Child and Adolescent Psychiatry: Blackwell's Neurology and Psychiatry Access Series (Access)

416 Pages·2005·2.55 MB·English

by  Sandra Sexson

BLACKWELL’S NEUROLOGY AND PSYCHIATRY ACCESS SERIES
Child and Adolescent
Psychiatry
SECOND EDITION
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Other books in Blackwell’s Neurology and Psychiatry Access Series
David: Child and Adolescent Neurology, 2nd Edition
Corey-Bloom: Adult Neurology, 2nd Edition
Rubin & Zorumski: Adult Psychiatry, 2nd Edition
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BLACKWELL’S NEUROLOGY AND PSYCHIATRY ACCESS SERIES
Child and
Adolescent
Psychiatry
SECOND EDITION
EDITED BY
Sandra B. Sexson, MD, FAACAP, FACP
Professor and Chief
Division of Child, Adolescent and Family Psychiatry
Department of Psychiatry and Health Behavior
Medical College of Georgia
Augusta
Georgia
SERIES EDITOR
Ronald B. David, MD, FAAP, FAAN
Richmond, Virginia
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© 2005 by Blackwell Publishing Ltd
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First published 1997
Second Edition 2005
Library of Congress Cataloging-in-Publication Data
Child and adolescent psychiatry. -- 2nd ed. / edited by Sandra B. Sexson.
p. ; cm. -- (Blackwell’s neurology and psychiatry access series)
Includes bibliographical references and index.
ISBN-13: 978-1-4051-1768-5
ISBN-10: 1-4051-1768-0
1. Child psychiatry. 2. Adolescent psychiatry. I. Sexson,
Sandra B.
II. Series.
[DNLM: 1. Mental Disorders--Adolescent. 2. Mental Disorders--Child.
3. Mental Disorders--Infant. 4. Adolescent Psychiatry. 5. Child
Psychiatry. WS 350 C535015 2005]
RJ499.C48228 2005
618.92’89--dc22
2005016573
ISBN-13: 978–1–405–117685
ISBN-10: 1–4051–1768–0
A catalogue record for this title is available from the British Library
Set in 9.25/12pt Palatino by Sparks, Oxford – www.sparks.co.uk
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Contents
Contributors, vii 9 Anxiety Disorders, 113
Osvaldo Gaytan, MD, Andro Giorgadze, MD, and Shannon
Foreword, x
Croft, MD
Preface to the Second Edition, xii
10 Mood Disorders, 132
Preface to the First Edition, xiii Robert A. Kowatch, MD, Graham J. Emslie, MD, John
Wilkaitis, MD, and Arden D. Dingle, MD
Section 1: Assessment and Evaluation 11 Eating Disorders, 154
Editor: Douglas O. Lee, MD David A. Waller, MD
1 Psychiatric Examination and Diagnosis in Children 12 Psychotic Disorders, 163
and Adolescents, 3 Karen M. Hochman, MD and Elaine F. Walker, PhD
Myla Harrison, MD and Jeffrey Newcorn, MD
13 Disorders with Physical Symptoms, 177
2 Diagnostic Instruments, 19 Arden D. Dingle, MD
Aradhana A. Sood, MD and Donald P. Oswald, PhD
14 Substance Use Disorders, 190
3 Psychiatric Evaluation: Biomedical Assessment, 31 Steven L. Jaffe, MD
Douglas O.Lee, MD and Thomas K. Cummins, MD
4 Strategic Treatment Planning and Therapeutic Section 3: Clinical Conditions and
Interventions, 37 Situations
Arden D. Dingle, MD and Douglas O. Lee, MD Editor: Sandra B. Sexson, MD
15 Issues in Infant Psychiatry, 201
Section 2: Diagnostic Categories Ayelet Talmi, PhD and Robert J. Harmon, MD
Editor: Arden D. Dingle, MD
16 Common Behavioral Issues in Clinical Practice, 225
5 Developmental Disabilities: Mental Retardation and Mary Lynn Dell, MD
Pervasive Developmental Disorders, 63
17 Chronic Illness in Children and Adolescents, 264
Douglas O. Lee, MD and Deepa Gopalakrishnan, MD
Arden D. Dingle, MD and Sandra B. Sexson, MD
6 Developmental Disabilities: Learning Disorders, 79
18 The School’s Role in the Psychosocial Development of
Ann Abramowitz, PhD
Children, 278
7 Attention-defi cit/Hyperactivity Disorders, 91 Graeme Hanson, MD
Iliyan Ivanov, MD and Jeffrey Newcorn, MD
19 Child and Adolescent Sexuality, 287
8 Disruptive Disorders and Aggressive Behavior, 105 Debbie R. Carter, MD and Sarah Herbert, MD
Niranjan S. Karnik, MD, PhD and Hans Steiner, Dr med
univ, FAPA, FAACAP, FAPM
v
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vi Contents
20 Risk-taking and Dangerous Behavior in Children and 22 Child and Adolescent Responses to Trauma, 321
Adolescents, 303 Michael D. DeBellis, MD, MPH and Anandhi Narasimhan,
David J. Mullen, MD and Robert L. Hendren, DO MD
21 Evaluating and Managing Attachment Diffi culties in Bibliography, 339
Children, 311
Index, 383
Shannon Croft, MD and Marianne Celano, PhD
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Contributors
Ann Abramowitz, PhD is a clinical psychologist with a primary ap- Mary Lynn Dell, MD, MTS, ThM is on the faculty of the Department
pointment in the Department of Psychology, Emory University. She of Psychiatry and Behavioral Sciences at Emory University. She com-
also teaches in the department of Psychiatry and Behavioral Sciences. pleted her medical education and her general psychiatry training at
She trained at SUNY Stony Brook. Her interests include learning dif- Indiana University and her child and adolescent psychiatry training
fi culties, behavior problems, and ADHD, with a focus on early inter- at Emory University. After serving on the faculties at both Emory and
vention and multimodal treatment. the University of Pennsylvania, Dr Dell was a NIMH Research Fellow.
She also served on the faculty of George Washington University be-
Dr Debbie Carter is a native of New York and graduated from Jeffer- fore returning to Emory. Her areas of special interest include pediatric
son Medical College. She completed her general and child psychiatry psychiatry consultation and liaison, psychiatric ethics, and religion
postgraduate training at Thomas Jefferson University Hospital in and spirituality in psychiatry.
Philadelphia, Pennsylvania. Dr Carter is an Associate Professor at the
University of Colorado Health Sciences Center, which she joined in Arden D. Dingle, MD is an Associate Professor of Psychiatry and
1995. She is the Residency Training Director in the Division of Child Behavioral Sciences and the Training Director, Child and Adolescent
and Adolescent Psychiatry and is the Medical Director of the Kempe Psychiatry, at Emory University School of Medicine in Atlanta, Geor-
Therapeutic Preschool in the Department of Pediatrics. gia. She graduated from UMDNJ-New Jersey Medical School and
completed a combined residency in pediatrics, psychiatry, and child
Marianne Celano, PhD is an Associate Professor in the Department and adolescent psychiatry at Mount Sinai Medical Center in New
of Psychiatry & Behavioral Sciences at the Emory University School of York City. Her interests include medical education, medically ill chil-
Medicine. She is a licensed psychologist specializing in clinical work dren, and community child and adolescent psychiatry.
with children and families. Her research interests include child mal-
treatment, pediatric asthma, family interaction patterns associated Graham Emslie, MD is a Professor and the Chief of the Child and Ad-
with childhood depression, and cultural issues in psychiatry. olescent Psychiatry Division at the University of Texas Southwestern
Medical Center at Dallas (UTSW). He holds the Charles E. and Sarah M.
Shannon Croft, MD is an Assistant Professor of Psychiatry and Be- Seay Chair in Child Psychiatry at UTSW. Dr Emslie completed his med-
havioral Sciences at Emory University School of Medicine, and Direc- ical training at Aberdeen University in Scotland, his general psychiatry
tor of Child Psychiatry at Grady Hospital in Atlanta, Georgia. He is training at the University of Rochester, NY, and Child Psychiatry train-
a graduate of Emory’s Medical School, where he also completed both ing at Stanford University. His research interests are in the psychop-
psychiatry and child psychiatry residencies. He has recently gradu- harmacological and psychosocial treatments of early-onset psychiatric
ated from Emory’s Psychoanalytic Institute. His areas of interest in- disorders, including depression, anxiety disorders, and ADHD.
clude community child and adolescent psychiatry and the effects of
trauma on children and families. Andro Giorgadze, MD is a resident in the Child and Adolescent Psy-
chiatry Program at Emory University School of Medicine in Atlanta,
Michael D. DeBellis MD, MPH is a Professor of Psychiatry and Georgia. He is a graduate of Tbilisi State Medical University and
Behavioral Sciences at Duke University Medical Center. He is the completed his psychiatry residency training also at Emory Univer-
Director of the Healthy Childhood Brain Development Research Pro- sity School of Medicine. His special areas of interest are the biological
gram at Duke. Dr DeBellis completed his medical training at the State underpinnings of psychotherapeutic change.
University of New York at Downstate, his general psychiatry train-
ing at New York University, New York, and child psychiatry training Deepa Gopalakrishnan, MD is an Assistant Professor of Psychiatry
at the University of Pittsburgh Medical Center, Western Psychiatry and Behavioral Sciences at Emory University School of Medicine,
Institute and Clinic. He also completed a research fellowship at NIH. Atlanta, Georgia. She is the Director of the Preschool and School
His research interests are in childhood brain and cognitive develop- programs in the division of child and adolescent psychiatry. She is a
ment, child maltreatment, and pediatric PTSD. graduate of Mysore Medical College, India, and completed her resi-
vii
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viii Contributors
dencies in psychiatry at Albany Medical Center, Albany, NY and in Karen Hochman, MD, FRCPC is an Assistant Professor of Psychiatry
child and adolescent psychiatry at Emory University School of Medi- and Behavioral Sciences at Emory University School of Medicine in
cine, Atlanta, Georgia. Atlanta, Georgia. She is a graduate of the Faculty of Medicine, at Uni-
versity of Manitoba, Canada and divided her psychiatry residency
Osvaldo Gaytan MD/ PHD is a child and adolescent psychiatry resi- training between the University of Toronto and the University of
dent at Emory University School of Medicine, Atlanta, Georgia. He Manitoba. Her research interest lies in identifying specifi c indicators
is a graduate of the University of Texas at El Paso and received his of risk in adolescents at elevated risk of developing psychosis.
MD/PhD from the University of Texas Medical School at Houston.
He completed his residency in psychiatry at Emory University. His Iliyan Ivanov, MD is a clinical instructor at the division of child and
special area of research interest is in the effects of early life trauma on adolescent psychiatry at the Mount Sinai School of Medicine in New
the development of psychiatric disorders. York City. He is a graduate of the Bulgarian Academy of Medicine,
and he completed residencies in psychiatry and child and adolescent
Graeme Hanson, MD is Clinical Professor of Psychiatry and Pediatrics psychiatry at the Mount Sinai School of Medicine in New York. He
at the University of California, San Francisco, where he was Director has been working in the area of psychopharmacological treatment
of Training in Child and Adolescent Psychiatry until 2005. Dr Han- of ADHD.
son received his MD from Harvard Medical School and completed
both adult and child psychiatry residencies at Massachusetts Mental Steven L. Jaffe, MD is an Emeritus Professor of Psychiatry and
Health Center. He is Co-Chair of the Committee on Schools for the Behavioral Sciences at Emory University School of Medicine and
American Academy of Child and Adolescent Psychiatry. His profes- Clinical Professor of Psychiatry at Morehouse School of Medicine
sional interests are in child and adolescent growth and development, in Atlanta, Georgia. He attended Johns Hopkins University and the
and in teaching and training in child and adolescent mental health. Albert Einstein College of Medicine. He completed a pediatric intern-
ship at UCLA, a psychiatry residency at the Massachusetts Mental
Robert J Harmon, MD is Professor of Psychiatry and Pediatrics, Health Center where he was a teaching fellow at Harvard Medical
University of Colorado School of Medicine; Medical Director CeDAR School and a child psychiatry fellowship at Emory University School
(Center for Dependency, Addiction, & Rehabilitation) at the Anschutz of Medicine. He specializes in the treatment of adolescent substance
Centers for Advanced Medicine, University of Colorado Hospital; and abuse disorders.
Director, The Irving Harris Program in Child Development and Infant
Mental Health, University of Colorado School of Medicine, Denver, Niranjan Karnik, MD, PhD is a resident in child and adolescent
Colorado. Dr Harmon completed his medical training – as well as his psychiatry program at Stanford University Hospital & Clinics, and
adult psychiatry and child & adolescent psychiatry training – at the the Lucile Packard Children’s Hospital in Palo Alto, California. He
University of Colorado School of Medicine. He spent three years at is a graduate of the University of Pennsylvania, the University of Il-
the National Institute of Child Health and Human Development in linois at Urbana-Champaign, and the University of Illinois College of
Bethesda, Maryland as a Research Associate in Child Development. Medicine. He was awarded his PhD in Sociology with a focus on chil-
He is a lecturer and author of more than 150 publications on infant dren in vulnerable circumstances including foster, refugee, and street
psychiatry, infant and family development, and the effects of the children. He completed his psychiatry residency training at Stanford
death of an infant on the family. University Hospital and Clinics. His current research interests focus
on incarcerated juveniles, homeless youth, and cultural competence
Robert L. Hendren, DO is Professor of Psychiatry, Executive Direc- in medical education.
tor, MIND Institute (Medical Investigation of Neurodevelopmental
Disorders) and Chief, Division of Child and Adolescent Psychiatry, Robert A. Kowatch, MD is a Professor of Psychiatry and Pediatrics at
University of California, Davis. Dr. Hendren took his residency in Cincinnati Children’s Hospital Medical Center and the University of
general psychiatry at the Mayo Graduate School of Medicine and his Cincinnati Medical Center, of Cincinnati. He completed his internship
child and adolescent psychiatry fellowship at the Yale Child Study in internal medicine at The Graduate Hospital under the auspices of
Center. His primary areas of research and publication are neuroimag- the University of Pennsylvania, and his residency in psychiatry at
ing, psychopharmacology, neurodevelopmental disorders, including the Hospital of the University of Pennsylvania. His research interests
pervasive developmental disorder, bipolar disorder, schizophrenia are in the treatment of child and adolescent bipolar disorders and the
spectrum disorders, and impulse control disorders. neurobiology of these disorders.
Sarah Herbert, MD is a clinical adjunct assistant professor in the Douglas O. Lee, MD is an Assistant Professor of Psychiatry and Be-
Department of Psychiatry and Behavioral Sciences at Morehouse havioral Sciences at the Emory University School of Medicine and
School of Medicine in Alanta, Georgia. She is a child and adolescent is Director of the Psychopharmacology Consultation Program at the
psychiatrist who has had a signifi cant interest in issues of sexuality Emory Autism Center in Atlanta, Georgia. He graduated from the
and gender identity throughout her career. She presents on these University of Pennsylvania and from Temple University School of
subjects at national meetings, teaches at Emory School of Medicine Medicine. He completed his psychiatry residency at Bellevue Hospi-
as well as Morehouse, and is on the Sexual Orientation and Gender tal-New York University and his child and adolescent psychiatry resi-
Identity Issues Committee of the American Academy of Child and dency at Children’s Hospital-Harvard Medical School. His interests
Adolescent Psychiatry. include children and adolescents with ADHD and autism.
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Contributors ix
David J. Mullen, MD is an Associate Professor of Psychiatry in the chiatry residency at the University of Michigan in Ann Arbor. His
Division of Child and Adolescent Psychiatry within the Department research interests are in the area of aggression and its relationship
of Psychiatry at the University of New Mexico School of Medicine to psychopathology, psychopathologies associated with trauma and
in Albuquerque, New Mexico. Dr Mullen completed his training in victimization, and pediatric and psychiatric comorbidity.
medicine at the University of Oklahoma and completed residencies
in both general as well as child and adolescent psychiatry at the Uni- Ayelet Talmi, PhD is an Instructor in the Department of Psychiatry
versity of New Mexico. He is the Executive Medical Director of the at The University of Colorado Health Sciences Center (UCHSC). As
University of New Mexico Children’s Psychiatric Center, Inpatient a licensed clinical psychologist and neurodevelopmental infant spe-
Services. He has also provided psychiatric consultation to the Ber- cialist, she provides consultation and therapeutic services to infants,
nalillo County Juvenile Detention Center for the past 13 years. His toddlers, and families seen at The Children’s Hospital, in addition
interests include disruptive behavior disorders and mood disorders to conducting research on fragile infants’ interactions with their care-
in children and adolescents. givers. Dr. Talmi received her PhD in child clinical and develop mental
psychology from the University of Denver, completed her clinical in-
Jeffrey Newcorn, MD is an Associate Professor of Psychiatry and ternship at The Children’s Hospital in Denver, Colorado, and was a
Pediatrics, and the Director of Child and Adolescent Psychiatry, NIMH-funded Developmental Psychobiology Postdoctoral Research
Mount Sinai School of Medicine. He graduated from the University Fellow at UCHSC. Dr. Talmi is also a graduate ZERO TO THREE
of Rochester School of Medicine and did his psychiatry and child and Solnit Fellow. She is on the faculty of both the The Irving Harris Pro-
adolescent psychiatry residencies at the Tufts-New England Medical gram in Child Development and Infant Mental Health at UCHSC, and
Center. His research interests include attention defi cit hyperactivity at the Center for Family and Infant Interaction.
disorders and associated comorbid disorders.
David Waller, MD is a Clinical Professor of Psychiatry at the Univer-
Sandra B. Sexson, MD is Professor and Chief as well as Training sity of Texas Southwestern Medical Center and Children’s Medical
Director of the Division of Child, Adolescent, and Family Psychia- Center, Dallas, Texas. He is a graduate of Harvard College and the
try within the Department of Psychiatry and Health Behavior at the Johns Hopkins University School of Medicine, and he completed resi-
Medical College of Georgia in Augusta, Georgia. Dr Sexson gradu- dencies in pediatrics at Johns Hopkins University School of Medicine,
ated from the University of Mississippi School of Medicine and com- in psychiatry at the Massachusetts General Hospital and in child and
pleted postgraduate training in child development (University of adolescent psychiatry at Children’s Hospital in Boston. Eating disor-
Mississippi), general psychiatry (University of Texas at San Antonio) ders is an area of special interest.
and child psychiatry (Washington University in St. Louis). Prior to her
present appointment, she has served as Chief of Child and Adolescent Elaine F. Walker, PhD is the Chair of Psychology and the Samuel
Psychiatry and Training Director at Wright State University in Day- Candler Dobbs Professor of Psychology and Neuroscience at Emory
ton, Ohio, and at Emory University. Her primary professional focus University. She is a graduate of Washington University in St Louis,
has been in psychiatric education with a clinical and research focus MO. Her research interests are in the areas of the causes of major
in education, and in the emotional issues of children and adolescents mental disorders, for example the developmental course of schizo-
with chronic medical illnesses. She is an active leader in psychiatric phrenia, especially childhood precursors.
education in the United States.
John Wilkaitis, MD is a child and adolescent psychiatry resident at
Hans Steiner, Dr med univ, FAPA, FAACAP, FAPM is a Professor Cincinnati Children’s Hospital while collaborating in research with
of Psychiatry and Behavioral Sciences, Child Psychiatry and Child Dr. Melissa Delbello, Dr Stephen Strakowski, and Dr Robert Kowatch
Development at the Stanford University School of Medicine. He at the University of Cincinnati. He graduated from medical school
received his Doctor medicinae universalis from the University of and psychiatry residency at the University of Mississippi and has an
Vienna, Austria, in 1972. He completed his residency in psychiatry MS in Chemistry.
at SUNY Upstate Medical Center and his child and adolescent psy-
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Foreword
Traditional textbooks convey knowledge. It is the goal of Classifi cation systems induce orderliness in thinking and
this text in the Blackwell’s Neurology and Psychiatry Access enhance our ability to communicate effectively. A review of
Series to convey not only essential knowledge but also the the most enduring hierarchical classifi cation systems, par-
collected wisdom of its many highly regarded contributors. ticularly that of Linnaeus (that is, phyla, genera, species),
To achieve the goal of conveying not only knowledge but makes clear the value of grouping according to discriminat-
also wisdom, each book in this series is built on a structural ing features, as well as the value of simplicity, expandability,
framework that was well received by critics and readers and dynamism.
alike in David: Pediatric Neurology for the Clinician and the The goal, whatever the classifi cation system, is to seek the
fi rst editions of Child and Adolescent Neurology, Adult Neu- most powerful discriminating features that will produce the
rology, Child and Adolescent Psychiatry, and Adult Psychiatry greatest diagnostic clarity. Discriminating features should
(Mosby). Each volume is divided into three sections: avoid crossing domains. Much of the confusion that arises
(cid:127) tools for diagnosis in diagnosis may be the result of the clinician who unwit-
(cid:127) diseases and disorders tingly crosses the anatomic, pathologic, pathophysiologic,
(cid:127) common problems. phenomenologic, and etiologic classifi cation domains used
Also included to facilitate a physician’s use of this book are: in medicine (for example, the inclusion of anatomically
(cid:127) Nosologic diagnosis tables oriented ‘temporal lobe seizures’ in a phenomenologically
(cid:127) ‘Pearls and perils’ boxes based classifi cation system that includes complex partial
(cid:127) ‘Consider consultation when…’ boxes seizures). Some conditions, such as brain tumors, are classi-
(cid:127) selected annotated bibliographies fi ed according to their histopathology and lend themselves
(cid:127) a complete bibliography well to this classifi cation system. Others, such as headaches
and (new in this edition) and movement disorders, are classifi ed phenomenologi-
(cid:127) ‘Key clinical questions and what they unlock.’ cally and are therefore much less easily classifi ed. In other
The Nosologic diagnosis tables are based on a discrimina- cases, discriminators must encompass inclusionary, as well
tor model to promote clearer understanding, and are supe- as, exclusionary features. At times, we can only use a crite-
rior to a criterion-based model and others that lack similar rion-based system or construct tables to compare features.
specifi city. Arbitrarily, we label as consistent features those which
occur more than 75% of the time. Features are considered
variable when they occur less than 75% of the time. The
Whoever having undertaken to speak or write hath
diagnostic tables should be viewed, therefore, only as a be-
fi rst laid for themselves some [basis] to their argu-
ginning in the extremely diffi cult effort to make diagnosis
ment such as hot or cold or moist or dry or whatever
more precise and biologically based. How well this book
else they choose, thus reducing their subject within a
accomplishes the goals of identifying the most powerful
narrow compass.
discrimination features for maximum diagnostic clarity is
limited by the current state of the art in child and adolescent
Hippocrates
neurology. In some areas, several features, when clustered
As Hippocrates has suggested, structure is the key to learn- together, serve to discriminate.
ing. Unless there is a structure onto which knowledge can This text is designed to be pithy, not exhaustive, as there
be built, confusion and disorganization are the inevitable are already many available of this ilk. Each text in this se-
consequences. ries refl ects appropriate stylistic differences among content
x
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