Symposium to Highlight Latest Advances in Child and Adolescent Psychiatry

During APA’s 2018 Annual Meeting in May, the American Academy of Child and Adolescent Psychiatry(AACAP) is sponsoring a special symposium to share updates on the latest advances in the treatment of youth for depression, anxiety, autism spectrum disorder (ASD), and disruptive mood dysregulation disorder (DMDD).

I will begin the session by discussing my presidential initiative on depression awareness and screening in youth. Among the topics I will cover are the consequences of untreated depression in youth such as impaired school performance, poor peer relationships, disruptive family functioning, and suicidality and treatment options for depression in children and adolescents.

John T. Walkup, M.D., a professor of psychiatry at the Weill Cornell Medical College, will review the age of onset of the various anxiety disorders and their clinical presentations across the life span. There are myriad reasons why childhood anxiety is not identified and treated, which include confusion regarding healthy anxiety and pathological anxiety, lack of awareness and advocacy as compared with other childhood conditions, and the perception that anxiety disorders are not severe or as impairing as other psychiatric disorders. As a result, children with untreated anxiety are at risk of developing problems with adaptation and coping and maladaptive behaviors including substance use disorders, suicidal behavior, and nonsuicidal self-injury as they move from childhood to adolescence and young adulthood. The presentation will conclude with guidance on the identification and treatment of anxiety disorder symptoms.

Jeremy M. Veenstra-VanderWeele, M.D., the Ruane Professor for the Implementation of Science for Child and Adolescent Mental Health at Columbia University Medical Center, will review the evidence base for behavioral and medication treatments for ASD. To date, all evidence-based interventions in ASD are based upon either empirical findings (for example, risperidone) or basic behavioral principles (for example, applied behavior analysis). In contrast, he will describe initial forays into ASD treatment studies based upon neurobiology, highlighting both the advantages of mechanistic hypotheses and the challenges of studies targeting the core symptoms of ASD. He will also outline some of the challenges of translating hypotheses from the bench to the bedside. Finally, integration of treatment using a blend of precision medicine, empirical treatment, and the symptom-based approach most frequently practiced in psychiatry will be described.

Finally, Gabrielle Carlson, M.D., president-elect of AACAP, will review DMDD, a condition defined by frequent explosive outbursts occurring within the context of chronic, pervasive irritability, beginning in early childhood though not diagnosable until age 6. Circumstantial evidence classifies this condition as a mood disorder, where it appears in DSM-5. Carlson will review how the condition evolved and speculates that although it originated ostensibly as a response to the overdiagnosis of bipolar disorder in children, the overdiagnosis of bipolar disorder occurred because of the absence of a good diagnostic home for explosive outbursts.

We invite all psychiatrists treating children or adolescents to attend this session and hear from the experts in the field on this important topic. ■