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The transition to college is associated with significant changes in social support networks and concomitant increases in depressive symptoms. First-year students who are more socially engaged within their new academic settings may experience greater overall wellbeing. Behavioral activation (BA) is an evidence-based intervention which promotes individuals’ engagement with valued activities and has been examined as a possible primary prevention for depressive symptoms among first-year students. Yet, the important role of social adjustment, and its impact on students’ activity level, has not yet been considered. The current study is a secondary data analysis of research evaluating a BA-based intervention embedded into a first-year orientation course. The aim of the project was to evaluate the efficacy of BA on improving social adjustment and the effect of social adjustment on subsequent depressive symptoms. A diverse sample of college students ( n = 71) attending a state university in the mid-Atlantic region reported on their levels of depression, behavioral activation, and social adjustment. Students then received either BA or standard programming. Results suggest that improved engagement in valued activities at mid-intervention was associated with increases in students’ perceptions of their own social adjustment. This, in turn, predicted steeper decreases in rates of depressive symptoms post-intervention. Findings also indicate that greater social adjustment improved the efficacy of a BA-based intervention in reducing depressive symptoms, but had no impact on depressive symptoms for students receiving the standard orientation programming.

Dialectical Behavior Therapy (DBT) is an internationally recognized empirically supported treatment for patients who meet criteria for multiple diagnoses and exhibit unsafe, high-risk behaviors. DB...

The purpose of this article is to describe the development and evaluation of an 11-session patient safety and quality improvement curriculum for first-year child and adolescent psychiatry fellows. The curriculum uses the Learning from Defects tool which teaches fellows how to conduct an analysis of a safety event they have encountered in their clinical work. The Learning from Defects tool provides a structured approach to address adverse clinical events and identify system failures by providing a framework to determine what happened, examine why it happened, implement interventions to reduce the probability that a similar event will recur, and evaluate whether the interventions were effective. Six fellows participated in the curriculum during their protected didactics time. Curriculum evaluation included an assessment of fellows’ knowledge, skills, and attitudes toward patient safety and quality improvement before and immediately after the curriculum, and 6-months later. Immediately upon completion of the curriculum, fellows reported more confidence and comfort with patient safety and quality improvement-related tasks in their clinical practice. Fellows reported a positive perception of the curriculum related to their learning objectives and utility in the future career. At the 6-month follow-up, the majority of fellows continued to work on their Learning from Defects project and endorsed the intention to participate in patient safety and quality improvement work in the future. This study provides preliminary support for implementing this patient safety and quality improvement curriculum utilizing the Learning from Defects tool in child and adolescent psychiatry fellowship programs. The Learning from Defects tool offers a practical way to teach patient safety and quality improvement skills that potentially can be generalized to future clinical work.

AIM Paediatric emergency departments (ED) nationwide experience a shared burden of boarding mental health patients. Whilst boarding, some patients have a change in disposition from hospitalization to discharge home. This phenomenon raises concern because EDs often have scarce resources for mental health patients. We sought to understand which patient and clinical factors are associated with a change in disposition outcome. METHODS A nested age-sex-race frequency-matched case-control study was conducted including paediatric patients who presented to an urban PED for mental healthcare over a 36-month period. Control patients included patients admitted to an inpatient psychiatric facility, whilst case patients were those discharged home. Descriptive statistics and multivariable logistic regression analyses were performed to compare groups. RESULTS Case patients were more likely to receive intramuscular Haloperidol (OR 2.2 [CI 1.1-4.4]) for agitation and a psychiatric consult (OR 2.3 [1.4-3.9]) whilst boarding. Case patients were also more likely to present with behavioural concerns (OR 1.8 [CI 1.1-3.1]) and have additional complexities such as medical comorbidities (OR 1.8 [CI 1.1-2.9]) or suicidal ideation/attempt (OR 2.6 [CI 1.1-6.1]). Amongst the most common themes for disposition change was improved patient status (58.8%). CONCLUSION These findings suggest that boarding mental health patients have different disposition outcomes and thus may benefit from patient-specific treatment interventions. Given that patients' statuses may change during the boarding period prompting discharge to home, more focus should be directed to developing brief evidence-based practises that may be implemented in the ED and effectively bridge the gap to outpatient mental health services.

To understand the risk factors for seclusion in a sample of children and adolescents admitted to an inpatient psychiatry unit looking at demographic, clinical severity, life experience, and diagnostic characteristics.An unmatched case-control retrospective analysis of psychiatric records in a pediatric inpatient unit from December 2011 to December 2015 (N = 1986) RESULTS: Individual characteristics, including demographics, clinical severity, and clinical presentation as per the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) jointly predicted seclusion in adolescents, with younger age, male sex, black race, having a prior admission, and having a disruptive behavior or bipolar and related disorder diagnoses being predictive of seclusion. While demographic and clinical severity factors were predictive of seclusion in multivariate models, clinical diagnoses only added modestly to the variance explained.High-risk demographic and clinical characteristics for seclusion events in children and adolescents can provide valuable information to guide interventions to prevent seclusion events during their hospitalization.

Exposure-based cognitive-behavioral therapy (CBT) is a well-established treatment for anxiety disorders and obsessive-compulsive disorder (OCD) in youth. Although a majority of youth respond to CBT, a substantial portion remain symptomatic and/or experience a return of symptoms after completing a course of treatment. This highlights the need for further improvements to this evidence-based treatment. Given that parent behaviors can negatively influence treatment, addressing parental behaviors in CBT serves as a novel and promising treatment target to improve youth's therapeutic outcomes. The authors review three common parent behaviors that influence anxiety and treatment outcomes: family accommodation, parent anxious behaviors, and management of disruptive behaviors. The authors then discuss each behavior, its effect on anxiety/OCD and treatment, and how to address the behavior within the context of CBT. In doing so, therapeutic learning can be optimized to improve CBT outcomes for youth with anxiety disorders and/or OCD.

Pediatric burn injuries are stressful for parents, yet few burn clinics report screening caregivers. We evaluated psychometric properties of a two-item depression screener administered to parents of children with burns during outpatient clinic visits. We also examined associations between parent depression symptoms and child characteristics. We used a retrospective review of pediatric patients with burn injuries (n = 496, age range: 0–21 years; M = 5.0 years, SD = 4.4 years) from an outpatient specialty burn clinic. Sample was 54.8% male; ethnicity was 42.4% Black/African American and 42.2% White. Most children (94.7%) had a burn TBSA of 10% or less and partial thickness burns (87%). Depression measure was administered at two time points as part of routine care: T1 (n = 496) and T2 (n = 121). Score range was 0 to 8. The means were 1.17 (SD = 1.74) at T1 and 0.81 (SD = 1.40) at T2. The majority scored ≤3 (89.9% caregivers) at T1. The measure demonstrated satisfactory internal consistency at T1 (Cronbach α = .74) and T2 (α = .82). Scores at T1 and T2 for a subsample (n = 121) were related (r = .61, p < .001). Parents of non-White children tended to report higher depression scores at T1. At T2, being female and greater burn degree were associated with higher depression scores. This brief two-item scale used with caregivers of pediatric burn patients is a reasonable method for screening parental depression in this setting. Given the association between parental depression and child characteristics, further studies are needed, including examination of predictive validity of parental depression with pediatric outcomes.

When compared to one another, multiple informants’ reports of adolescent internalizing problems often reveal low convergence. This creates challenges in the delivery of clinical services, particularly for severe outcomes linked to internalizing problems, namely suicidal thoughts and behaviors. Clinicians would benefit from methods that facilitate interpretation of multi-informant reports, particularly in inpatient settings typified by high-cost care and high-stakes decision-making. 765 adolescent inpatients (70.3% female; Mage = 14.7) and their parents completed measures of adolescent internalizing problems. We obtained baseline clinical and treatment characteristics from electronic medical records. Latent class analysis revealed four reporting patterns: Parent-Adolescent Low (LL; 49.0%), Parent Low-Adolescent High (PL-AH; 11.5%), Parent High-Adolescent Low (PH-AL; 21.8%), Parent-Adolescent High (HH; 17.6%). Relative to the LL class, adolescents in the PH-AL and PL-AH classes were more likely to be admitted with suicidality. In terms of treatment characteristics and relative to the LL class, HH and PH-AL adolescents were more likely to receive standing antipsychotics, PH-AL adolescents were more likely to be in seclusion, and HH adolescents had longer hospital stays. At discharge and relative to the LL class, HH, PH-AL, and PL-AH adolescents were more likely to receive an anxiety disorder diagnosis. Further, HH, PH-AL, and PL-AH adolescents were more likely to receive partial hospitalization or care in another restrictive environment after inpatient treatment, relative to the LL class. This naturalistic study informs clinical decision-making by aiding our understanding of how multi-informant reports facilitate interpretations of adolescents’ clinical presentations as well as predictions about treatment characteristics.

Objective Seclusion and restraint are procedures utilized in youth psychiatric settings. While a number of agencies have called for a reduction and ultimate elimination of the use of these practices, there has been limited research on behavioral programs to reduce seclusion/restraint. This is particularly true for research on behavioral programming in youth psychiatric partial hospital settings. As such, the current study sought to examine the effectiveness of a modified version of Positive Behavioral Interventions and Supports (M-PBIS) implemented on a youth psychiatric partial hospital service to reduce seclusion/restraint. Method This naturalistic, prospective study covered a 26-month period and utilized a pre–post design. M-PBIS features include a defined set of positive behavioral expectations, a system to teach behavioral expectations, reinforcement of appropriate behaviors, data collection/evidence-based decision making, individual support for those not responding to the unit-wide system, active support by all stakeholders (including all staff members agreeing to the program), and positive recognition among staff. Results With a sample of 442 admissions, there were meaningful reductions in the percent of patients who were in seclusion/restraint (from 47.6 to 6.7%) as well as the overall seclusion/restraint rate (from 3.56 ( SD = 1.94) to 0.48 ( SD = 0.64)). Furthermore, there was a significant reduction in the use of Pro Re Nata (PRN) medication for agitation/aggression (percent of patient who received a PRN decreased from 33.3 to 12.9%). Conclusions This naturalistic study suggests that M-PBIS is a promising intervention for use in youth psychiatric partial hospital services to reduce seclusion/restraint and PRN medication for agitation/aggression. Reduction and ultimate elimination of seclusion/restraint is a critical objective in improving the quality and safety of acute mental health services for youth.

Attrition between emergency department discharge and outpatient follow-up is well documented across a variety of pediatric ailments. Given the importance of outpatient medical care and the lack of related research in pediatric burn populations, we examined sociodemographic factors and burn characteristics associated with outpatient follow-up adherence among pediatric burn patients. A retrospective review of medical records was conducted on patient data extracted from a burn registry database at an urban academic children’s hospital over a 2-year period (January 2018–December 2019). All patients were treated in the emergency department and discharged with instructions to follow-up in an outpatient burn clinic within 1 week. A total of 196 patients (Mage = 5.5 years; 54% male) were included in analyses. Average % TBSA was 1.9 (SD = 1.5%). One third of pediatric burn patients (33%) did not attend outpatient follow-up as instructed. Older patients (odds ratio [OR] = 1.00; 95% confidence interval [CI]: [0.99–1.00], P = .045), patients with superficial burns (OR = 9.37; 95% CI: [2.50–35.16], P = .001), patients with smaller % TBSA (OR = 1.37; 95% CI: [1.07–1.76], P = .014), and patients with Medicaid insurance (OR = 0.22; 95% CI: [0.09–0.57], P = .002) or uninsured/unknown insurance (OR = 0.07; 95% CI: [0.02–0.26], P = .000) were less likely to follow up, respectively. Patient gender, race, ethnicity, and distance to clinic were not associated with follow-up. Follow-up attrition in our sample suggests a need for additional research identifying factors associated with adherence to follow-up care. Identifying factors associated with follow-up adherence is an essential step in developing targeted interventions to improve health outcomes in this at-risk population.

This cohort study identifies characteristics of mental health patients boarding for longer than 24 hours in a pediatric emergency department.

Higher level or acute psychiatric care for youth is intended to be active but short-term treatment focussing on crisis stabilisation, assessment, safety monitoring, and longer-term treatment planning. The focus of this article is on describing common challenges and the effort to address these challenges through new approaches to acute psychiatric care for children and adolescents. The review finds that (1) inpatient paediatric psychiatry beds are in high demand and often difficult to access, (2) there are a number of common challenges these units face including managing length of stays, readmissions, and adverse events, and (3) there are encouraging therapeutic approaches adapted for this setting. There is still much work to be done to advance the evidence-base for acute psychiatric care for youth particularly in defining and assessing an effective admission. Paediatric psychiatry patients are a vulnerable population and call for our best tools to be put to use to improve the quality and safety of care.

There is a need for a brief, validated measure of quality of life (QOL) for children to monitor their adjustment to burn injuries. We aimed to apply a Rasch analysis to an existing measure of QOL from the dermatology literature to a clinical sample of pediatric burn patients. The Children’s Dermatology Life Quality Index (CDLQI) was administered to pediatric burn patients (N = 253) during a standard clinic visit. Rasch analysis was used to examine psychometric properties of this measure with a burn sample. The CDLQI showed an adequate fit to the Rasch model. Test difficulty is .61 logits greater than person ability. Results of item reliability and separation analyses were sufficiently strong and indicated a unidimensional latent trait. Person reliability (.74) and separation analyses (1.64) were moderate. Finally, the CDLQI was able to moderately separate the group of respondents into low and high levels of QOL impairments related to burn injuries. The Rasch model demonstrated that the CDLQI is a reliable and valid scale that adequately measures QOL impairments in children following burn injuries.

Pruritus is a common problem following burn injuries; however, the literature to date has focused on adult survivors and/or pediatric survivors of large burns. The current study examines acute postburn pruritus in children under the age of 4 years (N = 256) with smaller burns (mean TBSA = 3.99%), which represents the most common type of patient typically treated in pediatric burn centers. Parents rated their child for pruritus, irritability, and sleep disturbances; additionally, parents completed a self-report of distress. Nearly half (47.3%) were rated by parents as displayed some level of pruritus, with the greatest proportion rated as mild. Regression analysis indicated that child minority status, greater burn TBSA, and more days elapsed since burn predicted higher levels of pruritus. In turn, pruritus was positively correlated with child irritability, delayed sleep onset, sleep disturbance, and parent distress. Thus, our results indicate that parent-rated pruritus in young pediatric burn patients is important to evaluate, as itch is significantly associated with other important clinical outcomes as early as the first month of the burn for pediatric patients and their parents.

Objective: This study examined differences between children with ADHD and comorbid depression ( n = 26), ADHD only ( n = 111), and a community control group ( n = 130) on measures of family and maternal characteristics. Method: The present study utilized a large, community sample. Diagnoses required positive endorsements from multiple sources. ANOVAs and chi-square tests were conducted to determine group differences. Results: Compared with children with ADHD alone and community controls, mothers of depressed ADHD children reported decreased family cohesion, limited participation in social/recreational activities, increased maternal depressive symptoms, difficulty coping with parenting roles, and higher rates of bipolar and anxiety disorders. Mothers of children with ADHD (with or without comorbid depression) reported increased conflict, decreased cohesion, and poor maternal coping compared with community controls. Conclusion: Findings are consistent with prior literature suggesting that families of children with ADHD and depression demonstrate both similar and unique characteristics. Clinical implications are discussed.

Anger regulation among adolescents is important to investigate given theoretical and empirical support for its critical association with peer relationships. This study examined two aspects of anger regulation (i.e., inhibition, dysregulation) using self-report and peer-nominations and their associations with social acceptance among 163 Black and White adolescents ([Formula: see text] = 13.87 years). We explored gender and ethnicity differences in anger regulation predicting peer acceptance. Self-reports and peer-nominations of anger regulation were significantly correlated. Within-gender ethnicity differences in anger regulation were found: White girls reported higher levels of anger inhibition than Black girls, and Black girls reported higher levels of anger dysregulation than White girls. For all adolescents, self-reports and nominations of anger inhibition were associated with higher levels of social acceptance, whereas nominations of anger dysregulation predicted lower social acceptance. The results indicate the importance of considering gender and ethnicity in adolescents’ anger management within peer contexts.

Background Premonitory urges are central to emerging behavioral models of chronic tic disorders (CTD). Urge reduction has been proposed as a behavioral explanation for tic maintenance and exacerbation as well as the efficacy of behavioral treatments. Prior investigations have produced inconsistent findings despite common methodologies. The current study evaluated the possibility that data aggregation obscures distinct and meaningful patterns of change in urge ratings when tics are freely expressed versus suppressed. Method Participants (n = 12) included children with moderate-to-marked tic severity and noticeable premonitory urges. Tic frequencies and urge ratings were obtained at 15 s and 10-s intervals, respectively, across an alternating sequence of 10-min tic freely and 40-min tic suppression conditions. Patterns were established using a two step approach. Results Five distinct patterns of urge rating change emerged, suggesting data aggregation may obscure meaningful patterns in the urge–tic relationship when tics are completed versus suppressed. Limitations Eligibility criteria may have unintentionally excluded younger affected children and included older participants with more severe tic disorders than commonly seen. Additional research with less stringent eligibility criteria and a larger sample size will help validate the results. Conclusions The relationship between urges and tics is much more complex than previously theorized. Investigations that rely on global assessments of urge and tic severity and/or assume uniformity when aggregating participant data may obscure meaningful differences in the urge–tic relationship. Future investigations should examine the possibility that individual differences and/or developmental considerations modulate the functional urge–tic relationship.

Environmental sources of psychosocial support have been found to modulate or protect against the development of psychopathology and risk behavior among adolescents. Capturing sources of environmental support across multiple developmental contexts requires the availability of well-validated, concise assessments-of which there are few in the existing literature. In order to address this need, the current study explored the factor structure, concurrent and convergent validity of the Environmental Supports Scale (ESS; Genetic, Social, and General Psychology Monographs, 117; 395-417, 1991) with a community sample of adolescents. An unconstrained exploratory factor analysis revealed a separate factor for home, school, and neighborhood settings. Internal consistency and test-retest reliability were evaluated for each factor. Concurrent and predictive validity analyses revealed that the ESS was associated in the expected directions across a range of constructs relevant to adolescent development including internalizing symptoms, well-being, external influences, and engagement in risk behavior. Convergent validity for the neighborhood context was established with an assessment of neighborhood environmental adversity. A brief assessment of perceived environmental support across key developmental contexts provides an important tool for research on resilience processes during adolescence and may help illuminate key protective factors and inform intervention and prevention efforts.

The use of seclusion and restraints (SR) in acute hospital settings remains a controversial practice. Despite the focus on SR in the psychiatric services literature, data on SR use in pediatric day hospital settings is lacking. A case-control retrospective analysis for children admitted into a pediatric psychiatry day hospital in a 2-year span examined predictors of SR use. Demographic and clinical descriptors were examined in relation to SR events using univariate and multivariate regression models. Significant univariate risk factors for SR use were psychiatric morbidity, history of physical abuse, post-traumatic stress disorder, having any anxiety disorder, and younger age. Knowledge of risk factors for SR use in pediatric psychiatric day hospitals can avert use of SR and lead to improved safety in a trauma-informed care model.

Parents commonly report elevated distress following a child's burn injury, yet limited research has identified child or injury characteristics that may explain parent distress. The main goal of the current study is to examine prevalence and predictors of parent distress following children's burn injuries by evaluating distress symptoms in a clinic sample of parents whose children present for evaluation and treatment at a regional burn center. Participants included parents of 407 children who experienced a burn injury. Of this sample, follow-up data at a second time point was obtained for 130 children and their caregivers. Parents completed a measure of distress. Clinical and demographic variables were extracted retrospectively from the medical chart. Clinical and at risk levels of distress were reported by nearly 19% of parents at Time 1. Parent distress at Time 1 was associated with child minority race, fewer days since burn injury, and greater burn size. A propensity score was used to account for potential differences between parents with data at Time 1 only versus those with data at Time 2. Parents with Time 2 data tended to have higher levels of distress at Time 1. Of parents with Time 2 data, 17% continued to report elevated distress, and Time 1 distress was the best predictor of later distress. A proportion of parents report elevated distress following their children's burn injuries. Our results suggest that best practices should include routine screening of parent distress following pediatric burn injuries to guide appropriate interventions.

Tic-suppression-based treatments (TSBTs) represent a safe and effective treatment option for Chronic Tic Disorders (CTDs). Prior research has demonstrated that treatment naive youths with CTDs have the capacity to safely and effectively suppress tics for prolonged periods. It remains unclear how tic suppression is achieved. The current study principally examines how effective suppression is achieved and preliminary correlates of the ability to suppress tics. Twelve youths, ages 10 to 17 years, with moderate-to-marked CTDs participated in an alternating sequence of tic freely and reinforced tic suppression conditions during which urge intensity and tic frequency were frequently assessed. Probability of tics occurring was half as likely following high-intensity urges during tic suppression (31%) in contrast to low-intensity urges during tic freely conditions (60%). Age was not associated with ability to suppress. Intelligence indices were associated with or trended toward greater ability to suppress tics. Attention difficulties were not associated with ability to suppress but were associated with tic severity. In contrast to our “selective suppression” hypothesis, we found participants equally capable of suppressing their tics regardless of urge intensity during reinforced tic suppression. Tic suppression was achieved with an “across-the-board” effort to resist urges. Preliminary data suggest that ability to suppress may be associated with general cognitive variables rather than age, tic severity, urge severity, and attention. Treatment naive youths appear to possess a capacity for robust tic suppression. TSBTs may bolster these capacities and/or enable their broader implementation, resulting in symptom improvement.

Children and adolescents seem to suffer from anxiety disorders at rates similar to adults. Interestingly, anxiety symptoms appear to generally decline over time within children as evidenced by lower rates in early and middle adolescence. There is some evidence that there may be heterogeneous subpopulations of adolescent children with different trajectories of anxiety symptoms, including a class of adolescents with elevated levels of anxiety that do not dissipate over time. Anxiety sensitivity has been identified as an important risk factor in the development of anxiety psychopathology. This study prospectively examined the development of anxiety symptoms in a sample of 277 adolescents (M age = 11.52; 44 % female, 56 % male) over a 3 year period including the influence of anxiety sensitivity on this development. Further, this study investigated whether there were distinct classes of adolescents based on their anxiety symptom trajectories and including anxiety sensitivity as a predictor. Consistent with other reports, findings indicated an overall decline in anxiety symptoms over time in the sample. However, three classes of adolescents were found with distinct anxiety symptom trajectories and anxiety sensitivity was an important predictor of class membership. Adolescents with elevated anxiety sensitivity scores were more likely to be classified as having high and increasing anxiety symptoms over time versus having moderate to low and decreasing anxiety symptoms over time. There are important implications for identification of adolescents and children who are at risk for the development of an anxiety disorder.

Adolescent alcohol use is associated with myriad adverse consequences and contributes to the leading causes of mortality among youth. Despite the magnitude of this public health problem, evidenced-based treatment initiatives for alcohol use disorders in youth remain inadequate. Identifying promising pharmacological approaches may improve treatment options. Naltrexone is an opiate receptor antagonist that is efficacious for reducing drinking in adults by attenuating craving and the rewarding effects of alcohol. Implications of these findings for adolescents are unclear; however, given that randomized trials of naltrexone with youth are non-existent. We conducted a randomized, double-blinded, placebo-controlled cross-over study, comparing naltrexone (50 mg/daily) and placebo in 22 adolescent problem drinkers aged 15-19 years (M = 18.36, standard deviation = 0.95; 12 women). The primary outcome measures were alcohol use, subjective responses to alcohol consumption, and alcohol-cue-elicited craving assessed in the natural environment using ecological momentary assessment methods, and craving and physiological reactivity assessed using standard alcohol cue reactivity procedures. Results showed that naltrexone reduced the likelihood of drinking and heavy drinking (P's ≤ 0.03), blunted craving in the laboratory and in the natural environment (P's ≤ 0.04), and altered subjective responses to alcohol consumption (P's ≤ 0.01). Naltrexone was generally well tolerated by participants. This study provides the first experimentally controlled evidence that naltrexone reduces drinking and craving, and alters subjective responses to alcohol in a sample of adolescent problem drinkers, and suggests larger clinical trials with long-term follow-ups are warranted.

Emerging research suggests that genetic influences on adolescent drinking are moderated by environmental factors. The present study builds on molecular-genetic findings by conducting the first analysis of gene-environment interactions in the association between a functional single nucleotide polymorphism (SNP) of the μ-opioid receptor (OPRM1) gene (A118G) and risk of developing an alcohol use disorder (AUD) during adolescence. Specifically, we tested whether variation in parenting practices or affiliation with deviant peers moderated the link between the OPRM1 gene and risk of an AUD.Adolescents reporting European ancestry (N = 104), ages 12 to 19 years (M = 15.60, SD = 1.77), were interviewed to ascertain AUD diagnoses, provided a DNA sample for genetic analyses, and completed measures of parental monitoring and deviant peer affiliation. Logistic regression was used to test the effects of environmental variables and their interactions with OPRM1 genotype as predictors of AUD diagnosis while controlling for age and sex.Case-control comparisons showed that the proportion of youth with an AUD (n = 18) significantly differed by genotype such that 33.3% of G allele carriers met criteria for an AUD compared to 10.8% of youth who were homozygous for the A allele (p = 0.006). The OPRM1 × parental monitoring (odds ratio = 0.16) and OPRM1 × deviant peer affiliation (odds ratio = 7.64) interactions were significant predictors of AUD risk, such that G allele carriers with high levels of deviant peer affiliation or lower levels of parental monitoring had the greatest likelihood of developing an AUD (p-values0.01).This study provides initial evidence that the association between the A118G SNP of the OPRM1 gene and risk of AUDs is moderated by modifiable factors. These results are limited, however, by the small sample size and require replication.

Although adolescents frequently engage in a variety of risky behaviors, much remains unknown about the specific etiologies of such tendencies. Candidate genetic variants, such as the COMT Val 158 Met polymorphism, may be related to risk-taking propensity, particularly as this variant is linked to functional enzymatic differences influencing dopamine function in regions including the prefrontal cortex. The present study aimed to examine the COMT Val 158 Met variant in relation to risk-taking propensity in a community sample of youth. As part of a larger longitudinal study on adolescent risk behaviors, 223 youths (average age 11.3 years) from the metropolitan Washington D.C. area completed a measure of risk-taking propensity, the Balloon Analog Risk Task-Youth Version (BART-Y), and provided saliva samples for DNA extraction and genotyping. Results indicate that females, but not males, who are carriers of the COMT 158 Met allele had higher risk-taking propensity scores on the BART-Y compared to Val homozygotes. Analyses were also conducted in the 111 European American participants, and results were consistent with those of the full sample analyses. This study represents the first investigation of a genetic substrate of risk-taking propensity, measured by a behavioral task, in youth. Results should be taken as quite preliminary, given the small sample. Implications are discussed.

The study examined discrepancies in mother and child reports of parental knowledge (PK) of a child’s whereabouts, activities, and companions, as well as the extent to which discrepancies in reports of PK are related to child risk-taking behavior concurrently and prospectively across two time points. The sample consisted of 219 mother and early adolescent youth (Mn age = 11.0, SD = .8) dyads. Mother and child reports of PK significantly differed and, at both waves, scores on the risk taking composite related negatively to both mother and child reports of PK and positively to the discrepancy between the two reports. A significant interaction between mother and child reports was found at wave 2, such that the relation between child reported PK and risk behavior was stronger when mothers reported high levels of parental knowledge versus low levels of parental knowledge. Prospective analyses indicated a main effect of mother report.

Cocaine use and dependence remains an important public health concern. Thus, the identification of individual difference factors that may maintain cocaine use remains an important goal. The goal of the current study is to test whether the cognitive vulnerability of anxiety sensitivity (AS), an identified risk factor for anxiolytic use and use-related disorders, is related to cocaine dependence diagnosis (n 5 168) among a sample of drug users currently enrolled in residential treatment (N 5 304). Results demonstrated that AS was significantly related to cocaine dependence and remained significant after controlling for sex, age, alcohol dependence, hallucinogen dependence, major depressive disorder, panic disorder, and posttraumatic stress disorder. Taken together, these data suggest that AS may have a specific relation to cocaine dependence, calling into question the notion that AS is positively related only to drugs with anxiolytic properties. Keywords: cocaine; substance dependence; substance use disorders; anxiety sensitivity; anxiety Cocaine use and cocaine use disorders (CUDs) remain a serious public health concern. According to the latest National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration [SAMHSA], 2009b), estimates of current (past-month) cocaine use and CUDs among people aged 12 years and older have remained quite stable over the past 6 years. Further, nearly 75% of current cocaine users met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association [APA], 1994) criteria for a CUD (dependence or abuse), making CUD the third most common illicit substance use disorder (SUD; SAMHSA, 2009b). Cocaine use has also been associated with various negative outcomes including hospitalization, increased vulnerability to other serious medical conditions or infections, and even death (DeBeck et al., 2009; Minkoff et al., 2008; Shannon et al., 2008; SAMHSA, 2008, 2009a). According to two annual reports generated through the Drug Abuse Warning Network (DAWN), cocaine was the most frequently cited illicit substance involved in all hospital emergency department visits, followed by marijuana, heroin, and other stimulants (SAMHSA, 2008). Cocaine appears to be involved in approximately one-third of all emergency department visits for substance misuse, and seven of eight participating states reported increases in percentages of drug-related deaths between 2006 and 2007 (SAMHSA, 2008, 2009a). Approximately 19% of current cocaine users use crack cocaine (SAMHSA, 2009b). Among the many impairments associated with crack cocaine use, repeated crack cocaine use has been identified as a central risk factor for several infectious diseases, including human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), human papillomavirus (HPV) infection, and viral hepatitis C (HCV) infection (DeBeck et al., 2009; Minkoff et al., 2008; Shannon et al., 2008). Several factors can contribute to infectious diseases vulnerability among crack cocaine users. Crack cocaine users may be at an increased vulnerability to contract disease either directly, via the sharing of contaminated needles and drug paraphernalia (e.g., Latkin et al., 2009), or indirectly, through the frequent high-risk sexual behaviors that these individuals tend to engage while intoxicated (e.g., Minkoff et al., 2008). In sum, repeated crack cocaine use may place individuals at risk for substantial adverse health and social consequences associated with use. Given the serious public health issues linked to cocaine use and its disorders, the need to identify individual difference factors that may maintain crack cocaine use remains an important goal. One individual difference that appears relevant to substance use and substance dependence is anxiety sensitivity (AS), or fear of anxiety-related sensations (e.g., increased heart rate, sweating, muscle tension, headaches) caused by the belief that there will be some negative physical, social, or mental outcome as a result of having those symptoms. …

One hundred thirty seven adolescents (M=15.3 yrs, SD=1.0 yr, n=72 girls) were recruited into temperament groups when they were 4 months of age based on reactivity to novel auditory/visual stimuli (Fox, Henderson, Rubin, Calkins,Schmidt, 2001). Behavioral inhibition was observed across infancy (14 and 24 months). Additionally, self-reported substance-related problems and behavioral risk-taking was assessed during adolescence. High behavioral inhibition increased risk for substance-related problems among boys, whereas high behavioral inhibition protected against substance-related problems among girls, B=-1.18, SE=.48, 95% CI=-2.13 to -.24; p.05. Additionally, high behavioral inhibition protected lower risk-taking children from adolescent substance-related problems whereas high behavioral inhibition increased risk for substance-related problems among higher risk-taking children, B=.04, SE=.02, 95% CI=.00 to .08. Findings from this prospective, multi-informant, longitudinal study suggest that risk-taking and gender may interact with temperamental traits to place adolescents at differential risk for substance-related related behavior problems.

Emerging evidence suggests that anxiety sensitivity (AS) predicts subsequent development of anxiety symptoms and panic attacks as well as clinical syndromes in adult samples. The primary aim of the present study was to determine whether AS similarly acts as a vulnerability factor in the pathogenesis of anxiety symptoms among youth in early adolescence (ages 9–13). A large nonclinical community sample of youth (n = 277) was prospectively followed over 1 year. The Childhood Anxiety Sensitivity Index (CASI: Silverman, Fleisig, Rabian, & Peterson, 1991 ) served as the primary predictor. After controlling for baseline anxiety symptoms as well as depression, AS significantly predicted the future development of anxiety symptoms. Consistent with the adult literature and expectancy theory, AS appears to act as a risk factor for anxiety symptoms in youth.

The goal of the current study was to examine the combined influence of positive reinforcement processes using a behavioral task measuring risk taking propensity (RTP) and negative reinforcement processes using a behavioral task measuring deficits in distress tolerance (DT) on a range of risk taking behaviors among early adolescents. Participants included a community sample of 230 early adolescents (aged 9–13) who completed two behavioral tasks assessing reinforcement processes as well as reported on past year risk behavior involvement as assessed by items from the Youth Risk Behavior Surveillance System at a baseline and a 1-year follow-up assessment. Data indicated that at the Wave 2 assessment, RTP was positively related to number of risk-taking behaviors in the past year but only for those with low DT, with this finding persisting after controlling for the significant influence of male gender and higher sensation seeking. Results of the present study highlight the importance of considering both positive and negative reinforcement processes in combination when investigating vulnerability factors for early risk behavior engagement in youth.

Researchers have identified the association between the use of cocaine and sexual behavior as an important risk factor for HIV infection and have attempted to elucidate the nature of this association. Several lines of research have suggested that facilitation of sexual behavior during intoxication with cocaine may be because of the direct pharmacological effects of the drug (e.g., increase in sexual desire), whereas others have pointed to the importance of factors related to the context of drug use (e.g., opportunities for sexual behavior, expectations about the effects of the drug, social norms). The present study explored the perceived effects of cocaine and heroin on sexual behavior, as well as the social context of drug use as a function of drug type (cocaine vs. heroin), among 46 inner-city drug users who reported a history of regular use of both crack cocaine and heroin. Results indicated that compared to heroin, cocaine had deleterious effects on participants' perceived sexual desire and performance. Despite such deleterious effects on sexual behavior, cocaine was more frequently used with an intimate partner than heroin. Furthermore, participants did not differ in the extent to which they used the two drugs in other social contexts (e.g., with friends, family, or neighbors). These preliminary results suggest that the relationship between cocaine and sexual behavior, especially among long-term cocaine users, may be facilitated by opportunities for sex that exist in the context of cocaine use, rather than by the pharmacological effects of the drug.

Female inner-city substance users evidence greater crack/cocaine use and are more likely to be dependent on this drug than on any other drug. Additionally, female inner-city substance users evidence greater crack/cocaine use and are more likely to be dependent on this drug than their male counterparts, despite no consistent difference demonstrated in use and dependence across other drugs. Because no published work has empirically examined the factors underlying this link between females and crack/cocaine, the current study examined the role of theoretically relevant personality and environmental variables. Among 152 (37% female) individuals in a residential substance-use treatment program, females evidenced greater use of crack/cocaine (current and lifetime heaviest) and were significantly more likely to evidence crack/cocaine dependence than their male counterparts. In contrast, no gender differences were found for any other substance across alcohol, cannabis, and hallucinogens (including PCP). Surprisingly, females were more impulsive than their male counterparts, with impulsivity serving as a risk factor in the relationship between gender and crack/cocaine dependence and lifetime heaviest use. Females also evidenced higher levels of negative emotionality and childhood abuse, but neither variable served as a risk factor in the relationship between gender and crack/cocaine dependence or use. Limitations and future directions are discussed, including the need for further exploration of impulsivity across its various dimensions as well as the inclusion of additional variables such as social context variables to account more fully for this complex link between gender and crack/cocaine.

Objective To evaluate the emotional and behavioral functioning of children with bladder exstrophy–epispadias complex (BEEC), taking into account developmental and gender considerations. This study also sought to overcome methodological limitations of previous studies evaluating psychological well-being of children with BEEC. Methods Eighty-six children were consecutively evaluated using the parent report version of the Behavior Assessment System for Children during visits to a multidisciplinary urology clinic. Results Results indicated normative emotional and behavioral functioning across the sample. However, there was a significant effect of age, such that older children consistently had worse internalizing symptoms and adaptive functioning. Males tended to have more externalizing problems as they aged, and also tended to have lower levels of adaptive functioning but this was independent of age. The level of psychological impairment was unrelated to the specific type of BEEC, and was also unrelated to whether or not the patient had undergone continence surgery. Conclusion Children with BEEC have a greater likelihood of experiencing a wide range of emotional and behavioral problems as they reach adolescence. These findings point to the need to prevent potential psychological distress by intervening with these children before they become clinically impaired.

Adolescence is the time between the beginning of sexual maturation and adulthood, typically bounded by the ages of 13 to 19 years. One construct that holds a central place in many theories of development and psychopathology is impulsivity. Impulsivity has been considered to play an important role in normal behavior as well as linked to several problematic behaviors that are present or arise during adolescence. Impulsivity, considered to be a multidimensional construct, has been defined and measured in a variety of ways. This chapter will discuss the definitions of impulsivity, measurement (including self-report and behavioral tasks), developmental course, behaviors and disorders in which it is implicated, and future directions.

Risk-taking behavior involves making choices with uncertain positive or negative outcomes. Evidence suggests that risk-taking behavior is influenced by emotional state. One such emotional experience is social anxiety, which has been related to both risk-avoidant and risk-seeking decision making. The present study examined a community sample of 34 adolescents grouped into low (Low SA Group) and high (High SA Group) social anxiety (SA). Both groups were compared on changes in performance on a risk taking task (Balloon Analogue Risk Task) between a social threat condition (modified Trier Social Stress Test, High Stress) and a control condition (Low Stress). These conditions were administered on different days, and the order was counterbalanced across subjects. A group x condition interaction revealed that the High SA Group showed greater risk-taking behavior when exposed to the High Stress Condition compared to the Low Stress Condition, while the Low SA Group evidenced no difference between the two conditions. Conceivable interpretations for the increased risk behavior under the condition of social stress for those high in social anxiety are discussed as well as implications for understanding the complex relationship between social anxiety and risk behavior.