Faculty Bibliography

Exposure to trauma is a common event in the lives of children and adolescents living in the United States. Although a minority of youth develop full posttraumatic stress disorder (PTSD) after a traumatic event, those who do tend to have an extended course of symptoms in multiple functional domains and higher rates of psychiatric comorbidities. Pediatric PTSD can play an important role in legal settings, and requires that an expert witness be well versed in advances in clinical and conceptual models of this diagnosis and familiar with current research devoted to the posttraumatic response in youth. This review is designed to be a resource for the forensic evaluator and outlines the current understanding of epidemiological and clinical features of pediatric PTSD, as well as the neurobiological, dimensional, and developmental conceptual models that describe it.

To identify various biopsychosocial risk factors associated with suicidality in juvenile detention facilities and the effectiveness of suicide prevention protocols currently in use. Medical literature searches were conducted using databases like Pub Med, Ovid, and Google Scholar to identify studies conducted in and outside of United States. The prevalence of suicide among youth imprisoned at detention facilities has risen. Psychiatric disorders are common among such population, making them vulnerable to suicidal tendencies. Suicide risk screening within first 24 h of admission to the detention facility has shown to lower the risk of suicide. Identification of high risk individuals and their further psychiatric assessment is advocated. Much of work with regards to screening tools and instruments is underway and further study is required to get a better understanding.

Various screening questionnaires have been established to identify psychopathology in children and adolescents. Some of these instruments include the pediatric symptom checklist (PSC), the pediatric symptom checklist (CBCL) and reporting questionnaire for children (RQC). However, many of the patients and their families may not speak English, and this can be a barrier to identifying and properly treating monolingual Spanish-speaking patients and families. There is a need for optimal mental health screening in Spanish speaking populations given the continued growth of the United States as a diverse country with complex demographic structure. Because of the diversity within the use of Spanish in Hispanic countries of origin, the aim of this study is to present unified Spanish versions of the RQC and PSC achieved through simultaneously and independently translating them into three versions of Spanish (RQC-SP and PSC-SP). To test the psychiatric validity of RQC-SP and PSC-SP, these both were administered simultaneously along with the Spanish version of the CBCL, which had already been well established. All three of these tools were given to Spanish speaking parents of pediatric outpatients (n = 22) while waiting for their clinic appointments. The RQC-SP had a correlation to the CBCL with R = 0.779 and p < 0.001. The RQC-SP as compared with the CBCL had a false negative of 0/8 (0.00) with a sensitivity of 8/8 = 1.00. The false positives were 2/14 (0.143) and specificity 12/15 (0.85). The PSC-SP correlated with the CBCL with R = 0.897 and p < 0.001. The PSC-SP correlation with the CBCL had false negative of 7/8 (0.875) and sensitivity of 1/8 (0.125) and false positive 0/14 (0.00) and specificity 14/14 (1.00). The RQC-SP and PSC-SP are brief, well-validated, reliable instruments designed.

Child abuse is a problem that affects over six million children in the United States each year. Child neglect accounts for 78 % of those cases. Despite this, the issue of child neglect is still not well understood, partially because child neglect does not have a consistent, universally accepted definition. Some researchers consider child neglect and child abuse to be one in the same, while other researchers consider them to be conceptually different. Factors that make child neglect difficult to define include: (1) Cultural differences; motives must be taken into account because parents may believe they are acting in the child's best interests based on cultural beliefs (2) the fact that the effect of child abuse is not always immediately visible; the effects of emotional neglect specifically may not be apparent until later in the child's development, and (3) the large spectrum of actions that fall under the category of child abuse. Some of the risk factors for increased child neglect and maltreatment have been identified. These risk factors include socioeconomic status, education level, family composition, and the presence of dysfunction family characteristics. Studies have found that children from poorer families and children of less educated parents are more likely to sustain fatal unintentional injuries than children of wealthier, better educated parents. Studies have also found that children living with adults unrelated to them are at increased risk for unintentional injuries and maltreatment. Dysfunctional family characteristics may even be more indicative of child neglect. Parental alcohol or drug abuse, parental personal history of neglect, and parental stress greatly increase the odds of neglect. Parental depression doubles the odds of child neglect. However, more research needs to be done to better understand these risk factors and to identify others. Having a clearer understanding of the risk factors could lead to prevention and treatment, as it would allow for health care personnel to screen for high-risk children and intervene before it is too late. Screening could also be done in the schools and organized after school activities. Parenting classes have been shown to be an effective intervention strategy by decreasing parental stress and potential for abuse, but there has been limited research done on this approach. Parenting classes can be part of the corrective actions for parents found to be neglectful or abusive, but parenting classes may also be useful as a preventative measure, being taught in schools or readily available in higher-risk communities. More research has to be done to better define child abuse and neglect so that it can be effectively addressed and treated.

In psychiatry, pregnancy introduces an element into the treatment setting that is complex and may require exploration. Often, in the psychotherapeutic relationship, the psychiatrist may use therapeutic techniques and provide no self disclosure to the patient by Tinsley (Am J Psychiatry 160(1): 27-31, 2003). The patient reveals all of their innermost thoughts. This can bring about curiosity for the patient about the clinician's life and result in asking personal questions which can at times be uncomfortable for the therapist, particularly for those still in training. This may feel like a boundary crossing which can pose a therapeutic challenge. The clinician is challenged to further enhance the therapeutic relationship and further help the patient on their journey to self exploration. While it is inevitable that patients will have reactions to their therapists, this can be played out in a number of ways, both at the conscious and unconscious level. While numerous studies have looked at the impact of the therapist's pregnancy on the patient and their treatment, there is no information about the effect of a therapist having a negative pregnancy outcome. Negative outcomes include the therapist having a miscarriage, delivering a still-born or both the therapist and baby dying. This case report describes a clinical scenario in which a psychiatry resident in training delivered a stillborn baby at 37 weeks and the impact of that on a long term psychotherapy patient.

In the last three decades there has been ample research to demonstrate that instituting Multisystemic Therapy for serious juvenile offenders, keeping them in the community with intensive intervention, can significantly reduce recidivism. When there is recidivism, it is less severe than in released incarcerated juveniles. Multisystemic Therapy provides 24 h available parental guidance, family therapy, individual therapy, group therapy, educational support and quite importantly a change of peer group. In New York City, there is the new mandate through the Juvenile Justice Initiative to implement interventions to keep juvenile offenders in the community rather than sending them to be incarcerated. However, this paper aims to examine how teaching prosocial values in early childhood can reduce the incidence of first-time juvenile delinquency. Programs such as the Perry School Project will be discussed to demonstrate that although somewhat expensive, these innovative programs nonetheless are quite cost-effective as the cost to society of adjudication, incarceration and victim damages are significantly greater. Along with teaching prosocial 0020 values, there has been renewed interest in early identification of youth at risk for developing Antisocial Personality Disorder. An update is given on the status of both promising approaches in early intervention to prevent serious juvenile delinquency and hence adult criminality.

Adolescence is marked by establishing a sense of identity, core values, a sense of one's relationship to the outside world and heightened peer relationships. In addition, there is also risk taking, impulsivity, self exploration and dramatic increase in sexuality. The dramatic increase in the use of cell phones and the Internet has additional social implications of sexting and cyberbullying. Sexting refers to the practice of sending sexually explicit material including language or images to another person's cell phone. Cyberbullying refers to the use of this technology to socially exclude, threaten, insult or shame another person. Studies of cell phone use in the 21st century report well over 50 % of adolescents use them and that text messaging is the communication mode of choice. Studies also show a significant percentage of adolescents send and receive sex messaging, both text and images. This paper will review this expanding literature. Various motivations for sexting will also be reviewed. This new technology presents many dangers for adolescents. The legal implications are extensive and psychiatrists may play an important role in evaluation of some of these adolescents in the legal context. This paper will also make suggestions on future remedies and preventative actions.

Stalking is a complex behavioral phenomenon that is unique in that it necessarily involves a prolonged dyadic relationship between both a perpetrator and a victim. Since criminalization of stalking behavior in the 1990s, different conceptual typologies have attempted to classify this behavior to assess risk and aid in management decisions. The authors reviewed the current literature regarding the most recent and accepted stalking classification systems. The three predominant stalker typologies currently in use include Zona's stalker-victim types, Mullen's stalker typology, and the RECON stalker typology. Of these, the RECON classification system alone was developed in an attempt to separate stalkers into groups based on previously known risk factors for behaviorally based phenomenon such as propensity for violence. Understanding and simplifying these classification systems may enhance the potential that new research will lead to evidence-based management and treatment strategies in the stalking situation.