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Continued from page 21 has been found to be linked with poor executive function (Sheridan et al, 2017). Exposure to
violent trauma has been hypothesized to particularly affect fronto-limbic and corpus callosal
connections (Fani et al, 2021). These changes may also predispose youth to internalizing and externalizing problems.
Moreover, the effects of multiple ACEs or PTSD symptoms among parents may seep into their parenting of children,
contributing to intergenerational transmission of ACEs (Narayan, Lieberman, and Masten, 2021). Efforts to proac-
tively screen for ACEs and to provide trauma-informed care are crucial. Given the significant negative impact of ear-
ly adversity on the physiological stress response, improving self-regulation in children with ACEs is one of the key
areas to focus efforts on (Goldstein et al, 2021). Addressing social determinants of health is important. A recent re-
port by CDC notes that children in households with the lowest income level had the greatest prevalence of ADHD,
behavior or conduct problems, depression, and anxiety, while children in households with the highest income level
tended to have a greater prevalence of positive mental health indicators (CDC). For youth in foster care, prior re-
search indicated high rates of antipsychotic medication use. Some recent research suggests that Medicaid efforts to
reduce over-prescribing among children and adolescents have led to a reduction in antipsychotic medication usage
for children and adolescents (Pennap et al, 2018). However, rates of interclass psychotropic polypharmacy still re-
main significant in some areas (Lohr et al, 2018). Psychotherapeutic approaches are a critical component of the treat-
ment of psychiatric conditions in children and adolescents. Availability of quality psychotherapy could potentially
even reduce the likelihood of medication over-prescribing among children and adolescents.
While the overall number of child and adolescent psychiatrists has increased in the last decade, there continues to be
a shortage of child and adolescent psychiatrists (AACAP). According to a study by Anderson et al published in 2015,
34.8% of children receiving outpatient care for psychiatric conditions were seen by PCPs only, 26.2% saw psychia-
trists only, and 15.2% saw psychologists/social workers only (Anderson et al, 2015). Currently, about 70% of coun-
ties in the US do not have a child psychiatrist. This shortage may particularly affect those living in poverty, children
and adolescents suffering from internalizing disorders, and those from minority backgrounds (Manseau and Case,
2014).
Efforts and measures are needed at every level, namely policy-making, community, schools, primary care, emergen-
cy mental health services, psychiatry, police, media, to address this crisis. These could be in the form of: Expanding
training opportunities and resources in child & adolescent psychiatry for other mental health professionals and for
primary care physicians, increasing access to psychiatric services particularly for at-risk children and adolescents,
improving training in culturally sensitive care, implementing measures to make schools and communities safe from
bullying and gun violence, increasing training of educators to help recognize mental health problems among chil-
dren in a timely manner, socio-economic measures to address poverty, inequities and disparities, increasing re-
sources for support of at-risk parents, improving awareness and education of the public about psychiatric conditions
in youth, improving screening of psychiatric conditions and ACEs in children and adolescents, limiting children’s
exposure to risky or harmful web-based content, and implementing prevention programs for emotional learning
(hhs.gov). Increasing the amount of child and adolescent training that general psychiatrists receive during residency
(currently 2 months is required) may be another helpful step. (Training in child and adolescent psychiatry adds an
important developmental lens, which can be helpful even for evaluation and treatment of adult patients). Finally, the
best treatment is prevention. So, research and measures focusing on primary and secondary prevention in child and
adolescent psychiatry are warranted.

Addressing childhood mental health is of paramount importance. ‘The future wellbeing of our country depends on
how we support and invest in the next generation’ -US Surgeon General, Vivek Murthy (hhs.gov).

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