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Vázquez AL, Chou T, Helseth SA, Gudiño OG, Rodríguez MMD. Juntos hacemos la diferencia [together we make the difference]: A network analysis of Latinx caregivers' use of youth support services. FAMILY PROCESS 2024; 63:788-802. [PMID: 37277975 PMCID: PMC10696132 DOI: 10.1111/famp.12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 04/14/2023] [Accepted: 05/12/2023] [Indexed: 06/07/2023]
Abstract
Latinx families face unique barriers to accessing traditional youth mental health services and may instead rely on a wide range of supports to meet youth emotional or behavioral concerns. Previous studies have typically focused on patterns of utilization for discrete services, classified by setting, specialization, or level of care (e.g., specialty outpatient, inpatient, informal supports), yet little is known about how youth support services might be accessed in tandem. This analysis used data from the Pathways to Latinx Mental Health study - a national sample of Latinx caregivers (N = 598) from across the United States collected at the start of the coronavirus pandemic (i.e., May-June 2020) - to describe the broad network of available supports that are used by Latinx caregivers. Using exploratory network analysis, we found that the use of youth psychological counseling, telepsychology, and online support groups was highly influential on support service utilization in the broader network. Specifically, Latinx caregivers who used one or more of these services for their child were more likely to report utilizing other related sources of support. We also identified five support clusters within the larger network that were interconnected through specific sources of support (i.e., outpatient counseling, crisis, religious, informal, and non-specialty). Findings offer a foundational look at the complex system of youth supports available to Latinx caregivers, highlighting areas for future study, opportunities to advance the implementation of evidence-based interventions, and channels through which to disseminate information about available services.
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Affiliation(s)
- Alejandro L. Vázquez
- Department of Psychology, Utah State University, Logan, Utah, USA
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tommy Chou
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sarah A. Helseth
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Brown University School of Public Health, Providence, Rhode Island, USA
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Margherio SM, Evans SW, Monopoli WJ, Langberg JM. Cost-Effectiveness of a Training Intervention for Adolescents with ADHD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:819-833. [PMID: 33630716 DOI: 10.1080/15374416.2021.1875323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to examine the costs and cost-effectiveness of a school-based training intervention delivered at varying levels of intensity with adolescents with attention-deficit/hyperactivity disorder (ADHD). Costs were examined in relation to post-treatment and 6-month follow-up effects of the Challenging Horizons Program (CHP), a training intervention for adolescents with ADHD. METHOD A total of 326 middle-school students (71% male; 77% White) with ADHD were randomized to an after-school version of the CHP (CHP-AS), a less-intensive mentoring version (CHP-M), or routine community care. Detailed time logs were maintained throughout the study and were used to estimate costs associated with each condition. Student grade point average (GPA) and parent-rated ADHD symptoms and organization skills were collected at post-treatment and 6-month follow-up. RESULTS The cost analysis revealed that CHP-AS was more costly per student than CHP-M, both in terms of overall costs and direct expenses to the school. However, CHP-AS was less costly per hour of intervention provided to the youth than CHP-M. Incremental cost-effectiveness ratios revealed that CHP-M may be the more cost-effective option for post-treatment effects, yet CHP-AS may be the more cost-effective option in the long term for sustained gains in organization skills and GPA. CONCLUSIONS This study provides stakeholders important information to make decisions regarding allocation of finite monetary resources to meet their prioritized goals.
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Bailin A, Cho E, Sternberg A, Evans SC, Hollinsaid NL, Bearman SK, Weisz JR. Principle-Guided Psychotherapy for Children and Adolescents (FIRST): study protocol for a randomized controlled effectiveness trial in outpatient clinics. Trials 2023; 24:682. [PMID: 37864269 PMCID: PMC10589969 DOI: 10.1186/s13063-023-07717-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/07/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Hundreds of youth psychotherapy randomized trials have generated scores of helpful empirically supported treatments (ESTs). However, the standardized structure of many ESTs and their focus on a single disorder or homogeneous cluster of problems may not be ideal for clinically referred youths who have comorbidity and whose treatment needs may shift from week to week. This concern has prompted development of flexible transdiagnostic, modular youth psychotherapies. One of these, designed for efficient training and implementation, is FIRST-a transdiagnostic intervention built on five empirically supported principles of change (i.e., feeling calm, increasing motivation, repairing thoughts, solving problems, and trying the opposite) and targeting common internalizing and externalizing youth mental health disorders and problems. FIRST has shown promise in improving youth mental health in three open trials. Now, in a more rigorous test, we seek to (1) conduct a randomized controlled trial comparing FIRST to usual care in real-world clinical practice settings; (2) examine a promising candidate mediator of change-regulation of negative emotions; and (3) explore variables that may influence clinicians' treatment implementation. METHODS This is an assessor-naïve randomized controlled effectiveness trial in youth outpatient community clinics in New England and Texas. Using double randomization, clinic-employed clinicians and treatment-referred youths (7-15 years old) are independently randomly allocated (1:1) to FIRST or usual care. We aim to recruit 212 youth participants, all referred through normal community pathways, with elevated symptoms of anxiety, depression, conduct problems, or post-traumatic stress. This study will test the effectiveness of FIRST compared to usual care on mental health outcomes, examine whether those outcomes are mediated by regulation of negative emotions, and explore clinician factors that may be associated with FIRST implementation and outcomes. Session recordings are coded to assess treatment fidelity. DISCUSSION This study will evaluate the effectiveness of FIRST in youth community mental health settings, relative to the care usually provided in those settings. If FIRST is found to be effective, it could offer an efficient and practical method to increase use of empirically supported treatment principles in real-world practice contexts. TRIAL REGISTRATION NIH Clinical Trials Registry, NCT04725721. Registered 27 January 2021, https://clinicaltrials.gov/ct2/show/study/NCT04725721.
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Affiliation(s)
- Abby Bailin
- Department of Educational Psychology, The University of Texas at Austin, 1912 Speedway, Suite 5.708, Austin, TX, 78712-1289, USA.
| | - Evelyn Cho
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02318, USA
| | - Ariel Sternberg
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02318, USA
| | - Spencer C Evans
- University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33146, USA
| | - Nathan L Hollinsaid
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02318, USA
| | - Sarah Kate Bearman
- Department of Educational Psychology, The University of Texas at Austin, 1912 Speedway, Suite 5.708, Austin, TX, 78712-1289, USA
| | - John R Weisz
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02318, USA
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Bailin A, Cho E, Sternberg A, Evans SC, Hollinsaid NL, Kate Bearman S, Weisz JR. Principle-Guided Psychotherapy for Children and Adolescents (FIRST): Study Protocol for a Randomized Controlled Effectiveness Trial in Outpatient Clinics. RESEARCH SQUARE 2023:rs.3.rs-3210987. [PMID: 37720052 PMCID: PMC10503852 DOI: 10.21203/rs.3.rs-3210987/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background Hundreds of youth psychotherapy randomized trials have generated scores of helpful empirically supported treatments (ESTs). However, the standardized structure of many ESTs and their focus on a single disorder or homogeneous cluster of problems may not be ideal for clinically referred youths who have comorbidity and whose treatment needs may shift from week to week. This concern has prompted development of flexible transdiagnostic, modular youth psychotherapies. One of these, designed for efficient training and implementation, is FIRST-a transdiagnostic intervention built on five empirically supported principles of change (i.e., feeling calm, increasing motivation, repairing thoughts, solving problems, and trying the opposite) and targeting common internalizing and externalizing youth mental health disorders and problems. FIRST has shown promise in improving youth mental health in three open trials. Now, in a more rigorous test, we seek to (1) conduct a randomized controlled trial comparing FIRST to usual care in real-world clinical practice settings; (2) examine a promising candidate mediator of change-regulation of negative emotions; and (3) explore variables that may influence clinicians' treatment implementation. Methods This is an assessor-naïve randomized controlled effectiveness trial in youth outpatient community clinics in New England and Texas. Using double randomization, clinic-employed clinicians and treatment-referred youths (7-15 years old) are independently randomly allocated (1:1) to FIRST or usual care. We aim to recruit 212 youth participants, all referred through normal community pathways, with elevated symptoms of anxiety, depression, conduct problems, or post-traumatic stress. This study will test the effectiveness of FIRST compared to usual care on mental health outcomes, examine whether those outcomes are mediated by regulation of negative emotions, and explore clinician factors that may be associated with FIRST implementation and outcomes. Session recordings are coded to assess treatment fidelity. Discussion This study will evaluate the effectiveness of FIRST in youth community mental health settings, relative to the care usually provided in those settings. If FIRST is found to be effective, it could offer an efficient and practical method to increase use of empirically supported treatment principles in real-world practice contexts. Trial registration NIH Clinical Trials Registry, NCT04725721. Registered 27 January 2021, https://clinicaltrials.gov/ct2/show/study/NCT04725721.
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Waxmonsky JG, Waschbusch DA, Groff D, Jairath B, Sekhar DL, Sibley MH, Logan JM, Fogel B. Effects of a Primary Care-Based Engagement Intervention for Improving Use of ADHD Treatments. J Pediatr Health Care 2023; 37:537-547. [PMID: 37227324 DOI: 10.1016/j.pedhc.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/30/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Uptake of attention deficit hyperactivity disorder (ADHD) treatments is low in primary care. A quasi-experimental study assessed the impact of a primary care-based engagement intervention to improve ADHD treatment use. METHOD Families of children with ADHD from four pediatric clinics were invited to participate in a two-stage intervention. The first step was an assessment battery to assess functioning and identify goals, followed by an in-office engagement session run by primary care staff. RESULTS Of the 636 invited families, 184 (28.9%) completed ratings, with 95 (51%) families completing the engagement session. ADHD office visits varied based on the number of steps completed (0-2). ADHD prescriptions decreased over time in families completing neither step but increased for children previously unmedicated whose parents completed either step. Families completing both steps had the highest rates of nonmedication ADHD treatments. DISCUSSION A brief two-step engagement intervention was associated with increased uptake of ADHD treatments.
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Sevastidis A, Wanni Arachchige Dona S, Gold L, Sciberra E, Coghill D, Le HND. Social gradient in use of health services and health-related quality of life of children with attention-deficit/hyperactivity disorder: A systematic review. JCPP ADVANCES 2023; 3:e12170. [PMID: 37720590 PMCID: PMC10501702 DOI: 10.1002/jcv2.12170] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/04/2023] [Indexed: 09/19/2023] Open
Abstract
Aims ADHD (attention-deficit/hyperactivity disorder) affects 5% of children on average. Despite the high need to access services for ADHD treatment, not all children with ADHD utilise healthcare services equally. This study aims to systematically synthesise evidence of equity and equality in health service use/costs and health-related quality of life (HRQoL)/wellbeing of children with ADHD across socioeconomic (SES) classes. Methods The literature search was conducted across seven databases (Academic Search complete, MEDLINE Complete, PsycINFO, ERIC, Global Health, CINAHL and EconLit). The search was limited to peer-reviewed articles published to 23rd January 2023 in English and focused on children. Study quality was assessed using the Critical Appraisal Skills Program (CASP), Joanna Briggs Institute (JBI) and Mixed Methods Appraisal Tool (MMAT) checklists. Results 25 out of 1207 articles were eligible for inclusion. The results showed that SES was associated with different types of healthcare utilisation. Only three studies were found on HRQoL/well-being. Children with ADHD from low SES families had lower HRQoL than children from high SES families. Conclusion This study found that a social gradient exists in both healthcare service use and children's HRQoL among those with ADHD.
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Affiliation(s)
- Abraham Sevastidis
- Deakin Health EconomicsSchool of Health and Social DevelopmentFaculty of HealthDeakin UniversityBurwoodVictoriaAustralia
| | - Sithara Wanni Arachchige Dona
- Deakin Health EconomicsSchool of Health and Social DevelopmentFaculty of HealthDeakin UniversityBurwoodVictoriaAustralia
| | - Lisa Gold
- Deakin Health EconomicsSchool of Health and Social DevelopmentFaculty of HealthDeakin UniversityBurwoodVictoriaAustralia
- Murdoch Children's Research InstituteRoyal Children's HospitalBurwoodVictoriaAustralia
| | - Emma Sciberra
- Murdoch Children's Research InstituteRoyal Children's HospitalBurwoodVictoriaAustralia
- School of PsychologyFaculty of HealthDeakin UniversityBurwoodVictoriaAustralia
- Departments of Paediatrics and PsychiatryFaculty of Medicine, Dentistry and Health SciencesThe University of MelbourneBurwoodVictoriaAustralia
- The Centre for Social and Early Emotional Development (SEED)Deakin UniversityBurwoodVictoriaAustralia
| | - David Coghill
- Murdoch Children's Research InstituteRoyal Children's HospitalBurwoodVictoriaAustralia
- Departments of Paediatrics and PsychiatryFaculty of Medicine, Dentistry and Health SciencesThe University of MelbourneBurwoodVictoriaAustralia
| | - Ha Nguyet Dao Le
- Deakin Health EconomicsSchool of Health and Social DevelopmentFaculty of HealthDeakin UniversityBurwoodVictoriaAustralia
- Murdoch Children's Research InstituteRoyal Children's HospitalBurwoodVictoriaAustralia
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Molina BSG, Kennedy TM, Howard AL, Swanson JM, Arnold LE, Mitchell JT, Stehli A, Kennedy EH, Epstein JN, Hechtman LT, Hinshaw SP, Vitiello B. Association Between Stimulant Treatment and Substance Use Through Adolescence Into Early Adulthood. JAMA Psychiatry 2023; 80:933-941. [PMID: 37405756 PMCID: PMC10323757 DOI: 10.1001/jamapsychiatry.2023.2157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/02/2023] [Indexed: 07/06/2023]
Abstract
Importance Possible associations between stimulant treatment of attention-deficit/hyperactivity disorder (ADHD) and subsequent substance use remain debated and clinically relevant. Objective To assess the association of stimulant treatment of ADHD with subsequent substance use using the Multimodal Treatment Study of ADHD (MTA), which provides a unique opportunity to test this association while addressing methodologic complexities (principally, multiple dynamic confounding variables). Design, Setting, and Participants MTA was a multisite study initiated at 6 sites in the US and 1 in Canada as a 14-month randomized clinical trial of medication and behavior therapy for ADHD but transitioned to a longitudinal observational study. Participants were recruited between 1994 and 1996. Multi-informant assessments included comprehensively assessed demographic, clinical (including substance use), and treatment (including stimulant treatment) variables. Children aged 7 to 9 years with rigorously diagnosed DSM-IV combined-type ADHD were repeatedly assessed until a mean age of 25 years. Analysis took place between April 2018 and February 2023. Exposure Stimulant treatment of ADHD was measured prospectively from baseline for 16 years (10 assessments) initially using parent report followed by young adult report. Main Outcomes and Measures Frequency of heavy drinking, marijuana use, daily cigarette smoking, and other substance use were confidentially self-reported with a standardized substance use questionnaire. Results A total of 579 children (mean [SD] age at baseline, 8.5 [0.8] years; 465 [80%] male) were analyzed. Generalized multilevel linear models showed no evidence that current (B [SE] range, -0.62 [0.55] to 0.34 [0.47]) or prior stimulant treatment (B [SE] range, -0.06 [0.26] to 0.70 [0.37]) or their interaction (B [SE] range, -0.49 [0.70] to 0.86 [0.68]) were associated with substance use after adjusting for developmental trends in substance use and age. Marginal structural models adjusting for dynamic confounding by demographic, clinical, and familial factors revealed no evidence that more years of stimulant treatment (B [SE] range, -0.003 [0.01] to 0.04 [0.02]) or continuous, uninterrupted stimulant treatment (B [SE] range, -0.25 [0.33] to -0.03 [0.10]) were associated with adulthood substance use. Findings were the same for substance use disorder as outcome. Conclusions and Relevance This study found no evidence that stimulant treatment was associated with increased or decreased risk for later frequent use of alcohol, marijuana, cigarette smoking, or other substances used for adolescents and young adults with childhood ADHD. These findings do not appear to result from other factors that might drive treatment over time and findings held even after considering opposing age-related trends in stimulant treatment and substance use.
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Affiliation(s)
- Brooke S. G. Molina
- Departments of Psychiatry, Psychology, & Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Traci M. Kennedy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrea L. Howard
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - James M. Swanson
- Department of Pediatrics, University of California, Irvine, Irvine
| | - L. Eugene Arnold
- Department of Psychiatry & Behavioral Health, Ohio State University, Columbus
| | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Annamarie Stehli
- Department of Pediatrics, University of California, Irvine, Irvine
| | - Edward H. Kennedy
- Department of Statistics & Data Science, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Lily T. Hechtman
- Division of Child Psychiatry, McGill University and Montreal Children’s Hospital, Montreal, Quebec, Canada
| | | | - Benedetto Vitiello
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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Ewell Foster C, Magness C, Czyz E, Kahsay E, Martindale J, Hong V, Baker E, Cavataio I, Colombini G, Kettley J, Smith PK, King C. Predictors of Parent Behavioral Engagement in Youth Suicide Discharge Recommendations: Implications for Family-Centered Crisis Interventions. Child Psychiatry Hum Dev 2022; 53:1240-1251. [PMID: 34136980 DOI: 10.1007/s10578-021-01176-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
The number of youth presenting to Emergency Departments (EDs) with psychiatric chief complaints has almost doubled in the last decade. With pediatric patients, ED brief interventions and discharge recommendations necessitate meaningful parental engagement to optimize youth safety and support. This study examined parent-level factors (stigmatizing attitudes, self-efficacy beliefs, distress symptoms, and illness-related stressors) in relation to parents' behavioral engagement (i.e., participation in and follow-through with best practice discharge recommendations). In this short-term prospective study, participants were 118 parent-youth (aged 11-18) dyads (57% female) recruited from a psychiatric ED. Parents' behavioral engagement was measured with parent- and youth-self report at 2-week follow-up. Parents' self-reported anxious and depressive symptoms, insomnia, stress, and stigmatizing attitudes were not related to engagement 2 weeks later. Higher parental self-efficacy beliefs were significantly associated with greater engagement in standard discharge recommendations. Implications for maximizing parent implementation of clinical recommendations during a youth suicide crisis are discussed.
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Affiliation(s)
- Cynthia Ewell Foster
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Christina Magness
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Ewa Czyz
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Eskira Kahsay
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Jonathan Martindale
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Victor Hong
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Elaina Baker
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Isabella Cavataio
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Gigi Colombini
- Institute for Hope and Human Flourishing, Bloomfield Hills, MI, USA
| | - John Kettley
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Patricia K Smith
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Cheryl King
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
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Vitulano LA, Mitchell JT, Vitulano ML, Leckman JF, Saunders D, Davis N, Woodward D, Goodhue B, Artukoglu B, Kober H. Parental perspectives on attention-deficit/hyperactivity disorder treatments for children. Clin Child Psychol Psychiatry 2022; 27:1019-1032. [PMID: 35695509 DOI: 10.1177/13591045221108836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated parental perspectives and experiences on the evaluation and treatment process associated with attention-deficit/hyperactivity disorder (ADHD). Five hundred sixty-eight parents of youth 2-28 years-old (M = 9.37; SD = 4.11) diagnosed with ADHD responded to a 14-item online survey about their child's diagnosis and treatment. Parents reported that they had tried an average of 4.49 interventions (SD = 2.63). Parents further shared factors in treatment selection, most helpful parenting strategies, and preferences for types of treatments and treatment targets. A majority of parents reported incorporating many non-traditional strategies (e.g., exercise, healthy eating, outdoor activities) with goals of improving their child's coping skills, study habits, and anger management. The findings show that treatment choices were often selected based on trust in the provider, research support, and the child's preference. Given parental preferences for non-traditional strategies, treatment development efforts should consider these strategies as a component of a broader multimodal treatment approach to ADHD.
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Affiliation(s)
| | | | | | | | - David Saunders
- Yale Child Study Center.,5798Columbia University, New York, NY, USA
| | | | | | | | | | - Hedy Kober
- Yale University Department of Psychiatry
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Sibley MH, Arnold LE, Swanson JM, Hechtman LT, Kennedy TM, Owens E, Molina BS, Jensen PS, Hinshaw SP, Roy A, Chronis-Tuscano A, Newcorn JH, Rohde LA. Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD. Am J Psychiatry 2022; 179:142-151. [PMID: 34384227 PMCID: PMC8810708 DOI: 10.1176/appi.ajp.2021.21010032] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE It is estimated that childhood attention deficit hyperactivity disorder (ADHD) remits by adulthood in approximately 50% of cases; however, this conclusion is typically based on single endpoints, failing to consider longitudinal patterns of ADHD expression. The authors investigated the extent to which children with ADHD experience recovery and variable patterns of remission by adulthood. METHODS Children with ADHD (N=558) in the Multimodal Treatment Study of ADHD (MTA) underwent eight assessments over follow-ups ranging from 2 years (mean age, 10.44 years) to 16 years (mean age, 25.12 years) after baseline. The authors identified participants with fully remitted, partially remitted, and persistent ADHD at each time point on the basis of parent, teacher, and self-reports of ADHD symptoms and impairment, treatment utilization, and substance use and mental disorders. Longitudinal patterns of remission and persistence were identified that considered context and timing. RESULTS Approximately 30% of children with ADHD experienced full remission at some point during the follow-up period; however, a majority of them (60%) experienced recurrence of ADHD after the initial period of remission. Only 9.1% of the sample demonstrated recovery (sustained remission) by study endpoint, and only 10.8% demonstrated stable ADHD persistence across study time points. Most participants with ADHD (63.8%) had fluctuating periods of remission and recurrence over time. CONCLUSIONS The MTA findings challenge the notion that approximately 50% of children with ADHD outgrow the disorder by adulthood. Most cases demonstrated fluctuating symptoms between childhood and young adulthood. Although intermittent periods of remission can be expected in most cases, 90% of children with ADHD in MTA continued to experience residual symptoms into young adulthood.
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Affiliation(s)
- Margaret H. Sibley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle Children’s Research Institute
| | - L. Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, Nisonger Center, Columbus Ohio
| | - James M. Swanson
- Child Development Center, School of Medicine, University of California, Irvine
| | - Lily T. Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Traci M. Kennedy
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Elizabeth Owens
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | | | | | - Stephen P. Hinshaw
- Department of Psychology, University of California, Berkeley, Department of Psychiatry & Behavioral Sciences, University of California, San Francisco
| | | | | | - Jeffrey H. Newcorn
- Department of Psychiatry & Pediatrics, Icahn School of Medicine at Mount Sinai
| | - Luis A. Rohde
- ADHD and Developmental Psychiatry Programs, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul
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Vázquez AL, Culianos D, Flores CMN, Alvarez MDLC, Barrett TS, Domenech Rodríguez MM. Psychometric Evaluation of a Barriers to Mental Health Treatment Questionnaire for Latina/o/x Caregivers of Children and Adolescents. CHILD & YOUTH CARE FORUM 2021; 51:847-864. [PMID: 34642563 PMCID: PMC8494628 DOI: 10.1007/s10566-021-09656-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/13/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
Background Knowledge regarding barriers faced by Latina/o/x caregivers in accessing youth mental health services (MHS) have largely depended on resource intensive interview-based assessments. Objective We evaluated a questionnaire for Latina/o/x caregivers of youths that presents a briefer and more feasible alternative. Method We conducted a psychometric evaluation of the Barriers to Treatment Questionnaire - Latina/o/x Caregivers (BTQ-LC) with a sample of 598 Latina/o/x caregivers from across the United States. Descriptive statistics and confirmatory factor analyses were used to identify common barriers to services, confirm the factor structure of the scale, and establish construct validity. Results Descriptive statistics suggest that not knowing where and how to access services, and normalization of youth psychopathology were the most frequently reported barriers among caregivers of youth with clinically elevated problems on the CBCL. Confirmatory factor analysis suggests that the BTQ-LC was best represented by a three-factor structure: (1) structural, (2) perceptions regarding mental health problems, and (3) services. Our finding suggest that the BTQ-LC could also be used as a single factor as fit indices ranged from acceptable to poor. BTQ-LC scales were all negatively correlated with the utilization of common youth MHS (i.e., psychological counseling, medical doctors, school professionals). Conclusions The BTQ-LC represents an important step towards improving our understanding and assessment of barriers to services contributing to mental health disparities among Latina/o/x youths.
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Affiliation(s)
- Alejandro L Vázquez
- Department of Psychology, Utah State University, 2810 Old Main Hill, 84322 Logan, UT USA
| | - Demi Culianos
- Department of Psychology, Utah State University, 2810 Old Main Hill, 84322 Logan, UT USA
| | | | | | - Tyson S Barrett
- Department of Psychology, Utah State University, 2810 Old Main Hill, 84322 Logan, UT USA
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Green CD, Langberg JM. A Review of Predictors of Psychosocial Service Utilization in Youth with Attention-Deficit/Hyperactivity Disorder. Clin Child Fam Psychol Rev 2021; 25:356-375. [PMID: 34498154 DOI: 10.1007/s10567-021-00368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders. Professional practice guidelines recommend combined treatment, psychopharmacological and psychosocial, for youth with ADHD. There have been multiple reviews of pharmacological prescription practices and utilization, however, less is known about predictors of ADHD psychosocial service utilization. Given the importance of accessing psychosocial treatment in relation to improving functional impairment, this review synthesizes evidence on predictors of ADHD psychosocial intervention utilization in clinic, community, and school settings. Eighteen studies were identified and included in the review. Findings are summarized across informant profile factors, predisposing characteristics, and barriers and facilitators. The most robust findings were for the impact of symptom severity/impairment, the presence of comorbidities, and age on ADHD psychosocial service utilization. Race/ethnicity, sex, parental knowledge of the disorder and insurance coverage were also identified as key factors. Future avenues of research are provided, and clinical and policy implications targeted at reducing psychosocial treatment disparities in youth with ADHD are discussed.
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Affiliation(s)
- Cathrin D Green
- Virginia Commonwealth University, 806 W. Franklin St, Box 842018, Richmond, VA, 23284, USA
| | - Joshua M Langberg
- Virginia Commonwealth University, 806 W. Franklin St, Box 842018, Richmond, VA, 23284, USA.
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13
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Hare MM, Garcia AM, Hart KC, Graziano PA. Intervention response among preschoolers with ADHD: The role of emotion understanding. J Sch Psychol 2020; 84:19-31. [PMID: 33581768 DOI: 10.1016/j.jsp.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/08/2020] [Accepted: 11/13/2020] [Indexed: 01/29/2023]
Abstract
Emotion recognition/understanding (ERU), which is the ability to correctly identify emotional states in others as well as one's self, plays a key role in children's social-emotional development and is often targeted in early intervention programs. Yet the extent to which young children's ERU predicts their intervention response remains unclear. The current study examined the extent to which initial levels of ERU and changes in ERU predicted intervention response to a multimodal early intervention program (Summer Treatment Program for Pre-Kindergarteners; STP-PreK). Participants included 230 young children (Mage = 4.90, 80.0% male) with attention-deficit/hyperactivity disorder (ADHD) who participated in the 8-week STP-PreK. Children's ERU was measured via a standardized behavioral task. Similarly, standardized measures of academic achievement (Woodcock-Johnson-IV), executive functioning (Head-Toes-Knees-Shoulders-Task), and social-emotional functioning (Challenging Situation Task) were obtained pre- and post-intervention. Parents and teachers also reported on children's behavioral functioning pre- and post-intervention. Children with better initial ERU made greater improvements in academic, executive functioning (EF), and social-emotional domains, along with decreases in inattention symptom severity. However, pre-intervention levels of ERU were not associated with improvements in parent/teacher report of hyperactivity, oppositional defiant disorder, and overall behavioral impairment. Lastly, changes in ERU only predicted improvement in EF, but not any other school readiness outcomes. We provide preliminary evidence that initial levels of ERU predict intervention response across school readiness domains in a sample of preschoolers with ADHD.
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Affiliation(s)
- Megan M Hare
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL 33199, USA
| | - Alexis M Garcia
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL 33199, USA
| | - Katie C Hart
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL 33199, USA
| | - Paulo A Graziano
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL 33199, USA.
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14
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Abstract
Objective: The objective of the study is to examine whether children aged 7 to 11 years with very well-characterized ADHD, recruited from the community, have a similar number of healthy lifestyle behaviors as compared with typically developing children from the same community. Method: Parents of children with (n = 184) and without (n = 104) ADHD completed a lifestyle questionnaire asking about water intake, sweetened beverage consumption, multivitamin/supplement use, reading, screen time, physical activity, and sleep. A lifestyle index was formed from these seven domains (0-7), and multivariable ordered logistic regression was used to examine the association of ADHD status and total healthy lifestyle behaviors. Results: Children with ADHD were almost twice as likely to have fewer healthy behaviors, even after adjustment for age, sex, intelligence quotient (IQ), ADHD medication use, household income, and four comorbid psychiatric disorders (odds ratio [OR] [95% confidence interval] = 1.95 [1.16, 3.30], p = .01). Conclusion: Future research is needed to assess the effects of a combined lifestyle intervention in this group.
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Affiliation(s)
| | - Joel T. Nigg
- Oregon Health & Science University, Portland, OR, USA
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15
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Silva D, Colvin L, Glauert R, Stanley F, Srinivas Jois R, Bower C. Literacy and Numeracy Underachievement in Boys and Girls With ADHD. J Atten Disord 2020; 24:1392-1402. [PMID: 26689936 DOI: 10.1177/1087054715613438] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine literacy and numeracy outcomes, among children with and without ADHD by gestational age and gender. Method: De-identified linked population data from the Western Australian Monitoring of Drug Dependence Systems, Western Australian Literacy and Numeracy Assessment database, and the Midwives Notification System used information on 6,819 children with ADHD compared with 14,451 non-ADHD children. Results: Twenty-three percent of boys and 28% of girls with ADHD had numeracy scores below the benchmark in School Year 3, compared with 11% of children without ADHD. These differences were also evident in reading, writing, and spelling through primary school. Children with ADHD and reduced gestational age were at a greater risk of not meeting numeracy and reading benchmarks, compared with children born at term. Conclusion: Children with ADHD are disadvantaged from an early age in key areas of learning, and this risk increased with reduction in gestational age at birth.
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Affiliation(s)
- Desiree Silva
- Telethon Kids Institute, University of Western Australia, Perth , Western Australia.,School of Paediatrics and Child Health, University of Western Australia.,Joondalup Health Campus, Joondalup, Western Australia
| | - Lyn Colvin
- Telethon Kids Institute, University of Western Australia, Perth , Western Australia
| | - Rebecca Glauert
- Telethon Kids Institute, University of Western Australia, Perth , Western Australia
| | - Fiona Stanley
- Telethon Kids Institute, University of Western Australia, Perth , Western Australia.,School of Paediatrics and Child Health, University of Western Australia
| | | | - Carol Bower
- Telethon Kids Institute, University of Western Australia, Perth , Western Australia
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16
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Greenhill LL, Swanson JM, Hechtman L, Waxmonsky J, Arnold LE, Molina BSG, Hinshaw SP, Jensen PS, Abikoff HB, Wigal T, Stehli A, Howard A, Hermanussen M, Hanć T. Trajectories of Growth Associated With Long-Term Stimulant Medication in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry 2020; 59:978-989. [PMID: 31421233 PMCID: PMC7021562 DOI: 10.1016/j.jaac.2019.06.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/11/2019] [Accepted: 08/07/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To estimate long-term stimulant treatment associations on standardized height, weight, and body mass index trajectories from childhood to adulthood in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (MTA). METHOD Of 579 children with DSM-IV ADHD-combined type at baseline (aged 7.0-9.9 years) and 289 classmates (local normative comparison group [LNCG]), 568 and 258 respectively, were assessed 8 times over 16 years (final mean age = 24.7). Parent interview data established subgroups with self-selected Consistent (n = 53, 9%), Inconsistent (n = 374, 66%), and Negligible (n = 141, 25%) stimulant medication use, as well as patients starting stimulants prior to MTA entry (n = 211, 39%). Height and weight growth trajectories were calculated for each subgroup. RESULTS Height z scores trajectories differed among subgroups (F = 2.22, p < .0001) and by stimulant use prior to study entry (F = 2.22, p < .001). The subgroup-by-assessment interaction was significant (F = 2.81, p < .0001). Paired comparisons revealed significant subgroup differences at endpoint: Consistent was shorter than Negligible (-0.66 z units /-4.06 cm /1.6 inches, t = -3.17, p < 0.0016), Consistent shorter than Inconsistent (-0.45 z units /-2.74 cm /-1.08 inches, t = -2.39, p < .0172), and the Consistent shorter than LNCG (-0.54 z units/+3.34 cm/ 1.31 inches, t = -3.30, p < 0.001). Weight z scores initially diverged among subgroups, converged in adolescence, and then diverged again in adulthood when the Consistent outweighed the LNCG (+ 3.561 z units /+7.47 kg /+16.46 lb, p < .0001). CONCLUSION Compared with those negligibly medicated and the LNCG, 16 years of consistent stimulant treatment of children with ADHD in the MTA was associated with changes in height trajectory, a reduction in adult height, and an increase in weight and body mass index. CLINICAL TRIAL REGISTRATION INFORMATION Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA); https://clinicaltrials.gov/; NCT00000388.
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Affiliation(s)
- Laurence L Greenhill
- Division of Child Psychiatry, New York State Psychiatric Institute, and Columbia University, New York, NY.
| | | | - Lily Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - James Waxmonsky
- Pennsylvania State University Division of Child and Adolescent Psychiatry, Centre County
| | | | | | - Stephen P Hinshaw
- University of California, Berkeley, and the University of California, San Francisco
| | - Peter S Jensen
- University of Arkansas for Medical Sciences, Little Rock, and The REACH Institute, New York, NY
| | - Howard B Abikoff
- Division of Child Psychiatry, New York State Psychiatric Institute, and Columbia University, New York, NY
| | - Timothy Wigal
- Clinical Services for Avida Inc., Newport Beach, California
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17
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Do Working Memory Deficits Underlie Reading Problems in Attention-Deficit/Hyperactivity Disorder (ADHD)? JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:433-446. [PMID: 29923160 DOI: 10.1007/s10802-018-0447-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Reading problems are common in children with ADHD and show strong covariation with these children's underdeveloped working memory abilities. In contrast, working memory training does not appear to improve reading performance for children with ADHD or neurotypical children. The current study bridges the gap between these conflicting findings, and combines dual-task methodology with Bayesian modeling to examine the role of working memory for explaining ADHD-related reading problems. Children ages 8-13 (M = 10.50, SD = 1.59) with and without ADHD (N = 78; 29 girls; 63% Caucasian/Non-Hispanic) completed a counterbalanced series of reading tasks that systematically manipulated concurrent working memory demands. Adding working memory demands produced disproportionate decrements in reading comprehension for children with ADHD (d = -0.67) relative to Non-ADHD children (d = -0.18); comprehension was significantly reduced in both groups when working memory demands were increased. These effects were robust to controls for foundational reading skills (decoding, sight word vocabulary) and comorbid reading disability. Concurrent working memory demands did not slow reading speed for either group. The ADHD group showed lower comprehension (d = 1.02) and speed (d = 0.69) even before adding working memory demands beyond those inherently required for reading. Exploratory conditional effects analyses indicated that underdeveloped working memory overlapped with 41% (comprehension) and 85% (speed) of these between-group differences. Reading problems in ADHD appear attributable, at least in part, to their underdeveloped working memory abilities. Combined with prior cross-sectional and longitudinal findings, the current experimental evidence positions working memory as a potential causal mechanism that is necessary but not sufficient for effectively understanding written language.
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18
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Silva D, Colvin L, Glauert R, Stanley F, Srinivasjois R, Bower C. Literacy and Numeracy Underachievement in Boys and Girls With ADHD. J Atten Disord 2020; 24:1305-1316. [PMID: 26290485 DOI: 10.1177/1087054715596575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim was to determine literacy and numeracy outcomes, among children with and without ADHD by gestational age and gender. Method: De-identified linked population data from the Western Australian Monitoring of Drugs of Dependence System and Western Australian Literacy and Numeracy Assessment databases, and the Midwives Notification System used information on 6,819 children with ADHD compared with 14,451 non-ADHD children. Results: A total of 23% of boys and 28% of girls with ADHD had numeracy scores below the benchmark in School Year 3, compared with 11% of children without ADHD. These differences were also evident for reading, writing, and spelling through primary school. Children with ADHD and reduced gestational age were at a greater risk of not meeting numeracy and reading benchmarks, compared with children born at term. Conclusion: Children with ADHD are disadvantaged from an early age in key areas of learning, and this risk increased with reduction in gestational age at birth.
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Affiliation(s)
- Desiree Silva
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Australia.,Joondalup Health Campus, University of Western Australia, Perth, Australia
| | - Lyn Colvin
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Rebecca Glauert
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Fiona Stanley
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | | | - Carol Bower
- Telethon Kids Institute, University of Western Australia, Perth, Australia
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19
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Cusick CN, Langberg JM, Breaux R, Green CD, Becker SP. Caffeine Use and Associations With Sleep in Adolescents With and Without ADHD. J Pediatr Psychol 2020; 45:643-653. [PMID: 32386419 DOI: 10.1093/jpepsy/jsaa033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/07/2020] [Accepted: 04/16/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare caffeine consumption in the morning, afternoon, and evening in adolescents with and without attention-deficit/hyperactivity disorder (ADHD) and examine associations with sleep functioning. METHODS Participants were 302 adolescents (ages 12-14) with (N = 140) and without (N = 162) ADHD. Adolescents wore actigraph watches to assess total sleep time and wake after sleep onset and reported on sleep-wake problems and the number of caffeinated beverages consumed per day in the morning, afternoon, and evening. Parents reported on adolescents' difficulties initiating and maintaining sleep. Chi-square tests, odds ratios, and path analyses were conducted. RESULTS Analyses controlled for sex, medication status, and pubertal development. Adolescents with ADHD were 2.47 times more likely to consume caffeine in the afternoon and evening than adolescents without ADHD. Path analyses indicated significant associations between afternoon caffeine use and more self-reported sleep problems for adolescents with and without ADHD, and an association between evening caffeine use and self-reported sleep problems only in adolescents with ADHD. Afternoon caffeine use was associated with parent-reported sleep problems in adolescents with ADHD only. Caffeine use was not associated with actigraphy-assessed sleep. CONCLUSION This is the first study to show that adolescents with ADHD consume more caffeine than peers during later times of the day. Additionally, caffeine use is more consistently associated with poorer subjective sleep functioning in adolescents with ADHD. Pediatricians and mental health professionals should assess for caffeine use in adolescents with ADHD and co-occurring sleep problems.
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Affiliation(s)
| | | | - Rosanna Breaux
- Department of Psychology, Virginia Polytechnic Institute and State University
| | | | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
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20
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Bourchtein E, Langberg JM, Cusick CN, Breaux RP, Smith ZR, Becker SP. Featured Article: Technology Use and Sleep in Adolescents With and Without Attention-Deficit/Hyperactivity Disorder. J Pediatr Psychol 2020; 44:517-526. [PMID: 30615174 DOI: 10.1093/jpepsy/jsy101] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/15/2018] [Accepted: 11/18/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study used a multi-informant approach to examine differences in types and rates of technology used by adolescents with and without attention-deficit/hyperactivity disorder (ADHD), associations between technology use and sleep/daytime sleepiness, and whether technology use was differentially related to sleep/daytime sleepiness in adolescents with and without ADHD. METHODS Eighth graders with (n = 162) and without (n = 140) ADHD were recruited. Adolescents completed questionnaires assessing time spent using technology, sleep-wake problems, school-night time in bed, and daytime sleepiness. Parents and teachers reported on adolescents' technology use and daytime sleepiness, respectively. RESULTS Adolescents with ADHD had significantly greater total technology, television/movie viewing, video game, and phone/video chatting use than adolescents without ADHD. Adolescents with ADHD engaged in twice as much daily video game use compared to those without ADHD (61 vs. 31 min). Controlling for medication use, ADHD status, pubertal development, sex, and internalizing symptoms, greater parent- and adolescent-reported technology use was associated with more sleep-wake problems and less time in bed. ADHD status did not moderate the relations between technology use and these sleep parameters. In contrast, ADHD status moderated the association between parent-reported technology use and teacher-reported daytime sleepiness, such that this association was significant only for adolescents with ADHD. CONCLUSIONS Technology use, although more prevalent in adolescents with ADHD, is linked with more sleep problems and reduced school-night sleep duration regardless of ADHD status. Technology use is associated with teacher-rated daytime sleepiness only in adolescents with ADHD. Clinicians should consider technology usage when assessing and treating sleep problems.
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Affiliation(s)
| | | | - Caroline N Cusick
- Department of Psychology, Virginia Commonwealth University.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | - Zoe R Smith
- Department of Psychology, Virginia Commonwealth University
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine
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21
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Zendarski N, Sciberras E, Mensah F, Hiscock H. Factors Associated With Educational Support in Young Adolescents With ADHD. J Atten Disord 2020; 24:750-757. [PMID: 30328744 DOI: 10.1177/1087054718804351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: This study aimed to examine patterns of use and factors associated with education support use in students with ADHD during early adolescence. Method: Participants were 130 adolescents (M = 13.7 years, SD = 1.1) with ADHD. Educational support use and the factors associated with use were collected by parent and teacher questionnaires and standardized academic tests during the 2014-2015 school years. Support rates and categories are described. Logistic regression models examine individual, family, and school variables associated with support versus no support. Results: About two thirds of students with ADHD (60%) had accessed education support in the current school year, which included social support (36%), Individualized Educational Plans (IEPs; 22%), Student Support Groups (SSGs; 18%), counseling (17%), mentoring (15%), and homework support (9%). Academic risk (adjusted odds ratio [OR] = 2.30, 95% confidence interval [CI] = [1.03, 5.14], p = .04), behavioral problems (adjusted OR = 1.47, 95% CI = [1.01, 2.14], p = .047), and attending a Catholic school (adjusted OR = 5.10, 95% CI = [1.59, 16.42], p = .006) were associated with receiving support independent of adolescent age, gender, ADHD medication use, and socioeconomic status. Conclusions: Future research needs to determine whether education support makes a difference to long-term outcomes for students with ADHD and to determine why some students at academic risk receive no support.
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Affiliation(s)
- Nardia Zendarski
- Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Australia
| | - Emma Sciberras
- Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia.,Deakin University, Burwood, Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
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22
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Langberg JM, Molitor SJ, Oddo LE, Eadeh HM, Dvorsky MR, Becker SP. Prevalence, Patterns, and Predictors of Sleep Problems and Daytime Sleepiness in Young Adolescents With ADHD. J Atten Disord 2020; 24:509-523. [PMID: 28162039 DOI: 10.1177/1087054717690810] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The primary objective of this study was to evaluate the prevalence of multiple types of sleep problems in young adolescents with ADHD. Method: Adolescents comprehensively diagnosed with ADHD (N = 262) and their caregivers completed well-validated measures of sleep problems and daytime sleepiness. Participants also completed measures related to medication use, comorbidities, and other factors that could predict sleep problems. Results: Daytime sleepiness was by far the most common sleep problem, with 37% of adolescents meeting the clinical threshold according to parent report and 42% according to adolescent report. In contrast, prevalence rates for specific nighttime sleep problems ranged from 1.5% to 7.6%. Time spent in bed, bedtime resistance, ADHD inattentive symptoms, and Sluggish Cognitive Tempo (SCT) symptoms were significant in the final model predicting daytime sleepiness. Conclusion: Adolescents with ADHD commonly experience problems with daytime sleepiness that may significantly affect their functioning, but this may not be directly attributable to specific sleep problems.
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Distance-Delivered Parent Training for Childhood Disruptive Behavior (Strongest Families™): a Randomized Controlled Trial and Economic Analysis. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019. [PMID: 29516341 DOI: 10.1007/s10802-018-0413-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Disruptive behavior disorders are prevalent in youth, yet most children with disruptive behavior do not have access to timely, effective treatment. Distance-delivered service (e.g., via telephone, Internet) can overcome several barriers to care. This study tested the effectiveness of a 12-week parent training program, Strongest Families™ Parenting the Active Child, delivered via written material, skill-based videos, and telephone coaching sessions, as compared to usual care in reducing child externalizing behavior. Participants were 172 primary caregivers of a 6- to 12-year-old (29% girls; M age = 8.5 years) recruited from community children's mental health clinics. Participants were randomized to either Strongest Families™ or usual care and completed measures of child externalizing behavior, parenting practices, parent distress, and intervention services consumed at baseline and 5-, 10-, 16-, and 22-months post-baseline. Growth curve analysis showed significant reductions in externalizing behavior in both conditions over time. Improvements were significantly greater at 10 months in the Strongest Families™ condition (d = 0.43). At 22 months, however, the differences were not significant and small in magnitude (d = -0.05). The intervention decreased inconsistent discipline significantly more than usual care. Parents in both conditions showed significant reductions in distress. We also conducted a cost-effectiveness analysis to assess the value for money of the Strongest Families™ program versus usual care. Distance parent training is a promising way to increase access to, and reduce costs associated with, mental health care for families with a child with disruptive behavior.
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24
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Capriotti MR, Pfiffner LJ. Patterns and Predictors of Service Utilization Among Youth With ADHD-Predominantly Inattentive Presentation. J Atten Disord 2019; 23:1251-1261. [PMID: 28064560 DOI: 10.1177/1087054716677817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study examined rates and predictors of educational and mental health service utilization among youth with ADHD-predominantly inattentive presentation (ADHD-I). Method: Participants were 199 children with ADHD-I in Grades 2 to 5. Parents reported past-year child service utilization. Parents and teachers rated child ADHD and oppositional defiant disorder (ODD) symptom severity and functional impairment. Children completed an academic achievement test. Results: All children had impairment at school and home. Most received some sort of school service (79%), but only 23% received community-based services. ADHD symptom severity was unrelated to service utilization. However, higher parent-rated functional impairment predicted community service utilization. Academic underachievement and higher teacher-rated functional impairment predicted school service utilization. Conclusion: Many youth with ADHD-I experience impairment across domains without receiving adequate services for these problems. Functional impairment appears to be a stronger predictor of service utilization than ADHD symptom severity, demonstrating the importance of impairment in understanding service needs for ADHD-I.
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25
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Perrin HT, Heller NA, Loe IM. School Readiness in Preschoolers With Symptoms of Attention-Deficit/Hyperactivity Disorder. Pediatrics 2019; 144:e20190038. [PMID: 31331986 PMCID: PMC6855898 DOI: 10.1542/peds.2019-0038] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare school readiness in preschoolers with and without attention-deficit/hyperactivity disorder (ADHD) symptoms using a comprehensive framework. We hypothesized that preschoolers with ADHD symptoms have higher odds of school readiness impairment. METHODS Children ages 4 to 5 years (n = 93) were divided into 2 groups on the basis of presence of ADHD symptoms (ADHD group, n = 45; comparison group, n = 48). School readiness was assessed through 10 component measures, including direct assessments and standardized questionnaires, regarding 5 school readiness domains: physical well-being and motor development, social and emotional development, approaches to learning, language, and cognition and general knowledge. Analysis of covariance compared group mean scores on component measures. Domain impairment was defined as score ≥1 SD from the test population mean in the unfavorable direction on ≥1 measure in the domain. School readiness impairment was defined as impairment in ≥2 of 5 domains. Logistic regression predicted impairment within domains and overall readiness. RESULTS The ADHD group demonstrated significantly worse mean scores on 8 of 10 component measures and greater odds of impairment in all domains except for cognition and general knowledge. Overall, 79% of the ADHD group and 13% of the comparison group had school readiness impairment (odds ratio 21, 95% confidence interval 5.67-77.77, P < .001). CONCLUSIONS Preschoolers with ADHD symptoms are likely to have impaired school readiness. We recommend early identification of school readiness impairment by using a comprehensive 5-domain framework in children with ADHD symptoms paired with targeted intervention to improve outcomes.
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Affiliation(s)
- Hannah T Perrin
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Nicole A Heller
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Irene M Loe
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
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26
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King CA, Arango A, Kramer A, Busby D, Czyz E, Foster CE, Gillespie BW. Association of the Youth-Nominated Support Team Intervention for Suicidal Adolescents With 11- to 14-Year Mortality Outcomes: Secondary Analysis of a Randomized Clinical Trial. JAMA Psychiatry 2019; 76:492-498. [PMID: 30725077 PMCID: PMC6495350 DOI: 10.1001/jamapsychiatry.2018.4358] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE The prevalence of suicide among adolescents is rising, yet little is known about effective interventions. To date, no intervention for suicidal adolescents has been shown to reduce mortality. OBJECTIVE To determine whether the Youth-Nominated Support Team Intervention for Suicidal Adolescents-Version II (YST) is associated with reduced mortality 11 to 14 years after psychiatric hospitalization for suicide risk. DESIGN, SETTING, AND PARTICIPANTS This post hoc secondary analysis of a randomized clinical trial used National Death Index (NDI) data from adolescent psychiatric inpatients from 2 US psychiatric hospitals enrolled in the clinical trial from November 10, 2002, to October 26, 2005. Eligible participants were aged 13 to 17 years and presented with suicidal ideation (frequent or with suicidal plan), a suicide attempt, or both within the past 4 weeks. Participants were randomized to receive treatment as usual (TAU) or YST plus TAU (YST). Evaluators and staff who matched identifying data to NDI records were masked to group. The length of NDI follow-up ranged from 11.2 to 14.1 years. Analyses were conducted between February 12, 2018, and September 18, 2018. INTERVENTIONS The YST is a psychoeducational, social support intervention. Adolescents nominated "caring adults" (mean, 3.4 per adolescent from family, school, and community) to serve as support persons for them after hospitalization. These adults attended a psychoeducational session to learn about the youth's problem list and treatment plan, suicide warning signs, communicating with adolescents, and how to be helpful in supporting treatment adherence and positive behavioral choices. The adults received weekly supportive telephone calls from YST staff for 3 months. MAIN OUTCOMES AND MEASURES Survival 11 to 14 years after index hospitalization, measured by NDI data for deaths (suicide, drug overdose, and other causes of premature death), from January 1, 2002, through December 31, 2016. RESULTS National Death Index records were reviewed for all 448 YST study participants (319 [71.2%] identified as female; mean [SD] age, 15.6 [1.3] years; 375 [83.7%] of white race/ethnicity). There were 13 deaths in the TAU group and 2 deaths in the YST group (hazard ratio, 6.62; 95% CI, 1.49-29.35; P < .01). No patients were withdrawn from YST owing to adverse effects. CONCLUSIONS AND RELEVANCE The findings suggest that the YST intervention for suicidal adolescents is associated with reduced mortality. Because this was a secondary analysis, results warrant replication with examination of mechanisms. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00071617.
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Affiliation(s)
- Cheryl A. King
- Department of Psychiatry, University of Michigan, Ann Arbor
| | | | - Anne Kramer
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Danielle Busby
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Ewa Czyz
- Department of Psychiatry, University of Michigan, Ann Arbor
| | | | - Brenda W. Gillespie
- Consulting for Statistics, Computing and Analytics Research at the University of Michigan, Ann Arbor
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Arnold LE, Roy A, Taylor E, Hechtman L, Sibley M, Swanson JM, Mitchell JT, Molina BSG, Rohde LA. Predictive utility of childhood diagnosis of ICD-10 hyperkinetic disorder: adult outcomes in the MTA and effect of comorbidity. Eur Child Adolesc Psychiatry 2019; 28:557-570. [PMID: 30232561 DOI: 10.1007/s00787-018-1222-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/03/2018] [Indexed: 01/20/2023]
Abstract
Diagnostic guidelines differ between DSM attention-deficit/hyperactivity disorder (ADHD) and ICD hyperkinetic disorder (HKD). Only 145 of 579 children age 7-9 in the Multimodal Treatment Study of ADHD (the MTA) with combined-type DSM-IV ADHD met criteria for ICD-10 HKD, because major internalizing comorbidities and more stringent symptom count/pervasiveness requirements excluded most. The 145 HKD had significantly better 14-month medication response than the rest. We explored whether HKD had greater adult symptom persistence and/or impairment than other ADHD. Multi-informant assessments were done for 16 years. We used the 12/14/16-year assessments, in young adulthood. The post-attrition 109 with baseline HKD had no greater adult persistence of ADHD symptoms/impairment than 367 without HKD, but had more cumulative stimulant use, more job losses, lower emotional lability, and fewer car crashes. However, those excluded for internalizing comorbidity but otherwise meeting HKD criteria had significantly more persistence. Only 6 of the 109 (5.5%) with baseline HKD met ICD-10 criteria for HKD in adulthood, compared to 25 of 367 (6.8%) without a childhood HKD diagnosis. Despite greater initial symptom severity, HKD had no worse 16-year young adult outcome than others, except for job losses, balanced by less emotional lability and fewer crashes. Comorbid internalizing disorder seems to have worse prognosis than initial severity/pervasiveness of ADHD symptoms.
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Affiliation(s)
- L Eugene Arnold
- Department of Psychiatry and Behavioral Health, Ohio State University, 395E McCampbell Hall, 1581 Dodd Dr, Columbus, OH, 43210, USA.
| | - Arunima Roy
- Division of Molecular Psychiatry, University Hospital Würzburg, Würzburg, Germany
| | - Eric Taylor
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Lily Hechtman
- McGill University, Montreal Children's Hospital, Montreal, Canada
| | - Margaret Sibley
- Department of Psychiatry and Behavioral Health, Florida International University, Miami, USA
| | - James M Swanson
- Department of Pediatrics, University of California Irvine, Irvine, USA
| | - John T Mitchell
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, USA
| | - Brooke S G Molina
- Departments of Psychiatry, Psychology, and Pediatrics, University of Pittsburgh, Pittsburgh, USA
| | - Luis A Rohde
- Division of Child and Adolescent Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul and National Institute of Developmental Psychiatry for Children and Adolescents, Porto Alegre, Brazil
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Leon SL, Polihronis C, Cloutier P, Zemek R, Newton AS, Gray C, Cappelli M. Family Factors and Repeat Pediatric Emergency Department Visits for Mental Health: A Retrospective Cohort Study. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2019; 28:9-20. [PMID: 31001347 PMCID: PMC6457444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Approximately 45% of youth presenting to the emergency department (ED) for mental health (MH) concerns will have a repeat ED visit. Since youth greatly depend on their caregivers to access MH services, the objective of this study was to determine if family characteristics were associated with repeat ED visits. METHODS A retrospective cohort study of youth aged 6-18 years (62% female) treated at a tertiary pediatric ED for a discharge diagnosis related to MH was conducted. Data were gathered from medical records, telephone interviews, and questionnaires. Family factor contribution was analyzed using a multivariable logistic regression model controlling for demographic, clinical and service utilization factors. Variables associated with earlier and more frequent visits were determined using cox regression and negative binomial regression. RESULTS Of 266 participants, 70 (26%) had a repeat visit. While caregiver history of MH treatment decreased the odds of having a repeat ED visit, family functioning and perceived family burden were not associated with repeat visits. Post-visit MH services, prior psychiatric hospitalization, higher severity of symptoms, and living closer to the hospital increased the odds of repeat visits. CONCLUSIONS This study examined the contribution of multiple family factors in predicting repeat MH visits to the ED. Results suggest caregiver characteristics may impact the decision to return. Healthcare providers should therefore consider caregiver and youth service utilization factors to inform patient management and discharge planning.
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Affiliation(s)
- Stephanie L Leon
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- University of Ottawa, Faculty of Social Sciences, School of Psychology, Ottawa, Ontario
| | | | - Paula Cloutier
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
- University of Ottawa, Faculty of Medicine, Department of Pediatrics, Ottawa, Ontario
| | - Amanda S Newton
- University of Alberta, Department of Pediatrics, Faculty of Medicine and Dentistry, Edmonton, Alberta
| | - Clare Gray
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Mario Cappelli
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
- University of Ottawa, Faculty of Graduate and Postdoctoral Studies, Ottawa, Ontario
- Ontario Centre of Excellence for Child and Youth Mental Health, Ottawa, Ontario
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Blume F, Kuehnhausen J, Reinelt T, Wirth A, Rauch WA, Schwenck C, Gawrilow C. The interplay of delay aversion, timing skills, and impulsivity in children experiencing attention-deficit/hyperactivity disorder (ADHD) symptoms. ACTA ACUST UNITED AC 2019; 11:383-393. [DOI: 10.1007/s12402-019-00298-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/14/2019] [Indexed: 11/24/2022]
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Swanson JM, Wigal T, Jensen P, Mitchell JT, Weisner TS, Murray DW, Arnold LE, Hechtman L, Molina BSG, Owens E, Belendiuk K, Howard AL, Wigal S, Sorenson P, Stehli A. The Qualitative Interview Study of Persistent and Nonpersistent Substance Use in the MTA: Sample Characteristics, Frequent Use, and Reasons for Use. J Atten Disord 2018; 22:21S-37S. [PMID: 29090967 PMCID: PMC6746244 DOI: 10.1177/1087054717714058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate participants' perceptions about frequent use and reasons for substance use (SU) in the qualitative interview study, an add-on to the multimodal treatment study of ADHD (MTA). METHOD Using the longitudinal MTA database, 39 ADHD cases and 19 peers with Persistent SU, and 86 ADHD cases and 39 peers without Persistent SU were identified and recruited. In adulthood, an open-ended interview was administered, and SU excerpts were indexed and classified to create subtopics (frequent use and reasons for use of alcohol, marijuana, and other drugs). RESULTS For marijuana, the Persistent compared with Nonpersistent SU group had a significantly higher percentage of participants describing frequent use and giving reasons for use, and the ADHD group compared with the group of peers had a significantly higher percentage giving "stability" as a reason for use. CONCLUSION Motivations for persistent marijuana use may differ for adults with and without a history of ADHD.
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Affiliation(s)
| | | | - Peter Jensen
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA,Reach Institute, New York, NY, USA
| | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Thomas S. Weisner
- Departments of Psychiatry & Anthropology, UCLA, Los Angeles, CA, USA
| | - Desiree W. Murray
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA,Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA
| | - L. Eugene Arnold
- Department of Psychiatry, Ohio State University, Columbus, OH, USA
| | - Lily Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Brooke S. G. Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth Owens
- Institute of Human Development and Department of Psychology, University of California, Berkeley, CA, USA
| | - Katherine Belendiuk
- Department of Real World Data Science, Genentech, South San Francisco, CA, USA
| | | | | | - Page Sorenson
- University of California, San Francisco, Research Development Office
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Weisner TS, Murray DW, Jensen PS, Mitchell JT, Swanson JM, Hinshaw SP, Wells K, Hechtman L, Molina BSG, Arnold LE, Sorensen P, Stehli A. Follow-Up of Young Adults With ADHD in the MTA: Design and Methods for Qualitative Interviews. J Atten Disord 2018; 22:10S-20S. [PMID: 28617075 PMCID: PMC5711631 DOI: 10.1177/1087054717713639] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Qualitative interviews with 183 young adults (YA) in the follow-up of the Multimodal Treatment Study of Children With and Without ADHD (MTA) provide rich information on beliefs and expectations regarding ADHD, life's turning points, medication use, and substance use (SU). METHOD Participants from four MTA sites were sampled to include those with persistent and atypically high SU, and a local normative comparison group (LNCG). Respondents were encouraged to "tell their story" about their lives, using a semistructured conversational interview format. RESULTS Interviews were reliably coded for interview topics. ADHD youth more often desisted from SU because of seeing others going down wrong paths due to SU. Narratives revealed very diverse accounts and explanations for SU-ADHD influences. CONCLUSION Qualitative methods captured the perspectives of YAs regarding using substances. This information is essential for improving resilience models in drug prevention and treatment programs and for treatment development for this at-risk population.
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Affiliation(s)
| | - Desiree W. Murray
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Peter S. Jensen
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA and the Reach Institute, New York, NY, USA
| | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Stephen P. Hinshaw
- Department of Psychology, University of California, Berkeley, CA, USA and the University of California, San Francisco, CA, USA
| | - Karen Wells
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Lily Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Brooke S. G. Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - L. Eugene Arnold
- Department of Psychiatry, Ohio State University, Columbus, OH, USA
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Lin E, Durbin J, Guerriere D, Volpe T, Selick A, Kennedy J, Ungar WJ, Lero DS. Assessing care-giving demands, resources and costs of family/friend caregivers for persons with mental health disorders: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:613-634. [PMID: 29498120 DOI: 10.1111/hsc.12546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2018] [Indexed: 06/08/2023]
Abstract
As mental health (MH) care has shifted from institutional settings to the community, families and friends are responsible for providing the majority of the care at home. The substantial literature on the adverse effects experienced by caregivers has focused mainly on psychological morbidity. Less attention has been paid to how caregivers for persons with MH disorders interact with larger social systems and the impacts of factors such as financial strain, lost time from leisure activities, and the availability of health and social services. We conducted a scoping review of MH and other caregiver questionnaires published between 1990 and 2016 to determine whether they addressed four key domains: caregiver work demands, resource needs, resource utilisation and costs. A range of health and social care databases were searched, including MEDLINE and Health and Psychosocial Instruments. After screening for relevance and quality, our search identified 14 instruments addressing elements related to one or more of our domains. Because these instruments covered only a small portion of our domains, we conducted a second targeted search of the general care-giving literature and consulted with experts, identifying an additional 18 instruments. A total of 32 questionnaires were reviewed, 14 specific to care-giving for mental health problems and 18 for other health conditions. Our search identified instruments or items within instruments that assess constructs in each of our domains, but no one instrument covered them completely. Additionally, some constructs were evaluated in detail and others only addressed by single items. While these instruments are helpful for moving measurement beyond the psychological impacts of care-giving, our results serve only as an initial guide. Additional methodological work is needed to more comprehensively measure the impact of care-giving for individuals with MH disorders and to contribute to the development of more meaningful and effective policies and programmes.
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Affiliation(s)
- Elizabeth Lin
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Janet Durbin
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Denise Guerriere
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Tiziana Volpe
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
| | - Avra Selick
- Provincial System and Support Program, Centre for Addiction & Mental Health, Toronto, ON, Canada
| | - Julia Kennedy
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Donna S Lero
- Centre for Families, Work and Well-Being, University of Guelph, Guelph, ON, Canada
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Splett JW, George MW, Zaheer I, Weist MD, Evans SW, Kern L. Symptom Profiles and Mental Health Services Received Among Referred Adolescents. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-017-9244-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Evaluating mental health service use during and after emergency department visits in a multisite cohort of Canadian children and youth. CAN J EMERG MED 2017; 21:75-86. [DOI: 10.1017/cem.2017.416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractObjectivesThe goal of this study was to examine the mental health needs of children and youth who present to the emergency department (ED) for mental health care and to describe the type of, and satisfaction with, follow-up mental health services accessed.MethodsA 6-month to 1.5-year prospective cohort study was conducted in three Canadian pediatric EDs and one general ED, with a 1-month follow-up post-ED discharge. Measures included 1) clinician rating of mental health needs, 2) patient and caregiver self-reports of follow-up services, and 3) interviews regarding follow-up satisfaction. Data analysis included descriptive statistics and the Fisher’s exact test to compare sites.ResultsThe cohort consisted of 373 children and youth (61.1% female; mean age 15.1 years, 1.5 standard deviation). The main reason for ED presentations was a mental health crisis. The three most frequent areas of need requiring action were mood (43.8%), suicide risk (37.4%), and parent-child relational problems (34.6%). During the ED visit, 21.6% of patients received medical clearance, 40.9% received a psychiatric consult, and 19.4% were admitted to inpatient psychiatric care. At the 1-month post-ED visit, 84.3% of patients/caregivers received mental health follow-up. Ratings of service recommendations were generally positive, as 60.9% of patients obtained the recommended follow-up care and 13.9% were wait-listed.ConclusionsChildren and youth and their families presenting to the ED with mental health needs had substantial clinical morbidity, were connected with services, were satisfied with their ED visit, and accessed follow-up care within 1-month with some variability.
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McAuley T, Crosbie J, Charach A, Schachar R. Clinical, Sociobiological, and Cognitive Predictors of ADHD Persistence in Children Followed Prospectively Over Time. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:765-776. [PMID: 27473334 DOI: 10.1007/s10802-016-0189-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
With increasing awareness that ADHD is chronically disabling, a burgeoning literature has examined childhood clinical indicators of ADHD persistence. This study investigates whether childhood factors reflecting biological risk and cognitive reserve have additive predictive value for the persistence of ADHD that is unique beyond childhood indicators of disorder severity. One-hundred thirty children with ADHD (mean age = 8.9 years, 75 % male) were followed into adolescence (mean age = 14.0 years). Childhood ADHD and co-morbidities were assessed via interviews with parents and teachers; parental psychopathology was assessed via parent interview; exposure to neurobiological and psychosocial adversity were indexed by parent questionnaire; and cognitive reserve was evaluated through children's performance on measures of IQ and executive functioning. Univariate analyses identified childhood inattention and hyperactivity-impulsivity, co-morbid oppositional defiant disorder, overall impairment, and paternal anxiety and depression as more prevalent amongst adolescents with persistent compared with remitted ADHD. Only child-level predictors remained significant in a final multivariate model. These results suggest that children who are most likely to experience persistent ADHD have a more severe clinical presentation in childhood, reflected by increased levels of inattention, oppositional behavior, and impairment. They also are more likely to have fathers with internalizing concerns, but these concerns do not uniquely predict ADHD persistence beyond child-level factors. Contrary to expectations, childhood adversity and cognitive functioning did not predict the course of ADHD.
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Affiliation(s)
- Tara McAuley
- Department of Psychology, Centre for Mental Health Research, University of Waterloo, 200 University Ave West, Waterloo, ON, Canada.
| | - Jennifer Crosbie
- Department of Psychiatry Research, Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada
| | - Alice Charach
- Department of Psychiatry Research, Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada
| | - Russell Schachar
- Department of Psychiatry Research, Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada
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DuPaul GJ, Morgan PL, Farkas G, Hillemeier MM, Maczuga S. Eight-Year Latent Class Trajectories of Academic and Social Functioning in Children with Attention-Deficit/Hyperactivity Disorder. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 46:979-992. [DOI: 10.1007/s10802-017-0344-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Swanson JM, Arnold LE, Molina BSG, Sibley MH, Hechtman LT, Hinshaw SP, Abikoff H, Stehli A, Owens EB, Mitchell JT, Nichols Q, Howard A, Greenhill LL, Hoza B, Newcorn J, Jensen P, Vitiello B, Wigal T, Epstein J, Tamm L, Lakes KD, Waxmonsky J, Lerner M, Etcovitch J, Murray D, Muenke M, Acosta M, Arcos-Burgos M, Pelham WE, Kraemer H. Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression. J Child Psychol Psychiatry 2017; 58:663-678. [PMID: 28295312 PMCID: PMC6168061 DOI: 10.1111/jcpp.12684] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Multimodal Treatment Study (MTA) began as a 14-month randomized clinical trial of behavioral and pharmacological treatments of 579 children (7-10 years of age) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type. It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates (258 without ADHD) added as a local normative comparison group (LNCG), with assessments 2-16 years after baseline. METHODS Primary (symptom severity) and secondary (adult height) outcomes in adulthood were specified. Treatment was monitored to age 18, and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication (Consistent, Inconsistent, and Negligible). For the follow-up, hypothesis-generating analyses were performed on outcomes in early adulthood (at 25 years of age). Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup differences reflecting benefit (symptom reduction) and cost (height suppression) associated with extended use of medication. RESULTS For ratings of symptom severity, the ADHD-LNCG comparison was statistically significant for the parent/self-report average (0.51 ± 0.04, p < .0001, d = 1.11), documenting symptom persistence, and for the parent/self-report difference (0.21 ± 0.04, p < .0001, d = .60), documenting source discrepancy, but the comparisons of naturalistic subgroups reflecting medication effects were not significant. For adult height, the ADHD group was 1.29 ± 0.55 cm shorter than the LNCG (p < .01, d = .21), and the comparisons of the naturalistic subgroups were significant: the treated group with the Consistent or Inconsistent pattern was 2.55 ± 0.73 cm shorter than the subgroup with the Negligible pattern (p < .0005, d = .42), and within the treated group, the subgroup with the Consistent pattern was 2.36 ± 1.13 cm shorter than the subgroup with the Inconsistent pattern (p < .04, d = .38). CONCLUSIONS In the MTA follow-up into adulthood, the ADHD group showed symptom persistence compared to local norms from the LNCG. Within naturalistic subgroups of ADHD cases, extended use of medication was associated with suppression of adult height but not with reduction of symptom severity.
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Affiliation(s)
- James M. Swanson
- Department of Pediatrics, School of Medicine, University of California, Irvine, CA
| | - L. Eugene Arnold
- Department of Psychiatry, Ohio State University, Nisonger Center, Columbus, OH
| | - Brooke S. G. Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine, PA
| | | | - Lily T. Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | | | - Howard Abikoff
- Child Study Center at New York University Langone Medical Center, NY
| | - Annamarie Stehli
- Department of Pediatrics, School of Medicine, University of California, Irvine, CA
| | | | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Quyen Nichols
- Department of Psychological Science, University of Vermont, Burlington, VT
| | - Andrea Howard
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | | | - Betsy Hoza
- Department of Psychological Science, University of Vermont, Burlington, VT
| | - Jeffrey Newcorn
- Department of Psychiatry, Mount Sinai Medical School, New York, NY
| | - Peter Jensen
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | | | - Jeffery Epstein
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Leanne Tamm
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Kimberly D. Lakes
- Department of Pediatrics, School of Medicine, University of California, Irvine, CA
| | | | - Marc Lerner
- Orange County Department of Education, Costa Mesa, CA
| | - Joy Etcovitch
- Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Desiree Murray
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC
| | | | - Maria Acosta
- National Human Genome Research Institute, Bethesda, MD
| | | | - William E. Pelham
- Department of Psychology, Florida International University, Miami, FL
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Specific Components of Pediatricians' Medication-Related Care Predict Attention-Deficit/Hyperactivity Disorder Symptom Improvement. J Am Acad Child Adolesc Psychiatry 2017; 56:483-490.e1. [PMID: 28545753 PMCID: PMC5448310 DOI: 10.1016/j.jaac.2017.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/23/2017] [Accepted: 03/29/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The development of attention-deficit/hyperactivity disorder (ADHD) care quality measurements is a prerequisite to improving the quality of community-based pediatric care of children with ADHD. Unfortunately, the evidence base for existing ADHD care quality metrics is poor. The objective of this study was to identify which components of ADHD care best predict patient outcomes. METHOD Parents of 372 medication-naïve children in grades 1 to 5 presenting to their community-based pediatrician (N = 195) for an ADHD-related concern and who were subsequently prescribed ADHD medication were identified. Parents completed the Vanderbilt ADHD Parent Rating Scale (VAPRS) at the time ADHD was raised as a concern and then approximately 12 months after starting ADHD medication. Each patient's chart was reviewed to measure 12 different components of ADHD care. RESULTS Across all children, the mean decrease in VAPRS total symptom score during the first year of treatment was 11.6 (standard deviation 10.1). Of the 12 components of ADHD care, shorter times to first contact and more teacher ratings collected in the first year of treatment significantly predicted greater decreases in patient total symptom scores. Notably, it was timeliness of contacts, defined as office visits, phone calls, or email communication, that predicted more ADHD symptom decreases. Office visits alone, in terms of number or timeliness, did not predict patient outcomes. CONCLUSION The magnitude of ADHD symptom decrease that can be achieved with the use of ADHD medications was associated with specific components of ADHD care. Future development and modifications of ADHD quality care metrics should include these ADHD care components.
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Reed MO, Jakubovski E, Johnson JA, Bloch MH. Predictors of Long-Term School-Based Behavioral Outcomes in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2017; 27:296-309. [PMID: 28253029 PMCID: PMC5439457 DOI: 10.1089/cap.2015.0168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore predictors of 8-year school-based behavioral outcomes in attention-deficit/hyperactivity disorder (ADHD). METHODS We examined potential baseline predictors of school-based behavioral outcomes in children who completed the 8-year follow-up in the multimodal treatment study of children with ADHD. Stepwise logistic regression and receiver operating characteristic (ROC) analysis identified baseline predictors that were associated with a higher risk of truancy, school discipline, and in-school fights. RESULTS Stepwise regression analysis explained between 8.1% (in-school fights) and 12.0% (school discipline) of the total variance in school-based behavioral outcomes. Logistic regression identified several baseline characteristics that were associated with school-based behavioral difficulties 8 years later, including being male (associated with truancy and school discipline), African American (school discipline, in-school fights), increased conduct disorder (CD) symptoms (truancy), decreased affection from parents (school discipline), ADHD severity (in-school fights), and study site (truancy and school discipline). ROC analyses identified the most discriminative predictors of truancy, school discipline, and in-school fights, which were Aggression and Conduct Problem Scale Total score, family income, and race, respectively. CONCLUSIONS A modest, but nontrivial portion of school-based behavioral outcomes, was predicted by baseline childhood characteristics. Exploratory analyses identified modifiable (lack of paternal involvement, lower parental knowledge of behavioral principles, and parental use of physical punishment), somewhat modifiable (income and having comorbid CD), and nonmodifiable (African American and male) factors that were associated with school-based behavioral difficulties. Future research should confirm that the associations between earlier specific parenting behaviors and poor subsequent school-based behavioral outcomes are, indeed, causally related and independent cooccurring childhood psychopathology. Future research might target increasing paternal involvement and parental knowledge of behavioral principles and reducing use of physical punishment to improve school-based behavioral outcomes in children with ADHD.
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Affiliation(s)
- Margot O. Reed
- College of the Holy Cross, Worcester, Massachusetts.,Yale Child Study Center, New Haven, Connecticut
| | - Ewgeni Jakubovski
- Yale Child Study Center, New Haven, Connecticut.,Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | | | - Michael H. Bloch
- Yale Child Study Center, Department of Psychiatry, Yale University, New Haven, Connecticut
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Impact of Mental Health Comorbidities on the Community-Based Pediatric Treatment and Outcomes of Children with Attention Deficit Hyperactivity Disorder. J Dev Behav Pediatr 2017; 38:20-28. [PMID: 27902542 PMCID: PMC5198773 DOI: 10.1097/dbp.0000000000000359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Children with attention deficit hyperactivity disorder (ADHD) often exhibit psychiatric comorbidities, which may impact illness presentation, diagnosis, and treatment outcomes. Guidelines exist for dealing with these complex cases but little is known about how comorbidities are being handled in community pediatric settings. The purpose of this study was to evaluate how mental health comorbidities affect community physicians' ADHD care practices and patients' symptom trajectories. METHOD Medical charts of 319 children presenting at primary care clinics for ADHD-related concerns were reviewed. Physician assessment and treatment behaviors were extracted and parents rated ADHD symptoms at the time of diagnosis and at 3, 6, and 12 months. Baseline ratings were used to group children, as no comorbid mental health condition, internalizing, or externalizing comorbid condition. Multilevel analyses compared community physician care behaviors and ADHD symptom trajectories across groups. RESULTS Approximately, 50 percent of the sample met screening criteria for a comorbid mental health condition. For children diagnosed with ADHD and treated with medication, community physician care largely did not differ across groups, but children with internalizing comorbidities made significantly smaller improvements in inattentive and hyperactive/impulsive symptoms compared with children with no comorbidities. CONCLUSION Children with ADHD and mental health comorbidities, particularly internalizing disorders, exhibit less robust response to ADHD medication and may require additional testing before starting medication and/or alternative treatment approaches. Potential barriers to conducting comprehensive assessments and to providing multi-modal treatment are discussed.
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Pei J, Baugh L, Andrew G, Rasmussen C. Intervention recommendations and subsequent access to services following clinical assessment for fetal alcohol spectrum disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 60:176-186. [PMID: 27987413 DOI: 10.1016/j.ridd.2016.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/26/2016] [Accepted: 11/13/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Children with fetal alcohol spectrum disorders (FASD) and prenatal alcohol exposure (PAE) experience multiple difficulties requiring various interventions. Researchers have called for investigation into service use with respect to clinically recommended interventions. AIMS To examine intervention recommendations for children with FASD/PAE and subsequent access to these recommended interventions. METHODS AND PROCEDURES Intervention recommendations following FASD assessment were examined for children (1-17 years). Recommendations were compared according to diagnostic status and demographic and environmental variables. Subsequent access to several interventions was examined for 45 participants. OUTCOMES AND RESULTS A variety of recommendations were given. Children with FASD received more recommendations overall and received more education, anticipatory guidance, family support, and safety recommendations than undiagnosed children with PAE. Undiagnosed children received more mental health and reassessment recommendations. Older children received fewer family support and developmental therapy recommendations but more mental health recommendations than younger age groups. Many families accessed modified school programming, developmental therapy, psychiatry, child counseling, and parent support as recommended. CONCLUSIONS AND IMPLICATIONS Children with FASD and PAE have extensive needs and should receive individualized recommendations. An assessment is valuable even without an FASD diagnosis. Areas of high/low service access may provide insight into accessibility and perceived importance of interventions. WHAT THIS PAPER ADDS This study responds to important research questions regarding the intervention needs of individuals with FASD. It is novel in its exploration of intervention recommendations given to children prenatally exposed to alcohol without an FASD diagnosis (rather than only children with FASD) and in its examination of post-assessment service use patterns specifically in relation to clinical recommendations.
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Affiliation(s)
- Jacqueline Pei
- Department of Educational Psychology, University of Alberta, 6-102 Education North, University of Alberta, Edmonton, AB T6G 2G5, Canada.
| | - Lauren Baugh
- Department of Educational Psychology, University of Alberta, 6-102 Education North, University of Alberta, Edmonton, AB T6G 2G5, Canada.
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, 3rd Floor, Edmonton, AB T6G 1C9, Canada; Glenrose Rehabilitation Hospital, 10230 111 Avenue Northwest, Edmonton, AB T5G 0B7, Canada.
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, 3rd Floor, Edmonton, AB T6G 1C9, Canada.
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Methodological considerations in service use assessment for children and youth with mental health conditions; issues for economic evaluation. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 42:296-308. [PMID: 24961357 DOI: 10.1007/s10488-014-0570-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Economic evaluations are increasingly used in decision-making. Accurate measurement of service use is critical to economic evaluation. This qualitative study, based on expert interviews, aims to identify best approaches to service use measurement for child mental health conditions, and to identify problems in current methods. Results suggest considerable agreement on strengths (e.g., availability of accurate instruments to measure service use) and weaknesses, (e.g., lack of unit prices for services outside the health sector) or alternative approaches to service use measurement. Experts also identified some unresolved problems, for example the lack of uniform definitions for some mental health services.
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Wagner JL, Ferguson PL, Kellermann T, Smith G, Brooks B. Behavioral health referrals in pediatric epilepsy. Epilepsy Res 2016; 127:72-77. [PMID: 27565414 DOI: 10.1016/j.eplepsyres.2016.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 07/28/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to examine the feasibility of a behavioral health referral protocol and barriers to behavioral health care in a pediatric epilepsy clinic. A sample of 93 youth with epilepsy ages 10-17 and caregivers completed behavioral health and seizure severity measures during a routine epilepsy clinic visit. Key findings are that 47 (50.5%) of the youth screened positive for a behavioral health referral, and 35 of these youth were referred for behavioral health services. However, only 20% made and presented for the behavioral health appointment. The most commonly cited barrier for accessing and utilizing behavioral health care was stigma related- a mental health label for the child. The significance of this study lies in the revelation that solely screening for and educating caregivers about behavioral health symptoms and providing behavioral health referral information is not an ideal model. Instead, stigma related barriers point to the necessity of continued integrated physical and behavioral health care within the pediatric epilepsy visit.
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Affiliation(s)
- Janelle L Wagner
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA; Comprehensive Epilepsy Program, Medical University of South Carolina, Charleston, SC, USA; Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
| | - Pamela L Ferguson
- Division of General Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Tanja Kellermann
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Gigi Smith
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA; Comprehensive Epilepsy Program, Medical University of South Carolina, Charleston, SC, USA; Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Byron Brooks
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
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Weisz J, Bearman SK, Santucci LC, Jensen-Doss A. Initial Test of a Principle-Guided Approach to Transdiagnostic Psychotherapy With Children and Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:44-58. [DOI: 10.1080/15374416.2016.1163708] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- John Weisz
- Department of Psychology, Harvard University
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Jabbour M, Reid S, Polihronis C, Cloutier P, Gardner W, Kennedy A, Gray C, Zemek R, Pajer K, Barrowman N, Cappelli M. Improving mental health care transitions for children and youth: a protocol to implement and evaluate an emergency department clinical pathway. Implement Sci 2016; 11:90. [PMID: 27389410 PMCID: PMC4936307 DOI: 10.1186/s13012-016-0456-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/18/2016] [Indexed: 11/10/2022] Open
Abstract
Background While the emergency department (ED) is often a first point of entry for children and youth with mental health (MH) concerns, there is a limited capacity to respond to MH needs in this setting. Child MH systems are typically fragmented among multiple ministries, organizations, and providers. Communication among these groups is often poor, resulting in gaps, particularly in transitions of care, for this vulnerable population. The evidence-based Emergency Department Mental Health Clinical Pathway (EDMHCP) was created with two main goals: (1) to guide risk assessment and disposition decision-making for children and youth presenting to the ED with MH concerns and (2) to provide a streamlined transition to follow-up services with community MH agencies (CMHAs) and other providers. The purpose of this paper is to describe our study protocol to implement and evaluate the EDMHCP. Methods/design This mixed methods health services research project will involve implementation and evaluation of the EDMHCP in four exemplar ED-CMHA dyads. The Theoretical Domains Framework will be used to develop a tailored intervention strategy to implement the EDMHCP. A multiple baseline study design and interrupted time-series analysis will be used to determine if the EDMHCP has improved health care utilization, medical management of the MH problems, and health sector coordination. The primary process outcome will be the proportion of patients with MH-specific recommendations documented in the health record. The primary service outcome will be the proportion of patients receiving the EDMHCP-recommended follow-up at 24-h or at 7 days. Data sources will include qualitative interviews, health record audits, administrative databases, and patient surveys. A concurrent process evaluation will be conducted to assess the degree of variability and fidelity in implementation across the sites. Discussion This paper presents a novel model for measuring the effects of the EDMHCP. Our development process will identify how the EDMHCP is best implemented among partner organizations to deliver evidence-based risk management of children and youth presenting with MH concerns. More broadly, it will contribute to the body of evidence supporting clinical pathway implementation within novel partnerships. Trial registration ClinicalTrials.gov (NCT02590302)
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Affiliation(s)
- Mona Jabbour
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada. .,Faculty of Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Canada. .,Psychiatric & Mental Health Research, CHEO Research Institute, Ottawa, Canada.
| | - S Reid
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada.,Faculty of Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Canada.,Psychiatric & Mental Health Research, CHEO Research Institute, Ottawa, Canada
| | - C Polihronis
- Psychiatric & Mental Health Research, CHEO Research Institute, Ottawa, Canada.,Department of Psychology, Carleton University, Ottawa, Canada
| | - P Cloutier
- Psychiatric & Mental Health Research, CHEO Research Institute, Ottawa, Canada.,Centre for Pediatric Mental Health Services and Policy Research, CHEO Research Institute, Ottawa, Canada
| | - W Gardner
- Centre for Pediatric Mental Health Services and Policy Research, CHEO Research Institute, Ottawa, Canada.,Department of Epidemiology, University of Ottawa, Ottawa, Canada
| | - A Kennedy
- Psychiatric & Mental Health Research, CHEO Research Institute, Ottawa, Canada.,Psychology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - C Gray
- Psychiatric & Mental Health Research, CHEO Research Institute, Ottawa, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, Canada.,Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - R Zemek
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada.,Faculty of Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Canada.,Clinical Research Unit, CHEO Research Institute, Ottawa, Canada
| | - K Pajer
- Department of Psychiatry, University of Ottawa, Ottawa, Canada.,Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - N Barrowman
- Clinical Research Unit, CHEO Research Institute, Ottawa, Canada.,Department of Statistics, University of Ottawa, Ottawa, Canada
| | - M Cappelli
- Psychiatric & Mental Health Research, CHEO Research Institute, Ottawa, Canada.,Centre for Pediatric Mental Health Services and Policy Research, CHEO Research Institute, Ottawa, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, Canada.,Department of Psychology, University of Ottawa, Ottawa, Canada
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Weissberg-Benchell J, Rausch J, Iturralde E, Jedraszko A, Hood K. A randomized clinical trial aimed at preventing poor psychosocial and glycemic outcomes in teens with type 1 diabetes (T1D). Contemp Clin Trials 2016; 49:78-84. [PMID: 27267154 PMCID: PMC4969210 DOI: 10.1016/j.cct.2016.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/24/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
Abstract
Adolescents with type 1 diabetes have an increased risk for a variety of emotional and behavioral challenges as well as negative diabetes outcomes. This study was designed to compare the effectiveness of a depression-prevention, resilience promotion program with an advanced diabetes education program. Each program consisted of 9 group-based sessions. There were 264 adolescents enrolled in this multi-site randomized clinical trial. The primary outcomes were depressive symptoms and glycemic control; secondary outcomes included resilience skills, diabetes management and adherence, and diabetes-specific distress. The goal of the present paper is to describe the study design, the intervention, and the baseline characteristics of the sample. Preliminary data suggests that enrollment, randomization and retention were successful. Longitudinal follow-up and examination of mechanisms of action as they relate to psychosocial and glycemic outcomes will be explored in the future.
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Affiliation(s)
| | - Joseph Rausch
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Esti Iturralde
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Aneta Jedraszko
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Korey Hood
- Stanford University School of Medicine, Palo Alto, CA, United States
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Silverstein M, Hironaka LK, Feinberg E, Sandler J, Pellicer M, Chen N, Cabral H. Using Clinical Data to Predict Accurate ADHD Diagnoses Among Urban Children. Clin Pediatr (Phila) 2016; 55:326-32. [PMID: 26130393 DOI: 10.1177/0009922815591882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diagnosing attention deficit hyperactivity disorder (ADHD) requires reports of child behavior from 2 settings-most commonly home and school. Obtaining this information from teachers, however, is often challenging. We sought to determine if clinical data, supplementary to parent symptom scales, could be useful in predicting DSM-compliant diagnoses. Parents and teachers reported ADHD symptoms for 156 children using Vanderbilt scales; care managers collected clinical data; a team of specialists determined whether children met diagnostic criteria for ADHD. The ability of a parent Vanderbilt alone to predict an ADHD diagnosis was 56% (95% confidence interval = 45%, 67%). By adding child age and grade retention history to the multivariable model, the probability rose to 78% (95% confidence interval = 59%, 93%). In the maximally predictive model-which included 5 covariates-the predictive validity rose to 84% (95% confidence interval = 52%, 99%). Supplementing parent symptom reports with clinical data may be a viable alternative in certain cases when teacher reports are unavailable.
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Affiliation(s)
- Michael Silverstein
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - L Kari Hironaka
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Emily Feinberg
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA Boston University School of Public Health, Boston, MA, USA
| | - Jenna Sandler
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Michelle Pellicer
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Ning Chen
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Howard Cabral
- Boston University School of Public Health, Boston, MA, USA
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Nigg JT, Johnstone JM, Musser ED, Long HG, Willoughby MT, Shannon J. Attention-deficit/hyperactivity disorder (ADHD) and being overweight/obesity: New data and meta-analysis. Clin Psychol Rev 2015; 43:67-79. [PMID: 26780581 DOI: 10.1016/j.cpr.2015.11.005] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/18/2015] [Accepted: 11/24/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Literature has suggested that ADHD may be associated with increased risk of obesity. If so, this would have important clinical implications. OBJECTIVE To clarify the size of the association between ADHD and obesity and to evaluate key moderators of the association including medication, gender, age, and psychiatric comorbidity. METHOD Two preliminary studies are presented to supply critical additional data for the meta-analysis: a two-year longitudinal study of an ADHD case-control sample of 313 children aged 7-11, and a national survey study of 45,309 families in the United States using the 2012 National Survey of Children's Health. Formal meta-analysis was then conducted. The identification procedure yielded 43 studies, reporting 225 comparisons or effect sizes, studying 703,937 participants An overall effect size was estimated with a random effects model (after pooling within study using a modified fixed effects model). Effect size was then examined in relation to medication, gender, age, and psychiatric comorbidity. RESULTS The new study of children revealed no reliable association of ADHD and body mass index at any age or time point. In the national survey, ADHD was associated with obesity only in adolescent girls but not in children or boys; this effect was statistically accounted for by covarying of depression and conduct disorder. In the meta-analysis, the composite effect size was OR=1.22 (95% CI=1.11-1.34); 22 studies provided effects with medication controlled, yielding a composite effect size of OR=1.30 (95% CI=1.12-1.50). Pooled across age the association without covariates was reliable in females (OR=1.19 [1.01-1.41]) but not males (OR=1.10 [0.95-1.23]) although males and females did not statistically differ. Pooled across gender, the association was significantly larger in adults (>18years) (OR=1.37 [1.19-1.58]) than in youth (OR=1.13 [1.00-1.27]), p=.04. CONCLUSIONS ADHD has a small overall association with obesity, but this effect is moderate in adults. The effect is likely to be of no clinical significance in children, possible clinical significance in adolescent girls with comorbid disorders, and of clinical relevance by adulthood.
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Affiliation(s)
- Joel T Nigg
- Oregon Health & Science University, Portland, OR, United States.
| | | | - Erica D Musser
- Florida International University, Miami, FL, United States
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Abstract
Asian American adults endorse more symptoms of social anxiety (SA) on self-report measures than European Americans, but demonstrate lower prevalence rates of SA disorder in epidemiological studies. These divergent results create ambiguity concerning the mental health needs of Asian Americans. The present study is the first to investigate this issue in adolescents through assessment of self-reported SA in Asian American high school students. Parent and self-ratings of impairment related to SA and self-reported mental health service use for SA were also measured. Asian American students endorsed a greater number of SA symptoms and scored in the clinical range more frequently than other ethnic groups. Also, Asian American and Latino students endorsed more school impairment related to SA than other ethnic groups. No differences in parent-reported impairment or service utilization were identified. Implications for future research and treatment for SA among Asian American adolescents are discussed.
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Pharmacotherapy of the Preschool ADHD Treatment Study (PATS) Children Growing Up. J Am Acad Child Adolesc Psychiatry 2015; 54:550-6. [PMID: 26088659 PMCID: PMC4475273 DOI: 10.1016/j.jaac.2015.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/30/2015] [Accepted: 04/24/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the long-term psychopharmacological treatment of children first diagnosed with attention-deficit/hyperactivity disorder (ADHD) as preschoolers. METHOD In a systematic, prospective, naturalistic follow-up, 206 (68.0%) of the 303 children who participated in the Preschool ADHD Treatment Study (PATS) were reassessed 3 years (mean age 7.4 years) and 179 (59.1%) were reassessed 6 years (mean age 10.4 years) after completion of the controlled study. Pharmacotherapy and clinical data were obtained from the parents. Pharmacotherapy was defined as use of a specific class of medication for at least 50% of the days in the previous 6 months. RESULTS At year 3, a total of 34.0% of the participants were on no pharmacotherapy, 41.3% were on stimulant monotherapy, 9.2% were on atomoxetine alone or with a stimulant, 8.3% were on an antipsychotic usually together with a stimulant, and the remaining 7.2% were on other pharmacotherapy; overall, 65.0% were on an indicated ADHD medication. At year 6, a total of 26.8% of the participants were on no pharmacotherapy, 40.2% were on stimulant monotherapy, 4.5% were on atomoxetine alone or with a stimulant, 13.4% were on an antipsychotic, and 15.1% were on other pharmacotherapy; overall, 70.9% were on an indicated ADHD medication. Antipsychotic treatment was associated with more comorbidity, in particular disruptive behavior disorders and pervasive development disorders, and a lower level of functioning. CONCLUSION In this study, the long-term pharmacotherapy of preschoolers with ADHD was heterogeneous. Although stimulant medication continued to be used by most children, about 1 child in 4 was off medication, and about 1 in 10 was on an antipsychotic.
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