CHILD ANXIETY & TIC DISORDER CLINIC
Faculty: Tanya Murphy, M.D.
Second year Child & Adolescent Psychiatry residents complete a four-month rotation in the UF Child/Adolescent Anxiety & Tic Disorder Clinic at Shands Children’s Hospital. The overall goal of this rotation is to learn, practice, and apply psychiatric skills in the evaluation, diagnosis, treatment, and management of children and adolescents with a variety of anxiety and tic disorders. In addition to the clinic rotation, there is an optional research option.
A. Required 4 months rotation occurring in the second year at Institution 1 and requiring 10% of the resident’s time.
B. Faculty consists of 1 full-time child psychiatrist and 1 full-time clinical psychologist.
C. Residents spend 1.5-2 hours for new evaluations, which consist of interviews with patient & family and review of standardized assessment tools. Residents also conduct follow-up visits. Faculty is available on-site for consultations, and all new patients are seen with attending faculty. Psychology services are available to address testing needs or assess appropriateness for CBT interventions.
D. This clinic population consists of 46% females and 54% males, ages 5 to 17 years, with an average age of 10.7 years. The patients are mostly Caucasians (over 90%), with the remainder consisting of African American, Asian and Hispanic youths. The children and adolescents served have obsessive-compulsive disorder (30%), Tourette’s syndrome or other tic disorders (40%), separation anxiety (4%), phobias (5%), generalized anxiety disorder (16%), and other anxiety disorders. Treatment modalities in the clinic include medications, various individual therapies, including cognitive behavioral therapy, parent and patient education; occasional nutritional supplementation, and occasional family therapy.
E. On average, a resident follows 4 to 6 patients, for medication management and psychotherapies.
F. All new and follow up patients are discussed with the faculty on an individual basis before any recommendations are made to the patient and family. Faculty is also available to see these patients with residents.
G. Following are the goals and objectives for this rotation:
Goal: To become proficient in applying psychiatric skills in the evaluation, diagnosis, treatment, and management of children and adolescents with a variety of anxiety and tic disorders
Objectives:
Knowledge: The resident should demonstrate knowledge of the fundamentals of evaluation, diagnosis, and treatment of children and adolescents with a variety of anxiety disorders, such as obsessive-compulsive disorder, Tourette’s syndrome, other tic disorders, trichotillomania, separation anxiety, phobias, generalized anxiety disorder, panic disorder and Asperger’s syndrome. Furthermore, the resident should be aware of
- The most common co-morbid diagnoses of children and adolescents with primary anxiety and/or tic disorders and how this impacts evaluation and treatment.
- The role of pharmacotherapy and cognitive behavioral therapy in the treatment of anxiety and tic disorders, including drug interactions and contraindications.
- Negative stereotypes surrounding anxiety and tic disorders.
- Psychological, social, economic, and cultural issues pertaining to patients and families dealing with anxiety and tic disorders.
Skills: The resident should demonstrate ability to
- Perform a child/adolescent specific physical, neurological and mental status exam.
- Assess neuropsychiatric disorders in an outpatient setting.
- Interview children, adolescents and their families.
- Perform oral case presentations.
- Communicate effectively.
- Counsel and educate patients/families about their specific disorder (s) and the resources available to them.
- Write clear, concise clinical assessment/evaluation reports in a timely manner.
Attitudes: The resident should demonstrate
- A strong sense of responsibility for patients/families demonstrated by respect, compassion and integrity.
- Commitment to supervision to continuously improve his/her skills in the evaluation, diagnosis, treatment and management of children and adolescents with anxiety and tic disorders.
- Ethical conduct in the treatment of all patients and families, including confidentiality of patient information, informed consent, right to refuse treatment, and business practices.
- Sensitivity and responsiveness to patient’s/family’s culture, age, gender, and disabilities.
- Ability to resolve conflicts between personal-moral convictions and patient/family’s choices.
- Good self-assessment skills and a willingness to admit mistakes.
