French validity of two substance‐use screening tests among adolescents: A comparison of the CRAFFT and DEP‐ADO

A functional neuroimaging study of self-other processing alterations in atypical developmental trajectories of psychotic-like experiences

Self-disturbances constitute a hallmark of psychosis, but it remains unclear whether these alterations are present in at-risk populations, and therefore their role in the development of psychosis has yet to be confirmed. The present study addressed this question by measuring neural correlates of self-other processing in youth belonging to three developmental trajectories of psychotic experiences. Eighty-six youths were recruited from a longitudinal cohort of over 3800 adolescents based on their trajectories of Psychotic-Like Experiences from 12 to 16 years of age. Participants underwent neuroimaging at 17 years of age (mean). A functional neuroimaging task evaluating self- and other-related trait judgments was used to measure whole-brain activation and connectivity. Youth who showed an increasing trajectory displayed hypoactivation of the dorsomedial prefrontal cortex and hypoconnectivity with the cerebellum. By contrast, youth who showed a decreasing trajectory displayed decreased activation of the superior temporal gyrus, the inferior frontal gyrus, and the middle occipital gyrus. These findings suggest that the increasing trajectory is associated with alterations that might erode distinctions between self and other, influencing the emergence of symptoms such as hallucinations. The decreasing trajectory, in comparison, was associated with hypoactivations in areas influencing attention and basic information processing more generally. These alterations might affect the trajectories’ susceptibilities to positive vs. negative symptoms, respectively.

Neural alterations of emotion processing in atypical trajectories of psychotic-like experiences

The aim of this study was to investigate the neural bases of facial emotion processing before the onset of clinical psychotic symptoms in youth belonging to well-defined developmental trajectories of psychotic-like experiences (PLEs). A unique sample of 86 youths was recruited from a population-based sample of over 3800 adolescents who had been followed from 13 to 17 years of age. Three groups were identified based on validated developmental trajectories: a control trajectory with low and decreasing PLEs, and two atypical trajectories with moderate to elevated baseline PLEs that subsequently decreased or increased. All had functional magnetic resonance imaging data collected during a facial emotion processing task. Functional activation and connectivity data were analyzed for different contrasts. The increasing PLE trajectory displayed more positive psychotic symptoms while the decreasing trajectory exhibited more negative symptoms relative to the control group. During face processing, both atypical trajectories displayed decreased activations of the right inferior frontal gyrus (IFG), while the increasing trajectory displayed a negative signal in the precentral gyrus. The increasing PLE trajectory also displayed impaired connectivity between the amygdala, ventromedial prefrontal cortex, and cerebellum, and between the IFG, precuneus, and temporal regions, while the decreasing trajectory exhibited reduced connectivity between the amygdala and visual regions during emotion processing. Both atypical PLE trajectories displayed alterations in brain regions involved in attention salience. While the increasing trajectory with more positive symptoms exhibited dysconnectivity in areas that influence emotion salience and face perception, the decreasing trajectory with more negative symptoms had impairments in visual information integration areas. These group-specific features might account for the differential symptom expression.

Social integration and substance use: assessing the effects of an early intervention programme for youth

AIM

Appropriate social integration has been shown to be a protective factor against substance use among adolescents and associated negative consequences. Promoting social integration through early intervention with adolescents using substances is thus necessary and is the aim of the Identification, Assessment and Follow-up of Adolescents with Substance Use (in French, Dépistage - évaluation - parrainage d'adolescents consommateurs de substances (DEPART) programme. The present study aimed to describe this programme and its participants from 2009 to 2013 as well as to assess its effects on social integration.

METHODS

Data from 398 adolescents using substances who attended the DEPART programme were analysed.

RESULTS

The results showed that almost 80% of the adolescents admitted to the DEPART programme were boys, with a large proportion using cannabis. Globally, social integration did not increase from admission to discharge from the programme, but a shift was observed for school and professional integration. Additionally, after the intervention, we observed that social integration was more important in younger patients.

CONCLUSIONS

This study showed that adolescents with problematic substance use mostly consumed soft drugs and that those who were integrated into the DEPART programme at a younger age were more likely to be socially integrated at the end of the programme.

[Evaluation of the Brazilian version of the CRAFFT/CESARE scale for screening drug use by adolescents]

The scope of this article is to present the Brazilian version of the CRAFFT scale for screening drug use among adolescents and to assess its comprehensibility. It is a descriptive and quantitative study, which evaluated the applicability of the Brazilian version of the CRAFFT scale through a convenience sample of adolescents aged 14-21 enrolled at two technical schools. Three main aspects were evaluated: difficulty in understanding the scale; the validity of the translated scale comparing a subsample (28,8%) that also filled out the CEBRID questionnaire; and the percentage of adolescents who scored positive on the CRAFFT/CESARE using the pre-established cutoff point. The kappa coefficient was applied to establish correspondence between questionnaires and the ROC curve was used to evaluate the psychometric differences within different cutoffs. The CRAFFT/CESARE scale was applied in 2005 students, of which 1882 are within the defined age bracket. Only 2.2% of adolescents had difficulty in understanding the questions. The specificity of the CRAFFT/CESARE scale was 73.3%, and sensitivity was 87.1%. The concordance degree (Kappa) was considered good (0.461). The CRAFFT/CESARE scored positive in 36.2% of the adolescents.

Ecological Momentary Assessment (EMA) Goes to Jail

Abstract. Ecological Momentary Assessment (EMA) involves the repeated collection of data in everyday life. This method has helped uncover underlying mechanisms in several mental disorders. EMA studies are still scarce in adolescent patients and particularly incarcerated juvenile offenders (IJO), possibly due to their frequent rule-breaking and high impulsivity. This study evaluated the feasibility and reliability of EMA in IJO. One hundred three antisocial adolescents (mean age 14.8, 78% boys, including 52 IJO and 51 institutionalized antisocial adolescents, IAA) answered four times a day during 8 days questions about their antisocial behavior, negative affect, impulsivity, and fear of punishment, on a handheld computer. Staff members also regularly reported on each participant’s antisocial behavior. This first application of EMA in IJO overall supported its feasibility, with an excellent participation rate (95%) and a good compliance in completers (84%). About one-third of IJO participants dropped out, with no evidence of sampling bias across a wide range of indicators, while 96% of IAA completed EMA. No reactivity or lack of objectivity was observed. One- to two-thirds of the variance was within-person and reliability was acceptable to good. EMA can thus be reliably used in IJO to study the dynamics of daily antisocial behavior as it naturally unfolds in its context.

Psychometric properties of the German version of the CRAFFT

INTRODUCTION

The CRAFFT questionnaire is a widely utilized measure of problematic alcohol and drug use. The brief screening instrument has been translated into multiple languages, and some studies regarding its psychometric properties have been published. However, investigations on the factorial validity of the CRAFFT in a clinical sample are not available yet and empirical findings on the psychometric properties of the German version of the CRAFFT are very limited.

METHODS

Data were collected in a German sample of 316 adolescent patients treated in emergency departments following alcohol intoxication. Problematic alcohol use was assessed using the German version of the CRAFFT. Data concerning frequency and quantity of alcohol consumption were collected. A confirmatory factor analysis using the 6 items of the CRAFFT modelled as categorical indicators of a single latent factor using a robust weighted least squares estimator was conducted. We also calculated a reliability coefficient and correlations between the CRAFFT and external criteria of alcohol use.

RESULTS

The unidimensional model showed excellent global goodness-of-fit (χ(2)=9.76, df=8, χ(2)/df=1.22, RMSEA=0.027, CFI=0.983, TLI=0.976) and satisfying local parameters (standardized factor loadings between 0.37 and 0.69). We observed a poor reliability coefficient of 0.525. A positive association with alcohol use indicated construct validity of the German CRAFFT.

DISCUSSION

Concerning its factorial and construct validity the German version of the CRAFFT is a promising instrument for measuring problematic alcohol use in clinical adolescent populations, but the reliability has definitely to be investigated again in further studies.

Adolescent substance use screening in primary care: Validity of computer self-administered versus clinician-administered screening

BACKGROUND

Computer self-administration may help busy pediatricians' offices increase adolescent substance use screening rates efficiently and effectively, if proven to yield valid responses. The CRAFFT screening protocol for adolescents has demonstrated validity as an interview, but a computer self-entry approach needs validity testing. The aim of this study was to evaluate the criterion validity and time efficiency of a computerized adolescent substance use screening protocol implemented by self-administration or clinician-administration.

METHODS

Twelve- to 17-year-old patients coming for routine care at 3 primary care clinics completed the computerized screen by both self-administration and clinician-administration during their visit. To account for order effects, we randomly assigned participants to self-administer the screen either before or after seeing their clinician. Both were conducted using a tablet computer and included identical items (any past-12-month use of tobacco, alcohol, drugs; past-3-month frequency of each; and 6 CRAFFT items). The criterion measure for substance use was the Timeline Follow-Back, and for alcohol/drug use disorder, the Adolescent Diagnostic Interview, both conducted by confidential research assistant interview after the visit. Tobacco dependence risk was assessed with the self-administered Hooked on Nicotine Checklist (HONC). Analyses accounted for the multisite cluster sampling design.

RESULTS

Among 136 participants, mean age was 15.0 ± 1.5 years, 54% were girls, 53% were black or Hispanic, and 67% had ≥3 prior visits with their clinician. Twenty-seven percent reported any substance use (including tobacco) in the past 12 months, 7% met criteria for an alcohol or cannabis use disorder, and 4% were HONC positive. Sensitivity/specificity of the screener were high for detecting past-12-month use or disorder and did not differ between computer and clinician. Mean completion time was 49 seconds (95% confidence interval [CI]: 44-54) for computer and 74 seconds (95% CI: 68-87) for clinician (paired comparison, P < .001).

CONCLUSIONS

Substance use screening by computer self-entry is a valid and time-efficient alternative to clinician-administered screening.

Psychometric properties and concurrent validity of the CRAFFT among Norwegian adolescents. Ung@hordaland, a population-based study

The aim of the study was to examine the psychometric properties of the CRAFFT-questionnaire, and its concurrent validity with self-reported measures of alcohol consumption and illicit drug use ever among Norwegian adolescents. This study employs data from the ung@hordaland survey (N=9680). The concurrent validity of the CRAFFT-questionnaire was examined both as a case-finder with different cut-offs, but also as an ordinal scale. The ordinal scale was constructed by counting the number of affirmative responses from 0 to 6. Current self-reported excessive alcohol consumption, frequent binge drinking and any illicit drug use ever were employed as concurrent validity measures. The internal reliability of CRAFFT was adequate, and there was a linear relationship between CRAFFT-score and excessive alcohol consumption, frequent binge drinking and illicit drug use ever for both genders. Overall, this study shows a good concurrent validity and adequate psychometric properties of the CRAFFT-questionnaire. There results indicate, however, that the use of CRAFFT as a case-finder needs further research, as a suitable cut-point was difficult to determine. The authors conclude that in a clinical setting one positive answer is enough to warrant further investigation, and for research purposes the use of the questionnaire as an ordinal scale or using a cut-point of 2 might be preferable.

The prevention access and risk taking in young people (PARTY) project protocol: a cluster randomised controlled trial of health risk screening and motivational interviewing for young people presenting to general practice

BACKGROUND

There are growing worldwide concerns about the ability of primary health care systems to manage the major burden of illness in young people. Over two thirds of premature adult deaths result from risks that manifest in adolescence, including injury, neuropsychiatric problems and consequences of risky behaviours. One policy response is to better reorientate primary health services towards prevention and early intervention. Currently, however, there is insufficient evidence to support this recommendation for young people. This paper describes the design and implementation of a trial testing an intervention to promote psychosocial risk screening of all young people attending general practice and to respond to identified risks using motivational interviewing.

MAIN OUTCOMES

clinicians' detection of risk-taking and emotional distress, young people's intention to change and reduction of risk taking.

SECONDARY OUTCOMES

pathways to care, trust in the clinician and likelihood of returning for future visits. The design of the economic and process evaluation are not detailed in this protocol.

METHODS

PARTY is a cluster randomised trial recruiting 42 general practices in Victoria, Australia. Baseline measures include: youth friendly practice characteristics; practice staff's self-perceived competency in young people's care and clinicians' detection and response to risk taking behaviours and emotional distress in 14-24 year olds, attending the practice. Practices are then stratified by a social disadvantage index and billing methods and randomised. Intervention practices receive: nine hours of training and tools; feedback of their baseline data and two practice visits over six weeks. Comparison practices receive a three hour seminar in youth friendly practice only. Six weeks post-intervention, 30 consecutive young people are interviewed post-consultation from each practice and followed-up for self-reported risk taking behaviour and emotional distress three and 12 months post consultation.

DISCUSSION

The PARTY trial is the first to examine the effectiveness and efficiency of a psychosocial risk screening and counselling intervention for young people attending primary care. It will provide important data on health risk profiles of young people attending general practice and on the effects of the intervention on engagement with primary care and health outcomes over 12 months.

TRIAL REGISTRATION

ISRCTN16059206.

[Screening, referring and counseling of adolescents for substance abuse. A randomized controlled study on 2120 students]

OBJECTIVES

The DEP-ADO assessment questionnaire defines three alcohol- and drug-related risk levels: low (green light), intermediate (yellow light) and high risk (red light). Our study sought to evaluate whether a DEP-ADO systematic screening by school nurses and physicians improves referring to specialized addiction consultations.

METHOD

Randomized controlled study with allocation of subjects by matched pairs of school classes: 1045 adolescents received a group information; 1075 adolescents were met individually and filled in the questionnaire; then either they received a risk reduction oriented intervention (yellow light) or were referred to an addiction outpatient clinic (red light).

RESULTS

In the DEP-ADO group, 27 yellow lights (2.8%) and 15 red lights (1.6%) were identified. One adolescent of the DEP-ADO group actually went to the addiction consultation during the 3 months following the intervention (NS). Twenty youths consulted at least a second time the school nurse or physician, among whom 18 belonging to the intervention group and two to the control group (p=0.0003).

CONCLUSION

A systematic screening with the DEP-ADO questionnaire did not increase the reference rate to the addiction consultation. The links between age, smoking and risk level suggest screening strategies restraining, for the younger, proposal of the DEP-ADO to the pupils smoking tobacco. ROC-ADO study demonstrates the need to empower the relations between school health providers and addiction consultations.

Validity of a brief screening instrument-CRAFFT in a multiethnic Asian population

AIM

To validate the CRAFFT screening test, against the DSM IV Axis 1-based diagnostic inventory in a population of adolescents and young adult males in Singapore.

METHODS

The 23,248 participants belonged to a cohort of males who had undergone a medical examination prior to enlistment for military service. This study took place between August 2004 and August 2005. Subjects underwent a two-stage assessment and were administered the CRAFFT questionnaire and the Composite International Diagnostic Interview (CIDI).

RESULTS

The mean age of the subjects was 19 years (range, 16 to 26 years). The CRAFFT showed moderately high levels of internal consistency (Cronbach's α=0.73). The optimum cutoff point for drug-related disorder either abuse or dependence and alcohol-related disorder either abuse or dependence criterions were found at CRAFFT score of 1 or higher.

CONCLUSION

The CRAFFT test is a valid means of screening adolescents for substance-related disorders in a multiethnic population of adolescent and young adult males.

Primary care services provided to adolescents in detention: a cross-sectional study using ICPC-2

AIM

The aim of this study was to provide a detailed description of the health problems for which primary care services are provided to adolescents in a juvenile detention facility in Europe.

METHODS

We reviewed the medical files of all detainees in a juvenile detention centre in Switzerland in 2007. The health problems for which primary care services were provided were coded using the International Classification for Primary Care, version 2. Analysis was descriptive, stratified by gender.

RESULTS

A total of 314 adolescents (18% female) aged 11-19 years were included. Most (89%) had a health assessment and 195 (62%) had consultations with a primary care physician; 80% of the latter had a physical health problem, and 60% had a mental health problem. The most commonly managed problems were skin (49.7%), respiratory (23.6%), behavioural (22.6%) and gynaecological problems (females: 23.9%); 13% females (no males) had sexually transmitted infections (STI), and 8.7% were pregnant. Substance abuse was common (tobacco: 64.6%, alcohol: 26.2%, cannabis: 31.3%).

CONCLUSION

In addition to health problems known to be more prevalent among young offenders, such as mental health problems and STI, these adolescent detainees required care for a range of common primary care problems. These data should inform the development of comprehensive primary care services in all juvenile detention facilities in Europe.