Diagnostic Interview Schedule For Children Research Articles

Mental Health of High-Risk Urban Youth: The Housing Subsidies Paradox.

Housing subsidies, including public housing and Section 8 vouchers, are key components of the social safety net, intended to promote family and child welfare. Studies evaluating the impact of housing subsidies on child and adolescent mental health, however, are generally inconclusive. This may reflect variation in the influence by type of subsidies to income, improved physical environment, increased access to resources, and improved perception of neighborhood safety. Further, most prior research focused on housing subsidies failed to simultaneously formally assess child psychopathology. In the present study, we examine, among adolescents (ages 9-17) from a low-income, urban minority area, the association of housing with psychiatric symptoms and disorders, as well as with their social functioning. The data were obtained from the Stress & Justice Study (S&J) baseline survey, an investigation designed to examine impact of parental criminal justice system involvement (CJSI) on their children's mental health. Housing type during the past year was categorized from parental report as public housing, section 8, both, or neither. Child mental health was assessed with the Diagnostic Interview Schedule for Children (DISC). Additionally, family resources and physical quality of the housing environment by housing type was assessed, and we tested whether these dimensions mediated associations of housing type with the adolescent's current mental health outcomes. We found that while internalizing and externalizing disorders and impairment were attenuated by individual characteristics (e.g., SES, CJSI), internalizing and externalizing symptom counts were significantly more prevalent among children in subsidized housing, compared to those in non-subsidized housing, after controlling for individual characteristics. These findings have the potential to inform whether, and through which mechanisms, housing subsidies are associated with adolescent mental health.

Proximity to traffic and exposure to polycyclic aromatic hydrocarbons in relation to Attention Deficit Hyperactivity Disorder and conduct disorder in U.S. children.

Traffic related air pollution (TRAP) and its component polycyclic aromatic hydrocarbons (PAHs) may be neurotoxic in children. There is limited research on postnatal exposure to TRAP and PAHs and child neurodevelopment. We linked data from the U.S. NHANES 2001-2004 with the National Highway Planning Network 2005 to examine the proximity to major roads (highway or urban/rural principal arterials), urinary PAH metabolites, and diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) based on Diagnostic Interview Schedule for Children (C-DISC) in 1253 children aged 8-15 years. We calculated odds ratios (ORs) and 95% Confidence Intervals (CIs) for ADHD and CD by traffic proximity and PAH exposures using logistic regression adjusted for confounders. Higher ADHD prevalence was observed among children living <500m (9.86%) compared to those ≥500m (3.84%) from a major road. Prevalence of children with CD was comparable (<500m: 2.51% and ≥500m: 2.43%). We found little difference in urinary PAH metabolite levels between children living near major roads and those who did not. Children living <500m from a major road had a non-significant OR of 2.06 (95% CI 0.85-5.03) for ADHD diagnosis. Children living on ≥2 major roads within 500m of a highway had a non-significant OR of 2.27 (95% CI 0.71-7.26) for ADHD diagnosis. There was no association between proximity to major roads and CD diagnosis. We found living close to a major road was not associated with increased PAH levels. We did not find statistically significant relation between proximity to a major road or urinary PAH metabolite levels and ADHD or CD diagnosis in this cross-sectional analysis. Prospective studies are needed for the investigation of postnatal TRAP exposure and ADHD and CD diagnosis.

Can't get you out of my head: Persistence and remission of psychotic experiences in adolescents and its association with self-injury and suicide attempts

BackgroundPersistent psychotic experiences (PEs) may increase risk for mental disorders, non-suicidal self-injury (NSSI), and suicide attempts, relative to PEs that are more transient and remitting in nature. Most investigations of PE persistence have incorporated only two waves of data, and have not investigated the persistence of different PE subtypes and their association with future NSSI and suicide attempts. This study aimed to investigate the association between PE persistence, NSSI, and suicide attempts using three waves of prospective data. A secondary aim was to investigate potential reverse pathways where self-injurious behaviour (and its persistence) instead precedes subsequent PE occurrence. MethodParticipants were 1100 adolescents (12–17 years) from an Australian prospective cohort study; with three time points over two years. The Self-Harm Behaviour Questionnaire was used to assess NSSI and suicide attempts. Four PE subtypes (auditory hallucinatory experiences [HEs], and three delusional experiences) were assessed using the Diagnostic Interview Schedule for Children. Logistic regression analyses were conducted where PEs was grouped into five categories according to their persistence across the three waves of data. Analyses were adjusted for sociodemographics and substance use. ResultsOverall, persistence of PEs (with endorsement of PE across two or three waves) was associated with the highest risk of incident NSSI and suicide attempts at 1- and 2-year follow-up (OR range: 2.57–12.25), whereas remitted PEs (with endorsement of PE at baseline only) were not associated with increased risk of future NSSI or suicide attempts. This pattern of association was evident for auditory HEs but not for most other PE subtypes; although some estimates had wide confidence intervals. There was no support for reverse temporality. ConclusionOur findings support and extend the two-wave cohort literature demonstrating that PEs which persist over time are more robust predictors of future NSSI and suicidal behaviour. Auditory HEs that are persisting in nature are an important but under-recognised risk factor for NSSI and suicide attempts during adolescence, and current findings should inform clinical guidelines into the predictors of self-harm and suicide risk at this life stage.

Attachment, mentalizing, and eating disorder symptoms in adolescent psychiatric inpatients and healthy controls: a test of a mediational model.

Research has supported a link between insecure attachment and eating disorders (EDs) in adolescents; however, mechanisms accounting for this association remain unclear. Growing evidence suggests impaired mentalizing as a potential mechanism. Yet, little is known about the relationship between mentalizing and ED symptoms or how it relates to the link between attachment and EDs in adolescents. This study examined mentalizing deficits in adolescents with ED symptoms relative to psychiatric and healthy controls and tested a mediational model, wherein mentalizing capacity mediates the relationship between attachment and ED symptoms. Inpatient adolescents with EDs and other pathology (n = 568) and healthy controls (n = 184) were administered the child attachment interview, the movie for the assessment of social cognition and the diagnostic interview schedule for children to assess attachment, mentalizing and ED symptoms, respectively. Inpatients showed lower attachment security and more hypermentalizing than healthy adolescents. Hypermentalizing explained the association between insecure attachment and ED symptoms. These findings suggest potential utility of targeting mentalizing in prevention and treatment of EDs in adolescents. Level III, case-control analytic study.

Persistence of disruptive mood dysregulation disorder in children with attention-deficit/hyperactivity disorder

Disruptive mood dysregulation disorder (DMDD) is common in children with ADHD yet it is not known how persistent DMDD is in this population. As such we aimed to investigate the persistence of disruptive mood dysregulation disorder (DMDD) in a community sample of children with ADHD. The sample comprised children (n = 136) participating in a cohort study with data available at age 7 and age 10. DMDD status was ascertained using proxy items from the Diagnostic Interview Schedule for Children, Version IV. Of those with DMDD at age 7 (n = 30), eight (21.1%) had DMDD that persisted at age 10. In the first study investigating the longitudinal course of DMDD in ADHD one in five children with ADHD+DMDD at age 7 continued to meet diagnostic criteria for DMDD three years later.

Mediators of the association between psychotic experiences and future non-suicidal self-injury and suicide attempts: results from a three-wave, prospective adolescent cohort study.

Psychotic experiences (PEs) are robustly associated with subsequent non-suicidal self-injury (NSSI) and suicide attempts, but questions remain as to the temporal relation and underlying cause of this association. Most investigations have incorporated only two waves of data, and no study has comprehensively investigated mediating pathways. This study aimed to investigate both the PE-NSSI and PE-suicide attempt association, and their relevant mediators, across three waves of prospective data. Participants were from an Australian prospective longitudinal cohort of 1100 adolescents (12-17years); data were collected at three time points over 2 years. NSSI and suicide attempts were measured using the Self-Harm Behaviour Questionnaire. Items from the Diagnostic Interview Schedule for Children were used to assess four PE subtypes (auditory hallucinatory experiences [HEs] and three delusional experiences). Potential mediators of interest included: psychological distress, self-reported mental disorders, self-esteem, recent traumatic life events (e.g. bullying, sexual assault), emotion regulation, and impulsivity/other personality traits. Analyses were adjusted for sociodemographics and substance use. Auditory HEs were indirectly associated with future NSSI and suicide attempts via recent traumatic life events, high psychological distress, and low self-esteem, across three waves of data. Other PE subtypes were generally not associated with incident NSSI/suicide attempts at 1- and 2-year follow-up, either directly or indirectly. These findings highlight the importance of screening for auditory HEs when assessing a young person's self-harm/suicide risk. Clinical assessment would be further enhanced by a comprehensive review of recent interpersonal traumatic events, as well as levels of self-esteem and distress.

Mental health disorders and adolescent peer relationships.

RationaleMental health disorders often arise during adolescence, with disruptive behavior disorders and anxiety disorders among the most common. Given the salience of peer relationships during adolescence, and research suggesting that mental health disorders negatively impact social functioning, this study uses novel methodology from social network analysis to uncover the social processes linking disruptive behavior disorders and anxiety disorders with adolescent friendships. In particular, the study focuses on peer withdrawal, peer popularity, and peer homophily in relation to both disorders.MethodsData come from 15-year old students in four Scottish secondary schools (N = 602). Diagnoses of disruptive behavior disorders and anxiety disorders were produced using the Diagnostic Interview Schedule for Children, and peer relationship data were obtained through a friendship nomination survey. Exponential random graph models were used to estimate the probability of peer withdrawal, peer popularity, and peer homophily based on each disorder.ResultsResults demonstrated that adolescents with disruptive behavior disorders were more popular than their peers without disruptive behavior disorders (OR: 1.47, CI: 1.20, 1.87). Friendship was also more likely between two adolescents both with or both without disruptive behavior disorders (OR: 1.26, CI: 1.07, 1.47), demonstrating peer homophily. There was no evidence that anxiety disorders were related to adolescent peer relationships.ConclusionsFindings from this study suggest that disruptive behavior disorders may be socially rewarded (e.g., peer popularity) and socially clustered (e.g., homophily), whereas anxiety disorders show no such trends. Thus, intervention efforts must account for the peer social status that may be gained from engaging in disruptive behavior during this developmental period. Further, given that similarity in DBD status is associated with an increased likelihood of friendship, adolescents are likely to be surrounded by peers who reinforce their behaviors.

Investigating the role of hallucinatory experiences in the transition from suicidal thoughts to attempts.

Psychotic experiences, including auditory hallucinatory experiences (HEs), are strongly associated with both suicidal thoughts and behaviour. This study examined their role in the ideation-to-attempt transition in adolescents, including their direct and indirect effect via potential mediators. Participants were from an Australian prospective longitudinal cohort of 1669 adolescents (12-17years); of which a subsample endorsing baseline suicidal ideation (n=216) was the focus of most analyses. Suicidal thoughts and behaviours were measured using the Self-Harm Behaviour Questionnaire. The Diagnostic Interview Schedule for Children was used to assess auditory HEs. Potential mediators of interest were psychological distress and Interpersonal Theory of Suicide (IPTS) constructs. Among adolescents reporting suicidal ideation at baseline (n=216), 6.5% had attempted suicide during follow-up. The size of auditory HEs' univariate effect suggests a possible strong relationship with increased risk of incident suicide attempts (OR=2.40; 95%CI=0.76-7.56); however, there was inadequate statistical power to produce a precise estimate. When HEs were accompanied by distress there was a nine-fold increased risk of acting on suicidal thoughts. Distress was independently associated with risk of attempt transition (OR=4.09), whereas IPTS constructs were poor explanatory variables in most models. Adolescents with psychological distress and auditory HEs are at high risk of incident suicide attempts. Further investigations on the role of negative/distressing content of hallucinations in the ideation-to-attempt transition are warranted.

Severity and Frequency of Antisocial Behaviors: Late Adolescence/Young Adulthood Antisocial Behavior Index.

An Antisocial Behavior index (ASB-I) for children (ages 5 to 15) was previously developed by obtaining clinician ratings of the seriousness or severity of various behaviors with the goal of improving assessment of antisocial behaviors (ASB) longitudinally. We extend the instrument for use in late adolescence/young adulthood, as socially unacceptable conduct manifests differently across developmental stages. As in the original study, this extension (the ASB-I YA) is based on independent ratings of ASB seriousness/severity during late adolescence/young adulthood (16 to 28 years) made by nine experienced clinicians. The items rated were drawn from the Oppositional Defiant Disorder and Conduct Disorder schedules of the NIMH Diagnostic Interview Schedule for Children (DISC-IV) and the Elliott Delinquency scales, plus new or modified items developmentally appropriate for late adolescence/young adulthood. Specific ratings were based on the developmental stage and reported frequency of the behaviors. The study also describes the distribution of ASB-I YA scores in the Boricua Youth Study. Reliability was substantial for the average ratings of each subscale and for the total score [ICC(3,9): .88 to .95]. Certain items were rated as more severe when occurring in late adolescence/young adulthood compared to childhood/early adolescence (e.g., hitting someone on purpose); however, most ratings were similar across developmental periods. Most importantly, raters reliably and consistently rated the items describing ASB in young adulthood, allowing the computation of the ASB-I YA score. Together with the ASB-I, the ASB-I YA can further advance the study of ASB progression from childhood into young adulthood.

2.50 DIAGNOSTIC INTERVIEW SCHEDULE FOR CHILDREN, VERSION 5 (DISC-5): DEVELOPMENT AND VALIDATION OF ADHD AND TIC DISORDER MODULES

The Diagnostic Interview Schedule for Children (DISC) has been used in research and clinical settings to assess DSM-5 criteria of mental disorders in children. DISC-5 was recently developed, and it included updates to both the ADHD and tic disorder modules to reflect changes in DSM-5 criteria. The DISC-5 tic module differed substantially from DISC-IV in response to previous research showing poor agreement between the DISC-IV and expert clinical assessment of tic disorders. This study was conducted to determine sensitivity and specificity of the DISC-5 parent- and youth-report ADHD and tic disorder modules.

Predictive Validity of the CRAFFT for Substance Use Disorder.

The utility of CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) in identifying current and future problematic substance use and substance use disorders (SUDs) in pediatric emergency department (PED) patients is unknown. We conducted a secondary analysis of a study in 16 PEDs to determine the concurrent and predictive validity of CRAFFT with respect to SUD. At baseline, 4753 participants aged 12 to 17 years completed an assessment battery (CRAFFT and other measures of alcohol, drug use, and risk behaviors). A subsample was readministered the battery at 1-, 2-, and 3-year follow-up to investigate future SUDs. Of 2175 participants assigned to follow-up, 1493 (68.6%) completed 1-year, 1451 (66.7%) completed 2-year, and 1265 (58.1%) completed the 3-year follow-up. A baseline CRAFFT value of ≥2 was significantly associated with problematic substance use or mild or moderate to severe SUD diagnosis on the Diagnostic Interview Schedule for Children at baseline (P < .001). The results persisted after 1, 2, and 3 years (P < .001). The best combined sensitivity and specificity was achieved with a baseline CRAFFT value of ≥1 as a cutoff for predicting problematic substance use and a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of mild SUD at 1, 2, and 3 years. The baseline CRAFFT score that best predicted a moderate to severe SUD at 1 year was ≥2; but at 2 and 3 years, the cutoff score was ≥1. CRAFFT has good concurrent validity for problematic substance use and SUD in PED patients and is useful in predicting SUDs at up to 3 years follow-up but with limited sensitivity.

Disruptive Mood Dysregulation Disorder in Juvenile Justice.

Disruptive mood dysregulation disorder (DMDD) is a new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). We compared juvenile justice involved youths with DMDD to those with disruptive behavior disorders (DBDs) and other mood disorders, to clarify the differences and to investigate differential correlates to DMDD relative to DBDs or mood disorders. Diagnostic and demographic data were available for 9,819 youths served by 57 juvenile justice sites. A subsample of 2,498 youths had data relevant to our study. The youths self-assessed mental health status on the Voice Diagnostic Interview Schedule for Children (V-DISC), and we retrofitted the V-DISC data to derive an approximate DMDD diagnosis. The retrofitted criteria for DMDD were met by 3.3 percent of justice-involved youths. Results from multinomial regression showed that, after adjustment for covariates, those with DMDD had fewer differences compared with those with other mood disorders than did those meeting criteria for DBDs. Consistent with the DSM-5 classification of DMDD as a depressive disorder, those with DMDD shared more characteristics with youths with mood disorders than with those reporting DBDs. Externalizing behaviors leading to justice involvement may overshadow internalizing symptoms of DMDD, but mood-related conditions should be identified and treated in this population.

Psychiatric Disorders, Antiretroviral Medication Adherence and Viremia in a Cohort of Perinatally HIV-Infected Adolescents and Young Adults

Perinatally HIV-infected (PHIV+) adolescents and young adults (AYA) are at risk for suboptimal antiretroviral therapy (ART) adherence and mental health and substance use problems that, in HIV-infected adults, predict nonadherence. Studies on the relationship between psychiatric and substance use disorders (SUD) and adherence among PHIV+ AYA are limited, but may be important for informing evidence-based interventions to promote adherence. Data were analyzed from 3 annual follow-up interviews (FU2-FU4, N = 179) in a longitudinal study of PHIV+ AYA. Psychiatric disorders (anxiety, disruptive behavior, mood and SUD) were assessed with the Diagnostic Interview Schedule for Children. Adherence was self-reported missed ART doses within the past week. Viral load (VL) results were abstracted from medical charts. Multiple logistic regression analyzed cross-sectional associations between psychiatric disorders and (1) missed ART dose and (2) VL > 1000 copies/mL. Multiple linear regression assessed associations between psychiatric disorders and proportion of VL values >1000 copies/mL over time. At FU2, 53% of PHIV+ AYA had any psychiatric disorder, 35% missed an ART dose in the past week and 47% had a VL > 1000 copies/mL. At FU2, behavioral disorders were associated with missed dose (P = 0.009) and VL > 1000 (P = 0.019), and mood disorders were associated with missed dose (P = 0.041). At FU4, behavioral disorders were associated with missed dose (P = 0.009). Behavioral disorders (P = 0.041), SUD (P = 0.016) and any disorder (P = 0.008) at FU2 were associated with higher proportion of VLs >1000 across FU2-FU4. Addressing psychiatric disorder and SUD among PHIV+ AYA may improve ART adherence outcomes in this population. Targeted interventions should be developed and tested.

Poverty, Parental Mental Health and Child/Adolescent Mental Disorders: Findings from a National Australian Survey

The purpose of this study is to examine the association between poverty and child mental disorders, and in particular, address an important knowledge gap by examining the influence of primary carer mental health in these relationships. We extend previous research by differentiating by specific child mental disorders, age group (4–11 and 12–17 year-olds) and gender using data from a 2013/14 national survey of 4–17 year-olds in Australia, Young Minds Matter (N = 6310). Mental disorders were assessed using the Diagnostic Interview Schedule for Children – Version IV. Primary carer mental health problems were determined by three self-reported measures. We calculated a poverty line according to OECD standards. The greatest risk of any mental disorders when living in poverty was among 12–17 year-old males (unadjusted OR = 2.77; 95% CIs = 1.91–4.02), a significantly higher risk than for 4–11 year-old males, and particularly strong for Attention-Deficit/Hyperactivity Disorder (ADHD). By disorder type, poverty was most strongly related to Conduct Disorder (CD) and least strongly related to Major Depressive Disorder (unrelated in adolescent females). When adjusting for primary carer mental health problems, the associations between poverty and child mental disorders were not statistically significant, except among 12–17 year-old males, and for CD and ADHD in the whole sample. Further adjustment for family structure and area-level disadvantage accounted for these associations. Our results demonstrated the importance of paying attention to parental and child mental health, and the child’s developmental stage and gender when assessing the welfare, social and health service needs of families and their children living in poverty.

S137. DO HALLUCINATIONS PREDICT THE TRANSITION FROM SUICIDAL THOUGHTS TO ATTEMPTS? RESULTS FROM AN AUSTRALIAN LONGITUDINAL COHORT STUDY

BackgroundAlthough suicidal ideation is a well-documented risk factor for suicidal behaviour, the majority of those with suicidal thoughts do not go on to make an attempt. Therefore, it is important to improve prediction of which individuals are more likely to act on their suicidal thoughts, as highlighted in Klonsky and May’s (2015) ideation-to-action framework. Auditory hallucinations (AH) and psychological distress (PD) are strongly associated with both suicidal thoughts and behaviour, but their role in the ideation-to-attempt transition has not been investigated in a longitudinal dataset.MethodsParticipants were from an Australian longitudinal cohort of 1793 adolescents (12–17 years). Suicidal thoughts and behaviours were measured using the Self-Harm Behaviour Questionnaire. The Diagnostic Interview Schedule for Children was used to assess AH. PD was categorised using the General Health Questionnaire (GHQ) clinical cut-off. Those reporting suicidal ideation were stratified into four groups: (i) Those who did not have PD or AH (reference group), (ii) AH only, (iii) PD only, and (iv) PD and AH. Using logistic regression, we examined associations between baseline suicidal ideation, and incident suicide attempts during the 12-month follow-up, stratified by the four comparison groups. All analyses were adjusted for age and sex.ResultsAH were strongly and independently associated with baseline suicidal ideation (OR=3.84; 95%CI=2.46–6.02) and suicide attempts in the following 12 months (OR=3.21; 95%CI=1.18–8.76). Among adolescents with baseline suicidal ideation (n=235; 13.1%), 14 or 6.0% attempted suicide at follow-up. Those with AH only were not at significantly increased risk of transition from suicidal thoughts to attempts (OR=2.97; 95%CI=0.26–34.59). Similarly, adolescents with PD only did not have a significant increase in transition from ideation to attempts (OR=4.48; 95%CI=0.91–22.14). Adolescents who had both PD and AH had an eight-fold increased risk (OR=8.42; 95%CI=1.46–48.67) of acting on their suicidal thoughts.DiscussionAdolescents with both PD and AH had the greatest likelihood of acting on their suicidal thoughts. AH alone did not significantly predict the transition from suicidal thoughts to attempts despite high odds ratios, possibly due to the low prevalence of suicide attempts among ideators and consequently limited statistical power. Future studies examining for negative and distressing content of hallucinations may assist in explaining their role in the ideation-to-attempt transition. Screening adolescents who are distressed and have hallucinations may assist with predicting those at greatest risk of future suicide attempts.

Effect of Middle School Interventions on Alcohol Misuse and Abuse in Mexican American High School Adolescents

Substance abuse preventive interventions frequently target middle school students and demonstrate efficacy to prevent early onset and use of alcohol and illicit drugs. However, evidence of sustained results to prevent later patterns of alcohol misuse and more serious alcohol abuse disorders has been lacking, particularly for US Latino populations. To test whether a universal middle school prevention program can reduce the frequency of alcohol misuse and rates of alcohol use disorder 5 years after implementation with a Mexican American sample. A previous randomized clinical trial was conducted with 516 Mexican American 7th graders and at least 1 parent who identified as having Mexican origin. Three annual cohorts of families were recruited from rosters of 4 middle schools and randomized to the 9-session Bridges/Puentes family-focused group intervention or a workshop control condition. Recruitment, screening, pretest, and randomization occurred in the same academic year for each cohort: 2003-2004, 2004-2005, and 2005-2006. Data acquisition for the follow-up assessments of late-adolescent alcohol misuse and abuse, which were not included in the initial randomized clinical trial, was conducted from September 2009 to September 2014; analysis was conducted between August 2016 and July 2017. In this assessment, 420 children (81.4%) of the sample were included, when the majority were in their final year of high school. The 9-session Bridges/Puentes intervention integrated youth, parent, and family intervention sessions that were delivered in the spring semester at each school, with separate groups for English-dominant vs Spanish-dominant families. The control workshop was offered during the same semester at each school, also in English and Spanish. Primary outcomes were diagnostic assessment of lifetime alcohol use disorder in the 12th grade, 5 years after the intervention, based on the Diagnostic Interview Schedule for Children and past-year frequency of alcohol use, binge drinking, and drunkenness based on the 2001 Youth Risk Behavior Survey. Of the 420 participants, 215 (51.2%) were girls (mean [SD] age, 17.9 [0.62] years). The intervention reduced the likelihood of having an alcohol use disorder (β = -.93; SE, 0.47; P = .047; odds ratio, 0.39). Intervention associations with past-year alcohol use frequency, binge drinking, and drunkenness were moderated by baseline substance use. The intervention reduced the frequency of alcohol use (β = -.51; SE, 0.24; P = .04; Cohen d = 0.43) and drunkenness (β = -.51; SE, 0.26; P = .049; Cohen d = 0.41) among youth who reported any previous substance use at baseline (T1 initiators) but not among those who had not initiated any substance use (T1 abstainers) at baseline. For past-year binge drinking, the intervention finding did not reach statistical significance among T1 initiators (β = -.40; SE, 0.23; P = .09) or T1 abstainers (β = .23; SE, 0.14; P = .11). Study results support an association between a universal middle school intervention and alcohol misuse and alcohol use disorders among Mexican American high school students and implementation of universal middle school interventions to reach Latino communities.

Association Between Psychiatric Disorders, Substance Use, and Sexual Risk Behaviors in Perinatally HIV-Exposed Youth

As youth with perinatally acquired HIV infection age, there is a need for studies that identify predictors and correlates of sexual risk behaviors. We examined the association between psychiatric disorders and substance use disorders (SUD) with sexual risk behaviors in youth with perinatally acquired HIV infection and perinatally HIV-exposed but uninfected youth. Participants were recruited from four medical centers in New York City. The Diagnostic Interview Schedule for Children and the Adolescent Sexual Behavior Assessment were administered to assess psychiatric disorders and sexual behaviors, respectively. SUD and behavior disorders were correlated with either ever having had penetrative sex or recent condomless sex for participants with perinatally acquired HIV infection only. Results suggest that clinicians should screen and treat patients for SUD and behavioral disorders to reduce sexual risk behaviors in youth with perinatally acquired HIV infection.

Evaluating anxiety and depression symptoms in children and adolescents with prior mild traumatic brain injury: Agreement between methods and respondents

ABSTRACTPsychological functioning can be adversely impacted after a mild traumatic brain injury (mTBI) and may be a potential target for intervention. Despite the use of symptom ratings or structured diagnostic interview to assess long-term anxiety and depression symptoms in children and adolescents post-injury, no known studies have considered the agreement between different assessment methods and between respondents. The objectives of this study were to investigate the agreement between symptom ratings and structured diagnostic interview and between children and parents’ symptom reporting. Participants (N = 33; 9–18 years old) were recruited from the Emergency Department and assessed on average 22.8 months (SD = 5.6) after their mTBI. Anxiety and depression symptoms were evaluated via subscales of a questionnaire (Behavior Assessment System for Children) and parts of a computerized structured diagnostic interview (generalized anxiety disorder and major depressive episode; Diagnostic Interview Schedule for Children – C-DISC-IV) administered individually to children and their parents. Results showed that the inter-method agreement to identify high levels of anxiety and depression was moderate to perfect in children while it was lower in parents. Although a similar percentage of participants with elevated anxiety or depression were identified by both children and parents, the agreement between youth and parents was variable, ranging from poor to good for anxiety and poor to moderate for depression. These results highlight the importance of collecting youth and parents’ reports of anxiety and depression symptoms and considering potential discrepancies between informants’ answers.

Association Between Parenting Style and Social Outcomes in Children with and Without Attention-Deficit/Hyperactivity Disorder: An 18-Month Longitudinal Study.

In a community-based sample of children with attention-deficit/hyperactivity disorder (ADHD) (n = 179) and non-ADHD controls (n = 212), this longitudinal study explored changes in parenting style over time; and whether parenting style prospectively predicts child functional outcomes. Attention-deficit/hyperactivity disorder diagnosis was assessed using the Conners ADHD index and Diagnostic Interview Schedule for Children IV. Children (70.3% boys) were assessed at baseline (mean age: 7.3 yr) and after 18 months (mean age: 8.9 yr) using a range of parent- and teacher-reported measures of child socioemotional and academic functioning. Parenting style was assessed through parent-reported measures of warmth, consistency, and anger. At 18-month follow-up, there was a small significant decline in parenting warmth and parenting anger, and an increase in parenting consistency across groups. In the ADHD group, parenting warmth at baseline was positively related to 18-month prosocial behavior and responsibility by parent report, whereas parenting consistency predicted these child outcomes by teacher report. Parenting anger was positively associated with peer problems and negatively associated with prosocial behavior, self-control, and responsibility by parent report. Associations were similar for non-ADHD controls and all associations held after adjusting for a range of family, child, and parent factors. After additional adjustment of baseline levels of child functioning, parenting warmth and consistency continued to be associated with 18-month child outcomes. Parenting style was unrelated to emotional problems and academic competence over time. Parenting style is independently related to aspects of future social outcomes of children with ADHD. Results hold implications for parenting interventions aimed at managing ADHD-related social impairments over time.

Child maltreatment and age of alcohol and marijuana initiation in high-risk youth

IntroductionYouth with a history of child maltreatment use substances and develop substance use disorders at rates above national averages. Thus far, no research has examined pathways from maltreatment to age of substance use initiation for maltreated youth. We examined the longitudinal impact of maltreatment in early childhood on age of alcohol and marijuana use initiation, and whether internalizing and externalizing behaviors at age 8 mediates the link between maltreatment and age of substance use initiation. Materials and methodsData were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) at ages 4, 8, 12, and 18. Maltreatment was assessed through reviews of administrative records and youth self-reports. Behavior problems were assessed with the Child Behavior Checklist. Age of substance use initiation was assessed with the Young Adult version of the Diagnostic Interview Schedule for Children. ResultsPath analyses indicated mediated effects from a history of maltreatment to age at first alcohol and marijuana use through externalizing behaviors. Considering type of maltreatment, direct effects were found from physical abuse to age of alcohol initiation, and mediated effects were found from sexual abuse and neglect to initial age of alcohol and marijuana use through externalizing behaviors. Direct effects for marijuana use initiation and indirect effects through internalizing behavior problems were not significant for either substance. ConclusionsExternalizing behavior is one pathway from childhood maltreatment to age of substance use initiation. Services for maltreated youth should incorporate substance use prevention, particularly among those with early externalizing problems.