Subset Of Youth Research Articles

Interpretation of vulnerability and cumulative disadvantage among unaccompanied adolescent migrants in Greece: A qualitative study.

In settings of mass displacement, unaccompanied minors (UAMs) are recognized as a vulnerable group and consequently prioritized by relief efforts. This study examines how the interpretation of vulnerability by the national shelter system for male UAMs in Greece shapes their trajectories into adulthood. Between August 2018 and April 2019, key informant interviews were carried out with child protection staff from Greek non-governmental organizations that refer UAMs to specialized children's shelters in Athens to understand how child protection workers interpret vulnerability. In-depth interviews and life history calendars were collected from 44 male migrant youths from Afghanistan, Pakistan, Bangladesh, and Iran who arrived in Greece as UAMs but had since transitioned into adulthood. Analysis of in-depth interviews and life history calendars examined how cumulative disadvantage and engagement with the shelter system altered youths' trajectories into adulthood. Younger adolescents were perceived as more vulnerable and prioritized for shelters over those who were "almost 18" years old. However, a subset of youths who requested shelter at the age of 17 years had experienced prolonged journeys where they spent months or years living on their own in socially isolated environments that excluded them from experiences conducive to adolescent development. The shelter system for UAMs in Greece enabled youths to develop new skills and networks that facilitated integration into society, and transferred them into adult housing when they turned 18 years old so that they could continue developing new skills. Those who were not in shelters by age 18 years could not access adult housing and lost this opportunity. Limitations included possible underrepresentation of homeless youth as well as the inability to capture all nationalities of UAMs in Greece, though the 2 most common nationalities, Afghan and Pakistani, were included. Due to the way vulnerability was interpreted by the shelter system for UAMs, youths who had the greatest need to learn new skills to facilitate their integration often had the least opportunity to do so. To avoid creating long-lasting disparities between UAMs who are placed in shelters and those who are not, pathways should be developed to allow young adult males to enter accommodation facilities and build skills and networks that facilitate integration. Furthermore, cumulative disadvantages should be taken into account while assessing UAMs' vulnerability. Following UAMs' trajectories into early adulthood was critical for capturing this long-term consequence of the shelter system's interpretation of vulnerability.

Validity and Reliability of the Violence Risk Scale-Youth Sexual Offense Version.

The present study examined the validity and reliability of a youth sexual offense risk assessment and treatment planning tool, the Violence Risk Scale-Youth Sexual Offense Version (VRS-YSO), on a sample of 102 court-adjudicated youth referred to assessment and/or treatment outpatient services followed up an average of 11.7 years in the community. VRS-YSO scores demonstrated "good" to "excellent" interrater reliability (intraclass correlation coefficients [ICCs] = .64-.83). Exploratory factor analysis (EFA) of the static and dynamic items identified three latent dimensions consistent with the extant risk literature labeled Sexual Deviance, Antisocial Tendencies, and Family Concerns. VRS-YSO scores showed strong patterns of convergence with scores from the Estimate of Risk for Adolescent Sexual Offense Recidivism (ERASOR), Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II), and the Juvenile Sexual Offense Recidivism Risk Assessment Tool-II (J-SORRAT-II). VRS-YSO scores, in turn, demonstrated moderate to high predictive accuracy for sexual, violent (sexual and nonsexual), and general recidivism (significant areas under curve [AUCs] = .67-.88). Examination of pre-posttreatment change data on the subset of youth who attended treatment services found VRS-YSO change scores to be significantly associated with reductions in general recidivism, but not other recidivism outcomes. Future research and clinical applications of the VRS-YSO in youth sexual offense assessment and treatment planning are discussed.

1347-P: Improvement in Peripheral Insulin Sensitivity (IS) with Metformin (MET) in Adolescents with Type 1 Diabetes (T1D) Is Not Mediated by Muscle Mitochondrial Change

T1D youth are insulin resistant and we recently demonstrated that whole-body IS improved after 3 months of MET therapy. We also found that youth with T1D and type 2 diabetes both have skeletal muscle mitochondrial dysfunction that correlated with IS, but with a unique pattern in T1D. We aimed to determine if improvement in IS in T1D youth following MET was related to improvement in mitochondrial function. Forty-nine youth aged 12-21 years with T1D participated in Effects of MEtformin on CardiovasculaR Function in AdoLescents with T1D (EMERALD), a randomized, double-blind, placebo-controlled study. Youth were randomized to 3 months of MET titrated to 1000mg BID over 4 weeks or placebo (PLA). Assessments prior to and after MET or PLA included a hyperinsulinemic euglycemic clamp (80 mU/m2/minute insulin) to evaluate IS (glucose infusion rate [GIR]) and, in a subset of youth, calf 31Phosphorus magnetic resonance spectroscopy (MRS) before, during, and after 90 sec of near-maximal isometric exercise to evaluate post-exercise muscle mitochondrial function. Change with treatment for each group was compared via t-test or Mann Whitney U, as appropriate. Twenty-two youth with pre/post MRS (n=12 MET, n=10 PLA, 16.3±2.1 years, 45% female, 91% Caucasian, BMI 25.6±3.9 kg/m2, 7.4±3.7 years T1D duration, HbA1c 8.2±1.1%) were included. GIR increased more in the MET group (MET 1.5 [1.1-2.1] vs. PLA 0.4 [-0.1-0.9] mg/kg/minute, p=0.024). There were no differences between groups in any mitochondrial measure (initial phosphocreatine [PCr] synthesis, ADP and PCr time constants, oxidative phosphorylation, maximal mitochondrial function) or the related measures of creatine kinase reaction or anaerobic glycolysis. In summary, metformin improves peripheral IS in T1D youth, but likely not via muscle mitochondrial-mediated mechanisms. Further research is needed to understand mitochondrial dysfunction and metformin-induced improvements in IS in T1D. Disclosure K.L. Tommerdahl: None. M. Cree-Green: None. P. Bjornstad: Advisory Panel; Self; Horizon, XORTX. Consultant; Self; Bayer US, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company. A. Carreau: Advisory Panel; Self; Pfizer Inc. Y. Garcia Reyes: None. A.D. Baumgartner: None. M.S. Brown: None. B. Newcomer: None. J.E.B. Reusch: Board Member; Self; American Diabetes Association. Other Relationship; Self; Merck & Co., Inc. K.J. Nadeau: None. Funding American Diabetes Association (7-11-CD-08 to K.J.N.)

Hoarding Symptoms in Children and Adolescents With Obsessive-Compulsive Disorder: Clinical Features and Response to Cognitive-Behavioral Therapy.

Although adult hoarding disorder is relatively common and often debilitating, few studies have examined the phenomenology of pediatric hoarding. We examined the clinical phenomenology and response to cognitive-behavioral therapy (CBT) treatment in youths with a diagnosis of obsessive-compulsive disorder (OCD) with and without hoarding symptoms. Age was tested as a moderator across analyses, given prior findings that the impact of hoarding symptoms may not become apparent until adolescence. Youths (N= 215; aged 7-17 years) with OCD pursuing evaluation and/or treatment at a university-based specialty clinic participated in the current study. Presence of hoarding symptoms was assessed as part of a larger battery. Data from a subset of youths (n= 134) who received CBT were included in treatment response analyses. Youths with hoarding symptoms did not differ from those without hoarding symptoms with respect to overall OCD symptom severity and impairment. Youths with hoarding met criteria for more concurrent diagnoses, including greater rates of internalizing and both internalizing/externalizing, but not externalizing-only, disorders. Youths with and without hoarding symptoms did not significantly differ in rate of response to CBT. Age did not moderate any of these relationships, suggesting that the presence of hoarding symptoms was not associated with greater impairments across the clinical presentation of OCD or its response to treatment by age. We found no evidence that hoarding is associated with greater OCD severity or poorer treatment response in affected youth. Theoretical and clinical implications of these findings, including future directions for research on testing developmental models of hoarding across the lifespan, are discussed.

Baseline and follow-up activity and functional connectivity in reward neural circuitries in offspring at risk for bipolar disorder.

Bipolar disorder (BD) is a serious psychiatric illness with demonstrated abnormalities in reward processing circuitry. Examining this circuitry in youth at familial risk for BD may provide further insight into the underlying mechanisms of BD development. In this study, we compared offspring of bipolar parents (OBP, n = 32), offspring of comparison parents with non-BD psychopathology (OCP, n = 36), and offspring of healthy parents (OHP, n = 39) during a functional magnetic resonance imaging reward processing task. Elastic net regression analyses identified 26 activity, functional connectivity (FC), and demographic variables that explained 34.24% of the variance in group (λ = 0.224). ANOVA and post-hoc analyses revealed that OBP had significantly lower right ventral striatum-left caudal anterior cingulate FC to loss (OBP versus OCP: p = 0.028, OBP versus OHP: p = 0.015) and greater right pars orbitalis-left (OBP versus OCP: p = 0.003, OBP versus OHP: p = 0.036) and -right (OBP versus OCP: p = 0.001, OBP versus OHP: p = 0.038) orbitofrontal cortex FC to reward versus OCP and OHP, respectively. These findings were not affected by non-BD psychopathology, psychotropic medication use, or symptomatology. There were no changes in, or relationships between, neuroimaging or symptom measures at follow-up (mean(SD) = 2.70(1.22) year inter-scan interval) in a subset of youth with follow-up data (OBP, n = 14; OCP, n = 8; OHP, n = 19). These findings suggest that lower right ventral striatum-left caudal anterior cingulate FC to loss and greater right pars orbitalis-orbitofrontal cortex FC to reward may be trait-level neural markers that may reflect risk for BD in at-risk youth. These findings comprise important steps toward identifying neural markers of BD risk, which may enhance early identification and guide interventions for youth at familial risk for BD.

The reliability of full-length lower limb radiographic alignment measurements in skeletally immature youth.

PurposeReliable radiographic measurement techniques are important for investigating limb alignments prior to and following paediatric anterior cruciate ligament (ACL) reconstruction. We investigated the inter- and intraobserver reliability of alignment measurements from lower extremity anteroposterior and lateral radiographs of adolescents having undergone transphyseal ACL reconstructionMethodsA total of 15 of 90 patients who had undergone transphyseal ACL reconstruction were randomly selected for alignment measurements of radiographs of operative and nonoperative limbs. Radiographs were de-identified, randomized to three varying sequences and made available in electronic format to three blinded investigators: a junior orthopaedic resident, a senior orthopaedic resident and a paediatric orthopaedic attending. Coronal measurements comprised the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and mechanical axis deviation (MAD), measured from standing teleoroentgenograms of the lower extremities. Tibial slope was measured on lateral knee radiographs of operative limbs. The intra-class correlation coefficient (ICC) was calculated for each of the three coronal measures and for tibial slope.ResultsIntraobserver reliability was excellent across all measures (ICC > 0.75) except for tibial slope in one investigator’s measurements (good or ICC = 0.68 for the operative limbs) and mLDFA in another investigator’s measurements (fair or ICC = 0.49 for the operative limbs, and poor ICC = 0.27 for the nonoperative limbs). Interobserver reliability was excellent across all investigators for all measurements for operative and nonoperative limbs.ConclusionsRadiographic measurements of lower extremity alignment may be reliably measured on teleoroentgenograms in a subset of youth who underwent transphyseal ACL reconstruction.Level of EvidenceIII

“P” and “DP:” Examining Symptom-Level Bifactor Models of Psychopathology and Dysregulation in Clinically Referred Children and Adolescents

This study examined cross-informant evidence for a general factor of psychopathology ("P") and a narrower, clinically oriented dysregulation general factor based on the Dysregulation Profile ("DP") in a large clinical sample of children and adolescents. We also compared the magnitude of P and DP general factor associations with self-harm and suicidal ideation as an indicator of criterion validity. Itemwise data from the Child Behavior Checklist (N= 2,934; 4-18 years of age) were analyzed using confirmatory bifactor modeling and replicated in a supplementary analysis using Youth Self Report data (N= 2,395). General P and DP bifactor models fit the data better than single-factor and correlated factor models. Cross-informant criterion analyses on a subset of youth (n= 1,552) suggested that whether modeled as latent P or DP, associations with a brief composite index of self-harm and suicidal ideation are essentially of the same magnitude. Our findings provide novel, large-sample support for the existence of general factors of psychopathology and dysregulation in clinically referred children and adolescents using a standardized rating system of psychopathology symptoms. Moreover, our results provide preliminary evidence that general psychopathology and dysregulation factors are clinically meaningful constructs. In addition, our findings raise the possibility that the DP general factor may serve as an efficient proxy for the general psychopathology factor in future clinical applications. Further efforts are necessary to understand the core empirical meaning of the P factor and to determine how it can be applied to clinical assessment and intervention.

Two Years of Relationship-Focused Mentoring for First Nations, Métis, and Inuit Adolescents: Promoting Positive Mental Health

First Nations, Métis, and Inuit (FNMI) youth are disproportionately affected by a range of negative health outcomes including poor emotional and psychosocial well-being. At the same time, there is increasing awareness of culturally-specific protective factors for these youth, such as cultural connectedness and identity. This article reports the findings of a mixed-methods, exploratory longitudinal study on the effects of a culturally-relevant school-based mentoring program for FNMI youth that focuses on promoting mental well-being and the development of cultural identity. Participants included a cohort of FNMI adolescents whom we tracked across the transition from elementary to secondary school. We utilized data from annual surveys (n=105) and a subset of youth whom we interviewed (n=28). Quantitative analyses compared youth who participated in 1 or 2years of mentoring programs with those who did not participate. At Wave 3, the 2-year mentoring group demonstrated better mental health and improved cultural identity, accounting for Wave 1 functioning. These results were maintained when sex and school climate were accounted for in the models. Sex did not emerge as a significant moderator; however, post hoc analyses with simple slopes indicated that the mentoring program benefited girls more than boys for both outcomes. Interview data were coded and themed through a multi-phase process, and revealed that the mentoring program helped participants develop their intrapersonal and interpersonal skills, and enhanced their cultural and healthy relationships knowledge base. Collectively, the quantitative and qualitative components of this study identify multiple years of culturally-relevant mentoring as a promising approach for promoting well-being among FNMI youth.

Leveraging After-School Programs to Minimize Risks for Internalizing Symptoms Among Urban Youth: Weaving Together Music Education and Social Development.

This study examined a university-community partnership, focusing on mental health promotion within an after-school music program. We pursued two goals: (a) supporting staff around student engagement and behavior management; (b) integrating social-emotional activities into the curriculum. We assessed youth's mental health needs and examined feasibility of social-emotional activities delivered. One-hundred sixty-two youth participated in activities, while a subset of youth (n=61) and their parents provided information on mental health need. Rates of anxiety and depression symptoms were high, and youth reported high satisfaction with the activities. Results suggest promise of this model for mental health promotion for urban youth.

Character Development among Youth of Color from Low-SES Backgrounds: An Examination of Boy Scouts of America’s ScoutReach Program

This study examined character attributes associated with participation in ScoutReach, Boy Scouts of America’s recent program innovation created to deliver Scouting curriculum to underserved populations. Participants were predominantly Black/African American (72.9%; N = 266, Mage = 10.54, SD = 1.58) and resided in low-income urban communities. Youth completed surveys assessing how much they embody different character attributes (e.g., kindness, helpfulness, hopeful future expectations), and a subset of youth (n = 22) also participated in semi-structured interviews examining character-shaping experiences within the program. Results replicated an eight-factor character structure established with youth involved in traditional Scouting programs, and indicated that involvement in ScoutReach may positively contribute to the development in youth of prosocial behaviors, future career goals, tolerance beliefs, and the manifestation of character attributes across Scouting and non-Scouting contexts. Together, these findings have implications for measuring character constructs among youth of color from low-SES backgrounds, and for the conduct of youth-serving character development programs more generally.

Screening for Trauma in Early Adolescence: Findings from a Diverse School District

Abundant evidence demonstrates that traumatized adolescents are at increased risk of a host of negative psychoeducational and functional outcomes, but demographic disparities are often seen in access to and use of mental health services and supports. In light of this, the current study examines the prevalence of trauma experiences and traumatic stress in middle school students from a large urban school district serving a high proportion of diverse immigrant and low-income families. Descriptive statistics document the mean reported number of trauma experiences and posttraumatic stress subscale scores by participants’ sociodemographic variables. Inferential statistics report significant differences associated with race/ethnicity, gender, and type of trauma—including exposure as a victim or a witness. Results show complex and significant racial/ethnic group differences in the experience and symptomatology of trauma among the entire screened sample as well as the subset of youth with elevated distress. Furthermore, findings document the predictive value of particular trauma events related to early adolescents’ severity of self-reported traumatic stress. These in-depth findings underscore the need for routine, school-based screening to identify and bring culturally competent, trauma-informed support and interventions to middle school students experiencing traumatic stress.

Psychosocial Interventions and Therapeutic Support as a Standard of Care in Pediatric Oncology.

Research indicates that a subset of youths with childhood cancer and their parents will experience significant psychological distress throughout the course of their illness. Importantly, the existing literature indicates that psychosocial support is beneficial in decreasing symptoms of distress in these families. The aim of the current review is to determine the extent of the evidence to support a standard of psychosocial care for children and their families throughout the cancer trajectory; thus, we examined the research related to psychosocial outcomes in youth with cancer and their parents.

Neurobiology of Sensory Overresponsivity in Youth With Autism Spectrum Disorders.

More than half of youth with autism spectrum disorders (ASDs) have sensory overresponsivity (SOR), an extreme negative reaction to sensory stimuli. However, little is known about the neurobiological basis of SOR, and there are few effective treatments. Understanding whether SOR is due to an initial heightened sensory response or to deficits in regulating emotional reactions to stimuli has important implications for intervention. To determine differences in brain responses, habituation, and connectivity during exposure to mildly aversive sensory stimuli in youth with ASDs and SOR compared with youth with ASDs without SOR and compared with typically developing control subjects. Functional magnetic resonance imaging was used to examine brain responses and habituation to mildly aversive auditory and tactile stimuli in 19 high-functioning youths with ASDs and 19 age- and IQ-matched, typically developing youths (age range, 9-17 years). Brain activity was related to parents' ratings of children's SOR symptoms. Functional connectivity between the amygdala and orbitofrontal cortex was compared between ASDs subgroups with and without SOR and typically developing controls without SOR. The study dates were March 2012 through February 2014. Relative increases in blood oxygen level-dependent signal response across the whole brain and within the amygdala during exposure to sensory stimuli compared with fixation, as well as correlation between blood oxygen level-dependent signal change in the amygdala and orbitofrontal cortex. The mean age in both groups was 14 years and the majority in both groups (16 of 19 each) were male. Compared with neurotypical control participants, participants with ASDs displayed stronger activation in primary sensory cortices and the amygdala (P < .05, corrected). This activity was positively correlated with SOR symptoms after controlling for anxiety. The ASDs with SOR subgroup had decreased neural habituation to stimuli in sensory cortices and the amygdala compared with groups without SOR. Youth with ASDs without SOR showed a pattern of amygdala downregulation, with negative connectivity between the amygdala and orbitofrontal cortex (thresholded at z > 1.70, P < .05). Results demonstrate that youth with ASDs and SOR show sensorilimbic hyperresponsivity to mildly aversive tactile and auditory stimuli, particularly to multiple modalities presented simultaneously, and show that this hyperresponsivity is due to failure to habituate. In addition, findings suggest that a subset of youth with ASDs can regulate their responses through prefrontal downregulation of amygdala activity. Implications for intervention include minimizing exposure to multiple sensory modalities and building coping strategies for regulating emotional response to stimuli.

Juvenile crime and juvenile justice: Patterns, models, and implications for clinical and legal practice

Abstract While rates of juvenile crime have declined over the past decade, public preoccupation with youth violence remains high, periodically fueling judicial and legislative “get-tough” policies and social movements. For most young people, criminal activity, if any, is mild, infrequent, peer-driven, and peaks in late adolescence and early adulthood, declining steadily thereafter. A small subset of persistently antisocial youths begin their criminal careers earlier, commit more frequent and more serious offenses, continue their offending throughout the life-course, and are characterized by a number of neurocognitive, personality, and diagnostic features. Individual, familial, and social forces all combine to influence juvenile criminal behavior, but another small subset of youths, with a characteristic cognitive and temperamental profile, appear to be staunchly resilient to the criminogenic influences around them. The success of intervention and treatment modalities for childhood antisocial behavior depends both on the type of subjects to which they are applied and the consistency and comprehensiveness with which they are implemented and carried out.

Identifying high-risk youth for secondary gang prevention

Efforts to reduce gang violence by deterring youth from joining street gangs are of major interest in cities across the United States. Current thinking supports a comprehensive gang reduction approach that includes concurrent efforts that prevent joining, encourage leaving, and interrupt gang violence. This paper focuses on a method of strengthening the prevention component by improving the identification of youth at high risk for gang joining. The authors advocate a secondary prevention approach supported by an empirically based assessment of risk factors consistently associated with gang joining in rigorous studies across multiple locations in the United States, Canada, and Europe.The process of developing a Gang Risk of Entry Factors (GREF) assessment tool to identify youth at high risk for gang involvement is described in the context of the authors' collaboration with ongoing comprehensive gang reduction efforts undertaken by the City of Los Angeles. The rationale for the approach as well as the framework used to create and implement the assessment in a collaborative context is detailed.Process-level data is reported on the usefulness of the assessment for identifying high-risk clients for secondary gang prevention. Analyses suggest that boys referred to the gang reduction program had risk levels that were no higher than risk levels observed in general school populations on three of the four risk factors compared (though the girls referred were higher risk on these factors). Using the assessment to screen youth allowed programs to identify and enroll only the subset of youth with risk levels similar to youth from the same neighborhoods who self-reported gang involvement on six of the eight risk factors.Identifying youth with high risks provides the opportunity to implement secondary gang prevention programs that are more intensive than programs typically provided for primary prevention. The assessment supports more intensive efforts that can be focused on a common set of risks the clients are experiencing, as well as challenges unique to each individual.

What clinical differences distinguish depressed teens with and without comorbid externalizing problems?

ObjectiveThis study examined differences in co-occurring symptoms, psychosocial correlates, health care utilization and functional impairment in youth who screened positive for depression, stratified by whether or not they also self-reported externalizing problems. MethodsThe AdoleSCent Health Study examined a random sample of youth ages 13–17 enrolled in a health care system. A total of 2291 youth (60.7% of the eligible sample) completed a brief depression screen: the two-item Patient Health Questionnaire. The current analyses focus on a subset of youth (n=113) who had a follow-up interview and screened positive for possible depression on the Patient Health Questionnaire 9 using a cutoff score of 11 or higher [1]. Youth were categorized as having externalizing behavior if their score was ≥7 on the Pediatric Symptom Checklist (PSC) externalizing scale [2,3]. χ2 tests and Wilcoxon rank sum tests were used to compare groups. ResultsDifferences between groups included that youth with depression and externalizing symptoms had a higher rate of obesity and had higher self-reported functional impairment than youth with depression symptoms alone. ConclusionsAdding screening for externalizing problems to existing recommendations for depression screening may help primary care providers to identify a high-risk depressed group of youth for referral to mental health services.

Novel Interventions in Children's Healthcare (NICH): a promising treatment for intractable pediatric pain

A subset of youth with recurrent and chronic pain face complex psychosocial challenges. Some of these youth do not respond to multidisciplinary outpatient care, are at increased risk for repeated hospitalizations, and utilize a disproportionate amount of healthcare resources. Intensive behavioral health interventions for youth with complex medical conditions have proven effective in improving psychosocial functioning and reducing avoidable hospitalizations. Based on this research, we adapted an intensive behavioral health program to treat youth with chronic pain who have not responded to multidisciplinary care and have been repeatedly hospitalized. The intervention, NICH, involves family-based problem solving, care coordination, and case management. Treatment is implemented across settings (home, hospital, and tele-health). We present a case series of youth (n=4) with chronic intractable pain (Cases A-D: 7yrs female with leg pain; 10yrs male with neuropathic pain; 15yrs female with chest pain; 15yrs male with back pain). We documented emergency department (ED) visits and admissions pre-, during, and post-treatment. During the 5 months pre-treatment, participants had 1-16 (M=6.25, SD=6.70) hospitalizations and ED visits. None were regularly attending school. Case A had 3 ED visits, Case B was hospitalized once for a 6-day period, Case C had 3 ED visits and 2 hospitalizations, and Case D had 16 ED visits. Since beginning treatment, all participants have had zero hospital or ED visits, and have returned to school or completing online classes. Initial findings suggest substantial reductions in hospital/ED visits and healthcare costs for each patient. These four cases accumulated an estimated $93,000 in hospital/ED costs, averaging $23,250 each. Since involvement in NICH, all had no costs associated with hospital/ED visits. NICH involves delivering intensive behavioral healthcare in real world settings and holds promise for improving health and psychosocial functioning, reducing unnecessary healthcare spending, and preventing long-term pain rehabilitation hospitalizations for youth with chronic pain. A subset of youth with recurrent and chronic pain face complex psychosocial challenges. Some of these youth do not respond to multidisciplinary outpatient care, are at increased risk for repeated hospitalizations, and utilize a disproportionate amount of healthcare resources. Intensive behavioral health interventions for youth with complex medical conditions have proven effective in improving psychosocial functioning and reducing avoidable hospitalizations. Based on this research, we adapted an intensive behavioral health program to treat youth with chronic pain who have not responded to multidisciplinary care and have been repeatedly hospitalized. The intervention, NICH, involves family-based problem solving, care coordination, and case management. Treatment is implemented across settings (home, hospital, and tele-health). We present a case series of youth (n=4) with chronic intractable pain (Cases A-D: 7yrs female with leg pain; 10yrs male with neuropathic pain; 15yrs female with chest pain; 15yrs male with back pain). We documented emergency department (ED) visits and admissions pre-, during, and post-treatment. During the 5 months pre-treatment, participants had 1-16 (M=6.25, SD=6.70) hospitalizations and ED visits. None were regularly attending school. Case A had 3 ED visits, Case B was hospitalized once for a 6-day period, Case C had 3 ED visits and 2 hospitalizations, and Case D had 16 ED visits. Since beginning treatment, all participants have had zero hospital or ED visits, and have returned to school or completing online classes. Initial findings suggest substantial reductions in hospital/ED visits and healthcare costs for each patient. These four cases accumulated an estimated $93,000 in hospital/ED costs, averaging $23,250 each. Since involvement in NICH, all had no costs associated with hospital/ED visits. NICH involves delivering intensive behavioral healthcare in real world settings and holds promise for improving health and psychosocial functioning, reducing unnecessary healthcare spending, and preventing long-term pain rehabilitation hospitalizations for youth with chronic pain.

Taking Disruptive Mood Dysregulation Disorder Out for a Test Drive

Taking Disruptive Mood Dysregulation Disorder Out for a Test Drive

Defining Treatment Response and Remission in Child Anxiety: Signal Detection Analysis Using the Pediatric Anxiety Rating Scale

ObjectiveTo determine optimal Pediatric Anxiety Rating Scale (PARS) percent reduction and raw score cut-offs for predicting treatment response and remission among children and adolescents with anxiety disorders. MethodData were from a subset of youth (N = 438; 7–17 years of age) who participated in the Child/Adolescent Anxiety Multimodal Study (CAMS), a multi-site, randomized controlled trial that examined the relative efficacy of cognitive-behavioral therapy (CBT; Coping Cat), medication (sertraline [SRT]), their combination, and pill placebo for the treatment of separation anxiety disorder, generalized anxiety disorder, and social phobia. The clinician-rated PARS was administered pre- and posttreatment (delivered over 12 weeks). Quality receiver operating characteristic methods assessed the performance of various PARS percent reductions and absolute cut-off scores in predicting treatment response and remission, as determined by posttreatment ratings on the Clinical Global Impression scales and the Anxiety Disorders Interview Schedule for DSM-IV. Corresponding change in impairment was evaluated using the Child Anxiety Impact Scale. ResultsReductions of 35% and 50% on the six-item PARS optimally predicted treatment response and remission, respectively. Post-treatment PARS raw scores of 8 to 10 optimally predicted remission. Anxiety improved as a function of PARS-defined treatment response and remission. ConclusionsResults serve as guidelines for operationalizing treatment response and remission in future research and in making cross-study comparisons. These guidelines can facilitate translation of research findings into clinical practice.

Evaluation of a School-wide Preventive Intervention for Adolescents: The Secondary Social and Emotional Aspects of Learning (SEAL) Programme

Adolescence is a time during which youth are at an increased risk of developing mental health disorders, yet there are relatively few empirically validated preventive interventions designed for implementation in the secondary/high school phase of education. The aim of the current study was to evaluate the impact of one such programme, entitled ‘social and emotional aspects of learning (SEAL)’, over a 2-year period using a quasi-experimental pre-test–post-test control group design. Our sample consisted of 4,443 students (aged 11–12 at the start of the study) attending 41 secondary schools across England—2,442 at 22 SEAL schools and 2,001 at 19 matched control schools. Our outcome measures were the emotional symptoms and conduct problems subscales of the self-report version of the Strengths and Difficulties Questionnaire. Hierarchical linear modelling indicated that the SEAL programme had no discernible impact upon either of these domains of mental health. Further analysis using data from a subset of youth whose baseline scores placed them ‘at-risk’ demonstrated a reduction in difficulties in those attending SEAL schools, but this was matched by a similar trend in those attending control schools. Finally, although there was evidence that student outcomes for conduct problems were mediated by implementation quality, the associated effect size was very small. Variability in student outcomes for emotional symptoms appeared to be unrelated to implementation quality. The implications of these findings for school-based preventive interventions are discussed using three explanatory frameworks—theory failure, implementation failure and research failure.