Attitudes and beliefs toward biobehavioural research participation: voices and concerns of urban adolescent females receiving outpatient mental health treatment

PubMed Central

Brawner, Bridgette M.; Volpe, Ellen M.; Stewart, Jennifer M.; Gomes, Melissa M.

2015-01-01

Background Biobehavioural research methodology can be invasive and burdensome for participants—particularly adolescents with mental illnesses. Human biological researchers should consider how methodological impositions may hinder adolescent research participation. However, literature on adolescent’s voices and concerns toward biobehavioural research participation is virtually non-existent. Aim This study was designed to determine adolescents’ perceptions of participation in research involving the collection of biomarkers via blood, saliva and/or urine samples. Subjects and methods Urban adolescent females (aged 12–19) receiving outpatient mental health treatment (n = 37) participated in focus groups with concurrent survey administration to explore attitudes, beliefs and willingness/intentions toward biobehavioural research participation. Results Participants had favourable attitudes toward biobehavioural research and were amenable to provide each specimen type. Mistrust for research emerged, however, and concerns related to privacy and confidentiality were expressed. Conclusion Participant recruitment is a critical component in study design and implementation; this includes knowledge of population-specific recruitment barriers and facilitators. This innovative paper provides a context for the research participants’ decision-making process, strategies to allay fears and concerns and concrete areas to target in research-related interventions. Although the findings are from a specific, US-based sample, the implications warrant replication of the research in other geosocial settings. PMID:23822716

Treatment of trauma- and abuse-related dissociative symptom disorders in children and adolescents.

PubMed

Weber, Scott

2009-02-01

Dissociation is believed to be one of the most common underlying psychological processes among children and adolescents receiving mental health treatment, but most of the dissemination of information about dissociation has occurred among psychiatrists and psychologists. Modes of treatment for dissociation as it affects children and adolescents are described. Current research and practice scholarly articles on treatment of children and adolescents for dissociation and dissociative symptom disorders were accessed and critically reviewed. Prognosis in children and adolescents can vary widely among patients and between the specific types of dissociation disorder; however, expert clinicians and researchers agree that early, intense treatment offers the greatest possibility of full recovery.

[Metformin efficiency for the adolescent PCOS treatment].

PubMed

Kedikova, S; Sirakov, M; Boyadzhieva, M

2012-01-01

PCOS is a polyglandular heterogenic metabolic condition, which frequency in adolescence is defined between 11-26%. There are some aspects of PCOS which can be seen in a regular puberty and vice versa. This makes the adolescent PCOS a condition which is rather complicated to diagnose as well as to treat. The pathophysiology of PCOS is not fully clarified, but is well established the fundamental role of the insulin resistance and the hyperinsulinemia. This fact explains the detailed investigations of the insulin sensitizers use for the PCOS treatment. Nevertheless there is insufficient experience with this medication group for the adolescent PCOS treatment in Bulgaria. To evaluate the Metformin efficiency for the adolescent PCOS treatment. This is a prospective study including 55 girls with menstrual irregularities aged between 13 and 18 years. None of the subjects had previously been diagnosed with any endocrine pathology or had received any hormonal treatment for at least three months prior to their evaluation. They have been evaluated according to the diagnostic criteria for PCOS in adolescence accepted in 2010. The incidence of PCOS in our research was 38.9%. In 66.7% of them the body mass index was higher than normal. Insulin resistance was diagnosed in 90.5%. The insulin resistance was improved in 80% of the PCOS patients after six months therapy with Metformin 2 x 850 mg/p.d. The menstrual function was regulated in 77.8% of the cases.

History of Orthodontic Treatment, Treatment Needs and Influencing Factors in Adolescents in Croatia.

PubMed

Špalj, Stjepan; Katić, Višnja; Vidaković, Renata; Šlaj, Martina; Šlaj, Mladen

2016-06-01

The aim of this study was to assess the orthodontic treatment needs of adolescents in Zagreb, Croatia, in relation to their orthodontic treatment history, caries experience and socio-demographic parameters. The study sample comprised 1,289 adolescents from 12 randomly selected public schools in Zagreb, Croatia. The subjects were 15-18 years old (mean age 16.3±1.4), and 51% of them were girls. The Dental Aesthetic Index (DAI), the sum of the numbers of decayed, missing and filled teeth (DMFT index), and a questionnaire (covering socio-demographic issues, oral health-related attitudes and behaviours) were employed in this study. The data was analyzed by means of Chi-square test, analysis of variance, and multiple logistic regression models. The DMFT score was higher in adolescents with no orthodontic history (5.2±3.7) than in those who were under orthodontic treatment at the time of the research (4.5±3.2; p=0.043). More than 60% of the adolescents have never undergone any orthodontic treatment, around 24% previously undergone treatment and 15% were under treatment at the time of the research. Overall, 85% of the adolescents' orthodontic appliances were removable, and the girls were more often under orthodontic treatment. One fifth of the studied population had severe or very severe malocclusion. Adolescents with previous orthodontic treatment were more often interested in better teeth alignment, changes in their teeth positioning and continuing orthodontic treatment. Multiple logistic regression model demonstrated that previously treated adolescents, in comparison with their untreated peers, were on average older (p=0.002), were less satisfied with the appearance of their teeth (p=0.001), they had higher malocclusion severity (p=0.046), and fewer dental caries (p<0.001), changed toothbrushes more often (p=0.012), and their mothers attained higher education (p<0.001). Although many adolescents received orthodontic treatment, the severity of their malocclusion was

Treatment Techniques and Outcomes in Multidimensional Family Therapy for Adolescent Behavior Problems

PubMed Central

Hogue, Aaron; Dauber, Sarah; Samuolis, Jessica; Liddle, Howard A.

2010-01-01

The link between treatment techniques and long-term treatment outcome was examined in an empirically supported family-based treatment for adolescent drug abuse. Observational ratings of therapist interventions were used to predict outcomes at 6 and 12 months posttreatment for 63 families receiving multidimensional family therapy. Greater use of in-session family-focused techniques predicted reduction in internalizing symptoms and improvement in family cohesion. Greater use of family-focused techniques also predicted reduced externalizing symptoms and family conflict, but only when adolescent focus was also high. In addition, greater use of adolescent-focused techniques predicted improvement in family cohesion and family conflict. Results suggest that both individual and multiperson interventions can exert an influential role in family-based therapy for clinically referred adolescents. PMID:17176187

A qualitative study of experience of parents of adolescents who received ECT.

PubMed

Grover, Sandeep; Varadharajan, Natarajan; Avasthi, Ajit

2017-12-01

To evaluate the experience of parents of adolescents who received ECT for severe mental illness. Using qualitative methods, 6 parents of 5 adolescents were interviewed by using a self-designed semi-structured interview after the completion of ECT course. The clinicians involved in the ECT procedure, i.e., seeking informed consent and administration of ECT were not aware about the study. All the interviews were recorded and the content was analysed and themes were generated. Parents of all the 5 adolescents expressed that their children were considered for ECT only after the patient had not responded to medication and were unmanageable. Prior to ECT the treating doctors did explain to them about the ECT procedure, they were given information booklet and they were not coerced to consent for ECT. Some of the parents reported that they had dilemma prior to giving consent and were scared prior to the first ECT. However, as the clinical condition of their children improved, they felt that ECT was a good treatment. Majority of the parents felt that ECT was delayed for their children. When asked about restriction in use of ECT in children and adolescents, the parents expressed that it is important for law makers to understand the distress of the parents,when their children are acutely ill. They expressed that decision of administration of ECT must be left to the family and the treating clinicians. Parents of adolescents considered for ECT are generally satisfied with the treatment procedure. Copyright © 2017 Elsevier B.V. All rights reserved.

Qualitative Treatment-Subgroup Interactions in a Randomized Clinical Trial of Treatments for Adolescents with ADHD: Exploring What Cognitive-Behavioral Treatment Works for Whom

PubMed Central

Geurts, Hilde M.; Prins, Pier J. M.; Van Mechelen, Iven; Van der Oord, Saskia

2016-01-01

Objective This study explored qualitative treatment-subgroup interactions within data of a RCT with two cognitive behavioral treatments (CBT) for adolescents with ADHD: a planning-focused (PML) and a solution-focused CBT (SFT). Qualitative interactions imply that which treatment is best differs across subgroups of patients, and are therefore most relevant for personalized medicine. Methods Adolescents with ADHD (N = 159) received either PML or SFT. Pre-, post- and three-month follow-up data were gathered on parent-rated ADHD symptoms and planning problems. Pretreatment characteristics were explored as potential qualitative moderators of pretest to follow-up treatment effects, using an innovative analyses technique (QUINT; Dusseldorp & Van Mechelen, 2014). In addition, qualitative treatment-subgroup interactions for the therapeutic changes from pre- to posttest and from post- to follow-up test were investigated. Results For the entire time span from pretest to follow-up only a quantitative interaction was found, while from posttest to follow-up qualitative interactions were found: Adolescents with less depressive symptoms but more anxiety symptoms showed more improvement when receiving PML than SFT, while for other adolescents the effects of PML and SFT were comparable. Discussion Whereas subgroups in both treatments followed different trajectories, no subgroup was found for which SFT outperformed PML in terms of the global change in symptoms from pretest to three months after treatment. This implies that, based on this exploratory study, there is no need for personalized treatment allocation with regard to the CBTs under study for adolescents with ADHD. However, for a subgroup with comorbid anxiety symptoms but low depression PML clearly appears the treatment of preference. Trial Registration Nederlands Trial Register NTR2142 PMID:26977602

Qualitative Treatment-Subgroup Interactions in a Randomized Clinical Trial of Treatments for Adolescents with ADHD: Exploring What Cognitive-Behavioral Treatment Works for Whom.

PubMed

Boyer, Bianca E; Doove, Lisa L; Geurts, Hilde M; Prins, Pier J M; Van Mechelen, Iven; Van der Oord, Saskia

2016-01-01

This study explored qualitative treatment-subgroup interactions within data of a RCT with two cognitive behavioral treatments (CBT) for adolescents with ADHD: a planning-focused (PML) and a solution-focused CBT (SFT). Qualitative interactions imply that which treatment is best differs across subgroups of patients, and are therefore most relevant for personalized medicine. Adolescents with ADHD (N = 159) received either PML or SFT. Pre-, post- and three-month follow-up data were gathered on parent-rated ADHD symptoms and planning problems. Pretreatment characteristics were explored as potential qualitative moderators of pretest to follow-up treatment effects, using an innovative analyses technique (QUINT; Dusseldorp & Van Mechelen, 2014). In addition, qualitative treatment-subgroup interactions for the therapeutic changes from pre- to posttest and from post- to follow-up test were investigated. For the entire time span from pretest to follow-up only a quantitative interaction was found, while from posttest to follow-up qualitative interactions were found: Adolescents with less depressive symptoms but more anxiety symptoms showed more improvement when receiving PML than SFT, while for other adolescents the effects of PML and SFT were comparable. Whereas subgroups in both treatments followed different trajectories, no subgroup was found for which SFT outperformed PML in terms of the global change in symptoms from pretest to three months after treatment. This implies that, based on this exploratory study, there is no need for personalized treatment allocation with regard to the CBTs under study for adolescents with ADHD. However, for a subgroup with comorbid anxiety symptoms but low depression PML clearly appears the treatment of preference. Nederlands Trial Register NTR2142.

Adolescence and asthma management: the perspective of adolescents receiving primary health care☆

PubMed Central

Araújo, Alisson; Rocha, Regina Lunardi; Alvim, Cristina Gonçalves

2014-01-01

Objective: To study the influence of adolescence characteristics on asthma management. Methods: This was a qualitative study conducted in the city of Divinópolis, Minas Gerais, Southeast Brazil. Data were collected through semistructured interviews guided by a questionnaire with seven asthmatic adolescents followed-up in the primary public health care service of the city. Results: Using content analysis, three thematic categories were observed in the adolescents' responses: 1) family relationships in the treatment of asthma in adolescence; 2) the asthmatic adolescents and their peers; and 3) the role of the school for the asthmatic adolescents. Conclusions: The results demonstrated that peers, family, and school should be more valued by health professionals and by health care services when treating asthmatic adolescents, as these social relationships are closely associated with the adolescent and have an important role in asthma management. Attempts to meet the demands of adolescents contribute to improve asthma management. PMID:25479845

Practitioner Review: Adolescent alcohol use disorders: assessment and treatment issues

PubMed Central

Perepletchikova, Francheska; Krystal, John H.; Kaufman, Joan

2014-01-01

Background Alcohol use disorders in adolescents are associated with significant morbidity and mortality. Over the past decade, there has been a burgeoning of research on adolescent alcohol use disorders. Methods A summary of the alcohol assessment tools is provided, and randomized studies reviewed and synthesized to provide an overview of state of the art knowledge of treatment of adolescent alcohol use disorders. Animal models of addiction are also briefly reviewed, and the value of translational research approaches, using findings from basic studies to guide the design of clinical investigations, is also highlighted. Results Comorbidity is the rule, not the exception in adolescent alcohol use disorders. Comprehensive assessment of psychiatric and other substance use disorders, trauma experiences, and suicidality is indicated in this population to optimize selection of appropriate clinical interventions. In terms of available investigated treatments for adolescents with alcohol use disorders, Multidimensional Family Therapy and group administered Cognitive Behavioral Therapies have received the most empirical support to date. There is a paucity of research on pharmacological interventions in this patient population, and no firm treatment recommendations can be made in this area. Conclusions Given the high rate of relapse after treatment, evaluation of combined psychosocial and pharmacological interventions, and the development of novel intervention strategies are indi cated. PMID:19017028

Early Therapeutic Alliance and Treatment Outcome in Individual and Family Therapy for Adolescent Behavior Problems

ERIC Educational Resources Information Center

Hogue, Aaron; Dauber, Sarah; Stambaugh, Leyla Faw; Cecero, John J.; Liddle, Howard A.

2006-01-01

The impact of early therapeutic alliance was examined in 100 clients receiving either individual cognitive-behavioral therapy (CBT) or family therapy for adolescent substance abuse. Observational ratings of adolescent alliance in CBT and adolescent and parent alliance in family therapy were used to predict treatment retention (in CBT only) and…

Early weight gain predicts outcome in two treatments for adolescent anorexia nervosa.

PubMed

Le Grange, Daniel; Accurso, Erin C; Lock, James; Agras, Stewart; Bryson, Susan W

2014-03-01

Determine whether early weight gain predicts full remission at end-of-treatment (EOT) and follow-up in two different treatments for adolescent anorexia nervosa (AN), and to track the rate of weight gain throughout treatment and follow-up. Participants were 121 adolescents with AN (mean age = 14.4 years, SD = 1.6), from a two-site (Chicago and Stanford) randomized controlled trial. Adolescents were randomly assigned to family-based treatment (FBT) (n = 61) or individual adolescent focused therapy (AFT) (n = 60). Treatment response was assessed using percent of expected body weight (EBW) and the global score on the Eating Disorder Examination (EDE). Full remission was defined as having achieved ≥95% EBW and within one standard deviation of the community norms of the EDE. Full remission was assessed at EOT as well as 12-month follow-up. Receiver operating characteristic analyses showed that the earliest predictor of remission at EOT was a gain of 5.8 pounds (2.65 kg) by session 3 in FBT (area under the curve (AUC) = 0.670; p = .043), and a gain of 7.1 pounds (3.20 kg) by session 4 in AFT (AUC = 0.754, p = .014). Early weight gain did not predict remission at follow-up for either treatment. A survival analysis showed that weight was marginally superior in FBT as opposed to AFT (Wald chi-square = 3.692, df = 1, p = .055). Adolescents with AN who receive either FBT or AFT, and show early weight gain, are likely to remit at EOT. However, FBT is superior to AFT in terms of weight gain throughout treatment and follow-up. Copyright © 2013 Wiley Periodicals, Inc.

An Open Trial of Acceptance-based Separated Family Treatment (ASFT) for Adolescents with Anorexia Nervosa

PubMed Central

Timko, C. Alix; Zucker, Nancy L.; Herbert, James D.; Rodriguez, Daniel; Merwin, Rhonda M.

2016-01-01

Family based-treatments have the most empirical support in the treatment of adolescent anorexia nervosa; yet, a significant percentage of adolescents and their families do not respond to manualized family based treatment (FBT). The aim of this open trial was to conduct a preliminary evaluation of an innovative family-based approach to the treatment of anorexia: Acceptance-based Separated Family Treatment (ASFT). Treatment was grounded in Acceptance and Commitment Therapy (ACT), delivered in a separated format, and included an ACT-informed skills program. Adolescents (ages 12–18) with anorexia or sub-threshold anorexia and their families received 20 treatment sessions over 24 weeks. Outcome indices included eating disorder symptomatology reported by the parent and adolescent, percentage of expected body weight achieved, and changes in psychological acceptance/avoidance. Half of the adolescents (48.0%) met criteria for full remission at the end of treatment, 29.8% met criteria for partial remission, and 21.3% did not improve. Overall, adolescents had a significant reduction in eating disorder symptoms and reached expected body weight. Treatment resulted in changes in psychological acceptance in the expected direction for both parents and adolescents. This open trial provides preliminary evidence for the feasibility, acceptability, and efficacy of ASFT for adolescents with anorexia. Directions for future research are discussed. PMID:25898341

Treatment of sexually compulsive adolescents.

PubMed

Gerber, James

2008-12-01

We clarified the nature of sexual compulsivity in adolescence, addressed who is labeled as "sexually compulsive youth," conceptualized the underlying factors of sexual compulsivity, and outlined a treatment format. We focused on trauma, dissociation, attachment, and self-concept. We questioned the conventional perceptions of who is included in this group. We reiterated that the belief that sexually compulsive adolescents are abusive males is no longer considered accurate. The evolution and accessibility of the Internet only raises greater concerns about compulsive sexual behavior, as more adolescents are brought into therapy because of Internet use to seek sexual interaction or stimulation. The sexually compulsive youth is as likely to be the clean-cut, high-achieving, intelligent student as is the economically deprived, juvenile delinquent on the street. This article began with the observation that adolescents rarely receive any direct, accurate information about sexuality and intimacy. The messages taken in through music, television, movies, politicians, popular press, clergy, and school are polarizing and contradictory. Beyond this are the implications as to how we, as a society, treat the youths that do present with sexual behavior problems. We have tended to treat these youth (as well as adults) with disdain and to designate sexually abusive youth the same as adult offenders with harsher, more punitive treatment interventions. Research and clinical experience now strongly question this type of response. This article is consistent with this leaning. Early psychological injury, from sexual abuse, physical abuse, exposure to violence, attachment trauma, or early sexualization, is at the root of sexually compulsive behavior. While it is necessary to reign in out-of-control and destructive behaviors, if we acknowledge that the source of the behavior is psychological injury, then it is cruel and inconsistent to treat the individual with disdain or as a pariah. The

An open trial of Acceptance-based Separated Family Treatment (ASFT) for adolescents with anorexia nervosa.

PubMed

Timko, C Alix; Zucker, Nancy L; Herbert, James D; Rodriguez, Daniel; Merwin, Rhonda M

2015-06-01

Family based-treatments have the most empirical support in the treatment of adolescent anorexia nervosa; yet, a significant percentage of adolescents and their families do not respond to manualized family based treatment (FBT). The aim of this open trial was to conduct a preliminary evaluation of an innovative family-based approach to the treatment of anorexia: Acceptance-based Separated Family Treatment (ASFT). Treatment was grounded in Acceptance and Commitment Therapy (ACT), delivered in a separated format, and included an ACT-informed skills program. Adolescents (ages 12-18) with anorexia or sub-threshold anorexia and their families received 20 treatment sessions over 24 weeks. Outcome indices included eating disorder symptomatology reported by the parent and adolescent, percentage of expected body weight achieved, and changes in psychological acceptance/avoidance. Half of the adolescents (48.0%) met criteria for full remission at the end of treatment, 29.8% met criteria for partial remission, and 21.3% did not improve. Overall, adolescents had a significant reduction in eating disorder symptoms and reached expected body weight. Treatment resulted in changes in psychological acceptance in the expected direction for both parents and adolescents. This open trial provides preliminary evidence for the feasibility, acceptability, and efficacy of ASFT for adolescents with anorexia. Directions for future research are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Dysfunctional Attitudes Scale Perfectionism: A Predictor and Partial Mediator of Acute Treatment Outcome among Clinically Depressed Adolescents

ERIC Educational Resources Information Center

Jacobs, Rachel H.; Silva, Susan G.; Reinecke, Mark A.; Curry, John F.; Ginsburg, Golda S.; Kratochvil, Christopher J.; March, John S.

2009-01-01

The effect of perfectionism on acute treatment outcomes was explored in a randomized controlled trial of 439 clinically depressed adolescents (12-17 years of age) enrolled in the Treatment for Adolescents with Depression Study (TADS) who received cognitive behavior therapy (CBT), fluoxetine, a combination of CBT and FLX, or pill placebo. Measures…

A qualitative analysis of aspects of treatment that adolescents with anorexia identify as helpful.

PubMed

Zaitsoff, Shannon; Pullmer, Rachelle; Menna, Rosanne; Geller, Josie

2016-04-30

This study aimed to identify aspects of treatment that adolescents with anorexia nervosa (AN) believe are helpful or unhelpful. Adolescent females receiving treatment for AN or subthreshold AN (n=21) were prompted during semi-structured interviews to generate responses to open-ended questions on what they felt would be most helpful or unhelpful in treating adolescents with eating disorders. Eight codes were developed and the two most frequently endorsed categories were (1) Alliance, where the therapist demonstrates clinical expertise and also expresses interest in the patient (n=21, 100.0%), and (2) Client Involvement in treatment (n=16, 76.2%). These top two categories were shared by participants with AN versus subthreshold AN and participants with high versus low readiness to change their dietary restriction behaviours. Development of the coding scheme and sample participant responses will be discussed. The integration of identified factors into empirically supported treatments for adolescent AN, such as Family-based Treatment, will be considered. This study provides initial information regarding aspects of treatment that adolescents identify as most helpful or unhelpful in their treatment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Counseling Received by Adolescents Undergoing Voluntary Medical Male Circumcision: Moving Toward Age-Equitable Comprehensive Human Immunodeficiency Virus Prevention Measures.

PubMed

Kaufman, Michelle R; Patel, Eshan U; Dam, Kim H; Packman, Zoe R; Van Lith, Lynn M; Hatzold, Karin; Marcell, Arik V; Mavhu, Webster; Kahabuka, Catherine; Mahlasela, Lusanda; Njeuhmeli, Emmanuel; Seifert Ahanda, Kim; Ncube, Getrude; Lija, Gissenge; Bonnecwe, Collen; Tobian, Aaron A R

2018-04-03

The minimum package of voluntary medical male circumcision (VMMC) services, as defined by the World Health Organization, includes human immunodeficiency virus (HIV) testing, HIV prevention counseling, screening/treatment for sexually transmitted infections, condom promotion, and the VMMC procedure. The current study aimed to assess whether adolescents received these key elements. Quantitative surveys were conducted among male adolescents aged 10-19 years (n = 1293) seeking VMMC in South Africa, Tanzania, and Zimbabwe. We used a summative index score of 8 self-reported binary items to measure receipt of important elements of the World Health Organization-recommended HIV minimum package and the US President's Emergency Plan for AIDS Relief VMMC recommendations. Counseling sessions were observed for a subset of adolescents (n = 44). To evaluate factors associated with counseling content, we used Poisson regression models with generalized estimating equations and robust variance estimation. Although counseling included VMMC benefits, little attention was paid to risks, including how to identify complications, what to do if they arise, and why avoiding sex and masturbation could prevent complications. Overall, older adolescents (aged 15-19 years) reported receiving more items in the recommended minimum package than younger adolescents (aged 10-14 years; adjusted β, 0.17; 95% confidence interval [CI], .12-.21; P < .001). Older adolescents were also more likely to report receiving HIV test education and promotion (42.7% vs 29.5%; adjusted prevalence ratio [aPR], 1.53; 95% CI, 1.16-2.02) and a condom demonstration with condoms to take home (16.8% vs 4.4%; aPR, 2.44; 95% CI, 1.30-4.58). No significant age differences appeared in reports of explanations of VMMC risks and benefits or uptake of HIV testing. These self-reported findings were confirmed during counseling observations. Moving toward age-equitable HIV prevention services during adolescent VMMC likely requires

Counseling Received by Adolescents Undergoing Voluntary Medical Male Circumcision: Moving Toward Age-Equitable Comprehensive Human Immunodeficiency Virus Prevention Measures

PubMed Central

Kaufman, Michelle R; Patel, Eshan U; Dam, Kim H; Packman, Zoe R; Van Lith, Lynn M; Hatzold, Karin; Marcell, Arik V; Mavhu, Webster; Kahabuka, Catherine; Mahlasela, Lusanda; Njeuhmeli, Emmanuel; Seifert Ahanda, Kim; Ncube, Getrude; Lija, Gissenge; Bonnecwe, Collen; Tobian, Aaron A R

2018-01-01

Abstract Background The minimum package of voluntary medical male circumcision (VMMC) services, as defined by the World Health Organization, includes human immunodeficiency virus (HIV) testing, HIV prevention counseling, screening/treatment for sexually transmitted infections, condom promotion, and the VMMC procedure. The current study aimed to assess whether adolescents received these key elements. Methods Quantitative surveys were conducted among male adolescents aged 10–19 years (n = 1293) seeking VMMC in South Africa, Tanzania, and Zimbabwe. We used a summative index score of 8 self-reported binary items to measure receipt of important elements of the World Health Organization–recommended HIV minimum package and the US President’s Emergency Plan for AIDS Relief VMMC recommendations. Counseling sessions were observed for a subset of adolescents (n = 44). To evaluate factors associated with counseling content, we used Poisson regression models with generalized estimating equations and robust variance estimation. Results Although counseling included VMMC benefits, little attention was paid to risks, including how to identify complications, what to do if they arise, and why avoiding sex and masturbation could prevent complications. Overall, older adolescents (aged 15–19 years) reported receiving more items in the recommended minimum package than younger adolescents (aged 10–14 years; adjusted β, 0.17; 95% confidence interval [CI], .12–.21; P < .001). Older adolescents were also more likely to report receiving HIV test education and promotion (42.7% vs 29.5%; adjusted prevalence ratio [aPR], 1.53; 95% CI, 1.16–2.02) and a condom demonstration with condoms to take home (16.8% vs 4.4%; aPR, 2.44; 95% CI, 1.30–4.58). No significant age differences appeared in reports of explanations of VMMC risks and benefits or uptake of HIV testing. These self-reported findings were confirmed during counseling observations. Conclusions Moving toward age-equitable HIV

Major Depression in the National Comorbidity Survey- Adolescent Supplement: Prevalence, Correlates, and Treatment

PubMed Central

Avenevoli, Shelli; Swendsen, Joel; He, Jian-Ping; Burstein, Marcy; Merikangas, Kathleen

2015-01-01

Objective To present the 12-month prevalence of DSM-IV major depressive disorder (MDD) and severe MDD, examine sociodemographic correlates and comorbidity, and describe impairment and service utilization. Method Data are from the National Comorbidity Survey-Adolescent Supplement (NCS-A), a nationally representative survey of 10,123 adolescents aged 13 to 18 years that assesses DSM-IV disorders using the Composite International Diagnostic Interview (CIDI) Version 3.0. One parent or surrogate of each participating adolescent was also asked to complete a self-administered questionnaire. Results Lifetime and 12-month prevalence of MDD were 11.0% and 7.5%, respectively. The corresponding rates of severe MDD were 3.0% and 2.3%. The prevalence of MDD increased significantly across adolescence, with markedly greater increases among females than males. Most cases of MDD were associated with psychiatric comorbidity and severe role impairment, and a substantial minority reported suicidality. The prevalence of severe MDD was about a quarter of that of all MDD cases; estimates of impairment and clinical correlates were of 2- to 5-fold greater magnitude for severe versus mild/moderate depression, with markedly higher rates for suicidal thoughts and behaviors. Treatment in any form was received by the majority of adolescents with 12-month DSM-IV MDD (60.4%), but only a minority received treatment that was disorder-specific or from the mental health sector. Conclusion Findings underscore the important public health significance of depression among US adolescents and the urgent need to improve screening and treatment access in this population. PMID:25524788

Adolescent Experience of Psychotropic Treatment

PubMed Central

Floersch, Jerry; Townsend, Lisa; Longhofer, Jeffrey; Munson, Michelle; Winbush, Victoria; Kranke, Derrick; Faber, Rachel; Thomas, Jeremy; Jenkins, Janis H.; Findling, Robert L.

2009-01-01

Despite growing concern over the treatment of adolescents with psychiatric medications, little research has examined youth understandings and interpretations of mental illness and psychotropic treatment. This article reports the exploratory findings of semi-structured and open-ended interviews carried out with 20 adolescents diagnosed with one or more psychiatric disorders, and who were currently prescribed psychiatric medications. Grounded theory coding procedures were used to identify themes related to adolescent subjective experience with psychiatric medications. The categories identified are interpreted as different points of view through which adolescents understand and take action upon their illness concerns; their need for medication treatment; their perceptions of how medications work; their responses to parental and other influences upon medication treatment; and, their everyday management activities. PMID:19293284

Determinants of Adult Functional Outcome in Adolescents Receiving Special Educational Assistance

ERIC Educational Resources Information Center

McGeown, H. R.; Johnstone, E. C.; McKirdy, J.; Owens, D. C.; Stanfield, A. C.

2013-01-01

Background: This study investigates the role of IQ, autistic traits and challenging behaviours in affecting adult outcomes among adolescents who receive special educational assistance. Methods: A total of 58 participants were recruited from an ongoing longitudinal study. All received assessments of IQ, behavioural patterns (using the Childhood…

Treatment Utilization Among Adolescent Substance Users: Findings from the 2002 to 2013 National Survey on Drug Use and Health.

PubMed

Haughwout, Sarah P; Harford, Thomas C; Castle, I-Jen P; Grant, Bridget F

2016-08-01

Adolescent substance users face serious health and social consequences and benefit from early diagnosis and treatment. The objectives of this study were to observe trends in treatment utilization; examine correlates of treatment utilization and treatment types/settings among adolescent substance users with and without substance use disorder (SUD); and assess gender differences. National Survey on Drug Use and Health data were pooled across 2002 to 2013, with a combined sample of 79,885 past-year substance users ages 12 to 17 (17,510 with SUD and 62,375 without SUD). Treatment was defined as receiving treatment or counseling for use of alcohol or any drug, not counting cigarettes. Trends were assessed by joinpoint linear regression, and multivariable logistic regression assessed odds ratios of treatment utilization. Percentages of past-year treatment use did not change in 2002 to 2013. Treatment utilization was more prevalent among adolescents with SUD than without (11.4% vs. 1.4%) and among males than females. Among adolescents with and without SUD, criminal justice involvement and perceiving a need for treatment increased adolescent treatment utilization, while SUDs other than alcohol abuse, older age, and talking to parents increased treatment use among adolescents with SUD, and polysubstance use and male gender increased treatment among those without SUD. Treatment gaps persisted among non-Hispanic Blacks for both groups with and without SUD, male Hispanics with SUD, female non-Hispanic Asians without SUD, and private insurance coverages. Gender differences were observed in SUD, race/ethnicity, and insurance coverage. Most adolescents received treatment for both alcohol and drug use, and self-help group and outpatient rehabilitation facility were the most used treatment settings. Treatment utilization among adolescents with past-year substance use remained low and unimproved in 2002 to 2013. Treatment gaps among minority populations, insurance coverage, and in

Reduced school dropout rates among adolescent mothers receiving school-based prenatal care.

PubMed

Barnet, Beth; Arroyo, Carmen; Devoe, Margo; Duggan, Anne K

2004-03-01

Adolescent pregnancy is associated with increased school dropout rates. Dropping out amplifies the probability of persistent social and economic disadvantage. Whether school-based health centers might help reduce school absenteeism and dropout rates in this group has not been well studied. To examine the association of school-based prenatal services on school attendance and dropout rates. In this retrospective cohort study, using school rosters from an alternative school, we identified adolescents aged 18 years or younger who delivered a baby between July 1, 1995, and August 30, 1997, in Baltimore, Md. We linked school records spanning 3 years with medical records and birth certificates. School variables such as attendance and dropout rates were examined in relation to the teen's year of pregnancy and prenatal care setting (school-based vs non-school-based). Hierarchical logistic regression was used to examine effects of school-based prenatal care on dropout and promotion or graduation rates, with adjustment for baseline group differences. We identified 431 predominantly African American, low-income adolescents who attended the alternative school in their pregnancy school year. In the year prior to pregnancy, most performed poorly in school and had significant absenteeism. During their pregnancy school year, teens receiving school-based prenatal care were absent 12 fewer days, as compared with those receiving non-school-based care (P =.001), and their dropout rate was half that of those receiving non-school-based care (6% vs 15%; P =.02). Hierarchical logistic regression analyses, with adjustment for baseline prepregnancy differences, demonstrated that teens receiving school-based prenatal care were less likely to drop out of school during the pregnancy year (adjusted odds ratio, 0.39; 95% confidence interval, 0.15-0.99; P =.048). Absenteeism and dropout rates were reduced for pregnant adolescents receiving prenatal care at a school-based health center in an urban

EEG neurofeedback effects in the treatment of adolescent anorexia nervosa.

PubMed

Lackner, Nina; Unterrainer, Human-Friedrich; Skliris, Dimitris; Shaheen, Sandra; Dunitz-Scheer, Marguerite; Wood, Guilherme; Scheer, Peter Jaron Zwi; Wallner-Liebmann, Sandra Johanna; Neuper, Christa

2016-01-01

A pre-post design including 22 females was used to evaluate the effectiveness of neurofeedback in the treatment of adolescent anorexia nervosa. Resting EEG measures and a psychological test-battery assessing eating behavior traits, clinical symptoms, emotionality, and mood were obtained. While both the experimental (n = 10) and control group (n = 12) received their usual maintenance treatment, the experimental group received 10 sessions of individual alpha frequency training over a period of 5 weeks as additional treatment. Significant training effects were shown in eating behavior traits, emotion regulation, and in relative theta power in the eyes closed condition. Although the results are limited due to the small sample size, these are the first empirical data demonstrating the benefits of neurofeedback as a treatment adjunct in individuals with anorexia nervosa.

Effects of a psychological intervention on the quality of life of obese adolescents under a multidisciplinary treatment.

PubMed

Freitas, Camila R M; Gunnarsdottir, Thrudur; Fidelix, Yara L; Tenório, Thiago R S; Lofrano-Prado, Mara C; Hill, James O; Prado, Wagner L

To investigate the effects of multidisciplinary treatment with and without psychological counseling on obese adolescents' self-reported quality of life. Seventy-six obese adolescents (15.87±1.53 y) were allocated into psychological counseling group (PCG; n=36) or control group (CG; n=40) for 12 weeks. All participants received the same supervised exercise training, nutritional and clinical counseling. Participants in PCG also received psychological counseling. QOL was measured before and after 12 weeks of intervention by Generic Questionnaire for the Evaluation of Quality of Life (SF-36). The dropout rate was higher in GC (22.5%) when compared with PCG (0.0%) (p<0.001). After 12 weeks, participants from PCG presents lower body weight, relative fat mass and higher free fat mass (p<0.001 for all) compared to GC. QOL improved among adolescents from both groups (p<0.05), however, a better QOL was reported from those adolescents enrolled in PCG. The inclusion of a psychological counseling component in multidisciplinary treatment for adolescent obesity appears to provide benefits observed for improved QOL as compared with treatment without psychological counseling. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Who receives cannabis use offers: A general population study of adolescents.

PubMed

Burdzovic Andreas, Jasmina; Pape, Hilde

2015-11-01

Drug use is predicated on a combination of "willingness" and "opportunity". That is, independent of any desire to use drugs, a drug use opportunity is required; be it indirect (i.e., being in a drug-use setting) or direct (i.e., receiving a direct drug offer). However, whether some youth are more likely to encounter such direct drug use opportunities is not fully known. We examined whether certain characteristics placed adolescents at greater risk for being offered cannabis, after accounting for a number of demographic-, contextual-, interpersonal-, and personal-level risk factors. We utilized data from a Norwegian school survey (n=19,309) where the likelihood of receiving cannabis offer in the past year was estimated using logistic regression models. Substantive focus was on the individual and combined effects of personal (i.e., delinquency) and interpersonal (i.e., cannabis-using close friend) risk factors. Separate models were fit for middle- and high-school students. Delinquency was a significant risk factor for receiving cannabis offers, as was a cannabis-using best friend. In addition, peer cannabis use increased the risk of cannabis offers mostly for adolescents on the lower delinquency spectrum, but less so for highly delinquent adolescents. These interaction effects were primarily driven by the middle-school cohort. Cannabis offers were more likely to be extended to youth of certain high-risk profiles. Targeted prevention strategies can therefore be extended to a general profile of younger adolescents with externalizing problems and cannabis-using peers. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Efficacy of three treatment protocols for adolescents with social anxiety disorder: a 5-year follow-up assessment.

PubMed

Garcia-Lopez, Luis-Joaquin; Olivares, Jose; Beidel, Deborah; Albano, Anne-Marie; Turner, Samuel; Rosa, Ana I

2006-01-01

Few studies have reported long-term follow-up data in adults and even fewer in adolescents. The purpose of this work is to report on the longest follow-up assessment in the literature on treatments for adolescents with social phobia. A 5-year follow-up assessment was conducted with subjects who originally received either Cognitive Behavioral Group Therapy for Adolescents (CBGT-A), Social Effectiveness Therapy for Adolescents--Spanish version (SET-Asv), or Intervención en Adolescentes con Fobia Social--Treatment for Adolescents with Social Phobia (IAFS) in a controlled clinical trial. Twenty-three subjects completing the treatment conditions were available for the 5-year follow-up. Results demonstrate that subjects treated either with CBGT-A, SET-Asv and IAFS continued to maintain their gains after treatments were terminated. Either the CBGT-A, SET-Asv and IAFS can provide lasting effects to the majority of adolescents with social anxiety. Issues that may contribute to future research and clinical implications are discussed.

Food addiction in overweight and obese adolescents seeking weight-loss treatment.

PubMed

Meule, Adrian; Hermann, Tina; Kübler, Andrea

2015-05-01

Some forms of overeating closely resemble addictive behaviour. The Yale Food Addiction Scale (YFAS) was developed to measure such addiction-like eating in humans and has been employed in numerous studies for examining food addiction in adults. Yet, little is known about food addiction in children and adolescents. Fifty adolescents were recruited at the beginning of treatment in a weight-loss hospital and completed the YFAS among other questionnaires. Nineteen participants (38%) received a YFAS diagnosis, who did not differ in age, body mass and gender distribution from those not receiving a diagnosis. However, those with food addiction reported more binge days, more frequent food cravings, higher eating, weight and shape concerns, more symptoms of depression and higher attentional and motor impulsivity. Eating restraint and nonplanning impulsivity did not differ between groups. Results replicate findings from studies in obese adults such that food addiction is not related to age, gender, body mass or eating restraint, but to higher eating pathology, more symptoms of depression and higher impulsivity. Furthermore, results highlight that particularly attentional impulsivity is related to 'food addiction'. Addiction-like eating appears to be a valid phenotype in a substantial subset of treatment-seeking, obese adolescents. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

Adolescent Community Reinforcement Approach implementation and treatment outcomes for youth with opioid problem use.

PubMed

Godley, Mark D; Passetti, Lora L; Subramaniam, Geetha A; Funk, Rodney R; Smith, Jane Ellen; Meyers, Robert J

2017-05-01

This paper compares adolescents with primary opioid problem use (OPU) to those with primary marijuana or alcohol problem use (MAPU) who received up to six months of Adolescent Community Reinforcement Approach (A-CRA), an empirically supported treatment. Intake clinical characteristics, treatment implementation measures, and clinical outcomes of two substance problem groups (OPU and MAPU) were compared using data from 1712 adolescents receiving A-CRA treatment. Data were collected at intake and 3, 6, and 12 months post-intake. At intake, adolescents in the OPU group were more likely than those in the MAPU group to be Caucasian, older, female, and not attending school; report greater substance and mental health problems; and engage in social and health risk behaviors. There was statistical equivalence between groups in rates of A-CRA treatment initiation, engagement, retention, and satisfaction. Both groups decreased significantly on most substance use outcomes, with the OPU group showing greater improvement; however, the OPU group had more severe problems at intake and continued to report higher frequency of opioid use and more days of emotional problems and residential treatment over 12 months. The feasibility and acceptability of A-CRA for OPUs was demonstrated. Despite significantly greater improvement by the OPU group, they did not improve to the level of the MAPU group over 12 months, suggesting that they may benefit from A-CRA continuing care up to 12 months, medication to address opioid withdrawal and craving, and the inclusion of opioid-focused A-CRA procedures. Copyright © 2017 Elsevier B.V. All rights reserved.

Effectiveness of the Treatment Readiness and Induction Program for increasing adolescent motivation for change.

PubMed

Becan, Jennifer E; Knight, Danica K; Crawley, Rachel D; Joe, George W; Flynn, Patrick M

2015-03-01

Success in substance abuse treatment is improved by problem recognition, desire to seek help, and readiness to engage in treatment, all of which are important aspects of motivation. Interventions that facilitate these at treatment induction for adolescents are especially needed. The purpose of this study is to assess the effectiveness of TRIP (Treatment Readiness and Induction Program) in promoting treatment motivation. Data represent 519 adolescents from 6 residential programs who completed assessments at treatment intake (time 1) and 35 days after admission (time 2). The design consisted of a comparison sample (n=281) that had enrolled in treatment prior to implementation of TRIP (standard operating practice) and a sample of clients that had entered treatment after TRIP began and received standard operating practice enhanced by TRIP (n=238). Repeated measures ANCOVAs were conducted using each time 2 motivation scale as a dependent measure. Motivation scales were conceptualized as representing sequential stages of change. LISREL was used to test a structural model involving TRIP participation, gender, drug use severity, juvenile justice involvement, age, race-ethnicity, prior treatment, and urgency as predictors of the stages of treatment motivation. Compared to standard practice, adolescents receiving TRIP demonstrated greater gains in problem recognition, even after controlling for the other variables in the model. The model fit was adequate, with TRIP directly affecting problem recognition and indirectly affecting later stages of change (desire for help and treatment readiness). Future studies should examine which specific components of TRIP affect change in motivation. Copyright © 2015 Elsevier Inc. All rights reserved.

Effectiveness of the Treatment Readiness and Induction Program for Increasing Adolescent Motivation for Change

PubMed Central

Becan, Jennifer E.; Knight, Danica K.; Crawley, Rachel D.; Joe, George W.; Flynn, Patrick M.

2014-01-01

Success in substance abuse treatment is improved by problem recognition, desire to seek help, and readiness to engage in treatment, all of which are important aspects of motivation. Interventions that facilitate these at treatment induction for adolescents are especially needed. The purpose of this study is to assess the effectiveness of TRIP (Treatment Readiness and Induction Program) in promoting treatment motivation. Data represent 519 adolescents from 6 residential programs who completed assessments at treatment intake (Time 1) and 35 days after admission (Time 2). The design consisted of a comparison sample (n = 281) that had enrolled in treatment prior to implementation of TRIP (standard operating practice) and a sample of clients that had entered treatment after TRIP began and received standard operating practice enhanced by TRIP (n = 238). Repeated measures ANCOVAs were conducted using each Time 2 motivation scale as a dependent measure. Motivation scales were conceptualized as representing sequential stages of change. LISREL was used to test a structural model involving TRIP participation, gender, drug use severity, juvenile justice involvement, age, race-ethnicity, prior treatment, and urgency as predictors of the stages of treatment motivation. Compared to standard practice, adolescents receiving TRIP demonstrated greater gains in problem recognition, even after controlling for the other variables in the model. The model fit was adequate, with TRIP directly affecting problem recognition and indirectly affecting later stages of change (desire for help and treatment readiness). Future studies should examine which specific components of TRIP affect change in motivation. PMID:25456094

Dynamic effects among patients' treatment needs, beliefs, and utilization: a prospective study of adolescents in drug treatment.

PubMed

Schell, Terry L; Orlando, Maria; Morral, Andrew R

2005-08-01

To document the prospective, reciprocal relationships among substance use problems, utilization of drug treatment, and predisposing beliefs thought to increase treatment utilization. Persistent Effects of Treatment Study-Adolescent (PETS-A), conducted by the Center on Substance Abuse Treatment. This was a longitudinal study of youths originally participating in one of two CSAT studies; one sample included 476 youths receiving residential drug treatment, and the other included 519 youths receiving outpatient treatment. This study uses five waves of data collected over a 12-month period to examine the temporal relationships among four variables: treatment dose, substance use problems, drug resistance self-efficacy, and perceived need for treatment (PNT). Data from this longitudinal study were analyzed using cross-lagged panel models, and structural equation modeling techniques were used to estimate the prospective, reciprocal relationships among these four variables in each of the two samples, while controlling for several covariates. Both PNT and low drug resistance self-efficacy led to higher levels of subsequent treatment. However, low self-efficacy presaged increases in drug problems while PNT predicted decreases. Understanding the role of psychological variables in the utilization of health services is complicated for psychological disorders because beliefs that affect treatment can also influence the disorder itself. Efforts to keep adolescents in drug treatment should focus on convincing youth that treatment can help them with their problems, rather than convincing them that they cannot resist drugs on their own. While both messages increase treatment utilization, the latter belief undermines the effects of treatment.

Dynamic Effects among Patients' Treatment Needs, Beliefs, and Utilization: A Prospective Study of Adolescents in Drug Treatment

PubMed Central

Schell, Terry L; Orlando, Maria; Morral, Andrew R

2005-01-01

Objective To document the prospective, reciprocal relationships among substance use problems, utilization of drug treatment, and predisposing beliefs thought to increase treatment utilization. Data Source Persistent Effects of Treatment Study-Adolescent (PETS-A), conducted by the Center on Substance Abuse Treatment. This was a longitudinal study of youths originally participating in one of two CSAT studies; one sample included 476 youths receiving residential drug treatment, and the other included 519 youths receiving outpatient treatment. Study Design This study uses five waves of data collected over a 12-month period to examine the temporal relationships among four variables: treatment dose, substance use problems, drug resistance self-efficacy, and perceived need for treatment (PNT). Data from this longitudinal study were analyzed using cross-lagged panel models, and structural equation modeling techniques were used to estimate the prospective, reciprocal relationships among these four variables in each of the two samples, while controlling for several covariates. Principal Findings Both PNT and low drug resistance self-efficacy led to higher levels of subsequent treatment. However, low self-efficacy presaged increases in drug problems while PNT predicted decreases. Conclusions Understanding the role of psychological variables in the utilization of health services is complicated for psychological disorders because beliefs that affect treatment can also influence the disorder itself. Efforts to keep adolescents in drug treatment should focus on convincing youth that treatment can help them with their problems, rather than convincing them that they cannot resist drugs on their own. While both messages increase treatment utilization, the latter belief undermines the effects of treatment. PMID:16033496

Gambling-Related Attitudes and Behaviors in Adolescents Having Received Instant (Scratch) Lottery Tickets as Gifts

PubMed Central

Kundu, Priya V.; Pilver, Corey E.; Desai, Rani A.; Steinberg, Marvin A.; Rugle, Loreen; Krishnan-Sarin, Suchitra; Potenza, Marc N.

2012-01-01

Objective Instant (scratch) lottery ticket gambling is popular among adolescents. Prior research has not determined whether adolescents’ gambling behavior and attitudes toward gambling are influenced by the receipt of scratch lottery tickets as gifts. Method Cross-sectional survey data from 2,002 Connecticut high school students with past-year gambling were analyzed using bivariate approaches and logistic regression analyses. Interactions between gambling-problem severity and lottery-gift status were examined in relation to multiple outcomes. Results Adolescents who received a scratch lottery ticket as a gift compared with those who did not were more likely to report features of problem gambling, buy scratch lottery tickets for themselves, and buy and receive other types of lottery tickets; they were also less likely to report parental disapproval of gambling and to see gambling prevention efforts as important. Later (≥15 years) age-at-gambling-onset was inversely linked to gambling-problem severity in the lottery gift group (odds ratio [OR] = .38) but not in the nongift group (OR = .91), yielding a significant severity by gift status interaction. Other academic, health, and gambling-related correlates of gambling-problem severity were similar in the gift and nongift groups. Conclusions For adolescents, the receipt of scratch lottery tickets as gifts during childhood or adolescence was associated with risky/problematic gambling and with gambling-related attitudes, behaviors, and views suggesting greater gambling acceptability. The extent to which the receipt of scratch lottery tickets may promote gambling behaviors and the development of gambling problems warrants consideration. Education, prevention, and treatment strategies should incorporate findings relating to receipt of gambling products by underage individuals. PMID:23299004

Comprehensive obesity evaluation and treatment of three adolescents: a case series.

PubMed

Taylor, Sharonda J Alston; Peterson, Mitchell A; Garland, Beth H; Hastings, Elisabeth S

2016-02-01

Adolescent obesity is a chronic disease that is impacted from each patient's biopsychosocial milieu. Successfully treating pediatric obesity requires long-term, innovative, systematic involvement to facilitate patient and family engagement and change. Extensive chart review was done for three obese adolescents who underwent comprehensive weight management in an adolescent clinic seen within the past 5 years. The charts were reviewed starting from the time of initial contact through the last visit in the clinic. The patients are no longer receiving care within the clinic. The patients presented with BMI>99th percentile, family history of obesity, severe psychosocial stressors, and multiple obesity-related comorbidities. Their treatment involved comprehensive multidisciplinary intervention in an adolescent weight management clinic within a tertiary care center. In addition to rigorous support through frequent office visits, these patients all eventually required temporary, alternative living arrangements to successfully implement recommendations. One patient resided with another family member; two went to inpatient weight management program care for 2-3 months. All subjects successfully lost weight when away from their primary residence, and they demonstrated improvement or resolution of comorbidities. This case series of three adolescents who underwent comprehensive obesity evaluation and treatment demonstrates multidisciplinary care across interconnected treatment programs and active engagement of family. Those who maintained successful weight loss reduced sedentary time, demonstrated family support (e.g., key members attending follow-up visits), and altered their living environment and were committed to their own health goals.

Suicidal events in the Treatment for Adolescents With Depression Study (TADS).

PubMed

Vitiello, Benedetto; Silva, Susan G; Rohde, Paul; Kratochvil, Christopher J; Kennard, Betsy D; Reinecke, Mark A; Mayes, Taryn L; Posner, Kelly; May, Diane E; March, John S

2009-04-21

The Treatment for Adolescents with Depression Study (TADS) database was analyzed to determine whether suicidal events (attempts and ideation) occurred early in treatment, could be predicted by severity of depression or other clinical characteristics, and were preceded by clinical deterioration or symptoms of increased irritability, akathisia, sleep disruption, or mania. TADS was a 36-week randomized, controlled clinical trial of pharmacologic and psychotherapeutic treatments involving 439 youths with major depressive disorder (DSM-IV criteria). Suicidal events were defined according to the Columbia Classification Algorithm of Suicidal Assessment. Patients were randomly assigned into the study between spring 2000 and summer 2003. Forty-four patients (10.0%) had at least 1 suicidal event (no suicide occurred). Events occurred 0.4 to 31.1 weeks (mean +/- SD = 11.9 +/- 8.2) after starting TADS treatment, with no difference in event timing for patients receiving medication versus those not receiving medication. Severity of self-rated pretreatment suicidal ideation (Suicidal Ideation Questionnaire adapted for adolescents score > or = 31) and depressive symptoms (Reynolds Adolescent Depression Scale score > or = 91) predicted occurrence of suicidal events during treatment (P < .05). Patients with suicidal events were on average still moderately ill prior to the event (mean +/- SD Clinical Global Impressions-Severity of Illness scale score = 4.0 +/- 1.3) and only minimally improved (mean +/- SD Clinical Global Impressions-Improvement scale score = 3.2 +/- 1.1). Events were not preceded by increased irritability, akathisia, sleep disturbance, or manic signs. Specific interpersonal stressors were identified in 73% of cases (N = 44). Of the events, 55% (N = 24) resulted in overnight hospitalization. Most suicidal events occurred in the context of persistent depression and insufficient improvement without evidence of medication-induced behavioral activation as a precursor

Dysfunctional Attitudes Scale Perfectionism: A Predictor and Partial Mediator of Acute Treatment Outcome among Clinically Depressed Adolescents

PubMed Central

Jacobs, Rachel H.; Silva, Susan G.; Reinecke, Mark A.; Curry, John F.; Ginsburg, Golda S.; Kratochvil, Christopher J.; March, John S.

2009-01-01

The effect of perfectionism on acute treatment outcomes was explored in a randomized controlled trial of 439 clinically depressed adolescents (12–17 years of age) enrolled in the Treatment for Adolescents with Depression Study (TADS) who received cognitive behavior therapy (CBT), fluoxetine, a combination of CBT and FLX, or pill placebo. Measures included the Children’s Depression Rating Scale–Revised, the Suicidal Ideation Questionnaire–Grades 7–9, and the perfectionism subscale from the Dysfunctional Attitudes Scale (DAS). Predictor results indicate that adolescents with higher versus lower DAS perfectionism scores at baseline, regardless of treatment, continued to demonstrate elevated depression scores across the acute treatment period. In the case of suicidality, DAS perfectionism impeded improvement. Treatment outcomes were partially mediated by the change in DAS perfectionism across the 12-week period. PMID:20183664

Treatment of PCOS in adolescence.

PubMed

Warren-Ulanch, Julia; Arslanian, Silva

2006-06-01

Polycystic ovary syndrome (PCOS) is increasingly being recognized in adolescent girls seeking treatment for signs and symptoms of hyperandrogenism. It is difficult to diagnose PCOS in adolescents, therefore a high index of suspicion is necessary. Timely screening and treatment are crucial because another important component of the syndrome is insulin resistance/hyperinsulinemia increasing the risk for type 2 diabetes, dyslipidemia, and cardiovascular sequelae. Diagnosis of PCOS in adolescents should include a thorough family history, exclusion of other causes of hyperandrogenism, and appropriate laboratory evaluation. The scarcity of controlled clinical trials makes treatment controversial. Therapeutic options include lifestyle intervention, oral contraceptive pills, and insulin sensitizers. Long-term follow-up is needed to determine the effectiveness of these approaches in changing the natural history of the reproductive and metabolic outcomes without causing undue harm.

Behavioural treatment of non-compliance in adolescents with newly acquired spinal cord injuries.

PubMed

Gorski, Jo Anne; Slifer, Keith J; Townsend, Vanessa; Kelly-Suttka, Jennifer; Amari, Adrianna

2005-01-01

To demonstrate the efficacy of using differential reinforcement to treat non-compliance in adolescents with spinal cord injury. A case series design was used to examine three adolescents (aged 14-16 years) with tetraplegia who received multi-disciplinary rehabilitation treatment and a behavioural contract programme during an in-patient hospital admission. Assessment included collecting data on each patient's weekly percentage of compliance with all rehabilitation goals, weekly percentage of negative affect observed in therapy sessions and scores on a measure of mobility in physical therapy. Compliance with rehabilitation demands improved from a baseline of 20-65% to 80% or greater after the patients received differential reinforcement for participating in the rehabilitation regimen. Patients exhibited less anger, sadness and frustration during therapy sessions once contracts were started. The adolescents demonstrated greater compliance after the implementation of a behavioural contract. Future studies should identify the specific variables that affect psychological adjustment and predict 'readiness' to participate in rehabilitation.

Changes in tobacco use among adolescent smokers in substance abuse treatment.

PubMed

Shelef, Karni; Diamond, Guy S; Diamond, Gary M; Myers, Mark G

2009-06-01

Adolescents with substance use disorders (SUDs) smoke cigarettes more than youth in the general population. Little is known about changes in smoking patterns during and after outpatient SUD treatment. We examined whether receiving SUD treatment had a differential impact on cigarette smoking behaviors of mild (<10 cigarettes per day [CPD]), moderate (10-19 CPD), and heavy (>or=20 CPD) smokers (smoked on >or=60 days in the past 90). Our sample included 378 adolescents from the Cannabis Youth Treatment study, who were assessed at intake, and after 3, 6, 9, and 12 months. Results indicate that after controlling for the effect of changes in cannabis use, mild smokers decreased days of smoking during treatment and follow-up, whereas moderate and heavy smokers demonstrated a small decrease over treatment, and no change over follow-up. Heavy smokers demonstrated a slight decrease in CPD during the treatment phase. These results suggest that, whereas cigarette smoking may decrease for mild smokers while in SUD treatment, the addition of specialized smoking interventions may be necessary to effect change in cigarette smoking for moderate and heavy smokers. Copyright (c) 2009 APA, all rights reserved.

Treatment motivation among caregivers and adolescents with substance use disorders

PubMed Central

Cornelius, T.; Earnshaw, V. A.; Menino, D.; Bogart, L. M.; Levy, S.

2017-01-01

Substance use disorders (SUDs) in adolescence have negative long-term health effects, which can be mitigated through successful treatment. Caregivers play a central role in adolescent treatment involvement; however, studies have not examined treatment motivation and pressures to enter treatment in caregiver/adolescent dyads. Research suggests that internally motivated treatment (in contrast to coerced treatment) tends to lead to better outcomes. We used Self-Determination Theory (SDT) to examine intersecting motivational narratives among caregivers and adolescents in SUD treatment. Relationships between motivation, interpretation of caregiver pressures, adolescent autonomy, and relatedness were also explored. Adolescents in SUD treatment and their caregivers (NDyads = 15) were interviewed about treatment experiences. Interviews were coded for treatment motivation, including extrinsic (e.g., motivated by punishment), introjected (e.g., motivated by guilt), and identified/integrated motivation (e.g., seeing a behavior as integral to the self). Internalization of treatment motivation, autonomy support/competence (e.g., caregiver support for adolescent decisions), and relatedness (e.g., acceptance and support) were also coded. Four dyadic categories were identified: agreement that treatment was motivated by the adolescent (intrinsic); agreement that treatment was motivated by the caregiver (extrinsic); agreement that treatment was motivated by both, or a shift towards adolescent control (mixed/transitional); and disagreement (adolescents and caregivers each claimed they motivated treatment; conflicting). Autonomy support and relatedness were most prominent in intrinsic dyads, and least prominent in extrinsic dyads. The mixed/transitional group was also high in autonomy support and relatedness. The extrinsic group characterized caregiver rules as an unwelcome mechanism for behavioral control; caregivers in the other groups saw rules as a way to build adolescent

Treatment motivation among caregivers and adolescents with substance use disorders.

PubMed

Cornelius, T; Earnshaw, V A; Menino, D; Bogart, L M; Levy, S

2017-04-01

Substance use disorders (SUDs) in adolescence have negative long-term health effects, which can be mitigated through successful treatment. Caregivers play a central role in adolescent treatment involvement; however, studies have not examined treatment motivation and pressures to enter treatment in caregiver/adolescent dyads. Research suggests that internally motivated treatment (in contrast to coerced treatment) tends to lead to better outcomes. We used Self-determination theory (SDT) to examine intersecting motivational narratives among caregivers and adolescents in SUD treatment. Relationships between motivation, interpretation of caregiver pressures, adolescent autonomy, and relatedness were also explored. Adolescents in SUD treatment and their caregivers (N Dyads =15) were interviewed about treatment experiences. Interviews were coded for treatment motivation, including extrinsic (e.g., motivated by punishment), introjected (e.g., motivated by guilt), and identified/integrated motivation (e.g., seeing a behavior as integral to the self). Internalization of treatment motivation, autonomy support/competence (e.g., caregiver support for adolescent decisions), and relatedness (e.g., acceptance and support) were also coded. Four dyadic categories were identified: agreement that treatment was motivated by the adolescent (intrinsic); agreement that treatment was motivated by the caregiver (extrinsic); agreement that treatment was motivated by both, or a shift towards adolescent control (mixed/transitional); and disagreement (adolescents and caregivers each claimed they motivated treatment; conflicting). Autonomy support and relatedness were most prominent in intrinsic dyads, and least prominent in extrinsic dyads. The mixed/transitional group was also high in autonomy support and relatedness. The extrinsic group characterized caregiver rules as an unwelcome mechanism for behavioral control; caregivers in the other groups saw rules as a way to build adolescent

Treatment planning: A key milestone to prevent treatment dropout in adolescents with borderline personality disorder.

PubMed

Desrosiers, Lyne; Saint-Jean, Micheline; Breton, Jean-Jacques

2015-06-01

The aim of this study was to gain a broader appreciation of processes involved in treatment dropout in adolescents with borderline personality disorder (BPD). A constructivist grounded theory was chosen using a multiple-case research design with three embedded levels of analysis (adolescent, parent, and care setting). Theoretical sampling and the different stages of analysis specific to grounded theory were performed according to the iterative process of constant comparative analysis. Twelve cases were examined (nine dropouts among adolescents with BPD and for the purpose of falsification, one dropout of suicidal adolescent without BPD and two completed treatments among adolescents with BPD). To document the cases, three groups of informants were recruited (adolescents, parents, and therapists involved in the treatment) and 34 interviews were conducted. Psychological characteristics, perception of mental illness and mental health care, and help-seeking context were the specific treatment dropout vulnerabilities identified in adolescents with BPD and in their parents. However, their disengagement became an issue only when care-setting response--including mitigation of accessibility problems, adaptation of services to needs of adolescents with BPD, preparation for treatment, and concern for clinicians' disposition to treat--was ill-suited to these treatment dropout vulnerabilities. Treatment planning proves to be a key milestone to properly engage adolescents with BPD and their parent. Systematic assessment of treatment dropout vulnerabilities before the intervention plan is laid out could foster better-suited responses of the care setting thus decreasing the incidence of treatment discontinuation in adolescents with BPD. Treatment dropout vulnerabilities specific to adolescents with BPD and their parents can be detected before the beginning of treatment. Premature treatment termination may be prevented if the care setting considers these vulnerabilities at treatment

[Diagnosis and treatment of child and adolescent depression].

PubMed

Bunge, Eduardo L; Carrea, Gabriela; Tosas de Molina, Mar; Soto, Natalie

2011-01-01

The present paper reviews the available literature on the current state of knowledge regarding depression in children and adolescents. Empirically supported psychotherapeutic treatment adjustments for children are described, such as the Self-Control Therapy (CBT), Penn Prevention Program; and other treatments that are experimental phase. Similarly empirically supported psychotherapeutic treatment adjustments for adolescents are described, such as Adolescent Coping with Depression, Interpersonal Psychotherapy; and other treatments that are experimental phase as Biblotherapy and Attachment-Based Family Therapy.

[AIT (Adolescent Identity Treatment) - an Integrative Treatment Model for the Treatment of Personality Disorders].

PubMed

Schlüter-Müller, Susanne

2017-07-01

AIT (Adolescent Identity Treatment) - an Integrative Treatment Model for the Treatment of Personality Disorders Personality disorders are patterns of maladaptive personality traits that have an impact on the individual throughout the life span. Borderline Personality Disorder (BPD) is a very severe, but treatable mental disorder. Identity disturbance is seen as the central construct for detecting severe personality pathology - and, most notably, borderline personality disorder - in adults and adolescents. Crises in the development of identity usually resolve into a normal and consolidated identity with flexible and adaptive functioning whereas identity diffusion is viewed as a lack of integration of the concept of the self and significant others. It is seen as the basis for subsequent personality pathology, including that of borderline personality disorder. Although BPD has its onset in adolescence and emerging adulthood the diagnosis is often delayed. In most cases, specific treatment is only offered late in the course of the disorder and to relatively few individuals. Adolescent Identity Treatment (AIT) is a treatment model that focuses on identity pathology as the core characteristic of personality disorders. This model integrates specific techniques for the treatment of adolescent personality pathology on the background of object-relation theories and modified elements of Transference-Focused Psychotherapy. Moreover, psychoeducation, a behavior-oriented homeplan and intensive family work is part of AIT.

Daily Spiritual Experiences and Adolescent Treatment Response

PubMed Central

LEE, MATTHEW T.; VETA, PAIGE S.; JOHNSON, BYRON R.; PAGANO, MARIA E.

2014-01-01

The purpose of this study is to explore changes in belief orientation during treatment and the impact of increased daily spiritual experiences (DSE) on adolescent treatment response. One-hundred ninety-five adolescents court-referred to a 2-month residential treatment program were assessed at intake and discharge. Forty percent of youth who entered treatment as agnostic or atheist identified themselves as spiritual or religious at discharge. Increased DSE was associated with greater likelihood of abstinence, increased prosocial behaviors, and reduced narcissistic behaviors. Results indicate a shift in DSE that improves youth self-care and care for others that may inform intervention approaches for adolescents with addiction. PMID:25525291

Daily Spiritual Experiences and Adolescent Treatment Response.

PubMed

Lee, Matthew T; Veta, Paige S; Johnson, Byron R; Pagano, Maria E

2014-04-01

The purpose of this study is to explore changes in belief orientation during treatment and the impact of increased daily spiritual experiences (DSE) on adolescent treatment response. One-hundred ninety-five adolescents court-referred to a 2-month residential treatment program were assessed at intake and discharge. Forty percent of youth who entered treatment as agnostic or atheist identified themselves as spiritual or religious at discharge. Increased DSE was associated with greater likelihood of abstinence, increased prosocial behaviors, and reduced narcissistic behaviors. Results indicate a shift in DSE that improves youth self-care and care for others that may inform intervention approaches for adolescents with addiction.

Parental strategies used in the family meal session of family-based treatment for adolescent anorexia nervosa: Links with treatment outcomes.

PubMed

White, Hannah J; Haycraft, Emma; Madden, Sloane; Rhodes, Paul; Miskovic-Wheatley, Jane; Wallis, Andrew; Kohn, Michael; Meyer, Caroline

2017-04-01

Examine relationships between parental mealtime strategies used in the family meal session of family-based treatment (FBT) and adolescent outcomes at EOT (session 20). Eighteen families with an adolescent receiving FBT-AN participated. Parental strategies during videoed family meals were assessed using a family mealtime coding system. Change scores were calculated for both adolescent %EBW and EDE scores. Increased use of parental direct and non-direct eating prompts during the family meal was associated with greater adolescent weight gain at EOT. Use of parental mealtime strategies was not associated with any significant change in adolescent eating psychopathology at EOT. Parental verbal eating prompts during the family meal may be effective in promoting short-term weight gain. During the family meal session, parents should be encouraged to maintain a direct focus on their adolescent child's eating behaviour which may assist their child with food consumption and potential weight gain. Further research examining food-based interactions among parents and their adolescent child with AN is needed. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:433-436). © 2016 Wiley Periodicals, Inc.

Parent-focused treatment for adolescent anorexia nervosa: a study protocol of a randomised controlled trial

PubMed Central

2014-01-01

Background Family-based treatment is an efficacious outpatient intervention for medically stable adolescents with anorexia nervosa. Previous research suggests family-based treatment may be more effective for some families when parents and adolescents attend separate therapy sessions compared to conjoint sessions. Our service developed a novel separated model of family-based treatment, parent-focused treatment, and is undertaking a randomised controlled trial to compare parent-focused treatment to conjoint family-based treatment. Methods/Design This randomised controlled trial will recruit 100 adolescents aged 12–18 years with DSM-IV anorexia nervosa or eating disorder not otherwise specified (anorexia nervosa type). The trial commenced in 2010 and is expected to be completed in 2015. Participants are recruited from the Royal Children’s Hospital Eating Disorders Program, Melbourne, Australia. Following a multidisciplinary intake assessment, eligible families who provide written informed consent are randomly allocated to either parent-focused treatment or conjoint family-based treatment. In parent-focused treatment, the adolescent sees a clinical nurse consultant and the parents see a trained mental health clinician. In conjoint family-based treatment, the whole family attends sessions with the mental health clinician. Both groups receive 18 treatment sessions over 6 months and regular medical monitoring by a paediatrician. The primary outcome is remission at end of treatment and 6 and 12 month follow up, with remission defined as being ≥ 95% expected body weight and having an eating disorder symptom score within one standard deviation of community norms. The secondary outcomes include partial remission and changes in eating pathology, depressive symptoms and self-esteem. Moderating and mediating factors will also be explored. Discussion This will be first randomised controlled trial of a parent-focused model of family-based treatment of adolescent

Parent-focused treatment for adolescent anorexia nervosa: a study protocol of a randomised controlled trial.

PubMed

Hughes, Elizabeth K; Le Grange, Daniel; Court, Andrew; Yeo, Michele S M; Campbell, Stephanie; Allan, Erica; Crosby, Ross D; Loeb, Katharine L; Sawyer, Susan M

2014-04-08

Family-based treatment is an efficacious outpatient intervention for medically stable adolescents with anorexia nervosa. Previous research suggests family-based treatment may be more effective for some families when parents and adolescents attend separate therapy sessions compared to conjoint sessions. Our service developed a novel separated model of family-based treatment, parent-focused treatment, and is undertaking a randomised controlled trial to compare parent-focused treatment to conjoint family-based treatment. This randomised controlled trial will recruit 100 adolescents aged 12-18 years with DSM-IV anorexia nervosa or eating disorder not otherwise specified (anorexia nervosa type). The trial commenced in 2010 and is expected to be completed in 2015. Participants are recruited from the Royal Children's Hospital Eating Disorders Program, Melbourne, Australia. Following a multidisciplinary intake assessment, eligible families who provide written informed consent are randomly allocated to either parent-focused treatment or conjoint family-based treatment. In parent-focused treatment, the adolescent sees a clinical nurse consultant and the parents see a trained mental health clinician. In conjoint family-based treatment, the whole family attends sessions with the mental health clinician. Both groups receive 18 treatment sessions over 6 months and regular medical monitoring by a paediatrician. The primary outcome is remission at end of treatment and 6 and 12 month follow up, with remission defined as being ≥ 95% expected body weight and having an eating disorder symptom score within one standard deviation of community norms. The secondary outcomes include partial remission and changes in eating pathology, depressive symptoms and self-esteem. Moderating and mediating factors will also be explored. This will be first randomised controlled trial of a parent-focused model of family-based treatment of adolescent anorexia nervosa. If found to be efficacious, parent

Does family-based treatment reduce the need for hospitalization in adolescent anorexia nervosa?

PubMed

Lock, James; Agras, W Stewart; Bryson, S W; Brandt, Harry; Halmi, Katherine A; Kaye, Walter; Wilfley, Denise; Woodside, Blake; Pajarito, Sarah; Jo, Booil

2016-09-01

We examined the timing and number of days of hospitalization during the course of treatment, hospitalization effects on outcome, and predictors and moderators of the use of hospitalization in adolescents with anorexia nervosa (AN). Data used in this study were collected from 158 adolescents (ages 12 to 18 years of age) who met DSM-IVTR criteria for AN (exclusive of the amenorrhea criteria) randomized to receive either Family Based Treatment (FBT) or Systemic Family Therapy (SyFT) in a 7 site study. The trajectory of hospital day use is similar in the first 5 weeks irrespective of treatment allocation. However, days of hospitalization continued to increase throughout SyFT but leveled off in FBT after ∼5 weeks of treatment. Early hospitalization was a negative predictor for improvements in percent weight change for both treatment groups (t(1)=2.6, p = 0.011). Co-morbid psychopathology predicted early hospital use in both treatments. Higher levels of eating related obsessions and depression moderated hospitalization rates suggesting that FBT reduces early hospitalization rates compared to SyFT for these subgroups. These data support and extend findings from previous studies by identifying patterns of hospital use, and predictors and moderators of treatment effect for early hospitalization use in adolescent AN. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:891-894). © 2016 Wiley Periodicals, Inc.

Treatment trends in adolescent clavicle fractures.

PubMed

Yang, Scott; Werner, Brian C; Gwathmey, Frank W

2015-01-01

Controversy continues with regard to decision making for operative treatment of adolescent clavicle fractures, while the literature continues to support operative treatment for select middle third fractures in adults. The purpose of our study was to evaluate the recent trends in nonoperative and operative management of adolescent clavicle fractures in the United States. Data were derived from a publicly available database of patients, PearlDiver Patient Records Database. The database was queried for ICD-9 810.02 (closed fracture of shaft of clavicle), with the age restriction of either 10 to 14 or 15 to 19 years old, along with CPT-23500 (closed treatment of clavicular fracture) and CPT-23515 (open treatment of clavicular fracture) from 2007 to 2011. The χ analysis was used to determine statistical significance with regard to procedural volumes, sex, and region. The Student t test was used to compare average charges between groups. A significant increase in the number of adolescent clavicle fractures managed operatively (CPT-23510, ages 10 to 19 y) from 309 in 2007 to 530 in 2011 was observed (P<0.0001). There was a significantly greater increase in operative management of clavicle fractures in the age 15 to 19 subgroup compared with the age 10 to 14 subgroup (P<0.0001). In the operative group, there was a trend toward a higher number of males being managed with operative intervention. The overall average monetary charge for both nonoperatively and operatively managed adolescent clavicle fractures increased significantly in the study period. A statistically significant increase in normalized incidence of operatively managed adolescent clavicle fractures was noted in the midwest, south, and west regions with the greatest increase in west region where the incidence increased over 2-fold (P<0.0001). Adolescent clavicle fractures seem to be being treated increasingly with open reduction and internal fixation recently, especially in the 15 to 19 age group. Nevertheless

Risperidone: a review of its use in the treatment of irritability associated with autistic disorder in children and adolescents.

PubMed

Scott, Lesley J; Dhillon, Sohita

2007-01-01

Risperidone (Risperdal), a psychotropic atypical antipsychotic agent, is thought to act via dopamine D(2) and serotonin (5-HT [5-hydroxytryptamine])(2A) receptor antagonism. The clinical efficacy of oral risperidone in the treatment of bipolar mania and schizophrenia in adult patients is well established. In the US, risperidone is also approved for the treatment of irritability associated with autistic disorder in children and adolescents aged 5-16 years, for the treatment of schizophrenia in adolescents aged 13-17 years and, as monotherapy, for the short-term treatment of acute manic and mixed episodes associated with bipolar I disorder in children and adolescents aged 10-17 years. Oral risperidone treatment was better than placebo treatment in reducing irritability and other behavioral symptoms associated with autistic disorder in children and adolescents in two well designed short-term trials, with these benefits maintained in those receiving risperidone for up to 6 months. The drug had a clinically manageable tolerability profile, with most adverse events being of mild to moderate intensity. There are some aspects of treatment, such as weight gain, somnolence, and hyperglycemia, that require monitoring, and the long-term safety of risperidone in children and adolescents with autistic disorder remains to be fully determined. With these issues in mind, risperidone offers a valuable emerging option for the treatment of irritability associated with autistic disorder in children and adolescents.

Prevalence, comorbidities and outpatient treatment of anorexia and bulimia nervosa in German children and adolescents.

PubMed

Jaite, Charlotte; Hoffmann, Falk; Glaeske, Gerd; Bachmann, Christian J

2013-06-01

This study aimed at investigating the prevalence, psychiatric comorbidity and outpatient treatment in a sample of German children and adolescents with eating disorders (EDs). Data of a large German statutory health insurance company were analysed and outpatients aged between 10 and 21 years with an ED diagnosis in 2009 were identified. Of 248,558 insured children and adolescents, 1,404 patients (79.9 % females, mean age: 16.7; SD: 3.3 years) matched the inclusion criteria. The large majority of patients with anorexia nervosa (AN) and bulimia nervosa (BN) were females (94.7 and 92.7 %), on which we focus in the following analyses. The prevalence in females was 0.28 % (AN) and 0.20 % (BN). Psychiatric comorbidity was diagnosed in 59.8 % (AN) and 64.1 % (BN) of patients, respectively. Most patients were treated with psychotherapy (AN: 75.7 %, BN: 78.5 %), 16.4 % (AN) and 20.2 % (BN) of our patients received pharmacotherapy with either antidepressants or antipsychotics. 23.5 % (AN) and 21.1 % (BN) received no treatment with psychotherapy, antidepressants or antipsychotics. This naturalistic study suggests that in young ED outpatients, EDs seem to be underdiagnosed and treatment does not necessarily comply with current guidelines. Therefore, dissemination of state-of-the-art knowledge on diagnosis and treatment in children and adolescents with EDs constitutes an important educational goal.

Neural Correlates of Antidepressant Treatment Response in Adolescents with Major Depressive Disorder

PubMed Central

Klimes-Dougan, Bonnie; Vu, Dung Pham; Westlund Schreiner, Melinda; Mueller, Bryon A.; Eberly, Lynn E.; Camchong, Jazmin; Westervelt, Ana; Lim, Kelvin O.

2016-01-01

Abstract Objective: The neural changes underlying response to antidepressant treatment in adolescents are unknown. Identification of neural change correlates of treatment response could (1) aid in understanding mechanisms of depression and its treatment and (2) serve as target biomarkers for future research. Method: Using functional magnetic resonance imaging, we examined changes in brain activation and functional connectivity in 13 unmedicated adolescents with major depressive disorder (MDD) before and after receiving treatment with a selective serotonin reuptake inhibitor medication for 8 weeks. Specifically, we examined brain activation during a negative emotion task and resting-state functional connectivity (RSFC), focusing on the amygdala to capture networks relevant to negative emotion. We conducted whole-brain analyses to identify how symptom improvement was related to change in brain activation during a negative emotion task or amygdala RSFC. Results: After treatment, clinical improvement was associated with decreased task activation in rostral and subgenual anterior cingulate cortex and increased activation in bilateral insula, bilateral middle frontal cortices, right parahippocampus, and left cerebellum. Analysis of change in amygdala RSFC showed that treatment response was associated with increased amygdala RSFC with right frontal cortex, but decreased amygdala RSFC with right precuneus and right posterior cingulate cortex. Conclusion: The findings represent a foothold for advancing understanding of pathophysiology of MDD in adolescents by revealing the critical neural circuitry changes that underlie a positive response to a standard treatment. Although preliminary, the present study provides a research platform for future work needed to confirm these biomarkers at a larger scale before using them in future target engagement studies of novel treatments. PMID:27159204

Contingency management improves smoking cessation treatment outcomes among highly impulsive adolescent smokers relative to cognitive behavioral therapy.

PubMed

Morean, Meghan E; Kong, Grace; Camenga, Deepa R; Cavallo, Dana A; Carroll, Kathleen M; Pittman, Brian; Krishnan-Sarin, Suchitra

2015-03-01

Impulsive adolescents have difficulty quitting smoking. We examined if treatments that provide behavioral incentives for abstinence improve treatment outcomes among impulsive adolescent smokers, who have been shown to be highly sensitive to reward. We ran secondary data analyses on 64 teen smokers (mean age=16.36 [1.44]; cigarettes/day=13.97 [6.61]; 53.1% female; 90.6% Caucasian) who completed a four-week smoking cessation trial to determine whether impulsive adolescents differentially benefit from receiving cognitive behavioral therapy (CBT), contingency management (CM), or the combination of the two (CM/CBT). Indices of treatment efficacy included self-report percent days abstinent and end of treatment biochemically-confirmed 7-day point prevalence abstinence (EOT abstinence). We assessed self-reported impulsivity using the Brief Barratt Impulsiveness Scale. We used univariate Generalized Linear Modeling to examine main effects and interactions of impulsivity and treatment condition as predictors of self-reported abstinence, and exact logistic regression to examine EOT abstinence. CM/CBT and CM were comparably effective in promoting abstinence, so analyses were conducted comparing the efficacy of CBT to treatments with a CM component (i.e., CM and CM/CBT). CBT and deficient self-regulation predicted lower self-reported abstinence rates within the total analytic sample. Treatments containing CM were more effective than CBT in predicting 1) self-reported abstinence among behaviorally impulsive adolescents (% days abstinent: CM 77%; CM/CBT 81%; CBT 30%) and 2) EOT point prevalence abstinence among behaviorally impulsive adolescents and adolescents with significant deficits in self-regulation. CM-based interventions may improve the low smoking cessation rates previously observed among impulsive adolescent smokers. Copyright © 2014 Elsevier Ltd. All rights reserved.

The importance of therapeutic processes in school-based psychosocial treatment of homework problems in adolescents with ADHD.

PubMed

Breaux, Rosanna P; Langberg, Joshua M; McLeod, Bryce D; Molitor, Stephen J; Smith, Zoe R; Bourchtein, Elizaveta; Green, Cathrin D

2018-05-01

To evaluate the importance of therapeutic processes in two brief school-based psychosocial treatments targeting homework problems in adolescents with attention-deficit/hyperactivity disorder (ADHD) as delivered by school mental health professionals. A sample of 222 middle school students (72% male; M age = 12.00 years, SD = 1.02) diagnosed with ADHD was randomized to receive either a contingency-management or a skills-based treatment for homework problems. Both treatments included 16 individual sessions (20-min each) and 2 parent/family meetings. Adolescents and school mental health professionals reported on the working alliance in the middle of the treatment; professionals rated adolescent involvement at each of the 16 sessions, parent involvement during both parent meetings, and parent commitment to carry out the established homework plan. Attendance at parent meetings was also recorded. Therapeutic processes predicted objective, parent-reported, and teacher-reported academic outcomes. Parent engagement was particularly important for the contingency-based treatment, whereas working alliance and adolescent involvement were most important for the skills-based treatment. Therapeutic processes such as developing a strong working alliance and engaging parents and students are key elements of treatment delivery and receipt in school-based mental health programming and should be explicitly trained and monitored. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Treatment Outcomes in an Adolescent Chemical Dependency Program.

ERIC Educational Resources Information Center

Ralph, Norbert; McMenamy, Carol

1996-01-01

Investigates treatment outcomes for all admissions to an adolescent chemical dependency program over a 10-month period. Interviews with parents of patients were conducted. The effect of various pretreatment and treatment factors on outcomes were investigated. Better treatment outcome was associated with older adolescents, greater participation in…

Identifying Efficacious Treatment Components of Panic Control Treatment for Adolescents: A Preliminary Examination

ERIC Educational Resources Information Center

Micco, Jamie A.; Choate-Summers, Molly L.; Ehrenreich, Jill T.; Pincus, Donna B.; Mattis, Sara G.

2007-01-01

Panic Control Treatment for Adolescents (PCT-A) is a developmentally sensitive and efficacious treatment for adolescents with panic disorder. The present study is a preliminary examination of the relative efficacy of individual treatment components in PCT-A in a sample of treatment completers; the study identified when rapid improvements in panic…

A randomized controlled trial of cognitive-behavioral therapy versus treatment as usual for adolescents with autism spectrum disorders and comorbid anxiety.

PubMed

Storch, Eric A; Lewin, Adam B; Collier, Amanda B; Arnold, Elysse; De Nadai, Alessandro S; Dane, Brittney F; Nadeau, Joshua M; Mutch, P Jane; Murphy, Tanya K

2015-03-01

Examine the efficacy of a personalized, modular cognitive-behavioral therapy (CBT) protocol among early adolescents with high-functioning autism spectrum disorders (ASDs) and co-occurring anxiety relative to treatment as usual (TAU). Thirty-one children (11-16 years) with ASD and clinically significant anxiety were randomly assigned to receive 16 weekly CBT sessions or an equivalent duration of TAU. Participants were assessed by blinded raters at screening, posttreatment, and 1-month follow-up. Youth randomized to CBT demonstrated superior improvement across primary outcomes relative to those receiving TAU. Eleven of 16 adolescents randomized to CBT were treatment responders, versus 4 of 15 in the TAU condition. Gains were maintained at 1-month follow-up for CBT responders. These data extend findings of the promising effects of CBT in anxious youth with ASD to early adolescents. © 2014 Wiley Periodicals, Inc.

Treatment of Adolescents with Anorexia Nervosa.

ERIC Educational Resources Information Center

Patel, Dilip R.; Pratt, Helen D.; Greydanus, Donald E.

2003-01-01

Reviews research on the treatment of adolescents with anorexia nervosa, including the general approach, treatment setting, treatment of medical complications, nutritional management, psychopharmacotherapy, psychotherapy, treatment efficacy and outcome studies, comparison studies, and prevention programs. (EV)

Counseling About Skin Cancer Prevention Among Adolescents: What Do Parents Receive From Health Care Providers?

PubMed

McRee, Annie-Laurie; Mays, Darren; Kornides, Melanie L; Gilkey, Melissa B

2017-10-01

Adolescence is a high-risk period for ultraviolet radiation exposure, a primary cause of skin cancer later in life. We sought to characterize receipt of health care provider-delivered counseling about skin cancer prevention (SCP) among parents of adolescents. In 2016, we conducted an online survey with a national sample of parents of adolescents aged 11-17 years (n = 1,253). Multivariable logistic regression assessed correlates of receiving counseling from a health care provider about any of the six skin cancer prevention (SCP) topics. Only half (49%) of parents recalled discussing any SCP topic with their child's provider; the prevalence was highest for sunscreen (39%) and lowest for indoor tanning (3%). Parents had greater odds of receiving counseling if they had a child with more sun-reactive skin (odds ratio [OR] = 1.53); a family history of skin cancer (OR = 1.38); or a higher quality relationship with the provider (OR = 1.47; all p < .05). Greater attention to SCP counseling is needed, especially for exposures such as indoor tanning that remain prevalent among adolescents but are rarely addressed in clinical encounters. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Atomoxetine for the Treatment of ADHD in Incarcerated Adolescents.

PubMed

Jillani, Sarah; Patel, Prina; Trestman, Robert; Kamath, Jayesh

2016-06-01

Effective interventions for adolescents with attention deficit/hyperactivity disorder (ADHD) in the correctional setting may improve care during incarceration, decrease risk of substance relapse, and reduce recidivism after release from the correctional setting of these individuals. The present report delineates the epidemiology of adolescent ADHD in the correctional setting and its association with substance use disorders and comorbid psychiatric illnesses. Evidence suggests that adolescents with ADHD have a higher risk of arrest and incarceration during adulthood. The present report examines evidence related to efficacy of atomoxetine, a nonstimulant medication for the treatment of adolescent ADHD, and presents data from a case series evaluating the effectiveness of atomoxetine for the treatment of adolescent ADHD in the Connecticut correctional setting. The results from the case series suggest that atomoxetine is effective for the treatment of adolescent ADHD in the context of significant past substance use. In summary, adolescents with ADHD have an elevated risk of incarceration and developing substance use disorders. The present review and pilot case series suggest that atomoxetine is an effective treatment for adolescents with ADHD in the correctional setting. © 2016 American Academy of Psychiatry and the Law.

Family functioning in two treatments for adolescent anorexia nervosa.

PubMed

Ciao, Anna C; Accurso, Erin C; Fitzsimmons-Craft, Ellen E; Lock, James; Le Grange, Daniel

2015-01-01

Family functioning impairment is widely reported in the eating disorders literature, yet few studies have examined the role of family functioning in treatment for adolescent anorexia nervosa (AN). This study examined family functioning in two treatments for adolescent AN from multiple family members' perspectives. Participants were 121 adolescents with AN ages 12-18 from a randomized-controlled trial comparing family-based treatment (FBT) to individual adolescent-focused therapy (AFT). Multiple clinical characteristics were assessed at baseline. Family functioning from the perspective of the adolescent and both parents was assessed at baseline and after 1 year of treatment. Full remission from AN was defined as achieving both weight restoration and normalized eating disorder psychopathology. In general, families dealing with AN reported some baseline impairment in family functioning, but average ratings were only slightly elevated compared to published impaired functioning cutoffs. Adolescents' perspectives on family functioning were the most impaired and were generally associated with poorer psychosocial functioning and greater clinical severity. Regardless of initial level of family functioning, improvements in several family functioning domains were uniquely related to full remission at the end of treatment in both FBT and AFT. However, FBT had a more positive impact on several specific aspects of family functioning compared to AFT. Families seeking treatment for adolescent AN report some difficulties in family functioning, with adolescents reporting the greatest impairment. Although FBT may be effective in improving some specific aspects of family dynamics, remission from AN was associated with improved family dynamics, regardless of treatment type. © 2014 Wiley Periodicals, Inc.

Evidence for reading improvement following tDCS treatment in children and adolescents with Dyslexia.

PubMed

Costanzo, Floriana; Varuzza, Cristiana; Rossi, Serena; Sdoia, Stefano; Varvara, Pamela; Oliveri, Massimiliano; Giacomo, Koch; Vicari, Stefano; Menghini, Deny

2016-01-01

There is evidence that non-invasive brain stimulation transitorily modulates reading by facilitating the neural pathways underactive in individuals with dyslexia. The study aimed at investigating whether multiple sessions of transcranial direct current stimulation (tDCS) would enhance reading abilities of children and adolescents with dyslexia and whether the effect is long-lasting. Eighteen children and adolescents with dyslexia received three 20-minute sessions a week for 6 weeks (18 sessions) of left anodal/right cathodal tDCS set at 1 mA over parieto-temporal regions combined with a cognitive training. The participants were randomly assigned to the active or the sham treatment; reading tasks (text, high and low frequency words, non-words) were used as outcome measures and collected before treatment, after treatment and one month after the end of treatment. The tolerability of tDCS was evaluated. The active group showed reduced low frequency word reading errors and non-word reading times. These positive effects were stable even one month after the end of treatment. None reported adverse effects. The study shows preliminary evidence of tDCS feasibility and efficacy in improving non-words and low frequency words reading of children and adolescents with dyslexia and it opens new rehabilitative perspectives for the remediation of dyslexia.

Disordered gambling in adolescents : epidemiology, diagnosis, and treatment.

PubMed

Pietrzak, Robert H; Ladd, George T; Petry, Nancy M

2003-01-01

Rapid expansion of legalized gambling has been associated with increased rates of gambling disorders among adults and adolescents worldwide. Epidemiologic studies suggest that, in North America, up to 6% of adults and 20% of adolescents have a gambling problem. Despite increasing prevalence rates of gambling disorders, little research is available on how to treat such disorders in adolescents. Much of what is known about how to treat adolescent problem and pathological gambling comes from research on psychosocial and psychopharmacologic treatments for adult pathological gambling. Risk factors for adolescent gambling disorders include male gender, alcohol and drug use, deviant peers, family history of gambling, and impulsive behavior. While several risk factors characterize disordered gambling among adolescents, the extent to which these characteristics are related remains to be determined. In terms of screening for adolescent problem and pathological gambling, several instruments designed to reflect the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria for pathological gambling are available. Psychosocial approaches used to treat adult pathological gambling include Gamblers Anonymous, cognitive-behavioral therapy (CBT), and motivational enhancement therapy (MET). Among adolescents, CBT as well as an eclectic therapy have been helpful in reducing problematic gambling behavior. In terms of pharmacotherapy, three classes of psychotropic drugs have been used to treat adult pathological gambling - serotonin reuptake inhibitors, opioid antagonists, and mood stabilizers. While some of these pharmacotherapies have been efficacious in treating adult pathological gambling, additional double-blind, placebo-controlled studies are needed to determine the long-term effectiveness of these treatments. No known study has evaluated the use of psychopharmacologic agents in treating adolescent pathological gambling. Possible reasons for the lack of research on

Cognitive behavioral treatment outcomes in adolescent ADHD.

PubMed

Antshel, Kevin M; Faraone, Stephen V; Gordon, Michael

2014-08-01

To assess the efficacy of cognitive behavioral therapy (CBT) for managing adolescent ADHD. A total of 68 adolescents with ADHD and associated psychiatric comorbidities completed a manualized CBT treatment protocol. The intervention used in the study was a downward extension of the Safren et al. program for adults with ADHD who have symptoms unresolved by medication. Outcome variables consisted of narrow band (ADHD) and broadband (e.g., mood, anxiety, conduct) symptom measures (Behavior Assessment System for Children-2nd edition and ADHD-Rating Scales) as well as functioning measures (parent/teacher ratings and several ecologically real-world measures). Treatment effects emerged on the medication dosage, parent rating of pharmacotherapy adherence, adolescent self-report of personal adjustment (e.g., self-esteem), parent and teacher ratings of inattentive symptoms, school attendance, school tardiness, parent report of peer, family and academic functioning and teacher report of adolescent relationship with teacher, academic progress, and adolescent self-esteem. Adolescents with ADHD with oppositional defiant disorder were rated by parents and teachers as benefiting less from the CBT intervention. Adolescents with ADHD and comorbid anxiety/depression were rated by parents and teachers as benefiting more from the CBT intervention. A downward extension of an empirically validated adult ADHD CBT protocol can benefit some adolescents with ADHD. © 2012 SAGE Publications.

Dialectical behavior therapy for adolescents with bipolar disorder: results from a pilot randomized trial.

PubMed

Goldstein, Tina R; Fersch-Podrat, Rachael K; Rivera, Maribel; Axelson, David A; Merranko, John; Yu, Haifeng; Brent, David A; Birmaher, Boris

2015-03-01

The purpose of this study was to conduct a pilot randomized trial of dialectical behavior therapy (DBT) versus psychosocial treatment as usual (TAU) for adolescents diagnosed with bipolar disorder (BP). We recruited participants 12-18 years of age with a primary BP diagnosis (I, II, or operationalized not otherwise specified [NOS] criteria) from a pediatric specialty clinic. Eligible patients were assigned using a 2:1 randomization structure to either DBT (n=14) or psychosocial TAU (n=6). All patients received medication management from a study-affiliated psychiatrist. DBT included 36 sessions (18 individual, 18 family skills training) over 1 year. TAU was an eclectic psychotherapy approach consisting of psychoeducational, supportive, and cognitive behavioral techniques. An independent evaluator, blind to treatment condition, assessed outcomes including affective symptoms, suicidal ideation and behavior, nonsuicidal self-injurious behavior, and emotional dysregulation, quarterly over 1 year. Adolescents receiving DBT attended significantly more therapy sessions over 1 year than did adolescents receiving TAU, possibly reflecting greater engagement and retention; both treatments were rated as highly acceptable by adolescents and parents. As compared with adolescents receiving TAU, adolescents receiving DBT demonstrated significantly less severe depressive symptoms over follow-up, and were nearly three times more likely to demonstrate improvement in suicidal ideation. Models indicate a large effect size, for more weeks being euthymic, over follow-up among adolescents receiving DBT. Although there were no between-group differences in manic symptoms or emotional dysregulation with treatment, adolescents receiving DBT, but not those receiving TAU, evidenced improvement from pre- to posttreatment in both manic symptoms and emotional dysregulation. DBT may offer promise as an adjunct to pharmacotherapy in the treatment of depressive symptoms and suicidal ideation for

Treatment Seeking and Self-Constructed Explanations of Pain and Pain Management Strategies Among Adolescents with Temporomandibular Disorder Pain.

PubMed

Nilsson, Ing-Marie; Willman, Ania

2016-01-01

To explore adolescents' explanations of their temporomandibular disorder (TMD) pain, their pain management strategies for TMD pain, and their treatment-seeking behavior. One-on-one interviews were conducted with 21 adolescents aged 15 to 19 years who had TMD pain and followed a semistructured interview guide. Subjects were strategically selected from patients referred to an orofacial pain clinic. All participants had been examined and received a pain diagnosis based on the Research Diagnostic Criteria for TMD. The interviews focused on the adolescents' experiences of TMD pain, their strategies for handling pain, and how they seek care. The interviews were recorded, transcribed verbatim, and analyzed using qualitative manifest content analysis. Qualitative manifest content analysis revealed two categories: (1) self-constructed explanations, with three subcategories (situation-based explanatory model, physical/biologic model, and psychological explanatory model); and (2) pain management strategies, with four subcategories (social support, treatment, relaxation/rest, and psychological strategies). Adolescents used physical activities and psychological and pharmacologic treatment to manage pain. Reasons for seeking treatment were to be cured, to obtain an explanation for their pain, and because their symptoms bother others. Adolescents living with TMD pain develop self-constructed explanations and pain management strategies. With access to these descriptions, dentists can be better prepared to have a dialogue with their adolescent patients about their own explanations of pain, the nature of pain, and in which situations the pain appears. Dentists can also explore adolescent patients' pain management strategies and perhaps also suggest new treatment strategies at an earlier stage.

Adolescents and consent to treatment.

PubMed

Dickens, B M; Cook, R J

2005-05-01

Adolescents, defined by WHO as 10 to 19 years old, can give independent consent for reproductive health services if their capacities for understanding have sufficiently evolved. The international Convention on the Rights of the Child, almost universally ratified, limits parental powers, and duties, by adolescents' "evolving capacities" for self-determination. Legal systems may recognize "mature minors" as enjoying adult rights of medical consent, even when consent to sexual relations does not absolve partners of criminal liability; their consent does not make the adolescents offenders. There is usually no chronological "age of consent" for medical care, but a condition of consent, meaning capacity for understanding. Like adults, mature minors enjoy confidentiality and the right to treatment according to their wishes rather than their best interests. Minors incapable of self-determination may grant or deny assent to treatment for which guardians provide consent. Emancipated minors' self-determination may also be recognized, for instance on marriage or default of adults' guardianship.

Characteristics of seeking treatment among U.S. adolescents with eating disorders.

PubMed

Forrest, Lauren N; Smith, April R; Swanson, Sonja A

2017-07-01

The majority of persons with eating disorders (EDs) do not seek ED treatment, yet little is known about treatment-seeking barriers or facilitators. The aim of the study is to describe the characteristics associated with seeking ED treatment among U.S. adolescents with EDs. Data from a nationally representative cross-sectional study of U.S. adolescents ages 13-18 years were used for these analyses. Specifically, adolescents who met criteria for lifetime EDs (N = 281) were included. Sociodemographic information, characteristics of EDs, psychiatric comorbidities, and other mental health service use were assessed via interview. Only 20% of adolescents sought ED treatment. Females were 2.2 (95% CI 0.8, 6.4) times more likely to seek treatment than males (19.9% vs. 8.9%). Adolescents who met criteria for anorexia nervosa or bulimia nervosa were 2.4 (95% CI 0.9, 6.3) and 1.9 (95% CI 1.0, 3.8) times more likely to seek treatment than adolescents who met criteria for binge-eating disorder (27.5% and 22.3% vs. 11.6%). Specific ED behaviors (restriction and purging), ED-related impairment, and any mental health service use were also associated with adolescent treatment seeking. Adolescent treatment seeking was infrequent overall, with individuals with counter-stereotypic ED presentations least likely to have sought treatment. Adolescent treatment seeking could be promoted through increasing awareness among the public and healthcare professionals that EDs affect a heterogeneous group of people. More generally, research involving both treatment-seeking and non-treatment-seeking individuals holds great potential to refine the field's knowledge of ED etiology, prevalence, treatment, and prevention. © 2017 Wiley Periodicals, Inc.

[Probiotics as an items of increasing the effectiveness of treatment of community-acquired pneumonia in adolescents].

PubMed

Gonchar, N V; Kassner, L N; Korenev, P B; Il'kovich, Iu M; Mogilina, S V; Petrov, L N

2011-01-01

The aim of the work was to evaluate the efficiency of microbial probiotics Vitaflor and metabolic probiotic Aktoflor-C in complex treatment of community-acquired pneumonia in adolescents in a hospital. The observation involved 38 children aged 11 to 18 years with radiologically verified community-acquired pneumonia, including 23 boys and 15 girls. Patients were divided in 3 groups. Patients in group 1 (n = 13) simultaneously with the antibiotic therapy received per os Vitaflor probiotic containing symbiotic strains of Lactobacillus acidophilus; patients in group 2 (n = 10) along with antibiotic therapy received per os metabolic probiotic Aktoflor-C, containing low molecular weight exometabolites bacteria; patient of the comparison group (n = 15) received antibiotic therapy only. The effectiveness of the used treatment schemes was assessed on the dynamics of the gut state microbiot acoarding to an extended bacteriological examination of faecal flora, level of saliva IgA secretory (before and after treatment), the dynamics of SF-36 quality of life 1 month after discharge from hospital. Was conducted a study of economic efficiency of different modes of therapy. Results showed that adolescents with community-acquired pneumonia during standard antibiotic therapy indicated development of dysbiotic bowel disturbances in the form of reliable oppression of the bifidobacteria and laktoflora. Dysbiosis of the microbial associations are not conducive to proper implementation of immune and nutritional functions of the intestine that shows the imperfection of rehabilitation of patients with pneumonia according to the evaluation of SF-36 quality of life. Pharmacoeconomic analysis revealed the benefits of probiotic metabolic type "Aktoflor" used in addition to standard therapy of community-acquired pneumonia in adolescents.

Hormone treatment of gender identity disorder in a cohort of children and adolescents.

PubMed

Hewitt, Jacqueline K; Paul, Campbell; Kasiannan, Porpavai; Grover, Sonia R; Newman, Louise K; Warne, Garry L

2012-05-21

To describe the experience of hormone treatment of gender identity disorder (GID) in children and adolescents within a specialist clinic. Cohort study by medical record review of children aged 0-17 years referred during 2003-2011 for management at the GID clinic in a tertiary paediatric referral centre - the Royal Children's Hospital, Melbourne, Victoria. Clinical characteristics of the patient population, hormone treatment provided, frequency of referrals with time. Thirty-nine children and adolescents were referred for gender dysphoria. Seventeen individuals were pubertal with persistent GID, and were considered eligible for hormone treatment. Seven patients, comprising three biological males and four biological females, had legally endorsed hormone treatment. In this group, gender dysphoria was first noted at 3-6 years of age. Hormone treatment with GnRH analogue to suppress pubertal progression (phase 1) was given at 10-16 years of age. Treatment with cross-sex hormones (phase 2) was given at 15.6-16 years. One patient purchased cross-sex hormone treatment overseas. One patient received oestrogen and progesterone for menstrual suppression before phase 1. The annual frequency of new referrals increased continuously over the study period. Hormone treatment for pubertal suppression and subsequent gender transition needs to be individualised within stringent protocols in multidisciplinary specialist units.

Pharmacological treatment for attention deficit hyperactivity disorder: functional outcomes in children and adolescents from non-Western countries.

PubMed

Altin, Murat; El-Shafei, Ahmed A; Yu, Maria; Desaiah, Durisala; Treuer, Tamas; Zavadenko, Nikolay; Gao, Hong Yun

2013-09-13

Functional outcomes were measured over a 12-month period in children and adolescents with attention deficit hyperactivity disorder (ADHD) after they received monotherapy. Prospective, observational, noninterventional study. Conducted in six non-Western countries. Outpatients 6 to 17 years of age with a verified diagnosis of ADHD in accordance with the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR), together with their physicians, decided to initiate or switch treatment for ADHD. Patients were prescribed pharmacological monotherapy: methylphenidate (n=221), nootropic agents (n=91), or atomoxetine (n=234). Patients were followed for changes in their functional status and quality of life, which were assessed with the Child Health and Illness Profile-Child Edition (CHIP-CE) Achievement domain. At the end of the study, a mean improvement on the CHIP-CE Achievement domain score was observed for all countries and therapies except in Taiwan, where patients received atomoxetine, and in Lebanon, where patients received methylphenidate. No patient experienced a serious adverse event during the study. Four patients discontinued due to a treatment-emergent adverse event. After 12 months of treatment, clinical and functional outcomes were improved in children and adolescents from non-Western countries who initiated and remained on their prescribed pharmacological monotherapy.

Adolescent perspectives on social support received in the aftermath of sexual abuse: a qualitative study.

PubMed

Schönbucher, Verena; Maier, Thomas; Mohler-Kuo, Meichun; Schnyder, Ulrich; Landolt, Markus A

2014-04-01

The extent and quality of social support provided to young survivors of sexual abuse (SA) have only rarely been examined. This qualitative study aimed to investigate adolescent perspectives on social support received in the aftermath of SA. A total of 26 sexually victimized adolescents (15-18 years old) participated in a qualitative face-to-face, in-depth interview that focused on perceived social support. Qualitative content analysis was conducted as per Mayring (2008) using the qualitative data analysis program ATLAS.ti. In addition, quantitative correlational analyses were conducted to identify characteristics of SA and their associations with perceived social support. Although participants perceived parental support as the most necessary type of support, they were much more satisfied with support from peers. In particular, adolescents stated that they wished they had received more emotional support from their parents in order to better cope with the abuse. About half of participants reported having received counseling, and counseling was seen as very helpful in dealing with the consequences of SA. Only a few adolescents mentioned their school as a source of support. Intra-familial abuse, younger victim age at the time of abuse, an adult perpetrator, and severe abuse were all negatively associated with satisfaction with perceived support. Our results suggest that support for young survivors of SA needs to be improved. Prevention of SA needs particular focus on improving parental reactions to SA, facilitating access to professional support, and raising teacher awareness of the importance of their role in the provision of support for sexually victimized children.

Cognitive-Behavioral Treatment of Panic Disorder in Adolescence

ERIC Educational Resources Information Center

Pincus, Donna B.; May, Jill Ehrenreich; Whitton, Sarah W.; Mattis, Sara G.; Barlow, David H.

2010-01-01

This investigation represents the first randomized controlled trial to evaluate the feasibility and efficacy of Panic Control Treatment for Adolescents (PCT-A). Thirteen adolescents, ages 14 to 17, were randomized to 11 weekly sessions of PCT-A treatment, whereas 13 were randomized to a self-monitoring control group. Results indicate that…

Long-lasting improvement following tDCS treatment combined with a training for reading in children and adolescents with dyslexia.

PubMed

Costanzo, Floriana; Rossi, Serena; Varuzza, Cristiana; Varvara, Pamela; Vicari, Stefano; Menghini, Deny

2018-03-14

Noninvasive brain stimulation transiently modulates reading ability in individuals with dyslexia by facilitating the underactive neural pathways in them. However, its long-term effects have not been determined. This study confirmed the ameliorative effects of multiple sessions of transcranial direct current stimulation (tDCS) combined with a training for reading on the reading abilities of children and adolescents with dyslexia and examined whether they are long-lasting. Twenty-six children and adolescents with dyslexia received 3 20-min sessions per week for 6 weeks (18 sessions) of left anodal/right cathodal tDCS, set to 1 mA, over the parieto-temporal regions, combined with training for reading. The participants were randomly assigned to receive active or sham treatment. Reading measures (text, high- and low-frequency words, non-words) were recorded before and immediately after the treatment and 1 and 6 months later. The long-term tolerability to tDCS was also evaluated. The active group received long-lasting benefits in reading. Specifically, the non-word reading efficiency index improved at every time point, as did the low-frequency word reading efficiency index at 1 and 6 months after the end of the treatment. No differences emerged in the sham group. No long-term adverse effects were documented. This study provides evidence of persistent improvements in reading in children and adolescents with dyslexia, constituting a new rehabilitative approach for the remediation of dyslexia. Copyright © 2018 Elsevier Ltd. All rights reserved.

Attrition from an Adolescent Addiction Treatment Program: A Cross Validation.

ERIC Educational Resources Information Center

Mathisen, Kenneth S.; Meyers, Kathleen

Treatment attrition is a major problem for programs treating adolescent substance abusers. To isolate and cross validate factors which are predictive of addiction treatment attrition among adolescent substance abusers, screening interview and diagnostic variables from 119 adolescent in-patients were submitted to a discriminant equation analysis.…

Socioeconomic differences in adolescent substance abuse treatment participation and long-term outcomes.

PubMed

Lui, Camillia K; Sterling, Stacy A; Chi, Felicia W; Lu, Yun; Campbell, Cynthia I

2017-05-01

Socioeconomic status (SES) has been consistently linked to poorer access, utilization and outcomes of health care services, but this relationship has been understudied in adolescent substance abuse treatment research. This study examined SES differences in adolescent's treatment participation and long-term outcomes of abstinence and 12-step attendance over five years after treatment. Data are from 358 adolescents (ages 13-18) who were recruited at intake to substance abuse treatment between 2000 and 2002 at four Kaiser Permanente Northern California outpatient treatment programs. Follow-up interviews of adolescents and their parents were conducted at 1, 3, and 5years, with over 80% response rates across time points. Using parent SES as a proxy for adolescent SES, no socioeconomic differences were found in treatment initiation, treatment retention, or long-term abstinence from alcohol or drugs. Parent education, but not parent income, was significantly associated with 12-step attendance post-treatment such that adolescents with higher parent education were more likely to attend than those with lower parent education. Findings suggest a lack of socioeconomic disparities in substance abuse treatment participation in adolescence, but potential disparities in post-treatment 12-step attendance during the transition from adolescence to young adulthood. Copyright © 2017 Elsevier Ltd. All rights reserved.

Use of appropriate initial treatment among adolescents and young adults with cancer.

PubMed

Potosky, Arnold L; Harlan, Linda C; Albritton, Karen; Cress, Rosemary D; Friedman, Debra L; Hamilton, Ann S; Kato, Ikuko; Keegan, Theresa H M; Keel, Gretchen; Schwartz, Stephen M; Seibel, Nita L; Shnorhavorian, Margarett; West, Michele M; Wu, Xiao-Cheng

2014-11-01

There has been little improvement in the survival of adolescent and young adult (AYA) cancer patients aged 15 to 39 years relative to other age groups, raising the question of whether such patients receive appropriate initial treatment. We examined receipt of initial cancer treatment for a population-based sample of 504 AYAs diagnosed in 2007-2008 with acute lymphoblastic leukemia (ALL), Hodgkin's or non-Hodgkin's lymphoma, germ cell cancer, or sarcoma. Registry data, patient surveys, and detailed medical record reviews were used to evaluate the association of patient demographic, socioeconomic, and health care setting characteristics with receipt of appropriate initial treatment, which was defined by clinical specialists in AYA oncology based on adult guidelines and published literature available before 2009 and analyzed with multivariable logistic regression. All statistical tests were two-sided. Approximately 75% of AYA cancer patients in our sample received appropriate treatment, 68% after excluding stage I male germ cell patients who all received appropriate treatment. After this exclusion, appropriate treatment ranged from 79% of sarcoma patients to 56% of ALL patients. Cancer type (P < .01) and clinical trial participation (P = .04) were statistically significantly associated with appropriate treatment in multivariable analyses. Patients enrolled in clinical trials were more likely to receive appropriate therapy relative to those not enrolled (78% vs 67%, adjusted odds ratio = 2.6, 95% confidence interval = 1.1 to 6.4). Except for those with early stage male germ cell tumors, approximately 30% (or 3 in 10) AYA cancer patients did not receive appropriate therapy. Further investigation is required to understand the reasons for this potential shortfall in care delivery. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Optimizing linkage to care and initiation and retention on treatment of adolescents with newly diagnosed HIV infection

PubMed Central

Ruria, Eva Caroline; Masaba, Rose; Kose, Judith; Woelk, Godfrey; Mwangi, Eliud; Matu, Lucy; Ng’eno, Hillary; Bikeri, Beatrice; Rakhmanina, Natella

2017-01-01

Objective: Unsuccessful linkage to care and treatment increases adolescent HIV-related morbidity and mortality. This study evaluated the effect of a novel adolescent and youth Red Carpet Program (RCP) on the timing and outcomes of linkage to care. Design: A prepost implementation evaluation of the pilot RCP program. Settings: Healthcare facilities (HCFs) and schools in Homa Bay County, Kenya. Study participants: HIV-infected adolescents (15–19 years) and youth (20–21 years). Interventions: RCP provided fast-track peer-navigated services, peer counseling, and psychosocial support at HCFs and schools in six Homa Bay subcounties in 2016. RCP training and sensitization was implemented in 50 HCFs and 25 boarding schools. Main outcome measures: New adolescent and youth HIV diagnosis, linkage to and retention in care and treatment. Results: Within 6 months of program rollout, 559 adolescents and youths (481 women; 78 men) were newly diagnosed with HIV (15–19 years n = 277; 20–21 years, n = 282). The majority (n = 544; 97.3%) were linked to care, compared to 56.5% at preimplementation (P < 0.001). All (100.0%; n = 559) adolescents and youths received peer counseling and psychosocial support, and the majority (n = 430; 79.0%) were initiated on treatment. Compared to preimplementation, the proportion of adolescents and youths who were retained on treatment increased from 66.0 to 90.0% at 3 months (P < 0.001), and from 54.4 to 98.6% at 6 months (P < 0.001). Conclusion: Implementation of RCP was associated with significant improvement in linkage to and early retention in care among adolescent and youth. The ongoing study will fully assess the efficacy of this linkage-to-care approach. PMID:28665883

Medical marijuana use among adolescents in substance abuse treatment.

PubMed

Salomonsen-Sautel, Stacy; Sakai, Joseph T; Thurstone, Christian; Corley, Robin; Hopfer, Christian

2012-07-01

To assess the prevalence and frequency of medical marijuana diversion and use among adolescents in substance abuse treatment and to identify factors related to their medical marijuana use. This study calculated the prevalence and frequency of diverted medical marijuana use among adolescents (n = 164), ages 14-18 years (mean age = 16.09, SD = 1.12), in substance abuse treatment in the Denver metropolitan area. Bivariate and multivariate analyses were completed to determine factors related to adolescents' use of medical marijuana. Approximately 74% of the adolescents had used someone else's medical marijuana, and they reported using diverted medical marijuana a median of 50 times. After adjusting for gender and race/ethnicity, adolescents who used medical marijuana had an earlier age of regular marijuana use, more marijuana abuse and dependence symptoms, and more conduct disorder symptoms compared with those who did not use medical marijuana. Medical marijuana use among adolescent patients in substance abuse treatment is very common, implying substantial diversion from registered users. These results support the need for policy changes that protect against diversion of medical marijuana and reduce adolescent access to diverted medical marijuana. Future studies should examine patterns of medical marijuana diversion and use in general population adolescents. Copyright © 2012 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Current treatment approaches to overweight in adolescents.

PubMed

Durant, Nefertiti; Cox, Joanne

2005-08-01

The prevalence of overweight among adolescents aged 12 to 19 in the United States has steadily increased since the 1960s. The purpose of this review is to familiarize primary care clinicians with the most recent primary care, pharmacotherapy, and surgical options for the treatment of overweight in adolescence. Initial treatment of the overweight adolescent should involve a comprehensive approach that facilitates changes in diet, exercise, and behavior that engage the entire family as participants and role models. For adolescents in whom a comprehensive program of diet, exercise, and behavior modification is unsuccessful, referral to a multidisciplinary team to explore further options, which may include medication and bariatric surgery, should be considered. Experience with medication for use in weight loss and bariatric surgery in adolescents is limited. Currently, two medications, orlistat and sibutramine, have been approved by the United States Food and Drug Administration for long-term use in adolescents. Bariatric surgery is currently recommended only for adolescents who are severely overweight (body mass index>or=40) and have comorbid conditions. This intervention should be considered only after failure of other comprehensive interventions and intense medical and psychologic evaluation by a specialty referral center. More research is needed to clarify the roles and timing of diet, exercise, behavior modification, pharmacotherapy, and surgical intervention. Also, long-term studies are needed to further determine the benefits and risks of pharmacotherapy and bariatric surgery in adolescents.

Characterizing HIV Manifestations and Treatment Outcomes of Perinatally Infected Adolescents in Asia

PubMed Central

Chokephaibulkit, Kulkanya; Kariminia, Azar; Oberdorfer, Peninnah; Nallusamy, Revathy; Bunupuradah, Torsak; Hansudewechakul, Rawiwan; Dung, Khu Thi Khanh; Saphonn, Vonthanak; Kumarasamy, Nagalingeswaran; Lumbiganon, Pagakrong; Viet, Do Chau; Kurniati, Nia; Yusoff, Nik Khairuddin Nik; Razali, Kamarul; Fong, Siew Moy; Khanh, Truong Huu; Wati, Dewi Kumara; Sohn, Annette H.

2013-01-01

Background More perinatally HIV-infected children in Asia are reaching adolescence. Methods We analyzed data from July 1991 to March 2011 reported by 18 clinics in six countries of children age >12 years. Results Of 1,254 adolescents, 33 (2.6%) died, and 52 (4.2%) were lost to follow-up within 2.4-year (3566 person-years) median follow-up period. Of 1,061 adolescents under active follow-up, 485 (46%) were male, median (IQR) age was 14.7 (13.3-16.4) years, 73% had lost a parent(s), 93% attended school, and 62% were aware of their HIV status. At the most recent evaluation, 93% were receiving highly active antiretroviral therapy (ART), 71% (N=737/1035) had CD4 >500 cells/mm3 and 86% (N=718/830) had viral load (VL) <400 copies/mL. Current CD4 >200 cells/mm3, no previous WHO stage 3 or 4, and being on a first-line regimen were independently associated with recent VL <400 copies/mL. Current age <15 years, VL <400 copies/ml, CD4 15-24% (vs. <10%) at ART initiation, no previous WHO stage 3 or 4, and ART duration of >1 year were associated with recent CD4 >500 cells/mm3.Primary causes of death after age 12 were opportunistic infections (N=15/33) and other AIDS- or treatment-related conditions (N=9/33). Those at age 12 with CD4 <200 vs. >500 cells/mm3 and those with VL >10,000 vs. <10,000 copies/mL were 17.4 and 4.76 times more likely to die in adolescence, respectively. Conclusion Adolescents in this cohort have been successfully maintained in HIV care. Initiating treatment at earlier stages of disease was associated with immune recovery and virologic suppression during adolescence. PMID:23942457

Service use among Mexico City adolescents with suicidality

PubMed Central

Borges, Guilherme; Benjet, Corina; Medina-Mora, Maria Elena; Orozco, Ricardo; Familiar, Itziar; Nock, Matthew K.; Wang, Philip S.

2009-01-01

Background We report the lifetime and 12-month prevalence and associations of mental health treatment among Mexican adolescents with suicide-related outcomes (SROs; including ideation, plans, gestures and attempts). Methods A representative multistage probability household survey of 3005 adolescents aged 12 to 17 years residing in the Mexico City Metropolitan Area was carried out in 2005. Discrete time survival analyses were used to assess the relationships between SROs and receiving treatment for emotional, alcohol, or drug problems. Results The prevalence of lifetime service use among respondents with SROs was 35% for those with ideation only, 44% for those with ideation and plan, 49% for those with gesture and 50% for those with attempt; the prevalence of 12-month service use was 10%, 24%, 6% and 21%, respectively. Timing between onset of SRO and receiving treatment for emotional, alcohol, or drug problems showed that about 50% of adolescents will have contact with a service provider before developing any SRO. Healthcare professionals were the most likely to be consulted, followed by school-based programs. Limitations This survey was limited to adolescents living in one of the largest metropolitan areas in the world and the analyses used data on retrospectively reported ages of onset that are subject to recall errors. Conclusions Most suicidal adolescents do not receive treatment, and many adolescents develop their suicidality in spite of prior contacts with service providers. Interventions to increase treatment, prevention, and monitoring are sorely needed for this vulnerable population. PMID:19411113

Emerging from Depression: Treatment of Adolescent Depression Using the Major Treatment Models of Adult Depression.

ERIC Educational Resources Information Center

Long, Kathleen M.

Noting that adolescents who commit suicide are often clinically depressed, this paper examines various approaches in the treatment of depression. Major treatment models of adult depression, which can be directly applied to the treatment of the depressed adolescent, are described. Major treatment models and selected research studies are reviewed in…

Treatment of polycystic ovary syndrome in adolescence.

PubMed

Vitek, Wendy; Hoeger, Kathleen M

2014-05-01

Adolescence is a time of rapidly changing reproductive hormones and menstrual patterns making diagnosis of polycystic ovary syndrome (PCOS) challenging in this population. Nonetheless, there is significant concern that the metabolic and reproductive abnormalities that emerge at adolescence associated with a diagnosis of PCOS have lifelong implications for the individual. There are limited data available on the best treatments for the adolescent with PCOS. The focus of treatment is often best served by attention to the individual abnormalities such as menstrual dysfunction, symptoms of androgen excess such as hirsutism and acne, possible metabolic dysfunction primarily seen with concurrent obesity, and concerns related to self-image and mood disorders. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Depressive symptoms and clinical status during the Treatment of Adolescent Suicide Attempters (TASA) Study.

PubMed

Vitiello, Benedetto; Brent, David A; Greenhill, Laurence L; Emslie, Graham; Wells, Karen; Walkup, John T; Stanley, Barbara; Bukstein, Oscar; Kennard, Betsy D; Compton, Scott; Coffey, Barbara; Cwik, Mary F; Posner, Kelly; Wagner, Ann; March, John S; Riddle, Mark; Goldstein, Tina; Curry, John; Capasso, Lisa; Mayes, Taryn; Shen, Sa; Gugga, S Sonia; Turner, J Blake; Barnett, Shannon; Zelazny, Jamie

2009-10-01

To examine the course of depression during the treatment of adolescents with depression who had recently attempted suicide. Adolescents (N = 124), ages 12 to 18 years, with a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression Rating Scale-Revised (CDRS-R) score of 36 or higher, entered a 6-month treatment with antidepressant medication, cognitive-behavioral therapy focused on suicide prevention, or their combination (Comb), at five academic sites. Treatment assignment could be either random or chosen by study participants. Intent-to-treat, mixed effects regression models of depression and other relevant ratings were estimated. Improvement and remission rates were computed with the last observation carried forward. Most patients (n = 104 or 84%) chose treatment assignment, and overall, three fourths (n = 93) received Comb. In Comb, CDRS-R declined from a baseline adjusted mean of 49.6 (SD 12.3) to 38.3 (8.0) at week 12 and to 27.0 (10.1) at week 24 (p < .0001), with a Clinical Global Impression -defined improvement rate of 58.0% at week 12 and 72.2% at week 24 and a remission (CDRS-R ≤ 28) rate of 32.5% at week 12 and 50.0% at week 24. The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline (r = 0.43, p < .0001) and declined in parallel. When vigorously treated with a combination of medication and psychotherapy, adolescents with depression who have recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents with depression. Copyright © 2009 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

The Treatment of Adolescent Suicide Attempters (TASA) Study: Predictors of Suicidal Events in an Open Treatment Trial

PubMed Central

Brent, David; Greenhill, Larry; Compton, Scott; Emslie, Graham; Wells, Karen; Walkup, John; Vitiello, Benedetto; Bukstein, Oscar; Stanley, Barbara; Posner, Kelly; Kennard, Betsy; Cwik, Mary; Wagner, Ann; Coffey, Barbara; March, John; Riddle, Mark; Goldstein, Tina; Curry, John; Barnett, Shannon; Capasso, Lisa; Zelazny, Jamie; Hughes, Jennifer; Shen, Sa; Gugga, Sonia; Turner, J. Blake

2009-01-01

Objective To identify the predictors of suicidal events and attempts in depressed adolescent suicide attempters treated in an open treatment trial. Method Adolescents who had made a recent suicide attempt and had unipolar depression (n=124) were either randomized (n=22) or given a choice (n=102) among three conditions. Two participants withdrew prior to treatment assignment. The remaining 124 youth received either: a specialized psychotherapy for suicide attempting adolescents (n=17), a medication algorithm (n=14), or the combination (n=93). The participants were followed up 6 months after intake with respect to rate, timing, and predictors of a suicidal event (attempt or acute suicidal ideation necessitating emergency referral). Results The morbid risks of suicidal events and attempts upon 6-month follow-up were 0.19 and 0.12, respectively, with a median time to event of 44 days. Higher self-rated depression, suicidal ideation, family income, greater number of previous suicide attempts, lower maximum lethality of previous attempt, history of sexual abuse, and lower family cohesion predicted the occurrence, and earlier time to event, with similar findings for the outcome of attempts. A slower decline in suicidal ideation was associated with the occurrence of a suicidal event. Conclusions In this open trial, the 6-month morbid risks for suicidal events and for re-attempts were lower than in other comparable samples, suggesting that this intervention should be studied further. Important treatment targets include suicidal ideation, family cohesion, and sequelae of previous abuse. Because 40% of events occurred with 4 weeks of intake, an emphasis on safety planning and increased therapeutic contact early in treatment may be warranted. PMID:19730274

CONTRAIS: CONservative TReatment for Adolescent Idiopathic Scoliosis: a randomised controlled trial protocol.

PubMed

Abbott, Allan; Möller, Hans; Gerdhem, Paul

2013-09-05

Idiopathic scoliosis is a three-dimensional structural deformity of the spine that occurs in children and adolescents. Recent reviews on bracing and exercise treatment have provided some evidence for effect of these interventions. The purpose of this study is to improve the evidence base regarding the effectiveness of conservative treatments for preventing curve progression in idiopathic scoliosis. Previously untreated girls and boys with idiopathic scoliosis, 9 to 17 years of age with at least one year of remaining growth and a curve Cobb angle of 25-40 degrees will be included. A total of 135 participants will be randomly allocated in groups of 45 patients each to receive one of the three interventions. All three groups will receive a physical activity prescription according to the World Health Organisation recommendations. One group will additionally wear a hyper-corrective night-time brace. One group will additionally perform postural scoliosis-specific exercises. Participation in the study will last until the curve has progressed, or until cessation of skeletal growth. OUTCOME variables will be measured every 6 months. The primary outcome variable, failure of treatment, is defined as progression of the Cobb angle more than 6 degrees, compared to the primary x-ray, seen on two consecutive spinal standing x-rays taken with 6 months interval. Secondary outcome measures include the SRS-22r and EQ5D-Y quality of life questionnaires, the International Physical Activity Questionnaire (IPAQ) short form, and Cobb angle at end of the study. This trial will evaluate which of the tested conservative treatment approaches that is the most effective for patients with adolescent idiopathic scoliosis. NCT01761305.

Randomized Clinical Trial of Clinic-Integrated, Low-Intensity Treatment to Prevent Deterioration of Disease Care in Adolescents With Type 1 Diabetes

PubMed Central

Holmes, Clarissa S.; Chen, Rusan; Mackey, Eleanor; Grey, Margaret; Streisand, Randi

2014-01-01

OBJECTIVE To evaluate the efficacy of two office-based treatments designed to prevent deterioration in glycemic control in young adolescents with type 1 diabetes in a randomized clinical trial. An individualized, more intensive family teamwork Coping skills program was compared with a diabetes Education treatment. RESEARCH DESIGN AND METHODS A baseline assessment was followed by four brief treatment sessions and immediate posttesting over the course of 1.5 years. Families of 226 early adolescents (ages 11–14) were randomized to receive either individualized coping skills education or diabetes education as adjunctive treatment to quarterly medical appointments. Continued follow-up occurred at 3.5-month intervals for a long-term follow-up of up to 3 years. A post hoc Usual Care group facilitated comparisons of glycemic control. RESULTS Growth curve analysis showed that both treatment groups successfully prevented deterioration in adolescent disease care and simultaneously improved adolescent and parent quality of life that included indicators of more effective communication and reduced adherence barriers—without a concomitant increase in diabetes-related or general family conflict. However, contrary to expectation, the Education group was more efficacious than the Coping group in improvement of disease adherence and glycemic control over a 3-year follow-up. CONCLUSIONS Low-intensity office-based quarterly treatment can maintain or improve disease care adherence in early adolescence when provided to adolescent/parent dyads. Better outcomes are achieved when treatment goals and techniques match the needs of the targeted population. PMID:24623027

Causes and Treatment of Insomnia among Adolescents.

ERIC Educational Resources Information Center

Morrison, Jack R.; And Others

1985-01-01

As much as 13 percent of the adolescent population may suffer from chronic insomnia, which can impair the victim's daily existence and affect personal life, school performance, and school attendance. The prevalence of adolescent insomnia, and its cause, diagnosis, and treatment are examined. (Author/CB)

Poor Outcomes in a Cohort of HIV-Infected Adolescents Undergoing Treatment for Multidrug-Resistant Tuberculosis in Mumbai, India

PubMed Central

Isaakidis, Petros; Paryani, Roma; Khan, Samsuddin; Mansoor, Homa; Manglani, Mamta; Valiyakath, Asmaa; Saranchuk, Peter; Furin, Jennifer

2013-01-01

Background Little is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10–19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF) project in Mumbai, India. Methods A retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation. Results The median age was 16 (IQR 14–18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8–250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens. Conclusions Early mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial

Poor outcomes in a cohort of HIV-infected adolescents undergoing treatment for multidrug-resistant tuberculosis in Mumbai, India.

PubMed

Isaakidis, Petros; Paryani, Roma; Khan, Samsuddin; Mansoor, Homa; Manglani, Mamta; Valiyakath, Asmaa; Saranchuk, Peter; Furin, Jennifer

2013-01-01

Little is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10-19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF) project in Mumbai, India. A retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation. The median age was 16 (IQR 14-18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8-250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens. Early mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial support for co-infected adolescents

Adolescents' and parents' experiences of managing the psychosocial impact of appearance change during cancer treatment.

PubMed

Williamson, Heidi; Harcourt, Diana; Halliwell, Emma; Frith, Hannah; Wallace, Melissa

2010-01-01

Using combined qualitative data from multiple case study interviews and an online survey, this study explored the impact of appearance change on 22 adolescents receiving cancer treatment aged 13 to 18 years and six of their parents. Data were analyzed using template analysis. Appearance changes were a major concern. Adolescents typically struggled to adapt to new experiences and concerns related to this highly sensitive issue. Many felt anxious and self-conscious and were reluctant to reveal appearance changes in public. These feelings were compounded by the negative reactions of others (e.g., staring, teasing, and inappropriate questioning), which sometimes lead to avoidance of social activity and threats of noncompliance. Parents of these children felt ill-prepared to manage appearance-related anxieties. Adolescents wanted support to develop the practical and social skills necessary to maintain a "normal" appearance and manage the negative responses of others. However, some adolescents showed resilience and, with support from friends and family, developed strategies to manage their altered appearance and its social consequences. These strategies are explored, which can inform interventions to support adolescents and parents.

Cognitive remediation therapy for adolescent inpatients with severe and complex anorexia nervosa: A treatment trial.

PubMed

Harrison, Amy; Stavri, Pamela; Ormond, Lynn; McEnemy, Francine; Akyol, Dilan; Qureshi, Annum; Al-Khairulla, Hind

2018-05-01

Cognitive remediation therapy (CRT) is a low-intensity treatment adjunct for individuals with severe and complex anorexia nervosa (AN) with difficulties in globally oriented, flexible thinking. Previously trialled in adults, this study investigated whether individual and group CRT was a feasible, acceptable, and beneficial treatment for 125 adolescent inpatients with severe and complex AN. Seventy patients (mean age = 15.22, SD = 1.44) received 10 sessions of individual CRT, and 55 patients (mean age = 14.89, SD = 1.74) received 10 sessions of group CRT. In individual CRT, 1 patient (1.43%) dropped out, and there were medium-sized improvements in bigger picture thinking and set-shifting, small to large-sized improvements in switching-related initiation and inhibition skills, and large-sized improvements in motivation to recover. Group CRT had higher dropout (9.09%; n = 5) and produced small-sized improvements in global information processing and medium-sized improvements in self-reported cognitive flexibility and high acceptability ratings. Data suggest that a randomised controlled trial for adolescents with AN is warranted. Copyright © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.

Identity: empirical contribution. Changes in the identity integration of adolescents in treatment for personality disorders.

PubMed

Feenstra, Dine J; Hutsebaut, Joost; Verheul, Roel; van Limbeek, Jacques

2014-02-01

A renewed interest in identity as one of the core markers of personality disorders has been introduced by the DSM-5 Level of Personality Functioning Scale. However, little is known about the utility of the construct of identity in children and adolescents. This study aimed to broaden the knowledge of identity integration as a core component of personality functioning in adolescents. The authors investigated levels of identity integration, as measured by the Severity Indices of Personality Problems (SIPP-118; Verheul et al., 2008), in adolescents in both normal (n = 406) and clinical populations (n = 285). Furthermore, changes in levels of identity integration during treatment were investigated in a clinical subsample (n = 76). Levels of identity integration were not associated with age. They were, however, associated with the absence or presence of personality pathology. Most adolescents receiving inpatient psychotherapy gradually changed toward more healthy levels of identity integration; a significant number, however, remained at maladaptive levels of identity functioning after intensive psychotherapy.

Convergence in Reports of Adolescents' Psychopathology: A Focus on Disorganized Attachment and Reflective Functioning.

PubMed

Borelli, Jessica L; Palmer, Alexandra; Vanwoerden, Salome; Sharp, Carla

2017-12-13

Although convergence in parent-youth reports of adolescent psychopathology is critical for treatment planning, research documents a pervasive lack of agreement in ratings of adolescents' symptoms. Attachment insecurity (particularly disorganized attachment) and impoverished reflective functioning (RF) are 2 theoretically implicated predictors of low convergence that have not been examined in the literature. In a cross-sectional investigation of adolescents receiving inpatient psychiatric treatment, we examined whether disorganized attachment and low (adolescent and parent) RF were associated with patterns of convergence in adolescent internalizing and externalizing symptoms. Compared with organized adolescents, disorganized adolescents had lower parent-youth convergence in reports of their internalizing symptoms and higher convergence in reports of their externalizing symptoms; low adolescent self-focused RF was associated with low convergence in parent-adolescent reports of internalizing symptoms, whereas low adolescent global RF was associated with high convergence in parent-adolescent reports of externalizing symptoms. Among adolescents receiving inpatient psychiatric treatment, disorganized attachment and lower RF were associated with weaker internalizing symptom convergence and greater externalizing symptom convergence, which if replicated, could inform assessment strategies and treatment planning in this setting.

Parental guided self-help family based treatment for adolescents with anorexia nervosa: A feasibility study.

PubMed

Lock, James; Darcy, Alison; Fitzpatrick, Kathleen Kara; Vierhile, Molly; Sadeh-Sharvit, Shiri

2017-09-01

Family-based treatment (FBT) is an evidence-based treatment for adolescent anorexia nervosa (AN), but many families cannot access it. This study evaluated feasibility, acceptability, and preliminary treatment effects of a parental guided self-help (GSH) version of FBT for adolescent AN. This was a case-series design. Parents of medically stable adolescents (11-18 years) with DSM-5 AN were recruited over 12 months. Parents received online training in parental GSH FBT and 12 20-30 min GSH sessions by phone or online over 6 months. Recruitment, dropout, changes in weight, and eating-related psychopathology were assessed. Analyses used mixed modeling that included all data for all participants. Of the 19 families that participated, most were white (94%) and from intact families (88%). Baseline median BMI (mBMI) percent was 85.01% (SD = 4.31). Participants' mBMI percent increased to 97.31% (SD ± 7.48) at the end of treatment (EOT) (ES = 2.06; CI= 0.13-3.99). Eating-related psychopathology improved by EOT (ES = 0.58; CI=.04-1.21). Dropout rate was 21% during treatment and 33% during follow-up. Parental GSH-FBT is feasible and acceptable to families willing to undertake online treatment. Follow-up data was only available for nine families (47%); thus further systematic evaluation is required before reaching conclusions about the efficacy of this approach. © 2017 Wiley Periodicals, Inc.

The Severely Disturbed Adolescent; Inpatient, Residential, and Hospital Treatment.

ERIC Educational Resources Information Center

Easson, William M.

The text is an attempt to clarify specific indications for hospital treatment and to highlight the type of adolescent disturbance that might be helped in an inpatient therapeutic environment. Chapters discuss the prescription of residential treatment, the therapeutic facilities of a residential unit for disturbed adolescents, the continued…

Mania Symptoms and HIV-Risk Behavior among Adolescents in Mental Health Treatment

ERIC Educational Resources Information Center

Stewart, Angela J.; Theodore-Oklota, Christina; Hadley, Wendy; Brown, Larry K.; Donenberg, Geri; DiClemente, Ralph

2012-01-01

This study explored whether adolescents with elevated symptoms of mania (ESM+) engage in more HIV risk behaviors than those with other psychiatric disorders and examined factors associated with HIV risk behavior among ESM+ adolescents. Eight hundred forty adolescents (56% female, 58% African American, "M" age = 14.9 years) who received mental…

Effects of adolescent treatment with nicotine, harmane, or norharmane in male Sprague-Dawley rats.

PubMed

Goodwin, Amy K; Lantz-McPeak, Susan M; Robinson, Bonnie L; Law, C Delbert; Ali, Syed F; Ferguson, Sherry A

2015-01-01

The initiation of tobacco use occurs most often in adolescence and may be especially detrimental as the adolescent brain is undergoing substantial development. In addition to nicotine, there are over 9000 other compounds present in tobacco products, including the β-carbolines harmane and norharmane. The present study aimed to determine the long-term effects of adolescent exposure to nicotine (NIC), harmane (HAR), or norharmane (NOR) on locomotor activity, learning and memory, anxiety-like behavior, motor coordination, and monoamine/metabolite concentrations in the striatum and nucleus accumbens of male Sprague-Dawley rats. Beginning on postnatal day (PND) 27 and continuing through PND 55, subjects received twice daily intraperitoneal injections of 1ml/kg saline (CON), 0.5mg NIC/kg, 0.5mg HAR/kg, or 0.5mg NOR/kg. Body weight, food, and water intake were measured daily (PNDs 27-96). Locomotor activity was assessed on PND 40 or 41, PND 55, and PNDs 81 and 82. Other behaviors (anxiety-like behavior, motor coordination, and spatial learning and memory) were assessed at least 25 days after drug exposure ended (PNDs 80-91). On PND 97, subjects were decapitated and the striatum and nucleus accumbens were dissected and frozen for analysis. NIC treatment significantly decreased food intake, but did not alter locomotor activity during or after treatment. HAR and NOR treatment, however, caused significant open field hypoactivity. Motor coordination, water maze performance, and concentrations of monoamines and metabolites in the striatum and nucleus accumbens were unaltered by any drug treatment. These results indicate a long-lasting effect on activity levels from adolescent HAR or NOR treatment; however, there were few long-lasting NIC effects. Given the paucity of data describing effects of HAR or NOR exposure, these data should encourage additional studies of these tobacco constituents as well as constituent combination studies. Published by Elsevier Inc.

Depressive Symptoms and Clinical Status during the Treatment of Adolescent Suicide Attempters Study (TASA)

PubMed Central

Vitiello, Benedetto; Brent, David; Greenhill, Laurence L.; Emslie, Graham; Wells, Karen; Walkup, John T.; Stanley, Barbara; Bukstein, Oscar; Kennard, Betsy D.; Compton, Scott; Coffey, Barbara; Cwik, Mary F.; Posner, Kelly; Wagner, Ann; March, John S.; Riddle, Mark; Goldstein, Tina; Curry, John; Capasso, Lisa; Mayes, Taryn; Shen, Sa; Gugga, S. Sonia; Turner, J. Blake; Barnett, Shannon; Zelazny, Jamie

2009-01-01

Objective To examine the course of depression during the treatment of depressed adolescents who had recently attempted suicide. Method Adolescents (N=124), age 12–18 years, with a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression Rating Scale-Revised (CDRS-R) score of 36 or greater, entered a 6-month treatment with antidepressant medication, cognitive-behavioral therapy focused on suicide prevention, or their combination (Comb), at five academic sites. Treatment assignment could be either random or chosen by study participants. Intent-to-treat, mixed effects regression models of depression and other relevant ratings were estimated. Improvement and remission rates were computed with the last observation carried forward. Results Most patients (N=104 or 84%) chose treatment assignment and, overall, three-fourths (N=93) received Comb. In Comb, CDRS-R declined from a baseline adjusted mean of 49.6 (SD 12.3) to 38.3 (8.0) at week 12, and to 27.0 (10.1) at week 24 (p<0.0001), with a Clinical Global Impression-defined improvement rate of 58.0% at week 12, and 72.2% at week 24; and a remission (CDRS-R ≤28) rate of 32.5% at week 12 and 50.0% at week 24. CDRS-R and the Scale for Suicidal Ideation (SSI) scores were correlated at baseline (r=0.43, p<0.0001), and declined in parallel. Conclusions When vigorously treated with a combination of medication and psychotherapy, depressed adolescents who have recently attempted suicide show rates of improvement and remission of depression that appear comparable to those observed in non-suicidal depressed adolescents. PMID:20854770

Anorexia Nervosa in Adolescence and Maudsley Family-Based Treatment

ERIC Educational Resources Information Center

Hurst, Kim; Read, Shelly; Wallis, Andrew

2012-01-01

Anorexia nervosa is a serious psychiatric disorder that usually occurs in adolescence. The course of the illness can be protracted. Current empirical evidence suggests that the Maudsley Family-Based Treatment (MFBT) is efficacious for adolescents. MFBT empowers parents as a crucial treatment resource to assist in their child's recovery. The…

Adolescence and polycystic ovary syndrome: current concepts on diagnosis and treatment.

PubMed

Spritzer, P M; Motta, A B

2015-11-01

Adolescence is a time characterised by changes in reproductive hormones and menstrual patterns, which makes it difficult to diagnose polycystic ovary syndrome (PCOS) in this population. The diagnosis of PCOS has a great physical and psychosocial impact on the young person. Despite the importance of a diagnosis of PCOS at adolescence, data available are limited. This review focuses on analysing markers of PCOS diagnosis and possible treatments in adolescence. Although, during adolescence, diagnosis criteria of PCOS overlap with physiological changes including clinical manifestations of hyperandrogenism (acne and hirsutism), oligo/amenorrhoea, anovulation and ovarian microcysts, there is agreement that irregular menses and hyperandrogenaemia should be used to diagnose PCOS in this population. Moreover, considering that PCOS phenotype could change through the reproductive age and that adolescents display heterogeneous ovarian morphology, it has been proposed that diagnosis of PCOS should be confirmed after the age of 18. The first-line treatment for menstrual irregularity and hirsutism are oral contraceptive pills (OCPs) and for obesity and metabolic abnormalities are lifestyle changes. Insulin-sensitizer drugs, such as metformin, may be added to the treatment in the presence of metabolic alterations. Antiandrogen drugs may also be associated for treating moderate to severe hirsutism. During adolescence, physiological changes overlap with signs and symptoms of PCOS; thus the diagnosis criteria should be carefully considered. Regarding the treatment of adolescents with PCOS, non-pharmacological interventions include lifestyle changes. Pharmacological treatments comprise OCPs, antiandrogens and metformin, used isolated or combined. During adolescence, physiological changes overlap with signs and symptoms of PCOS; thus the diagnosis criteria should be carefully considered. Regarding the treatment of adolescents with PCOS, non-pharmacological interventions include

Diagnosis and treatment of polycystic ovarian syndrome in adolescents.

PubMed

Nicandri, Katrina F; Hoeger, Kathleen

2012-12-01

To review what is understood about the pathophysiology of polycystic ovarian syndrome (PCOS), the diagnostic challenges of PCOS in adolescent women, associated risk factors, as well as the best evidence-based treatment options for adolescence. Diagnosing PCOS in adolescents requires a unique set of criteria for which no single marker currently exists. Adolescents at high risk for developing the syndrome are congenital virilization, low birth weight, premature pubarche, central precocious puberty, large for gestational age girls born to overweight mothers, obesity syndromes, insulin-resistant features, and girls born to parents with PCOS, central obesity, or diabetes in whom PCOS ought to be suspected when associated with irregular menses. Insulin, hyperandrogenemia, and adipocytokines are integral players in the pathophysiology of PCOS. PCOS may be an inheritable trait; however, no gene has yet been identified. Quality of life remains a concern for young women with PCOS. Lifestyle modifications geared to prevent long-term sequelae remain the first-line treatment in conjunction with oral contraceptive pills. Identifying PCOS in adolescents remains a diagnostic dilemma, but early intervention and treatment can improve long-term health.

Bulimia nervosa in adolescents: prevalence and treatment challenges

PubMed Central

Hail, Lisa; Le Grange, Daniel

2018-01-01

Bulimia nervosa (BN) is a serious psychiatric illness that typically develops during adolescence or young adulthood, rendering adolescents a target for early intervention. Despite the increasing research devoted to the treatment of youth with anorexia nervosa (AN) and adults with BN, there remains a dearth of evidence for treating younger individuals with BN. To date, there have been four published randomized controlled trials comparing psychosocial treatments, leaving significant room to improve treatment outcomes. Family-based treatment is the leading treatment for youth with AN, while cognitive-behavioral therapy is the leading intervention for adults with BN. Involving caregivers in treatment shows promising results, however, additional research is needed to investigate ways in which this treatment can be adapted further to achieve higher rates of recovery. PMID:29379324

Adolescents entering chemical dependency treatment in private managed care: ethnic differences in treatment initiation and retention.

PubMed

Campbell, Cynthia I; Weisner, Constance; Sterling, Stacy

2006-04-01

There has been little research on adolescents of different ethnicities in chemical dependency (CD) treatment, despite a focus on ethnic disparities in health care in recent years. In particular, little is known about ethnic differences in utilization of adolescent CD services. We examined treatment initiation and treatment retention in a sample of African American, Native American, Latino, Asian American, and Caucasian adolescents entering CD treatment in a private, managed care health plan (n = 419). Our conceptual framework included ethnicity as the main factor as well as measures of external pressure and internal motivation/readiness for treatment, family environment, psychiatric co-morbidities, and severity of alcohol and drug problems. Logistic and Poisson regression were used to examine differences. The study found ethnic differences in treatment initiation and treatment retention. Native American adolescents had lower odds of returning after intake to initiate treatment compared with Caucasians (odds ratio [OR] .35, p = .009), and African American youth spent less time in treatment than Caucasians (RR: .49, p < .001). Study findings indicate differences in treatment initiation for Native Americans and in treatment retention for African Americans. Intake and orientation sessions offer an opportunity to intervene with Native American youth. Given their high psychiatric co-morbidity, they may also benefit from the availability of psychiatric services. Even after adjusting for severity, we found shorter treatment retention for African American adolescents and suggest that organizational factors, such as cultural competency, may play an important role.

CONTRAIS: CONservative TReatment for Adolescent Idiopathic Scoliosis: a randomised controlled trial protocol

PubMed Central

2013-01-01

Background Idiopathic scoliosis is a three-dimensional structural deformity of the spine that occurs in children and adolescents. Recent reviews on bracing and exercise treatment have provided some evidence for effect of these interventions. The purpose of this study is to improve the evidence base regarding the effectiveness of conservative treatments for preventing curve progression in idiopathic scoliosis. Methods/design Patients: Previously untreated girls and boys with idiopathic scoliosis, 9 to 17 years of age with at least one year of remaining growth and a curve Cobb angle of 25–40 degrees will be included. A total of 135 participants will be randomly allocated in groups of 45 patients each to receive one of the three interventions. Interventions: All three groups will receive a physical activity prescription according to the World Health Organisation recommendations. One group will additionally wear a hyper-corrective night-time brace. One group will additionally perform postural scoliosis-specific exercises. Outcome: Participation in the study will last until the curve has progressed, or until cessation of skeletal growth. Outcome variables will be measured every 6 months. The primary outcome variable, failure of treatment, is defined as progression of the Cobb angle more than 6 degrees, compared to the primary x-ray, seen on two consecutive spinal standing x-rays taken with 6 months interval. Secondary outcome measures include the SRS-22r and EQ5D-Y quality of life questionnaires, the International Physical Activity Questionnaire (IPAQ) short form, and Cobb angle at end of the study. Discussion This trial will evaluate which of the tested conservative treatment approaches that is the most effective for patients with adolescent idiopathic scoliosis. Trial registration NCT01761305 PMID:24007599

The economic costs of chronic pain among a cohort of treatment seeking adolescents in the United States

PubMed Central

Groenewald, Cornelius B.; Essner, Bonnie S.; Wright, Davene; Fesinmeyer, Megan D.; Palermo, Tonya M.

2014-01-01

The aim of this study was to assess the economic cost of chronic pain among adolescents receiving interdisciplinary pain treatment. Information was gathered from 149 adolescents (ages 10-17) presenting for evaluation and treatment at interdisciplinary pain clinics in the United States. Parents completed a validated measure of family economic attributes, the Client Service Receipt Inventory, to report on health service use and productivity losses due to their child's chronic pain retrospectively over 12 months. Health care costs were calculated by multiplying reported utilization estimates by unit visit costs from the 2010 Medical Expenditure Panel Survey. The estimated mean and median costs per participant were $11,787 and $6,770 respectively. Costs were concentrated in a small group of participants, the top 5 % of those patients incurring the highest costs accounted for 30 % of total costs while the lower 75 % of participants accounted for only 34 % of costs. Total costs to society for adolescents with moderate to severe chronic pain were extrapolated to $19.5 billion annually in the U.S. The cost of childhood chronic pain presents a substantial economic burden to families and society. Future research should focus on predictors of increased health services use and costs in adolescents with chronic pain. Perspective This cost of illness study comprehensively estimates the economic costs of chronic pain in a cohort of treatment-seeking adolescents. The primary driver of costs was direct medical costs followed by productivity losses. Because of its economic impact, policy makers should invest resources in the prevention, diagnosis, and treatment of chronic pediatric pain. PMID:24953887

[Effect of body image in adolescent orthodontic treatment].

PubMed

Minghui, Peng; Jing, Kang; Xiao, Deng

2017-10-01

This study was designed to probe the psychological factors adolescent orthodontic patients, the role of body image and self-esteem in the whole process of orthodontic treatment and the impact on the efficacy and satisfaction of orthodontic. Five hundred and twenty-eight patients were selected in this study. The Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) , Rosenberg Self-Esteem Scale (SES), Negative Physical Self-General (NPS-G) and other body analysis scale study after orthodontic lasted 18-24 months were used to investigate the role of body image in adolescent orthodontic treatment. Esthetic evaluation of patients teeth after correction had been significantly improved, patient self-evaluation difference IOTN-AC doctor evaluation, Psychosocial Impact of Dental Aesthetics Questionnaire-tooth confidence, aesthetic concerns, psychological impact and social function were significantly improved. The improvement of the dental aesthetics component (T2 when doctors evaluate IOTN-AC) was positively correlated with the evaluation of the efficacy, and was significantly negatively correlated with the negative emotions of patients at baseline. Negative body image-dental dissatisfied-cognitive component and the affective component, the overall negative body image and negative emotions can predict patient satisfaction with treatment efficacy. Orthodontic treatment not only improves the self-aesthetic evaluation of adolescent patients, but also has a positive effect on the mental health of adolescent patients.

A Pilot SMART for Developing an Adaptive Treatment Strategy for Adolescent Depression.

PubMed

Gunlicks-Stoessel, Meredith; Mufson, Laura; Westervelt, Ana; Almirall, Daniel; Murphy, Susan

2016-01-01

This pilot study was conducted to assess the feasibility and acceptability of 4 adaptive treatment strategies (ATSs) for adolescent depression to plan for a subsequent full-scale clinical trial. The ATSs aim to address 2 questions that arise when personalizing treatment: (a) For adolescents treated with Interpersonal Psychotherapy for depressed adolescents (IPT-A; Mufson et al., 2004 ), at what time point should therapists make the determination that the adolescent is not likely to respond if the initial treatment plan is continued (week 4 or week 8)? (b) For adolescents who are judged to need their treatment augmented, should the therapist increase the number of IPT-A sessions or add pharmacotherapy (fluoxetine)? A 16-week pilot sequential multiple assignment randomized trial (SMART) was conducted with 32 adolescents (M age = 14.9) who had a diagnosis of major depressive disorder, dysthymic disorder, or depressive disorder not otherwise specified. Adolescents were primarily female (75%) and Caucasian (84.4%). Data regarding the feasibility and acceptability of the study and treatment procedures and treatment response rates were collected. Week 4 was the more feasible and acceptable decision point for assessing need for a change to treatment. Adolescents, parents, and therapists reported a range of attitudes about medication and more intensive therapy as treatment options. Results from the pilot study have yielded additional research questions for the full-scale SMART and will improve our ability to successfully conduct the trial.

Cigarette and cannabis use trajectories among adolescents in treatment for attention-deficit/hyperactivity disorder and substance use disorders.

PubMed

Gray, Kevin M; Riggs, Paula D; Min, Sung-Joon; Mikulich-Gilbertson, Susan K; Bandyopadhyay, Dipankar; Winhusen, Theresa

2011-09-01

Cigarette smoking is common in adolescents with attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD). However, little is known about the relationship between cigarette and cannabis use trajectories in the context of treatment for both ADHD and SUD. To address this research gap, we report collateral analyses from a 16-week randomized, controlled trial (n=303) of osmotic-release methylphenidate (OROS-MPH) in adolescents with ADHD concurrently receiving cognitive behavioral therapy (CBT) targeting non-nicotine SUD. Participants completed cigarette and cannabis use self-report at baseline and throughout treatment. Analyses were performed to explore the relationships between cigarette smoking, cannabis use, and other factors, such as medication treatment assignment (OROS-MPH versus placebo). Baseline (pre-treatment) cigarette smoking was positively correlated with cannabis use. Negligible decline in cigarette smoking during treatment for non-nicotine SUD was observed in both medication groups. Regular cigarette and cannabis users at baseline who reduced their cannabis use by >50% also reduced cigarette smoking (from 10.8±1.1 to 6.2±1.1 cigarettes per day). Findings highlight the challenging nature of concurrent cannabis and cigarette use in adolescents with ADHD, but demonstrate that changes in use of these substances during treatment may occur in parallel. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Cigarette and Cannabis Use Trajectories Among Adolescents in Treatment for Attention-Deficit/Hyperactivity Disorder and Substance Use Disorders

PubMed Central

Gray, Kevin M.; Riggs, Paula D.; Min, Sung-Joon; Mikulich-Gilbertson, Susan K.; Bandyopadhyay, Dipankar; Winhusen, Theresa

2011-01-01

Background Cigarette smoking is common in adolescents with attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD). However, little is known about the relationship between cigarette and cannabis use trajectories in the context of treatment for both ADHD and SUD. To address this research gap, we report collateral analyses from a 16-week randomized, controlled trial (n=303) of osmotic-release methylphenidate (OROS-MPH) in adolescents with ADHD concurrently receiving cognitive behavioral therapy (CBT) targeting non-nicotine SUD. Methods Participants completed cigarette and cannabis use self-report at baseline and throughout treatment. Analyses were performed to explore the relationships between cigarette smoking, cannabis use, and other factors, such as medication treatment assignment (OROS-MPH versus placebo). Results Baseline (pre-treatment) cigarette smoking was positively correlated with cannabis use. Negligible decline in cigarette smoking during treatment for non-nicotine SUD was observed in both medication groups. Regular cigarette and cannabis users at baseline who reduced their cannabis use by >50% also reduced cigarette smoking (from 10.8±1.1 to 6.2±1.1 cigarettes per day). Conclusions Findings highlight the challenging nature of concurrent cannabis and cigarette use in adolescents with ADHD, but demonstrate that changes in use of these substances during treatment may occur in parallel. PMID:21411243

Text message reminders to improve outpatient therapy attendance among adolescents: a pilot study.

PubMed

Branson, Christopher E; Clemmey, Philip; Mukherjee, Preetika

2013-08-01

High rates of missed appointments and attrition are common barriers to treatment for adolescents attending outpatient mental health treatment. Such figures indicate a need for innovative strategies to engage youth in treatment. The current quasi-experimental pilot study examined the feasibility, acceptability, and preliminary efficacy of text message (TM) appointment reminders to improve attendance in a sample of 48 adolescents attending outpatient therapy. The sample was approximately 46% Latino and 40% African American with an equal number of males and females. Adolescents receiving TM reminders demonstrated significantly higher rates of attendance (65%) than a historical control group (49%) (p < .05). Participants in the TM group received reminders for the majority (88%) of their scheduled sessions with only 4% of reminders not received due to phone-related problems. Additionally, TM reminders received high patient satisfaction ratings. Findings from the present study suggest that TM reminders may be a cost-effective and developmentally appropriate strategy for engaging adolescents in treatment. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Parent Involvement in CBT Treatment of Adolescent Depression: Experiences in the Treatment for Adolescents with Depression Study (TADS)

ERIC Educational Resources Information Center

Wells, Karen C.; Albano, Anne Marie

2005-01-01

The Treatment for Adolescents With Depression Study (TADS) evaluated the short- and long-term effectiveness of cognitive behavior therapy (CBT) alone, fluoxetine alone, and their combination, relative to pill placebo, and the 12-week treatment effects were recently published (TADS Team, 2004). Results showed that treatment that combined CBT with…

Chronic Nicotine Treatment During Adolescence Attenuates the Effects of Acute Nicotine in Adult Contextual Fear Learning.

PubMed

Holliday, Erica D; Gould, Thomas J

2017-01-01

Adolescent onset of nicotine abuse is correlated with worse chances at successful abstinence in adulthood. One reason for this may be due to enduring learning deficits resulting from nicotine use during adolescence. Previous work has indicated that chronic nicotine administration beginning in late adolescence (PND38) caused learning deficits in contextual fear when tested in adulthood. The purpose of this study was to determine if chronic nicotine treatment during adolescence would alter sensitivity to nicotine's cognitive enhancing properties in adulthood. C57BL/6J mice received saline or chronic nicotine (12.6mg/kg/day) during adolescence (postnatal day 38) or adulthood (postnatal day 54) for a period of 12 days. Following a 30-day protracted abstinence, mice received either an acute injection of saline or nicotine (0.045, 0.18, and 0.36mg/kg) prior to training and testing a mouse model of contextual fear. It was found that chronic nicotine administration in adult mice did not alter sensitivity to acute nicotine following a protracted abstinence. In adolescent mice, chronic nicotine administration disrupted adult learning and decreased sensitivity to acute nicotine in adulthood as only the highest dose tested (0.36mg/kg) was able to enhance contextual fear learning. These results suggest that adolescent nicotine exposure impairs learning in adulthood, which could increase the risk for continued nicotine use in adulthood by requiring administration of higher doses of nicotine to reverse learning impairments caused by adolescent nicotine exposure. Results from this study add to the growing body of literature suggesting chronic nicotine exposure during adolescence leads to impaired learning in adulthood and demonstrates that nicotine exposure during adolescence attenuates the cognitive enhancing effects of acute nicotine in adulthood, which suggests altered cholinergic function. © The Author 2016. Published by Oxford University Press on behalf of the Society for

Crohn's disease in adolescence: presentation and treatment.

PubMed

Cullen, Mick; Barnes, Claire

2015-05-13

Crohn's disease is a chronic inflammatory bowel condition that affects more than 115,000 people in the UK. This article focuses on Crohn's disease in adolescents. Management of the condition in this group should address adolescent-specific characteristics and treatment goals. Key elements include optimising growth, pubertal development and social functioning, including education. The condition can affect an individual's mental and emotional wellbeing significantly, as well as their physical health. As adolescence is a time of great change, the additional burden of a chronic illness can prove difficult to manage. The authors provide information on the presentation of Crohn's disease in adolescence and insights into the particular issues encountered by this group.

A Pilot SMART for Developing an Adaptive Treatment Strategy for Adolescent Depression

PubMed Central

Gunlicks-Stoessel, Meredith; Mufson, Laura; Westervelt, Ana; Almirall, Daniel; Murphy, Susan

2015-01-01

Objective(s) This pilot study was conducted to assess the feasibility and acceptability of four adaptive treatment strategies (ATSs) for adolescent depression to plan for a subsequent full-scale clinical trial. The ATSs aim to address two questions that arise when personalizing treatment: (1) for adolescents treated with Interpersonal Psychotherapy for depressed adolescents (IPT-A) (Mufson et al, 2004), at what time point should therapists make the determination that the adolescent is not likely to respond if the initial treatment plan is continued (week 4 or week 8), and (2) for adolescents who are judged to need their treatment augmented, should the therapist increase the number of IPT-A sessions or add pharmacotherapy (fluoxetine). Method A 16 week pilot sequential multiple assignment randomized trial (SMART) was conducted with 32 adolescents (mean age = 14.9) who had a diagnosis of Major Depressive Disorder, Dysthymic Disorder, or Depressive Disorder NOS. Adolescents were primarily female (75%) and Caucasian (84.4%). Data regarding the feasibility and acceptability of the study and treatment procedures and treatment response rates was collected. Results Week 4 was the more feasible and acceptable decision point for assessing need for a change to treatment. Adolescents, parents, and therapists reported a range of attitudes about medication and more intensive therapy as treatment options. Conclusions The ATSs including the week 4 decision point showed promise in terms of their feasibility and acceptability. Results from the pilot study have yielded additional research questions for the full-scale SMART and will improve our ability to successfully conduct the trial. PMID:25785788

Consumer satisfaction with the Child and Adolescent Mental Health Service and its association with treatment outcome: a 3-4-year follow-up study.

PubMed

Solberg, Cathrine; Larsson, Bo; Jozefiak, Thomas

2015-04-01

Consumer satisfaction studies with the Child and Adolescent Mental Health Service (CAMHS) have mainly assessed evaluations in a short-term follow-up perspective. Adolescent reports with CAMHS have not been included nationally. The purposes of this study were to explore adolescent and parental satisfaction with the CAMHS in a 3-4-year follow-up perspective, and to examine the relationships between reported consumer satisfaction and clinical parameters such as reason for adolescent referral, emotional/behavioral symptoms and treatment outcome. Of 190 adolescent-parent pairs in a sample of CAMHS outpatients, 120 completed a Consumer Satisfaction Questionnaire. Parents assessed adolescent emotional/behavior problems both at baseline and at follow-up by completing the Child Behavior Checklist (CBCL). Correlations were examined between adolescent and parental evaluations. The relationships between service satisfaction and symptom load at baseline and follow-up and treatment outcome at follow-up were explored. Overall, adolescents and parents were satisfied with the services received from the CAMHS. The correlations between adolescent and parent consumer satisfaction ratings were low to moderate. Consumer satisfaction was significantly and negatively correlated with symptom load on the CBCL Total Problems scores at baseline, but not at follow-up. There was no difference in satisfaction levels between those who improved after treatment and those who did not. Given the differences in informant ratings of consumer satisfaction, it is important to include both adolescent and parental perceptions in evaluations of CAMHS services and treatment outcomes. Consumer satisfaction should serve as a supplement to established standardized outcome measures.

Evidence-Based Psychosocial Treatments for Adolescents with Disruptive Behavior

PubMed Central

McCart, Michael R.; Sheidow, Ashli J.

2016-01-01

Objective This article updates the earlier reviews of evidence-based psychosocial treatments for disruptive behavior in adolescents (Brestan & Eyberg, 1998; Eyberg, Nelson, & Boggs, 2008), focusing primarily on the treatment literature published from 2007 to 2014. Method Studies were identified through an extensive literature search and evaluated using Journal of Clinical Child and Adolescent Psychology (JCCAP) level of support criteria, which classify studies as well established, probably efficacious, possibly efficacious, experimental, or of questionable efficacy based on existing evidence. The JCCAP criteria have undergone modest changes in recent years. Thus, in addition to evaluating new studies from 2007–2014 for this update, all adolescent-focused articles that had been included in the 1998 and 2008 reviews were re-examined. In total, 86 empirical papers published over a 48-year period and covering 50 unique treatment protocols were identified and coded. Results Two multicomponent treatments that integrate strategies from family, behavioral, and cognitive-behavioral therapy met criteria as well established. Summaries are provided for those treatments, as well as for two additional multicomponent treatments and two cognitive-behavioral treatments that met criteria as probably efficacious. Treatments designated as possibly efficacious, experimental, or of questionable efficacy are listed. Additionally, moderator/mediator research is summarized. Conclusions Results indicate that since the prior reviews, there has been a noteworthy expansion of research on treatments for adolescent disruptive behavior, particularly treatments that are multicomponent in nature. Despite these advances, more research is needed to address key gaps in the field. Implications of the findings for future science and clinical practice are discussed. PMID:27152911

The role of pharmacotherapy in the treatment of adolescent substance use disorders

PubMed Central

Hammond, Christopher J.

2016-01-01

Summary Adolescent substance use disorders (SUDs) are associated with elevated morbidity and mortality, and represent a significant public health cost. While psychosocial interventions for adolescent SUDs have demonstrated short-term efficacy, many youth relapse after treatment. A potential approach to improve treatment response is to use adjunctive pharmacotherapy. An increasing number of medications have been shown to improve SUD treatment outcomes for alcohol, tobacco, and opioid use disorders in adults. Although relatively few randomized controlled medication trials have been conducted in adolescents, results suggest that pharmacotherapies when added to psychosocial interventions may hold similar promise for improving outcomes for adolescents with SUDs. This article provides a review of current research on the safety and efficacy of pharmacotherapies used in the treatment of adolescent SUDs. PMID:27613346

[Structured treatment interruption in HIV-infected adolescents].

PubMed

Vidal, P; Lalande, M; Rodiere, M

2009-07-01

Structured treatment interruption in HIV is now being debated. There are 2 cases in which it may be discussed: when the initial treatment was started early and when there is no compliance to treatment [Yeni P, et al. Les nouvelles recommandations de prise en charge des personnes infectées par le VIH 2006. Paris: Flammarion médecine-sciences; 2006]. Noncompliant behavior is one of the characteristics of chronic illness during adolescence. In HIV infection, however, the prognosis is negatively influenced because the resulting resistance to the antiretroviral therapy can further reduce therapeutic options. Therefore, it is important in such a critical period to consider both what is consciously and unconsciously at stake and what responsible action could be taken when a specialist is faced with spontaneous (unplanned) treatment interruption. We report here examples of follow-up care, interruption, and resumption of treatment in 4 female adolescents.

Evidence-based psychosocial treatments for child and adolescent depression.

PubMed

David-Ferdon, Corinne; Kaslow, Nadine J

2008-01-01

The evidence-base of psychosocial treatment outcome studies for depressed youth conducted since 1998 is examined. All studies for depressed children meet Nathan and Gorman's (2002) criteria for Type 2 studies whereas the adolescent protocols meet criteria for both Type 1 and Type 2 studies. Based on the Task Force on the Promotion and Dissemination of Psychological Procedures guidelines, the cognitive-behavioral therapy (CBT) based specific programs of Penn Prevention Program, Self-Control Therapy, and Coping with Depression-Adolescent are probably efficacious. Interpersonal Therapy-Adolescent, which falls under the theoretical category of interpersonal therapy (IPT), also is a probably efficacious treatment. CBT provided through the modalities of child group only and child group plus parent components are well-established intervention approaches for depressed children. For adolescents, two modalities are well-established (CBT adolescent only group, IPT individual), and three are probably efficacious (CBT adolescent group plus parent component, CBT individual, CBT individual plus parent/family component). From the broad theoretical level, CBT has well-established efficacy and behavior therapy meets criteria for a probably efficacious intervention for childhood depression. For adolescent depression, both CBT and IPT have well-established efficacy. Future research directions and best practices are offered.

Post-traumatic stress disorder in children and adolescents: epidemiology, diagnosis and treatment options.

PubMed

Donnelly, Craig L; Amaya-Jackson, Lisa

2002-01-01

Post-traumatic stress disorder (PTSD) is a common psychiatric condition in childhood and adolescence. Rates vary widely depending upon the type of trauma exposure. Interpersonal traumas, such as rape or physical abuse, are more likely to result in PTSD than exposure to natural or technological disaster. Clinical presentations are exceedingly complex and children with PTSD are at increased risk of having comorbid psychiatric diagnoses. Because of its complexity and frequent occurrence with other disorders, assessment of PTSD necessitates a broad-based evaluation utilizing multiple informations and structured instruments specific to the symptoms of PTSD in youth. Cognitive-behavioral therapy (CBT) is the treatment of first choice. Pharmacological agents for PTSD treatment have received little empirical investigation in childhood. Pharmacological treatment is used to target disabling symptoms of the disorder, which limit psychotherapy or life functioning, by helping children to tolerate working through distressful material in therapy and life. Pharmacological treatment should be based on a stepwise approach utilizing broad spectrum medications such as the selective serotonin reuptake inhibitors as first-line agents. Comorbid conditions should be identified and treated with appropriate medication or psychosocial interventions. Treatment algorithms are provided to guide rational medication strategies for children and adolescents with PTSD, subsyndromal PTSD, and in PTSD that is comorbid with other psychiatric conditions of childhood. Reduction in even one debilitating symptom of PTSD can improve a child's overall functioning across multiple domains.

Discordance in Diagnoses and Treatment of Psychiatric Disorders in Children and Adolescents with 22q11.2 Deletion Syndrome

PubMed Central

Young, Andrea S.; Shashi, Vandana; Schoch, Kelly; Kwapil, Thomas; Hooper, Stephen R.

2011-01-01

This study examines the rate of utilization of mental health services in children and adolescents with 22q11DS relative to their remarkably high rate of psychiatric disorders and behavior problems. Seventy-two children and adolescents with 22q11DS were participants; their parents completed the Diagnostic Interview Schedule for Children (DISC) and the Child Behavior Checklist (CBCL). The results indicated that 22q11DS children and adolescents have higher rates of psychopathology than the general pediatric population, with ADHD and anxiety disorders being the most common. However, among youth with 22q11DS, those with psychopathology are often no more likely to receive either pharmacological or non-pharmacological mental health care than those without a given psychiatric diagnosis. Thus, although psychopathology is fairly common in this sample, many children with 22q11DS may not be receiving needed psychiatric care. These results have significant implications for these children and their families, as well as for the health care providers who treat them. In particular, the results may suggest a need for careful screening of psychiatric disorders that are likely to affect this population as well, as making appropriate treatment recommendations to remedy childhood mental health problems. Since these children face an extraordinarily high risk of psychoses in late adolescence/adulthood, treatment of childhood psychopathology could be crucial in mitigating the risk/consequences of major psychiatric illnesses in later life. PMID:21743818

Recovery among Adolescents: Models for Post-Treatment Gains in Drug Abuse Treatments

PubMed Central

Joe, George W.; Knight, Danica Kalling; Becan, Jennifer E.; Flynn, Patrick M.

2013-01-01

Recovery among adolescents undergoing substance abuse treatment was modeled in terms of pre-treatment motivation, therapeutic relationships, psychological functioning, treatment retention, legal pressures, DSM diagnoses, and client demographics. To address between program differences, a within-covariance matrix, based on 547 youth, was used. Applicability of the results across treatment modalities was also examined. The data were from the NIDA-sponsored DATOS Adolescent study. Results from structural equation models (estimated using Mplus) indicated that higher pre-treatment motivation predicted stronger counselor and in-treatment peer relationships, better counselor relationships and retention predicted less illegal drug use at follow-up, and DSM diagnosis was important in the treatment process. Overall, illegal drug use at follow-up was associated with post-treatment alcohol consumption, cigarette use, condom nonuse, psychological distress, criminality, and school non-attendance. The results document the importance of motivation and therapeutic relationships on recovery, even when taking into account the relative effects of legal pressures, DSM diagnoses, and demographics. PMID:24238715

A Self-Efficacy Scale for Chemical Dependency in Adolescence.

ERIC Educational Resources Information Center

St. Mary, Sharon; Russo, Thomas J.

This study was conducted to develop a scale that assesses perceptions of self-efficacy in potentially stressful situations for chemically dependent adolescents. Adolescent subjects (N=100) currently receiving treatment for chemical dependency were given a 20-situation questionnaire, the Adolescent Self-Efficacy Scale (ASES). Students were…

Impact of a physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent vaccines

PubMed Central

Gargano, Lisa M; Herbert, Natasha L; Painter2, Julia E; Sales, Jessica M; Morfaw3, Christopher; Rask2, Kimberly; Murray4, Dennis; DiClemente2, Ralph; Hughes, James M

2013-01-01

Four vaccines are recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices for adolescents. Parental attitudes may play a key role in vaccination uptake in this age group. In 2011, we conducted a cross-sectional survey among parents of adolescents in one county in Georgia to identify parental attitudes toward adolescent vaccination, reasons for vaccine acceptance or refusal, and impact of a physician recommendation for vaccination. Physician recommendation was reported as one of the top reasons for receipt or intent to receive any of the vaccines. Physician recommendation of any of the four vaccines was associated with receipt of Tdap (p < 0.001), MCV4 (p < 0.001), and HPV (p = 0.03) and intent to receive Tdap (p = 0.05), MCV4 (p = 0.005), and HPV (p = 0.05). Compared with parents who did not intend to have their adolescent vaccinated with any of the vaccines, parents who did intend reported higher perceived susceptibility (3.12 vs. 2.63, p = 0.03) and severity of disease (3.89 vs. 3.70, p = 0.02) and higher perceived benefit of vaccination (8.48 vs. 7.74, p = 0.02). These findings suggest that future vaccination efforts geared toward parents may benefit from addressing the advantages of vaccination and enhancing social norms. Physicians can play a key role by providing information on the benefits of adolescent vaccination. PMID:23883781

[Differences between adolescents with pathological Internet use in inpatient and outpatient treatment].

PubMed

Wartberg, Lutz; Moll, Bettina; Baldus, Christiane; Thomsen, Monika; Thomasius, Rainer

2017-07-01

In epidemiological studies high prevalence estimates for pathological Internet use in adolescence were reported. There are only few studies published, reporting data of adolescents seeking treatment concerning their pathological Internet use. Currently, a comparison of patients in inpatient versus outpatient treatment is not available. We investigated 74 adolescents reporting pathological Internet use with standardized questionnaires concerning problematic Internet use, psychopathological symptoms and life satisfaction. Overall, 35 adolescents were treated in an outpatient and another 39 adolescents in an inpatient setting. A substantial portion in both groups showed comorbid mental health problems. There were no differences in the degree of problematic Internet use between the two groups. However, compared to adolescents in an outpatient setting, adolescents in inpatient treatment reported longer average Internet usage times, a lower life satisfaction as well as more anxiety/depressiveness and self-esteem problems. In a multivariate logistic regression analysis Internet usage time and life satisfaction were identified as statistically significant factors for the affiliation to one of the two treatment groups. The results of the present study could be useful as a further description of this group of patients and more general to develop interventions for adolescents reporting pathological Internet use.

Current perspectives in the USA on the diagnosis and treatment of pelvic inflammatory disease in adolescents.

PubMed

Risser, William L; Risser, Jan M; Risser, Amanda L

2017-01-01

In this review, the epidemiology, diagnosis, and treatment of pelvic inflammatory disease (PID) are discussed from a USA perspective and the difficulties that USA adolescents face in recognizing and seeking care for PID and other sexually transmitted infections (STIs) are emphasized. Females aged 15-24 years have the highest incidence of cervical infection with Chlamydia trachomatis and Neisseria gonorrheae , the principal causes of PID. PID is common in this age group. However, the incidence of PID in the USA is not known, because it is not a reportable disease, and because clinicians vary in the criteria used for the diagnosis. The Centers for Disease Control and Prevention (CDC) recommended the following diagnostic criteria that include lower abdominal or pelvic pain and at least one of the following: adnexal tenderness or cervical motion tenderness or uterine tenderness. Because PID can have serious sequelae, the criteria emphasize sensitivity (few false-negatives) at the expense of specificity (some false-positives). Patients who have PID are usually treated in the outpatient setting, following the CDC's Guidelines for the Treatment of Sexually Transmitted Diseases 2015. They receive one dose of an intramuscular cephalosporin, together with 2 weeks of oral doxy cycline, and sometimes oral metronidazole. Improvement should usually be evident in 3 days. The USA does not offer comprehensive sex education for adolescents in public or private schools. Adolescents are unlikely to recognize the symptoms of PID and seek medical treatment. Confidentiality is important to adolescents, and low cost or free sources of confidential care are uncommon, making it unlikely that an adolescent would seek care even if she suspected an STI. The CDC has concluded that screening programs for chlamydia and gonorrhea infection help prevent PID; however, the lack of appropriate sources of care makes adolescents' participation in screening programs unlikely.

Treatment of adolescent tobacco smokers: issues and opportunities for exposure reduction approaches.

PubMed

Moolchan, Eric T; Aung, A Thiri; Henningfield, Jack E

2003-06-05

The cycle of tobacco dependence typically begins with the initiation of tobacco use during adolescence. Many teenagers try to quit smoking, fail and subsequently desire treatment for their tobacco dependence. Adolescents do not currently benefit from the same level of societal support for quit attempts as adults, and they may be less motivated for total cessation despite the short and long-term health consequences of smoking. Overall, the combination of low participation, high attrition and low complete cessation rates for adolescent smokers in treatment prompts the consideration of alternative treatment endpoints. It is likely that interactions among the processes of child and adolescent development, smoke exposure and trajectory influence patterns of tobacco use and treatment for tobacco dependence in adolescents. A rational framework is needed to integrate the study of these dynamic interactions to address tobacco dependence among youth from an exposure reduction, in addition to a cessation, perspective. This paper considers the issues and potential implications of tobacco exposure reduction therapy as an intermediate treatment goal for adolescent smokers who are dependent or dependence-prone, but for whom initial treatment interventions do not yield complete tobacco cessation.

Treatment Response to an Intensive Summer Treatment Program for Adolescents with ADHD

ERIC Educational Resources Information Center

Sibley, Margaret H.; Smith, Bradley H.; Evans, Steven W.; Pelham, William E.; Gnagy, Elizabeth M.

2012-01-01

Objective: There are presently almost no empirically validated treatments for adolescents with ADHD. However, in childhood, behavioral treatments for ADHD typically include behavioral parent training, classroom interventions, and intensive child-directed interventions. Method: The present investigation examines treatment gains following an 8-week…

Relapse and Recurrence Prevention in the Treatment for Adolescents with Depression Study

ERIC Educational Resources Information Center

Simons, Anne D.; Rohde, Paul; Kennard, Betsy D.; Robins, Michele

2005-01-01

Relapse and recurrence in adolescent depression are important problems. Much less is known about relapse prevention compared to the acute treatment of depression in adolescents. Based on previous research, theoretical predictions, and clinical experience, the Treatment for Adolescents With Depression Study (TADS) protocol was designed to determine…

Photodynamic therapy as a novel treatment for halitosis in adolescents: study protocol for a randomized controlled trial.

PubMed

Lopes, Rubia Garcia; de Godoy, Camila Haddad Leal; Deana, Alessandro Melo; de Santi, Maria Eugenia Simões Onofre; Prates, Renato Araujo; França, Cristiane Miranda; Fernandes, Kristianne Porta Santos; Mesquita-Ferrari, Raquel Agnelli; Bussadori, Sandra Kalil

2014-11-14

Halitosis is a common problem that affects a large portion of the population worldwide. The origin of this condition is oral in 90% and systemic in 10% of cases. The unpleasant odor is mainly the result of volatile sulfur compounds produced by Gram-negative bacteria. However, it has recently been found that anaerobic Gram-positive bacteria also produce hydrogen sulfide (H2S) in the presence of amino acids, such as cysteine. Light, both with and without the use of chemical agents, has been used to induce therapeutic and antimicrobial effects. In photodynamic therapy, the antimicrobial effect is confined to areas covered by photosensitizing dye. The aim of the present study is to evaluate the antimicrobial effect of photodynamic therapy on halitosis in adolescents through the analysis of volatile sulfur compounds measured using gas chromatography and microbiological analysis of coated tongue. A quantitative clinical trial will be carried out involving 60 adolescents randomly divided into the following groups: group 1 will receive treatment with a tongue scraper, group 2 will receive photodynamic therapy applied to the posterior two-thirds of the dorsum of the tongue, and group 3 will receive combined treatment (tongue scraper and photodynamic therapy). Gas chromatography (OralChromaTM) and microbiological analysis will be used for the diagnosis of halitosis at the beginning of the study. Post-treatment evaluations will be conducted at one hour and 24 hours after treatment. The statistical analysis will include the Shapiro-Wilk test for the determination of the distribution of the data. If normal distribution is demonstrated, analysis of variance followed by Tukey's test will be used to compare groups. The Kruskal-Wallis test followed by the Student-Newman-Keuls test will be used for data with non-normal distribution. Either the paired t-test or the Wilcoxon test will be used to compare data before and after treatment, depending on the distribution of the data. The

The Effect of Race/Ethnicity on the Relation between Substance Use Disorder Diagnosis and Substance Use Treatment Receipt among Male Serious Adolescent Offenders.

PubMed

Mansion, Andre D; Chassin, Laurie

2016-02-01

The high rates of substance disorders in the juvenile justice system, as well as the relation between substance use and reoffending, suggest the importance of substance use treatment service and understanding the factors that influence treatment provision. The current study tested whether race/ethnicity affects the relation between substance use disorder diagnosis and the receipt of substance use treatment services among a sample of male serious juvenile offenders (N=638). Findings showed that among adolescents with a substance use disorder diagnosis, there were no race/ethnicity differences in substance use treatment receipt. However, among adolescents without a substance use disorder diagnosis, non-Hispanic Caucasians were more likely to receive substance use treatment than were Hispanics or African-Americans. Additionally, findings showed that there were race/ethnicity differences in service receipt at moderate levels of substance use problems, such that non-Hispanic Caucasians were more likely to receive substance use treatment than Hispanics or African-Americans. There were no race/ethnicity differences in treatment receipt when substance use problems were either very severe or very low. Results suggest that race/ethnicity may play a role in service provision in the juvenile justice system when levels of need are less clear.

Focus on anorexia nervosa: modern psychological treatment and guidelines for the adolescent patient

PubMed Central

Espie, Jonathan; Eisler, Ivan

2015-01-01

Anorexia nervosa is a serious condition associated with high mortality. Incidence is highest for female adolescents, and prevalence data highlight a pressing unmet need for treatment. While there is evidence that adolescent-onset anorexia has relatively high rates of eventual recovery, the illness is often protracted, and even after recovery from the eating disorder there is an ongoing vulnerability to psychosocial problems in later life. Family therapy for anorexia in adolescence has evolved from a generic systemic treatment into an eating disorder-specific format (family therapy for anorexia nervosa), and this approach has been evidenced as an effective treatment. Individual treatments, including cognitive behavioral therapy, also have some evidence of effectiveness. Most adolescents can be effectively and safely managed as outpatients. Day-patient treatment holds promise as an alternative to inpatient treatment or as an intensive program following a brief medical admission. Evidence is emerging of advantages in detecting and treating adolescent anorexia nervosa in specialist community-based child and adolescent eating-disorder services accessible directly from primary care. Limitations and future directions for modern treatment are considered. PMID:25678834

Effectiveness of Motivational Incentives for Adolescent Marijuana Users in a School-Based Intervention.

PubMed

Stewart, David G; Felleman, Benjamin I; Arger, Christopher A

2015-11-01

This study examined whether adolescents receiving Motivational Interviewing (MI) intervention have different outcomes compared to those receiving Motivational Incentives (Motivational Interviewing combined with Contingency Management; MI+CM). A total of 136 adolescents (from a parent study of 220 adolescents) with problematic substance use were recruited from 8 high schools in Washington State, where they completed either 8-weeks of MI or MI+CM. Frequency of marijuana use was assessed at baseline, at the end-of-treatment, and at 16-week follow-up. A balanced and matched sample was created using propensity scores, then analyzed using Hierarchical Linear Modeling (HLM). Multilevel regression analyses revealed that adolescents who received MI+CM exhibited a greater reduction in use across time (p<.05). Reductions at the end-of-treatment were greater for the MI+CM condition (Cohen's d=-.82) compared to MI alone (Cohen's d=-.33), but did not differ at 16-week follow-up. Adolescents receiving MI+CM showed significantly fewer negative consequences of marijuana use at the end-of-treatment (t1, 124=2.26, p<.05), higher use of coping strategies (t1, 124=3.01, p<.01), and increased likelihood to attend additional treatment for substance use (χ2 1, 124=4.12 p<.05), though hypothesized improvements in motivation and school attendance were not found. Use of coping strategies at the end-of-treatment had a significant indirect effect on the relationship between the intervention condition and marijuana use at the end-of-treatment (F3, 121=10.20, R2=.20, p<.01). These results suggest that the inclusion of contingencies into adolescent marijuana treatment decreases the end-of-treatment frequency of marijuana use and related consequences while increasing the use of coping strategies and the pursuit of additional treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

The bi-directional relationship between parent-child conflict and treatment outcome in treatment-resistant adolescent depression.

PubMed

Rengasamy, Manivel; Mansoor, Brandon M; Hilton, Robert; Porta, Giovanna; He, Jiayan; Emslie, Graham J; Mayes, Taryn; Clarke, Gregory N; Wagner, Karen Dineen; Keller, Martin B; Ryan, Neal D; Birmaher, Boris; Shamseddeen, Wael; Asarnow, Joan Rosenbaum; Brent, David A

2013-04-01

To examine the bidirectional relationship between parent-child discord and treatment outcome for adolescent treatment-resistant depression. Depressed youth who had not responded to an adequate course of a selective serotonin reuptake inhibitor (SSRI) were randomized to either a switch to another SSRI or venlafaxine, with or without the addition of cognitive behavior therapy (CBT) in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) study. The Conflict Behavior Questionnaire was used to assess adolescent (CBQ-A) and parent-reported (CBQ-P) parent-child discord. The impact of remission on parent-child conflict, and the differential impact of medication and CBT on the CBQ-A and CBQ-P, were assessed using generalized linear models. Although there were no differential treatment effects on parent or adolescent-report of conflict, remission was associated with improvement in the CBQ-P. In general, intake family conflict did not predict remission, except in the sub-group of participants whose parents reported clinically significant parent-child conflict at intake, for whom high levels of parent-reported conflict predicted a lower likelihood of remission. Conflict also did not moderate treatment response. Remission of depression may be sufficient to reduce parent-reported parent-child conflict. However, higher parent-reported conflict, in the clinically significant range, predicts a lower likelihood of remission from depression. Clinical trial registration information-Treatment of SSRI-Resistant Depression in Adolescents (TORDIA); http://clinicaltrials.gov/; NCT00018902. Copyright © 2013 American Academy of Child & Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Perception of Non-surgical Periodontal Treatment in Individuals Receiving or Not Receiving Local Anaesthesia.

PubMed

Leung, W Keung; Duan, Yi Ran; Dong, Xiao Xiao; Yeung, Kim Wai Shadow; Zhou, Shuang Ying; Corbet, Esmonde F; Meng, Huan Xin

2016-01-01

Patients might refuse the offer of local anaesthesia (LA) administration prior to dental treatment. This study investigates subjective discomfort perception during non-surgical mechanical periodontal therapy delivered with or without LA. Sixty patients with mild to moderate chronic periodontitis and prior periodontal debridement experience were randomly enrolled in nonsurgical therapy of a quadrant with or without LA administration. Patients were free to comply or not with the allocated LA arrangement. Visual analogue scales (VAS) of discomfort perception at various stages of the treatment as well as overall satisfaction were recorded. Demographic, psychosocial and periodontal parameters were recorded. Thirty-one patients undergoing nonsurgical periodontal therapy not receiving (LA-) and 29 participants receiving LA (LA+) were studied. Compared to LA- patients, LA+ individuals perceived less discomfort during treatment and reported less dental anxiety (p<0.05). Lower overall treatment satisfaction was associated with prior unpleasant periodontal experience (p=0.047). Overall, debridement discomfort was associated with not receiving LA, noncompliance with the pain control regimen allocated, longer treatment duration, greater gingival inflammation and a higher percentage sites with probing pocket depths≥5 mm (p<0.05). Clinicians should be aware that patients who refuse LA can experience higher dental anxiety and therefore may require various pain control strategies for comfort during nonsurgical periodontal therapy, which, if not employed, can lead to less periodontal treatment satisfaction.

Interpersonal Contact and Attitudes toward Adolescents Who Abuse Substances

ERIC Educational Resources Information Center

Richardson, George B.; Montgomery, LaTrice; Brubaker, Michael D.

2016-01-01

Only 7.6% of adolescents in need of substance abuse treatment actually receive it. Many adolescents are hesitant to seek treatment due to public stigma (i.e., negative attitudes and beliefs of the general public toward individuals who abuse substances). However, decades of research indicate that interpersonal contact with stigmatized groups helps…

Correlates of tobacco dependence and motivation to quit among young people receiving mental health treatment.

PubMed

Grana, Rachel A; Ramo, Danielle E; Fromont, Sebastien C; Hall, Sharon M; Prochaska, Judith J

2012-09-01

Young people with mental health concerns are at high-risk for initiation and continuation of tobacco use. To inform treatment needs, the current study sought to describe tobacco dependence, motivations to quit and associated sociodemographic factors among young people seen in mental health settings. Sixty adolescent and young adult smokers (age mean=19.5 years, range 13-25) receiving outpatient mental health treatment completed measures of tobacco dependence, motivation to quit smoking, mental health, and social environmental factors. Participants averaged 8.0 cigarettes per day (SD=6.6) and moderate nicotine dependence (mFTQ M=4.8, SD=1.6). Participants' mean rating (10-point scales) of perceived difficulty with avoiding relapse during a quit attempt was significantly higher (M=6.7, SD=2.6), than ratings of desire (M=5.1, SD=2.6) and perceived success (M=4.6, SD=2.6) with quitting. Over half (52%) did not intend to quit smoking in the next 6 months, and few (11%) were prepared to quit in the next 30 days. Mental health treatment and symptomatology measures were unrelated to level of dependence or motivation to quit. Among the social environmental factors, having close friends who smoke was associated with greater perceived difficulty with avoiding relapse during a quit attempt (r=0.25, p<0.01). In this sample of adolescent and young adult smokers in mental health treatment, moderate levels of tobacco dependence and motivation to quit were observed and found to be unrelated to mental health measures. Over half of the sample was not intending to quit smoking in the near future, supporting the need for treatment strategies aimed at increasing motivation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Bone mineral density in children and adolescents with Prader-Willi syndrome: a longitudinal study during puberty and 9 years of growth hormone treatment.

PubMed

Bakker, N E; Kuppens, R J; Siemensma, E P C; Tummers-de Lind van Wijngaarden, R F A; Festen, D A M; Bindels-de Heus, G C B; Bocca, G; Haring, D A J P; Hoorweg-Nijman, J J G; Houdijk, E C A M; Jira, P E; Lunshof, L; Odink, R J; Oostdijk, W; Rotteveel, J; Van Alfen, A A E M; Van Leeuwen, M; Van Wieringen, H; Wegdam-den Boer, M E J; Zwaveling-Soonawala, N; Hokken-Koelega, A C S

2015-04-01

Longitudinal data on bone mineral density (BMD) in children and adolescents with Prader-Willi Syndrome (PWS) during long-term GH treatment are not available. This study aimed to determine effects of long-term GH treatment and puberty on BMD of total body (BMDTB), lumbar spine (BMDLS), and bone mineral apparent density of the lumbar spine (BMADLS) in children with PWS. This was a prospective longitudinal study of a Dutch PWS cohort. Seventy-seven children with PWS who remained prepubertal during GH treatment for 4 years and 64 children with PWS who received GH treatment for 9 years participated in the study. The children received GH treatment, 1 mg/m(2)/day (≅ 0.035 mg/kg/d). BMDTB, BMDLS, and BMADLS was measured by using the same dual-energy x-ray absorptiometry machine for all annual measurements. In the prepubertal group, BMDTB standard deviation score (SDS) and BMDLSSDS significantly increased during 4 years of GH treatment whereas BMADLSSDS remained stable. During adolescence, BMDTBSDS and BMADLSSDS decreased significantly, in girls from the age of 11 years and in boys from the ages of 14 and 16 years, respectively, but all BMD parameters remained within the normal range. Higher Tanner stages tended to be associated with lower BMDTBSDS (P = .083) and a significantly lower BMADLSSDS (P = .016). After 9 years of GH treatment, lean body mass SDS was the most powerful predictor of BMDTBSDS and BMDLSSDS in adolescents with PWS. This long-term GH study demonstrates that BMDTB, BMDLS, and BMADLS remain stable in prepubertal children with PWS but decreases during adolescence, parallel to incomplete pubertal development. Based on our findings, clinicians should start sex hormone therapy from the age of 11 years in girls and 14 years in boys unless there is a normal progression of puberty.

Diagnostic Profiles among Urban Adolescents with Unmet Treatment Needs: Comorbidity and Perceived Need for Treatment

ERIC Educational Resources Information Center

Hogue, Aaron; Dauber, Sarah

2013-01-01

The goal of this study was to document comorbidity profiles of psychiatric disorder and perceived need for treatment among urban adolescents with unmet behavioral health needs. Participants were 303 community-referred adolescents and their primary caregivers. Adolescents included both boys (54%) and girls and were primarily Hispanic (58%), African…

Why Adolescent Problem Gamblers Do Not Seek Treatment

ERIC Educational Resources Information Center

Ladouceur, Robert; Blaszczynski, Alexander; Pelletier, Amelie

2004-01-01

Prevalence studies indicate that approximately 40% of adolescents participate in regular gambling with rates of problem gambling up to four times greater than that found in adult populations. However, it appears that few adolescents actually seek treatment for such problems. The purpose of this study was to explore potential reasons why…

Feasibility of Implementing the Adolescent Community Reinforcement Approach in School Settings for Adolescents with Substance Use Disorders

ERIC Educational Resources Information Center

Hunter, Brooke D.; Godley, Mark D.; Godley, Susan H.

2014-01-01

Nationally, approximately 10% of adolescents in need of treatment for a substance use (SU) disorder receive treatment. School-based treatment may provide an important opportunity to reduce the treatment gap by facilitating access to services. While some school-based SU treatment exists, little is known about whether newer, evidence-based…

Utilization of ring-shaped bone allograft for surgical treatment of adolescent post-tubercular kyphosis

PubMed Central

Yin, Xiang; Liu, Peng; Liu, Yao-yao; Fan, Wei-Li; Liu, Bai-yi; Zhao, Jian-Hua

2017-01-01

Abstract This study aimed to investigate the mid-term outcome of ring-shaped bone allografts in the surgical treatment of adolescent post-tubercular kyphosis secondary to spinal tuberculosis. The records of adolescent patients diagnosed with spinal tuberculosis who received treatment in our department between 2009 and 2013 were retrospectively reviewed. The anterior approach was used in cases of cervical kyphosis and the posterior approach was used in cases of thoracic and lumbar kyphosis. During the surgery, the ring-shaped bone was used as a structural bone graft associated with the cancellous bone filing in the center portion of the ring shape. Cobb's angle, signs of spinal infusion on computed tomography, and complications were followed up. A total of 25 patients were included in our study. Among them, 3 involved the cervical region, 5 involved the thoracic region, 8 involved the thoracolumbar region, and 9 involved the lumbar region. The preoperative kyphosis deformity was a mean 65° Cobb's angle (40°–97°) compared to the postoperative 14° Cobb's angle (10°–21°) for an average correction of 51°. All wounds healed well without graft rejection. All patients achieved bone fusion 3 months postoperative for a 100% fusion rate. Our results show that the ring-shaped allograft bone is an effective option for the treatment of adolescent kyphosis. The ring-shaped allograft bone demonstrated satisfactory mechanical strength and vertebral fusion without mid-term metallic toxicity. PMID:28614236

Subthreshold Substance Use and the Treatment of Resistant Depression in Adolescents

PubMed Central

Goldstein, Benjamin I.; Shamseddeen, Wael; Spirito, Anthony; Emslie, Graham; Clarke, Greg; Wagner, Karen Dineen; Asarnow, Joan Rosenbaum; Vitiello, Benedetto; Ryan, Neal; Birmaher, Boris; Mayes, Taryn; Onorato, Matthew; Zelazny, Jamies; Brent, David A.

2009-01-01

Objective Despite the known association between substance use disorders (SUD) and major depressive disorder (MDD) among adolescents, little is known regarding substance use among adolescents with MDD. Method Youth with MDD who had not improved after an adequate SSRI trial (N = 334) were enrolled in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) trial. Analyses examined substance use (via the Drug Use Severity Index) and changes therein in relation to treatment and depressive symptoms. Adolescents meeting SUD criteria via the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version at baseline were excluded. Results Substance use was common: 28.1% reported repeated experimentation at baseline. Substance-related impairment was associated with baseline depression severity, older age, physical/sexual abuse, family conflict, hopelessness, and comorbid oppositional defiant disorder/conduct disorder. There was significant improvement in substance-related impairment among adolescents who responded to MDD treatment. Baseline suicidal ideation was higher among subjects who progressed to high substance-related impairment (≥75th percentile) versus those whose substance-related impairment remained low (<75th percentile), and parental depressive symptoms predicted persistence of high substance-related impairment during the study. MDD response was best among adolescents with low 12-week substance-related impairment scores regardless of whether they had high or low baseline substance-related impairment. There were no significant differential effects of specific treatments, pharmacological or CBT, on substance use. Conclusions Substance use is common among adolescents with treatment-resistant MDD. Subjects who had persistently low substance-related impairment or who demonstrated reduced substance-related impairment had better MDD treatment response, although the direction of this association is uncertain. PMID

Interpersonal Contact and Attitudes Toward Adolescents Who Abuse Substances.

PubMed

Richardson, George B; Montgomery, LaTrice; Brubaker, Michael D

2016-12-01

Only 7.6% of adolescents in need of substance abuse treatment actually receive it. Many adolescents are hesitant to seek treatment due to public stigma (i.e., negative attitudes and beliefs of the general public toward individuals who abuse substances). However, decades of research indicate that interpersonal contact with stigmatized groups helps reduce stigma. This study used structural equations and data from 638 undergraduate students to test the relationships between students' total interpersonal contact with individuals who abuse substances and their attitudes toward those individuals. We found that total contact did not have significant effects on stigma and was associated with better helping attitudes toward adolescents who abuse alcohol but not marijuana. In addition, African Americans and females endorsed greater stigmatization of adolescents who abuse alcohol but better helping attitudes toward those who had received treatment. Increasing contact with individuals who abuse substances, irrespective of type and valence, may not be widely useful as a way of improving attitudes toward such people.

Back to School After Cancer Treatment: Making Sense of the Adolescent Experience.

PubMed

Choquette, Anne; Rennick, Janet E; Lee, Virginia

2016-01-01

Little is known about the influence of cancer on the adolescent's developing self-identity and social relationships as he/she transitions back to school following cancer treatment. The purpose of this study was to explore the meaning of returning to school for adolescents who have completed cancer treatment. In this qualitative study, in-depth interviews using an interpretive descriptive approach were conducted with 11 adolescents (aged 13-17 years) who had completed treatment for cancer. The transcripts of the audiotaped interviews were analyzed thematically and reviewed by the study team. Three main themes suggested that the return to school hallmarked the end of an illness episode and a welcome return to a sense of well-being: (a) being on the right track, (b) bridging two worlds, and (c) establishing a new life at school. Nearly all adolescents described being negatively impacted by the cancer experience. However, the ability to maintain friendships during the transition emerged as particularly salient to allow the adolescents to rise above the challenges and residual effects of cancer treatment. Returning to school following cancer treatment affects adolescents' beliefs about themselves, their self-identity, and their social relationships. Understanding the meaning that adolescents ascribed to returning to school facilitated the development of practice recommendations to improve adjustment to school. Our study findings illuminate an important gap in the existing resources for adolescents in the posttreatment phase of cancer. Recommendations to promote healthy psychosocial development are proposed to better support adolescents during the reintegration to school.

Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners

PubMed Central

Feucht, Cynthia; Brown, Kelly; Ramsay, Jessica

2018-01-01

Anxiety disorders are common in children and adolescents with reported prevalence rates between 10% and 30%. A combined approach to treatment has been found to be the most effective for optimal outcomes and is typically comprised of psychotherapy (especially exposure-based cognitive behavior therapy), family and patient education, and use of medication if indicated. In children and adolescents who might benefit from use of medications, selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice. The safety and efficacy of medications other than SSRIs in the treatment of children and adolescents with anxiety disorders are not fully established. Most children and adolescents respond well to treatment with long lasting resolution of symptoms, although, recurrence of the same, or development of a different type of anxiety disorder, is not uncommon. In most children and adolescents, anxiety disorders tend to persist into adulthood requiring long-term treatment planning. This paper reviews the pharmacological agents used in the treatment of anxiety disorders in children and adolescents. PMID:29441280

Adolescent silymarin treatment increases anxiety-like behaviors in adult mice.

PubMed

Kosari-Nasab, Morteza; Rabiei, Afshin; Doosti, Mohammad-Hossein; Salari, Ali-Akbar

2014-08-01

Adolescence is one of the most important periods of brain development in mammals. There is increasing evidence that some medicines during this period can affect brain and behavioral functions in adulthood. Silymarin (SM), a mixture of flavonolignans extracted from the milk thistle Silybum marianum, is known as a hepatoprotective, anti-inflammatory, and neuroprotective drug. Although researchers have extensively studied the effects of SM during adulthood, to date there is no information on the effects of this drug during the stages of brain development on behavioral functions in adulthood. In the current study, we investigated the effects of adolescent SM treatment on body weight and anxiety-like behaviors in adult male and female mice. Adolescent NMRI mice (postnatal day 30-50) were treated orally with water or SM (50 and 100 mg/kg). Animals were weighed during drug treatment and were then subjected to open field, elevated plus maze, and light-dark box tests from postnatal day 70. The results indicated that adolescent SM treatment increased anxiety-like behaviors in open field, elevated plus maze, and light-dark box in adult mice, while not altering body weight. Collectively, these findings suggest that adolescent SM treatment may have profound effects on the development of brain and behavior in adulthood.

Treatment Effectiveness for Male Adolescent Sexual Offenders: A Meta-Analysis and Review

ERIC Educational Resources Information Center

Walker, Donald F.; McGovern, Shannon K.; Poey, Evelyn L.; Otis, Kathryn E.

2004-01-01

Research concerning the treatment of sexual offenders has generally focused on the treatment of adult offenders. The effectiveness of treatments for male adolescent sexual offenders (N = 644) was assessed in a meta-analysis of 10 studies. Overall, the results were surprisingly encouraging, suggesting that treatments for male adolescent sexual…

Family-Based Treatment for Adolescents with Anorexia Nervosa: A Dissemination Study

PubMed Central

Couturier, Jennifer; Isserlin, Leanna; Lock, James

2010-01-01

Objective This open trial of Family-Based Treatment for Anorexia Nervosa was completed in order to assess the dissemination of this treatment, including effectiveness, fidelity, and acceptability. Method Fourteen adolescents with Anorexia Nervosa were recruited with mean age 14.0±1.5 years (range 12–17 years). Therapists were trained using a workshop, manual and weekly supervision. Sessions were videotaped and rated for treatment fidelity. Pre- and post-treatment assessments were compared. Results Weight was significantly increased by an average of 7.8 kg. Dietary restraint showed significant improvement, as did interoceptive deficits and maturity fears. Of the 9 participants who had secondary amenorrhea at baseline, 8 had regained menstrual function. Treatment fidelity was rated as at least considerable 72% of the time in phase I of the treatment. Adolescents and parents found the treatment to be acceptable. Discussion This preliminary investigation of the dissemination of Family-Based Treatment for adolescents with Anorexia Nervosa indicates that this treatment is effective not only for weight restoration, but also in improving some psychological symptoms including dietary restraint, interoceptive deficits, and maturity fears. In addition, this treatment was adopted with considerable fidelity and was acceptable to adolescents and parents. PMID:20419524

Correlates of receiving recommended adolescent vaccines among youth with special health care needs: Findings from a statewide survey.

PubMed

Reiter, Paul L; McRee, Annie-Laurie

2016-06-08

Many youth with special health care needs (YSHCN) have not received recommended adolescent vaccines, yet data are lacking on correlates of vaccination among this population. Such information can identify subgroups of YSHCN that may be at risk for under-immunization and strategies for increasing vaccination. We analyzed weighted data from a population-based sample of parents with an 11- to 17-year-old child with a special health care need from the 2010-2012 North Carolina Child Health Assessment and Monitoring Program (n=604). We used ordinal logistic regression to identify correlates of how many recommended vaccines (tetanus booster, meningococcal, and HPV [at least one dose] vaccines) adolescents had received. Only 12% of YSHCN (18% of females and 7% of males) had received all three vaccines. More YSHCN had received tetanus booster vaccine (91%) than meningococcal (28%) or HPV vaccines (32%). In multivariable analyses, YSHCN who were female (OR=2.59, 95% CI: 1.57-4.24), ages 16-17 (OR=2.06, 95% CI: 1.10-3.87), or who had a preventive check-up in the past year (OR=2.98, 95% CI: 1.24-7.21) had received a greater number of the vaccines. YSHCN from households that contained a person with at least some college education had received fewer of the vaccines (OR=0.57, 95% CI: 0.33-0.96). Vaccine coverage did not differ by type of special health care need. Vaccine coverage among YSHCN is lacking and particularly low among those who are younger or male. Reducing missed opportunities for vaccination at medical visits and concomitant administration of adolescent vaccines may help increase vaccine coverage among YSHCN. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Treatment of School Avoidance in Children and Adolescents With Psychiatric Illness.

PubMed

Reissner, Volker; Jost, Diana; Krahn, Ulrike; Knollmann, Martin; Weschenfelder, Ann-Kathrin; Neumann, Anja; Wasem, Jürgen; Hebebrand, Johannes

2015-09-25

5-10% of schoolchildren in Germany are absent from school without an excuse more than five times per year. We investigate the effectiveness of manual-based, multimodal cognitive behavioral therapy focusing on school-avoidant behavior and on the underlying mental disorders. 112 school avoiders were recruited from an outpatient child and adolescent psychiatric clinic and adaptively randomized into two treatment groups. The first group received manual-based multimodal treatment (MT), the second group treatment as usual (TAU) in the child and adolescent mental health care system. The primary outcome of the study was the percentage of classes attended in the five days prior to first measurement (before the intervention), as well as 6 and 12 months afterward. In each of these periods, school attendance was characterized as regular, partial, or none. Secondary outcomes were the severity of anxiety and depressive symptoms, self-efficacy, and quality of family life. In both treatment arms, the percentage of regular school attenders rose to about 60% in 6 months, regardless of the intervention (MT 60.6%, TAU 58.3%; odds ratio [OR] for changes over baseline 6.94, 95% confidence interval [CI] 3.98-12.12, p< 0.001; OR for MT versus TAU 1.05, 95% CI 0.58-1.90, p = 0.875). The improvement persisted 12 months after inclusion. In accordance with earlier studies, we found that manual-based multimodal treatment did not improve school avoidance to any greater extent than treatment as usual. Future studies should focus on the conditions for successful reintegration in school and on the differential indicators for outpatient versus inpatient treatment.

Mentalization-Based Treatment for Self-Harm in Adolescents: A Randomized Controlled Trial

ERIC Educational Resources Information Center

Rossouw, Trudie I.; Fonagy, Peter

2012-01-01

Objective: We examined whether mentalization-based treatment for adolescents (MBT-A) is more effective than treatment as usual (TAU) for adolescents who self-harm. Method: A total of 80 adolescents (85% female) consecutively presenting to mental health services with self-harm and comorbid depression were randomly allocated to either MBT-A or TAU.…

Listening Clearly: Alternative Treatments for Adolescent Depression

ERIC Educational Resources Information Center

McGlasson, Terry D.

2012-01-01

For many years now, Cognitive Behavioral Therapy and anti-depressant medications have been the primary treatments for adolescent depression. However, there are many youth today with mild to moderate depressive symptoms for whom these treatments are not necessary. This article briefly summarizes several alternative therapeutic approaches for…

Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents.

PubMed

Batista, Klaus Bsl; Thiruvenkatachari, Badri; Harrison, Jayne E; O'Brien, Kevin D

2018-03-13

Prominent upper front teeth are a common problem affecting about a quarter of 12-year-old children in the UK. The condition develops when permanent teeth erupt. These teeth are more likely to be injured and their appearance can cause significant distress. Children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of their teeth. If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait and provide treatment in adolescence. To assess the effects of orthodontic treatment for prominent upper front teeth initiated when children are seven to 11 years old ('early treatment' in two phases) compared to in adolescence at around 12 to 16 years old ('late treatment' in one phase); to assess the effects of late treatment compared to no treatment; and to assess the effects of different types of orthodontic braces. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 27 September 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 8), MEDLINE Ovid (1946 to 27 September 2017), and Embase Ovid (1980 to 27 September 2017). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Randomised controlled trials of orthodontic treatments to correct prominent upper front teeth (Class II malocclusion) in children and adolescents. We included trials that compared early treatment in children (two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces versus late treatment in adolescents (one-phase) with any type of orthodontic braces or head-braces, and trials that compared any

The Bidirectional Relationship Between Body Mass Index and Treatment Outcome in Adolescents with Treatment-Resistant Depression

PubMed Central

Mansoor, Brandon; Rengasamy, Manivel; Hilton, Robert; Porta, Giovanna; He, Jiayan; Spirito, Anthony; Emslie, Graham J.; Mayes, Taryn L.; Clarke, Gregory; Wagner, Karen Dineen; Shamseddeen, Wael; Birmaher, Boris; Ryan, Neal

2013-01-01

Abstract Objective Depression and obesity are associated, but the impact of obesity on depression treatment outcome, or, conversely, the impact of treatment on body mass index (BMI) in depressed adolescents has not been reported. In this article, we examine the bidirectional relationships between BMI and treatment response in adolescents with treatment-resistant depression. Method Participants in the Treatment of Selective Serotonin Reuptake Inhibitor (SSRI) Resistant Depression in Adolescents (TORDIA) study had height and weight assessed at baseline, weekly for the first 6 weeks, biweekly for the next 6 weeks, and monthly from weeks 12 through 24. The impact of baseline BMI as a predictor and moderator of treatment response was assessed. In addition, participants' changes in BMI were assessed as a function of specific treatment assignment and treatment response. Results Participants assigned to SSRIs had a greater increase in BMI-for-age-sex z-score and weight than did those assigned to venlafaxine. Post-hoc, those treated with paroxetine or citalopram had the biggest increases in BMI, relative to fluoxetine or venlafaxine. Overweight or obesity was neither a predictor nor a moderator of treatment outcome, nor of subsequent BMI change. Conclusions Overweight status does not appear to affect treatment response in adolescents with resistant depression. The successful treatment of depression does not appear to favorably affect weight or BMI. Fluoxetine and venlafaxine are less likely to cause an increase in BMI than paroxetine or citalopram. PMID:24024532

The Bi-Directional Relationship Between Parent–Child Conflict and Treatment Outcome in Treatment-Resistant Adolescent Depression

PubMed Central

Rengasamy, Manivel; Mansoor, Brandon M.; Hilton, Robert; Porta, Giovanna; He, Jiayan; Emslie, Graham J.; Mayes, Taryn; Clarke, Gregory N.; Wagner, Karen Dineen; Keller, Martin B.; Ryan, Neal D.; Birmaher, Boris; Shamseddeen, Wael; Asarnow, Joan Rosenbaum; Brent, David A.

2013-01-01

Objective To examine the bidirectional relationship between parent–child discord and treatment outcome for adolescent treatment-resistant depression. Method Depressed youth who had not responded to an adequate course of a selective serotonin reuptake inhibitor (SSRI) were randomized to either a switch to another SSRI or venlafaxine, with or without the addition of cognitive behavior therapy (CBT) in the Treatment of SSRI-Resistant Depression in Adolescents (TORDIA) study. The Conflict Behavior Questionnaire was used to assess adolescent (CBQ-A) and parent-reported (CBQ-P) parent–child discord. The impact of remission on parent–child conflict, and the differential impact of medication and CBT on the CBQ-A and CBQ-P, were assessed using generalized linear models. Results Although there were no differential treatment effects on parent or adolescent-report of conflict, remission was associated with improvement in the CBQ-P. In general, intake family conflict did not predict remission, except in the sub-group of participants whose parents reported clinically significant parent–child conflict at intake, for whom high levels of parent-reported conflict predicted a lower likelihood of remission. Conflict also did not moderate treatment response. Conclusions Remission of depression may be sufficient to reduce parent-reported parent–child conflict. However, higher parent-reported conflict, in the clinically significant range, predicts a lower likelihood of remission from depression. Clinical trial registration information—Treatment of SSRI-Resistant Depression in Adolescents (TORDIA); http://clinicaltrials.gov/;NCT00018902. PMID:23582868

Treatment Compliance in Adolescents after Attempted Suicide: A Two-Year Follow-Up Study

PubMed Central

Burns, Craig D.; Cortell, Ranon; Wagner, Barry M.

2008-01-01

Objective To describe mental health services utilization for adolescents after attempted suicide, explore factors related to treatment compliance, and determine the relationship between compliance and suicidality. Method Eighty-five adolescents (ages 13–18) who had attempted suicide and their families were recruited from four psychiatric hospitals and were evaluated for symptoms of psychopathology. Subsequent assessments were conducted every six months for two years to determine treatment utilization, treatment compliance (non-adherence to medication regimes or non-attendance of psychosocial treatments against provider advice), attitudes towards treatments utilized, and further suicide attempts and ideation. Results Adolescents with a disruptive behavior disorder diagnosis were less compliant with individual psychotherapy, as were those with a substance dependence other than alcohol or marijuana. Those with an affective/anxiety disorder diagnosis were less compliant with psychopharmacological interventions (6 months post attempt). Parental perception of treatment as helpful was predictive of greater compliance, while adolescents' attitudes towards treatment were not predictive of compliance. Finally, compliance with treatment was not generally predictive of future suicidality. Conclusion Interventions focused on increasing compliance with mental health treatment for adolescent suicide attempters should focus on specific child psychopathology, as well as parental attitudes towards treatment. PMID:18596554

The Role of Pharmacotherapy in the Treatment of Adolescent Substance Use Disorders.

PubMed

Hammond, Christopher J

2016-10-01

Adolescent substance use disorders (SUDs) are a significant public health issue due to the associated morbidity, mortality, and societal cost. While effective for some adolescents, psychosocial interventions generally produce small-to-moderate reductions in substance use. Most youth relapse within 12 months of treatment. One approach to improve outcomes is through adjunctive pharmacotherapy. Medication assisted treatments have been shown to improve adult SUD treatment outcomes, and preliminary studies in adolescents suggest that combining medication with psychosocial interventions may also enhance SUD outcomes for youth. This article presents a comprehensive review and grading of the evidence from studies conducted in adolescents with SUDs. Copyright © 2016 Elsevier Inc. All rights reserved.

New perspectives in the hormonal treatment of gender dysphoria in adolescence.

PubMed

Fernández, María; Guerra, Patricia; Díaz, Mónica; García-Vega, Elena; Álvarez-Diz, Jose A

2015-01-01

Hormonal treatments have been used in adolescents with gender dysphoria in the last decade. The professionals working in gender dysphoria treatment units cannot ignore this new demand. The evolution of care for such adolescents according to the last three versions of the Standards of Care (SC) of the World Professional Association for Transgender Health is described. Starting with the fifth version of the SC, hormonal treatment of adolescents has been contemplated. Recent protocols for hormonal intervention carried out by specialized clinics are analyzed. Finally, the pros and cons of hormonal treatment are debated. These hormonal interventions have major impact on the physical, social, and psychosexual development of patients and have ethical and moral implications for professionals.

High rates of virological failure and drug resistance in perinatally HIV-1-infected children and adolescents receiving lifelong antiretroviral therapy in routine clinics in Togo

PubMed Central

Salou, Mounerou; Dagnra, Anoumou Y; Butel, Christelle; Vidal, Nicole; Serrano, Laetitia; Takassi, Elom; Konou, Abla A; Houndenou, Spero; Dapam, Nina; Singo-Tokofaï, Assetina; Pitche, Palokinam; Atakouma, Yao; Prince-David, Mireille; Delaporte, Eric; Peeters, Martine

2016-01-01

Introduction Antiretroviral treatment (ART) has been scaled up over the last decade but compared to adults, children living with HIV are less likely to receive ART. Moreover, children and adolescents are more vulnerable than adults to virological failure (VF) and emergence of drug resistance. In this study we determined virological outcome in perinatally HIV-1-infected children and adolescents receiving ART in Togo. Methods HIV viral load (VL) testing was consecutively proposed to all children and adolescents who were on ART for at least 12 months when attending HIV healthcare services for their routine follow-up visit (June to September 2014). Plasma HIV-1 VL was measured using the m2000 RealTime HIV-1 assay (Abbott Molecular, Des Plaines, IL, USA). Genotypic drug resistance was done for all samples with VL>1000 copies/ml. Results and discussion Among 283 perinatally HIV-1-infected children and adolescents included, 167 (59%) were adolescents and 116 (41%) were children. The median duration on ART was 48 months (interquartile range: 28 to 68 months). For 228 (80.6%), the current ART combination consisted of two nucleoside reverse transcriptase inhibitors (NRTIs) (zidovudine and lamivudine) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) (nevirapine or efavirenz). Only 28 (9.9%) were on a protease inhibitor (PI)-based regimen. VL was below the detection limit (i.e. 40 copies/ml) for 102 (36%), between 40 and 1000 copies/ml for 35 (12.4%) and above 1000 copies/ml for 146 (51.6%). Genotypic drug-resistance testing was successful for 125/146 (85.6%); 110/125 (88.0%) were resistant to both NRTIs and NNRTIs, 1/125 (0.8%) to NRTIs only, 4/125 (3.2%) to NNRTIs only and three harboured viruses resistant to reverse transcriptase and PIs. Overall, 86% (108/125) of children and adolescents experiencing VF and successfully genotyped, corresponding thus to at least 38% of the study population, had either no effective ART or had only a single effective drug in

Predictors of non-drug psychiatric/psychotherapeutic treatment in children and adolescents with mental or behavioural disorders.

PubMed

Abbas, Sascha; Ihle, Peter; Adler, Jürgen-Bernhard; Engel, Susanne; Günster, Christian; Holtmann, Martin; Kortevoss, Axel; Linder, Roland; Maier, Werner; Lehmkuhl, Gerd; Schubert, Ingrid

2017-04-01

Children and adolescents with mental health problems need effective and safe therapies to support their emotional and social development and to avoid functional impairment and progress of social deficits. Though psychotropic drugs seem to be the preferential treatment, psychotherapy and psychosocial interventions are essential in mental health care. For Germany, current data on the utilization of psychotherapy and psychosocial interventions in children with mental health problems is lacking. To analyse why certain children and adolescents with mental or behavioural disorders do and others do not receive non-drug treatment, we assessed predictors associated with specific non-drug psychiatric/psychotherapeutic treatment including psychosocial interventions, psychotherapy and other non-drug treatments. The study is based on data of two large German health insurance funds, AOK and TK, comprising 30 % of the German child and adolescent population. Predictors of non-drug psychiatric/psychotherapeutic treatment were analysed for 23,795 cases and two controls for every case of the same age and sex in children aged 0-17 years following a new diagnosis of mental or behavioural disorder in 2010. Predictors were divided according to Andersen's behavioural model into predisposing, need and enabling factors. The most prominent and significant predictors positively associated with non-drug psychiatric/psychotherapeutic treatment were the residential region as predisposing factor; specific, both ex- and internalizing, mental and behavioural disorders, psychiatric co-morbidity and psychotropic drug use as need factors; and low area deprivation and high accessibility to outpatient physicians and inpatient institutions with non-drug psychiatric/psychotherapeutic department as enabling factors. In conclusion, the present study suggests that the residential region as proxy for supply of therapist and socioeconomic situation is an influencing factor for the use of psychotherapy. The

Multicentre analysis of second-line antiretroviral treatment in HIV-infected children: adolescents at high risk of failure.

PubMed

Boerma, Ragna S; Bunupuradah, Torsak; Dow, Dorothy; Fokam, Joseph; Kariminia, Azar; Lehman, Dara; Kityo, Cissy; Musiime, Victor; Palumbo, Paul; Schoffelen, Annelot; Sophan, Sam; Zanoni, Brian; Rinke de Wit, Tobias F; Calis, Job C J; Sigaloff, Kim C E

2017-09-15

The number of HIV-infected children and adolescents requiring second-line antiretroviral treatment (ART) is increasing in low- and middle-income countries (LMIC). However, the effectiveness of paediatric second-line ART and potential risk factors for virologic failure are poorly characterized. We performed an aggregate analysis of second-line ART outcomes for children and assessed the need for paediatric third-line ART. We performed a multicentre analysis by systematically reviewing the literature to identify cohorts of children and adolescents receiving second-line ART in LMIC, contacting the corresponding study groups and including patient-level data on virologic and clinical outcomes. Kaplan-Meier survival estimates and Cox proportional hazard models were used to describe cumulative rates and predictors of virologic failure. Virologic failure was defined as two consecutive viral load measurements >1000 copies/ml after at least six months of second-line treatment. We included 12 cohorts representing 928 children on second-line protease inhibitor (PI)-based ART in 14 countries in Asia and sub-Saharan Africa. After 24 months, 16.4% (95% confidence interval (CI): 13.9-19.4) of children experienced virologic failure. Adolescents (10-18 years) had failure rates of 14.5 (95% CI 11.9-17.6) per 100 person-years compared to 4.5 (95% CI 3.4-5.8) for younger children (3-9 years). Risk factors for virologic failure were adolescence (adjusted hazard ratio [aHR] 3.93, p  < 0.001) and short duration of first-line ART before treatment switch (aHR 0.64 and 0.53, p  = 0.008, for 24-48 months and >48 months, respectively, compared to <24 months). In LMIC, paediatric PI-based second-line ART was associated with relatively low virologic failure rates. However, adolescents showed exceptionally poor virologic outcomes in LMIC, and optimizing their HIV care requires urgent attention. In addition, 16% of children and adolescents failed PI-based treatment and will require

Issues in the Treatment of Antisocial Adolescent Substance Abusers.

ERIC Educational Resources Information Center

McKay, James R.; Buka, Stephen L.

1994-01-01

Presents findings from research programs: first on substance abuse in juvenile offenders/adolescents with psychiatric/behavioral disorders focused on treatment issues (attributions for substance use, beliefs about effects of drugs, perceptions of family functioning); and second on psychiatric disorders in adolescent substance abuse patients…

Coping with an HIV infection. A multicenter qualitative survey on HIV positive adolescents' perceptions of their disease, therapeutic adherence and treatment.

PubMed

Michaud, Pierre-André; Suris, Joan-Carles; Thomas, Ralph; Gnehm, Hanspeter E; Cheseaux, Jean-Jacques

2010-05-01

HIV-positive adolescents face a number of challenges in dealing with their disease and its treatment. In this qualitative study, twenty-nine HIV-positive adolescents aged 13 to 20 years (22 girls), who live in Switzerland, were asked, in a semi-structured interview (duration of 40-110 minutes), to describe their perceptions and experiences with the disease itself and with therapeutic adherence. While younger adolescents most often thought of their disease as fate, older adolescents usually knew that they had received it through vertical transmission, although the topic appeared to be particularly difficult to discuss for those living with their HIV-positive mothers. Based on their attending physician's assessment, 18 subjects were judged highly adherent, 4 fairly and 7 poorly adherent. High adherence appeared linked with adequate psychological adjustment and effective coping mechanisms, as well as with the discussion and adoption of explicit medication-taking strategies. The setting and organisation of health care teams should allow for ongoing discussions with HIV-positive adolescents that focus on their perceptions of their disease, how they cope with it and with the treatment, and how they could improve their adherence.

Unmet orthodontic treatment need in rural Nigerian adolescents.

PubMed

Otuyemi, O D; Ugboko, V I; Adekoya-Sofowora, C A; Ndukwe, K C

1997-10-01

A survey of orthodontic treatment need was carried out among randomly selected rural Nigerian adolescents using the index of orthodontic treatment need. Altogether, 704 subjects (381 boys and 323 girls) aged 12-18 years (mean 14.8, SD 1.79) were recruited in the study. The results indicated that 12.6% of the population were in objective need of orthodontic treatment. Whilst there was a discrepancy in the proportions of Nigerian adolescents needing orthodontic treatment on aesthetic and dental health grounds, girls were found to have a more attractive dental appearance and less orthodontic treatment need than boys. However, the differences were not statistically significant (P>0.05). The correlation between the orthodontist's and the subject's rating of dental appearance was found to be low (r=0.35). The study also provided reliable baseline data for planning orthodontic services in Nigeria especially in areas where there are no dental services.

Brief Report: The Association of Autistic Traits and Behavioural Patterns in Adolescents Receiving Special Educational Assistance

ERIC Educational Resources Information Center

Paul, Abigail R.; McKechanie, Andrew G.; Johnstone, Eve C.; Owens, David G. Cunningham; Stanfield, Andrew C.

2015-01-01

Introduction: The study aim was to describe behaviours associated with autistic traits. Methods: The Childhood Behaviour Checklist (CBCL) and Social Communication Questionnaire (SCQ) were used as measures of behaviour and autistic traits respectively in 331 adolescents receiving educational support. CBCL scores were compared between three groups…

Integrating Cognitive Behavioral Therapy and Pharmacotherapy in the Treatment of Adolescent Depression

ERIC Educational Resources Information Center

Ginsburg, Golda S.; Albano, Anne Marie; Findling, Robert L.; Kratochvil, Christopher; Walkup, John

2005-01-01

Recent evidence from the Treatment for Adolescents With Depression Study (TADS) suggests that combining cognitive behavioral and pharmacological treatments holds the most promise for ameliorating depression among adolescents. This article describes lessons learned during the TADS trial about how to integrate these two treatments in the care of…

Patient Characteristics and Treatment Outcomes for African American, Hispanic, and White Adolescents in DATOS-A.

ERIC Educational Resources Information Center

Rounds-Bryant, Jennifer L.; Staab, Jennifer

2001-01-01

Compared background, pre-treatment characteristics, and post-treatment outcomes of African American, Hispanic, and white adolescent substance abusers participating in the Drug Abuse Treatment Outcome Studies for Adolescents (DATOS-A). Found that patients were similar with respect to basic pre-treatment demographics. Compared to white adolescents,…

Concurrent Trajectories of Change in Adolescent and Maternal Depressive Symptoms in the TORDIA Study

PubMed Central

Esposito-Smythers, Christianne; Curby, Timothy W.; Renshaw, Keith D.

2013-01-01

Depression has a heightened prevalence in adolescence, with approximately 15 % of adolescents experiencing a major depressive episode by age 18. Depression in adolescence also poses a risk for future distress and impairment. Despite treatment advances, many adolescents relapse after initial remission. Family context may be an important factor in the developmental trajectory of adolescent depression, and thus in enhancing treatment. This study examined concurrent change over time in adolescent and maternal depressive symptoms in the context of the Treatment of Resistant Depression in Adolescents study. Participants were 334 adolescents (mean age: 16; SD: 1.6; 70 % female, 84 % Caucasian), and their mothers (n = 241). All adolescents were clinically depressed when they entered the study and had received previous selective serotonin reuptake inhibitor (SSRI) treatment. Adolescents received acute treatment for 12 weeks and additional treatment for 12 more weeks. Adolescent depression and suicidal ideation were assessed at 0, 6, 12, 24, 48 and 72 weeks, while maternal depressive symptoms were assessed at 0, 12, 24, 48 and 72 weeks. Latent basis growth curve analyses showed a significant correlation over 72 weeks between trajectories of maternal and adolescent depressive symptoms, supporting the hypothesis of concurrent patterns of change in these variables. The trajectories were correlated more strongly in a subsample that included only dyads in which mothers reported at least one depressive symptom at baseline. Results did not show a correlation between trajectories of maternal depressive symptoms and adolescent suicidal ideation. These findings suggest that adolescent and maternal depressive symptoms change in tandem, and that treatment for adolescent depression can benefit the wider family system. Notably, most mothers in this sample had subclinical depressive symptoms. Future research might explore these trajectories in dyads with more severely depressed mothers

Concurrent trajectories of change in adolescent and maternal depressive symptoms in the TORDIA study.

PubMed

Perloe, Alexandra; Esposito-Smythers, Christianne; Curby, Timothy W; Renshaw, Keith D

2014-04-01

Depression has a heightened prevalence in adolescence, with approximately 15 % of adolescents experiencing a major depressive episode by age 18. Depression in adolescence also poses a risk for future distress and impairment. Despite treatment advances, many adolescents relapse after initial remission. Family context may be an important factor in the developmental trajectory of adolescent depression, and thus in enhancing treatment. This study examined concurrent change over time in adolescent and maternal depressive symptoms in the context of the Treatment of Resistant Depression in Adolescents study. Participants were 334 adolescents (mean age: 16; SD: 1.6; 70 % female, 84 % Caucasian), and their mothers (n = 241). All adolescents were clinically depressed when they entered the study and had received previous selective serotonin reuptake inhibitor (SSRI) treatment. Adolescents received acute treatment for 12 weeks and additional treatment for 12 more weeks. Adolescent depression and suicidal ideation were assessed at 0, 6, 12, 24, 48 and 72 weeks, while maternal depressive symptoms were assessed at 0, 12, 24, 48 and 72 weeks. Latent basis growth curve analyses showed a significant correlation over 72 weeks between trajectories of maternal and adolescent depressive symptoms, supporting the hypothesis of concurrent patterns of change in these variables. The trajectories were correlated more strongly in a subsample that included only dyads in which mothers reported at least one depressive symptom at baseline. Results did not show a correlation between trajectories of maternal depressive symptoms and adolescent suicidal ideation. These findings suggest that adolescent and maternal depressive symptoms change in tandem, and that treatment for adolescent depression can benefit the wider family system. Notably, most mothers in this sample had subclinical depressive symptoms. Future research might explore these trajectories in dyads with more severely depressed mothers.

Treatment Compliance of Adolescents after Attempted Suicide: A 2-Year Follow-Up Study

ERIC Educational Resources Information Center

Burns, Craig D.; Cortell, Ranon; Wagner, Barry M.

2008-01-01

The study investigates compliance with mental health treatments among suicidal adolescents. Results show that child psychopathology and parental attitudes toward treatment plays an important part in increasing compliance with mental health treatment for adolescent suicide attempters.

Impact of dental treatment under general anesthesia on the oral health-related quality of life of adolescents and adults with special needs.

PubMed

Chang, Juhea; Patton, Lauren L; Kim, Hae-Young

2014-12-01

This study aimed to assess the perception of the family's primary caregiver on the oral health-related quality of life (OHRQoL), and the impact on family dynamics, of dental treatment under general anesthesia (GA) in adolescent and adult patients with intellectual and developmental disabilities (IDD) and neurocognitive disorders. Self-administered questionnaires were completed, before dental treatment, by 116 primary family caregivers of patients who received dental treatment under GA, and 102 (88%) of these caregivers completed the same questionnaires within 4 wk after treatment. The Child Oral Health Impact Profile (COHIP) and the Family Impact Scale (FIS) were shortened to a 14-item COHIP (COHIP-14) and a 12-item FIS (FIS-12) based on the limitations of patients' communication. The COHIP-14 and FIS-12 scores and each subscale improved after treatment. The baseline scores varied based on certain characteristics of the patients, such as age, disabilities, medications, caregivers, meal types, cooperation levels, and treatment needs. The postoperative improvement in OHRQoL was significant in the patients who were older than 30 yr of age, originally eating soft meals, displaying no or very low levels of cooperation, or receiving endodontic treatment. Based on the primary caregiver perceptions, the OHRQoL of adolescents and adults with IDD and neurocognitive disorders was improved by dental treatment under GA. © 2014 Eur J Oral Sci.

Childhood maltreatment histories, alcohol and other drug use symptoms, and sexual risk behavior in a treatment sample of adolescents.

PubMed

Oshri, Assaf; Tubman, Jonathan G; Burnette, Mandi L

2012-05-01

We tested a structural model of relations among self-reported childhood maltreatment, alcohol and other drug abuse and dependence symptoms, and sexual risk behavior in a sample of adolescents receiving outpatient treatment of substance use problems. Structured interviews were administered to an ethnically diverse sample of 394 adolescents (114 girls, 280 boys; mean = 16.30 years; SD = 1.15 years; 44.9% Hispanic, 20.6% African American, 25.4% White non-Hispanic, and 9.1% other) in 2 outpatient treatment settings. Path analyses yielded findings consistent with a mediation model. Alcohol abuse and dependence symptoms mediated (1) relations between emotional neglect scores and sex with co-occurring alcohol use and (2) relations between sexual abuse scores and sex with co-occurring alcohol use. Drug abuse and dependence symptoms mediated relations between (1) neglect scores and (2) sexual intercourse with co-occurring alcohol or drug use, as well as unprotected sexual intercourse. Efforts to treat alcohol or drug use problems among adolescents or to prevent transmission of HIV or other sexually transmitted infections among youths with substance use problems may require tailoring treatment or prevention protocols to address client histories of maltreatment.

Childhood Maltreatment Histories, Alcohol and Other Drug Use Symptoms, and Sexual Risk Behavior in a Treatment Sample of Adolescents

PubMed Central

Tubman, Jonathan G.; Burnette, Mandi L.

2012-01-01

Objectives. We tested a structural model of relations among self-reported childhood maltreatment, alcohol and other drug abuse and dependence symptoms, and sexual risk behavior in a sample of adolescents receiving outpatient treatment of substance use problems. Methods. Structured interviews were administered to an ethnically diverse sample of 394 adolescents (114 girls, 280 boys; mean = 16.30 years; SD = 1.15 years; 44.9% Hispanic, 20.6% African American, 25.4% White non-Hispanic, and 9.1% other) in 2 outpatient treatment settings. Results. Path analyses yielded findings consistent with a mediation model. Alcohol abuse and dependence symptoms mediated (1) relations between emotional neglect scores and sex with co-occurring alcohol use and (2) relations between sexual abuse scores and sex with co-occurring alcohol use. Drug abuse and dependence symptoms mediated relations between (1) neglect scores and (2) sexual intercourse with co-occurring alcohol or drug use, as well as unprotected sexual intercourse. Conclusions. Efforts to treat alcohol or drug use problems among adolescents or to prevent transmission of HIV or other sexually transmitted infections among youths with substance use problems may require tailoring treatment or prevention protocols to address client histories of maltreatment. PMID:22401530

Cognitive Behavioral Treatment for Recurrent Binge Eating in Adolescent Girls: A Pilot Trial

PubMed Central

DeBar, Lynn L.; Wilson, G. Terence; Yarborough, Bobbi Jo; Burns, Beryl; Oyler, Barbara; Hildebrandt, Tom; Clarke, Gregory N.; Dickerson, John; Striegel, Ruth H.

2013-01-01

There is a need for treatment interventions to address the high prevalence of disordered eating throughout adolescence and early adulthood. We developed an adolescent-specific manualized CBT protocol to treat female adolescents with recurrent binge eating and tested its efficacy in a small, pilot randomized controlled trial. We present lessons learned in recruiting adolescents, a description of our treatment approach, acceptability of the treatment for teens and parents, as well as results from the pilot trial. Participants in the CBT group had significantly fewer posttreatment eating binges than those in a treatment as usual/delayed treatment (TAU-DT) control group; 100% of CBT participants were abstinent at follow-up. Our results provide preliminary support for the efficacy of this adolescent adaptation of evidence-based CBT for recurrent binge eating. The large, robust effect size estimate observed for the main outcome (NNT=2) places this among the larger effects observed for any mental health intervention. PMID:23645978

[Health care for adolescents with gender dysphoria].

PubMed

Fernández, María; Guerra, Patricia; Martín, Eloya; Martínez, Noelia; Álvarez-Diz, Jose Antonio

2018-02-28

Dysphoria gender treatment in adolescents is recent. Studies of adolescents treated with analogs are reduced. To ensure the quality of care and safety of the child, follow-up studies are necessary. The aim of the present research was to describe the characteristics of the process of medical and psychological attention in adolescents with the DG in the Gender Identity Treatment Unit of Asturias in the period 2007-2015. The sample included 20 minors attended in the Gender Identity Treatment Unit of Asturias in the period 2007-2015. The clinical history was made to collect the variables. It was made descriptive analysis. 10% of adolescents abandoned in the process of psychological counseling, 80% began to be valued by endocrinology and 10% continued exclusively in psychological consultations. Of the medical treated adolescents, 13.3% were treated with analogues and 86.7% received cross-hormonal treatment (THC) directly. The most prevalent secondary effects were dermatological problems (40%), followed by mastodynia without galactorrhea (26.7%) and hot flashes (20%). 20% performed gender confirmation surgeries. The profile of the adolescent treated in the unit of Asturias is a subject that begins hormonal treatment after psychological accompaniment and endocrinological evaluation. The minor has adverse effects after treatment. Once the hormonal treatment has been established, they do not abandon the process.

The Effect of Drug Treatment on Criminal Behavior among Adolescents in DATOS-A.

ERIC Educational Resources Information Center

Farabee, David; Shen, Haikang; Hser, Yih-Ing; Grella, Christine E.; Anglin, M. Douglas

2001-01-01

Examined criminal activity among 1,167 adolescents who participated in the Drug Abuse Treatment Outcome Studies for Adolescents (DATOS-A). Found that among adolescents who had engaged in criminal activity 12 months prior to treatment entry, reduced alcohol or marijuana use were independently associated with significant reductions in the likelihood…

Shifts in Attachment Relationships: A Study of Adolescents in Wilderness Treatment

ERIC Educational Resources Information Center

Bettmann, Joanna E.; Tucker, Anita R.

2011-01-01

This study examined shifts in adolescents' attachment relationships with parents and peers during a 7-week wilderness therapy program. Ninety-six adolescents, aged 14-17, completed three quantitative measurements evaluating attachment relationships with mother, father and peers pre and post treatment. Adolescents reported improved attachment…

Remission and Residual Symptoms after Short-Term Treatment in the Treatment of Adolescents with Depression Study (TADS)

ERIC Educational Resources Information Center

Kennard, Betsy; Silva, Susan; Vitiello, Benedetto; Curry, John; Kratochvil, Christopher; Simons, Anne; Hughes, Jennifer; Feeny, Norah; Weller, Elizabeth; Sweeney, Michael; Reinecke, Mark; Pathak, Sanjeev; Ginsburg, Golda; Emslie, Graham; March, John

2006-01-01

Objective: To ascertain remission rates in depressed youth participating in the Treatment for Adolescents With Depression Study (TADS), a multisite clinical trial that randomized 439 adolescents with major depressive disorder (MDD) to a 12-week treatment of fluoxetine (FLX), cognitive-behavioral therapy (CBT), their combination (COMB), or clinical…

Effectiveness of a multimodal inpatient treatment for adolescents with anorexia nervosa in comparison with adults: an analysis of a specialized inpatient setting : treatment of adolescent and adult anorexics.

PubMed

Naab, Silke; Schlegl, Sandra; Korte, Alexander; Heuser, Joerg; Fumi, Markus; Fichter, Manfred; Cuntz, Ulrich; Voderholzer, Ulrich

2013-06-01

There is evidence for an increased prevalence and an earlier onset of anorexia nervosa (AN) in adolescents. Early specialized treatment may improve prognosis and decrease the risk of a chronic course. The current study evaluates the effectiveness of a multimodal inpatient treatment for adolescent AN patients treated in a highly specialized eating disorder unit for adults. 177 adolescents and 1,064 adult patients were included. The evaluation focused on eating behavior, depressive symptoms and general psychopathology. All measured variables decreased significantly in both groups during inpatient treatment. No differences were found concerning weight gain, improvement of global eating disorder symptomatology as well as depressive symptoms. However, adults showed a higher psychological distress and in this regard also a greater improvement. Results indicate that treating adolescent AN patients in a highly specialized eating disorder unit for adults can be an effective treatment setting for these patients.

Causes and treatment of mandibular and condylar fractures in children and adolescents: a review of 104 cases.

PubMed

Shi, Jun; Chen, Zhibiao; Xu, Bing

2014-03-01

There are no uniform treatments, standards, and specifications for conservative and surgical management of mandibular fractures in children and adolescents. To review the management of mandibular fractures in children and adolescents at our institution. The medical records of 104 children and adolescents (60 male and 44 female) treated for mandibular fractures from 2005 to 2012 at the Ninth People's Hospital, Shanghai, China, were retrospectively reviewed. The participants were classified as having deciduous dentition (age ≤6 years), mixed dentition (age >6 but <12 years), and permanent dentition (age ≥12 but ≤16 years). Conservative treatment and surgical management. Helkimo clinical dysfunction and anamnestic indices. Condylar process fractures accounted for 55.7% of the fractures (112 fractures of 201 total fracture sites), and symphysis fractures, parasymphysis fractures, fractures of the body, and fractures of the angle accounted for 20.9%, 11.9%, 7.0%, and 3.5% of the fractures, respectively. A total of 83 cases with 159 fracture sites with complete follow-up data were included in the treatment analysis. In these 83 patients, 77 fractures were dentigerous bone fractures, 46 were intracapsular fractures, and 36 were extracapsular fractures. Dentigerous bone fractures of the mandible were managed by closed or open reduction in children younger than 12 years and were managed more often by open reduction and fixation in those between ages 12 and 16 years. Closed treatment was performed for 22 condylar process fractures (28.6%), and open reduction was carried out for 55 condylar process fractures (71.4%). In patients with intracapsular fractures, there was no significant relationship between dentation age and treatment method (P = .06). Most patients with extracapsular fractures with permanent dentition underwent surgical fixation (73.3%), whereas most with deciduous dentition received conservative treatment (87.5%). In patients with condylar process

Family-Based Cognitive-Behavioral Treatments for Suicidal Adolescents and their Integration with Individual Treatment

ERIC Educational Resources Information Center

Wells, Karen C.; Heilbron, Nicole

2012-01-01

A considerable research base underscores the importance of family functioning in the risk for and treatment of adolescent suicidal thoughts and behaviors. This paper reviews the extant empirical literature documenting associations between features of the family context and adolescent suicidal thoughts and behaviors. A case example is provided to…

The Emerging Role for rTMS in Optimizing the Treatment of Adolescent Depression

PubMed Central

Croarkin, Paul E.; Wall, Christopher A.; McClintock, Shawn M.; Kozel, F. Andrew; Husain, Mustafa M.; Sampson, Shirlene M.

2010-01-01

Major depressive disorder (MDD) in adolescents is a common illness and significant public health problem. Treatment is challenging due to recurrences and limited modalities. Selective serotonin reuptake inhibitors (SSRIs) and Cognitive Behavioral Therapy (CBT) are considered the standard of care in severe or treatment resistant MDD in this age group. However, responses to these interventions are often suboptimal. A growing body of research supports the efficacy of repetitive transcranial magnetic stimulation for the treatment of MDD in adults. Induced seizures are a primary safety concern, although this is rare with appropriate precautions. There is, however, limited experience with rTMS as a therapeutic intervention for adolescent psychiatric disturbances. This review will summarize the rTMS efficacy and safety data in adults and describe all published experience with adolescent MDD. Applications in other adolescent psychiatric illnesses such as schizophrenia and attention-deficit/hyperactivity disorder (ADHD) are reviewed. Safety and ethical issues are paramount with investigational treatments in adolescent psychiatric illnesses. However, further research with rTMS in adolescent MDD is imperative to establish standards for optimal stimulation site, treatment parameters, and its role in treatment algorithms. These may diverge from adult data. Early intervention with neuromodulation could also hold the promise of addressing the developmental course of dysfunctional neurocircuitry. PMID:20418774

An Overview of Outpatient Treatment of Adolescent Substance Abuse

ERIC Educational Resources Information Center

Galanter, Marc; Glickman, Linda; Singer, David

2007-01-01

This paper reviews the literature on ambulatory substance abuse treatment for adolescents, including brief intervention, Twelve-Step-based outpatient treatment, family-based treatment, cognitive behavioral therapy, and pharmacologic treatment. An overview of socially and culturally specific strategies is also included. The diversity of settings…

Reward-related frontostriatal activity and smoking behavior among adolescents in treatment for smoking cessation.

PubMed

Garrison, Kathleen A; Yip, Sarah W; Balodis, Iris M; Carroll, Kathleen M; Potenza, Marc N; Krishnan-Sarin, Suchitra

2017-08-01

Tobacco use is often initiated during adolescence and continued into adulthood despite desires to quit. A better understanding of the neural correlates of abstinence from smoking in adolescents may inform more effective smoking cessation interventions. Neural reward systems are implicated in tobacco use disorder, and adolescent smokers have shown reduced reward-related ventral striatal activation related to increased smoking. The current study evaluated nondrug reward anticipation in adolescent smokers using a monetary incentive delay task in fMRI pre- and post- smoking cessation treatment (n=14). This study tested how changes in neural responses to reward anticipation pre- to post-treatment were related to reduced smoking. An exploratory analysis in a larger sample of adolescents with only pre-treatment fMRI (n=28) evaluated how neural responses to reward anticipation were related to behavioral inhibition and behavioral activation scales. Adolescent smokers showed pre- to post-treatment increases in reward anticipation-related activity in the bilateral nucleus accumbens and insula, and medial prefrontal cortex, and greater increases in reward anticipation-related activity were correlated with larger percent days of smoking abstinence during treatment. These findings suggest that reduced smoking during smoking cessation treatment is associated with a "recovery of function" in frontostriatal responses to nondrug reward anticipation in adolescent smokers, although comparison with a developmental control group of adolescent nonsmokers is warranted. Copyright © 2017 Elsevier B.V. All rights reserved.

Working memory capacity and addiction treatment outcomes in adolescents.

PubMed

Houck, Jon M; Feldstein Ewing, Sarah W

2018-01-01

Brief addiction treatments including motivational interviewing (MI) have shown promise with adolescents, but the factors that influence treatment efficacy in this population remain unknown. One candidate is working memory, the ability to hold a fact or thought in mind. This is relevant, as in therapy, a client must maintain and manipulate ideas while working with a clinician. Working memory depends upon brain structures and functions that change markedly during neurodevelopment and that can be negatively impacted by substance use. In a secondary analysis of data from a clinical trial for adolescent substance use comparing alcohol/marijuana education and MI, we evaluated the relationship between working memory and three-month treatment-outcomes with the hypothesis that the relationship between intervention conditions and outcome would be moderated by working memory. With a diverse sample of adolescents currently using alcohol and/or marijuana (N = 153, 64.7% male, 70.6% Hispanic), we examined the relationship between baseline measures of working memory and alcohol and cannabis-related problem scores measured at the three-month follow-up. The results showed that lower working memory scores were associated with poorer treatment response only for alcohol use, and only within the education group. No relationship was found between working memory and treatment outcomes in the MI group. The results suggest that issues with working memory capacity may interfere with adolescents' ability to process and implement didactic alcohol and marijuana content in standard education interventions. These results also suggest that MI can be implemented equally effectively across the range of working memory functioning in youth.

Adolescents Who Have Sexually Harmed: An Evaluation of a Specialist Treatment Programme

ERIC Educational Resources Information Center

Edwards, Rachel; Whittaker, Mette Kristensen; Beckett, Richard; Bishopp, Daz; Bates, Andrew

2012-01-01

Little research has been conducted to date exploring the extent to which treatment can impact upon dynamic factors thought to be related to sexually harmful behaviour in adolescents. This study explores the within-treatment change in a group of adolescent males who have sexually harmed. Pre- and post-treatment psychometric data for 34 participants…

Decision-making authority and substance abuse treatment for adolescents: a survey of state laws.

PubMed

Lallemont, Tori; Mastroianni, Anna; Wickizer, Thomas M

2009-04-01

State laws concerning decision-making authority for voluntary inpatient substance abuse (SA) treatment of minors may be a potential barrier to appropriate treatment. We sought to identify and classify relevant laws related to the provision of voluntary inpatient SA treatment to adolescents 12 to 17 years (minors) as an exploratory assessment to improve understanding of how these laws might affect treatment decisions. In summer 2006, we conducted a survey of statutes, regulations, and legal cases in the 50 states and the District of Columbia regarding the authority of parents (or guardians) and minors to make treatment decisions for voluntary inpatient SA treatment. All 50 states have laws applicable to voluntary inpatient SA treatment for adolescents, and the laws vary significantly throughout the nation. If a minor and parent disagree about SA treatment, some states defer to the decision-making authority of the minor, whereas other states defer to the parent. Most significantly, the majority of states fail to specify whether the minor's or the parent's decision will control in the event of a conflict. The lack of clarity in state laws regarding decision-making authority for voluntary inpatient SA treatment of minors may create a potential barrier to treatment for adolescents, especially those with more serious SA problems. This lack of clarity could lead to confusion among parents, adolescents, healthcare professionals, and treatment facilities, and ultimately could result in a failure to treat adolescents in need of medical attention. Policymakers should ensure that state laws clearly specify procedures to enable treatment if a conflict arises between adolescents and parents, including procedures to ensure that the due process rights of adolescents are protected.

Three-year chemical dependency and mental health treatment outcomes among adolescents: the role of continuing care.

PubMed

Sterling, Stacy; Chi, Felicia; Campbell, Cynthia; Weisner, Constance

2009-08-01

Few studies have examined the effects of treatment factors, including the types of services [chemical dependency (CD), psychiatric, or both], on long-term outcomes among adolescents following CD treatment, and whether receiving continuing care may contribute to better outcomes. This study examines the effect of the index CD and ongoing CD and psychiatric treatment episodes, 12-step participation, and individual characteristics such as CD and mental health (MH) severity and gender, age, and ethnicity, on 3-year CD and MH outcomes. Participants were 296 adolescents aged 13 to 18 seeking treatment at 4 CD programs of a nonprofit, managed care, integrated health system. We surveyed participants at intake, 1 year, and 3 years, and examined survey and administrative data, and CD and psychiatric utilization. At 3 years, 29.7% of the sample reported total abstinence from both alcohol and drugs (excluding tobacco). Compared with girls, boys had only half the odds of being abstinent (OR = 0.46, p = 0.0204). Gender also predicted Externalizing severity at 3 years (coefficients 18.42 vs. 14.77, p < 0.01). CD treatment readmission in the second and third follow-up years was related to abstinence at 3 years (OR = 0.24, p = 0.0066 and OR = 3.33, p = 0.0207, respectively). Abstinence at 1 year predicted abstinence at 3 years (OR = 4.11, p < 0.0001). Those who were abstinent at 1 year also had better MH outcomes (both lower Internalizing and Externalizing scores) than those who were not (11.75 vs. 15.55, p = 0.0012 and 15.13 vs. 18.06, p = 0.0179, respectively). A CD treatment episode resulting in good 1-year CD outcomes may contribute significantly to both CD and MH outcomes 3 years later. The findings also point to the value of providing a continuing care model of treatment for adolescents.

Cognitive-behavioral group treatment for social phobia in adolescents. A preliminary study.

PubMed

Albano, A M; Marten, P A; Holt, C S; Heimberg, R G; Barlow, D H

1995-10-01

The present study is a preliminary evaluation of the effectiveness of a new cognitive-behavioral group treatment protocol for social phobia in adolescents. Five adolescents with social phobia were treated in a 16-session group treatment program, with parental involvement in selected sessions. Treatment involved skills training (social skills, problem solving, assertiveness), cognitive restructuring, behavioral exposure, and homework. Self-report measures of anxiety and depression, taken throughout treatment, indicated significant improvements over a 1-year follow-up period. Behavior test measures also indicated a decrease in subjective anxiety ratings after treatment which was maintained at follow-up. Structured diagnostic interviews 1 year after treatment confirmed full remission of social phobia for four subjects, with one subject's phobia in partial remission. Overall, the present findings support the continued evaluation of this protocol for social phobic adolescents.

Medical Marijuana Use among Adolescents in Substance Abuse Treatment

ERIC Educational Resources Information Center

Salomonsen-Sautel, Stacy; Sakai, Joseph T.; Thurstone, Christian; Corley, Robin; Hopfer, Christian

2012-01-01

Objective: To assess the prevalence and frequency of medical marijuana diversion and use among adolescents in substance abuse treatment and to identify factors related to their medical marijuana use. Method: This study calculated the prevalence and frequency of diverted medical marijuana use among adolescents (n = 164), ages 14-18 years (mean age…

Pharmacokinetics and Pharmacokinetic/Pharmacodynamic Relationships of Etravirine in HIV-1-Infected, Treatment-Experienced Children and Adolescents in PIANO.

PubMed

Kakuda, Thomas N; Brochot, Anne; Green, Bruce; Nijs, Steven; Vis, Peter; Opsomer, Magda; Tomaka, Frank L; Hoetelmans, Richard M W

2016-11-01

PIANO (NCT00665847) investigated etravirine pharmacokinetics, efficacy, and safety in children and adolescents. Treatment-experienced, HIV-1-infected patients (≥6 to <18 years) received etravirine 5.2 mg/kg twice daily (maximum 200 mg twice daily) plus background antiretrovirals. A population pharmacokinetic model was developed, and etravirine C 0h and AUC 0-12h were estimated. Relationships among intrinsic/extrinsic factors and etravirine pharmacokinetics and pharmacokinetics with pharmacodynamics were assessed. The best model describing etravirine pharmacokinetics consisted of a single compartment with sequential zero- and first-order absorption following a lag time. Interindividual variability terms were included on clearance (CL/F) and the first-order input rate constant (KA). The final model estimates (coefficient of variation, %) for CL/F and KA were 46.3 (11) L/h and 1.07 (34) h -1 , respectively. Overall, median (range) estimated etravirine C 0h and AUC 0-12h were 287 (2-2276) ng/mL and 4560 (62-28,865) ng · h/mL, respectively. Exposure was slightly lower in adolescents vs children. Sex and adherence did not affect etravirine pharmacokinetics. Factors significantly affecting etravirine exposure were body weight (higher with lower weight), race (lower in Asians than in white or black patients), and the use of certain HIV protease inhibitors. Virologic response (<50 copies/mL at week 48) was lower in the lowest etravirine AUC 0-12h quartile vs the upper 3 quartiles (41% vs 67% to 76%). Rash occurred more frequently in the highest quartile than in the lower 3 quartiles (52% versus 8% to 20%). Etravirine 5.2 mg/kg twice daily in treatment-experienced, HIV-1-infected children and adolescents provides comparable exposure to that in adults receiving etravirine 200 mg twice daily and is the recommended dose for children and adolescents. © 2016, The American College of Clinical Pharmacology.

Adolescent fluoxetine treatment decreases the effects of neonatal immune activation on anxiety-like behavior in mice.

PubMed

Majidi-Zolbanin, Jafar; Azarfarin, Maryam; Samadi, Hanieh; Enayati, Mohsen; Salari, Ali-Akbar

2013-08-01

Experimental studies have shown conflicting effects of neonatal infection on anxiety-like behaviors and hypothalamic-pituitary-adrenal (HPA) axis activity in adult rats. We investigated for the first time whether neonatal exposure to lipopolysaccharide (LPS) is associated with increased levels of anxiety-like behaviors in mice. Moreover, there have been several studies showing that adolescent fluoxetine (FLX) treatment can influence HPA axis development and prevent occurrence of psychiatric disorders induced by common early-life insults. In the present study, we also investigated the effects of adolescent FLX exposure following neonatal immune activation on anxiety-like behavior in mice. Neonatal mice were treated to LPS (50μg/kg) or saline on postnatal days (PND) 3 and 5, then male and female mice of both neonatal intervention groups received oral administration of FLX (5 and 10mg/kg/day) or water via regular drinking bottles during the adolescent period (PNDs 35-65). The results showed that postnatal immune challenge increased anxiety-like behavior in the open field, elevated plus-maze and light-dark box in adult mice (PND 90). Furthermore, the adolescent FLX treatment inhibited the anxiety-like behavior induced by neonatal infection in both sexes. However, this study indicates the negative effects of the FLX on normal behavioral symptoms in male control mice. Taken together, the current data provide experimental evidence that neonatal infection increases anxiety levels in male and female mice in adulthood. Additionally, the findings of this study support the hypothesis that an early pharmacological intervention with FLX may be an effective treatment for reducing the behavioral abnormalities induced by common early-life insults. Copyright © 2013 Elsevier B.V. All rights reserved.

Cocaine-seeking behavior in a genetic model of attention-deficit/hyperactivity disorder following adolescent methylphenidate or atomoxetine treatments*

PubMed Central

Jordan, Chloe J.; Harvey, Roxann C.; Baskin, Britahny B.; Dwoskin, Linda P.; Kantak, Kathleen M.

2014-01-01

Background Attention-deficit/hyperactivity disorder (ADHD) is often comorbid with cocaine abuse. Controversy exists regarding long-term consequences of ADHD medications on cocaine abuse liability. Whereas childhood methylphenidate treatment may be preventative, methylphenidate in teens appears to further increase later cocaine abuse risk. In rodents, adolescent methylphenidate treatment further increases adult cocaine self-administration in the Spontaneously Hypertensive Rat (SHR) model of ADHD, whereas adolescent atomoxetine treatment does not. Effects of ADHD medications on cocaine cue reactivity, a critical component of addiction, are unknown. Methods To investigate this, SHR, Wistar-Kyoto (inbred control) and Wistar (outbred control) rats received therapeutically relevant doses of methylphenidate (1.5 mg/kg, oral) and atomoxetine (0.3 mg/kg, intraperitoneal), or respective vehicles from post-natal day 28–55. Cocaine seeking, reflecting cue reactivity, was measured in adulthood during self-administration maintenance and cue-induced reinstatement tests conducted under a second-order schedule. Results Compared to control strains, SHR earned more cocaine infusions, emitted more cocaine-seeking responses during maintenance and reinstatement testing, and required more sessions to reach the extinction criterion. Compared to vehicle, adolescent methylphenidate, but not atomoxetine, further increased cocaine intake during maintenance testing in SHR. Adolescent atomoxetine, but not methylphenidate, decreased cocaine seeking during reinstatement testing in SHR. Neither medication had effects on cocaine intake or cue reactivity in control strains. Conclusions The SHR successfully model ADHD and cocaine abuse comorbidity and show differential effects of adolescent ADHD medications on cocaine intake and cue reactivity during adulthood. Thus, SHR have heuristic value for assessing neurobiology underlying the ADHD phenotype and for evaluating pharmacotherapeutics for ADHD

Treatment of eating disorders in child and adolescent psychiatry.

PubMed

Herpertz-Dahlmann, Beate

2017-11-01

Recent research on the multimodal treatment of eating disorders in child and adolescent psychiatry has yielded a significant increase in randomized controlled trials and systematic reviews. This review aims to present relevant findings published during the last 2 years related to medical and psychological treatment of anorexia nervosa, bulimia nervosa and avoidant/restrictive food intake disorder (ARFID). For anorexia nervosa, recent reports described the efficacy of different treatment settings, lengths of hospital stay and high vs. low-calorie refeeding programmes. For both anorexia and bulimia nervosa, a number of randomized controlled trials comparing individual and family-oriented treatment approaches were published. For the newly defined ARFID, only very preliminary results on possible treatment approaches implying a multidisciplinary treatment programme were obtained. Although there is some evidence of the effectiveness of new child and adolescent psychiatric treatment approaches to eating disorders, the relapse rate remains very high, and there is an urgent need for ongoing intensive research.

Working Memory Training for Adolescents with Cannabis Use Disorders: A Randomized Controlled Trial

ERIC Educational Resources Information Center

Sweeney, Mary M.; Rass, Olga; DiClemente, Cara; Schacht, Rebecca L.; Vo, Hoa T.; Fishman, Marc J.; Leoutsakos, Jeannie-Marie S.; Mintzer, Miriam Z.; Johnson, Matthew W.

2018-01-01

Adolescent cannabis use is associated with working memory impairment. The present randomized controlled trial assigned adolescents ages 14 to 21 enrolled in cannabis use treatment to receive either working memory training (experimental group) or a control training (control group) as an adjunctive treatment. Cognitive function, drug use, and other…

Comprehensive Stuttering Treatment or Adolescents: A Case Study

ERIC Educational Resources Information Center

Coleman, Craig E.

2018-01-01

Purpose: This article will focus on a hypothetical case study to highlight comprehensive assessment and treatment for adolescent children who stutter. Method: Assessment and treatment are laid out with a literature review utilizing the components of the International Classification of Functioning, Disability and Health model. Specific assessment…

Enhancing the Delivery of an Empirically-Supported Trauma-Focused Treatment for Adolescents: Providers' Views of the Role of Technology and Web-Based Resources.

PubMed

Orengo-Aguayo, Rosaura E; Hanson, Rochelle F; Moreland, Angela D; Jobe-Shields, Lisa; Adams, Zachary W

2018-07-01

This mixed-methods study assessed providers' views of the use of technology in the delivery of an empirically supported mental health treatment for adolescents (Trauma-Focused Cognitive Behavioral Therapy; TF-CBT). Thematic qualitative interviews were conducted with nine experienced providers. Emerging themes served as the basis for the creation of a quantitative web-based survey, completed by 56 TF-CBT experts, to assess the perceived helpfulness of the recommendations. Technology was perceived as a useful, appealing, and familiar tool that could greatly enhance the delivery of this treatment modality with adolescents. Main recommendations included the creation of a mobile application targeting all of the treatment components and a website with developmentally appropriate resources for providers, caregivers, and teens. Technology may be a useful tool for enhancing service delivery and promoting engagement among youth receiving trauma-focused mental health treatment.

What is the impact of comorbid depression on adolescent substance abuse treatment?

PubMed

Hersh, Jacqueline; Curry, John F; Kaminer, Yifrah

2014-01-01

Substance use disorders (SUDs) are among the most common psychiatric diagnoses in adolescents. Some research suggests that comorbid depression in adolescents with SUD is associated with increased likelihood of alcohol dependence, poorer social competence, and greater risk for suicide attempts. However, little is known about how depression influences adolescent substance abuse treatment retention and outcomes. This review aimed to summarize the effects of comorbid depression on treatment retention and outcomes across 13 adolescent SUD treatment studies. RESULTS indicated that depression has a mixed relationship with treatment retention and outcomes, exerting a negative, positive, or nonsignificant effect depending on aspects of the study. More research needs to be done, particularly addressing the potential mediators and moderators of the relationship between depression and SUD outcomes. Importantly, recognizing that the studies varied widely in hypotheses and research methods, the field needs to develop more standardized methods to allow for a clearer understanding of the role of comorbid depression.

Exploring stimulant treatment in ADHD: narratives of young adolescents and their parents

PubMed Central

2014-01-01

Background Young adolescents’ and their parents’ experiences with Attention-Deficit/Hyperactivity Disorder (ADHD) and its treatment were explored to investigate beliefs and attitudes regarding use of stimulant medication, and their influence on treatment decisions. Methods Using in-depth qualitative interviews, 12 adolescents with ADHD aged 12 – 15 years, and their parents described their experiences of ADHD and its treatment. Twenty four interviews, 12 with adolescents and 12 with their parents elicited detailed descriptions of beliefs about ADHD, attitudes about stimulant use and the circumstances surrounding treatment decisions. Verbatim transcripts were iteratively analyzed by a team of researchers following an interpretive interactionist framework. Results Young people offered three themes describing ADHD: 1) personality trait, 2) physical condition or disorder, and 3) minor issue or concern. Regarding medication use, youth described 1) benefits, 2) changes in sense of self, 3) adverse effects, and 4) desire to discontinue use. Parents’ beliefs were more homogeneous than youth beliefs, describing ADHD as a disorder requiring treatment. Most parents noted benefits from stimulant use. Themes were 1) medication as a last resort, 2) allowing the child to reach his or her potential; and 3) concerns about adverse and long-term effects. Families described how responsibility for treatment decisions is transferred from parent to adolescent over time. Conclusions Young adolescents can have different beliefs about ADHD and attitudes about medication use from their parents. These beliefs and attitudes influence treatment adherence. Incorporating input from young adolescents when making clinical decisions could potentially improve continuity of treatment for youth with ADHD. PMID:24725829

Family Functioning and Relationship Quality for Adolescents in Family-based Treatment with Severe Anorexia Nervosa Compared with Non-clinical Adolescents.

PubMed

Wallis, Andrew; Miskovic-Wheatley, Jane; Madden, Sloane; Rhodes, Paul; Crosby, Ross D; Cao, Li; Touyz, Stephen

2018-01-01

This longitudinal study explored family functioning and relationship quality for adolescents with severe anorexia nervosa (AN). An important outcome given healthy family functioning supports effective adolescent development. Fifty-four female adolescents and their parents, treated with family-based treatment after inpatient admission, and 49 non-clinical age-matched adolescents and their parents were compared at assessment and 6 months after session 20. At baseline, AN group mothers and fathers reported poorer family function. AN adolescents were notably similar to controls, reporting poorer function in only one domain. There were no changes for adolescents, an improvement for mothers in the AN group, but an increase in perceived impairment for fathers in both groups, with AN fathers more affected. The similarity in adolescent reports and the increase for fathers over time may indicate that normal adolescent family processes occur even in the midst of serious illness. There is a need to provide intervention to ameliorate the impact of treatment on parents. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Randomized Clinical Trial of Parent-Focused Treatment and Family-Based Treatment for Adolescent Anorexia Nervosa.

PubMed

Le Grange, Daniel; Hughes, Elizabeth K; Court, Andrew; Yeo, Michele; Crosby, Ross D; Sawyer, Susan M

2016-08-01

There have been few randomized clinical trials (RCTs) for adolescents with anorexia nervosa (AN). Most of these posit that involving all family members in treatment supports favorable outcomes. However, at least 2 RCTs suggest that separate parent and adolescent sessions may be just as effective as conjoint treatment. This study compared the relative efficacy of family-based treatment (FBT) and parent-focused treatment (PFT). In PFT, the therapist meets with the parents only, while a nurse monitors the patient. Participants (N = 107) aged 12 to 18 years and meeting DSM 4(th)Edition criteria for AN or partial AN were randomized to either FBT or PFT. Participants were assessed at baseline, end of treatment (EOT), and at 6 and 12 months posttreatment. Treatments comprised 18 outpatient sessions over 6 months. The primary outcome was remission, defined as ≥95% of median body mass index and Eating Disorder Examination Global Score within 1 SD of community norms. Remission was higher in PFT than in FBT at EOT (43% versus 22%; p = .016, odds ratio [OR] = 3.03, 95% CI = 1.23-7.46), but did not differ statistically at 6-month (PFT 39% versus FBT 22%; p = .053, OR = 2.48, CI = 0.989-6.22), or 12-month (PFT 37% versus FBT 29%; p = .444, OR = 1.39, 95% CI = 0.60-3.21) follow-up. Several treatment effect moderators of primary outcome were identified. At EOT, PFT was more efficacious than FBT in bringing about remission in adolescents with AN. However, differences in remission rates between PFT and FBT at follow-up were not statistically significant. A Randomised Controlled Trial of Two Forms of Family-Based Treatment and the Effect on Percent Ideal Body Weight and Eating Disorders Symptoms in Adolescent Anorexia Nervosa; http://www.anzctr.org.au/; ACTRN12610000216011. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

The Treatment for Adolescents with Depression Study (TADS): Demographic and Clinical Characteristics

ERIC Educational Resources Information Center

n/a; n/a

2005-01-01

Objective: The Treatment for Adolescents With Depression Study is a multicenter, randomized clinical trial sponsored by the NIMH. This study is designed to evaluate the short- and long-term effectiveness of four treatments for adolescents with major depressive disorder: fluoxetine, cognitive-behavioral therapy, their combination, and, acutely,…

Interdisciplinary treatment of an adolescent with unilateral cleft lip and palate.

PubMed

Adusumilli, Sai Prakash; Sudhakar, P; Mummidi, Bhaskar; Reddy, K V Baburam; Rao, C H Hanumantha; Raju, B H V Rama Krishnam

2013-03-01

The present case report describes the importance of interdisciplinary approach and gives an understanding on management of an adolescent with unilateral cleft lip and palate. Failure of fusion between medial nasal process and maxillary process or between the palatal process leads to the formation of clefts. Clefts are result of genetic or environmental factors or a combination of both. Common dental problems associated with clefts includes anterior and posterior crossbites, hypodontia, malformation and abnormal eruption pattern. A girl, aged 15 years reported with a chief complaint of unesthetic appearance of her maxillary anterior teeth. She had unilateral cleft lip and palate and had received cheiloplasty and palatoplasty when she was in young age and rhinoplasty when she was 14 years of age. At pretreatment evaluation, she had concave profile with maxillary arch constriction and oroantral fistula and mesially tipped maxillary left canine. This patient's treatment was unconventional, but it was successful in significantly improving her masticatory function and smile, along with favorable dental and facial results. Generalized esthetics and function were significantly improved in this patient without orthognathic surgery, and treatment results were stable 3 years after the appliance removal. Clinical considerations, sequencing of treatment phases as shown in this case report can be utilized while treating an adolescent with cleft lip and palate. If the skeletal discrepancy is mild and esthetic concerns are minimal, dental compensation by orthodontic treatment alone might be recommended. The cephalometric analysis and prediction tracings provide further information for deciding whether a patient can be treated by orthodontics alone, or by orthodontics and an orthognathic surgical procedure. A change in axial inclination of the teeth can camouflage the skeletal relationship adequately. However, one should be cautious in a growing patient, because he or she might

The effect of driven exercise on treatment outcomes for adolescents with anorexia and bulimia nervosa.

PubMed

Stiles-Shields, Colleen; DclinPsy, Bryony Bamford; Lock, James; Le Grange, Daniel

2015-05-01

This study investigated the prevalence of driven exercise (DE) and its role in treatment outcome for adolescents with bulimia nervosa (BN) and anorexia nervosa (AN). Participants were 201 adolescents with an eating disorder (ED) (80 with BN and 121 with AN) presenting for outpatient treatment at two specialist clinics. All adolescents participated in one of two randomized controlled trials. Descriptive statistics were conducted to evaluate the presence and frequency of baseline DE. Exploratory hierarchical regressions were used to evaluate the effect of baseline DE on treatment outcomes. About 66.3% of adolescents with BN and 23.1% of adolescents with AN presented with baseline DE. The presence of baseline DE predicted significantly worse outcomes for adolescents with AN in terms of ED symptom severity (ps < .004); however, baseline DE did not significantly predict any of the evaluated outcomes for adolescents with BN (ps < .05). The results of this secondary exploratory data suggest that DE is prevalent for adolescents with BN and AN. However, DE may be related to different constructs for adolescents with AN than those with BN, suggesting differences in treatment needs. © 2014 Wiley Periodicals, Inc.

Incorporating Social Support in the Treatment of Anorexia Nervosa: Special Considerations for Older Adolescents and Young Adults

PubMed Central

Pisetsky, Emily M.; Utzinger, Linsey M.; Peterson, Carol B.

2016-01-01

Currently, research support is strongest for family-based treatment (FBT) for the treatment of anorexia nervosa (AN) in adolescents. However, a strong evidence base for treatments for older adolescents and young adults with AN is lacking. Emphasizing social support in the treatment of AN may be beneficial for older adolescents and young adults with AN. This paper provides a brief review of the literature on FBT for adolescent AN and provides a case example of adolescent AN treated with FBT. We then discuss novel treatments that have incorporated social support for older adolescents and young adults with AN, such as modified FBT and couples-based interventions. We provide case studies of each of these novel treatment approaches as well. Additionally, this paper highlights and discusses developmental considerations and challenges in working with older adolescents and young adults with AN. PMID:27429544

Bright light treatment as add-on therapy for depression in 28 adolescents: a randomized trial.

PubMed

Niederhofer, Helmut; von Klitzing, Kai

2011-01-01

In the last decade, a significant incidence of depression in the younger population has been observed. Bright light therapy, an effective therapeutic option for depressed adults, could also provide safe, economical, and effective rapid recovery in adolescents. The randomized trial included 28 inpatients (18 females and 10 males) between 14 and 17 years old with depressive complaints. The study was conducted between February and December of 2010 in Rodewisch, Germany. Half of the patients (n = 14) first received placebo (50 lux) 1 hour a day in the morning from 9:00 am to 10:00 am for 1 week and then received bright light therapy (2,500 lux) for 1 week in the morning from 9:00 am to 10:00 am. The other half (n = 14) first received bright light therapy and then received placebo. Patients were encouraged to continue ongoing treatment (fluoxetine 20 mg/day and 2 sessions of psychotherapy/week) because there were no changes in medication/dosage and psychotherapy since 1 month before the 4-week study period. For assessment of depressive symptoms, the Beck Depression Inventory (BDI) was administered 1 week before and 1 day before placebo treatment, on the day between placebo and bright light treatment, and on the day after and 1 week after bright light treatment. Saliva samples of melatonin and cortisol were collected at 8:00 am and 8:00 pm 1 week before and 1 day before placebo treatment, on the day between placebo and bright light treatment, on the day after bright light treatment, and 1 week after bright light treatment and were assayed for melatonin and cortisol to observe any change in circadian timing. The BDI scores improved significantly (P = .015). The assays of saliva showed significant differences between treatment and placebo for evening melatonin (P = .040). No significant adverse reactions were observed. Antidepressant response to bright light treatment in this age group was statistically superior to placebo. World Health Organization International Clinical

Assessment and Treatment of Anxiety Disorders in Children and Adolescents

PubMed Central

Wehry, Anna M.; Beesdo-Baum, Katja; Hennelly, Meghann M.; Connolly, Sucheta D.; Strawn, Jeffrey R.

2015-01-01

Recent advances in the developmental epidemiology, neurobiology and treatment of pediatric anxiety disorders have increased our understanding of these conditions and herald improved outcomes for affected children and adolescents. This article reviews the current epidemiology, longitudinal trajectory, and neurobiology of anxiety disorders in youth. Additionally, we summarize the current evidence for both psychotherapeutic and psychopharmacologic treatments of fear-based anxiety disorders (e.g., generalized, social and separation anxiety disorders) in children and adolescents. Current data suggest that these disorders begin in childhood and adolescence, exhibit homotypic continuity and increase the risk of secondary anxiety and mood disorders. Psychopharmacologic trials involving selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SSNRIs) are effective in pediatric patients with anxiety disorders and have generally demonstrated moderate effect sizes. Additionally, current data support cognitive-behavioral therapy (CBT) are efficacious in the treatment of these conditions in youth and that combination of CBT + an SSRI may be associated with greater improvement than would be expected with either treatment as monotherapy. PMID:25980507

A case series of family-based treatment for adolescents with atypical anorexia nervosa.

PubMed

Hughes, Elizabeth K; Le Grange, Daniel; Court, Andrew; Sawyer, Susan M

2017-04-01

The aim of this case series was to examine engagement in and outcomes of family-based treatment (FBT) for adolescents with DSM-5 atypical AN, that is, adolescents who were not underweight at presentation. Consecutive referrals for FBT of adolescents with atypical AN to a specialist child and adolescent eating disorder program were examined. Engagement in treatment (i.e., dose of treatment, completion rate), and changes in psychological symptomatology (i.e., eating disorder symptoms, depressive symptoms, self-esteem, obsessive compulsiveness), weight, and menstrual function were examined. The need for additional interventions (i.e., hospitalization and medication), and estimated remission rates were also examined. The sample comprised 42 adolescents aged 12-18 years (88% female). Engagement in FBT was high, with 83% completing at least half the treatment dose. There were significant decreases in eating disorder and depressive symptoms during FBT (p < .05) but no improvement in self-esteem. There was no significant change in percent of median BMI for age and gender for the sample as a whole (105 vs. 106%, p = .128). However, adolescents who were not admitted to hospital prior to FBT gained some weight (M = 3.4 kg) while those who were admitted did not gain weight during FBT (M = 0.2 kg, p < .01). The overall remission rate ranged from 38 to 52% depending on the criteria applied. FBT appears to be an effective treatment for adolescents with atypical AN. However, more research is needed into systematic adaptations of FBT and other treatments that could improve overall remission rates. © 2017 Wiley Periodicals, Inc.

An Evaluation of a Smartphone–Assisted Behavioral Weight Control Intervention for Adolescents: Pilot Study

PubMed Central

Duncombe, Kristina M; Lott, Mark A; Hunsaker, Sanita L; Duraccio, Kara M; Woolford, Susan J

2016-01-01

Background The efficacy of adolescent weight control treatments is modest, and effective treatments are costly and are not widely available. Smartphones may be an effective method for delivering critical components of behavioral weight control treatment including behavioral self-monitoring. Objective To examine the efficacy and acceptability of a smartphone assisted adolescent behavioral weight control intervention. Methods A total of 16 overweight or obese adolescents (mean age=14.29 years, standard deviation=1.12) received 12 weeks of combined treatment that consisted of weekly in-person group behavioral weight control treatment sessions plus smartphone self-monitoring and daily text messaging. Subsequently they received 12 weeks of electronic-only intervention, totaling 24 weeks of intervention. Results On average, participants attained modest but significant reductions in body mass index standard score (zBMI: 0.08 standard deviation units, t (13)=2.22, P=.04, d=0.63) over the in-person plus electronic-only intervention period but did not maintain treatment gains over the electronic-only intervention period. Participants self-monitored on approximately half of combined intervention days but less than 20% of electronic-only intervention days. Conclusions Smartphones likely hold promise as a component of adolescent weight control interventions but they may be less effective in helping adolescents maintain treatment gains after intensive interventions. PMID:27554704

Adolescent and parent alliances with therapists in Brief Strategic Family Therapy with drug-using Hispanic adolescents.

PubMed

Robbins, Michael S; Mayorga, Carla C; Mitrani, Victoria B; Szapocznik, José; Turner, Charles W; Alexander, James F

2008-07-01

This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent, adolescent) and family level (within-family differences) for families that either dropped out or completed family therapy. Participants were 31 Hispanic adolescents and their family members who received brief strategic family therapy for the treatment of adolescent drug use. Videotapes of first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that Completer cases had significantly higher levels of alliance across all family members than Dropout cases, and Dropout cases had significantly higher unbalanced alliances than Completer cases. Clinical implications are discussed.

Children and adolescents referred for treatment of anxiety disorders: differences in clinical characteristics.

PubMed

Waite, Polly; Creswell, Cathy

2014-01-01

Reports of the clinical characteristics of children and adolescents with anxiety disorders are typically based on community populations or from clinical samples with exclusion criterion applied. Little is known about the clinical characteristics of children and adolescents routinely referred for treatment for anxiety disorders. Furthermore, children and adolescents are typically treated as one homogeneous group although they may differ in ways that are clinically meaningful. A consecutive series of children (n=100, aged 6-12 years) and adolescents (n=100, aged 13-18 years), referred to a routine clinical service, were assessed for anxiety and comorbid disorders, school refusal and parental symptoms of psychopathology. Children with a primary anxiety disorder were significantly more likely to be diagnosed with separation anxiety disorder than adolescents. Adolescents with a primary anxiety disorder had significantly higher self and clinician rated anxiety symptoms and had more frequent primary diagnoses of social anxiety disorder, diagnoses and symptoms of mood disorders, and irregular school attendance. Childhood and adolescence were considered categorically as distinct, developmental periods; in reality changes would be unlikely to occur in such a discrete manner. The finding that children and adolescents with anxiety disorders have distinct clinical characteristics has clear implications for treatment. Simply adapting treatments designed for children to make the materials more 'adolescent-friendly' is unlikely to sufficiently meet the needs of adolescents. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Need for orthodontic treatment among Brazilian adolescents: evaluation based on public health

PubMed Central

de Freitas, Carolina Vieira; Souza, João Gabriel Silva; Mendes, Danilo Cangussu; Pordeus, Isabela Almeida; Jones, Kimberly Marie; Martins, Andréa Maria Eleutério de Barros Lima

2015-01-01

OBJECTIVE: To identify the prevalence and the severity of malocclusions and to analyze factors associated with the need for orthodontic treatment of Brazilian adolescents. METHODS: This exploratory, cross-sectional study was carried out based on secondary data from the national epidemiological survey on oral health in Brazil (2002-2003). Socio-demographic conditions, self-perception, and the existence and degree of malocclusion, using the Dental Aesthetic Index, were evaluated in 16,833 adolescent Brazilians selected by probabilistic sample by conglomerates. The dependent variable need orthodontic treatment was estimated from the severity of malocclusion. The magnitude and direction of the association in bivariate and multivariate analyzes from a Robust Poisson regression was estimated. RESULTS: The majority of the adolescents needed orthodontic treatment (53.2%). In the multivariate analysis, the prevalence of the need for orthodontic treatment was larger among females, non-whites, those that perceived a need for treatment, and those that perceived their appearance as normal, bad, or very bad. The need for orthodontic treatment was smaller among those that lived in the Northeast and Central West macro-regions compared to those living in Southeast Brazil and it was also smaller among those that perceived their chewing to be normal or their oral health to be bad or very bad. CONCLUSIONS: There was a high prevalence of orthodontic treatment need among adolescents in Brazil and this need was associated with demographic and subjective issues. The high prevalence of orthodontic needs in adolescents is a challenge to the goals of Brazil's universal public health system. PMID:25769190

Antipsychotic Treatment of Adolescent Dual Diagnosis Patients

PubMed Central

Price, Scott A.; Brahm, Nancy C.

2011-01-01

BACKGROUND A diagnosis of schizophrenia requires development of a pharmacotherapy regimen that balances many factors in the therapeutic decision-making process. Patient age and the presence or absence of comorbid chemical dependency represent two factors. Comorbid chemical dependency can have a profound impact on the successful treatment of schizophrenia, making patients with dual diagnoses of schizophrenia and chemical dependence a uniquely challenging population. There is little information regarding treatment of schizophrenia and chemical dependence in the pediatric population. Existing data from pediatric and adult populations may facilitate a well-guided and knowledgeable approach to treating pediatric dual diagnosis patients. METHODS A review of the literature for medication trials evaluating antipsychotic medication used to treat schizophrenia in childhood and adolescence as well as antipsychotic use in the treatment of the dual diagnoses of schizophrenia and chemical dependence was done. Databases for Ovid MEDLINE, PubMed, and PsycInfo were searched using the terms “addiction,” “adolescence,” “childhood,” “dual diagnosis,” “schizophrenia,” and “substance abuse.” Results were limited to English-language articles. RESULTS Seven articles were identified related to psychotic disorders and substance abuse in pediatric populations. Psychosis measurement instruments included the Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale, and Clinical Global Impression. Mean improvements were insignificant in most cases. Medication trials included clozapine, olanzapine, risperidone, and molindone. Trial safety concerns included metabolic effects, increased prolactin levels, and akathisia. One study with random assignment to olanzapine was discontinued early because of substantial weight gain without evidence of superior efficacy. Clozapine treatment was associated with more adverse drug events. CONCLUSION There is a great need for

Baseline Depressive Symptoms Predict Poor Substance Use Outcome Following Adolescent Residential Treatment

ERIC Educational Resources Information Center

Subramaniam, Geetha A.; Stitzer, Maxine A.; Clemmey, Philip; Kolodner, Ken; Fishman, Marc J.

2007-01-01

Objective: To characterize baseline depressive symptoms among substance-abusing adolescents and determine their association with post residential treatment substance use outcomes. Method: In total, 153 adolescents (mean age 6.6 years, plus or minus 0.11) entering residential treatment were assessed at intake and at 3, 6, 9, and 12 months. Beck…

Alcohol consumption among first- and second-generation immigrant and native adolescents in 23 countries: Testing the importance of origin and receiving country alcohol prevalence rates.

PubMed

Barsties, Lisa S; Walsh, Sophie D; Huijts, Tim; Bendtsen, Pernille; Molcho, Michal; Buijs, Thomas; Vieno, Alessio; Elgar, Frank J; Stevens, Gonneke W J M

2017-11-01

This internationally comparative study examines differences in alcohol consumption between first- and second-generation immigrant and native adolescents. We also investigate to what extent origin and receiving country alcohol per capita consumption (APCC) rates and proportions of heavy episodic drinkers (HED) are associated with immigrant adolescents' alcohol consumption. We used cross-sectional survey data from the 2013/2014 Health Behaviour in School-aged Children study. Applying multilevel regression analyses, we investigated the lifetime frequency of alcohol use and drunkenness in 69 842 13- to 15-year-olds in 23 receiving countries, with immigrants from over 130 origin countries (82% natives, 6% first-generation immigrants and 12% second-generation immigrants). The lifetime frequency of alcohol use was higher among natives than among first- and second-generation immigrants, while no differences were found between the latter two. Lifetime drunkenness was more frequent among first-generation immigrants than among natives and second-generation immigrants. Higher origin country APCC and HED were associated with more frequent lifetime alcohol use and drunkenness among immigrant adolescents. Cross-level interactions revealed that for lifetime frequency of alcohol use, the origin country HED effects were stronger for first- than for second-generation immigrant adolescents. Further, especially for first-generation immigrants, a higher receiving country HED was related to lower lifetime frequencies of alcohol use and drunkenness. Our results suggest differences in lifetime frequencies of alcohol use and drunkenness between natives and first- and second-generation immigrant adolescents. Origin country APCC and HED seem to affect immigrant adolescents' alcohol consumption differently than receiving country APCC and HED. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety.

PubMed

Higa-McMillan, Charmaine K; Francis, Sarah E; Rith-Najarian, Leslie; Chorpita, Bruce F

2016-01-01

Anxiety disorders are the most common mental health disorder among children and adolescents. We examined 111 treatment outcome studies testing 204 treatment conditions for child and adolescent anxiety published between 1967 and mid-2013. Studies were selected for inclusion in this review using the PracticeWise Evidence-Based Services database. Using guidelines identified by this journal (Southam-Gerow & Prinstein, 2014), studies were included if they were conducted with children and/or adolescents (ages 1-19) with anxiety and/or avoidance problems. In addition to reviewing the strength of the evidence, the review also examined indicators of effectiveness, common practices across treatment families, and mediators and moderators of treatment outcome. Six treatments reached well-established status for child and adolescent anxiety, 8 were identified as probably efficacious, 2 were identified as possibly efficacious, 6 treatments were deemed experimental, and 8 treatments of questionable efficacy emerged. Findings from this review suggest substantial support for cognitive-behavioral therapy (CBT) as an effective and appropriate first-line treatment for youth with anxiety disorders. Several other treatment approaches emerged as probably efficacious that are not primarily CBT based, suggesting that there are alternative evidence-based treatments that practitioners can turn to for children and adolescents who do not respond well to CBT. The review concludes with a discussion of treatments that improve functioning in addition to reducing symptoms, common practices derived from evidence-based treatments, mediators and moderators of treatment outcomes, recommendations for best practice, and suggestions for future research.

Sexual sensation seeking, co-occurring sex and alcohol use, and sexual risk behavior among adolescents in treatment for substance use problems.

PubMed

Oshri, Assaf; Tubman, Jonathan G; Morgan-Lopez, Antonio A; Saavedra, Lissette M; Csizmadia, Annamaria

2013-01-01

This study evaluated relations between sexual sensation seeking, co-occurring sex and alcohol use, and sexual risk behaviors (eg, unprotected intercourse and multiple sex partners) among adolescents receiving treatment for substance abuse problems. The ethnically diverse sample included 394 adolescents recruited from outpatient treatment (280 males; Mage  = 16.33 years, SDage  = 1.15). Structural equation modeling (SEM) was used to test direct and indirect paths between sexual sensation seeking and sexual risk behaviors via the frequency of co-occurring sex and alcohol use. Conditional indirect effects by gender were also tested. Analyses identified significant effects of sexual sensation seeking on co-occurring sex and alcohol use and sexual risk behaviors. The path from co-occurring sex and alcohol use to unprotected intercourse was significantly stronger among adolescent girls, suggesting a mediation effect moderated by gender. No gender difference was found for the indirect path from sexual sensation seeking and number of past year sexual partners via co-occurring sex and alcohol use. Selected prevention efforts are needed to promote HIV risk reduction among adolescents in substance abuse treatment. The documented conditional indirect effect for unprotected intercourse suggests that HIV prevention programs should pay special attention to gender-specific patterns of alcohol use and sexual risk behavior when tailoring program content. (Am J Addict 2013; 22:197-205). Copyright © American Academy of Addiction Psychiatry.

Treatment of anorexia nervosa in children and adolescents.

PubMed

Weaver, Laurel; Sit, Lydia; Liebman, Ronald

2012-04-01

In this review, we discuss the treatment of anorexia nervosa (AN) in children and adolescents, highlighting inpatient and outpatient psychiatric treatment. AN is an illness that involves medical and psychological issues; hence, treatment often requires the seamless integration of several medical professionals. It is important that the treatment model be unified and consistent as patients transition from inpatient to outpatient treatment. We briefly describe the therapeutic principles involved in treatment of AN and then give examples of how we employ these principles across treatment settings and with multiple medical professionals.

Posttreatment Factors Influencing Outcome of Adolescent Chemical Dependency Treatment.

ERIC Educational Resources Information Center

Shoemaker, Ruth H.; Sherry, Patrick

1991-01-01

Adolescents (n=144) in in-patient chemical dependency treatment completed questionnaires designed to determine pre- and posttreatment environmental, psychological, and problem severity influences on outcome of treatment. Results indicated that posttreatment psychosocial environment measures and pretreatment problem severity indicators consistently…

The Impact of an Eight-Day Intensive Treatment for Adolescent Panic Disorder and Agoraphobia on Comorbid Diagnoses

PubMed Central

Gallo, Kaitlin P.; Chan, Priscilla T.; Buzzella, Brian A.; Whitton, Sarah W.; Pincus, Donna B.

2012-01-01

Previous research findings have shown positive effects of cognitive-behavioral therapy for primary anxiety disorders as well as for non-primary, co-occurring anxiety disorders. In this study, we analyzed data from an existing randomized controlled trial of intensive treatment for Panic Disorder with or without Agoraphobia (PDA) to examine the effects of the treatment on comorbid psychiatric diagnoses. The overall frequency and severity of aggregated comorbid diagnoses decreased in a group of adolescents who received an 8-day treatment for PDA. Results suggest that an 8-day treatment for PDA can alleviate the symptoms of some specific comorbid clinical diagnoses; specifically Specific Phobias, Generalized Anxiety Disorder, and Social Phobia. These findings suggest that an intensive treatment for PDA is associated with reductions in comorbid symptoms even though disorders other than PDA are not specific treatment targets. PMID:22304887

Substance Use and the Treatment of Resistant Depression in Adolescents

ERIC Educational Resources Information Center

Goldstein, Benjamin I.; Shamseddeen, Wael; Spirito, Anthony; Emslie, Graham; Clarke, Greg; Wagner, Karen Dineen; Asarnow, Joan Rosenbaum; Vitiello, Benedetto; Ryan, Neal; Birmaher, Boris; Mayes, Taryn; Onorato, Matthew; Zelazny, Jamie; Brent, David A.

2009-01-01

Objective: Despite the known association between substance use disorders and major depressive disorder (MDD) among adolescents, little is known regarding substance use among adolescents with MDD. Method: Youths with MDD who had not improved after an adequate selective serotonin reuptake inhibitor trial (N = 334) were enrolled in the Treatment of…

Time-to-treatment of mental disorders in a community sample of Dutch adolescents. A TRAILS study.

PubMed

Raven, D; Jörg, F; Visser, E; Oldehinkel, A J; Schoevers, R A

2017-04-01

Timely recognition and treatment of mental disorders with an onset in childhood and adolescence is paramount, as these are characterized by greater severity and longer persistence than disorders with an onset in adulthood. Studies examining time-to-treatment, also referred to as treatment delay, duration of untreated illness or latency to treatment, and defined as the time between disorder onset and initial treatment contact, are sparse and all based on adult samples. The aim of this study was to describe time-to-treatment and its correlates for any health care professional (any care) and secondary mental health care (secondary care), for a broad range of mental disorders, in adolescents. Data from the Dutch community-based cohort study TRacking Adolescents' Individual Lives Survey (TRAILS; N = 2230) were used. The Composite International Diagnostic Interview (CIDI) was administered to assess DSM-IV disorders, the age of onset, and the age of initial treatment contact with any health care professional in 1584 adolescents of 18-20 years old. In total 43% of the adolescents (n = 675) were diagnosed with a lifetime DSM-IV disorder. The age of initial treatment contact with secondary care was based on administrative records from 321 adolescents without a disorder onset before the age of 10. Descriptive statistics, cumulative lifetime probability plots, and Cox regression analyses were used analyze time-to-treatment. The proportion of adolescents who reported lifetime treatment contact with any care varied from 15% for alcohol dependence to 82% for dysthymia. Regarding secondary care, proportions of lifetime treatment contact were lower for mood disorders and higher for substance dependence. Time-to-treatment for any care varied considerably between and within diagnostic classes. The probability of lifetime treatment contact for mood disorders was above 90%, whereas for other mental disorders this was substantially lower. An earlier age of onset predicted a longer, and

Treatment Services Received in the CASAWORKS for Families Program

ERIC Educational Resources Information Center

Mckay, James R.; Gutman, Marjorie; Mclellan, A. Thomas; Lynch, Kevin G.; Ketterlinus, Robert

2003-01-01

This article presents information on treatment services received by women participating in an initial multistate evaluation of CASAWORKS families. Results indicated most women received services to address medical, employment, basic needs, alcohol and drug, family, and psychiatric problems during the first six months of the program. The clients…

Drugs for the acute treatment of migraine in children and adolescents.

PubMed

Richer, Lawrence; Billinghurst, Lori; Linsdell, Meghan A; Russell, Kelly; Vandermeer, Ben; Crumley, Ellen T; Durec, Tamara; Klassen, Terry P; Hartling, Lisa

2016-04-19

Numerous medications are available for the acute treatment of migraine in adults, and some have now been approved for use in children and adolescents in the ambulatory setting. A systematic review of acute treatment of migraine medication trials in children and adolescents will help clinicians make evidence-informed management choices. To assess the effects of pharmacological interventions by any route of administration versus placebo for migraine in children and adolescents 17 years of age or less. For the purposes of this review, children were defined as under 12 years of age and adolescents 12 to 17 years of age. We searched seven bibliographic databases and four clinical trial registers as well as gray literature for studies through February 2016. We included prospective randomized controlled clinical trials of children and adolescents with migraine, comparing acute symptom relieving migraine medications with placebo in the ambulatory setting. Two reviewers screened titles and abstracts and reviewed the full text of potentially eligible studies. Two independent reviewers extracted data for studies meeting inclusion criteria. We calculated the risk ratios (RRs) and number needed to treat for an additional beneficial outcome (NNTB) for dichotomous data. We calculated the risk difference (RD) and number needed to treat for an additional harmful outcome (NNTH) for proportions of adverse events. The percentage of pain-free patients at two hours was the primary efficacy outcome measure. We used adverse events to evaluate safety and tolerability. Secondary outcome measures included headache relief, use of rescue medication, headache recurrence, presence of nausea, and presence of vomiting. We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created 'Summary of findings' tables. We identified a total of 27 randomized controlled trials (RCTs) of migraine symptom-relieving medications, in which 9158 children and

Perception of orthodontic treatment need in children and adolescents.

PubMed

Spalj, Stjepan; Slaj, Martina; Varga, Suzana; Strujic, Mihovil; Slaj, Mladen

2010-08-01

Patients' and parents' perception of malocclusion are important in determining orthodontic treatment demand, motivation, and cooperation. The aim of this study was to investigate differences in perception of treatment need in currently orthodontically treated, previously treated, and untreated subjects. The sample comprised 3196 children and adolescents (1593 males and 1603 females) aged 8-19 years (mean age 13.0 +/- 3.6 years) from 24 randomly selected public schools in Zagreb, Croatia. Objective treatment need was assessed clinically using the Dental Aesthetic Index (DAI). Subjective treatment need was estimated separately by an orthodontic resident, the child/adolescent and his/her parent using the Standardized Continuum of Aesthetic Need (SCAN) procedure. The children/adolescents completed a questionnaire that had five questions with five-point Likert-type scale answers concerning satisfaction with dental appearance, importance of teeth for facial appearance, and malocclusion-related quality of life. Spearman correlation and logistic regression were used for statistical analysis. Associations between objective and subjective orthodontic treatment need were weak but statistically significant (Rho from 0.20 to 0.50; P < 0.05). Malocclusion-related quality of life was poorly associated with treatment need. Satisfaction with tooth appearance showed the most frequent statistically significant correlation (Rho from -0.14 to -0.35; P < 0.05), while importance of aligned teeth for facial appearance and social contacts had the weakest correlation with treatment need. Perception of treatment need was greater in previously treated subjects. Parents' perception had a low predictive value. The findings of this study show that malocclusion has more impact on emotional well-being than on function or social contacts.

Young Women’s Perspectives of Their Adolescent Treatment Programs: A Qualitative Study

PubMed Central

Clark, Miriam; Buchanan, Rohanna

2018-01-01

The perspectives of at-risk adolescent clients can play an important role in informing treatment services. The current study examines qualitative interview data from 15 young women with histories of maltreatment. Using a semi-structured qualitative interview approach, we asked the women to think retrospectively about their treatment experiences as adolescent girls. Results highlight the need for providing adolescent girls with reliable and practical information about risky sexual behavior and drug use from relatable and trustworthy helping professionals. We discuss strategies for developing and maintaining trust and delivering specific content. PMID:29470424

Variables Associated with Treatment Failure among Adolescent Sex Offenders

ERIC Educational Resources Information Center

Eastman, Brenda J.

2005-01-01

While an adolescent sexual offender's response to treatment is thought to be impacted by both static and dynamic factors, there is no objective method of assessing the likelihood of success or failure in treatment. The assessment of amenability to treatment is generally a subjective process completed by clinicians in the field. Using descriptive…

The efficacy of two adolescent substance abuse treatments and the impact of comorbid depression: results of a small randomized controlled trial.

PubMed

Santisteban, Daniel A; Mena, Maite P; Muir, Joan; McCabe, Brian E; Abalo, Clara; Cummings, Amanda M

2015-03-01

The purpose of this randomized trial was to investigate the efficacy of 2 behavioral treatments focusing on different change mechanisms in ameliorating a borderline personality disorder constellation of behaviors and substance use in adolescents referred by juvenile diversion programs. Forty adolescents 14-17 years of age and meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for borderline personality disorder and substance use disorders were randomized to integrative borderline personality disorder-oriented adolescent family therapy (I-BAFT) or individual drug counseling. This design allowed a comparison of 2 manualized interventions, 1 family based and 1 individually oriented. Profiles of clinical change were used to detect impact and estimate treatment effect sizes. Primary analyses showed that both interventions had a clinically significant impact on borderline personality disorder behaviors 12 months after baseline but with no differential treatment effects. The impact on substance use was more complex. Subgroup analyses revealed that adolescents with depression had significantly more severe profiles of borderline personality disorder and substance use. These youths were the only group to show reductions in substance use, but they only did so if they received the I-BAFT intervention. Study data also documented the high dosage of intensive residential treatment needed by this population. Results highlight the intensive treatment needs of juvenile justice-involved youths with co-occurring substance use and borderline personality disorder including depression, the hybrid outpatient and residential treatment often required by this population, and the promise of a family-oriented approach, particularly for youths with severe symptoms and co-occurring depression. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Utilization of ring-shaped bone allograft for surgical treatment of adolescent post-tubercular kyphosis: A retrospective study.

PubMed

Yin, Xiang; Liu, Peng; Liu, Yao-Yao; Fan, Wei-Li; Liu, Bai-Yi; Zhao, Jian-Hua

2017-06-01

This study aimed to investigate the mid-term outcome of ring-shaped bone allografts in the surgical treatment of adolescent post-tubercular kyphosis secondary to spinal tuberculosis.The records of adolescent patients diagnosed with spinal tuberculosis who received treatment in our department between 2009 and 2013 were retrospectively reviewed. The anterior approach was used in cases of cervical kyphosis and the posterior approach was used in cases of thoracic and lumbar kyphosis. During the surgery, the ring-shaped bone was used as a structural bone graft associated with the cancellous bone filing in the center portion of the ring shape. Cobb's angle, signs of spinal infusion on computed tomography, and complications were followed up.A total of 25 patients were included in our study. Among them, 3 involved the cervical region, 5 involved the thoracic region, 8 involved the thoracolumbar region, and 9 involved the lumbar region. The preoperative kyphosis deformity was a mean 65° Cobb's angle (40°-97°) compared to the postoperative 14° Cobb's angle (10°-21°) for an average correction of 51°. All wounds healed well without graft rejection. All patients achieved bone fusion 3 months postoperative for a 100% fusion rate.Our results show that the ring-shaped allograft bone is an effective option for the treatment of adolescent kyphosis. The ring-shaped allograft bone demonstrated satisfactory mechanical strength and vertebral fusion without mid-term metallic toxicity.

Perceived Need for Treatment and Engagement in Mental Health Services Among Community-Referred Racial/Ethnic Minority Adolescents.

PubMed

Fisher, Jacqueline Horan; Lichvar, Emily; Hogue, Aaron; Dauber, Sarah

2018-03-10

This study examines clinical and family predictors of perceived need for treatment and engagement in mental health treatment services among community-referred racial/ethnic minority adolescents and their primary caregivers. Findings indicated that the majority of families perceived a need for treatment, but that perceived need was not associated with treatment engagement. Family factors (i.e., low cohesion and high conflict within the family) predicted perceived need for treatment among adolescents, whereas clinical factors (i.e., adolescent internalizing and externalizing symptomatology) predicted caregiver perceived need for adolescent treatment. Neither clinical nor family factors predicted treatment engagement.

Bipolar Disorder in Adolescence: Diagnosis and Treatment.

ERIC Educational Resources Information Center

Wilkinson, Great Buyck; Taylor, Priscilla; Holt, Jan R.

2002-01-01

Due to developmental issues and overlapping symptoms with other disorders, diagnosing bipolar disorder in adolescents is often a confusing and complex process. This article highlights diagnostic criteria, symptoms and behaviors, and the differential diagnosis process. Treatment options are also discussed. (Contains 17 references.) (GCP)

Anterolateral ankle impingement in adolescents: outcomes of nonoperative and operative treatment.

PubMed

Edmonds, Eric W; Chambers, Reid; Kaufman, Elizabeth; Chambers, Henry G

2010-03-01

Ankle sprains in adolescents usually resolve with conservative management but a few patients may develop ankle impingement syndrome. There have been adult studies addressing surgical treatment of this pathology, but our study evaluated the surgical management of anterolateral ankle impingement in adolescents by comparing their outcomes after nonoperative treatment and subsequent surgical intervention. Thirteen patients (children and adolescents) diagnosed with ankle impingement by history, physical examination, and magnetic resonance imaging during a 9-year period at our institution underwent eventual arthroscopic debridement. A retrospective chart review of these patients was performed and they were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) functional rating scale on 3 separate occasions: (1) initial presentation, (2) termination of nonoperative management, and (3) final postoperative follow-up visit. Thirteen adolescents (11 girls and 2 boys; 14 ankles) with a mean age of 15.6 (11.9-18.3) years met the inclusion criteria; of these, all had arthroscopic surgery. Mean duration of reported symptoms was 9.6 (4-15) months and mean duration of nonoperative management (physical therapy, activity modifications) was 6.9 (2-12) months. The mean AOFAS rating (out of 100 total) at initial presentation was 68.4 (40-84) and after nonoperative management was no better with a mean of 68.2 (63-76). The mean AOFAS rating at final follow-up was 90.6 (52-100), which was statistically significant (Padolescent with nonassociated chondromalacia. Knowledge of this entity is critical for making the correct diagnosis and eventual treatment. In fact, once the diagnosis of impingement is confirmed by clinical and

Reasons and determinants for not receiving treatment for common mental disorders.

PubMed

van Beljouw, Ilse; Verhaak, Peter; Prins, Marijn; Cuijpers, Pim; Penninx, Brenda; Bensing, Jozien

2010-03-01

This study focused on patients in the general population whose anxiety or depressive disorder is untreated. It explored reasons for not receiving treatment and compared four groups of patients-three that did not receive treatment for different reasons (no problem perceived, no perceived need for care, and unmet need for care) and one that received treatment-regarding their predisposing, enabling, and need factors. Cross-sectional data were used for 743 primary care patients with current anxiety or depressive disorder from the Netherlands Study of Depression and Anxiety (NESDA). Diagnoses were confirmed with the Composite International Diagnostic Interview. Patients' perception of the presence of a mental problem, perceived need for care, service utilization, and reasons for not receiving treatment were assessed with the Perceived Need for Care Questionnaire. Forty-three percent of the respondents with a six-month anxiety or depression diagnosis did not receive treatment. Twenty-one percent of all respondents with depression or anxiety expressed a need for care but did not receive any. Preferring to manage the problem themselves was the most common reason for respondents to avoid seeking treatment. There were no significant differences in clinical need factors between treated patients and untreated patients with a perceived need for care. Compared with patients in the other two untreated groups, untreated patients with a perceived need for care were more hindered in regard to symptom severity, functional disability, and psychosocial functioning. General practitioners should pay considerable attention to patients whose need for care is unmet. Furthermore, findings support the implementation of patient empowerment in mental health care in order to contribute to easily accessible and patient-centered care.

Investigating self-efficacy, disease knowledge and adherence to treatment in adolescents with cystic fibrosis.

PubMed

Faint, Nicholas R; Staton, Janelle M; Stick, Stephen M; Foster, Juliet M; Schultz, André

2017-05-01

Patient adherence is integral to the effectiveness of prescribed treatment, and is associated with beneficial disease outcomes, yet in adolescents with cystic fibrosis, adherence is often sub-optimal. Multiple factors may contribute to treatment adherence, including disease knowledge and self-efficacy. In adolescents with cystic fibrosis: (i) to compare the disease knowledge of adolescents and their parents before transition to adult care; (ii) to determine the relationship between disease knowledge (adolescent, parent) and adherence; and (iii) to evaluate self-efficacy and its association with disease knowledge and adherence. Adolescents with cystic fibrosis and their parents were recruited from a tertiary children's hospital. Disease knowledge and self-efficacy was assessed using the Knowledge of Disease Management-CF and General Self-Efficacy Scales respectively. Using pharmacy records, medication possession ratio was calculated to measure treatment adherence in the preceding year. Thirty-nine adolescent (aged 12-17 (median 14) years) and parent pairs were recruited. Adherence to hypertonic saline, but not other medications, was significantly associated with disease knowledge in adolescents (r 2  = 0.40, P = 0.029). Mean (SD) adolescent self-efficacy was 30.8 (4.0), and not associated with disease knowledge or adherence. Mean (SD) disease knowledge was less in adolescents than parents (55 (16)% and 72 (14)% respectively, P < 0.001). Disease knowledge is sub-optimal in adolescents with cystic fibrosis, even in the 2 years immediately before transition to adult care. Given that adherence with some treatments has been associated with disease knowledge our results suggest the need for educational interventions in adolescents with cystic fibrosis to optimise self-management and health outcomes. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Family-based treatment of eating disorders in adolescents: current insights

PubMed Central

Rienecke, Renee D

2017-01-01

Eating disorders are serious illnesses associated with significant morbidity and mortality. Family-based treatment (FBT) has emerged as an effective intervention for adolescents with anorexia nervosa, and preliminary evidence suggests that it may be efficacious in the treatment of adolescents with bulimia nervosa. Multifamily therapy for anorexia nervosa provides a more intensive experience for families needing additional support. This review outlines the three phases of treatment, key tenets of family-based treatment, and empirical support for FBT. In addition, FBT in higher levels of care is described, as well as challenges in the implementation of FBT and recent adaptations to FBT, including offering additional support to eating-disorder caregivers. Future research is needed to identify families for whom FBT does not work, determine adaptations to FBT that may increase its efficacy, develop ways to improve treatment adherence among clinicians, and find ways to support caregivers better during treatment. PMID:28615982

Family-based treatment of eating disorders in adolescents: current insights.

PubMed

Rienecke, Renee D

2017-01-01

Eating disorders are serious illnesses associated with significant morbidity and mortality. Family-based treatment (FBT) has emerged as an effective intervention for adolescents with anorexia nervosa, and preliminary evidence suggests that it may be efficacious in the treatment of adolescents with bulimia nervosa. Multifamily therapy for anorexia nervosa provides a more intensive experience for families needing additional support. This review outlines the three phases of treatment, key tenets of family-based treatment, and empirical support for FBT. In addition, FBT in higher levels of care is described, as well as challenges in the implementation of FBT and recent adaptations to FBT, including offering additional support to eating-disorder caregivers. Future research is needed to identify families for whom FBT does not work, determine adaptations to FBT that may increase its efficacy, develop ways to improve treatment adherence among clinicians, and find ways to support caregivers better during treatment.

Adolescent suicide risk screening: the effect of communication about type of follow-up on adolescents' screening responses.

PubMed

King, Cheryl A; Hill, Ryan M; Wynne, Henry A; Cunningham, Rebecca M

2012-01-01

This experimental study examined the effect of communication about type of screening follow-up (in-person follow-up vs. no in-person follow-up) on adolescents' responses to a self-report suicide risk screen. Participants were 245 adolescents (131 girls, 114 boys; ages 13-17; 80% White, 21.6% Black, 9.8% American Indian, 2.9% Asian) seeking medical emergency services. They were randomized to a screening follow-up condition. Screening measures assessed primary risk factors for suicidal behavior, including suicidal thoughts, depressive symptoms, alcohol use, and aggressive/delinquent behavior. There was no main effect of follow-up condition on adolescents' screening scores; however, significant interactions between follow-up condition and public assistance status were evident. Adolescents whose families received public assistance were less likely to report aggressive-delinquent behavior if assigned to in-person follow-up. Adolescents whose families did not receive public assistance reported significantly higher levels of suicidal ideation if assigned to in-person follow-up. Findings suggest that response biases impact some adolescents' responses to suicide risk screenings. Because national policy strongly recommends suicide risk screening in emergency settings, and because screening scores are used to make critical decisions regarding risk management and treatment recommendations, findings indicate the importance of improving the reliability and validity of suicide risk screening for adolescents.

Major Depression and Treatment Response in Adolescents with ADHD and Substance Use Disorder

PubMed Central

Warden, Diane; Riggs, Paula D.; Min, Sung-Joon; Mikulich-Gilbertson, Susan K.; Tamm, Leanne; Trello-Rishel, Kathlene; Winhusen, Theresa

2011-01-01

Background Major depressive disorder (MDD) frequently co-occurs in adolescents with substance use disorders (SUD) and attention deficit hyperactivity disorder (ADHD), but the impact of MDD on substance treatment and ADHD outcomes and implications for clinical practice are unclear. Methods Adolescents (n=303; ages 13-18) meeting DSM-IV criteria for ADHD and SUD were randomized to Osmotic Release Methylphenidate (OROS-MPH) or placebo and 16 weeks of cognitive behavioral therapy (CBT). Adolescents with (n=38) and without (n=265) MDD were compared on baseline demographic and clinical characteristics as well as non-nicotine substance use and ADHD treatment outcomes. Results Adolescents with MDD reported more non-nicotine substance use days at baseline and continued using more throughout treatment compared to those without MDD (p<0.0001 based on Timeline Followback; p<0.001 based on urine drug screens). There was no difference between adolescents with and without MDD in retention or CBT sessions attended. ADHD symptom severity (based on DSM-IV ADHD Rating Scale) followed a slightly different course of improvement although with no difference between groups in baseline or 16-week symptom severity or 16 week symptom reduction. There was no difference in days of substance use or ADHD symptom outcomes over time in adolescents with MDD or those without MDD treated with OROS-MPH or placebo. Depressed adolescents were more often female, older, and not court ordered. Conclusions These preliminary findings suggest that compared to non-depressed adolescents with ADHD and SUD, those with co-occurring MDD have more severe substance use at baseline and throughout treatment. Such youth may require interventions targeting depression. PMID:21885210

[PRIMARY HEADACHE IN CHILDREN AND ADOLESCENTS--DIAGNOSIS AND TREATMENT].

PubMed

Matar, Amal Khourieh; Kerem, Nogah C; Srugo, Isaac; Genizi, Jacob

2015-12-01

Primary headaches are one of the most common disorders of childhood, with migraine and tension type headaches (TTHs) being the most frequent ones. In spite of their prevalence, there is paucity of knowledge regarding the underlying pathophysiological mechanisms that cause headaches and regarding the unique aspects of headaches in children and adolescents. To review the literature and summarize the knowledge regarding clinical features, diagnosis and management of primary headache in children and adolescents, mainly migraine and TTH. Most of our current knowledge regarding primary headaches in children and adolescents is driven from extrapolations from studies that were conducted with adult patients. Therefore, it needs to be validated for the different age groups. Migraines may be diagnosed effectively based on the 2nd edition of the International Classification of Headache Disorders (ICHD-II), however, TTH is diagnosed mainly by the absence of features found in other headache types. Treatment strategies for primary headaches vary according to patient's age, family structure, culture and beliefs, headache diagnosis, and based on the disability the headache imposes on the patient's daily living. It was shown that a multidisciplinary approach, that includes continuing counseling, education, and reassurance, in combination with pharmacological and non-pharmacological treatment, is an effective strategy for children and adolescents suffering from primary headaches. Further studies are needed to enrich our knowledge about the pathophysiological mechanisms that cause headaches in children and adolescents and to develop efficient strategies to alleviate their burden.

Treatment Model for the Adolescent Sex Offender.

ERIC Educational Resources Information Center

Margolin, Leslie

1983-01-01

Defines the adolescent sex offender as an individual whose problem is primarily moral and social. Discusses how individuals adopt and internalize social norms, emphasizing peer interactions, role taking, and collective behavior. Describes a treatment program which emphasizes the functions of labeling, group therapy, and structured living…

Quality of life and stress level in adolescents with idiopathic scoliosis subjected to conservative treatment.

PubMed

Kinel, Edyta; Kotwicki, Tomasz; Podolska, Anna; Białek, Marianna; Stryła, Wanda

2012-01-01

Quality of life (QoL) and stress level of adolescents with idiopathic scoliosis is under growing consideration by physicians, physiotherapists and other specialists (psychologist, nurses). The aim of the study was to evaluate the quality of life and stress level in adolescents with idiopathic scoliosis who are under brace treatment. It involved 45 adolescents, ages ranging between 10.0 and 15.0 years, all with Adolescent Idiopathic Scoliosis (AIS) with Cobb angle between 20-45 degrees. The adolescents were wearing the same kind of brace (Chêneau orthosis) for more than 3 months for at least 12h per day. Two questionnaires were used: the Brace Questionnaire (BrQ) and Bad Sobernheim Stress Questionnaire (BSSQ). The analysis considered the type of treatment, curve location, correlation of the total score with age, Cobb angle and Bunnell rotation angle. The age was 13.6 ± 1.3 years. Cobb angle was 31.7 ± 7.6 degrees. The mean score for BrQ was 78.1 ± 11.3 points. Adolescents revealed higher score with BSSQ Deformity (median = 15) comparing to BSSQ Brace (median = 12). Conservative treatment does not severely impact on the quality of life of scoliotic adolescents. The adolescents who were under brace treatment suffered moderate level of stress from the deformity.

Subanesthetic ketamine infusions for the treatment of children and adolescents with chronic pain: a longitudinal study.

PubMed

Sheehy, Kathy A; Muller, Elena A; Lippold, Caroline; Nouraie, Mehdi; Finkel, Julia C; Quezado, Zenaide M N

2015-12-01

Chronic pain is common in children and adolescents and is often associated with severe functional disability and mood disorders. The pharmacological treatment of chronic pain in children and adolescents can be challenging, ineffective, and is mostly based on expert opinions and consensus. Ketamine, an N-methyl-D-aspartate receptor antagonist, has been used as an adjuvant for treatment of adult chronic pain and has been shown, in some instances, to improve pain and decrease opioid-requirement. We examined the effects of subanesthetic ketamine infusions on pain intensity and opioid use in children and adolescents with chronic pain syndromes treated in an outpatient setting. Longitudinal cohort study of consecutive pediatric patients treated with subanesthetic ketamine infusions in a tertiary outpatient center. Outcome measurements included self-reported pain scores (numeric rating scale) and morphine-equivalent intake. Over a 15-month period, 63 children and adolescents (median age 15, interquartile range 12-17 years) with chronic pain received 277 ketamine infusions. Intravenous administration of subanesthetic doses of ketamine to children and adolescents on an outpatient basis was safe and not associated with psychotropic effects or hemodynamic perturbations. Overall, ketamine significantly reduced pain intensity (p < 0.001) and yielded greater pain reduction in patients with complex regional pain syndrome (CRPS) than in patients with other chronic pain syndromes (p = 0.029). Ketamine-associated reductions in pain scores were the largest in postural orthostatic tachycardia syndrome (POTS) and trauma patients and the smallest in patients with chronic headache (p = 0.007). In 37% of infusions, patients had a greater than 20 % reduction in pain score. Conversely, ketamine infusions did not change overall morphine-equivalent intake (p = 0.3). These data suggest that subanesthetic ketamine infusion is feasible in an outpatient setting and may benefit children and

[The consequences of closed traumatic brain injury and piracetam efficacy in their treatment in adolescents].

PubMed

Zavadenko, N N; Guzilova, L S

2008-01-01

The efficacy of piracetam in the treatment of the consequences of moderate and severe closed traumatic brain injury was assessed in 42 patients, aged 12-18 years, who suffered traumatic disorders 1,5-5 years before this study. Adolescents from the main group (20 patients) received piracetam in dosage of 40-50 mg/kg (or 1600-2400 mg daily) during one month. 22 patients of the second group were examined as controls. The positive therapeutic effects of piracetam on cognitive (memory, attention, executive functions) and motor (coordination) functions as well as the speed of cognitive and motor performance were demonstrated in this study.

Symptom trajectories throughout two family therapy treatments for adolescent anorexia nervosa.

PubMed

Murray, Stuart B; Pila, Eva; Le Grange, Daniel; Sawyer, Susan M; Hughes, Elizabeth K

2017-11-01

This study aimed to examine the trajectory of symptom remission and affective functioning throughout the course of two family-based treatments for adolescent anorexia nervosa (AN): conjoint family-based treatment (FBT) and parent-focused treatment (PFT). Participants were 107 adolescents (M age  = 15.5 years, SD = 1.5) with a primary diagnosis of AN who participated in a randomized clinical trial comparing FBT (N = 55) and PFT (N = 51). Patient weight and self-reported assessments of dietary restraint and positive and negative affect were recorded at regular intervals throughout treatment. Multilevel models revealed increases in weight (β = 0.33, p < .001) and positive affect (β = 0.03, p < .001), and decreases in dietary restraint (β = -0.03, p < .001) and negative affect (β = -0.04, p < .001) over the course of treatment. No significant effects emerged by treatment type. These findings suggest that PFT may bring about comparable trajectories of weight gain and reduced dietary restraint as conjoint FBT, despite adolescents not being directly involved in treatment. These findings also highlight that the exclusively behavioral focus throughout both PFT and FBT is associated with significant increments in positive affect and significant reductions in negative affect. © 2017 Wiley Periodicals, Inc.

Psychiatric disorders among adolescents from Lebanon: prevalence, correlates, and treatment gap.

PubMed

Maalouf, Fadi T; Ghandour, Lilian A; Halabi, Fadi; Zeinoun, Pia; Shehab, Al Amira Safa; Tavitian, Lucy

2016-08-01

Adolescence is a critical age for the development of psychiatric disorders. Although Lebanon, a low-to-middle income country, has suffered from decades of war and political instability, the burden of psychiatric disorders among adolescents in Lebanon remains unclear. This study aims to estimate the prevalence of psychiatric disorders among adolescents in the Lebanese capital, Beirut, and to study the correlates and treatment seeking behavior associated with these disorders. Through a multistage cluster sampling design, 510 adolescents, aged 11-17 years were recruited from a household sample in Beirut in 2012. Parents and adolescents completed a battery of self-reported questionnaires and interviews including the Development and Well-being Assessment (DAWBA), the Peer-Relations Questionnaire (PRQ), and a demographic/clinical information questionnaire. Logistic regression models were used to study the correlates of psychiatric disorders. The 30-day prevalence of psychiatric disorders was 26.1 %, with anxiety disorders (13.1 %) and ADHD (10.2 %) being the most prevalent disorders. Only 6 % of those with disorders reported seeking professional help. Parental marital status, not attending school, having a chronic medical condition, having a family history of psychiatric disorders, as well as propensity to bullying and to being victimized by peers emerged as correlates of having psychiatric disorders. A clear treatment gap is evident with a high 30-day prevalence of psychiatric disorders among adolescents in Beirut coupled with a very low percentage seeking treatment. Scaling up mental health services and addressing potential barriers to seeking care would be important to close this gap.

Adolescent Patient Preferences Surrounding Partner Notification and Treatment for Sexually Transmitted Infections

PubMed Central

Reed, Jennifer L.; Huppert, Jill S.; Gillespie, Gordon L.; Taylor, Regina G.; Holland, Carolyn K.; Alessandrini, Evaline A.; Kahn, Jessica A.

2015-01-01

Objectives Important barriers to addressing the sexually transmitted infection (STI) epidemic among adolescents are the inadequate partner notification of positive STI results and insufficient rates of partner testing and treatment. However, adolescent attitudes regarding partner notification and treatment are not well understood. The aim was to qualitatively explore the barriers to and preferences for partner notification and treatment among adolescent males and females tested for STIs in an emergency department (ED) setting and to explore the acceptability of ED personnel notifying their sexual partners. Methods This was a descriptive, qualitative study in which a convenience sample of 40 adolescents (18 females, 22 males) 14 to 21 years of age who presented to either adult or pediatric EDs with STI-related complaints participated. Individualized, semistructured, confidential interviews were administered to each participant. Interviews were audiotaped and transcribed verbatim by an independent transcriptionist. Data were analyzed using framework analysis. Results Barriers to partner notification included fear of retaliation or loss of the relationship, lack of understanding of or concern for the consequences associated with an STI, and social stigma and embarrassment. Participants reported two primary barriers to their partners obtaining STI testing and treatment: lack of transportation to the health care site and the partner's fear of STI positive test results. Most participants preferred to notify their main sexual partners of an STI exposure via a face-to-face interaction or a phone call. Most participants were agreeable with a health care provider (HCP) notifying their main sexual partners of STI exposure and preferred that the HCP notify the partner by phone call. Conclusions There are several adolescent preferences and barriers for partner notification and treatment. To be most effective, future interventions to prevent adolescent STIs should incorporate

Adolescent patient preferences surrounding partner notification and treatment for sexually transmitted infections.

PubMed

Reed, Jennifer L; Huppert, Jill S; Gillespie, Gordon L; Taylor, Regina G; Holland, Carolyn K; Alessandrini, Evaline A; Kahn, Jessica A

2015-01-01

Important barriers to addressing the sexually transmitted infection (STI) epidemic among adolescents are the inadequate partner notification of positive STI results and insufficient rates of partner testing and treatment. However, adolescent attitudes regarding partner notification and treatment are not well understood. The aim was to qualitatively explore the barriers to and preferences for partner notification and treatment among adolescent males and females tested for STIs in an emergency department (ED) setting and to explore the acceptability of ED personnel notifying their sexual partners. This was a descriptive, qualitative study in which a convenience sample of 40 adolescents (18 females, 22 males) 14 to 21 years of age who presented to either adult or pediatric EDs with STI-related complaints participated. Individualized, semistructured, confidential interviews were administered to each participant. Interviews were audiotaped and transcribed verbatim by an independent transcriptionist. Data were analyzed using framework analysis. Barriers to partner notification included fear of retaliation or loss of the relationship, lack of understanding of or concern for the consequences associated with an STI, and social stigma and embarrassment. Participants reported two primary barriers to their partners obtaining STI testing and treatment: lack of transportation to the health care site and the partner's fear of STI positive test results. Most participants preferred to notify their main sexual partners of an STI exposure via a face-to-face interaction or a phone call. Most participants were agreeable with a health care provider (HCP) notifying their main sexual partners of STI exposure and preferred that the HCP notify the partner by phone call. There are several adolescent preferences and barriers for partner notification and treatment. To be most effective, future interventions to prevent adolescent STIs should incorporate these preferences and address the

Metasynthesis of the Views about Treatment of Anorexia Nervosa in Adolescents: Perspectives of Adolescents, Parents, and Professionals

PubMed Central

Sibeoni, Jordan; Orri, Massimiliano; Valentin, Marie; Podlipski, Marc-Antoine; Colin, Stephanie; Pradere, Jerome; Revah-Levy, Anne

2017-01-01

Background Anorexia nervosa in adolescents can be a difficult-to-treat disease. Because qualitative research is a well-established method for deepening our understanding of subjective experiences, such as eating disorders and their treatment, we sought to perform a systematic review of qualitative studies to synthesize the views of adolescents with this disease, their parents, and their healthcare providers about its treatment. Methods We performed a thematic synthesis to develop the central themes that summarize all of the topics raised in the articles included in our review. The quality of the articles was assessed by the Critical Appraisal Skills Program. Results We included 32 articles from seven different countries. Two central themes were inductively developed from the analysis: (1) the treatment targets (i.e., symptoms and patients in context), and (2) a therapeutic tool—a relationship, specifically the core concept of the therapeutic relationship. Conclusion Our results underline the difficulty in establishing a therapeutic alliance, the barriers to it, especially the risk that professionals, adolescents, and parents will not converse about treatment; although such a dialogue appears to be an essential component in the construction of a therapeutic alliance. PMID:28056106

Metasynthesis of the Views about Treatment of Anorexia Nervosa in Adolescents: Perspectives of Adolescents, Parents, and Professionals.

PubMed

Sibeoni, Jordan; Orri, Massimiliano; Valentin, Marie; Podlipski, Marc-Antoine; Colin, Stephanie; Pradere, Jerome; Revah-Levy, Anne

2017-01-01

Anorexia nervosa in adolescents can be a difficult-to-treat disease. Because qualitative research is a well-established method for deepening our understanding of subjective experiences, such as eating disorders and their treatment, we sought to perform a systematic review of qualitative studies to synthesize the views of adolescents with this disease, their parents, and their healthcare providers about its treatment. We performed a thematic synthesis to develop the central themes that summarize all of the topics raised in the articles included in our review. The quality of the articles was assessed by the Critical Appraisal Skills Program. We included 32 articles from seven different countries. Two central themes were inductively developed from the analysis: (1) the treatment targets (i.e., symptoms and patients in context), and (2) a therapeutic tool-a relationship, specifically the core concept of the therapeutic relationship. Our results underline the difficulty in establishing a therapeutic alliance, the barriers to it, especially the risk that professionals, adolescents, and parents will not converse about treatment; although such a dialogue appears to be an essential component in the construction of a therapeutic alliance.

Impact of Childhood Trauma on Treatment Outcome in the Treatment for Adolescents with Depression Study (TADS)

ERIC Educational Resources Information Center

Lewis, Cara C.; Simons, Anne D.; Nguyen, Lananh J.; Murakami, Jessica L.; Reid, Mark W.; Silva, Susan G.; March, John S.

2010-01-01

Objective: The impact of childhood trauma was examined in 427 adolescents (54% girls, 74% Caucasian, mean = 14.6, SD = 1.5) with major depressive disorder participating in the Treatment for Adolescents with Depression Study (TADS). Method: TADS compared the efficacy of cognitive behavioral therapy (CBT), fluoxetine (FLX), their combination (COMB),…

Meeting the goal of concurrent adolescent and adult licensure of HIV prevention and treatment strategies.

PubMed

Hume, Michelle; Lewis, Linda L; Nelson, Robert M

2017-12-01

The ability of adolescents to access safe and effective new products for HIV prevention and treatment is optimised by adolescent licensure at the same time these products are approved and marketed for adults. Many adolescent product development programmes for HIV prevention or treatment products may proceed simultaneously with adult phase III development programmes. Appropriately implemented, this strategy is not expected to delay licensure as information regarding product efficacy can often be extrapolated from adults to adolescents, and pharmacokinetic properties of drugs in adolescents are expected to be similar to those in adults. Finally, adolescents enrolled in therapeutic HIV prevention and treatment research can be considered adults, based on US Food and Drug Administration (FDA) regulations and the appropriate application of state law. The FDA permits local jurisdictions to apply state and local HIV/sexually transmitted infection minor treatment laws so that adolescents who are HIV-positive or at risk of contracting HIV may be enrolled in therapeutic or prevention trials without obtaining parental permission. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Do patients discussed at a lung cancer multidisciplinary team meeting receive guideline-recommended treatment?

PubMed

Boxer, Miriam M; Duggan, Kirsten J; Descallar, Joseph; Vinod, Shalini K

2016-03-01

Clinical guidelines provide evidence-based management recommendations to guide practice. This study aimed to evaluate whether patients discussed at a lung cancer multidisciplinary team meeting received guideline-recommended treatment and determine reasons for not receiving guideline-recommended treatment. All new lung cancer patients discussed at the Liverpool/Macarthur lung cancer multidisciplinary team meeting between 1 December 2005 and 31 December 2010 were included. Guideline-recommended treatment was assigned according to pathology, stage and ECOG (Eastern Co-operative Oncology Group) performance status as per the 2004 Australian Lung Cancer Guidelines. This was compared with actual treatment received to determine adherence to guidelines. For those patients who did not receive guideline-recommended treatment, the medical record was reviewed to determine the reason(s) for this. Survival was compared between those who did and did not receive guideline-recommended treatment. 808 new patients were discussed at the multidisciplinary team meeting. Guideline-recommended treatment could not be assigned in 2% of patients due to missing data. 435 patients (54%) received guideline-recommended treatment, and 356 (44%) did not. The most common reasons for not receiving guideline-recommended treatment were a decline in ECOG performance status (24%), large tumor volume precluding radical radiotherapy (17%), comorbidities (15%) and patient preference (13%). Patients less than 70 years who received guideline-recommended treatment had improved survival compared with those who did not. A significant proportion of lung cancer patients did not receive guideline-recommended treatment due to legitimate reasons. Alternative guidelines are needed for patients not suitable for current best practice. Treatment according to guidelines was a predictor for survival. © 2015 Wiley Publishing Asia Pty Ltd.

Adolescent idiopathic scoliosis: Indications and efficacy of nonoperative treatment

PubMed Central

Canavese, Federico; Kaelin, André

2011-01-01

The strategy for the treatment of idiopathic scoliosis depends essentially upon the magnitude and pattern of the deformity, and its potential for progression. Treatment options include observation, bracing and/or surgery. During the past decade, several studies have demonstrated that the natural history of adolescent idiopathic scoliosis can be positively affected by nonoperative treatment, especially bracing. Other forms of conservative treatment, such as chiropractic or osteopathic manipulation, acupuncture, exercise or other manual treatments, or diet and nutrition, have not yet been proven to be effective in controlling spinal deformity progression, and those with a natural history that is favorable at the completion of growth. Observation is appropriate treatment for small curves, curves that are at low risk of progression, and those with a natural history that is favorable at the completion of growth. Indications for brace treatment are a growing child presenting with a curve of 25°–40° or a curve less than 25° with documented progression. Curves of 20°–25° in patients with pronounced skeletal immaturity should also be treated. The purpose of this review is to provide information about conservative treatment of adolescent idiopathic scoliosis. Indications for conservative treatment, hours daily wear and complications of brace treatment as well as brace types are discussed. PMID:21221217

Cognitive performance in adolescents with Delayed Sleep-Wake Phase Disorder: Treatment effects and a comparison with good sleepers.

PubMed

Richardson, C; Micic, G; Cain, N; Bartel, K; Maddock, B; Gradisar, M

2018-06-01

The present study aimed to investigate whether Australian adolescents with Delayed Sleep-Wake Phase Disorder have impaired cognitive performance and whether chronobiological treatment for Delayed Sleep-Wake Phase Disorder improves adolescents' sleep, daytime functioning and cognitive performance. Adolescents with Delayed Sleep-Wake Phase Disorder (mean = 15.68 ± 2.1 y, 62% f) reported significantly later sleep timing (d = 1.03-1.45), less total sleep time (d = 0.82) and greater daytime sleepiness (d = 2.66), fatigue (d = 0.63) and impairment (d = 2.41), compared to good sleeping adolescents (mean = 15.9 ± 2.4 y, 75% f). However, there were no significant between-group differences (all p > 0.05) in performance on the Operation Span (ηp 2  = 0.043), Digit Span (forwards: ηp 2  = 0.002, backwards: ηp 2  = 0.003), Letter Number Sequencing (ηp 2  < 0.001) (working memory) and Digit-Symbol Substitution Tasks (ηp 2  = 0.010) (processing speed). Adolescents with Delayed Sleep-Wake Phase Disorder went on to receive 3 weeks of light therapy. At 3 months post-treatment, adolescents with Delayed Sleep-Wake Phase Disorder reported significantly advanced sleep timing (d = 0.56-0.65), greater total sleep time (d = 0.52) and improved daytime sleepiness (d = 1.33), fatigue (d = 0.84) and impairment (d = 0.78). Performance on the Operation Span (d = 0.46), Letter Number Sequencing (d = 0.45) and Digit-Symbol Substitution tasks (d = 0.57) also significantly improved. Copyright © 2018. Published by Elsevier Ltd.

Surgical Treatment of Adolescent Clavicle Fractures: Results and Complications.

PubMed

McIntosh, Amy L

2016-06-01

No level 1 evidence is available to guide the surgical treatment of adolescent clavicle fractures. Adult literature is not applicable as adolescent mid-diaphyseal clavicle fractures do not develop nonunions, and only a small percentage (10% to 20%) are symptomatic from malunions. Current indications for operative fixation are: (1) completely displaced midshaft fracture with shortening of >2 cm; (2) superior displacement with skin tenting and/or an impending open fracture; (3) associated neurovascular injury; (4) open clavicular fracture; and (5) floating shoulder with a completely displaced clavicular fracture. Future large prospective randomized studies will need to be performed to accurately define which adolescent patients will "truly" benefit from surgical intervention.

Parallel Demand-Withdraw Processes in Family Therapy for Adolescent Drug Abuse

PubMed Central

Rynes, Kristina N.; Rohrbaugh, Michael J.; Lebensohn-Chialvo, Florencia; Shoham, Varda

2013-01-01

Isomorphism, or parallel process, occurs in family therapy when patterns of therapist-client interaction replicate problematic interaction patterns within the family. This study investigated parallel demand-withdraw processes in Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, hypothesizing that therapist-demand/adolescent-withdraw interaction (TD/AW) cycles observed early in treatment would predict poor adolescent outcomes at follow-up for families who exhibited entrenched parent-demand/adolescent-withdraw interaction (PD/AW) before treatment began. Participants were 91 families who received at least 4 sessions of BSFT in a multi-site clinical trial on adolescent drug abuse (Robbins et al., 2011). Prior to receiving therapy, families completed videotaped family interaction tasks from which trained observers coded PD/AW. Another team of raters coded TD/AW during two early BSFT sessions. The main dependent variable was the number of drug use days that adolescents reported in Timeline Follow-Back interviews 7 to 12 months after family therapy began. Zero-inflated Poisson (ZIP) regression analyses supported the main hypothesis, showing that PD/AW and TD/AW interacted to predict adolescent drug use at follow-up. For adolescents in high PD/AW families, higher levels of TD/AW predicted significant increases in drug use at follow-up, whereas for low PD/AW families, TD/AW and follow-up drug use were unrelated. Results suggest that attending to parallel demand-withdraw processes in parent/adolescent and therapist/adolescent dyads may be useful in family therapy for substance-using adolescents. PMID:23438248

Adolescent perceptions of orthodontic treatment risks and risk information: A qualitative study.

PubMed

Perry, John; Johnson, Ilona; Popat, Hashmat; Morgan, Maria Z; Gill, Paul

2018-04-24

For effective risk communication, clinicians must understand patients' values and beliefs in relation to the risks of treatment. This qualitative study aimed to explore adolescent perceptions of orthodontic treatment risks and risk information. Five focus groups were carried out with 32 school/college pupils aged 12-18 in Wales, UK. Participants were purposively selected and had all experienced orthodontic treatment. A thematic approach was used for analysis and data collection was completed at the point of data saturation. Four themes emerged from the data; (a) day-to-day risks of orthodontic treatment, (b) important orthodontic risk information, (c) engaging with orthodontic risk information and (d) managing the risks of orthodontic treatment. Day-to-day risks of orthodontic treatment that were affecting participants "here and now" were of most concern. Information about preventing the risks of treatment was deemed to be important. Participants did not actively seek risk information but engaged passively with information from convenient sources. Perceptions of risk susceptibility influenced participants' management of the risks of orthodontic treatment. This study demonstrates that adolescent patients can understand information about the nature and severity of orthodontic treatment risks. However, adolescent patients can have false perceptions if the risks are unfamiliar, perceived only to have a future impact or if seen as easy to control. Adolescent patients must be provided with timely and easily accessible risk information and with practical solutions to prevent the risks of treatment. The views and experiences gathered in this study can assist clinicians to better understand their young patients' beliefs about treatment risks, facilitate effective risk communication and contribute to improved patient-centred care. Copyright © 2018 Elsevier Ltd. All rights reserved.

Treatment Guidelines for Children and Adolescents with Bipolar Disorder

ERIC Educational Resources Information Center

Kowatch, Robert A.; Fristad, Mary; Birmaher, Boris; Wagner, Karen Dineen; Findling, Robert L.; Hellander, Martha

2005-01-01

Clinicians who treat children and adolescents with bipolar disorder desperately need current treatment guidelines. These guidelines were developed by expert consensus and a review of the extant literature about the diagnosis and treatment of pediatric bipolar disorders. The four sections of these guidelines include diagnosis, comorbidity, acute…

Predictors of Physical Altercation among Adolescents in Residential Substance Abuse Treatment

PubMed Central

Crawley, Rachel D.; Becan, Jennifer Edwards; Knight, Danica Kalling; Joe, George W.; Flynn, Patrick M.

2014-01-01

This study tested the hypothesis that basic social information-processing components represented by family conflict, peer aggression, and pro-aggression cognitive scripts are related to aggression and social problems among adolescents in substance abuse treatment. The sample consisted of 547 adolescents in two community-based residential facilities. Correlation results indicated that more peer aggression is related to more pro-aggression scripts; scripts, peer aggression, and family conflict are associated with social problems; and in-treatment physical altercation involvement is predicted by higher peer aggression. Findings suggest that social information-processing components are valuable for treatment research. PMID:26622072

The impact of an 8-day intensive treatment for adolescent panic disorder and agoraphobia on comorbid diagnoses.

PubMed

Gallo, Kaitlin P; Chan, Priscilla T; Buzzella, Brian A; Whitton, Sarah W; Pincus, Donna B

2012-03-01

Previous research findings have shown positive effects of cognitive-behavioral therapy for primary anxiety disorders as well as for nonprimary, co-occurring anxiety disorders. In this study, we analyzed data from an existing randomized controlled trial of intensive treatment for panic disorder with or without agoraphobia (PDA) to examine the effects of the treatment on comorbid psychiatric diagnoses. The overall frequency and severity of aggregated comorbid diagnoses decreased in a group of adolescents who received an 8-day treatment for PDA. Results suggest that an 8-day treatment for PDA can alleviate the symptoms of some specific comorbid clinical diagnoses; in particular specific phobias, generalized anxiety disorder, and social phobia. These findings suggest that an intensive treatment for PDA is associated with reductions in comorbid symptoms even though disorders other than PDA are not specific treatment targets. Copyright © 2011. Published by Elsevier Ltd.

The effects of single versus mixed gender treatment for adolescent girls with ADHD.

PubMed

Babinski, Dara E; Sibley, Margaret H; Ross, J Megan; Pelham, William E

2013-01-01

This study evaluated the social behavior of adolescents with attention deficit hyperactivity disorder (ADHD) in single and mixed gender treatment settings. We collected ratings of social behavior (i.e., prosocial peer interactions, assertiveness, self-management, compliance, physical aggression, relational aggression) during single and mixed gender games within the Summer Treatment Program-Adolescent for 10 girls (M age = 13.17, 80% Hispanic) and 11 boys (M age = 12.89, 54.55% Hispanic). Counselors completed ratings immediately following 10 recreational periods for each adolescent they supervised (5 single gender games, 5 mixed gender games). Gender (female vs. male) × Setting (single vs. mixed gender) ANOVAs were conducted. If a significant interaction emerged, post hoc tests were also conducted. Several Gender × Setting interactions emerged, suggesting that girls benefit more from single gender formats than mixed gender formats. Girls showed more assertiveness, self-management, and compliance in single compared to mixed gender settings. A somewhat different pattern of results emerged for boys, which showed more appropriate social behavior (i.e., self-management, compliance) and less inappropriate social behavior (i.e., physical and relational aggression) in mixed gender settings compared to single gender settings. In contrast to previous ADHD treatment studies, these findings suggest that gender may impact treatment response for adolescents. Therefore, it is important that future studies evaluate whether current treatments for ADHD are appropriate for girls with ADHD and whether gender-specific treatments are necessary to address the unique difficulties of adolescent girls with ADHD.

An Overview of the Effectiveness of Adolescent Substance Abuse Treatment Models.

ERIC Educational Resources Information Center

Muck, Randolph; Zempolich, Kristin A.; Titus, Janet C.; Fishman, Marc; Godley, Mark D.; Schwebel, Robert

2001-01-01

Describes current approaches to adolescent substance abuse treatment, including the 12-step treatment approach, behavioral treatment approach, family-based treatment approach, and therapeutic community approach. Summarizes research that assesses the effectiveness of these models, offering findings from the Center for Substance Abuse Treatment's…

Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial.

PubMed

Mehlum, Lars; Tørmoen, Anita J; Ramberg, Maria; Haga, Egil; Diep, Lien M; Laberg, Stine; Larsson, Bo S; Stanley, Barbara H; Miller, Alec L; Sund, Anne M; Grøholt, Berit

2014-10-01

We examined whether a shortened form of dialectical behavior therapy, dialectical behavior therapy for adolescents (DBT-A) is more effective than enhanced usual care (EUC) to reduce self-harm in adolescents. This was a randomized study of 77 adolescents with recent and repetitive self-harm treated at community child and adolescent psychiatric outpatient clinics who were randomly allocated to either DBT-A or EUC. Assessments of self-harm, suicidal ideation, depression, hopelessness, and symptoms of borderline personality disorder were made at baseline and after 9, 15, and 19 weeks (end of trial period), and frequency of hospitalizations and emergency department visits over the trial period were recorded. Treatment retention was generally good in both treatment conditions, and the use of emergency services was low. DBT-A was superior to EUC in reducing self-harm, suicidal ideation, and depressive symptoms. Effect sizes were large for treatment outcomes in patients who received DBT-A, whereas effect sizes were small for outcomes in patients receiving EUC. Total number of treatment contacts was found to be a partial mediator of the association between treatment and changes in the severity of suicidal ideation, whereas no mediation effects were found on the other outcomes or for total treatment time. DBT-A may be an effective intervention to reduce self-harm, suicidal ideation, and depression in adolescents with repetitive self-harming behavior. Clinical trial registration information-Treatment for Adolescents With Deliberate Self Harm; http://ClinicalTrials.gov/; NCT00675129. Copyright © 2014 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Psychiatric treatment received by primary care patients with panic disorder with and without agoraphobia

PubMed Central

Marcks, Brook A.; Weisberg, Risa B.; Keller, Martin B.

2013-01-01

Objective Although the majority of individuals with panic disorder first present to the primary care setting, little is known about the psychiatric treatment primary care patients with the disorder typically receive. The purpose of the current study was to explore characteristics of treatment received by those with panic disorder with and without agoraphobia, examine demographic and clinical predictors of receiving treatment, and explore treatment barriers. Methods This study uses data from the Primary Care Anxiety Project (PCAP), which is a naturalistic, longitudinal study of anxiety disorders in primary care patients. This study presents data on 235 PCAP participants diagnosed with panic disorder with (N=150) or without agoraphobia (N=85) at the study intake assessment. Results Many patients with panic disorder were not receiving psychiatric treatment at study intake, with those without agoraphobia being less likely to receive treatment. Psychotropic medications were the treatment of choice, with SSRIs/SNRIs being the most commonly received class of medications. Only 39% of those with panic disorder with agoraphobia and 24% of those without agoraphobia were receiving psychotherapy, and use of empirically supported interventions was rare. The most common treatment barriers were: not believing in utilizing medication/therapy for emotional problems and not receiving a treatment recommendation from one’s provider. Conclusions The findings suggest a need for better treatment dissemination, in addition to making interventions more accessible and/or adapting them to the particular needs of primary care patients. PMID:19487354

Aphasia rehabilitation during adolescence: a case report.

PubMed

Laures-Gore, Jacqueline; McCusker, Tiffany; Hartley, Leila L

2017-06-01

Descriptions of speech-language interventions addressing the unique aspects of aphasia in adolescence appear to be nonexistent. The current paper presents the case of a male adolescent who experienced a stroke with resultant aphasia and the speech and language therapy he received. Furthermore, we discuss the issues that are unique to an adolescent with aphasia and how they were addressed with this particular patient. Traditional language and apraxia therapy was provided to this patient with inclusion of technology and academic topics. The patient demonstrated improvements in his speech and language abilities, most notably his reading comprehension and speech production. Age-related issues, including academic needs, group treatment, socialization, adherence/compliance, independence and family involvement, emerged during intervention. Although aphasia therapy for adolescents may be similar in many aspects to selected interventions for adults, it is necessary for the clinician to be mindful of age-related issues throughout the course of therapy. Goals and interventions should be selected based on factors salient to an adolescent as well as the potential long-term impact of therapy. Implications for Research Aphasia and its treatment in adolescence need to be further explored. Academics and technology are important aspects of aphasia treatment in adolescence. Issues specific to adolescence such as socialization, adherence/compliance, and independence are important to address in speech-language therapy.

A review of repetitive transcranial magnetic stimulation for adolescents with treatment-resistant depression.

PubMed

Magavi, Leela R; Reti, Irving M; Vasa, Roma A

2017-04-01

This review examines the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) as a treatment for treatment-resistant depression in adolescents. A systematic review of six databases was conducted. Ten multi-subject trials, all uncontrolled, and five case reports met inclusion criteria. Twelve studies focused on treatment efficacy, whereas three studies focused exclusively on adverse events. All efficacy studies focused on adolescents only; 10 of these studies indicated that rTMS may demonstrate some benefit. Improvement within 2-8 weeks was reported in most studies, with a few studies indicating potential long-term benefits. A variety of adverse events occurred including scalp pain, which was the most common, as well as seizures. Controlled studies of rTMS are warranted to further examine whether this treatment is a potential option for adolescents with treatment-resistant depression.

[Life styles in adolescence: sexual behavior of Portuguese adolescents].

PubMed

Ferreira, Maria Margarida da Silva Reis Dos Santos; Torgal, Maria Constança Leite de Freitas Paúl Reis

2011-06-01

Recent studies have shown that adolescents have initiated their sex lives earlier and earlier, without, however, receiving consistent sex education. The objectives of this study were to analyze the sexual behavior of adolescent high school students and identify the habits of sexual health in sexually active adolescent high school students. An exploratory study was conducted with 680 adolescents, whose age ranged between 15 and 19 years. Results showed that most participants had not initiated their sex life; boys are those who most report having had sexual relations; not all the interviewed adolescents used condoms during sex; most adolescents do not practice sexual health surveillance. It is important for sexually active adolescents to receive health care and counseling. Health institutions and their workers must be proactive in trying to approach adolescents.

Tailoring Cognitive Behavioral Treatment for Binge Eating in Adolescent Girls

ERIC Educational Resources Information Center

Yarborough, Bobbi Jo; DeBar, Lynn L.; Firemark, Alison; Leung, Sue; Clarke, Gregory N.; Wilson, G. Terence

2013-01-01

Whereas effective treatments exist for adults with recurrent binge eating, developmental factors specific to adolescents point to the need for a modified treatment approach for youth. We adapted an existing cognitive behavioral therapy treatment manual for adults with bulimia nervosa and binge eating disorder (Fairburn, 2008) for use with…

Electroconvulsive therapy in adolescents: a retrospective study from north India.

PubMed

Grover, Sandeep; Malhotra, Savita; Varma, Sannidhya; Chakrabarti, Subho; Avasthi, Ajit; Mattoo, Surendra K

2013-06-01

There are minimal data on the use of electroconvulsive therapy (ECT) in adolescents from India. The present study aimed to evaluate the clinical profile and effectiveness of ECT in adolescents (aged 13-18 years). A retrospective chart review was carried out to identify adolescents (aged 13-18 years) who had received ECT during the period 1999-2011. During the study period, 39 such patients received ECT; complete records of 25 patients were available. Details regarding their sociodemographic, clinical, and treatment data were extracted from these records for the present study. During the study period, 658 patients received ECT, of which 39 were aged 18 or younger (5.9%). Schizophrenia (n = 14; 56%) was the commonest diagnosis for which ECT was used in adolescents, followed by depression (n = 3; 12%). Catatonic symptoms (n = 17; 68%) were the most common symptoms among these subjects. Electroconvulsive therapy was considered as a treatment of choice taking the clinical picture account in about three fourths of the patients (n = 19; 76%). The mean (SD) numbers of ECTs administered per patient were 10.1 (4.87) (range, 2-21). The mean (SD) response rate to ECT was 76% (23.3%) (range, 31%-100%). Response rates according to diagnosis were the following: 76.3% for schizophrenia, 87.2% for depression, 81.8% for psychosis (not otherwise specified), and 77.7% for acute and transient psychosis. Response rate in patients with catatonia was 91.6%. Prolonged seizures, nausea and vomiting, and headache were reported in 2 cases each. Electroconvulsive therapy is used less frequently in children and adolescents compared to the older patients. This study shows that ECT is effective in the treatment of severe psychiatric disorders in adolescents and is associated with the same frequency of adverse effects as the adults.

Is weight gain really a catalyst for broader recovery?: The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa.

PubMed

Accurso, Erin C; Ciao, Anna C; Fitzsimmons-Craft, Ellen E; Lock, James D; Le Grange, Daniel

2014-05-01

The main aims of this study were to describe change in psychological outcomes for adolescents with anorexia nervosa across two treatments, and to explore predictors of change, including baseline demographic and clinical characteristics, as well as weight gain over time. Participants were 121 adolescents with anorexia nervosa from a two-site (Chicago and Stanford) randomized controlled trial who received either family-based treatment or individual adolescent supportive psychotherapy. Psychological symptoms (i.e., eating disorder psychopathology, depressive symptoms, and self-esteem) were assessed at baseline, end of treatment, 6-month, and 12-month follow-up. Conditional multilevel growth models were used to test for predictors of slope for each outcome. Most psychological symptoms improved significantly from baseline to 12 month follow-up, regardless of treatment type. Depressive symptoms and dietary restraint were most improved, weight and shape concerns were least improved, and self-esteem was not at all improved. Weight gain emerged as a significant predictor of improved eating disorder pathology, with earlier weight gain having a greater impact on symptom improvement than later weight gain. Adolescents who presented with more severe, complex, and enduring clinical presentations (i.e., longer duration of illness, greater eating disorder pathology, binge-eating/purging subtype) also appeared to benefit more psychologically from treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

Conceptual and Clinical Issues in the Treatment of Adolescent Alcohol and Substance Misusers.

ERIC Educational Resources Information Center

Filstead, William J.; Anderson, Carl L.

1983-01-01

Describes a system of care and clinical issues central to service delivery to adolescents with alcohol/drug problems. Recognizes the importance of adolescence as a developmental period and its implications for treatment. Develops criteria to distinguish the most appropriate level of care for the adolescent's presenting clinical condition. (CMG)

The Role of Readiness to Change in Response to Treatment of Adolescent Depression

ERIC Educational Resources Information Center

Lewis, Cara C.; Simons, Anne D.; Silva, Susan G.; Rohde, Paul; Small, David M.; Murakami, Jessica L.; High, Robin R.; March, John S.

2009-01-01

The effect of readiness to change on treatment outcome was examined among 332 adolescents (46% male, 74% Caucasian), ages 12 through 17 years (M = 14.6, SD = 1.5), with major depressive disorder who were participating in the Treatment for Adolescents With Depression Study (TADS). TADS is a randomized clinical trial comparing the effectiveness of…

Body Type, Personality Temperament and Psychotherapeutic Treatment of Female Adolescents.

ERIC Educational Resources Information Center

Stewart, Horace

1982-01-01

Sought to define the population and formulate tentative treatment implications from the results of somatotyping 60 emotionally disturbed adolescent girls. Results showed a predominance of endomorphic-mesomorph and mesomorphic-endomorph temperament. Tentative treatment recommendations are given. (Author/JAC)

Characteristics and problems of 600 adolescent cannabis abusers in outpatient treatment.

PubMed

Tims, Frank M; Dennis, Michael L; Hamilton, Nancy; J Buchan, Betty; Diamond, Guy; Funk, Rod; Brantley, Laura B

2002-12-01

Risk factors among adolescent substance abusers have been shown to correlate with substance use severity. Characteristics related to severity, such as demographic and family factors, peer influences, psychiatric co-morbidity and HIV risk behaviors, are examined for a sample of adolescent cannabis users entering treatment. These data are from a clinical trial study utilizing blocked random assignment of clients to one of five treatment conditions. The study targeted adolescents entering outpatient treatment for primarily cannabis abuse or dependence. Treatment and research facilities in four metropolitan areas of the US were used to recruit study participants. Treatment was delivered in outpatient drug-free settings. Participants were 600 clients, ages 12-18, admitted to outpatient substance abuse treatment programs for cannabis problems, 96% with DSM-IV diagnoses of substance abuse or dependence, with the remaining 4% having at least one symptom of dependence plus significant problems indicating need for treatment. The Global Appraisal of Individual Needs (GAIN) was used to collect the information presented in this paper. The GAIN incorporates DSM-IV criteria for substance use disorders, conduct disorder and attention deficit hyperactivity disorder, as well as dimensional (scale) measures for physical and mental health. All participants reported at least one symptom of substance use disorders, and 46% met the DSM-IV criteria for substance dependence, while 50% met criteria for a diagnosis of abuse. Only 20% of the participants perceived any need for help with problems associated with their drug or alcohol use. Clients participating in the study typically presented multiple problems at treatment entry, most often including conduct disorder, attention deficit hyperactivity disorder (ADHD), internal (mental) distress, and physical health distress. The co-occurrence of conduct disorder and ADHD was found in 30% of the sample. Clients meeting criteria for substance

Hodgkin lymphoma in children, adolescents and young adults - a comparative study of clinical presentation and treatment outcome.

PubMed

Englund, Annika; Glimelius, Ingrid; Rostgaard, Klaus; Smedby, Karin E; Eloranta, Sandra; Molin, Daniel; Kuusk, Thomas; Brown, Peter de Nully; Kamper, Peter; Hjalgrim, Henrik; Ljungman, Gustaf; Hjalgrim, Lisa Lyngsie

2018-02-01

Hodgkin lymphoma (HL) treatment protocols for children, adolescents and young adults traditionally differ, but the biological and clinical justification for this remains uncertain. We compared age-dependent clinical presentation and treatment and outcome for 1072 classical HL patients 0-24 years diagnosed in Denmark (1990-2010) and Sweden (1992-2009) in pediatric (n = 315, Denmark <15 years, Sweden <18 years) or adult departments (n = 757). Distribution of clinical characteristics was assessed with Pearson's chi 2 -test and Mantel-Haenszel trend test. The Kaplan-Meier method was used for survival analyses. Hazard ratios (HR) were used to compare the different treatment groups and calculated using Cox regression. Children (0-9 years) less often presented with advanced disease than adolescents (10-17 years) and young adults (18-24 years) (stage IIB-IV: children 32% vs. adolescents 50%, and adults 55%; p < .005). No variation in overall survival (OS) was seen between pediatric and adult departments or by country. Danish pediatric patients received radiotherapy (36%) less frequently than Swedish pediatric patients (71%) (p < .0001). Ten-year event-free survival (EFS) was lower among Danish pediatric patients (0-14 years) (0.79; 95% confidence interval (CI) 0.70-0.86) than among Swedish pediatric patients (0-17 years) (0.88; 95% CI 0.83-0.92), HR (1.93; 95% CI 1.08-3.46). A similar pattern was seen between adult patients in the two countries: Denmark 10-year EFS 0.85 (95% CI 0.81-0.88), Sweden 0.88 (95% CI 0.84-0.91), adjusted HR 1.51 (95% CI 1.03-2.22). Adolescents and young adults shared similar clinical presentation suggesting a rationale of harmonized treatment for these groups. Both adult and pediatric protocols provided high OS with no significant difference between the departments. The less frequent use of radiotherapy in Danish pediatric patients corresponded to a lower EFS, but comparable OS in all groups confirmed effective rescue strategies

Psychiatric treatment received by primary care patients with panic disorder with and without agoraphobia.

PubMed

Marcks, Brook A; Weisberg, Risa B; Keller, Martin B

2009-06-01

Although the majority of individuals with panic disorder first present to the primary care setting, little is known about the psychiatric treatment that primary care patients with the disorder typically receive. The purpose of this study was to explore characteristics of treatment received by patients with panic disorder with agoraphobia and by those with panic disorder without agoraphobia, examine demographic and clinical predictors of receiving treatment, and explore treatment barriers. This study used data from the Primary Care Anxiety Project (PCAP), which is a naturalistic, longitudinal study of anxiety disorders among primary care patients. This study presents data for 235 PCAP participants diagnosed at the study intake assessment as having panic disorder with agoraphobia (N=150) or without agoraphobia (N=85). Many patients with panic disorder were not receiving psychiatric treatment at study intake (38%), with those without agoraphobia being less likely to receive treatment. Psychotropic medications were the treatment of choice, with selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors being the most commonly received class of medications (34%). Only 38% of those with panic disorder with agoraphobia and 24% of those with panic disorder without agoraphobia were receiving psychotherapy, and the use of empirically supported interventions was rare. The most common treatment barriers were not believing in using medication or therapy for emotional problems and not receiving a treatment recommendation from one's provider. The findings suggest a need for better treatment dissemination, in addition to making interventions more accessible or adapting them to the particular needs of primary care patients.

Help-Seeking and Internal Obstacles to Receiving Support in the Wake of Community Violence Exposure: The Case of Arab and Jewish Adolescents in Israel

ERIC Educational Resources Information Center

Guterman, Neil B.; Haj-Yahia, Muhammad M.; Vorhies, Vanessa; Ismayilova, Leyla; Leshem, Becky

2010-01-01

We examined help-seeking and internal obstacles to receiving psychosocial support in the wake of community violence exposure in a sample of 1,835 Arab and Jewish adolescents living in Israel. Paper and pencil surveys conducted in schools examined adolescents' personal victimization and witnessing of community violence in the past year, and then…

Comprehensive Stuttering Treatment for Adolescents: A Case Study.

PubMed

Coleman, Craig E

2018-01-09

This article will focus on a hypothetical case study to highlight comprehensive assessment and treatment for adolescent children who stutter. Assessment and treatment are laid out with a literature review utilizing the components of the International Classification of Functioning, Disability and Health model. Specific assessment and treatment strategies and approaches are discussed. Using the International Classification of Functioning, Disability and Health model can help guide clinicians through the assessment and treatment process to ensure that all areas of stuttering are considered. Comprehensive assessment and treatment helps clinicians address all relevant elements of a stuttering disorder, rather than focusing exclusively on reducing speech disruptions.

Cognitive Behavioral Treatment for Recurrent Binge Eating in Adolescent Girls: A Pilot Trial

ERIC Educational Resources Information Center

DeBar, Lynn L.; Wilson, G. Terence; Yarborough, Bobbi Jo; Burns, Beryl; Oyler, Barbara; Hildebrandt, Tom; Clarke, Gregory N.; Dickerson, John; Striegel, Ruth H.

2013-01-01

There is a need for treatment interventions to address the high prevalence of disordered eating throughout adolescence and early adulthood. We developed an adolescent-specific manualized CBT protocol to treat female adolescents with recurrent binge eating and tested its efficacy in a small, pilot randomized controlled trial. We present lessons…

Social phobia, depression and eating disorders during middle adolescence: longitudinal associations and treatment seeking.

PubMed

Ranta, Klaus; Väänänen, Juha; Fröjd, Sari; Isomaa, Rasmus; Kaltiala-Heino, Riittakerttu; Marttunen, Mauri

2017-11-01

Longitudinal associations between social phobia (SP), depression and eating disorders (EDs), and the impact of antecedent SP and depression on subsequent treatment seeking for EDs have rarely been explored in prospective adolescent population studies. We aimed to examine these associations in a large-scale follow-up study among middle adolescents. We surveyed 3278 Finnish adolescents with a mean age of 15 years for these disorders. Two years later, 2070 were reached and again surveyed for psychopathology and treatment seeking. Longitudinal associations between the self-reported disorders and treatment-seeking patterns for self-acknowledged ED symptoms were examined in multivariate analyses, controlling for SP/depression comorbidity and relevant socioeconomic covariates. Self-reported anorexia nervosa (AN) at age 15 years predicted self-reported depression at age 17 years. Furthermore, self-reported SP at age 15 years predicted not seeking treatment for bulimia nervosa (BN) symptoms, while self-reported depression at age 15 years predicted not seeking treatment for AN symptoms during the follow-up period. Adolescents with AN should be monitored for subsequent depression. Barriers caused by SP to help seeking for BN, and by depression for AN, should be acknowledged by healthcare professionals who encounter socially anxious and depressive adolescents, especially when they present with eating problems.

Insulin pump treatment in children and adolescents with type 1 diabetes.

PubMed

Hofer, S; Meraner, D; Koehle, J

2012-08-01

Within children and adolescents with type 1 diabetes insulin pump treatment is of increasing interest. Frequency of insulin pump therapy shows a rapid and steep increase in toddlers and young children. Insulin pumps allow a close to physiologic insulin delivery due to basal rates programmed over 24 hours with circadian rhythms taken into account. Furthermore, another advantage of technical devices as insulin pumps is the application of extremely small amounts of insulin, as needed in very young children, with the possibility of titration of infusion rates down to 0.01E/h. Dawn Phenomenon and hypoglycemic events are main indications for insulin pump treatment in children and adolescents. A significant reduction of severe hypoglycemia, especially nocturnal hypoglycemia was shown, whereas a reduction of HbA1c and an improvement of metabolic control has been reported in short term and in some but not all long term studies. Ketoacidosis rate did not increase in insulin pump therapy. Complications due to continuous subcutaneous insulin infusion, like local infections and dermatological changes are frequent but were not associated with glycemic control and did not lead to discontinuation of insulin pump treatment. Pump discontinuation rate in general is low, varying from 1% in very young children up to 6% in pubertal adolescent girls. Insulin pump treatment was shown to be safe and efficient and the simplicity of handling the devices as well as an improvement of quality of life may explain the rapid increase of pump treatment in young children and adolescents with type 1 diabetes.

The effects of single versus mixed gender treatment for adolescent girls with ADHD

PubMed Central

Babinski, Dara E.; Sibley, Margaret H.; Ross, J. Megan; Pelham, William E.

2013-01-01

Objective This study evaluated the social behavior of adolescents with ADHD in single and mixed gender treatment settings. Method We collected ratings of social behavior (i.e., prosocial peer interactions, assertiveness, self-management, compliance, physical aggression, relational aggression) during single and mixed gender games within the Summer Treatment Program-Adolescent (STP-A) for 10 girls (mean age 13.17, 80% Hispanic) and 11 boys (mean age 12.89, 54.55% Hispanic). Counselors completed ratings immediately following 10 recreational periods for each adolescent they supervised (5 single gender games, 5 mixed gender games). Gender (female versus male) x setting (single versus mixed gender) ANOVAs were conducted. If a significant interaction emerged, post hoc tests were also conducted. Results Several gender by setting interactions emerged, suggesting that girls benefit more from single gender formats than mixed gender formats. Girls showed more assertiveness, self-management, and compliance in single compared to mixed gender settings. A somewhat different pattern of results emerged for boys, which showed more appropriate social behavior (i.e., self-management, compliance) and less inappropriate social behavior (i.e., physical and relational aggression) in mixed gender settings compared to single gender settings. Conclusions In contrast to previous ADHD treatment studies, these findings suggest that gender may impact treatment response for adolescents. Therefore, it is important that future studies evaluate whether current treatments for ADHD are appropriate for girls with ADHD, and if gender-specific treatments are necessary to address the unique difficulties of adolescent girls with ADHD. PMID:23330787

The Expression of Distress by Children Receiving Medical Treatment.

ERIC Educational Resources Information Center

Ballard, Brenda D.; Gipson, Martin

The nature of children's distress reactions to medical treatment is examined in terms of age and sex differences and initial normative data are provided. Predominately white, middle class children, ages 1 to 11, were observed while receiving allergy treatment injections. Males were observed on 453 injection occasions while females were observed on…

Dialectical Behavioral Therapy and EMDR for Adolescents in Residential Treatment: A Practical and Theoretical Perspective

ERIC Educational Resources Information Center

Lovelle, Carole

2005-01-01

DBT and EMDR as primary treatment methods provide effective treatment for adolescents in the setting of group residential facilities. Regardless of the intensity of the pathology or the length of stay, these compatible treatment methods provide adolescents with significant decreases in the impact of traumatic memories and increased emotional…

Research Knowledge among the Participants in the Treatment for Adolescents with Depression Study (TADS)

ERIC Educational Resources Information Center

Vitiello, Benedetto; Kratochvil, Christopher J.; Silva, Susan; Curry, John; Reinecke, Mark; Pathak, Sanjeev; Waslick, Bruce; Hughes, Carroll W.; Prentice, Ernest D.; May, Diane E.; March, John S.

2007-01-01

A study examined the extent to which parents and adolescents participating in the Treatment for Adolescents With Depression Study (TADS) understood the study. The results concluded that most were well-informed, and also parents were overall better informed than adolescents.

GAD-treatment of children and adolescents with recent-onset type 1 diabetes preserves residual insulin secretion after 30 months.

PubMed

Ludvigsson, Johnny; Chéramy, Mikael; Axelsson, Stina; Pihl, Mikael; Akerman, Linda; Casas, Rosaura

2014-07-01

This study aimed to analyse data from two different studies (phase II and phase III) regarding the safety and efficacy of treatment with alum formulated glutamic acid decarboxylase GAD65 (GAD-alum) at 30 months after administration to children and adolescents with type 1 diabetes. The phase II trial was a double-blind, randomised placebo-controlled study, including 70 children and adolescents who were followed for 30  months. Participants received a subcutaneous injection of either 20 µg of GAD-alum or placebo at baseline and 1 month later. During a subsequent larger European phase III trial including three treatment arms, participants received two or four subcutaneous injections of either 20 µg of GAD-alum and/or placebo at baseline, 1, 3 and 9  months. The phase III trial was prematurely interrupted at 15 months, but of the 148 Swedish patients, a majority completed the 21 months follow-up, and 45 patients completed the trial at 30 months. Both studies included GAD65 auto-antibodies-positive patients with fasting C-peptide ≥ 0.10 nmol/l. We have now combined the results of these two trials. There were no treatment related adverse events. In patients treated with 2 GAD-alum doses, stimulated C-peptide area under the curve had decreased significantly less (9  m: p  <  0.037; 15 m: p  <  0.032; 21 m: p  <  0.003 and 30  m: p <  0.004), and a larger proportion of these patients were also able to achieve a peak stimulated C-peptide > 0.2  nmol/L (p  <  0.05), as compared with placebo. Treatment with two doses of GAD-alum in children and adolescents with recent-onset type 1 diabetes shows no adverse events and preserves residual insulin secretion. Copyright © 2013 John Wiley & Sons, Ltd.

The treatment of adolescent transsexuals: changing insights.

PubMed

Cohen-Kettenis, Peggy T; Delemarre-van de Waal, Henriette A; Gooren, Louis J G

2008-08-01

Treatment of individuals with gender identity disorder (GID) has in medicine nearly always met with a great deal of skepticism. Professionals largely follow the Standards of Care of the World Professional Association for Transgender Health. For adolescents, specific guidelines have also been issued by the British Royal College of Psychiatrists. To describe the stepwise changes in treatment policy which, in recent years, have been made by the team of the Gender Identity Clinic at the VU University Medical Center in Amsterdam, The Netherlands. The first step taken to treat adolescents was that, after careful evaluation, (cross-sex hormone) treatment could start between the ages of 16 and 18 years. A further step was the suppression of puberty by means of gonadotropin-releasing hormone analogs in 12-16 year olds; the latter serves also as a diagnostic tool. Very recently, other clinics in Europe and North America have followed this policy. Results. The first results from the Amsterdam clinic show that this policy is promising. Professionals who take responsibility for these youth and are willing to help should yet be fully aware of the impact of their interventions. In this article, the pros and cons of the various approaches to youngsters with GID are presented, hopefully inciting a sound scientific discussion of the issue.

[Hometreatment- an effective alternative to inpatient treatment in child and adolescent psychiatry?].

PubMed

Boege, Isabel; Schepker, Renate; Herpertz-Dahlmann, Beate; Vloet, Timo D

2015-11-01

In many countries hometreatment (HT) offers a cost-effective alternative to hospitalization for children and adolescents with mental health problems requiring intensive mental healthcare. However, the database on HT varies as HT may refer to different models and settings of intensive outpatient treatment. In Germany HT is not used routinely in mental healthcare in child and adolescent psychiatry, therefore the data on HT in Germany, especially in child and adolescent psychiatry, are scarce although funding for studies investigating the effectiveness of HT is available. This review represents a comprehensive search in electronic databases (1980-2014) of literature on HT. It provides as well an overview of the underlying concepts of and the present evidence for HT. In addition, the evidence base on HT for specific child and adolescent mental health disorders is reviewed. Future prospects for the development of HT in Germany facing the upcoming change in health service commissioning (PEPP = «pauschalierendes Entgeltsystem in Psychiatric und Psychosomatik>) are discussed, as HT in child and adolescent psychiatry, when accurately indicated, can be a valid alternative to inpatient treatment.

Adolescent vaccination: coverage achieved by ages 13-15 years, and vaccinations received as recommended during ages 11-12 years, National Health Interview Survey 1997-2003.

PubMed

McCauley, Mary Mason; Stokley, Shannon; Stevenson, John; Fishbein, Daniel B

2008-12-01

To present progress toward Healthy People 2010 vaccination objectives for adolescents aged 13-15 years, and to determine how much catch-up and routine vaccination was administered at the recommended ages of 11-12 years. Data from the 1997-2003 National Health Interview Survey were evaluated. In the first analysis, vaccination coverage levels for adolescents aged 13-15 years were determined for each survey year. Main outcome measures include the percent of adolescents who had received the three-dose hepatitis B vaccine (Hep B) series, the two-dose measles/mumps/rubella vaccine (MMR) series, the tetanus and diphtheria toxoids (Td) booster, and one dose of varicella vaccine. In the second analysis, data from all survey years were combined and vaccination dates were analyzed to determine the percentage of adolescents who were missing any vaccines at ages 11-12 and received them at that age. Data for varicella vaccine were sufficient only for the first analysis. Among the approximately 15%-20% of respondents who reported vaccination history from records in the home and who were reporting on a 13-15-year-old, coverage with three doses of Hep B increased significantly during 1997-2001, from 15.2% to 55.0%. Coverage with MMR and Td fluctuated, with no significant increase; highs were 76.7% for MMR in 2003 and 36.2% for Td in 2002. Examination of vaccination dates for all surveyed adolescents showed that among 11-12-year-olds who needed catch-up vaccine, 0.6%-31.3% were brought up to date for Hep B and 22.1%-31.8% were brought up to date for MMR. For Td, 2.6%-15.4% of 11-12-year-olds who had not previously received Td received the vaccine. Vaccination coverage among adolescents aged 13-15 years was below the Healthy People 2010 goals of 90%, but generally increased over the survey years. However, the suboptimal delivery of needed vaccines during ages 11 and 12 is concerning in light of recent vaccine recommendations targeted at this age. Continuing to focus on strategies to

Adolescent Substance Abuse Treatment: Organizational Change and Quality of Care

ERIC Educational Resources Information Center

Rieckmann, Traci; Fussell, Holly; Doyle, Kevin; Ford, Jay; Riley, Katherine J.; Henderson, Stuart

2011-01-01

Substance abuse treatment agencies serving youth face unique barriers to providing quality care. Interviews with 17 adolescent programs found that family engagement, community involvement, and gender and diversity issues affected treatment delivery. Programs report organizational change efforts with implications for future process improvement…

Developing Community Reinforcement and Family Training (CRAFT) for Parents of Treatment-Resistant Adolescents.

PubMed

Kirby, Kimberly C; Versek, Brian; Kerwin, MaryLouise E; Meyers, Kathleen; Benishek, Lois A; Bresani, Elena; Washio, Yukiko; Arria, Amelia; Meyers, Robert J

2015-05-04

We describe a project focused on training parents to facilitate their treatment-resistant adolescent's treatment entry and to manage their child after entry into community-based treatment. Controlled studies show that Community Reinforcement and Family Training (CRAFT) is a unilateral treatment that fosters treatment entry of adults; however, there are no controlled trials for parents with a substance-abusing child. We examined the behavioral parent training literature to guide us in tailoring CRAFT for parents of adolescents. We discuss adaptations to CRAFT, outcomes and experiences gained from a brief pilot of the revised CRAFT program, and the future directions of this work.

Treatment Adherence, Competence, and Outcome in Individual and Family Therapy for Adolescent Behavior Problems

ERIC Educational Resources Information Center

Hogue, Aaron; Henderson, Craig E.; Dauber, Sarah; Barajas, Priscilla C.; Fried, Adam; Liddle, Howard A.

2008-01-01

This study examined the impact of treatment adherence and therapist competence on treatment outcome in a controlled trial of individual cognitive-behavioral therapy (CBT) and multidimensional family therapy (MDFT) for adolescent substance use and related behavior problems. Participants included 136 adolescents (62 CBT, 74 MDFT) assessed at intake,…

Functioning and Quality of Life in the Treatment for Adolescents with Depression Study (TADS)

ERIC Educational Resources Information Center

Vitiello, Benedetto; Rohde, Paul; Silva, Susan; Wells, Karen; Casat, Charles; Waslick, Bruce; Simons, Anne; Reinecke, Mark; Weller, Elizabeth; Kratochvil, Christopher; Walkup, John; Pathak, Sanjeev; Robins, Michele; March, John

2006-01-01

Obective: To test whether 12-week treatment of major depression improved the level of functioning, global health, and quality of life of adolescents. Method: The Treatment for Adolescents With Depression Study was a multisite, randomized clinical trial of fluoxetine, cognitive-behavioral therapy (CBT), their combination (COMB), or clinical…

Cancer-Related Fatigue in Adolescents and Young Adults After Cancer Treatment: Persistent and Poorly Managed.

PubMed

Spathis, Anna; Hatcher, Helen; Booth, Sara; Gibson, Faith; Stone, Paddy; Abbas, Laura; Barclay, Matt; Brimicombe, James; Thiemann, Pia; McCabe, Martin G; Campsey, Rachel; Hooker, Louise; Moss, Wendy; Robson, Jane; Barclay, Stephen

2017-09-01

Cancer-related fatigue is the most prevalent and distressing symptom experienced by adolescents and young adults (AYAs). An electronic survey was undertaken to ascertain current fatigue management and perceptions of its effectiveness. Eighty-five percent of responders (68/80) experienced fatigue, and it was worse more than 1 year after cancer treatment ended, compared to <1 year (p = 0.007). Forty-one percent received no fatigue management. Although advice to exercise was the most frequent intervention, the greatest impact of fatigue was on the ability to exercise and most did not find exercise advice helpful. Early intervention is warranted, supporting AYAs to persevere with increasing activity.

OBJECTIVE AND SUBJECTIVE EVALUATION OF ADOLESCENT'S ORTHODONTIC TREATMENT NEEDS AND THEIR IMPACT ON SELF-ESTEEM.

PubMed

Sharma, Anshika; Mathur, Anmol; Batra, Manu; Makkar, Diljot Kaur; Aggarwal, Vikram Pal; Goyal, Nikita; Kaur, Puneet

2017-01-01

To investigate the presence of association between objective and subjective evaluation of orthodontic treatment needs in adolescents and their impact on their self-esteem. Cross-sectional study with adolescents aged 10-17 years old in Sri Ganganagar city, Rajasthan, India. The objective index of orthodontic treatment need (IOTN) dental health component (DHC) and the subjective aesthetic component (AC) were used to determine the normative and the self-perception need for orthodontic treatment, respectively. The selected students were further examined for dental trauma, tooth loss, and dental caries. Rosenberg Self-Esteem Scale was applied for self-esteem level determination. Linear regression analysis was executed to test the individual association of different independent clinical variables with self-esteem scores. Among 1,140 studied adolescents, the prevalence of dental normative orthodontic treatment need was in 56.9% of individuals, whereas 53.3% of individuals considered themselves as needy for the treatment. Multivariate analyses revealed that out of all dental disorders, DHC followed by AC of IOTN had maximum impact on the self-esteem of the adolescence. Dissatisfaction with dental appearance is a strong predictor for low self-esteem in adolescence.

The Treatment of Adolescent Suicide Attempters Study (TASA): Predictors of Suicidal Events in an Open Treatment Trial

ERIC Educational Resources Information Center

Brent, David A.; Greenhill, Laurence L.; Compton, Scott; Emslie, Graham; Wells, Karen; Walkup, John T.; Vitiello, Benedetto; Bukstein, Oscar; Stanley, Barbara; Posner, Kelly; Kennard, Betsy D.; Cwik, Mary F.; Wagner, Ann; Coffey, Barbara; March, John S.; Riddle, Mark; Goldstein, Tina; Curry, John; Barnett, Shannon; Capasso, Lisa; Zelazny, Jamie; Hughes, Jennifer; Shen, Sa; Gugga, S. Sonia; Turner, J. Blake

2009-01-01

Objective: To identify the predictors of suicidal events and attempts in adolescent suicide attempters with depression treated in an open treatment trial. Method: Adolescents who had made a recent suicide attempt and had unipolar depression (n =124) were either randomized (n = 22) or given a choice (n = 102) among three conditions. Two…

Surgical treatment of primary gynecomastia in children and adolescents.

PubMed

Fischer, Sebastian; Hirsch, Tobias; Hirche, Christoph; Kiefer, Jurij; Kueckelhaus, Maximilian; Germann, Günter; Reichenberger, Matthias A

2014-06-01

Idiopathic gynecomastia is a common diagnosis in children and adolescents. Though medical treatments reveal potentially harmful side effects, surgical interventions are performable in numerous techniques. In children and adolescents, only minimal evidence exists. This retrospective study presents our experiences with two common surgical techniques, namely subcutaneous mastectomy and combination with liposuction. This retrospective study included all patients <18 years who underwent surgery due to idiopathic gynecomastia. Height, weight and grade of gynecomastia according to Simon's classification before surgery were reviewed in all patients' files. Additionally, duration of surgery, inpatient stay and postoperative complications were documented. Follow-up examinations were performed with assessment of scar formation, numbness and retraction of the nipple region. Furthermore, patients were asked to report on general satisfaction with surgery (satisfactory/not satisfactory) and esthetic outcome on a numeric scale (1 = good, 6 = bad). 37 patients underwent surgery for verified idiopathic gynecomastia. Grade of gynecomastia was I° in 13.5% (n = 5), II° in 40.5% (n = 15) and III° in 46% (n = 17) of cases. Subcutaneous mastectomy was applied in 11 patients (group I, 30%) and both subcutaneous mastectomy and liposuction in 26 patients (group II, 70.3%). Postoperative complications occurred in two patients. Long-term follow-up was performed in 32 patients after a median of 34 months (range 6-96 months). Hypertrophic scar formation was seen in one patient (3%) and nipple retraction in two patients (5%). Recurrence of gynecomastia occurred in two patients (5%). Patient rating was satisfactory in 9% of cases and esthetic outcome was received with a median of 2.0 (1-5). In comparing both surgical techniques, combination of mastectomy and liposuction revealed better results in every measure except for surgical duration (median 73 vs. 90 min). Surgical correction of

Parents' experiences of their adolescent's mental health treatment: Helplessness or agency-based hope.

PubMed

Brown, Jenny

2018-06-01

This article explores some core findings from a qualitative investigation of parents' experiences of their child's treatment in an adolescent mental health service in Sydney, Australia. In particular, the research question was, "How does parents' involvement in the child/adolescent's treatment influence their perception of how they can be helpful in their child's recovery?" The theme of parent hope emerged from the broad qualitative exploration of parent's experience of their involvement in their adolescent's intensive treatment program. A purposive sample of 14 sets of parents participated, being interviewed at admission, discharge, and 6 months following their adolescent's discharge. A continuum of high, moderate, and low levels of hope were evident in this parent sample 6 months after their treatment involvement. The strongly emergent theme was the relationship between parents' hope and agency/self-efficacy. Parents who remained more passive in expecting expert helpers to fix their child experienced reduced hope months after finishing the program. When parents positively changed their interaction with their child, they felt a more sustained hopefulness. These findings generate the hypothesis that if parents are actively involved in changing themselves as part of their child's treatment, they experience increased hope and effectiveness in contributing to their child's recovery.

Oral Cryotherapy for Preventing Oral Mucositis in Patients Receiving Cancer Treatment.

PubMed

Riley, Philip; McCabe, Martin G; Glenny, Anne-Marie

2016-10-01

In patients receiving treatment for cancer, does oral cryotherapy prevent oral mucositis? Oral cryotherapy is effective for the prevention of oral mucositis in adults receiving fluorouracil-based chemotherapy for solid cancers, and for the prevention of severe oral mucositis in adults receiving high-dose melphalan-based chemotherapy before hematopoietic stem cell transplantation (HSCT).

A Population-Based Observational Study of First-Course Treatment and Survival for Adolescent and Young Adult Females with Breast Cancer

PubMed Central

DeRouen, Mindy C.; Gomez, Scarlett L.; Press, David J.; Tao, Li; Kurian, Allison W.

2013-01-01

Purpose Young age at breast cancer diagnosis is associated with poor survival. However, little is known about factors associated with first-course treatment receipt or survival among adolescent and young adult (AYA) females aged 15–39 years. Methods Data regarding 19,906 eligible AYA breast cancers diagnosed in California during 1992–2009 were obtained from the population-based California Cancer Registry. Multivariable logistic regression was used to evaluate clinical and sociodemographic differences in treatment receipt. Multivariable Cox proportional hazards regression was used to examine differences in survival by initial treatment, and by patient and tumor characteristics. Results Black and Hispanic AYAs diagnosed with in situ or stages I–III breast cancer were more likely than White AYAs to receive breast-conserving surgery (BCS) without radiation; Asian and Hispanic AYAs were more likely than Whites to receive mastectomy. Women in lower socioeconomic status (SES) neighborhoods were more likely to omit radiation after BCS, more likely to receive mastectomy, and less likely to receive chemotherapy, compared to those in higher SES neighborhoods. Among patients with invasive disease, survival improved an average of 5% per year during 1992–2009. AYAs who received BCS with radiation experienced better survival than other surgery/radiation options. Black AYAs had poorer survival than Whites. AYAs who resided in higher SES neighborhoods had better survival. Conclusions Treatment receipt among AYAs with breast cancer varied by race/ethnicity and neighborhood SES. Poor survival for Black AYAs and AYAs living in low SES neighborhoods in models adjusted for treatment receipt suggests that factors other than treatment may also be important to disease outcome. PMID:24066271

The Treatment for Adolescents with Depression Study (TADS): Methods and Message at 12 Weeks

ERIC Educational Resources Information Center

March, John; Silva, Susan; Vitiello, Benedetto

2006-01-01

Funded by the National Institute of Mental Health, the Treatment for Adolescents With Depression Study (TADS) is intended to evaluate the short-term (12 weeks) and longer-term (36 weeks) effectiveness of four treatments for adolescents with DSM-IV major depressive disorder: clinical management with fluoxetine (FLX), cognitive-behavioral therapy…

The Adolescent Community Reinforcement Approach for Adolescent Cannabis Users, Cannabis Youth Treatment (CYT) Series, Volume 4.

ERIC Educational Resources Information Center

Godley, Susan Harrington; Meyers, Robert J.; Smith, Jane Ellen; Karvinen, Tracy; Titus, Janet C.; Godley, Mark D.; Dent, George; Passetti, Lora; Kelberg, Pamela

This publication was written for therapists and their supervisors who may want to implement the adolescent community reinforcement approach intervention, which was one of the five interventions tested by the Center for Substance Abuse Treatment's (CSAT's) Cannabis Youth Treatment (CYT) Project. The CYT Project provided funding to support a study…

Pharmacological Treatment of Obesity in Children and Adolescents: Present and Future

PubMed Central

Iughetti, Lorenzo; China, Mariachiara; Berri, Rossella; Predieri, Barbara

2011-01-01

The prevalence of overweight and obesity is increasing in children and adolescents worldwide raising the question on the approach to this condition because of the potential morbidity, mortality, and economic tolls. Dietetic and behavioral treatments alone have only limited success; consequently, discussion on strategies for treating childhood and adolescent obesity has been promoted. Considering that our knowledge on the physiological systems regulating food intake and body weight is considerably increased, many studies have underlined the scientific and clinical relevance of potential treatments based on management of peripheral or central neuropeptides signals by drugs. In this paper, we analyze the data on the currently approved obesity pharmacological treatment suggesting the new potential drugs. PMID:21197151

Efficacy of transdiagnostic cognitive-behavioral group therapy for anxiety disorders and headache in adolescents.

PubMed

Sharma, Pragya; Mehta, Manju; Sagar, Rajesh

2017-03-01

Anxiety disorders and headache are both among the most prevalent disorders among adolescents. Although cognitive behavioral therapy (CBT) has proved its efficacy with each of these disorders individually, there are several barriers to its utilization, including cost, gaps in knowledge about treatment delivery and modes, and its utility with comorbid disorders. The current study examined the comparative efficacy of a 12 week TCBT Group treatment (n=32) versus treatment as usual group (n=31) (TAU) in adolescents with anxiety disorders and headache in a north Indian hospital based setting. Results from 63 adolescents suggested while both conditions improved significantly on the Headache Impact Test and Children's Global Assessment Scale, those receiving TCBT showed significantly greater improvement than those in the TAU condition. Participants receiving TCBT, but not those in the TAU condition, showed significant improvement on the State Trait Anxiety Inventory. The study provides evidence supporting the efficacy of TCBT in adolescents with anxiety disorders and headache. Further, group TCBT has the benefits of easy dissemination and increased access to evidence-based treatment, thus, lowering costs and therapist time. Copyright © 2016 Elsevier Ltd. All rights reserved.

Therapist adherence to a motivational-interviewing intervention improves treatment entry for substance-misusing adolescents with low problem perception.

PubMed

Smith, Douglas C; Hall, James A; Jang, Mijin; Arndt, Stephan

2009-01-01

This study evaluated whether adherence to the Strengths-Oriented Referral for Teens (SORT) model, a motivational interviewing (MI)-consistent intervention addressing ambivalence about attending treatment, positively predicted adolescents' initial-session attendance. Therapist adherence was rated in 54 audiotaped SORT sessions by coders who were blind to treatment-entry status. Higher adherence scores reflected greater use of MI and solution focused language, discussion of client strengths, and dialogue with families on treatment need and options. Therapist adherence during adolescent segments interacted with adolescent problem perception. Predicted probabilities of attending initial sessions increased for low-problem-perception adolescents at increasingly higher therapist adherence. Although replication studies are needed, the SORT model of providing MI-consistent debriefing following initial assessments appears to be a promising approach for increasing treatment entry. Initial support for the treatment-matching hypothesis was found for substance-misusing adolescents contemplating treatment entry.

Kganya Motsha Adolescent Centre: a model for adolescent friendly HIV management and reproductive health for adolescents in Soweto, South Africa.

PubMed

Nkala, Busisiwe; Khunwane, Mamakiri; Dietrich, Janan; Otwombe, Kennedy; Sekoane, Itumeleng; Sonqishe, Bulelwa; Gray, Glenda

2015-01-01

This paper reports on Kganya Motsha Adolescent Centre, an adolescent program specifically established to provide voluntary counseling and testing as well as management of HIV-positive young people in Soweto, South Africa. A retrospective cross-sectional analysis, using clinic records of young people accessing services from 2008 to 2012, was conducted. Of the 11,522 who tested, 7689 (67%) were females. The total number of HIV infections was 410, with an HIV prevalence of 3.6% (95% CI 3.2-3.9%). More females (332, 4% vs. 72, 2%; p < 0.0001) were HIV-infected than males. Of those testing HIV positive, 109 (26.5%) had a median CD4 cell count of 491 (IQR 345-686) cells/mm(3). Only 12/410 individuals (2.9%) were eligible for antiretroviral treatment and 10 (2.4%) of those successfully received treatment. The program observed that young people testing HIV positive would not return for follow up blood specimens or confirmatory results. Future programs should consider innovative ways of retaining adolescents in care to reduce potential HIV transmissions that could lead to deteriorating health.

Oral Aripiprazole as Maintenance Treatment in Adolescent Schizophrenia: Results From a 52-Week, Randomized, Placebo-Controlled Withdrawal Study.

PubMed

Correll, Christoph U; Kohegyi, Eva; Zhao, Cathy; Baker, Ross A; McQuade, Robert; Salzman, Phyllis M; Sanchez, Raymond; Nyilas, Margaretta; Carson, William

2017-09-01

To evaluate the efficacy, safety, and tolerability of aripiprazole, a dopamine D 2 receptor partial agonist, as maintenance treatment in adolescent outpatients with schizophrenia. This was a multicenter, double-blind, placebo-controlled, randomized withdrawal design trial. Participants 13 to 17 years of age with a diagnosis of schizophrenia (DSM-IV-TR) were first cross-titrated from their other oral antipsychotic(s) (4-6 weeks), then stabilized (7-21 weeks) on oral aripiprazole 10 to 30 mg/d, and finally randomized 2:1 to continuation of oral aripiprazole or to placebo in a double-blind maintenance phase (≤52 weeks). The primary endpoint was time from randomization to exacerbation of psychotic symptoms/impending relapse. Safety and tolerability were assessed. Of 201 enrolled participants, 146 were randomized to aripiprazole (n = 98) or placebo (n = 48) in the double-blind maintenance phase. Treatment with aripiprazole was associated with a significantly longer time to exacerbation of psychotic symptoms/impending relapse compared with placebo (hazard ratio, 0.46 [95% CI = 0.24-0.88]; p = .016). Aripiprazole was associated with lower rates of serious treatment-emergent adverse events (TEAEs) versus placebo (3.1% versus 12.5%; p = .059) and severe TEAEs (2.0% versus 10.4%; p = .039). The rate of discontinuation due to TEAEs was lower with aripiprazole versus placebo (20.4% versus 39.6%, p = .014; number-needed-to-harm = 5.1). The incidences of extrapyramidal symptoms, weight gain, and somnolence were similar or lower with aripiprazole than with placebo, and no TEAEs related to elevated serum prolactin were reported. Based on Tanner staging, 27.6% of participants treated with aripiprazole and 16.7% of those who received placebo progressed one or two stages from baseline. Aripiprazole was observed to be safe and effective for the maintenance treatment of adolescents with schizophrenia. Efficacy and Safety Study of Oral Aripiprazole in Adolescents With

Change in expressed emotion and treatment outcome in adolescent anorexia nervosa.

PubMed

Moskovich, Ashley A; Timko, C Alix; Honeycutt, Lisa K; Zucker, Nancy L; Merwin, Rhonda M

2017-01-01

Expressed emotion (EE) has been associated with poor outcomes in anorexia nervosa (AN); however, whether changes in EE predict superior treatment outcomes is unknown. The current study examined whether decreases in EE during an open trial of a novel family-based treatment for AN predicted symptoms at end of treatment. Forty-seven adolescents (12-18 years of age) with AN or sub-threshold AN and their parents (mothers: n = 47, fathers: n = 39) participated in 6 months of family treatment. Measures of AN symptomatology (Eating Disorder Examination completed by adolescent and end of treatment recovery status) and parental EE (Family Questionnaire completed by parents which measures two facets of EE: critical communication [CC] and emotional over-involvement [EOI]) were collected at baseline and end of treatment. Parental EOI, but not CC, significantly decreased during the course of treatment. Change in mothers', but not fathers', EE accounted for additional variance in AN symptomatology at end of treatment above baseline EE and baseline AN symptom levels. Findings suggest a greater emphasis on parent support during treatment may improve outcomes.

Do Different Diagnostic Criteria Impact Polycystic Ovary Syndrome Diagnosis for Adolescents?

PubMed

Akgül, Sinem; Düzçeker, Yasemin; Kanbur, Nuray; Derman, Orhan

2018-06-01

Although early diagnosis of polycystic ovary syndrome (PCOS) in adolescents might allow for earlier treatment and prevention of chronic disorders, incorrect or premature diagnosis carries risks of unnecessary treatment and psychological distress. There is no consensus concerning which diagnostic criteria to use for adolescents and current criteria vary. The objective of this study was to determine whether using different diagnostic criteria will affect PCOS diagnosis in adolescents. Fifty-two patients aged 13-18 years with at least 2 of the following criteria were included in the study: (1) oligomenorrhea or amenorrhea; (2) Clinical or biochemical hyperandrogenism; and (3) polycystic ovaries on ultrasonography. Patients were then categorized according to the 6 different criteria for PCOS. National Institutes of Health, Rotterdam criteria, Androgen Excess Society, Amsterdam criteria, Endocrine Society criteria, and the Pediatric Endocrine Society criteria. The characteristics of adolescents who were diagnosed with PCOS were also evaluated. Forty-one patients out of 52 (78.8%) received diagnosis with National Institutes of Health and Endocrine Society criteria, all with Rotterdam criteria, 45/52 (86.5%) with Androgen Excess Society criteria, 36/52 (69.2%) with Amsterdam criteria and 34/52 (65.4%) with the Pediatric Endocrine Society criteria. This study shows that the choice of guideline used does have a great effect on whether an adolescent received the PCOS diagnosis or not. For physicians using the broader criteria, care should be taken to ensure the patient does not receive diagnosis because of the physiological changes seen during puberty, which might mimic PCOS. For those using stricter criteria, close monitoring of patients who do not receive diagnosis is necessary to prevent chronic complications. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Computerised CBT for depressed adolescents: Randomised controlled trial.

PubMed

Smith, Patrick; Scott, Rebecca; Eshkevari, Ertimiss; Jatta, Fatoumata; Leigh, Eleanor; Harris, Victoria; Robinson, Alex; Abeles, Paul; Proudfoot, Judy; Verduyn, Chrissie; Yule, William

2015-10-01

Depression in adolescents is a common and impairing problem. Effective psychological therapies for depression are not accessed by most adolescents. Computerised therapy offers huge potential for improving access to treatment. To test the efficacy of Stressbusters, a Computerised-CBT (C-CBT) programme for depression in young people. Multi-site, schools-based, RCT of C-CBT compared to Waiting List, for young people (N = 112; aged 12-16) with significant symptoms of depression, using multiple-informants (adolescents, parents, teachers), with follow-up at 3 and 6 months. Relative to being on a Waiting List, C-CBT was associated with statistically significant and clinically meaningful improvements in symptoms of depression and anxiety according to adolescent self-report; and with a trend towards improvements in depression and anxiety according to parent-report. Improvements were maintained at follow-up. Treatment gains were similar for boys and girls across the participating age range. Treatment effect was partially mediated by changes in ruminative thinking. Teachers rated adolescents as having few emotional or behavioural problems, both before and after intervention. C-CBT had no detectable effect on academic attainment. In the month after intervention, young people who received C-CBT had significantly fewer absences from school than those on the Waiting List. C-CBT shows considerable promise for the treatment of mild-moderate depression in adolescents. Copyright © 2015 Elsevier Ltd. All rights reserved.

HIV-related chronic lung disease in adolescents: are we prepared for the future?

PubMed

Goussard, Pierre; Gie, Robert P

2017-12-01

Chronic lung diseases (CLD) are the most chronic disease occurring in adolescents living with human immunodeficiency virus (ALHIV). In ALHIV who received antiretroviral therapy (ART) late in childhood, bronchiectasis, bronchiolitis obliterans and interstitial pneumonitis are common. In adolescents who received ART early in life the spectrum of CLD has changed with asthma and chronic obstructive pulmonary disease being common. Areas covered: The aim of this paper was to review CLD in ALHIV. We conducted a literature review of electronic databases focusing on CLD that were common prior to the introduction of ART (1996-2004), the present situation where ART is widely available (2005 to 2016), and articles which aided us speculating on the impact of HIV-related CLD in adolescents transitioning to adult HIV-clinics. Amongst the approximately 2.1 million adolescents living with HIV, CLD commonly occurs. Awareness of the CLD amongst ALHIV needs to be raised to ensure that disease appropriate treatment is available to these vulnerable adolescents. Expert commentary: As adolescents' transition from pediatric HIV-clinics to adult HIV-clinics the evidence shows that adolescents might not receive optimal care if adult pulmonologists are not aware of the CLD that commonly occur in ALHIV.

Effectiveness of the Challenging Horizons After-School Program for Young Adolescents With ADHD

PubMed Central

Evans, Steven W.; Schultz, Brandon K.; DeMars, Christine E.; Davis, Heather

2012-01-01

There are no empirically supported psychosocial treatments for adolescents with attention-deficit hyperactivity disorder (ADHD). This study examined the treatment benefits of the Challenging Horizons Program (CHP), a psychosocial treatment program designed to address the impairment and symptoms associated with this disorder in young adolescents. In addition to evaluating social and academic functioning outcomes, two critical questions from previous studies pertaining to the timing, duration, and family involvement in treatment were addressed. Forty-nine students recruited in two cohorts were randomly assigned to receive either the CHP or a community care condition. Outcomes suggested that students who received the CHP improved compared to students in the control condition on measures of symptoms and impairment. Implications related to timing, duration, and family involvement are reported, as well as recommendations for future studies. PMID:21658528

DIAGNOSIS AND TREATMENT OF ADHD DURING ADOLESCENCE IN THE PRIMARY CARE SETTING: REVIEW AND FUTURE DIRECTIONS

PubMed Central

Brahmbhatt, Khyati; Hilty, Donald M.; Hah, Mina; Han, Jaesu; Angkustsiri, Kathy; Schweitzer, Julie

2017-01-01

Introduction Attention deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder with a worldwide prevalence of about 5% in school age children. Objective The goal of this review is to assist primary care providers (PCPs) in diagnosing and treating ADHD in adolescents. Methods PubMed, PsychInfo and Science Citation Index databases were searched from March 1990–2015 with the key words: attention deficit hyperactivity disorder, primary care/pediatrics and children/adolescents, abstracts addressing diagnosis and/or treatment with 105 citations identified including supplementary treatment guidelines/books. Results Adolescent ADHD presents with significant disturbances in attention, academic performance and family relationships with unique issues associated with this developmental period. Diagnostic challenges include the variable symptom presentation during adolescence, complex differential diagnosis and limited training and time for PCPs to conduct thorough evaluations. The evidence-base for treatments in adolescence in comparison to those in children or adults with ADHD is relatively weak. Providers should be cognizant of prevention, early identification and treatment of conditions associated with ADHD that emerge during adolescence as substance use disorders. Conclusions Adolescent ADHD management for the PCP is complex, requires further research, and perhaps new primary care-psychiatric models, to assist in determining the optimal care for patients at this critical period. PMID:27209327

Maladaptive schemas in adolescent females with anorexia nervosa and implications for treatment.

PubMed

Damiano, Stephanie R; Reece, John; Reid, Sophie; Atkins, Linsey; Patton, George

2015-01-01

Recent research has highlighted the presence of Young's Early Maladaptive Schemas (EMSs) in individuals with an eating disorder (ED). This study assessed the EMSs reported by adolescent females with Anorexia Nervosa (AN) compared with a community group. Thirty-six adolescent females diagnosed with AN or subthreshold AN and 111 female secondary school students completed a questionnaire that included the Young Schema Questionnaire, the Behavior Assessment System for Children Self-report of Personality, and the Eating Disorder Screen for Primary Care. Two independent AN subtypes and two community subtypes were derived from responses to the questionnaire, and significant differences between the four comparison groups were found. High Pathology AN participants reported the highest level of psychological maladjustment. Social Isolation and Emotional Inhibition appeared to be most characteristic of adolescent AN in this sample. The results suggest that EMSs may require attention in the treatment of AN in adolescent females, and that different AN subtypes may require individualized treatment approaches. Copyright © 2014 Elsevier Ltd. All rights reserved.

Development of adaptable and flexible treatment manuals for externalizing and internalizing disorders in children and adolescents.

PubMed

Bauermeister, José J; So, Cheryl Y C; Jensen, Peter S; Krispin, Orit; El Din, Amira Seif

2006-03-01

In this paper we describe the process used to develop treatment manuals for internalizing and externalizing disorders in children and adolescents. These manuals were developed to offer health care providers and others working in child mental health a flexible intervention that could be adapted to different countries and localities based on: 1) the amount of health care and school resources that are available; 2) the nature and severity of the types of problems children have; and 3) the preferences and cultural factors that are important within these communities. We also discuss the experiences and cultural issues faced by sites in Egypt, Lebanon, Israel, and Brazil who volunteered to implement the manualized treatment programs. The feedback received from these sites indicates that the manuals can be implemented to help children with internalizing and externalizing problems.

Empirically Derived Subtypes of Adolescent Depression: Latent Profile Analysis of Co-Occurring Symptoms in the Treatment for Adolescents with Depression Study (TADS)

ERIC Educational Resources Information Center

Herman, Keith C.; Ostrander, Rick; Walkup, John T.; Silva, Susan G.; March, John S.

2007-01-01

A latent profile analysis was conducted on the co-occurring symptoms of 423 adolescents diagnosed with major depressive disorder as part of the Treatment for Adolescents with Depression Study (TADS), a multisite, randomized treatment trial. The participants had a mean (SD) age of 14.6 (1.5) years; of the sample, 45.6% was male and 73.8% was white.…

Assessment of quality of life of children and adolescents with cancer during their treatment.

PubMed

Vlachioti, Efrosini; Matziou, Vasiliki; Perdikaris, Pantelis; Mitsiou, Maria; Stylianou, Christos; Tsoumakas, Konstantinos; Moschovi, Maria

2016-05-01

The purpose of this study was to evaluate the quality of life of children and adolescents with any type of cancer in all phases of their treatment. Fifty-six newly diagnosed patients diagnosed with malignancy and hospitalized in a Pediatric Hematology-Oncology Unit in Athens were included in the study. Minneapolis-Manchester Quality of Life Instrument was used for data collection from July 2010 to December 2012. The assessment of children and adolescents' quality of life who were under treatment was performed in three different stages of treatment. The results of the study showed that the quality of life of children and adolescents with cancer did not change notably during their treatment (F = 0.16, P = 0.86 and F = 0.03, P = 0.97). For the first measurement, at the beginning of the therapy, the score on the scale for quality of life for children and adolescents was 3.44 and 3.88, respectively, in the middle of the treatment 3.36 and 3.89, respectively, and 3.43 and 3.89, respectively, when therapy was completed. Children and adolescents diagnosed with hematologic cancer stated higher quality of life scores (z = -1.61, P = 0.05 and t = 2.64, P = 0.007). Moreover, teenage patients (F = 13.22, P = 0.001) and male patients (t = 2.31, P = 0.02 and t = 2.27, P = 0.02) expressed better quality-of-life scores. According to the results, children and adolescents with any kind of cancer have better quality-of-life scores at the end of their treatment, and when they are supported by their family. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Support after the completion of cancer treatment: perspectives of Australian adolescents and their families.

PubMed

Wakefield, C E; McLoone, J; Butow, P; Lenthen, K; Cohn, R J

2013-07-01

Young people recovering from cancer may lack adequate support post-treatment, yet little is known about the types of support and information young Australians and their families need. This study investigated adolescent/young adult cancer survivors' and their families' perceptions of care and support needs after completing cancer treatment. Seventy semi-structured interviews were conducted with 19 survivors (mean age 16.1 years), 21 mothers, 15 fathers and 15 siblings. Interviews were recorded, transcribed and analysed using the conceptual framework of Miles and Huberman. Post-treatment, participants regarded medical staff positively but were reluctant to ask for their help fearing it may deflect resources away from patients still receiving treatment. Appraisals of social workers' and psychologists' support post-treatment were mixed. Formal emotional support was rarely accessed and participants reported that any additional funds should be directed to greater psychological support in this period. Participants also reported the need for additional financial support post-treatment. Clinicians need to be aware that while young people and their families may not demand support post-treatment, they may 'suffer in silence' or burden family members and friends with the responsibility of providing emotional support, though they may be experiencing distress also. © 2013 John Wiley & Sons Ltd.

Provider, Patient, and Family Perspectives of Adolescent Alcohol Use and Treatment in Rural Settings

ERIC Educational Resources Information Center

Gordon, Adam J.; Ettaro, Lorraine; Rodriguez, Keri L.; Mocik, John; Clark, Duncan B.

2011-01-01

Purpose: We examined rural primary care providers' (PCPs) self-reported practices of screening, brief interventions, and referral to treatment (SBIRT) on adolescent alcohol use and examined PCPs', adolescents', and parents' attitudes regarding SBIRT on adolescent alcohol use in rural clinic settings. Methods: In 2007, we mailed surveys that…

Access and completion of a Web-based treatment in a population-based sample of tornado-affected adolescents.

PubMed

Price, Matthew; Yuen, Erica K; Davidson, Tatiana M; Hubel, Grace; Ruggiero, Kenneth J

2015-08-01

Although Web-based treatments have significant potential to assess and treat difficult-to-reach populations, such as trauma-exposed adolescents, the extent that such treatments are accessed and used is unclear. The present study evaluated the proportion of adolescents who accessed and completed a Web-based treatment for postdisaster mental health symptoms. Correlates of access and completion were examined. A sample of 2,000 adolescents living in tornado-affected communities was assessed via structured telephone interview and invited to a Web-based treatment. The modular treatment addressed symptoms of posttraumatic stress disorder, depression, and alcohol and tobacco use. Participants were randomized to experimental or control conditions after accessing the site. Overall access for the intervention was 35.8%. Module completion for those who accessed ranged from 52.8% to 85.6%. Adolescents with parents who used the Internet to obtain health-related information were more likely to access the treatment. Adolescent males were less likely to access the treatment. Future work is needed to identify strategies to further increase the reach of Web-based treatments to provide clinical services in a postdisaster context. (c) 2015 APA, all rights reserved).

Access and Completion of a Web-Based Treatment in a Population-Based Sample of Tornado-Affected Adolescents

PubMed Central

Price, Matthew; Yuen, Erica; Davidson, Tatiana M.; Hubel, Grace; Ruggiero, Kenneth J.

2015-01-01

Although web-based treatments have significant potential to assess and treat difficult to reach populations, such as trauma-exposed adolescents, the extent that such treatments are accessed and used is unclear. The present study evaluated the proportion of adolescents who accessed and completed a web-based treatment for post-disaster mental health symptoms. Correlates of access and completion were examined. A sample of 2,000 adolescents living in tornado-affected communities was assessed via structured telephone interview and invited to a web-based treatment. The modular treatment addressed symptoms of PTSD, depression, and alcohol and tobacco use. Participants were randomized to experimental or control conditions after accessing the site. Overall access for the intervention was 35.8%. Module completion for those who accessed ranged from 52.8% to 85.6%. Adolescents with parents who used the Internet to obtain health-related information were more likely to access the treatment. Adolescent males were less likely to access the treatment. Future work is needed to identify strategies to further increase the reach of web-based treatments to provide clinical services in a post-disaster context. PMID:25622071

Effect of Economic Assets on Sexual Risk-Taking Intentions Among Orphaned Adolescents in Uganda

PubMed Central

Han, Chang-Keun; Neilands, Torsten B.; Ismayilova, Leyla; Sperber, Elizabeth

2010-01-01

Objectives. We examined the effect of economic assets on sexual risk-taking intentions among school-going AIDS-orphaned adolescents in rural Uganda. Methods. AIDS-orphaned adolescents from 15 comparable schools were randomly assigned to control (n = 133) or treatment (n = 127) conditions. Treatment participants received child savings accounts, workshops, and mentorship. This economic intervention was in addition to the traditional care and support services for school-going orphaned adolescents (counseling and school supplies) provided to both treatment and control groups. Adolescents in the treatment condition were compared with adolescents in the control condition at baseline and at 10 months after the intervention. Results. After control for sociodemographic factors, child-caregiver/parental communication, and peer pressure, adolescents in the economic intervention group reported a significant reduction in sexual risk-taking intentions compared with adolescents in the control condition. Conclusions. The findings indicate that in Uganda, a country devastated by poverty and disease (including HIV/AIDS), having access to economic assets plays an important role in influencing adolescents' sexual risk-taking intentions. These findings have implications for the care and support of orphaned adolescents, especially in poor African countries devastated by poverty and sexually transmitted diseases. PMID:20075323

A Unified, Transdiagnostic Treatment for Adolescents With Chronic Pain and Comorbid Anxiety and Depression

PubMed Central

Allen, Laura B.; Tsao, Jennie C.I.; Seidman, Laura C.; Ehrenreich-May, Jill; Zeltzer, Lonnie K.

2017-01-01

Chronic pain disorders represent a significant public health concern, particularly for children and adolescents. High rates of comorbid anxiety and unipolar mood disorders often complicate psychological interventions for chronic pain. Unified treatment approaches, based on emotion regulation skills, are applicable to a broad range of emotional disorders and suggest the possibility of extending these interventions to chronic pain and pain-related dysfunction. This case report describes the use of a unified protocol for treatment of an adolescent boy with chronic daily headache and social anxiety and an adolescent girl with whole body pain and depression. Following weekly, 50-minute individual treatment sessions, the boy demonstrated notable improvement in emotional symptoms, emotion regulation skills, somatization, and functional disability. The girl showed some improvement on measures of anxiety and depression, although there appeared to be a worsening of pain symptoms and somatization. However, both patients demonstrated improvement over follow-up. This case study illustrates the potential utility of a unified treatment approach targeting pain and emotional symptoms from an emotion regulation perspective in an adolescent population. PMID:28824271