[Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy]. / Medienbezogene Störungen im Kindes- und Jugendalter: Evidenzpapier der Gemeinsamen Suchtkommission der kinder- und jugendpsychiatrischen und psychotherapeutischen Fachgesellschaft und Verbände (DGKJP, BAG, BKJPP).

Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy Abstract. Media-associated disorders (MAD) describe the problematic use of the internet, certain electronic devices in general as well as digital applications. During childhood and adolescence, digital games and social media are the most commonly used applications. In May 2019, as first MAD "gaming disorder" was included as a clinical diagnosis in the ICD-11. The prevalence of MAD in German children and adolescents is estimated to lie between 3 % and 5 %. In most cases, MAD are accompanied by psychiatric comorbidities. MAD ensue because of dysfunctional learning processes in combination with general and specific risk factors. They are associated with neural changes like those of substance-associated addictions. Diagnostics can be based on validated questionnaires and clinical exploration, though a standardized diagnostic path is not yet common. Treatment depends on the level of severity and generally comprises outpatient, day-clinic, and inpatient therapy approaches with elements from cognitive-behavioral therapy and under parental involvement. Suitable treatments are not yet available in all German regions and have also not been sufficiently evaluated. Moreover, only a few studies exist on the efficacy of prevention measures addressing MAD in children and adolescents. Thus, further research is strongly required.

The Hawai'i Child and Adolescent Psychiatry Resources for Primary Care: An Evidence-Informed Tool to Improve Quality of Care.

Mental health continues to be a significant concern both globally and locally in Hawai'i, with nearly half of all mental illness beginning in childhood or adolescence. A shortage of mental health providers has led to less than a third of patients receiving appropriate and timely care. Primary care providers are often the first-line responders to untreated mental health conditions, but they are often underprepared to address these conditions. To help provide guidance to primary care providers and other first-line responders, a child and adolescent mental health resource manual was developed, that is tailored to Hawai'i. This manual was presented at several pediatric didactic sessions and general conferences to describe its evolution, utility, to elicit feedback, as well as for an initial distribution. While feedback was overall positive, future manual development and strategic updates will be made to insure its suitability and timeliness, while continuing circulation efforts to primary care providers will ultimately benefit a greater proportion of children in need.

[Where did all the men in child and adolescent psychiatry and psychotherapy go? The influence of gender on the choice of specialization]. / Wo sind die Männer im Fachgebiet Kinder- und Jugendpsychiatrie und Psychotherapie?

Where did all the men in child and adolescent psychiatry and psychotherapy go? The influence of gender on the choice of specialization Abstract. Objective: To examine the factors influencing graduates to choose child and adolescent psychiatry (CAP) or orthopaedic surgery (OR) as a career specialty. Method: We distributed a web-based survey to residents in child and adolescent psychiatry and orthopedic surgery in Germany. The survey included questions related to the factors contributing to their career choice, particularly sociodemographic, workplace, and education-related matters. Results: 101 participants completed the questionnaires (CAP: 49 women, 10 men; OR 21 women and 21 men). CAP residents were significantly older and more often married with children. Exposure to the subject during medical school was significantly more common among OR residents. CAP residents rated the factors "time for breaks," "regular work hours," "structured workday," "reconciliation of work and family life," "overall work load," and "sufficient time for each individual patient" as significantly more important than did OR residents. OR residents in turn considered "spectacular cases," "fast decision-making," "high technical requirements," and "positive experiences during medical school" as significantly more important. A family-friendly workplace was especially more important to woman in CAP. Conclusions: There is a need to rebrand the perception of psychiatry and to expose medical students early on to the subject if we are to attract more (male) psychiatrists in the future.

Knowledge, attitudes, and experience of child and adolescent psychiatrists in Turkey concerning pediatric electroconvulsive therapy.

OBJECTIVE: Electroconvulsive therapy (ECT) is a treatment modality in children that can be life-saving but is rarely preferred. In this study, we aimed to evaluate the knowledge, experience, and attitudes of child and adolescent psychiatrists (CAPs) in Turkey about pediatric ECT and to draw attention to possible gaps and needs regarding this treatment in the child and adolescent psychiatric policies of Turkey. METHOD: An electronic survey was prepared and shared with child and adolescent psychiatric residents and specialists. The participants were asked about their residency training, clinical experience, and opinion about ECT. The obtained data were entered in SPSS Statistics 23.0. Descriptive analyses and chi-squared tests were applied. RESULTS: One hundred and ninety-one CAPs filled in the questionnaire, 28.8% of whom assessed their knowledge level as "I have no knowledge." Only 34% of them stated that their patients, most of whom had mood disorders, schizophrenia, and catatonia, had received ECT before. Four of these patients were under 12 years old. Sixty-six percent of the participants suggested that ECT was safe in adolescents, whereas only 5.8% held this view for prepubertal children. The most common reason for physicians not to apply ECT was "lack of means to apply ECT," and 92.7% stated that opportunities should be provided for pediatric ECT treatment by the hospital administration. CONCLUSION: This is the first data to present the knowledge and attitudes of CAPs in Turkey about ECT. The results suggest that physicians need to have more knowledge about ECT.

Prevalencia de trastornos mentales en menores de edad atendidos en un hospital psiquiátrico departamental / Prevalence of mental disorders in children treated in a public psychiatric hospital

RESUMEN Objetivo Determinar la prevalencia de los trastornos mentales presentados en menores de edad en un hospital psiquiátrico departamental. Método Estudio de prevalencia de periodo. Se empleó una base de datos secundaria suministrada por el Hospital Psiquiátrico Universitario del Valle (HPUV) de Santiago de Cali, proveniente del registro de la historia clínica sistematizada correspondiente al año 2014. La población estuvo conformada por los pacientes menores de edad que consultaron durante el periodo, se utilizó la totalidad de los registros disponibles en la base de datos. Resultados Del total de consultas atendidas se encontró que el 35,7% (755) correspondía al sexo femenino y el 64,3% al masculino (1 361). El principal diagnostico psiquiátrico atendido en esta población fue el episodio depresivo con 11,6% seguido por los trastornos mixtos de la conducta y de las emociones con un 8,5%. Conclusiones La evolución en el tiempo de la salud mental no ha cambiado significativamente. La pasada encuesta nacional de salud mental 2015 presenta resultados similares al encontrado en el presente estudio, particularmente en la región pacífica, donde la depresión y trastornos de conducta son más prevalentes.(AU)

ABSTRACT Objective To determine the prevalence of mental disorders in children treated at a regional psychiatric hospital. Materials and Methods Period prevalence study. A secondary database was supplied by the Hospital Psiquiátrico Universitario del Valle (HPUV) of Santiago de Cali. This database came from the systematized clinical history of the year 2014. The population consisted of underage patients who consulted during the period. All the records available in the database were used. Results Of the total number of children who visited the clinic, 35.7% (755) were females and 64.3% were males (1 361). The main psychiatric diagnosis observed in this population was depressive episode (11.6%), followed by mixed behavioral and emotional disorder (8.5%). Conclusions The evolution of mental health over time has not changed significantly. The 2015 National Mental Health Survey presents similar results to those found in this study, particularly in the Pacific region, where depression and behavioral disorders are more prevalent.(AU)

Child and adolescent psychiatry in the Far East: A 5-year follow up on the Consortium on Academic Child and Adolescent Psychiatry in the Far East (CACAP-FE) study.

AIM: Data pertaining to child and adolescent psychiatry (CAP) training systems are limited as extant research has mostly been derived from one-time data collection. This 5-year follow-up survey collects updated information on CAP training systems in the Far East, allowing for the tracking of system changes over the past 5 years. METHODS: Data were obtained from 18 countries, or functionally self-governing areas, in the Far East, 17 of which were also included in the original study. An online questionnaire was completed by leading CAP professionals in each country. Questions were expanded in the present study to capture the contents of CAP training. RESULTS: When compared to data from the original study, there has been progress in CAP training systems in the last 5 years. Specifically, there has been an increase in the number of countries with CAP training programs and national guidelines for the training. In addition, the number of CAP departments/divisions affiliated with academic institutions/universities has increased. Findings from 12 of 18 countries in the present study provide data on clinical contents. All informants of the present study reported the need for more child and adolescent psychiatrists and allied professionals. CONCLUSION: Despite progress in CAP training systems over the last 5 years, the need for more professionals in child and adolescent mental health care in all the relevant areas in this region have yet to be adequately addressed. Continued national efforts and international collaborations are imperative to developing and sustaining new CAP training systems while facilitating improvements in existing programs.

Factors associated with treatment intensification in child and adolescent psychiatry: a cross-sectional study.

BACKGROUND: More knowledge about characteristics of children and adolescents who need intensive levels of psychiatric treatment is important to improve treatment approaches. These characteristics were investigated in those who need youth Assertive Community Treatment (youth-ACT). METHOD: A cross-sectional study among children/adolescents and their parents treated in either a regular outpatient clinic or a youth-ACT setting in a specialized mental health treatment center in the Netherlands. RESULTS: Child, parent and family/social context factors were associated with treatment intensification from regular outpatient care to youth-ACT. The combination of the child, parent, and family/social context factors adds substantially to the predictive power of the model (Nagelkerke R2 increasing from 36 to 45% for the three domains separately, to 61% when all domains are combined). The strongest predictors are the severity of psychiatric disorders of the child, parental stress, and domestic violence. CONCLUSIONS: Using a wide variety of variables that are potentially associated with treatment intensification from regular outpatient clinic to youth-ACT, we constructed a regression model illustrating a relatively strong relation between the predictor variables and the outcome (Nagelkerke R2 = 0.61), with three strong predictors, i.e. severity of psychiatric disorders of the child, parental stress, and domestic violence. This emphasizes the importance of a system-oriented approach with primary attention for problem solving and stress reduction within the system, in addition to the psychiatric treatment of the child, and possibly also the parents.

Non-epileptic seizures in children: Views and approaches at a UK child and adolescent psychiatry conference.

PURPOSE: To describe clinical experiences of paediatric non-epileptic seizures (NES) among doctors attending a UK child and adolescent psychiatry conference. METHODS: Sixty-six participants completed a semi-structured bespoke questionnaire. Results are reported using descriptive statistics. RESULTS: Two-thirds of respondents regarded the best name for the disorder to be "non-epileptic seizures". Although most doctors saw new cases each year, two-thirds described their own service as poorly equipped to manage NES. Anti-epileptic drugs (AEDs) were commonly still being taken by children without epilepsy 6 months after their diagnosis. Preferred treatment approaches included supportive case management and cognitive behavioural therapy. Joint working with paediatrics and liaison with schools were seen as important. CONCLUSION: Despite many clinicians having experience of the disorder, NES seemed to occupy a neglected status, often falling between paediatrics and child mental health, with inadequately defined care pathways leading to sub-optimal treatment. Re-configuration of services to prioritise liaison with paediatrics and education may support development of effective treatment, thus maximising health, social and educational opportunities for young people and their families.

Management of Mental Health Crises Among Youths With and Without ASD: A National Survey of Child Psychiatrists.

OBJECTIVE: This study compared management by child psychiatrists of mental health crises among youths with and without autism spectrum disorder (ASD). METHODS: A custom online mental health crisis services survey was administered to members of the American Academy of Child and Adolescent Psychiatry. The survey probed three domains of crisis management: willingness to work with youths with a history of mental health crisis, comfort level in managing a mental health crisis, and availability of external resources during a crisis. Child psychiatrists reporting on management of youths with ASD (N=492) and without ASD (N=374) completed the survey. RESULTS: About 75% of psychiatrists in both groups were willing to accept a child with a history of a mental health crisis in their practice. During a crisis, psychiatrists caring for youths with ASD had less access to external consultation resources, such as a crisis evaluation center or other mental health professionals, compared with those caring for youths without ASD. Psychiatrists also expressed concerns about the ability of emergency department professionals and emergency responders to manage mental health crises among youths in a safe and developmentally appropriate manner, particularly among those with ASD. CONCLUSIONS: Child psychiatrists are in need of more external resources to manage youths with ASD who are experiencing a mental health crisis. There is also a need to develop best practice procedures for emergency responders who are working with youths experiencing a mental health crisis.

Survey to child/adolescent psychiatry and developmental/behavioral pediatric training directors to expand psychiatric-mental health training to nurse practitioners.

BACKGROUND: There is an ongoing shortage of child mental health professionals. Nurse practitioners (NPs) who completed behavioral and mental health training have proven that they can diagnose and manage many pediatric problems. PURPOSE: To ask the training directors of both child/adolescent psychiatry (CAP) and developmental/behavioral pediatric (DBP) programs about their receptivity and willingness to give additional training for NPs who provide care to children with behavioral and mental health issues and examine the main obstacles to the development of such programs. METHODS: A survey was sent to 151 CAP and DBP training directors in the United States. RESULTS: The return rate was 67% (N = 101). Only 12% expressed objection to the concept of additional NP training in CAP or DBP, but only 53% of training directors currently reported having sufficient faculty to do so. Some training directors reported already having advanced behavioral and mental health training programs for NPs (31%) and most (82%) would consider expanding, if funded. CONCLUSIONS: There is support for advanced training for NPs, but funding is needed to make this a reality. IMPLICATIONS FOR PRACTICE: Expansion of such programs might rapidly improve accessibility and reduce waiting time of mental health providers for children and adolescents.

Treatment of Attention-Deficit/Hyperactivity Disorder in Preschool-Age Children: Child and Adolescent Psychiatrists' Adherence to Clinical Practice Guidelines.

OBJECTIVES: To compare child and adolescent psychiatrists' (CAPs) practices in the treatment of preschool children with attention-deficit/hyperactivity disorder (P-ADHD) with published guidelines, and to determine which clinical factors most influence physicians' decisions to initiate pharmacotherapy for P-ADHD. METHODS: We developed and mailed the Preschool ADHD Treatment Questionnaire (PATQ) to a randomly selected national sample of ∼2200 CAPs trained in the management of ADHD. The PATQ asked CAPs about their approach to clinical management of children ages 4-5 years with ADHD-specifically, how often they recommend parent training in behavior management, medication as a first- or second-line treatment, and which medication they typically choose first. CAPs also rated the perceived importance of 19 different clinical factors in their decision to initiate pharmacotherapy. These 19 factors reflected five child-centered areas of concern: ADHD risk factors, education concerns, social issues (SI), emotional stress, and physical safety (PS). The physicians were asked to rate each factor on a 4-point Likert scale from "not important" to "very important." RESULTS: The final sample consisted of 339 board-certified CAPs. When adherence to the Academy of Child and Adolescent Psychiatry (AACAP) guidelines was defined as initial treatment with behavior management (not medication) and pharmacotherapy specifically with methylphenidate as second-line treatment, only 7.4% of CAPs followed clinical guidelines. Most physicians identified PS as an important or very important factor when initiating pharmacotherapy for P-ADHD (93.4%), followed by educational concerns (EC) (79.9%), emotional stress (69.6%), SI (52.8%), and the presence of risk factors for ADHD (32.7%). CONCLUSIONS: The overwhelming majority of CAPs do not follow current AACAP guidelines for treatment of P-ADHD, especially regarding medication initiation and selection. When deciding whether to prescribe medication for P-ADHD, safety and EC were the most important and historical risk factors for ADHD were the least important clinical factors.

Experiences with Patient Refusal of Off-Label Prescribing of Psychotropic Medications to Children and Adolescents in Japan.

OBJECTIVE: In child and adolescent psychiatry, the off-label prescribing of psychotropic medications is common. The purpose of this study was to examine the experiences of Japanese child and adolescent psychiatrists with off-label prescribing to children and/or adolescents (hereafter referred to as "children") and to identify the factors associated with these experiences. METHODS: A prospective questionnaire was sent to 1628 psychiatrists belonging to the Japanese Society for Child and Adolescent Psychiatry. Stepwise logistic regression analyses were used to determine whether demographic characteristics or categories of psychotropic medications were able to independently predict patient refusals of off-label prescribing. RESULTS: The final sample included 447 psychiatrists, and 93% of the respondents (416/447) had experiences with off-label prescribing to children. In addition, 39.7% of the respondents (165/416) experienced patient refusal of off-label prescribing when they informed the children and/or parents of the prescribing. The most commonly prescribed off-label psychotropic medications were antipsychotics (82.0%). Patient refusal was significantly more frequent when the respondents informed parents (p=0.02) and children (p<0.01) about off-label prescribing than when they did not. A stepwise logistic regression analysis revealed that informing parents (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.09-6.82) or children (OR, 1.70; 95% CI, 1.12-2.58) about off-label prescribing and antidepressant use (OR, 2.98; 95% CI, 1.25-7.10) increased the odds of patient refusal of off-label prescribing; however, prescribers' years in practice decreased the odds (OR, 0.98; 95% CI, 0.96-1). CONCLUSIONS: Off-label prescribing of psychotropic medications is common among child and adolescent psychiatrists in Japan. Furthermore, the psychiatrists' experiences with patient refusal of off-label prescribing were significantly associated with informing the parents/patients about off-label prescribing, particularly with regard to use of antidepressants. Further studies are required to support the development of decision making among clinicians.

[Need for youth welfare services following child and adolescent psychiatry treatment- a descriptive analysis]. / Jugendhilfebedarf nach (teil-)stationärer kinder- und jugendpsychiatrischer Behandlung.

OBJECTIVE: Cooperation between health and youth welfare services plays a prominent role in the psychosocial healthcare of children and adolescents with mental disorders. The need analysis presented here measured how many children and adolescents engaged youth welfare services before and after inpatient or daycare treatment. METHOD: The number of completed treatments from 36 Bavarian daycare and inpatient child and adolescent psychiatric clinics were recorded over a period of 6 months. Besides sociodemographic and diagnostic data, information was collected about indicated and subsequently realized measures of youth welfare following clinical and day care treatment. RESULTS: 33 %of the clinically treated children and adolescents participated in a youth-welfare measure after psychiatric treatment. In the run-up to clinical treatment, 38 % of the treated children and adolescents had engaged services of youth welfare. Half of the children and adolescents contacted both youth welfare services as well as child and adolescent psychiatric services. The residential setting of youth care is of major importance to the cooperative treatment. CONCLUSIONS: The provision of both youth welfare services and child and adolescent psychiatry treatment is usually not a matter of going from one system to another, but rather consists of different constellations of complex processes of mutual assistance. The goal is to carry out a structured survey of the common clientele and to develop a crossover system and common care structures in order to improve the overall cooperation.

[The treatment needs of migrant children according to child and adolescent psychiatrists from medical clinics and in private practice]. / Anforderungen an die Behandlung von Migrantenkindern aus Sicht niedergelassener und leitender Ärzte für Kinder- und Jugendpsychiatrie.

OBJECTIVE: How does the German child and adolescent psychiatry system respond to the increasing number of migrant children and adolescents? METHOD: Senior doctors from German child and adolescent psychiatric hospitals (Association of Medical Hospital Directors in Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Germany, BAG) completed a specially constructed questionnaire about the treatment needs of migrant children, while a «random, representative¼ sample of child and adolescent psychiatrists in private practice (German Professional Association for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, BKJPP) was administered a slightly modified version. RESULTS: The 100 psychiatrists in private practice represented only about one-eighth of their group, whereas the 55 medical directors comprised a representative sample. One-third of the hospitals has treatments tailored to the specific needs of migrants. In both settings, however, competent interpreters were rarely found, despite the treatment problems arising from the understanding the illness by the parents, language problems, and the clinical knowledge of the patient. Cultural diversity is perceived as enriching. The migration background and the sex of child and adolescent psychiatrists influence the treatment of migrants. CONCLUSION: Facilitating the process of «cultural opening¼ in child and adolescent psychiatry involves enacting concrete steps, such as the funding of interpreter costs.

Predictors of polypharmacy and off-label prescribing of psychotropic medications: a national survey of child and adolescent psychiatrists.

We employed a national survey of child psychiatrists to examine typical prescribing practices for children with anxiety, depression, and disruptive behavior disorders. We examined the extent to which polypharmacy and off-label prescribing occur in routine practice and the degree to which child characteristics, child psychiatrist characteristics, and medication availability may influence these prescribing practices. We found that child psychiatrists most often prescribed medications that were on-label according to U.S. Food and Drug Administration (FDA) guidelines, and that they were progressively less likely to choose medications with partial approval (i.e., medications having pediatric approval but not for the patient's age or problem type), and then medications with no pediatric approval. We also found that prescribing multiple concomitant medications was the norm. We employed best subsets regression to determine the best theoretically relevant predictors to explain polypharmacy and off-label prescribing and found that the best fitting model only included number of child diagnoses. These findings suggest that comorbidity is an important issue in the pharmacotherapy of children with mental health disorders and one that must be addressed in future clinical trials.

The current and ideal state of mental health training: pediatric program director perspectives.

OBJECTIVE: To assess pediatric residency program director (PD) perceptions of the current state of mental health (MH) training, their receptivity to curricular changes, and perceptions of their residents' knowledge and skills in MH care. METHODS: We performed a cross-sectional study utilizing a Web-based survey of pediatric residency PDs to assess program characteristics, learning modalities PDs currently had or would implement, and their knowledge of the new American Academy of Pediatrics' MH competencies. PDs then ranked their residents' knowledge and skills for 29 MH competencies. Analyses included descriptive statistics and bivariate and multivariate analyses to assess for associations between variables, particularly MH model of care and perceived competence. RESULTS: Ninety-nine PDs (51%) responded. A total of 87% of PDs reported that MH care was taught as part of another rotation, yet PDs were receptive to curricular changes. Only 45% of PDs were aware of the 2009 American Academy of Pediatrics competencies, and PDs infrequently rated their residents' MH skills and knowledge to be above average. Attention-deficit/hyperactivity disorder (ADHD) was an exception: 64% reported above-average ADHD knowledge in diagnoses and 57% in treatment. There was an association between enhanced MH services in continuity clinics and perceived resident systems-based practice (P < .01) and medical knowledge (P = .04). CONCLUSIONS: PDs acknowledged that MH training is not emphasized, leading to deficiencies in their residents' knowledge and skills in MH care. The receptivity of PDs suggests the need for targeted dissemination of national guidelines or curriculum. Integrated models of care may be one way to improve resident competencies, but this deserves further study.

Child and adolescent psychiatrists' attitudes and practices prescribing second generation antipsychotics.

OBJECTIVE: The purpose of this study was to examine psychiatrists' attitudes and practices in prescribing second-generation antipsychotics (SGA) to children and adolescents (referred to here as "children") and identify factors associated with off-label SGA use. METHODS: A survey was mailed to a national, randomly selected sample of 1600 child and adolescent psychiatrists identified by the American Medical Association. Multivariable logistic regression was used to identify factors, including psychiatrists' characteristics, practice characteristics, and psychiatrists' attitudes, that are associated with off-label SGA use (i.e., SGAs used in children with attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, or nonbipolar mood disorders). RESULTS: The final sample included 340 psychiatrists. Overall, respondents reported higher use and appropriateness of SGAs for United States Food and Drug Administration (FDA)-approved disorders, symptoms of aggression, and older child age. More than one third (36%) of respondents reported some off-label SGA use. Significant predictors of off-label use were: Practicing at inpatient/residential facilities (odds ratio [OR]=4.2, p=0.001); white/non-Hispanic race/ethnicity (OR=0.3, p<0.0001), agreeing that SGAs should be used for ADHD with aggression (OR=7.1, p<0.0001); and agreeing that SGAs should be used for severe delinquent behaviors (OR=1.9, p=0.03). CONCLUSIONS: Psychiatrists' attitudes about prescribing SGAs to children exhibiting aggressive symptoms were associated with off-label SGA use. Research is needed to understand the construct of aggression, potential interaction effects of aggression with diagnostic criteria, and their impact on SGA use.