AACAP NewsA Publication of the n November/December 2013 n Volume 44, Issue 6

Inside...Game Shows and Children: No Longer a Trivial Pursuit ...............299

Revised ADHD Parents Medication Guide Is Now Available! ..........307

Paramjit Joshi, MD, Incoming AACAP President and Internationalist ........ 312

Congratulations to AACAP’s 100% Clubbers! ............322

TABLE of CONTENTS

COLUMNS Jean Dunham, MD, Section Editor • jeandunham@gmail.com

Jerry M. Wiener Resident Member to Council: “Hand-Offs” • Sourav Sengupta, MD, MPH . . . . . . . . . . . . . . . . . . . . . . . 293

Clinical Vignettes: Finger Exercises • Martin J. Drell, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .294

Psychotherapy: John Burton, MD: Winner of the 2013 AACAP Norbert and Charlotte Rieger Psychoynamic Psychotherapy Paper Award • Nathaniel Donson, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .296

Youth Culture: Game Shows and Children: No Longer a Trivial Pursuit • Caroline Nguyen, MD . . . . . . . . . . . . . . . . . . . .299

COMMITTEES Ellen Heyneman, MD, Section Editor • eheyneman@uscd.edu

Consumer Issues Committee: DSM-5 Update: Clinical Considerations for Proposed Criteria for Non-Suicidal Self-Injury • Nicole Garber, MD, Alice Mao, MD, and Lorena Reyna . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .302

NEWS Stuart Goldman, MD, Section Editor • stuart.goldman@childrens.harvard.edu

News Updates • Stuart Goldman, MD, and Garrett Sparks, MD, MS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .304

Revised ADHD Parents Medical Guide Is Now Available! • Theodore A. Petti, MD, MPH . . . . . . . . . . . . . . . . . . . . . . . .307

CPT Coding Corner • Benjamin Shain, MD, PhD, Sherry Barron-Seabrook, MD, and David Berland, MD . . . . . . . . . . . . .309

AACAP K12 Physician Scientist Program in Substance Abuse Funded by the National Institute on Drug Abuse • Elizabeth Goggin and Yoshie Davison, MSW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310

FEATURES Debbie Carter, MD, Section Editor • debbie.carter@ucdenver.edu

Paramjit Joshi, MD, Incoming AACAP President and Internationalist • Diane Shrier, MD . . . . . . . . . . . . . . . . . . . . . . . . . . 312

Media Page • Garrett Sparks, MD, MS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314

Poetry: In Memory of the Future • Diane Kaufman, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316

MEETINGS Eva Szigethye, MD, Section Editor • szigethye@upmc.edu

Call for Papers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317

Call for Exhibitors! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318

FOR YOUR INFORMATIONMembership Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321

Distinguished Fellows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321

Congratulations to AACAP’s 100% Clubbers! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322

AACAP Membership Evolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323

Members and the News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324

Get in the News! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325

AACAP Policy Statement Requirements and Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326

Thank You for Supporting AACAP! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327

Putting the FUN in Fundraising! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328

Life Insurance for Your AACAP Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328

Classifieds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329

MiSSion StatEMEnt

Mission of AACAP: Promote the

healthy development of children,

adolescents, and families through

research, training, prevention,

comprehensive diagnosis and

treatment and to meet the

professional needs of child and

adolescent psychiatrists throughout

their careers.

Amended and Approved by Council, June 27, 2010

FunCtion anD RolES oF tHE aMERiCan aCaDEMy oF CHilD anD aDolESCEnt PSyCHiatRyThe American Academy of Child and Adolescent Psychiatry’s role is to lead its membership through collective action, peer support, continuing education, and mobilization of resources. The Academy

■ Establishes and supports the highest ethical and professional standards of clinical practice.

■ Advocates for the mental health and public health needs of children, adolescents, and families.

■ Promotes research, scholarship, training, and continued expansion of the scientific base of our profession.

■ Liases with other physicians and health care providers and collaborates with others who share common goals.

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MiSSion oF AACAP NewsThe mission of AACAP News includes:1 Communication among AACAP members, components, and leadership.2 Education regarding child and adolescent psychiatry.3 Recording the history of AACAP.4 Artistic and creative expression of AACAP members.5 Provide information regarding upcoming AACAP events.6 Provide a recruitment tool.

EDITOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Uma Rao, MD

MANAGING EDITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rob Grant

PRODUCTION EDITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Patricia J. Jutz, MA

COLUMNS EDITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Jean Dunham, MD

COMPONENTS EDITOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ellen Heyneman, MD

NEWS EDITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Stuart Goldman, MD

OPINION EDITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Christopher Varley, MD

FEATURE EDITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alvin Rosenfeld, MD

ANNUAL MEETING EDITOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Eva Szigethy, MD

PHOTOGRAPHY EDITOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alvin Rosenfeld, MD

CONTRIBUTING EDITOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diane K. Shrier, MD

RESIDENT EDITOR: MEDIA PAGE. . . . . . . . . . . . . . . . . . . . . Garrett M. Sparks, MD

oFFiCER S

Paramjit T. Joshi, MD, President

Gregory K. Fritz, MD, President-elect

Martin J. Drell, MD, Past President

Aradhana “Bela” Sood, MD, Secretary

David G. Fassler, MD, Treasurer

Warren Y.K. Ng, MD, Chair, Assembly of Regional Organizations of Child and Adolescent Psychiatry

CounCil MEMbER S

Mark S. Borer, MDDebra E. Koss, MDDeborah Deas, MD

Neal Ryan, MDSteven J. Cozza, MD

Joan Luby, MDKayla Pope, MD

Kaye L. McGinty, MDJenna Saul, MD

Harsh Trivedi, MD

JERRY M. WIENER RESIDENT MEMBER Vandai X. Le, MD

JOHN E. SCHOWALTER RESIDENT MEMBER Marika Wrzosek, MD

ROBERT L. STUBBLEFIELD RESIDENT FELLOW Anita Chu, MD

EXECUTIVE DIRECTOR Heidi Büttner Fordi, CAE

JOURNAL EDITOR Andrés Martin, MD, MPH

PROGRAM COMMITTEE CHAIR Gabrielle Carlson, MD

AACAP News is an official membership publication of the American Academy of Child and Adolescent Psychiatry, published six times annually. This publication is protected by copyright and can be reproduced with the

permission of the American Academy of Child and Adolescent Psychiatry. Publication of articles and advertising does not in any way constitute endorsement or approval by

the American Academy of Child and Adolescent Psychiatry.

© 2013 The American Academy of Child and Adolescent Psychiatry, all rights reserved

ColuMn CooRDinatoR S

Ayesha Mian, MD, mian@bcm.tmc.edu Child Psychiatry Around the Globe

Timothy Dugan, MD, timothy_Dugan@hms.harvard.edu Clinical Vignettes

Sala S.N. Webb, MD, SWebb@mcvh-vcu.edu Diversity and Culture

Arden Dingle, MD, adingle@emory.edu Ethics

Stephen Zerby, MD, zerbysa@upmc.edu Forensics

Rachel Ritvo, MD, rzrmd@comcast.net  Psychotherapy

Sandra DeJong, MD, SDejong@challiance.org  Youth Culture

Charles Joy, MD, crjoy1@gmail.com Poetry Coordinator

NOVEMBER/DECEMBER 2013 293

JERRY M. WIENER RESIDENT MEMBER TO COUNCIL

“Hand-Offs”

■ Sourav Sengupta, MD, MPH

Alex and I used to battle in each session. Verbally sparring, testing limits, setting boundaries. His parents didn’t know what to do with him. His teachers didn’t know what to do with him. And, as a trainee therapist, I certainly didn’t know what to do with him. And yet, here we were – 2 years later, feeling comfortable enough to talk openly, even about an upcoming transfer to a colleague. There was plenty more work to be done, but it was no longer for us to do. I had plenty of regrets. What if I had begun engaging his parents more actively earlier in the treatment course? What if we had fol-lowed through on exploring his anxieties around asking a girl out? But there were plenty of highlights. That time his parents excitedly shared that the “kind and firm” approach had borne fruit. The session he attended during his school vacation when we discussed video games and their parallels to his life.

Life and professional transitions require many such “hand-offs.” I have been tremendously fortunate to have served the past two years as the Jerry Wiener Resident Member of Council. In my “senior” year on Council, I have been privileged to serve as co-chair of the Committee on Medical Students and Residents (MSR) with Eric Williams, MD, a role model in leadership and service. My colleagues on the MSR Committee have been passionate and tireless in their efforts to improve and expand the Academy experience for trainees. I was able to serve as a liaison to the Training and Education Committee, and share a trainee’s perspective with Dr. Drell’s Back to Project Future Presidential Initiative. I was able to work with Kristin

Kroeger Ptakowski and Liz DiLauro to promote advocacy involvement amongst trainees. I am hopeful that I was able to represent the trainee perspective on Council as it deliberated truly signifi-cant developments and changes in the Academy for the years to come. It was challenging and interesting work, which is no small thing.

And now, I am thrilled to “hand-off” to two wonderful and capable col-leagues – Marika Wrzosek, MD, the current Schowalter Resident Member of Council and Vandai le, MD, the incoming Wiener Resident Member of Council. Dr. Wrzosek will bring her considerable leadership experience, passion, and pragmatism as she takes on her senior leadership role and completes her child and adolescent psychiatry fel-lowship at the Massachusetts General Hospital. With Dr. Wrzosek’s assistance, Dr. Le will be “learning the ropes” and incorporating her past experiences leading the national Psychiatry Student Interest Group Network, while she begins her CAP fellowship journey at UCLA. Thankfully, they will both benefit from the leadership and wisdom of Dr. Williams, who continues on as co-chair of the MSR Committee, and Ashley Rutter, our staff liaison extraordinaire.

Alex and I sat across from each other at our last session. We had been seeing less of each other recently, mostly as he had become more engaged in his social life and I was preparing to transition to a new region and job. I was worried how the session would go. Would we experi-ence a recurrence of resistance? Would we be too busy taking care of logistical details to process the end of this relation-ship? In the end, we were able to have an honest conversation about how far he had come and where he wanted to go next. And now, a colleague would take over. All in all, we had done good work together.

As I shift into new roles – becoming a New Yorker(!), becoming an attending, becoming a father, starting up a new clinical program – I’m excited to transi-tion to a new role within the Academy: Early Career Psychiatrist. I’m proud of the good work we’ve done together. I’m excited to “hand off” to my colleagues and watch as they continue to grow and improve AACAP programs and resources for our members in training. And I’m looking forward to a great deal more – challenging and interesting work. There will be plenty of good work to come. n

Dr. Sengupta is a graduate of Duke University and Tufts University School of Medicine. He completed his residency and CAP fellowship at the Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center. He recently joined the faculty at the University at Buffalo. Dr. Sengupta has completed his term as the AACAP’s Jerry M. Wiener Resident Member to Council. He may be reached at sourav.sengupta@alumni.duke.edu.

“I’m excited to “hand off” to my colleagues and watch as they continue to grow and improve AACAP programs and resources for our members in training. And I’m looking forward to a great deal more – challenging and interesting work. There will be plenty of good work to come.”

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294 AACAP NEWS

CLINICAL VIGNETTES

Finger Exercises

■ Martin J. Drell, MD

Charlene was a delightful, almost 12-year-old, female whom I had seen for a chronic sense of

sadness. She identified the precipitant as having difficulties with her friend whom she could not live with and could not live without. She described in detail the friend’s constant need for attention and her jealousy whenever Charlene spent time with others. There was much drama and many calls from her friend. Charlene felt controlled, guilty, and stuck. In the end, her mother intervened and said that Charlene needed a break from her friend. Charlene was relieved and lonely. She perked up as she found new friends to hang around with. The sessions ended by mutual agreement.

Shortly afterwards, Charlene asked to see me. This time, there was less of a specific precipitant. My assess-ment was that she was now depressed. The depression improved with a trial of SSRI’s.

As I got to know Charlene, I also got to know her parents who are two professionals with high standards for themselves and Charlene. Good grades and deportment were expected. There were consequences if this did not occur. The consequences usually involved increased negative attention from the mom. A brief exploration into the ongo-ing cycle of behavior revealed that the mother was a “child of divorce” who was raised by a young mother who worked full-time, attended school, and dated in addition to her parenting duties. Her father was available per the custo-dial agreement and not that emotionally involved. Mom described how she

compensated for her situation, by setting high standards for herself, being self-controlled, and pseudo-independent. She simply did not burden her parents. Her hunger for approval and acceptance was down-played. The links between her past and her parenting style were not appreciated.

Mom married Charlene’s father, who was an older man who had “wooed” her like she had never been wooed before. The father, in turn, had his own child-hood story. He described living in the shadow of his overly strict “successful father” who retired and died early. The father was in a continual Dorian Gray race not to grow old and to best his father’s achievements. Despite feeling that he had failed to do so, he kept on trying. He looked 10 years younger than his age and was, like the mother, attrac-tive and likeable.

After my three-month absence due to personal medical problems, the parents wanted me to see Charlene, whom they felt was about to be kicked out of her private school. Charlene was not thrilled to come in, but agreed if her mom could come with her to the session.

In the session, Charlene described that her grades were generally good, which was true. Mother, however, pointed out that she was always getting e-mails about C’s and missed homework assign-ments. She feared, inexplicably, that Charlene would be kicked out of school and would be forced to attend a public school. A closer evaluation revealed that Charlene had “wandering grades” and that she did poorly in various classes. Sometimes history was the problem, sometimes math.

“It takes a lot of skill to do badly in only one class at a time like that. Most of the time kids do badly at one class or another, but you do okay sometimes in classes and sometimes not. What’s that about?”

Mom leapt to answer the question citing her daughter’s poor organizational skills,

her love of social media sites, and her slight dyslexia. Charlene cringed.

“But how does that explain the ups and downs in different classes?” I asked Charlene specifically.

Mom interrupted to talk about how Charlene did not do her homework much of the time. “I keep reminding her of her responsibilities” she said.

“Do you think that helps?” I asked. “Do you think she doesn’t know that her homework is due? Charlene’s not dumb,” I added.

“She just can’t seem to get it all done,” said Mom. As this exchange went on, I could see Charlene getting angrier. With exasperation, she finally spoke to the dilemma. “I can’t do it all at once. It’s like I’m holding a bucket with 11 holes in it and I only have 10 fingers. If I do my history, then my Spanish doesn’t get done.”

“So it’s an issue of focus?” I asked. There was no answer to that question from Charlene. Instead, Mom answered. “Everyone has responsibilities. Charlene expects me to have food at meal times. She expects when she goes to the bathroom that there’s toilet paper there. I do my part and so does her father. He works hard to make sure there’s electric-ity and food on the table. Homework is Charlene’s responsibility.”

“It’s hard to do it,” said Charlene. “I’m bad at self control. I’m not even a teen-ager yet!”

Mom continued. “And we set up for Charlene to have extra time with her Spanish teacher… and she didn’t go!”

I went to check on my math grade and when I got back, the teacher was gone,” responded Charlene.

“I’m afraid she’ll have to go to sum-mer school or be kicked out of school. She’d then have to go to public school,” said Mom.

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NOVEMBER/DECEMBER 2013 295

“You two seem pretty angry at each other,” I responded. “Charlene, is your screwing up your grades one at a time a way of getting back at Mom?” To accentuate my point, I stopped the action and looked at Charlene. “I have something for you.” I then pretended like I was searching for something in my shirt pocket. After pretending to fumble about, I pulled out my hand with the middle finger up.” Charlene immedi-ately laughed and got the point about her grades being a passive-aggressive way of saying “F _ _ _ you” to her mom because she was upset with her. “Perhaps it would be better to talk more directly without the fancy finger work,” I said with a smile.

“I understand,” said the mom, “but this is serious stuff. I wouldn’t be doing this if Charlene got good grades. It does make a difference. I remember that I could have done better on my PSAT. You can always do better.” She then reminded Charlene once again that she had pro-vided her a tutor. Charlene winced.

“I like the tutor,” said Charlene. “She’s nice to me. Not like you.” I noted that Charlene’s remark was considerably less passive-aggressive and waited to see the mom’s response, which came immediately:

“And so why did the tutor want to quit coming? She said that you weren’t doing what you needed to do.”

“And when I found that out, I did my homework,” Charlene said with consid-erable feeling.

“So you feared the tutor would disap-pear,” I asked.

I noted that Charlene responded strongly to my remark and I suspected that Charlene was dealing with her issues with her mom via displacement to the tutor. With this in mind, I continued.

“And do you sometimes fear that Mom will disappear?” Charlene, at that point, seemed stunned. Looking at Mom, she seemed stunned also.

“When I was little and I’d get angry and run to my room, Mom would follow me up the stairs and soothe me. Now she doesn’t,” said Charlene.

With this, Mom put her hand on Charlene’s shoulder and said in a low voice, “I know how you feel.”

“Maybe you two could talk about these feelings with each other. It might be better than getting angry and getting bad grades.” They agreed.

The next week, Mom called to say that Charlene was sick. I asked her if she wanted to come in. She willingly did so and spent the session talking about growing up and trying not to get upset with her mother, who she perceived as being overwhelmed. She described how she tried to be as little a problem as possible. “I got good grades, was very compliant, and spent a lot of time with my friends.”

She then went over doing the same with her father, who she saw as “there, but not there.” She was upset that he did not seem to care very much about Charlene either. It was clear that his non-respon-siveness was even more upsetting since the death of her mother 10 years earlier.

“You remind me of a friend of mine who longed for more contact with her busy father.” She had explained that she was aware of this longing while growing up, but knew that her father was being a normal bring-home-the-bacon dad, whose role was not to do much parent-ing. “And do you know what I told my friend? I told her that there are very few 4-year-olds that are that sophisticated, and that regardless of the social norms of the day, she hungered for her father to be with her more.”

The mom nodded. As it came time to wrap up the session, Mom said “I really need to figure out why I’m so hard on my daughter.”

“That sounds like a great thing to think about. If you’d like to talk some more, I’d be glad to assist.” As she left, I joked with her about the fact that she had commented several times that she probably needed to see me more than Charlene. She smiled back. I hoped that she comprehended the transferential beauty of her finally allowing herself to have a session of her own. n

Dr. Drell is past-president of AACAP and head of the Division of Infant, Child, and Adolescent Psychiatry at the Louisiana State University Medical School in New Orleans, Louisiana. Dr. Drell may be reached at MDrell@lsuhsc.edu.

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296 AACAP NEWS

PSYCHOTHERAPY

John Burton, MD: Winner of the 2013 AACAP Norbert and Charlotte Rieger Psychodynamic Psychotherapy Paper Award

■ nathaniel Donson, MD

AACAP’s Norbert and Charlotte Rieger Psychodynamic Psychotherapy Paper Award was

established in 2001 to encourage the writing of clinical case material about the effectiveness of the doctor-patient relationship in the healing of disturbed young children. For the past 13 years, AACAP and the Rieger Foundation have agreed that the preservation of psychotherapeutic skills, within our long tradition of the practice of dynamic psychotherapy by child and adolescent psychiatrists (CAPS), remains essential to good clinical practice. Papers are judged for the award by members of AACAP’s Psychotherapy Committee according to a series of criteria, including a review of pertinent psychiatric literature, the flow of engaging psychodynamic clini-cal material, an appreciation of devel-opmental principles, and the paper’s uses as a teaching or research tool. The Rieger Award offers a stipend of $4,500 to the author of the winning paper submitted before the May 1st deadline each year. 

This year’s winner of the Rieger Psychodynamic Psychotherapy Award is John K. burton, MD. His paper is entitled “Neutrality, Abstinence, and the Therapist’s Sexual Orientation: Complex Meanings for the Adolescent in Treatment.”

Dr. Burton’s paper begins with the statement: “The principles of neutrality

and abstinence are the cornerstones of psychodynamic work.” He emphasizes in his introduction that, “Neutrality allows the therapist to listen ... [and that] Abstinence requires the therapist to ... neither confirm nor deny ideas the patient may form about the “real” person of the therapist.” The remainder of his paper presents a clinical case that illustrates the therapeutic dilemma that neutrality presents in child and adoles-cent work. “Each phase of development poses particular challenges to remain-ing neutral in order to allow the flow of free thought.” Dr. Burton acknowl-edges that therapists must “appreciate [our child and adolescent patients’] use of us as developmental objects ... as adults who offer them a new way to experience themselves.”

The paper focuses on the challenges specific to adolescents, for whom sexu-ality and gender, especially in relation to adults, is a fundamental part of the task of identity formation. His case descrip-tion focuses on the meaning that his sexual orientation had for his patient, Diana. He uses sexual orientation to explore the limits of neutrality and abstinence as it exemplifies one of those “traits that are fundamental aspects of the therapist’s identity [which must be] extremely meaningful to a develop-ing adolescent [but which are] neither physically evident nor evident from the therapist’s visible social role.” 

Eighteen years of age at the beginning of her treatment, Diana had with-drawn from college and was living at home. Although beautiful, talented, and intelligent, she described herself as “the most lost person you will ever meet,” and “felt that her life was meaning-less unless she achieved a permanent celebrity status.” When younger, she had been chronically anxious about aca-demic performance, and felt awkward and easily humiliated until, in seventh

grade, she turned into a magnetic young woman. She subsequently became sexually seductive, avoided classes, engaged in self-cutting (once severe in the presence of her father), smoked pot, and attended late night parties – with a subsequent slide from honors to resource classes. She felt that her child-hood masturbation had ruined her. Her parents were perplexed.

Dr. Burton’s initial diagnoses included major depressive disorder and general-ized anxiety disorder, with possible borderline personality disorder, with consideration of an adolescent develop-mental crisis despite her characterologic “pervasive patterns of maladaptive behavior.” She had been non-compliant with both cognitive and dialectical behavior therapy and refused to take medication regularly enough for an adequate trial, although later in her work with Dr. Burton she accepted medica-tion. Four-times-weekly psychoanalysis was recommended in order best to con-tain and explore Diana’s intense affects.

John Burton, MD

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NOVEMBER/DECEMBER 2013 297

“Each phase of development poses particular challenges to remaining neutral in order to allow the flow of free thought.” Dr. Burton acknowledges that therapists must “appreciate [our child and adolescent patients’] use of us as developmental objects ... as adults who offer them a new way to experience themselves.”

continued on page 298

She had disparaged previous female therapists but felt that having a male would be “more interesting,” although frustrated that Dr. Burton was unreveal-ing about his personal life. Instead, she decided that their work would be a “game” that she fully intended to win – to get Dr. Burton to open up about himself. In response, he made efforts to develop a therapeutic alliance by encouraging her to see their work as an opportunity to learn about herself rather than a game of combat; and so they gradually began to explore her gender conflicts and she acknowledged greater ease at drawing male than female figures. However, her most powerful transferences were orga-nized around Dr. Burton’s gender and her fantasies about his sexual orienta-tion, in order, as she put it, “to gain the upper hand.”

Erotized and romantic transferences were part of her family mythol-ogy and she and her mother and her friends would debate, “Is he or isn’t he gay?” And so Dr. Burton always found himself in the middle of a therapeutic conundrum as to whether he ought to defend his principles of abstinence or gratify Diana’s curiosity. She often dressed and behaved in ways that were powerfully alluring although more often grossly caricatured feminine behaviors.  

Dr. Burton faced the following dilemma: “I sat paralyzed in amazement. Her relentless enactments caused me to retreat into a stricter version of my gay identity. I reassured myself in my denial of any erotic feelings I had toward her ... [which] protected me from the danger

of being alone in a room with a very sexualized young person, but simultane-ously spurred on her desperate efforts to excite me.” Needless to say, Diana persistently dismissed Dr. Burton’s efforts to understand the meanings of her sexual preoccupations and “invariably subverted the therapeutic process into a power struggle.”

As time went on, their analysis of a dream “supported her emerging efforts to observe and make sense of her inner world,” her hopelessness of success in a man’s world, and her feelings of mater-nal deprivation, all formerly obscured by their adversarial paternal transference-countertransference struggles. Further understanding of subsequent dream narratives enriched Diana’s discoveries about her anxious and chaotic inner life, her recurrent fears of losing control of her erotic transferences, intensify-ing her experience of the analysis as a battleground between knowing and not knowing hidden secrets about herself. However, Diana’s analysis continued to progress toward themes of maternal Oedipal rivalry; she began to experience a lifting of her mood and an increase in her motivation and confidence. As she became aware in the transference and less afraid of a vengeful part of herself, she was freer to renounce her omnipo-tent seduction fantasies and eventually to identify with admired aspects of her mother.

In a recent phone discussion, Dr. Burton reviewed his struggles, which compli-cated writing up this case. He stressed particularly his need to let time go by in order to feel more settled within himself about his tumultuous experience with Diana, taking almost two years after ter-minating the case before he could write up the case as a means to better under-stand it, and not merely as an interesting contribution to the literature. Dr. Burton was grateful to his supervisor, Dr. Karen Gilmore, who identified the material as an important contribution and remained available to him throughout the process of writing. “In order to write a narrative about the therapeutic issues of neutrality and abstinence, there were some things I needed to understand about [Diana] - to find a treatment narrative inside of all of the intense and chaotic material which we had both experienced at the time. I

needed to let my experience of the case play out and gain some distance, to be out of the action, to work out my own self-view and perspectives about the work, which seemed so impossible while it was happening.” Dr. Burton wrote with even more conviction, finding that Diana was doing well at a six-year fol-low-up. Although she no longer required medication, she felt things intensely, was fully engaged in pursuing a career, and felt herself to be in good control of her passions and sexual drives.

Dr. John K. Burton grew up on a farm in rural New England before attending Harvard College, where he graduated magna cum laude in Slavic Languages and Literatures. His honors thesis explored the transformation of the mother-child relationship in Soviet literature; it was his first foray into a lifelong preoccupation with the inner life of the child, and foreshadowed his future involvement in psychoanalysis. Before moving to New York to obtain his medi-cal degree at the Columbia University College of Physicians and Surgeons, Dr. Burton worked on a research trial of a novel AIDS treatment, then stayed on at Columbia in residencies in general and child and adolescent psychiatry, serving as chief in both programs. He subsequently worked on several ADHD treatment studies at the Research Unit for Pediatric Psychopharmacology of the New York State Psychiatric Institute and was director of the medical student course in child psychiatry at Columbia University. He has published on the diagnosis and treatment of trauma in The American Journal of Psychiatry and on adolescent transference and sexual orientation in the American Journal of Psychoanalysis, presented at annual AACAP meetings, served as a member of AACAP’s Television and Media Committee, and edited the “Kids and Popular Culture” section of the Academy’s website. 

Dr. Burton is currently assistant profes-sor of Clinical Psychiatry at Columbia University College of Physicians and Surgeons, and a faculty member of the Columbia Center for Psychoanalytic Training and Research where he teaches a course in gender development. He currently maintains a private practice,

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John Burton, MD continued from page 297

supervises residents, and is director of a year-long class for senior fellows entitled “Using Psychodynamic Theory to Enhance Clinical Practice.”  

Although Dr. Burton spent his adult life in the urban centers of Boston and New York, he continues to appreciate the fundamental role of nature in treat-ing disease. His abiding interest in the interrelationship of mental, physical, and spiritual health has been a cornerstone of his approach to clinical work, and his interests include yoga, exercise, art therapy, complementary medicine, and their interface with allopathic medi-cine. He is board-certified in Integrative Holistic Medicine, is a Vinyasa Yoga Alliance certified instructor, and has a working knowledge and ongoing interest

in Ayurveda, as well as the Western herbal tradition.

Dr. Burton asked that I express his gratitude to the members of AACAP’s Psychotherapy Committee for their support and mentorship throughout the process of re-writing this paper for a child and adolescent psychiatry audi-ence and expressed his appreciation that his experiences with his patient will reach a wider therapeutic audience.  He is particularly pleased that, out of the constellation of AACAP awards, the Rieger Foundation has singled out high-level psychodynamic work which “informs everything I do with all sorts of patients who would otherwise lose the quality of treatment that they deserve.” n

Dr. Donson is in the private practice of psychiatry and psychoanalysis in Englewood, New Jersey; is a liai-son member for the Association for Child Psychoanalysis of AACAP’s Psychotherapy Committee; and on the faculties of the Columbia (New York) Psychoanalytic Center for Training and Research and the Institute for Infant and Preschool Mental Health in East Orange, New Jersey. He may be reached at MnDonson@aol.com.

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“Perhaps, if children want the opportunity to be involved in competitive games and competitions on television in our modern era, we should find a way to protect them both from the industry and from pressures within the family.”

YOUTH CULTURE

Game Shows and Children: No Longer a Trivial Pursuit

■ Caroline nguyen, MD

According to the 2012 Bureau of Labor Statistics’ (BLS) American Time Use Survey, America’s

youth spend a remarkable amount of time watching television. Children and teenagers watch 24.6 hours per week, which amounts to an astounding 1,200 hours per year. For context, consider the number of hours children actually spend in school: 900 hours per year. Overall, time spent watching television replaced opportunities to engage in meaning-ful conversations with family, further explore educational opportunities, and develop hobbies. While children have access to any number of types of shows on television, more than ever, shows today feature children who are not actors, but who are portraying a version of themselves. Over the past decades, programs have progressed from “game shows” featuring children to “reality TV” shows consisting of child contestants.

“Real” children on television during the 1980’s and 1990’s were predominantly featured on game shows. Networks such as Nickelodeon aired game shows featuring everyday boys and girls from across the country, sometimes with their families. For example, Double Dare featured two teams of school-age children competing against each other by answering trivia questions or “daring” the opposing team to compete against the clock in a physical challenge. The spin-off Family Double-Dare followed a similar format with mom, dad, and two kids. Numerous other game shows fea-tured children, including Legends of the Hidden Temple, with more challenging

tasks pitting six teams of two chil-dren each against each other. Each episode had a historical theme, and contestants answered trivia questions as well as participated in challenging physical activities based on the history, mythology, and geography related to the theme. Where in the World is Carmen San Diego? focused mostly on geographical trivia interwoven in a complicated narrative of worldwide espionage. Guts featured children com-peting on tight ropes, climbing “zero G” walls horizontally, crawling through tight mazes, and shooting basketballs while bouncing off bungee cords.

Children competing on such shows usually only committed to one episode of airtime. They wore casual, age-appro-priate clothing, consisting of T-shirts and pants or shorts. They succeeded through team-work and were rewarded for pro-social behaviors and knowledge they might have learned at school. These everyday children appeared enthusiastic, genuine, and to be having a lot of fun. The game-show hosts would interview the children about their dream careers, pets, or favorite hobbies. Being smart was rewarded and even cool, while at the same time the trivia questions provided viewers with an opportunity to learn new information. The overall focus was not on creating fame for the children or putting them in the spotlight. In fact, the prizes won on these shows were CD players, sneakers, skateboards, and trips to space camp. These were not impossible dreams.

In the year 2000, there were only four reality television shows, but now, just 14 years later, there are over 300 non-scripted reality shows, many of which feature children. Far from the whole-some but messy challenges in Double Dare, Toddlers and Tiara portrays a whole different world of intense com-petition. These very young children compete in different beauty pageants each week, wearing short dresses that reveal midriffs and layers of make-up

and hairspray. Parents validate “diva” or “bratty” behaviors and the producers focus on developing rivalries among the hundreds of young girls competing. Even when a young girl earns second place among hundreds of girls, the child will oftentimes cry, throw temper tantrums, and demonstrate defiant behaviors, while the parents do very little limit-setting. These girls are evaluated on the thousands of dollars the families spend on dresses, hair, and make-up. Children are even under pressure to wear “flip-pers” to cover up the natural changes in dentition that children experience as part of normal development. The elements of academics and sportsmanship are forgotten, replaced by a certain image of “beauty,” overt sexuality, fame, and excessive wealth.

As a resident of Pittsburgh for over six years, I was excited to watch Dance Moms, since it is based on a dance studio in Pittsburgh. While all of the

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young girls are very talented dancers, I was incredibly distracted by the constant bickering and arguing between the dance instructor, Abby, and all of the “dance moms.” I found myself empathiz-ing with the mothers who expressed concerns about the provocative dance moves, revealing outfits, and Abby’s bel-ligerent teaching style. Simultaneously, I felt great dismay that a show that should have been focused on the girls’ talent was really centered on moms who were catty toward one another, and who were on a mission to live vicariously through the girls’ accomplishments. It made me feel as though we needed more reality game shows featuring families who can serve as good role models.

The good-natured games from the 1980’s and 1990’s, which focused on sportsmanship and emphasized intelligence and athleticism, have disap-peared. Games shows or competitions that may have educational value either cater to adults or do not actually portray young children as the competitors. Even competition shows that appear to have been produced with good inten-tions have their own controversies. For examples, 2007’s Kid Nation featured forty children ages 8-15 years placed in

a New Mexico ghost town faced with a task of building a society. The show sparked debates about child neglect and abuse by both network producers and parents for allowing these children to have relatively little supervision in a New Mexico dessert. Children who appear on shows such as Kid Nation, America’s Got Talent, The X-factor, or So You Think You Can Dance spend long hours under strenuous work conditions while their personal lives are highly exposed at a young age. As of 2013, child entertainment laws vary widely by state regarding protective require-ments. California is among the strictest, with an extensive process for obtaining a permit, a five-day limit on the number of consecutive work-days for children, and a five-day total for the number of days excused from school. Courts sometimes force families to set aside the money earned for when the child grows up instead of using it for their own agenda. On the other hand, there are 18 states that have no regulations regarding children who are involved in entertain-ment, and over 20 states that do not even require permits. Perhaps, if children want the opportunity to be involved in competitive games and competitions on television in our modern era, we should

find a way to protect them both from the industry and from pressures within the family.

We still worry that children and adoles-cents spend too much time watching television instead of engaging in educa-tional activities, sports, or meaningful conversations with family members. But in addition to concerns about how much time they do spend watching television, our goal should be to offer entertain-ment options that can be pro-social, fun, and educational. For the everyday American child who wishes either to compete on television or watch from home, producing shows that encourage cooperation, sportsmanship, intelligence, and authenticity would represent a great step forward. n

Reference

2012 BLS American Time Use Survey by the A.C. Nielson Company screenrant.com/reality-tv-statistics-info-graphic-aco-149257/Wages and House Divi-sion, Child Entertainment laws, accessed 1/1/2013.

Dr. Nguyen is currently a PGY3 child and adolescent psychiatry resident at the University of Pittsburgh Medical Center (UPMC)/Western Psychiatric Institute and Clinic (WPIC). Her professional interests include ADHD and college mental health, while in her spare time she enjoys musicals, dining out, and museums. She may be reached at nguyenc3@upmc.edu.

Game Shows and Children continued from page 299

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COMMITTEES

CONSUMER ISSUES COMMITTEE

DSM-5 Update: Clinical Considerations for Proposed Criteria for Non-Suicidal Self-Injury

Clinical ChallengesChild and adolescent psychiatrists face many clinical challenges. However, the adolescent who presents with a history of non-suicidal self-injury can stir anxiety in even the most seasoned clinician. Counter transference can arise because adolescents may be resistant to stopping a maladaptive coping strategy that provides conscious and unconscious secondary gains. Helpless feelings can arise because caregivers and treatment team members are looking for solutions from the psychiatrist. In addition, the family’s reaction to the self-injury may cause additional distress for the adoles-cent, which can lead to an increase in self-injurious behaviors. Non-suicidal self-injury (NSSI) has been added to DSM-5 under the section “Conditions for Further Study.” The objectives of this article are to delineate proposed DSM-5 criteria for NSSI and provide relevant clinical information pertaining to man-agement of this condition in adolescents.

What is non-Suicidal Self-injury?NSSI is defined as “direct and deliberate destruction of body tissue in the absence of any observable intent to die” (Nock, 2010). The mean age of onset of NSSI reported in various studies is between 12-14 years (Nock, 2009). These behav-iors have been the focus of treatment for many individuals. Therefore, proposed criteria for NSSI is included in the newly revised (DSM-5) in the chapter “Conditions for Further Study.”

Risk FactorsA history of anxiety, depression, alcohol misuse, cannabis use, tobacco use, and antisocial behavior were associated with self-injury in one study (Moran, 2011). NSSI was also associated with a history of abuse, poor verbal skills, poor

problem-solving skills, poor distress tolerance, genetic predisposition of high emotional and cognitive reactivity, and identification with Goth subculture (Nock, 2010).

Over 90% of adolescents that engage in self-injury meet criteria for a psychiatric diagnosis. The most common diagnoses are depression, substance abuse and dependence, conduct disorder, pho-bias, and antisocial personality disorder (Ougrin, 2012).

Why Do teenagers Engage in Self-injury?There are many possible explanations as to why adolescents engage in self-injurious behavior. However, talking to

■ nicole Garber, MD, alice Mao, MD, and lorena Reyna

Proposed Criteria for non-Suicidal Self-injury in DsM-5American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).

During the year and over a period of time, the individual has engaged in inten-tional self-inflicted damage to his or her body aimed to induce bleeding, bruising or pain (cutting, burning, hitting, etc.), with the intent on only minor/moderate physical harm.

The individual engages in this type behavior with one or more of the following expectations to:

• Obtain relief from a negative feeling or cognitive state.• Resolve an interpersonal difficulty.• Induce a positive feeling state.

The intentional self-injury is associated with at least one of the following:• Interpersonal difficulties or negative thoughts occurring immediately prior

to act.• Prior to the act, a period of preoccupation with the intended behavior that is

difficult to control.• Frequent thinking of self-injury, even when it is not acted upon.

The behavior is not socially sanctioned or restricted to picking a scab or nail biting.

The behavior causes clinically significant distress in interpersonal, academic or other important areas of functioning.

The behavior does not occur exclusively during psychotic episodes, delirium, substance abuse, or substance withdrawal. In those with a neurodevelopmen-tal disorder, the behavior is not part of a pattern of repetitive stereotypes. The behavior is not better explained by another mental disorder or condition.

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COMMITTEESthe child or adolescent will be helpful in identifying precipitating and perpetuat-ing factors to self-injury. Some possible explanations (Nock, 2010):

■ To regulate affect

■ To avoid feelings of “numbness”

■ To signal personal distress to others and request help

■ Self-injurious behaviors are being sustained by positive or negative reinforcement

■ Self-punishment after commit-ting acts that have distressed or harmed others

Suggestions for intervention ■ Screen for NSSI in each patient.

■ Be aware of your own affect and anxiety in response to disclosures of NSSI.

■ Maintaining a respectful and curious attitude may elicit more information.

■ Ask what factors led to the injury and how they were feeling before and after the self-injurious act.

■ Identify high-risk situations where the patient is likely to use self-injury as a coping strategy.

■ Introduce replacement behaviors. Replacement behavior seeks to substitute the thoughts and urges to self-injure with positive activi-ties, thoughts, and skills. Examples include holding an ice cube or a rubber band around the wrist that is pulled when distressed. More adaptive skills such as talking to others, writing in a journal, or other self-soothing techniques may be used (Walsh, 2012).

treatment optionsDialectical Behavior Therapy (DBT) improves emotional regulation, distress tolerance, and interpersonal effective-ness skills. Recently, DBT has been adapted for adolescents. In all studies, DBT was found to significantly decrease non-suicidal self-injury in adolescents (Nock et al., 2007).

A recent study compared high qual-ity treatment-as-usual (TAU) to mentalization-based treatment (MBT) for adolescents. MBT is a psychodynamic therapy that works by increasing aware-ness about an individual’s own mind, the minds of others, and the actions that result. This awareness helps increase emotional regulation and relation-ships. In a study of eighty adolescents with depression and self-harm, it was shown that MBT was better than TAU in decreasing self-injury and depression scores (Rossouw, 2012).

ConclusionsAlthough managing self-injury with patients can be anxiety-provoking, it is important to ask about self-injurious behaviors with every patient. Attempt to determine the function, severity, and frequency of self-injury. Consider working with the patient on replace-ment behaviors. In addition, MBT and DBT may provide effective treatment of NSSI and should be kept in mind. Further research is needed to provide more information about management, treatment outcomes, and prognostic indicators for children and adolescents who have recurrent NSSI. n

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing

Nixon M, Cloutier P, Jansson S (2008). Nonsuicidal Self-harm in youth: a population based survey. Canadian Medical Association Journal 178:306-312

Moran P, Coffey C, Romaniuk H, Olssosn C, Borschmann R, Carlin J, Patton G (2011). The Natural History of self-harm from adoles-cence to young adulthood: a population based cohort study. The Lancet 379:236-243

Lineman M, Comatose K, Murray A, Brown M, Gallop R, Heard H, et al. (2006). Two-year randomized controlled trial and follow up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry 63:757-766

Ougrin D, Zundel T, Kyriakopoulos M, Banarsee R, Stahl D, Taylor E (2012). Ado-lescents with suicidal and nonsuicidal self-harm: clinical characteristics and response to therapeutic assessment. Psychologic Assessment 24:11-20

Hankin B, Abela J (2011). Nonsuicidal self-injury in adolescence: prospective rates and risk factors in a 2½ year longitudinal study. Psychiatry Research 186:65-70

Nock M (2010). Self Iinjury. Annual Review of Clinical Psychology 6:339-363

Asarnow J R, Porta G, Spirito A, Emsie G, Clarke G, Wagner K, et al. (2011). Suicide at-tempts and nonsuicidal self-injury in the treat-ment of resistant depression in adolescents: findings from the TORDIA trial. J Am Acad Child Adolesc Psychiatry 50:772-781

Nock M, Teper R, Hollander M (2007). Psychological treatment of self-injury among adolescents. Journal of Clinical Psychology 63:1081-1089

Rossouw TI, Fonagy P (2012). Mentalization-based treatment for self-harm in adolescents: a randomized controlled study. J Am Acad Child Adolesc Psychiatry 51:1304-1313

Walsh B (2012). Treating Self Injury, A Practical Guide. New York, New York: The Guilford Press

Nock MK (2009). Why do people hurt themselves? New insights into the nature and function of self-injury. Curr Dir Psychol Sci 18:78–83

Dr. Nicole Garber is a clinical assistant pro-fessor of Psychiatry at University of Texas Medical School-Houston. She may be reached at nicoledgarber@comcast.net.

Dr. Alice Mao is a member of the AACAP Consumer Issues Committee, and associate professor of Psychiatry at Baylor College of Medicine. She may be reached at maobrams@aol.com.

Lorena Reyna is a fourth year medical stu-dent at Baylor College of Medicine. She may be reached at lereyna@bcm.edu.

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News UPDATES by Stuart Goldman, MD, and Garrett Sparks, MD, MS

teenage Drivers Sleep-deprived, intoxicated, and Distracted

According to research by Brandon Schoettle and Michael Sivak at the University of Michigan Transportation Research Institute (white papers available online), the number of teenagers and young adults with their driver’s license has decreased substantially over the last few decades. No longer the right of passage it once was, getting a driver’s license is more trouble than it’s worth. They don’t have time to learn to drive, they don’t want to worry about the cost of owning or maintaining a vehicle, or they just prefer to walk, ride a bike, or take public transportation. That doesn’t necessarily mean the roads are much safer, and a series of recent studies discusses some of the most important factors in teenager auto safety.

In the July JAMA Pediatrics, Alexandra Martiniuk and colleagues wondered whether not getting enough sleep would increase the risk of teenagers getting into car accidents, and by just how much. They obtained questionnaire responses from about 19,000 newly licensed Australian drivers and followed their police-reported crash data for two years. Those who reported getting less than six hours of sleep a night were 21% more likely to get into an accident. Light weekend sleepers were 55% more likely to get into run-off-the-road crashes. These sleep deprivation-associated crashes were more likely to occur after 8 pm. Good sleep is so important for our patients for so many outcomes, but the risk of dangerous car crashes gives us even more impetus to assess the sleep of our patients and address the behaviors of poor sleepers.

Of course, one question is what these youth who are staying out late and not sleeping are doing with their time that might also be contributing to these crashes. Patrick O’Malley and Lloyd Johnston published a study of high school seniors driving after using drugs or alcohol. They examined data from 22,000 respondents of the Monitoring the Future study from 2001 to 2011. More than one-fourth of high school seniors either drove or rode with a driver after smoking marijuana or drinking alcohol. These behaviors differed little across demographic groups. Driving after drinking has actually decreased somewhat over time, but driving after smoking marijuana has dramatically increased. Such behaviors significantly increase the risk for accidents, and with the inevitable liberalization of marijuana policies in the United States, we have to worry that more youths are going to be making more bad decisions. Child and adolescent psychiatrists must take advantage of opportunities to educate our patients about the dangers of not only driving drunk, but of driving high as well.

From the “do not try this at home” file of research studies, Jeffrey Epstein and

colleagues put 28 teenagers with ADHD and 33 without ADHD behind the wheel to assess their driving performance while distracted (well, behind the wheel of a driving simulator, that is). The teens were warned that they would be receiving phone calls and text messages through-out the 40-minute driving program. The teenagers with ADHD were withheld their stimulants on the day of the study. The ADHD group performed relatively poorly with more changes in speed and lane position than their peers. However, the distractions even the playing field. Everyone did poorly while texting, with slower driving and more changes in speed and lane position. Bizarrely, cell phone conversations actually seemed to improve driving outcomes compared to no distraction at all. This latter finding should be interpreted carefully given the artificial conditions, but the stakes are clearly high when our patients decide to text and drive.

There are too many bad jokes about teenage driving, but behind those jokes is the scary reality that teenagers are so much more likely to have bad things happen to them when they get behind the wheel, especially when they are not at their best. We can at least educate our patients and their parents about these risks and hope they make better deci-sions for themselves.

Mariniuk AL, Senserrick T, Lo S, Williamson A, et al. (2013). Sleep-deprived young drivers and the risk for crash: the DRIVE prospective cohort study. JAMA Pediatr 167(7):647-55

O’Malley PM, Johnston LD (2013). Driving after drug or alcohol use by US high school seniors, 2001-2011. Am J Public Health. Sep 12. [Epub ahead of print]

Narad M, Garner AA, Brassell AA, Saxby D, et al. (2013). Impact of distraction on the driving performance of adolescents with and without attention-deficit/hyperactivity disorder. JAMA Pediatr. Aug 12. [Epub ahead of print]

In each issue of AACAP News, we include brief commentary and a link to newsworthy items that the membership might have missed or that merit repeating. If you have suggestions for this column, please send them to me at

stuart.goldman@childrens.harvard.edu.

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you are What you Eat, or at least Maybe your behaviors are

Computer science gave us the concept of GIGO, or “garbage in, garbage out.” While this obviously applies to an errant line of code leading to a computer program behaving badly, the same may be true of our patients as well. A pair of recent studies explores the effects of diet on externalizing behavior in children.

Diet quality is an established risk factor for depression and anxiety in adults and adolescents, but how does mater-nal and early postnatal nutrition affect a child? Michael Berk and colleagues asked this question by examining data of over 23,000 women from the Norwegian Mother and Child Cohort Study. The women’s diets were classi-fied through a complicated algorithm as either “healthy” or “unhealthy,” and the internalizing and externalizing problems of their children were assessed at various points through age five. The authors found that higher intakes of unhealthy food by a mother during pregnancy predicted greater problems with exter-nalizing behaviors in her child, and a mother with a poor postnatal diet was more likely to have a child with both externalizing and internalizing behaviors. These effects persisted despite control-ling for various maternal socioeconomic factors, depression, substance use, and even the child’s own diet.

In more bad news for 5-year-olds with exposure to unhealthy foods, soda consumption seems to have a substantial association with a variety of negative outcomes. In a sample of 2,929 children, nearly 43% consumed at least one soda per day, and 4% consumed four or more sodas per day. Suglia et al. found a very clear dose response curve between soda and higher rates of aggressive behaviors. Children who drank four or more sodas had more attention problems and were more than twice as likely to destroy things belonging to others, get into fights, and physically attack people compared to those who drank no soda. The authors corrected for various sociodemographic factors and behaviors like television watching and candy consumption, and the independent effect of soda on these outcomes remained intact.

While each of these studies went to great lengths to statistically control for various factors that might confound the relation-ship between diet and behaviors, some aspects of parenting styles and attitudes are quite difficult to quantify in large data collections. Also, the mechanisms by which junk food affects behavior are largely speculative at this point. That said, these studies further inform discussions we can have with parents and children about the importance of what goes into their body, even when it comes to their feelings and behaviors.

Finally in the good news depart-ment, Belfort et al.’s study of over 2000 mothers, that appeared in July’s JAMA Pediatrics, found that the well-known benefits of breastfeeding, that is decreased gastrointestinal infections and otitis media, extended to improved cognition as well. While there have been studies in the past that have also come to this conclusion, many of the prior studies were either poorly controlled or dichotomized the group into exclu-sively breastfed versus other and did not account for the many children who were a mixture of breastfed and other foods. Additionally, they looked for positive effects for mothers who consumed fish. The belief being that some of the pro-posed benefits of breast milk were from breast milk fatty acids and these would increase with the external consumption of the same fatty acids that then might be excreted in breast milk.

They found that there was a linear relationship between breastfeeding and scores on the Peabody Picture Vocabulary Test at age three and the Kaufman Brief Intelligence Test at age seven, and that this effect extended to both the exclusive and partially breast-fed children. More specifically at age three years, for the Peabody Picture Vocabulary Test, there was an increase of 0.21 points per month breastfed as well as increased scores on the Kaufman Brief Intelligence Test at age seven years 0.35 verbal points per month for breastfed; and 0.29 nonverbal points per month for breastfed. This translates into almost a ½ standard deviation improve-ment for each of these measures. Further analysis revealed that for babies that were exclusively breast fed the gains per month, for the first 6 months, were

even higher at 0.5 points per month of exclusive breastfeeding. Stratifying the group by consumption of fish suggested a positive correlation between maternal fish consumption and test scores, but it did not reach statistical significance.

The message to families is clear; the benefits of breastfeeding are broad. The authors recommend (if possible) 6 months of exclusive breastfeeding followed by six more months of mixed feedings. While this puts great demand on working mothers, an already stressed group, the results appear clear.

Jacka FN, Ystrom E, Brantsaeter AL, Karevold E, et al. (2013). Maternal and early postnatal nutrition and mental health of offspring by age 5 years: a prospective cohort study. J Am Acad Child Adolesc Psychiatry. July 19. [Epub ahead of print]

Suglia SF, Solnick S, Hemenway D (2013). Soft drinks consumption is associated with behavior problems in 5-year-olds. J Pediatr. Aug 19. [Epub ahead of print]

Belfort, MB, Rifas-Shiman, SL, Kleinman, KP et al. (2013). Infant feeding and childhood cognition at ages 3 and 7 years effects of breastfeeding duration and exclusivity. JAMA Pediatr 167(9):836-844. doi:10.1001/ jamapediatrics.2013.455. archpedi.jamanetwork.com/article.aspx?articleid=1720224

unpacking the Phenomena of Psychosis

While psychotic phenomenon has been described for over a century, the complex nature of psychosis continues to be a challenging one to unravel. Biological risks factors (both genetic and acquired) have been identified as well as have experiential factors. While there has been progress in the treatment of psychosis, it has been slower and more modest than most (including this writer) would have anticipated. There has been an ever growing effort for the early identification and understanding of those at risk, with the hope of revers-ing or at least minimizing the impact, of this most serious set of disorders. The two prospective studies reviewed below are important stepping-stones in our growing understanding. In the first, they examine the relationship between

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psychotic or near-psychotic phenomena at age 12 and then again at age 18. In the second, the authors look at the impact of trauma on the development of psychosis.

Relationship between Psychotic Symptoms at 12 and 18In the first study, Zammit et al., in July’s American Journal of Psychiatry, looked at a non-clinical birth cohort of over 4,000 subjects and evaluated them with the Psychosis Like Symptom Interview (PLSI), a semi-structured interview based upon the Schedule for Clinical Assessment in Neuropsychiatry (SCAN). This was done both at age 12 and again at age 18. They divided the cohort at age 12 into those who had (with respect to psycho-sis): None (88.4%), Suspected (7.1%) and Definite (4.5%) symptoms. In the 18-year-old cohort, they further divided them into: None (71.8%), Suspected (12.2%), Definite (5.5), At-risk (2.2%), and Disorder (8.3%) with respect to psychotic symptoms. Of these, 1.7% of the 18-year-olds were diagnosed with a psychosis.

In tracking specific individuals, 78.7% of those with psychotic symptoms on the PLSI at age 12 had fully remitted by age 18. However, even though the majority of those with psychotic symptoms at age 12 had remitted, the odds ratio (OR) of having psychotic symptoms at 18 were increased for both those with suspected symptoms (OR 5.6) or definite symp-toms (OR 12.7). There also was a more modest increase in psychotic symptoms at age18 for those who had symptoms at age 12 that were associated with either fever or sleep deprivation. Overall, the positive predictive value of having psychotic symptoms at 18 for those hav-ing symptoms at 12 ranged from 5.5 to 22.8%. The authors concluded that even though there was a correlation between disorders at 12 and at 18, the correla-tions and predictive values were too low to make preventative interventions a realistic and cost effective option.

Despite this limitation, their find-ings suggest that there is a real and not uncommon continuum of psy-chotic symptoms in 12-year-olds that most clinicians have not appreciated. This also held true for a continuum of psychotic symptoms in 18-year-olds, with higher rates of diagnosable disorders. It is noteworthy that about 75% of those identified at 18 could have been identified by asking about hallucinations alone.

For clinicians there are several take away points. First, psychotic symptoms in both 12- and 18-year-olds are far more common than the rates of psychotic dis-orders. Next, that relatively few of those affected by symptoms at 12 will develop actual disorders. More importantly, while having symptoms does put one at risk, albeit modestly, the risk is too mod-est to lead to active intervention. Finally, many of the 18-year-olds with actual disorders are going untreated, suggesting that screening in schools or in primary care offices, for 18-year-olds, might be very helpful in reaching out to this at-need population.

trauma and PsychosisIn the second article, Kelleher et al., in July’s American Journal of Psychiatry, looked at the bi-directional relation-ship between trauma and psychotic symptoms. In their study of 1,100 Irish adolescents, they looked at three spe-cific questions: 1) Does psychosis predict increased rates of trauma? 2) Does trauma predict increased rates of psy-chosis? 3) Does cessation of trauma lead to resolution of psychotic symptoms? In their study, they used a combina-tion of self-reports and the Adolescent Psychotic Screener at baseline, and then follow-up at both 3 and 12 months. The children were predominately 13 and 14 years of age, with a smattering of 15- and 16-year-olds. At baseline, 5.5% reported psychotic symptoms and almost 40% reported bullying, with 10% report-ing having been physically assaulted.

Addressing each of their questions they found that psychotic symptoms predicted increased rates of physical assaults and bullying at 3 and 12 months. However, after baseline adjustments the increased rates of assaults were signifi-cant and the bullying was a trend but not significant for those with psychotic symptoms. They also found that trauma was predictive of psychosis, including a dose-response relationship between severity (dose) of trauma and psychotic symptoms. Finally they found that the cessation of trauma led to a significant reduction in psychotic symptoms.

For clinicians, the take-away message is clear: there is a bi-directional relation-ship between trauma and psychosis and interrupting this cycle will result in decreased rates and symptomology. The nature of being “at-risk” for children with psychotic symptoms broadens still to include victimization. Additionally, the impact of victimization now extends to increased rates of psychosis. The mandate for screening and interventions around any type of victimization contin-ues to grow.

Zammit S, Kounali D, Cannon M, David AS, Gunnell D, et al. (2013). Psychotic experi-ences and psychotic disorders at age 18 in relation to psychotic experiences at age 12 in a longitudinal population-based cohort study. Am J Psychiatry 170:742–750 ajp.psychiatryonline.org/article.aspx?articleid=1685281

Kelleher I, Keeley K, Corcoran P, et al. (2013). Childhood trauma and psychosis in a prospective cohort study: cause, effect, and directionality. Am J Psychiatry 170:734-741 ajp.psychiatryonline.org/article.aspx?articleid=1680037

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Revised ADHD Parents Medication Guide Is Now Available!

■ theodore a. Petti, MD, MPH

As attention-deficit/hyperactiv-ity disorder (ADHD) has been diagnosed more frequently in

both pediatric and adult populations, the diagnosis and treatment of this highly prevalent neurodevelopmental disorder has come under increasing scrutiny. Critics have been more scathing and the general public, including parents of youngsters with ADHD, continue to be puzzled as to what to do. In response, Council approved the revised “ADHD Parents Medication Guide“ (PMG) in August. This second edition builds upon the original 1992 guide developed through collaboration between AACAP and Children and Adults with ADHD (CHADD) and published in a CHADD magazine. Issues of concern related to ADHD and its treatment were presented in a question and answer format. The first ADHD Guide, a collaborative effort between the American Psychiatric Association (APA) and our AACAP was approved in 2007. In its effort to inform the public about good practice, CHADD reports distributing thousands of the earlier guides to interested parents and others.

In a well-attended symposium at our 2012 Annual Meeting in San Francisco titled “The Biological Basis for ADHD and Medication Treatment Response: Making Sense of the Data for Professionals and Families,” it was disconcerting to note that many of our members had been unaware of the Guide and had not used it as a means to alert families about a valu-able resource. Having access to such a useful tool is particularly important since the past decade has witnessed

advances on numerous research fronts into the biological basis for ADHD and its treatment.

The revised AACAP “ADHD Parents Medication Guide,” co-sponsored by the APA, was developed by a Pediatric Psychopharmacology Initiative (PPI) in conjunction with members from the APA, CHADD, the American Academy of Pediatrics, and NAMI. Research of the past decade forms the foundation for the insights and recommenda-tions found in the Guide. But even as advances are made to understand this multi-faceted disorder, critics continue to question the diagnosis and the role of medication in treatment. Whitaker in the highly acclaimed and cited ANATOMY OF AN EPIDEMIC (2010) questions the ADHD diagnosis and its treatment with medication. He implies more harm than good comes from the ADHD diagnosis and treatment. However, he manages to ignore a decade of advances in our knowledge base. Sroufe in a widely read and discussed article in The New York Times asserted medications have no long-term benefit for youth with ADHD. This op-ed article has been followed by numerous articles in The New York Times, including a highly emotional story describing a child who only did well after his ADHD medication was discontinued. Shortly after, another front page New York Times article described physicians in poverty areas using ADHD medications to fix the environmental ills of society with medications of question-able value causing bad side effects.

Critically absent in The New York Times and other misleading publications are the significant scientific advances made to better understand and treat ADHD symptoms. The Guide provides citations to some of this evolving evidence-base that allow professionals, families, and the general public to acquire updated knowledge and current insights into the disorder. Guidance is offered through answers to commonly voiced concerns by families and the general public. After a brief introduction to orient the reader, the issues addressed under the

first major Guide heading, “Causes, Symptoms & Choosing Treatment” are typical of the information presented. Its subheadings, with elaboration for each, include the following: What is ADHD? What causes ADHD? How can I find out if my child has ADHD? When can ADHD be diagnosed? Why are more boys than girls diagnosed with ADHD? Why are more children being diagnosed with ADHD? How does ADHD affect my child’s ability to form friendships? What are some of the more common disorders that can accompany ADHD? What types of treatments are effec-tive? Will medication cure my child? A side bar in this section lists “Potential Consequences When ADHD Is Left Untreated.”

Other major headings include “Choices in Medication,” “Taking ADHD Medication,” “Stimulant Medication & Addiction,” “Side Effects & ADHD Medication,” “School & the Child with ADHD,” “Psychosocial Treatments,” “Unproven Treatments,” “Transition to College,” “Transition of Adolescents with ADHD into Adulthood,” and “What Does the Future Hold?” The final section, “For More Information about ADHD” provides: a compen-dium of national organizations with contact information; and ADHD-related publications in English and Spanish, recommended readings for children, teens and college students, and families and caregivers.

continued on page 308

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Committee members who worked to revise the Guide are listed at the end of the publication. All deserve appre-ciation for persevering through a long, drawn-out process. The Guide has been vetted by the APA and the collaborat-ing organizations, members of the PPI and its parent Research Committee, and other Academy components. We hope that you took the opportunity to review the Guide in Orlando at the Annual Meeting. You can access it at the AACAP website where it can be found in the ADHD Resource Center. The direct link is www.aacap.org/app_themes/aaCaP/Docs/resource_centers/adhd/adhd_parents_medication_guide_201305.pdf. n

References

Whitaker, R (2010). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. New York: Broadway Paperbacks

Sroufe AL (2012). Ritalin gone wrong. The New York Times Jan 29:SR1

Dr. Petti is Professor of Psychiatry, Rutgers-Robert Wood Johnson Medical School and staff psychiatrist at Rutgers-University Behavioral Health Care. He was the Chair of the Work Group to revise the ADHD Parents Medication Guide. He can be reached at pettita@rutgers.edu.

Attention Life Members!Stay involved. Stay connected to all Life Members activities, programs, and photos by reading the Life Members eNewsletter distributed quarterly via e-mail. Did you receive the latest Life Member eNewsletter in September?

Impact. Since 2010, the Life Members Fund has made an investment in 37 residents and 31 medical students. This has been achieved through its two grant awards, Education Outreach for Child and Adolescent Psychiatry Residents and Mentorship Grants for Medical Students. 68 lives you impacted, who are and we hope will become the next generation of child and adolescent psychiatrists.

Donate. Do you think we can double this in the next two years? Our skills have never been more important, but the deficit of available child and adolescent psychiatrists is growing. This deficit means fewer children have access. This is not acceptable. Who better than Life Members to be the leader in solving this deficit?

To donate, visit www.aacap.org/donate.

Membership: Do you think you are a Life Member? AACAP Members qualify as Life Members when your age plus your years of AACAP membership equals 98.

To learn more about all Life Member activities, grant awards, membership, eNewsletter, or to donate, please contact the Development Department at 202.966.7300, ext. 140, or at development@aacap.org.

Revised ADHD Parents Medication Guide continued from page 307

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CPT CODING CORNER

■ benjamin Shain, MD, PhD, Sherry barron-Seabrook, MD, and David berland, MD, CPT Coding Subcommittee

Visit 1 Scenario 1: Attended by parent(s)/guardian(s); patient not present

You may code this 90791 (psychiatric diagnostic evaluation) or 90792 (psychi-atric diagnostic evaluation with medical services). “Medical services” refers to a medical activity, such as writing a prescription or ordering clinical labs but, more importantly, may also refer to any documented medical thinking, such as considering medication or the impact of a medical comorbidity.

The patient need not be present for 90791/90792. From CPT 2013: “In certain circumstances one or more other informants (family members, guardians, or significant others) may be seen in lieu of the patient.”

Scenario 2: Attended by patient, alone or accompanied by parent(s)/guardian(s)

option 1: Report 90791 or 90792 as above.

option 2: Report an evaluation and management (E/M) code for a new office patient (99201-99205). The patient must be “new,” i.e., not seen for any service in the last 3 years by you or any member of your group in the same specialty and subspecialty. The commonly used first visit codes by child and adolescent psy-chiatrists (CAP) are 99204 and 99205, which require both comprehensive history and comprehensive exam plus moderate (99204) or high (99205) com-plexity medical decision-making.

Visit 2option 1: Regardless of the code selected for the first visit, you may report 90791 or 90792 for the second evaluation visit. (From 2013 CPT: “Codes 90791, 90792 may be reported more than once for the patient when separate diagnostic evaluations are conducted with the patient and other informants.”)

option 2: Select an established patient, office visit E/M code, 99212-99215. These codes require documentation of 2 of 3 key components (history, examina-tion, medical decision-making). If the patient is not present, document the medically appropriate level of history and medical decision-making. The patient must be present to document the key component of examination.

See the AACAP website www.aacap.org/aaCaP/Clinical_Practice_Center/business_of_Practice/CPt_and_Reimbursement.aspx?hkey=e53bd2fa-d1f9-4db5-bbfa-17f48bec4e35 for extensive coding educational materials, including details of criteria for E/M codes.

Contact Jennifer Medicus at jmedicus@aacap.org or 202.587.9670 with questions. n

This is the first in a series of bi-monthly CPT coding articles based on frequently asked questions. Submit requests for future articles to Jennifer Medicus (jmedicus@aacap.org).

Q: My office evaluation for children and adolescents takes place over two 1-hour visits. What are the best CPt codes to use?

a: you have several choices of codes depending on who attends which appointments and the services provided.

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AACAP K12 Physician Scientist Program in Substance Abuse Funded by the National Institute on Drug Abuse

■ Elizabeth Goggin, Research Program Manager, and yoshie Davison, MSW, Director of Research, Training and Education

The annual K12 Physician Scientist Program in Substance Abuse retreat was held June 13-15 in San

Diego, CA, preceding the College on Problems of Drug Dependence’s (CPDD) annual meeting.

The NIDA-AACAP K12 Physician Scientist Program in Substance Abuse Program was established in 1998 to increase the number of child and adolescent psychiatrists who are career investigators in pediatric mental health and addiction research. The grant provides up to five years of salary sup-port and mentored addiction research training for qualified child and adoles-cent psychiatrists who intend to establish careers as independent investigators. The current cohort of six scholars received their awards in June 2010 and continue to address clinically-important research gaps in the fourth year of their program with the following projects:

■ Margaret benningfield, MD, Vanderbilt University Medical Center

◗ K12 Research: Neurobiology of Impulsivity, Risk Taking & Reward in Youth at Risk for Addiction

■ brady Case, MD, Emma Pendleton Bradley Hospital

◗ K12 Research: Epidemiology of Adolescent Substance Use Treatment

■ Michelle Horner, Do, University of Pittsburgh

◗ K12 Research: The Role of Affective Processing in Etiology of Substance Use Disorder

■ leslie Hulvershorn, MD, MSc, Indiana University

◗ K12 Research: Neural Correlates of Emotion Dysregulation in Youth at Risk for Substance Abuse

■ Mini tandon, Do, Washington University in St. Louis School of Medicine

◗ K12 Research: Prenatal Cigarette Exposure and Course of Childhood ADHD

■ Greg tau, MD, PhD, Research Foundation for Mental Hygiene, Inc.

◗ K12 Research: Neural Correlates of Multiple Memory Systems in Adolescent Cannabis Use

In addition to the six scholars, the retreat was attended by the program director, Paula Riggs, MD, advisory committee chair Catherine Martin, MD, advisory committee members, bennett leventhal, MD, neal Ryan, MD, and Frances levin, MD, grants oversight committee repre-sentative, Peter tanguay, MD, mentors Peter Finn, PhD, Joan luby, MD, Peter Martin, MD, bradley Peterson, MD, anthony Spirito, PhD, and Ralph tarter, PhD, and AACAP staff yoshie Davison, MSW, director of research, training, and

education, and liz Goggin, research program manager.

The retreat included a review session of each scholar’s research aims and an informative presentation on career development, funding, and collabora-tive research. Susan Weiss, PhD, NIDA’s former Associate Director for Scientific Affairs, presented NIDA’s current finan-cial climate and gave scholars helpful funding strategies for early career inves-tigators. The attendees also participated in roundtable discussions on topics such as matching grant ideas to fund-ing mechanisms, summary statements and responding to reviewers, estab-lishing order of authorship, and target journal selection.

This retreat marked the last time mentors will attend the K12 retreat and Drs. Finn, luby, Martin, Peterson, Spirito, and tarter were thanked for their dedica-tion and commitment which has directly impacted the success of this program. Dr. Riggs, Martin, and Ms. Davison also thanked Dr. Weiss for her invaluable feedback from NIDA, and recognized scholars and advisory committee mem-bers for their excellent contributions. n

K12 Retreat Attendees (top left to right): Bennett Leventhal, MD, Brady Case, MD, Peter Martin, MD, Liz Goggin, Susan Weiss, PhD, Margaret Benningfield, MD, Ralph Tarter, PhD, Bradley Peterson, MD, Joan Luby, MD, Leslie Hulvershorn, MD, MSc, Peter Tanguay, MD, Neal Ryan, MD, Anthony Spirito, PhD, Peter Finn, PhD, Michelle Horner, DO, Catherine Martin, MD, Mini Tandon, DO, Greg Tau, MD, PhD, Paula Riggs, MD, and Yoshie Davison, MSW.

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■ Diane Shrier, MD, Contributing Editor

Paramjit t. Joshi, MD, has long-standing interests and expertise in working with international com-

munities and with children in refugee camps around the world. In hindsight, chance happenings related to important early-life and family experiences led to a major professional focus.

Dr. Joshi was born in 1949 in post-colonial India shortly after India gained independence from the Raj and the British Empire and the subsequent partitioning of India and Pakistan in 1947, which resulted in major population movements between the two newly sep-arated countries. Her parents were both Sikhs, with her father’s family having lived in India for generations, while her mother’s family had lived in Pakistan. Both families highly valued education for their children, including daughters, which was unusual at that time. As part of the partitioning, many families of Hindu and Sikh backgrounds from the part of India that became Pakistan ended up in temporary refugee camps in India, including Dr. Joshi’s mother’s family. Eventually, arrangements were made such that Muslims from India would swap houses with Sikhs and Hindus from Pakistan.

Dr. Joshi’s mother had by that time already completed her college education in Pakistan and was the first girl in her village to get a college education. She had wanted to go to medical school, but that would have precluded marriage, and her parents wanted her to marry.

Dr. Joshi’s father served in the British military, fought in WWII in Burma against the Japanese, and continued in the military after liberation from Britain. Dr. Joshi loved the military life, and its values had tremendous influence on her character. She appreciated the impor-tance of self-discipline, responsibility, punctuality, and not complaining, but “pulling your socks up” and doing what you needed to do.

Dr. Joshi was given the following choices of profession by her parents: doctor, engineer, lawyer, or nurse. Her life-long ambition had been to join the military, but only women who were physicians or nurses could do so, which led to her choice to be a physician. She gradu-ated from the same medical school to which her mother had applied but did not attend, an excellent Christian medi-cal college founded by Edith Brown, a missionary from England. The heads of the various departments were medical missionaries from Britain, New Zealand, or the United States. It had been one of only two all-women medical schools, which in 1956 had become co-educa-tional. By the time Dr. Joshi enrolled, there were 25 men and 25 women. She became the first physician in her family.

Dr. Jean Griffith, the head of pediatrics at the time, made a big impact on Dr. Joshi in her clinical years, resulting in her specialization in pediatrics and subse-quent choice to sub-specialize in child and adolescent psychiatry.

Dr. Joshi presented a case in morn-ing rounds of a 15-year-old girl with yellow nails and skin who appeared to have jaundice of unknown etiology. Dr. Griffith asked Dr. Joshi if she had looked at the patient’s sclera and taken a family history of what was happening in her life, neither of which Dr. Joshi had done. Dr. Griffith yelled at Dr. Joshi and shamed her in front of everyone, shout-ing, “Why does this patient not have jaundice? The sclera are not yellow!” Dr. Joshi later listened to the patient’s story. The young girl had wanted to finish high school but her parents wanted her to get married. She made herself appear to be ill by taking turmeric and rubbing it on her skin, because then no one would want to marry her if she were ill. Dr. Griffith suggested a consultation with a visiting Irish psychiatrist. This was Dr. Joshi’s first exposure to psychiatry and William breakey, MD, who helped her to understand why a person’s motiva-tions are so important.

In her second year of medical school, Dr. Joshi met her future husband, a class-mate, and they married after Dr. Joshi had completed her pediatric residency in 1974. Her oldest son was born in India, and her youngest son, two years later, in Colorado. Her husband had trained as an internist but really wanted to relocate to the United States, and she reluctantly went along. Foreign medical gradu-ates (then and now) had to repeat their residency training in order to be allowed to practice in the United States. During her husband’s re-training in Denver, Colorado, Dr. Joshi was a “stay-at-home” mom for two years while she studied for the examination for foreign medical graduates and tried to decide what to do next. She did not want to repeat her general pediatric training. She consid-ered all the pediatric subspecialties and, through an experience at National Jewish Hospital in Denver, decided upon child and adolescent psychiatry. She was accepted at Johns Hopkins in Baltimore and there again encountered the psychiatrist who had consulted on her 15-year-old patient in medical school. Dr. Breakey had also immigrated to the United States from Ireland and was head of community psychiatry at Johns Hopkins.

Paramjit Joshi, MD, Incoming AACAP President and Internationalist

Paramjit T. Joshi, MD, President, AACAP

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NEWSFEATURESJames (Jim) Harris, MD, and his pedia-trician wife, Catherine (Cathy) D’Angelis, MD, hosted monthly journal clubs and dinners for the residents. Dr. Harris was the division chief and also her child and adolescent psychiatry training director. Joseph Coyle, MD, became division chief in Dr. Joshi’s second year of child training. After she completed her training, he offered her the position of director of the inpatient unit. Drs. Coyle, Harris and D’Angelis were big influences, mentors, and guides in the development of her professional life.

While Dr. Joshi was at Johns Hopkins, she was asked if she had any interest in helping children who were refugees as a result of the war in the Balkans. Dr. Joshi stated, “I usually never say no to things and then figure it out later as I go along.” When she visited the refugee camp, she was reminded of her mother’s refugee experience, and she became actively involved in developing interventions for refugee children in many countries.

In regard to Dr. Joshi’s involvement in organizational child and adolescent psy-chiatry, early on in her career Dr. Harris encouraged her to become involved in the Maryland Regional Council of Child and Adolescent Psychiatry and advised her to become a Delegate of the Assembly of Regional Organizations at AACAP.

David Pruitt, MD, then president of AACAP, invited Dr. Joshi to join a Work Group on Consumer Issues, which included James Mcintyre, ii, MD, David Fassler, MD, alice Mao, MD, and Henry Gault, MD, among others. For 10 years, Dr. Joshi was involved in writing AACAP’s Facts for Families. She was elected to AACAP’s Council. Richard (Dick) Sarles, MD, was very active in both the Maryland Regional Council and AACAP and encouraged Dr. Joshi to become president of the Maryland Regional Council, which she eventually did.

She would have happily stayed for her entire career at Johns Hopkins with her supportive Baltimore child and adoles-cent psychiatry community, but fate again intervened after 22 years at Hopkins. Her final position at Johns

Hopkins was clinical director and interim Child Psychiatry Division director.

Maryland Pao, MD, was a medical student when Dr. Joshi was a resident and later ran the Consultation/Liaison service at Johns Hopkins. She and Dr. Joshi were close friends. Dr. Pao left Hopkins to run the Consultation/Liaison service at Children’s National Medical Center (CNMC) in Washington, D.C. When a search committee was estab-lished to find a new chair for CNMC, Dr. Pao insisted Dr. Joshi at least take a look. The visit reminded Dr. Joshi how much she had enjoyed pediatrics and being part of a children’s hospital, and she was offered the position. She called Dr. Coyle, her division director, who told her “there is a right place and time to move – not too early, and not too late in your career, and this position sounded just right.”

Dr. Joshi is now in her 16th year as chair of psychiatry at CNMC and is “happy as a clam.” Among many initiatives in the department since Dr. Joshi’s arrival, CNMC offers a dual 3-year combined clinical and research training program in affiliation with the National Institute of Mental Health for two fellows a year, with the goal of increasing the num-ber of child and adolescent psychiatry researchers.

Dr. Joshi talked about her Presidential Initiative. She wanted something that would enhance AACAP and be sustained after her presidency, focusing on the international community. Many AACAP members are first or second generation immigrants who wish to find a way to give back to their home country. AACAP is very rich in resources not available in other countries. Her Presidential Initiative will have four components:

Make AACAP resources more user-friendly. The Education and Training Committee has been tasked to look at Academy resources that could be used by our international colleagues and to create an inventory of resources available from other international organizations.

The Web Committee will be looking at ways to make www.aacap.org more user-friendly.

The Membership Committee has been asked to create a member-ship category that would enable international child psychiatrists to become members/affiliate mem-bers to access AACAP resources.

Relationships will be established with international organiza-tions such as the World Health Organization, the International Association of Child and Adolescent Psychiatry and Allied Professions, the European Society of Child and Adolescent Psychiatry, the Asian Society of Child and Adolescent Psychiatry, and AACAP’s already strong ties with Canada and Mexico will be strengthened.

In addition to providing resources from AACAP for use by other countries, Dr. Joshi wants AACAP to become a reposi-tory for information about international organizations and institutions to enable our members and trainees who want international experiences to know where they can get the best experience in each country. A Steering Committee will help guide Dr. Joshi with this initiative (bennett l. leventhal, MD, norbert Skokauskas, MD, Joaquin Fuentes, MD, young Shin Kim, MD, PhD, and Howard liu, MD). n

Dr. Shrier is clinical professor of psychia-try and pediatrics, George Washington University Medical Center, Washington, D.C., and contributing editor to AACAP News. She may be reached at diane-shrier@rcn.com.

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Media Page ■ Garrett Sparks, MD, MS, Resident Editor

Monkey MindA Memoir of Anxiety

■ by Daniel Smith

Simon & Schuster, 2013 224 pages – $16.00 paperback

Former staff writer at The Atlantic, Daniel Smith (who now uses the moniker monkeyminder on twitter, and blogs at monkeymindchronicles.com) has aptly chosen monkey mind, a Buddhist term for being scat-tered, out of control, and indecisive, as the central metaphor around which he builds his autobiographical tale of anxiety. Beyond the evoca-tion of the primitive, the atavistic, and the aggressive, monkeys are also pretty silly. As Smith paints layer upon layer of neuroses throughout his childhood and professional career, he also respects that there may be no more palatable way to stomach misery than through humor. And while he never passes the opportunity to make a joke, Smith also lets us struggle with him as he tries to make sense of a childhood sexual trauma and very real losses.

The chapters read like racing thoughts. One moment, he considers his relationship as a teenager with an adult woman who took his virginity, the next the genesis of his hydrophobia, and the next his reconciliation of nature and nurture as he ponders how his relationship with his mother (and sharing her genes) influenced him to become the writer he is today. Smith’s mother suffered from panic dis-order and saw therapy patients in the study of his childhood home. He recalls sneaking to her office to scratch “therapist” off her business cards, leaving only the word “psycho,” and listening to her therapy sessions with clients through the furnace vents. Smith tumbles through college, his first writing jobs, his love for Philip Roth, and failed relationships, finally coming to a sort of uneasy peace that anxiety sufferers often accept.

Others have written about experiences with anxiety and depression, but rarely with such a careful balance of the heavy and the light. If Woody Allen wrote books instead of directing films, he may have written something not so different from Monkey Mind. A child psychiatrist will find his paradoxical observations both familiar and fresh, particularly with his reflections upon his childhood and development.

NEWSFEATURES

aaCaP members who would like to have their work featured on the Media Page may send a copy and/or a synopsis to the Resident Editor, Garrett Sparks, MD, at Western Psychiatric institute and Clinic, 3811 o’Hara Street, Pittsburgh, Pa, 15213 or e-mail sparksgm@upmc.edu.

NOVEMBER/DECEMBER 2013 315

Intravenous Hope, Stat!

■ by William taylor, MD

Amazon Digital Services, 2013 373 pages – 3.49 e-book only

IV Hope opens with a halting question: “We trust doctors not to kill us. Can we trust them not to kill themselves?” The Introduction is literally a guide for how a suicidal physician can immediately seek help. And that is the sort of urgency that pervades this e-book only publication from Dr. William Taylor, a retired child and adolescent psychiatrist from Connecticut.

Dr. Taylor examines the causes and effects of health profession-als’ suicides, including quotes from various doctors about their struggles, links to articles on morale in the health professionals, research on physician attitudes, and brief excerpts from discus-sions of the state of medical practice in the future. This is no series of essays about risk factors or collected narratives crafted to paint a comprehensive picture of health care professional suicide. Rather, Dr. Taylor takes the voice of a psychiatrist and directly addresses the reader, assuming that the reader may be the one who is hurting and needs help. He offers practical tips and organizes external resources with the ultimate goal of being useful for the reader.

Psychiatrists should be aware of various resources for not only our patients but also our colleagues who may be in need of support. Intravenous Hope, Stat! aims to be such a resource.

PArent Power: the Key to AMeriCA’s ProsPerity

■ by Jack Westman, MD, MS

CreateSpace Independent Publishing, 2013 262 pages – $12.00 paperback

Child and adolescent psychiatrist Jack Westman is Professor Emeritus of Psychiatry at the University of Wisconsin School of Medicine and Public Health and author of over 150 professional publications and eleven books. He also directs Wisconsin Cares, a non-profit advocacy organization of retired professionals with an interest in the well-being of families and children and particular focus on maximiz-ing the potential for children to develop into productive citizens.

Lawmakers are challenged by questions concerning how to best strengthen families through public policy. In Parent Power, Dr. Westman details his formulation regarding why many families are not living up to their full potential. He describes the central role of parenthood as the driving force for successful families, including narratives, analyses, and statistics dissecting worrisome social trends in violence, substance use, child maltreatment, and negative mental health outcomes.

Many familiar with Dr. Westman’s proposed solutions would describe some of the policies promoted by Wisconsin Cares as pro-vocative. In Parent Power, he passionately and thoroughly argues his rationale for these controversial measures.

316 AACAP NEWS

Individuals interested in submitting poetry should e-mail Poetry Coordinator Charles Joy, MD, at crjoy1@gmail.com.

316 AACAP NEWS

We all participate in the pain of the worldSome make itSome endure itSome turn their eyes awaySome plead for pain to stopSome are witnessesSome are perpetratorsSome are victimsSome are innocentsSome are hatefulSome carry angerSome carry rage Some carry sorrowSome carry tears And weep for us all Some carry guns and pull the trigger Some carry burdens so greatBreaking hearts and spiritsSplitting us from God and each other 20 elementary school children murdered6 adults trying to protect them Slaughtered on the altar of violence They learned awful things in school that dayAnd we the living Do we dare to look uponUnfathomable Unimaginable Terror and painIn the face of a 20 year oldWho first killed his motherBut as that was not nearly enough26 more dread deeds had to followThen turned the gun upon himselfMourners must mourn Cry out their pain and seek solace Wherever they may find itThat is their task When all bodies have been buried Some will think to feel to ask What will the days after bringWill we honor or forget the deadWho once laughed and played And loved and lived like usTake meaningful action Or hopelessly bow our headsWe all participate in the pain in the worldShattered hearts despair more bloodshed

In

Memory

of

the

Futureby Diane Kaufman, MD

Poetry

FEATURES

NEWS

NOVEMBER/DECEMBER 2013 317

MEETINGS

Call for Papers

AACAP’s 61st Annual Meeting takes place October 20-25, 2014, at the Manchester Grand Hyatt and Marriott Marquis and Marina in San Diego, California. Abstract proposals are prerequisites for acceptance of any presentations. Topics may include any aspect of child and adolescent psychiatry: clinical treatment, research, training, development, service delivery, or administration.

Abstract proposals must be received at AACAP by tuesday, February 18, 2014, or by Monday, June 16, 2014 for (late) New Research Posters. The online Call for Papers submission form will be available at www.aacap.org in December 2013, and all submissions must be made online.

Questions? Contact AACAP’s Meetings Department at 202.966.7300, ext. 2006 or meetings@aacap.org.

AACAP is proud to announce the upcoming release of lifelong learning Module 10: abuse and neglect, adoption and Foster Care, Custody and Divorce,

Dissociative Disorders, Personality Disorders, Reactive attachment Disorder, and Relevant updates for Child and adolescent Psychiatrists. With the purchase of this module you will

have the opportunity to earn 38 AMA PRA Category 1 Credits™ (8 of which will count towards self-assessment) to use toward your ABPN MOC requirements.

AACAP’s Newest Lifelong Learning Module is Available

SPECIAL PROMOTIONorder Module 10 when you pay your 2014 membership dues by January 31, 2014

and SAVE $60!Orders received after this date will not qualify for this promotion.

For questions about Module 10 or maintenance of certification, please contact Quentin Bernhard III, CME Coordinator, at 202.587.9675 or at qbernhard@aacap.org.

to order Module 10:

Online – Purchase via our Online Publication Store at www.aacap.org.

By Fax/Mail – Download and print a publication order from www.aacap.org/moc.

By PhOne – Call 202.587.9675 to place your order over the phone.

318 AACAP NEWS

MEETINGS

Call for Exhibitors!Reserve your space now to exhibit at each of AACAP’s annual Institutes. We offer tabletop exhibits to allow exhibitors the chance to connect with specific demographics within the child and adolescent psychiatry community. Approximately six tabletop exhibits are available at each meeting and are placed in high-traffic areas, providing exhibitors with the greatest opportunity to meet attendees. The vast majority of our attendees are practicing physicians. Exhibit opportunities are below:

2014 Psychopharmacology update instituteLaurence L. Greenhill, MD and Jean Frazier, MD, Co-ChairsTreating the Refractory Patient: Adding Expertise to Evidence-Based MethodsJanuary 10-11, 2014Sheraton New York Hotel and TowersNew York, New YorkExpected Attendance: 500+

Douglas b. Hansen, MD 39th annual Review Course in Child and adolescent PsychiatryLouis J. Kraus, MD and Joan Luby, MD, Co-ChairsMarch 22-24, 2014Westin Chicago River NorthChicago, IllinoisExpected Attendance: 200+

the Exhibitor Prospectus for aaCaP’s 61st annual Meeting, October 20-25, 2014 at the Manchester Grand Hyatt in San Diego, California will be mailed in May.

For more information, please visit www.aacap.org/ExhibitandSponsoror contact:AACAP Meetings & Exhibits ManagerPhone: 202.966.9518Fax: 202.966.5894Email: exhibits@aacap.org

MEETINGS

Session Recordings and Notebooks are available for purchase from past and current AACAP meetings!

■ Psychopharmacology update institute

■ annual Review Course

■ annual Meeting institutes and other sessions

For a complete list, visit the Past Meeting Resources and Publications page at www.aacap.org/cme_and_meetings.

to order notebooks:

Order online through the Publication Store at www.aacap.org. Questions? Call: 202.966.3594

New this year! session recordings from the 2013 annual Meeting

and Psychopharmacology Update institutenow include PowerPoint slides. also available are new bundles of annual

Meeting highlights on aDhD, Mood Disorders, and DSM-5.

to order Session Recordings:

Please visit: http://aacap.sclivelearningcenter.comor contact:Multiview7701 Las Colinas Ridge, 5th floor, Irving, TX 75063Phone: 972.402.7098 • Fax: 972.402.7035

The Editorial Board of AACAP News is soliciting photographs from

AACAP members to be published on its front page, inside standing alone, or accompanying relevant articles or stories. The published photographs should—

in some artistic way—illustrate themes pertaining to children, childhood, parents and children, parenting, or families. All AACAP members are invited to submit up to

two photographs every two months for consideration.

A committee of five experienced photographers who are AACAP members—David Corwin, M.D., James Harris, M.D., Fred Seligman, M.D., ludwig Szymanski, M.D., and alvin Rosenfeld, M.D.—will select the photos to be used. Photos not selected will be included in the voting for the subsequent two issues, along with all newly submitted photos. Unused photos will be retained by the AACAP to be used if and when a story they might illustrate is to be published. The AACAP News may edit photos to enhance them or make them suitable for publication. If you would like your photo(s) considered, please send a high-resolution version to Dr. Rosenfeld, the AACAP News photo editor, at aRosen45@aol.com. Please include a description, 50 words or less, of the photo and the circumstances it illustrates. n

Share Your Photo Talents with AACAP News

320 AACAP NEWS

NOVEMBER/DECEMBER 2013 321

NEWSFOR YOUR INFORMATION

beth belkin, MD, PhDScarsdale, NYChristopher bellonci, MDBoston, MAnancy black, MDWashington, DCSucheta Connolly, MDChicago, ILtracey Cornella-Carlson, MDOconomowoc, WIHanumanth Damerla, MDArcadia, CASandra Fritsch, MDPortland, ME

Cathryn Galanter, MDBrooklyn, NYStuart Goldman, MDBoston, MAEllen Heyneman, MDSan Diego, CAKathleen Kelley, MDChicago, ILGeetha Kumar, MDHaddonfield, NJMarybeth lake, MDChicago, ILJoanne loritz, MDNapa, CAJames McGough, MDLos Angeles, CAMichael naylor, MDChicago, ILJeffrey newcorn, MDNew York, NYMani Pavuluri, MD, PhDChicago, ILbarry Sarvet, MDSpringfield, MAKirti Saxena, MDHouston, TXbrett Schneider, MDSilver Spring, MDJoshua Sparrow, MDBoston, MAannie Steinberg, MDNarberth, PAKirk Wolfe, MDLake Oswego, OR

Congratulations to the 2013 Distinguished Fellows!Membership

CORNERPay your Dues online

Did you know that the Members-Only section of the AACAP website provides valuable information regarding member issues and can save time and effort by providing you with the tools to manage your account? By logging into www.aacap.org, you can:

■ Pay dues online

■ View/Edit your profile

■ Update your Member Directory listing

■ Reset your password or change your login information

■ Purchase publications

For all questions regarding your membership con-tact membership@aacap.org. We’re here to help!

Need help making your dues payment? Contact us to discuss flexible installment payment options.

NOVEMBER/DECEMBER 2013 321

322 AACAP NEWS

FOR YOUR INFORMATION

100% Club

Congratulations to aaCaP’s 100% Clubbers! These programs signed up 100% of their residents! way to go!

albert Einstein College of Medicine-Montefiore Medical CenterLouise Ruberman, MD

albert Einstein College of Medicine at bronx-lebanon HospitalArturo Sanchez-Lacey, MD, MPH

ann & Robert H. lurie Children’s Hospital of Chicago/McGaw Medical Center of northwestern universityJennifer Kurth, DO

baylor College of MedicineLaurel L. Williams, DO

brown universityJeffrey I Hunt, MD

Cambridge Health allianceCynthia J. Telingator, MD

Carilion Clinic-Virginia tech Carilion SchoolFelicity A. Adams, MD

Case Western Reserve university/ university Hospitals Case Medical CenterMolly McVoy, MD

Children’s Hospital Medical Center of akron/nEoCoMSumru A. Bilge-Johnson, MD

Children’s national Medical Center/ George Washington universitySandra Rackley, MD

Cincinnati Children’s Hospital Medical Center/university of Cincinnati College of MedicineSuzanne Sampang, MD

College of Medicine, Mayo Clinic (Rochester)Cosima C. Swintak, MD

Dartmouth-Hitchcock Medical CenterSusan M. Smiga, MD

Duke university HospitalAdrian Angold, MBBS

Emory university School of MedicineArden D. Dingle, MD

Georgetown university Hospital/ adventist behavioral HealthMatthew Biel, MD, MSc

Harlem Hospital CenterKareem Ghalib, MD

indiana university School of MedicineDavid W. Dunn, MD

institute of living/Hartford HospitalRobert Sahl, MD

Johns Hopkins universityRoma A. Vasa, MD

louisiana State universityMartin Drell, MD

louisiana State university – ShreveportRita Horton, MD

Maine Medical CenterSandra L. Fritsch, MD

Medical College of GeorgiaSandra Sexson, MD

Michigan State universityMadhvi Richards, MD

Mount Sinai School of MedicineJohn O’ Brien, MD

nassau university Medical CenterMeena Ramani, MD

national Capital Consortium/Walter ReedJoseph Dougherty, MD

new york university School of MedicineJess Shatkin, MD, MPH

Penn State university/Milton S. Hershey Medical CenterFauzia Mahr, MD

Rush university Medical CenterAdrienne Adams, MD

Southern illinois universityAyame Takahashi, MD

St. luke’s-Roosevelt Hospital CenterGeorge Gaveras, MD

Stanford universityShashank V. Joshi, MD

Suny Health Science Center at brooklynCathryn A. Galanter, MD

texas a&M College of Medicine-Scott and White ProgramKyle E. Morrow, MD

thomas Jefferson universityJames Luebbert, MD

tufts Medical CenterJohn Sargent, MD

tulane universityMary Margaret Gleason, MD

uPMC Medical Education Program-Western Psychiatric institute and ClinicSansea Jacobson, MD

university of alabama Medical CenterLee I Ascherman, MD, MPH

university of arizonaKathy W. Smith, MD

university of arkansas for Medical SciencesGail L. Eisenhauer, MD

university at buffaloDavid L. Kaye, MD

university of California-San DiegoEllen Heyneman, MD

university of ChicagoKaram Radwan, MD

university of FloridaKimberly A. White, MD

university of illinois College of Medicine at ChicagoKathleen Kelley, MD

university of iowa Hospitals and ClinicsPeter Daniolos, MD

university of Kentucky College of MedicineMarian Swope, MD

university of MarylandSarah Edwards, MD

university of MassachusettsMary Ahn, MD

university of Mississippi Medical CenterFaiza N. Qureshi, MD

university of Missouri-ColumbiaLaine M. Young-Walker, MD

university of nevada School of MedicineErika Ryst, MD

university of new MexicoAnilla Del Fabbro, MD

university of north Carolina HospitalsKaren K. Poulos, MD

university of South DakotaTamara L. Vik, MD, BS

university of tennesseeJyotsna S. Ranga, MD

university of texas Health Science Center at San antonioBrigitte Bailey, MD

university of utahDoug Gray, MD

university of Vermont/ Fletcher allen Health CareDavid Rettew, MD

university of WashingtonChristopher Varley, MD

Vanderbilt universityOliver M. Stroeh, MD

Vidant Medical Center/East Carolina universityNadyah J. John, MD, BS

Wake Forest university School of MedicineSiham Muntasser, MD

Washington university/ b-JH/SlCH ConsortiumAnne L. Glowinski, MD, MPE

West Virginia universityBharati Desai, MD

Wright State universityChristina G. Weston, MD

yale Child Study CenterDorothy E. Stubbe, MD

NOVEMBER/DECEMBER 2013 323

NEWSFOR YOUR INFORMATION

NOVEMBER/DECEMBER 2013 323

324 AACAP NEWS

FOR YOUR INFORMATION

Members and theNEWS

■ Greg Fritz, MD, wrote an article for the Providence Journal. The article, “Stigma of Mental Illness Robs Children of Treatment,” was published on August 11, 2013.

■ Michael brody, MD, Henry Gault, MD, and Dorothy Stubbe, MD, were interviewed by Family Circle. The article, “Teens Under Stress and Pressure: How Can You Help?” appeared in the August 2013 issue of the magazine.

■ Scott Krakower, MD, spoke with a reporter for WebMD. The article, “Childhood Tummy Aches May Be Tied to Adult Anxiety” was posted on August 12, 2013.

■ Kaye McGinty, MD, was interviewed by The Associated Press. The article, “NC Expands Psychiatry Via Video Conferencing” was posted on August 19, 2013.

■ John Evaldson, MD, and Carol larroque, MD, wrote an article in the Albuquerque Journal. The article, “Disruption of Care Hurting the Most Vulnerable Patients,” appeared on August 24, 2013.

■ David Fassler, MD, wrote a letter to the editor of The New York Times. The letter, “A Teenager’s Suicide: What Can Be Learned?” appeared on September 8, 2013.

■ Victor Fornari, MD, was interviewed by HealthDay News. The article, “Adopted Teens More Likely to Attempt Suicide, Study Finds,” appeared on September 9, 2013.

■ Gene beresin, MD, spoke to a reporter for WBUR Boston’s NPR Station. The segment, “The Checkup: Meltdown U. and Mental Health Tips for Parents of College Kids,” aired on September 9, 2013.

■ Paul Weigle, MD, was interviewed by a reporter for Fox News. The article, “‘Training Simulation: Mass Killers Often Share Obsession with Violent Video Games,” appeared on September 12, 2013.

■ Myo Myint, MD, wrote a letter to the editor to The Times Picayune in New Orleans. The letter, “Without Mental Health Safety Net, Tragedy is Inevitable: Letter,” was posted on September 16, 2013.

■ Martin J. Drell, MD, was interviewed by WWL Radio. The segment, “Study: Despite Hookup Culture, Sex not Prevalent on Campuses,” appeared on September 17, 2013.

■ Glenn Saxe, MD, spoke with a reporter from CNN. The article, “Talking to Kids about D.C. Navy Yard Shootings: a Tough Task for Parents,” was posted on September 17, 2013.

AACAP’s Communications Office connects journalists with AACAP members. If you would like to work with the media, please contact the Communications Office with your area of interest at communications@aacap.org.

The following is a snapshot of AACAP members’ recent work with the media.

NOVEMBER/DECEMBER 2013 325

NEWSFOR YOUR INFORMATION

Get in the News!All AACAP Members are encouraged to submit articles and news items for pub-lication, as well as photographs, poems, cartoons, and drawings.

Categories for submission and consider-ation are:

■ letters to the Editor, of 250 words or less, submitted in response to an article published in the AACAP News should be submitted directly to the Editor at urao@mmc.edu or through the National Office to Managing Editor Rob Grant at rgrant@aacap.org. Please include your name and contact information.

■ Photographs to be published on the front page, inside standing alone, or accompanying relevant articles or stories. Photographs should—in an artistic way—illustrate themes pertain-ing to children, childhood, parents

and children, parenting, or families. Members are invited to submit up to two photographs every two months for consideration. Please send a high-resolution version to the AACAP News photo editor at aRosen45@aol.com along with a description of 50 words or less.

■ opinion pieces, including debates, 800-1500 words

■ articles approved by and coming from Committees, 600-1200 words

■ For a list of column coordinators for Diversity and Culture, Forensics, Ethics, Clinical Vignettes, and Youth Culture email pjutz@aacap.org.

■ newsworthy items

◗ Fully developed News Articles, 800-1500 words

◗ Kudos, highlighting member achievements 250 words or less

◗ Regional Organization of Child and Adolescent Psychiatry, 250 words or less

◗ Committee activity reports or updates, 250 words or less

■ Features, 600-1200 words

◗ Interviews ◗ Discussions of movies or literature ◗ Creative Arts, e.g. poems, cartoons,

drawings (limited to 1 page)

to learn More: Visit www.aacap.org/1953_Society

326 AACAP NEWS

FOR YOUR INFORMATION

Congratulations to aaCaP’s 100% Clubbers! These programs signed up 100% of their residents! way to go!

albert Einstein College of Medicine-Montefiore Medical CenterLouise Ruberman, M.D.

albert Einstein College of Medicine at bronx-lebanon HospitalArturo Sanchez-Lacey, M.D., M.P.H.

ann & Robert H. lurie Children’s Hospital of Chicago/McGaw Medical Center of northwestern universityJennifer Kurth, D.O.

baylor College of MedicineLaurel L. Williams, D.O.

brown universityJeffrey I Hunt, M.D.

Cambridge Health allianceCynthia J. Telingator, M.D.

Carilion Clinic-Virginia tech Carilion SchoolFelicity A. Adams, M.D.

Case Western Reserve university/ university Hospitals Case Medical CenterMolly McVoy, M.D.

Children’s Hospital Medical Center of akron/nEoCoMSumru A. Bilge-Johnson, M.D.

Children’s national Medical Center/ George Washington universitySandra Rackley, M.D.

Cincinnati Children’s Hospital Medical Center/university of Cincinnati College of MedicineSuzanne Sampang, M.D.

College of Medicine, Mayo Clinic (Rochester)Cosima C. Swintak, M.D.

Dartmouth-Hitchcock Medical CenterSusan M. Smiga, M.D.

Duke university HospitalAdrian Angold, MBBS

Emory university School of MedicineArden D. Dingle, M.D.

Georgetown university Hospital/ adventist behavioral HealthMatthew Biel, M.D., MSc

Harlem Hospital CenterKareem Ghalib, M.D.

indiana university School of MedicineDavid W. Dunn, M.D.

institute of living/Hartford HospitalRobert Sahl, M.D.

Johns Hopkins universityRoma A. Vasa, M.D.

louisiana State universityMartin Drell, M.D.

louisiana State university – ShreveportRita Horton, M.D.

Maine Medical CenterSandra L. Fritsch, M.D.

Medical College of GeorgiaSandra Sexson, M.D.

Michigan State universityMadhvi Richards, M.D.

Mount Sinai School of MedicineJohn O’ Brien, M.D.

nassau university Medical CenterMeena Ramani, M.D.

national Capital Consortium/Walter ReedJoseph Dougherty, M.D.

new york university School of MedicineJess Shatkin, M.D., MPH

Penn State university/Milton S. Hershey Medical CenterFauzia Mahr, M.D.

Rush university Medical CenterAdrienne Adams, M.D.

Southern illinois universityAyame Takahashi, M.D.

St. luke’s-Roosevelt Hospital CenterGeorge Gaveras, M.D.

Stanford universityShashank V. Joshi, M.D.

Suny Health Science Center at brooklynCathryn A. Galanter, M.D.

texas a&M College of Medicine-Scott and White ProgramKyle E. Morrow, M.D.

thomas Jefferson universityJames Luebbert, M.D.

tufts Medical CenterJohn Sargent, M.D.

tulane universityMary Margaret Gleason, M.D.

uPMC Medical Education Program-Western Psychiatric institute and ClinicSansea Jacobson, M.D.

university of alabama Medical CenterLee I Ascherman, M.D., MPH

university of arizonaKathy W. Smith, M.D.

university of arkansas for Medical SciencesGail L. Eisenhauer, M.D.

university at buffaloDavid L. Kaye, M.D.

university of California-San DiegoEllen Heyneman, M.D.

university of ChicagoKaram Radwan, M.D.

university of FloridaKimberly A. White, M.D.

university of illinois College of Medicine at ChicagoKathleen Kelley, M.D.

university of iowa Hospitals and ClinicsPeter Daniolos, M.D.

university of Kentucky College of MedicineMarian Swope, M.D.

university of MarylandSarah Edwards, M.D.

university of MassachusettsMary Ahn, M.D.

university of Mississippi Medical CenterFaiza N. Qureshi, M.D.

university of Missouri-ColumbiaLaine M. Young-Walker, M.D.

university of nevada School of MedicineErika Ryst, M.D.

university of new MexicoAnilla Del Fabbro, M.D.

university of north Carolina HospitalsKaren K. Poulos, M.D.

university of South DakotaTamara L. Vik, M.D., BS

university of tennesseeJyotsna S. Ranga, M.D.

university of texas Health Science Center at San antonioBrigitte Bailey, M.D.

university of utahDoug Gray, M.D.

university of Vermont/ Fletcher allen Health CareDavid Rettew, M.D.

university of WashingtonChristopher Varley, M.D.

Vanderbilt universityOliver M. Stroeh, M.D.

Vidant Medical Center/East Carolina universityNadyah J. John, M.D., BS

Wake Forest university School of MedicineSiham Muntasser, M.D.

Washington university/ b-JH/SlCH ConsortiumAnne L. Glowinski, M.D., MPE

West Virginia universityBharati Desai, M.D.

Wright State universityChristina G. Weston, M.D.

yale Child Study CenterDorothy E. Stubbe, M.D.

aaCaP Policy Statement ProceduresOnce a final draft policy statement is submitted to the Policy Statement Advisory Committee (PSAC), the PSAC Chair directs that:

■ the author(s) is told of what major revisions or minor edits are necessary. After the author(s) has revised the statement, they may resubmit to the PSAC;

OR

■ the author(s) is informed that the statement does not meet the criteria for a policy statement.

■ After the PSAC approval, the Executive Committee reviews the statement to decide whether it should be placed on Council agenda or sent to Council via mail ballot.

■ Council members can opt to accept the state-ment as written or place on the Council agenda for deliberation. If even one member requests deliberation, the policy statement is placed on the next Council agenda.

If Council approves the statement, the author(s) is alerted to any minor changes recommended. Statement is printed in AACAP News and distributed to the recommended sources then placed on the AACAP Web site. If Council does not approve the statement, the author(s) may be requested to rewrite and resubmit to the PSAC.

Every two years, the PSAC reviews all policy state-ments for necessary revisions or updates. Revisions are made by the original author(s), if available, or by known specialists in that area of expertise. The revising author(s) is given a 3-month period to make changes and resubmit to the PSAC for final approval.

*Revised 3/2005

AACAP has well-established guidelines for the submission of Policy Statements for consideration and periodically publishes those guidelines for your information. Please keep this information for your future reference.

aaCaP Policy Statement RequirementsPolicies should:

• Be a statement regarding an important policy issue• Be well written, as briefly as possible• Identify the target audience• Have the potential of having some specific impact• Include ideas for distribution

In formulating the Policy Statement, the author(s) should keep in mind the criteria as stated above. Platitudinous statements supporting “Apple Pie” and “Motherhood” or condemning the multitude of actions, behaviors, social events, or cultural patterns which may have some negative effect on children and families are not likely to serve the AACAP well and may, ultimately, undermine the credibility of AACAP efforts in other areas.

The final draft policy statement should be submitted by an individual author(s) or body (e.g., component or Assembly) to the Policy Statement Advisory Committee via the national office. In formulating the policy statement, the authors should keep in mind the criteria as stated above. Statement must include ideas for distribution. If the authors wish to have the statement on the next Executive Committee or Council agenda, they must have the draft statement in to the National Office eight weeks in advance.

*Revised 1/2009

NOVEMBER/DECEMBER 2013 327

NEWSFOR YOUR INFORMATION

Thank You for Supporting AACAP!AACAP is committed to the promotion of mentally healthy children, adolescents, and families through research, training, advocacy, prevention, comprehensive diagnosis and treatment, peer support, and collaboration. Thank you to the following donors for their generous financial support of our mission.

Gifts Received July 1, 2013 to august 31, 2013

$100,000 and upSuperHERo Sponsorship of the aaCaP annual MeetingLilly USA, LLC

$50,000 to $99,999 actionHERo Sponsorship of the aaCaP annual MeetingOtsuka America Pharmaceutical, Inc.

WonderHERo Sponsorship of the aaCaP annual MeetingShire

$10,000 to $24,999SidekickHERo Sponsorship of the aaCaP annual MeetingNoven Pharmaceuticals, Inc.

SidekickHERo Sponsorship of the aaCaP annual MeetingSidra Medical and Research Center

Early Career Psychiatrist (ECP) Meet & Greet Sponsorship of the aaCaP annual MeetingAmerican Professional Agency, Inc.

Mobile app Sponsorship of the aaCaP annual MeetingAmerican Professional Agency, Inc.

$1,000 to $4,999General ContributionVirginia Q. Anthony

aaCaP Jeanne Spurlock Minority Fellowship FundVirginia Q. Anthony

Virginia Q. anthony FundVirginia Q. Anthony

$500 to $999Campaign for America’s KidsParamjit T. Joshi, MDMental Health Addiction and

Retardation Organizations of America Inc.

$100 to $499Campaign for America’s KidsSumru Bilge-Johnson, MDJohn M. Diamond, MDMartin J. Drell, MD†Benjamin I. Goldstein, MD, PhDNiranjan Subhash Karnik, MD, PhDDavid C. Ruck, MDJohn E. Sadler, MDMrityunjoy Sengupta*Quentin T. Smith, MD

life Members FundE. James Anthony, MD, FRCPVirginia Q. AnthonyPerry B. Bach, MDDouglas A. Kramer, MD, MSJames MacIntyre, II, MDSpencer D. Marcus, MDHoward Rudominer, MDQuentin T. Smith, MD

Virginia Q. anthony FundL. Eugene Arnold, MDJenna Saul, MDAdrian Sondheimer, MD

up to $99Campaign for America’s KidsCarol A. Beresford, MDKhyati Brahmbhatt, MD*Deborah Carlson, MDGloria M. Carrera, MD*Dugald D. Chisholm, Jr., MD*Nicole Christiansen, MD*Stephen Commins, MD*T. Shawn Crombie, MDMaguy Destin-Jeanty, MD*Victor Fornari, MDAlan Gurwitt, MDSusan Hoerter, DO*Jieun Kim, MD*Ryan Ley, MD*Carlene MacMillan, MD*David Widitz, MD*

Virginia Q. anthony FundWun Jung Kim, MD, MPH†

Every effort was made to list names correctly. If you find an error, please accept our apologies and contact the Development Department at development@aacap.org or 202.966.7300 ext. 130.

* Indicates a first-time donor to AACAP° Indicates honorarium donations† The Development Department apologizes for omitting these individuals in the previous issue of AACAP News, and thanks them

again for their generosity as Monthly Donors.

NOVEMBER/DECEMBER 2013 327

328 AACAP NEWS

FOR YOUR INFORMATION

Life insurance is an asset you may not think of donating to AACAP until you understand how powerful, practical, and simple it can be. It can be used to create a much greater philanthropic impact at AACAP than you might have thought possible.

To learn more, or tell us of your life insurance plans:

Please contact Development by e-mail at development@aacap.org,

call us at 202-966-7300 x140, or visit www.aacap.org/1953_Society.

Three Ways to Gift Life Insurance to AACAP

1. Designate AACAP as beneficiary of your current life insurance policy; or

2. Purchase a new policy and name AACAP as the owner and beneficiary. You will then be asked to contribute the equivalent of the annual premium to AACAP. This premium contribution is tax-deductible and is used by AACAP to pay the insurance premium; or

3. Give AACAP a fully paid life insurance policy that your family obligations no longer require.

When you Designate aaCaP as beneficiaryYou can create a wonderful legacy by designating AACAP as a partial or full beneficiary of an existing policy. You will retain ownership of the policy and the flexibility to change your beneficiary designation later if your circumstances change, but any policy proceeds distributed to AACAP will be exempt from estate tax in your estate and create a wonderful legacy at comparatively low cost.

Life Insurance for Your AACAP FamilyPutting the

“FUN” in Fundraising

www.Donate.aaCaP.org

The Development Team’s come up with an exciting new program where YOU can create a personalized fundraising page! It’s called Peer-to-Peer (P2P) Fundraising.

Create youR own fundraising page today! Donate your Birthday, your next 5k run or any event that’s special to you. Instead of presents or gifts, ask your friends and loved ones to donate to CFAK – now they can do it through YOU!

It’s easy to set up and FUN to do. You can help raise money for CFAK that goes towards new research, advocacy, and education – all to benefit children with mental illness.

Visit www.Donate.aaCaP.org and get started today!

If you have any questions, contact the Development office via e-mail at development@aacap.org or by phone at 202.966.7300 ext. #140.

Donate.AACAP.org Create a Personal

Fundraising Page Today!

NOVEMBER/DECEMBER 2013 329

NEWSFOR YOUR INFORMATIONLife Insurance for Your AACAP Family

ClassifiedsMaRylanDCHilD/aDolESCEnt PSyCHiatRiSt

The Department of Psychiatry and Behavioral Science at The Johns Hopkins University School of Medicine in Baltimore is offering full-time faculty position for an academically oriented BC/BE child and adolescent psychiatrist in the Division of Child/Adolescent Psychiatry. Rank, tenure status and sal-ary commensurate with experience and qualifications.

This position provides an excellent opportunity for a superb clinician or investigator committed to improving the lives of children and adolescents suffer-ing from psychiatric disorders through direct patient care, research and/or education.

The Johns Hopkins University is an equal opportunity/affirmative action employer committed to recruiting, supporting, and fostering a diverse community of outstanding faculty, staff and students.

Submit Applications To:Robert Findling, MD, MBADirector, Child/Adolescent PsychiatryJHU School of MedicineE-mail: rfindli1@jhmi.edu

nEW JERSEyCHilD/aDolESCEnt PSyCHiatRiSt

Private Practice PT/FT Fee for service private practice opportunity in northern Bergen County.

Contact Dr. Mohab Hanna atdocmohanna@gmail.com 

tEXaSboaRD CERtiFiED CHilD PSyCHiatRiSt

The University of Texas Southwestern Medical Center Department of Psychiatry, Division of Child and Adolescent Psychiatry is seeking a

Medical Director for the Eating Disorders Program at Children’s Medical Center, Legacy Campus. Level of appointment will be commensurate with experience. The Eating Disorders Program offers a full continuum of therapeutic programs to support patients and their families. The program includes 12 inpatient beds, a partial hospitalization program, an intensive outpatient program and outpatient care. The Eating Disorders Program at Children’s is the only one in Texas and the multi-state area to offer this full continuum of care for children and adolescents, girls and boys with eating disorders and other eating-related illnesses.

The Division of Child and Adolescent Psychiatry provides a continuum of care through outpatient, inpatient, day treat-ment, and partial hospital. Psychiatric consult services are provided in the Emergency Department, medical/surgi-cal and intensive care units at Children’s Medical Center.

The primary responsibility of the suc-cessful candidate will be to provide clinical leadership to a multi-disciplinary team including Psychologists, Nurses, Family Therapists, Teachers and Child Psychiatry Fellows, and have experience treating children and adolescents with eating disorders. The candidate’s back-ground should include experience with psychiatric assessment and treatment.

Qualifications: The primary responsibil-ity of the successful candidate will be to provide clinical leadership to a multi-dis-ciplinary team including Psychologists, Nurses, Family Therapists, Teachers and Child Psychiatry Fellows, and have experience treating children and adolescents with eating disorders. The candidate’s background should include experience with psychiatric assessment and treatment of children and adoles-cents. Preference given to candidates with clinical and/or research experience in eating disorders.

Candidates must hold a MD or DO and have or be able to obtain a Texas medi-cal license and be board certified or board eligible in Child and Adolescent Psychiatry.

Submit Applications To: Graham Emslie, MD 214.456.5918 214.456.4235E-mail:  graham.emslie@utsouthwestern.eduAddress: UT Southwestern Medical Center, 5323 Harry Hines Blvd MC 8589, Dallas, TX 75390 Website Address:  www.utsouthwestern.edu

nationWiDEPSyCHiatRiStS anD PSyCHiatRiC nuRSE PRaCtitionERS inVitED to Join tHE oPtuM tElEPSyCH SERViCES (tPS) tEaM.

TPS is now contracting with board certified, licensed psychiatrists and psychiatric nurse practitioners to join our team of highly qualified, innovative pro-fessionals to provide psychiatric services through a sophisticated system of care using cutting-edge video-conferencing technology. We have opportunities for general, child and adolescent, and geri-atric psychiatrists. 

• Practice where you want from any-where in the U.S.

• Practice when you want; part-time, full-time or in addition to other employment

• Training, equipment, EMR provided

• Paid for contracted hours and receive automatic payments

• Never worry about scheduling (even for no-shows), billing or collecting

Be a part of this exciting new system of care! Contact TelePsych Services at: optum.com/landing/telepsych-services, via phone (800) 996-4198 or e-mail at telepsych@optum.com.

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