L. Lee Carlisle

Training of child and adolescent psychiatry fellows in autism and intellectual disability

Patients with autism spectrum disorders and intellectual disability can be clinically complex and often have limited access to psychiatric care. Because little is known about post-graduate clinical education in autism spectrum disorder and intellectual disability, we surveyed training directors of child and adolescent psychiatry fellowship programs. On average, child and adolescent psychiatry directors reported lectures of 3 and 4 h per year in autism spectrum disorder and intellectual disability, respectively. Training directors commonly reported that trainees see 1–5 patients with autism spectrum disorder or intellectual disability per year for outpatient pharmacological management and inpatient treatment. Overall, 43% of directors endorsed the need for additional resources for training in autism spectrum disorder and intellectual disability, which, coupled with low didactic and clinical exposure, suggests that current training is inadequate.

Psychopharmacology of schizophrenia in children and adolescents.

The past 5 five years have seen major advances in the diagnosis and treatment of schizophrenia in children and adolescents. This article, reviews the clinical and diagnostic characteristics of schizophrenia in youth with an eye toward recent findings. This article also provides a more extensive review and update of the psychopharmacology of early-onset schizophrenia.

Child and Adolescent Telemental Health

Child and adolescent psychiatry is one of the most underserved specialties, especially in rural and impoverished regions. The chapter opens by discussing how increased utilization of telemental health has the potential to alleviate this shortage and improve availability of mental health care for children. A literature review is then presented, stressing the need for more studies on which strong evidence-based practice guidelines for child telemental health can be developed. A variety of potential sites where child telemental health services may be particularly useful include schools, rural primary care clinics, community mental health centers, juvenile correctional facilities, and urban day care to name a few. The remainder of the chapter focuses on the specific considerations regarding telemental health for children and adolescents. These include room setup, what toys should and should not be available, interview techniques for fostering an optimal virtual relationship with the child, as well as a section on cultural considerations and the use of telemental health within the juvenile justice system.

Trauma and Diverse Child Populations

It has been estimated that as many as two-thirds of American youth experience a potentially life-threatening event before 18 years of age and that half have experienced multiple potentially traumatic events. Race, ethnicity, and culture influence the frequency and nature of these traumas and also the ways in which children react to traumatic events. The authors discuss the varied influences of cultural background on these reactions to trauma, the varying presentations of diverse children experiencing troubling reactions, and the need to provide treatment to children and their families in a fashion that is culturally sensitive and acceptable to diverse families.

Suicide Among American Indian, Alaskan Native, and Native Hawaiian Pacific Islander Youth: An Unrealized Future

Suicide is the second leading cause of death for American Indian/Alaskan Native (AIAN) and Native Hawaiian Pacific Islander (NHPI) youth ages 15–24 years, sixth leading cause of death for AIAN males (Khan, Visions: BC’s Ment Health Addict J 5:6, 2008), and third for all NHPI youth age 10–14 years (Heron, Natl Vital Stat Rep 65:1, 2016). Cultural issues add a level of complexity to developing treatment plans and interventions, while historical trauma adds to the severity of usual risk factors for AIAN/NHPI youth. Presented is the case of a suicidal child and how the team utilized culturally appropriate treatment interventions. Mental health providers can help prevent suicide among this vulnerable group by having a better understanding of the cultural and historical contributors to the risk factors for suicide among AIAN/NHPI youth.