Subset Of Youth Research Articles

Effects on alcohol and substance use of a school-based training intervention for adolescents with ADHD

IntroductionAdolescents with attention-deficit/hyperactivity disorder (ADHD) may be at risk for early, escalating patterns of alcohol and substance use via academic, peer, and familial impairment. Existing school-based interventions for youth with ADHD effectively target these risk factors, yet their effects on alcohol and substance use have not been explored. We examined the immediate and long-term alcohol and substance use outcomes of an evidence-based school-based intervention for adolescents with ADHD. MethodA total of 186 (Mage = 15, 79% boys, 78% White, 11% Hispanic) adolescents with ADHD were randomized to either a school-based training intervention targeting academic and social skills or a treatment-as-usual control group. A subset of youth was followed into emerging adulthood (5 year follow-up; n = 73). Participants reported on their alcohol and substance use behaviors and problems at post-treatment, 6-month follow-up, and 5-year follow-up. ResultsTwo-part hurdle models controlling for prior use and demographics indicated treatment was associated with improvements in substance use outcomes among youth using any substances at 6-month follow-up (β = −0.45). However, among youth reporting any alcohol use at the 5-year follow-up, treatment was associated with worse alcohol use problems relative to the control condition (β = 0.27). Approximately 22% of intervention participants met criteria for risky drinking behavior compared to 5% of participants in the control group. ConclusionWe found mixed evidence that a school-based intervention associated with positive outcomes on academic, social, and emotional functioning for adolescents with ADHD also prevented adverse alcohol and substance use outcomes. These unexpected results serve as a call for extended follow-up periods to identify the durability of intervention benefits and potential for downstream iatrogenic effects. Additional research is needed to identify school-based intervention strategies that can effectively deter substance use risk among select populations.

Multicenter Analysis of Cardiometabolic-Related Diagnoses in Youth with Congenital Adrenal Hyperplasia: a PEDSnet study.

Small cohorts of youth with congenital adrenal hyperplasia (CAH) demonstrate increased risk of obesity and poor cardiometabolic health. To determine the odds of cardiometabolic-related diagnoses in youth with CAH compared to matched controls in a cross-sectional analysis in a large, multisite database (PEDSnet). Electronic health record data (2009-2019) were used to determine odds of cardiometabolic-related outcomes based on diagnosis, anthropometric and laboratory data using logistic regression among youth with CAH vs. controls. Six PEDSnet sites. Youth with CAH and >1 outpatient visit in PEDSnet (n=1,647) were propensity-score matched on 8 variables to controls (n=6,588). A subset of youth with classic CAH (n=547, with glucocorticoid and mineralocorticoid prescriptions) were matched to controls (n=2,188). N/A. Odds of having cardiometabolic-related diagnoses among youth over 2 years with CAH compared to matched controls. Outcomes were calculated for all individuals with CAH (median age at last visit 12.9 years [7.3, 17.6]) and a subset with classic CAH (median age at last visit 11.6 years [4.7, 17.5]) compared to their matched controls. All patients with CAH had higher odds of overweight/obesity (odds ratio [95% confidence interval] 3.63 [3.24,4.07]), hypertension (3.07 [2.60,3.64]), dysglycemia (1.95 [1.35,2.82], dyslipidemia (2.28 [1.79,2.91]) and liver dysfunction (2.30 [1.91,2.76]) compared to matched controls. Patients with classic CAH had higher odds of overweight/obesity (3.21 [2.61,3.93]), hypertension (8.22 [6.71,10.08]), and liver dysfunction (2.11 [1.55,2.89]) compared to matched controls. Overall, youth with CAH are at increased risk of diagnoses related to worse cardiometabolic health.

The genetic architecture of youth anxiety: a study protocol

BackgroundAnxiety disorders are the most common psychiatric problems among Canadian youth and typically have an onset in childhood or adolescence. They are characterized by high rates of relapse and chronicity, often resulting in substantial impairment across the lifespan. Genetic factors play an important role in the vulnerability toward anxiety disorders. However, genetic contribution to anxiety in youth is not well understood and can change across developmental stages. Large-scale genetic studies of youth are needed with detailed assessments of symptoms of anxiety disorders and their major comorbidities to inform early intervention or preventative strategies and suggest novel targets for therapeutics and personalization of care.MethodsThe Genetic Architecture of Youth Anxiety (GAYA) study is a Pan-Canadian effort of clinical and genetic experts with specific recruitment sites in Calgary, Halifax, Hamilton, Toronto, and Vancouver. Youth aged 10–19 (n = 13,000) will be recruited from both clinical and community settings and will provide saliva samples, complete online questionnaires on demographics, symptoms of mental health concerns, and behavioural inhibition, and complete neurocognitive tasks. A subset of youth will be offered access to a self-managed Internet-based cognitive behavioral therapy resource. Analyses will focus on the identification of novel genetic risk loci for anxiety disorders in youth and assess how much of the genetic risk for anxiety disorders is unique or shared across the life span.DiscussionResults will substantially inform early intervention or preventative strategies and suggest novel targets for therapeutics and personalization of care. Given that the GAYA study will be the biggest genomic study of anxiety disorders in youth in Canada, this project will further foster collaborations nationally and across the world.

Disparities in Glycemic Outcomes Persist in Youth with Type 1 Diabetes and High-Technology Use

Background. Racial disparities are well described in glycemic outcomes in youth with Type 1 diabetes mellites (T1D). Hemoglobin A1c (HbA1c) has some limitations in comparing glycemia across patient groups as there are individual variations in mean glucose and HbA1c. Objective. This study aimed to compare glycemic metrics obtained from (Dexcom G6) continuous glucose monitor (CGM) device with HbA1c levels controlling for race, age, duration of diabetes, race, insurance status, and insulin pump use with glycemic control. Subjects and Methods. Data analyzed included 188 patients, majority non-Hispanic White (NHW) (n = 147, 78.2%) and majority privately insured (n = 147, 78.2%). Half of the patients were using insulin pumps, (n = 94, 50.0%) and approximately half were female. Median age was 16.6 (interquartile range: 14.2–18.2) years old with a median age of diabetes diagnosis at 9.3-years old. Results. Significant differences were observed between NHW and non-Hispanic Black (NHB) patients in terms of HbA1c, 90-day mean glucose, and 90-day time >250 mg/dL (>13.9 mmol/L) (7.6% vs. 9.2%, 181 mg/dL vs. 220 mg/dL, and 16.3% vs. 34.7%, respectively, p < 0.001 for all comparisons). Multiple linear regression analysis was performed to predict the influence of age, duration of diabetes, race, insurance status, and insulin administration on glycemic outcomes. Regression analysis revealed significant equations for all glycemic outcomes, demonstrating a strong correlation ( p < 0.0001 , p = 0.0001 , and p < 0.0001 , respectively). However, after controlling for these variables, only race and duration of diabetes remained independently associated with glycemic outcomes, suggesting that these factors strongly influence glycemic control independent of age, sex, insurance, and pump use. Conclusion. Even in a subset of youth with T1D using CGM with high rates of insulin pump use, disparities in glycemic outcomes persist. When evaluating glycemic outcomes, race remained a significant cofactor despite controlling for age, duration of diabetes, sex, insurance status, and insulin administration type. These results add to the existing literature, and demonstrate race remains strong predictor of glycemic outcomes.

53-LB: Do the Right Thing—Intensive Intervention and Resulting Costs for Youth with High Social Risk and Type 1 Diabetes (T1D)

Introduction: A subset of youth with T1D experience high social risk that increases likelihood of dangerous complications. Limited behavioral health resources often result in low intensity interventions for these youth, resulting in ineffective care. While sole focus on cost outcomes is not advised, given the reported role of cost as a barrier to more equitable care, examining the economic value of intensive interventions designed for high social risk may better inform stakeholder decisions. Methods: Three healthcare systems provided Direct Cost data for youth with avoidable health concerns (e.g., multiple DKA events) who received an intensive behavioral health intervention (Novel Interventions in Children’s Healthcare: NICH). Youth were included in analyses if they had T1D and at least 1 year of cost data prior to and following NICH enrollment. Outpatient, ED, and inpatient costs were combined, with variability in amount and type of cost data present across sites. Costs following enrollment were standardized to account for duration of available financial data (example: $18k over 1.5 years transformed to $12k per year). Results: Analysis included 53 youth: mean age 14.2±2.4 years; 87% Medicaid; 58% Female, 42% Male; 32% Black, 29% Non-Hispanic White, 28% Hispanic/Latinx, 7% Pacific Islander, 2% Asian, 2% other racial and ethnic groups. Mean yearly direct costs were $58.1k and $21.8k, prior to and following NICH enrollment, respectively, but not significantly different. After removing 3 outliers (> 3 SD from the mean), average yearly costs significantly decreased (p=.015) from $20.4k to $9.5k per youth, largely due to inpatient charges. Discussion: Intensive intervention for youth with T1D and high social risk shows promise in substantially reducing cost of care, suggesting that increased investment in effectively serving youth can improve health equity, as evidenced by fewer inpatient stays, and provide future financial benefits for institutions. Disclosure A. Reed: None. D. V. Wagner: None. J. C. Wong: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. D. Naranjo: None. R. Padmanabhan: None. R. Navarro: None. E. Koblinski: None. K. A. Torres: None. C. Cruz: None. M. A. Harris: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

673-P: Youth with Type 1 Diabetes and Elevated A1C during the Coronavirus Disease-2019 (COVID-19) Pandemic—Examination of Family, Caregiver, and Medical Team Factors

Introduction: A subset of youth with T1D experience avoidable health problems, but it is unclear how specific social factors relate to these problems, particularly during the COVID-19 pandemic. We examined how systemic factors (caregiver, family, medical team) were related to medical outcomes in youth with elevated A1c from five academic medical centers during the pandemic. Methods: Youth 12-17 yrs with 1) T1D for ≥1 yr and 2) A1c≥10% in the past year were enrolled. Caregivers and youth completed measures of family conflict (Diabetes Family Conflict Scale-R); parent practices, stress, and health literacy (Alabama Parenting Questionnaire, Stress Index for Parents of Adolescents, BRIEF Health Literacy Scale); youth strengths and social support (Diabetes Strengths and Resilience, PROMIS); and family-medical team relationship (Quality of Healthcare Relationship) with EHR review including baseline A1c and acute complications (e.g., ED visits). Results: Participants were 157 youth with mean age 14.6 ± 1.6 years and mean A1c 11.0% ± 1.9%. 51% self-identified as Non-Hispanic White. Caregiver, family, and relational factors were significantly (p<.05) related to frequency of complications and A1c, with higher family conflict associated with higher A1c (r=.23) and more ED visits (r=.18). For caregivers, low health literacy (r=.17), inconsistent discipline practices (r=.20), and high parental stress related to low adolescent achievement (r=.26), were significantly (p<.05) associated with acute complications, as was youth report of low social support (r=-.20, p<.01). Positive family-medical team relationship was strongly related to lower A1c (r=-.30, p<.01). Discussion: Given these findings, screening and intervention efforts should emphasize targeting multiple systems and relationships with this population of youth, potentially with increased focus on the family-medical team relationship. Disclosure D.V.Wagner: None. L.Yglecias: None. J.Flores garcia: None. A.Torres sanchez: None. A.Bonilla ospina: None. J.Raymond: None. M.A.Harris: None. M.Perry: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Dexcom, Inc., Abbott Diabetes. J.C.Wong: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. D.Naranjo: None. A.Reed: None. C.Jenisch: None. C.Cruz: None. S.Mitchell: None. Funding JDRF

Characterizing the dimensional structure of early-life adversity in the Adolescent Brain Cognitive Development (ABCD) Study

Early-life adversity has profound consequences for youth neurodevelopment and adjustment; however, experiences of adversity are heterogeneous and interrelated in complex ways that can be difficult to operationalize and organize in developmental research. We sought to characterize the underlying dimensional structure of co-occurring adverse experiences among a subset of youth (ages 9–10) from the Adolescent Brain Cognitive Development (ABCD) Study (N = 7115), a community sample of youth in the United States. We identified 60 environmental and experiential variables that reflect adverse experiences. Exploratory factor analysis identified 10 robust dimensions of early-life adversity co-occurrence, corresponding to conceptual domains such as caregiver substance use and biological caregiver separation, caregiver psychopathology, caregiver lack of support, and socioeconomic disadvantage / neighborhood lack of safety. These dimensions demonstrated distinct associations with internalizing problems, externalizing problems, cognitive flexibility, and inhibitory control. Non-metric multidimensional scaling characterized qualitative similarity among the 10 identified dimensions. Results supported a nonlinear three-dimensional structure representing early-life adversity, including continuous gradients of “perspective”, “environmental uncertainty”, and “acts of omission/commission”. Our findings suggest that there are distinct dimensions of early-life adversity co-occurrence in the ABCD sample at baseline, and the resulting dimensions may have unique implications for neurodevelopment and youth behavior.

Single-Session Telehealth Booster for Youth Experiencing a Return of Anxiety After CBT: A Case Series

There is a subset of youth who, despite responding well to CBT, experience a return of anxiety in the years after treatment ends. Although empirical research and clinical recommendations have described approaches to prevent a return of anxiety following CBT, to our knowledge, no empirical or clinical articles have evaluated approaches to help youth who have experienced such a return. In this article, we take an initial step toward providing clinical guidance on addressing recurrence in youth with anxiety disorders by describing the development of an approach, a booster session delivered remotely using telehealth, and by presenting promising preliminary data in a case series among three youths who experienced a return of anxiety following CBT. Participants were N = 3 youths ages 10 to 15 years (M = 12 years; 33% male, 33% female, 33% nonbinary) who previously completed a full CBT protocol for anxiety disorders as part of outpatient clinical services in an urban area of the southeastern United States. Parent- and youth-report on youth anxiety severity were assessed pretreatment and posttreatment. Clinical response to the booster among these three families was mixed and varied by informant source, with an overall positive response according to parent ratings and a smaller response according to youth ratings. This case series represents an important first step toward addressing the return of anxiety in youth following CBT, and findings provide the impetus for further development and evaluation work of single session boosters. Limitations and implications of the findings are discussed.

Analyzing risky behaviors among different minority and majority race in teenagers in the USA using latent classes.

Objective: This study is to ascertain any inconsistencies in the trend of co-occurrence by sex of teenage health risk behavior patterns such as smoking, behaviors contributing to deliberate and unintentional injuries, risky sexual behavior, and sedentary lifestyle. Methods: The study's purpose was accomplished using Youth Risk Behavior Surveillance System (YRBSS) 2013 data. A Latent Class Analysis (LCA) was conducted for the entire sample of teenagers as well as separately for each sex. Results: In this subset of youths, marijuana use was acknowledged by more than half of them, and smoking cigarettes was far more likely. More than half of the individuals in this subset engaged in risky sexual practices, like not using a condom during their most recent encounter. Males were split into three categories based on their involvement in risky behavior, while females were split into four subgroups. Conclusion: Regardless of gender, various risk behaviors among teenagers are connected. However, gender variations in the higher risk of particular trends, such as mood disorders and depression among females, underline the significance of creating treatments that take adolescent demographics into account.

Acute effects of concussion among adolescents with attention-deficit/hyperactivity disorder

ABSTRACT Adolescents with ADHD have a greater lifetime history of concussion and experience concussion-like symptoms in the absence of a concussion, complicating concussion assessment and management. It is well established that individuals who experience greater acute symptoms following concussion are at risk for slower recovery and persistent symptoms. We examined whether youth with ADHD experience worse acute effects, within the first 72 h following concussion, compared to youth without ADHD. We hypothesized that youth with ADHD would perform worse on neurocognitive testing and endorse more severe symptoms acutely following injury, but the magnitude of change from pre injury to post injury would be similar for both groups, and thus comparable to baseline group differences. The sample included 852 adolescents with pre-injury and post-injury ImPACT results (within 72 h); we also conducted supplementary case-control analyses on a subset of youth with and without ADHD matched on demographics and pre-injury health history. For both samples, there were significant interaction effects for the Verbal Memory and Visual Motor Speed composites (p < 0.01, η 2 =.01–.07, small-medium effect), such that youth with ADHD showed a greater magnitude of diminished cognitive functioning from pre-injury to post-injury testing. There were no significant differences in the magnitudes of changes from pre injury to post injury with regard to overall symptom reporting (i.e., total symptom severity scores, total number of symptoms endorsed); however, there were group differences in endorsement rates for several individual symptoms. Further research is needed to determine whether such differential acute effects are associated with recovery time in youth with ADHD.

631-P: Youth with Type 1 Diabetes (T1D) and High Social Risk: Predictors of Glycemic Control

Objective: A subset of youth with T1D experience ongoing challenges with diabetes self-management, often due to social risk. This 5-site study examined which social factors were associated with hemoglobin A1c (A1c) , specifically in youth with preexisting high A1c. Methods: Youth with T1D for more than 1 year were included if between 12-17 years old and with at least one A1c value ≥10% in the past year. Chart review captured A1c values, and caregivers reported on social risk- with 16 risk variables (e.g., housing security, employment status) in initial analyses. Multivariable linear regression model included A1c from 1 year prior to enrollment as an outcome and backwards stepwise procedure retained covariates with p&amp;lt;0.10. Results: Participants (n=130) had a mean age of 14.4 (±1.6) years and mean A1c of 11.1 (±1.7) ; 49% reported male gender; 51% self-identified as Non-Hispanic White. A1c prior to study enrollment was predicted to be 0.68 lower in individuals whose caregiver had at least a college education and 0.65 higher when caregivers were divorced or separated. Conclusion: Findings suggest that, in youth with preexisting difficulty with glycemic variability, caregiver education level and marital status are associated with A1c - and, while not causal, may reflect unique value when screening for risk. This cohort will be followed to determine which factors predict future health concerns and associated need for intervention. Disclosure D.V.Wagner: None. L.Yglecias: None. J.J.Flores garcia: None. E.Salcedo-rodriguez: None. A.Torres sanchez: None. P.Dasika: None. J.Viana: None. D.D.Williams: None. D.Ferro: None. M.A.Harris: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Abbott Diabetes, Dexcom, Inc. J.Raymond: None. J.C.Wong: Consultant; Provention Bio, Inc., Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. A.Reed: None. D.Naranjo: None. C.Jenisch: None. C.Cruz: None. S.Mitchell: None. Funding JDRF

Symptoms, impairment and treatment needs among youth with orthostatic intolerance in a secondary care setting

ABSTRACT Studies characterizing Orthostatic Intolerance (OI) have primarily focused on a specific subtype (e.g., Postural Orthostatic Tachycardia Syndrome, POTS) treated in tertiary care, yet many with impairing symptoms do not meet subtype criteria. Study 1 used structured coding of electronic medical records to explore symptoms and impairment among 226 youth with OI in a common care setting (outpatient cardiology) over a 1-year period. Impairment was evident for 54.7% of youth. Greater impairment was associated with female gender, higher number and frequency of symptoms, and specific symptoms of headache, weakness, or exercise intolerance. Study 2 examined symptoms, functional disability, and treatment interest in a subset of youth from Study 1 (n = 75); data were collected 1–2 years after initial visit via phone interview. Fifty-six percent of participants remained symptomatic, with mean disability exceeding “substantial impairment” and most (78.6%) expressing desire for treatment. Greater disability was associated with more symptoms and the symptom of weakness. Critically, disability was more than twice as high among racial and ethnic minority youth. Results suggest that OI impairment is common among youth in secondary care, and many experience symptoms warranting treatment 1–2 years later. Future studies should identify sources of health disparities and develop efficacious treatments.

Psychological Functioning Among Latino Victims of Teen Dating Violence: The Role of Relational and Collective Resources.

This study examined whether the relationship between teen dating violence (DV) and psychological functioning (depression, anxiety, and hostility) varied as a function of relational and collective resources (social support, familism, and school connectedness) among Latino teen victims of DV. Data came from a subset of youth who experienced DV (n = 95) from the Dating Violence Among Latinos Adolescents Study, a national survey of Latino teens aged 12-18 years old. Multivariate regression models showed that school connectedness was associated with lower depression and anxiety for DV victims. Additionally, five interactions were significant across depression, anxiety, and hostility: Three following a pattern of protective-enhancing (DV × School connectedness for depression and anxiety; DV × Social support for anxiety) and two following a pattern of vulnerability-reactive (DV × Familism for anxiety and hostility). School connectedness is an important protective factor for Latino teen victims of DV and one that can inform intervention efforts. Latino victims of DV benefit from high levels of school connectedness and social support, especially when DV is high. At high levels of DV familism is associated with a worsening of mental health. It is important to understand the nuances of how these resources work at varying levels of DV for intervention and prevention purposes.

A cross-sectional cohort study of post-concussive symptoms and their relationships with depressive symptoms in youth with and without concussion

ABSTRACT Objectives To evaluate the frequency and severity of post-concussive symptoms in youth with a history of concussion relative to youth without concussion who had another medical diagnosis, as well as compare the correlations between post-concussive and depressive symptoms between groups. We hypothesized comparable symptom reporting and correlations in each group. Methods A total of 564 youth ages 8–18 years were assessed regarding post-concussive symptoms. A subset of youth (n = 360) were compared on correlations between post-concussive and depressive symptoms. Non-parametric statistics were used for most analyses. Results Youth with concussion reported a comparable number of post-concussive and depressive symptoms as youth with another medical condition without concussion. However, those with concussion reported greater post-concussive symptom severity (but small effect sizes). Relationships between post-concussive and depressive symptoms were comparable for both groups, but for those who sustained a concussion, the correlation was significantly stronger for females than males. Conclusions This study further demonstrates that post-concussive symptoms are nonspecific and provide little functional utility. Post-concussive and depressive symptoms are strongly correlated, particularly in females with concussion. Psychiatric comorbidities and other medical diagnoses should be assessed pre-injury because both affect interpretation of post-concussive symptom reports.

Profiles of juveniles with sex offense charges referred for competence evaluations.

Juveniles referred for adjudicative competence evaluations make up a subset of youth involved in the juvenile justice system. Among those referred for adjudicative competence evaluations, a significant number involve youth with current or past charges for sexual offenses. This study examines the profiles of youth with sexual offense charges who have been referred for competence evaluations at a state psychiatric hospital for children and adolescents. Differences between the characteristics of youth with and without sexual offenses were explored, and predictors of competence opinions were examined among the subset of youth with current or prior sexual charges (juveniles with sexual offenses, or JSOs). Findings indicated that youth with sexual offenses have several demographic, cognitive, clinical, and legal differences from youth without sexual offenses. Although youth with sexual offenses were less likely to be opined competent, presence of a sexual offense was not a predictor of competence opinions after controlling for other factors. Predictors of competence among JSOs were found to be similar to those among youth referred for competence evaluations in general. Primary diagnosis of an autism-related disorder was a unique predictor of being opined not competent among the JSO subgroup, but not the overall sample. Implications for practice, policy, and research are discussed.

Attention Problems and Restlessness as Transdiagnostic Markers of Severity and Treatment Response in Youth with Internalizing Problems.

Transdiagnostic models of psychopathology suggest that disorders may share common features that could influence their severity. Attention problems and psychomotor restlessness are included in the diagnostic criteria for several disorders, including disorders on the internalizing spectrum, but their transdiagnostic significance has received little attention. The present study identifies patterns of attention problems and restlessness among youth with internalizing problems, in order to understand their clinical significance in terms of internalizing symptom severity and response to cognitive behavioral therapy (CBT). Participants were 142 adolescents age 11-18 clinically referred for mood and/or anxiety problems. Latent class analysis was used to identify patterns of self-reported attention problems and psychomotor restlessness, and classes were compared on internalizing, depression, and anxiety severity. Differences in treatment response were examined in a subset of youth (n = 82; age 14-18) who participated in group CBT. Youth in the Attention Problems class (42% of sample) and youth in the Restless class (15% of sample) endorsed significantly more internalizing, depression, and anxiety problems than youth with Low Symptoms of attention problems or psychomotor restlessness (43% of sample). Youth in the Restless class responded significantly better to CBT than youth in the Low Symptoms of attention problems or psychomotor restlessness class in terms of decrease in overall internalizing problems. Attention problems and psychomotor restlessness appear to be important transdiagnostic markers of severity across the internalizing spectrum; however, they do not limit the effectiveness of CBT and, in the case of psychomotor restlessness, may forecast a good treatment response.

Dyadic Analysis of a Self-report Physical Activity Measure for Adult-Youth Dyads

Adult physical activity levels influence youth physical activity levels, but the nature of this relationship is still unknown. Most research focusing on this topic has been conducted with accelerometers, which are ideal since self-report physical activity measures can be biased. However, self-report measures for physical activity are useful to include in studies to gather information at low-cost. The purpose of this study was to further develop a self-report adult-youth dyad measure of physical activity. This study was conducted using secondary data analysis of the physical activity measures used in an intervention on behavioral nutrition (iCook 4-H). Participants were a sample of 214 adults (M = 39.0, SD = 8.0years) and youth (M = 9.4, SD = 0.7years) pairs. Accelerometer data was collected for a subset of youth (n = 122). There was dependency between the adult-youth physical activity data, and a dyadic confirmatory factor analysis model showed good fit to the data and achieved metric invariance, a measure to determine if the same construct was being measured in both youth and adults. Invariance was confirmed across matched versus unmatched sex pairs and some evidence of invariance with youth accelerometer data. Based on study findings, when using self-report measures of physical activity, researchers should measure both members of the adult-youth dyad to get more accurate measurements. Further validation of these findings is needed using an objective physical activity measure, like accelerometers, with all participants and more diverse samples.

Potential lethality of suicide attempts in youth.

Rates of suicide in youth have increased over the last 50years, yet our ability to predict suicidal behaviours has not significantly improved during this time. Examining predictors of suicide attempt lethality can enhance our understanding of suicidality in youth, yet research has focused on actual medical lethality (the actual danger to life resulting from a suicide attempt) rather than potential lethality (the potential for death that is associated with a suicide attempt). Thus, the aim of the present study was twofold: first, we quantified the percentage of youth for whom the severity of suicide attempt was misclassified by considering only actual lethality; second, we tested whether key variables that predict the actual lethality of suicide attempts also predict the potential lethality of suicide attempts in youth. We examined these questions in a sample of children and adolescents admitted to a psychiatric inpatient unit following a suicide attempt. Over 70% of youth who made serious suicide attempts would have been misclassified by assessments relying on only actual lethality. Although several variables relevant to the construct of actual lethality significantly predicted potential lethality (e.g., male sex, substance use disorder), others did not. In addition, we found that the subset of youth who would have been misclassified as low risk based on actual lethality had a disproportionately high need for healthcare resources due to future hospital admissions. The present study provides evidence to suggest that considering potential lethality may lead to improved detection and prediction of suicide risk in youth, and in doing so supports recent calls to broaden considerations of the lethality associated with suicide attempts.

747-P: (Social) Profiling Youth with T1D: Examining the Standard Care Nonresponders

Objective: A subset of youth with chronic medical conditions, including T1D, are unresponsive to typical medical and behavioral health interventions, often resulting in avoidable acute health problems such as DKA. This study examines how youth with T1D who are unresponsive to standard care compare to similarly referred youth with other chronic medical conditions. Methods: Participants were referred by medical providers due to lack of response to standard care - as evidenced by avoidable ED visits and/or lab values chronically out of range - including 50 youth with T1D and 54 with other chronic medical conditions, such as cystic fibrosis, end-stage renal disease, and seizure disorder. Retrospective chart reviews collected presence and frequency of social risks. Mean age was 14.5 years; 48% were female; 85% were non-Hispanic White. Results: Social risk prevalence was high across medical conditions (see Figure).Youth with T1D were significantly more likely to have experienced multiple social risks, such as difficulty attending school, DHS involvement, and drug/alcohol abuse by youth and caregivers. Conclusions: When compared to youth struggling with self-management of other chronic conditions, youth with T1D experienced significantly higher prevalence and frequency of social risks. Interventions developed for this vulnerable population should include components that directly target these important social factors. Disclosure D.V. Wagner: None. A. Hartman: None. C. Jenisch: None. I. Guttmann-Bauman: None. H. El-Mansy: None. M.A. Harris: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

748-P: Emergency Department Use and Social Vulnerability in Youth with T1D

Objective: A subset of youth with T1D are at high risk of preventable acute events, such as DKA, and associated emergency department (ED) visits. Although studies have identified social factors associated with acute utilization risk between all youth with T1D, less is known about how to distinguish such risk amongst those already demonstrating poor health outcomes. This study examines the association between social risk and preventable complications in youth already struggling with self-management. Methods: Youth (n=50) identified by medical providers as exhibiting chronic self-management difficulties were included in this study. Retrospective chart reviews of the year prior to medical provider referral included number of ED visits and identified social risk factors. Mean youth age was 14.6 years (SD=2.9); 38% were female; 90% were Caucasian. Results: The relationship between frequency of ED visits and total number of social risks was nonsignificant; however, the presence of specific individual social risks was associated with presence of an ED visit (Table 1). Conclusions: This is one of the first studies that identified the relationship between social risk and ED utilization in a high-risk pediatric population with T1D. While it is widely understood that social risk is associated with increased utilization, this study identifies key variables that may differentiate youth already at-risk for poor health outcomes. Disclosure A. Hartman: None. D.V. Wagner: None. C. Jenisch: None. S.A. Barry-Menkhaus: None. H. Luzod: None. L.E. Vaz: None. H. Gottfried-Lee: None. D. Phan: None. M.A. Harris: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust