What Is an Adolescent Psychiatrist?

What is Psychiatry?

Psychiatry is the branch of medicine focused on the diagnosis, treatment and prevention of mental, emotional and behavioral disorders.  Psychiatrists are medical doctors that assess the mental and physical aspects of mental illness. They perform multiple laboratory and psychological tests in order to properly diagnose their patients. Their education and clinical training equip them to understand the complex relationship between emotional and other medical illnesses and the relationships with genetics and family history, to evaluate medical and psychological data, to make a diagnosis, and to work with patients to develop treatment plans.

Some treatments offered by psychiatrists include psychotherapy, medications and psychosocial interventions. Psychotherapy is also known as talk therapy, and it involves discussion between the doctor, the patient, and their family if needed. Due to the wide range of illnesses a psychiatrist may treat, different patients may benefit from different treatments.  Some may recover after a few weeks or months of talk therapy, while others require additional medication and treatment in order to conquer their respective illness.

Other types of psychotherapies help patients change behaviors or thought patterns, explore the effect of past relationships and experiences on present behaviors, and psychotherapies that are tailored to help solve other problems in specific ways.  In addition, cognitive behavior therapy is sometimes used for problem-solving or other beneficial life skills. Psychoanalysis is an intensive form of therapy and requires extensive and frequent sessions with the child or adolescent, and is typically used in more severe illnesses or disorders.

What is Adolescent Psychiatry?

An adolescent psychiatrist is medically licensed as a physician to diagnose and treat children and adolescents with disorders of thinking and feeling or similar behavioral issues. Examples of these issues include anxiety, ADHD, depression, mood disorders, obsessive compulsive disorders, and/or suicidal thoughts.  Adolescent psychiatrists use biological, psychological, and social factors to diagnose and treat children and adolescents with these disorders. Pediatric psychiatrists prescribe treatment plans using psychotherapy, psychoanalysis, hospitalization, and/or medication.

This type of psychiatry is considered a specialized field.  Any practicing and licensed adolescent or child psychiatrist would first become a certified general psychiatrist and then apply for training and certification programs to become a Board-certified adolescent psychiatrist. Although the title would suggest this type of medical doctor would only interact with adolescent patients, they typically do still accept adult patients, and they interact with adult family members or relevant adults as a comprehensive treatment for the child or children under their care.

What is the difference between an adolescent psychiatrist and an adolescent psychologist?  A child and adolescent psychiatrist is a licensed physician, just as a cardiologist or a surgeon is a physician with a specialization.  A psychologist does have to obtain a PhD, but they are not physicians.  An adolescent psychologist uses talk therapy, psychotherapy or similar techniques to treat a patient, whereas a psychiatrist looks for medical causes of behavioral and mood disturbances and appropriate use of medications to treat mental illness.  A child may see both a psychiatrist and a psychologist as a part of a comprehensive treatment.

There may be negative emotion if you or your child are recommended to see a psychologist, but it can be a positive experience as part of a treatment plan that you develop with the doctor.  Just as a cardiologist suggests lifestyle changes and prescribes medications to improve heart health, an adolescent psychiatrist provides medical insight and may prescribe medications with the goal of improving a child or adolescent’s mental health. In addition, just as a cardiologist must go through extensive training and education to practice in their field, so must an adolescent psychiatrist.

History of Adolescent Psychiatry

In the United States, the first juvenile court was established in Illinois in the year 1899.  In 1909, a group of wealthy women concerned with juvenile delinquency created the Juvenile Psychopathic Institute and hired a neurologist, William Healy, M.D., to be its first director.  (Ninety years later, the Centers for Disease Control (CDC) would identify and accept violence as a public health issue).  Dr. Healy led a team that not only analyzed the juveniles neurologically by IQ and brain function tests, but also studied their social factors, attitudes, and motivations.  

Over the next several decades, many European influences became pervasive in the current American child psychiatry practices, due to the influx of immigrants escaping religious persecution in the 1930s and 1940s .  Organic and biological aspects of child and adolescent psychiatry began to develop around this time. Behavioral research and studies became popular in academic psychology, with John Watson and B.F. Skinner being articulate advocates of what was once considered a failed pathway espoused by forgotten old men near retirement age.  

The First Child Psychiatrist

Doctor Leo Kanner was the first physician to be identified as a child psychiatrist in the United States, and he founded the Division of Child and Adolescent Psychiatry at Johns Hopkins hospital in 1930. In 1953, he published the first textbook, titled Child Psychiatry, which introduced the specialty to the academic world.  As the increase in academic literature and research became available, medical professionals became more aware of child and adolescent psychiatry and the need for such a specialized field.

World War II kickstarted the development of child psychiatry as we know it today.  Due to the huge military draft, background histories were available for hundreds of thousands of late adolescents and young adults with varied backgrounds and socio-economic levels – rich, poor, white, African-American, educated, uneducated, urbanite, and farmer.  The establishment of background histories provided proof that soldiers with a history of behavioral issues were more likely to be prematurely discharged, disciplined, wounded or killed.   Of course, there was a great need for additional research and education in order to understand such a complex medical yet social and behavioral issue.

The National Mental Health Act

President Harry Truman signed the National Mental Health Act on July 3, 1946, three years before the National Institute of Mental Health was established with the goal of prevention of mental illness.  Quality of mothering was identified as a key aspect in adolescent mental health prevention – if the mother “failed”, then professionals were needed to intervene and save the child from developing into a criminal or delinquent.  Women’s magazines began sprouting up to communicate the need for “good mothering” and offered tips and ideas for how to properly raise children.  

The American Academy of Child Psychiatry (AACP) was founded in 1953, although it was preceded by two organizations interested in children’s mental health: The American Orthopsychiatric Association, and the American Association of Psychiatric Clinics for Children.  The AACP was formed by a group of 96 psychiatrists, who established a member-only requirement with membership only by invitation, sent out to those who made an “outstanding contribution to the field of child psychiatry” along with certification from the American Board of Psychiatry and Neurology (ABPN) .  

In 1958, an ABPN committee along with its president and secretary, determined the beginning requirements for new psychiatric disciplines focused on adolescent and child psychiatry. This included residency requirements and the formation of the ABPN committee on Certification in Child Psychiatry was formed, in addition to development of the first certifying examination requirement.  Although the original exam was in essay format, it quickly became obvious to the committee that the essays were too tedious to grade.  A follow-up oral exam was required, which did not make the essay exam takers very happy, since they had to come back to complete yet another exam. 

During this same time period, the Accreditation Council for Graduate Medical Education’s Residency Review Committee (RRC) in Psychiatry approved eleven child psychiatry residency programs, with the stipulation that child psychiatry residencies must be linked to medical centers.  According to Schohamer , this was the saving grace of child psychiatry to be accepted as a legitimate medical practice.  From this point on, all adolescent and child psychiatrists would be medical physicians specializing in mental health.

The AACP eventually became an open, not invitation only, national association during the 1960s, with the Journal of the American Academy of Child Psychiatry first published in 1962.  Membership was available to members on the basis of their education and experience in child psychiatry, which tripled the number of members to almost 700 members. The American Psychiatric Association (APA) “adopted” the AACP into the APA building in the late 1960s.  Five years later, Virginia Anthony was hired and remains the academy’s executive director.  

Child Psychiatry: A Plan for the Coming Decades was published in 1983 after five years of work of child psychiatrists, nationally known general psychiatrists, pediatricians, deans, professors of epidemiology, nursing, psychology, law, leaders of the NIMH and various child advocates.  Although recommendations for personnel requirements, clinical services, and training were included, the book’s main focus was based on developing research strategies that utilized biological and epidemiological data to understand and treat adolescents and children with mental health issues. 

Today, membership is close to 7,000 and the official name has changed to be the American Academy of Child and Adolescent Psychiatry.  In addition to the AACP Journal, numerous other books and research have been published across the globe, in at least six different languages.  Since the 1890s, adolescent and child psychiatry have evolved in its understanding of developmental psychopathology and have shown how intertwined developmental stages are for a child’s diagnosis and treatment.  In the decades to come, genetics, neuroimaging and other new techniques will not only affect the work with children, but determine the type and number of professional organizations that will be needed to treat children and adolescents with mental illness. 

Although parenting magazines still exist, the focus is not so much on good mothering, although some basic practices are accepted to raise a healthy child, it is now generally accepted that medical illness is not always the result of bad parenting, although in some cases, parental abuse or neglect has been the cause.  Adolescent psychiatry has developed into a profession that is vital to the health and happiness of millions of children and adolescents. 

How to become an Adolescent Psychiatrist

Adolescent psychiatry is a field projected to grow in the near future, with the need vastly outweighing the number of practicing psychiatrists available.  The U.S. Bureau of Health Professions projected that the demand for child and adolescent psychiatry services would increase by 100% between 1995 and 2020. Currently, an estimated 80% of emotionally disturbed children and adolescents receive mental health treatment, and recent graduates specializing in adolescent psychiatry report receiving multiple job offers in a profession that allows for a diversity of job options, work-life balance, and flexibility.  

The path to becoming and adolescent psychiatrist is long. An adolescent or child psychiatrist must first excel at general psychiatry practice before they begin specializing in adolescents and children. Psychiatrists are typically Board-certified prior to becoming a Certified Adolescent Psychiatrist (CAP). They are trained to treat patients throughout their life cycle.  Although CAP may be their specialty, many still accept and see adult patients as well in addition to their younger clients, or perhaps do additional counseling with parents of the child they are treating. 

The following is needed to become Board-certified as an Adolescent Psychiatrist: Four years of post-graduate training, 2 years of child and adolescent psychiatry training, at least two years of residency training, and Board-certification in general psychiatry.  Below is additional information from the Bureau of Labor Statistics on Adolescent Psychiatry:

The required training involves completion of an internship, two to three years of general psychiatry residency, and two years of CAP specialty training.   Extensive training and education are required to become an adolescent and child psychiatrist, and that should be a consideration of anyone considering entering this field in addition to some of the benefits described above.

Of course, there are different employment options for child and adolescent psychiatry. Hospitals, in-patient care centers, and private practices provide different opportunities and work environments. A hospital or care center is typically open 24 hours a day, 7 days a week, so varied shifts and irregular schedules are required at certain times. A private practice allows for more flexibility and control when determining the psychiatrist's schedule. Although providing treatment to children and adolescents can be rewarding, it can also be emotionally stressful.

The first step to becoming a child or adolescent psychiatrist is to earn a bachelor’s degree in virtually any major. Some may choose biology or science, while others may choose psychology or humanities. A bachelor’s degree is required for entry into any legitimate medical school. Where possible, enroll in the pre-medical program in order to learn about the health profession and get hands-on experience and knowledge of medical research, educational opportunities, and philosophies in various fields of medicine.

Before graduating with a bachelor’s degree, the process of applying to medical school is necessary. The medical College Admission Test (MCAT) evaluates a student’s knowledge of the sciences and liberal arts as well as critical thinking and problem-solving skills. Admission to medical schools is highly competitive. A future adolescent psychiatrist may volunteer at hospitals or other medical health centers in order to stand out on their application and obtain valuable experience and knowledge of the field.

Once accepted to medical school, two years of classroom and laboratory instruction covers anatomy, obstetrics and gynecology, pediatrics, pharmacology and biochemistry, in addition to topics geared toward future adolescent psychiatrics including pediatric medicine, family history, genetics and human behavior. A 4-year program would then lead to two years of supervised clinical internships and experiences. A 6 to 7-year program (M.D/PhD programs) allow students to focus on a specialized area of expertise through clinical and research opportunities.

A future child or adolescent psychiatrist will be required to complete a one-year internship with a certified psychiatry residency program followed by a 4-year residency requirement. The first two years of residency focuses on general psychiatry, whereas the last two years focus on the chosen area of expertise or specialization. Once these requirements have been successfully completed, the U.S. Medical Licensing Examination must be passed in order to become a licensed physician.

After achieving licensing and before practicing with any children or adolescents, professional adolescent psychiatrists must obtain certification in general psychiatry from the American Board of psychiatry and Neurology (ABPN), which requires a degree from an accredited medical school, current state medical license, and passing of an exam. The Child and Adolescent Psychiatry (CAP) exam is a voluntary exam that allows for additional certification specialized for children and adolescents, and is administered by the ABPN.

Throughout the extensive training, competence in the fundamentals of the theory and practice of psychiatry is gained prior to acquiring knowledge of child and adolescent psychiatry training, including normal child and family development, psychopathology, and treatment. Disorders that appear in childhood such as autism spectrum disorders, ADHD, learning disabilities, mental retardation, mood disorders, disruptive mood dysregulation disorder, depressive and anxiety disorders, drug dependency and delinquency (conduct) disorders are given special focus and importance.

Children and adolescents are treated with a developmental framework in mind: certain symptoms may not be pathological at certain development ages. For example, a hyperactive, impulsive, inattentive, aggressive five-year-old with developmental delays may not necessarily be diagnosed with ADHD despite having several symptoms of the disorder, due to the fact that developmentally, the child is at age two. In addition, children metabolize and respond to medications differently than adults and may require adjustments in dosing and frequency. Working with schools and other care providers is essential for proper diagnosis and treatment.

According to Dr. Isreal Sokeye , counseling plus medication is more successful than medication alone or therapy alone, and data shows that medications help children with significant self-harm and aggressive behaviors stay calm, as in the case of children with autism, thereby allowing them to learn skills. Observation of children or adolescents in their school classrooms and interacting with school counselors, psychologists, and social workers provides a more comprehensive assessment of the child’s functioning and academic progress.

In May 2013, the CDC reported that annually, up to one in every five U.S. children experiences a mental disorder. Unfortunately, many do not receive care for a variety of reasons: lack of healthcare, poverty, a shortage of proper mental health care providers, and reduced access in rural areas.

Children and adolescents are more likely to overcome mental illness with early detection and treatment. Children can become at risk for this disorder during periods of change such as divorce, changing schools, moving, death of a loved one, or other traumatic experiences. Symptoms range from internal to external and include irritability, anger, aggression, mood swings, hyperactivity, withdrawal, isolation, crying, guilt and suicidal ideas.

Adolescent psychiatrists are important today more than ever, based on the growing needs of children and adolescents with mental illnesses. If you are a parent or child in need of an adolescent psychiatrist’s services, schedule an evaluation as soon as possible. There is no shame in getting your child the help they need and deserve.  No stigma should be associated with seeking professional help for any illness or disorder a child may have whether it is physical, mental or emotional.

As mentioned previously, adolescent and child psychiatry can be a very demanding and challenging occupation, but it can also be very rewarding. Due to the extensive training and education requirements, it does take tremendous dedication and determination to become an adolescent psychiatrist. 

References

American Psychiatric Association (APA).  What is Psychiatry? 2017.  Retrieved August 31, 2017 from: https://www.psychiatry.org/patients-families/what-is-psychiatry

Beasley, Marie.  What is a Child and Adolescent Psychiatritst?  Child Psychiatry Corner.  February 10, 2014.  Retrieved August 31, 2017 from: https://www.childpsychiatrycorner.com/what-is-a-child-and-adolescent-psychiatrist/

Schowalter, John E.  Child Adolescent Psychiatry, Addiction.  September 1, 2003. Retrieved August 30, 2017 from: http://www.psychiatrictimes.com/articles/history-child-and-adolescent-psychiatry-united-states

John Hopkins Children Center.  Child and Adolescent Psychiatry.  Retrieved August 31, 2017 from: http://www.hopkinsmedicine.org/johns-hopkins-childrens-center/what-we-treat/specialties/child-adolescent-psychiatry/index.html

AACAP.  Child and Adolescent Psychiatry.  Retrieved August 30, 2017 from: https://www.aacap.org/AACAP/Medical_Students_and_Residents/Medical_Students/Why_Child_and_Adolescent_Psychiatry.aspx

U.S. Bureau of Labor Statistics, O*NET OnLine, American Academy of Child & Adolescent Psychiatry, Salary.com (August 2015)

Study.com How to Become a Pediatric Psychiatrist Retrieved September 1, 2017 from: http://study.com/articles/How_to_Become_a_Pediatric_Psychiatrist_Education_and_Career_Roadmap.html

University of Minnesota Medical School Affiliate. http://www.prairie-care.com/blog/what-does-a-child-psychiatrist-do-by-israel-sokeye-md/ December 9, 2013. Dr. Israel Sokeye.