Teaching Ethics in Child and Adolescent Psychiatry: Vignette-Based Curriculum

Introduction: Ethics is an integral component of child and adolescent psychiatry. While ethics can seem abstract or philosophical, its tenets are fundamental to the practice of medicine. Understanding relevant ethical principles shapes how practitioners make decisions in all activities, including clinical, administrative, research, and scholarly. Methods: Using the American Academy of Child and Adolescent Psychiatry (AACAP) Code of Ethics as the framework, these vignettes serve as stimulus material to help teach the ethical principles relevant to child and adolescent psychiatry practice. Each vignette briefly describes a clinical situation in practice, followed by questions and possible appropriate responses. The teacher\u27s guide includes a discussion of the relevant ethical principles and perspectives on how to think about the issues involved. A supplementary overview of ethical issues in child and adolescent psychiatry and a list of resources are also provided. Results: We and other child and adolescent psychiatrists have used this curriculum at professional organizational meetings, in residency programs, and in teaching medical students with positive learner responses. Discussion: This curriculum was developed by members of the AACAP Ethics Committee with input from the entire committee in an effort to produce material that was easy to use and provided valuable content about an essential aspect of practice that is relevant to all practitioners at all levels. While designed for child and adolescent psychiatrists, the content is relevant to all physicians working with children, adolescents, and families

Recruitment in Child Psychiatry: The Impact of a Voluntary Fellowship Program on Medical Students Career Decisions

This study was designed to measure interest in child and adolescent psychiatry among medical students and to assess the impact of an innovative medical student fellowship program on that interest. Students (N = 916) from ten medical schools completed an online survey designed to measure their interest in child and adolescent psychiatry and their understanding of the subspecialty. Students (N = 123) participating in a voluntary child and adolescent psychiatry fellowship offered at six of the ten medical schools completed an online survey designed to evaluate the quality of their experience and to measure the impact of the fellowship program on their understanding of the subspecialty and on their interest in becoming child and adolescent psychiatrists. There exists relatively low interest in pursuing a career in child and adolescent psychiatry among medical students in general, with 79% of fellowship non-participants stating that they have ruled out a career in the subspecialty. Medical students also indicated they had limited knowledge of the field, with 61% of non-fellows stating that they had little or no understanding of child and adolescent psychiatry. Conversely, medical students who did report a strong understanding of child and adolescent psychiatry were much more likely to show interest in pursuing a career in the field. The fellowship was rated highly by participating medical students, with 83% of participants rating the experience Good or Excellent; the fellowship appeared to make its biggest impact on students understanding of the subspecialty, with 53% indicating that their understanding was greatly increased. The fellowship program succeeded in strengthening a strong initial interest in a child and adolescent psychiatry career among medical students. 62% of participants said they joined the fellowship program in part because they were already considering a career in the subspecialty, and 64% of students continued to express that interest after taking part in fellowship activities. 22% of participants stated the fellowship program greatly increased their desire to become child and adolescent psychiatrists. Given the high prevalence of pediatric mental disorders, a closer look at the state of child and adolescent psychiatry education and recruitment is warranted. Psychiatric disorders are among the most frequently diagnosed medical conditions in children and adolescents, and there is a shortage of clinicians who are equipped to treat them. Only 2% of medical students indicated a very strong understanding of child and adolescent psychiatry and 1% of medical students expressed a maximal interest in pursuing a career in the subspecialty. Medical education must prepare primary care physicians, many of whom will encounter a significant number of pediatric patients with mental illness, to properly assess and treat them. Moreover, leaders in child and adolescent psychiatry must continue improving existing recruitment initiatives. Until medical school curricula include more teaching of child development and psychopathology, the fellowship can prove to be an effective vehicle through which to teach medical students about child and adolescent psychiatry. The fellowship is particularly effective as the program provides medical students with opportunities to work directly with children and their families in clinical settings and in schools. That exposure, coupled with effective mentoring relationships, has turned the fellowship into an effective recruitment tool for child and adolescent psychiatry

Which executive functioning deficits are associated with AD/HD, ODD/CD and comorbid AD/HD+ODD/CD?

Item does not contain fulltextThis study investigated (1) whether attention deficit/hyperactivity disorder (AD/HD) is associated with executive functioning (EF) deficits while controlling for oppositional defiant disorder/conduct disorder (ODD/CD), (2) whether ODD/CD is associated with EF deficits while controlling for AD/HD, and (3)~whether a combination of AD/HD and ODD/CD is associated with EF deficits (and the possibility that there is no association between EF deficits and AD/HD or ODD/CD in isolation). Subjects were 99~children ages 6–12 years. Three putative domains of EF were investigated using well-validated tests: verbal fluency, working memory, and planning. Independent of ODD/CD, AD/HD was associated with deficits in planning and working memory, but not in verbal fluency. Only teacher rated AD/HD, but not parent rated AD/HD, significantly contributed to the prediction of EF task performance. No EF deficits were associated with ODD/CD. The presence of comorbid AD/HD accounts for the EF deficits in children with comorbid AD/HD+ODD/CD. These results suggest that EF deficits are unique to AD/HD and support the model proposed by R. A. Barkley (1997).17 p

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

The Role of Nurse Practitioners in Meeting the Need for Child and Adolescent Services: a Statewide Survey

The high prevalence of child and adolescent mental health disorders coupled with shortages in ageappropriate mental health services pose a significant problem likely to be exacerbated over time. A survey was designed to identify the current status of and need for child and adolescent psychiatrists (CAPs) and mental health services, as well as strategies and recommendations to address identified needs in the state of New York. Key informants from each county and New York City were surveyed by telephone (N = 58). Most respondents identified a shortage of child and adolescent psychiatry services and reported that when CAPs are unavailable, nurse practitioners (NPs) are currently among the top four professional groups who prescribe and/or monitor psychotropic medication. Almost half of the respondents (48%) identified employing NPs with advanced certification in child and adolescent psychiatry as a promising strategy to improve access to care. Addressing the shortage of CAPs can provide an opportunity for the nursing profession to advance its role in the provision of mental health services to youth

Retrieval of Life Affirming Values and their Incorporation into a Suicidality Prevention Plan

Abstract. This article is intended primarily as a companion piece to provide additional background and illustration for a submission by the same authors to The Journal of the American Academy of Child and Adolescent Psychiatry. It is also the second in a series appearing in Conscience Works to characterize recently employed techniques to render psychiatric treatment of children and adolescents in a conscience sensitive manner. It consists of a progressive Case Presentation interwoven with Discussion points, which together demonstrate the retrieval of life affirming values in the context of suicidality management and the incorporation of these values in an overall suicidality prevention plan

The Role of Nurse Practitioners in Meeting the Need for Child and Adolescent Services: a Statewide Survey

The high prevalence of child and adolescent mental health disorders coupled with shortages in ageappropriate mental health services pose a significant problem likely to be exacerbated over time. A survey was designed to identify the current status of and need for child and adolescent psychiatrists (CAPs) and mental health services, as well as strategies and recommendations to address identified needs in the state of New York. Key informants from each county and New York City were surveyed by telephone (N = 58). Most respondents identified a shortage of child and adolescent psychiatry services and reported that when CAPs are unavailable, nurse practitioners (NPs) are currently among the top four professional groups who prescribe and/or monitor psychotropic medication. Almost half of the respondents (48%) identified employing NPs with advanced certification in child and adolescent psychiatry as a promising strategy to improve access to care. Addressing the shortage of CAPs can provide an opportunity for the nursing profession to advance its role in the provision of mental health services to youth

Assessing the perceived applicability of Barkley's Defiant Teens Manual to African American and European American families

African American adolescent males are being diagnosed with externalizing behavior disorders more than any other group. However, there is a dearth of studies that addresses psychosocial treatment for African American adolescent males with these behavioral issues. This study assessed the perceived applicability of the Defiant Teen's Manual designed by Barkley, Robin, and Foster (1989), as a treatment for African American male adolescents and their families. Fifty-four African American and European American families with male adolescents ages 11 to 14 were included in the study. Subjects were asked to respond to a questionnaire that assessed their perception of the appropriateness of the treatment for their adolescent and family. Additional factors such as socioeconomic status (SES) and family makeup were also assessed to identify their impact on families. Multivariate and univariate analyses of variance, regression analysis, and mean comparisons were used to analyze data. Overall findings indicated that groups did not differ based on race, and/or family makeup regarding the perceived appropriateness of the Defiant Teen's manual to their families. However, African-American families rated three behavioral management steps as less appropriate for their families, and single parents rated one behavior management step as less appropriate for their families