrics/legislation & jurisprudence , Pediatrics/standards , Physician's Role , Recurrence
Munchausen Syndrome by Proxy/diagnosis , Adolescent , Adult , Child , Diagnosis, Differential , Female , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Mental Disorders/psychology , Mother-Child Relations , Mothers/psychology , Motivation , Munchausen Syndrome/diagnosis , Munchausen Syndrome/epidemiology , Munchausen Syndrome/psychology , Munchausen Syndrome by Proxy/epidemiology , Munchausen Syndrome by Proxy/psychology , Prognosis
The recent trial and conviction of Kathy Bush for abusing her daughter is used to illustrate (1) the nature of the motivation, in at least some cases of MBP, and (2) the importance of distinguishing the motivation found in MBP from that found in other forms of child abuse and other conditions involving factitious illness production.
Child Abuse/diagnosis , Child Abuse/legislation & jurisprudence , Motivation , Munchausen Syndrome by Proxy/diagnosis , Munchausen Syndrome by Proxy/legislation & jurisprudence , Adult , Child , Child Abuse/psychology , Child, Preschool , Diagnosis, Differential , Expert Testimony , Factitious Disorders/diagnosis , Factitious Disorders/psychology , Female , Florida , Humans , Mandatory Reporting , Munchausen Syndrome by Proxy/psychology , Physician's Role
Munchausen by proxy is a disorder in which a child is victimized through a form of child abuse called pediatric condition falsification (PCF). PCF has been documented for psychological and psychiatric conditions including one such form presented here in which educational disabilities are the focus of falsification. Parents meet their own self-serving needs through "impostering" as good mothers. This maternal mental disorder is called factitious disorder by proxy. This article presents a series of cases in which children have PCF that primarily consists of educational disabilities. Characteristics of the children, their mothers, and their families are outlined and outcomes for the 9 children in the sample are discussed. Guidelines for identification of children with PCF in educational settings are provided, and special guidance is offered in differential diagnosis.
Education, Special , Learning Disabilities/diagnosis , Munchausen Syndrome by Proxy/diagnosis , Adolescent , Attention Deficit Disorder with Hyperactivity/diagnosis , Child , Child Abuse/diagnosis , Child Abuse/legislation & jurisprudence , Child Behavior Disorders/diagnosis , Child, Preschool , Diagnosis, Differential , Female , Humans , Male , Munchausen Syndrome by Proxy/legislation & jurisprudence
Examples of fabrication of illness in children are described. Primarily uncomplicated cries for help are differentiated from two major subtypes (the Active Inducer and the Doctor Addict) which define the spectrum of Munchausen syndrome by proxy. Primary differences involve the form of deception, age of the victim, and maternal affect. Five histories are presented and it is suggested that doctor addiction is more common than has thus far been recognized.
Child Abuse/psychology , Munchausen Syndrome/diagnosis , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Mother-Child Relations , Munchausen Syndrome/psychology , Psychopathology
