Child psychiatry

1. Pediatric and Adolescent
Mental Health
John Sargent, M.D.

2. Goals of Child Rearing
 Optimal development
 Effective emotional, cognitive and
behavioral functioning

3.  Capacity for meaningful occupational
participation
 Satisfying relationships and family life
 Rewarding recreational experiences
 Successful adaptation to and participation
in one’s neighborhood and community

4. Recognizing Intrinsic Differences
 Physical Status
 Intellectual capacity
 Temperament
 Culture and ethnicity

5.  Family relationships
 Socio economic status/access to resources
 Capacity for modulation of emotions
 Capacity to manage and direct behavior

6. Unique Characteristics of Child
Mental Health Problems
 Often represent gene-environmental
interactions
 Symptoms of the disorder often worsen the
disorder
 Impact development and overall skill
acquisition

7.  Affect and are affected by family relationships and
family behavior
 Early recognition and early effective treatment
significantly reduce mortality and morbidity
 Sources of resilience and risk strongly influence
the occurrence and course of child and
adolescent mental health problems

8. Sources of Resilience
 High intelligence
 Even temperament
 Physical attractiveness
 Special skills and abilities
 Commitment of caretaker to child’s
well being and development
 Strong social support for family and
caretaker

9. Sources of Risk
 Poverty
 Recent move or immigration
 Marked marital or post separation conflict

10.  Family violence, abuse or neglect
 Community disruption
 Poor resource availability

11. Types of Child and Adolescent
Mental Health Problems
 Disorders of Social Interaction
 Autism
 Aspergers Syndrome
 Internalizing Disorders
 Anxiety Disorders
 Depression
 Trauma Responses
 Externalizing Disorders
 Attention Deficit Hyperactivity Disorder
 Conduct Disorder

12.  Appetite Disorders
 Eating Disorder
 Substance Abuse
 Self-Harming Behavior
 Mental Retardation
 Learning Disability
 Early onset major mental illness
 Schizophrenia
 Bipolar Disorder

13. Mental Health Treatment Options for
Children and Adolescents
 Individual Psychotherapy
 Family education and psychotherapy
 Psychopharmacology

14.  Special education programs
 Treatment programs
 Inpatient residential
 Day treatment
 Legal responses
 Detention
 Group homes
 Probation

15.  Community treatment
 Home based therapy
 Therapeutic foster care
 Mentoring programs
 Crisis intervention
 Mobile crisis unit
 Police with special training

16. Goals of Treatment
 To enhance the child’s adaptation to
his environment
 To support the community’s efforts to
accommodate to the child’s unique
differences

17. Specific Child Psychiatric Syndromes
and Treatment
 Autism and Asperger’s
 Spectrum of poor socializing ability
 Generally require educational/behavioral
program
 May require medication for anxiety,
aggressiveness or hyperactivity
 Prognosis depends on language development
and intellectual capacity

18. Attention Deficit Hyperactivity Disorder
 3 – 6% of population
 Onset before age 7
 Problems with concentration, activity level and organization
 Concerns at home, school and with peers
 Treatment includes
 Stimulants
 Educational support
 Parental supervision
 Consistency

19. Depression
 3% of children
 5 – 8% of adolescents
 Risk for suicidal behavior
 School failure
 Poor relationship and occupational outcome
 Treatment: combination of psychotherapy
and SSRI medication
 Major issue
 Early identification
 Appropriate treatment

20. Anxiety Disorders
 5% of children
 Excessive worry interfering with function
 Obsessive Compulsive Disorder most common
 Worry is alleviated by rigid and time consuming
compulsions, counting, washing and checking
 Social anxiety is frequently troubling during adolescence
interfering with social relationships and self=esteem
 Treatment can be very effective

21. Post Traumatic Stress Disorder
 Significant trauma through abuse, neglect,
illness, accident or other traumatic
expericene
 Symptoms include arousal changes,
avoidance and reexperencing
 Can be persistent and seriously disabling

22.  Often complicated by depression,
substance abuse and risk taking behavior
 Psychotherapy highly effective, especially if
initiated early

23. Eating Disorders
 1 – 3% of adolescent and young adult
women
 Bulimia (recurrent binge eating and
purging) can be chronic and relapsing

24.  Anorexia has 5 – 10% mortality rate
and can be chronic
 Early treatment most effective
 Requires multidisciplinary treatment
approach

25. Conduct Disorder
 More common in boys
 Cruelty to animals often an early symptom
 Can persist and develop into antisocial
personality and lifelong criminality

26.  Linked to poor parental supervision and
family violence
 Often associated with substance abuse
 Positive relationship with school and with
prosocial peers are good prognostic signs

27.  Placement away from home and with
similar youth does not improve the problem
 Home based, intensive family treatment
leads to 75% recovery rate

28. Substance Abuse
 Has declined in youth in the past 15 years
 Frequently associated with other
psychiatric disorders and complicates their
treatment
 Use of several drugs is common

29.  Drug abuse is associated with poor family
relationships and poor parental supervision
 Treatment is based on improving family
relationships and building the child’s skills
and abilities

30. Bipolar Disorder
 Can occur in childhood and adolescence
 Mood fluctuations are associated with marked
irritability, temper outbursts and impulsivity
 Can be difficult to treat and is often chronic
 Frequently occurs in families with other member
swith Bipolar Disorder which can complicate
treatment

31. Concluding Remarks
 Decreasing stigma remains essential
 Parity in insurance coverage and improved
access to effective care for poor and
underinsured are extremely important

32.  Planning for transition to adulthood
significant
 Social and human costs of non treatment
are enormous
 Competence and human connections are
important treatment goals

33.  There is great need for more Child and
Adolescent Psychiatrists (only 7000 in USA
for 7.5 million seriously affected children)
 Effective treatments are available and lead
to more productive and satisfying lives for
children and their families