- Email: [email protected]
1.2 Sleep and Pediatric Mental Health
CLINICAL PERSPECTIVES 1.0 — 1.2
82 Protecting Youth Online: The Law, the Risks, and Clinicians’ Roles 83 Psychiatric Crisis Services for Children and Families: Mobilizing Resources and Thinking “Outside the Box” to Meet Community Needs 84 Psychotropic Polypharmacy: A Serious Concern Among Children and Adolescents in the United States of America Foster Care System 85 Communication and Language Disorders in Clinical Populations From a Broad Perspective
CLINICAL PERSPECTIVES 1 HEALTH PROMOTION IN PEDIATRIC MENTAL HEALTH Scott Shannon, MD, University of Colorado, scottshannon@ cowisp.net; Kristopher Kaliebe, MD, University of South Florida, [email protected]; Mary Rondeau, ND, Wholeness Center, [email protected]; Francisco Navarro, MD, Mind Health Institute, Pasadena, [email protected] Objectives: Exercise, sleep, and diet constitute core foundations of health. Sadly, most mental health professionals feel uncomfortable working in these arenas with patients and families. This workshop will provide practical skills for assessing and then enhancing these critical and relevant health behaviors. Methods: Pediatric obesity has become a national epidemic and a true health crisis. Obesity drives increased risk for internalizing disorders, externalizing disorders, ADHD, sleep problems, and decreased quality of life. It creates higher risk for a range of other health disorders that in turn also deteriorate quality of life. Not surprisingly, pediatric obesity has been linked to exercise, diet, and sleep. Although pediatric obesity is a clear health crisis, a range of other mental health issues is linked to exercise, sleep, and diet. For example, exercise has been demonstrated to be an effective treatment for ADHD and improve executive functions. Diet has an increasingly clear relationship to mood, attention, and anxiety. Sleep and ADHD are closely linked in a likely bidirectional mechanism. Results: Participants are encouraged to actively participate in the workshop with questions, dialogue, and comments. Presenters share insights and experiences to create an atmosphere of practical application. Participants have increased knowledge and treatment models of how to incorporate a prescribed fitness program in an outpatient setting. They also feel comfortable assessing sleep quality and problems in children. Conclusions: Childhood and adolescence are critical time periods for growth and brain development. When a child’s health becomes compromised, mental health and quality of life suffer. The field of child and adolescent psychiatry has become more focused on treating pathology than supporting health. Prescribed fitness, sound sleep, and proper nutrition provide a benefit to a pediatric mental health practice. The participant leaves the workshop ready to encounter fitness, sleep, and diet issues in their practice with enhanced comfort and clinical acumen. Fitness/exercise, sound sleep, and proper nutrition are supports that enhance the mental health and well-being of all children.
PRE, OBE, SLP Sponsored by AACAP's Complementary and Integrative Medicine Committee http://dx.doi.org/10.1016/j.jaac.2017.07.010
1.1 HEALTH PROMOTION IN PEDIATRIC MENTAL HEALTH Mary Rondeau, ND, Wholeness Center, mary.rondeau@ wholeness.com Objectives: Diet, gut health, and nutritional factors play a role in development and overall mental and physical health. Unfortunately, most mental health professionals feel uncomfortable assessing and making basic nutritional recommendations with patients and families. The nutrition and gut portion of this workshop will provide practical skills for assessing and then
S2
www.jaacap.org
enhancing these critical and relevant health behaviors as they relate to nutrition in children. Methods: Pediatric obesity has become a national epidemic and a true health crisis. Obesity drives increased risk for internalizing disorders, externalizing disorders, ADHD, sleep problems, and decreased quality of life. There is a growing body of evidence strengthening the connection between nutritional deficiencies, dietary habits, and the enteric microbiome to mental health disorders. Calorically dense, nutrient-poor foods have replaced calorically light, nutrient-dense foods at an alarming rate. The gut microbiome alters the epigenetic expression of genes within the central nervous system. The gut microbiome influences regulation of intestinal health but also influences the immune and nervous systems and vice versa. Rodent models have demonstrated that a diet deficient in magnesium leads to changes in the gut microbiome, which directly related to interleukin-6 production in the hippocampus and subsequent deterioration in behaviors. The gut microbiome, micronutrient intake, and human nutrition meet with what we eat. This presentation reviews several research-supported nutrients that have become deficient in the diet and how to incorporate testing, as well as dietary strategies, into daily practice. Results: Nutrition and gut health play a central role in maintenance of health. Nutritional deficiencies are common among children. Little time is spent on health interviews on dietary quality and dietary recommendation. This program will emphasize nutritional assessment and dietary strategies and how to incorporate into practice. Conclusions: Nutritional recommendations should be a part of mental health treatment protocols for children. The participant leaves the workshop ready to assess and recommend dietary strategies.
PRE, OBE, SLP http://dx.doi.org/10.1016/j.jaac.2017.07.791
1.2 SLEEP AND PEDIATRIC MENTAL HEALTH Scott Shannon, University of Colorado, scottshannon@ cowisp.net Objectives: Sleep issues have been correlated with pediatric anxiety, mood, behavioral disorders, and ADHD. In specific disorders, such as autism spectrum disorder or fetal alcohol syndrome, the rates of sleep disorder may reach 85 percent. Sleep disturbances may be caused by primary mental illness, comorbid mental illnesses, or by the medications prescribed to treat the above. Over the last 50 years, pediatric sleep issues have grown much more common, and total sleep time has fallen noticeably in children. Sleep issues are highly correlated with mental illness in children. For example, rates of key sleep concerns are often elevated fivefold in children diagnosed with ADHD (before the use of stimulant medication) compared with healthy control subjects. Furthermore, the huge overlap between the cognitive symptoms of sleep loss and the profile of ADHD has made this a rich arena for research. For some clinical concerns, such as ADHD, the causation with sleep disorders may be bidirectional; that is, a sleep disorder can create features of ADHD, and ADHD often creates a sleep issue. Methods: This presentation will review the common types of pediatric sleep issues encountered in the clinical practice, how to screen for them, and simple, practical steps to address these issues in actual practice. Results: Sleep plays a central role in the maintenance of health, both physical and mental. This is true at all ages, but it is particularly critical in the pediatric population. Sleep issues are common in a pediatric mental health practice. Child and adolescent psychiatrists play an important role in the screening for and initial treatment of sleep issues in children. This may be made more important by research that demonstrates that parents often under-report sleep issues to their primary care physicians. However, little time in training or continuing education focuses on the issue of sleep disturbances. This program will demonstrate how a large mental health clinic that emphasizes wellness and health promotion screens for sleep issues and how they are commonly addressed. Conclusions: Screening for and treating pediatric sleep issues can play a central role in mental health. Pediatric mental health professionals must evaluate and address sleep concerns.
PRE, OBE, SLP http://dx.doi.org/10.1016/j.jaac.2017.07.792
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
82 Protecting Youth Online: The Law, the Risks, and Clinicians’ Roles 83 Psychiatric Crisis Services for Children and Families: Mobilizing Resources and Thinking “Outside the Box” to Meet Community Needs 84 Psychotropic Polypharmacy: A Serious Concern Among Children and Adolescents in the United States of America Foster Care System 85 Communication and Language Disorders in Clinical Populations From a Broad Perspective
CLINICAL PERSPECTIVES 1 HEALTH PROMOTION IN PEDIATRIC MENTAL HEALTH Scott Shannon, MD, University of Colorado, scottshannon@ cowisp.net; Kristopher Kaliebe, MD, University of South Florida, [email protected]; Mary Rondeau, ND, Wholeness Center, [email protected]; Francisco Navarro, MD, Mind Health Institute, Pasadena, [email protected] Objectives: Exercise, sleep, and diet constitute core foundations of health. Sadly, most mental health professionals feel uncomfortable working in these arenas with patients and families. This workshop will provide practical skills for assessing and then enhancing these critical and relevant health behaviors. Methods: Pediatric obesity has become a national epidemic and a true health crisis. Obesity drives increased risk for internalizing disorders, externalizing disorders, ADHD, sleep problems, and decreased quality of life. It creates higher risk for a range of other health disorders that in turn also deteriorate quality of life. Not surprisingly, pediatric obesity has been linked to exercise, diet, and sleep. Although pediatric obesity is a clear health crisis, a range of other mental health issues is linked to exercise, sleep, and diet. For example, exercise has been demonstrated to be an effective treatment for ADHD and improve executive functions. Diet has an increasingly clear relationship to mood, attention, and anxiety. Sleep and ADHD are closely linked in a likely bidirectional mechanism. Results: Participants are encouraged to actively participate in the workshop with questions, dialogue, and comments. Presenters share insights and experiences to create an atmosphere of practical application. Participants have increased knowledge and treatment models of how to incorporate a prescribed fitness program in an outpatient setting. They also feel comfortable assessing sleep quality and problems in children. Conclusions: Childhood and adolescence are critical time periods for growth and brain development. When a child’s health becomes compromised, mental health and quality of life suffer. The field of child and adolescent psychiatry has become more focused on treating pathology than supporting health. Prescribed fitness, sound sleep, and proper nutrition provide a benefit to a pediatric mental health practice. The participant leaves the workshop ready to encounter fitness, sleep, and diet issues in their practice with enhanced comfort and clinical acumen. Fitness/exercise, sound sleep, and proper nutrition are supports that enhance the mental health and well-being of all children.
PRE, OBE, SLP Sponsored by AACAP's Complementary and Integrative Medicine Committee http://dx.doi.org/10.1016/j.jaac.2017.07.010
1.1 HEALTH PROMOTION IN PEDIATRIC MENTAL HEALTH Mary Rondeau, ND, Wholeness Center, mary.rondeau@ wholeness.com Objectives: Diet, gut health, and nutritional factors play a role in development and overall mental and physical health. Unfortunately, most mental health professionals feel uncomfortable assessing and making basic nutritional recommendations with patients and families. The nutrition and gut portion of this workshop will provide practical skills for assessing and then
S2
www.jaacap.org
enhancing these critical and relevant health behaviors as they relate to nutrition in children. Methods: Pediatric obesity has become a national epidemic and a true health crisis. Obesity drives increased risk for internalizing disorders, externalizing disorders, ADHD, sleep problems, and decreased quality of life. There is a growing body of evidence strengthening the connection between nutritional deficiencies, dietary habits, and the enteric microbiome to mental health disorders. Calorically dense, nutrient-poor foods have replaced calorically light, nutrient-dense foods at an alarming rate. The gut microbiome alters the epigenetic expression of genes within the central nervous system. The gut microbiome influences regulation of intestinal health but also influences the immune and nervous systems and vice versa. Rodent models have demonstrated that a diet deficient in magnesium leads to changes in the gut microbiome, which directly related to interleukin-6 production in the hippocampus and subsequent deterioration in behaviors. The gut microbiome, micronutrient intake, and human nutrition meet with what we eat. This presentation reviews several research-supported nutrients that have become deficient in the diet and how to incorporate testing, as well as dietary strategies, into daily practice. Results: Nutrition and gut health play a central role in maintenance of health. Nutritional deficiencies are common among children. Little time is spent on health interviews on dietary quality and dietary recommendation. This program will emphasize nutritional assessment and dietary strategies and how to incorporate into practice. Conclusions: Nutritional recommendations should be a part of mental health treatment protocols for children. The participant leaves the workshop ready to assess and recommend dietary strategies.
PRE, OBE, SLP http://dx.doi.org/10.1016/j.jaac.2017.07.791
1.2 SLEEP AND PEDIATRIC MENTAL HEALTH Scott Shannon, University of Colorado, scottshannon@ cowisp.net Objectives: Sleep issues have been correlated with pediatric anxiety, mood, behavioral disorders, and ADHD. In specific disorders, such as autism spectrum disorder or fetal alcohol syndrome, the rates of sleep disorder may reach 85 percent. Sleep disturbances may be caused by primary mental illness, comorbid mental illnesses, or by the medications prescribed to treat the above. Over the last 50 years, pediatric sleep issues have grown much more common, and total sleep time has fallen noticeably in children. Sleep issues are highly correlated with mental illness in children. For example, rates of key sleep concerns are often elevated fivefold in children diagnosed with ADHD (before the use of stimulant medication) compared with healthy control subjects. Furthermore, the huge overlap between the cognitive symptoms of sleep loss and the profile of ADHD has made this a rich arena for research. For some clinical concerns, such as ADHD, the causation with sleep disorders may be bidirectional; that is, a sleep disorder can create features of ADHD, and ADHD often creates a sleep issue. Methods: This presentation will review the common types of pediatric sleep issues encountered in the clinical practice, how to screen for them, and simple, practical steps to address these issues in actual practice. Results: Sleep plays a central role in the maintenance of health, both physical and mental. This is true at all ages, but it is particularly critical in the pediatric population. Sleep issues are common in a pediatric mental health practice. Child and adolescent psychiatrists play an important role in the screening for and initial treatment of sleep issues in children. This may be made more important by research that demonstrates that parents often under-report sleep issues to their primary care physicians. However, little time in training or continuing education focuses on the issue of sleep disturbances. This program will demonstrate how a large mental health clinic that emphasizes wellness and health promotion screens for sleep issues and how they are commonly addressed. Conclusions: Screening for and treating pediatric sleep issues can play a central role in mental health. Pediatric mental health professionals must evaluate and address sleep concerns.
PRE, OBE, SLP http://dx.doi.org/10.1016/j.jaac.2017.07.792
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017