Child and Adolescent Psychiatry: The Next 10 Years
By Thomas F. Anders, MD |
May 1, 2008
Dr Anders is distinguished professor of psychiatry and behavioral sciences, M.I.N.D. Institute, University of California, Davis, and immediate past president, American Academy of Child & Adolescent Psychiatry. He reports that he has no conflicts of interest concerning the subject matter of this article.
The research imperative
Research currently drives our field, and I expect that it will continue to do so in the years ahead. Propelled by NIMH's highly successful Decade of the Brain and the subsequent delineation of the human genome, the field of neuroscience has made major advances in our understanding of the structure and function of the brain and how biology interacts with the environment to affect behavior and mental disorders. The speed of the advances in our knowledge over the past 10 years will only increase over the next 10. Thomas Insel, MD, the current director of NIMH, has wondered why so few medical students choose careers in psychiatry when so many majored in neuroscience as undergraduates. After all, psychiatry is one of the few medical specialties that comprises clinical neuroscience. It is my prediction that given some of the workforce and stigma reduction efforts outlined above, this lack of interest in clinical neuroscience will dissipate.
Research in genetics, genomics, proteonomics, and neuropharmacology will continue to advance and attract the brightest MDs and PhDs to our field. Research will lead to even better, more specific individualized treatments for mental disorders. Responses to treatment will be more rapid and more sustained. Medications will have fewer adverse effects. An increased focus on developmental neuroscience will specifically result in better treatments for children and attract more people into child and adolescent psychiatry. More research- focused, academic training programs for child psychiatrists, similar to those developed at Yale and the University of Colorado, will appear.
I doubt, however, that our new-found knowledge will ever determine that all psychiatric disorders are uniquely genetic. We will become more knowledgeable about how genes are regulated at the molecular level by environmental events and developmental experiences. In short, we will learn much more about behavioral genetics and about the multi-dimensional context of behavior. In 10 years, I predict that child and adolescent psychiatrists will practice a much more sophisticated version of evidence-based developmental psychiatry with more individually relevant evidence to inform our clinical decisions.
But there are also dangers ahead. The budgetary constraints that are affecting our economy in general and our research enterprise in particular are significantly curtailing our research productivity. The politicization of research priorities and federal prohibitions on some kinds of research potentially add to the loss of the US research enterprise's competitive edge. Globalization of research has intensified competition and may result in a reverse brain drain. These political, economic, and regulatory pressures have impacted the morale of scientists and altered the public's perception of our research enterprise. At least in the press and in the halls of Congress, there appears to be a progressive loss of confidence in our work.12,13 These perceptions have often, although not exclusively, been particularly directed at general and child and adolescent psychiatry.
Despite these concerns, I anticipate that the current economic and political pressures will lessen and that our research results will lead to even better understanding of basic mechanisms of brain function and behavior and to ever better treatments for mental disorders. I am optimistic that our economy will strengthen and that our nation's commitment to innovation through research will again flourish. I further predict that the public's trust in medicine in general and psychiatry in particular will be restored after a period of reflection and soul searching by our professional groups as we resolve serious concerns related to ethics and influence. In 10 years, the psychiatry research enterprise (basic and clinical neuroscience) will be more vigorous than it is today, and a developmental focus will dominate the research agenda and involve more child and adolescent psychiatrists.