Adolescent Psychiatry - Volume 10, Issue 1, 2020

Background and Goals: The role of milieu therapy on inpatient treatment has become more prominent due to the changing landscape of hospital care, with shorter length of stay, higher patient acuity, and rapid turnover. The modern inpatient unit promotes less individual psychotherapy with the psychiatrist or therapist, and more milieu and group based treatment that emphasizes acute stabilization. Methods: The authors share some of the core domains that provide the basic framework for milieu treatment within an acute care setting when working with adolescents and transitional age youth (TAY), with the aim to share clinical considerations for milieu therapy and offer practical ideas for implementation in clinical practice. Discussion: The therapeutic milieu and collaboration of an interdisciplinary team has a significant impact on hospital treatment. Considerations for milieu therapy implementation in an inpatient unit include developmentally informed concepts related to milieu treatment of adolescents and TAY patients in a hospital setting.

Background: By the year 2020, children of color will become the majority of those 18 years of age and under in United States. There is a dearth of research that investigates the developmental trajectories of children of color, especially those who live in communities where they are exposed to traumatic events. African American males reared in poverty and/or living in violent communities are an especially vulnerable group. Methods: This paper examines the unique experiences of Black male adolescents and their emotional, psychological, and neurobiological responses to trauma. Discussion: Trauma has multifaceted effects on the lives of Black males. Behavioral disturbances can result in exclusion from school, leading to further traumatization and deprivation. Much of what appears to be antisocial behavior is in fact adaptive response to living in violent communities. It is important to consider the role of this complex interweaving of circumstances in understanding the development of this vulnerable group.

Background: Adolescents and parents often disagree about the perception of bullying victimization since adults tend to underestimate its occurrence. Objective: This study identifies factors that can influence maternal perception of bullying victimization experienced by her son/daughter in the past 12 months. Methods: This cross-sectional study involved a representative sample of in-school adolescents (n=669, 11-15-years) living in Itaboraí city, Brazil (mean age±SE: 13.01±0.07 years; 51.7% females). A 3-stage probabilistic sampling procedure (random selection of census units, eligible households and target child) generated sampling weights. Trained lay interviewers individually applied semi-structured questionnaires to mothers and adolescents in the households. Multivariable logistic regression analysis examined factors potentially influencing maternal perception of bullying victimization experienced by her son/daughter: adolescent gender and age, adolescent self-perceived bullying victimization, exposure to severe physical punishment by parents, internalizing/externalizing behaviour problems identified by the Youth Self-Report/YSR, maternal education and maternal anxiety/depression identified by the 20-item Self-Reporting Questionnaire/SRQ-20. Results: Univariable logistic regression analysis identified a strong association between adolescent self-perceived bullying victimization and maternal perception of bullying victimization experienced by her son/daughter. Multivariable models showed that adolescent perception influenced maternal perception when adolescents had no clinical internalizing behaviour problems and when mothers had higher education. Conclusion: Anxious/depressive adolescents may hide victimization incidents, while those with no problems probably reveal these incidents to the mother. Considering that maternal low education is an indicator of low socioeconomic status, which is associated with multiple stressors, less educated mothers may be more likely to interpret these incidents as a common part of growing-up.

Objective: The journey into adulthood is a critical phase of profound psychological and social change, especially for children with long-term care needs, including those with Intellectual Disability (ID). In this paper, we aim to describe the clinical picture of patients with mild to profound ID during the transition from childhood to adulthood. Methods: We explored the prevalence of all comorbidities in 53 patients with mild to profound ID before and after transition. We collected information on the services taking care of the person at the time of follow up and about the actual occupation, if any. Results: Out of the whole sample of patients, 79% were in touch with an adult health service after transition and about one fifth required care from more than one institution. 81% were currently employed in centres managed by health services. The distribution of main diagnosis and comorbidities both changed (χ2(1, n=42)=116.7; p<.001 and χ2 (1, n=42)=267.4; p<.001, respectively) after the transition to adulthood. Transition to adulthood was characterized by the emergence, as main diagnosis, of psychiatric disorders, as well as by a slight increase of frequencies of comorbidities. Conclusions: After transition from childhood to adulthood a change in epidemiology was observed. This may reflect a clinical evolution or a discontinuity in the use of diagnostic labels between paediatric and adult committed services. We propose suggestions for better management of the transition phase.

Background: The Borderline Personality Feature Scale for Children (BPFS-C) is currently the only dimensional measure of child and adolescent borderline features and the English version has been shown to have good psychometric properties. To extend the use of this measure with French speaking adolescents, it is essential to examine the reliability and validity of the French BPFS-C. Objective: The present study sought to assess the psychometric properties of the French BPFS-C. Methods: A community sample of 394 adolescents and young adults completed the Borderline Personality Features Scale for Children (BPFS-C), as well as the Million Adolescent Clinical Inventory (MACI) borderline tendency subscale, the Child Behavior Checklist- Youth Self-Report (CBCL-YSR) and the Beck Youth Inventories (BYI). Results: The findings show that both the long and short French BPFS-C have good internal consistency and convergent validity. Affect regulation, identity, relationship difficulties and self-harm were found to be closely inter-connected rather than distinct factors. Conclusion: The findings indicate that both long and short versions of French BPFS-C have good psychometric properties and provide preliminary evidence that the total scores are reliable and valid indicators of borderline personality features in adolescents and young adults.

Background: Screening adolescents for depression has recently been advocated by two major national organizations. However, this practice is not without controversy. Objective: To review diagnostic, clinical, and conflict of interest issues associated with the calls for routine depression screening in adolescents. Methods: The evaluation of depression screening by the US Preventive Services Task Force is compared and contrasted with those of comparable agencies in the UK and Canada, and articles arguing for and against screening are reviewed. Internal pharmaceutical industry documents declassified through litigation are examined for conflicts of interest. A case is presented that illustrates the substantial diagnostic limitations of self-administered mental health screening tools. Discussion: The value of screening adolescents for psychiatric illness is questionable, as is the validity of the screening tools that have been developed for this purpose. Furthermore, many of those advocating depression screening are key opinion leaders, who are in effect acting as third-party advocates for the pharmaceutical industry. The evidence suggests that a commitment to marketing rather than to science is behind their recommendations, although their conflicts of interest are hidden in what seem to be impartial third-party recommendations.