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Kolitsopoulos F, Ramaker S, Chappell P, Broderick S, Bao W, Lokhnygina Y, Compton S, Orazem J. Response to Chadi A. Calarge re: "Effects of Long-Term Sertraline Use on Pediatric Growth and Development: The Sertraline Pediatric Registry for the Evaluation of Safety (SPRITES)". J Child Adolesc Psychopharmacol 2024; 34:104-105. [PMID: 38350152 DOI: 10.1089/cap.2023.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
| | - Sara Ramaker
- Global Product Development, Pfizer, Collegeville, Pennsylvania, USA
| | - Philip Chappell
- Global Product Development, Pfizer, Groton, Connecticut, USA
| | - Samuel Broderick
- Department of Statistics, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Warren Bao
- Global Product Development, Pfizer, New York, New York, USA
| | - Yuliya Lokhnygina
- Department of Statistics, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Scott Compton
- Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina, USA
| | - John Orazem
- Global Product Development, Pfizer, Collegeville, Pennsylvania, USA
- Global Product Development, Pfizer, Groton, Connecticut, USA
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2
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Ong CX, Foo YY, Compton S. The impact of human cadaveric dissection on professional identity formation in medical students. BMC Med Educ 2023; 23:970. [PMID: 38114993 PMCID: PMC10731900 DOI: 10.1186/s12909-023-04913-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND As technology advances, some schools are moving away from human cadaveric dissection to teach anatomy, leading to concern regarding the possible loss of a professional identity building experience. This study explored the role of dissection in students' professional identity formation. METHODS A mixed-methods study was conducted using survey methodology and semi-structured interviews of medical students at an American-style graduate-entry medical school in Singapore. The questionnaire adopted the conceptual framework of the Ring Theory of Personhood and the MacLeod-Clark Professional Identity Scale was used to measure professional identity, followed by semi-structured interviews of students using Braun and Clarke's six-phase reflexive thematic analysis. RESULTS Respondents did not differ substantively from non-respondents by age, nationality, or ethnicity, and year of entering medical school, however, they were slightly more female dominant. The number of hours of hands-on participation in dissection showed no significant relationship (r2 = 0.010; p = 0.424) with professional identity formation measured by the MacLeod-Clark Professional Identity Scale. Despite the survey results, semi-structured interviews revealed rich and nuanced findings suggesting the influence of dissection in participants' professional identity formation through deepening students' appreciation of humanistic values and enhancing their notions of patients' personhood. Notably, students without dissection experience did not express these sentiments and were orientated towards knowledge acquisition. CONCLUSION While our findings do not suggest that dissection strongly impacts students' professional identity formation, students shared thought-provoking experiences which suggest some level of its contribution. Careful consideration of this phenomenon should be exercised prior to removing dissection in favour of technological alternatives.
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Affiliation(s)
- Ci Xin Ong
- Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore.
| | - Yang Yann Foo
- Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Scott Compton
- Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore
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3
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Babiano-Espinosa L, Skarphedinsson G, Weidle B, Wolters LH, Compton S, Ivarsson T, Skokauskas N. eCBT Versus Standard Individual CBT for Paediatric Obsessive-Compulsive Disorder. Child Psychiatry Hum Dev 2023; 54:1567-1576. [PMID: 35460057 PMCID: PMC9028897 DOI: 10.1007/s10578-022-01350-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/23/2022]
Abstract
Obsessive-compulsive disorder (OCD) is characterized by recurring obsessions and compulsions often with severe impairment affecting 1-3% of children and adolescents. Cognitive behavioural therapy (CBT) is the therapeutic golden standard for paediatric OCD. However, face-to-face CBT is limited by accessibility, availability, and quality of delivery. Enhanced CBT (eCBT) a combination of face-to-face sessions at the clinic and treatment at home via webcam and a supportive app system aims to address some of these barriers. In this pilot study, we compared eCBT outcomes of 25 paediatric patients with OCD benchmarked against traditional face-to-face CBT (n = 269) from the Nordic Long-term OCD Treatment Study, the largest paediatric OCD CBT study to date. Pairwise comparisons showed no difference between eCBT and NordLOTS treatment outcomes. Mean estimate difference was 2.5 in favour of eCBT (95% CI - 0.3 to 5.3). eCBT compared to NordLOTS showed no significant differences between response and remission rates, suggesting similar effectiveness.
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Affiliation(s)
- Lucía Babiano-Espinosa
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Klostergata 46, 7030 Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | - Gudmundur Skarphedinsson
- Faculty of Psychology, University of Iceland, Nyi-Gardur, Saemundargata 12, 102 Reykjavík, Iceland
| | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Klostergata 46, 7030 Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | - Lidewij H. Wolters
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Klostergata 46, 7030 Trondheim, Norway
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
| | - Tord Ivarsson
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Klostergata 46, 7030 Trondheim, Norway
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Norbert Skokauskas
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Klostergata 46, 7030 Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
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4
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Perochon S, Di Martino JM, Carpenter KLH, Compton S, Davis N, Eichner B, Espinosa S, Franz L, Krishnappa Babu PR, Sapiro G, Dawson G. Early detection of autism using digital behavioral phenotyping. Nat Med 2023; 29:2489-2497. [PMID: 37783967 PMCID: PMC10579093 DOI: 10.1038/s41591-023-02574-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/25/2023] [Indexed: 10/04/2023]
Abstract
Early detection of autism, a neurodevelopmental condition associated with challenges in social communication, ensures timely access to intervention. Autism screening questionnaires have been shown to have lower accuracy when used in real-world settings, such as primary care, as compared to research studies, particularly for children of color and girls. Here we report findings from a multiclinic, prospective study assessing the accuracy of an autism screening digital application (app) administered during a pediatric well-child visit to 475 (17-36 months old) children (269 boys and 206 girls), of which 49 were diagnosed with autism and 98 were diagnosed with developmental delay without autism. The app displayed stimuli that elicited behavioral signs of autism, quantified using computer vision and machine learning. An algorithm combining multiple digital phenotypes showed high diagnostic accuracy with the area under the receiver operating characteristic curve = 0.90, sensitivity = 87.8%, specificity = 80.8%, negative predictive value = 97.8% and positive predictive value = 40.6%. The algorithm had similar sensitivity performance across subgroups as defined by sex, race and ethnicity. These results demonstrate the potential for digital phenotyping to provide an objective, scalable approach to autism screening in real-world settings. Moreover, combining results from digital phenotyping and caregiver questionnaires may increase autism screening accuracy and help reduce disparities in access to diagnosis and intervention.
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Affiliation(s)
- Sam Perochon
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
- Ecole Normale Supérieure Paris-Saclay, Gif-sur-Yvette, France
| | - J Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Kimberly L H Carpenter
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Naomi Davis
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Brian Eichner
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Steven Espinosa
- Office of Information Technology, Duke University, Durham, NC, USA
| | - Lauren Franz
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
- Departments of Biomedical Engineering, Mathematics, and Computer Science, Duke University, Durham, NC, USA
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA.
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5
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Coffman M, Di Martino JM, Aiello R, Carpenter KL, Chang Z, Compton S, Eichner B, Espinosa S, Flowers J, Franz L, Perochon S, Krishnappa Babu PR, Sapiro G, Dawson G. Relationship between quantitative digital behavioral features and clinical profiles in young autistic children. Autism Res 2023; 16:1360-1374. [PMID: 37259909 PMCID: PMC10524806 DOI: 10.1002/aur.2955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/06/2023] [Indexed: 06/02/2023]
Abstract
Early behavioral markers for autism include differences in social attention and orienting in response to one's name when called, and differences in body movements and motor abilities. More efficient, scalable, objective, and reliable measures of these behaviors could improve early screening for autism. This study evaluated whether objective and quantitative measures of autism-related behaviors elicited from an app (SenseToKnow) administered on a smartphone or tablet and measured via computer vision analysis (CVA) are correlated with standardized caregiver-report and clinician administered measures of autism-related behaviors and cognitive, language, and motor abilities. This is an essential step in establishing the concurrent validity of a digital phenotyping approach. In a sample of 485 toddlers, 43 of whom were diagnosed with autism, we found that CVA-based gaze variables related to social attention were associated with the level of autism-related behaviors. Two language-related behaviors measured via the app, attention to people during a conversation and responding to one's name being called, were associated with children's language skills. Finally, performance during a bubble popping game was associated with fine motor skills. These findings provide initial support for the concurrent validity of the SenseToKnow app and its potential utility in identifying clinical profiles associated with autism. Future research is needed to determine whether the app can be used as an autism screening tool, can reliably stratify autism-related behaviors, and measure changes in autism-related behaviors over time.
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Affiliation(s)
- Marika Coffman
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Department of Psychiatric and Behavioral Sciences, Duke University, Durham, NC, USA
| | - J. Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Rachel Aiello
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Department of Psychiatric and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Kimberly L.H. Carpenter
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Department of Psychiatric and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Zhuoqing Chang
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Scott Compton
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Department of Psychiatric and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Brian Eichner
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Steve Espinosa
- Office of Information Technology, Duke University, Durham, NC, USA
| | - Jacqueline Flowers
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Department of Psychiatric and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Lauren Franz
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Department of Psychiatric and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Sam Perochon
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
- Ecole Normale Superieure Paris-Saclay, Gif-Sur-Yvette, France
| | | | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
- Department of Biomedical Engineering, Mathematics, and Computer Sciences, Duke University, Durham, NC, USA
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Department of Psychiatric and Behavioral Sciences, Duke University, Durham, NC, USA
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6
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Krishnappa Babu PR, Aikat V, Di Martino JM, Chang Z, Perochon S, Espinosa S, Aiello R, L H Carpenter K, Compton S, Davis N, Eichner B, Flowers J, Franz L, Dawson G, Sapiro G. Blink rate and facial orientation reveal distinctive patterns of attentional engagement in autistic toddlers: a digital phenotyping approach. Sci Rep 2023; 13:7158. [PMID: 37137954 PMCID: PMC10156751 DOI: 10.1038/s41598-023-34293-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/27/2023] [Indexed: 05/05/2023] Open
Abstract
Differences in social attention are well-documented in autistic individuals, representing one of the earliest signs of autism. Spontaneous blink rate has been used to index attentional engagement, with lower blink rates reflecting increased engagement. We evaluated novel methods using computer vision analysis (CVA) for automatically quantifying patterns of attentional engagement in young autistic children, based on facial orientation and blink rate, which were captured via mobile devices. Participants were 474 children (17-36 months old), 43 of whom were diagnosed with autism. Movies containing social or nonsocial content were presented via an iPad app, and simultaneously, the device's camera recorded the children's behavior while they watched the movies. CVA was used to extract the duration of time the child oriented towards the screen and their blink rate as indices of attentional engagement. Overall, autistic children spent less time facing the screen and had a higher mean blink rate compared to neurotypical children. Neurotypical children faced the screen more often and blinked at a lower rate during the social movies compared to the nonsocial movies. In contrast, autistic children faced the screen less often during social movies than during nonsocial movies and showed no differential blink rate to social versus nonsocial movies.
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Affiliation(s)
| | - Vikram Aikat
- Department of Computer Science, Duke University, Durham, NC, USA
| | - J Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Zhuoqing Chang
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Sam Perochon
- Ecole Normale Supérieure Paris-Saclay, Gif-Sur-Yvette, France
| | - Steven Espinosa
- Office of Information Technology, Duke University, Durham, NC, USA
| | - Rachel Aiello
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Kimberly L H Carpenter
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Naomi Davis
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Brian Eichner
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Jacqueline Flowers
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Lauren Franz
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA.
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA.
- Departments of Biomedical Engineering, Mathematics, and Computer Science, Duke University, Durham, NC, USA.
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7
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Isaev DY, Sabatos-DeVito M, Di Martino JM, Carpenter K, Aiello R, Compton S, Davis N, Franz L, Sullivan C, Dawson G, Sapiro G. Computer Vision Analysis of Caregiver-Child Interactions in Children with Neurodevelopmental Disorders: A Preliminary Report. J Autism Dev Disord 2023:10.1007/s10803-023-05973-0. [PMID: 37103659 PMCID: PMC10603206 DOI: 10.1007/s10803-023-05973-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/28/2023]
Abstract
We report preliminary results of computer vision analysis of caregiver-child interactions during free play with children diagnosed with autism (N = 29, 41-91 months), attention-deficit/hyperactivity disorder (ADHD, N = 22, 48-100 months), or combined autism + ADHD (N = 20, 56-98 months), and neurotypical children (NT, N = 7, 55-95 months). We conducted micro-analytic analysis of 'reaching to a toy,' as a proxy for initiating or responding to a toy play bout. Dyadic analysis revealed two clusters of interaction patterns, which differed in frequency of 'reaching to a toy' and caregivers' contingent responding to the child's reach for a toy by also reaching for a toy. Children in dyads with higher caregiver responsiveness had less developed language, communication, and socialization skills. Clusters were not associated with diagnostic groups. These results hold promise for automated methods of characterizing caregiver responsiveness in dyadic interactions for assessment and outcome monitoring in clinical trials.
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Affiliation(s)
- Dmitry Yu Isaev
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.
| | - Maura Sabatos-DeVito
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - J Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Kimberly Carpenter
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rachel Aiello
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Scott Compton
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Naomi Davis
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Lauren Franz
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Connor Sullivan
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA.
- Departments of Biomedical Engineering, Computer Science, and Mathematics, Duke University, Durham, NC, USA.
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Babu PRK, Di Martino JM, Chang Z, Perochon S, Carpenter KLH, Compton S, Espinosa S, Dawson G, Sapiro G. Exploring Complexity of Facial Dynamics in Autism Spectrum Disorder. IEEE Trans Affect Comput 2023; 14:919-930. [PMID: 37266390 PMCID: PMC10231874 DOI: 10.1109/taffc.2021.3113876] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Atypical facial expression is one of the early symptoms of autism spectrum disorder (ASD) characterized by reduced regularity and lack of coordination of facial movements. Automatic quantification of these behaviors can offer novel biomarkers for screening, diagnosis, and treatment monitoring of ASD. In this work, 40 toddlers with ASD and 396 typically developing toddlers were shown developmentally-appropriate and engaging movies presented on a smart tablet during a well-child pediatric visit. The movies consisted of social and non-social dynamic scenes designed to evoke certain behavioral and affective responses. The front-facing camera of the tablet was used to capture the toddlers' face. Facial landmarks' dynamics were then automatically computed using computer vision algorithms. Subsequently, the complexity of the landmarks' dynamics was estimated for the eyebrows and mouth regions using multiscale entropy. Compared to typically developing toddlers, toddlers with ASD showed higher complexity (i.e., less predictability) in these landmarks' dynamics. This complexity in facial dynamics contained novel information not captured by traditional facial affect analyses. These results suggest that computer vision analysis of facial landmark movements is a promising approach for detecting and quantifying early behavioral symptoms associated with ASD.
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Affiliation(s)
| | - J Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Zhuoqing Chang
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Sam Perochon
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Kimberly L H Carpenter
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Scott Compton
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Steven Espinosa
- Office of Information Technology, Duke University, Durham, NC, USA
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC. USA
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Biomedical Engineering, Mathematics, and Computer Sciences, Duke University, Durham, NC, USA
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Perochon S, Matias Di Martino J, Carpenter KLH, Compton S, Davis N, Espinosa S, Franz L, Rieder AD, Sullivan C, Sapiro G, Dawson G. A tablet-based game for the assessment of visual motor skills in autistic children. NPJ Digit Med 2023; 6:17. [PMID: 36737475 PMCID: PMC9898502 DOI: 10.1038/s41746-023-00762-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023] Open
Abstract
Increasing evidence suggests that early motor impairments are a common feature of autism. Thus, scalable, quantitative methods for measuring motor behavior in young autistic children are needed. This work presents an engaging and scalable assessment of visual-motor abilities based on a bubble-popping game administered on a tablet. Participants are 233 children ranging from 1.5 to 10 years of age (147 neurotypical children and 86 children diagnosed with autism spectrum disorder [autistic], of which 32 are also diagnosed with co-occurring attention-deficit/hyperactivity disorder [autistic+ADHD]). Computer vision analyses are used to extract several game-based touch features, which are compared across autistic, autistic+ADHD, and neurotypical participants. Results show that younger (1.5-3 years) autistic children pop the bubbles at a lower rate, and their ability to touch the bubble's center is less accurate compared to neurotypical children. When they pop a bubble, their finger lingers for a longer period, and they show more variability in their performance. In older children (3-10-years), consistent with previous research, the presence of co-occurring ADHD is associated with greater motor impairment, reflected in lower accuracy and more variable performance. Several motor features are correlated with standardized assessments of fine motor and cognitive abilities, as evaluated by an independent clinical assessment. These results highlight the potential of touch-based games as an efficient and scalable approach for assessing children's visual-motor skills, which can be part of a broader screening tool for identifying early signs associated with autism.
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Affiliation(s)
- Sam Perochon
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
- Ecole Normale Supérieure Paris-Saclay, Gif-Sur-Yvette, France
| | - J Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Kimberly L H Carpenter
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Naomi Davis
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Steven Espinosa
- Office of Information Technology, Duke University, Durham, NC, USA
| | - Lauren Franz
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Amber D Rieder
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Connor Sullivan
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA.
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA.
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Babu PRK, Di Martino JM, Chang Z, Perochon S, Aiello R, Carpenter KL, Compton S, Davis N, Franz L, Espinosa S, Flowers J, Dawson G, Sapiro G. Complexity analysis of head movements in autistic toddlers. J Child Psychol Psychiatry 2023; 64:156-166. [PMID: 35965431 PMCID: PMC9771883 DOI: 10.1111/jcpp.13681] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Early differences in sensorimotor functioning have been documented in young autistic children and infants who are later diagnosed with autism. Previous research has demonstrated that autistic toddlers exhibit more frequent head movement when viewing dynamic audiovisual stimuli, compared to neurotypical toddlers. To further explore this behavioral characteristic, in this study, computer vision (CV) analysis was used to measure several aspects of head movement dynamics of autistic and neurotypical toddlers while they watched a set of brief movies with social and nonsocial content presented on a tablet. METHODS Data were collected from 457 toddlers, 17-36 months old, during their well-child visit to four pediatric primary care clinics. Forty-one toddlers were subsequently diagnosed with autism. An application (app) displayed several brief movies on a tablet, and the toddlers watched these movies while sitting on their caregiver's lap. The front-facing camera in the tablet recorded the toddlers' behavioral responses. CV was used to measure the participants' head movement rate, movement acceleration, and complexity using multiscale entropy. RESULTS Autistic toddlers exhibited significantly higher rate, acceleration, and complexity in their head movements while watching the movies compared to neurotypical toddlers, regardless of the type of movie content (social vs. nonsocial). The combined features of head movement acceleration and complexity reliably distinguished the autistic and neurotypical toddlers. CONCLUSIONS Autistic toddlers exhibit differences in their head movement dynamics when viewing audiovisual stimuli. Higher complexity of their head movements suggests that their movements were less predictable and less stable compared to neurotypical toddlers. CV offers a scalable means of detecting subtle differences in head movement dynamics, which may be helpful in identifying early behaviors associated with autism and providing insight into the nature of sensorimotor differences associated with autism.
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Affiliation(s)
| | - J. Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Zhuoqing Chang
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Sam Perochon
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
- Ecole Normale Supérieure Paris-Saclay, Gif-Sur-Yvette, France
| | - Rachel Aiello
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Kimberly L.H. Carpenter
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Naomi Davis
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Lauren Franz
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Steven Espinosa
- Office of Information Technology, Duke University, Durham, NC, USA
| | - Jacqueline Flowers
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Duke Center for Autism and Brain Development, Duke University, Durham, NC, USA
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
- Department of Biomedical Engineering, Mathematics, and Computer Sciences, Duke University, Durham, NC, USA
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Casline EP, Ogle RR, Peris TS, Kendall PC, Piacentini J, Compton S, Keeton C, Ginsburg GS. Client-rated facilitators and barriers to long-term youth anxiety disorder recovery. J Clin Psychol 2022; 78:2164-2179. [PMID: 35687807 PMCID: PMC9561069 DOI: 10.1002/jclp.23400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/10/2022] [Accepted: 05/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study examined client ratings of 26 facilitators and barriers to anxiety improvement approximately 6 years after randomization to treatment for anxiety. METHOD 319 youth (average 17.12 years old; 82.1% Caucasian; 58.6% female) participated in the longitudinal follow-up study to child and adolescent anxiety multimodal study (CAMS), a randomized controlled trial of medication, cognitive-behavioral therapy (CBT), combination, and placebo. RESULTS Correcting for multiple comparisons, CBT components (i.e., problem solving, changing unhelpful thoughts, relaxation skills) were rated significantly more helpful among youth without, versus with, an anxiety disorder at follow-up. Barriers that differentiated youth with and without an anxiety disorder included being bullied and difficulty applying therapy content to new situations. Comparisons between youth with different anxiety disorder trajectories (e.g., stable remission, relapsed, or chronically ill) also revealed several differences. CONCLUSION Findings suggest that client-rated facilitators and barriers covary with anxiety disorder recovery and may serve as useful tools when evaluating long-term treatment efficacy.
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Affiliation(s)
| | - Robert R. Ogle
- Counseling Center, Yeshiva University, New York, NY, USA
| | - Tara S. Peris
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
| | | | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Courtney Keeton
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Golda S. Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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Davis N, Lunsford-Avery J, Compton S, Dawson G. 0497 Associations between Sleep Problems and ADHD Symptoms in Early Childhood: A Longitudinal, Primary-Care Based Study. Sleep 2022. [DOI: 10.1093/sleep/zsac079.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Sleep problems are common, impairing correlates of ADHD. These associations may emerge as early as toddlerhood, suggesting sleep-focused interventions in early development may improve ADHD-related outcomes. However, previous research has been limited by cross-sectional methodology and small, clinically-referred samples. Thus, relationships between sleep and ADHD symptoms over time and in non-clinical samples remain unknown. The current study evaluated concurrent and longitudinal relationships between sleep problems and ADHD symptoms in early childhood in a large, non-clinical sample.
Methods
Children were recruited from primary care clinics at an academic medical center and assessed at two time points: T1 (n=1806, mean age: 20 months) and T2 (n=646, mean age: 37 months). Sleep problems and ADHD symptoms were evaluated via the caregiver-reported Child Behavior Checklist (CBCL) Sleep and DSM-Oriented ADHD scales, respectively. At T2, caregivers also completed the ADHD Rating Scale (ADHD-RS), which includes inattention and hyperactive/impulsive subscales. Associations between sleep and ADHD were examined using Pearson correlations at each time point. Stability of and longitudinal relationships between sleep and ADHD symptoms were also examined.
Results
Greater sleep problems were correlated with elevated CBCL ADHD at T1 (r=.40, p<.001) and T2 (r=.49, p<.001). At T2, greater sleep problems were also related to increased ADHD-RS scores (r=.44, p<.001), with similar relationships for inattention (r=.41) and hyperactivity/impulsivity (r=.43). Sleep problems (r=.51, p<.001) and CBCL ADHD (r=.52, p<.001) were moderately stable over time. Using the CBCL, partial correlations indicated that T1 sleep was associated with T2 ADHD after controlling for T1 ADHD (r=.11, p<.01); T1 ADHD was associated with T2 sleep problems after controlling for T1 sleep problems (r=.17, p<.001).
Conclusion
Sleep disturbances and ADHD symptoms were bi-directionally associated in a non-clinical sample of young children recruited in primary care. Results are consistent with conceptualization of ADHD as a 24-hour disorder and suggest that incorporating behavioral sleep techniques into empirically-based ADHD treatments may improve clinical outcomes for young children displaying ADHD symptoms. Future research may focus on 1) optimizing identification of toddlers and preschoolers at risk for sleep problems and ADHD and 2) developing interventions that can be delivered in primary care settings.
Support (If Any)
P50HD093074 , K23MH108704
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13
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Rustandy F, Yann FY, Compton S. Language Discordance Between Students and Patients: Impact on Clinical Learning. Proceedings of Singapore Healthcare 2022. [DOI: 10.1177/20101058221077797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The clinical education of medical students relies on having direct patient experiences, which can be challenging when the patient population speaks multiple languages. In Singapore, students regularly encounter patients with whom they do not speak the same language. Objective The purpose of this study was to examine the role of student–patient language discordance (SPLD) on students’ clinical education experience. Methods In this sequential mixed-methods study, medical students who have completed at least 1 year of clinical education at the Duke-NUS Medical School in Singapore were asked to complete an online survey to obtain their self-reported language proficiency in local languages, experiences interacting with patients who do not speak English, and perceptions of the impact on clinical learning. A follow-up interview with selected participants was conducted. Results Overall, 35.9% of eligible students responded to the survey. Demographic analysis of respondents adequately represented the school’s overall student population. Non-Mandarin-speaking respondents reported that learning medicine in a multilingual environment negatively impacts clinical learning due to significantly more frequent challenges to clerking patients and feeling hindered from learning from doctors due to language barriers. However, no difference was observed in the performance on clinical exams of the three groups. Qualitative interviews uncovered possible reasons for the confounding results and two interrelated themes that highlight clinical learning experiences and challenges in a multilingual environment. Conclusion Students perceive SPLD as a hindrance toward their clinical education experience. Follow-up interviews uncovered the quandary of using translators and how language discordance impacts student’s professional identity formation.
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Sarraf-Yazdi S, Compton S. The toll of staying dry in a sea of context. Med Educ 2022; 56:17-19. [PMID: 34766647 DOI: 10.1111/medu.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/13/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - Scott Compton
- Duke-NUS Medical School, Office of Education, Singapore
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15
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Perochon S, Di Martino M, Aiello R, Baker J, Carpenter K, Chang Z, Compton S, Davis N, Eichner B, Espinosa S, Flowers J, Franz L, Gagliano M, Harris A, Howard J, Kollins SH, Perrin EM, Raj P, Spanos M, Walter B, Sapiro G, Dawson G. A scalable computational approach to assessing response to name in toddlers with autism. J Child Psychol Psychiatry 2021; 62:1120-1131. [PMID: 33641216 PMCID: PMC8397798 DOI: 10.1111/jcpp.13381] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 08/15/2020] [Accepted: 12/04/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study is part of a larger research program focused on developing objective, scalable tools for digital behavioral phenotyping. We evaluated whether a digital app delivered on a smartphone or tablet using computer vision analysis (CVA) can elicit and accurately measure one of the most common early autism symptoms, namely failure to respond to a name call. METHODS During a pediatric primary care well-child visit, 910 toddlers, 17-37 months old, were administered an app on an iPhone or iPad consisting of brief movies during which the child's name was called three times by an examiner standing behind them. Thirty-seven toddlers were subsequently diagnosed with autism spectrum disorder (ASD). Name calls and children's behavior were recorded by the camera embedded in the device, and children's head turns were coded by both CVA and a human. RESULTS CVA coding of response to name was found to be comparable to human coding. Based on CVA, children with ASD responded to their name significantly less frequently than children without ASD. CVA also revealed that children with ASD who did orient to their name exhibited a longer latency before turning their head. Combining information about both the frequency and the delay in response to name improved the ability to distinguish toddlers with and without ASD. CONCLUSIONS A digital app delivered on an iPhone or iPad in real-world settings using computer vision analysis to quantify behavior can reliably detect a key early autism symptom-failure to respond to name. Moreover, the higher resolution offered by CVA identified a delay in head turn in toddlers with ASD who did respond to their name. Digital phenotyping is a promising methodology for early assessment of ASD symptoms.
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Affiliation(s)
- Sam Perochon
- Department of Electrical and Computer Engineering, Duke University
| | | | - Rachel Aiello
- Department of Psychiatry and Behavioral Sciences, Duke University
| | | | | | - Zhuoqing Chang
- Department of Electrical and Computer Engineering, Duke University
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University
| | - Naomi Davis
- Department of Psychiatry and Behavioral Sciences, Duke University
| | | | | | | | - Lauren Franz
- Department of Psychiatry and Behavioral Sciences, Duke University
| | | | - Adrianne Harris
- Department of Psychiatry and Behavioral Sciences, Duke University.; Department of Psychology & Neuroscience, Duke University
| | - Jill Howard
- Department of Psychiatry and Behavioral Sciences, Duke University
| | - Scott H. Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University
| | - Eliana M. Perrin
- Department of Pediatrics, Duke University.; Duke Center for Childhood Obesity Research
| | - Pradeep Raj
- Department of Electrical and Computer Engineering, Duke University
| | - Marina Spanos
- Department of Psychiatry and Behavioral Sciences, Duke University
| | - Barbara Walter
- Department of Psychiatry and Behavioral Sciences, Duke University
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Chang Z, Di Martino JM, Aiello R, Baker J, Carpenter K, Compton S, Davis N, Eichner B, Espinosa S, Flowers J, Franz L, Harris A, Howard J, Perochon S, Perrin EM, Krishnappa Babu PR, Spanos M, Sullivan C, Walter BK, Kollins SH, Dawson G, Sapiro G. Computational Methods to Measure Patterns of Gaze in Toddlers With Autism Spectrum Disorder. JAMA Pediatr 2021; 175:827-836. [PMID: 33900383 PMCID: PMC8077044 DOI: 10.1001/jamapediatrics.2021.0530] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/05/2021] [Indexed: 12/18/2022]
Abstract
Importance Atypical eye gaze is an early-emerging symptom of autism spectrum disorder (ASD) and holds promise for autism screening. Current eye-tracking methods are expensive and require special equipment and calibration. There is a need for scalable, feasible methods for measuring eye gaze. Objective Using computational methods based on computer vision analysis, we evaluated whether an app deployed on an iPhone or iPad that displayed strategically designed brief movies could elicit and quantify differences in eye-gaze patterns of toddlers with ASD vs typical development. Design, Setting, and Participants A prospective study in pediatric primary care clinics was conducted from December 2018 to March 2020, comparing toddlers with and without ASD. Caregivers of 1564 toddlers were invited to participate during a well-child visit. A total of 993 toddlers (63%) completed study measures. Enrollment criteria were aged 16 to 38 months, healthy, English- or Spanish-speaking caregiver, and toddler able to sit and view the app. Participants were screened with the Modified Checklist for Autism in Toddlers-Revised With Follow-up during routine care. Children were referred by their pediatrician for diagnostic evaluation based on results of the checklist or if the caregiver or pediatrician was concerned. Forty toddlers subsequently were diagnosed with ASD. Exposures A mobile app displayed on a smartphone or tablet. Main Outcomes and Measures Computer vision analysis quantified eye-gaze patterns elicited by the app, which were compared between toddlers with ASD vs typical development. Results Mean age of the sample was 21.1 months (range, 17.1-36.9 months), and 50.6% were boys, 59.8% White individuals, 16.5% Black individuals, 23.7% other race, and 16.9% Hispanic/Latino individuals. Distinctive eye-gaze patterns were detected in toddlers with ASD, characterized by reduced gaze to social stimuli and to salient social moments during the movies, and previously unknown deficits in coordination of gaze with speech sounds. The area under the receiver operating characteristic curve discriminating ASD vs non-ASD using multiple gaze features was 0.90 (95% CI, 0.82-0.97). Conclusions and Relevance The app reliably measured both known and new gaze biomarkers that distinguished toddlers with ASD vs typical development. These novel results may have potential for developing scalable autism screening tools, exportable to natural settings, and enabling data sets amenable to machine learning.
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Affiliation(s)
- Zhuoqing Chang
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina
| | - J. Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina
| | - Rachel Aiello
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
| | - Jeffrey Baker
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Kimberly Carpenter
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
| | - Naomi Davis
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
| | - Brian Eichner
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Steven Espinosa
- Office of Information Technology, Duke University, Durham, North Carolina
| | - Jacqueline Flowers
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
| | - Lauren Franz
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Adrianne Harris
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina
| | - Jill Howard
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
| | - Sam Perochon
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina
- Ecole Normale Supérieure Paris-Saclay, Cachan, France
| | - Eliana M. Perrin
- Department of Pediatrics, Duke University, Durham, North Carolina
- Duke Center for Childhood Obesity Research, Duke University, Durham, North Carolina
| | | | - Marina Spanos
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
| | - Connor Sullivan
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
| | | | - Scott H. Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Duke Institute for Brain Sciences, Duke University, Durham, North Carolina
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
- Department of Biomedical Engineering, Mathematics, and Computer Sciences, Duke University, Durham, North Carolina
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Kolitsopoulos F, Ramaker S, Compton S, Broderick S, Orazem J, Bao W, Lokhnygina Y, Chappell P. Sertraline Pediatric Registry for the Evaluation of Safety: Design and Clinical Characteristics of Pediatric Patients Prescribed Sertraline. J Child Adolesc Psychopharmacol 2021; 31:411-420. [PMID: 34287023 DOI: 10.1089/cap.2020.0170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives: To describe the study design and clinical characteristics of patients in the Sertraline Pediatric RegIstry for The Evaluation of Safety (SPRITES). Methods: SPRITES is an open-label postmarketing study of development and safety outcomes in patients aged 6 to 16 years treated with sertraline (with or without psychotherapy) compared with psychotherapy alone for up to 3 years in the United States. Baseline data included demographics and psychiatric history. Primary outcomes included measures of cognitive and emotional development (Trails B, Behavior Rating Inventory of Executive Function [BRIEF]), physical development (height and weight), and pubertal status (Tanner Stage). Data were also collected on present/lifetime risk of suicide-related events using the Columbia-Suicide Severity Rating Scale. Results: SPRITES enrolled 941 patients between the ages of 6 and 16 years. Patients' baseline mean age was 11.9 years (2.9), 57.2% were female, and 84.8% were white. Most patients (78.4%) had an anxiety disorder, and 15.6% were diagnosed with obsessive-compulsive disorder. The mean age at onset of first mental illness was 7.9 years. A higher percentage of sertraline-treated patients compared with patients who received no pharmacological treatment received prior psychotherapy (59.0% vs. 34.4%, p < 0.001), psychotropic medications for a psychiatric disorder (14.1% vs. 3.3%, p < 0.001), and other non-sertraline selective serotonin reuptake inhibitors (8.6% vs. 1.2%, p < 0.001). Most patients were moderately ill on the Clinical Global Impressions-Severity scale, and a higher (p < 0.001) percentage of sertraline-treated patients had a moderate-to-severe mental illness score compared with the no pharmacological treatment group (73.0% vs. 57.8%, respectively). Although patients at high and imminent risk of a suicidal event were excluded at study entry, the sertraline-treated patients reported higher levels of lifetime suicidal behavior compared with patients treated with no pharmacological treatment (5.8% vs. 2.5%, p = 0.039). Conclusions: Baseline data from this nonrandomized observational study suggest that patients prescribed sertraline are reflective of a more mentally ill study population compared with patients receiving psychotherapy. ClinicalTrials.gov identifier: NCT01302080.
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Affiliation(s)
| | - Sara Ramaker
- Global Product Development, Pfizer, Collegeville, Pennsylvania, USA
| | - Scott Compton
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - John Orazem
- Global Product Development, Pfizer, New York, New York, USA
| | - Weihang Bao
- Global Product Development, Pfizer, New York, New York, USA
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Harstad S, Bjaastad JF, Hjemdal O, Compton S, Waaktaar T, Aalberg M. Competence and Adherence Scale for Cognitive Behavioural Therapy (CAS-CBT) for anxiety disorders in youth: reliability and factor structure. Behav Cogn Psychother 2021; 49:1-13. [PMID: 34013852 DOI: 10.1017/s1352465821000217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND There has been increased research interest into the concept of treatment integrity within psychotherapy research. The Competence and Adherence Scale for Cognitive Behavioural Therapy (CAS-CBT) was developed to measure therapists' competence and adherence in cognitive behavioural therapy (CBT), when delivered to children and youth with anxiety disorders. AIMS The aim of this study was to evaluate the psychometric properties of the CAS-CBT in a naturalistic treatment setting. METHOD Ratings of 212 randomly selected sessions from a clinical effectiveness trial for children with anxiety disorders (n = 165, mean age = 10.46 years, SD = 1.49) were analysed to assess the psychometric properties of CAS-CBT. Therapy format included both individual sessions and group sessions. RESULTS Internal consistency for the CAS-CBT was excellent (Cronbach's alpha = .88). Factor analysis suggested a two-factor solution for the total sample, where the first factor was related to CBT structure and session goals, and the second factor was associated with process and relational skills. The individual CBT treatment condition (ICBT) and group CBT treatment condition (GCBT) showed the same factor solution. CONCLUSION The CAS-CBT is a feasible and reliable measure for assessing competence and adherence to CBT in the treatment of anxious children. Future research is needed to further assess the generalizability of this scale, its psychometric properties in different treatment populations and with other treatment approaches, and ideally with larger sample sizes.
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Affiliation(s)
- Stine Harstad
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital
| | | | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
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Peris TS, Sugar CA, Rozenman MS, Walkup JT, Albano AM, Compton S, Sakolsky D, Ginsburg G, Keeton C, Kendall PC, McCracken JT, Piacentini J. Long-term Service Use Among Youths Previously Treated for Anxiety Disorder. J Am Acad Child Adolesc Psychiatry 2021; 60:501-512. [PMID: 33301814 DOI: 10.1016/j.jaac.2020.07.911] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/06/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE (1) To describe rates of long-term service use among subjects previously enrolled in a landmark study of youth anxiety disorder treatment and followed into early adulthood; (2) to examine predictors of long-term service use; and (3) to examine the relationship between anxiety diagnosis and service use over time. METHOD The Child/Adolescent Anxiety Multimodal Extended Long-term Study prospectively assessed youths treated through the Child/Adolescent Anxiety Multimodal Study at ages 7-17 years into early adulthood. A total of 319 youths (mean age 17.7, 55.2% female) previously randomized to cognitive-behavioral therapy, sertraline, combination, or placebo for the treatment of anxiety participated; 318 had service use data. Four annual clinic assessments were conducted along with telephone check-ins every 6 months. RESULTS Overall, 65.1% of participants endorsed receiving some form of anxiety treatment over the course of the follow-up period, with more subjects reporting medication use than psychotherapy; 35.2% reported consistent use of services over the course of the study. Overall, service use declined over time in subjects with less severe anxiety but remained more steady in those with recurrent/chronic symptoms. Levels of life stress and depressive symptoms were associated with amount of service use over time whereas treatment-related variables (type of initial intervention, acute response, remission) were not. A subset of youths remained chronically anxious despite consistent service use. CONCLUSION These findings point to the need to develop models of care that approach anxiety disorders as chronic health conditions in need of active long-term management.
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Affiliation(s)
| | | | | | - John T Walkup
- Robert and Ann Lurie Children's Hospital, Chicago, Illinois
| | | | | | - Dara Sakolsky
- Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
| | | | - Courtney Keeton
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kagan ER, Frank HE, Norris LA, Palitz SA, Chiappini EA, Knepley MJ, Crane ME, Philips KE, Ginsburg GS, Keeton C, Albano AM, Piacentini J, Peris T, Compton S, Sakolsky D, Birmaher B, Kendall PC. Antidepressant Use in a 3- to 12-Year Follow-up of Anxious Youth: Results from the CAMELS Trial. Child Psychiatry Hum Dev 2021; 52:41-48. [PMID: 32253545 PMCID: PMC7541463 DOI: 10.1007/s10578-020-00983-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The current study explored whether patient characteristics predicted patterns of antidepressant use (i.e., never used, single episode of use, or two or more episodes) in a naturalistic follow-up. Participants in the child/adolescent multimodal (CAMS) extended long-term study. (n = 318) indicated medication use over the course of eight follow-up visits, 3-12 years after receiving treatment in CAMS. 40.6% of participants reported never using an antidepressant during follow-up, 41.4% reported a single episode of antidepressant use, and 18.0% reported multiple episodes of antidepressant use. Greater baseline anxiety severity marginally predicted a single episode of antidepressant use; baseline depression severity predicted multiple episodes of use. Reasons for discontinuing antidepressants included perceived ineffectiveness (31.8%), side effects (25.5%), and improvement in symptoms (18.5%). Exploratory analyses examined predictors of medication use. Findings suggest that antidepressant use is common among anxious youth, as is discontinuation of antidepressant use. Clinical implications and future directions are discussed.
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Affiliation(s)
- Elana R. Kagan
- Department of Behavioral Psychology, Kennedy Krieger Institute/Johns Hopkins School of Medicine, Baltimore, MD
| | - Hannah E. Frank
- Department of Psychology, Temple University, Philadelphia, PA
| | | | | | | | - Mark J. Knepley
- Department of Psychology, Temple University, Philadelphia, PA
| | | | | | - Golda S. Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, West Harford, CT
| | - Courtney Keeton
- Division of Child & Adolescent Psychiatry, Johns Hopkins, Baltimore, MD
| | | | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA
| | - Tara Peris
- Department of Psychiatry, UCLA, Los Angeles, CA
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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Jumat MR, Wong P, Foo KX, Lee ICJ, Goh SPL, Ganapathy S, Tan TY, Loh AHL, Yeo YC, Chao Y, Cheng LTE, Lai SH, Goh SH, Compton S, Hwang NC. From Trial to Implementation, Bringing Team-Based Learning Online-Duke-NUS Medical School's Response to the COVID-19 Pandemic. Med Sci Educ 2020; 30:1649-1654. [PMID: 32837796 PMCID: PMC7402390 DOI: 10.1007/s40670-020-01039-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Muhammad Raihan Jumat
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Peiyan Wong
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- National University of Singapore, Singapore, Singapore
| | - Ke Xiang Foo
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Irene Cheng Jie Lee
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Suzanne Pei Lin Goh
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- KK Women’s and Children Hospital, Singapore, Singapore
| | - Sashikumar Ganapathy
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- KK Women’s and Children Hospital, Singapore, Singapore
| | - Thean Yen Tan
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Changi General Hospital, Singapore, Singapore
| | - Alwin Hwai Liang Loh
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Singapore General Hospital, Singapore, Singapore
| | - Yen Ching Yeo
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- KK Women’s and Children Hospital, Singapore, Singapore
| | - Yinxia Chao
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- National Neuroscience Institute, Singapore, Singapore
| | - Lionel Tim-Ee Cheng
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Singapore General Hospital, Singapore, Singapore
| | - Siang Hui Lai
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Singapore General Hospital, Singapore, Singapore
| | - Sok Hong Goh
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Scott Compton
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Nian Chih Hwang
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Singapore General Hospital, Singapore, Singapore
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Compton S, Sarraf‐Yazdi S, Rustandy F, Radha Krishna LK. Medical students' preference for returning to the clinical setting during the COVID-19 pandemic. Med Educ 2020; 54:943-950. [PMID: 32519383 PMCID: PMC7300867 DOI: 10.1111/medu.14268] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 05/27/2023]
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has led to widespread disruptions in the clinical education of medical students. In managing students' return to the clinical setting, medical schools face the challenge of balancing education, service and risk considerations. To compound this challenge, medical students may prefer not to re-enter during a period of great uncertainty, leading to substantive downstream sequelae on individual, institutional and national levels. Understanding students' views on resuming clinical experiences, therefore, is an important consideration. The purpose of this study was to assess medical students' preference for re-entering the clinical setting during the COVID-19 pandemic and to explore personal and environmental characteristics associated with that preference. METHODS We conducted an electronic survey of currently enrolled medical students at the Duke-NUS Medical School, less than a month into the COVID-19 pandemic. Survey items were aligned with a conceptual framework related to medical students' preference for returning to the clinical setting. The framework consisted of three domains: (a) non-modifiable demographic information; (b) factors thought to be modifiable through the course of medical education, including burnout, tolerance for ambiguity, motivation and professionalism, and (c) students' perception of COVID-19 infection risk to self. RESULTS Approximately one-third (n=63) of 179 students preferred not to return to the clinical setting. Results of a multivariable analysis indicated that compared to this group, the two-thirds (n=116) of students favouring return showed evidence of greater autonomous (or internal) motivation, a greater sense of professional responsibility and a lower self-perception of harbouring risk to patients. CONCLUSIONS Students' preference on returning to the clinical environment stems from the interplay of several key factors, and is substantively associated with perceptions of professional responsibility and their own potential risk to the health care system. Mindfully considering and addressing these issues may help medical schools in their preparation for returning students to the clinical setting.
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Jensen S, Højgaard DRMA, Hybel KA, Mortensen EL, Skarphedinsson G, Melin K, Ivarsson T, Nissen JB, Weidle B, Valderhaug R, Torp NC, Dahl K, Compton S, Thomsen PH. Distinct trajectories of long-term symptom severity in pediatric obsessive-compulsive disorder during and after stepped-care treatment. J Child Psychol Psychiatry 2020; 61:969-978. [PMID: 31736082 DOI: 10.1111/jcpp.13155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/02/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND First-line treatments for pediatric obsessive-compulsive disorder (OCD) include exposure-based cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs). No studies have thus far identified distinct classes and associated predictors of long-term symptom severity during and after treatment. Yet, these could form the basis for more personalized treatment in pediatric OCD. METHOD The study included 269 OCD patients aged 7-17 years from the Nordic Long-term OCD Treatment Study (NordLOTS). All participants received stepped-care treatment starting with 14 weekly sessions of manualized CBT. Nonresponders were randomized to either prolonged CBT or SSRIs. Symptom severity was assessed using the Children's Yale-Brown Obsessive-Compulsive Scale at seven time points from pre- to post-treatment and over a three-year follow-up. Latent class growth analysis (LCGA) was performed to identify latent classes of symptom severity trajectories. Univariate and multivariate analyses were used to detect differences between classes and identify predictors of trajectory class membership including several clinical and demographic variables. TRIAL REGISTRY Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119. RESULTS Three LCGA classes were identified: (a) acute, sustained responders (54.6%); (b) slow, continued responders (23.4%); and (c) limited long-term responders (21.9%). Class membership was predicted by distinct baseline characteristics pertaining to age, symptom severity, contamination/cleaning and anxiety symptoms. CONCLUSIONS The LCGA suggests three distinct trajectory classes of long-term symptom severity during and after treatment in pediatric OCD with different clinical profiles at pretreatment. The results point to required clinical attention for adolescent patients with contamination/cleaning and anxiety symptoms who do not show convincing responses to first-line treatment even though they may have reached the established cutoff for treatment response.
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Affiliation(s)
- Sanne Jensen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Katja A Hybel
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - Karin Melin
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tord Ivarsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Judith Becker Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Robert Valderhaug
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nor Christian Torp
- Division of Mental Health and Addiction, Department of Child and Adolescent Psychiatry, Vestre Viken Hospital, Drammen, Norway
| | - Kitty Dahl
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
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24
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Jumat MR, Chow PKH, Allen JC, Lai SH, Hwang NC, Iqbal J, Mok MUS, Rapisarda A, Velkey JM, Engle DL, Compton S. Grit protects medical students from burnout: a longitudinal study. BMC Med Educ 2020; 20:266. [PMID: 32787919 PMCID: PMC7425562 DOI: 10.1186/s12909-020-02187-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/04/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Burnout is a serious issue plaguing the medical profession with potential negative consequences on patient care. Burnout symptoms are observed as early as medical school. Based on a Job Demands-Resources model, this study aims to assess associations between specific job resources measured at the beginning of the first year of medical school with burnout symptoms occurring later in the first year. METHODS The specific job resources of grit, tolerance for ambiguity, social support and gender were measured in Duke-NUS Medical School students at the start of Year 1. Students were then surveyed for burnout symptoms at approximately quarterly intervals throughout the year. Using high ratings of cynicism and exhaustion as the definition of burnout, we investigated the associations of the occurrence of burnout with student job resources using multivariable logistic regression analysis. RESULTS Out of 59 students, 19 (32.2%) indicated evidence of burnout at some point across the first year of medical school. Stepwise multivariable logistic regression analysis identified grit as having a significant protective effect against experiencing burnout (Odds Ratio, 0.84; 95%CI 0.74 to 0.96). Using grit as a single predictor of burnout, area under the ROC curve was 0.76 (95%CI: 0.62 to 0.89). CONCLUSIONS Grit was identified as a protective factor against later burnout, suggesting that less gritty students are more susceptible to burnout. The results indicate that grit is a robust character trait which can prognosticate burnout in medical students. These students would potentially benefit from enhanced efforts to develop grit as a personal job resource.
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Affiliation(s)
- Muhammad Raihan Jumat
- Office of Education, Duke-NUS Medical School, 8 College Rd., Level 3, Singapore, 169857, Singapore
| | - Pierce Kah-Hoe Chow
- Office of Education, Duke-NUS Medical School, 8 College Rd., Level 3, Singapore, 169857, Singapore
- Singapore General Hospital, Singapore, Outram Road, Singapore, 169608, Singapore
| | - John Carson Allen
- Office of Education, Duke-NUS Medical School, 8 College Rd., Level 3, Singapore, 169857, Singapore
| | - Siang Hui Lai
- Office of Education, Duke-NUS Medical School, 8 College Rd., Level 3, Singapore, 169857, Singapore
- Singapore General Hospital, Singapore, Outram Road, Singapore, 169608, Singapore
| | - Nian-Chih Hwang
- Office of Education, Duke-NUS Medical School, 8 College Rd., Level 3, Singapore, 169857, Singapore
- Singapore General Hospital, Singapore, Outram Road, Singapore, 169608, Singapore
| | - Jabed Iqbal
- Office of Education, Duke-NUS Medical School, 8 College Rd., Level 3, Singapore, 169857, Singapore
- Singapore General Hospital, Singapore, Outram Road, Singapore, 169608, Singapore
| | - May Un Sam Mok
- Singapore General Hospital, Singapore, Outram Road, Singapore, 169608, Singapore
| | - Attilio Rapisarda
- Office of Education, Duke-NUS Medical School, 8 College Rd., Level 3, Singapore, 169857, Singapore
| | - John Matthew Velkey
- Department of Psychology and Neuroscience, Duke University School of Medicine, North Carolina, 27708, Durham, USA
| | - Deborah Lynn Engle
- Department of Psychology and Neuroscience, Duke University School of Medicine, North Carolina, 27708, Durham, USA
| | - Scott Compton
- Office of Education, Duke-NUS Medical School, 8 College Rd., Level 3, Singapore, 169857, Singapore.
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25
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Dawson G, Sun JM, Baker J, Carpenter K, Compton S, Deaver M, Franz L, Heilbron N, Herold B, Horrigan J, Howard J, Kosinski A, Major S, Murias M, Page K, Prasad VK, Sabatos-DeVito M, Sanfilippo F, Sikich L, Simmons R, Song A, Vermeer S, Waters-Pick B, Troy J, Kurtzberg J. A Phase II Randomized Clinical Trial of the Safety and Efficacy of Intravenous Umbilical Cord Blood Infusion for Treatment of Children with Autism Spectrum Disorder. J Pediatr 2020; 222:164-173.e5. [PMID: 32444220 DOI: 10.1016/j.jpeds.2020.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate whether umbilical cord blood (CB) infusion is safe and associated with improved social and communication abilities in children with autism spectrum disorder (ASD). STUDY DESIGN This prospective, randomized, placebo-controlled, double-blind study included 180 children with ASD, aged 2-7 years, who received a single intravenous autologous (n = 56) or allogeneic (n = 63) CB infusion vs placebo (n = 61) and were evaluated at 6 months postinfusion. RESULTS CB infusion was safe and well tolerated. Analysis of the entire sample showed no evidence that CB was associated with improvements in the primary outcome, social communication (Vineland Adaptive Behavior Scales-3 [VABS-3] Socialization Domain), or the secondary outcomes, autism symptoms (Pervasive Developmental Disorder Behavior Inventory) and vocabulary (Expressive One-Word Picture Vocabulary Test). There was also no overall evidence of differential effects by type of CB infused. In a subanalysis of children without intellectual disability (ID), allogeneic, but not autologous, CB was associated with improvement in a larger percentage of children on the clinician-rated Clinical Global Impression-Improvement scale, but the OR for improvement was not significant. Children without ID treated with CB showed significant improvements in communication skills (VABS-3 Communication Domain), and exploratory measures including attention to toys and sustained attention (eye-tracking) and increased alpha and beta electroencephalographic power. CONCLUSIONS Overall, a single infusion of CB was not associated with improved socialization skills or reduced autism symptoms. More research is warranted to determine whether CB infusion is an effective treatment for some children with ASD.
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Affiliation(s)
- Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC; Marcus Center for Cellular Cures, Duke University School of Medicine, Durham, NC.
| | - Jessica M Sun
- Marcus Center for Cellular Cures, Duke University School of Medicine, Durham, NC
| | - Jennifer Baker
- Marcus Center for Cellular Cures, Duke University School of Medicine, Durham, NC
| | - Kimberly Carpenter
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC
| | - Megan Deaver
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC
| | - Lauren Franz
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC
| | - Nicole Heilbron
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC
| | - Brianna Herold
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC
| | - Joseph Horrigan
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC
| | - Jill Howard
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC
| | - Andrzej Kosinski
- Marcus Center for Cellular Cures, Duke University School of Medicine, Durham, NC
| | - Samantha Major
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC
| | - Michael Murias
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC
| | - Kristin Page
- Marcus Center for Cellular Cures, Duke University School of Medicine, Durham, NC
| | - Vinod K Prasad
- Marcus Center for Cellular Cures, Duke University School of Medicine, Durham, NC
| | - Maura Sabatos-DeVito
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC
| | | | - Linmarie Sikich
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC
| | - Ryan Simmons
- Marcus Center for Cellular Cures, Duke University School of Medicine, Durham, NC
| | - Allen Song
- Marcus Center for Cellular Cures, Duke University School of Medicine, Durham, NC; Duke Brain Imaging and Analysis Center, Duke University School of Medicine, Durham, NC
| | - Saritha Vermeer
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC
| | - Barbara Waters-Pick
- Marcus Center for Cellular Cures, Duke University School of Medicine, Durham, NC
| | - Jesse Troy
- Marcus Center for Cellular Cures, Duke University School of Medicine, Durham, NC
| | - Joanne Kurtzberg
- Marcus Center for Cellular Cures, Duke University School of Medicine, Durham, NC
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26
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Krishna L, Tay KT, Yap HW, Koh ZYK, Ng YX, Ong YT, Shivananda S, Compton S, Mason S, Kanesvaran R, Toh YP. Combined novice, near-peer, e-mentoring palliative medicine program: A mixed method study in Singapore. PLoS One 2020; 15:e0234322. [PMID: 32502180 PMCID: PMC7274408 DOI: 10.1371/journal.pone.0234322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/24/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION An acute shortage of senior mentors saw the Palliative Medicine Initiative (PMI) combine its novice mentoring program with electronic and peer mentoring to overcome insufficient mentoring support of medical students and junior doctors by senior clinicians. A three-phased evaluation was carried out to evaluate mentees' experiences within the new CNEP mentoring program. METHODS Phase 1 saw use of a Delphi process to create a content-valid questionnaire from data drawn from 9 systematic reviews of key aspects of novice mentoring. In Phase 2 Cognitive Interviews were used to evaluate the tool. The tool was then piloted amongst mentees in the CNEP program. Phase 3 compared mentee's experiences in the CNEP program with those from the PMI's novice mentoring program. RESULTS Thematic analysis of open-ended responses revealed three themes-the CNEP mentoring process, its benefits and challenges that expound on the descriptive statistical analysis of specific close-ended and Likert scale responses of the survey. The results show mentee experiences in the PMI's novice mentoring program and the CNEP program to be similar and that the addition of near peer and e-mentoring processes enhance communications and support of mentees. CONCLUSION CNEP mentoring is an evolved form of novice mentoring built on a consistent mentoring approach supported by an effective host organization. The host organization marshals assessment, support and oversight of the program and allows flexibility within the approach to meet the particular needs of mentees, mentors and senior mentors. Whilst near-peer mentors and e-mentoring can make up for the lack of senior mentor availability, their effectiveness hinges upon a common mentoring approach. To better support the CNEP program deeper understanding of the mentoring dynamics, policing and mentor and mentee training processes are required. The CNEP mentoring tool too needs to be validated.
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Affiliation(s)
- Lalit Krishna
- Academic Palliative & End of Life Care Centre, Palliative Care Institute Liverpool, University of Liverpool, Liverpool, United Kingdom
- Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Centre of Biomedical Ethics, National University of Singapore, Singapore, Singapore
- * E-mail:
| | - Kuang Teck Tay
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hong Wei Yap
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Zachary Yong Keat Koh
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yong Xiang Ng
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yun Ting Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sushma Shivananda
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Stephen Mason
- Academic Palliative & End of Life Care Centre, Palliative Care Institute Liverpool, University of Liverpool, Liverpool, United Kingdom
- Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom
| | - Ravindran Kanesvaran
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Ying Pin Toh
- Department of Family Medicine, National University Health System, Singapore, Singapore
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27
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Makover HB, Kendall PC, Olino T, Carper MM, Albano AM, Piacentini J, Peris T, Langley AK, Gonzalez A, Ginsburg GS, Compton S, Birmaher B, Sakolsky D, Keeton C, Walkup J. Mediators of youth anxiety outcomes 3 to 12 years after treatment. J Anxiety Disord 2020; 70:102188. [PMID: 32078966 PMCID: PMC10783175 DOI: 10.1016/j.janxdis.2020.102188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/13/2019] [Accepted: 01/07/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Test changes in perceived coping efficacy, negative self-statements, and interpretive biases to threat during treatment as potential mediators of the relationship between randomly assigned treatment conditions and long-term anxiety follow-ups. Age at randomization was also tested as a moderator of mediational relationships. METHOD Participants included 319 youth (ages 7-17) from the Child/Adolescent Multimodal Study (CAMS) who participated in a naturalistic follow-up beginning an average of 6.5 years after the end of the CAMS intervention. The intervention conditions included cognitive behavioral therapy (CBT; Coping Cat), pharmacotherapy (sertraline), combined CBT and sertraline, and pill placebo. Putative mediators were measured four times during the intervention phase. Follow-up consisted of four annual assessments of current anxiety. RESULTS Reductions on a measure of interpretive bias to threat over the course of the combined condition intervention, as compared to the placebo condition, mediated anxiety outcomes at the first follow-up visit. This mediated effect was not significant for the CBT-only or sertraline-only conditions when compared to the placebo condition. No other significant mediated effects were found for putative mediators. Age did not significantly moderate any mediated effects. CONCLUSION Changes in youth-reported interpretive biases to threat over the course of combined youth anxiety interventions, as compared to a placebo intervention, may be associated with lower anxiety an average of 6.5 years following treatment.
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Affiliation(s)
- Heather B Makover
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA.
| | - Philip C Kendall
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA.
| | - Thomas Olino
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA
| | - Matthew M Carper
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA
| | - Anne Marie Albano
- Columbia University Clinic for Anxiety and Related Disorders, 1775 Broadway, Suite 601, New York, NY, 10019, USA
| | - John Piacentini
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Tara Peris
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Audra K Langley
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Araceli Gonzalez
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Golda S Ginsburg
- The Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry, 550 North Broadway, Suite 202, Baltimore, MD, 21205, USA
| | - Scott Compton
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3527, Durham, NC, 27710, USA
| | - Boris Birmaher
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Dara Sakolsky
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Courtney Keeton
- The Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry, 550 North Broadway, Suite 202, Baltimore, MD, 21205, USA
| | - John Walkup
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine, 446 East Ontario, Suite 7-200, Chicago, IL, 60611, USA
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Sanchez DJ, Strauman TJ, Compton S. Impact of Student Perceptions of the Educational Program on Burnout in Medical School. Med Sci Educ 2019; 29:1077-1087. [PMID: 34457586 PMCID: PMC8368313 DOI: 10.1007/s40670-019-00812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Burnout is considered to be at the opposite end of the continuum from engagement. People who experience burnout first go through various intermediate patterns that lead to burnout, which in medical students is associated with reduced empathy, intention to leave school, and suicidal ideation. Thus, understanding how to mitigate burnout is of primary importance. In this study, we investigate if students' positive perceptions of the educational program's alignment with adult education principles decreased symptoms suggestive of typical patterns of intermediate burnout. METHODS We conducted a cross-sectional survey study of all currently enrolled Duke-NUS Medical School students in Singapore (n = 238). An electronic questionnaire contained demographic questions and additional measures for factors known to be associated with burnout, including depression, anxiety, social support, and workload. In addition, we measured students' perceptions of how well the educational program aligned with adult learning principles by using a modified version of the Andragogical Practices Inventory (API) to suit medical education. An intermediate pattern of burnout was measured using the Maslach Burnout Inventory (MBI). Using logistic regression, we then assessed the unique association between the presence of an intermediate pattern of burnout with students' perceptions of the educational program's alignment with adult learning principles. RESULTS The survey response rate was 52%. Overall, 76% (95% CI 67-84%) displayed symptoms suggestive of an intermediate pattern of burnout. Perceptions of the educational program's alignment with adult learning principles were found to be inversely related to the pattern of burnout after controlling for depression, anxiety, and subjective workload. DISCUSSION AND CONCLUSION Though adult learning theory is the subject of rich debate, the results of this study suggest that promoting educational activities that are aligned with adult learning principles may help to ultimately reduce the risk of burnout in medical school students.
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Affiliation(s)
- Daniel J. Sanchez
- Office of Education, Duke-NUS Medical School, 8 College Rd, Singapore, 169857 Singapore
| | - Timothy J. Strauman
- Office of Education, Duke-NUS Medical School, 8 College Rd, Singapore, 169857 Singapore
- Department of Psychology and Neuroscience, Duke University, 417 Chapel Dr, Durham, NC 27708 USA
| | - Scott Compton
- Office of Education, Duke-NUS Medical School, 8 College Rd, Singapore, 169857 Singapore
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Abstract
Electrospraying (ES) dissolved viral particles, followed by charge reduction and size analysis with a differential mobility analyzer (DMA), offers a flexible size-analysis tool for small particles in solution. The technique relies on pioneering work by Kaufman and colleagues, commercialized by TSI, and often referred to as GEMMA. However, viral studies with TSI's GEMMA have suffered from limited resolving power, possibly because of imperfections in either the instrument (DMA or charge reduction) or the sample solution preparation. Here, we explore the limits of the resolution achievable by GEMMA, taking advantage of (i) cleaner charge reduction methods and (ii) DMAs of higher resolving power. Analysis of the literature provides indications that mobility peak widths (fwhm) of 2% or less may be achieved by combining careful sample preparation with improved instrumentation. Working with purified PP7 bacteriophage particles small enough to be classifiable by existing high-resolution DMAs, we confirm that fairly narrow viral mobility peaks may be obtained (relative full width at half-maximum fwhm <5%). Comparison of spectra of a given apian virus sample obtained with TSI's GEMMA and our improved instrumentation confirms that one critical limitation is the DMA. This is further verified by narrow peaks from murine parvovirus, norovirus, and encephalomyelitis virus samples, obtained in our improved GEMMA with little sample preparation, directly from infected cell cultures. Classification of purified large (60 nm) coliphage PR772 particles leads to broad peaks, due to both viral degradation and limited intrinsic resolution of the DMAs used to cover the range of such large particles. We conclude that improved DMAs suitable for high-resolution analysis of particles larger than 30 nm need to be developed to determine the intrinsic mobility width of viral particles.
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Affiliation(s)
- J Fernández-García
- Yale University , Department of Mechanical Engineering , New Haven , Connecticut 06520 , United States
| | - S Compton
- Yale University , School of Medicine , New Haven , Connecticut 06520 , United States
| | - D Wick
- BVS, Inc. , Stevensville , Montana 59870 , United States
| | - J Fernandez de la Mora
- Yale University , Department of Mechanical Engineering , New Haven , Connecticut 06520 , United States
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Carpenter KLH, Baranek GT, Copeland WE, Compton S, Zucker N, Dawson G, Egger HL. Sensory Over-Responsivity: An Early Risk Factor for Anxiety and Behavioral Challenges in Young Children. J Abnorm Child Psychol 2019; 47:1075-1088. [PMID: 30569253 PMCID: PMC6508996 DOI: 10.1007/s10802-018-0502-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Anxiety disorders are prevalent and significantly impact young children and their families. One hypothesized risk factor for anxiety is heightened responses to sensory input. Few studies have explored this hypothesis prospectively. This study had two goals: (1) examine whether sensory over-responsivity is predictive of the development of anxiety in a large prospective sample of children, and (2) identify whether anxiety mediates the relationship between sensory over-responsivity and behavioral challenges. Children's sensory and anxiety symptoms were assessed in a community sample of 917 at 2-5 and again in 191 of these children at 6 years old. Parents also reported on a number of additional behavioral challenges previously found to be associated with both sensory over-responsivity and anxiety separately: irritability, food selectivity, sleep problems, and gastrointestinal problems. Forty three percent of preschool children with sensory over-responsivity also had a concurrent impairing anxiety disorder. Preschool sensory over-responsivity symptoms significantly and positively predicted anxiety symptoms at age six. This relationship was both specific and unidirectional. Finally, school-age anxiety symptoms mediated the relationship between preschool sensory over-responsivity symptoms and both irritability and sleep problems at school-age. These results suggest sensory over-responsivity is a risk factor for anxiety disorders. Furthermore, children who have symptoms of sensory over-responsivity as preschoolers have higher levels of anxiety symptoms at school-age, which in turn is associated with increased levels of school-age behavioral challenges.
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Affiliation(s)
- Kimberly L H Carpenter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA.
| | - Grace T Baranek
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant Hall, CB #7120, Chapel Hill, NC, 27599-7120, USA
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar Street, CHP 133, Los Angeles, CA, 90089-9003, USA
| | - William E Copeland
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Helen L Egger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, 1 Park Avenue, 7th Floor, New York, NY, 10016, USA
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Swan AJ, Kendall PC, Olino T, Ginsburg G, Keeton C, Compton S, Piacentini J, Peris T, Sakolsky D, Birmaher B, Albano AM. Results from the Child/Adolescent Anxiety Multimodal Longitudinal Study (CAMELS): Functional outcomes. J Consult Clin Psychol 2018; 86:738-750. [PMID: 30138013 DOI: 10.1037/ccp0000334] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To report functional outcomes from the multisite Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), which examined the impact of youth anxiety treatment (cognitive-behavioral therapy [CBT], coping cat; Sertraline, SRT; COMB [CBT + SRT]; pill placebo) on (a) global and (b) domain-specific functioning assessed an average of 3.1 times, 3- to 12-years postrandomization (first assessment = mean 6.5 years postrandomization). METHOD Three-hundred and 19 of 488 families from the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al., 2008) participated. Growth curve modeling examined the impact of treatment condition and acute treatment outcomes (i.e., response, remission) on global functioning, global and domain-specific impairment, and life satisfaction across follow-up visits. Logistic regressions explored the impact of treatment remission and condition on low frequency events (arrests/convictions) and education. RESULTS Treatment responders and remitters demonstrated better global functioning, decreased overall impairment, and increased life satisfaction at follow-up. Treatment remission, but not response, predicted decreased domain-specific impairment (social relationships, self-care/independence, academic functioning), and maintenance of increased life satisfaction across follow-ups. Participants in the CBT condition, compared with pill placebo, demonstrated improved trajectories pertaining to life satisfaction, overall impairment, and impairment in academic functioning. Randomization to CBT or COMB treatment was associated with increasing employment rates. Trajectories for participants randomized to SRT was not significantly different from placebo. Treatment outcome and condition did not predict legal outcomes, school/work variables, or family life. CONCLUSION Positive early intervention outcomes are associated with improved overall functioning, life satisfaction, and functioning within specific domains 6.5 years posttreatment. Treatment type differentially predicted trajectories of functioning. Findings support the positive impact of pediatric anxiety treatment into adolescence and early adulthood. (PsycINFO Database Record
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Affiliation(s)
- Anna J Swan
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone
| | | | | | - Golda Ginsburg
- Child Division of Department of Psychiatry, University of Connecticut Health
| | - Courtney Keeton
- Department of Psychiatry and Behavioral Services, Johns Hopkins University School of Medicine
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles
| | - Tara Peris
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles
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Murias M, Major S, Compton S, Buttinger J, Sun JM, Kurtzberg J, Dawson G. Electrophysiological Biomarkers Predict Clinical Improvement in an Open-Label Trial Assessing Efficacy of Autologous Umbilical Cord Blood for Treatment of Autism. Stem Cells Transl Med 2018; 7:783-791. [PMID: 30070044 PMCID: PMC6216432 DOI: 10.1002/sctm.18-0090] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/05/2018] [Indexed: 12/20/2022] Open
Abstract
This study was a phase I, single-center, and open-label trial of a single intravenous infusion of autologous umbilical cord blood in young children with autism spectrum disorder (ASD). Twenty-five children between the ages of 2 and 6 with a confirmed diagnosis of ASD and a qualified banked autologous umbilical cord blood unit were enrolled. Safety results and clinical outcomes measured at 6 and 12 months post-infusion have been previously published. The purpose of the present analysis was to explore whether measures of electroencephalography (EEG) theta, alpha, and beta power showed evidence of change after treatment and whether baseline EEG characteristics were predictive of clinical improvement. The primary endpoint was the parent-reported Vineland adaptive behavior scales-II socialization subscale score, collected at baseline, 6- and 12-month visits. In addition, the expressive one word picture vocabulary test 4 and the clinical global impression-improvement scale were administered. Electrophysiological recordings were taken during viewing of dynamic social and nonsocial stimuli at 6 and 12 months post-treatment. Significant changes in EEG spectral characteristics were found by 12 months post-infusion, which were characterized by increased alpha and beta power and decreased EEG theta power. Furthermore, higher baseline posterior EEG beta power was associated with a greater degree of improvement in social communication symptoms, highlighting the potential for an EEG biomarker to predict variation in outcome. Taken together, the results suggest that EEG measures may be useful endpoints for future ASD clinical trials. Stem Cells Translational Medicine 2018;7:783-791.
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Affiliation(s)
- Michael Murias
- Duke Institute for Brain SciencesDuke UniversityDurhamNorth CarolinaUSA
- Duke Center for Autism and Brain DevelopmentDuke UniversityDurhamNorth CarolinaUSA
| | - Samantha Major
- Duke Center for Autism and Brain DevelopmentDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth CarolinaUSA
| | - Scott Compton
- Duke Center for Autism and Brain DevelopmentDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth CarolinaUSA
| | - Jessica Buttinger
- Duke Center for Autism and Brain DevelopmentDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth CarolinaUSA
| | - Jessica M. Sun
- Robertson Clinical and Translational Cell Therapy ProgramDuke UniversityDurhamNorth CarolinaUSA
| | - Joanne Kurtzberg
- Robertson Clinical and Translational Cell Therapy ProgramDuke UniversityDurhamNorth CarolinaUSA
| | - Geraldine Dawson
- Duke Institute for Brain SciencesDuke UniversityDurhamNorth CarolinaUSA
- Duke Center for Autism and Brain DevelopmentDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth CarolinaUSA
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Hale AE, Ginsburg GS, Chan G, Kendall PC, McCracken J, Sakolsky D, Birmaher B, Compton S, Marie Albano A, Walkup J. Mediators of Treatment Outcomes for Anxious Children and Adolescents: The Role of Somatic Symptoms. J Clin Child Adolesc Psychol 2018; 47:94-104. [PMID: 28278599 PMCID: PMC6129169 DOI: 10.1080/15374416.2017.1280804] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors are effective treatments for pediatric anxiety disorders. However, the mechanisms of these treatments are unknown. Previous research indicated that somatic symptoms are reduced following treatment, but it is unclear if their reductions are merely a consequence of treatment gains. This study examined reductions in somatic symptoms as a potential mediator of the relationship between treatment and anxiety outcomes. Participants were 488 anxious youth ages 7-17 (M = 10.7), 50.4% male, 78.9% Caucasian, enrolled in Child/Adolescent Anxiety Multimodal Study, a large randomized control trial comparing 12-week treatments of CBT, sertraline, a combination of CBT and sertraline, and a pill placebo. Causal mediation models were tested in R using data from baseline, 8-, and 12-week evaluations. Somatic symptoms were assessed using the Panic/Somatic subscale from the Screen for Child Anxiety Related Emotional Disorders. Youth outcomes were assessed using the Pediatric Anxiety Rating Scale and Children's Global Assessment Scale. Reductions in somatic symptoms mediated improvement in anxiety symptoms and global functioning for those in the sertraline-only condition based on parent report. Conditions involving CBT and data based on child reported somatic symptoms did not show a mediation effect. Findings indicate that reductions in somatic symptoms may be a mediator of improvements for treatments including pharmacotherapy and not CBT. Although the overall efficacy of sertraline and CBT for anxiety may be similar, the treatments appear to function via different mechanisms.
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Affiliation(s)
- Amy E. Hale
- University of Connecticut Health Center, 65 Kane St, West Hartford, CT 06119
| | - Golda S. Ginsburg
- University of Connecticut Health Center, 65 Kane St, West Hartford, CT 06119
| | - Grace Chan
- University of Connecticut Health Center, 65 Kane St, West Hartford, CT 06119
| | | | - James McCracken
- UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, CA
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Højgaard DRMA, Hybel KA, Ivarsson T, Skarphedinsson G, Becker Nissen J, Weidle B, Melin K, Torp NC, Valderhaug R, Dahl K, Mortensen EL, Compton S, Jensen S, Lenhard F, Thomsen PH. One-Year Outcome for Responders of Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry 2017; 56:940-947.e1. [PMID: 29096776 DOI: 10.1016/j.jaac.2017.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 08/23/2017] [Accepted: 09/06/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study describes 1-year treatment outcomes from a large sample of cognitive-behavioral therapy (CBT) responders, investigates age as a possible moderator of these treatment outcomes, and evaluates clinical relapse at the 1-year follow-up. METHOD This study is the planned follow-up to the Nordic Long-term OCD [obsessive-compulsive disorder] Treatment Study (NordLOTS), which included 177 children and adolescents who were rated as treatment responders following CBT for OCD. Participants were assessed with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) at 6- and 12-month follow-up. Treatment response and remission were defined as CY-BOCS total scores ≤15 and ≤10, respectively. Linear mixed-effects models were used to analyze all outcomes. RESULTS At 1 year, a total of 155 children and adolescents (87.6%) were available for follow-up assessment, with 142 of these (91.6%) rated below a total score of ≤15 on the CY-BOCS. At 1-year follow-up, 121 (78.1%) were in remission. On average, CY-BOCS total scores dropped by 1.72 points during the first year after terminating treatment (p = .001). A total of 28 participants (15.8%) relapsed (CY-BOCS ≥ 16) at either the 6- or 12-month assessment; only 2 patients required additional CBT. CONCLUSION Results suggest that manualized CBT in a community setting for pediatric OCD has durable effects for those who respond to an initial course of treatment; children and adolescents who respond to such treatment can be expected to maintain their treatment gains for at least 1 year following acute care. Clinical trial registration information- Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119.
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Affiliation(s)
- Davíð R M A Højgaard
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark.
| | - Katja A Hybel
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Tord Ivarsson
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo
| | | | - Judith Becker Nissen
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Bernhard Weidle
- Regional Center for Child and Youth Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karin Melin
- Queen Silvia's Children's Hospital, Sahlgrenska, University Hospital, Gothenburg, Sweden
| | - Nor Christian Torp
- Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway
| | - Robert Valderhaug
- Regional Center for Child and Youth Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Hospital of Aalesund, Norway
| | - Kitty Dahl
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo
| | | | | | - Sanne Jensen
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Fabian Lenhard
- Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden and the Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Per Hove Thomsen
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
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Pistorello J, Jobes D, Compton S, Locey NS, Walloch JC, Gallop R, Au JS, Noose SK, Young M, Johnson J, Dickens Y, Chatham P, Jeffcoat T, Dalto G, Goswami S. Developing Adaptive Treatment Strategies to Address Suicidal Risk in College Students: A Pilot Sequential, Multiple Assignment, Randomized Trial (SMART). Arch Suicide Res 2017; 22:644-664. [PMID: 29220633 PMCID: PMC6125229 DOI: 10.1080/13811118.2017.1392915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This pilot study investigated the potential to utilize adaptive treatment strategies for treating moderate to severe suicidal risk among college students. This article will describe the unique study design and report on feasibility and acceptability findings. A 2-stage Sequential Multiple Assignment Randomized Trial (SMART) was conducted: In Stage 1, 62 suicidal college students were randomized to either a suicide-focused or a treatment-as-usual condition (4-8 weeks). Those deemed insufficient responders were re-randomized to one of two Stage 2 interventions-both suicide-focused but one comprehensive and multimodal and the other flexible and theoretically agnostic (4-16 additional weeks). Recruitment rates were high, treatment dropout levels were lower than expected for the setting, study dropouts were rare, and counselors were able to deliver suicide-focused approaches with fidelity. Treatment satisfaction was high among clients and moderately high among counselors. Findings from this pilot show that a SMART is highly feasible and acceptable to suicidal college students, counselors, and campuses.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Maria Young
- University of Nevada, Reno, Counseling Services
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Lee P, Zehgeer A, Ginsburg GS, McCracken J, Keeton C, Kendall PC, Birmaher B, Sakolsky D, Walkup J, Peris T, Albano AM, Compton S. Child and Adolescent Adherence With Cognitive Behavioral Therapy for Anxiety: Predictors and Associations With Outcomes. J Clin Child Adolesc Psychol 2017; 48:S215-S226. [PMID: 28448176 DOI: 10.1080/15374416.2017.1310046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cognitive behavioral therapy (CBT) for anxiety disorders is effective, but nonadherence with treatment may reduce the benefits of CBT. This study examined (a) four baseline domains (i.e., demographic, youth clinical characteristics, therapy related, family/parent factors) as predictors of youth adherence with treatment and (b) the associations between youth adherence and treatment outcomes. Data were from 279 youth (7-17 years of age, 51.6% female; 79.6% White, 9% African American), with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) diagnoses of separation anxiety disorder, generalized anxiety disorder, and/or social phobia, who participated in CBT in the Child/Adolescent Anxiety Multimodal Study. Adherence was defined in three ways (session attendance, therapist-rated compliance, and homework completion). Multiple regressions revealed several significant predictors of youth adherence with CBT, but predictors varied according to the definition of adherence. The most robust predictors of greater adherence were living with both parents and fewer youth comorbid externalizing disorders. With respect to outcomes, therapist ratings of higher youth compliance with CBT predicted several indices of favorable outcome: lower anxiety severity, higher global functioning, and treatment responder status after 12 weeks of CBT. Number of sessions attended and homework completion did not predict treatment outcomes. Findings provide information about risks for youth nonadherence, which can inform treatment and highlight the importance of youth compliance with participating in therapy activities, rather than just attending sessions or completing homework assignments.
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Affiliation(s)
- Phyllis Lee
- a Department of Psychiatry, University of Connecticut Health
| | - Asima Zehgeer
- a Department of Psychiatry, University of Connecticut Health
| | | | - James McCracken
- b Division of Child and Adolescent Psychiatry,UCLA Semel Institute of Neuroscience and Human Behavior
| | - Courtney Keeton
- c Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine
| | | | | | - Dara Sakolsky
- e Department of Psychiatry, University of Pittsburgh
| | - John Walkup
- f Department of Child and Adolescent Psychiatry, Weill Cornell Medical College
| | - Tara Peris
- b Division of Child and Adolescent Psychiatry,UCLA Semel Institute of Neuroscience and Human Behavior
| | - Anne Marie Albano
- g Department of Child and Adolescent Psychiatry, Columbia University
| | - Scott Compton
- h Department of Psychiatry and Behavioral Sciences, Duke University
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Fournier KB, Brown CG, Yeoman MF, Fisher JH, Seiler SW, Hinshelwood D, Compton S, Holdener FR, Kemp GE, Newlander CD, Gilliam RP, Froula N, Lilly M, Davis JF, Lerch MA, Blue BE. X-ray transport and radiation response assessment (XTRRA) experiments at the National Ignition Facility. Rev Sci Instrum 2016; 87:11D421. [PMID: 27910608 DOI: 10.1063/1.4960501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Our team has developed an experimental platform to evaluate the x-ray-generated stress and impulse in materials. Experimental activities include x-ray source development, design of the sample mounting hardware and sensors interfaced to the National Ignition Facility's diagnostics insertion system, and system integration into the facility. This paper focuses on the X-ray Transport and Radiation Response Assessment (XTRRA) test cassettes built for these experiments. The test cassette is designed to position six samples at three predetermined distances from the source, each known to within ±1% accuracy. Built-in calorimeters give in situ measurements of the x-ray environment along the sample lines of sight. The measured accuracy of sample responses as well as planned modifications to the XTRRA cassette is discussed.
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Affiliation(s)
- K B Fournier
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94551, USA
| | - C G Brown
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94551, USA
| | - M F Yeoman
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94551, USA
| | - J H Fisher
- Fifth Gait Technologies, Inc., 14040 Camden Circle, Huntsville, Alabama 35803, USA
| | - S W Seiler
- Defense Threat Reduction Agency, 8725 John J. Kingman Road, Fort Belvoir, Virginia 22060-6201, USA
| | - D Hinshelwood
- Naval Research Laboratory, 4555 Overlook Ave. SW, Washington, DC 20375, USA
| | - S Compton
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94551, USA
| | - F R Holdener
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94551, USA
| | - G E Kemp
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94551, USA
| | - C D Newlander
- Fifth Gait Technologies, Inc., 14040 Camden Circle, Huntsville, Alabama 35803, USA
| | - R P Gilliam
- Fifth Gait Technologies, Inc., 14040 Camden Circle, Huntsville, Alabama 35803, USA
| | - N Froula
- Fifth Gait Technologies, Inc., 14040 Camden Circle, Huntsville, Alabama 35803, USA
| | - M Lilly
- Dynasen, Inc., 20 Arnold Pl., Goleta, California 93117, USA
| | - J F Davis
- Defense Threat Reduction Agency, 8725 John J. Kingman Road, Fort Belvoir, Virginia 22060-6201, USA
| | - Maj A Lerch
- Defense Threat Reduction Agency, 8725 John J. Kingman Road, Fort Belvoir, Virginia 22060-6201, USA
| | - B E Blue
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94551, USA
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Califano R, Tariq N, Compton S, Fitzgerald DA, Harwood CA, Lal R, Lester J, McPhelim J, Mulatero C, Subramanian S, Thomas A, Thatcher N, Nicolson M. Expert Consensus on the Management of Adverse Events from EGFR Tyrosine Kinase Inhibitors in the UK. Drugs 2016; 75:1335-48. [PMID: 26187773 PMCID: PMC4532717 DOI: 10.1007/s40265-015-0434-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) such as gefitinib, erlotinib, and afatinib are standard-of-care for first-line treatment of EGFR-mutant advanced non-small cell lung cancer (NSCLC). These drugs have a proven benefit in terms of higher response rate, delaying progression and improvement of quality of life over palliative platinum-based chemotherapy. The most common adverse events (AEs) are gastrointestinal (GI) (diarrhoea and stomatitis/mucositis) and cutaneous (rash, dry skin and paronychia). These are usually mild, but if they become moderate or severe, they can have a negative impact on the patient’s quality of life (QOL) and lead to dose modifications or drug discontinuation. Appropriate management of AEs, including prophylactic measures, supportive medications, treatment delays and dose reductions, is essential. A consensus meeting of a UK-based multidisciplinary panel composed of medical and clinical oncologists with a special interest in lung cancer, dermatologists, gastroenterologists, lung cancer nurse specialists and oncology pharmacists was held to develop guidelines on prevention and management of cutaneous (rash, dry skin and paronychia) and GI (diarrhoea, stomatitis and mucositis) AEs associated with the administration of EGFR-TKIs. These guidelines detail supportive measures, treatment delays and dose reductions for EGFR-TKIs. Although the focus of the guidelines is to support healthcare professionals in UK clinical practice, it is anticipated that the management strategies proposed will also be applicable in non-UK settings.
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Affiliation(s)
- R Califano
- Cancer Research UK Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK,
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Affiliation(s)
| | | | - Sandy Cook
- Duke-NUS Graduate Medical School, Singapore
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Hoff AL, Kendall PC, Langley A, Ginsburg G, Keeton C, Compton S, Sherrill J, Walkup J, Birmaher B, Albano AM, Suveg C, Piacentini J. Developmental Differences in Functioning in Youth With Social Phobia. J Clin Child Adolesc Psychol 2015; 46:686-694. [PMID: 26630122 DOI: 10.1080/15374416.2015.1079779] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Social phobia (SoP) in youth may manifest differently across development as parent involvement in their social lives changes and social and academic expectations increase. This cross-sectional study investigated whether self-reported and parent-reported functioning in youth with SoP changes with age in social, academic, and home/family domains. Baseline anxiety impairment data from 488 treatment-seeking anxiety-disordered youth (ages 7-17, N = 400 with a SoP diagnosis) and their parents were gathered using the Child Anxiety Impact Scale and were analyzed using generalized estimating equations. According to youth with SoP and their parents, overall difficulties, social difficulties, and academic difficulties increased with age, even when controlling for SoP severity. These effects significantly differed for youth with anxiety disorders other than SoP. Adolescents may avoid social situations as parental involvement in their social lives decreases, and their withdrawn behavior may result in increasing difficulty in the social domain. Their avoidance of class participation and oral presentations may increasingly impact their academic performance as school becomes more demanding. Implications are discussed for the early detection and intervention of SoP to prevent increased impairment over the course of development.
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Affiliation(s)
| | | | - Audra Langley
- b Department of Psychiatry , University of California , Los Angeles
| | - Golda Ginsburg
- c Department of Psychiatry , University of Connecticut School of Medicine
| | - Courtney Keeton
- d Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine
| | - Scott Compton
- e Department of Psychiatry and Behavioral Science , Duke University Medical Center
| | | | - John Walkup
- g Division of Child and Adolescent Psychiatry , Weill Cornell Medical College
| | - Boris Birmaher
- h Western Psychiatric Institute and Clinic , University of Pittsburgh Medical Center
| | | | | | - John Piacentini
- b Department of Psychiatry , University of California , Los Angeles
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Kendall PC, Cummings CM, Villabø MA, Narayanan MK, Treadwell K, Birmaher B, Compton S, Piacentini J, Sherrill J, Walkup J, Gosch E, Keeton C, Ginsburg G, Suveg C, Albano AM. Mediators of change in the Child/Adolescent Anxiety Multimodal Treatment Study. J Consult Clin Psychol 2015; 84:1-14. [PMID: 26460572 DOI: 10.1037/a0039773] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Test changes in (a) coping efficacy and (b) anxious self-talk as potential mediators of treatment gains at 3-month follow-up in the Child/Adolescent Anxiety Multimodal Treatment Study (CAMS). METHOD Participants were 488 youth (ages 7-17; 50.4% male) randomized to cognitive-behavioral therapy (CBT; Coping cat program), pharmacotherapy (sertraline), their combination, or pill placebo. Participants met Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Coping efficacy (reported ability to manage anxiety provoking situations) was measured by youth and parent reports on the Coping Questionnaire, and anxious self-talk was measured by youth report on the Negative Affectivity Self-Statement Questionnaire. Outcome was measured using the Pediatric Anxiety Rating Scale (completed by Independent Evaluators blind to condition). For temporal precedence, residualized treatment gains were assessed at 3-month follow-up. RESULTS Residualized gains in coping efficacy mediated gains in the CBT, sertraline, and combination conditions. In the combination condition, some unique effect of treatment remained. Treatment assignment was not associated with a reduction in anxious self-talk, nor did anxious self-talk predict changes in anxiety symptoms. CONCLUSIONS The findings suggest that improvements in coping efficacy are a mediator of treatment gains. Anxious self-talk did not emerge as a mediator.
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Affiliation(s)
| | | | | | - Martina K Narayanan
- Department of Psychology, The Norwegian Center for Child Behavioral Development
| | | | | | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University
| | - John Piacentini
- Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles
| | - Joel Sherrill
- Child and Adolescent Mental Health, National Institute of Mental Health
| | - John Walkup
- Department of Child and Adolescent Psychiatry, Cornell University
| | - Elizabeth Gosch
- Department of Psychology, Philadelphia College of Osteopathic Medicine
| | - Courtney Keeton
- Department of Child and Adolescent Psychiatry, Johns Hopkins University
| | - Golda Ginsburg
- Department of Child and Adolescent Psychiatry, Johns Hopkins University
| | - Cindy Suveg
- Department of Psychology, University of Georgia
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Skarphedinsson G, Compton S, Thomsen PH, Weidle B, Dahl K, Nissen JB, Torp NC, Hybel K, Melin KH, Valderhaug R, Wentzel-Larsen T, Ivarsson T. Tics Moderate Sertraline, but Not Cognitive-Behavior Therapy Response in Pediatric Obsessive-Compulsive Disorder Patients Who Do Not Respond to Cognitive-Behavior Therapy. J Child Adolesc Psychopharmacol 2015; 25:432-9. [PMID: 26091197 PMCID: PMC4491151 DOI: 10.1089/cap.2014.0167] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate whether the presence of tic disorder is negatively associated with sertraline (SRT) outcomes, but not with continued cognitive-behavioral therapy (CBT), in a sample of youth who were unresponsive to an initial full course of CBT. METHODS In the Nordic Long-Term OCD Study, children and adolescents with OCD who were rated as nonresponders to 14 weeks of open-label CBT were randomized to continued CBT (n=28) or SRT treatment (n=22) for an additional 16 weeks of treatment. We investigated whether the presence or absence of comorbid tic disorder moderated treatment outcomes on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). RESULTS Twelve out of 50 (24.0%) participants were diagnosed with comorbid tic disorder, with 7 receiving continued CBT and 5 receiving SRT, respectively. In patients without tic disorder, results showed no significant between-group differences on average CY-BOCS scores. However, in patients with comorbid tic disorder, those who received SRT had significantly lower average CY-BOCS scores than those who received continued CBT. CONCLUSIONS Children and adolescents with OCD and comorbid tic disorder, who are nonresponders to an initial 14 week course of CBT, may benefit more from a serotonin reuptake inhibitor (SRI) than from continued CBT.
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Affiliation(s)
| | - Scott Compton
- Duke University Medical Center Department of Psychiatry, Durham, North Carolina
| | - Per Hove Thomsen
- Aarhus University Hospital, Centre for Child and Adolescent Psychiatry, Risskov, Denmark
| | - Bernhard Weidle
- Norwegian University of Science and Technology, Faculty of Medicine, Regional Center for Child and Youth Mental Health and Child Welfare, Trondheim, Norway
| | - Kitty Dahl
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Judith Becker Nissen
- Aarhus University Hospital, Centre for Child and Adolescent Psychiatry, Risskov, Denmark
| | - Nor Christian Torp
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.,Department of Child and Adolescent Psychiatry, Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway
| | - Katja Hybel
- Aarhus University Hospital, Centre for Child and Adolescent Psychiatry, Risskov, Denmark
| | - Karin Holmgren Melin
- OCD-Clinic, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Robert Valderhaug
- Norwegian University of Science and Technology, Faculty of Medicine, Regional Center for Child and Youth Mental Health and Child Welfare, Trondheim, Norway
| | - Tore Wentzel-Larsen
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.,Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Tord Ivarsson
- Aarhus University Hospital, Centre for Child and Adolescent Psychiatry, Risskov, Denmark
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White SW, Lerner MD, McLeod BD, Wood JJ, Ginsburg GS, Kerns C, Ollendick T, Kendall PC, Piacentini J, Walkup J, Compton S. Anxiety in youth with and without autism spectrum disorder: examination of factorial equivalence. Behav Ther 2015; 46:40-53. [PMID: 25526834 PMCID: PMC4273846 DOI: 10.1016/j.beth.2014.05.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 05/21/2014] [Accepted: 05/22/2014] [Indexed: 12/28/2022]
Abstract
Although anxiety is frequently reported among children and adolescents with autism spectrum disorder (ASD), it has not been established that the manifest symptoms of anxiety in the context of ASD are the same as those seen in youth without ASD. This study sought to examine the metric and latent factor equivalence of anxiety as measured by the Multidimensional Anxiety Scale for Children, parent-report (MASC-P) and child-report (MASC-C), in youth with anxiety disorders and ASD with intact verbal ability (n=109, M(age)=11.67 years, 99 male) and a gender-matched comparison group of typically developing (TD) children and adolescents with anxiety disorders but without ASD (n=342, M(age)=11.25 years, 246 male). Multigroup factorial invariance (MFI) using structural equation modeling indicated equivalent latent factors in youth with and without ASD on the MASC-C (metric invariance). However, the item means and covariances along with the relations among the factor scores were different for the youth with ASD (i.e., lack of evidence for scalar or structural invariance). The MASC-P data did not fit the measure's established structure for either the ASD or TD group, and post-hoc exploratory factor analysis revealed a different factor structure in the ASD group. Findings suggest that the MASC-C may not measure identical constructs in anxious youth with and without ASD. Further research on the structure of the MASC in clinical samples is warranted.
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Maso K, Jones K, Ruffino J, Sabic A, Compton S. 1537The AHKER Study: Assessing HIV Knowledge of Emergency Residents. Open Forum Infect Dis 2014. [PMCID: PMC5781474 DOI: 10.1093/ofid/ofu052.1083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kristi Maso
- Emergency Medicine, Detroit Receiving Hospital/Wayne State University, Detroit, MI
| | - Kerin Jones
- Emergency Medicine, Detroit Receiving Hospital/Wayne State University, Detroit, MI
| | - Jessica Ruffino
- Emergency Medicine, Detroit Receiving Hospital/Wayne State University, Detroit, MI
| | - Adnan Sabic
- Emergency Medicine, Detroit Receiving Hospital/Wayne State University, Detroit, MI
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Fournier KB, Brown CG, May MJ, Compton S, Walton OR, Shingleton N, Kane JO, Holtmeier G, Loey H, Mirkarimi PB, Dunlop WH, Guyton RL, Huffman E. A geophysical shock and air blast simulator at the National Ignition Facility. Rev Sci Instrum 2014; 85:095119. [PMID: 25273784 DOI: 10.1063/1.4896119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The energy partitioning energy coupling experiments at the National Ignition Facility (NIF) have been designed to measure simultaneously the coupling of energy from a laser-driven target into both ground shock and air blast overpressure to nearby media. The source target for the experiment is positioned at a known height above the ground-surface simulant and is heated by four beams from the NIF. The resulting target energy density and specific energy are equal to those of a low-yield nuclear device. The ground-shock stress waves and atmospheric overpressure waveforms that result in our test system are hydrodynamically scaled analogs of full-scale seismic and air blast phenomena. This report summarizes the development of the platform, the simulations, and calculations that underpin the physics measurements that are being made, and finally the data that were measured. Agreement between the data and simulation of the order of a factor of two to three is seen for air blast quantities such as peak overpressure. Historical underground test data for seismic phenomena measured sensor displacements; we measure the stresses generated in our ground-surrogate medium. We find factors-of-a-few agreement between our measured peak stresses and predictions with modern geophysical computer codes.
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Affiliation(s)
- K B Fournier
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - C G Brown
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - M J May
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - S Compton
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - O R Walton
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - N Shingleton
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - J O Kane
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - G Holtmeier
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - H Loey
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - P B Mirkarimi
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - W H Dunlop
- Lawrence Livermore National Laboratory, P.O. Box 808, L-481, Livermore, California 94550, USA
| | - R L Guyton
- National Securities Technologies, Vasco Rd., Livermore, California 94551, USA
| | - E Huffman
- National Securities Technologies, Vasco Rd., Livermore, California 94551, USA
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Read KL, Settipani CA, Peterman J, Kendall PC, Compton S, Piacentini J, McCracken J, Bergman L, Walkup J, Sakolsky D, Birmaher B, Albano AM, Rynn M, Ginsburg G, Keeton C, Gosch E, Suveg C, Sherrill J, March J. Predicting Anxiety Diagnoses and Severity with the CBCL-A: Improvement Relative to Other CBCL Scales? J Psychopathol Behav Assess 2014; 37:100-111. [PMID: 26257470 DOI: 10.1007/s10862-014-9439-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Child Behavior Checklist (CBCL) is a widely used parent-report of child and adolescent behavior. We examined the ability of the CBCL-A scale, a previously published subset of CBCL items, to predict the presence of generalized anxiety disorder (GAD), separation anxiety disorder (SAD), and social phobia (SoP), as well as anxiety severity, among 488 youth randomized in the Child Anxiety Multimodal Study (CAMS). We predicted that the CBCL-A's unique inclusion of items related to somatic symptoms would better identify anxiety disorder and severity than other CBCL scales, given that somatic complaints are often key features of anxiety among youth. Results support the use of the anxiety-based CBCL subscales as first-line screeners for generally elevated symptoms of anxiety, rather than tools to identify specific anxiety disorders. Although somatic symptoms are often reported and included in diagnostic criteria for certain anxiety disorders (e.g., SAD, GAD), the unique combination of somatic and non-somatic symptoms for the CBCL-A subscale did not increase its ability to consistently predict the presence of specific anxiety disorders.
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Freeman J, Sapyta J, Garcia A, Compton S, Khanna M, Flessner C, FitzGerald DP, Mauro C, Dingfelder R, Benito K, Harrison J, Curry J, Foa E, March J, Moore P, Franklin M. Family-based treatment of early childhood obsessive-compulsive disorder: the Pediatric Obsessive-Compulsive Disorder Treatment Study for Young Children (POTS Jr)--a randomized clinical trial. JAMA Psychiatry 2014; 71:689-98. [PMID: 24759852 PMCID: PMC4511269 DOI: 10.1001/jamapsychiatry.2014.170] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE Cognitive behavior therapy (CBT) has been established as efficacious for obsessive-compulsive disorder (OCD) among older children and adolescents, yet its effect on young children has not been evaluated sufficiently. OBJECTIVE To examine the relative efficacy of family-based CBT (FB-CBT) involving exposure plus response prevention vs an FB relaxation treatment (FB-RT) control condition for children 5 to 8 years of age. DESIGN, SETTING, AND PARTICIPANTS A 14-week randomized clinical trial (Pediatric Obsessive-Compulsive Disorder Treatment Study for Young Children [POTS Jr]) conducted at 3 academic medical centers between 2006 and 2011, involving 127 pediatric outpatients 5 to 8 years of age who received a primary diagnosis of OCD and a Children's Yale-Brown Obsessive Compulsive Scale total score of 16 or higher. INTERVENTIONS Participants were randomly assigned to 14 weeks of (1) FB-CBT, including exposure plus response prevention, or (2) FB-RT. MAIN OUTCOMES AND MEASURES Responder status defined as an independent evaluator-rated Clinical Global Impression-Improvement scale score of 1 (very much improved) or 2 (much improved) and change in independent evaluator-rated continuous Children's Yale-Brown Obsessive Compulsive Scale total score. RESULTS Family-based CBT was superior to FB-RT on both primary outcome measures. The percentages of children who were rated as 1 (very much improved) or 2 (much improved) on the Clinical Global Impression-Improvement scale at 14 weeks were 72% for FB-CBT and 41% for FB-RT. The effect size difference between FB-CBT and FB-RT on the Clinical Global Impression-Improvement scale was 0.31 (95% CI, 0.17-0.45). The number needed to treat (NNT) with FB-CBT vs FB-RT was estimated as 3.2 (95% CI, 2.2-5.8). The effect size difference between FB-CBT and FB-RT on the Children's Yale-Brown Obsessive Compulsive Scale at week 14 was 0.84 (95% CI, 0.62-1.06). CONCLUSIONS AND RELEVANCE A comprehensive FB-CBT program was superior to a relaxation program with a similar format in reducing OCD symptoms and functional impairment in young children (5-8 years of age) with OCD. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00533806.
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Affiliation(s)
- Jennifer Freeman
- Alpert Medical School of Brown University; Bradley-Hasbro Children’s Research Center,Corresponding author: Jennifer Freeman, PhD – , Alpert Medical School of Brown University, Bradley-Hasbro Children’s Research Center, Coro West – 2 Floor, 1 Hoppin St., Providence, RI 02903 USA, Phone: 401-444-2568, Fax: 401-444-8742
| | | | - Abbe Garcia
- Alpert Medical School of Brown University; Bradley-Hasbro Children’s Research Center
| | | | | | - Chris Flessner
- Alpert Medical School of Brown University; Bradley-Hasbro Children’s Research Center
| | | | | | | | - Kristen Benito
- Alpert Medical School of Brown University; Bradley-Hasbro Children’s Research Center
| | | | | | - Edna Foa
- University of Pennsylvania School of Medicine
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Piacentini J, Bennett S, Compton S, Kendall P, Birmaher B, Albano AM, March J, Sherrill J, Sakolsky D, Ginsburg G, Rynn M, Bergman RL, Gosch E, Waslick B, Iyengar S, McCracken J, Walkup J. 24- and 36-week outcomes for the Child/Adolescent Anxiety Multimodal Study (CAMS). J Am Acad Child Adolesc Psychiatry 2014; 53:297-310. [PMID: 24565357 PMCID: PMC3982864 DOI: 10.1016/j.jaac.2013.11.010] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 11/06/2013] [Accepted: 11/26/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We report active treatment group differences on response and remission rates and changes in anxiety severity at weeks 24 and 36 for the Child/Adolescent Anxiety Multimodal Study (CAMS). METHOD CAMS youth (N = 488; 74% ≤ 12 years of age) with DSM-IV separation, generalized, or social anxiety disorder were randomized to 12 weeks of cognitive-behavioral therapy (CBT), sertraline (SRT), CBT+SRT (COMB), or medication management/pill placebo (PBO). Responders attended 6 monthly booster sessions in their assigned treatment arm; youth in COMB and SRT continued on their medication throughout this period. Efficacy of COMB, SRT, and CBT (n = 412) was assessed at 24 and 36 weeks postrandomization. Youth randomized to PBO (n = 76) were offered active CAMS treatment if nonresponsive at week 12 or over follow-up and were not included here. Independent evaluators blind to study condition assessed anxiety severity, functioning, and treatment response. Concomitant treatments were allowed but monitored over follow-up. RESULTS The majority (>80%) of acute responders maintained positive response at both weeks 24 and 36. Consistent with acute outcomes, COMB maintained advantage over CBT and SRT, which did not differ, on dimensional outcomes; the 3 treatments did not differ on most categorical outcomes over follow-up. Compared to COMB and CBT, youth in SRT obtained more concomitant psychosocial treatments, whereas those in SRT and CBT obtained more concomitant combined (medication plus psychosocial) treatment. CONCLUSIONS COMB maintained advantage over CBT and SRT on some measures over follow-up, whereas the 2 monotherapies remained indistinguishable. The observed convergence of COMB and monotherapy may be related to greater use of concomitant treatment during follow-up among youth receiving the monotherapies, although other explanations are possible. Although outcomes were variable, most CAMS-treated youth experienced sustained treatment benefit. Clinical trial registration information-Child and Adolescent Anxiety Disorders (CAMS); URL: http://clinicaltrials.gov. Unique identifier: NCT00052078.
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Affiliation(s)
- John Piacentini
- University of California-Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior.
| | | | | | | | - Boris Birmaher
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center
| | - Anne Marie Albano
- New York State Psychiatric Institute–Columbia University Medical Center
| | | | - Joel Sherrill
- Division of Services and Intervention Research, National Institute of Mental Health (NIMH)
| | - Dara Sakolsky
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center
| | | | - Moira Rynn
- New York State Psychiatric Institute–Columbia University Medical Center
| | - R. Lindsey Bergman
- University of California–Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior
| | | | | | - Satish Iyengar
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center
| | - James McCracken
- University of California–Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior
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Nagurka R, Bechmann S, Gluckman W, Scott SR, Compton S, Lamba S. Utility of initial prehospital end-tidal carbon dioxide measurements to predict poor outcomes in adult asthmatic patients. PREHOSP EMERG CARE 2014; 18:180-4. [PMID: 24400881 DOI: 10.3109/10903127.2013.851306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE To determine if an initial (before treatment) prehospital end-tidal carbon dioxide (EtCO2) measurement in adult, non-chronic obstructive pulmonary disease (COPD), asthmatic patients predicts patient outcomes. METHODS This is a retrospective chart review of EtCO2 assessment data in a convenience sample of adult, asthmatic patients transported via advanced life support (ALS) units to a large, urban, academic hospital. Initial EtCO2 measurements were obtained routinely on all respiratory distress patients in the field, and emergency department physicians were unaware of the results. Data were analyzed using descriptive statistics, including percentages, means, and 95% confidence intervals (CI). RESULTS We reviewed data for prehospital initial EtCO2 measurements on 299 unique asthma patients (repeat visits by same patient were not included). Mean (SD) age was 43.1 years (12.5) and 142 (47.5%) were male. The mean EtCO2 measurement was 38.8 mmHg (SD ± 9.5; CI: 37.7-39.9; range: 14-82). Examination of initial EtCO2 measurements by deciles revealed that extreme values, in the lowest (14-28 mmHg) and highest (50-82 mmHg) deciles, experienced more markers of poor outcome than less extreme measurements. Patients were thus dichotomized by extreme (n = 59) or nonextreme (n = 240) EtCO2 measurements. More extreme patients were ultimately intubated (30.5 vs. 5.8%; p < 0.001; positive predictive value (ppv) = 30.5% ), and/or admitted to the intensive care unit (ICU) (28.8 vs. 6.7%; p <0.001; ppv = 28.8%), and/or died (5.1 vs. 0%; p = 0.007 [Fisher's exact test]; ppv = 5.1%), than nonextreme patients, respectively. CONCLUSION Extreme (both low and high) prehospital initial EtCO2 measurements may be associated with markers of poor patient outcomes. Future work will prospectively determine whether the addition of this information improves early recognition of severe asthma episodes beyond clinical assessment.
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Compton S, Swor RA, Dunne R, Welch RD, Zalenski RJ. Urban Public School Teachers' Attitudes and Perceptions of the Effectiveness of CPR and Automated External Defibrillators. American Journal of Health Education 2013. [DOI: 10.1080/19325037.2003.10761861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Scott Compton
- a Department of Emergency Medicine , Wayne State University , Detroit , MI , 48201
| | - Robert A. Swor
- a Department of Emergency Medicine , Wayne State University , Detroit , MI , 48201
| | - Robert Dunne
- a Department of Emergency Medicine , Wayne State University , Detroit , MI , 48201
| | - Robert D. Welch
- a Department of Emergency Medicine , Wayne State University , Detroit , MI , 48201
| | - Robert J. Zalenski
- a Department of Emergency Medicine , Wayne State University , Detroit , MI , 48201
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