ADOLESCENCE

Adolescence is a unique period of life.  It is also the stage of development during which major mental illnesses begin, most of which go undiagnosed and untreated until later in life.  The demand for psychiatrists to diagnose and treat these disorders in adolescents is outstripping the supply of child and adolescent-trained psychiatrists.  General psychiatrists willing and able to work with adolescents can expand their practice by helping to meet this need.  The American Society for Adolescent Psychiatry is an organization that can support general psychiatrists in obtaining the skill and confidence to do so.

The concept of adolescence as a distinct phase of development is relatively recent.  Prior to the turn of the century, adolescents were considered smaller versions of adults.  Western societies then began to afford adolescents some reprieve from adult responsibilities.  Educational expectations expanded, along with a corresponding delay in gainful employment.  Secondary education was increasingly supported for all young people, and today most young people attend college, as well.  In addition, the development of the juvenile justice system signals the recognition that adolescents do not bear the same level of culpability for criminal acts as do adults.  Recently, evidence of significant neural development continuing into the third decade of life was presented in the case against capital punishment for children under eighteen years of age.

 In addition to being recognized as a unique period of development, adolescence is increasingly recognized as a unique period for the development of psychopathology.  It was long believed that major mental illnesses typically had their onset during early adulthood.  However, there is an increasing body of literature tracing early signs of psychosis and mood disorder to adolescence.  From the other end of the developmental spectrum, Attention Deficit Hyperactivity Disorder, once believed to typically resolve by adolescence, is increasingly recognized as a persistent problem through adolescence and into adulthood.  In each case, the signs and symptoms of the disorders are altered during adolescence, and can present a diagnostic challenge.  Psychiatrists skilled in establishing a rapport with adolescents and in evaluating their psychiatric conditions are needed.

 However, adolescents with psychiatric conditions are an underserved population.  Sound methods of sampling and assessment have estimated that the prevalence of functionally impairing mental disorders in children and adolescents is approximately 20%, and that only about 20% of those affected receive any type of mental health intervention.  The need for more trained psychiatrists is being recognized in the popular press.  CNN has reported that psychotropic medications are being prescribed by practitioners with inadequate training and experience, such as pediatricians or primary care physicians.  Recognition of the need for trained psychiatrists is also evident in efforts by several states to encourage the practice of  tele-psychiatry to fill the void. 

 Despite the obvious need, a shortage in child and adolescent psychiatrists has long been recognized, and is likely to persist.  The United States Bureau of Health Professions projects that by 2020, there will only be enough child and adolescent psychiatrists to meet two thirds of the demand.  The Bureau projects a 100% increase in the use of child and adolescent psychiatrists, compared to an increase of 19% in the use of general psychiatrists.  However, during the 1990’s, the number of child and adolescent psychiatry residency positions and training programs actually decreased.  General psychiatrists with interest and experience in treating adolescents have the opportunity to expand their practice, while providing a needed service to their communities. 

 Since child and adolescent psychiatry has been recognized as a subspecialty by the American Board of Psychiatry and Neurology, some general psychiatrists have been reluctant to work with minors.  However, general psychiatrists can help to fill the need by obtaining training and experience in the assessment and treatment of adolescents.  One avenue is to complete a fellowship in child and adolescent psychiatry.  However, a two-year fellowship carries a cost in time and potential earnings that is prohibitive to mid-career practitioners. 

 Another avenue is to take advantage of professional organizations which offer continuing medical education opportunities.  The American Society for Adolescent Psychiatry is the only organization dedicated to adolescent psychiatry, and it offers membership to general psychiatrists, as well as to child and adolescent psychiatrists.  Its annual meeting provides approximately 25 hours of CME in adolescent psychiatry.  The Annals of the American Society for Adolescent Psychiatry published annually provides a more in depth treatment of some of the subject matter of the annual meeting.  The organization also provides opportunities to boost practitioners’ credentials.  The Society is a medium-sized, national organization with readily available leadership opportunities, such as Committees on Education or on Topical Studies.  If the practitioner desires further validation of their expertise, the Society supports the American Board for Adolescent Psychiatry, which offers an examination to obtain board certification.

 The American Society for Adolescent Psychiatry offers a supportive, collegial atmosphere, in which experienced clinicians and researchers readily share their expertise.  It is a particularly valuable resource for the general psychiatrist who has the temperament and the inclination to work with teens and young adults.  Many of the Society’s senior members can attest to the personal and professional satisfactions of caring for these youngsters, and setting the tone for how they will cope with the challenges of mental disorders throughout their adult lives.  Interested psychiatrists can learn more about the Society at www.adolpsych.org, or can contact me directly at drferro@optonline.net.

Footnotes

Thomas, CR, Holzer, CE, National Distribution of Child and Adolescent Psychiatrists, JAACAP, Volume 38(1), January 1999, pp 9-15

 Kim, WJ, Child and Adolescent Psychiatry Workforce: A Critical Shortage and National Challenge, Academic Psychiatry, 27:4, Winter 2003

 CNN.com, Shortage of Child Psychiatrists Takes Nationwide Toll, April 7, 2006

 Slaff, B Handbook of Child and Adolescent Psychiatry, Volume 3 Adolescence: Development and Syndromes, ed. Flaherty, LT, Sarles RM, pps. 5-11

Home | About GLIPS | Advocacy | Articles | Info for Patients | Member Information