Tuesday, May 5, 2015

Benefits of Early Intervention for ASD Persist Two Years Later, Study Shows

The positive effects of an early intervention for very young children with Autism Spectrum Disorder (ASD) appear to be maintained two years after the intervention ends, according to a report online in the Journal of the American Academy of Child and Adolescent Psychiatry.

Annette Estes, Ph.D., director of the University of Washington Autism Center, and colleagues prospectively examined evidence for the sustained effects of the Early Start Denver Model (ESDM), a comprehensive behavioral early intervention approach for children with autism, ages 12 to 48 months. The study included 39 children with ASD who began participation in a randomized clinical trial of ESDM between 18 and 30 months; clinicians who were naïve to previous intervention group status later assessed the children across multiple domains of functioning at age six, two years after ESDM ended.

The researchers found that the ESDM group maintained the gains made during early intervention across symptom domains at age six, including overall intellectual ability, adaptive behavior, symptom severity, and challenging behavior. While no group differences in core autism symptoms were found immediately posttreatment, the ESDM group demonstrated improved core autism symptoms compared with the community-intervention-as-usual group two years later. The two groups received equivalent intervention hours during the original study, but the ESDM group received fewer hours during the follow-up period, according to the report.

“These results provide evidence that gains from early intensive intervention are maintained two years later,” the authors state. “This is the first study to examine the role of early ESDM behavioral intervention initiated below 30 months of age in altering the longer term developmental course of autism.”

For more information about early ASD interventions, see the Psychiatric News article, “Intensive, Two-Year Intervention Benefits Kids With Autism.”

(Image: Marcin Pawinski/shutterstock.com)

Monday, May 4, 2015

New York State Project Shows Progress in Reducing Use of Seclusion, Restraint for Children With Mental Illness

Three New York State mental health treatment facilities participating in a project to decrease the use of seclusion and restraint for children with severe emotional disorders demonstrated significant decreases in restraint and seclusion episodes per 1,000 client-days, according to a report published online Friday in Psychiatric Services in Advance titled "The New York State Office of Mental Health Positive Alternatives to Restraint and Seclusion (PARS) Project." Moreover, each facility identified specific activities that contributed to success, including ways to facilitate open, respectful two-way communication between management and staff and between staff and youth, and greater involvement of youth in program decision making.

The intervention used by the three facilities included training, on-site mentors and peer specialists, and on-site consultation from the Office of Technical Assistance of the National Association of State Mental Health Program Directors (NASMHPD). The intervention’s primary methodology was implementation of NASMHPD’s “Six Core Strategies to Reduce the Use of Seclusion and Restraint.”

The study authors examined data from the New York State Incident Management and Reporting System on restraint and seclusion episodes per 1,000 client days over a four-year period (2007–2011). Qualitative data were collected via notes from facility consultations, site visits, steering committee reviews, site conference calls with the New York State Office of Mental Health (OMH), and site reports.

At facility one, the number of incidents per 1,000 client-days decreased from 67 to 25; at facility two, the decrease was from 63 to 7; and at facility three, the decrease was from 99 to 13.

“The primary finding of this project was that the creation of coercion- and violence-free environments where use of restraint and seclusion is markedly decreased requires a major commitment by all staff over an extended period to fully understand and internalize the strategies involved and embrace the changes in facility culture,” Lloyd Sederer, M.D., medical director of the New York State Office of Mental Health and a coauthor of the report, told Psychiatric News. “In New York, OMH is promoting facilities’ engagement in learning collaboratives so that facilities can reduce use of restraint and seclusion and realize significant positive outcomes."

For related information, see the Psychiatric News article, "Psychiatric Hospital Aesthetics Affect Seclusion, Restraint Use."

(Image: Rikke/shutterstock.com)

Friday, May 1, 2015

APA Event Addresses Mental Health Needs of American Indians

American Indians have long experienced lower health status when compared with other Americans. During an APA-sponsored event in Sioux Falls, S.D., on Thursday, community leaders and mental health professionals called for more to be done to address the mental health needs of this population.

“We know what the health inequities are among the Native American population,” APA CEO and Medical Director Saul Levin, M.D., M.P.A, told conference attendees. “It’s time for us to do something. APA is here to help and can use its lobbyists to help address these issues to legislatures.”

Debanjana Bhattacharya, M.D., M.P.H. (left), a fourth-year psychiatry resident at the Sanford School of Medicine at the University of South Dakota and APA minority fellow, described the toll mental illness was having on the people of South Dakota alone. “Suicide rates for American Indians in South Dakota are 2.5 times than the rates in the surrounding states of Iowa, Nebraska, and North Dakota,” said Bhattacharya, who helped organize the event. Alcohol use disorder is also one of the leading causes of death among American Indians residing in South Dakota.

To help address these needs, individuals from the public and private sectors recently formed the Alliance for American Indian Behavioral Health, which aims to advance health equity for Native Americans within the Sioux Falls area through the promotion of available resources and training in cultural competence for non-Native American health care professionals.

Yesterday's event was sponsored by APA’s Division of Diversity and Health Equity in conjunction with the South Dakota Psychiatric Association.

To read more about efforts in addressing mental health issues among American Indians, see the Psychiatric News article "White House Hosts Briefing on Federal Suicide Prevention Efforts."

(Image: Vabren Watts/Psychiatric News)

Thursday, April 30, 2015

Study Finds Victims of Childhood Bullying Are More Likely to Have Mental Health Problems Than Those Maltreated

Being bullied during childhood has a greater negative impact on the mental health of young adults than experiencing maltreatment early in life, according to a study published in The Lancet Psychiatry. Specifically, children who were bullied were found to be around five times more likely to experience anxiety and nearly twice as likely to report depression and self-harm at age 18 than children who were maltreated.

For the study, Dieter Wolke, Ph.D., a professor of psychology at the University of Warwick, UK, and colleagues analyzed data on maltreatment, bullying, and overall mental health from two longitudinal studies—the Avon Longitudinal Study of Parents and Children (ALSPAC) in the United Kingdom (ALSPAC) and Great Smoky Mountains Study (GSMS) in the United States.

The study included 4,026 children from ALSPAC—whose parents provided information about their exposure to maltreatment (defined as physical, emotional, or sexual abuse, or severe maladaptive parenting, or both) between the ages 8 weeks and 8.6 years; exposure to bullying was assessed during conversations with the children at ages 8, 10, and 13—and 1,420 children from GSMS, who reported information on maltreatment and bullying between the ages of 9 and 16. Symptoms of anxiety, depression, self-harm, and suicidality were measured at age 18.

Of the 4,026 children in the ALSPAC cohort, 341 (8 percent) were exposed to only maltreatment, 1,197 (30 percent) were exposed to only bullying, and 283 (7 percent) were exposed to both maltreatment and bullying. As adults, 402 (10 percent) were classified as having anxiety, 316 (8 percent) as having depression, and 361 (9 percent) as having reported self-harm in the past year. A total of 207 (15 percent) in the GSMS cohort were exposed to only maltreatment, 225 (16 percent) to only bullying, and 159 (10 percent) to both maltreatment and bullying. As adults, 135 (12 percent) were classified as having anxiety, 87 (6 percent) as having depression, and 64 (7 percent) as having reported self-harm in the past year.

After adjusting for potential confounders, the authors reported that being bullied only was a higher risk for overall mental health problems than was being maltreated only in both cohorts (OR 1.6 [95% CI 1.1–2.2] for ALSPAC; 3.8 [1.8–7.9] for GSMS). Children who were bullied were more likely to have anxiety (4.9 [2.0–12.0] for GSMS), depression (1.7 [1.1–2.7] for ALSPAC) and self-harm (1.7 [1.1–2.6] for ALSPAC) as adults than children who were maltreated by adults.

While governmental efforts have focused almost exclusively on public policy to address family maltreatment, less attention and resources have been directed at addressing bullying, the study authors note. “Since bullying is frequent and found in all social groups, and current evidence supports that bullied children have similar or worse long-term mental health outcomes than maltreatment, this imbalance requires attention,” they write.

For more on the long-term effects of bullying, see the Psychiatric News article, “Effects of Bullying Don’t End When School Does.”

(Image: Monkey Business Images/Shutterstock)

Wednesday, April 29, 2015

Most Children With ADHD Stay on Stimulant Medication, Study Shows

Stimulant medication continued to be used by most children three to six years after the conclusion of research known as the Preschool ADHD Treatment Study (PATS) in which they had participated. About 1 in 4 children was no longer taking medication, and about 1 in 10 was on an antipsychotic. Antipsychotic treatment was associated with more comorbidity.

Those are the findings of a prospective, naturalistic follow-up study of PATS by Benedetto Vittielo, M.D., of the National Institute of Mental Health, and colleagues at several other institutions, published in the Journal of Child and Adolescent Psychiatry. 

They reassessed 206 of the 303 children who had participated in PATS at three years and 179 children at six years after completion of the controlled study. Pharmacotherapy and clinical data were obtained from the parents. Pharmacotherapy was defined as use of a specific class of medication for at least 50 percent of the days in the previous six months.

At year three, overall, 34 percent were on no pharmacotherapy, 41.3 percent were on stimulant monotherapy; 9.2 percent on atomoxetine (alone or with a stimulant); 8.3 percent on an antipsychotic, usually together with a stimulant; and the remaining 7.2 percent were on other pharmacotherapy. Overall, 65.0% were on an indicated ADHD medication.

At year six, just under 27 percent were on no pharmacotherapy, 40.2 percent were on stimulant monotherapy, 4.5 percent on atomoxetine, alone or with a stimulant, 13.4 percent on 
an antipsychotic, and 15.1 percent on other pharmacotherapy. Overall, 70.9% were on an indicated ADHD medication.

Antipsychotic treatment was associated with more comorbidity, in particular disruptive behavior disorders and pervasive development disorders, and a lower level of functioning.

For related information, see the Psychiatric News article “Study Assesses Association Between Weight Gain, ADHD Medication.”

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Tuesday, April 28, 2015

New Book From APA Describes Mental Illnesses for General Audiences

Patients, families, and others now have access to the latest information on mental disorders and available treatments through a comprehensive, easy-to-understand book that APA released today, Understanding Mental Disorders: Your Guide to DSM-5.

“We need to have a conversation in this country, and everyone has to have a greater literacy and understanding of these illnesses,” said former Rhode Island Congressman Patrick Kennedy (left) at a launch event at the National Press Club in Washington, D.C. Kennedy, who is one of the country's leading advocates on mental health issues, wrote the foreword to the 370-page book. "It empowers patients and their loved ones by giving them knowledge and understanding."

Understanding Mental Disorders is based on the latest, fifth edition of APA's Diagnostic and Statistical Manual of Mental Disorders. The organization of the book follows that of DSM-5 and lists risk factors, warning signs, symptoms, and treatments for each disorder. The book also includes brief case studies to illustrate real-life examples of people with these conditions.

“This book can lead to helpful communication between patients, their families, and their psychiatrists,” noted APA President Paul Summergrad, M.D. (right), chair of psychiatry at Tufts University School of Medicine.

Besides patients and their families, Understanding Mental Disorders will be helpful for other health professionals, law enforcement personnel, educators, coaches, members of the clergy, as well as others who want to educate themselves about mental illness.

"Psychiatrists now have an authoritative source of information on mental disorders to recommend to their patients and loved ones," said APA President-Elect Renée Binder, M.D. “The book will overcome stigma about mental illness because it emphasizes that these are brain disorders and they are treatable.”

In addition to Kennedy, Summergrad, and Binder, participating in the launch of the book at the National Press Club were Jeffrey Borenstein, M.D., a member of the book’s advisory panel; Paul Gionfriddo, president and CEO of Mental Health America; and Barbara Van Dahlen, Ph.D., the founder and president of Give an Hour.

For more in Psychiatric News about Understanding Mental Disorders, see "New Manual to Offer One-of-Kind Layperson’s Guide to DSM-5."

--aml   (Image: David Hathcox)

Monday, April 27, 2015

Anxious Parents Can Transmit Anxiety to Children, Twin Study Shows

The association between parental and offspring anxiety and neuroticism appears to be environmental rather than genetic—that is, children and adolescents learn anxious behaviors from their parents rather than inheriting anxiety genetically.

That’s the conclusion of a remarkable study titled "The Intergenerational Transmission of Anxiety: A Children-of-Twins Study" by Thalia C. Eley, Ph.D., of Kings College London and colleagues at institutions in the United States and Sweden. The study was published in AJP in Advance.

Researchers used data from the Twin and Offspring Study of Sweden comprising information on 387 monozygotic twin families and 489 dizygotic twin families. Parental anxious personality was self-reported by twins using 20 items from the Karolinska Scales of Personality. Offspring anxiety symptoms were measured using items from the Child Behavior Checklist (30). Twins, their spouses, and offspring all reported on offspring behavior over the previous six months. A method of statistical analysis called Structural Equation Modeling allowed the researchers to quantify the effects of additive genetic, common environmental—that is, nongenetic effects that make members of a nuclear family similar to one another—and nonshared environmental effects (which make members of a family different from one another) of parental anxiety.

For both anxiety and neuroticism, the models provide support for significant direct environmental transmission from parents to their adolescent offspring. In contrast, there was no evidence of significant genetic transmission, according to the report.

Robert Freedman, M.D., editor of the American Journal of Psychiatry, told Psychiatric News, “This study is a landmark, because it is the first to clearly establish the early transmission of anxiety symptoms from parents to children, not through their shared genetic background, but rather from the way in which anxious parents raise their children. Parents who are anxious can now be counseled and educated on ways to minimize the impact of their anxiety on the child's development.”

For related information, see the Psychiatric News article “CBT for Child Anxiety May Confer Long-Term Protection From Suicidality.”

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