Faculty Bibliography

Children and adolescents with autism spectrum disorder and/or an intellectual disability (ASD/ID) are psychiatrically hospitalized at disproportionately higher rates than youth without ASD/ID. Despite this, few studies have compared the clinical courses of youth with and without ASD/ID in inpatient (IP) child and adolescent psychiatry (CAP) settings. This study used a cross-sectional design of all youth (M = 14.0 years, SD = 2.6 years) admitted to an urban IP unit between 2018 and 2021 to examine differences between ASD/ID and non-ASD/ID youth across dimensions of sociodemographic and psychiatric history and clinical course. 1101 Patients were included in the study and 170 (15.4%) had a history of ASD/ID. ASD/ID youth were more likely to be younger, be male, have histories of violence, and on average have more prior hospitalizations and existing psychotropic prescriptions than their non-ASD/ID counterparts. ASD/ID youth were less likely than their non-ASD/ID peers to be admitted for suicidality and more likely to be admitted for aggression; they had longer average lengths of stay, received more IP emergency medications for agitation, and experienced greater polypharmacy at discharge. The IP psychiatric clinical course of ASD/ID youth differs from that of non-ASD/ID youth, suggesting that ASD/ID youth often present to IP settings with externalizing symptoms. Findings highlight the importance of clinical strategies tailored to the unique needs of ASD/ID youth to improve their care in general IP CAP settings.

PURPOSE/OBJECTIVE:Our goals were to: 1) examine the occurrence of behavioral and emotional symptoms in children on the autism spectrum in a large national sample, stratifying by sex, and 2) evaluate whether children with increased autism-related social communication deficits also experience more behavioral and emotional problems. METHODS: Participants (n = 7,998) were from 37 cohorts from the Environmental influences on Child Health Outcomes (ECHO) Program. Cross-sectional information on demographic factors, parent-report of an ASD diagnosis by clinician, Social Responsiveness Scale (SRS) scores, and Child Behavior Checklist (CBCL) scores were obtained for children aged 2.5-18 years by surveys. We examined mean differences in CBCL Total Problems and DSM-oriented subscale scores by autism diagnosis and by child sex. Analyses using logistic regression were conducted to examine whether autism was associated with higher CBCL scores. We further examined if these relationships differed by child age category (< 6 years, 6-11 years, 12 + years). The relationships between SRS score and CBCL total and subscale scores were examined using quantile regression models, with analyses adjusted for child sex and age. RESULTS: In ECHO, 553 youth were reported by a parent to have a clinician diagnosis of autism spectrum disorder (ASD) (432 [78%] boys and 121 [22%] girls). Youth on the spectrum had higher mean CBCL raw scores on Total Problems and all DSM-oriented subscales compared to those not on the spectrum (all p < 0.0001). Analyses adjusted for sex and stratified by age group indicated that higher odds of autism diagnosis were associated with total, depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) scales in the top 30% of the CBCL score distribution. Autistic girls were more likely to have parent-reported depression and anxiety compared to autistic boys. In quantile regression analyses, we observed evidence of stronger associations between SRS and CBCL for those in higher quantiles of CBCL total problems scale score (beta representing 1-unit change in SRS associated with 1-unit increase in CBCL total problems scale score), among children in the 70-90th percentile (β = 1.60, p < 0.01), or top 10th percentile (β = 2.43, p < 0.01) of the CBCL total problems scale score distribution. Similar findings were seen for the DSM-oriented depression, anxiety, and ADHD subscales. CONCLUSION/CONCLUSIONS: Results from this large national sample suggest increased behavioral and emotional problems among autistic children compared to non-autistic children throughout early life. Among children on the spectrum this may warrant increased monitoring for co-occurring behavioral and emotional problems.

OBJECTIVE:Our study examined the association between state-level structural racism and past year rates of suicide ideation (SI) and suicide attempts (SA) among non-Hispanic Black, Hispanic, and non-Hispanic White adolescents. METHOD/METHODS:This secondary analysis used state- and individual-level linked data combining multiple years (ie, 2011-2019) of the Youth Risk Behavior Surveys, the 2019 American Community Survey, and the 2019 state-level Structural Racism Index (SRI), a composite measuring state-level Black-White (B-W) and Hispanic-White (H-W) racial inequities across 5 domains: residential segregation, incarceration rates, educational attainment, economic indicators, and employment status. A series of generalized estimating equations were used to examine the association between structural racism and past-year SI and past-year SA, with race/ethnicity as a moderator, adjusting for state- and individual-level covariates, among US adolescents. RESULTS:Negative associations were observed between B-W SRI with SI (adjusted b [95% CI] = -0.011 [-0.017, -0.003], p =.004), and SA (-0.011 [-0.018, -0.004], p = .002), as well as between H-W SRI with SI (-0.008 [-0.016, -0.0002], p = .044), and SA (-0.011 [-0.018, -0.004], p = .001). These associations were significantly modified by race and ethnicity for both B-W SRI and H-W SRI. Both Black (SI= -0.011 [-0.02, -0.002]; SA= -0.011 [-0.019, -0.004]) and Hispanic (SI = -0.097 [-0.011, -0.004]; SA = -0.011 [-0.018, -0.004]) adolescents living in states with higher structural racism had lower rates of past-year SI and SA relative to White adolescents. Exploratory analyses identified a negative association between the residential segregation index and past-year SI and SA among Black and Hispanic adolescents. Meanwhile, a positive association emerged between B-W incarceration index and past-year SA, but not past-year SI, among Black adolescents. CONCLUSION/CONCLUSIONS:Adolescents in states with higher SRI were at lower risk for past-year SI and SA. Racial inequities across various institutions may differentially influence suicide-related risk among adolescents. Structural racism may play an important role in conferring risk for SI and SA, and its impact may vary across Black, Hispanic, and White adolescents. Attending to institutional level markers of racism may help to improve the cultural responsiveness of youth suicide prevention strategies. STUDY PREREGISTRATION INFORMATION/UNASSIGNED:Study Preregistration: Does State-level Structural Racism Impact Risk for Suicidal Thoughts and Behaviors Among US Adolescents Across Race and Ethnicity? https://www.jaacap.org/article/S0890-8567(23)00124-7/fulltext PLAIN LANGUAGE SUMMARY: This secondary analysis examines the link between structural racism and risk for suicidal ideation and attempts among US adolescents using state- and individual-level linked data from the 2011-2019 Youth Risk Behavior Surveys, the 2019 American Community Survey, and the 2019 state-level Structural Racism Index. Black and Hispanic adolescents living in states with higher structural racism had lower rates of past-year suicidal ideation and suicide attempts relative to White adolescents. Exploratory analyses identified a negative association between the residential segregation and suicidality among Black and Hispanic adolescents, underscoring the need to address specific issues in developing culturally-responsive suicide prevention efforts. DIVERSITY & INCLUSION STATEMENT/UNASSIGNED:We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.

OBJECTIVE/UNASSIGNED:Online racial discrimination (ORD) is a growing problem among Latine youth that may help explain their elevated risk for suicidal thoughts and behaviors. The present study examined the relation between direct and indirect experiences of ORD on suicidal ideation in a nationally representative sample of Latine youth in the United States. METHOD/UNASSIGNED:This cross-sectional study used data collected in 2020 to 2021 from the National Survey on Critical Digital Literacy, a population-based, mixed-methods study on the psychological impact of online racism experiences among US adolescents aged 11 to 19 years. Participants are self-identified Latine adolescents (N = 243; 56.8% male) inclusive of all racial backgrounds. Logistic regression analyses were conducted to test the association between individual (ie, direct) and vicarious (ie, indirect) ORD and suicidal ideation in the past 2 weeks. RESULTS/UNASSIGNED:Adjusting for demographics, hours spent online, and depression symptoms, findings from the logistic regression model showed that adolescents with higher levels of individual ORD had higher odds of endorsing suicidal ideation in the past 2 weeks (adjusted odds ratio = 2.19, 95% CI = 1.02-4.69) compared to those with lower levels. This association was not observed with vicarious ORD (adjusted odds ratio = 0.85, 95% CI = 0.50-1.43). CONCLUSION/UNASSIGNED:Findings suggest that direct, but not indirect, exposures to ORD may confer elevated risk for thinking about suicide among Latine youth, above and beyond the effects of depression symptoms and hours spent online. Addressing direct ORD may help to improve the cultural responsiveness of youth suicide prevention strategies targeting Latine youth. DIVERSITY & INCLUSION STATEMENT/UNASSIGNED:We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Autistic youth often present to the emergency department with psychiatric concerns, including suicidal thoughts and behaviors. While implementation of suicide prevention practices is essential in the emergency department, guidelines specific to the autism population are not available and suicide risk assessment and management for autistic youth may be challenging for providers. This pilot study evaluated pediatric emergency medicine (PEM) physician training, attitudes, and confidence in assessing and managing suicide risk in autistic compared to non-autistic patient populations. We also explored the relationship between prior training and confidence. PEM physicians’ confidence in providing suicide-related care was significantly lower for autistic compared to non-autistic youth. Prior training in autism, but not in youth suicide, predicted confidence. Results suggest improved supports for emergency department providers are needed to promote suicide risk identification and intervention for autistic youth.

BACKGROUND/UNASSIGNED:Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition with a multifactorial etiology, many aspects of which remain unclear. Emerging evidence suggests a potential association between ASD and clinical manifestations resulting from hormonal imbalances, henceforth named "steroidopathies." The present study aims to investigate the association between ASD, steroidopathies and altered steroid hormone levels. METHODS/UNASSIGNED:A cohort of 100 individuals aged 9-18 years was examined, comprising 50 autistic individuals (25 males, 25 females) compared to 50 individuals diagnosed with other neuropsychiatric disorders (20 males, 30 females). Data were collected on steroidopathies (including hirsutism, severe acne, irregular menstrual cycles, polycystic ovary syndrome, endometriosis, pubertal disorders) in participants and their first-degree relatives, as well as on maternal pregnancy and delivery complications. Blood samples were analyzed to assess hormonal profiles, including testosterone, estradiol, and vitamin D levels. A multivariate logistic regression analysis was conducted, with ASD status as the dependent variable and hormone levels, steroidopathies and other pregnancy-related conditions as independent variables. Sex and age were included as covariates. RESULTS/UNASSIGNED: = 0.0057). CONCLUSION/UNASSIGNED:These findings support the hypothesis of an association between steroidopathies and altered steroid hormone levels with ASD, suggesting that steroid hormone profiles could potentially serve as early biomarkers in future research. Furthermore, consideration of maternal endocrine health and prenatal exposures may contribute to a better understanding of ASD risk.

BACKGROUND/UNASSIGNED:Unaccompanied migrant youths are at elevated risk for exposure to trauma and related mental health challenges, but there is minimal evidence guiding best practices. We conducted a systematic review of quantitative studies that examined mental health evaluation and treatment services for unaccompanied migrant youths resettled in the United States (US). METHODS/UNASSIGNED:In accordance with the PRISMA 2020 statement, a literature search was conducted for empirical studies in nine databases and publicly available search engines. Citation tracking also assisted in identifying additional studies, including from the gray literature. The study protocol was pre-registered (PROSPERO ID: CRD42023396805). Inclusion criteria required that studies be published between January 1, 2000 and November 11, 2024 and report quantitative results that evaluate mental health status or mental health treatment outcomes for youths (younger than 18 years) who were unaccompanied when they arrived in the US. Descriptive, narrative synthesis was used for analysis of results. Mixed Method Appraisal Tool was used to appraise study quality. RESULTS/UNASSIGNED: = 1494 children)-six cohort studies (retrospective or prospective), five cross-sectional, one non-controlled trial, and one program evaluation-met inclusion criteria. Ten evaluated mental health using diverse questionnaires and most focused on trauma-related symptoms. Three focused on mental health treatment. Findings demonstrated heterogeneous methods of evaluating mental health symptoms and implementing treatment services for unaccompanied migrant youths, although many indicated high rates of reported traumatic exposure. Most reported higher rates of trauma-related and internalizing symptoms and all treatment studies demonstrated initial promise. Likely due to difficulty in accessing unaccompanied migrant youths, most studies used convenience samples limiting generalizability of findings. CONCLUSIONS/UNASSIGNED:Rigorous studies with comprehensive collection of sociodemographic characteristics are needed to inform the development of evidence-based services that accurately detect and effectively treat mental health challenges among unaccompanied migrant youths.