AACAP Annual Meeting

SAN DIEGO – Adolescents with substance abuse and depression should be simultaneously treated for both conditions – and preferably by the same provider or clinical team, said Dr. Paula Riggs, professor of psychiatry and director of the division of substance dependence at the University of Colorado at Denver, Aurora.

“It’s hard to be successful in drug treatment under the best of circumstances. If you have an untreated Axis I mental health disorder, it’s not going to go well,” said Dr. Riggs, who is an expert in treating comorbid adolescent substance abuse and psychiatric disorders.

“Adolescent depressions usually do not remit with abstinence” from drugs and alcohol, Dr. Riggs said at the annual meeting of the American Academy of Child and Adolescent Psychiatry. “If you have a kid walk through your door with depression and SUD [substance abuse disorder], treating the SUD won’t make the depression go away. Once you’ve got both, you’ve got two things you’ve got to address – and preferably in an integrated fashion.”

Successful treatment of childhood depression does reduce the risk of later substance abuse, especially if the depression remits within 12 weeks of starting treatment, said Dr. Riggs. “But the converse is not true,” she said.

About 25%-50% of adolescents who present for mental health treatment meet criteria for SUDs, Dr. Riggs said. And more than half of preteens with mental health problems are at risk for developing a SUD by the time they reach adolescence, she said. “By and large, psychiatric problems are pediatric-onset illnesses, and we know from ample research that most adults who suffer from addiction started using when they were adolescents,” she added.

But all too often, teens with comorbid SUD and Axis I disorders go without treatment, said Dr. Riggs.

In a recent pooled analysis of 2,111 adolescents with comorbid major depression and SUD, 48% were treated for depression and 10% received help for substance abuse, she noted. Furthermore, being in the juvenile justice system was the strongest predictor of dual treatment. “I don’t know why people aren’t up in arms about that,” she said. “We kind of require kids to fall in the hole to get treatment.”

In 2013, the Substance Abuse and Mental Health Services Administration recommended that adolescents with comorbid SUD and depression receive integrated, simultaneous treatment for both disorders, Dr. Riggs noted. No matter which problem arose first, “recovery depends on treating both the addiction and the mental health problem,” she said.

Currently, the best treatment for adolescent SUD is motivational enhancement, “totally integrated with cognitive behavioral therapy,” Dr. Riggs said. Motivational incentives should encourage attendance, abstinence, and alternative activities that do not involve drugs, she added.

Individual therapy is more effective than group therapy for treating comorbid substance abuse and psychiatric disorders. But studies also suggest that the patient’s family should be involved in treatment, Dr. Riggs said. Furthermore, coordinating mental health care, substance abuse treatment, and family therapy has been shown to significantly alleviate symptoms in patients with SUDs who also have Axis I major depressive disorder, attention-deficit/hyperactivity disorder, or an anxiety disorder, she said.

Data support the judicious use of antidepressants for adolescents who have major depressive disorder with comorbid SUD, Dr. Riggs said.

In her randomized controlled trial of fluoxetine versus placebo in teens with major depression and SUD, fluoxetine showed “about the same safety profile as in kids who were not using drugs, despite nonabstinence.” And overall treatment gains lasted for a year after treatment, she said. “If you don’t see remission in the first month of substance abuse treatment, I would not hesitate to use fluoxetine,” she added. “You have got to do a comprehensive diagnostic assessment at baseline, and get a really good longitudinal history to map symptom onset. The bottom line is, if you are carefully monitoring the substance, and if the kid is in substance treatment, continue the fluoxetine.”

Clinicians and parents should not look the other way when the substance in question is cannabis, Dr. Riggs emphasized. “Prenatal exposure to marijuana can cause irritable babies, deficits in abstract reasoning and memory, symptoms that look like ADHD, and executive functioning deficits,” she said. “Marijuana use in adolescence doubles your risk of developing depression or an anxiety disorder in your twenties. And all of it adds up to poor academic achievement and underachievement in adulthood.”

Dr. Riggs reported receiving research support from the National Institute on Drug Abuse and the ENCOMPASS substance abuse treatment program.

SAN DIEGO – Adolescents with substance abuse and depression should be simultaneously treated for both conditions – and preferably by the same provider or clinical team, said Dr. Paula Riggs, professor of psychiatry and director of the division of substance dependence at the University of Colorado at Denver, Aurora.

“It’s hard to be successful in drug treatment under the best of circumstances. If you have an untreated Axis I mental health disorder, it’s not going to go well,” said Dr. Riggs, who is an expert in treating comorbid adolescent substance abuse and psychiatric disorders.

“Adolescent depressions usually do not remit with abstinence” from drugs and alcohol, Dr. Riggs said at the annual meeting of the American Academy of Child and Adolescent Psychiatry. “If you have a kid walk through your door with depression and SUD [substance abuse disorder], treating the SUD won’t make the depression go away. Once you’ve got both, you’ve got two things you’ve got to address – and preferably in an integrated fashion.”

Successful treatment of childhood depression does reduce the risk of later substance abuse, especially if the depression remits within 12 weeks of starting treatment, said Dr. Riggs. “But the converse is not true,” she said.

About 25%-50% of adolescents who present for mental health treatment meet criteria for SUDs, Dr. Riggs said. And more than half of preteens with mental health problems are at risk for developing a SUD by the time they reach adolescence, she said. “By and large, psychiatric problems are pediatric-onset illnesses, and we know from ample research that most adults who suffer from addiction started using when they were adolescents,” she added.

But all too often, teens with comorbid SUD and Axis I disorders go without treatment, said Dr. Riggs.

In a recent pooled analysis of 2,111 adolescents with comorbid major depression and SUD, 48% were treated for depression and 10% received help for substance abuse, she noted. Furthermore, being in the juvenile justice system was the strongest predictor of dual treatment. “I don’t know why people aren’t up in arms about that,” she said. “We kind of require kids to fall in the hole to get treatment.”

In 2013, the Substance Abuse and Mental Health Services Administration recommended that adolescents with comorbid SUD and depression receive integrated, simultaneous treatment for both disorders, Dr. Riggs noted. No matter which problem arose first, “recovery depends on treating both the addiction and the mental health problem,” she said.

Currently, the best treatment for adolescent SUD is motivational enhancement, “totally integrated with cognitive behavioral therapy,” Dr. Riggs said. Motivational incentives should encourage attendance, abstinence, and alternative activities that do not involve drugs, she added.

Individual therapy is more effective than group therapy for treating comorbid substance abuse and psychiatric disorders. But studies also suggest that the patient’s family should be involved in treatment, Dr. Riggs said. Furthermore, coordinating mental health care, substance abuse treatment, and family therapy has been shown to significantly alleviate symptoms in patients with SUDs who also have Axis I major depressive disorder, attention-deficit/hyperactivity disorder, or an anxiety disorder, she said.

Data support the judicious use of antidepressants for adolescents who have major depressive disorder with comorbid SUD, Dr. Riggs said.

In her randomized controlled trial of fluoxetine versus placebo in teens with major depression and SUD, fluoxetine showed “about the same safety profile as in kids who were not using drugs, despite nonabstinence.” And overall treatment gains lasted for a year after treatment, she said. “If you don’t see remission in the first month of substance abuse treatment, I would not hesitate to use fluoxetine,” she added. “You have got to do a comprehensive diagnostic assessment at baseline, and get a really good longitudinal history to map symptom onset. The bottom line is, if you are carefully monitoring the substance, and if the kid is in substance treatment, continue the fluoxetine.”

Clinicians and parents should not look the other way when the substance in question is cannabis, Dr. Riggs emphasized. “Prenatal exposure to marijuana can cause irritable babies, deficits in abstract reasoning and memory, symptoms that look like ADHD, and executive functioning deficits,” she said. “Marijuana use in adolescence doubles your risk of developing depression or an anxiety disorder in your twenties. And all of it adds up to poor academic achievement and underachievement in adulthood.”

Dr. Riggs reported receiving research support from the National Institute on Drug Abuse and the ENCOMPASS substance abuse treatment program.

SAN DIEGO – Adolescents with substance abuse and depression should be simultaneously treated for both conditions – and preferably by the same provider or clinical team, said Dr. Paula Riggs, professor of psychiatry and director of the division of substance dependence at the University of Colorado at Denver, Aurora.

“It’s hard to be successful in drug treatment under the best of circumstances. If you have an untreated Axis I mental health disorder, it’s not going to go well,” said Dr. Riggs, who is an expert in treating comorbid adolescent substance abuse and psychiatric disorders.

“Adolescent depressions usually do not remit with abstinence” from drugs and alcohol, Dr. Riggs said at the annual meeting of the American Academy of Child and Adolescent Psychiatry. “If you have a kid walk through your door with depression and SUD [substance abuse disorder], treating the SUD won’t make the depression go away. Once you’ve got both, you’ve got two things you’ve got to address – and preferably in an integrated fashion.”

Successful treatment of childhood depression does reduce the risk of later substance abuse, especially if the depression remits within 12 weeks of starting treatment, said Dr. Riggs. “But the converse is not true,” she said.

About 25%-50% of adolescents who present for mental health treatment meet criteria for SUDs, Dr. Riggs said. And more than half of preteens with mental health problems are at risk for developing a SUD by the time they reach adolescence, she said. “By and large, psychiatric problems are pediatric-onset illnesses, and we know from ample research that most adults who suffer from addiction started using when they were adolescents,” she added.

But all too often, teens with comorbid SUD and Axis I disorders go without treatment, said Dr. Riggs.

In a recent pooled analysis of 2,111 adolescents with comorbid major depression and SUD, 48% were treated for depression and 10% received help for substance abuse, she noted. Furthermore, being in the juvenile justice system was the strongest predictor of dual treatment. “I don’t know why people aren’t up in arms about that,” she said. “We kind of require kids to fall in the hole to get treatment.”

In 2013, the Substance Abuse and Mental Health Services Administration recommended that adolescents with comorbid SUD and depression receive integrated, simultaneous treatment for both disorders, Dr. Riggs noted. No matter which problem arose first, “recovery depends on treating both the addiction and the mental health problem,” she said.

Currently, the best treatment for adolescent SUD is motivational enhancement, “totally integrated with cognitive behavioral therapy,” Dr. Riggs said. Motivational incentives should encourage attendance, abstinence, and alternative activities that do not involve drugs, she added.

Individual therapy is more effective than group therapy for treating comorbid substance abuse and psychiatric disorders. But studies also suggest that the patient’s family should be involved in treatment, Dr. Riggs said. Furthermore, coordinating mental health care, substance abuse treatment, and family therapy has been shown to significantly alleviate symptoms in patients with SUDs who also have Axis I major depressive disorder, attention-deficit/hyperactivity disorder, or an anxiety disorder, she said.

Data support the judicious use of antidepressants for adolescents who have major depressive disorder with comorbid SUD, Dr. Riggs said.

In her randomized controlled trial of fluoxetine versus placebo in teens with major depression and SUD, fluoxetine showed “about the same safety profile as in kids who were not using drugs, despite nonabstinence.” And overall treatment gains lasted for a year after treatment, she said. “If you don’t see remission in the first month of substance abuse treatment, I would not hesitate to use fluoxetine,” she added. “You have got to do a comprehensive diagnostic assessment at baseline, and get a really good longitudinal history to map symptom onset. The bottom line is, if you are carefully monitoring the substance, and if the kid is in substance treatment, continue the fluoxetine.”

Clinicians and parents should not look the other way when the substance in question is cannabis, Dr. Riggs emphasized. “Prenatal exposure to marijuana can cause irritable babies, deficits in abstract reasoning and memory, symptoms that look like ADHD, and executive functioning deficits,” she said. “Marijuana use in adolescence doubles your risk of developing depression or an anxiety disorder in your twenties. And all of it adds up to poor academic achievement and underachievement in adulthood.”

Dr. Riggs reported receiving research support from the National Institute on Drug Abuse and the ENCOMPASS substance abuse treatment program.

SAN DIEGO – Adolescents with attention-deficit/hyperactivity disorder are at increased risk of substance abuse disorders, especially if their parents smoke or abuse alcohol or drugs, said Dr. Iliyan S. Ivanov. Interventions that target schools, communities, and families can help, especially if these programs last more than 10 weeks and include training for children and parents, he said.

© iStock / ThinkStockPhotos.com

Several psychosocial modalities can aid teens with attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD), but the evidence to date particularly supports family therapy, Dr. Ivanov said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Parents with SUDs often don’t realize that their children know about their substance abuse, he emphasized. For this and other reasons, these children might harbor positive feelings about “light” (or soft) drugs, such as cannabis, which further increases their risk of using drugs, alcohol, or tobacco, said Dr. Ivanov, of the division of child and adolescent psychiatry at Mount Sinai Hospital, New York.

In addition to family therapy, adolescents with ADHD and SUD can benefit from “contingency management,” in which they earn rewards if they achieve positive outcomes, he said. “For example, look for the first negative urine test, and use that for positive reinforcement instead of using negative punishment for positive urine screens,” he said. “You really have to be on top of educating the parent or whoever is implementing the rewards that it is a moving target. The rules will change as the adolescent’s feelings change or improve.”

Medications are often key to treating adolescent ADHD; however, evidence is limited on whether they improve or control comorbid SUD in most cases, Dr. Ivanov said. “Stimulants are effective in controlling ADHD symptoms but have limited efficacy in controlling SUD,” he added. “Stimulant treatment is most effective when used concurrently with SUD treatment, and that is best done in a clinic with some kind of behavioral therapy.”

In longitudinal studies, stimulants such as methylphenidate usually have a neutral effect on substance abuse in children and adults, Dr. Ivanov said. An exception is smoking, he noted. Patients with ADHD have an especially hard time quitting tobacco use, but are less likely to start if they receive consistent treatment with stimulants (Pediatrics 2014;133:1070-80), he said. Osmotic-release oral system methylphenidate (OROS-MPH) also has been found to improve substance abuse treatment outcomes in patients who have ADHD with comorbid conduct disorder (J. Subst. Abuse Treat. 2013;44:224-30), Dr. Ivanov said.

Clinicians should carefully monitor adolescents on stimulants who have SUDs because of the potential for abuse, Dr. Ivanov emphasized. “Given the pharmacokinetics of the long-term stimulants, they might be the better choice,” he said. Also consider drugs with different mechanisms of action, such as lisdexamfetamine, a prodrug stimulant that the brain takes up relatively slowly; atomoxetine, which has distinct neurophysiological effects; extended-release guanfacine; omega fatty acids; buproprion; serotonin norepinephrine reuptake inhibitors; and glutamatergic agents, he said.

Clinicians also should educate patients about proper medication use and should closely follow them, use random urine toxicology screens to look for substance use, and check to see whether the patient has sought scripts from other clinicians, Dr. Ivanov said. New York State has passed legislation requiring prescribers to carry out these checks through prescription monitoring registries, he noted.

Because severe substance abuse predicts worse treatment outcomes for both ADHD and SUD (J. Subst. Abuse Treat. 2013;44:224-30), early detection and prevention of SUDs are key, and several screening tools can help, Dr. Ivanov said. The most comprehensive, the POSIT (Problem-Oriented Screening Assessment for Teenagers) tool, assesses patients for SUDs and also for unrelated problems, he added. The tool is self-administered, as is AUDIT (the Alcohol Use Disorders Identification Test), while CRAFFT (which stands for Car Relax Alone Forget Friends Trouble) is intended for interviews, he said.The CRAFFT tool asks about key signals of worsening substance use, such as riding in a car driven by someone who is intoxicated, using substances to relax or while alone, forgetting incidents that occurred while intoxicated, having friends or family express concern about substance use, and getting into trouble while using alcohol or drugs.

Why are teens with ADHD at particular risk of developing SUDs? In part, they might have greater neural reward processing than other children, as well as deficits in conflict resolution, Dr. Ivanov said. These combined factors lead to a cumulative risk effect for SUD compared with either ADHD alone or parental SUD alone.

The brain’s tendency to seek sensation also peaks in early to middle adolescence, making this age particularly vulnerable to substance abuse, whether or not children have ADHD, Dr. Ivanov noted. But ADHD exacerbates this risk. In one study individuals with ADHD were significantly more likely to abuse alcohol (adjusted odds ratio, 14.28; 95% confidence interval, 1.49-138.88) and drugs (aOR, 3.48; 95% CI, 1.38-8.79), compared with controls (PLoS One 2014;9:e105640). These individuals also were more likely to develop drug dependencies as adults, even if they did not abuse substances during adolescence.

Dr. Ivanov reported receiving honoraria from Lundbeck, a pharmaceutical company that specializes in therapies for brain disease.

SAN DIEGO – Adolescents with attention-deficit/hyperactivity disorder are at increased risk of substance abuse disorders, especially if their parents smoke or abuse alcohol or drugs, said Dr. Iliyan S. Ivanov. Interventions that target schools, communities, and families can help, especially if these programs last more than 10 weeks and include training for children and parents, he said.

© iStock / ThinkStockPhotos.com

Several psychosocial modalities can aid teens with attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD), but the evidence to date particularly supports family therapy, Dr. Ivanov said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Parents with SUDs often don’t realize that their children know about their substance abuse, he emphasized. For this and other reasons, these children might harbor positive feelings about “light” (or soft) drugs, such as cannabis, which further increases their risk of using drugs, alcohol, or tobacco, said Dr. Ivanov, of the division of child and adolescent psychiatry at Mount Sinai Hospital, New York.

In addition to family therapy, adolescents with ADHD and SUD can benefit from “contingency management,” in which they earn rewards if they achieve positive outcomes, he said. “For example, look for the first negative urine test, and use that for positive reinforcement instead of using negative punishment for positive urine screens,” he said. “You really have to be on top of educating the parent or whoever is implementing the rewards that it is a moving target. The rules will change as the adolescent’s feelings change or improve.”

Medications are often key to treating adolescent ADHD; however, evidence is limited on whether they improve or control comorbid SUD in most cases, Dr. Ivanov said. “Stimulants are effective in controlling ADHD symptoms but have limited efficacy in controlling SUD,” he added. “Stimulant treatment is most effective when used concurrently with SUD treatment, and that is best done in a clinic with some kind of behavioral therapy.”

In longitudinal studies, stimulants such as methylphenidate usually have a neutral effect on substance abuse in children and adults, Dr. Ivanov said. An exception is smoking, he noted. Patients with ADHD have an especially hard time quitting tobacco use, but are less likely to start if they receive consistent treatment with stimulants (Pediatrics 2014;133:1070-80), he said. Osmotic-release oral system methylphenidate (OROS-MPH) also has been found to improve substance abuse treatment outcomes in patients who have ADHD with comorbid conduct disorder (J. Subst. Abuse Treat. 2013;44:224-30), Dr. Ivanov said.

Clinicians should carefully monitor adolescents on stimulants who have SUDs because of the potential for abuse, Dr. Ivanov emphasized. “Given the pharmacokinetics of the long-term stimulants, they might be the better choice,” he said. Also consider drugs with different mechanisms of action, such as lisdexamfetamine, a prodrug stimulant that the brain takes up relatively slowly; atomoxetine, which has distinct neurophysiological effects; extended-release guanfacine; omega fatty acids; buproprion; serotonin norepinephrine reuptake inhibitors; and glutamatergic agents, he said.

Clinicians also should educate patients about proper medication use and should closely follow them, use random urine toxicology screens to look for substance use, and check to see whether the patient has sought scripts from other clinicians, Dr. Ivanov said. New York State has passed legislation requiring prescribers to carry out these checks through prescription monitoring registries, he noted.

Because severe substance abuse predicts worse treatment outcomes for both ADHD and SUD (J. Subst. Abuse Treat. 2013;44:224-30), early detection and prevention of SUDs are key, and several screening tools can help, Dr. Ivanov said. The most comprehensive, the POSIT (Problem-Oriented Screening Assessment for Teenagers) tool, assesses patients for SUDs and also for unrelated problems, he added. The tool is self-administered, as is AUDIT (the Alcohol Use Disorders Identification Test), while CRAFFT (which stands for Car Relax Alone Forget Friends Trouble) is intended for interviews, he said.The CRAFFT tool asks about key signals of worsening substance use, such as riding in a car driven by someone who is intoxicated, using substances to relax or while alone, forgetting incidents that occurred while intoxicated, having friends or family express concern about substance use, and getting into trouble while using alcohol or drugs.

Why are teens with ADHD at particular risk of developing SUDs? In part, they might have greater neural reward processing than other children, as well as deficits in conflict resolution, Dr. Ivanov said. These combined factors lead to a cumulative risk effect for SUD compared with either ADHD alone or parental SUD alone.

The brain’s tendency to seek sensation also peaks in early to middle adolescence, making this age particularly vulnerable to substance abuse, whether or not children have ADHD, Dr. Ivanov noted. But ADHD exacerbates this risk. In one study individuals with ADHD were significantly more likely to abuse alcohol (adjusted odds ratio, 14.28; 95% confidence interval, 1.49-138.88) and drugs (aOR, 3.48; 95% CI, 1.38-8.79), compared with controls (PLoS One 2014;9:e105640). These individuals also were more likely to develop drug dependencies as adults, even if they did not abuse substances during adolescence.

Dr. Ivanov reported receiving honoraria from Lundbeck, a pharmaceutical company that specializes in therapies for brain disease.

SAN DIEGO – Adolescents with attention-deficit/hyperactivity disorder are at increased risk of substance abuse disorders, especially if their parents smoke or abuse alcohol or drugs, said Dr. Iliyan S. Ivanov. Interventions that target schools, communities, and families can help, especially if these programs last more than 10 weeks and include training for children and parents, he said.

© iStock / ThinkStockPhotos.com

Several psychosocial modalities can aid teens with attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD), but the evidence to date particularly supports family therapy, Dr. Ivanov said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Parents with SUDs often don’t realize that their children know about their substance abuse, he emphasized. For this and other reasons, these children might harbor positive feelings about “light” (or soft) drugs, such as cannabis, which further increases their risk of using drugs, alcohol, or tobacco, said Dr. Ivanov, of the division of child and adolescent psychiatry at Mount Sinai Hospital, New York.

In addition to family therapy, adolescents with ADHD and SUD can benefit from “contingency management,” in which they earn rewards if they achieve positive outcomes, he said. “For example, look for the first negative urine test, and use that for positive reinforcement instead of using negative punishment for positive urine screens,” he said. “You really have to be on top of educating the parent or whoever is implementing the rewards that it is a moving target. The rules will change as the adolescent’s feelings change or improve.”

Medications are often key to treating adolescent ADHD; however, evidence is limited on whether they improve or control comorbid SUD in most cases, Dr. Ivanov said. “Stimulants are effective in controlling ADHD symptoms but have limited efficacy in controlling SUD,” he added. “Stimulant treatment is most effective when used concurrently with SUD treatment, and that is best done in a clinic with some kind of behavioral therapy.”

In longitudinal studies, stimulants such as methylphenidate usually have a neutral effect on substance abuse in children and adults, Dr. Ivanov said. An exception is smoking, he noted. Patients with ADHD have an especially hard time quitting tobacco use, but are less likely to start if they receive consistent treatment with stimulants (Pediatrics 2014;133:1070-80), he said. Osmotic-release oral system methylphenidate (OROS-MPH) also has been found to improve substance abuse treatment outcomes in patients who have ADHD with comorbid conduct disorder (J. Subst. Abuse Treat. 2013;44:224-30), Dr. Ivanov said.

Clinicians should carefully monitor adolescents on stimulants who have SUDs because of the potential for abuse, Dr. Ivanov emphasized. “Given the pharmacokinetics of the long-term stimulants, they might be the better choice,” he said. Also consider drugs with different mechanisms of action, such as lisdexamfetamine, a prodrug stimulant that the brain takes up relatively slowly; atomoxetine, which has distinct neurophysiological effects; extended-release guanfacine; omega fatty acids; buproprion; serotonin norepinephrine reuptake inhibitors; and glutamatergic agents, he said.

Clinicians also should educate patients about proper medication use and should closely follow them, use random urine toxicology screens to look for substance use, and check to see whether the patient has sought scripts from other clinicians, Dr. Ivanov said. New York State has passed legislation requiring prescribers to carry out these checks through prescription monitoring registries, he noted.

Because severe substance abuse predicts worse treatment outcomes for both ADHD and SUD (J. Subst. Abuse Treat. 2013;44:224-30), early detection and prevention of SUDs are key, and several screening tools can help, Dr. Ivanov said. The most comprehensive, the POSIT (Problem-Oriented Screening Assessment for Teenagers) tool, assesses patients for SUDs and also for unrelated problems, he added. The tool is self-administered, as is AUDIT (the Alcohol Use Disorders Identification Test), while CRAFFT (which stands for Car Relax Alone Forget Friends Trouble) is intended for interviews, he said.The CRAFFT tool asks about key signals of worsening substance use, such as riding in a car driven by someone who is intoxicated, using substances to relax or while alone, forgetting incidents that occurred while intoxicated, having friends or family express concern about substance use, and getting into trouble while using alcohol or drugs.

Why are teens with ADHD at particular risk of developing SUDs? In part, they might have greater neural reward processing than other children, as well as deficits in conflict resolution, Dr. Ivanov said. These combined factors lead to a cumulative risk effect for SUD compared with either ADHD alone or parental SUD alone.

The brain’s tendency to seek sensation also peaks in early to middle adolescence, making this age particularly vulnerable to substance abuse, whether or not children have ADHD, Dr. Ivanov noted. But ADHD exacerbates this risk. In one study individuals with ADHD were significantly more likely to abuse alcohol (adjusted odds ratio, 14.28; 95% confidence interval, 1.49-138.88) and drugs (aOR, 3.48; 95% CI, 1.38-8.79), compared with controls (PLoS One 2014;9:e105640). These individuals also were more likely to develop drug dependencies as adults, even if they did not abuse substances during adolescence.

Dr. Ivanov reported receiving honoraria from Lundbeck, a pharmaceutical company that specializes in therapies for brain disease.

SAN DIEGO – Google search terms related to mental illness and violence were highly linked over a 10-year period, an analysis of 7 trillion Internet queries showed.

“We found that, over time, there was a very strong correlation between searches for ‘mentally ill’ and ‘violent,’ and between other common terms for mental illness and violence,” Dr. Matthew Burkey said in an interview. The study methodology “is a public health tool we can use to measure the effects of antistigma campaigns to combat the idea that people with mental health problems are inherently violent,” added Dr. Burkey of the departments of child and adolescent psychiatry at the Johns Hopkins University, Baltimore.

Public surveys have shown that people tend to associate mental illness with violence, but social desirability bias – in which respondents “say what you want them to hear” – can affect survey results, Dr. Burkey said at the annual meeting of the American Academy of Child and Adolescent Psychiatry. When people search the Internet, their behavior is less likely to reflect concerns about how others perceive them, he added. “Online search activity may represent a window into ‘hidden’ perceptions of personal attitudes by revealing patterns in searches for information,” he and his associates noted.

Using the Google Correlate, Dr. Burkey and his associates analyzed 7 trillion Internet queries between Jan. 1, 2004, and Feb. 5, 2014. The search term “mentally ill” correlated most strongly with the search term “violent,” with an r value of 0.90, the investigators found. Among the other 19 search terms that most correlated with “mentally ill,” “crime” ranked fourth, “on violence” ranked seventh, “violence” ranked 10th, and “violence in America” ranked 16th, they reported.

Six searches related to violence also ranked among the 20 terms that were most correlated with searches for “mental illness” (30%; two-sided P value < .000001), the researchers said. Those terms included “violent behavior,” “pro gun control,” “violence in America,” “crime,” “violent crime,” and “crimes committed,” they said. In contrast, searches for “schizophrenia,” “schizophrenic,” and “mental disorder” did not correlate with terms related to violence, they reported.

After the Sandy Hook Elementary School shooting, a substantial spike occurred in searches for “mentally ill” and “violent,” Dr. Burkey said. “In the wake of a shooting, public interest in mental illness grows, and people jump to conclusions about causes.”

He and his associates reported no funding sources or conflicts of interest.

SAN DIEGO – Google search terms related to mental illness and violence were highly linked over a 10-year period, an analysis of 7 trillion Internet queries showed.

“We found that, over time, there was a very strong correlation between searches for ‘mentally ill’ and ‘violent,’ and between other common terms for mental illness and violence,” Dr. Matthew Burkey said in an interview. The study methodology “is a public health tool we can use to measure the effects of antistigma campaigns to combat the idea that people with mental health problems are inherently violent,” added Dr. Burkey of the departments of child and adolescent psychiatry at the Johns Hopkins University, Baltimore.

Public surveys have shown that people tend to associate mental illness with violence, but social desirability bias – in which respondents “say what you want them to hear” – can affect survey results, Dr. Burkey said at the annual meeting of the American Academy of Child and Adolescent Psychiatry. When people search the Internet, their behavior is less likely to reflect concerns about how others perceive them, he added. “Online search activity may represent a window into ‘hidden’ perceptions of personal attitudes by revealing patterns in searches for information,” he and his associates noted.

Using the Google Correlate, Dr. Burkey and his associates analyzed 7 trillion Internet queries between Jan. 1, 2004, and Feb. 5, 2014. The search term “mentally ill” correlated most strongly with the search term “violent,” with an r value of 0.90, the investigators found. Among the other 19 search terms that most correlated with “mentally ill,” “crime” ranked fourth, “on violence” ranked seventh, “violence” ranked 10th, and “violence in America” ranked 16th, they reported.

Six searches related to violence also ranked among the 20 terms that were most correlated with searches for “mental illness” (30%; two-sided P value < .000001), the researchers said. Those terms included “violent behavior,” “pro gun control,” “violence in America,” “crime,” “violent crime,” and “crimes committed,” they said. In contrast, searches for “schizophrenia,” “schizophrenic,” and “mental disorder” did not correlate with terms related to violence, they reported.

After the Sandy Hook Elementary School shooting, a substantial spike occurred in searches for “mentally ill” and “violent,” Dr. Burkey said. “In the wake of a shooting, public interest in mental illness grows, and people jump to conclusions about causes.”

He and his associates reported no funding sources or conflicts of interest.

SAN DIEGO – Google search terms related to mental illness and violence were highly linked over a 10-year period, an analysis of 7 trillion Internet queries showed.

“We found that, over time, there was a very strong correlation between searches for ‘mentally ill’ and ‘violent,’ and between other common terms for mental illness and violence,” Dr. Matthew Burkey said in an interview. The study methodology “is a public health tool we can use to measure the effects of antistigma campaigns to combat the idea that people with mental health problems are inherently violent,” added Dr. Burkey of the departments of child and adolescent psychiatry at the Johns Hopkins University, Baltimore.

Public surveys have shown that people tend to associate mental illness with violence, but social desirability bias – in which respondents “say what you want them to hear” – can affect survey results, Dr. Burkey said at the annual meeting of the American Academy of Child and Adolescent Psychiatry. When people search the Internet, their behavior is less likely to reflect concerns about how others perceive them, he added. “Online search activity may represent a window into ‘hidden’ perceptions of personal attitudes by revealing patterns in searches for information,” he and his associates noted.

Using the Google Correlate, Dr. Burkey and his associates analyzed 7 trillion Internet queries between Jan. 1, 2004, and Feb. 5, 2014. The search term “mentally ill” correlated most strongly with the search term “violent,” with an r value of 0.90, the investigators found. Among the other 19 search terms that most correlated with “mentally ill,” “crime” ranked fourth, “on violence” ranked seventh, “violence” ranked 10th, and “violence in America” ranked 16th, they reported.

Six searches related to violence also ranked among the 20 terms that were most correlated with searches for “mental illness” (30%; two-sided P value < .000001), the researchers said. Those terms included “violent behavior,” “pro gun control,” “violence in America,” “crime,” “violent crime,” and “crimes committed,” they said. In contrast, searches for “schizophrenia,” “schizophrenic,” and “mental disorder” did not correlate with terms related to violence, they reported.

After the Sandy Hook Elementary School shooting, a substantial spike occurred in searches for “mentally ill” and “violent,” Dr. Burkey said. “In the wake of a shooting, public interest in mental illness grows, and people jump to conclusions about causes.”

He and his associates reported no funding sources or conflicts of interest.

SAN DIEGO – Extended-release dexmethylphenidate combined with guanfacine caused no adverse cardiovascular effects among children with attention-deficit/hyperactivity disorder, according to results from a double-blind, randomized trial of 207 patients presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Amy Karon/Frontline Medical News

On electrocardiography, a QTc interval prolongation of more than 500 ms raises concerns about arrhythmia and sudden death, “but this study showed that this did not happen with combination treatment,” lead investigator Dr. Gregory Sayer said in an interview. “In fact, there were no clinically meaningful cardiovascular effects.

“The take-home message is that combination therapy with dexmethylphenidate extended release and guanfacine immediate release is a cardiovascularly safe option for patients who might require dual therapy.”

Stimulants for ADHD were previously thought to carry the risk of sudden cardiac death, noted Dr. Sayer, a third-year psychiatry resident at the University of California, Los Angeles. Although further analyses revealed that these concerns were unfounded, clinicians have continued to question the milder cardiovascular effects of stimulants for ADHD, as well as the effects of combining stimulants with alpha-2 agonists such as guanfacine, which can improve cognitive function in ADHD, he said.

Therefore, Dr. Sayer and his associates monitored pulse, blood pressure, and electrocardiograms in children with ADHD who were 7-14 years old and had been randomized in a double-blinded fashion to immediate-release guanfacine (1-3 mg/day), extended-release dexmethylphenidate (5-20 mg/day), or both. They measured vital signs and ECGs at baseline, at the end of the 8-week dose-optimization period, and then monthly during a 12-month, open-label maintenance phase, they reported.

Guanfacine and dexmethylphenidate had “opposing cardiovascular effects,” although none of these effects were clinically significant, the researchers said. During titration, guanfacine monotherapy lowered children’s pulse and blood pressure; dexmethylphenidate increased pulse, blood pressure, and QTc interval; and combination therapy increased diastolic blood pressure alone, they said. “The combination group’s parameters fell between the ranges for both monotherapy groups, and there were no significant QTc changes in the combination therapy group,” Dr. Sayer added.

“Combination treatment may buffer long-term cardiovascular effects of guanfacine and stimulant monotherapy, possibly reducing risk from the small but significant changes resulting from either single treatment,” he and his associates concluded.

During the yearlong maintenance phase, cardiovascular measures remained stable except for a borderline significant increase in pulse in the guanfacine group (P = .06) and a decrease in systolic blood pressure in the dexmethylphenidate group (P < .0001, the researchers reported.

The study is part of a larger trial that is examining the effects of combination therapy on ADHD symptoms and cognitive effects, such as working memory, Dr. Sayer noted. In the current study, the researchers did not continuously monitor vital signs, such as with a Holter monitor, so they could not eliminate the possibility of cardiac phenomena occurring between monitoring points, he added.

The National Institute of Mental Health funded the study. Dr. Sayer declared having no conflicts of interest. Two coauthors reported financial or advisory relationships with Akili Interactive Labs, Sunovion, and other companies.

SAN DIEGO – Extended-release dexmethylphenidate combined with guanfacine caused no adverse cardiovascular effects among children with attention-deficit/hyperactivity disorder, according to results from a double-blind, randomized trial of 207 patients presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Amy Karon/Frontline Medical News

On electrocardiography, a QTc interval prolongation of more than 500 ms raises concerns about arrhythmia and sudden death, “but this study showed that this did not happen with combination treatment,” lead investigator Dr. Gregory Sayer said in an interview. “In fact, there were no clinically meaningful cardiovascular effects.

“The take-home message is that combination therapy with dexmethylphenidate extended release and guanfacine immediate release is a cardiovascularly safe option for patients who might require dual therapy.”

Stimulants for ADHD were previously thought to carry the risk of sudden cardiac death, noted Dr. Sayer, a third-year psychiatry resident at the University of California, Los Angeles. Although further analyses revealed that these concerns were unfounded, clinicians have continued to question the milder cardiovascular effects of stimulants for ADHD, as well as the effects of combining stimulants with alpha-2 agonists such as guanfacine, which can improve cognitive function in ADHD, he said.

Therefore, Dr. Sayer and his associates monitored pulse, blood pressure, and electrocardiograms in children with ADHD who were 7-14 years old and had been randomized in a double-blinded fashion to immediate-release guanfacine (1-3 mg/day), extended-release dexmethylphenidate (5-20 mg/day), or both. They measured vital signs and ECGs at baseline, at the end of the 8-week dose-optimization period, and then monthly during a 12-month, open-label maintenance phase, they reported.

Guanfacine and dexmethylphenidate had “opposing cardiovascular effects,” although none of these effects were clinically significant, the researchers said. During titration, guanfacine monotherapy lowered children’s pulse and blood pressure; dexmethylphenidate increased pulse, blood pressure, and QTc interval; and combination therapy increased diastolic blood pressure alone, they said. “The combination group’s parameters fell between the ranges for both monotherapy groups, and there were no significant QTc changes in the combination therapy group,” Dr. Sayer added.

“Combination treatment may buffer long-term cardiovascular effects of guanfacine and stimulant monotherapy, possibly reducing risk from the small but significant changes resulting from either single treatment,” he and his associates concluded.

During the yearlong maintenance phase, cardiovascular measures remained stable except for a borderline significant increase in pulse in the guanfacine group (P = .06) and a decrease in systolic blood pressure in the dexmethylphenidate group (P < .0001, the researchers reported.

The study is part of a larger trial that is examining the effects of combination therapy on ADHD symptoms and cognitive effects, such as working memory, Dr. Sayer noted. In the current study, the researchers did not continuously monitor vital signs, such as with a Holter monitor, so they could not eliminate the possibility of cardiac phenomena occurring between monitoring points, he added.

The National Institute of Mental Health funded the study. Dr. Sayer declared having no conflicts of interest. Two coauthors reported financial or advisory relationships with Akili Interactive Labs, Sunovion, and other companies.

SAN DIEGO – Extended-release dexmethylphenidate combined with guanfacine caused no adverse cardiovascular effects among children with attention-deficit/hyperactivity disorder, according to results from a double-blind, randomized trial of 207 patients presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Amy Karon/Frontline Medical News

On electrocardiography, a QTc interval prolongation of more than 500 ms raises concerns about arrhythmia and sudden death, “but this study showed that this did not happen with combination treatment,” lead investigator Dr. Gregory Sayer said in an interview. “In fact, there were no clinically meaningful cardiovascular effects.

“The take-home message is that combination therapy with dexmethylphenidate extended release and guanfacine immediate release is a cardiovascularly safe option for patients who might require dual therapy.”

Stimulants for ADHD were previously thought to carry the risk of sudden cardiac death, noted Dr. Sayer, a third-year psychiatry resident at the University of California, Los Angeles. Although further analyses revealed that these concerns were unfounded, clinicians have continued to question the milder cardiovascular effects of stimulants for ADHD, as well as the effects of combining stimulants with alpha-2 agonists such as guanfacine, which can improve cognitive function in ADHD, he said.

Therefore, Dr. Sayer and his associates monitored pulse, blood pressure, and electrocardiograms in children with ADHD who were 7-14 years old and had been randomized in a double-blinded fashion to immediate-release guanfacine (1-3 mg/day), extended-release dexmethylphenidate (5-20 mg/day), or both. They measured vital signs and ECGs at baseline, at the end of the 8-week dose-optimization period, and then monthly during a 12-month, open-label maintenance phase, they reported.

Guanfacine and dexmethylphenidate had “opposing cardiovascular effects,” although none of these effects were clinically significant, the researchers said. During titration, guanfacine monotherapy lowered children’s pulse and blood pressure; dexmethylphenidate increased pulse, blood pressure, and QTc interval; and combination therapy increased diastolic blood pressure alone, they said. “The combination group’s parameters fell between the ranges for both monotherapy groups, and there were no significant QTc changes in the combination therapy group,” Dr. Sayer added.

“Combination treatment may buffer long-term cardiovascular effects of guanfacine and stimulant monotherapy, possibly reducing risk from the small but significant changes resulting from either single treatment,” he and his associates concluded.

During the yearlong maintenance phase, cardiovascular measures remained stable except for a borderline significant increase in pulse in the guanfacine group (P = .06) and a decrease in systolic blood pressure in the dexmethylphenidate group (P < .0001, the researchers reported.

The study is part of a larger trial that is examining the effects of combination therapy on ADHD symptoms and cognitive effects, such as working memory, Dr. Sayer noted. In the current study, the researchers did not continuously monitor vital signs, such as with a Holter monitor, so they could not eliminate the possibility of cardiac phenomena occurring between monitoring points, he added.

The National Institute of Mental Health funded the study. Dr. Sayer declared having no conflicts of interest. Two coauthors reported financial or advisory relationships with Akili Interactive Labs, Sunovion, and other companies.

SAN DIEGO – Children with recent-onset epilepsy were more than 2.5 more likely to have Axis I psychiatric disorders than were healthy controls in a prospective, case-control study.

“Children with epilepsy have a significant vulnerability to psychiatric comorbidity,” said Jana E. Jones, Ph.D., and her associates at the University of Wisconsin, Madison. “It will be important to study these children over multiple time points in order to begin to understand the trajectory of psychiatric disorders in epilepsy.”

At baseline, 17%-34% of children with epilepsy had depression, anxiety, or attention-deficit hyperactivity disorder (ADHD), compared with 3%-16% of their age- and sex-matched first-degree cousins (P = .01 for all), the researchers found. Two years later, anxiety still occurred significantly more often among patients in the epilepsy group (31% vs. 10% for controls; P< .001), as did ADHD (19% vs. 4%, respectively; P = .01), they said. These differences remained significant for subgroups of children with focal and generalized epilepsy, compared with controls, Dr. Jones reported at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

The prevalence of depression also remained higher in the epilepsy group at 2-year follow-up (8% vs. 3% for controls), but the difference was not statistically significant. Factors such as age of epilepsy onset, duration of seizures, and number of medications did not appear to affect the likelihood of Axis I disorders, the researchers said.

As recently as 2012, little was known about psychiatric comorbidities in children with epilepsy, said the investigators, noting that their study is the first prospective one of 2 years’ duration on the topic.

The study included 163 children aged 8-18 years. At baseline, all 92 children in the epilepsy group had been diagnosed in the past 12 months and had no other neurologic disorders or developmental disabilities. The researchers identified Axis I disorders by using the Schedule for Affective Disorders and Schizophrenia.

The analysis also found that IQ scores for children with epilepsy averaged 100.8 points (standard deviation, 13.7), which was significantly lower than the mean of 108.4 (SD, 11.1) for the control group.

The National Institutes of Health supported the research. The researchers reported no conflicts of interest.

SAN DIEGO – Children with recent-onset epilepsy were more than 2.5 more likely to have Axis I psychiatric disorders than were healthy controls in a prospective, case-control study.

“Children with epilepsy have a significant vulnerability to psychiatric comorbidity,” said Jana E. Jones, Ph.D., and her associates at the University of Wisconsin, Madison. “It will be important to study these children over multiple time points in order to begin to understand the trajectory of psychiatric disorders in epilepsy.”

At baseline, 17%-34% of children with epilepsy had depression, anxiety, or attention-deficit hyperactivity disorder (ADHD), compared with 3%-16% of their age- and sex-matched first-degree cousins (P = .01 for all), the researchers found. Two years later, anxiety still occurred significantly more often among patients in the epilepsy group (31% vs. 10% for controls; P< .001), as did ADHD (19% vs. 4%, respectively; P = .01), they said. These differences remained significant for subgroups of children with focal and generalized epilepsy, compared with controls, Dr. Jones reported at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

The prevalence of depression also remained higher in the epilepsy group at 2-year follow-up (8% vs. 3% for controls), but the difference was not statistically significant. Factors such as age of epilepsy onset, duration of seizures, and number of medications did not appear to affect the likelihood of Axis I disorders, the researchers said.

As recently as 2012, little was known about psychiatric comorbidities in children with epilepsy, said the investigators, noting that their study is the first prospective one of 2 years’ duration on the topic.

The study included 163 children aged 8-18 years. At baseline, all 92 children in the epilepsy group had been diagnosed in the past 12 months and had no other neurologic disorders or developmental disabilities. The researchers identified Axis I disorders by using the Schedule for Affective Disorders and Schizophrenia.

The analysis also found that IQ scores for children with epilepsy averaged 100.8 points (standard deviation, 13.7), which was significantly lower than the mean of 108.4 (SD, 11.1) for the control group.

The National Institutes of Health supported the research. The researchers reported no conflicts of interest.

SAN DIEGO – Children with recent-onset epilepsy were more than 2.5 more likely to have Axis I psychiatric disorders than were healthy controls in a prospective, case-control study.

“Children with epilepsy have a significant vulnerability to psychiatric comorbidity,” said Jana E. Jones, Ph.D., and her associates at the University of Wisconsin, Madison. “It will be important to study these children over multiple time points in order to begin to understand the trajectory of psychiatric disorders in epilepsy.”

At baseline, 17%-34% of children with epilepsy had depression, anxiety, or attention-deficit hyperactivity disorder (ADHD), compared with 3%-16% of their age- and sex-matched first-degree cousins (P = .01 for all), the researchers found. Two years later, anxiety still occurred significantly more often among patients in the epilepsy group (31% vs. 10% for controls; P< .001), as did ADHD (19% vs. 4%, respectively; P = .01), they said. These differences remained significant for subgroups of children with focal and generalized epilepsy, compared with controls, Dr. Jones reported at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

The prevalence of depression also remained higher in the epilepsy group at 2-year follow-up (8% vs. 3% for controls), but the difference was not statistically significant. Factors such as age of epilepsy onset, duration of seizures, and number of medications did not appear to affect the likelihood of Axis I disorders, the researchers said.

As recently as 2012, little was known about psychiatric comorbidities in children with epilepsy, said the investigators, noting that their study is the first prospective one of 2 years’ duration on the topic.

The study included 163 children aged 8-18 years. At baseline, all 92 children in the epilepsy group had been diagnosed in the past 12 months and had no other neurologic disorders or developmental disabilities. The researchers identified Axis I disorders by using the Schedule for Affective Disorders and Schizophrenia.

The analysis also found that IQ scores for children with epilepsy averaged 100.8 points (standard deviation, 13.7), which was significantly lower than the mean of 108.4 (SD, 11.1) for the control group.

The National Institutes of Health supported the research. The researchers reported no conflicts of interest.

SAN DIEGO– Children of very low birthweight had higher rates of mental health disorders 10 to 14 years later than did age-matched controls, but teachers generally did not detect these differences, and instead their mental health assessments were associated with children’s socioeconomic status, a prospective study found.

The finding “has implications for mental health service access” and shows that teachers need education about the long-term mental health risks faced by very-low-birthweight (VLBW) children, said Dr. Fiona McNicholas, a visiting professor at Stanford (Calif.) University, and her associates. Clinicians should routinely follow VLBW children and should promote early environmental enrichment for these children, the investigators said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Dr. McNicholas and her associates studied 65 children in Dublin, Ireland, who averaged 11.6 years of age (range, 10-14 years) and had weighed less than 1,500 g, or 3.3 pounds, at birth. The investigators matched each VLBW child with the next child born in the same maternity ward who was of normal birthweight and the same sex. Children, their parents, and their teachers all responded to the Strengths & Difficulties Questionnaire (SDQ, http://www.sdqinfo.com/) regarding the children. The investigators also assessed the children using the Developmental Well-Being Assessment (http://www.dawba.com/), they said.Almost one-third (32%) of the VLBW cohort had a mental health diagnosis on the DAWBA, which resembled findings from a recent study in Norway (http://www.ncbi.nlm.nih.gov/pubmed/22752364), reported Dr. McNicholas, also a professor of psychiatry at University College, Dublin. In contrast, only 14% of controls had a DAWBA diagnosis (P = .03), they said.

The rate of abnormal or clinical scores on the SDQ also was four to five times greater for VLBW children, compared with controls, based on child self-report (20% vs. 4%; P = .028) and parental report (32% vs. 8%; P = .007). Teachers “generally underreported pathology,” the investigators said, so scoring between the two groups (8% vs. 2%; P = .463) while large did not achieve statistical significance. The most common diagnosis was attention-deficit/hyperactivity disorder, which affected 17% of VLBW children and 8% of controls, the researchers added. Anxiety disorders were also common, and rates were slightly higher in VLBW children (12.5%) than among controls (9.8%).

In an analysis of variance test, teachers’ assessments of total SDQ scores depended on children’s socioeconomic status (P < .05) but not on birthweight, IQ score, or gender, reported Dr. McNicholas and her associates. “Initial investment needs to be met with ongoing surveillance and psychoeducation to ensure that disorders are recognized early and offered appropriate interventions,” the investigators concluded.

The overall rate of consent to participate among VLBW children was only 50%, and participants were of higher socioeconomic status than were nonparticipants (P < .001), the researchers noted.

Shire supported the research. The investigators reported advisory board relationships with Shire and received conference and travel support from the company. They declared no other conflicts of interest.

SAN DIEGO– Children of very low birthweight had higher rates of mental health disorders 10 to 14 years later than did age-matched controls, but teachers generally did not detect these differences, and instead their mental health assessments were associated with children’s socioeconomic status, a prospective study found.

The finding “has implications for mental health service access” and shows that teachers need education about the long-term mental health risks faced by very-low-birthweight (VLBW) children, said Dr. Fiona McNicholas, a visiting professor at Stanford (Calif.) University, and her associates. Clinicians should routinely follow VLBW children and should promote early environmental enrichment for these children, the investigators said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Dr. McNicholas and her associates studied 65 children in Dublin, Ireland, who averaged 11.6 years of age (range, 10-14 years) and had weighed less than 1,500 g, or 3.3 pounds, at birth. The investigators matched each VLBW child with the next child born in the same maternity ward who was of normal birthweight and the same sex. Children, their parents, and their teachers all responded to the Strengths & Difficulties Questionnaire (SDQ, http://www.sdqinfo.com/) regarding the children. The investigators also assessed the children using the Developmental Well-Being Assessment (http://www.dawba.com/), they said.Almost one-third (32%) of the VLBW cohort had a mental health diagnosis on the DAWBA, which resembled findings from a recent study in Norway (http://www.ncbi.nlm.nih.gov/pubmed/22752364), reported Dr. McNicholas, also a professor of psychiatry at University College, Dublin. In contrast, only 14% of controls had a DAWBA diagnosis (P = .03), they said.

The rate of abnormal or clinical scores on the SDQ also was four to five times greater for VLBW children, compared with controls, based on child self-report (20% vs. 4%; P = .028) and parental report (32% vs. 8%; P = .007). Teachers “generally underreported pathology,” the investigators said, so scoring between the two groups (8% vs. 2%; P = .463) while large did not achieve statistical significance. The most common diagnosis was attention-deficit/hyperactivity disorder, which affected 17% of VLBW children and 8% of controls, the researchers added. Anxiety disorders were also common, and rates were slightly higher in VLBW children (12.5%) than among controls (9.8%).

In an analysis of variance test, teachers’ assessments of total SDQ scores depended on children’s socioeconomic status (P < .05) but not on birthweight, IQ score, or gender, reported Dr. McNicholas and her associates. “Initial investment needs to be met with ongoing surveillance and psychoeducation to ensure that disorders are recognized early and offered appropriate interventions,” the investigators concluded.

The overall rate of consent to participate among VLBW children was only 50%, and participants were of higher socioeconomic status than were nonparticipants (P < .001), the researchers noted.

Shire supported the research. The investigators reported advisory board relationships with Shire and received conference and travel support from the company. They declared no other conflicts of interest.

SAN DIEGO– Children of very low birthweight had higher rates of mental health disorders 10 to 14 years later than did age-matched controls, but teachers generally did not detect these differences, and instead their mental health assessments were associated with children’s socioeconomic status, a prospective study found.

The finding “has implications for mental health service access” and shows that teachers need education about the long-term mental health risks faced by very-low-birthweight (VLBW) children, said Dr. Fiona McNicholas, a visiting professor at Stanford (Calif.) University, and her associates. Clinicians should routinely follow VLBW children and should promote early environmental enrichment for these children, the investigators said at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Dr. McNicholas and her associates studied 65 children in Dublin, Ireland, who averaged 11.6 years of age (range, 10-14 years) and had weighed less than 1,500 g, or 3.3 pounds, at birth. The investigators matched each VLBW child with the next child born in the same maternity ward who was of normal birthweight and the same sex. Children, their parents, and their teachers all responded to the Strengths & Difficulties Questionnaire (SDQ, http://www.sdqinfo.com/) regarding the children. The investigators also assessed the children using the Developmental Well-Being Assessment (http://www.dawba.com/), they said.Almost one-third (32%) of the VLBW cohort had a mental health diagnosis on the DAWBA, which resembled findings from a recent study in Norway (http://www.ncbi.nlm.nih.gov/pubmed/22752364), reported Dr. McNicholas, also a professor of psychiatry at University College, Dublin. In contrast, only 14% of controls had a DAWBA diagnosis (P = .03), they said.

The rate of abnormal or clinical scores on the SDQ also was four to five times greater for VLBW children, compared with controls, based on child self-report (20% vs. 4%; P = .028) and parental report (32% vs. 8%; P = .007). Teachers “generally underreported pathology,” the investigators said, so scoring between the two groups (8% vs. 2%; P = .463) while large did not achieve statistical significance. The most common diagnosis was attention-deficit/hyperactivity disorder, which affected 17% of VLBW children and 8% of controls, the researchers added. Anxiety disorders were also common, and rates were slightly higher in VLBW children (12.5%) than among controls (9.8%).

In an analysis of variance test, teachers’ assessments of total SDQ scores depended on children’s socioeconomic status (P < .05) but not on birthweight, IQ score, or gender, reported Dr. McNicholas and her associates. “Initial investment needs to be met with ongoing surveillance and psychoeducation to ensure that disorders are recognized early and offered appropriate interventions,” the investigators concluded.

The overall rate of consent to participate among VLBW children was only 50%, and participants were of higher socioeconomic status than were nonparticipants (P < .001), the researchers noted.

Shire supported the research. The investigators reported advisory board relationships with Shire and received conference and travel support from the company. They declared no other conflicts of interest.