ADVANCED CHILD AND ADOLESCENT PSYCHIATRY
Week 1 Lecture 1: Introduction
Week 2 Lecture 2: Autism Spectrum Disorder Literature
● The peer relationships of girls with ASD at school: comparison to
boys and girls with and without ASD. Dean M, Kasari C, Shih W,
Frankel F, Whitney R, Landa R, Lord C, Orlich F, King B, Harwood R.
● Social attention and autism symptoms in high functioning women
with autism spectrum disorder. Ketelaars MP, In ‘t Veld A, Mol A,
Swaab H, Bodrij F, van Rijn S.
● Diagnosis of autism spectrum disorder: reconciling the syndrome, its
diverse origins, and variation in expression. Constantino JN, Charman
T
Week 3 Lecture 3: Anxiety and Compulsions Literature
● Obsessive-compulsive disorder in children and adolescents Barton,
R., & Heyman, I. (2016).
● Optimizing exposure therapy with an inhibitory retrieval approach
and the OptEx Nexus Craske, M. G., Treanor, M., Zbozinek, T. D., &
Vervliet, B. (2022).
● Factsheet VGCT: Exposure: new insights
Week 4 Lecture 4: Psychotic Disorders Literature
● Perceived social stress and symptom severity among help-seeking
adolescents with versus without clinical high risk for psychosis
Millman, Z. B. et al. (2018).
● Psychosis in children and adolescents. McClellan, J. (2018).
● Changes in the adolescent brain and the pathophysiology of
psychotic disorders Matcheri S Keshavan, Jay Giedd, Jennifer Y F Lau,
David A Lewis, Tomáš Paus
Week 5 Lecture 5: Borderline Personality Literature
Disorder ● The diagnosis that should speak its name: why it is ethically right to
diagnose and treat personality disorder during adolescence.
Hutsebaut, J., Clarke, S. L., & Chanen, A. M. (2023).
● Adolescents with personality disorders suffer from severe psychiatric
stigma: evidence from a sample of 131 patients. Catthoor, K.,
Feenstra, D. J., Hutsebaut, J., Schrijvers, D., & Sabbe, B. (2015).
● The attitudes of psychiatric hospital staff toward hospitalization and
treatment of patients with borderline personality disorder. Ehud
Bodner, Sara Cohen-Fridel, et al (2015)
● A life span perspective on Borderline Personality Disorder Videler,
A.C., Hutsebaut, J., Schilkens, J. E., Sobczak (2019)
Week 6 Lecture 6: Attachment Disorders Literature
● The use and abuse of attachment theory in clinical practice with
maltreated children, Part II: Treatment Allen, B. (2011).
● Misperceptions of reactive attachment disorder persist in Poor
methods and unsupported conclusions. Allen, B. (2018).
● Practice parameters for the assessment and treatment of children
and adolescents with reactive attachment disorder and disinhibited
social engagement disorder. Zeanah, C. H. et al. (2016).
Week 7 Lecture 7: Eating Disorders Literature
● Emotion-focused family therapy for eating disorders in children and
, adolescents. Lafrance Robinson, A. et al. (2013).
● Royal Australian and New Zealand College of Psychiatrists clinical
practice guidelines for the treatment of eating disorders. Hay, P. et
al. (2014).
Lecture 1: INTRODUCTION
DIFFERENCES BETWEEN SPECIALISTS (in hierarchy, education, and professional - at the same level but -)
● Psychiatrist (as a medical specialist): controls and treats somatic symptoms, prescribes medication, duties at night and during
the weekend
● Clinical psychologist: specialist in (neuro-) psychological assessment and psychotherapy treatment
● At LUMC Curium - Psychologist-specialist vs Psychaitrist:
○ Similarities: same responsibilities as the psychiatrist
○ Difference: except for medical duties
CHILD AND ADOLESCENT DEVELOPMENT AND DISORDERS
● Normal development (cognitive, social, emotional)
● Atypical development – most common disorders:
○ Learning disabilities (such as dyslexia)
○ Speech-language disorders
○ Intellectual disabilities
○ Neurodevelopmental disorders, such as ADHD and autism
● Complex disorders – and comorbidity
○ Anxiety
○ Depression
○ Eating disorders
○ Attachment disorders/trauma
○ Stressor-related disorders
○ Personality disorders
○ Psychotic disorders
ORGANIZATION OF PSYCHOLOGICAL SERVICES IN THE NETHERLANDS
● Child Healthcare / Youth and Family Centre
○ 0-18 yrs: 0-4 child consultation clinic; 4-18 youth and family center
○ No referral of a general practitioner is needed
● Basic mental healthcare (Basic GGZ)
● Specialized mental healthcare (Specialistische GGZ): LUMC Curium
○ All ages
○ Referral of a general practitioner or Youth and family center is needed
○ Most complex cases
○ 0-18 yrs: local authorities pay (they receive funds from the central government) (16 => parents don’t need to know)
○ 18+ years: health insurance that pays
TREATMENT OUTCOME
● Factors that influence client outcomes can be divided into four areas
○ Extra-therapeutic factors
○ Expectancy effects
○ Specific therapy techniques
○ Common factors: empathy, warmth, and the therapeutic relationship have been shown to correlate more highly with
client outcomes than specialized treatment interventions.
● Alliance and expectancy are active ingredients of treatment.
TREATMENT RELATIONSHIP
● Interpersonal skills:
, ○ Verbal fluency
○ Interpersonal perception (what is happening between you and the client - knowledge on our regulation)
○ Affective modulation and expressiveness
○ Warmth and acceptance
○ Empathy
○ Focus on other
● Therapist:
○ Is someone you can trust, who can help you and understand you
○ Aware of the client’s age, characteristics, cultural background, and context
○ Flexible and will adjust therapy if resistance to the treatment is apparent or the client is not making adequate
progress
○ Communicates hope and optimism
○ Aware of their own psychological process and do not inject their own material into the therapy process unless such
actions are deliberate and therapeutic
LUMC CURIUM
ORGANIZATION
● LUMC – is divided into 4 divisions
● Division 3 – department Psychiatry
● Sub-department Child and Adolescent Psychiatry
● Head of Curium: Prof dr Robert Vermeiren and Manager: Willeke van den Oudenrijn
● 3 care programs - partly based on diagnostic classification
○ Neurodevelopmental disorders: Mirjam Rinne
○ Emotional disorders (anxiety, psychotic): Tes Mijnders, Eva van Well
○ Complex disorders and family problems: Lian Nijland, Lucas Korthals Altes + Janine Baartmans (De Viersprong)
AT LUMC CURIUM COMBINATION OF
● Patient care
● Research - in clinical practice, with the most complex group (severe and enduring problems)
● Education/training of professionals - all levels from MSc to specialist
● Management
PATIENT CARE
● Within a program
○ Inpatient and outpatient treatment
○ Guidelines for the diagnostic process (mainly outpatient) and treatment process
● In outpatient and inpatient teams
○ Different levels of education of professionals
○ Diagnostic process and treatment process are done by the same persons/in the same team, supervised by a specialist
○ Specific treatment programs/therapies (CBT, DBT, psychotherapy, nonverbal therapy, farmaceutical treatment, family
therapy)
INDIVIDUALLY PLANNED TREATMENT PROGRAM
● As short as possible, as intensive as necessary:
○ Outpatient treatment, individually and/or family
○ Home treatment, individually and/or family
○ Day clinic (chair)
○ Clinic Inpatient (bed)
○ “Flexbed”
○ Bed on prescription (BOR)
○ Chair on prescription (SOR)
○ Consultation by telephone (TOR)
(DAY) CLINICAL TREATMENT CURIUM LUMC
1. Focused individualized treatment: concrete treatment goals
2. Treatment climate: working from competencies, skills training
, 3. Short inpatient treatment in strong cooperation with outpatient treatment and home training
4. Families in control
5. Empowerment of the family
6. Outpatient pre- and post-clinical treatment programs
BASIC ATTITUDE TOWARDS FAMILIES
● Parents are competent and experts about their child, and the treatment team are experts on theoretical knowledge about the
disorder and treatment
● Parents go on together with their children, the team passes by
● Building on the competencies of the child and the family
● Goal is not to cure but to foster functioning and find a new balance for the child and the family
● Non-Violent Resistance (Chaim Omer) – parental (or adult) presence in the child’s mind, to reduce helplessness and gain
authority by supporting parents.
INDIVIDUAL PAPER ASSIGNMENT REFERRAL AND INTAKE AT LUMC CURIUM
● Referral:
○ First by telephone (referrer and parent) => teams
○ Referral letter
○ DAWBA (development and well-being assessment questionnaire), interview and rating
● Intake:
○ Interview with parents and child
○ Child psychiatric examination
○ Importance of the differential diagnosis for hypotheses generation
INTAKE AND TREATMENT AT LUMC CURIUM
● Diagnostic process: assessing child’s developmental history, psychological assessment (IQ, questionnaires), information from
school
● Multidisciplinary meeting with a specialist, social worker/family therapist, and student, when indicated with a psychologist for
results from psychological assessment => descriptive diagnosis (not DSMV-classification per se) + treatment plan
● Meeting with parents and children for advice
● Treatment => 3 monthly multidisciplinary evaluation
WORKING WITH CHILDREN AND YOUNG PEOPLE VS ADULT MENTAL HEALTH CARE
● Working with different developmental phases
● Always working with families/caretakers
● Working with schools, community, legal system, etc.
● C&A psychiatry is a relatively young specialism still in development
○ More complex, more differentiated, more co-operation => more difficult?
Lecture 2: AUTISM SPECTRUM DISORDER
DSM-5 AND ASD
CATEGORY A ● Deficits in social and emotional reciprocity
Week 1 Lecture 1: Introduction
Week 2 Lecture 2: Autism Spectrum Disorder Literature
● The peer relationships of girls with ASD at school: comparison to
boys and girls with and without ASD. Dean M, Kasari C, Shih W,
Frankel F, Whitney R, Landa R, Lord C, Orlich F, King B, Harwood R.
● Social attention and autism symptoms in high functioning women
with autism spectrum disorder. Ketelaars MP, In ‘t Veld A, Mol A,
Swaab H, Bodrij F, van Rijn S.
● Diagnosis of autism spectrum disorder: reconciling the syndrome, its
diverse origins, and variation in expression. Constantino JN, Charman
T
Week 3 Lecture 3: Anxiety and Compulsions Literature
● Obsessive-compulsive disorder in children and adolescents Barton,
R., & Heyman, I. (2016).
● Optimizing exposure therapy with an inhibitory retrieval approach
and the OptEx Nexus Craske, M. G., Treanor, M., Zbozinek, T. D., &
Vervliet, B. (2022).
● Factsheet VGCT: Exposure: new insights
Week 4 Lecture 4: Psychotic Disorders Literature
● Perceived social stress and symptom severity among help-seeking
adolescents with versus without clinical high risk for psychosis
Millman, Z. B. et al. (2018).
● Psychosis in children and adolescents. McClellan, J. (2018).
● Changes in the adolescent brain and the pathophysiology of
psychotic disorders Matcheri S Keshavan, Jay Giedd, Jennifer Y F Lau,
David A Lewis, Tomáš Paus
Week 5 Lecture 5: Borderline Personality Literature
Disorder ● The diagnosis that should speak its name: why it is ethically right to
diagnose and treat personality disorder during adolescence.
Hutsebaut, J., Clarke, S. L., & Chanen, A. M. (2023).
● Adolescents with personality disorders suffer from severe psychiatric
stigma: evidence from a sample of 131 patients. Catthoor, K.,
Feenstra, D. J., Hutsebaut, J., Schrijvers, D., & Sabbe, B. (2015).
● The attitudes of psychiatric hospital staff toward hospitalization and
treatment of patients with borderline personality disorder. Ehud
Bodner, Sara Cohen-Fridel, et al (2015)
● A life span perspective on Borderline Personality Disorder Videler,
A.C., Hutsebaut, J., Schilkens, J. E., Sobczak (2019)
Week 6 Lecture 6: Attachment Disorders Literature
● The use and abuse of attachment theory in clinical practice with
maltreated children, Part II: Treatment Allen, B. (2011).
● Misperceptions of reactive attachment disorder persist in Poor
methods and unsupported conclusions. Allen, B. (2018).
● Practice parameters for the assessment and treatment of children
and adolescents with reactive attachment disorder and disinhibited
social engagement disorder. Zeanah, C. H. et al. (2016).
Week 7 Lecture 7: Eating Disorders Literature
● Emotion-focused family therapy for eating disorders in children and
, adolescents. Lafrance Robinson, A. et al. (2013).
● Royal Australian and New Zealand College of Psychiatrists clinical
practice guidelines for the treatment of eating disorders. Hay, P. et
al. (2014).
Lecture 1: INTRODUCTION
DIFFERENCES BETWEEN SPECIALISTS (in hierarchy, education, and professional - at the same level but -)
● Psychiatrist (as a medical specialist): controls and treats somatic symptoms, prescribes medication, duties at night and during
the weekend
● Clinical psychologist: specialist in (neuro-) psychological assessment and psychotherapy treatment
● At LUMC Curium - Psychologist-specialist vs Psychaitrist:
○ Similarities: same responsibilities as the psychiatrist
○ Difference: except for medical duties
CHILD AND ADOLESCENT DEVELOPMENT AND DISORDERS
● Normal development (cognitive, social, emotional)
● Atypical development – most common disorders:
○ Learning disabilities (such as dyslexia)
○ Speech-language disorders
○ Intellectual disabilities
○ Neurodevelopmental disorders, such as ADHD and autism
● Complex disorders – and comorbidity
○ Anxiety
○ Depression
○ Eating disorders
○ Attachment disorders/trauma
○ Stressor-related disorders
○ Personality disorders
○ Psychotic disorders
ORGANIZATION OF PSYCHOLOGICAL SERVICES IN THE NETHERLANDS
● Child Healthcare / Youth and Family Centre
○ 0-18 yrs: 0-4 child consultation clinic; 4-18 youth and family center
○ No referral of a general practitioner is needed
● Basic mental healthcare (Basic GGZ)
● Specialized mental healthcare (Specialistische GGZ): LUMC Curium
○ All ages
○ Referral of a general practitioner or Youth and family center is needed
○ Most complex cases
○ 0-18 yrs: local authorities pay (they receive funds from the central government) (16 => parents don’t need to know)
○ 18+ years: health insurance that pays
TREATMENT OUTCOME
● Factors that influence client outcomes can be divided into four areas
○ Extra-therapeutic factors
○ Expectancy effects
○ Specific therapy techniques
○ Common factors: empathy, warmth, and the therapeutic relationship have been shown to correlate more highly with
client outcomes than specialized treatment interventions.
● Alliance and expectancy are active ingredients of treatment.
TREATMENT RELATIONSHIP
● Interpersonal skills:
, ○ Verbal fluency
○ Interpersonal perception (what is happening between you and the client - knowledge on our regulation)
○ Affective modulation and expressiveness
○ Warmth and acceptance
○ Empathy
○ Focus on other
● Therapist:
○ Is someone you can trust, who can help you and understand you
○ Aware of the client’s age, characteristics, cultural background, and context
○ Flexible and will adjust therapy if resistance to the treatment is apparent or the client is not making adequate
progress
○ Communicates hope and optimism
○ Aware of their own psychological process and do not inject their own material into the therapy process unless such
actions are deliberate and therapeutic
LUMC CURIUM
ORGANIZATION
● LUMC – is divided into 4 divisions
● Division 3 – department Psychiatry
● Sub-department Child and Adolescent Psychiatry
● Head of Curium: Prof dr Robert Vermeiren and Manager: Willeke van den Oudenrijn
● 3 care programs - partly based on diagnostic classification
○ Neurodevelopmental disorders: Mirjam Rinne
○ Emotional disorders (anxiety, psychotic): Tes Mijnders, Eva van Well
○ Complex disorders and family problems: Lian Nijland, Lucas Korthals Altes + Janine Baartmans (De Viersprong)
AT LUMC CURIUM COMBINATION OF
● Patient care
● Research - in clinical practice, with the most complex group (severe and enduring problems)
● Education/training of professionals - all levels from MSc to specialist
● Management
PATIENT CARE
● Within a program
○ Inpatient and outpatient treatment
○ Guidelines for the diagnostic process (mainly outpatient) and treatment process
● In outpatient and inpatient teams
○ Different levels of education of professionals
○ Diagnostic process and treatment process are done by the same persons/in the same team, supervised by a specialist
○ Specific treatment programs/therapies (CBT, DBT, psychotherapy, nonverbal therapy, farmaceutical treatment, family
therapy)
INDIVIDUALLY PLANNED TREATMENT PROGRAM
● As short as possible, as intensive as necessary:
○ Outpatient treatment, individually and/or family
○ Home treatment, individually and/or family
○ Day clinic (chair)
○ Clinic Inpatient (bed)
○ “Flexbed”
○ Bed on prescription (BOR)
○ Chair on prescription (SOR)
○ Consultation by telephone (TOR)
(DAY) CLINICAL TREATMENT CURIUM LUMC
1. Focused individualized treatment: concrete treatment goals
2. Treatment climate: working from competencies, skills training
, 3. Short inpatient treatment in strong cooperation with outpatient treatment and home training
4. Families in control
5. Empowerment of the family
6. Outpatient pre- and post-clinical treatment programs
BASIC ATTITUDE TOWARDS FAMILIES
● Parents are competent and experts about their child, and the treatment team are experts on theoretical knowledge about the
disorder and treatment
● Parents go on together with their children, the team passes by
● Building on the competencies of the child and the family
● Goal is not to cure but to foster functioning and find a new balance for the child and the family
● Non-Violent Resistance (Chaim Omer) – parental (or adult) presence in the child’s mind, to reduce helplessness and gain
authority by supporting parents.
INDIVIDUAL PAPER ASSIGNMENT REFERRAL AND INTAKE AT LUMC CURIUM
● Referral:
○ First by telephone (referrer and parent) => teams
○ Referral letter
○ DAWBA (development and well-being assessment questionnaire), interview and rating
● Intake:
○ Interview with parents and child
○ Child psychiatric examination
○ Importance of the differential diagnosis for hypotheses generation
INTAKE AND TREATMENT AT LUMC CURIUM
● Diagnostic process: assessing child’s developmental history, psychological assessment (IQ, questionnaires), information from
school
● Multidisciplinary meeting with a specialist, social worker/family therapist, and student, when indicated with a psychologist for
results from psychological assessment => descriptive diagnosis (not DSMV-classification per se) + treatment plan
● Meeting with parents and children for advice
● Treatment => 3 monthly multidisciplinary evaluation
WORKING WITH CHILDREN AND YOUNG PEOPLE VS ADULT MENTAL HEALTH CARE
● Working with different developmental phases
● Always working with families/caretakers
● Working with schools, community, legal system, etc.
● C&A psychiatry is a relatively young specialism still in development
○ More complex, more differentiated, more co-operation => more difficult?
Lecture 2: AUTISM SPECTRUM DISORDER
DSM-5 AND ASD
CATEGORY A ● Deficits in social and emotional reciprocity
