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3.11 NEUROPSYCHOLOGICAL DYSFUNCTION IN COLLEGE STUDENTS WHO MISUSE STIMULANTS
NEW RESEARCH POSTERS 3.10 – 3.12
pediatrician attitudes and comfort level regarding practical implementation of the SBIRT model.
EBP NIDA SUD Supported by the NIDA-AACAP Resident Training Award (NIDA task order number HHSN271201500070C) http://dx.doi.org/10.1016/j.jaac.2016.09.140
3.10 SPECIFIC DIFFERENCES IN AUDITORY BRAIN STEM RESPONSE IN YOUNG PATIENTS WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER Emma Linnea Claesdotter-Hybbinette, MD, Dept of Child and Adolescent Psychiatry, Lund University, Lovisastigen 13, Lund, Sweden; Matti Cervin; Sofia Akerlund; Maria Råstam, MD; Magnus Lindvall Objectives: The auditory brainstem response (ABR) is often affected in neurodevelopmental disorders. The aim of this study was to investigate differences in ABR in young females and young males with ADHD compared to control subjects. Methods: We studied 63 drug naïve females with ADHD and no comorbidity (mean 13.8 years, SD 2.5), 26 female controls with no psychiatric record (mean 13.8 years, SD 2.7), 48 drug naïve males with ADHD and no comorbidity (mean 13.1 years, SD 1.8), and 20 male controls with no psychiatric record (mean 12.8 years, SD 1.7). All patients were diagnosed according to the DSM-IV. The ABR consists of seven peaks (wave I–VII) that occur 10 ms following a stimulus recorded by electrodes on the mastoid processes of each ear and on the forehead. Results: Comparing the ABR of 63 girls with ADHD to 26 age correlated control subjects 3 traits were identified, denoted TR6, TR14 and TR15. The higher value in TR6 (p¼0.000064), is explained by more aberrant curve profiles in the thalamic region. In TR14, the aberration was found in a region from superior olivary complex to thalamus (p¼0.00059). TR15 (p¼0.00035), is explained by more aberrant curve profiles in the lateral leminiscus. When looking at the ABR from 48 young males with ADHD and comparing them to 20 age correlated control subjects, we found 3 traits; TR4, TR5 and TR14. TR 4 is a lower correlation to a norm curve in inferior colliculus and thalamic area (p¼0.00105). TR5 identifies irregular curve profiles representing the nucleus cochlea (p¼0,00027). TR14, is described as an aberration in superior olivary complex to thalamus(p¼0.00013). Bonferroni correction was used to account for multiple comparisons. Conclusions: These data indicate specific aberrations in the ABR in ADHD subjects compared to normal controls. Young females with ADHD exhibited a significantly different ABR in a region between cochlear nucleus and superior olivary complex and in the thalamic region. In the male ADHD group ABR aberrancy was found in the midbrain region and in the more peripheral part; nucleus cocleus. To further substantiate our findings there is a need for longitudinal studies with control subjects with other psychiatric diagnoses.
ADHD DIAG ND http://dx.doi.org/10.1016/j.jaac.2016.09.142
3.11 NEUROPSYCHOLOGICAL DYSFUNCTION IN COLLEGE STUDENTS WHO MISUSE STIMULANTS Timothy E. Wilens, MD, Psychopharmacology, Massachusetts General Hospital, 55 Fruit St, Yawkey 6900, Boston, MA 021142696; Nicholas W. Carrellas, BA; MaryKate Martelon, MSPH; Courtney Zulauf, BA; Nicholas R. Morrison, MS; Andrew Simon, MS; Amy Yule, MD; Ronna S. Fried, EdD; Rayce Anselmo, PsyD Objectives: Relatively little is known about the neuropsychological profiles of college students who misuse stimulants. Methods: The data presented are from college students who misused prescription stimulant medications (not including cocaine, methamphetamine)
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
and from control subjects (no stimulant misuse). Students were assessed neuropsychologically using the clinically relevant Behavioral Rating Inventory of Executive Functioning (BRIEF), the Cambridge Automated Neuropsychological Test and Battery (CANTAB), and other tests of cognitive functioning. Results: The analysis included 198 control subjects [age 20.7 2.6 years (SD)] and 100 stimulant misusers (20.7 1.7 years). Compared with control subjects, misusers were more likely to have repeated a grade in school (P ¼ 0.03) and to have a lower digit span-scaled score (P ¼ 0.03). On the BRIEF, misusers were significantly more likely to have higher scores on 8 of 12 subscales, including inhibition (P ¼ 0.001), initiation (P ¼ 0.04), working memory (P ¼ 0.01), plan/organize (P ¼ 0.02), and self-monitoring (P ¼ 0.01), when adjusting for race and sex. Likewise, when dichotomizing the BRIEF as abnormal (T score > 65), misusers had more abnormalities than control subjects in five of nine specific subscales, as well as overall metacognition, behavioral regulation, and global index (P < 0.05). On the CANTAB, male misusers were more likely to have a lower value for the number of problems solved in minimal moves than male control subjects (P ¼ 0.046). For the visual processing, male misusers were significantly more likely to have a lower score compared with male control subjects (P ¼ 0.007). For other tests of the CANTAB, we found that misusers were more likely to have a higher score on the correct latency-median-positive compared with control subjects (P ¼ 0.01). Conclusions: These data are among the first to demonstrate higher risk for neuropsychological dysfunction in college students who misuse stimulants compared with students who do not misuse stimulants.
ADHD STIM SUD Supported by NIH grant K24DA016264 http://dx.doi.org/10.1016/j.jaac.2016.09.143
3.12 CHILDHOOD PREDICTORS OF SUBSTANCE USE DISORDER IN ADULTHOOD: A 12-YEAR LONGITUDINAL INVESTIGATION Mini Tandon, DO, Psychiatry (Child Division), Washington University in St. Louis, 4444 Forest Park Avenue, Box 8134, St. Louis, MO 63108; Rebecca Tillman, MS; Joan L. Luby, MD Objectives: The authors investigated childhood predictors of SUD in adulthood, using data from a comprehensive, longitudinal study over 12 years, originally ascertained for the study of BD. We hypothesized that mania would be a key predictor of adult SUD. Methods: A total of 268 participants (ages 7–16 years) at baseline were assessed comprehensively using the Washington University in St. Louis KSADS as part of the longitudinal Phenomenology and Course of Pediatric BD-I study (PI MH-53063). Participants were assessed every 2 years over a period of 12 years. Family history was assessed directly by interview of parents and siblings in 90 percent of the families. Adaptive functioning was measured with The Children’s Global Assessment Scale (CGAS). SUD was defined using DSM-IV criteria, including for alcohol, marijuana, and other illicit drug use (e.g., sedatives, opioids, cocaine, other). A subset of participants (N ¼ 154) was assessed as adults approximately 3.5 years after the original study was completed by new raters not involved in the childhood study and blind to subject characteristics. SUD was assessed at this time with the NetSCID (Structured Clinical Interview for DSM Disorders). Childhood predictors of adult SUD outcomes using logistic regression models were conducted. Dependent variables in three separate models were SUD, alcohol use disorder, and drug use disorder. Covariates in the models were gender, childhood SES, and family SUD. Results: Mania did not predict adult SUD after controlling for family SUD. Childhood CGAS scores were associated significantly with adult substance, alcohol, and drug use disorders after accounting for gender, childhood SES, family SUD, and the additional covariate childhood mania diagnosis. Odds ratios indicate that a one-point decrease in childhood CGAS score corresponds to a 6 percent increase in the odds of developing adult substance (P ¼ 0.0011), alcohol (P ¼ 0.0015), and drug use disorders (P ¼ 0.0033).
www.jaacap.org
S145
pediatrician attitudes and comfort level regarding practical implementation of the SBIRT model.
EBP NIDA SUD Supported by the NIDA-AACAP Resident Training Award (NIDA task order number HHSN271201500070C) http://dx.doi.org/10.1016/j.jaac.2016.09.140
3.10 SPECIFIC DIFFERENCES IN AUDITORY BRAIN STEM RESPONSE IN YOUNG PATIENTS WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER Emma Linnea Claesdotter-Hybbinette, MD, Dept of Child and Adolescent Psychiatry, Lund University, Lovisastigen 13, Lund, Sweden; Matti Cervin; Sofia Akerlund; Maria Råstam, MD; Magnus Lindvall Objectives: The auditory brainstem response (ABR) is often affected in neurodevelopmental disorders. The aim of this study was to investigate differences in ABR in young females and young males with ADHD compared to control subjects. Methods: We studied 63 drug naïve females with ADHD and no comorbidity (mean 13.8 years, SD 2.5), 26 female controls with no psychiatric record (mean 13.8 years, SD 2.7), 48 drug naïve males with ADHD and no comorbidity (mean 13.1 years, SD 1.8), and 20 male controls with no psychiatric record (mean 12.8 years, SD 1.7). All patients were diagnosed according to the DSM-IV. The ABR consists of seven peaks (wave I–VII) that occur 10 ms following a stimulus recorded by electrodes on the mastoid processes of each ear and on the forehead. Results: Comparing the ABR of 63 girls with ADHD to 26 age correlated control subjects 3 traits were identified, denoted TR6, TR14 and TR15. The higher value in TR6 (p¼0.000064), is explained by more aberrant curve profiles in the thalamic region. In TR14, the aberration was found in a region from superior olivary complex to thalamus (p¼0.00059). TR15 (p¼0.00035), is explained by more aberrant curve profiles in the lateral leminiscus. When looking at the ABR from 48 young males with ADHD and comparing them to 20 age correlated control subjects, we found 3 traits; TR4, TR5 and TR14. TR 4 is a lower correlation to a norm curve in inferior colliculus and thalamic area (p¼0.00105). TR5 identifies irregular curve profiles representing the nucleus cochlea (p¼0,00027). TR14, is described as an aberration in superior olivary complex to thalamus(p¼0.00013). Bonferroni correction was used to account for multiple comparisons. Conclusions: These data indicate specific aberrations in the ABR in ADHD subjects compared to normal controls. Young females with ADHD exhibited a significantly different ABR in a region between cochlear nucleus and superior olivary complex and in the thalamic region. In the male ADHD group ABR aberrancy was found in the midbrain region and in the more peripheral part; nucleus cocleus. To further substantiate our findings there is a need for longitudinal studies with control subjects with other psychiatric diagnoses.
ADHD DIAG ND http://dx.doi.org/10.1016/j.jaac.2016.09.142
3.11 NEUROPSYCHOLOGICAL DYSFUNCTION IN COLLEGE STUDENTS WHO MISUSE STIMULANTS Timothy E. Wilens, MD, Psychopharmacology, Massachusetts General Hospital, 55 Fruit St, Yawkey 6900, Boston, MA 021142696; Nicholas W. Carrellas, BA; MaryKate Martelon, MSPH; Courtney Zulauf, BA; Nicholas R. Morrison, MS; Andrew Simon, MS; Amy Yule, MD; Ronna S. Fried, EdD; Rayce Anselmo, PsyD Objectives: Relatively little is known about the neuropsychological profiles of college students who misuse stimulants. Methods: The data presented are from college students who misused prescription stimulant medications (not including cocaine, methamphetamine)
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
and from control subjects (no stimulant misuse). Students were assessed neuropsychologically using the clinically relevant Behavioral Rating Inventory of Executive Functioning (BRIEF), the Cambridge Automated Neuropsychological Test and Battery (CANTAB), and other tests of cognitive functioning. Results: The analysis included 198 control subjects [age 20.7 2.6 years (SD)] and 100 stimulant misusers (20.7 1.7 years). Compared with control subjects, misusers were more likely to have repeated a grade in school (P ¼ 0.03) and to have a lower digit span-scaled score (P ¼ 0.03). On the BRIEF, misusers were significantly more likely to have higher scores on 8 of 12 subscales, including inhibition (P ¼ 0.001), initiation (P ¼ 0.04), working memory (P ¼ 0.01), plan/organize (P ¼ 0.02), and self-monitoring (P ¼ 0.01), when adjusting for race and sex. Likewise, when dichotomizing the BRIEF as abnormal (T score > 65), misusers had more abnormalities than control subjects in five of nine specific subscales, as well as overall metacognition, behavioral regulation, and global index (P < 0.05). On the CANTAB, male misusers were more likely to have a lower value for the number of problems solved in minimal moves than male control subjects (P ¼ 0.046). For the visual processing, male misusers were significantly more likely to have a lower score compared with male control subjects (P ¼ 0.007). For other tests of the CANTAB, we found that misusers were more likely to have a higher score on the correct latency-median-positive compared with control subjects (P ¼ 0.01). Conclusions: These data are among the first to demonstrate higher risk for neuropsychological dysfunction in college students who misuse stimulants compared with students who do not misuse stimulants.
ADHD STIM SUD Supported by NIH grant K24DA016264 http://dx.doi.org/10.1016/j.jaac.2016.09.143
3.12 CHILDHOOD PREDICTORS OF SUBSTANCE USE DISORDER IN ADULTHOOD: A 12-YEAR LONGITUDINAL INVESTIGATION Mini Tandon, DO, Psychiatry (Child Division), Washington University in St. Louis, 4444 Forest Park Avenue, Box 8134, St. Louis, MO 63108; Rebecca Tillman, MS; Joan L. Luby, MD Objectives: The authors investigated childhood predictors of SUD in adulthood, using data from a comprehensive, longitudinal study over 12 years, originally ascertained for the study of BD. We hypothesized that mania would be a key predictor of adult SUD. Methods: A total of 268 participants (ages 7–16 years) at baseline were assessed comprehensively using the Washington University in St. Louis KSADS as part of the longitudinal Phenomenology and Course of Pediatric BD-I study (PI MH-53063). Participants were assessed every 2 years over a period of 12 years. Family history was assessed directly by interview of parents and siblings in 90 percent of the families. Adaptive functioning was measured with The Children’s Global Assessment Scale (CGAS). SUD was defined using DSM-IV criteria, including for alcohol, marijuana, and other illicit drug use (e.g., sedatives, opioids, cocaine, other). A subset of participants (N ¼ 154) was assessed as adults approximately 3.5 years after the original study was completed by new raters not involved in the childhood study and blind to subject characteristics. SUD was assessed at this time with the NetSCID (Structured Clinical Interview for DSM Disorders). Childhood predictors of adult SUD outcomes using logistic regression models were conducted. Dependent variables in three separate models were SUD, alcohol use disorder, and drug use disorder. Covariates in the models were gender, childhood SES, and family SUD. Results: Mania did not predict adult SUD after controlling for family SUD. Childhood CGAS scores were associated significantly with adult substance, alcohol, and drug use disorders after accounting for gender, childhood SES, family SUD, and the additional covariate childhood mania diagnosis. Odds ratios indicate that a one-point decrease in childhood CGAS score corresponds to a 6 percent increase in the odds of developing adult substance (P ¼ 0.0011), alcohol (P ¼ 0.0015), and drug use disorders (P ¼ 0.0033).
www.jaacap.org
S145