Background: Complementary and alternative medicine (CAM) has become increasingly popular over the past 20 years and is used by many adolescents and their families. CAM includes a host of integrative approaches whose difference from traditional medicine center around its holistic rather than compartmentalized approach to the patient, in which evaluation of health and well-being considers the mind, body, and spirit. Methods: This article provides an overview of both pharmacologic and non-pharmacologic approaches, with a focus on 1) how CAM can be used in clinical practice; 2) how to best choose amongst available approaches guided by research findings that provide information to maximize safety and efficacy. Two hypothetical cases illustrate how to apply the research base of evidence to patients and thus avoid diagnostic pitfalls and safety concerns. Results: Current research points to the efficacy of CAM in adult and adolescent populations and the efficacy of interventions that include attention to good nutrition, regular exercise, sunlight, and hygiene, especially as these interventions may prevent or reduce the incidence of conduct disorder. Recent studies suggest that CAM treatments can improve overall functioning and reduce difficulties such as insomnia, depression and aggression that occur due to anxiety, attentional deficits, and mood disorders. Conclusions: It is important to acknowledge the current public perception that CAM treatments are less likely to cause serious adverse effects as compared to conventional treatments. More studies of adolescent populations critical to confirm which complementary and alternative medicine treatments are both safe and efficacious. An informed open-minded attitude to non-conventional approaches has the potential to improve outcomes and trust amongst parents, adolescents and mainstream medical and behavioral health staff. Keywords: Adolescents, aggression, autism, ADHD, complementary and alternative medicine, dietary interventions, dietary supplements.

Background: This paper aims to consider whether adolescents’ rights differ from adults’ rights and whether applying a children’s rights framework is more helpful in pursuing a public health agenda for adolescents than promoting individual rights. Method: An overview of different types and categories of rights is provided. The need to balance rights and the relationships between mental health professionals’ roles and others’ reciprocal rights is discussed in order to aid consideration of the above questions. The context is healthcare provision for adolescents with mental health disorders and difficulties. The article is informed by practice in the public mental healthcare system in England, hence many examples are drawn from the English healthcare and legal literature, although international connections are made. Results: Adolescents’ rights differ from adults’ rights, especially because of the legal and political disabilities of childhood. Applying a rights framework offers one way of reasoning about ethical and legal challenges in adolescent mental health care. In England, however, having a Human Rights Act, with which all other law must be commensurate, has not resulted in significant promotion of the individual rights of adolescent minors who have capacity to consent. Pediatric professional organisations have met with some success in pursuing a public health agenda for adolescents by advocating for their human rights. Conclusion: Particularly given evidence that most lifetime psychiatric disorders have started by the end of adolescence, mental health professional organisations should strongly and actively advocate for human rights and global equity in healthcare provision for adolescents.

Background: The digital revolution has changed healthcare forever. In adolescent psychiatry, the infrastructure of our practice – billing, record-keeping and communication with patients and colleagues – is increasingly occurring electronically and online. Adolescent psychiatrists are likely to interface with technology in their practice, in part because of the high prevalence of use of social media among their patients and also among practitioners. Online professionalism means adhering to the clinical, ethical and legal principles of professional behavior while communicating via the Internet. Due to the unique characteristics of digital technology, professionalism breaches involving technology are easier to commit and have the potential for a broader impact than communication with traditional media. Physicians’ lapses in professionalism online have been documented by the media, researchers and state medical boards, and physicians have increasingly faced various kinds of censure for such lapses. Professional guidelines are emerging; however, these documents do not always provide straightforward answers to complex clinical scenarios. Method: This paper focuses on eight core issues in professionalism and digital technology: confidentiality, patient and practitioner privacy, liability, safety/mandated reporting, libel, netiquette, conflicts of interest and issues unique to psychotherapy. Each concept, as it applies to working with adolescents, is illustrated and discussed in the context of clinical vignettes. Thus, an overall conceptual framework and underlying thought process are emphasized here, rather than specific “do’s and don’ts.” While much of the research cited in this article is from studies of physicians, especially psychiatrists, the principles identified are applicable to all mental health professionals. Results: Online professionalism concerns for mental health professionals who work with adolescents cover a wide range of activities and types of communication. They may be usefully grouped into eight domains: 1) confidentiality, 2) privacy, 3) liability, 4) safety/mandated reporting, 5) libel, 6) “netiquette,” 7) conflicts of interest, and 8) issues unique to psychotherapy. Conclusions: Many situations do not have a clear-cut solution, but having an increased consciousness about and being able to think through relevant issues can prevent online professionalism breaches before they happen. Adolescent mental health providers need to exercise a judicious balance between embracing technology that serves to improve patient care and spurning online behaviors and digital modalities that threaten the fundamentals of professionalism.

Background: Although use of social media is an important part of adolescents’ lives, the mental health impact of this activity is largely unknown to practitioners. Methods: An extensive literature search was conducted regarding social media use among adolescents and the benefits and potential risks associated with that use. A PUBMED search was conducted using various terms including “social media and teens”, “social media and suicide”, “facebook and suicide”, “sexting”, “cyberbullying”, “facebook and teens”, “social media and self-injury”. Relevant articles were examined and used in this review. Also, reports on adolescent social media use from the Pew Internet and American Life Project were examined. Results: This newer form of communication has many benefits to adolescents and plays an important role in their social lives. Despite the numerous benefits of these technologies, there are also several potential risks that can be detrimental to the mental health and well-being of adolescents. Conclusions: It is critical that child psychiatrists and other mental health providers be informed of these potential risks so they can more effectively educate and treat their adolescent patients and their families.

Background: Most of the interventions developed for adolescents with learning disorders (LDs) focus on enhancing cognitive and learning skills. However, these adolescents have been usually found to score high on measures of insecure attachment orientations. Objectives: The purpose of the current analysis was to examine changes in attachment orientations towards parents, attachment- related representations of teachers, and feelings of loneliness among adolescents with LD during an open trial of a psychological intervention for adolescents diagnosed with learning disorders (the “I Can Succeed” program, or ICS). ICS aims to target both academic and emotional functioning. Methods: Participants included 40 adolescents with LD and their parents. Measures included Attachment to parents (Kerns); Attachment representations of teachers (Children’s Appraisal of Teacher as a Secure Base (CATSB); and Loneliness (Peer-Network Loneliness and Peer-Dyadic Loneliness Scale (PNDLS). Adolescents completed questionnaires before the ICS Intervention (baseline), at the end of the acute phase (end of treatment) and at a six months follow-up meeting (follow-up). Results: The main results of the current study indicate that 6 months after the “I Can Succeed” intervention, there was improvement in LD students’ attachment security to mothers, appraisals of homeroom teacher as a security-enhancing figures (more acceptance and less rejection), and satisfaction with relationships with peers and friends (lower dyadic loneliness scores). One practical implication concerns the use of attachment theory as a foundation upon which to develop interventions among adolescents with LD. Keywords: Adolescents, attachment, learning disorders, psychological intervention.

Marijuana is the most commonly used illicit substance in the United States and worldwide. Marijuana use is a problem of increasing magnitude among adolescents. Use typically begins in adolescence and is associated with a variety of adverse outcomes. This article will present an overview of trends in marijuana use, and will review the endocannabinoid system and marijuana. It will discuss recent policy developments in US and their implications, especially for adolescents. Existing treatments will be reviewed, including findings from a recent randomized double-blind trial of N-acetylcysteine, a compound that reverses the dysregulation of the glutamate system that occurs in substance dependence. The core treatment approaches include psychosocial interventions, sometimes in combination with each other. While a reduction in days of use is often achieved with most of these approaches, abstinence is a much more elusive goal. The evidence base for effective treatments remains inadequate especially with regard to adolescents, and there is an urgent need for more research in this area. Promising new treatments include N-acetylcysteine in conjunction with contingency management.