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State youth mental health providers pack
by Mary Helen
More than 120 mental health professionals spent the day learning how to
enhance the safety and well-being of South Carolina’s youth by
attending the Institute of Psychiatry’s (IOP) second annual Summer
Seminar Day on July 25.
Presentations provided clinicians with information on teens’ use of
Internet social networking sites, Asperger’s Disorder identification
and interventions, understanding of psychiatric medications prescribed
for youth, and harm prevention strategies for high at-risk youth. The
conference was sponsored jointly by the Youth Division at the IOP, the
IOP Office of Community and Professional Education and the MUSC Center
for Professional Development.
All of the speakers are experts in their fields. They provided the
audience information that is useful, valuable and easily understood
about complex behavioral issues to help guide parents, youth and health
Living in my space
Andrew Clark, M.D., a child psychiatry fellow in a specialized
adult/youth/research fellowship track, spoke on clinical concerns for
the social Internet with a focus on cyber-bullying, stranger contact
via the internet, and overuse of the internet by teens.
A member of the media committee of the American Academy of Child &
Adolescent Psychiatry, Clark emphasized that while most teens do not
experience problems with social Internet use, he advised that adults
provide guidelines for their children to include not posting personal
information, not flirting online, using caution and wisdom in posting
any photos and especially photos with identifying elements, and never
agreeing to meet anyone in person who was met online.
Clark cited various studies that have surveyed youth Internet use and
safety; one study of which suggested that 94 percent of American teens
ages 12-17 use the Internet, and 58 percent of online teens have a
social network profile online with 22 percent of teens visiting their
profile several times a day, according to research by Pew Internet and
American Life Project.
Laura A. Carpenter, Ph.D., an assistant professor of pediatrics
specializing in developmental pediatrics, addressed Asperger’s Disorder
with attention to identifying the disorder and differentiating it from
high functioning autism.
She recommended interventions to help maximize the potential of someone
with such a diagnosis. Individuals with Asperger’s, one of the group of
Autism spectrum disorders, show difficulty in the area of social skills
(poor eye contact, problems using gestures, difficulty understanding
other’s social cues), having a narrow but deep collection of interests,
and having poor motor coordination, she explained.
In order to correctly diagnose an individual with Asperger’s, she
advocated comprehensive and thorough evaluation and shared copies of
some of the standardized questionnaires that are part of a good
Carpenter’s discussion on intervention covered areas of social skills
training, ideas for using concrete visual guides, and sometimes the
addition of medications. She also shared statistics and epidemiological
data that suggest the incidence of all autism spectrum disorders is 6.5
per 1,000, and breaks down to autism at a ratio of 2.2 per 1,000,
Asperger’s 1 in 1,000, and other pervasive developmental disorders 3.3
Matthew S. Koval, M.D., an associate professor of psychiatry and
attending psychiatrist on the Child and Adolescent Inpatient Unit,
discussed the controversies, history and latest information on neural
stimulant and other treatments for children with attention
deficit/hyperactive disorder (ADHD).
While the Food and Drug Administration has directed drug makers to
change antidepressant labeling to include strong warnings about the
potential for suicidal thinking or behavior to develop when young
people are on these medications, no clear causal relationship has been
established, Koval explained. Koval also said that it is rare for
children who take these drugs to suffer from suicidal thoughts, or more
organized suicidal thoughts, initially with treatment. The risk is very
small and generally only associated with first starting the medication
or when doses are changed, Koval said.
Koval provided details about available therapies for ADHD, and
described how drugs vary in type, as well as effectiveness depending on
the child’s response to the medication.
Countering another concern, Koval said children who take ADHD drugs,
some of which rely upon amphetamines to increase focus and attention in
children, do not appear to suffer any greater risk of sudden cardiac
death than the general population, as some have suggested. Koval added
that the American Heart Association issued recommendations asking
prescribers of stimulant medications to run routine electrocardiograms
on patients, but the American Academy of Pediatrics has deemed these
tests usually unnecessary, but are indicated only when medical history
or physical exam points to the possibility of an underlying cardiac
Injury, suicide prevention
Markus Kruesi, M.D., a professor of psychiatry and chief of the youth
division in the Department of Psychiatry and Behavioral Sciences,
discussed how parents, medical and mental health providers can help
prevent a child from self-inflicted injury.
answered questions correctly received goodies, such as M&Ms, from
guest speaker Dr. Markus Kruesi.
In his presentation on suicide and injury prevention for at-risk
children and teens, Kruesi said that if they talk about suicide, young
black men are the most likely to carry out their wishes; young Latin or
Hispanic women are most likely to repeat a suicide attempt; and nearly
twice the number of suicide attempts were by females.
Obviously, the presence of a gun in the home increased dramatically the
risk of suicide by young people, but over-the-counter (OTC) drugs are
the most common weapon of choice. Acetaminophen, or Tylenol, poisoning
is a leading cause among youth attempting suicide by overdosing. Kruesi
said that the prevalence of large quantity medications make overdosing
more readily accessible.
“Can you imagine a kid trying to overdose if these drugs only came in
blister packages,” Kruesi asked. “That’s why a large quantity of loose
OTC painkillers has been banned in the United Kingdom. In fact, the
U.K. has a regulation requiring paracetamol to be sold in blister
Overall, of all premature fatalities among young people (between the
ages of 10 and 24), suicide ranks fifth. Roughly 10 percent of deaths
among youth is by suicide, but that number is down from several years
Kruesi explained how to spot behavior in children that may indicate a
propensity for suicide or self-harm.
Strong evidence pointing to individual risk factors include depression,
alcohol or drug abuse, antisocial behavior, poor peer relationships,
and expressed suicidal behavior by friends.
Evidence that may suggest a risk for self-harm include a child’s
feeling of hopelessness, media exposure to suicide, low self esteem,
smoking, eating disorders, poor physical health, a physical disability,
poor communi-cation in the family, homosexuality or bisexuality
(particular so for females, Kruesi said); and drug use.
Surprisingly, Kruesi said that a 1999 study he conducted in Chicago
determined that in more than half of emergency room visits for overdose
attempts by an adolescent, the parent had not been briefed on the
subject of suicide, and less than 30 percent of ER staff had warned
parents about limiting access to lethal means by their at-risk children.
“Parents who were taught about the risk of suicide in their kids were
nearly four times more likely to take new action to prevent it,” Kruesi
said. New action recommended includes removing all firearms, drugs, car
keys, and alcohol.
For information on IOP conferences, contact Heather Tyson at 792-7340
Friday, Aug. 1, 2008
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