ABSTRACT
This Parameter addresses the key concepts that differentiate the forensic evaluation of children and adolescents from a clinical assessment. There are ethical issues unique to the forensic evaluation, because the forensic evaluator's duty is to the person, court, or agency requesting the evaluation, rather than to the patient. The forensic evaluator clarifies the legal questions to be answered and structures the evaluation to address those issues. The forensic examination may include a review of collateral information, interviews and other assessments of the child or adolescent, and interviews with other relevant informants. The principles in this Parameter suggest the general approach to the forensic evaluation of children and adolescents and are relevant to delinquency, child custody, child maltreatment, personal injury, and other court-ordered and noncourt-ordered evaluations.
Subject(s)
Child Abuse/ethics , Child Abuse/legislation & jurisprudence , Child Abuse/psychology , Child Custody/ethics , Child Custody/legislation & jurisprudence , Ethics, Medical , Expert Testimony/ethics , Expert Testimony/legislation & jurisprudence , Forensic Psychiatry/ethics , Forensic Psychiatry/legislation & jurisprudence , Interview, Psychological/methods , Juvenile Delinquency/ethics , Malpractice/legislation & jurisprudence , Adolescent , Child , Confidentiality/legislation & jurisprudence , Humans , Juvenile Delinquency/legislation & jurisprudence , Juvenile Delinquency/psychology , Physician's Role , Psychotherapy/legislation & jurisprudence , United StatesABSTRACT
This practice parameter describes the epidemiology, clinical picture, differential diagnosis, course, risk factors, and pharmacological and psychotherapy treatments of children and adolescents with major depressive or dysthymic disorders. Side effects of the antidepressants, particularly the risk of suicidal ideation and behaviors are discussed. Recommendations regarding the assessment and the acute, continuation, and maintenance treatment of these disorders are based on the existent scientific evidence as well as the current clinical practice.
Subject(s)
Depressive Disorder, Major/drug therapy , Depressive Disorder, Major/therapy , Practice Patterns, Physicians' , Adolescent , Child , Child, Preschool , Depressive Disorder, Major/epidemiology , Female , Humans , Male , Prevalence , Psychotic Disorders/diagnosis , Psychotic Disorders/epidemiology , Psychotic Disorders/therapyABSTRACT
This practice parameter describes the assessment and treatment of children and adolescents with substance use disorders and is based on scientific evidence and clinical consensus regarding diagnosis and effective treatment as well as on the current state of clinical practice. This parameter 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.
Subject(s)
Alcoholism/rehabilitation , Personality Assessment , Psychotropic Drugs , Substance-Related Disorders/rehabilitation , Adolescent , Alcoholism/diagnosis , Alcoholism/epidemiology , Alcoholism/psychology , Child , Comorbidity , Cross-Sectional Studies , Humans , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Mental Disorders/psychology , Mental Disorders/rehabilitation , Reference Values , Risk Factors , Substance Abuse Detection , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology , Substance-Related Disorders/psychologyABSTRACT
Electroconvulsive therapy (ECT) may be an effective treatment for adolescents with severe mood disorders and other Axis I psychiatric disorders when more conservative treatments have been unsuccessful. ECT may be considered when there is a lack of response to two or more trials of pharmacotherapy or when the severity of symptoms precludes waiting for a response to pharmacological treatment. The literature on ECT in adolescents, including studies and case reports, was reviewed and then integrated into clinically relevant guidelines for practitioners. Mood disorders have a high rate of response to ECT (75%-100%), whereas psychotic disorders have a lower response rate (50%-60%). Consent of the adolescent's legal guardian is mandatory, and the patient's consent or assent should be obtained. State legal guidelines and institutional guidelines must be followed. ECT techniques associated with the fewest adverse effects and greatest efficacy should be used. The presence of comorbid psychiatric disorder is not a contraindication. Systematic pretreatment and posttreatment evaluation, including symptom and cognitive assessment, is recommended.
Subject(s)
Electroconvulsive Therapy/history , Mental Disorders/therapy , Adolescent , Adolescent Psychiatry/history , Adolescent Psychiatry/instrumentation , Contraindications , History, 20th Century , Humans , Referral and ConsultationABSTRACT
Enuresis is a symptom that is frequently encountered in child psychiatric evaluations. Careful assessment is required to identify specific urologic, developmental, psychosocial, and sleep-related etiologies. For most children with enuresis, however, a specific etiology cannot be determined. Treatment then involves supportive approaches, conditioning with a urine alarm, or medications--imipramine or desmopressin acetate. The psychosocial consequences of the symptom must be recognized and addressed with sensitivity during the evaluation and treatment of enuresis.
Subject(s)
Conditioning, Psychological , Deamino Arginine Vasopressin/therapeutic use , Enuresis/therapy , Psychotherapy/methods , Renal Agents/therapeutic use , Adolescent , Child , Combined Modality Therapy , Enuresis/diagnosis , Enuresis/drug therapy , Enuresis/etiology , Humans , Severity of Illness IndexABSTRACT
This practice parameter describes treatment with stimulant medication. It uses an evidence-based medicine approach derived from a detailed literature review and expert consultation. Stimulant medications in clinical use include methylphenidate, dextroamphetamine, mixed-salts amphetamine, and pemoline. It carries FDA indications for treatment of attention-deficit/hyperactivity disorder and narcolepsy.
Subject(s)
Attention Deficit Disorder with Hyperactivity/drug therapy , Brain/drug effects , Central Nervous System Stimulants/therapeutic use , Psychotropic Drugs/therapeutic use , Adolescent , Adult , Amphetamines/therapeutic use , Central Nervous System Stimulants/adverse effects , Central Nervous System Stimulants/pharmacology , Child , Child, Preschool , Contraindications , Drug Monitoring , Evidence-Based Medicine , Humans , Methylphenidate/therapeutic use , Narcolepsy/drug therapy , Pemoline/therapeutic use , Psychopharmacology , United StatesABSTRACT
This parameter reviews the current state of the prevention and management of child and adolescent aggressive behavior in psychiatric institutions, with particular reference to the indications and use of seclusion and restraint. It also presents guidelines that have been developed in response to professional, regulatory, and public concern about the use of restrictive interventions with aggressive patients with regard to personal safety and patient rights. The literature on the use of seclusion, physical restraint, mechanical restraint, and chemical restraint is reviewed, and procedures for carrying out each of these interventions are described. Clinical and regulatory agency perspectives on these interventions are presented. Effectiveness, indications, contraindications, complications, and adverse effects of seclusion and restraint procedures are addressed. Interventions are presented to provide more opportunities to promote patient independence and satisfaction with treatment while diminishing the necessity of using restrictive procedures.
