April 16, 1999

Making the transition from training in adult psychiatry to child psychiatry can be unsettling for residents because the old rules don't apply anymore.

"Very little I learned in my previous training prepared me for relating to children as a professional. Because they don't usually verbalize their feelings and problems, I would have kids coming to my office crying or screaming," said Jeff Bostic, M.D., Ed.D., a panelist at the annual meeting of the American Association of Directors of Psychiatric Residency Training last month in Santa Monica, Calif. Bostic is director of the school psychiatry program at Massachusetts General Hospital in Boston.

He soon realized he had to learn new forms of therapy to reach children. "When I tried techniques that worked well in adults, like empathy, five minutes later I had a kid bouncing a ball off my wall. However, it was hard on my professional identity to tell myself that now I am going to play on the floor with this kid.

"I also was painfully aware that I had gone from being destitute to poor. I had relocated and was moonlighting again while my colleagues in adult psychiatry were entering the workforce and earning more money."

He also had to develop an understanding of psychiatric disorders in children, which manifest themselves differently from those in adults.

"My treatment strategies based on the biopsychosocial model had to be refined with a greater emphasis on the social aspects. For example, rather than prescribe Prozac for a 2-year-old who appeared depressed, a colleague suggested I first try adding stimulation to the child's environment," said Bostic.

To develop a rapport with children and teenagers, Bostic learned new styles of communication. "I had to demedicalize my language and use different metaphors with children such as a cheetah running very fast for a few seconds and stopping to explain the physiology of panic attacks. To understand their world better, I familiarized myself with Nintendo games, the latest songs and artists, and main characters on popular television shows such as 'Beverly Hills 90210' and 'South Park.' "