Headache competencies in child neurology

This is a proposal for suggested physician competencies in the diagnosis and treatment of children and adolescent patients with headaches. Headaches are common in childhood and occur in up to 10% of school-aged children and over 20% of female adolescents. Therefore, the appropriate recognition, evaluation, and treatment should be a high priority of training and maintenance of certification programs.     

Neuropsychological issues in child psychology and child psychiatry

Neuropsychological aspects are of relevance to a variety of psychological concerns, especially in assessments. But is this trend represented in journals which do not explicitly refer to neuropsychologists? To investigate this question, publications in 2008 and 2009 editions of representative German journals on child psychology and psychiatry were bibliometrically analyzed. Main topics of neuropsychological publications were attention disorders and diagnostic issues. Neuropsychological findings support the development of assessment instruments and interventions and help improve the basic understanding of disorders and treatment limitations. For example, reduced attention or memory resources are possible hindrances for individual progress in cognitive behavioral intervention. An intensified dialogue of the disciplines is essential for developing advanced guidelines for diagnostics and therapy.     

Training general psychiatry residents in child and adolescent psychiatry

The authors describe the nature of current social and economic forces impacting on the education and future practice of general psychiatry residents in child and adolescent psychiatry. They review theoretical and practical reasons for training in child and adolescent psychiatry, analyze the form and content of what is currently taught based on a national survey of general training programs, and suggest guidelines for the training and postgraduate practice of general psychiatrists in evaluating and treating children and adolescents. The authors conclude that while social and economic changes necessitate general psychiatrists' clinical involvement with children and adolescents, insufficient general training may necessitate postgraduate education and supervision. They pose ethical and professional dilemmas for the field in meeting the national shortage of child and adolescent psychiatrists and propose strategies to enhance recruitment into child and adolescent residency training.     

Neuroimaging in child and adolescent psychiatry

Although less well studied in child and adolescent psychiatry than in adult psychiatry, brain imaging has significantly altered psychiatric research and practice. This review focuses on the modalities that are used to image the brain. These include structural imaging techniques of computer tomography (CT) and magnetic resonance imaging (MRI), as well as functional imaging techniques of computed electroencephalography (CEEG), positron emission tomography (PET), and single photon emission computed tomography (SPECT). The technologies are reviewed, strengths and weaknesses of modalities discussed, and research progress reported.     

Malpractice in child and adolescent psychiatry

Over the past 40 years, malpractice suits in child and adolescent psychiatry have gone from almost nonexistent to a source of major concern. Suits that involve child and adolescent patients remain fairly uncommon, and no damages are paid in six out of seven cases. The two cardinal principles for the clinician in avoiding and defending malpractice suits are to practice in accordance with his or her best clinical judgment and to document care, particularly in areas in which an unexpected adverse result may lead to a lawsuit. The most common areas that give rise to suit are failure to protect a child inpatient from assault or sexual interaction with another inpatient, adolescent suicide, medication errors, and issues related to child abuse. Evolving areas of malpractice law derive from incipient patient's rights legislation, development of the "direct victim" test in cases brought by third-party parents against therapists who have diagnosed children as sexually abused, implementation of new federal rules regarding privacy of records, and provision of medical information or treatment over the Internet.     

Functional neuroimaging in child psychiatry

Functional neuroimaging in child psychiatry presents unique scientific, ethical, and technical challenges. The study of childhood disorders presupposes knowledge of neurodevelopment and brain maturation. However, much of human brain science is based on inferences from animal work and indirect neurochemical measures from body fluids. Neuroimaging can examine brain development directly in humans. The benefits can be enormous for learning how and when to intervene to prevent or treat a disorder. These unprecedented potential gains are countered by complex and difficult ethical issues. Technical advances can reduce ethical concerns by minimizing risks. They also promise to enhance the sensitivity and specificity of the measures (eg, by improving spatial and temporal resolution). Judiciously designed investigations will permit the testing of a priori hypotheses built on rational models of neuropathology. Finally, it is the integration of scientific knowledge across the various fields of neuroscience and clinical research that will push the limits of our understanding of health and disease.     

Open reporting in child psychiatry

Although medical reports are usually viewed as special confidential communications between health care professionals, the author has found that there are many advantages to open communication with parents; having them present in conferences about their child and giving them copies of psychiatric reports. Personal experience, a survey done by the Child Development Program of BC Children's Hospital and the small amount of literature available suggest that "open reporting" increases parental understanding and taking of responsibility for constructive change.     

Equine-assisted therapy in child psychiatry

The use of a horse or pony as a therapeutic tool is often presented in the media as a recent phenomenon. A survey of 103 institutions shows that it is in fact an approach well rooted in child and adolescent psychiatry. However, professionals who use equine-assisted therapy are calling for an assessment to be carried out enabling them to hone their practices.