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Although conversion disorder rarely is diagnosed formally in ordinary pediatric practice, busy pediatricians often do encounter the phenomenon of conversion. Conversion is the experiencing of unacceptable emotional conflicts as symptoms, usually but not always physical, rather than as mental events. Conversion is commonplace, affecting almost all body systems. It must be recognized and managed appropriately early in its course, lest inappropriate evaluations and treatments occur; in addition to their other costs, such unnecessary procedures may introduce the child inadvertently to such symptomatization as a life-long pattern of behavior. More than a century ago, Briquet recognized that at least 50% of adult "professional patients" begin their symptomatic careers before puberty; thus, inappropriate care of the young patient who has conversion symptoms may have serious, long-lasting consequences. Problems in Diagnosing Conversion The traditional diagnostic elements of conversion often are difficult to demonstrate in pediatric practice. Almost all are either not specific to conversion or hard to confirm in young patients for reasons of developmental immaturity. These "standard" elements include the following: • Stress or conflict preceding symptoms (true of many illnesses) • Unconscious symptom production outside the patient's awareness (thus often inaccessible to the pediatrician) • A model for the symptom (either unverifiable or prone to observer bias) • Primary gain or relief of underlying conflict (again, difficult to confirm)

As stated initially, a significant proportion of health problems of youths have genetic predispositions and potentially identifiable antecedents of disease during childhood and adolescence. Until there is advancement in delineating the multiple dimensions and relationships of a psychobiologic developmental framework, interventions may fall short of their potential to either prevent or ameliorate these problems. To date, research has been limited by narrow definitions, lack of uniformity among measures, small samples, and homogenous populations. As a forward step, longitudinal investigations of subpopulations of youths may provide an opportunity for definitive study of the basic processes of puberty and be fruitful in evaluating the deleterious effects that stresses of contemporary life place on children and adolescents. In addition, efforts to communicate existing knowledge across disciplines and to approach psychobiologic research from an interdisciplinary perspective will enhance an understanding of the interplay of social, biologic, and environmental factors that are essential in the maturational process. This multidimensional approach with newer, broader perspectives is critical to advancing the development of a psychobiologic framework that will shed further light on the mechanisms of maturation and the interferences of this pubertal process that is the hallmark of adolescence.

The management of adolescent suicidal behavior in the practices of 48 pediatricians from Rochester and Syracuse, New York, was reviewed in the context of a rising local and national incidence. Alternative resources were found to be used much more heavily by suicidal adolescents in the two communities. Few pediatricians ask routinely about suicidal thoughts. The fatality rate is low enough to reinforce present practice, but suicidal symptoms are far more frequent than fatalities. It is hypothesized that avoidance of the issue by the pediatrician results in underutilization of this potentially valuable resource. Asking about the problem may result in a higher contact rate and, it is proposed, a better outcome. Depressive symptoms and appropriate responses to suicidal thinking are discussed.

Adolescents who have grand mal epilepsy and their parents were interviewed, and the adolescents were evaluated neurologically. Better seizure control and less neurologic disability were unexpectedly associated with less open communication between the adolescents and their families and friends, and with a poorer self-image and poorer expectations for the future. These findings were unrelated to IQ or school performance. This outcome is consistent with other studies of invisible defects and stigmatization, and suggests that youngsters who have relatively mild defects involving social disability may be more troubled than those with more apparent defects, for which denial may be operative. An incidental finding in the study was that a question more predictive of overall family, social, and academic function than the neurologic findings was simply whether or not the youngster was attending the appropriate grade in school for his or her age.

Adolescent depression and suicide are currently the focus of lively investigation. While diagnostic terminology and prevalence of depression remain unresolved, promising clarification is likely from the new assessment techniques readily available. These range from vigorous history taking and the use of questionnaires to biological tests. Associated depressive spectrum conditions are being defined. Like depression itself, they often respond to the new biological and psychological treatment methods of demonstrated effectiveness. Compounds are under development which may lessen side effects, and plasma antidepressant measurements are of proven value. Even with respect to adolescent suicidal behavior, where similar biological and psychological approaches have yielded less impressive results to date, energetic diagnosis and intervention can be lifesaving.

Bruno Bettelheim has spent his lifetime working on behalf of children and their secure upbringing. Having survived two concentration camps, he came to the United States and created a new therapeutic environment to help psychotic children survive their illnesses. He has frequently written about that experience; now he turns to a seemingly different subject, the fairy tale. He perceives an underlying continuity in his work, maintaining that the familiar fairy tale is, in fact, an art form, delineating the ultimate goal of child and man alike, a life with meaning. He indicates why other children's stories fail to attain this goal, and at the same time, why fairy tales themselves have fallen into disuse. In discussing their virtues, the author employs his extensive clinical experience, his engaging style, and, of course, the fairy tales themselves. Psychoanalytic assumptions constitute the organizing principle of his book, its consistency, and its occasional shortcomings