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Showing papers in "Journal of Psychosocial Nursing and Mental Health Services in 2005"


Journal Article•DOI•
TL;DR: It is suggested that residents' limited opportunities for communication with staff are primarily focused on care tasks, and staff can learn to modify conversational topics to better meet older adults' psychosocial needs.
Abstract: Nursing home residents primarily rely on staff for communication and interpersonal relationships. Challenged by staffing shortages and increasingly complex care, staff who provide the most communication with residents lack awareness and skills to effectively communicate with older adults. This study, a secondary analysis of staff-resident interactions from one nursing home, explores communication topics and the effects of an intervention. Staff from one unit were recorded during 2 hours of caregiving to provide a representative sample of their communication with residents. Staff then attended an educational program targeting improved awareness of communication needs and reducing "elderspeak". Recording was repeated post-intervention. Baseline conversations focused on activities of daily living (ADLs), personal-social, technical care, and health assessment. Post-intervention ADL talk decreased in staff-resident interactions, while personal-social topics increased. These findings suggest that residents' limited opportunities for communication with staff are primarily focused on care tasks. With increased communication awareness, staff can learn to modify conversational topics to better meet older adults' psychosocial needs.

55 citations


Journal Article•DOI•
TL;DR: A communication training program is described that significantly reduced the use of elderspeak by nursing assistants and led to a more respectful, less controlling, and equally as caring communication between Nursing assistants and nursing home residents.
Abstract: Because communication behaviors are difficult to change, practicing speech without elderspeak is helpful in preparing for actual clinical situations. The Communication Enhancement Model describes potential benefits of eliminating elderspeak in speech to older adults. Minimizing the use of elderspeak is hypothesized to reduce stereotype-based messages that older adults are incompetent and dependent. An improved communication environment promotes the cognitive and functional abilities of older adults. Achieving optimal communication environments may contribute to higher levels of well-being for older adults and to increased quality of life. Young adult care providers also may benefit from increased job satisfaction if they relate closely with care recipients.

54 citations


Journal Article•DOI•
Janet Colaizzi1•
TL;DR: The use of restraints in the care of psychiatric patients has been a topic of ethical controversy since the beginning of psychiatric medicine and American alienists expressed misgivings about the use of mechanical and chemical restraint but most were reluctant to relinquish any usable intervention.
Abstract: (1) The use of restraints in the care of psychiatric patients has been a topic of ethical controversy since the beginning of psychiatric medicine. (2) Enlightenment physicians regarded psychiatric illness as the loss of reason, and many advocated the use of restraints to help violent patients regain the use of reason. (3) John Conolly, a British alienist (a term used for psychiatrists) of the mid 1800s, claimed it was possible to treat psychiatric patients without the use of mechanical restraints, but he made liberal use of seclusion and physical restraint by attendants to manage violent behavior. (4) American alienists expressed misgivings about the use of mechanical and chemical restraint but most were reluctant to relinquish any usable intervention.

51 citations


Journal Article•DOI•
TL;DR: Posttraumatic stress disorder (PTSD) is characterized by symptoms in three domains: reexperiencing the trauma, avoiding stimuli associated with the traumatization, and symptoms of increased autonomic arousal.
Abstract: 1 Veterans of the military conflicts in Iraq and Afghanistan may have been exposed to significant psychological stressors, resulting in mental and emotional disorders 2 Posttraumatic stress disorder (PTSD) is characterized by symptoms in three domains: reexperiencing the trauma, avoiding stimuli associated with the trauma, and symptoms of increased autonomic arousal 3 Treatment of PTSD often requires both psychological and pharmacological interventions 4 In addition to PTSD, other mental disorders may be precipitated or worsened by exposure to combat, including depression, anxiety, psychosis, and substance abuse

47 citations


Journal Article•
TL;DR: This phenomenological study describes and enhances the understanding of what life is like for 6 mothers living with suicidal adolescents, and identifies six themes: failure as a good mother, the ultimate rejection, feeling alone in the Struggle, helplessness and powerlessness in the struggle, cautious parenting, and keeping an emotional distance.
Abstract: Adolescents who exhibit suicidal behaviors have a devastating effect on their mothers, but unfortunately, the mothers' experience is often the hidden dimension in the family. Currently, there is a considerable lack of research into the maternal experience of living with a suicidal adolescent. This phenomenological study describes and enhances the understanding of what life is like for 6 mothers living with suicidal adolescents. The data were collected through unstructured interviews. Thematic analysis using van Manen's methodology identified six themes: failure as a good mother, the ultimate rejection, feeling alone in the struggle, helplessness and powerlessness in the struggle, cautious parenting, and keeping an emotional distance. From these themes, the essence, "multiple loss and unresolved grief," was captured. The findings have implications for nursing education, practice, and research. In the provision of quality family-centered care, nurses can be educated and guided in their interventions by phenomenological research that recognizes the importance of the maternal perspective in the experience of living with suicidal adolescents.

40 citations


Journal Article•DOI•
Mikki Meadows-Oliver1•
TL;DR: An integrative review was conducted of 12 research articles that compare social support among low-income housed mothers and homeless mothers, using guidelines set forth by Ganong to better understand the relationship between social support and female-headed homeless families.
Abstract: Homelessness has been associated with levels of stress beyond the normal strain of living in poverty. For mothers who are homeless, support from their social networks may provide a buffer from some of the stresses associated with being homeless. To better understand the relationship between social support and female-headed homeless families, an integrative review was conducted of 12 research articles that compare social support among low-income housed mothers and homeless mothers, using guidelines set forth by Ganong. The included studies revealed four significant attributes of social support among housed and homeless mothers: size of the social support network; composition of the social support network; contacts with members of the social support network; and perceived support from members of the social support network. Nurses who work with homeless families are in a position to help develop ways for these families to cultivate and maintain their social support networks while homeless. Nurses can be available to offer support, including the necessary mental health services or referrals.

35 citations


Journal Article•DOI•
David Roe1•
TL;DR: This study explored how the course of SMI is related to individuals' subjective experience of self and conceptual and clinical implications of the relation between self and illness over time.
Abstract: A growing body of literature on the subjective experiences of people with severe mental illness (SMI) reveals the importance of the experience of self. The current study explored how the course of SMI is related to individuals' subjective experience of self. Bimonthly, comprehensive, semi-structured interviews with 43 people who had been discharged from psychiatric hospitalization were conducted over a 1 -year period. Qualitative analysis of the data revealed mutual influences between the experience of self and illness over time. Conceptual and clinical implications of the relation between self and illness are discussed.

30 citations


Journal Article•DOI•
TL;DR: The nursing profession has traditionally sought to explain sophisticated language to patients in understandable terms, and nurses serve in encouraging, supporting, and evaluating roles, all of which will be increasingly important as science and technology discover more information about the neurobiological basis for mental illnesses.
Abstract: Posttraumatic stress disorder (PTSD) is a disabling and prevalent psychiatric disorder. Researchers and scientists have developed a neurobiological basis, which provides a framework for understanding the complexities of PTSD, for many symtoms of the disorder. The estimated lifetime prevalence of PTSD among adult Americans is 7.8%, with women twice as likely as men to have PTSD. Onset of symptoms can occur years after exposure to trauma, and the duration of the illness can last a lifetime. Patients with PTSD often encounter multiple psychosocial problems that result from the symptoms they experience, and their distorted perceptions can affect relationships within the family and the workplace. Nurses in various roles (e.g., educator, therapist, prescriber, case manager, staff nurse) may encounter individuals with PTSD. The nursing profession has traditionally sought to explain sophisticated language to patients in understandable terms, and nurses serve in encouraging, supporting, and evaluating roles, all of which will be increasingly important as science and technology discover more information about the neurobiological basis for mental illnesses.

30 citations


Journal Article•DOI•
TL;DR: Cognitive-behavioral therapy is a highly effective treatment that decreases symptoms within 3 months and maintains gains at 2 years posttreatment, and personal psychotherapy demonstrates effectiveness by teaching adolescents how to self-monitor feelings, problem solve, link affect to events, and foster communication skills within the context of a supportive relationship.
Abstract: (1) Depression is a serious mental health problem particularly in children and adolescents that requires early identification and intervention. (2) Cognitive-behavioral therapy is a highly effective treatment that decreases symptoms within 3 months and maintains gains at 2 years posttreatment. It works by changing cognitive distortions and teaching problem solving and coping strategies. (3.)Interpersonal psychotherapy demonstrates effectiveness by teaching adolescents how to self-monitor feelings, problem solve, link affect to events, and foster communication skills within the context of a supportive relationship. 4(.)Psychopharmacological treatment has shown moderate effectiveness in treating depression in children and adolescents, but close monitoring is required to evaluate for adverse events, including suicidal behavior and agitation.

29 citations


Journal Article•DOI•
TL;DR: Frequent, consistent support of clients experiencing IPV from their families and friends is of considerable importance and can facilitate the buffering effects of such support against suicidal ideation and suicidal attempts.
Abstract: (1) Clients exposed to intimate partner violence (IPV) are at considerable risk for depression, suicide, and homicide. (2) Disclosure of IPV should be accompanied by nonjudgmental, careful, clear documentation of physical and emotional findings by nurses, including direct statements in clients' own words. (3) Frequent, consistent support of clients experiencing IPV from their families and friends (including nonjudgmental listening, unconditional acceptance, discussion of options, and exploring decisions) is of considerable importance and can facilitate the buffering effects of such support against suicidal ideation and suicidal attempts.

27 citations


Journal Article•DOI•
TL;DR: The majority of people diagnosed with autism do not have symptoms of mental retardation and need access to mainstream services to work on the problems presented by daily life.
Abstract: Autism is a behavioral diagnosis characterized by a triad of impairment, which includes impaired communication, impaired social skills, and impaired spontaneity. The outward behavior exhibited by people with autism represents a different cognitive processing style than that seen in typical development. Understanding the way people with autism process and store information is important for intervention. The majority of people diagnosed with autism do not have symptoms of mental retardation and need access to mainstream services to work on the problems presented by daily life.

Journal Article•DOI•
TL;DR: It is indicated that banning smoking on an acute admissions unit is feasible and well tolerated by patients and staff, although it may require extra vigilance for smoking-related contraband.
Abstract: In contrast to general medical hospitals, psychiatric hospitals often allow patients to smoke cigarettes. In addition to obvious health concerns, smoking can also interfere with clinical assessments and therapeutic activities, Implementation of a smoking ban on an acute male admissions unit did not result in any increase in aggressive behaviors. In addition, staff attitudes following the ban improved, and most staff members believed the ban was both ethical and beneficial to patients. Our research indicates that banning smoking on an acute admissions unit is feasible and well tolerated by patients and staff, although it may require extra vigilance for smoking-related contraband.

Journal Article•DOI•
TL;DR: The arts project promotes well-being and lifelong learning for the ward community through meaningful engagement in creative activity and has had wider implications for both staff and service users in reducing stress.
Abstract: A recent study of occupational stress on the unit (Clare, 2004) highlighted that staff valued the importance of the socialization process in reducing their stress levels. This process incorporates the need for peer support and acceptance, and an understanding of what is expected of them (e.g., roles and responsibilities), supported by a culture of learning, problem solving, and working together. This process is similar to the approach taken by the arts project in nurturing ideas and initiatives in a safe, respectful way. It is apparent that the arts project has been more than just a creative activity; it has had wider implications for both staff and service users in reducing stress. It has: * Enabled staff retention. In fact, there is a waiting list of nurses wishing to work on the unit. * Reduced incidents of damage to property. * Reduced use of p.r.n. medication. * Enhanced the good reputation of the service, which is often commented on by visitors to the unit. The arts project promotes well-being and lifelong learning for the ward community through meaningful engagement in creative activity.

Journal Article•DOI•
TL;DR: This paper found that most people with mental illnesses have made at least one attempt to quit smoking on their own and that psychiatric diagnosis and degree of nicotine dependence do not appear to be predictive of ability to quit.
Abstract: 1. Most people with mental illnesses have made at least one attempt to quit smoking on their own. 2. Psychiatric diagnosis and degree of nicotine dependence do not appear to be predictive of ability to quit. 3. People with mental illnesses are aware of nicotine replacement therapy (NRT), but do not combine it with a behavioral program, possibly contributing to the higher rates of recidivism in this population. 4. The lack of participation of mental health care providers in promoting smoking cessation is a complex issue.

Journal Article•DOI•
Holly M. Harner1•
TL;DR: Policy developed to protect young people from victimization, including mandatory reporting and statutory rape laws, should be evaluated for their consistent application to all children, regardless of age, race, gender, or pregnancy status.
Abstract: Although the mechanism by which early victimization, specifically sexual abuse, increases the risk of adolescent pregnancy is unclear, a relationship between previous victimization and adolescent pregnancy has been demonstrated. While partnering with an older man may initially offer the means necessary to escape a neglectful or violent family of origin, this protection be accompanied by an imbalance of power and control. Both adolescent mothers partnered with adult men and adolescent mothers partnered with male peers reported sexual abuse perpetrated by family members, family friends, strangers, and peers. Policies developed to protect young people from victimization, including mandatory reporting and statutory rape laws, should be evaluated for their consistent application to all children, regardless of age, race, gender, or pregnancy status.

Journal Article•
TL;DR: In this paper, a phenomenological study describes and enhances the understanding of what life is like for 6 monthers living with suicical adolescents, through unstructured interviews.
Abstract: Adolescents whe exhibit suicidal behaviors have a devastating effect on their mothers but unfortunately, the mothers exprience is often the hidden dimension in the family. maternal experience of living with a suicidal adolescent. This phenomenological study describes and enhances the understanding of what life is like for 6 monthers living with suicical adolescents. The data were collected through unstructured interviews. Thematic analysis using van Manen's methodoogy identified six themes: fallure as a good mother the ultimate rejection, feeling alone in the struggle, helplessness and powerlessness in the struggle, cautious parenting, and keeping an emotional distance. From these themes, the essence. multiple loss and unresoived grief, was captured. The findings have implications for nursing education, practice, and research. In the provision of quality family-centered care, nurses can be educated and guided in their interventions by phenomenological research that recognizes the practice, and research. In the provision of quality family-cen importance of the maternal perspective in the experience of living with suicidal adolescents.

Journal Article•DOI•
TL;DR: An overview of the body of research on medication administration hassles is provided and a tool to assess family caregivers who are involved in this important aspect of care is offered.
Abstract: Managing the medication regimens of dependent older adults in the home is a complex issue for family caregivers. The tasks involved can include helping the older adults manage their own medications or may require involvement in the purchasing, scheduling, and administering of multiple medications for serious conditions. The hassles associated with this responsibility are now known to be associated with increased caregiver strain. In this article, we provide an overview of the body of research on medication administration hassles and offer a tool to assess family caregivers who are involved in this important aspect of care.

Journal Article•DOI•
TL;DR: This article explores how, even with devastating changes in a loved one's sense of identity, one can find ways to respect a new level of relationship: I still feel that he's [Sherry's husband] a human being, and I've tried to ensure that he has a quality of life.
Abstract: The information presented in this article is meant not to provide answers, but rather to provoke thought about questions related to ethical decision making in people with Alzheimer's disease. Post (1995) suggested that: among the several most urgent questions of our time is whether human beings have in place the moral and ethical signposts that can point toward a future in which those who are so forgetful will be treated with dignity. (p. 1) Because American society places a high value on rationality and productivity, the life of people with Alzheimer's disease may be equated with hopelessness and uselessness. Thus, health care professionals have a moral obligation to rethink the assumptions that underlie their definitions of quality of life. We cannot know what should be done unless we learn to listen to the life stories of our patients and their families. Perhaps Sherry's comment best reflects how, even with devastating changes in a loved one's sense of identity, one can find ways to respect a new level of relationship: I still feel that he's [Sherry's husband] a human being, and I've tried to ensure that he has a quality of life. When I go visit him, sometimes he slips in and out of being normal. I would always hope that he's still treated with the dignity that he should have as a human being.... I guess what I'm saying is that, even though it seems weird,...there's still a human being in there sometimes, I guess there really is, and it's important to remember that. I can enjoy my husband a lot more now [that he's being cared for in a facility] than I could when I had him 24 hours a day. That was a nerve-wracking experience, especially when there were behavior problems.... He's still the love of my life.

Journal Article•DOI•
TL;DR: The aim of treatment of girls who self-harm is to facilitate understanding of the act and provide alternative, healthier coping strategies.
Abstract: People who self-harm are typically intelligent, adolescent or young adult, middle to upper class girls, who do so to feel something or, paradoxically, to stop feeling and calm down. Girls who self-harm need to feel understood, listened to non-judgmentally, and responded to in relation to the unspoken suffering behind the self-harm behavior. The aim of treatment of girls who self-harm is to facilitate understanding of the act and provide alternative, healthier coping strategies.

Journal Article•DOI•
TL;DR: The findings indicated that very few nurses had dated or engaged in sexual intercourse with discharged patients, and the few nurses who had done so tended to be younger men prepared at the registered psychiatric nursing diploma level.
Abstract: This was the first research study in Canada to explore intimacy boundary violations and sexual misconduct between nurses (both RNs and registered psychiatric nurses) and patients. Using a researcher-generated survey, a total of 923 mental health nurses commented on their sexual attraction to patients, and dating and sexual intercourse patterns with patients. The findings indicated that very few nurses had dated or engaged in sexual intercourse with discharged patients, and the few nurses who had done so tended to be younger men prepared at the registered psychiatric nursing diploma level. A small number of nurses believed it was permissible to have a sexual relationship with a patient while the patient was hospitalized, but none reported having a current relationship. Given the severity of this intimacy boundary violation, nurses need to be educated regarding the serious and dangerous psychiatric effects that can result for patients from engaging in a sexual relationship with nurses. The Code of Ethics of the Canadian Nurses Association and nurses' obligation to follow it needs to be reinforced. Nurses engaging in intimacy boundary violations are vulnerable to patient-initiated lawsuits.

Journal Article•DOI•
TL;DR: Establishing a therapeutic nurse-patient relationship helps forensic nurses perform accurate and useful risk assessments and facilitate formulation of individualized risk management plans, designed to meet patients' needs and ensure public safety.
Abstract: One of the unique roles of forensic nurses is to conduct risk assessments. Establishing a therapeutic nurse-patient relationship helps forensic nurses perform accurate and useful risk assessments. Accurate risk assessments can facilitate formulation of individualized risk management plans, designed to meet patients' needs and ensure public safety. The importance of forensic nurses' knowledge and application of appropriate communication and proper documentation cannot be overemphasized.

Journal Article•DOI•
TL;DR: At the end of the 3-year program, there were no new addicted individuals, and the number of addicted individuals decreased from 112 to 50 (after first treatment) and 26 (after second treatment).
Abstract: The goal of this project was to implement a model of drug abuse prevention, drawing on health care, psychosocial and legal principles, in a selected village community in Thailand. Primary, secondary, and tertiary prevention strategies were used within a nursing conceptual framework that included the interactions among the person, drugs, and environment. An initial community survey revealed 112 addicted individuals and identified many at-risk groups, such as children of addicted parents, adolescents, and women. Primary health care and dental health services were provided in the community, as well as drug abuse education and activities for school children and at-risk groups. Treatment camps were also established in the community on two occasions to provide detoxification and rehabilitation services for addicted individuals. At the end of the 3-year program, there were no new addicted individuals, and the number of addicted individuals decreased from 112 to 50 (after first treatment) and 26 (after second treatment). In addition, the villagers were more aware of problems related to using opium and heroin and of modern, approved drugs to treat illnesses. The prevention strategies were beneficial for the community members, as well as the addicted individuals and their families.

Journal Article•DOI•
TL;DR: Techniques nurses can use to facilitate understanding include restating what was heard to ensure understanding and to demonstrate active listening, asking open-ended questions, and checking for understanding.
Abstract: 1 Patients experience greater satisfaction with nursing care when they are truly understood 2 Being aware of taken-for-granted meanings and committing the time to seek clarification and explore meanings are two basic principles that can facilitate understanding 3 Techniques nurses can use to facilitate understanding include restating what was heard to ensure understanding and to demonstrate active listening, asking open-ended questions, and checking for understanding

Journal Article•DOI•
TL;DR: Current intervention strategies, which are considered best practice guidelines for early treatment of psychotic illness, are summarized.
Abstract: This article shares information about an exciting new approach in psychiatry. During the past 12 years, the authors have worked with young people experiencing their first episode of psychosis. It is clear that intervention at the earliest stages of psychotic illness allows clinicians to make a significant difference in the lives of young people and their families. This article summarizes current intervention strategies, which are considered best practice guidelines for early treatment.

Journal Article•DOI•
TL;DR: Self-report instruments for depression and suicide risk can help busy clinicians identify adult clients who may be at risk for depressive disorders and improve clinical decision making when self-report screening tools are used.
Abstract: Self-report instruments for depression and suicide risk can help busy clinicians identify adult clients who may be at risk for depressive disorders. These instruments provide a baseline measure of clients' behavioral status, reflect response to treatment, and improve clinical decision making. Such scales can also detect symptoms of depression regardless of whether they are reported or observed. Clinicians' recognition of depression is improved when self-report screening tools are used. When it is not feasible to conduct a thorough psychiatric evaluation, screening instruments can identify at-risk clients who need further evaluation.

Journal Article•DOI•
TL;DR: Cryotherapy is an alternative treatment that may be helpful to some patients with ECT-induced headaches and whether headache intensity and physiological measurements could predict use of an alternative analgesic (rescue medication) is investigated.
Abstract: Because headache is a common side effect of electroconvulsive therapy (ECT), this study sought to determine the effectiveness of cryotherapy (i.e., a frozen gel band) in relieving pain in patients with post-ECT headaches, and whether headache intensity and physiological measurements could predict use of an alternative analgesic (rescue medication). We used a quasi-experimental, crossover design to collect data from 31 patients ages 24 to 85 who had been referred for ECT at two medical facilities in San Diego, California. Measurements of patients' pain intensity were made at three intervals: upon perceiving headache, and at 30 and 60 minutes following the cryotherapy or acetaminophen interventions, based on the order of the crossover design. Data were analyzed using Hotelling's T 2 and logistic regression. No significant difference was found between cryotherapy and acetaminophen in relieving ECT-induced headaches (p = .420). There was no influence due to the crossover design (p = .313), nor where there significant changes in physiological measures from treatment (p = .420). Logistic regression showed that 50% of patients required rescue medication after 60 minutes for both treatments (R 2 = .498, p = .001), and 66% required rescue medication based on pain level and physiological measures (R 2 = .662, p <.008). Based on these results, cryotherapy is an alternative treatment that may be helpful to some patients with ECT-induced headaches.

Journal Article•DOI•
TL;DR: Nurses working with young people with ADHD in the justice system must carefully coordinate care among all health care providers and juvenile justice personnel, including attorneys, probation/parole officers, and court assessment personnel.
Abstract: 1. When working with juvenile offenders with ADHD, advanced practice nurses should consider prescribing stimulant medication in conjunction with other psychosocial interventions to achieve maximum treatment success. 2. Nurses working with young people with ADHD in the justice system must carefully coordinate care among all health care providers and juvenile justice personnel, including attorneys, probation/parole officers, and court assessment personnel. 3. Advocating for the individual needs of clients and their families is critical; often, this includes advocating for care that is not only evidence based, but also culturally competent.


Journal Article•DOI•
TL;DR: There is a need to address psychological emergency preparedness for mass disasters with the development of protocols and practice guidelines and incorporating rapid, cost-effective mental health assessments for children and adolescents.
Abstract: The effects of disasters may predispose many adolescents to psychological stress, which can interfere with their growth and development and disrupt their intrapsychic homeostasis. This may lead to negative long-term health outcomes and hamper normal development. Many nurses view traumatic events involving children, including adolescents, as the most frequent and stressful critical incidents. There is a need to address psychological emergency preparedness for mass disasters with the development of protocols and practice guidelines. Assessing and managing physical injuries may take priority in emergencies, but incorporating rapid, cost-effective mental health assessments for children and adolescents is essential.

Journal Article•DOI•
TL;DR: Recommendations include incorporating medications into comprehensive, holistic treatment, assessing for onset of severe akathesia as a marker of increased risk for self-harm, and advocating for more clinical trials of these medications in different childhood age groupings.
Abstract: The regulatory bodies of both the United States and United Kingdom have issued cautionary statements about prescribing antidepressant medications to treat major depressive disorder (MDD) in children younger than age 18. Despite these cautions, antidepressant agents, particularly SSRIs and serotonin activators, are regularly used to treat MDD in this age group, and increasingly so in very young children. This article considers the possible effects of antidepressant agents on the growth and development of children younger than age 18 and provides recommendations for the use and careful monitoring of these medications, including screening for physiological effects, selfinjurious behavior, and suicidal ideation. Guidelines for use of antidepressant agents with these populations include incorporating medications into comprehensive, holistic treatment, assessing for onset of severe akathesia as a marker of increased risk for self-harm, and advocating for more clinical trials of these medications in different childhood age groupings.