Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Child and Adolescent Psychiatry
Total Results:
11432
Intranasal Oxytocin in Children and Adolescents with Autism Spectrum Disorder
BACKGROUND:Experimental studies and small clinical trials have suggested that treatment with intranasal oxytocin may reduce social impairment in persons with autism spectrum disorder. Oxytocin has been administered in clinical practice to many children with autism spectrum disorder. METHODS:We conducted a 24-week, placebo-controlled phase 2 trial of intranasal oxytocin therapy in children and adolescents 3 to 17 years of age with autism spectrum disorder. Participants were randomly assigned in a 1:1 ratio, with stratification according to age and verbal fluency, to receive oxytocin or placebo, administered intranasally, with a total target dose of 48 international units daily. The primary outcome was the least-squares mean change from baseline on the Aberrant Behavior Checklist modified Social Withdrawal subscale (ABC-mSW), which includes 13 items (scores range from 0 to 39, with higher scores indicating less social interaction). Secondary outcomes included two additional measures of social function and an abbreviated measure of IQ. RESULTS:Of the 355 children and adolescents who underwent screening, 290 were enrolled. A total of 146 participants were assigned to the oxytocin group and 144 to the placebo group; 139 and 138 participants, respectively, completed both the baseline and at least one postbaseline ABC-mSW assessments and were included in the modified intention-to-treat analyses. The least-squares mean change from baseline in the ABC-mSW score (primary outcome) was -3.7 in the oxytocin group and -3.5 in the placebo group (least-squares mean difference, -0.2; 95% confidence interval, -1.5 to 1.0; P = 0.61). Secondary outcomes generally did not differ between the trial groups. The incidence and severity of adverse events were similar in the two groups. CONCLUSIONS:This placebo-controlled trial of intranasal oxytocin therapy in children and adolescents with autism spectrum disorder showed no significant between-group differences in the least-squares mean change from baseline on measures of social or cognitive functioning over a period of 24 weeks. (Funded by the National Institute of Child Health and Human Development; SOARS-B ClinicalTrials.gov number, NCT01944046.).
PMID: 34644471
ISSN: 1533-4406
CID: 5340542
Headache in ADHD as comorbidity and a side effect of medications: a systematic review and meta-analysis
There is mixed evidence on the association between headache and attention-deficit/hyperactivity disorder (ADHD), as well as headache and ADHD medications. This systematic review and meta-analysis investigated the co-occurrence of headache in children with ADHD, and the effects of ADHD medications on headache. Embase, Medline and PsycInfo were searched for population-based and clinical studies comparing the prevalence of headache in ADHD and controls through January 26, 2021. In addition, we updated the search of a previous systematic review and network meta-analysis of double-blind randomized controlled trials (RCTs) on ADHD medications on June 16, 2020. Trials of amphetamines, atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil with a placebo arm and reporting data on headache as an adverse event, were included. Thirteen epidemiological studies and 58 clinical trials were eligible for inclusion. In epidemiological studies, a significant association between headache and ADHD was found [odds ratio (OR) = 2.01, 95% confidence interval (CI) = 1.63-2.46], which remained significant when limited to studies reporting ORs adjusted for possible confounders. The pooled prevalence of headaches in children with ADHD was 26.6%. In RCTs, three ADHD medications were associated with increased headache during treatment periods, compared to placebo: atomoxetine (OR = 1.29, 95% CI = 1.06-1.56), guanfacine (OR = 1.43, 95% CI = 1.12-1.82), and methylphenidate (OR = 1.33, 95% CI = 1.09-1.63). The summarized evidence suggests that headache is common in children with ADHD, both as part of the clinical presentation as such and as a side effect of some standard medications. Monitoring and clinical management strategies of headache in ADHD, in general, and during pharmacological treatment are recommended.
PMID: 34635194
ISSN: 1469-8978
CID: 5091852
Physical and mental health impact of COVID-19 on children, adolescents, and their families: The Collaborative Outcomes study on Health and Functioning during Infection Times - Children and Adolescents (COH-FIT-C&A)
BACKGROUND:The COVID-19 pandemic has altered daily routines and family functioning, led to closing schools, and dramatically limited social interactions worldwide. Measuring its impact on mental health of vulnerable children and adolescents is crucial. METHODS:The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT - www.coh-fit.com) is an on-line anonymous survey, available in 30 languages, involving >230 investigators from 49 countries supported by national/international professional associations. COH-FIT has thee waves (until the pandemic is declared over by the WHO, and 6-18 months plus 24-36 months after its end). In addition to adults, COH-FIT also includes adolescents (age 14-17 years), and children (age 6-13 years), recruited via non-probability/snowball and representative sampling and assessed via self-rating and parental rating. Non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to promote health and prevent mental and physical illness in children and adolescents will be generated by COH-FIT. Co-primary outcomes are changes in well-being (WHO-5) and a composite psychopathology P-Score. Multiple behavioral, family, coping strategy and service utilization factors are also assessed, including functioning and quality of life. RESULTS:Up to June 2021, over 13,000 children and adolescents from 59 countries have participated in the COH-FIT project, with representative samples from eleven countries. LIMITATIONS/CONCLUSIONS:Cross-sectional and anonymous design. CONCLUSIONS:Evidence generated by COH-FIT will provide an international estimate of the COVID-19 effect on children's, adolescents' and families', mental and physical health, well-being, functioning and quality of life, informing the formulation of present and future evidence-based interventions and policies to minimize adverse effects of the present and future pandemics on youth.
PMCID:8486586
PMID: 34606810
ISSN: 1573-2517
CID: 5099492
Cortical and subcortical brain structure in generalized anxiety disorder: findings from 28 research sites in the ENIGMA-Anxiety Working Group
The goal of this study was to compare brain structure between individuals with generalized anxiety disorder (GAD) and healthy controls. Previous studies have generated inconsistent findings, possibly due to small sample sizes, or clinical/analytic heterogeneity. To address these concerns, we combined data from 28 research sites worldwide through the ENIGMA-Anxiety Working Group, using a single, pre-registered mega-analysis. Structural magnetic resonance imaging data from children and adults (5-90 years) were processed using FreeSurfer. The main analysis included the regional and vertex-wise cortical thickness, cortical surface area, and subcortical volume as dependent variables, and GAD, age, age-squared, sex, and their interactions as independent variables. Nuisance variables included IQ, years of education, medication use, comorbidities, and global brain measures. The main analysis (1020 individuals with GAD and 2999 healthy controls) included random slopes per site and random intercepts per scanner. A secondary analysis (1112 individuals with GAD and 3282 healthy controls) included fixed slopes and random intercepts per scanner with the same variables. The main analysis showed no effect of GAD on brain structure, nor interactions involving GAD, age, or sex. The secondary analysis showed increased volume in the right ventral diencephalon in male individuals with GAD compared to male healthy controls, whereas female individuals with GAD did not differ from female healthy controls. This mega-analysis combining worldwide data showed that differences in brain structure related to GAD are small, possibly reflecting heterogeneity or those structural alterations are not a major component of its pathophysiology.
PMCID:8486763
PMID: 34599145
ISSN: 2158-3188
CID: 5039482
Internet use and its impact on internalizing disorder symptoms and sleep in adolescents with an evening circadian preference
STUDY OBJECTIVES:This study sought to examine the relationship between internet use, sleep, and internalizing disorder symptoms in adolescents with an evening circadian preference. METHODS:One hundred seventy-two adolescents aged 10-18 years with an evening circadian preference completed a week of sleep diaries and questionnaires about internet use and internalizing disorder symptoms. RESULTS:Adolescents reported internet use for 3.81 hours on weekdays and 5.44 hours on weekends, with > 90% having access to both a computer with internet and a personal cell phone. A majority of adolescents used the internet from 4-8 pm (71%) and from 9-11 pm (62%). Common online activities included listening to music (77%), watching videos (64%), communicating with others (64%), and doing homework (58%). Late-night internet use (9-11 pm) was associated with more internalizing disorder symptoms. Middle-of-the-night internet use (midnight-5 am) was associated with a later bedtime, shorter total sleep time, and more internalizing disorder symptoms. Adolescents used the internet to fulfill social needs, to avoid or combat boredom, or for maladaptive activities. Using the internet for social interaction or avoidance/boredom was associated with higher internalizing disorder symptoms. Using the internet for maladaptive reasons was associated with more late-night and middle-of-the-night use. CONCLUSIONS:Adolescent internet use late at night and in the middle of the night is common. Internet use may be motivated by desires for social connection, by boredom/avoidance, or for maladaptive behaviors. Because middle-of-the-night internet use was associated with higher internalizing disorder symptoms and worse sleep, it presents as a potential target for intervention. CITATION:2021;17(10):2019-2027.
PMCID:8494100
PMID: 34606439
ISSN: 1550-9397
CID: 5173562
Household Chaos and Early Childhood Behavior Problems: The Moderating Role of Mother-Child Reciprocity in Lower-Income Families
Objective/UNASSIGNED:The study examined whether mother-child reciprocity across increasingly challenging contexts moderated the association between household chaos and early childhood behavior problems. Background/UNASSIGNED:Living in a chaotic household is associated with behavioral dysregulation in childhood. An important goal in discordant household contexts is to establish positive aspects of relationships that are associated with more favorable developmental outcomes. Method/UNASSIGNED:The study analyzed data from 127 mother-child dyads participating in the 3-year visit in a study of primarily low-income, African American/Black families in urban areas. Dyads were videotaped during three successive, increasingly challenging, interaction tasks. Multiple regression analyses examined household chaos, dyadic reciprocity, and the interplay of those as predictors of behavior problems. Results/UNASSIGNED:Greater household chaos was associated with more internalizing and externalizing behavior problems. Moderation analyses indicated that dyadic reciprocity during two challenging interaction tasks (but not during free play) attenuated the association between household chaos and internalizing problems. Conclusions/UNASSIGNED:Household chaos was not associated with internalizing problems among dyads who had a connected, supportive relationship in more challenging interactive contexts. Implications/UNASSIGNED:Improving shared positive affect and dyadic harmony in the parent-child relationship may help protect young children against the negative influence of chaotic contexts.
PMCID:8680262
PMID: 34924663
ISSN: 0197-6664
CID: 5095132
Journal of the American Academy of Child and Adolescent Psychiatry. 2021:Conference:(68th).DOI: 10.1016/j.jaac.2021.07.276
44.1 THE EXPERIENCE OF BLACK YOUTH IN THE UNITED STATES [Meeting Abstract]
Objectives: The history of racial discrimination against African American (AfAm) and Black people in the United States is deeply rooted in the history of this country. This presentation will help participants understand the intersection between racism, structural racism, and subsequent hardships as it relates to the AfAm youth's experience of discrimination. This presentation will also help participants learn practical approaches for exploring issues of discrimination with AfAm patients.
Method(s): The presenter will review the history of racial discrimination toward AfAm groups in the United States and give an overview of common experiences of discrimination for AfAm youth. Additionally, using the models of adolescent development of Erik Erikson, William Cross, James Marcia, and Beverly Tatum, the presenter will describe how racial prejudice impacts adolescent socialization and (racial) identity development, and the risk that this may confer for mental illness. Finally, the presenter will offer clinical pearls for clinicians to explore topics of racial and religious prejudice with AfAm patients.
Result(s): For AfAms, racism, segregation, and the resultant impacts on self-esteem and identity have been a constant reality and threat from the time of slavery through the present day. These brutal institutions, sanctioned and maintained by institutional racism, clearly manifest in all aspects of life for African Americans-segregated and unequal education system and housing, healthcare disparities, mental healthcare disparities, disproportionally elevated incarceration rates, and as painfully highlighted this past year, continued vulnerability to acts of violence at the hands of law enforcement. These disastrous long-term consequences have been documented and are clear. However, the experience of Black youth, introduced to these harsh realities over time, has strong implications during crucial periods of development, including physical, emotional, and identity development.
Conclusion(s): There is benefit for clinicians to incorporate exploration of the impact of racial discrimination, although it is challenging, in the evaluation and treatment of AfAm and Black youth. DEI, DEV, ADOL
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Method(s): The presenter will review the history of racial discrimination toward AfAm groups in the United States and give an overview of common experiences of discrimination for AfAm youth. Additionally, using the models of adolescent development of Erik Erikson, William Cross, James Marcia, and Beverly Tatum, the presenter will describe how racial prejudice impacts adolescent socialization and (racial) identity development, and the risk that this may confer for mental illness. Finally, the presenter will offer clinical pearls for clinicians to explore topics of racial and religious prejudice with AfAm patients.
Result(s): For AfAms, racism, segregation, and the resultant impacts on self-esteem and identity have been a constant reality and threat from the time of slavery through the present day. These brutal institutions, sanctioned and maintained by institutional racism, clearly manifest in all aspects of life for African Americans-segregated and unequal education system and housing, healthcare disparities, mental healthcare disparities, disproportionally elevated incarceration rates, and as painfully highlighted this past year, continued vulnerability to acts of violence at the hands of law enforcement. These disastrous long-term consequences have been documented and are clear. However, the experience of Black youth, introduced to these harsh realities over time, has strong implications during crucial periods of development, including physical, emotional, and identity development.
Conclusion(s): There is benefit for clinicians to incorporate exploration of the impact of racial discrimination, although it is challenging, in the evaluation and treatment of AfAm and Black youth. DEI, DEV, ADOL
Copyright
EMBASE:2014994845
ISSN: 1527-5418
CID: 5024302
Journal of the American Academy of Child and Adolescent Psychiatry. 2021:Conference:(68th):S322-S323.DOI: 10.1016/j.jaac.2021.07.786
CREATING AND IMPLEMENTING FACILITATED DIALOGS ON ANTIRACISM IN PSYCHIATRY, CHILD PSYCHIATRY, AND ACADEMIC MEDICINE [Meeting Abstract]
Objectives: There is a significant and urgent need across psychiatry and other academic medicine departments to design, create, and execute effective dialogues on race, while examining unconscious bias and privilege. The overarching goal of facilitated dialogue is to create a safe space for faculty, staff, and trainees of different racial backgrounds to engage in meaningful dialogue that helps all develop an antiracist approach to their work and lives.
Method(s): Based on the literature and the findings of a departmental needs assessment survey that we designed, we developed clear learning objectives, community norms, an 8-month curriculum, facilitator training and supervision, mixed-race dialogue group composition and logistics, and continuous improvement and comprehensive program evaluation. The curriculum covered topics spanning social identity, power and privilege, bias and discrimination, microaggressions, historical and structural racism, current events, cultural formulation and application to practice, allyship, and antiracism stance and action. Each facilitated dialogue session incorporated antiracist readings, videos, podcasts, immersive activities, and interactive group discussion.
Result(s): A total of 114 department faculty, staff, and trainees completed the antiracism education needs assessment survey. Ten clinical leaders were trained to serve as dialogue facilitators. Ninety-seven faculty, staff, and trainees from diverse sociodemographic backgrounds opted to participate, and 179 learner experience surveys were collected from October 2020 to January 2021. At least 94% of respondents felt engaged, safe in the dialogue environment, learned key antiracism concepts, and learned tools on how to take an antiracist stance in their work and lives.
Conclusion(s): Our curriculum, process, and facilitators have successfully addressed our goals of creating a safe space to discuss experiences with race and racism, staying open to the experiences of others, being open to new ways of viewing race, and furthermore use this new perspective to adopt an antiracist stance in their lives. Our workshop format is designed to help participants understand our process and to think through creating their own dialogues. It involves a mix of instructive and highly interactive activities, performed through breakouts and debriefings. AC, DEI, REST
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Method(s): Based on the literature and the findings of a departmental needs assessment survey that we designed, we developed clear learning objectives, community norms, an 8-month curriculum, facilitator training and supervision, mixed-race dialogue group composition and logistics, and continuous improvement and comprehensive program evaluation. The curriculum covered topics spanning social identity, power and privilege, bias and discrimination, microaggressions, historical and structural racism, current events, cultural formulation and application to practice, allyship, and antiracism stance and action. Each facilitated dialogue session incorporated antiracist readings, videos, podcasts, immersive activities, and interactive group discussion.
Result(s): A total of 114 department faculty, staff, and trainees completed the antiracism education needs assessment survey. Ten clinical leaders were trained to serve as dialogue facilitators. Ninety-seven faculty, staff, and trainees from diverse sociodemographic backgrounds opted to participate, and 179 learner experience surveys were collected from October 2020 to January 2021. At least 94% of respondents felt engaged, safe in the dialogue environment, learned key antiracism concepts, and learned tools on how to take an antiracist stance in their work and lives.
Conclusion(s): Our curriculum, process, and facilitators have successfully addressed our goals of creating a safe space to discuss experiences with race and racism, staying open to the experiences of others, being open to new ways of viewing race, and furthermore use this new perspective to adopt an antiracist stance in their lives. Our workshop format is designed to help participants understand our process and to think through creating their own dialogues. It involves a mix of instructive and highly interactive activities, performed through breakouts and debriefings. AC, DEI, REST
Copyright
EMBASE:2014995114
ISSN: 1527-5418
CID: 5024272
Journal of the American Academy of Child and Adolescent Psychiatry. 2021:Conference:(68th):S327-S328.DOI: 10.1016/j.jaac.2021.07.801
HOW TO GET PUBLISHED: TIPS, STRATEGIES, AND CONSULTATION FROM JAACAP AND JAACAP CONNECT [Meeting Abstract]
Objectives: Participants in this Workshop will learn methods by which to overcome common pitfalls and obstacles to scholarly writing and publication and will establish skills essential to getting papers published. Relatively few students, trainees, and clinicians publish scientific or other educational manuscripts because of limitations of time, experience, and access to mentorship. However, facilitating publishing opportunities for these groups is important because the process of authoring and publishing scientific manuscripts can increase competency in research literacy, engagement in evidence-based practices, and other skills needed to increase mastery in child and adolescent psychiatry.
Method(s): We provide attendees a "backstage pass" experience, combining practical instruction with individualized, hands-on training and consultation to build an early foundation for getting published. Topics covered include how to choose a publishable topic of interest and how to utilize and maintain mentorship relationships. Attendees also will receive personalized consultation and mentorship around their individual goals and their works in progress from peers and our presenters, who have significant and diverse experiences with authorship and publication-particularly with JAACAP and JAACAP Connect.
Result(s): Attendees will learn practical steps toward getting published in scholarly journals and strategies to overcome current limitations and obstacles. Participants also will have the opportunity to get started with mentored authorship and publishing experiences available through JAACAP Connect.
Conclusion(s): This Workshop provides medical students, residents, fellows, early-career psychiatrists, and other clinicians with limited scholarly experience both practical knowledge and foundational skills essential to writing and getting published. AC, ADV, R
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Method(s): We provide attendees a "backstage pass" experience, combining practical instruction with individualized, hands-on training and consultation to build an early foundation for getting published. Topics covered include how to choose a publishable topic of interest and how to utilize and maintain mentorship relationships. Attendees also will receive personalized consultation and mentorship around their individual goals and their works in progress from peers and our presenters, who have significant and diverse experiences with authorship and publication-particularly with JAACAP and JAACAP Connect.
Result(s): Attendees will learn practical steps toward getting published in scholarly journals and strategies to overcome current limitations and obstacles. Participants also will have the opportunity to get started with mentored authorship and publishing experiences available through JAACAP Connect.
Conclusion(s): This Workshop provides medical students, residents, fellows, early-career psychiatrists, and other clinicians with limited scholarly experience both practical knowledge and foundational skills essential to writing and getting published. AC, ADV, R
Copyright
EMBASE:2014993247
ISSN: 1527-5418
CID: 5024342
Journal of the American Academy of Child and Adolescent Psychiatry. 2021:Conference:(68th):S6-S7.DOI: 10.1016/j.jaac.2021.07.041
4.3 PEDIATRIC BEST-PRACTICE CONSENSUS GUIDELINES FOR MANAGEMENT OF AGITATION IN THE EMERGENCY DEPARTMENT [Meeting Abstract]
Objectives: Agitation and aggressive outbursts are common among pediatric patients seeking mental health evaluation in the emergency department (ED). Such actions can increase morbidity among patients, slow down care, and raise the risk of injury among staff. Yet there is little to guide ED clinicians in identifying those at risk for agitation and dysregulation, identifying etiology of agitation, or choosing nonpharmacologic and pharmacologic strategies for prevention and de-escalation of agitation and dysregulation.
Method(s): The 2019 Pediatric BETA (Best Practices in the Evaluation and Treatment of Agitation) guidelines were created utilizing Delphi methodology to obtain a consensus among a national group of emergency child and adolescent psychiatry experts. Ruth Gerson, MD, will review these guidelines as well as subsequent research on the management of agitation in pediatric patients in the ED.
Result(s): Consensus guidelines recommend a multimodal approach to managing agitation with the choice of intervention based on the etiology of agitation.
Conclusion(s): Participants will learn best practices for nonpharmacologic and pharmacologic de-escalation of agitation, as well as strategies for risk identification and prevention. AGG, IMD, PPC
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Method(s): The 2019 Pediatric BETA (Best Practices in the Evaluation and Treatment of Agitation) guidelines were created utilizing Delphi methodology to obtain a consensus among a national group of emergency child and adolescent psychiatry experts. Ruth Gerson, MD, will review these guidelines as well as subsequent research on the management of agitation in pediatric patients in the ED.
Result(s): Consensus guidelines recommend a multimodal approach to managing agitation with the choice of intervention based on the etiology of agitation.
Conclusion(s): Participants will learn best practices for nonpharmacologic and pharmacologic de-escalation of agitation, as well as strategies for risk identification and prevention. AGG, IMD, PPC
Copyright
EMBASE:2014993228
ISSN: 1527-5418
CID: 5024352
