Foreword: It s All Connected Harsh K. Trivedi. Preface: Interface Between Pediatrics and Children s Mental Health Sandra L.

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1 Interface Between Pediatrics and Children s Mental Health Foreword: It s All Connected Harsh K. Trivedi xiii Preface: Interface Between Pediatrics and Children s Mental Health Sandra L. Fritsch xv Pediatric Medical Home: Foundations, Challenges, and Future Directions 183 Harsh K. Trivedi, Nancy A. Pattison, and Lourival Baptista Neto The medical home concept has been in existence since the late 1960s and has recently been significantly broadened to encompass comprehensive primary care for all patient populations throughout the lifespan. This article provides (1) a review of the foundations and evolution of the medical home concept; (2) an analysis of patient/family, provider, and systemic challenges to developing an effective pediatric medical home particularly in relation to children s mental health needs; and (3) a discussion of future directions for its further adoption and successful implementation. Unexplained Physical Complaints 199 M. Elena Garralda Unexplained physical complaints are common in children, and form the basis for childhood somatization (the manifestation of distress through somatic symptoms) and somatoform disorders. Emotional symptoms and anxiety disorders are often comorbid with both unexplained physical symptoms and somatoform disorders. Risk factors include stress sensibility and probably biologic vulnerability in the child, mood and somatization disorders in the family, parental overinvolvement, and possibly limited psychological mindedness in relation to physical symptoms. The best evidence of efficacy is for family behavioral cognitive treatments, but for especially severe cases a multidisciplinary, carefully coordinated approach has been found to be clinically helpful. Mental Health Concerns of the Premature Infant Through the Lifespan 211 Douglas Vanderbilt and Mary Margaret Gleason Because of increased survival rates, neurodevelopmental issues, chronic medical problems, and sometimes complex family issues involved with prematurity, mental health clinicians commonly assess preterm clients and manage their behavioral and mental health problems. Understanding prematurity survival and neurodevelopmental outcomes is important for contextualizing the mental health problems seen in this high-risk population. This article provides a brief overview of prematurity outcomes in

2 viii the domains of prematurity relevant to practicing child psychiatrists. Prematurity is also examined as it relates to parental mental health challenges, infant mental health outcomes, high frequency attention problems, and psychiatric disorders. The complex interactions between prematurity and family well-being are also highlighted. Finally, evidence-based treatment modalities involved in prevention and management are explored. Psychiatric Features in Children with Genetic Syndromes: Toward Functional Phenotypes 229 Matthew S. Siegel and Wendy E. Smith Neurodevelopmental disorders with identified genetic etiologies present a unique opportunity to study gene-brain-behavior connections in child psychiatry. Parsing complex human behavior into dissociable components is facilitated by examining a relatively homogenous genetic population. As children with developmental delay carry a greater burden of mental illness than the general population, familiarity with the most common genetic disorders will serve practitioners seeing a general child population. In this article basic genetic testing and 11 of the most common genetic disorders are reviewed, including the evidence base for treatment. Based on their training in child development, family systems, and multimodal treatment, child psychiatrists are well positioned to integrate cognitive, behavioral, social, psychiatric, and physical phenotypes, with a focus on functional impairment. Developmental and Psychosocial Issues in Cystic Fibrosis 263 Michelle M. Ernst, Mark C. Johnson, and Lori J. Stark Cystic fibrosis (CF) is a multisystemic life-limiting genetic disorder, primarily affecting respiratory functioning. Most patients with CF are diagnosed by 2 years of age, and the current median predicted survival rate is 37.4 years old, with 95% of patients dying from complications related to pulmonary infection. Given the chronic, progressive, and disabling nature of CF, multiple treatments are prescribed, most on a daily basis. Thus, this illness requires children, with the aid of their families, to adopt multiple health-related behaviors in addition to managing more typical developmental demands. The morbidity and mortality factors pose cognitive, emotional, and behavioral challenges for many children with CF and their families. This article applies a developmental perspective to describing the psychosocial factors affecting psychological adjustment and health-related behaviors relevant to infants, preschool and school-age children, and adolescents with CF. Topics particularly pertinent to developmental periods and medical milestones are noted, with clinical implications highlighted. Psychiatric Issues in Pediatric Organ Transplantation 285 Margaret L. Stuber Solid organ transplantation has become the first line of treatment for a growing number of life-threatening pediatric illnesses. With improved survival, research into the long-term outcome of transplant recipients has become important to clinicians. Adherence to medical instructions

3 ix remains a challenge, particularly in the adolescent population. New immunosuppressant approaches promise to expand organ transplantation in additional directions. Extension of transplantation into replacement of organs such as faces and hands raises complex ethical issues. Inflammatory Bowel Disease 301 Eva Szigethy, Laura McLafferty, and Alka Goyal This article reviews the etiology, clinical characteristics, and treatment of inflammatory bowel disease (IBD) and associated psychological sequelae in children and adolescents with this lifelong disease. Pediatric-onset IBD, consisting of Crohn s disease and ulcerative colitis, has significant medical morbidity and in many young persons is also associated with psychological and psychosocial challenges. Depression and anxiety are particularly prevalent and have a multifaceted etiology, including IBD-related factors such as cytokines and steroids used to treat IBD and psychosocial stress. A growing number of empirically supported interventions, such as cognitive behavioral therapy, hypnosis, and educational resources, help youth and their parents cope with IBD as well as the psychological and psychosocial sequelae. While there is convincing evidence that such interventions can help improve anxiety, depression, and health-related quality of life, their effects on IBD severity and course await further study. Psychological Considerations of the Child with Asthma 319 Todd E. Peters and Gregory K. Fritz Asthma, the most common chronic disease in children and adolescents in industrialized countries, is typified by airway inflammation and obstruction leading to wheezing, dyspnea, and cough. However, the effect of asthma does not end with pulmonary changes. Research has shown a direct link between asthma and stress and psychiatric illness, which if untreated results in heightened morbidity and effects on society. The link between asthma and psychiatric illness, however, is often underappreciated by many pediatric and child mental health professionals. This article reviews the diagnosis and treatment of asthma as well as the correlation between asthma and psychiatric illness in children in an effort to improve management and treatment strategies for this prevalent disease. The Interface of Child Mental Health and Juvenile Diabetes Mellitus 335 Sandra L. Fritsch, Mark W. Overton, and Douglas R. Robbins Diabetes mellitus is a common childhood illness, and its management is often complicated by mental health challenges. Psychiatric comorbidities are common, including anxiety, depression, and eating disorders. The illness can profoundly affect the developing brain and family functioning and have lifelong consequences. The child mental health provider can provide valuable assistance to support the child and family and assessment and treatment of comorbid mental health problems and to promote positive family functioning and normal developmental progress.

4 x Pediatric Obesity: A Review for the Child Psychiatrist 353 Ann E. Maloney Child and adolescent psychiatrists frequently encounter children who are obese in their practices and may be asked to work alongside primary care physicians and other specialists who treat youngsters with obesity. To offer expert consultation, they must understand all aspects of the pediatric obesity epidemic. By summarizing the relevant endocrinology, cardiology, nutrition, exercise science, and public health literature, this review of pediatric obesity assesses the epidemic s background, delineates the challenges of clinical care, and appraises the therapeutic recommendations for this population of patients and their families. Psychiatric Concerns in Pediatric Epilepsy 371 I. Simona Bujoreanu, Patricia Ibeziako, and David Ray DeMaso Pediatric epilepsy is a common, chronic, and challenging physical illness for children and their families. This article provides a medical overview and discusses the cognitive functioning and psychosocial adjustment as well as the psychiatric management for children and adolescents with pediatric epilepsy. The management of these children involves establishing a collaborative health care approach, evaluating academic functioning, considering psychotherapy, and managing psychopharmacologic treatment. A thorough understanding of the biopsychosocial concerns in pediatric epilepsy can enable medical providers and mental health clinicians to promote resiliency and adaptation in children and their families facing troubling seizure disorders. Psychiatric Considerations in Children and Adolescents with HIV/AIDS 387 Tami D. Benton The psychosocial impact of human immunodeficiency virus (HIV) disease has been recognized since the beginning of the epidemic for affected adults, but there has been less focus on the impact of HIV on young people. Among HIV-positive (HIV+) adults, high levels of distress, psychiatric symptoms, and their associations with worse health outcomes were recognized early in the epidemic. Subsequently, many studies have focused on understanding the prevalence of psychiatric symptoms among HIV+ adults and on identifying effective treatments for these symptoms. Fewer studies have examined these symptoms and their treatments among HIV+ children and adolescents. This article reviews what is known about psychiatric syndromes among HIV+ youths, their treatments, and other psychosocial factors of concern to the psychiatrist when treating children and adolescents with HIV disease. Psychiatric Aspects of Pediatric Cancer 401 Brian P. Kurtz and Annah N. Abrams The diagnosis and treatment of children and adolescents with cancer has a tremendous and lasting effect on the patients, their families, and other

5 xi individuals in their social network. It carries a host of psychological and behavioral ramifications, from questions of mortality to changes in levels of functioning in multiple domains. In this review the authors address the psychosocial and treatment-related issues that arise in children with cancer, with attention to the adjustment to cancer at different developmental stages, mood and anxiety issues, treatment-related psychiatric sequelae, and the challenges faced by childhood cancer survivors. Partnerships Between Pediatric Palliative Care and Psychiatry 423 Caprice Knapp, Vanessa Madden, Daniel Button, Rebecca Brown, and Barbara Hastie Children with life-threatening illnesses and their families may face physical, emotional, psychosocial, and spiritual challenges throughout the children s course of illness. Pediatric palliative care is designed to meet such challenges. Given the psychosocial and emotional needs of children and their families it is clear that psychiatrists can, and do, play a role in delivering pediatric palliative care. In this article the partnership between pediatric palliative care and psychiatry is explored. The authors present an overview of pediatric palliative care followed by a summary of some of the roles for psychiatry. Two innovative pediatric palliative care programs that psychiatrists may or may not be aware of are described. Finally, some challenges that are faced in further developing this partnership and suggestions for future research are discussed. Index 439