Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behavior outcomes for their children. In this report, we provide an overview of the mental health challenges associated with teen parenthood, barriers that often prevent teen mothers from seeking mental health services, and interventions for this vulnerable population that can be integrated into primary care services. Pediatricians in the primary care setting are in a unique position to address the mental health needs of adolescent parents because teens often turn to them first for assistance with emotional and behavioral concerns. Consequently, pediatricians can play a pivotal role in facilitating and encouraging teen parents’ engagement in mental health treatment.

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The pediatric practitioner is often the first point-of-contact for children and adolescents suffering from mental illness. Part of the treatment planning for psychiatric diagnoses includes consideration of medication. Attention-deficit/ hyperactivity disorder, one of the most common diagnoses, is very responsive to stimulant medications; for children who are unable to tolerate stimulants or who do not achieve satisfactory symptom management, central a-agonists and atomoxetine are effective and generally well-tolerated alternative or augmentative agents. Depression and anxiety disorders are also frequently encountered in the pediatric office setting. The use of selective serotonin reuptake inhibitors is considered first-line psychopharmacology for depression and anxiety symptoms. Despite concerns for suicidal ideation related to this medication class, the benefits typically outweigh the risks. This review provides basic clinical pharmacology of stimulant and nonstimulant attention-deficit/hyperactivity disorder medications and selective serotonin reuptake inhibitors intended to serve as a primer for the general pediatrician.Approximately 1 in 5 children in the United States suffers from some form of mental illness, yet 80% of these children do not receive treatment. 1,2 It is estimated that 75% of children and adolescents with psychiatric disorders are seen in primary care. 3 Furthermore, 7.5% of children and adolescents are prescribed a psychiatric medication, and 85% of psychopharmacologic prescribing is by pediatric providers. 4,5 Consistent with the American Academy of Pediatrics' (AAP's) mission to enhance pediatric care in a medical home, the AAP charges the following: "Pediatric primary care providers have unique opportunities and a growing sense of responsibility to prevent and address mental health and substance abuse problems in the medical home." 6 The purpose of this review article is to empower primary care pediatricians as basic psychopharmacologists for the common mental health diagnoses of attention-deficit/hyperactivity disorder (ADHD), depression, and anxiety. Mental health care involves an array of interventions, including psychological education, and, contingent on the needs of the child, neuropsychological testing to assess for learning and other comorbid disorders, school accommodations, and psychotherapy. These treatment modalities are important aspects of care but are outside the scope of this article. ADHD MEDICATIONS Case VignetteJoey, a 6-year-old, 20-kg boy, presents to his pediatrician, Dr Smith, with complaints of significant hyperactivity, impulsivity, and defiance that are problematic in the classroom and at home. Presentation in the office and parent and teacher Vanderbilt rating scale scores* are consistent with At subsequent weekly or biweekly follow-ups, the dose is titrated to 10, 15, and 20 mg qAM based on parent and teacher Vanderbilt scores demonstrating little or no improvement. At the fourth follow-up, Dr Smith switches to amphetamine/ dextroamphetamine ER (A...

Summary Tumour pathogenesis is characterized by an immunosuppressive microenvironment that limits the development of effective tumour‐specific immune responses. This is in part the result of tumour‐dependent recruitment and activation of regulatory cells, such as myeloid‐derived suppressor cells and regulatory T cells in the tumour microenvironment and draining lymph nodes. Shedding of gangliosides by tumour cells has immunomodulatory properties, suggesting that gangliosides may be a critical factor in initiating an immunosuppressive microenvironment. To better define the immunomodulatory properties of gangliosides on antigen‐specific T‐cell activation and development we have developed an in vitro system using ganglioside‐treated murine bone‐marrow‐derived dendritic cells to prime and activate antigen‐specific CD4+ T cells from AND T‐cell receptor transgenic mice. Using this system, ganglioside treatment promotes the development of a dendritic cell population characterized by decreased CD86 (B7‐2) expression, and decreased interleukin‐12 and interleukin‐6 production. When these cells are used as antigen‐presenting cells, CD4 T cells are primed to proliferate normally, but have a defect in T helper (Th) effector cell development. This defect in Th effector cell responses is associated with the development of regulatory T‐cell activity that can suppress the activation of previously primed Th effector cells in a contact‐dependent manner. In total, these data suggest that ganglioside‐exposed dendritic cells promote regulatory T‐cell activity that may have long‐lasting effects on the development of tumour‐specific immune responses.

The purpose of this study is to examine the role of father involvement on infant distress among children born to teen mothers, particularly those who are depressed. 119 teen mothers (<20 years) and their infants (<6 months) enrolled in a quasi-experimental trial of a comprehensive pediatric primary care program. Data were drawn from mother-reported questionnaires administered at baseline, before participation in the intervention or comparison conditions. 29 % of teen mothers screened positive for depression. Mothers reported that 78 % of fathers were engaged with their children, typically seeing them a few times per month, and 71 % took financial responsibility for their children. In a multiple linear regression, father responsibility predicted lower infant distress, maternal depression predicted higher infant distress, and there was a significant interaction in which father engagement buffered the effect of maternal depression on infant distress. Fathers may be a protective resource for children born to teen mothers, even as early as the first 6 months of life, potentially mitigating the heightened risk associated with maternal depression in the postpartum period.

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Background The child behavior checklist-Juvenile bipolar disorder phenotype (CBCL-JBD) has been proposed as a distinct profile specific to children and adolescents who have been diagnosed with bipolar disorder. The objective of this study was to examine whether bipolar disorder youth with depression exhibit the “CBCL-Juvenile bipolar disorder phenotype.” Methods Thirty-two adolescents, ages 12–18 years, with a depressive episode associated with bipolar I disorder were recruited, and their primary caregivers completed the CBCL. Results Only the internalizing subscale (mean=70.2, SD=9.7) and total score (mean=71.5, SD=8.9) reached clinical significance (>70). Moreover, the CBCL-JBD profile scores of our subjects (204.6, SD=27.5) did not reach clinical significance (>210). Limitations Our subjects differed demographically from those in studies that have confirmed the CBCL-Juvenile bipolar disorder phenotype with regards to sex, age and ADHD comorbidity, thus limiting the interpretability of our comparisons with other studies. Furthermore, our investigation involved a small sample size and did not include a control group, which should be addressed in future studies. Conclusions The results of our study suggest that the CBCL-JBD profile is not characteristic of depressed youth with bipolar disorder. Better assessment tools for making an accurate and efficient diagnosis of bipolar disorder are needed so that appropriate treatment can be implemented and significant morbidity and mortality are minimized.

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