Dr. Jay Giedd says that the main alterations in the adolescent brain are the inverted U-shaped developmental trajectories with late childhood/early teen peaks for gray matter volume among others. Giedd adds that the adolescent brain is vulnerable to substances that artificially modulate dopamine levels since its reward system is in a state of flux.

The underlying proposition for any experimental/therapeutic trial is the uncertainty that the risks of treatment will be outweighed by its benefits. For some therapeutic interventions (e.g., exercise programs, vitamin supplementation), the potential for treatment-emergent adverse events may prima facie be low or negligible, whereas for others…

This article presents responses to the question of whether clozapine is ever appropriate to use in the pediatric population. Among others, Jean A. Frazier also agreed that clozapine is appropriate for use in the pediatric population. Clozapine has truly revolutionized the treatment of refractory patients with schizophrenia at any age. This agent…

A 9-year-old boy presents for assessment and treatment of his reactive, impulsive aggressive behavior that has been present for approximately 2 years. Six months ago, his pediatrician started treatment with OROS methylphenidate (MPH), which was titrated to 36 mg/day. There was moderate improvement in symptoms of attention-deficit/hyperactivity…

A 15-year-old male presents with moderately severe depression, and fluoxetine 20 mg is initiated. When he returns 14 days later, he describes suicidal ideations for the first time. He has recurrent thoughts of wishing he were dead, a plan, but no intent to act. How would this affect medication management? This article presents the opinions of five…

A 13-year-old boy presents with treatment-resistant symptoms of major depression. This is his first episode of depression, initially treated with 200 mg sertraline for 12 weeks with no significant benefit. The severe depression has shown a partial response to weekly cognitive-behavioral therapy (CBT) and fluoxetine, which was titrated up to 60 mg…

A 7-year-old girl with attention-deficit/hyperactivity disorder (ADHD), combined subtype, and oppositional defiant disorder presents with a complaint of marked insomnia. Her parents describe 60 to 90 minutes of nightly initial insomnia that began with the initiation of 36 mg OROS methylphenidate (Concerta) 2 months ago. Behavioral interventions…

High-risk studies are undertaken for at least four reasons: (1) to derive predictors of who will develop the condition being studied that will allow earlier intervention and prevention; (2) to understand the breadth of risk (i.e., if there are other related symptoms, conditions, and impairment related to the condition being studied); (3) to…

This article features the response to the important commentary by Dr. Carlson. The Amish Study represents, as she notes, a special research population for investigation of "classic" bipolar disorder viewed against a homogeneous cultural landscape where emerging biological and behavioral prodromal features can be identified. Dr. Carlson questions…

A 12-year-old boy with no psychiatric history and no evidence of substance use presents with his first manic episode. Throughout the past 4 weeks, his family, school, and friends have noted distinct changes in his mood and behavior. His mood has oscillated between euphoria and severe irritability, with little or no provocation. He has been awake…

Several case studies in implementing evidence-based treatments (EBTs) in organizations are presented. Two erroneous presuppositions about treatments with proven efficacy (henceforth called EBTs) frequently lead to major problems (Hoagwood et al., 2001). The first is that the development of an EBT has taken into account the fit between the…

Early diagnosis of selective mutism (SM) is an important concern. SM prevalence is higher than initially thought and at least three times higher in immigrant language minority children. Although the DSM-IV precludes diagnosing SM in immigrant children with limited language proficiency (as children acquiring a second language may normally undergo a…

In this article, the author seeks to review the history of The Journal of The American Academy of Child and Adolescent Psychiatry, it's many changes and struggles. Some would maintain that in its early years, the JAACAP was filled with clinically useful case vignettes. But then, their story goes, it took a sharp turn to the left, and now is packed…

This article argues that a child welfare system has a significant responsibility to detect and treat emotional and behavioral problems and disorders as a routine part of involvement with child protective services and out-of-home care. Given the very high risk of mental health needs in this population, preventing the development of these…