The Cost of Avoidance

As child psychiatrists, it is our job to ask questions, and many of us would say we are really good at it. We work with our patients to open up about their experiences, discussing fear, sadness, hope, and joy. By modeling this ability to open up in the office, we help guide children and adolescents through using other skills rather than avoidance. Although avoidance has its place at times, we help show our patients the connection between anxiety and avoidance. This necessity to embrace and challenge fears can be a difficult skill for our patients and also their families. Children bring forward questions that parents may want to avoid, fearing the answer might be more difficult for the child than the rejection of having the question avoided all together. As someone who works with children with chronic illnesses, this avoidance of the question can in fact increase the fear and anxiety of the child or adolescent. When talking to children, often they will express a greater fear than the reality of the situation because they determine that if their parent is avoiding the question, it must be really bad. This same struggle with avoidance can be true for us as child psychiatrists as well. The necessity to take on roles of leadership or run a team often presents itself, but excuses can come up to help us avoid these roles. We might say we are not properly trained, we did not go into medicine to do those responsibilities, or we are too busy. By avoiding these responsibilities, we are setting ourselves up for more frustration. As teams struggle, we have to follow the lead of others without the same clinical knowledge, which may result in additional errors. We must remember to practice what we preach and to identify the cost of avoidance.

Parents' experience of a shared parent-child stay during the first week of hospitalization in a child psychiatry inpatient ward

Hospitalization of children in an inpatient psychiatric ward is stressful for both the children and their parents, and separation from the parents during hospitalization is probably one major cause of this stress. We designated one room in a closed inpatient unit to enable a parent to stay with his/her child, including overnight, during the 1st week of hospitalization. We then examined the parents' experience of the shared parent-child stay. Thirty parents of 16 children aged 6-12 years admitted to our inpatient child psychiatry ward completed in-depth semi-structured interviews after that week's experience. The interviews covered the parents' experiences of the 1st week in the larger context of pre-hospitalization period, which also includes the decision to hospitalize the child. The contents of the interviews were analyzed by means of independent coders that identified the following major themes: (1) ambivalence and confusion of the parents as related to their decision to hospitalize their child in the time period just before admission; (2) gradual process of separation from the child during the joint stay at the ward; (3) building confidence and trust toward the staff. Themes 2 and 3 express benefits from the joint hospitalization that may have a strong positive impact on the child's and the parent's recovery. These themes warrant further evaluation of the proposed shared stay during hospitalization in future studies.

In Memoriam: Professor Joseph Biederman's Contributions to Child and Adolescent Psychiatry

OBJECTIVE

To provide an overview of Joe Biederman's contributions to child and adolescent psychiatry.

METHOD

Nine colleagues described his contributions to: psychopharmacology, comorbidity and genetics, pediatric bipolar disorder, autism spectrum disorders, Tourette's and tic disorders, clinical and neuro biomarkers for pediatric mood disorders, executive functioning, and adult ADHD.

RESULTS

Joe Biederman left us with many concrete indicators of his contributions to child and adolescent psychiatry. He set up the world's first pediatric psychopharmacology clinic and clinical research program in child adolescent psychiatry. As a young faculty member he began a research program that led to many awards and eventual promotion to full professor at Harvard Medical School. He was for many years the most highly cited researcher in ADHD. He achieved this while maintaining a full clinical load and was widely respected for his clinical acumen.

CONCLUSION

The world is a better place because Joe Biederman was here.

Polygenic Variation Underlying Educational Attainment and Attention-Deficit/Hyperactivity Disorder Indexes Behavior Ratings of Executive Functions in Child Psychiatry Outpatients

OBJECTIVE

We leveraged common genetic variation underlying ADHD, educational attainment (EA) and cognition (COG) to understand the nature of the Behavior Rating Inventory for Executive Functions (BRIEF) and its relationship to academic functioning.

METHOD

Participants were 991 youth, ages 7 to 17, consecutively referred for neuropsychiatric evaluation. Polygenic scores (PGS) for ADHD, EA, and COG were related to the BRIEF using regression analyses. Structural equation models were used to examine the associations between the PGS, BRIEF and academic outcomes (math, reading, and special education services [EDPLAN]).

RESULTS

After modeling the PGS together, only the EA and ADHD PGS significantly associated with the BRIEF. The BRIEF partially mediated the relationships between EA PGS with math and EDPLAN and fully mediated the relationship between ADHD PGS and EDPLAN.

CONCLUSION

Genetic data extend evidence that the BRIEF measures a construct relevant to educational success that differs from what is indexed by cognitive testing.

Remodeling Broken Systems: Addressing the National Emergency in Child and Adolescent Mental Health

A national emergency in child and adolescent mental health was declared in the United States in 2021 in the wake of the COVID-19 pandemic. This Open Forum discusses potential solutions to better support child and adolescent mental health by improving or expanding school-based mental health services, child psychiatry access programs, virtual mental health services, and new models of care (e.g., integrated youth services hubs and crisis stabilization units). The success of such programs is dependent on stable funding, strong leadership and accountability, robust and well-trained workforces, systems integration, and attention to health equity.

Addressing the Gap in Research Training in Child Psychiatry and Neurodevelopment

Psychiatric and neurodevelopmental conditions in children are common, often co-occur, and can be highly impairing. Moreover, psychiatric disorders that typically do not fully manifest until adulthood, such as schizophrenia, have their roots in early development, with atypical brain and behavioral patterns arising well before a clinical diagnosis is made. The relevance of brain development to improving outcomes of psychiatric and neurodevelopmental conditions underscores the need to cultivate a pipeline of investigators with the necessary training to conduct rigorous, developmentally focused research.

[Restraint in child psychiatry]

In child psychiatry, there are significant ethical challenges when patients put themselves at risk or refuse to cooperate in their care. This article illustrates two situations of violence and restraints and looks at how the vulnerability of caregivers can be acknowledged in order to find the best balance between the imperatives of protection and the respect of young inpatients in child psychiatry.

[Genetic Diagnostics in Everyday Clinical Practice in Child and Adolescent Psychiatry: Indications, Framework Conditions, Hurdles, and Proposed Solutions]

Genetic Diagnostics in Everyday Clinical Practice in Child and Adolescent Psychiatry: Indications, Framework Conditions, Hurdles, and Proposed Solutions Abstract: Health insurance covers medically necessary genetic testing in Germany. Diagnostic genetic testing has become increasingly important for child and adolescent psychiatry (CAP), reflected by the rising number of national guidelines relevant to CAP, including genetic testing in the recommended diagnostic work-up. However, implementation of theses guidelines in routine clinical care is lacking. This article provides a concise overview of the relevance of genetic testing in CAP-related national guidelines. It outlines the legal and financial framework for genetic testing in Germany. Furthermore, it points out barriers to implementation and offers potential solutions. It then provides examples from clinical practice highlighting the potential benefits patients and their family members might have from receiving a genetic diagnosis. The article closes by outlining future CAP-relevant areas in which genetic testing may become clinically relevant.

[Encopresis in children, the view of child psychiatry]

The article aims to provide a state of knowledge in the literature on encopresis in the child psychiatric population. The general definition of the symptom and its analysis are presented according to different approaches. Then, the clinic of encopresis is described according to its specificities. The main associated disorders and psychiatric/psychosocial risk factors are discussed in detail. Regarding patient care, the multidisciplinary approach, including the complementarity with the paediatrician, is essential in a number of cases. Finally, family approach and the impact of trauma would be interesting research perspectives.

[Sensory regulation disorders in child psychiatry]

INTRODUCTION

The processing of sensory information determines the development and growth of a child's abilities. Dysfunction in the processing of sensory stimuli can affect a child's behavior and can disrupt development. Sensory Regulation Disorders are frequently associated with Autism Spectrum Disorder (ASD), with the DSM-5 even including it as a diagnostic criterion. However, they are also observed in other neurodevelopmental disorders. At present, the frequency of Sensory Regulation Disorders in children consulting child psychiatry has never been evaluated, although it seems to be a population at risk.

OBJECTIVES

To evaluate the frequency of sensory regulation disorders in children between 3 and 6 years old who first consult a child psychiatrist in Marseille. To determine whether certain reasons for consultation are correlated with the presence of sensory regulation disorders.

METHODS

A multicenter cross-sectional study was conducted for four months in Marseille. Sensory regulation disorders were assessed by the second version of Dunn's short sensory profile.

RESULTS

Fifty-eight patients were included. A significant difference was found between the frequency of SRT in our primary child psychiatry population and the general population. Subgroup analyses according to the reason for consultation showed that there would be more SRT in the Motor Instability/Inattention, Conduct Disorder and Socialization Disorder subgroups.

CONCLUSION

We observed a higher frequency of SRT in the child psychiatry consultation population. SRT could explain, or at least partly participate in, the children's symptomatology. The results are in favor of an early detection of SRT in the population of children consulting child psychiatry. The evaluation of the sensory profiles of these children allows a better understanding of the child's functioning and an adjustment of the intervention and support strategies proposed to the family.

AI in Child Psychiatry: Exploring Future Tools for the Detection and Management of Mental Disorders in Children and Adolescents

This article explores the potential of artificial intelligence (AI) in the field of child psychiatry, focusing on screening, detection, diagnosis, therapeutic tools, and research development. In this non-exhaustive review, we will examine the interest of AI applications in intervention contexts such as parent education tools, emotion regulation tools, and cognitive-behavioral therapy tools through interactive applications. The network approach, a branch of machine learning, will also be considered. Some examples of machine learning applications in child psychiatry will be presented. Finally, we address the ethical question of the role of these applications, analyzing whether they represent a real beneficial tool or a potential danger.

The Joint Commission on the Mental Health of Children, 1965-1970: Emotional disturbance, race and paths not taken in child psychiatry

The Joint Commission on the Mental Health of Children (JCMHC) was a sprawling, multidisciplinary project that took shape in the years immediately after the assassination of President John F. Kennedy. Participants included child psychiatrists, educators, psychologists, social workers, philanthropists and other laypeople and professionals interested in the plight of children. While the original inspiration for the JCMHC was to address the potential for violence from disturbed children and adolescents, its findings and recommendations were an indictment of American society itself in which poor children went hungry, minority children were oppressed and there were not sufficient resources dedicated to the mental health of the nation's population of young people. The task forces and committees of the JCMHC spent significantly more time addressing prevention and mental health rather than mental illness. Two years into the work of the JCMHC, the leadership formed a committee to specifically examine issues related to race. The final report, published in popular book form as Crisis in Child Mental Health, arrived after the unraveling of the liberal consensus that had fueled President Lyndon Johnson's Great Society programs. Most of the proposed solutions for government intervention were ignored by the Nixon administration. The focus on mental health and the willingness to take a critical look at the detrimental effects of racism had represented child psychiatry at that time. In the decades that followed, however, child psychiatrists turned away from issues about prevention, race and environment and instead focused on the problems of mental illness in individual children.

New Directions in Child Psychiatry: Shaping Neurodevelopmental Trajectories

Historically, the field of child psychiatry has lagged behind the field of general psychiatry in terms of research innovations and the availability of empirically supported treatment modalities. However, over the last two decades there has been increasing interest in and research focused on the developmental origins of mental disorders examining both neurobiological and psychosocial etiologies.1 This has catalyzed the field leading to advances in understanding the developmental psychopathology of mental disorders and the generation of novel early interventions that have shown significant promise.2-4 Further, catalyzing this effort is new data demonstrating the powerful impact of psychosocial forces on neurodevelopment. New methodologies and discoveries in the basic areas of early childhood developmental psychology have led to a greater appreciation for the emotional and cognitive sophistication of children in the first three years of life. Advances in methods to understand preverbal children's emotional and attentional responses (through measures of eye gaze and suck for example) as well as observational methods to glean a variety of mental health relevant behaviors early in life (e.g. behavioral inhibition, pro-social behaviors and social motivation) have further elucidated and validated these capacities. In addition, measures of neural function using electroencephalogram and evoked response potentials (EEG/ERP) and functional magnetic resonance imaging (fMRI) as early as the neonatal period, with many analysis methods developed at WUSTL, have further informed this domain providing new insight into early brain and behavioral relationships as well as how intervention impact brain function.5-7.

DC Mental Health Access in Pediatrics: Evaluating a Child Psychiatry Access Program in Washington, DC

INTRODUCTION

Child psychiatry access programs (CPAPs) provide primary care providers (PCPs) with assistance in mental health diagnosis, management, and resource navigation.

METHOD

Data collected from DC Mental Health Access in Pediatrics (MAP) included PCPs and patient demographics, clinical encounter information, and provider satisfaction.

RESULTS

DC MAP consult volume increased 349.3% over the first 5 years. Services requested included care coordination (85.8%), psychiatric consultation (21.4%), and psychology/social work consultation (9.9%). Of psychiatry-involved consultations, PCPs managed patient medication care with DC MAP support 50.5% of the time. Most (94.1%) PCPs said they would recommend colleagues use DC MAP, and 29.6% reported diverting patients from the emergency departments using DC MAP.

DISCUSSION

DC MAP grew quickly, highlighting program impact and need. Demand for care coordination required flexible staffing and highlighted the need for coordination in pediatrics. Child psychiatry access programs offer an innovative way to enhance PCP management of their patients' mental health needs.

[An ethic of substitution towards an adolescent in psychological suffering]

In the light of our practice with adolescents admitted to child psychiatry, it appears that the most vulnerable among them are distinguished by their failure to request care. In resonance with a psychopathology of the link, the propensity of the professionals to substitute for it is palpable. From a phenomenological reading of the care practice and its ethical dimension, the aim is to try to confront the different components of substitution. The substitutive attitude opens the possibility of a co-creative encounter.

[Child psychiatry in the air of time]

Child psychiatry has undergone major changes over the last few decades, expanding its scope into ever more varied fields. The risk is to divide up the treatment of a single disorder into silos, to the detriment of global care. Indeed, if the diagnostic stage requires expertise, the follow-up must be organized in a global way where somatic problems have their place. The integrative approach makes it possible to respond to the different dimensions of the suffering and to involve the family, and even the social and school environment of the young patient.

[Child psychiatry in pediatric intensive care unit]

A study was conducted in the pediatric intensive care and resuscitation unit of the Nice pediatric hospitals, University Hospital Center Lenval (06) from January to March 2015. Its objective was to describe the events and child psychiatric interventions experienced by young patients. Of the 181 individuals managed during the research, 63 met the inclusion criteria.

Perspectives on addressing bipolar disorder in the obstetric setting

OBJECTIVE

Perinatal Psychiatry Access Programs have emerged to help obstetric professionals meet the needs of perinatal individuals with mental health conditions, including bipolar disorder (BD). We elucidate obstetric professionals' perspectives on barriers and facilitators to managing BD in perinatal patients, and how Access Programs may affect these processes.

METHODS

We conducted three focus groups with obstetric professionals, two with- and one without-exposure to an Access Program, the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms. Focus groups discussed experiences, barriers, facilitators, and solutions to caring for perinatal individuals with BD. Qualitative data were coded and analyzed by two independent coders; emergent themes were examined across exposure groups.

RESULTS

Thirty-one obstetric professionals (7 without-exposure, 24 with-exposure) participated. Identified themes included: (1) gaps in perinatal BD education; (2) challenges in patient assessment; (3) MCPAP for Moms as a facilitator for addressing BD; and (4) importance of continued outreach and destigmaization to increase care collaboration.

CONCLUSIONS

Barriers to obstetric professionals accessing adequate mental healthcare for their patients with BD abound. With psychiatric supports in place, it is possible to build obstetric professionals' capacity to address BD. Perinatal Psychiatry Access Programs can facilitate obstetric professionals bridging these gaps in mental health care.

Nurturing Children's Mental Health Body and Soul: Confronting American Child Psychiatry's Racist Past to Reimagine Its Antiracist Future

This paper unpacks the legacy of racism and white supremacy in American child psychiatry, connecting them to current racist inequities, to reimagine an antiracist future for the profession, and to serve all children's mental health body and soul. History reveals how child psychiatry has neglected and even perpetuated the intergenerational trauma suffered by minoritized children and families. By refusing to confront racial injustice, it has centered on white children's protection and deleted their role in white supremacist violence. An antiracist future for the profession demands a profound historical reckoning and comprehensive reimagining, a process that this paper begins to unfold.

[Touch-Massage® care in support of the helping relationship in child psychiatry]

Providing touch-massage care to children in child psychiatry is a process that requires specific learning and a certain psychological and emotional availability. In this context, clinical training in nursing provides tools and resources for the caregiver. This type of care consolidates the relationship of trust and lays the foundations of the helping relationship. The bodily approach allows to approach the awareness of the emotions and to bring appeasement.

Adults with Autism Spectrum Disorders, from Child Psychiatry Departments to Forensic Psychiatry Units: An Embarrassing Trajectory?

N/a.

Comparison of Use of the Massachusetts Child Psychiatry Access Program and Patient Characteristics Before vs During the COVID-19 Pandemic

This cross-sectional study compares the number of encounters at the Massachusetts Child Psychiatry Access Program, patient characteristics, and mental health diagnoses before vs during the COVID-19 pandemic.

[Time to collaborate? Experiences of paediatricians cooperating with child and adolescent psychiatry]

BACKGROUND

Pediatricians and child and adolescent psychiatrists share patient populations. However, the availability of child and adolescent psychiatric care in Dutch hospitals is often limited.

AIM

To inventorize the experiences and wishes of Dutch pediatricians with regard to collaboration between pediatrics and child and adolescent psychiatry, especially in the St. Antonius Hospital where consultation has been started.

METHOD

Online survey among pediatricians in 16 hospitals in the Netherlands and qualitative interviews with pediatricians and medical psychologists in the St. Antonius Hospital.

RESULTS

Interview attendees experienced obstacles in waiting lists, organization of care, and limited options for immediate consultation. The majority experienced that child and adolescent psychiatric care was insufficient in their hospitals.

CONCLUSION

Extending consultative collaboration could improve the care for children and reduce some of the obstacles experienced by the participants of this study. Consultation contributes to quality of care in hospitals and encourages collaboration.

Respect for Persons in the Psychiatric Treatment of Children and Adolescents

Child and adolescent psychiatry involves simultaneously balancing duties to various vulnerable parties. Balancing autonomy and protection for adolescents is complex; state laws governing these situations often add confusion. Common prescribing patterns in child psychiatry lack robust evidence, and utilization of stimulants, atypical antipsychotics, and polypharmacy has skyrocketed. Significant concerns about distributive justice arise from alarming patterns in psychiatric treatment of vulnerable populations, like those affected by poverty, racism, adverse childhood experiences, and certain legal statuses. Principles of justice and respect for persons support the need for safe, adequate, and appropriate psychiatric treatment, including psychosocial interventions and resources, for all children.

Making the Right Call: CPAN Helps Physicians Improve Behavioral Health

IN THE 19 MONTHS since the Texas Child Psychiatry Access Network (CPAN) has been up and running, it's kept any number of minor problems from becoming major ones.

Video Intervention Therapy for primary caregivers in a child psychiatry unit: a randomized feasibility trial

BACKGROUND

During child psychiatry hospitalization, working with the families or attachment figures is a challenge, most of the children who are admitted to these units come from multi-problem families, with limited research in this area. Video feedback (VF) interventions have proved to be a powerful resource to promote parental and child well-being in small children and has been used with parents with a psychiatric condition. Parental Reflective Functioning (PRF) is one of the parental abilities that can be improved with VF and could be especially important in coping with conflict and negative emotions in older children. The aim of this study is to implement Video Intervention Therapy (VIT) to enhance PRF in primary caregivers of inpatient psychiatric children. As there is no published research using VF with parents of children with severe psychopathology in a hospitalized context. This report, then, becomes a much needed pilot study providing evidence for a larger randomized control trial (RCT).

METHODS

The study is a single-center, two-arm feasibility randomized control trial with a qualitative component. Block randomization was done to generate a 2:1 allocation, leaving more participants in the intervention group. The intervention comprises four modules; every module has both one video-recorded play session and one VIT session (in a group setting) per week. Evaluation of the caregivers included assessments of PRF and well-being, and child assessment included parent-ratings and clinician-ratings of symptomatology and general functioning.

RESULTS

Thirty participants were randomized; eligibility and recruitment rate were 70.6% and 83.3%, respectively. The compliance-to-intervention rate was 85% in the VIT group and 90% in the control group. All participants completed entry evaluation and 90% at the 3-month follow-up. The intervention was acceptable to participants and feasible for therapists to deliver. Outcome data must be treated with caution due to the small numbers involved, yet indicate that the VIT may have a positive effect in improving parental and child mental health outcomes.

CONCLUSIONS

VIT for primary caregivers of child inpatient children was feasible to deliver and acceptable for participants, therapist, and the staff unit involved; there is sufficient evidence to undertake a full-scale effectiveness RCT.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03374904 . Registered on 14 December 2017.

Crisis Presentations of Children and Adolescents with Neurodevelopmental Disorders

Aim To inform the development of a care pathway for children and adolescents with neurodevelopmental disorders presenting to Children's Health Ireland (CHI) at Tallaght Emergency Department. Methods A retrospective study of cases with a neurodevelopmental disorder diagnosis (Autism Spectrum Disorder and/or Mild to Profound Intellectual Disability) presenting to the hospital Child Psychiatry services over a six-year period (Jan 2014 - December 2019). Results 72 patients identified, Autism Spectrum Disorder diagnosis most common (N=67, 93%). Nearly half of cases presenting with risk concerns (N= 35, 49%), same day hospital discharge (N = 53, 74%) and inpatient admission (N=19, 29%). Discussion Access to relevant community disability supports is significantly limited in Ireland with a resultant increase in carer stress and crisis presentations to the emergency department for psychosocial and disability related reasons.

[The evolution of child psychiatry emergencies: Results and reflections from a Nancy University Hospital study]

INTRODUCTION

Mental illness is one of the most common causes of disability, morbidity and mortality in childhood. According to the scientific literature, the prevalence of mental health disorders is an estimated 10% to 20% in the USA and similar results are found in France. Although primordial, outpatient care often appears insufficient with inequalities in its geographical distribution and its accessibility. These past decades have been marked by an increase in consultations for mental disorders in pediatric emergency departments. Is this trend indicative of a "defect" in the healthcare organization? Identifying the root causes of this inflation in psychiatric consultations seems of paramount importance in the improvement of healthcare policies. In France and worldwide, only a few studies deal with this subject. That is why we proposed to observe the evolution of the number of consultations for mental health reasons in the pediatric emergency department of Nancy University Hospital and to detail their characteristics.

MATERIALS AND METHODS

Ancillary comparative and retrospective study (2003-2013) on minors having received a child psychiatry consultation within the pediatric emergency department of Nancy University Hospital.

RESULTS

The number of consultations for mental health reasons increased by 119% (97 in 2003; 212 in 2013), while consultations for pediatrics reasons remained stable over the period studied. Consultations mainly dealt with females representing 55.6% of consultations in 2003 and 63.7% in 2013. Mean age of consultants was stable: 13.9 years (standard deviation=3.3 years) in 2003; 14.1 (2.5) years in 2013. Family structure witnessed a three-fold increase in the single-parent model. Regarding consultation motives, behavioral disorders were significantly more represented in 2013: 27.7% (RR=1.7; 95% CI 1.0-2.8; P<0.05) versus 16.5%. As far as diagnosis is concerned (ICD-10), emotional and behavioral disorders increased to 35.9% from 12.6% (RR=2.8; IC95% 1.6-5.1; P=0.0001).

CONCLUSIONS

In France, as well as in other western countries, the number of visits in pediatric emergency departments for mental health reasons more than doubled over a 10-year span. This growth mostly concerned externalizing disorders as a motive for consultation. Causes for this increase are multifactorial and closely related to the prevalence of psychiatric disorders in children. Some studies showed that economic factors played a major role on mental illness during such a downturn as the financial crisis of 2007-2008. Unemployment caused by economic crises can weaken pediatric caregivers and therefore their patients. Evolution of family structure and value also explains this trend. These past decades, the two-parent model, relevant till the 1960s, has evolved to a point where single parents are more quickly overwhelmed. Family values are now focused on consensus rather than duty and hedonism has become a central value. Women are more involved in the working world which became for all a performance field. Several studies have shown that social settings where competitiveness is the norm breed externalized disorders in children by advocating short-term efficiency. Moreover, the widespread use of screens in households as well as early exposure impact the psychomotor development, decrease the amount of sleep and may be responsible for the occurrence of many psychiatric disorders. There are some epidemiological reasons too. In 1971, Omran introduced a concept called "epidemiological transition" explaining how mental health issues appeared in the limelight through to the decline of infectious and cardiovascular diseases. This phenomenon has already occurred in western countries which could explain the increase in the prevalence of psychiatric disorders. In Africa, there is evidence it may have already started. Beyond all these considerations, the increase in consultations for mental disorders in pediatric emergency departments can be explained by a change in care consumption habits. Going straight to the local emergency department, accessible on a 24/7 basis, is easier than waiting for an outpatient appointment and is also free for the have-nots lacking proper insurance coverage. Scarce resources in ambulatory care may also explain the increased recourse to emergency services. Several reports have shown a lack of child psychiatrists and their uneven geographical distribution. For example, in the US only a third of children with mental disorders receive proper care, a lack which doubled between 1997 and 2010. Despite the reason for this trend, it is important to propose a better fitting of the healthcare system to the population needs, and to improve prevention and early identification. All these changes require further collective reflection.

[Telemental health service in child and adolescent psychiatry]

INTRODUCTION

Even though mental disorders present significant health burden worldwide, most patients with mental disorders do not receive adequate healthcare. The possibility of telemental health service came into prominence in Hungary due to the restriciton of face-to-face doctor-patient meetings. The present review, based on the last 20 years' scientific literature, aims to summarize the feasability, efficacy and effectivity of telemedicine services in child and adolescent psychiatry.

METHOD

A review by Gloff et al (17) summarized telepsychiatry service in children and adolescents before 2015. A literature search was generated in order to summarize current knowledge based on 3 international databases (Pubmed, Cochrane Database of Systematic Reviews és Web of Science) for scientific publi - cations after 2015. Search words were telemental health, children, adolescent, and telepsychiatry.

RESULTS

International literature showed similar feasability, efficacy and effectivity of evidence based diagnostic and therapeutic methods in tele- child and adolescent psychiatry as in face-to-face services.

CONCLUSION

The application of telemedicine in child and adolescent psychiatry is internationally accepted, feasible and effective. Its widespread use in Hungary would require a professional protocol which specifies the conditions and advices of telemental health services in this age group.

Content, diagnostic, correlational, and genetic similarities between common measures of childhood aggressive behaviors and related psychiatric traits

BACKGROUND

Given the role of childhood aggressive behavior (AGG) in everyday child development, precise and accurate measurement is critical in clinical practice and research. This study aims to quantify agreement among widely used measures of childhood AGG regarding item content, clinical concordance, correlation, and underlying genetic construct.

METHODS

We analyzed data from 1254 Dutch twin pairs (age 8-10 years, 51.1% boys) from a general population sample for whom both parents completed the A-TAC, CBCL, and SDQ at the same occasion.

RESULTS

There was substantial variation in item content among AGG measures, ranging from .00 (i.e., mutually exclusive) to .50 (moderate agreement). Clinical concordance (i.e., do the same children score above a clinical threshold among AGG measures) was very weak to moderate with estimates ranging between .01 and .43 for mother-reports and between .12 and .42 for father-reports. Correlations among scales were weak to strong, ranging from .32 to .70 for mother-reports and from .32 to .64 for father-reports. We found weak to very strong genetic correlations among the measures, with estimates between .65 and .84 for mother-reports and between .30 and .87 for father-reports.

CONCLUSIONS

Our results demonstrated that degree of agreement between measures of AGG depends on the type (i.e., item content, clinical concordance, correlation, genetic correlation) of agreement considered. Because agreement was higher for correlations compared to clinical concordance (i.e., above or below a clinical cutoff), we propose the use of continuous scores to assess AGG, especially for combining data with different measures. Although item content can be different and agreement among observed measures may not be high, the genetic correlations indicate that the underlying genetic liability for childhood AGG is consistent across measures.

[Merycism : when humain being starts ruminating]

Merycism is a rare and little-known functional gastrointestinal disorder. Indeed, the diagnosis is made, on average, with a delay of 21 to 77 months. This delay can lead to dramatic consequences for the patient such as significant weight loss, ionic imbalance and social isolation. Through a clinical situation, we evoke the difficulties and the particularities of the diagnosis of merycism as well as its management, in a situation evoking a disorder of the eating habits. This pathology can be found in various specialties such as general medicine, pediatrics, gastroenterology, endocrinology, dentistry, child psychiatry, psychiatry, neonatology services or maternity.

Use It or Lose It: Texas' New Behavioral Health Program Can Help Only If Physicians Use It

What if Texas lawmakers created a mental health service that physicians asked for but then not many physicians used it? So far, that is what's happening with the Child Psychiatric Access Network (CPAN), which gives pediatricians and family physicians across Texas free telemedicine-based consultation and training on community psychiatry.