Advances in Child Psychiatry Education and Training.

The article provides a comprehensive overview of the current state of child and adolescent psychiatry, including historical background and the impact of the COVID-19 pandemic. It discusses recent advances in theoretical frameworks related to physician burnout, prevention, access to care, diversity, equity, and inclusion, and trauma-informed care. The authors conclude by emphasizing the importance of education and training in improving the lives of youth and families and encourage their colleagues to push the boundaries of education and training for a better today and brighter tomorrow, while honoring and doing justice to those they serve.

The Mental Health Effects of Migrant Family Separation.

Many major medical organizations have asserted that family separation is a traumatic childhood experience due to critical disruptions in attachment and the child's environment. In this commentary, we aim to provide physicians with a growing body of recent data that examines the particular effects of separation on migrant families. Of note, there are myriad scenarios by which vulnerable youths who are fleeing torture and persecution may be separated from a primary attachment figure. Causes of premigration separation include diaspora of family members to avoid violence or persecution, as well as the separation that results from family members being kidnapped, trafficked, or murdered. During migration, family members may travel separate routes based on the physical abilities of travelers. This Commentary will examine the mental health impacts of postmigration separation: separation that occurs at the border upon arrival or that is experienced by resettled refugees separated from family members who continue to reside in refugee camps or the country of origin. This Commentary may allow psychiatrists a more nuanced perspective regarding the mental health of migrant families, while also enabling more effective advocacy through emerging data.

The Detention of Migrant Families.

In this letter to the editor, we attempt to summarize some existing literature on the detention of migrant youths and families while providing readers with a context for this issue. We discuss phases of trauma for migrant children prior to addressing current conditions, discuss existing research regarding the impact of detention on migrant families, and conclude with recommendations on how to improve safety and mental health conditions for migrant families in detention.

Growing Up With an Undocumented Parent in America: Psychosocial Adversity in Domestically Residing Immigrant Children.

According to Pew Research Center, 6 to 7 million children are residing in the United States with at least one undocumented parent. The vast majority of these children were born in the United States themselves, and a small minority were born outside America. Even more noteworthy is the longitudinal data that 7% to 9% of all children born in the United States between 2003 and 2014 have at least one undocumented parent. Given the numbers, it is highly likely that all child health care providers will encounter this population clinically. In this Clinical Perspectives article, we start by reviewing general and specific vulnerabilities in this population, and then discuss how child and adolescent psychiatrists can effectively help these children and their families. The majority of data presented herein refers to the US-born children of undocumented immigrants, but some may include foreign-born children of undocumented immigrants residing in America.

Electronic Screen Media Use in Youth With Autism Spectrum Disorder.

Electronic and social media play a prominent role in the lives of children and teenagers. Evidence suggests youth with autism spectrum disorder (ASD) use media differently than typically developing peers, and some of these differences place them at greater risk for negative health outcomes related to unhealthy and improper use of media. Such outcomes include physiologic, cognitive, social, emotional, and legal/safety problems. However, several technology-aided interventions have emerged to help youth with ASD across multiple domains. Parents of youth with ASD may benefit from several recommendations and resources from the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry.

U.S. Case Law and Legal Precedent Affirming the Due Process Rights of Immigrants Fleeing Persecution.

The political discourse on domestic immigration policy has shifted rapidly in recent years, mirrored by similar shifts in the geopolitical climate worldwide. However, a nuanced assessment of the legal basis backing such rhetoric is sorely lacking. This article examines the historical, legal, and case law precedent as it pertains specifically to immigrants who are fleeing persecution and residing within the United States. Due process rights emerged from the Fifth, Sixth, and Fourteenth Constitutional Amendments and have been expanded to include this population through several sequential United States Supreme Court Cases. We review the 1951 Convention Related to the Status of Refugees and 1967 Protocol Relating to the Status of Refugees and examine subsequent case law and legal precedent. We then present evidence documenting widespread violations of due process rights for immigrants fleeing persecution. Specifically, we address the right to a fair hearing for individuals fearing for their lives upon return to their home country, the right against wrongful detainment, and the right to apply for asylum regardless of religion or country of origin. We conclude by addressing potential counterarguments to our thesis, future directions, and the role of forensic psychiatrists.

Juvenile Competency to Stand Trial.

Competency to stand trial is interpreted as a protected due process right for all defendants and is defined as a defendant's fundamental knowledge and understanding of the criminal charges being filed, roles and procedures within the courtroom, and a general ability to work with the defense counsel. Questions of competency are most often raised by the judge, defense, or the prosecution, and competency evaluations are most often completed by psychiatrists or psychologists with forensic training or work experience. Mental illness, intellectual disability, developmental disorders, and developmental immaturity are the 4 main factors considered in most juvenile competency evaluations.

MAP as a model for practice-based learning and improvement in child psychiatry training.

Not only is there a growing literature demonstrating the positive outcomes that result from implementing evidence based treatments (EBTs) but also studies that suggest a lack of delivery of these EBTs in "usual care" practices. One way to address this deficit is to improve the quality of psychotherapy teaching for clinicians-in-training. The Accreditation Council for Graduate Medical Education (ACGME) requires all training programs to assess residents in a number of competencies including Practice-Based Learning and Improvements (PBLI). This article describes the piloting of Managing and Adapting Practice (MAP) for child psychiatry fellows, to teach them both EBT and PBLI skills. Eight child psychiatry trainees received 5 full days of MAP training and are delivering MAP in a year-long outpatient teaching clinic. In this setting, MAP is applied to the complex, multiply diagnosed psychiatric patients that present to this clinic. This article describes how MAP tools and resources assist in teaching trainees each of the eight required competency components of PBLI, including identifying deficits in expertise, setting learning goals, performing learning activities, conducting quality improvement methods in practice, incorporating formative feedback, using scientific studies to inform practice, using technology for learning, and participating in patient education. A case example illustrates the use of MAP in teaching PBLI. MAP provides a unique way to teach important quality improvement and practice-based learning skills to trainees while training them in important psychotherapy competence.

The effect of an end-of-clerkship review session on NBME psychiatry subject exam scores.

OBJECTIVE: The NBME Psychiatry Subject Examination (PSE) is used throughout North America to test MS-III end-of-clerkship knowledge; yet, literature on PSE preparatory methods remains sparse. This study assesses the effect of a curriculum intervention on NBME PSE scores. METHOD: An optional 1.5-hour review session and accompanying fill-in-the-blank handout was offered to 62 MS-III students 3 days before their exam. Students who did not attend the session were e-mailed the handout with completed answers. The primary outcome measure was a change in scores, with students in the previous year serving as the control group. RESULTS: The average raw PSE score of students offered the review session was 84.53, versus 77.15 for matched controls (p <0.0001). The effect size for the intervention was 0.89. CONCLUSION: This study may suggest that offering a comprehensive review session to third-year medical students 3 days before their NBME PSE significantly improves their scores.

18F-fallypride binding potential in patients with schizophrenia compared to healthy controls.

BACKGROUND: Molecular imaging of dopaminergic parameters has contributed to the dopamine hypothesis of schizophrenia, expanding our understanding of pathophysiology, clinical phenomenology and treatment. Our aim in this study was to compare (18)F-fallypride binding potential BP(ND) in a group of patients with schizophrenia-spectrum illness vs. controls, with a particular focus on the cortex and thalamus. METHODS: We acquired (18)F-fallypride positron emission tomography images on 33 patients with schizophrenia spectrum disorder (28 with schizophrenia; 5 with schizoaffective disorder) and 18 normal controls. Twenty-four patients were absolutely neuroleptic naïve and nine were previously medicated, although only four had a lifetime neuroleptic exposure of greater than two weeks. Parametric images of (18)F-fallypride BP(ND) were calculated to compare binding across subjects. RESULTS: Decreased BP(ND) was observed in the medial dorsal nucleus of the thalamus, prefrontal cortex, lateral temporal lobe and primary auditory cortex. These findings were most marked in subjects who had never previously received medication. CONCLUSIONS: The regions with decreased BP(ND) tend to match brain regions previously reported to show alterations in metabolic activity and blood flow and areas associated with the symptoms of schizophrenia.