News « American Society for Adolescent Psychiatry

30 Jan 2011

APA DOINGS — MAY 2010

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BY Richard Ratner, M.D., FASAP

Greetings, ASAPers from the aftermath of the annual APA Scientific and Business Meeting in New Orleans! I’m happy to report that the city, at least the part that has always attracted the tourism dollar, is back and up and running. For signs of Katrina you must go outside the central business district, which a few people did on a bus tour showing the devastation still in place. However, the convention center, hotels and happily, the restaurants are either still there or back with vigor. It was also too early in the life of the oil spill for that to have had any effect the city’s mood or food supplies.

Registration was definitely down this year, which it always is relative to the blockbuster cities of New York and San Francisco that historically draw the largest crowds. How much of this is due to the virtual extinction of the pharmaceutical industry-sponsored symposia that traditionally dominated Saturdays and Sundays is hard to say, but to the credit of the scientific program committee, there was a great deal of high quality stuff to attend. With the exception of Sunday, when a good number of people found they could not get into sessions they wanted to see because the rooms could not accommodate them, things evened out subsequently, and I heard no further complaints.

But what of the Assembly?

As those hardy followers of this occasional column know, the Assembly is the “legislative” arm of the APA, representing the rank and file membership primarily through the District Branches and State Associations, but also though membership by various affiliated organizations like ours, each of which have a vote. Most of the leadership of the APA rises through offices in the Assembly, including most of the current Board, though with the exception of APA president Dr. Schatzberg.

The Assembly’s role is to serve as a voice for the membership, which it does at least in part by having members submit action papers. They are considered, sometimes altered, and often passed for reference to the Board of Trustees, where hopefully, they will be considered and followed. Perhaps the most talked about issues this year involved not action papers but one position statement regarding the relationship of psychiatrists to the pharmaceutical industry and a talk given by Larry Faulkner, head of the ABPN.

Pharmaceutical Industry Relationship

A statement put together under Paul Appelbaum’s chairmanship lays out guidelines for what we should and should not do with regard to the industry. Much of it is unobjectionable and even overdue, but the devil is in the details, and some of them stuck in the craws of Assembly members. At the heart of the objections is the implicit notion that psychiatrists are rather passively influenced by drug company initiatives, including the visits of detail persons and various little gifts like pens, mugs, and sandwiches for lunch. Proponents argue that Pharma itself has adapted some of these changes, that the document represents guidelines rather than ethical rulings, and that the APA is going along with the rest of medicine in producing guidelines of this sort. Some people saw the conflict as one of older vs. younger colleagues, but this by no means fit every case. In the end, the Assembly again did not approve of these guidelines but sent them back to the Trustees for further consideration.

Maintenance of Certification

The other issue causing a stir was the description of the structure of the soon-to-arrive “maintenance of certification” guidelines, as described by Dr. Faulkner. Among a variety of other things, they include a section in which physicians will apparently have to seek satisfaction ratings from their patients! It does not appear that anyone has thought through whether this segment of the process is appropriate for psychiatrists, and most of the concerns expressed had to do with this provision.

Just when those older physicians like me who have been long grandfathered into lifelong certification thought we could relax, comes the news that the Federation of State Medical Boards has embraced in principle the notion of making the maintenance of one’s actual medical license contingent on patient satisfaction ratings. This means that some means of gauging “patient satisfaction” may find its way into all of our practices sooner or later. And, of course, all of this comes down when physicians’ incomes are under great pressure with added concerns about the effects of the new Health bill as it unfolds.

DSM5

On another matter, DSM5 is now entering field trials, as the period for commentary on the information posted on the website has now closed. However, the website is still running for anyone wishing to see what the thinking of various committees are.

Some good news was that the APA is again in the black after some ferocious cost-cutting (including layoffs of notable numbers of APA staff) and after a significant recovery of the stock market since last year.

APA Professional Liability Insurance

Those of you who have had malpractice insurance through the APA should by now know that the APA is changing its endorsement. PRMS, which had been the chosen agency, had decided it did not want to continue to insure only APA members. For the APA, this was a deal breaker, since this insurance is a membership benefit. Accordingly, APA went back to the market and, after further research and evaluation, has announced that the new official APA agency will be American Professional Insurance Co. Those of you insured through AACAP will know them as the agency that insures AACAP members. It will probably take time for the new company to be able to insure in all states, but when money is at stake, companies can be timely in arranging to do business.

Some other action papers of note addressed the situation that physicians cannot readily rescind prescriptions at the pharmacy when a patient’s circumstances change, which the Assembly felt should be allowed. We were surprised to learn that our President does not now send condolences to the family members of service members who die by suicide, as he does with those who die in the line of duty, so an action paper urged APA to lobby to get this changed. The Assembly also voted to ask mail order drug houses to provide less than 90 days of prescription medication without a financial penalty to the patient, if a psychiatrist does not feel it is safe to provide the patient such a large amount. It also voted to have APA ask to have the entire area of Evaluation and Management Codes revised so that psychiatrists can use them for both inpatient and outpatient visits.

The next annual meeting of the APA is in May 2011 in Honolulu. There may be some concerns about how many will register there, since they were already accepting hotel reservations for next year at this meeting, which I don’t recall ever seeing before. Oh well, to quote the Hawaiians’ all-purpose (hello, good-bye, go in peace, etc., etc.) greeting, Aloha from your ASAP APA Assembly rep—me.

30 Jan 2011

Megan’s Law for Kids; Have We Gone Too Far?

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Megan’s Law for Kids; Have We Gone Too Far?

Dean De Crisce, MD

All states, influenced by highly publicized sexual crimes, have created sex offender legislation to protect the public from sexual victimization.[i] Mandated registration of sexual offenders and community notification are outgrowths of this trend.

The Jacob Wetterling Act of 1994 provided national requirements for the registration of sexual offenders in all states. This was later amended by Megan’s Law in 1996, which required that sexual offenders not only be registered, but that the public be advised about offenders in their community (referred to as community notification).[ii] The purpose of such notification laws is to “facilitate public access to information about persons who have committed a sex offense” to enable appropriate precautionary protective measures against convicted sex offenders who might prove a threat to the safety of those in the community.[iii]

Recent legal reforms occurring in many states have allowed for mandated minimum sentencing guidelines for sexual crimes, public access to sexual offender hearing records, and juvenile sexual offender cases to be waived to adult court. As of 2009, 39 states mandate Megan’s Law registration for juvenile and child sexual offenders.[iv] Only 15 states provide for a statutory lower age limit for such registration, and allow for registration of children as young as 7; other states may have no lower age limit for the application of these laws.[v]

It is important to understand the varied crimes to which Megan’s Law may be applied. Registration may be mandated in the case of a 17 year old boy that violently raped a series of adult women in brutal home invasions. Likewise, an 11 year old boy that touched a sibling or schoolmate on a single occasion or a 15 year old that exposes himself in a prank (“mooning”) may be subject to Megan’s Law provisions.

As community stigma associated with sexual offending is enormous, the application of Megan’s Law to juvenile and child offenders may be counterproductive and lead to harmful consequences to young offenders and their families. Registration may be mandated until the age of adulthood or indefinitely.

Megan’s Law is generally applied through a “tiering” mechanism, based on the nature of the offense and the age of the victim. Tier 1 offenders generally continuously verify their address to law enforcement agencies. Tier 2 offenders may undergo day care center, summer camp, and community organization notification. Tier 3 offenders often require school and public notification, including publically accessible internet listing of the names and addresses of offenders. All three tiers allow some community knowledge of the offender and offense.

Tiering is determined, based on jurisdiction, by statute, judicial discretion or by the use of actuarial methods. Popular juvenile sex offender actuarial risk assessment instruments have little known studied, reliable predictive power; in fact, they provide numerical scores which have not been validated in outcomes studies to be predictive of risk. They are not equivalent to actuarial measures such as the Static 99, which are used in adults and provide valid actuarial prediction of risk. Relatively few studies have been done adequately on juvenile groups of offenders.

Laws such as community notification fail to consider various developmental, etiological, and risk factors with regard to juvenile and child offenders. Sexual offenders are comprised of a heterogeneous group. The development of inappropriate sexualized behaviors in youth is the result of a complex series of interacting interpersonal, biological, social, psychiatric and psychological factors.

Clearly, not all offenders who have committed a sexual offense suffer from a sexual disorder. The case of a juvenile who “moons” other students at a school dance does not necessarily indicate compulsive sexual pathology. Studies indicate that judgment and impulse control governed by prefrontal cortex development, does not reach adult levels until the early twenties.[vi] In fact, the diagnosis of a Paraphilia may not be made in a child less than 16 years of age (DSM IV-TR, 2000). Further, it is estimated that very low rates of juvenile offenders go on to offend as adults, especially after having received appropriate treatment.[vii] Rates for juvenile sexual reoffense are significantly lower than rates of recidivism for other delinquent behaviors.[viii]

The application of Megan’s law to juveniles or children must incorporate the following considerations and potential effects.

Sex offenses carry the greatest degree of social stigma. The stigma of “sex offender” carries with it a connation of “rapist,” regardless of the actual behaviors. Megan’s Law registration will follow a juvenile or child offender in any potential relocation with family over an indefinite number of years. Continued registration might be seen to reinforce the child’s identification as a sexual offender to the community, when the offense might otherwise diminish in its community impact over time.

A juvenile or child sexual offender might already have some social impairment and therefore could be expected to suffer significant rejection by teachers, peers or even family members. Depending on the tiering applied, the offender’s own school might be subject to public notification about the juvenile’s status. This might be expected to occur throughout the formative adolescent years when social interaction is paramount. That is, even after the completion of any mandated treatment, the child would likely have to disclose this status to potential employers, college applications, healthy dating opportunities and friendships. Privacy of registration could not reasonably be expected to be upheld. Appropriate social relationships are a protective factor against a child’s future risk; Megan’s law would significantly interfere with healthy social skills development as a result of likely further rejection.

Children are amenable to treatment with an excellent prognosis.[ix] Megan’s Law legislation is seen to be counter productive, as an effectively punitive measure rather than providing for rehabilitation geared to produce a successful member of society. Again, the constant reinforcement of self identification as a sexual offender might be seen to add to the risk for depression and hopelessness, thereby contributing to potential further recidivism, other behavioral disturbance and suicidality.

Registration and community notification may be harmful to the family of the offender. Such families might be identified as “harboring a sex offender,” or in some way seen as “soiled.” Even if the family moved to a different location, this judgment might reasonably be expected to follow them. This potential isolation from the community may be severely damaging to a family that is otherwise law-abiding and active in their community. The offender might also suffer from the family stressor, diminishing the otherwise protective factor of family support. In cases where the victims are siblings, victims might also be seen as representing some sort of danger to other children and families in the community.

y,Registration and community notification might present a risk of physical harm to the offender and their family, who might suffer attacks from vigilantes seeking “revenge.” This adds a potential catastrophic stressor to a family that has already suffered damage within itself. The reality of the situation is illustrated by the fact that the New Jersey registration website, for example, announces “Any actions taken against the individual named in the notification, including vandalism or property, verbal or written threats of harm, or physical violence against this person, his or her family, or employer, will result in arrest and prosecution for criminal acts. Vigilantism is not only a crime but an action that will undermine the efforts of those who have worked hard to enact this law.”[x]

The application of Megan’s Law to juvenile and child sexual offenders is a complex issue with potential widespread negative consequences for the youth and society. Although its primary purpose is to protect the public, it may be applied based on statute without regard for true community risk and without consideration of developmental factors, effectiveness, and consequences. The American Society for Adolescent Society, lying at the forefront for adolescent advocacy, should endorse proper exploration of these matters, and a reasoned, studied approach to their usefulness and outcomes.

Editor’s note: The ASAP Governing Board is presently considering the development of a position statement with regard to Megan’s Law and welcomes input and views from its membership. Please forward any comments to gpbmd@aol.com.

[i] Velazquez T. The Pursuit of Safety: Sex Offender Policy in the United States. Vera Institute of Justice, New York 2008.

[ii] Freeman-Longo, R. Prevention or problem. Sexual Abuse: A Journal of Research & Treatment, 8:2, 1996

[iii] New Jersey Office of the Attorney General, Megan’s Law registration website, 2010.

[iv] Szymanski, L. Megan’s Law: Juvenile Sex Offender Lower Age Limits. NCJJ Snapshot, 14:8. National Center for Juvenile Justice. Pittsburgh, PA 2009

[v] Ibid.

[vi] Gogtay, N, Giedd, J, Lusk L, et. al. Dynamic Mapping of Human Cortical Development during Childhood Through Early Adulthood, Proceedings of the National Academy of Sciences of the USA, 101(21):8174-8179, 2004

[vii] Association for the Treatment of Sexual Abusers. The effective legal management of offenders. ATSA 3:2000

[viii] Chaffin M, Bonner B, Pierce K. NCSBY Fact Sheet: What Research Shows About Adolescent Sex Offenders. Center on Child Abuse and Neglect, University of Oklahoma Health Sciences Center. 2007

[ix] Ibid.

[x] New Jersey Office of the Attorney General, Megan’s Law registration website, 2010

30 Jan 2011

Harold Koplewicz, M.D. Gives Schonfeld Address

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From the 2010 Annual Meeting….

BY Dominic Ferro, M.D.

In his address, Dr. Koplewicz displayed the erudition and eloquence that made him a most deserving recipient of ASAP’s Schonfeld Award. His address was entitled “More than Moody: Adolescent Angst, Depression and Suicide Risk”.

The concept of adolescent angst dates back to Anna Freud’s assertion that an adolescent not experiencing angst is missing an important stage of development. Adolescence is a period of dramatic change. The adolescent must adapt to the physical changes of puberty, to the demands of individuation from parents or guardians, to the development of complex social networks, to begin to conceive vocational goals and to define their sexual orientation. Modern neuroscience validates and clarifies the challenges faced by the adolescent.

In the human frontal cortex, the seat of executive functions, adolescents undergo an intense pruning of synaptic connections. An astounding peak of synaptic connectivity occurs during the second year of life, and it is during adolescence that connectivity declines to the modest levels of adults.

These neurological findings are consistent with the findings of cognitive scientists regarding executive functioning during adolescence. They have demonstrated that adolescents are about as capable as adults at discerning the risks and benefits of behavioral choices. However, they are not as adept at conforming their behavior. For instance, adolescents demonstrate awareness of the risks of driving while intoxicated, yet teen driving is the number one killer of adolescents. Similarly, adolescents understand the risks involved, but also have high rates of unprotected sex, smoking, vandalism and stealing.

Other findings indicate that adolescents do not process the facial expressions of others as well as adults. This correlates with imaging evidence that during tests of facial expression recognition, adolescents have greater activity in the amygdala than adults, whereas adults evidence greater activity in the prefrontal cortex. The amygdala is associated with emotional reactivity, particularly fear response, where as the prefrontal cortex is more involved in pattern recognition.

Adolescents are subject to intense passions, which contribute to increased risk behavior. They are also subject to high reward sensitivity, and as a result they tend to seek high levels of stimulation. So, it is not surprising that adolescents are more subject to peer influence and emotional arousal than adults.

Dr. Koplewicz reflected on the role of this constellation of changes in the adolescent brain and the resulting increase in risky behavior. In order to elucidate what adaptive function this might serve, he drew a parallel with the behavior of adolescent monkeys. He noted that in many species, the adolescent male takes a tremendous risk by leaving the safety of family and of familiar environs. Singly and in small groups, adolescent males seek to join and mate in other troops, thus increasing genetic diversity. Yet, in so doing they may be rejected or attacked by the troop members. The individual must become insensible to the individual risks and press on in service of improved survival as a species.

Dr. Koplewicz clarified the emerging picture of adolescent development and pathogenesis. He noted that 75% of serious mental illness starts during adolescence. He noted that, given all these changes, it is not surprising that suicidal ideation is a common phenomenon during this time of life. The roots of suicide contagions can be seen in light of the frequency of suicidal ideation, coupled with the increased vulnerability to peer influence. Impulsivity increases the risk of substance use disorders, which complicates treatment for depression and increase the risk of suicidal behaviors.

With regard to treatment, it is important to increase the adolescent’s future orientation, as their increased impulsivity and affective intensity tend to narrow their focus to the immediate term. Evidence suggests that more active treatments which engage the adolescent with greater interaction and which challenge latent cognitive abilities, such as CBT and DBT, are more effective for adolescents. The immediacy of the adolescent brain may necessitate more frequent sessions, perhaps even more frequent that once per week.

Dr. Koplewicz also spoke about incorporating what we know about adolescent strengths in our interventions. For instance, he noted that data reflect that adolescent males tend to use their seatbelt when they drive with adolescent females, but not when they drive with other adolescent males. He coupled this with data indicating that increased use of condoms can be attributed to increased demands made by female adolescents. Public health interventions are therefore more likely to be effective if they are directed at the female adolescents.

Our profession is fortunate to have a leader like Dr. Koplewicz working to apply clinical and basic sciences to aid in the formulating and intervening in the lives of our adolescent patients. The opportunity to honor him was one of the special moments of the 2010 Annual Meeting.

30 Jan 2011

Book Review Corner…

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Book Review Corner…

BY Gregory P. Barclay, M.D., Newsletter Editor

Editor’s note: In this edition, I am pleased to summarize 3 books I have recently read. They all relate to a common theme, which is how our increasing understanding of neuroscience helps us to understand and re-define the process of psychotherapy. As professionals with particular interests in adolescents, it is essential that we have a thorough and updated education in neuroscience, since what we are learning about the adolescent brain has enormous impact on how we conduct treatment and what we should expect from patients at an individual level. Moreover, as a society, our growing understanding of the adolescent brain moves us into the forefront of highly charged societal issues, including the controversies of trying adolescents who commit violent crimes as adults, invocation of the death penalty for adjudicated delinquents, and as Dr. DeCrise explains in his article, the requirement that youthful sexual offenders be placed on public monitoring.

The Behavioral Neuroscience of Adolescence, by Linda Spear, Ph.D. (2009, New York, Norton Professional Books), 368 pgs, hardcover. $40 US.

This book was presumably written for professionals without advanced training in neurosciences as well as those with more formal training and experience in the area. Even though I was in the latter group, I found myself challenged as I attempted to recall the basics of neuroanatomy and neurophysiology I learned 30 years ago as a medical student and later on during my residency in psychiatry. As a professional with that knowledge, I found Dr. Spear’s book to be a refreshing and comprehensive review of our current understanding of the teen brain. However, I would doubt that other professionals without advanced training in neurosciences would be able to grasp or fully comprehend the subjects as presented. For psychiatrists who work with adolescents, though, this book is one definitely to purchase and read, as the information it contains influences our expectations and approaches to adolescents in our daily work with them.

The book is divided into two sections. The first reviews overall brain structure, function, and development as influenced by evolutionary, genetic, hormonal, neural, and sociocultural factors. The interaction of these produce distinctly adolescent behaviors and thought processes that are reviewed in the book’s second section. Those later chapters include detailed reviewed of the neurodevelopmental basis of adolescent risk taking, social behavior, and cognitive capacities, as well as the basis for emergence of psychological and drug abuse disorders during adolescence.

This book is an excellent resource for any professional who works with adolescents. I found the use of bullets and italicized first sentences of paragraphs to be especially helpful for doing a quick read and review.

What Freud Didn’t Know - A Three-Step Practice for Emotional Well-Being through Neuroscience and Psychology, by Timothy B. Stokes, Ph.D. (2009, Rutgers University Press), 210 pgs., hardcover, $24.95 US

Although this book is intended for the lay person who struggles with emotional regulation problems, I found it to be a very useful book from my perspective as a treating provider. As its title suggests, Timothy Stokes reviews how Freud’s fundamental concepts of the Id, Ego, and Superego now are best understood as corresponding to brain regions of varying degrees of connectivity and maturity. He develops the concept of “Amygdala Scripts” and reviews how powerful emotional experiences are stored instantaneously in the amygdale and subsequently “hijack the neocortex”. This process is at the root of what maintains negative and distorted cognitions and compensatory maladaptive behavior, and therefore “mastering” the amygdale scripts is the core of his 3-step practice.

The 3-step practice is essentially a self-help style simplification of what is accomplished in Eye Movement Desensitization and Reprocessing (EMDR) and Dialectical Behavior Therapy. Dr. Stokes provides guidance on how to first establish an enhanced state of mindfulness so as to allow for access to deeply buried Amygdala scripts. Consequently, it is possible to develop enhanced insight to facilitate the mastering those scripts and attaining the third step, which is belief change. Throughout the book, there are examples and exercises designed for the motivated lay person to accomplish meaningful change. Dr. Stokes makes it clear, however, that many individuals with these problems require a much higher level of treatment delivered by a trained professional.

This book is useful to have on your shelf to share with a highly motivated and intelligent patient with emotional regulation problems, as it may assist them before committing to an extensive course of EMDR or DBT. It is also a good reference for patients already participating in psychotherapy.

Changing Minds in Therapy – Emotion, Attachment, Trauma, & Neurobiology, by Margaret Wilkinson (2010, New York, Norton Professional Books), 248 pgs., hardcover, $32 US.

This book is designed as a resource for therapists who conduct long term therapy with patients with trauma histories and/or disturbed early attachments. Dr. Wilkinson explores the dynamics of brain-mind change in therapy utilizing current research. She describes the neural basis of attachment, attunement, and affect regulation and how their development is influenced by our earliest attachments. Disruption of this process leads to observed changes in the orbitofrontal cortex where those experiences are initially encoded and consequently dictate how we experience emotion and relationships later in life. Dr. Wilkinson skillfully demonstrates with case examples how problems with attachment and attunement lead to clinical problems seen in the therapist’s office and how proper attunement by the therapist is central to the repair process.

Dr. Wilkinson’s book is divided into two sections. The first introduces the reader to the neurobiology of attachment, attunement, and affect regulation. In particular, she emphasizes how the right brain matures earlier than the left, and therefore how disruptions in attachment and attunement occurring at a very early age leave their residua in the right limbic structures, the Amygdala in particular. Since the ability to form memories with a verbal narrative occurs later and generally involves the left hippocampus, patients with early trauma experience right brain-mediated emotions in relationships that they neither understand nor can regulate unless therapeutic work is done to enable the left brain to neutralize the right. Dr. Wilkinson’s approach is a more traditional one in which she utilizes the therapeutic relationship itself over the course of time as the medium through which the repair process occurs. In this respect, she differs from the more contemporary therapies yet the general principles, e.g. harnessing the right limbic system with the left prefrontal cortex remains the same.

I found this to be a fascinating book because I have a particular clinical interest in adoption and attachment-related disturbances. In that respect, this is a good book for clinicians with similar interests who desire a deeper understanding of the neurobiology involved.

30 Jan 2011

The Annals

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As you may remember, I looked into the possibilities for on-line publication of the Annals after the ASAP Governing Board made the decision to discontinue support for print publication. After reviewing several possible publishers, I decided that Bentham Science Publishers (www.Bentham.org) offered the best option for the Annals. They would convert the Annals to a quarterly journal, available on-line with an option for readers to download and print out the entire issue or individual articles. They would also either offer a hard-cover print edition for a yearly volume (consisting of the four quarterly issues) to readers who wish to order it, or allow us to arrange for a print on demand volume with another publisher.

Last summer, Richard Rosner, Gregory Bunt and I met with Dr. Matthew Honan, the Managing Director of Bentham, to discuss the publication of the Annals by Bentham. Following this meeting, Dr. Honan sent me a draft of an agreement, which I forwarded to the Governing Board. At the suggestion of Frances Bell, the agreement was sent to a lawyer who has advised GAP about publication contracts for review. The lawyer had a number of comments and suggestions, which were sent to the Governing Board to review at the March Annual Meeting. I have continued to work to improve my understanding of on-line publication, a rapidly evolving field. Yesterday I sent a list of questions to Dr. Honan who replied today that he is pleased at our continued interest and will respond to the questions shortly.

In the meanwhile, I continue to receive submissions for the Annals, and am continuing to utilize the peer review process that has been in place. I am hopeful that the agreement with Bentham will be negotiated successfully and that we will be able to proceed rapidly with publication once it is signed. My goal is to have as many articles ready for publication as possible when we are ready to go.

The new version of the Annals will have greater flexibility with regard to content, so that letters to the editor and short articles may be included in addition to our traditional 20-25 page full length articles. In addition, the scope of the Annals would be expanded to a more global focus, and the Editorial Board will become international.

As always, thank you for your support.

–
Lois T. Flaherty, MD

Editor, Adolescent Psychiatry
9 Saint Mary Road
Cambridge, MA 02139

30 Jan 2011

Mark Your Calendar…

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Mark Your Calendar…

2010	Association of Academic Psychiatry (AAP)	Sept 21-25	The Westin Pasadena, Pasadena, CA
2010	APA September Components Meeting	Sept 22 – 25	Sheraton National Hotel, Arlington, VA
2010	American Association of Chairs of Departments of Psychiatry (AACDP)	Sept 25-26	The Westin Pasadena, Pasadena, CA
2010	ABPN-Part II Oral Exams	Oct 1-3	Omni William Penn Hotel, Pittsburg, PA
2010	APA Institute on Psychiatric Services	Oct 14-17	Boston, MA
2010	American Academy of Child & Adol Psychiatry (AACAP)	Oct 26-31	Hilton Hotel, New York, NY
2010	AAMC Annual Meeting	Nov 5-10	Washington, DC

2011	American College of Psychiatrists (ACP)	Feb 23-27	Fairmont Hotel, San Francisco
2011	AADPRT	March 2-5	Hilton Austin Hotel, Austin, TX
2011	CAS Spring Meeting	Maarch 3-5	Providence, RI
2011	American Society of Adolescent Psychiatry	March 26-27	New York, NY
2011	American Psychiatric Association (APA)	May 14-18	Honolulu, HI
2011	American College of Psychoanalysists	14-May	(in conjunction with APA)
2011	Association of Directors of Medical Student Education in Psychiatry (ADMSEP)	June 16-18	Hilton Savannah Desoto, Savannah, GA
2011	APA September Components Meeting	Sept 7 – 10	Sheraton National Hotel, Arlington, VA
2011	ABPN-Part II Oral Exams	Sept 9-11	Renaissance Cleveland, Cleveland, OH
2011	Association of Academic Psychiatry (AAP)	Sept 21-24	Hyatt Regency Scottsdale Resort & Spa, Scottsdale, AZ
2011	American Association of Chairs of Departments of Psychiatry (AACDP)	Sept 24-25	Hyatt Regency Scottsdale Resort & Spa, Scottsdale, AZ
2011	American Academy of Child & Adol Psychiatry (AACAP)	Oct 18-23	Sheraton Centre, Toronto, Canada
2011	APA Institute on Psychiatric Services	Oct 27-30	San Francisco, CA
2011	AAMC Annual Meeting	Nov 4-9	Denver, CO
2011	Group for the Advancement of Psychiatry (GAP)	Nov 10-12	Renaissance Westchester Hotel, White Plains, NY

2012	American College of Psychiatrists (ACP)	Feb 22-26	Grand Naples Resort, Naples, FL
2012	AADPRT	March 7 -10	Hilton San Diego Bayfront, San Diego
2012	CAS Spring Meeting	March 8-10	Santa Fe, NM
2012	Group fo the Advancement of Psychiatry (GAP)	March 29-31	Renaissance Westchester Hotel, White Plains, NY
2012	American Psychiatric Association (APA)	May 5-9	Philadelphia, PA
2012	Association of Directors of Medical Student Education in Psychiatry (ADMSEP)	June 14-16	Semiahmoo Resort, Blaine, WA
2012	APA September Component Meetings	Sept 5-8	Sheraton National Hotel, Washington, DC
2012	APA Institute on Psychiatric Services	Oct 4-7	New York, NY
2012	American Academy of Child & Adol Psychiatry (AACAP)	Oct 23-28	Hilton San Francisco, San Francisco, CA
2012	Group fo the Advancement of Psychiatry (GAP)	Nov 15-17	Renaissance Westchester Hotel, White Plains, NY

2013	American College of Psychiatrists (ACP)	Feb 20-24	Grand Hyatt Kaua’I,Kaua’I, HI
2013	AADPRT	March 6-9	Hilton Fort Lauderdale Marina Resort, Fort Lauderdale, FL
2013	Group for the Advancement of Psychiatry (GAP)	April 4-6	Renaissance Westchester Hotel, White Plains, NY
2013	APA Annual Meeting	May 18-22	San Francisco, CA
2013	APA Institute on Psychiatric Services	Oct 10-13	Philadelphia, PA
2013	American Academy of Child & Adol Psychiatry (AACAP)	Oct 22-27	Walt Disney World Dolphin, Orlando, FL
2013	Group for the Advancement of Psychiatry (GAP)	Nov 14-16	Renaissance Westchester Hotel, White Plains, NY

2014	American College of Psychiatrists (ACP)	Feb 20-24	Grand Hyatt, San Antonio, TX
2014	AADPRT	March 12-16	Hilton El Conquistador, Tucson, AZ
2014	Group for the Advancement of Psychiatry (GAP)	April 10-12	Renaissance Westchester Hotel, White Plains, NY
2014	APA Annual Meeting	May 3-7	New York, NY
2014	APA Institute on Psychiatric Services	Oct 30-Nov 2	San Francisco, CA
2014	Group for the Advancement of Psychiatry (GAP)	Nov 13-15	Renaissance Westchester Hotel, White Plains, NY

2015	American College of Psychiatrists (ACP)	Feb 18-22	Hyatt Regency, Huntington Beach, CA
2015	AADPRT	March 4-7	Hilton Orlando Bonnet Creek, Orlando, FL
2015	Group for the Advancement of Psychiatry (GAP)	April 16-18	Renaissance Westchester Hotel, White Plains, NY
2015	APA Annual Meeting	May 16-20	Toronto, Canada
2015	APA Institute on Psychiatric Services	Oct 8-11	New York, NY
2015	Group for the Advancement of Psychiatry (GAP)	Nov 12-14	Renaissance Westchester Hotel, White Plains, NY

30 Jan 2011

State of the Organisation…. from President Joe Kenan

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From The President…

BY Joseph Kenan, M.D.

When first I joined ASAP seven years ago, I saw the organization as a strong, vibrant, and thriving organization. The annual meetings were first-class, hosted at amazing hotels with excellent facilities. The President stayed in a Presidential Suite at the host hotel, complements of ASAP. The Board of Governors enjoyed splendid lunches and dinners, gratis, during the Board of Directors meeting. A several-hundred-page hardcover “annual” was produced yearly and sent to every member … etc., etc. … ***CHA-CHING*** Ahhh … The good old days.

I recall, next, attending my first Board of Governors’ meeting and learning the awful truth: the organization was hemorrhaging money. Although once the magnificent organization had a magnanimous reserve of over a hundred thousand dollars, the account was quickly nearing zero. Yearly expenditures outpaced receivables by bounds. Board Members openly “hoped” there would be an organization in a few years. I remember, during that meeting, eying the door and wondering how I could politely excuse myself and never return.

I’m glad I stuck it out. Over the years, the Board has made the necessary cuts to keep ASAP alive. Although I miss some of the perks and lavish displays of wealth, I am happier that the State of the Organization is the best it has been in years.

The 2010 ASAP annual conference was an unqualified success. We had more attendees than in any recent year; the venue at Cedars-Sinai was free, compliments of Psychological Trauma Center; the Cedar-Sinai Department of Addiction Services made a generous contribution of $10,000 to pay for CME; Joe Kenan M.D. and Associates provided the food; and the cocktail hour was hosted by The California Society for Adolescent Psychiatry.

Most important, the conference was a BLAST. Bobby Trendy, our celebrity guest-host for the Saturday reception at Eleven NightClub, WILL NOT STOP TALKING about all the amazing people he met and hopes that you all contact him to purchase pieces from his OVERPRICED and LUXURIOUS furniture collection.

Due to what turned out to be a fortuitous error, our reservation at THE MAGIC CASTLE was screwed up, which necessitated A VERY BRIEF meeting devoid of the usual pontifications.

The OSCAR-watching party at the ABBEY NIGHTCLUB was off the hook! Yes, that was PARIS HILTON in the VIP section. (The event didn’t cost ASAP a dime.)

Anyone who missed the local community AWARDS SHOW at the PLAYBOY MANSION missed the CHANCE OF A LIFETIME. ASAP took the award for “BEST NATIONAL ORGANIZATION SERVING ADOLESCENTS” during the event. Thank you MR. HEFNER, for hosting us. You are the consummate host.

Finally, ABAP (American Board of Adolescent Psychiatry) and ASAP merged. The ASAP governing board has established a new council on Board Certification in Adolescent Psychiatry with our own Richard Ratner, M.D. as council chair. The council is working to develop a new exam at this time but board certification for Adolescent Psychiatry is ALIVE AND WELL.

Mark your calendars: the next ASAP conference is MARCH 26 and 27, 2011 in New York. Dean DeCrisce is our Program Chair. He has rented out Lincoln Center and booked Tony Robbins as our keynote speaker; LADY GAGA will perform; and the event will be catered by Nobu (A LITTLE JOKE…)

And that’s the State of the Organization. Thank you. Good night.

30 Jan 2011

A Special Word of Thanks….

Tags: Joe Kenan, Joseph Kenan
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A Special Word of Thanks….

The Governing Board wishes to express or deepest appreciation and gratitude to ASAP President Joe Kenan, M.D .for his special efforts to make the 2010 annual meeting in Los Angeles a success. In particular, we thank you for arranging the special evening events and hosting us with refreshments paid at your expense. It was great, Joe, and you have our deepest thanks. Dean DeCrise, Greg Bunt, Sheldon Glass, Greg Barclay, Manuel Lopez-Leon, Gregg Dwyer, Chris Thompson, Adam Raff, Frances Bell & Fabian Saleh

30 Jan 2011

From Our Members

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From Our Members….

Thomas Wilkes, M.D. was awarded the Friends of Canada in October, 2009 for his work in securing the bid to host the 2016 IACAPAP meeting in Calgary

Lois T. Flaherty, M.D., past-president of ASAP and Editor of Adolescent Psychiatry, the Annals of the American Society for Adolescent Psychiatry was the recipient of the APA’s Distinguished Service Award at its recent annual meeting in New Orleans.

30 Jan 2011

From the Editor…

Tags: Gregory Barclay, Joe Kenan, Joseph Kenan
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BY Gregory P. Barclay, M.D.

In this summer edition of our society newsletter, I am pleased to introduce a lead article written by our President-Elect, Dean DeCrise, M.D. This article relates to the implications of Megan’s Law when applied to adolescents who commit sexual offenses. This is one of several controversial issues in which ASAP is considering taking a position and for which we have reactivated our newly formed Committee for Legislative and Judicial Affairs. I asked Dean to prepare this article so that our membership have a better understanding of the Megan’s Law issue before the council takes it up at our next business meeting. For those of you who were at our 2010 annual scientific meeting in Los Angeles, Dr. DeCrise’s article summarizes his excellent presentation on the treatment of adolescent sexual offenders. And, for those of you unable to attend our meeting, please don’t despair. We have also included Dom Ferro’s summary of the outstanding keynote presentation given by Schonfeld Award Recipient Harold Koplewitz, M.D. as well as our usual photo gallery of presenters and ASAP members hard at work in Los Angeles.

All of this edition’s articles and book reviews have a common connection – the developing adolescent brain. With the advent of functional MRI and other imaging procedures, there is now undeniable proof of what we who work with adolescents know from clinical experience: The adolescent brain is in a state of massive change and uneven development, the result of pruning with increased white matter and diminishing gray matter through to age 24 or later. Hence, their impulsivity, emotional over-reactivity, and cognitive immaturity have clearly established origins in brain development and are only influenced to a degree by hormones and sociocultural variables. This fact alone is of enormous significance to us as an organization established to advocate for adolescents, especially with the current trends to try adolescents who commit crimes as adults, invoking the death penalty for adolescent criminals, and, as Dr. DeCrise states in his summary, applying Megan’s Law to youthful sexual offenders.

In his president’s column, Dr. Joe Kenan describes the changes in ASAP’s membership and finances over the past decade. We are also sad to note the passing of some ASAP giants, Mike Kalogerakis, James Masterson, and Everett Dulit. The challenge before us at this time is how we can grow and adapt, as a society to advocate for adolescents with mental health and substance abuse problems, to meet current reality vs. the alternative of atrophying into irrelevance. It is key for our membership to become engaged and involved. ASAP membership is now open to non-psychiatric physicians and non-physician licensed mental health professionals, as well as continuing to offer reduced-cost membership to trainees. If we each recruited one member, our society would increase to 400 members! That alone might allow us some semblance of a return to those “hey days” conferences Dr. Kenan speaks of in his president’s column and grant us more legitimacy as an advocacy organization. It might also allow us to print and mail our newsletter once again! We all know colleagues with a passion for working with teens, so what is holding us back? Do consider asking a colleague to join, plan to attend our annual meeting in New York March 26-27, 2011, pay your dues on time, and join a committee or council (we have openings on the Governing Board and the Committee for Legislative and Judicial Affairs).

Finally, I continue to welcome any contributions to our newsletter. Please ask any residents or students interested in getting something published to contact me. Or, if you have something of your own (including poetry) to submit, or have a passion for reading and writing book reviews, drop me a line at gpbmd@aol.com.

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