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BACKGROUND AND OBJECTIVE: First-line, nonpharmacological therapy is recommended for many pediatric mental health (MH) conditions prior to initiating antipsychotic prescription therapies. Many children do not receive these recommended services, despite the known association between antipsychotic medications and metabolic dysfunction. The main objective of this study was to quantify the association among children's MH diagnosis categories, sociodemographic characteristics and receipt of first-line psychosocial care among children in Florida Medicaid METHODS: Florida Medicaid enrollment, healthcare and pharmacy claims were used for this multivariate analysis. Children were assigned to condition clusters wherein related diagnoses were grouped into clinically relevant categories. A total of 7704 children were included in the final analysis. RESULTS: Twenty-four percent of children in Florida Medicaid do not receive first-line, nonpharmacological psychosocial care. Age was significantly associated with not receiving psychosocial services, with older children less likely to receive. Non-Hispanic White children as well as those living in rural areas had lower odds of receiving behavioral intervention prior to initiating antipsychotics. Children with mood-disorders, behavior problems, anxiety and stress related disorders were more likely to receive first-line psychosocial care. CONCLUSIONS: This study provides an important understanding of the variability in receipt of first-line psychosocial care before antipsychotic medication initiation among children in Medicaid based on sociodemographic and MH health characteristics. These analyses can be used to develop quality improvement initiatives targeted toward children that are most vulnerable for not receiving recommended care. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We sought to examine the extent to which body mass index (BMI) was available in electronic health records for Florida Medicaid recipients aged 5 to 18 years taking Second-Generation Antipsychotics (SGAP). We also sought to illustrate how clinical data can be used to identify children most at-risk for SGAP-induced weight gain, which cannot be done using process-focused measures. METHODS: Electronic health record (EHR) data and Medicaid claims were linked from 2013 to 2019. We quantified sociodemographic differences between children with and without pre-and post-BMI values. We developed a linear regression model of post-BMI to examine pre-post changes in BMI among 4 groups: 1) BH/SGAP+ children had behavioral health conditions and were taking SGAP; 2) BH/SGAP- children had behavioral health conditions without taking SGAP; 3) children with asthma; and 4) healthy children. RESULTS: Of 363,360 EHR-Medicaid linked children, 18,726 were BH/SGAP+. Roughly 4% of linked children and 8% of BH/SGAP+ children had both pre and post values of BMI required to assess quality of SGAP monitoring. The percentage varied with gender and race-ethnicity. The R² for the regression model with all predictors was 0.865. Pre-post change in BMI differed significantly (P < .0001) among the groups, with more BMI gain among those taking SGAP, particularly those with higher baseline BMI. CONCLUSION: Meeting the 2030 Centers for Medicare and Medicaid Services goal of digital monitoring of quality of care will require continuing expansion of clinical encounter data capture to provide the data needed for digital quality monitoring. Using linked EHR and claims data allows identifying children at higher risk for SGAP-induced weight gain. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) has great public health relevance due to its high prevalence; adverse academic, social, economic, and health impacts on affected individuals and their families; and well established psychosocial and pharmacological treatment options.1 Typically presenting with childhood onset, ADHD remains an impairing disorder through adolescence to adulthood for a majority of those affected. It is well established that adolescents with any chronic health condition are difficult to engage in protracted illness management, with an estimated 50%-80% struggling with nonadherence, prompting significant efforts to identify adherence promotion interventions.2 Transition-age youth with ADHD are no exception, especially as it pertains to medication use.3 Indeed, ADHD intervention development for transition ages represents a high public health priority, as signaled through grant opportunities offered by the NIMH for pilot projects to refine and test interventions to sustain ADHD treatment effects across developmental transitions (see https://grants.nih.gov/grants/guide/rfa-files/RFA-MH-20-100.html). [ABSTRACT FROM AUTHOR]

Background: With an increasing prevalence of psychotropic polypharmacy, clinicians depend on drug-drug interaction (DDI) references to ensure safe regimens, but the consistency of such information is frequently questioned.Objectives: To evaluate the consistency of psychotropic DDIs documented in Clinical Pharmacology (CP), Micromedex (MM), and Lexicomp (LC) and summarize consistent psychotropic DDIs.Methods: In May 2016, we extracted severe or major psychotropic DDIs for 102 psychotropic drugs, including central nervous system (CNS) stimulants, antidepressants, an antimanic agent (lithium), antipsychotics, anticonvulsants, and anxiolytics-sedatives-hypnotics from CP, MM, and LC. We then summarized the psychotropic DDIs that were included in all 3 references and with evidence quality of "excellent" or "good" based on MM.Results: We identified 1496, 938, and 1006 unique severe or major psychotropic DDIs from CP, MM, and LC, respectively. Common adverse effects related to psychotropic DDIs include increased or decreased effectiveness, CNS depression, neurotoxicity, QT prolongation, serotonin syndrome, and multiple adverse effects. Among these interactions, only 371 psychotropic DDIs were documented in all 3 references, 59 of which had "excellent" or "good" quality of evidence based on MM.Conclusion: The consistency of psychotropic DDI documentation across CP, MM, and LC is poor. DDI documentations need standards that would encourage consistency among drug information references. The list of the 59 DDIs may be useful in the assessment of psychotropic polypharmacy and highlighting DDI alerts in clinical practice. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) has been found to be highly comorbid in children and adolescents with obsessive-compulsive disorder (OCD). Some have proposed, however, that obsessive anxiety may cause inattention and executive dysfunction, leading to inappropriate ADHD diagnoses in those with OCD. If this were the case, these symptoms would be expected to decrease following successful OCD treatment. The present study tested this hypothesis and evaluated whether ADHD symptoms at baseline predicted OCD treatment response. Obsessive-compulsive and ADHD symptoms were assessed in 50 youth enrolled in a randomized controlled trial investigating selective serotonin reuptake inhibitor and cognitive behavioral treatment. Repeated-measures analysis of variance (RMANOVA) revealed that ADHD symptoms at baseline do not significantly predict treatment outcome. A multivariate RMANOVA found that OCD treatment response moderated change in inattention; participants who showed greater reduction in OCD severity experienced greater reduction in ADHD-inattentive symptoms, while those with less substantial reduction in obsessions and compulsions showed less change. These findings suggest that children and adolescents with OCD and inattention may experience meaningful improvements in attention problems following OCD treatment. Thus, in many youth with OCD, inattention may be inherently tied to obsessions and compulsions. Clinicians may consider addressing OCD in treatment before targeting inattentive-type ADHD. [ABSTRACT FROM AUTHOR]

Selective serotonin reuptake inhibitors (SSRIs) are an efficacious and effective treatment for pediatric obsessive-compulsive disorder (OCD) but have received scrutiny due to a potential side effect constellation called activation syndrome. While recent research introduced a subjective measure of activation syndrome, objective measures have not been tested. This pilot study, using data from a larger randomized-controlled trial, investigated the potential of actigraphy to provide an objective measure of activation symptoms in 44 youths with OCD beginning an SSRI medication regimen. Data were collected over the first four weeks of a multi-site, parallel, double-blind, randomized, placebo controlled psychopharmacological treatment study and statistical modeling was utilized to test how activation syndrome severity predicts daily and nightly activity levels. Results indicated that youths with higher activation symptoms had lower daytime activity levels when treatment averages were analyzed; in contrast youths who experienced onset of activation symptoms one week were more likely to have higher day-time and night-time activity ratings that week. Results support actigraphy as a potential objective measure of activation symptoms. Subsequent studies are needed to confirm these findings and test clinical applications for use by clinicians to monitor activation syndrome during SSRI treatment. National Institutes of Health (5UO1 MH078594-01); NCT00382291. [ABSTRACT FROM AUTHOR]

Abstract: Background: To examine the efficacy of sequential sertraline and cognitive-behavioral therapy (CBT) treatment relative to CBT with pill placebo over 18 weeks in children and adolescents with obsessive–compulsive disorder (OCD). Methods: Forty-seven children and adolescents with OCD (Range = 7–17 years) were randomized to 18-weeks of treatment in one of three arms: 1) sertraline at standard dosing + CBT (RegSert + CBT); 2) sertraline titrated slowly but achieving at least 8 weeks on the maximally tolerated daily dose + CBT (SloSert + CBT); or 3) pill placebo + CBT (PBO + CBT). Assessments were conducted at screening, baseline, weeks 1–9, 13, and 17, and post-treatment. Raters and clinicians were blinded to sertraline (but not CBT) randomization status. Primary outcomes included the Children's Yale-Brown Obsessive–Compulsive Scale, and response and remission status. Secondary outcomes included the Child Obsessive Compulsive Impact Scale–Parent/Child, Children's Depression Rating Scale-Revised, Multidimensional Anxiety Scale for Children, and Clinical-Global Impressions-Severity. Results: All groups exhibited large within-group effects across outcomes. There was no group by time interaction across all outcomes suggesting that group changes over time were comparable. Conclusions: Among youth with OCD, there was no evidence that sequentially provided sertraline with CBT differed from those receiving placebo with CBT. ClinicalTrials.gov Identifier: NCT00382291. [Copyright &y& Elsevier]

Abstract: This study evaluated the psychometric properties of the Treatment-Emergent Activation and Suicidality Assessment Profile (TEASAP) in a clinical sample of 56 youth aged 7–17 with obsessive-compulsive disorder (OCD) who participated in a double-blind randomized controlled trial. The 38-item TEASAP demonstrated good internal consistency for its total score (α=0.93) and adequate to good performance for its five subscale scores (α=0.65–0.92). One-week test-retest stability (N=18) was adequate (Intraclass correlation coefficient [ICC]=0.68–0.80) except for Self-Injury (ICC=0.46). Construct validity was supported by total and subscale TEASAP score relationships with related constructs, including irritability, hyperactivity, externalizing behaviors, manic symptoms, and suicidal ideation, and the absence of relationships with unrelated constructs. Predictive validity was established for the Disinhibition subscale through significant associations with subsequent activation events. Furthermore, TEASAP sensitivity to change in activation scores over time was supported by longitudinal associations of TEASAP scores with clinician ratings of activation over the course of treatment. Findings indicate that the TEASAP has acceptable psychometric properties in a clinical sample of youth with OCD and merits further study in larger samples for additional refinement of its measurement approaches. [Copyright &y& Elsevier]

Abstract: Purpose: The chronic illness model advocates for psychoeducation within a collaborative care model to enhance outcomes. To inform psychoeducational approaches for ADHD, this study describes parent and adolescent knowledge, perceptions, and information sources and explores how these vary by sociodemographic characteristics, ADHD risk, and past child mental health service use. Methods: Parents and adolescents were assessed 7.7 years after initial school district screening for ADHD risk. The study sample included 374 adolescents (56% high and 44% low ADHD risk) aged, on average, 15.4 (standard deviation = 1.8) years, and 36% were African American. Survey questions assessed ADHD knowledge, perceptions, and cues to action and elicited used and preferred information sources. Multiple logistic regression was used to determine potential independent predictors of ADHD knowledge. McNemar tests compared information source utilization against preference. Results: Despite relatively high self-rated ADHD familiarity, misperceptions among parents and adolescents were common, including a sugar etiology (25% and 27%, respectively) and medication overuse (85% and 67%, respectively). African American respondents expressed less ADHD awareness and greater belief in sugar etiology than Caucasians. Parents used a wide range of ADHD information sources, whereas adolescents relied on social network members and teachers/school. However, parents and adolescents expressed similar strong preferences for the Internet (49% and 51%, respectively) and doctor (40% and 27%, respectively) as ADHD information sources. Conclusions: Culturally appropriate psychoeducational strategies are needed that combine doctor-provided ADHD information with reputable Internet sources. Despite time limitations during patient visits, both parents and teens place high priority on receiving information from their doctor. [Copyright &y& Elsevier]

The article discusses efforts to eliminate mental health disparities in the U.S. by the year 2020, led by the Department of Health and Human Services (HHS). It comments on racial and ethnic minorities' access to mental health services in 2012, as well as the impact of socioeconomic status and geography on health care. Other topics explored include minority adolescent psychiatry in the school and justice systems, the Disparities Action Plan from HHS, and advice for child psychiatrists.

Abstract: Little is known about factors that influence willingness to engage in treatment for attention deficit/hyperactivity disorder (ADHD). From 2007 to 2008, in the context of a longitudinal study assessing ADHD detection and service use in the United States, we simultaneously elicited ADHD treatment perceptions from four stakeholder groups: adolescents, parents, health care professionals and teachers. We assessed their willingness to use ADHD interventions and views of potential undesirable effects of two pharmacological (short- and long-acting ADHD medications) and three psychosocial (ADHD education, behavior therapy, and counseling) treatments. In multiple regression analysis, willingness was found to be significantly related to respondent type (lower for adolescents than adults), feeling knowledgeable, and considering treatments acceptable and helpful, but not significantly associated with stigma/embarrassment, respondent race, gender and socioeconomic status. Because conceptual models of undesirable effects are underdeveloped, we used grounded theory method to analyze open-ended survey responses to the question: “What other undesirable effects are you concerned about?” We identified general negative treatment perceptions (dislike, burden, perceived ineffectiveness) and specific undesirable effect expectations (physiological and psychological side effects, stigma and future dependence on drugs or therapies) for pharmacological and psychosocial treatments. In summary, findings indicate significant discrepancies between teens’ and adults’ willingness to use common ADHD interventions, with low teen willingness for any treatments. Results highlight the need to develop better treatment engagement practices for adolescents with ADHD. [Copyright &y& Elsevier]

Abstract: Purpose: This study describes the perspectives of parents and adolescents regarding clinical need for and attitudes toward care for attention-deficit hyperactivity disorder (ADHD). In addition, it explores as to how these views relate to past year usage of mental health services. Methods: Parents and adolescents were interviewed 6 years after the school district was screened for ADHD. Using standardized measures, mental health service usage, adolescent and parent perceived clinical needs (ADHD symptoms, disruptive behavior disorders, anxiety and/or depression, functioning), and enabling attitudes (treatment receptivity, ADHD stigma), as well as parent factors (caregiver strain, distress, instrumental social support) were assessed. Nested logistic regression modeling was used to determine the hierarchical contribution of parent and adolescent perspectives on past year service usage, after adjusting for previous usage of mental health services. Stepwise regression was conducted to identify the variables that were most predictive of service usage. Results: Among the adolescents who were at a high risk for ADHD, 79% had a history of lifetime mental health service usage, but only 42% had received any kind of mental health services in the past year. In hierarchical modeling, only parent inattention ratings and medication receptivity and adolescent ADHD stigma perceptions contributed significantly toward improved model fit. Stepwise regression confirmed these three variables to be predictors (OR: 1.2, 3.8, and .2, respectively) and identified adolescents-reported functioning as an additional predictor of service usage (OR: 1.1). Conclusion: Perceptions of adolescents regarding the stigma related to ADHD are influential in treatment receipt. Quality improvement interventions for adolescents with ADHD should include psychoeducational interventions for adolescents and their parents that target medication receptivity and the stigma related to ADHD. [Copyright &y& Elsevier]

The article presents a study that examines if clinical severity is greater among children outpatient attention deficit/hyperactivity disorder (ADHD) care in primary than in specialty mental health clinics. It explores the variation of clinical outcomes over six-month time intervals. Results suggest that the areas for quality improvement include the alignment of clinical severity with provider type, stimulant use in specialty mental health, and documentation of psychosocial treatment delivery.

Abstract: This study evaluated the psychometric properties of the attention deficit hyperactivity disorder (ADHD) Stigma Questionnaire (ASQ) among a community sample of 301 adolescents ages 11–19 years at high (n =192) and low risks (n =109) for ADHD. Study subjects were drawn from a cohort study assessing ADHD detection and service use. The 26-item ASQ demonstrated good internal consistency. Confirmatory factor analysis using random parceling supported a three-factor structure with highly correlated subscales of disclosure concerns, negative self image, and concern with public attitudes, and a Schmid–Leiman analysis supported an overall stigma factor. Test–retest stability was assessed after two weeks (n =45) and found to be adequate for all three subscales. Construct validity was supported by relationships with related constructs, including clinical maladjustment, depression, self-esteem, and emotional symptoms, and the absence of a relationship with school maladjustment. Findings indicate that the ASQ has acceptable psychometric properties in a large community sample of adolescents, some of whom met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for ADHD. [Copyright &y& Elsevier]

The article presents a study which investigated adolescent outcomes of attention-deficit/hyperactivity disorder (ADHD) in a community sample. The study conducted ADHD screening in 1,615 students followed by a case-control study after 8 years. Results indicate that children with ADHD were more likely to show oppositional defiant disorders (ODD) and that ODD increased the risk of the use of cannabis and alcohol. It also notes that ADHD heralds persistance of ADHD and comorbid symptoms.

Behavioral parent training (BPT) programs are considered the gold standard for intervening in early-onset conduct disorders.1 Our understanding of the disorder etiology has evolved from a focus on the coercive parent-child interaction to include more complex considerations, including gene-environment interactions.2 Refining our understanding of prevention and early intervention for these common and costly disorders is an important public health priority, because an estimated 3% of children and their families are affected, compromising adolescent and adult outcomes.2 As detailed in a recent review, the five most well-established BPTs, including the Incredible Years Series, contain common elements (use of didactics; modeling; role playing; and homework practice) and theoretical underpinnings (eg, social learning; attachment).3 Furthermore, they share the common bond of academic mentorship in the 1960s and 1970s. These BPT programs are referred to as "Hanf-Model BPT programs" in recognition of developers' influential faculty teacher, Dr. Constance Hanf, from the University of Oregon, Child Development and Rehabilitation Center.3. [ABSTRACT FROM AUTHOR]

Abstract: Little is known about family initiated self-care interventions in response to symptoms of attention deficit/hyperactivity disorder (ADHD), and how self-care may co-exist with professional treatments. This paper explores parental self-care strategies for children with hyperactivity or attention problems, and examines factors and domains that influence their use from the mixed method perspective. As part of a longitudinal cohort study of ADHD detection and service use, caregivers of a representative US community sample of 266 children at high risk for ADHD completed a questionnaire that assessed five self-care strategies (behavior modification, coping, diet, over-the-counter medication use and religious practices), and made open-ended inquiry about discipline changes in response to behavioral concerns. Questionnaire responses were analyzed using logistic regression approaches. Open-ended answers were open coded; secondary analysis followed Spradley''s model of domain analysis. Quantitative findings showed that behavior modification was the most commonly tried self-care strategy, followed by coping, diet, and religious practices. Over-the-counter trial was least common. The parents of professionally treated children were more likely to have employed behavior modification, coping strategies and over-the-counter medications than the parents of untreated children. Two-thirds of parents had changed their disciplinary action within three domains that were identified through qualitative analysis, including changes related to (a) the prevention of disciplinary problems (e.g., sustain eye contact, activation, consistency, clear instructions), (b) the solution of disciplinary problems (e.g., time-outs; privilege removal), and (c) parental coping associated with disciplinary problems (e.g., control own emotions, become less judgmental and more tolerant, and develop more appropriate expectations). These findings suggest that self-care strategies are commonly employed and appear to co-exist with professional treatment. Therefore, healthcare providers should actively explore parents’ use of such strategies as some of them may interfere with prescribed treatments (e.g., over-the-counter) or absorb parental resources without likely benefit (e.g., diet). [Copyright &y& Elsevier]

Objective: This study explores whether parental support networks vary by sociodemographic factors among children at high risk for attention-deficit/hyperactivity disorder (ADHD) and whether network characteristics influence the receipt of mental health treatment for the child. Method: A school district-wide, two-phase screening study design was used to identify 266 children at high risk for ADHD. Parents completed standardized instruments assessing network structure and function, DSM-IV diagnoses of disruptive disorders, caregiver strain, and treatment receipt, and children self-reported internalizing symptoms. Relationships were examined with analysis of variance and multivariate prediction, adjusting for sociodemographic characteristics, psychopathology, and parental strain. Results: Network characteristics varied by race and socioeconomic status (SES), but not by child gender. African-American and disadvantaged parents reported smaller network sizes, but more frequent contact and higher levels of support than their white and high-SES counterparts. High levels of instrumental support lowered the odds of ADHD treatment during the 12 months before (OR = .7, p < .001) and after (OR = .7, p < .001) the network assessment interview. In contrast, parental strain increased the likelihood of ADHD treatment during both periods. Conclusions: Clinicians should anticipate high levels of caregiver strain and low levels of instrumental support among their patients' parents and address the potential high need for respite care in treatment plans. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between child-reported dimensions of temperament and attention-deficit/ hyperactivity disorder (ADHD), as well as other indicators of child psychopathology, including disruptive disorders, depression, and anxiety. It also examined whether difficult child temperament scores independently predicted caregiver strain. Method: A school-district-wide, two-phase screening design (response rate 70% for phase 2) identified elementary school children at high risk for ADHD. Two hundred high-risk children and their parents completed standardized instruments to assess child temperament, DSM-IV diagnoses of disruptive disorders, children's symptoms of anxiety and depression, and caregiver strain. Relationships were examined using analysis of variance, correlations, and multivariate prediction models, adjusting for child sociodemographic characteristics and psychopathology. All estimates were weighted for sampling design and differential participation. Results: Combined subtype ADHD was associated with lower scores on task orientation and higher scores on general activity level. Depressive symptoms correlated significantly with all but one difficult temperament dimension, in a pattern consistent with clinical symptoms of depression. Child temperament did not vary by ADHD treatment status. Among these high-risk children, maternal caregiver strain experiences were increased by male gender, inattention symptoms, and oppositional defiant disorder, but not by difficult temperament scores. Conclusion: This study provides support for Graham and Stevenson's hypothesis of continuity between specific temperament traits and certain child psychiatric disorders, namely ADHD and depressive disorders. [ABSTRACT FROM AUTHOR]

Presents a study which examined how disorder characteristics and medication treatment affected the self-esteem of children with attention-deficit/hyperactivity disorder. Predictors of low self-esteem; Clinical implications; Limitations of the study.

Objective: To examine variation in patient characteristics (case-mix) and treatment patterns for attention-deficit/hyperactivity disorder (ADHD) by provider type.Method: By means of a two-stage study design, 102 children were identified as receiving treatment for ADHD in the past year, among a school district-wide sample of second-through fourth-grade special education students. Parent and child interviews were conducted using standardized measures of need for treatment, service use, and process of care.Results: Nearly three fourths of the children received treatment for ADHD by a primary care provider, and of these, 68% did not have any contact with a mental health specialist. Children treated only by a primary care provider had fewer comorbid conditions, less impairment, and lower levels of family burden than children treated only by a mental health specialist. Treatment of ADHD solely by primary care providers was characterized by fewer sessions, less time with the patient, and less use of multimodal therapies.Conclusion: Future studies examining clinical outcomes for ADHD treatment should take into account variation in case-mix and treatment patterns by provider type. [ABSTRACT FROM AUTHOR]

Objective: To examine the diagnostic utility of two commonly used attention-deficit hyperactivity disorder (ADHD) screening measures in a population of special education students and address whether screener performance is affected by demographic characteristics.Method: A school district population of special education students was screened for ADHD risk using two parent questionnaires, the 46-item Attention Deficit Disorders Evaluation Scale (ADDES) and the 10-item Conners Abbreviated Symptom Questionnaire (ASQ). All high-risk children and a random sample of low-risk children subsequently underwent DSM-IV-based diagnostic assessment through parental diagnostic interviews (Diagnostic Interview Schedule for Children Version 3.0). Diagnostic utility was summarized by sensitivity, specificity, predictive utilities of positive and negative tests, and efficiency, all of which were estimated using an approach that accounted for the sampling design.Results: Overall efficiency scores ranged between 70% and 74%. Sensitivity estimates were below 70% even at low screener cutoff scores. The ADDES did not perform significantly better than the ASQ. Significant gender and ethnicity effects emerged.Conclusions: Overall, both the ASQ and the ADDES yielded substantial numbers of false positives and false negatives among this population of children, indicating that alternative approaches will be required to accurately and efficiently identify children in need of services for ADHD. Child psychiatrists can play a valuable consulting role as school districts and primary care settings struggle to implement appropriate identification procedures for ADHD. [ABSTRACT FROM AUTHOR]

Examines the relationship between ethnicity and the attention deficit hyperactivity disorder (ADHD), and the amount of knowledge which persons have on ADHD. Reference to some of the measures being implemented to educate persons on the condition; Symptoms of the disorder; Findings of studies conducted.

Participants will learn about parent-child interaction therapy (PCIT), an evidence-based treatment for preschoolers with disruptive disorders and/or ADHD. It reviews the PCIT skills that parents learn and the skills that therapists use to coach the parents to mastery of the interaction skills. Workshop participants gain an understanding of PCIT, an evidence-based treatment shown to produce statistically and clinically significant improvements in the disruptive behaviors and ADHD symptoms of preschoolers. [Extracted from the article]

An abstract on a study that describes the treatment components and evidence-based outcomes through parent and child interaction therapy is presented.

Objective: We describe the trends in antiepileptic drug (AED) use in children and adolescents with epilepsy in the United States.Methods: We undertook a cross-sectional study based on Medicaid Analytic eXtract data set from 26 US states. Children and adolescents aged three to 18 years with at least one year continuous Medicaid fee-for-service coverage after the second outpatient or the first inpatient diagnosis of epilepsy in each calendar year during 1999 to 2009 were included in the study; therefore, 11 cohorts were established. A patient was defined as being exposed to a specific AED if he or she had at least one-day supply of the AED during the 1-year follow-up period. The annual prevalence of AEDs was reported, stratified by gender and age. The trends in AED use were evaluated through linear regression.Results: The sample sizes of the 11 cohorts ranged between 17,304 and 22,672. The annual prevalence of valproic acid use declined from 42.4% in 1999 to 26.5% in 2009, and the prevalence of carbamazepine use declined from 37.1% to 10.2%. Meanwhile, the prevalence of levetiracetam use increased from 5.1% to about 32.0% in 2009, and the prevalence of oxcarbazepine use increased from 1.3% to 19.1%. Since 2008, levetiracetam (29.6%) has replaced valproic acid (27.8%) as the most commonly used AED in children and adolescents with epilepsy. The prevalence of diazepam use increased from 11.6% to 28.1%.Significance: Compared with first- and second-generation antiepileptic drugs, third-generation AEDs have fewer adverse side effects, resulting in increased patient treatment adherence. Equally important is the economic impact of these newer AEDs. This first-of-its-kind study underscores the need for large database studies that objectively assess the cost-effectiveness of third-generation AEDs versus first- and second-generation AEDs in the treatment of childhood epilepsy. [ABSTRACT FROM AUTHOR]

Objective Activation Syndrome (AS) is a side-effect of antidepressants consisting of irritability, mania, self-harm, akathisia, and disinhibition. The current study was conducted to analyze how AS may hinder treatment outcome for multimodal treatment for children and adolescents with Obsessive-Compulsive Disorder. Methods Fifty-six children or adolescents were recruited at two treatment sites in a double-blind randomized-controlled trial where participants received Cognitive-Behavioral Therapy and were randomized to slow titration of sertraline, regular titration of sertraline or placebo. Results Using a recently developed measure of AS, results suggested that higher average levels of irritability, akathisia, and disinhibition significantly interfered with treatment response and explained 18% of the variance in obsessive-compulsive symptoms during treatment. Interestingly, only session-to-session increases in irritability resulted in a session-to-session increase in obsessive-compulsive symptoms. The observed results were unchanged with the addition of SSRI dosage as a covariate. Conclusions Results provide empirical support for the proposed hypothesis that AS may hinder multimodal treatment outcome for pediatric OCD. These findings suggest that dosage changes due to AS do not explain why those with higher AS had worse multimodal outcome. Other possible mechanisms explaining this observed disruption are proposed, including how AS may interfere with Cognitive-Behavioral Therapy. [ABSTRACT FROM AUTHOR]

The goal of this presentation is to assess provider utilization of pharmacogenomic testing (PGX) of genes involved in the metabolism of antidepressants (CYP2D6 and CYP2C19) in a child psychiatry clinic. The providers' response to the testing results and the quickness of utilization of the PGX results were examined. [Extracted from the article]