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"Child Psychiatry trends."
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Resting state functional brain connectivity in child and adolescent psychiatry: where are we now?
Approaching the 30th anniversary of the discovery of resting state functional magnetic resonance imaging (rsfMRI) functional connectivity, we reflect on the impact of this neuroimaging breakthrough on the field of child and adolescent psychiatry. The study of intrinsic functional brain architecture that rsfMRI affords across a wide range of ages and abilities has yielded numerous key insights. For example, we now know that many neurodevelopmental conditions are associated with more widespread circuit alterations across multiple large-scale brain networks than previously suspected. The emergence of population neuroscience and effective data-sharing initiatives have made large rsfMRI datasets publicly available, providing sufficient power to begin to identify brain-based subtypes within heterogeneous clinical conditions. Nevertheless, several methodological and theoretical challenges must still be addressed to fulfill the promises of personalized child and adolescent psychiatry. In particular, incomplete understanding of the physiological mechanisms driving developmental changes in intrinsic functional connectivity remains an obstacle to further progress. Future directions include cross-species and multimodal neuroimaging investigations to illuminate such mechanisms. Data collection and harmonization efforts that span multiple countries and diverse cohorts are urgently needed. Finally, incorporating naturalistic fMRI paradigms such as movie watching should be a priority for future research efforts.
Journal Article
The future of genomics for developmentalists
The momentum of genomic science will carry it far into the future and into the heart of research on typical and atypical behavioral development. The purpose of this paper is to focus on a few implications and applications of these advances for understanding behavioral development. Quantitative genetics is genomic and will chart the course for molecular genomic research now that these two worlds of genetics are merging in the search for many genes of small effect. Although current attempts to identify specific genes have had limited success, known as the missing heritability problem, whole-genome sequencing will improve this situation by identifying all DNA sequence variations, including rare variants. Because the heritability of complex traits is caused by many DNA variants of small effect in the population, polygenic scores that are composites of hundreds or thousands of DNA variants will be used by developmentalists to predict children's genetic risk and resilience. The most far-reaching advance will be the widespread availability of whole-genome sequence for children, which means that developmentalists would no longer need to obtain DNA or to genotype children in order to use genomic information in research or in the clinic.
Journal Article
Thinking the future of child and adolescent psychiatry: what are we talking about?
It is surprising to see to what extent the term mental health is used on a daily basis by politicians or the media in most countries of the world, while the word psychiatry is gradually being banned. This seems particularly true in the field of child and adolescent psychiatry: while one in three humans is a child or adolescent and psychiatric disorders are at the forefront in this age group, investments in child psychiatry are notoriously massively insufficient. Certainly, there has always been a reluctance to use the word psychiatry. Since psychiatry has existed, there has even been an antipsychiatry, particularly active with regard to children and adolescents. Thus, it is not uncommon to hear that children cannot have psychiatric problems, the latter being the prerogative of adults, prey to existential doubts or overwhelming responsibilities. Others will argue that it is psychiatrists who invent diseases such as ADHD or child depression. Some, finally, will consider that if children can indeed experience psychological distress, it is up to their families, especially their mothers, to take care of this, medicine and psychiatry having nothing to do with it. However, antipsychiatry does not explain alone the striking discrepancy between the pervasive discourse on young people’s mental health and the obvious lack of efforts to develop a satisfying child and adolescent psychiatry health-care system. To overcome such a paradoxical and dramatic situation, it is important to try to understand why.
Journal Article
Building Child and Adolescent Psychiatry Expertise in Ghana Through Training and Knowledge Dissemination: a Review of the Initial Collaboration Stages, Opportunities, and Challenges
Purpose of Review
Improving child and adolescent mental health (CAMH) is a priority worldwide. The majority of children with psychiatric conditions in low-middle-income countries (LMIC), like Ghana, receive no treatment due largely to limited resources and few CAMH training opportunities. The Komfo Anokye Teaching Hospital (KATH) and University of Michigan (UM) established a partnership to expand CAMH training for general psychiatrists in Ghana. Lessons learned from the early stages of the collaboration can serve as an adaptable roadmap for similar efforts to expand CAMH training in LMIC.
Recent Findings
Previous articles have discussed global academic partnership, training, and capacity building programs; however, early challenges, opportunities, and preparatory stages involved in creating a mutually beneficial collaboration aimed at improving child psychiatry expertise in a LMIC are under explored in the global mental health literature. This article seeks to fill that gap by using examples to highlight unique considerations for institutions in the initial stages of establishing their global partnership.
Summary
The early stages of a global partnership can impact the success of the collaboration. Collaborations should be bi-directional, sensitive to local culture, and flexible and establish achievable sustainable goals.
Journal Article
Changes in the Diagnosis of Autism: How Parents and Professionals Act and React in France
The category of autism has undergone huge changes over the past 20 years. This study was undertaken to analyze the changes and how parents have experienced the diagnostic process in France. Data were obtained from in-depth interviews with parents and psychiatrists, and from 248 questionnaires with open-ended questions filled in by parents. We compared the experiences of parents with adult autistic children to those of parents with young autistic children. Progressively earlier age at diagnosis was evidenced. These changes occurred later than in North America and the UK, due to the reluctance of French professionals to adopt the new classifications of diseases which they viewed as undervaluing both the physician’s holistic clinical skills, and psychoanalytical interpretations. Parents’ experiences and interviews with psychiatrists were analyzed in order to document changes over time in the diagnostic process following tensions between parents and professionals, and intra-professional debates in psychiatry. Our data support the notion that the diagnosis of autism is historically and nationally contingent. The interactions between changes in the diagnostic process, policy, and parental experiences have led to changes in the way autism is defined, understood, and experienced.
Journal Article
Ten years of child and adolescent psychiatry in Austria: a new medical speciality within the structures of public health services
We discuss the comprehensive work for the development of child and adolescent psychiatry in Austria, summarize the current status of care in various settings and focus on further developments. Intramural care offers about 50% of the places needed and is heterogeneously distributed over the country, extramural care offers already around one quarter of care in need. We calculated a fully developed extramural care system from about 2033. Further development of the Austrian care system in child and adolescent psychiatry needs collaborative efforts of all responsible players.
Journal Article
