The overview of the use of lithium in children and adolescents
Lithium has been used as a mood stabilizer to treat patients with bipolar disorder (BD) for many decades. Historically, there was little information available on the use of lithium in the pediatric population. The trials conducted over the past 15 years have provided rigorous data regarding the efficacy and safety of lithium in children and adolescents suffering from BD. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Ekaterina Stepanova, Robert L. Findling Tags: Clinical Perspectives 19 Source Type: research

18.4 the clinical complexities involved in diagnosing gender dysphoria in transitional-age youth (tay) with asd
Given the much-debated link between gender dysphoria (GD) and ASD, a case is presented to illustrate the potential clinical challenges and diagnostic complexities involved in patients who present with both gender issues and ASD, particularly in young adulthood. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: J. Corey A. Williams Source Type: research

18.3 a search for belonging: asd and engendering identity
The objective of this presentation is to illustrate the complexities of identity consolidation, including gender identity, in a 16-year-old boy with mild ASD and OCD, and the associated challenges for clinical management. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Peter T. Daniolos Source Type: research

18.2 social injustices and current affairs: the influence on gender identity development in youth with asd
The objective of this presentation is to illustrate the complexity of diagnosis and treatment planning in early adolescent youth presenting with gender dysphoria and co-occurring ASD. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Brandon S. Ito Source Type: research

18.1 dimensions of development in transitional-age youth (tay) with asd
The objective of this presentation is to describe multiple dimensions of development in individuals with ASD through adolescence and young adulthood. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Gerrit Ian Van Schalkwyk Tags: Clinical Perspectives 18 Source Type: research

19.1 fundamental first studies regarding the use of lithium in bipolar disorder
Lithium has been used for medical use since the 1840s in treatment of “brain gout.” It was first prescribed for mania in 1871 by William Hammond. It is one of the oldest psychotropic medications still used to treat patients with bipolar disorder. The purpose of this talk is to provide an overview of the use of lithium in children and adolescents with bipolar disor der, with the focus on a larger trial involving the comparison of lithium and divalproex (LvD). (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Amanda Sun, Ekaterina Stepanova Tags: Clinical Perspectives 19 Source Type: research

19.2 the collaborative lithium trials
Lithium has been known to be a safe and effective treatment for bipolar disorder in adults. However, there was little research regarding the use of lithium in youth with bipolar disorder. The Collaborative Lithium Trials (CoLT) is a series of multisite studies examining the safety and efficacy of lithium for the treatment of bipolar disorder in youth. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Maria Levine Tags: Clinical Perspectives 19 Source Type: research

Transforming traumatic impacts for lgbtq youth
LGBTQ youth experience significantly greater rates of family rejection, societal prejudice, and various traumas, and they have significantly greater risk for developing MDD, suicidality, and/or PTSD than their straight peers. This Symposium describes trauma-related behavioral health disparities of LGBTQ youth and 3 effective interventions to address related negative mental health outcomes in LGBTQ youth. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Judith A. Cohen, Scott Leibowitz Tags: Clinical Perspectives 20 Source Type: research

19.3 treatment of early age mania (team)
Lithium is one of the oldest treatments for bipolar disorder and was recently studied as part of the Treatment of Early Age Mania (TEAM) study in a head-to-head comparison with divalproex sodium and risperidone. This presentation will examine the outcomes for youth assigned to lithium in the initial 8-week trial. We will also examine youth switched to lithium after failing another treatment or partial responders who received lithium as an add-on (combination) treatment with one of the other 2 agents. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Adelaide Robb Tags: Clinical Perspectives 19 Source Type: research

20.2 trauma-focused cognitive-behavioral therapy (tf-cbt) for lgbtq youth
LGBTQ youth experience elevated rates of trauma and PTSD. This presentation describes modifications to an evidence-based trauma treatment, trauma-focused CBT (TF-CBT) for LGBTQ youth, and pilot outcomes of a quality improvement project to implement these modifications for LGBTQ youth with PTSD symptoms. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Judith A. Cohen Tags: Clinical Perspectives 20 Source Type: research

20.1 the family acceptance project's model for lgbtq youth
Historically, families were not included in interventions to decrease risk for LGBTQ youth. The Family Acceptance Project (FAP) was founded to study LGBTQ youth and families and to develop an evidence-grounded family support model to decrease family-rejecting behaviors and increase family-supportive and -accepting behaviors to reduce behavioral health disparities and increase connectedness. Family rejection is traumatic and must be addressed directly to reduce risk. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Caitlin Ryan Tags: Clinical Perspectives 20 Source Type: research

21.2 family therapy for treatment of conversion and somatic symptom disorders in the inpatient setting
The aim of this presentation is to describe how family therapy can be incorporated into the integrated care treatment model for children with conversion disorder (CD) and/or somatic symptom disorder (SSD) who are admitted to an inpatient program. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Daniel Spencer Tags: Clinical Perspectives 21 Source Type: research

21.1 integrating family therapy into the pediatric inpatient medical setting
This presentation will provide a framework for the integration of family therapy into the care of children and adolescents with conversion and somatic symptom disorders while in the inpatient pediatric setting. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Scott Shaffer Tags: Clinical Perspectives 21 Source Type: research

It ’s all relative: integrating family therapy into the treatment of somatic symptom and related disorders
Somatic symptoms in children exist within the context of family systems, and successful treatment often depends on creating change within these systems through family therapy. This Clinical Perspectives focuses on incorporating family therapy into the treatment of patients with somatic symptom and related disorders. Participants will be introduced to programs across levels of care that have successfully integrated family therapy into the treatment of these challenging patients. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Nora C. Oberfield, Lisa Hutchison, Lisa Hutchison Tags: Clinical Perspectives 21 Source Type: research

20.4 behavioral health disparities in lgbtq youth
Many child and adolescent psychiatrists are aware of studies suggesting that LGBTQ youth have significantly increased risk for adverse mental health outcomes relative to their heterosexual, cisgender peers. Such awareness represents a good starting point when working with LGBTQ and gender-diverse youth, but child and adolescent psychiatrists often receive little training in methods or approaches specific to helping these youth. In addition to the same types of trauma experienced by other youth, LGBTQ youth are at elevated risk for traumas related to their sexual orientation and/or gender identity, with differing levels of ...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Nathalie Szilagyi Tags: Clinical Perspectives 20 Source Type: research

20.3 group cbt resilience skills training for lgbtq youth
Existing studies demonstrate significantly increased rates of suicidal thoughts, suicide attempts, and depression, in addition to high rates of risk behaviors and maladaptive coping among LGBTQ youth. Strength-based interventions that promote resilience and improve mental health in these higher-risk minority populations are quite limited. Investigators developed a manualized CBT-based resilience class (RC) to teach emotional regulation and adaptive coping to depressed LGBTQ teenagers aged 12 –17 years. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Natalie Ramos Tags: Clinical Perspectives 20 Source Type: research

21.4 a model to prioritize family therapy in the treatment of conversion disorder in the outpatient clinic
The goal of this session is to provide an outpatient care model for treating patients with somatic symptom and conversion disorders, integrating family therapy as a key touchstone within a comprehensive multimodal treatment approach. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Xiaoyi “Sherry” Yao Tags: Clinical Perspectives 21 Source Type: research

21.3 family therapy in the partial hospital setting for the treatment of conversion disorder
The goal of this session is to describe the role of and approach to family therapy in the treatment of conversion disorder (CD) and somatic symptom disorder (SSD) in children and adolescents in a multidisciplinary, family-based partial hospital program. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Jamie Gainor DiPietro Tags: Clinical Perspectives 21 Source Type: research

Meeting children “where they are at”: models for the 21st century school-based mental health clinic
Estimates in the United States suggest that 49 percent of children have an unmet mental health need, with disadvantaged children disproportionately affected. Constraints on child mental health (CMH) services are occurring at a time of escalating concerns for youth substance abuse, suicide, and violence. In the United States, the majority of minors attend public school; this positions the school as an ideal site for CMH service provision. Additionally, Burns ’ 1995 landmark finding that the school in the United States is 70–80 percent of students’ only source of CMH treatment supports the placement of clin...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Shirley Alleyne, Matthew G. Biel, Shashank V. Joshi Tags: Clinical Perspectives 22 Source Type: research

22.1 project aware in nevada: advancing wellness and resiliency in education
After the 2012 tragedy at Sandy Hook Elementary School in Connecticut, President Obama allocated $55 million dollars to fund Project AWARE ( “Advancing Wellness and Resiliency in Education”). Twenty states, including Nevada, were awarded this 5-year SAMHSA grant. Each Project AWARE state chose 3 pilot school districts to develop demonstration programs that: 1) increase awareness of mental health issues among school-age youth; 2) trai n school personnel to detect and respond to mental health issues in youth; and 3) connect youth with mental health issues to appropriate services. (Source: Journal of the American ...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Erika Ryst Tags: Clinical Perspectives 22 Source Type: research

22.2 bridging access to care through school clinics
In 2019, the outlook for child and adolescent mental health services is disconcerting because of mental health facility closures and fewer hospital beds. Nationally, minority populations are overrepresented, with higher rates of mental disorders and more barriers to accessing care. Immigrant students experience anxiety with government decrees that threaten the stability of their home and family, compounding concerns for increasing suicide and self-harm. Strengthening of schools ’ mental health resource capacity improves identification, assessments, treatments, and outcomes for youth and their families. (Source: Journ...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Nancy Beyer Tags: Clinical Perspectives 22 Source Type: research

22.3 encouraging developments in educational settings with child psychiatrists
As mental health demands continue to rise, child and adolescent psychiatrists are challenged with the task of finding more efficient solutions that cultivate access and treatment, leading to unique venues of practice. One of the most effective solutions is school-based clinics. Child and adolescent psychiatrists in Denver School-Based Clinics (DSBCs) provide comprehensive mental health treatment to inner-city youth while collaborating with school systems to improve academic functioning for all students. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Kristie Ladegard Tags: Clinical Perspectives 22 Source Type: research

22.4 trading places for a better outcome: a mobile school-based mental health clinic
Early identification and treatment of mental illness has been shown to improve health and academic performance. Attrition rates in clinics for children with behavioral problems range from 35 percent to 75 percent. In 2016, the University of Florida, College of Medicine, Jacksonville ’s (UFJAX) Department of Psychiatry launched its School Psychiatry Program (UFSPP) in Duval County’s Pride Academy Schools (PAS). These schools service children with the most severe behavioral problems in the county. This presentation will describe the UFSPP, compare attendance and parent satisf action data to outpatient child psych...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Shirley Alleyne Tags: Clinical Perspectives 22 Source Type: research

Outpatient care that works better: novel methods of improving access, efficiency, and provider satisfaction
Physician burnout is a well-established problem as are its polyfactorial causes, including shortages of physicians and nurses, excess clerical tasks and regulatory requirements, electronic medical records, and patient access challenges. In primary care settings, new practice models have arisen to address these issues successfully, such as the team model in which patient care responsibility is distributed over an interdisciplinary team, including nurses, scribes, social workers, and others. Compared with usual care, this model allows physicians to provide high-quality care to a larger but manageable panel size within reason...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Nadine Schwartz, David Axelson Tags: Clinical Perspectives 23 Source Type: research

23.2 working with medical scribes, medical assistants, and registered nurses to improve outpatient clinic workflow and support physician wellness
A lecture presentation will be used to present issues related to physician burnout, specific to electronic medical record (EMR) documentation burden, and inefficiencies in clinical workflow. Since the implementation of the EMR, physicians spend more time on documentation and EMR-prompted tasks. The EMR has contributed to decreased efficiency during the patient visit and lengthier work hours to complete required documentation, both of which contribute to physician work dissatisfaction and burnout. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Amy Kim Tags: Clinical Perspectives 23 Source Type: research

23.1 utilization of 1-to-1 registered nurses: providers in a multi-site outpatient child psychiatry clinic
The demand for child and adolescent psychiatrist services far outweighs the supply of clinicians to meet it nationally. This dilemma requires systems and practices to adopt new approaches. Sharing the care responsibilities with a team can enable a physician or other advanced practice provider to manage more patients as effectively or more effectively in the same or less time. Research in practice transformation has identified numerous facilitators and barriers but has not yet distilled these into clear instructions to guide the way. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Nadine Schwartz Tags: Clinical Perspectives 23 Source Type: research

23.3 nurse practitioner leadership in a multidisciplinary outpatient clinic
We describe an integrated pediatric evaluation center in which a nurse practitioner has a key role to increase access to timely mental health care. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Alison Manning, Gary Maslow, Brenda Poirier, Kristen Stefureac, Nicole Heilbron Tags: Clinical Perspectives 23 Source Type: research

23.4 a registered nurse-centered collaborative care model for adolescents with depression in primary care achieves the “quadruple aim”
We describe a collaborative care intervention for adolescent depression embedded in a busy primary care practice. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Sandra Rackley Tags: Clinical Perspectives 23 Source Type: research

Outpatient management of irritability, impulsive aggression, and other severe behaviors in youth with asd
Individuals with ASD, intellectual disabilities, and neurodevelopmental syndromes comprise a complex group with unique needs. They face significant stressors while having limited coping abilities and tolerance for change. Maladaptive behaviors, including self-injurious behavior (SIB) and impulsive aggression, can impair daily functioning, cause stress to the caregivers and treatment team, and occasionally necessitate emergency mental health treatment. This presentation is designed to provide clinicians with current knowledge on the management of these patients, including specific therapies and overall strategies for develo...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Alice R. Mao, Ashok P. Yerramsetti, Bryan H. King Tags: Clinical Perspectives 24 Source Type: research

24.1 outpatient management of acute agitation, irritability, and impulsive aggression in asd
The objective of this presentation is to provide child and adolescent psychiatrists treating youth with ASD in outpatient settings with information on ways to prevent and manage acute agitation, irritability, and impulsive aggression. Despite precautions to help transition youth with ASD safely into the outpatient clinic, they can become aggressive, agitated, and violent in the unfamiliar clinic environment. This can pose a danger to the child, family, and clinic staff. Moreover, aggression is associated with negative outcomes for children with ASD and their caregivers, including decreased quality of life, increased stress...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Alice R. Mao Tags: Clinical Perspectives 24 Source Type: research

24.2 evaluation and management of self-injurious behavior in asd
Self-injurious behavior (SIB) in ASD is among the most difficult behaviors to manage. It occurs across a variety of comorbid diagnoses and genetic syndromes associated with ASD. The phenomenology of SIB for each individual can be remarkably stable and chronic. A functional behavioral analysis of symptoms is essential, because sensory needs, communication abilities, social drive, and environmental circumstances are key to understanding the predisposing, precipitating and perpetuating factors that are necessary to develop a case formulation and intervention plan. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Janice L. Forster Tags: Clinical Perspectives 24 Source Type: research

24.3 anxiety presentations in youth with asd
Current data indicate that approximately 40 percent of children and adolescents with ASD will experience an anxiety disorder, and that anxiety has a profound impact on daily functioning in children. Presentations of anxiety in ASD can vary from mild to severe, with severe presentations resulting in severe consequences such as aggression, self-injurious behaviors, school refusal, and suicidal ideation. Managing anxiety requires a thoughtful approach that considers the overlapping symptoms between anxiety and other co-occurring conditions, the developmental level of the child, the availability of specialized psychotherapy pr...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Roma A. Vasa Tags: Clinical Perspectives 24 Source Type: research

24.4 novel therapeutic options in asd
As the evidence base for pharmacologic intervention for ASD evolves, providers and caretakers are looking to novel therapeutic interventions. Although we do not fully understand the long-term implications of these interventions, they present a source of hope, particularly for youth with ASD who have not responded to other treatments. In this review, current emerging options of cannabidiol (CBD) oil, oxytocin, and repetitive transcranial magnetic stimulation (rTMS) for the treatment of ASD in children and adolescents are reviewed, with a focus on potential benefits and risks. (Source: Journal of the American Academy of Chil...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Jessica C. Sheu Tags: Clinical Perspectives 24 Source Type: research

25.4 applying systems of care principles to case formulation as a tool to support deprescribing efforts in foster care youth
Youth in the child welfare system are particularly vulnerable to inappropriate psychotropic medication regimes that include polypharmacy. It can be very difficult to take away psychotropic medications in a population that struggles with care fragmentation and instability. However, using a system-of-care approach to working with this population can aid in deprescribing efforts in clinical practice. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Wynne S. Morgan Tags: Clinical Perspectives 25 Source Type: research

25.3 considering providers ’ attitudes to guide deprescribing
This session will describe provider attitudes and beliefs associated with polypharmacy that need to be engaged in order to guide successful deprescribing efforts. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: William David Lohr Tags: Clinical Perspectives 25 Source Type: research

25.2 polypharmacy practice patterns: pharmacologic history supports the call for  deprescribing research
This presentation aims to characterize knowledge from concomitant pediatric psychotropic use (polypharmacy) trends as the foundation of evidence supporting the call for research on deprescribing protocols. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Julie M. Zito Tags: Clinical Perspectives 25 Source Type: research

25.1 deprescribing: what every child and adolescent psychiatrist should know
The goal of this session is to educate child and adolescent psychiatrists about deprescribing and to provide guidance on applying this principle in the clinical practice of child and adolescent psychiatry. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Megan Baker Tags: Clinical Perspectives 25 Source Type: research

When the meds aren't working: rethinking medication regimes for youth with a focus on deprescribing
This program provides an understanding of the causes of polypharmacy, how deprescribing efforts can be applied to child and adolescent psychiatry, and strategies for improving the rational use of medications, with an emphasis on the child-serving systems and a system-of-care (SOC) approach that serve our most vulnerable youth. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: William David Lohr, W. Peter Metz Tags: Clinical Perspectives 25 Source Type: research

24.5 the other patients: caregiver and clinician stress in treating asd
Youth with ASDs and severe psychopathology present unique challenges. Caregivers must expend significant time and resources on their daily care and treatment, often at great personal cost. This can cause the caregiver anxiety, deplete finances, and strain family relationships. There is a well-documented association with negative outcomes on disease course for youth with ASD, and with negative consequences for the families. This includes increased rates of mental illness (primarily depression and anxiety) in parents, other caretakers, and siblings. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Ashok P. Yerramsetti Tags: Clinical Perspectives 24 Source Type: research

Diagnosing bipolar disorder: where have we come from and where are we going
In spite of the changes to the DSM-5, including the addition of DMDD and further refining the classification of bipolar disorder, clinicians still struggle with how to best diagnose bipolar disorder in children and adolescents. We will review the history of diagnosing bipolar disorder in children and adolescents from the past 3 decades and present recent advances in assessment and differentiation from mood dysregulation from the perspectives of neuroscience, clinician decision making, and evidence-based assessment. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Cathryn A. Galanter, Boris Birmaher Tags: Clinical Perspectives 26 Source Type: research

26.1 historical perspective: bipolar disorder, temper tantrums, and dmdd
Cathryn Galanter, MD, will review the literature examining the increased diagnosis of pediatric bipolar disorder (BD), its overdiagnosis, and the eventual revisions to DSM-5. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Cathryn A. Galanter Tags: Clinical Perspectives 26 Source Type: research

26.2 discriminating between bipolar disorder and severe, chronic irritability using neuroscience
A major contributor to the conflation of mood dysregulation with pediatric bipolar disorder was the hypothesis that a type of mood dysregulation —nonepisodic, severe irritability in the context of hyperactivity—is a developmental phenotype for bipolar disorder. Testing this hypothesis required the development of an experimental clinical diagnosis representing this hypothetical developmental expression of bipolar disorder, severe mood dys regulation (SMD). Once established, investigations tested the discriminant validity between SMD and youth who have had a clear episode of mania (narrow phenotype pediatric bipo...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Joel Stoddard Tags: Clinical Perspectives 26 Source Type: research

26.3 clinician decision-making and expert ratings of pediatric bipolar disorder vignettes
Over recent decades, there has been an increase in the rates of bipolar disorder (BD) in children and adolescents. The increase was likely attributed to both better recognition and identification of BD, as well as overdiagnosis. Diagnostic conceptualization can be affected by heuristics and biases in clinical decision making. Interrater reliability in clinical practice using routine clinical procedures, compared with diagnostic interviews and rating scales, is understudied and often poor. A review of the diagnosis and challenges associated with symptom recognition and conceptualization of BD will be provided, along with th...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Jarrod M. Leffler, ABPP Tags: Clinical Perspectives 26 Source Type: research

26.4 evidence-based assessment and cognitive debiasing strategies can improve our clinical decisions
Innovations take time to diffuse through practice communities. The past 2 decades have included large volumes of research about evidence-based assessment (EBA), cognitive debiasing, and bipolar disorder. There are now fast, free methods with research validation that could help evaluate cases and improve detection of bipolar disorder while simultaneously protecting against overdiagnosis in cases with similar presentations because of more common etiologies. These EBA and debiasing techniques do not achieve their potential to help families without effective dissemination and implementation support. (Source: Journal of the Ame...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Eric Youngstrom Tags: Clinical Perspectives 26 Source Type: research

Improving emergency care for youth at risk for suicide
The goal of this Clinical Perspectives is to discuss innovations in suicide prevention in the emergency department (ED) and strategies for improving emergency care for youth with suicidal thoughts and behaviors. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Gary Maslow, Adrienne B. Inscoe, Donald T. Ellis Tags: Clinical Perspectives 27 Source Type: research

27.1 predicting 3-month risk for adolescent suicide attempts among pediatric emergency department patients in the ed-stars study
The adolescent suicide rate is rising in the United States, yet we have limited knowledge about the short-term prediction of suicide attempts, which is critical in the emergency department (ED) setting. Our aim was to determine predictors of attempts within 3 months of an ED visit in the full sample group and in subsample groups defined by sex and absence of recent suicidal thoughts. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Cheryl King Tags: Clinical Perspectives 27 Source Type: research

27.2 family intervention for suicide prevention
The emergency department (ED) increasingly is used to address pediatric mental health needs and, therefore, represents a critical window of intervention. Many youth with suicidal ideation who are treated in the ED, however, do not receive the appropriate follow-up care. This Clinical Perspectives provides clinicians with an overview of the Family Intervention for Suicide Prevention (FISP), a family-and youth-centered cognitive-behavioral intervention designed to provide a behavioral assessment of risk, increase safety, and promote continuity of care after discharge from the ED. (Source: Journal of the American Academy of C...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Adrienne B. Inscoe Tags: Clinical Perspectives 27 Source Type: research

27.3 enhancing psychiatric care in the emergency department: a children's comprehensive psychiatric emergency program
There has been a dramatic increase in pediatric patients presenting to emergency departments (EDs) for mental health crises, including suicidal ideation and attempts. These youths are often seen in medical EDs or in adult mental health EDs and frequently are not seen by child and adolescent psychiatrists across the United States. The goal of this presentation is to offer clinicians an example of a Children ’s Comprehensive Psychiatric Emergency Program (CCPEP) and to highlight the particular benefits that this program can offer. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Shilpa Agraharkar Tags: Clinical Perspectives 27 Source Type: research

27.4 promoting access to care after emergency department discharge: outcomes from an integrated pediatric mental health outpatient clinic
Research has shown a significant increase in the number of youth presenting to the emergency department (ED) for concerns related to suicidal behavior. Suicide risk particularly is elevated in the period immediately after ED discharge; therefore, strategies that promote rapid access to outpatient follow-up care are needed. (Source: Journal of the American Academy of Child and Adolescent Psychiatry)
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Gary Maslow Tags: Clinical Perspectives 27 Source Type: research

Positive psychiatry and positive psychology: translation to clinical practice
Child and adolescent mental health clinicians generally practice in a framework that emphasizes identification and treatment of mental illness toward a goal of symptom reduction. However, this method of treatment neglects the substantial and growing literature that demonstrates the benefits of positive psychosocial factors not only in alleviating suffering but also in building resilience and beyond, cultivating flourishing. Additionally, engagement in mental health care often is hampered by stigma associated with diagnoses; this stigma may be reduced through focusing on building character strengths and seeking to thrive ra...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - October 1, 2019 Category: Psychiatry Authors: Andrew Rosenfeld, Rama Rao Gogineni Tags: Clinical Perspectives 28 Source Type: research