William Bernet

Summary of the practice parameters for the assessment and treatment of children, adolescents, and adults with ADHD

This summary of the practice parameters describes the assessment, differential diagnosis, and treatment of children, adolescents, and adults who present with symptoms of attention-deficit/hyperactivity disorder. The rationales for specific recommendations are based on a review of the scientific literature and clinical consensus which is contained in the complete document. Assessment includes clinical interviews with the child and parents and standardized rating scales from parent and teachers. Testing of intelligence and academic achievement is usually required. Comorbidity is common. The cornerstones of treatment are support and education of parents, appropriate school placement, and psychopharmacology. The primary medications are psychostimulants, but antidepressants and alpha-adrenergic agonists are used in special circumstances. Other treatments such as behavior modification, school consultation, family therapy, and group therapy address remaining symptoms.

Practice Parameters for the Forensic Evaluation of Children and Adolescents Who May Have Been Physically or Sexually Abused

These practice parameters describe the forensic evaluation of children and adolescents who may have been physically or sexually abused. The recommendations are drawn from guidelines that have been published by various professional organizations and authors and are based on available scientific research and the current state of clinical practice. These parameters consider the clinical presentation of abused children, normative sexual behavior of children, interview techniques, the possibility of false statements, the assessment of credibility, and important forensic issues. These parameters were approved by Council of the American Academy of Child and Adolescent Psychiatry in September 1996.

Summary of the practice parameters for the assessment and treatment of children and adolescents with posttraumatic stress disorder

This summary provides an overview of the assessment and treatment recommendations contained in the Practice Parameters for the Assessment and Treatment of Children and Adolescents With Posttraumatic Stress Disorder. Major recommendations include the use of clinical interviewing with specific questioning about posttraumatic stress symptoms to diagnose this disorder; recognition of developmental considerations that may impact on how posttraumatic stress disorder symptoms manifest in children; and the use of trauma-focused treatment interventions. Limitations and controversies regarding the present state of knowledge in the area of childhood posttraumatic stress disorder are also discussed.

Bad nature, bad nurture, and testimony regarding MAOA and SLC6A4 genotyping at murder trials

Abstract:u2002 Recent research—in which subjects were studied longitudinally from childhood until adulthood—has started to clarify how a child’s environment and genetic makeup interact to create a violent adolescent or adult. For example, male subjects who were born with a particular allele of the monoamine oxidase A gene and also were maltreated as children had a much greater likelihood of manifesting violent antisocial behavior as adolescents and adults. Also, individuals who were born with particular alleles of the serotonin transporter gene and also experienced multiple stressful life events were more likely to manifest serious depression and suicidality. This research raises the question of whether testimony regarding a defendant’s genotype, exposure to child maltreatment, and experience of unusual stress is appropriate to present during the guilt or penalty phases of criminal trials, especially when capital punishment is a consideration. The authors present their experience in genotyping criminal defendants and presenting genetic information at criminal trials.

Parental Alienation, DSM-V, and ICD-11

Parental alienation is an important phenomenon that mental health professionals should know about and thoroughly understand, especially those who work with children, adolescents, divorced adults, and adults whose parents divorced when they were children. We define parental alienation as a mental condition in which a child—usually one whose parents are engaged in a high-conflict divorce—allies himself or herself strongly with one parent (the preferred parent) and rejects a relationship with the other parent (the alienated parent) without legitimate justification. This process leads to a tragic outcome when the child and the alienated parent, who previously had a loving and mutually satisfying relationship, lose the nurture and joy of that relationship for many years and perhaps for their lifetimes. The authors of this article believe that parental alienation is not a minor aberration in the life of a family, but a serious mental condition. The childs maladaptive behavior—refusal to see one of the parents—is driven by the false belief that the alienated parent is a dangerous or unworthy person. We estimate that 1% of children and adolescents in the U.S. experience parental alienation. When the phenomenon is properly recognized, this condition is preventable and treatable in many instances. There have been scores of research studies and hundreds of scholarly articles, chapters, and books regarding parental alienation. Although we have located professional publications from 27 countries on six continents, we agree that research should continue regarding this important mental condition that affects hundreds of thousands of children and their families. The time has come for the concept of parental alienation to be included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), and the International Classification of Diseases, Eleventh Edition (ICD-11).

Evaluating and Reporting Emotional Abuse in Children: Parent-Based, Action-Based Focus Aids in Clinical Decision-Making

Although physical and sexual abuses ate well recognized by the medical and legal systems, there has been difficulty and reluctance in addressing the issue of emotional abuse in children. This is unfortunate because all cases of physical abuse contain a coexisting emotional component whose impact may persist long after physical injuries have healed (Claussen and Crittenden, 1991; Hamarman and Ludwig, 2000). Furthermore, children may suffer emotional injuries in the absence of physical or sexual attacks. Emotional abuse distorts the processes of attachment and affective development (Pearl, 1994). Emotional abuse also may impair the childs capacity to develop appropriate emotional responses and may lead to lifelong emotional difficulties (Brothers, 1989; Ferguson and Dacey, 1997; Hart et al., 1998; Kent and Waller, 1998; McGee et al., 1997). Some of the difficulties in evaluating and reporting emotional abuse in children have derived from a lack of consensus definitions and guidelines delineating severities (American Professional Society on the Abuse of Children, 1995; Kaplan et al., 1999; Kavanagh, 1982; OHagan, 1995; Sedlakand Broadhurst, 1996; Thompson and Kaplan, 1996). For example, although the DSM-IVprovides diagnostic criteria for parent-child relational problems (V61.20), physicalabuse of child (V61.21), sexual abuse ofchild (V61.2l), and neglect ofchild (V61.21), there is no diagnosis for rhe emotional component of abuse (American Psychiatric Association, 1994). Similarly, neither the American Psychiatric Association nor the American Academy of Child and Adolescent Psychiatry has published practice parameters on the subject of emotional abuse of children. The intangible nature of emotional trauma makes medical and legal interventions troublesome, especially when similar

False Statements and the Differential Diagnosis of Abuse Allegations

OBJECTIVEnBecause child psychiatrists do not have a consistent way to classify the untruthful child and because there are no generally accepted definitions of the many ways in which false statements occur in allegations of abuse, the objective of this paper is to classify and define the various ways in which false statements occur in allegations of abuse.nnnMETHODnThe author reviewed 40 articles, chapters, and books that contained examples of false statements made by children or caregivers in the context of an abuse allegation.nnnRESULTSnThis paper clarifies the concepts of indoctrination, suggestion, fantasy, delusion, misinterpretation, miscommunication, innocent lying, deliberate lying, confabulation, pseudologia phantastica, overstimulation, group contagion, and perpetrator substitution.nnnCONCLUSIONnThe correct classification of abuse allegations is important in both clinical and forensic child psychiatry. The definitions in this paper, which are based on clinical experience, should be studied through systematic research.

Parental Alienation Disorder and DSM-V

Although parental alienation disorder (PAD) is a serious mental condition affecting many children and their families, it is not an official diagnosis or even mentioned in the Diagnostic and Statistical Manual of Mental Disorders. This article presents arguments for considering PAD a diagnosis: PAD is a prototypical example of a relational disorder; the phenomenon of PAD is almost universally accepted by mental health professionals; PAD is a valid and reliable construct; adopting criteria for PAD will promote systematic research; adopting criteria will reduce the misuse of the concept of PAD; and adopting criteria will improve the treatment of children with this disorder.

A Misunderstanding Regarding the Duty to Report Suspected Abuse

Confusion exists among professionals as to the circumstances under which a mandatory child abuse reporter must file a report. A review of the literature reveals that professionals sometimes feel obligated to make reports, even though they harbor no suspicion that abuse actually occurred. For example, some individuals believe that they must report abuse allegations made by other individuals, even if the mandatory reporter does not suspect abuse. The authors found that the mandatory reporting statutes of 49 states and the District of Columbia do not require reports unless the reporter has a suspicion of abuse. New York may be an exception. The authors conclude that mandatory reporters generally are not required to report abuse allegations if they themselves do not suspect that abuse occurred. This article encourages mandatory reporters to report abuse as required by the law, but not make unnecessary reports out of confusion or misinformation.

Summary of the practice parameters for the assessment and treatment of children and adolescents with substance use disorders

This summary describes the assessment and treatment of children and adolescents with substance use disorders and is based on scientific evidence regarding diagnosis and effective treatment as well as on the current state of clinical practice. Given the paucity of research on the treatment of substance use disorders in children and adolescents, many of the recommendations are drawn from the adult literature and current clinical practice. This summary considers risk factors for substance use and related problems, normative use of substances by adolescents, the comorbidity of substance use disorders with other psychiatric disorders, and treatment settings and modalities.