Jess P. Shatkin

Parasomnias and Movement Disorders in Children and Adolescents

Childhood parasomnias and movement disorders arise from a variety of etiologic factors. For some children, psychopathology plays a causal role in sleep disorders; in other cases, recurrent parasomnia episodes induce psychopathology. Current research reveals complex interconnections between sleep and mental health. As such, it is important that clinicians consider the impact psychiatric disorders have on childhood parasomnias. This article describes common parasomnias and movement disorders in children and adolescents, with emphasis on psychologic and behavioral comorbidities.

Mentoring in Psychiatric Residency Programs: A Survey of Chief Residents

ObjectiveMentorship is an important component of graduate education. This study assessed the perceptions of general psychiatry chief residents regarding the adequacy of mentorship provided during training.MethodsThe authors surveyed 229 chief residents participating in the APA National Chief Residents Leadership Program in 2004 and 2005. The survey assessed domains such as work hours, didactics, home and family life, and mentorship.ResultsOf the chief psychiatric residents surveyed, 49% reported that they did not have a clearly defined career development mentor, and 39% reported that they did not feel adequately mentored. Gender, race/ethnicity, marital status, moonlighting, medical school (American versus international), and type of residency program (academic versus community based) did not show significant association with either “having a clearly defined mentor” or “feeling adequately mentored,” based on chisquared tests for independence. Chief residents who had authored peer-reviewed publications were significantly more likely to report having a clearly defined mentor and to feel adequately mentored than those who did not author publications. Logistic regression analysis showed that having a clearly defined mentor was associated with twice the odds for feeling well prepared to practice psychiatry upon graduation compared with those who did not have a clearly defined mentor, even after controlling for gender, race, medical school, and residency program type.ConclusionHalf of the psychiatric chief residents surveyed reported the lack of a clearly defined career development mentor. In addition, a chief resident’s response of lacking a clear mentor was associated with the perception of being less prepared to practice psychiatry upon graduation. Psychiatric residency training programs may benefit from further clarification and implementation of effective mentorship programs.

Fitbit Flex: an unreliable device for longitudinal sleep measures in a non-clinical population

Dear Editor, Clinicians and researchers are increasingly interested in employing tracking devices to measure activity and sleep, both of which are calculated via algorithms that use accelerometer data [1]. While polysomnography (PSG) is viewed as the gold standard for assessing sleep, it is costly, time-intensive, and intrusive. Actigraphy is often preferred in situations for which PSG is not indicated, such as naturalistic conditions or for prolonged observations—days to weeks. However, actigraphs are relatively expensive as well, making them unsuitable to monitor large samples. As such, activity-tracking devices have been proposed as an alternative. Several recent reports, including one by Montgomery-Downs [2] published in this journal, suggest that consumer-level devices might offer a valid and reliable alternative, as they are easy to use and relatively low in cost [2–4]. We are writing this letter to report our disappointing experience with Fitbit Flex to measure sleep in a non-clinical sample of college students. We utilized the Fitbit Flex to measure sleep parameters longitudinally in a sample of college students enrolled in an IRB-approved pilot study of their sleep. One hundred and seven college students consented to monitor their sleep by wearing a Fitbit Flex for 1 week at three time points—baseline (September 2014), post-intervention (November 2014), and 3month follow-up (February 2015). Prior to baseline data collection, trained research staff taught the college students how to use the Fitbit Flex using a standardized protocol. The students also watched a video tutorial that explained how to operate the device. Additionally, we provided students the link to view the online video tutorial should they need a reminder on how to operate the device. Despite these efforts, the devices failed to capture a significant amount of sleep data at baseline (see Fig. 1): only about 14 % of the Fitbit Flexes recorded sleep six or seven nights and nearly 35 % failed to record any nights of sleep. Hypothesizing that the lack of data collected was due to user error, we retrained the students using a modified approach. After showing them how to use the Fitbit, we then asked participants to demonstrate how to track their sleep, including how to determine via the device’s light and vibration patterns to which mode the device was set (i.e., if the device was in the sleep mode or not). Students received the Fitbit Flex only after they demonstrated correct use. We subsequently found even less data were collected than previously, with nearly 70 % failing to capture any sleep data (see Fig. 1) or activity data. Of note, the lack of both sleep and activity data indicates a device failure rather than participants’ misuse. Prior to each distribution, the devices were fully charged and synced, and they appeared to function appropriately as signaled by light and vibration patterns. Due to the poor data obtained at the first two time points, we canceled the third objective sleep assessment. We contacted the Fitbit company for technical support, but found them to be generally unresponsive and ultimately not able to rectify the situation. While prior studies comparing Fitbits to actigraphs have indicated that consumer-level devices might be a feasible alternative to actigraphs, especially in non-clinical populations, most of these investigations focused on performance over a limited time period of 1 or 2 days. We are aware of only one other study that tested the performance reliability of a Fitbit * Jess P. Shatkin jess.shatkin@nyumc.org

The Child and Adolescent Mental Health Studies (CAMS) Minor at New York University.

ObjectiveThe authors describe the Child and Adolescent Mental Health Studies (CAMS) undergraduate college minor at New York University.MethodsThe authors detail the development, structure, and operation of the CAMS minor. They describe the importance of identifying program goals, building coalitions, creating an advisory board, selecting teaching materials and instructors, and establishing a viable financial model.ResultsThe authors present student evaluations from the first course, which demonstrate great satisfaction with the program.ConclusionThe successful development of the CAMS minor demonstrates that Schools of Medicine (more specifically, the departments of Psychiatry and Child and Adolescent Psychiatry) can have a positive impact on undergraduate student education, which may later translate into an increased number of students who consider entering medical school and child psychiatry.

A 2-year Progress Report of the AACAP-Harvard Macy Teaching Scholars Program

ObjectiveThe American Academy of Child and Adolescent Psychiatry (AACAP) has partnered with the Harvard Macy Program for Healthcare Educators so that selected child and adolescent psychiatry academic faculty might enhance their teaching expertise in order to possibly enhance recruitment of medical students into child and adolescent psychiatry.MethodsThirteen child psychiatry faculty have graduated from the AACAP-Harvard Macy Teaching Scholars Program (HMTSP). There are 10 additional child and adolescent psychiatry faculty members in the process of completing the program. A survey was created to broadly assess the effect of the AACAP-HMTSP training on the first 13 graduates of the program as a pilot to guide future study of the program. Three teaching scholars who are the first authors of this article (JH, DS, MH) conducted this survey and the data interpretation for this study.ResultsThirteen of the scholars submitted responses to the survey. All participants indicated a high degree of satisfaction with the HMTSP and with the overall usefulness of the concepts learned. All but one of the scholars reported that the program enhanced their teaching effectiveness. The scholars reported increased teaching of medical students (9 of 13) and psychiatry residents (6 of 13) after the HMTSP.ConclusionThe AACAP-Harvard Macy Teaching Scholars reported high levels of satisfaction with the overall program. Whether the reported increase in medical student and psychiatry resident mentoring and teaching will eventually lead to increased medical student recruitment into child and adolescent psychiatry remains to be determined.

Effects of a Risk and Resilience Course on Stress, Coping Skills, and Cognitive Strategies in College Students.

This study tested the impact of the skills-building component of a two-semester risk and resilience (R&R) course on the stress, coping skills, and cognitive style of 36 undergraduates compared to 62 students enrolled in a child and adolescent psychopathology course. In the fall, students learned about risk taking and decision-making as well as coping skills and positive cognitive styles. In the spring, students taught these skills to ninth graders. Upon completion of the fall semester, R&R students reported improvements in stress, coping, and dysfunctional attitudes. Although maintained, these gains did not increase after the spring semester. We conclude that the course, particularly the fall semester, is an effective, practical classroom intervention for reducing stress and improving resilience in undergraduates.

Insomnia: the Sleeping Giant of Pediatric Public Health

Insomnia among children and adolescents is ubiquitous and takes a great toll on youth and their families, impacting academic achievement, mood, social functioning, and a variety of developmental outcomes. Unfortunately, however, pediatric insomnia most often remains unidentified and untreated. When treatment is provided, it is most often in the form of medications, which are not FDA approved for that indication in children and adolescents. A comprehensive literature review was employed to establish the recommendations in this report. This article provides a review of sleep physiology and both current and recommended approaches to assessing and treating pediatric insomnia. Comprehensive assessment, accurate diagnosis, and evidence-based treatment of insomnia is imperative to the healthy development of children and adolescents. While clinicians often prescribe a variety of medications to treat pediatric insomnia, there is insufficient data to demonstrate efficacy and endorse their routine use. At this time, behavioral techniques, such as cognitive behavior therapy for insomnia and sleep hygiene education, should remain the first line of treatment. As a second-line consideration, melatonin, a dietary supplement, may be effective. Pediatric insomnia has an enormous impact on children, adolescents, and their families that requires adequate attention from clinicians and parents alike.

Video-teleconferencing with medical students to improve exposure to child and adolescent psychiatry.

ObjectiveThe chronic workforce shortage in child and adolescent psychiatry (CAP) remains a germane issue that has been difficult to deal with effectively. Collaboration between medical schools without sufficient CAP resources and those with enough to share may help improve interest in the field.MethodThis lecture series piloted a collaborative effort between CAP residents from a Midwest academic center and student-led interest groups from two osteopathic medical schools. CAP residents led nine interactive lectures with medical students on relevant topics, using video-teleconferencing. Baseline and follow-up surveys were used to assess attitudes and responses to the lecture series.ResultsA group of 175 students completed the baseline survey; 43 students completed the follow-up survey; 21 of 43 (48%) reported that the lectures would positively influence their career choice toward CAP.ConclusionsInteractive lectures via video teleconferencing demonstrated potential to improve medical students’ exposure to CAP, and they were well received in this initial pilot study.

Impact of a sleep course on sleep, mood and anxiety symptoms in college students: A pilot study

ABSTRACT Objective: To examine the impact of a sleep course on sleep-related behaviors, mood, and anxiety in college students. Participants: Participants were 145 students enrolled in either the sleep course (n = 70) or a psychology course (n = 75); data were collected in September 2014, November 2014, and February 2015. Methods: Sleep characteristics and symptoms of depression and anxiety were assessed using validated questionnaires and sleep logs. Linear, logistic and proportional odds regression models were used to test course effects. Results: In November, sleep course students reported significant differences in sleep hygiene (SHI; p < .001), perceived sleep latency (PSQI; p < .05), and circadian sleep phase (MEQ; p < .05), compared to controls. In February, the sleep course students maintained most of the aforementioned gains and reported fewer symptoms of depression (CES-D; p = .05) and anxiety (BAI; p < .05). Conclusions: These positive preliminary results indicate that focused education has the potential to improve sleep among college students.

Almost Psychiatry: The Impact of Teaching Child and Adolescent Mental Health Studies to Undergraduate College Students

ObjectiveThe Child and Adolescent Mental Health Studies (CAMS) program is housed in a Liberal Arts undergraduate college of a large research university. Psychiatrists, clinical psychologists, and social workers at the university’s medical center teach the courses. The purpose of this study is to evaluate the extent to which CAMS encourages graduates of the program to pursue a career in child and adolescent mental health (CAMH).MethodsIn 2015–2016, graduates of the CAMS program were invited to participate in a mixed methods study. In addition to statistical analyses, qualitative thematic analyses were performed to interpret free-text responses.ResultsForty-five percent (314/702) of invited graduates completed the online survey. Interviews were conducted with 11% (34/314) of participants by study staff over the phone. Quantitative results suggested that 81% (149/185) of participants enrolled in educational programs after graduation due to an interest in CAMH. A significantly higher proportion of the total sample (t = 3.661, p < .001) reported that they changed their career goals while undergraduate students compared to those who did so after graduation. Results of qualitative interviews with 34 participants uncovered five key themes unique to CAMS that may explain the program’s influence on graduates’ career choices and career development: practitioners-as-instructors, instructor mentorship, novel course content, experiential learning opportunities, and career training and skills.ConclusionsQuantitative and qualitative results indicated that teaching college undergraduate students about CAMH encourages them to set career goals within the field. These findings suggest the utility of implementing similar programs at other undergraduate colleges.