Mental Health
Beyond ADHD: How Well Are We Doing?
There has been increasing emphasis on the role of the pediatrician with respect to behavioral, learning, and mental health (MH) issues, and developmental behavioral rotations are now required in pediatric residency programs. We sought to examine whether this newer emphasis on MH is reflected in pediatricians' reports of their current practices.Barriers to the Identification and Management of Psychosocial Problems: Changes From 2004 to 2013
Pediatricians report many barriers to caring for children with mental health (MH) problems. The American Academy of Pediatrics (AAP) has focused attention on MH problems, but the impact on perceived barriers is unknown. We examined whether perceived barriers and their correlates changed from 2004 to 2013.Do Pediatricians Ask About Adverse Childhood Experiences in Pediatric Primary Care?
The stress associated with adverse childhood experiences (ACEs) has immediate and long-lasting effects. The objectives of this study were to examine 1) how often pediatricians ask patients' families about ACEs, 2) how familiar pediatricians are with the original ACE study, and 3) physician/practice characteristics, physicians' mental health training, and physicians' attitudes/beliefs that are associated with asking about ACEs.Pediatric Adverse Childhood Experiences: Implications for Life Course Health Trajectories
Life course health science integrates the extensive literature on early brain development, childhood trauma and adversity, epigenetics, developmental psychology, and mental health and teaches us that many adult health problems have their origins early in life.1 The timing, intensity, and cumulative burden of adversities, especially in the relative absence of protective factors, can affect gene expression, the conditioning of stress responses, and the development of immune system function. Individuals affected by a high burden of adverse experiences may adopt compensatory high-risk behaviors that can further erode their health and mental health.Translating Developmental Science to Address Childhood Adversity
Demystifying child development is a defining element of pediatric care, and pediatricians have long appreciated the profound influences that families and communities have on both child development and life course trajectories. Dramatic advances in the basic sciences of development are beginning to reveal the biologic mechanisms underlying well-established associations between a spectrum of childhood adversities and less than optimal outcomes in health, education and economic productivity. Pediatricians are well positioned to translate this new knowledge into both practice and policy, but doing so will require unprecedented levels of collaboration with educators, social service providers, and policy makers.Kinship Care
About 4.2% (3.1 million) of children in the United States, according to census data,1 reside with relatives or close family connections and with neither parent, an arrangement termed kinship care (KC). Health professionals frequently encounter children in KC and may better serve these children if they are aware of both the benefits and complexities of kinship arrangements.Use of a Brief Standardized Screening Instrument in a Primary Care Setting to Enhance Detection of Social-Emotional Problems Among Youth in Foster Care
To determine whether systematic use of a validated social-emotional screening instrument in a primary care setting is feasible and improves detection of social-emotional problems among youth in foster care.The Hand on the Door
Sometimes a moment can alter your life. For me, one such moment came in the middle of residency. I was moonlighting at the local health department—as residency obligations permitted—just 2 hours a week, seeing children and teens in foster care for their “annual exam.” The clinic provided basic care for about 200 of the 1200 children and teens in foster care in our county. Back then, the clinic operated very differently. Every patient got a 9 am appointment time and was given a number by which they were called back for what amounted to a brief physical.
