This special edition of International Review of Psychiatry presents timely topics related to child and adolescent mental health. These articles represent a current survey of some of the most important issues in the field of paediatric mental health.
Over the past decade, the landscape of how youth communicate with each other has been rapidly changing, especially with the rise of electronic media and, more specifically, social media use. Smartphones are ubiquitous and largely viewed as a rite of passage for adolescents and even some younger children. How much do we know about both the benefits and consequences of social media use? Other developments in the adolescent world include the bleaker trend of increasing rates of suicide. How can we stem the rising tide of youth suicide, the second leading cause of death in this population?
With the publication of the DSM-5 in 2013, paediatric mental health gained a new diagnosis, disruptive mood dysregulation disorder, with the hopes of decreasing paediatric bipolar diagnoses and subsequent antipsychotic prescribing. Along with the DSM-5, the pre-school diagnostic manual the DC: 0-3 also underwent a revision and is now the DC: 0-5 broadening the age range from birth to 5 years old. Over the past decade, a focussed, evidence-based approach to pre-school mental health treatment has transformed how we deliver care to our youngest patients. Another important area of focus of recent years is screening for and identifying trauma in our paediatric patients. We hope that by identifying trauma symptoms more effectively we can improve outcomes for our paediatric patients.
The past decade has also seen changes in the public view of marijuana use, both medicinally and recreationally. Changes in public attitude will likely have downstream effects on youth use and sequelae of use that will only be fully understand over the next decade following rigorous study. Another area of transformation in paediatric mental health has been the shift towards shorter length of stay on paediatric psychiatry inpatient units. What effect does shorter length of stay have on our paediatric patients? What are the readmission rates and can we make sure that – although the length of stay is shorter – youth will have a therapeutic experience? Focussing on multi-disciplinary treatment approaches and the role of autonomy in patient decision-making are also being increasingly emphasised in care delivery. Medical Psychologists offer a unique treatment approach to our paediatric patients with the potential to improve medical illness outcomes. The development of autonomy is important developmentally for our paediatric patients and an area for consideration amongst some of our most vulnerable patients.
Overall, the nine articles include a breadth of important topics in paediatric mental health.
Drs. Harrison and Zaim present the most up to date information on assessment and treatment of the most common disorders in pre-school mental health. This is a very important topic as early identification and treatment of pre-school age children can lead to decreased prevalence of mental health disorders in childhood and adolescence.
Dr. Hendrickson and colleagues present the latest information on the new paediatric mental health diagnosis, disruptive mood dysregulation disorder, DMDD. The intention of the creation of this diagnosis was to decrease paediatric bipolar disorder diagnoses and subsequent overuse of atypical antipsychotics. This article presents clinical information on assessment and treatment of these youth.
Dr. Grant and colleagues present new information on how we approach trauma screening in the paediatric population. This article compares trauma-specific screening with a broader psychiatric symptom and anxiety screen in two samples of youth who have experienced trauma. The authors offer screening recommendations to increase the likelihood of capturing trauma symptomatology since increased identification can lead to earlier treatment and better outcomes for these youth.
Dr. Hammond and colleagues present the most up to date information on marijuana use and the effects on adolescents. Marijuana use is widely becoming a public health issue for our adolescent patients and attitudes and beliefs are not aligned with the medical field’s knowledge. This is complicated by changes in public policy furthering the use of medicinal marijuana and legalisation of recreational use in some geographic areas.
Dr. Vidal and colleagues focus on social media use and depression in the adolescent population. Is it good or bad? This article suggests there are pros and cons, likely needing a more nuanced approach to use. We are still left with unanswered questions - if there is an association between social media use and depression what is the causality or is it bi-directional?
Increasing rates of suicide in the adolescent population is a disturbing trend we have not been able to adequately address. Dr. Cwik and colleagues discuss suicide screening, assessment and treatments, offering hope that this trend will soon decline.
The focus over the last few years on patient-centered care and autonomy can be particularly challenging in paediatric mental health. What age does autonomy of the patient play a role? While fostering the development of autonomy is crucial for healthy development, what happens when factors interfere with this development? Dr. Barnett discusses foster care placement and the role social services can play in both impeding and encouraging the development of autonomy.
Other treatment shifts that have occurred over the past few years include reducing length of paediatric psychiatry inpatient stays and increasing multi-disciplinary approaches to patient care. Dr. Reynolds and colleagues present an overview of paediatric psychiatry inpatient care, including utilisation trends, challenges to delivery of care and possibilities for improvement of inpatient care. Dr. Parrish and colleagues give an introduction and overview of the role of paediatric medical psychologists and how they are integral to improving outcomes of paediatric patients receiving medical care.
This issue illustrates the range of challenges and opportunities facing child and adolescent mental health providers. Societal changes affecting this population influence the profession to consider and re-think how to best treat and support our patients. In sum, the diverse group of topics presented in this issue of International Review of Psychiatry highlights trends in paediatric mental health ranging from changes in the delivery and focus of patient care to changes in the social landscape of adolescents, as well as, information on new paediatric diagnoses and approaches to care. All of these areas are important subjects to understanding where the field is today as well as what direction we need to head towards in the months and years ahead.