Discussion: Special Topics in Child and Adolescent Psychiatry
Many children face special issues that impact everyday life, whether it is within themselves, their families, or their environment. The PMHNP must be sensitive to these many issues that children and adolescents are faced with during important developmental years.

In this Discussion, you select a special population and analyze the psychological issues that the population faces. You also address the assessment and treatment needs of the population.  Special Topics in Child and Adolescent Psychiatry Essay

Learning Objectives
Students will:
Analyze psychological issues that may arise in children faced with special circumstances
Evaluate assessment measures used with children faced with special circumstances
Evaluate treatment options used with children faced with special circumstances
Analyze cultural influences on treatments (D)
To Prepare for the Discussion:

Review the Learning Resources.
Select one of the following topics for the Discussion:
Adoption
Foster care
Gender dysphoria
Forensic issues
Impact of terrorism on children

By Day 3
Post:

Write your selected disorder in the subject line of your Discussion post.
Explain the psychological issues that may result from your topic.
Describe the most effective assessment measure that could be used, and explain why you selected this.
Explain the treatment options available for children and adolescents involved with your selected disorder.
Explain how culture may influence treatment.

By Day 6
Respond to at least two of your colleagues who selected a topic other than the topic you selected. Provide at least two additional treatment strategies that could be used with this client and at least one additional cultural influence that you think should be considered. Explain your responses.

Special Topics in Child and Adolescent Psychiatry

Gender Dysphoria

The selected topic is gender dysphoria. Gender dysphoria occurs when an individual is not comfortable with their assigned gender (Steensma et al, 2013). Notably, adolescents become extremely uncomfortable with their body developments during adolescence. Children and especially adolescents with gender dysphoria undergo experience distress as well as functioning difficulties. As such, children and adolescents with gender dysphoria have numerous mental health needs.

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Psychological Issues for Children and Adolescents with Gender Dysphoria

Children and adolescents with gender dysphoria experience wavering levels of distress allied to the feelings and sense that their physical gender does not correspond with the gender they desire and identify with. The distress can vary from controllable to debilitating to distress, and hence it can result to significant problems with family and friends, academic performance, in addition to mental problems such as depression, self-harm, and even suicide. Moreover, this population experiences transphobia and they might be at a high risk of being discriminated, stigma, bullying, being socially excluded and physically assaulted. According to Steensma et al (2013), about 40% of children and 90% of adolescents with gender dysphoria manifest depressive symptoms, anxiety, suicide attempts, risky behaviors, as well as substance abuse symptoms. There may be also intentional self-harm to genitals in this population, and some adolescents attempt self-treatments using hormones at time accessed from black markets and this presents serious potential medical effects. Accordingly, children and adolescents with gender dysphoria are at higher risk of developing mental health problems (Atkinson, 2015).  Special Topics in Child and Adolescent Psychiatry Essay

Assessment Measures in Gender Dysphoria

A comprehensive and a systematic assessment of gender dysphoria in accordance with DSM-5 diagnostic criteria for gender dysphoria should be conducted. The PMHNP should also evaluate other psychological comorbidities. A risk and support evaluation is also important in order to assess if gender dysphoria is causing distress that impairs social or academic functioning (Berlin, 2016). This can be assessed by performing HEADSS assessment in order to cover all aspects of psychosocial assessment. In addition, HEADSS assessment will facilitate identification of the available support network as well as any risk that should be addressed. Of equal importance is the assessment of medication history and substance abuse because sometimes adolescents with gender dysphoria tend to use steroids acquired illegally. It is also important to perform an exhaustive sexual history. In case the adolescent fully trusts the health care provider, a physical examination can be done to examine the secondary sexual characteristics (Berlin, 2016).

Treatment Options

Psychotherapy in form of cognitive behavioral therapy (CBT) is an effective treatment option. CBT can help reduce stress and anxiety associated with gender dysphoria. This is because children and adolescents with gender dysphoria tend to fear expression themselves, are not comfortable with their assigned gender, and also face isolation, bullying, and stigmatization from their peers. This may have adverse psychological effects. Therefore, CBT can be effective in equipping this population with the appropriate coping skills to handle issues associated with gender dysphoria (Austin et al, 2018).

Cultural Influences on Treatments

Culture refers to the ideas, behaviors, and customs existing with a group of individuals. Therefore, culture can have a significant effect on the treatment of gender dysphoria. For example, children and adolescents with gender dysphoria may not come out and express their condition because it might be against the culture. Similarly, a person may fail to seek treatments such as hormone therapy or surgical reassignment therapy because this may be against the cultural values (Atkinson, 2015).

References

Atkinson S. (2015). Gender dysphoria. Mental Illness. 44(11), 792-796.

Austin A, Craig S & Alessi E. (2017). Affirmative Cognitive Behavior Therapy with Transgender and Gender Nonconforming Adults. Psychiatr Clin North Am. 40(1):141-156.

Berlin F. (2016). A Conceptual Overview and Commentary on Gender Dysphoria. Journal of the American Academy of Psychiatry and the Law. 44 (2) 246-252.

Steensma, T. D., McGuire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry. 52(6), 582-590.  Special Topics in Child and Adolescent Psychiatry Essay