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Fredrick JW, Becker SP. Personality Traits in Relation to Cognitive Disengagement Syndrome and ADHD Inattention in Two Samples of Children. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:460-472. [PMID: 38407137 PMCID: PMC11192613 DOI: 10.1080/15374416.2024.2316707] [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] [Indexed: 02/27/2024]
Abstract
OBJECTIVE Cognitive disengagement syndrome (CDS; previously referred to as sluggish cognitive tempo) is a set of behaviors, including excessive mind-wandering, mental fogginess, and hypoactivity, that are separate from ADHD inattentive (ADHD-IN) symptoms and linked to functional outcomes. However, CDS and ADHD-IN symptoms are strongly associated, and our understanding of whether personality correlates are similarly or differentially linked to CDS and ADHD-IN is limited. The objective of the current study was to examine personality correlates of CDS and ADHD-IN symptoms across two independent samples of school-aged youth. METHOD Study 1 included 207 school-aged children (ages 7-11; 63% male; 87.9% White) with or without teacher-reported elevations in CDS. Study 2 included 263 school-aged children (ages 8-12; 58% male; 75.3% White) with the full range of CDS symptomatology. Parents and teachers completed ratings of ADHD-IN and CDS, and parents also reported on their child's personality dimensions. RESULTS Across two samples and controlling for demographic characteristics as well as ADHD-IN symptoms and other personality traits, higher levels of FFFS-fear/shyness were uniquely associated with higher levels of parent- and teacher-reported CDS symptoms. In most models, lower levels of BAS-drive were also uniquely associated with higher levels of CDS. In contrast, when controlling for demographic characteristics and CDS symptoms, higher levels of BAS-impulsivity/fun-seeking were uniquely associated with higher levels of parent- and teacher-reported ADHD-IN symptoms. DISCUSSION The findings provide the clearest evidence to date that personality dimensions are differentially associated with ADHD-IN and CDS symptoms in children, further underscoring CDS as a distinct construct from ADHD-IN.
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Affiliation(s)
- Joseph W. Fredrick
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Wiggs KK, Breaux R, Langberg JM, Peugh JL, Becker SP. Examining daily stimulant medication use and sleep in adolescents with ADHD. Eur Child Adolesc Psychiatry 2024; 33:821-832. [PMID: 37043095 DOI: 10.1007/s00787-023-02204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/31/2023] [Indexed: 04/13/2023]
Abstract
Research has been inconclusive as to whether stimulant treatment causes or exacerbates sleep problems in adolescents with ADHD. This study examined sleep differences in adolescents with ADHD as a function of stimulant use. Participants were adolescents with ADHD (N = 159, ages 12-14). Parents reported on receipt of stimulant treatment (n = 92, 57.86%; n = 47 amphetamines, n = 45 methylphenidate). Adolescents wore actigraphs and completed daily diaries assessing sleep and daily use of stimulants for 2 weeks. Sleep parameters included daily-reported bedtime, sleep onset latency (SOL), sleep duration, daytime sleepiness, and difficulty waking the following morning; and actigraphy-measured sleep onset time, total time in bed, and sleep efficiency. We estimated between- and within-individual associations between stimulant medication use and sleep indices with all stimulants, after removing adolescents using sleep aids and weekend days, and as a function of stimulant type. Adolescent sleep did not differ between those receiving and not receiving stimulant treatment. Within individuals using stimulants, we largely observed no significant differences between medicated and unmedicated days, though findings were most often significant for school days only. Small effects were found indicating longer SOL, later sleep onset time, and more daytime sleepiness related to medication use. In contrast, there were slight improvements to sleep duration and sleep efficiency related to methylphenidate use, though methylphenidate was also associated with later sleep onset time and more daytime sleepiness. Given the inconsistent and small effects, findings suggest that stimulant medication may impact sleep, but does not appear to be a primary contributor to sleep problems in adolescents with ADHD.
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Affiliation(s)
- Kelsey K Wiggs
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 10006, Cincinnati, OH, 45206, USA.
| | - Rosanna Breaux
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Joshua M Langberg
- Department of Clinical Psychology, Rutgers University, Piscataway, NJ, USA
| | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 10006, Cincinnati, OH, 45206, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 10006, Cincinnati, OH, 45206, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Becker SP, Vaughn AJ, Zoromski AK, Burns GL, Mikami AY, Fredrick JW, Epstein JN, Peugh JL, Tamm L. A Multi-Method Examination of Peer Functioning in Children with and without Cognitive Disengagement Syndrome. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-16. [PMID: 38193746 DOI: 10.1080/15374416.2024.2301771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Cognitive disengagement syndrome (CDS) includes excessive daydreaming, mental confusion, and hypoactive behaviors that are distinct from attention-deficit/hyperactivity disorder inattentive (ADHD-IN) symptoms. A growing number of studies indicate that CDS symptoms may be associated with ratings of social withdrawal. However, it is important to examine this association in children specifically recruited for the presence or absence of CDS, and to incorporate multiple methods including direct observations of peer interactions. The current study builds on previous research by recruiting children with and without clinically elevated CDS symptoms and using a multi-method, multi-informant design including recess observations and parent, teacher, and child rating scales. METHOD Participants were 207 children in grades 2-5 (63.3% male), including 103 with CDS and 104 without CDS, closely matched on grade and sex. RESULTS Controlling for family income, medication status, internalizing symptoms, and ADHD-IN severity, children with CDS were observed during recess to spend more time alone or engaging in parallel play, as well as less time involved in direct social interactions, than children without CDS. Children with CDS were also rated by teachers as being more asocial, shy, and socially disinterested than children without CDS. Although children with and without CDS did not differ on parent- or self-report ratings of shyness or social disinterest, children with CDS rated themselves as lonelier than children without CDS. CONCLUSIONS Findings indicate that children with CDS have a distinct profile of peer functioning and point to the potential importance of targeting withdrawal in interventions for youth with elevated CDS symptoms.
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Affiliation(s)
- 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
- Department of Psychology, Washington State University
| | - Aaron J Vaughn
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Allison K Zoromski
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | | | | | - Joseph W Fredrick
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Jeffery N Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Leanne Tamm
- 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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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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Becker SP, Martinez AC, Wiggs KK, Langberg JM, Smith ZR. Multi-method examination of cognitive disengagement syndrome and ADHD inattentive symptoms in relation to early adolescents' academic functioning. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02311-8. [PMID: 37804421 DOI: 10.1007/s00787-023-02311-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
Cognitive disengagement syndrome (CDS), previously referred to as sluggish cognitive tempo, is a set of symptoms characterized by excessive daydreaming, mental fogginess, and slowed behavior/thinking. Studies examining the association between CDS and academic functioning have reported mixed findings and have relied upon limited measures of CDS, broad ratings of academic impairment, and/or focused only on elementary-aged children. The current study examined the relationship between CDS and academic functioning in adolescents using a comprehensive, multi-informant, multi-method design. Participants were 302 adolescents (Mage = 13.17 years; 44.7% female; 81.8% White; 52% with ADHD) recruited in the fall of their 8th grade. Above and beyond ADHD inattentive symptoms, CDS symptoms were related to poorer homework performance, lower math fluency, and lower daily academic motivation across multiple informants, and teacher-reported CDS symptoms were related to lower grades. Findings were not moderated by ADHD diagnosis, suggesting that associations between CDS and academic outcomes do not differ for adolescents with and without ADHD. Findings demonstrate that CDS symptoms are uniquely associated with daily academic difficulties as well as global indices of academic performance. These findings have implications for assessing and monitoring CDS symptoms in interventions aiming to improve the academic functioning in adolescents with and without ADHD.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Andrew C Martinez
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH, USA
| | - Kelsey K Wiggs
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH, USA
| | - Joshua M Langberg
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA
| | - Zoe R Smith
- Department of Psychology, Loyola University Chicago, Chicago, IL, 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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Fredrick JW, Cook TE, Langberg JM, Becker SP. Prospective association between evening circadian preference and academic functioning in adolescents: the role of daytime sleepiness. J Child Psychol Psychiatry 2023; 64:175-184. [PMID: 35953260 PMCID: PMC10087522 DOI: 10.1111/jcpp.13683] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is growing evidence for the role of circadian factors in adolescents' sleep and academic adjustment, with greater evening preference being linked to poorer academic functioning. However, studies have yet to evaluate this association prospectively in adolescence, nor have studies examined daytime sleepiness as a putative mechanism linking evening preference to poor academic functioning. The current study used a multi-informant design to test the prospective association of evening circadian preference, daytime sleepiness, and academic functioning (e.g., global academic impairment and grades) across 2 years in adolescence. As evening circadian preference, sleepiness, and academic problems are elevated in adolescents with ADHD, we used a sample enriched for adolescents with ADHD and explored whether ADHD moderated effects. METHOD Participants were 302 adolescents (Mage = 13.17 years; 44.7% female; 81.8% White; 52% with ADHD). In the fall of eighth grade, adolescents reported on their circadian preference, and in the fall of ninth grade, adolescents and parents completed ratings of daytime sleepiness. In the middle of 10th grade, parents and teachers reported on adolescents' academic impairment and at the end of 10th grade, adolescents' grade point average (GPA) was obtained from school records. RESULTS Above and beyond covariates (e.g., adolescent sex, ADHD status, medication, sleep duration) and baseline academic impairment, greater self-reported evening preference in 8th grade predicted increased parent ratings of academic impairment in 10th grade indirectly via adolescent and parent ratings of daytime sleepiness in 9th grade. Furthermore, evening preference in 8th grade predicted greater teacher ratings of academic impairment and lower average GPA in 10th grade via parent ratings of daytime sleepiness in 9th grade, controlling for covariates and baseline GPA. ADHD status did not moderate indirect effects. CONCLUSION Findings underscore daytime sleepiness as a possible intervening mechanism linking evening preference to poor academic functioning across adolescence. Intervention studies are needed to evaluate whether targeting circadian preference and sleepiness improves academic functioning in adolescents.
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Affiliation(s)
- Joseph W Fredrick
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Taryn E Cook
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joshua M Langberg
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Becker SP, Epstein JN, Burns GL, Mossing KW, Schmitt AP, Fershtman CEM, Vaughn AJ, Zoromski AK, Peugh JL, Simon JO, Tamm L. Academic functioning in children with and without sluggish cognitive tempo. J Sch Psychol 2022; 95:105-120. [PMID: 36371121 PMCID: PMC9663971 DOI: 10.1016/j.jsp.2022.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/23/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
Abstract
Sluggish cognitive tempo (SCT) is increasingly conceptualized as a transdiagnostic set of symptoms associated with poorer functional outcomes, although the extent to which SCT is associated with academic functioning remains unclear. This study recruited children based on the presence or absence of clinically elevated SCT symptoms, using a multi-informant and multi-method design to provide a comprehensive examination of academic functioning in children with and without clinically elevated SCT symptoms. Participants were 207 children in Grades 2-5 (ages 7-11 years; 63.3% male), including 103 with clinically elevated teacher-reported SCT symptoms and 104 without elevated SCT, closely matched on grade and sex. A multi-informant, multi-method design that included standardized achievement testing, curriculum-based measurement (CBM), grades, classroom and laboratory observations, and parent and teacher rating scales was used. Children with elevated SCT symptoms had poorer academic functioning than their peers across most domains examined. Specifically, compared to children without SCT, children with elevated SCT had significantly lower grade point average (d = 0.42) and standardized achievement scores (ds = 0.40-0.77), poorer CBM performance including lower productivity (ds = 0.39-0.51), poorer homework performance and organizational skills (ds = 0.58-0.85), and lower teacher-reported academic skills (ds = 0.63-0.74) and academic enablers (ds = 0.66-0.74). The groups did not significantly differ on percentage of time on task during classroom observations or academic enabler interpersonal skills. Most effects were robust to control of family income, medication use, and attention-deficit/hyperactivity disorder inattentive symptoms, although effects for motivation and study skills academic enablers were reduced. This study demonstrates that children with clinically elevated SCT symptoms have wide-ranging academic difficulties compared to their peers without SCT. Findings point to the potential importance of assessing and treating SCT to improve academic outcomes.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Jeffery N Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - G Leonard Burns
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Kandace W Mossing
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Aidan P Schmitt
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Chaya E M Fershtman
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Aaron J Vaughn
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Allison K Zoromski
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John O Simon
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leanne Tamm
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Fredrick JW, Yeaman KM, Yu X, Langberg JM, Becker SP. A multi-method examination of sluggish cognitive tempo in relation to adolescent sleep, daytime sleepiness, and circadian preference. J Child Psychol Psychiatry 2022; 63:1658-1667. [PMID: 35045192 DOI: 10.1111/jcpp.13568] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The field's understanding of the association between sluggish cognitive tempo (SCT) and sleep is severely limited by the lack of multi-method and multi-informant research designs that move beyond global ratings, often focused on a limited number of sleep-related domains, such as daytime sleepiness. The current study begins to address these limitations by using actigraphy, daily sleep diary, and self- and parent-report global ratings of sleep in adolescents, a developmental period marked by changes in SCT, sleep, and circadian function. As SCT and sleep are also associated with ADHD symptoms, we tested these associations in a sample of adolescents with and without ADHD. METHODS Adolescents (N = 302; M age = 13.17 years, 44.7% female) with (n = 162) and without ADHD (n = 140) and parents completed global ratings of sleep and daytime sleepiness, and adolescents completed a measure of circadian preference. Adolescents also wore actigraphs for approximately two weeks, during which daily diaries were completed. RESULTS Above and beyond demographic characteristics (i.e., sex, race, and family income), pubertal development, medication use, and ADHD group status, adolescents' self-reported SCT symptoms were uniquely associated with shorter sleep duration and later sleep onset per both actigraphy and daily diary. SCT symptoms were also uniquely associated with longer sleep onset latency and poorer overall sleep (per daily diary), more sleep/wake problems and daytime sleepiness (per adolescent rating), more difficulties initiating and maintaining sleep (per parent rating), and later eveningness preference (per adolescent rating). Nearly all significant effects remained in sensitivity analyses controlling for adolescent- or parent-reported ADHD symptom dimensions. CONCLUSIONS Findings provide the strongest evidence to date for SCT being uniquely linked to poorer sleep, greater daytime sleepiness, and a later evening circadian preference across subjective and objective measures. Longitudinal studies are needed to evaluate predictive and bidirectional associations.
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Affiliation(s)
- Joseph W Fredrick
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kiley M Yeaman
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Xiaoqian Yu
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Joshua M Langberg
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Duong MT, Bruns EJ, Lee K, Cox S, Coifman J, Mayworm A, Lyon AR. Rates of Mental Health Service Utilization by Children and Adolescents in Schools and Other Common Service Settings: A Systematic Review and Meta-Analysis. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:420-439. [PMID: 32940884 DOI: 10.1007/s10488-020-01080-9] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 01/21/2023]
Abstract
A meta-analysis was conducted to examine the relative rates of youth mental health service utilization across settings among the general population and among those with elevated mental health symptoms or clinical diagnoses. Rates of school-based mental health were compared to outpatient, primary care, child welfare, juvenile justice, and inpatient. Nine studies presented rates of mental health service use for general-population youth in the U.S., and 14 studies presented rates for youth with elevated symptoms or clinical diagnoses. Random effects meta-analysis was used to calculate mean proportions of youth receiving care in each sector. Of general population youth, 7.28% received school mental health services. Rates for other sectors are as follows: 7.26% in outpatient settings, 1.76% in primary care, 1.80% in inpatient, 1.35% in child welfare, and 0.90% juvenile justice. For youth with elevated mental health symptoms or diagnoses, 22.10% of youth were served by school-based mental health services, 20.56% outpatient settings, 9.93% primary care, 9.05% inpatient, 7.90% child welfare, and 4.50% juvenile justice. Schools and outpatient settings are the most common loci of mental health care for both the general population and samples of youth with elevated symptoms or clinical diagnoses, although substantial amounts of care are also provided in a range of other settings. Results hold potential for informing resource allocation, legislation and policy, intervention development, and research. Given that mental health services are delivered across many settings, findings also point to the need for interconnection across child-serving sectors, particularly schools and outpatient clinics.
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Affiliation(s)
- Mylien T Duong
- Education, Research, and Impact, Committee for Children, Seattle, USA.
| | - Eric J Bruns
- University of Washington School of Medicine, Seattle, USA
| | - Kristine Lee
- University of Washington School of Medicine, Seattle, USA
| | - Shanon Cox
- University of Washington School of Medicine, Seattle, USA
| | | | | | - Aaron R Lyon
- University of Washington School of Medicine, Seattle, USA
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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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Becker SP, Langberg JM, Eadeh HM, Isaacson PA, Bourchtein E. Sleep and daytime sleepiness in adolescents with and without ADHD: differences across ratings, daily diary, and actigraphy. J Child Psychol Psychiatry 2019; 60:1021-1031. [PMID: 31032953 PMCID: PMC6692210 DOI: 10.1111/jcpp.13061] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Children with attention-deficit/hyperactivity disorder (ADHD) experience greater sleep problems than their peers. Although adolescence is generally a developmental period characterized by insufficient sleep, few studies have used a multi-informant, multi-method design, to examine whether sleep differs in adolescents with and without ADHD. METHODS Targeted recruitment was used to enroll an approximately equal number of eighth-grade adolescents (mean age = 13 years) with (n = 162) and without ADHD (n = 140). Adolescents and parents completed global ratings of sleep problems; adolescents, parents, and teachers completed ratings of daytime sleepiness. Adolescents wore actigraphs and completed a daily sleep diary for approximately 2 weeks. RESULTS Adolescents with ADHD were more likely than adolescents without ADHD to obtain insufficient sleep on school days (per diary) and weekends (per diary and actigraphy). Adolescents with ADHD were also more likely to report falling asleep in class and to have stayed up all night at least twice in the previous 2 weeks (14% and 5% reported all-nighters for ADHD and comparison, respectively). In regression analyses controlling for a number of variables known to impact sleep (e.g. pubertal development, sex, medication use, having an externalizing, anxiety, or depression diagnosis), ADHD remained associated with shorter diary and actigraphy school night sleep duration, adolescent- and parent-reported daytime sleepiness, and parent-reported difficulties initiating and maintaining sleep and total sleep disturbance. Controlling for other variables, the odds of being classified with clinically elevated parent-reported sleep disturbance were 6.20 times greater for adolescents with ADHD. CONCLUSIONS Findings provide some of the clearest evidence yet that adolescents with ADHD experience more sleep problems and sleepiness than their peers without ADHD. It may be especially important to assess for sleep problems in adolescents with ADHD and to evaluate whether existing sleep interventions are effective, or can be optimized, for use in adolescents with ADHD who also have sleep problems.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joshua M Langberg
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Hana-May Eadeh
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Paul A Isaacson
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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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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Brinkman WB, Simon JO, Epstein JN. Reasons Why Children and Adolescents With Attention-Deficit/Hyperactivity Disorder Stop and Restart Taking Medicine. Acad Pediatr 2018; 18:273-280. [PMID: 28919571 PMCID: PMC5847416 DOI: 10.1016/j.acap.2017.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/03/2017] [Accepted: 09/04/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe the prevalence of reasons why children and adolescents stop and restart attention-deficit/hyperactivity disorder (ADHD) medicine and whether functional impairment is present after stopping medicine. METHODS We used the prospective longitudinal cohort from the Multimodal Treatment of Study of Children With ADHD. At the 12-year follow-up, when participants were a mean of 21.1 years old, 372 participants (76% male, 64% white) reported ever taking ADHD medicine. Participants reported the age when they last stopped and/or restarted ADHD medicine and also endorsed reasons for stopping and restarting. RESULTS Seventy-seven percent (286 of 372) reported stopping medicine for a month or longer at some time during childhood or adolescence. Participants were a mean of 13.3 years old when they last stopped medicine. The most commonly endorsed reasons for stopping medication related to 1) medicine not needed/helping, 2) adverse effects, 3) logistical barriers of getting or taking medication, and 4) social concerns or stigma. Seventeen percent (64 of 372) reported restarting medicine after stopping for a month or longer. Commonly endorsed reasons for restarting related to medicine being needed or medicine helping; and resolution of logistical barriers to getting or taking medicine. For both stopping and restarting, the proportion endorsing some reasons differed by age range, with the overall pattern suggesting that parental involvement in decisions decreased with age. Nearly all participants had impairment at the assessment after stopping, regardless of whether medication was resumed. CONCLUSIONS Different reasons for stopping and/or restarting medicine are relevant at different times for different teens. Tailored strategies may help engage adolescents as full partners in their treatment plan.
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Affiliation(s)
- William B Brinkman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - John O Simon
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeffery N Epstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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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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17
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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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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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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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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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23
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Feil EG, Frey A, Walker HM, Small JW, Seeley JR, Golly A, Forness SR. The Efficacy of a Home-School Intervention for Preschoolers With Challenging Behaviors: A Randomized Controlled Trial of Preschool First Step to Success. JOURNAL OF EARLY INTERVENTION 2014; 36:151-170. [PMID: 29225451 PMCID: PMC5720173 DOI: 10.1177/1053815114566090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The field of early intervention is currently faced with the challenge of reducing the prevalence of antisocial behavior in children. Longitudinal outcomes research indicates that increased antisocial behavior and impairments in social competence skills during the preschool years often serve as harbingers of future adjustment problems in a number of domains including mental health, interpersonal relations, and academic achievement. This article reports the results of a cross-site randomized controlled trial, in which 128 preschool children with challenging behaviors were assigned to either a Preschool First Step to Success (PFS) intervention (i.e., experimental) or a usual-care (i.e., control) group. Regression analyses indicated that children assigned to the Preschool First Step intervention had significantly higher social skills, and significantly fewer behavior problems, across a variety of teacher- and parent-reported measures at postintervention. Effect sizes for teacher-reported effects ranged from medium to large across a variety of social competency indicators; effect sizes for parent-reported social skills and problem behaviors were small to medium, respectively. These results suggest that the preschool adaptation of the First Step intervention program provides early intervention participants, staff, and professionals with a viable intervention option to address emerging antisocial behavior and externalizing behavior disorders prior to school entry.
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Kuriyan AB, Pelham WE, Molina BS, Waschbusch DA, Sibley MH, Gnagy EM. Concordance between parent and physician medication histories for children and adolescents with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2014; 24:269-74. [PMID: 24945086 PMCID: PMC4064728 DOI: 10.1089/cap.2013.0081] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE It is necessary for both clinicians and researchers who study attention-deficit/hyperactivity disorder (ADHD) to obtain a medication history for patients/participants for a variety of purposes. Because of the complexity of constructing medication histories using official records, parental report of medication for children with ADHD is the most commonly used source of information. However, the reliability and validity of parent reports of medication history have not been thoroughly studied. Previous studies have only examined the psychometrics of interview assessments of medication use for a maximum of a 12 month recall period. The current study compares parent report provided by a questionnaire and physician records for children and adolescents with ADHD. This is the first study to examine validity of retrospective recall for an extended medication history (prekindergarten-12th grade) using a questionnaire, and the first to examine validity of parental report of dosage. METHODS Participants with ADHD were part of the Pittsburgh ADHD Longitudinal Study. The current study utilized data from those in the ADHD group who had at least 1 year of data from the physician's records and corresponding records from the parent (n=178). RESULTS Percent agreement for medication use was >80%. Intraclass correlation coefficients for parent-provider agreement on total daily dosage of ADHD medications were in the good to excellent range. There were no significant predictors of agreement. CONCLUSIONS Our findings indicate that it is acceptable for clinics and research studies to obtain information about medication use for children with ADHD retrospectively solely based on parental report.
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Affiliation(s)
| | - William E. Pelham
- Department of Psychology, Florida International University, Miami, Florida
| | - Brooke S.G. Molina
- University of Pittsburgh Medical Center, Department of Psychiatry, Pittsburgh, Pennsylvania
| | | | - Margaret H. Sibley
- Department of Psychology, Florida International University, Miami, Florida.,State University of New York at Buffalo, Department of Psychology, Buffalo, New York
| | - Elizabeth M. Gnagy
- Department of Psychiatry, Florida International University, Miami, Florida
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25
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Molina BSG, Hinshaw SP, Eugene Arnold L, Swanson JM, Pelham WE, Hechtman L, Hoza B, Epstein JN, Wigal T, Abikoff HB, Greenhill LL, Jensen PS, Wells KC, Vitiello B, Gibbons RD, Howard A, Houck PR, Hur K, Lu B, Marcus S. Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD) (MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication. J Am Acad Child Adolesc Psychiatry 2013; 52:250-63. [PMID: 23452682 PMCID: PMC3589108 DOI: 10.1016/j.jaac.2012.12.014] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 12/17/2012] [Accepted: 12/19/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine long-term effects on substance use and substance use disorder (SUD), up to 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA; n = 436); to test whether medication at follow-up, cumulative psychostimulant treatment over time, or both relate to substance use/SUD; and to compare substance use/SUD in the ADHD sample to the non-ADHD childhood classmate comparison group (n = 261). METHOD Mixed-effects regression models with planned contrasts were used for all tests except the important cumulative stimulant treatment question, for which propensity score matching analysis was used. RESULTS The originally randomized treatment groups did not differ significantly on substance use/SUD by the 8-year follow-up or earlier (mean age = 17 years). Neither medication at follow-up (mostly stimulants) nor cumulative stimulant treatment was associated with adolescent substance use/SUD. Substance use at all time points, including use of two or more substances and SUD, were each greater in the ADHD than in the non-ADHD samples, regardless of sex. CONCLUSIONS Medication for ADHD did not protect from, or contribute to, visible risk of substance use or SUD by adolescence, whether analyzed as randomized treatment assignment in childhood, as medication at follow-up, or as cumulative stimulant treatment over an 8-year follow-up from childhood. These results suggest the need to identify alternative or adjunctive adolescent-focused approaches to substance abuse prevention and treatment for boys and girls with ADHD, especially given their increased risk for use and abuse of multiple substances that is not improved with stimulant medication. Clinical trial registration information-Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA); http://clinical trials.gov/; NCT00000388.
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Affiliation(s)
- Brooke S G Molina
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15213, USA.
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26
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Riddle MA, Yershova K, Lazzaretto D, Paykina N, Yenokyan G, Greenhill L, Abikoff H, Vitiello B, Wigal T, McCracken JT, Kollins SH, Murray DW, Wigal S, Kastelic E, McGough JJ, dosReis S, Bauzó-Rosario A, Stehli A, Posner K. The Preschool Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS) 6-year follow-up. J Am Acad Child Adolesc Psychiatry 2013; 52:264-278.e2. [PMID: 23452683 PMCID: PMC3660093 DOI: 10.1016/j.jaac.2012.12.007] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/29/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the clinical course of attention-deficit/hyperactivity disorder (ADHD) symptom severity and diagnosis from ages 3 to 5 up to 9 to 12 years during a 6-year follow-up after the original Preschool ADHD Treatment Study (PATS). METHOD A total of 207 participants (75% male) from the original PATS, assessed at baseline (mean age, 4.4 years, when all met criteria for ADHD) and 3 months later (before medication treatment), were re-evaluated in three follow-up assessment visits (year 3, mean age 7.4 years; year 4, 8.3 years; and year 6, 10.4 years). Parents and teachers rated symptom severity, and clinicians established psychiatric diagnoses. Analyses examined longitudinal changes in symptom severity and ADHD diagnosis. RESULTS Parent- and teacher-rated symptom severity decreased from baseline to year 3 but remained relatively stable and in the moderate-to-severe clinical range through year 6. Girls showed generally steeper decreases in symptom T-scores. At year 6, 89% (160/180) of remaining participants met ADHD symptom and impairment diagnostic criteria. Comorbidity of oppositional defiant disorder and/or conduct disorder was associated with a 30% higher risk of having an ADHD diagnosis at year 6 in the multiple logistic model. Medication status during follow-up, on versus off, did not predict symptom severity change from year 3 to year 6 after adjustment for other variables. CONCLUSIONS ADHD in preschoolers is a relatively stable diagnosis over a 6-year period. The course is generally chronic, with high symptom severity and impairment, in very young children with moderate-to-severe ADHD, despite treatment with medication. Development of more effective ADHD intervention strategies is needed for this age group.
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Affiliation(s)
- Mark A Riddle
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Baltimore, MD 21287, USA.
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Anastopoulos AD, Smith TF, Garrett ME, Morrissey-Kane E, Schatz NK, Sommer JL, Kollins SH, Ashley-Koch A. Self-Regulation of Emotion, Functional Impairment, and Comorbidity Among ChildrenWith AD/HD. J Atten Disord 2011; 15:583-92. [PMID: 20686097 PMCID: PMC3355528 DOI: 10.1177/1087054710370567] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [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 investigated the role of self-regulation of emotion in relation to functional impairment and comorbidity among children with and without AD/HD. METHOD A total of 358 probands and their siblings participated in the study, with 74% of the sample participants affected by AD/HD. Parent-rated levels of emotional lability served as a marker for self-regulation of emotion. RESULTS Nearly half of the children affected by AD/HD displayed significantly elevated levels of emotional lability versus 15% of those without this disorder. Children with AD/HD also displayed significantly higher rates of functional impairment, comorbidity, and treatment service utilization. Emotional lability partially mediated the association between AD/HD status and these outcomes. CONCLUSION Findings lent support to the notion that deficits in the self-regulation of emotion are evident in a substantial number of children with AD/HD and that these deficits play an important role in determining functional impairment and comorbidity outcomes.
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Vaughn AJ, Epstein JN, Rausch J, Altaye M, Langberg J, Newcorn JH, Hinshaw SP, Hechtman L, Arnold LE, Swanson JM, Wigal T. Relation between outcomes on a continuous performance test and ADHD symptoms over time. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2011; 39:853-64. [PMID: 21476025 PMCID: PMC3112297 DOI: 10.1007/s10802-011-9501-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examined the relationship between the developmental trajectories of neuropsychological functioning and ADHD symptomatology in a longitudinal sample of children ages 9 to 14. Participants and measures were derived from the Multimodal Treatment Study for ADHD including 534MTA participants and 254 normal controls. Despite improvement over time, MTA participants continued to receive higher ratings of ADHD symptomatology and exhibit greater difficulties across the majority of neuropsychological outcomes. No relations were found between improvements in neuropsychological functioning and ADHD symptomatology over time. Findings provide support for the persistence of neuropsychological functioning and ADHD symptomatology. Findings did not support the hypothesized relation between improvements in frontally-mediated neuropsychological functioning and ADHD symptomatology possibly due to the brief 1-year lag and limited assessment battery. Findings are discussed in relation to neuropsychological development including recommendations for future research.
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Affiliation(s)
- Aaron J Vaughn
- Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA.
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Kleinman RE, Brown RT, Cutter GR, Dupaul GJ, Clydesdale FM. A research model for investigating the effects of artificial food colorings on children with ADHD. Pediatrics 2011; 127:e1575-84. [PMID: 21576306 DOI: 10.1542/peds.2009-2206] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The United Kingdom and European Union recently restricted the use of artificial food colorings (AFCs) to improve the health of children. These decisions provide an interesting case study of the role of scientific evidence in the assessment of food additives and risk to children's health and formulation of food policy. Although there continues to be uncertainty concerning the link between AFCs and attention-deficit/hyperactivity disorder (ADHD), policy decisions have been made that have far-reaching implications. In addition, publicity surrounding the policy changes may shape public perceptions concerning effective management of ADHD. We believe that the balance of existing evidence neither refutes nor supports the link between AFCs and ADHD, which highlights the need for carefully designed studies to further investigate the link between AFCs and ADHD. In this article we describe a model for such studies. In developing our model, we drew from current investigative standards in ADHD research, such as those used in the landmark Multimodal Treatment Study of Children With ADHD. These standards encompass methodologic considerations including sample selection, outcome assessment, and data analyses. It is our hope that this model research methodology may prove valuable in addressing design considerations in future studies of AFCs and ADHD with the goal of producing reliable data that will enable policy-makers to better formulate effective, evidence-based food-policy decisions.
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Affiliation(s)
- Ronald E Kleinman
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
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Langberg JM, Molina BSG, Arnold LE, Epstein JN, Altaye M, Hinshaw SP, Swanson JM, Wigal T, Hechtman L. Patterns and predictors of adolescent academic achievement and performance in a sample of children with attention-deficit/hyperactivity disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2011; 40:519-31. [PMID: 21722025 PMCID: PMC3132152 DOI: 10.1080/15374416.2011.581620] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The current study examined predictors of academic achievement, measured by standardized test scores, and performance, measured by school grades, in adolescents (Mn age = 16.8) who met diagnostic criteria for Attention-Deficit/Hyperactivity Disorder (ADHD)-Combined type in early childhood (Mn age = 8.5; N = 579). Several mediation models were also tested to determine whether ADHD medication use, receipt of special education services, classroom performance, homework completion, or homework management mediated the relationship between symptoms of ADHD and academic outcomes. Childhood predictors of adolescent achievement differed from those for performance. Classroom performance and homework management mediated the relationship between symptoms of inattention and academic outcomes.
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Affiliation(s)
- Joshua M Langberg
- Department of Pediatrics University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, OH, USA.
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Langberg JM, Arnold LE, Flowers AM, Epstein JN, Altaye M, Hinshaw SP, Swanson JM, Kotkin R, Simpson S, Molina BSG, Jensen PS, Abikoff H, Pelham WE, Vitiello B, Wells KC, Hechtman L. Parent-reported homework problems in the MTA study: evidence for sustained improvement with behavioral treatment. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2010; 39:220-33. [PMID: 20390813 PMCID: PMC3086047 DOI: 10.1080/15374410903532700] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Parent-report of child homework problems was examined as a treatment outcome variable in the MTA-Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (ADHD). Five hundred seventy-nine children ages 7.0 to 9.9 were randomly assigned to either medication management, behavioral treatment, combination treatment, or routine community care. Results showed that only participants who received behavioral treatment (behavioral and combined treatment) demonstrated sustained improvements in homework problems in comparison to routine community care. The magnitude of the sustained effect at the 10-month follow-up assessment was small to moderate for combined and behavioral treatment over routine community care (d = .37, .40, respectively). Parent ratings of initial ADHD symptom severity was the only variable found to moderate these effects.
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Affiliation(s)
- Joshua M Langberg
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, 3333 Burnet Avenue, MLC 10006, Cincinnati, OH 45229-3039, USA.
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Medication adherence in the MTA: saliva methylphenidate samples versus parent report and mediating effect of concomitant behavioral treatment. J Am Acad Child Adolesc Psychiatry 2009; 48:501-510. [PMID: 19307987 DOI: 10.1097/chi.0b013e31819c23ed] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Although research supports the use of appropriately administered stimulant medication to treat children with ADHD, poor adherence and early termination undermine the efficacy of this treatment in real-world settings. Moreover, adherence measures often rely on parent report of medication use, and their validity and reliability are unknown. METHOD Drawing on data from 254 participants in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder, we examine the discrepancy between parents' verbal reports of medication adherence and physiological adherence measures determined via methylphenidate saliva assays collected at four time points during the 14-month treatment period. In addition, we examine the impact of physiologically documented medication adherence on parent- and teacher-reported outcomes through 14 months. RESULTS Overall, nearly one fourth (24.5%) of the saliva samples indicated nonadherence. Among subjects, 63 (24.8%) of the 254 participants were nonadherent on 50% or more of their repeated saliva assays. Only 136 (53.5%) of the subjects were adherent at every time point at which saliva assays were taken, indicating that some degree of nonadherence characterized nearly half of all other NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder-treated children. Findings also indicated that nonadherence produced greater deleterious effects in children in the medication-only condition compared with those receiving both medication and behavioral treatment. CONCLUSIONS Same-day saliva methylphenidate assays suggest that nearly half of the parents are inaccurate informants of their child's ADHD medication adherence and that parents may overestimate actual (physiological) adherence. This finding suggests the need for interventions to improve accuracy of parental report. Clinicians need to focus on adherence enhancement strategies to improve outcomes of children being treated with medication, particularly when benefits are suboptimal.
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Molina BSG, Hinshaw SP, Swanson JM, Arnold LE, Vitiello B, Jensen PS, Epstein JN, Hoza B, Hechtman L, Abikoff HB, Elliott GR, Greenhill LL, Newcorn JH, Wells KC, Wigal T, Gibbons RD, Hur K, Houck PR. The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. J Am Acad Child Adolesc Psychiatry 2009; 48:484-500. [PMID: 19318991 PMCID: PMC3063150 DOI: 10.1097/chi.0b013e31819c23d0] [Citation(s) in RCA: 693] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine any long-term effects, 6 and 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA; N = 436); to test whether attention-deficit/hyperactivity disorder (ADHD) symptom trajectory through 3 years predicts outcome in subsequent years; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers (local normative comparison group; N = 261). METHOD Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by parent, teacher, and youth report. RESULTS In nearly every analysis, the originally randomized treatment groups did not differ significantly on repeated measures or newly analyzed variables (e.g., grades earned in school, arrests, psychiatric hospitalizations, other clinically relevant outcomes). Medication use decreased by 62% after the 14-month controlled trial, but adjusting for this did not change the results. ADHD symptom trajectory in the first 3 years predicted 55% of the outcomes. The MTA participants fared worse than the local normative comparison group on 91% of the variables tested. CONCLUSIONS Type or intensity of 14 months of treatment for ADHD in childhood (at age 7.0-9.9 years) does not predict functioning 6 to 8 years later. Rather, early ADHD symptom trajectory regardless of treatment type is prognostic. This finding implies that children with behavioral and sociodemographic advantage, with the best response to any treatment, will have the best long-term prognosis. As a group, however, despite initial symptom improvement during treatment that is largely maintained after treatment, children with combined-type ADHD exhibit significant impairment in adolescence. Innovative treatment approaches targeting specific areas of adolescent impairment are needed.
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Langberg JM, Epstein JN, Altaye M, Molina BSG, Arnold LE, Vitiello B. The transition to middle school is associated with changes in the developmental trajectory of ADHD symptomatology in young 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 2008; 37:651-63. [PMID: 18645755 PMCID: PMC3096937 DOI: 10.1080/15374410802148095] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The attention deficit hyperactivity disorder (ADHD) symptom presentation of young adolescents with ADHD was examined in association with the transition to middle school. This study used data collected in the Multimodal Treatment Study of ADHD, which included children between 7 and 9 years of age with a diagnosis of ADHD (n = 258) and grade- and sex-matched controls (n = 112). The trajectory of ADHD symptoms before, during, and after the transition to middle school was modeled using hierarchical linear modeling. A clear developmental reduction in ADHD symptomatology was observed for all three ADHD symptom domains. For young adolescents with ADHD, the transition to middle school was associated with a disruption in the developmental decline of inattention, hyperactivity, and impulsivity symptoms as measured by parent ratings. This effect was also observed for teacher ratings of inattention and hyperactivity. These results support the assertion that the environmental changes associated with transitioning to middle school coincide with a transient reversal in ADHD symptom decline among children with ADHD.
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Affiliation(s)
- Joshua M Langberg
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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Swanson J, Arnold LE, Kraemer H, Hechtman L, Molina B, Hinshaw S, Vitiello B, Jensen P, Steinhoff K, Lerner M, Greenhill L, Abikoff H, Wells K, Epstein J, Elliott G, Newcorn J, Hoza B, Wigal T. Evidence, interpretation, and qualification from multiple reports of long-term outcomes in the Multimodal Treatment Study of children with ADHD (MTA): Part II: supporting details. J Atten Disord 2008; 12:15-43. [PMID: 18573924 DOI: 10.1177/1087054708319525] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review and provide details about the primary and secondary findings from the Multimodal Treatment study of ADHD (MTA) published during the past decade as three sets of articles. METHOD In the second of a two part article, we provide additional background and detail required by the complexity of the MTA to address confusion and controversy about the findings outlined in part I (the Executive Summary). RESULTS We present details about the gold standard used to produce scientific evidence, the randomized clinical trial (RCT), which we applied to evaluate the long-term effects of two well-established unimodal treatments, Medication Management (MedMGT) and behavior therapy (Beh), the multimodal combination (Comb), and treatment "as usual" in the community (CC). For each of the first three assessment points defined by RCT methods and included in intent-to-treat analyses, we discuss our definition of evidence from the MTA, interpretation of the serial presentations of findings at each assessment point with a different definition of long-term varying from weeks to years, and qualification of the interim conclusions about long-term effects of treatments for ADHD based on many exploratory analyses described in additional published articles. CONCLUSIONS Using a question and answer format, we discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families, clinicians, and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD.
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Affiliation(s)
- James Swanson
- UCI Child Development Center, University of California, Irvine, Irvine, CA 92612, USA.
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What is a mental health clinic? How to ask parents about help-seeking contacts within the mental health system. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2008; 35:241-9. [PMID: 18259852 DOI: 10.1007/s10488-008-0165-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 01/22/2008] [Indexed: 10/22/2022]
Abstract
We compared parents' endorsement of having contacted a "mental health clinic or agency" when seeking help for their child, with parents' recognition of having contacted specific, named mental health agencies in their geographic region. Data were from two studies involving parents of children and adolescents seeking mental health services. Across the two studies, only 28 and 41% of parents reported having contacted a "mental health agency," but 100% reported contact when asked about specific agencies by name. Incorporating this simple modification in future studies could provide more accurate documentation of help-seeking for, and utilization of, children's mental health services.
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Chung S, Domino ME, Jackson EW, Morrissey JP. Reliability of Self-Reported Health Service Use: Evidence from the Women with Co-occurring Disorders, and Violence Study. J Behav Health Serv Res 2008; 35:265-78. [DOI: 10.1007/s11414-007-9105-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 12/17/2007] [Indexed: 11/24/2022]
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Jensen PS, Arnold LE, Swanson JM, Vitiello B, Abikoff HB, Greenhill LL, Hechtman L, Hinshaw SP, Pelham WE, Wells KC, Conners CK, Elliott GR, Epstein JN, Hoza B, March JS, Molina BSG, Newcorn JH, Severe JB, Wigal T, Gibbons RD, Hur K. 3-year follow-up of the NIMH MTA study. J Am Acad Child Adolesc Psychiatry 2007; 46:989-1002. [PMID: 17667478 DOI: 10.1097/chi.0b013e3180686d48] [Citation(s) in RCA: 362] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE In the intent-to-treat analysis of the Multimodal Treatment Study of Children With ADHD (MTA), the effects of medication management (MedMgt), behavior therapy (Beh), their combination (Comb), and usual community care (CC) differed at 14 and 24 months due to superiority of treatments that used the MTA medication algorithm (Comb+MedMgt) over those that did not (Beh+CC). This report examines 36-month outcomes, 2 years after treatment by the study ended. METHOD For primary outcome measures (attention-deficit/hyperactivity disorder [ADHD] and oppositional defiant disorder [ODD] symptoms, social skills, reading scores, impairment, and diagnostic status), mixed-effects regression models and orthogonal contrasts examined 36-month outcomes. RESULTS At 3 years, 485 of the original 579 subjects (83.8%) participated in the follow-up, now at ages 10 to 13 years, (mean 11.9 years). In contrast to the significant advantage of MedMgt+Comb over Beh+CC for ADHD symptoms at 14 and 24 months, treatment groups did not differ significantly on any measure at 36 months. The percentage of children taking medication >50% of the time changed between 14 and 36 months across the initial treatment groups: Beh significantly increased (14% to 45%), MedMed+Comb significantly decreased (91% to 71%), and CC remained constant (60%-62%). Regardless of their treatment use changes, all of the groups showed symptom improvement over baseline. Notably, initial symptom severity, sex (male), comorbidity, public assistance, and parental psychopathology (ADHD) did not moderate children's 36-month treatment responses, but these factors predicted worse outcomes over 36 months, regardless of original treatment assignment. CONCLUSIONS By 36 months, the earlier advantage of having had 14 months of the medication algorithm was no longer apparent, possibly due to age-related decline in ADHD symptoms, changes in medication management intensity, starting or stopping medications altogether, or other factors not yet evaluated.
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Swanson JM, Elliott GR, Greenhill LL, Wigal T, Arnold LE, Vitiello B, Hechtman L, Epstein JN, Pelham WE, Abikoff HB, Newcorn JH, Molina BSG, Hinshaw SP, Wells KC, Hoza B, Jensen PS, Gibbons RD, Hur K, Stehli A, Davies M, March JS, Conners CK, Caron M, Volkow ND. Effects of stimulant medication on growth rates across 3 years in the MTA follow-up. J Am Acad Child Adolesc Psychiatry 2007; 46:1015-1027. [PMID: 17667480 DOI: 10.1097/chi.0b013e3180686d7e] [Citation(s) in RCA: 218] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the hypothesis of stimulant medication effect on physical growth in the follow-up phase of the Multimodal Treatment Study of Children With ADHD. METHOD Naturalistic subgroups were established based on patterns of treatment with stimulant medication at baseline, 14-, 24-, and 36-month assessments: not medicated (n = 65), newly medicated (n = 88), consistently medicated (n = 70), and inconsistently medicated (n = 147). Analysis of variance was used to evaluate effects of subgroup and assessment time on measures of relative size (z scores) obtained from growth norms. RESULTS The subgroup x assessment time interaction was significant for z height (p <.005) and z weight (p <.0001), due primarily to divergence of the newly medicated and the not medicated subgroups. These initially stimulant-naïve subgroups had z scores significantly >0 at baseline. The newly medicated subgroup showed decreases in relative size that reached asymptotes by the 36-month assessment, when this group showed average growth of 2.0 cm and 2.7 kg less than the not medicated subgroup, which showed slight increases in relative size. CONCLUSIONS Stimulant-naïve school-age children with Combined type attention-deficit/hyperactivity disorder were, as a group, larger than expected from norms before treatment but show stimulant-related decreases in growth rates after initiation of treatment, which appeared to reach asymptotes within 3 years without evidence of growth rebound.
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Molina BSG, Flory K, Hinshaw SP, Greiner AR, Arnold LE, Swanson JM, Hechtman L, Jensen PS, Vitiello B, Hoza B, Pelham WE, Elliott GR, Wells KC, Abikoff HB, Gibbons RD, Marcus S, Conners CK, Epstein JN, Greenhill LL, March JS, Newcorn JH, Severe JB, Wigal T. Delinquent behavior and emerging substance use in the MTA at 36 months: prevalence, course, and treatment effects. J Am Acad Child Adolesc Psychiatry 2007; 46:1028-1040. [PMID: 17667481 DOI: 10.1097/chi.0b013e3180686d96] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare delinquent behavior and early substance use between the children in the Multimodal Treatment Study of Children With ADHD (MTA; N = 487) and those in a local normative comparison group (n = 272) at 24 and 36 months postrandomization and to test whether these outcomes were predicted by the randomly assigned treatments and subsequent self-selected prescribed medications. METHOD Most MTA children were 11 to 13 years old by 36 months. Delinquency seriousness was coded ordinally from multiple measures/reporters; child-reported substance use was binary. RESULTS Relative to local normative comparison group, MTA children had significantly higher rates of delinquency (e.g., 27.1% vs. 7.4% at 36 months; p = .000) and substance use (e.g., 17.4% vs. 7.8% at 36 months; p = .001). Children randomized to intensive behavior therapy reported less 24-month substance use than other MTA children (p = .02). Random effects ordinal growth models revealed no other effects of initial treatment assignment on delinquency seriousness or substance use. By 24 and 36 months, more days of prescribed medication were associated with more serious delinquency but not substance use. CONCLUSIONS Cause-and-effect relationships between medication treatment and delinquency are unclear; the absence of associations between medication treatment and substance use needs to be re-evaluated at older ages. Findings underscore the need for continuous monitoring of these outcomes as children with attention-deficit/hyperactivity disorder enter adolescence.
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Swanson JM, Hinshaw SP, Arnold LE, Gibbons RD, Marcus S, Hur K, Jensen PS, Vitiello B, Abikoff HB, Greenhill LL, Hechtman L, Pelham WE, Wells KC, Conners CK, March JS, Elliott GR, Epstein JN, Hoagwood K, Hoza B, Molina BSG, Newcorn JH, Severe JB, Wigal T. Secondary evaluations of MTA 36-month outcomes: propensity score and growth mixture model analyses. J Am Acad Child Adolesc Psychiatry 2007; 46:1003-1014. [PMID: 17667479 DOI: 10.1097/chi.0b013e3180686d63] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate two hypotheses: that self-selection bias contributed to lack of medication advantage at the 36-month assessment of the Multimodal Treatment Study of Children With ADHD (MTA) and that overall improvement over time obscured treatment effects in subgroups with different outcome trajectories. METHOD Propensity score analyses, using baseline characteristics and severity of attention-deficit/hyperactivity disorder symptoms at follow-up, established five subgroups (quintiles) based on tendency to take medication at the 36-month assessment. Growth mixture model (GMM) analyses were performed to identify subgroups (classes) with different patterns of outcome over time. RESULTS All five propensity subgroups showed initial advantage of medication that disappeared by the 36-month assessment. GMM analyses identified heterogeneity of trajectories over time and three classes: class 1 (34% of the MTA sample) with initial small improvement followed by gradual improvement that produced significant medication effects; class 2 (52%) with initial large improvement maintained for 3 years and overrepresentation of cases treated with the MTA Medication Algorithm; and class 3 (14%) with initial large improvement followed by deterioration. CONCLUSIONS We failed to confirm the self-selection hypothesis. We found suggestive evidence of residual but not current benefits of assigned medication in class 2 and small current benefits of actual treatment with medication in class 1.
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Foster EM, Jensen PS, Schlander M, Pelham WE, Hechtman L, Arnold LE, Swanson JM, Wigal T. Treatment for ADHD: is more complex treatment cost-effective for more complex cases? Health Serv Res 2007; 42:165-82. [PMID: 17355587 PMCID: PMC1955245 DOI: 10.1111/j.1475-6773.2006.00599.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To determine the cost-effectiveness of three alternative high-quality treatments for attention deficit hyperactivity disorder (ADHD) relative to community care (CC) and to determine whether cost-effectiveness varies with the presence of comorbid disorders. DATA SOURCES/COLLECTION: The study included 579 children ages 7-9.9 with diagnosed ADHD at six sites. Data for the study were distilled from administrative data and from interviews with parents, including estimates of the child's functional impairment. These analyses focus on changes in functional impairment over 14 months. STUDY DESIGN The study involved a large clinical trial that randomized participants to one of four arms: routine CC, intensive medication management (MedMgt), multicomponent behavioral treatment, and a combination of behavioral treatment and medication. PRINCIPAL FINDINGS We assessed the cost-effectiveness of the alternatives using costs measured from a payer perspective. The preferred cost-effective treatment varies as a function of the child's comorbidity and of the policy maker's willingness to pay. For pure (no comorbidity) ADHD, high-quality MedMgt appears likely to be cost-effective at all levels of willingness to pay. In contrast, for some comorbid conditions, willingness to pay is critical: the policy maker with low willingness to pay likely will judge MedMgt most cost-effective. On the other hand, a policy maker willing to pay more now in expectation of future costs savings (involving, for example, juvenile justice), will recognize that the most cost-effective choice for comorbid conditions likely involves behavior therapy, with or without medication. CONCLUSIONS Analyses of costs and effectiveness of treatment for ADHD must consider the role of comorbidities.
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Affiliation(s)
- E Michael Foster
- Department of Maternal and Child Health, The University of North Carolina, School of Public Health, 407-C Rosenau Hall, CB 7445, Chapel Hill, NC 27599, USA
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Ford T, Hamilton H, Dosani S, Burke L, Goodman R. The children's services interview: validity and reliability. Soc Psychiatry Psychiatr Epidemiol 2007; 42:36-49. [PMID: 16969603 DOI: 10.1007/s00127-006-0092-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Children Service Interview was designed as a brief measure of service use related to mental health problems in Great Britain. METHOD We validated the Children's Services Interview against medical records from a sample of 87 children, and assessed test-retest reliability from 25 parents completing two interviews. We examined criterion validity by looking at the service use patterns of children attending clinics for different types of disorders. RESULTS The Children's Services Interview showed high levels of face validity and moderate or better concordance with medical records as far as contacts were recorded in the case notes. Test-retest reliability was moderate or better apart from contacts with the voluntary sector, teachers, and the number and duration of appointments with some professionals. CONCLUSION The study suggests the Children's Services Interview can extract moderately valid and reliable data on service use. DECLARATION OF INTEREST Tamsin Ford was supported by a Wellcome Clinical Training Fellowship in Health Services Research while completing this work.
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Affiliation(s)
- Tamsin Ford
- Kings College London, Institute of Psychiatry, London, UK.
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Jensen PS, Eaton Hoagwood K, Roper M, Arnold LE, Odbert C, Crowe M, Molina BSG, Hechtman L, Hinshaw SP, Hoza B, Newcorn J, Swanson J, Wells K. The services for children and adolescents-parent interview: development and performance characteristics. J Am Acad Child Adolesc Psychiatry 2004; 43:1334-44. [PMID: 15502592 DOI: 10.1097/01.chi.0000139557.16830.4e] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To date, no instrument has been developed that captures children's services use across primary care, specialty mental health, and other settings, including setting, treatment type, provider discipline, and length and intensity of specific interventions over varying follow-up periods. The authors developed a highly structured services assessment measure [Services for Children and Adolescents-Parent Interview (SCAPI)] for use in the National Institute of Mental Health Multimodal Treatment Study of Children With Attention Deficit Hyperactivity Disorder (MTA). METHOD After successfully piloting and refining the SCAPI during initial phases of the MTA, the authors used this measure at 24 months post-randomization to ascertain the previous 6 months of services use for all participating (516 of 579) MTA children and families and 285 age- and gender-matched classroom control children. RESULTS Findings revealed meaningful, face-valid differences between MTA and control children in levels and types of services used during the previous 6-month period. Services use data reported by parents was substantially in accord with data independently gathered by the research data center. Site variations were found in the level and use of several specific services, such as individual child psychotherapy (sites ranged from 0% to 6.8% among classroom controls compared with 9.7% to 46.1% among MTA participants) and special education services (0% to 14.6% among classroom controls, 27.5% to 34.8% among MTA participants), consistent with differences reported in other studies. CONCLUSIONS These data support the descriptive validity of SCAPI-ascertained services use data and indicate that the SCAPI can provide investigators and policymakers a valid means of assessing services type, intensity, onset and offset, provider type, and content.
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Affiliation(s)
- Peter S Jensen
- Center for the Advancement of Children's Mental Health of Columbia University, New York, 10032, USA.
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