AACAP Official Action. Summary of the practice parameters for child custody evaluation.

This summary is presented as a guide for clinicians evaluating the often delicate and complex issues surrounding a child custody dispute. The historical basis of child custody and the various judicial presumptions that have guided courts, as well as the differences between performing child custody evaluation and engaging in traditional clinical practice, are reviewed in the complete document. Issues that are common to all child custody disputes are presented, including continuity and quality of attachments, preference, parental alienation, special needs of children, education, gender issues, sibling relationships, parents' physical and mental health, parents' work schedules, parents' finances, styles of parenting and discipline, conflict resolution, social support systems, cultural and ethnic issues, ethics and values, and religion. In addition, special issues that complicate custody evaluations are presented, including infants in custody disputes, homosexual parents, grandparents' rights, parental kidnapping, relocation problems, allegations of sexual abuse, and advances in reproductive technology, such as frozen embryos, oocyte donation, and artificial insemination.

Practice parameters for child custody evaluation. American Academy of Child and Adolescent Psychiatry.

These practice parameters are presented as a guide for clinicians evaluating the often delicate and complex issues surrounding a child custody dispute. The historical basis of child custody and the various judicial presumptions that have guided courts are reviewed. The differences between performing child custody evaluation and engaging in traditional clinical practice are emphasized. Issues that are common to all child custody disputes are presented, including continuity and quality of attachments, preference, parental alienation, special needs of children, education, gender issues, sibling relationships, parents' physical and mental health, parents' work schedules, parents' finances, styles of parenting and discipline, conflict resolution, social support systems, cultural and ethnic issues, ethics and values, and religion. In addition, special issues that complicate custody evaluations are discussed, including infants in custody disputes, homosexual parents, grandparents' rights, parental kidnaping, relocation problems, allegations of sexual abuse, and advances in reproductive technology, such as frozen embryos, oocyte donation, and artificial insemination. An outline is provided that describes the complete evaluation process, from assessing referrals and planning a strategy through conducting clinical interviews, writing the report, and testifying in court.

Special issues in child custody evaluations.

The child and adolescent psychiatrist who performs child custody evaluations assumes an extraordinary responsibility. Operating at the interface of psychiatry and the law, this forensic psychiatrist is often confronted by special factors that can make a normally complicated process even more intricate. This paper examines the forensic psychiatrist's role in dealing with a number of special issues which often arise during child custody evaluations. These issues are: the mentally ill parent, the homosexual parent, stepparents, grandparents' rights, and parental kidnapping. Case vignettes are presented, and guidance for the clinician is provided.

Gender identity disorder in a five-year-old boy.

Markedly effeminate behavior in a young boy is a source of concern and confusion for parents, teachers, and the child. It also represents a therapeutic dilemma for the child psychiatrist. The case of a five-year-old boy with gender identity disorder of childhood is presented and the literature on hypotheses of etiology, treatment, and long-term follow-up is reviewed. The ethical and philosophical questions posed by such a case are discussed.

The differential diagnosis of dementia.

Contrary to prevailing medical belief, dementia is generally not caused by arteriosclerosis of cerebral vessels. There may be, in fact, as many as 50 different causes. While the two major types of dementia, Alzheimer's disease and multi-infarct dementia, are irreversible, perhaps 20 per cent of dementias are secondary to treatable causes, and are reversible. The most important of these is the pseudodementia of depression, which can be easily missed without a high degree of suspicion. Tips on the differential diagnosis of Alzheimer's disease, multi-infarct dementia, and pseudodementia are discussed, as are other causes of dementia secondary to various diseases or therapy.

Hyperventilation syndrome in children and adolescents: long-term follow-up.

Records of 34 hyperventilating children aged 18 years or younger seen at the Mayo Clinic over a 25-year period were reviewed. Five different clinical subtypes were identified. Evaluation and treatment varied considerably. At follow-up, 40% were still hyperventilating as adults, and many had signs and symptoms of chronic anxiety. Hyperventilation in childhood can be a signal that the child is experiencing severe anxiety, which may persist into adulthood.

Liver dysfunction and histologic abnormalities in neonatal hypopituitarism.

Pituitary aplasia or hypoplasia occurs in anencephalic and normocephalic infants. Two infants with hypopituitarism are described; in each the diagnosis was made clinically. The infants had frank clinical and histologic evidence of the neonatal hepatitis syndrome. There may be more than a chance relationship between the clinicopathologic findings of neonatal hypopituitarism and hepatitis.