Faculty Bibliography

Objective: Asthma medication adherence is low, particularly among African American adolescents, a high-risk group with respect to asthma prevalence, morbidity, and mortality. This study tested the utility of self-determination theory (SDT), a theory of motivation, to explain adherence to asthma medication regimens in African American adolescents. Method: We used baseline data from 168 urban African American adolescents (Mage = 13.94 years; 61% male) with poorly controlled asthma who were part of a trial testing the efficacy of interventions to improve adherence. Participants and their caregivers were interviewed using the Family Asthma Management System Scale; this study used the Asthma Medication Adherence subscale. Adolescents completed four asthma-specific scales representing the SDT constructs of autonomous motivation (one importance scale), competence (one confidence scale), and relatedness (two scales-family routines and parental support). Using multiple linear regression, we tested the hypothesis that SDT variables would predict adherence. Results: Adherence was significantly correlated with three SDT variables-importance, confidence, and family routines. In multivariate analysis, family routines was the only significant predictor of asthma adherence (p < .001). Asthma management behaviors integrated into and shared among family members was associated with better adherence. Greater confidence was marginally associated with increased adherence (p = .07). Conclusion: Though several variables representing SDT constructs were correlated with adherence, results demonstrate that family routines may be more relevant for African American adolescents' adherence than other SDT constructs. Thus, helping families to share and better integrate asthma care into daily schedules may be an important intervention strategy to improve medication adherence among high-risk African American adolescents. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

BACKGROUND: Support for cannabis ("marijuana") legalization is increasing in the United States (US). Use was recently legalized in two states and in Uruguay, and other states and countries are expected to follow suit. This study examined intentions to use among US high school seniors if cannabis were to become legally available. METHODS: Data from the last five cohorts (2007-2011) of high school seniors in Monitoring the Future, an annual nationally representative survey of students in the US were utilized. Data were analyzed separately for the 6116 seniors who reported no lifetime use of cannabis and the 3829 seniors who reported lifetime use (weighted Ns). We examined whether demographic characteristics, substance use and perceived friend disapproval towards cannabis use were associated with (1) intention to try cannabis among non-lifetime users, and (2) intention to use cannabis as often or more often among lifetime users, if cannabis was legal to use. RESULTS: Ten percent of non-cannabis-using students reported intent to initiate use if legal and this would be consistent with a 5.6% absolute increase in lifetime prevalence of cannabis use in this age group from 45.6% (95% CI=44.6, 46.6) to 51.2% (95% CI=50.2, 52.2). Eighteen percent of lifetime users reported intent to use cannabis more often if it was legal. Odds for intention to use outcomes increased among groups already at high risk for use (e.g., males, whites, cigarette smokers) and odds were reduced when friends disapproved of use. However, large proportions of subgroups of students normally at low risk for use (e.g., non-cigarette-smokers, religious students, those with friends who disapprove of use) reported intention to use if legal. Recent use was also a risk factor for reporting intention to use as often or more often. CONCLUSION: Prevalence of cannabis use is expected to increase if cannabis is legal to use and legally available.

Increasing attention is being paid to the relationship between attention deficit/hyperactivity disorder (ADHD) and obesity. While most available research focused on determining the extent of the association between ADHD and obesity, a few studies have examined the clinical implications of diagnosing/treating ADHD in individuals with obesity. Here, we provide a narrative review of studies addressing the impact of ADHD, or its treatment, in individuals with obesity. Reviewed studies suggest that ADHD impedes the successful treatment of obesity in individuals with comorbid ADHD and obesity. Preliminary evidence also suggests that ADHD treatment might significantly increase the effectiveness of weight management strategies. We discuss the limitations of the reviewed studies and provide suggestions for future research in the field.

Preventing unnecessary out-of-home placement for youth with behavioral and emotional needs is a goal of several public child-serving services, including child welfare, juvenile justice, and child mental health. Although a small number of manualized interventions have been created to promote family driven and community-based services and have empirical support, other less established programs have been initiated by local jurisdictions to prevent out-of-home placement. To synthesize what is known about efforts to prevent placement, this article describes the common program and practice elements of interventions described in 37 studies (published in 51 articles) that measured placement prevention outcomes for youth at risk for out-of-home care because of behavioral or mental health needs. The most common program elements across published interventions were program monitoring, case management, and accessibility promotion. The most common clinical practice elements for working with youth were assessment and individual therapy; for caregivers, problem solving skills were most frequently included; and family therapy was most common for the family unit. Effect size estimates for placement-related outcomes (decreased out-of-home placement, decreased hospitalization, decreased incarceration, and decreased costs) were calculated to estimate the treatment effectiveness of the interventions in which the program components and clinical practices are embedded.

The study of comorbid psychopathology among persons with autism spectrum disorder (ASD) is picking up steam. The purpose of this paper was to review and describe important characteristics of existing studies. Among the current crop of papers, depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) have been frequently evaluated. Groups studied have most frequently been children. Persons with ASD and normal intelligence quotient (IQ) scores have been studied more often than individuals with ASD and intellectual disability. Additional characteristics are discussed, and the implications of these data for future developments in the field are reviewed.

We examined mothers' verbal responses to their crawling or walking infants' object sharing (i.e. bids). Fifty mothers and their 13-month-olds were observed for 1 hour at home. Infants bid from a stationary position or they bid after carrying the object to their mothers. Mothers responded with affirmations (e.g. 'thank you'), descriptions ('red box'), or action directives ('open it'). Infants' locomotor status and the form of their bids predicted how mothers responded. Mothers of walkers responded with action directives more often than mothers of crawlers. Notably, differences in the responses of mothers of walkers versus those of crawlers were explained by differences in bid form between the two groups of infants. Walkers were more likely to engage in moving bids than crawlers, who typically shared objects from stationary positions. When crawlers displayed moving bids, their mothers offered action directives just as often as did mothers of walkers. Findings illustrate developmental cascades, wherein Infants' locomotor status affects how infants share objects with mothers, which in turn shapes mothers' verbal responses.

OBJECTIVE:Changes in autism diagnostic criteria found in DSM-5 may affect autism spectrum disorder (ASD) prevalence, research findings, diagnostic processes, and eligibility for clinical and other services. Using our published, total-population Korean prevalence data, we compute DSM-5 ASD and social communication disorder (SCD) prevalence and compare them with DSM-IV pervasive developmental disorder (PDD) prevalence estimates. We also describe individuals previously diagnosed with DSM-IV PDD when diagnoses change with DSM-5 criteria. METHOD/METHODS:The target population was all children from 7 to 12 years of age in a South Korean community (N = 55,266), those in regular and special education schools, and a disability registry. We used the Autism Spectrum Screening Questionnaire for systematic, multi-informant screening. Parents of screen-positive children were offered comprehensive assessments using standardized diagnostic procedures, including the Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule. Best-estimate clinical diagnoses were made using DSM-IV PDD and DSM-5 ASD and SCD criteria. RESULTS:DSM-5 ASD estimated prevalence was 2.20% (95% confidence interval = 1.77-3.64). Combined DSM-5 ASD and SCD prevalence was virtually the same as DSM-IV PDD prevalence (2.64%). Most children with autistic disorder (99%), Asperger disorder (92%), and PDD-NOS (63%) met DSM-5 ASD criteria, whereas 1%, 8%, and 32%, respectively, met SCD criteria. All remaining children (2%) had other psychopathology, principally attention-deficit/hyperactivity disorder and anxiety disorder. CONCLUSION/CONCLUSIONS:Our findings suggest that most individuals with a prior DSM-IV PDD meet DSM-5 diagnostic criteria for ASD and SCD. PDD, ASD or SCD; extant diagnostic criteria identify a large, clinically meaningful group of individuals and families who require evidence-based services.

OBJECTIVE: This study describes an empirically derived approach to diagnosing adolescent personality pathology that is clinically relevant and empirically grounded. METHOD: A random national sample of psychiatrists and clinical psychologists (N = 950) described a randomly selected adolescent patient (aged 13-18 years, stratified by age and gender) in their care using the Shedler-Westen Assessment Procedure-II-A for Adolescents (SWAP-II-A) and several additional questionnaires. RESULTS: We applied a form of factor analysis to identify naturally occurring personality groupings within the patient sample. The analysis yielded 10 clinically coherent adolescent personality descriptions organized into 3 higher-order clusters (internalizing, externalizing, and borderline-dysregulated). We also obtained a higher-order personality strengths factor. These factors and clusters strongly resembled but were not identical to factors similarly identified in adult patients. In a second, independent sample from an intensive day treatment facility, 2 clinicians (the patients' treating clinician and the medical director) independently completed the SWAP-II-A, the Child Behavior Checklist (CBCL), and a measure of adaptive functioning. Two additional clinicians, blinded to the data from the first 2 clinicians, independently rated patients' ward behavior using a validated measure of interpersonal behavior. Clinicians diagnosed the personality syndromes with high agreement and minimal comorbidity among diagnoses, and SWAP-II-A descriptions strongly correlated in expected ways with the CBCL, adaptive functioning, and ward ratings. CONCLUSION: The results support the importance of personality diagnosis in adolescents and provide an approach to diagnosing adolescent personality that is empirically based and clinically useful.

Objectives: Colonoscopy is the gold standard for colon cancer screening and prevention. Several new technologies have recently emerged in order to better assist gastroenterologists in their evaluation of the colonic mucosa to find and remove polyps during screening and surveillance colonoscopies. The ARC EndoCuff is a disposable plastic device with soft, hair-like projections that is placed at the tip of the colonoscope prior to the procedure (Image 1.). The device helps to stabilize the tip of the colonoscope and assists in flattening the folds of the colonic mucosa in order to better evaluate proximal colonic folds. We performed a retrospective chart review of patients who underwent screening and surveillance colonoscopy with and without EndoCuff. The aim of our study was to assess whether EndoCuff was more effective at detecting polyps and adenomas. Methods: Patients were retrospectively analyzed at a tertiary care medical center, urban and suburban outpatient practices from September 2013 thru November 2013. Only screening and surveillance colonoscopies were included. Based on previous learning curve results, the first 4 EndoCuff procedures for each operator were excluded. A comparison group was matched to Endocuff cases based on indication. Colonoscopy reports were retrospectively reviewed to obtain demographic information, total polyps and adenomas removed. This was used to calculate overall ADR and ADR by colon location (right vs. left). Paired t-tests were performed to assess for significance between EndoCuff and comparison group with respect to total polyps and adenomas removed and ADR. Results: 165 patients received EndoCuff and 153 patients underwent standard colonoscopy. Average polyps detected per patient in the EndoCuff group was 1.31 vs. 0.82 in standard colonoscopy (p=<0.001). Similar results were also observed in average adenoma per patient 0.8 vs 0.38 (p=<0.001). The ADR was highest amongst patients who underwent EndoCuff compared to standard colonoscopy (46.6% vs. 30.0%, p=0.!