John M. Diamond

Telepsychiatry assessments of child or adolescent behavior disorders: a review of evidence and issues.

BACKGROUND The limited number of mental health specialists for children has led to an increased need for child and adolescent psychiatrists to provide primary care consultations and treatment recommendations. Psychiatric assessments and treatments provided via two-way videoconferencing (telepsychiatry) have been used to increase the availability of child psychiatrists. This article reviews the literature on telepsychiatry assessment of children and adolescents. METHODS Research on telepsychiatry has focused on the comparability of telepsychiatric treatments to in-person treatment for adult patients. Relatively little research has addressed the ability of telepsychiatric assessments to facilitate favorable treatment outcomes, particularly for child or adolescent patients. This was a literature search using Medline via Ovid. It focused on English-language material published between 1996 and 2009. A range of search terms relating to assessment, mental health, telemedicine, and children was used. Any studies focusing on child and adolescent psychiatric assessment were included. RESULTS The limited literature on children is usually related to project descriptions or case reports. The studies tend to find acceptance and the diagnoses and recommendations are not seen as different from in-person assessments. Practical considerations that arise in giving telepsychiatric assessments are discussed. CONCLUSION Although there are significant weaknesses in the research justifying telepsychiatric assessments in children and adolescents, there are no data that suggest that this process contributes to negative outcomes. Details on the setting for telepsychiatry assessments and camera view have not been studied.

A case of neuroleptic malignant syndrome in a mentally retarded adolescent

The neuroleptic malignant syndrome is an uncommon but occasionally fatal reaction to antipsychotic medication characterized by fever, movement disorder, and stupor. A case is reported of a 16-year-old retarded male who progressed into coma after an injection of fluphenazine. The syndrome is discussed, and new pharmacological treatment approaches are reviewed. Brain-damaged patients are thought to be more susceptible to this syndrome. As recognition of the syndrome grows, there may well be more cases identified in the mentally retarded population.

Latchkey children: a pilot study investigating behavior and academic achievement

The effects of latchkey status on the normal development of children are poorly addressed in the literature. After formulating an operational definition, the prevalence, academic performance, and behavior characteristics of latchkey children were investigated in a rural area. Few differences were found to distinguish latchkey from nonlatchkey children.

A Comparison of Preferred Treatment Outcomes Between Children With ADHD and Their Parents

Objective: The newest guidelines for the treatment of ADHD call for the formation of an individualized treatment plan based on collaboration. Because the process of collaboration requires the communication of desired outcomes, the authors’ goal is to examine the preferred outcomes of treatment for ADHD for children and parents. Method: A preferred outcomes questionnaire is used to gather data. A listing of the outcomes in ranked order is generated for each group. Spearman’s rho is used to generate comparative data. Results: Our results indicate a significant correlation between the preferred outcomes of the children and the parents. There is one outlier regarding the use of medication. Conclusion: The existence of the single outlier concerning the use of medication may infer that an assessment of the child’s feelings regarding a medication regimen is therapeutically indicated.

Former Latchkey Children: Personality and Academic Correlates

The purpose of this study was to examine the prevalence and correlates (demographic, personality, and academic) of former latchkey status (children unsupervised by an adult after school during their elementary or middle school years) in a college student sample (N = 188). A clear operational definition of latchkey status was provided. Students were surveyed and administered a personality questionnaire, and their academic aptitude test scores were verified through university records. Twenty-five percent of the male and 14% of the female participants were identified as former latchkey children, resulting in an 18% latchkey prevalence rate. The mean age of onset of latchkey status was 8.7 years for the male and 10.0 years for the female subjects. Having been a latchkey child was positively associated with being male and Caucasian, coming from a one-parent family, and having had a mother who worked outside the home. Multivariate analyses of the personality and academic measures revealed no significant between-group differences.

A+KIDS, a Web-Based Antipsychotic Registry for North Carolina Youths: An Alternative to Prior Authorization

OBJECTIVE The rise in use of antipsychotics among U.S. children is well documented. Compliance rates with current safety-monitoring guidelines are low. In response, the North Carolina Division of Medical Assistance established the Antipsychotics-Keeping It Documented for Safety (A+KIDS) registry. The initial objectives of the project were to successfully establish a Web-based safety registry and to obtain and evaluate clinical information derived from the registry. METHODS In April 2011, A+KIDS began asking prescribers of antipsychotics for children age 12 and under to respond to a set of questions regarding dose, indication, and usage history. Antipsychotic registrations were examined by linking North Carolina Medicaid prescription claims to registry entries. Prescribers were classified into different types, and the number of patients and registrations per prescriber were examined. RESULTS In the initial six months, 730 prescribers registered 5,532 patients, 19% below age seven. By month 6 of the registry, 72% of all fills were registered with the program. Top diagnosis groups for registry patients were unspecified mood disorders, autism spectrum disorders, and disruptive behavior disorders. Top target symptoms were aggression (48%), irritability (19%), and impulsivity (11%). Psychosis accounted for 5% of the target symptoms. Twenty-eight percent of children were receiving no form of psychotherapy. Twenty-five percent of all A+KIDS prescribers were responsible for 81% of the registrations. CONCLUSIONS The A+KIDS registry initiative has been successful, as measured by rapid uptake, and is providing clinical information not available from claims data alone. Future efforts will allow for detailed examinations of antipsychotic utilization and further safety improvement.