Minnesota Chapter of the American Academy of Pediatrics

Joel Oberstar, MD

By Joel V. Oberstar, MD, CEO and Chief Medical Officer at PraireCare
Many youngsters experience adverse childhood events and psychosocial stressors and seem to take it “all in stride.” Indeed, many clinicians who work with children on a regular basis find their resilience to be inspiring.
Some kids, however, find that adverse events and the stress of everyday life can become overwhelming. In those instances, accurate diagnosis and treatment of a mental illness is essential.
The top three most prevalent mental illnesses in children relate to anxiety, depression and disruptive behavior disorders. Adjustment disorders with disturbance of mood or conduct present in response to an identifiable stressor or stressors occurring within 3 months of the onset of the stressor. In these instances, the symptoms or behaviors are evidenced by either marked distress or significant impairment in functioning, but do not rise to the severity of another specific DSM-IV-TR Axis I disorder (e.g., generalized anxiety disorder, major depressive disorder, etc.).
Treatment of adjustment disorders frequently involves supportive psychotherapy—either individually for the child or for both the child and family—as well as psychosocial supports. A child who has experienced an acute stress related to bullying at school, for example, might respond well to individual cognitive behavioral therapy and social skills training to help him deal more effectively with his peers. Likewise, contacting the school counselor may provide an opportunity for adult intervention with the bully.
Should emotional and/or behavioral symptoms progress in severity, diagnosis of an Axis I disorder is appropriate and more aggressive treatment frequently indicated. In such instances, more aggressive psychotherapy may be paired with pharmacological interventions. For example, a teenage girl who suffers from major depressive disorder relating to parent-child conflict and parent-parent conflict in the home may benefit from interpersonal psychotherapy along with family psychotherapy. Consideration may be given to initiating a low dose antidepressant such as citalopram or sertraline.
In either instance, recognition of the emotional and/or behavioral symptoms is essential to facilitating intervention. All children have access to children’s mental health case management through their county of residence; parents may call themselves to receive support. Referral to any one of a number of psychotherapists for an initial diagnostic assessment is frequently the first step in receiving psychotherapy. Of course, the primary care clinician may elect to initiate pharmacotherapy. Such clinicians are encouraged to utilize the newly established Minnesota Collaborative Psychiatric Consultation Service (referenced elsewhere in the newsletter) for diagnostic and therapeutic support. Referral to a child and adolescent psychiatrist is less commonly indicated but may certainly be appropriate in certain instances.

Diagnosis and Treatment of Adjustment Disorders

Grand Itasca Clinic & Hospital is seeking a board certified/board eligible outpatient Pediatric Physician to join our busy and growing primary care clinic practice. Grand Itasca is a fully integrated multi-specialty clinic and hospital located in Grand Rapids, Minnesota.

Pediatric Physician

Partners in Pediatrics, Ltd. is seeking a full time BC/BE Pediatrician. The standard work week for a full-time pediatrician is 4 days a week plus a rotation of nights and weekends. Night and weekend shifts are shared equally among all providers. The salary package is competitive. You will have paid time off (PTO) and be given a CME allowance as well as CME days to further your medical education. We offer health, dental, disability and life insurance. You will also be eligible for a lucrative profit sharing 401(k). For inquiries, please contact our recruiting leads, Dr. Lisa Irvin at lirvin@pipstop.com and Dr. Megan Camerino at mcarmerino@pipstop.com

BC/BE Pediatrician

We’re excited to announce an opening for a Communications Manager at the Minnesota Chapter of the American Academy of Pediatrics (MNAAP). This part-time, remote role is a unique opportunity for a communications professional with at least five years of experience, who is passionate about advancing child health through advocacy, education, and special projects.

Joel Oberstar, MD Category