- Email: [email protected]
6.75 THE ASSOCIATIONS BETWEEN ADOLESCENTS' SUBSTANCE USE, DEVIANT BEHAVIORS, SELF-REPORTED HEALTH, AND CYBERDATING ABUSE PERPETRATION
NEW RESEARCH POSTERS 6.73 – 6.75
6.73 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER AND CIGARETTE SMOKING: UNDERSTANDING THE FACTORS THAT INCREASE RISK OF SMOKING AMONG INDIVIDUALS WITH A HISTORY OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER Jessica D. Rhodes, PhD; Elizabeth M. Gnagy; William E. Pelham Jr., PhD; Brooke S.G. Molina, PhD, Psychiatry & Psychology, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213 Objectives: Children with ADHD are more likely to become regular cigarette smokers and to demonstrate more severe smoking behaviors. Specific smoking factors are prognostic of future abstinence and are considered risk factors for those with ADHD. It is likely the culmination of a number of factors that result in the risk of smoking among individuals with a history of ADHD. The present study hypothesized that 1) individuals with ADHD would be more likely to be daily smokers and smoke more in adulthood, as well as report more severe risk profiles, and 2) the risk profile would partially mediate the ADHD-smoking relationship. Methods: Data were used from the Pittsburgh ADHD Longitudinal Study (PALS). Participants included ADHD (n¼364; 89 percent male, 79 percent Caucasian) and nonADHD (n¼240; 89% male, 85% Caucasian) groups. ADHD probands were diagnosed in childhood using comprehensive procedures between 1987 and 1996. Annual and age-specific interviews were completed with all participants. A risk profile was created based on self-reported age of initiation, quantity of use, and withdrawal and craving severity during ages 1825. Smoking outcomes were at age 29/30 follow-up. Results: Childhood ADHD significantly predicted both adult daily smoking (Wald ¼ 9.9, p ¼ .002) and higher quantities (Wald ¼ 15.3, p<.001). A more severe risk profile significantly predicted adult daily smoking (Wald¼50.5, p<.001) and quantity (Wald¼35.8, p<.001). The risk profile partially mediated the relationship between ADHD history and daily smoking (Wald¼5.6, p¼.02, k2 ¼ 0.05), but did not mediate ADHD history and quantity (Wald¼14.4, p<.001, k2 ¼ 0.02). Conclusions: This is the first study, to our knowledge, to demonstrate that a more severe risk profile partially mediates the relationship between ADHD symptoms in childhood and daily smoking in adulthood. Contrary to hypotheses, the risk profile did not mediate the relationship between ADHD symptoms in childhood and quantity of cigarette consumption in adulthood. Processes such as social influences and nicotine sensitivity may contribute to the differential outcomes. The present study demonstrates that there are a number of factors that place individuals with a childhood history of ADHD at risk of smoking, and as such ought to be targeted in prevention and treatment efforts.
ADHD NIC SUD Supported by NIH grants AA011873 and DA12414 http://dx.doi.org/10.1016/j.jaac.2016.09.392
6.74 SUBSTANCE USE ESCALATION INTO EARLY ADULTHOOD AMONG THE CHILDREN IN THE MTA Brooke S.G. Molina, PhD, Psychiatry & Psychology, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213; Andrea L. Howard, PhD; James M. Swanson, PhD; Annamarie Stehli, MPH; John T. Mitchell, PhD Objectives: Children with ADHD report more substance use disorders by adulthood, but there is heterogeneity in the findings and little understanding in the progression. This study makes use of the longitudinal follow-up of the children in the multimodal treatment of ADHD (MTA) study to examine substance-specific escalation into early adulthood. We also tested the hypothesis that atypical teenage substance use may portend a particularly worsened prognosis for children with ADHD. Methods: A total of 579 children were diagnosed with DSM-IV-classified ADHD, combined subtype, and 258 children of Local Normative Comparison
S228
www.jaacap.org
Group (LNCG) without ADHD were followed to a mean age (Mage) of 25 years. Substance use was self-reported up to eight times using the Substance Use Questionnaire. SUD data were taken from 411 to 434 children with ADHD and from 219 to 229 children from LNCG (12, 14, and 16 years after ADHD baseline into adulthood). Results: ADHD group predicted more weekly marijuana use at Mage ¼ 25 (32.4 vs. 21.1 percent, P ¼ 0.0028) and daily smoking at all adult waves (e.g., 35.4 vs. 16.4 percent LNCG, P < 0.0001 at Mage ¼ 25) but not binge alcohol (35 percent at least monthly in both groups) or illicit drug use. Non-marijuana illicit and prescription drug misuse rates were low (e.g., 4.1 percent for stimulant misuse at age 25, both groups). Piece-wise latent growth curve models for categorical variables tested group differences in rate of change and frequency of use in adolescence (piece 1) and early adulthood (piece 2). Both groups demonstrated expected increases in substance use through adolescence but stable frequencies in early adulthood. Early and/or heavy adolescent substance use [52.5 percent ADHD, 39.5 percent LNCG, X2(1) ¼ 12.02, P ¼ 0.0005] predicted more frequent substance use at age 25 but not differently for the ADHD compared with LNCG groups. Conclusions: Support for our hypotheses was mixed, but the finding of increased regular marijuana use for children with ADHD was particularly important, given the heterogeneity across prior studies. Given the prognostic value of early/heavy teenage substance use for adult substance use and the chronicity of ADHD, our findings suggest that prevention and continued monitoring may be necessary to forestall the development of substancerelated problems in early adulthood.
ALC ADHD SUD Supported by NIDA DA039881 http://dx.doi.org/10.1016/j.jaac.2016.09.393
6.75 THE ASSOCIATIONS BETWEEN ADOLESCENTS’ SUBSTANCE USE, DEVIANT BEHAVIORS, SELF-REPORTED HEALTH, AND CYBERDATING ABUSE PERPETRATION Joris Van Ouytsel, MSc, Department of Communication Studies, University of Antwerp, Sint- Jacobstraat 2-4, Antwerp, 2000, Belgium; Elizabeth Torres, MPH; Koen Ponnet, PhD; Michel Walrave, PhD; Hye Jeong Choi, PhD; Jeff R. Temple, PhD Objectives: Little is known about how adolescent risk behaviors are related to Cyber Dating Abuse (CDA) perpetration. The present study focuses on the associations between sexual risk behaviors, substance use, self-reported health, deviant behaviors, and CDA perpetration. Methods: We report on a survey that was conducted among 705 respondents (n¼408; 57.9 percent Results: Adolescents with a self-reported history of sexual intercourse were more likely to engage in CDA perpetration than those who did reported that they did not have sexual intercourse (aOR:2.15;CI:1.18–3.93). Similarly, students who used substances (alcohol or drugs) prior to having sexual intercourse were more likely to have perpetrated CDA (aOR:1.32;CI: 1.03–1.70). Youth who reported use of alcohol (aOR:1.67;CI:1.03–2.72) and cigarettes (aOR:1.77; CI:1.13–2.78), and the misuse of over-the-counter (aOR:2.28; CI:1.13–4.63) and prescription (aOR:2.44;CI:1.41–4.24) medications were more likely to have engaged in CDA perpetration than their non-substance using counterparts. Youth who evaluated their physical health as worse than most teens their age were more likely to have engaged in CDA perpetration (aOR:5.79;CI: 2.89–11.60). Adolescents who reported bullying victimization (aOR:1.53;CI: 1.16–2.03) or perpetration (aOR:1.75;CI:1.28–2.38) were more likely to have engaged in CDA perpetration. Conclusions: Our results suggest that prevention efforts targeting dating violence and CDA could also discuss adolescents’ substance use, and that youth who use these substances might be a target group of prevention campaigns. Given the links with sexual behaviors comprehensive sexual education interventions may benefit from discussing CDA prevention and vice versa. CDA was also linked with engagement in cyber bullying. Coercive relationships with peers might be continued by these adolescents within their romantic relationships, and bullying and dating abuse might share similar
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
NEW RESEARCH POSTERS 6.76 – 6.78
underlying factors. The results have important implications for future research, prevention and intervention.
AGG ALC MED Supported by the National Institute of Child Health and Human Development (NICHD) grant K23HD059916 and the National Institute of Justice grant 2012-WG-BX-0005, and the Research Foundation - Flanders fellowship (FWO-Aspirant) http://dx.doi.org/10.1016/j.jaac.2016.09.394
6.76 SOCIODEMOGRAPHIC PROFILE AND MANAGEMENT IDENTIFICATION OF AGGRESSIVE PATIENTS AGED 6 TO 17 IN THE EMERGENCY ROOM AT UNIVERSITY OF PUERTO RICO HOSPITAL Joalex L. Antongiorgi, MD; Gustavo Fors, MD; JeanMarie Acevedo, PhD; Gloria Gonzalez Tejera, MD; Gloria M. Suau Sanchidrian, MD, Psychiatry, University of Puerto Rico, PO Box 365067, San Juan, PR 00936-5067 Objectives: For the last few decades, studies have determined that exposure to violence and traumatic events are common in children and adolescents. Childhood violence or trauma that goes unattended can affect the individual’s development and may lead to future psychological or psychiatric disorder. This study reports on the sociodemographic profile of this population and evaluates risk factors. Methods: From 2012- 2014, information data was gathered from 103 patients aged 6- 17 who were evaluated in an emergency room setting due to complaints of aggressiveness or related keywords. A protocol sheet was designed to gather information regarding risk factors that were documented by physicians. Results: The demographic data consists, mainly, of males from the metropolitan area with previous psychiatric diagnosis. When evaluating previous episodes of aggressive behavior, only 60 percent of the examined records documented this risk factor, and from this data we found 87 percent of those patients had a positive history of aggressive behavior. Screening for family history of violence was documented in 34 percent of the cases, and those reflected 53 percent as present. Only 45 percent of the examined records reported if the patient had been victims of violence, however the majority (73 percent) of those documented were victims of violence. We also found that only 47 percent of the patients had adequate substance abuse screening. From those that were documented, 68 percent of those presented with a history of substance abuse. Conclusions: From all the cases studied, only 46 percent were correctly documented with all of the pertinent risk factors. The results available support the literature that, in patients with aggressive behavior, being victims of violence, substance abusers and presenting with a history of violence are strong risk factors. Further study will be required after implementation of physician education and the use of Protocol Sheet created that was inspired by these findings.
AGG CON RF http://dx.doi.org/10.1016/j.jaac.2016.09.395
6.77 INTEGRATING BEHAVIORISM AND ATTACHMENT THEORY IN ADDRESSING DISRUPTIVE BEHAVIOR Beth Renee Troutman, PhD, Carver College of Medicine, Psychiatry Research, 1-182 Medical Education Building, Iowa City, IA 52242-1057 Objectives: This poster presents the results of a small open trial of a parent coaching approach integrating behaviorism and attachment theory in the treatment of children referred for disruptive behavior. Integration of Working Models of Attachment into Parent-Child Interaction Therapy (IoWA-PCIT) (Troutman, 2015; Troutman, 2016a; Troutman, 2016b) is a modification of an
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
evidence-based behavioral parent training intervention (Eyberg & Funderburk, 2011). Methods: This clinical trial is based on fifty children and their caregivers (biological, foster, and adoptive parents) referred for treatment to a clinic specializing in young children with disruptive behavior. The clinic is located in an academic department of Child and Adolescent Psychiatry. At the initial evaluation, caregiver(s) completed ratings of their child’s disruptive behavior on the Eyberg Child Behavior Inventory (ECBI). The ECBI was also completed at each subsequent session of IoWA-PCIT. Results: Forty-five of the 50 children referred for treatment (90%) participated in at least 3 sessions of IoWA-PCIT with their caregiver(s) and were included in analyses (mean number of sessions including evaluation session ¼ 13.8). Results indicate children participating in IoWA-PCIT with their caregivers exhibit significant decreases in overall level of disruptive behavior, as indicated by changes on the ECBI intensity scale (mother ratings t(44) ¼ 9.1, p < .001; father ratings t(17) ¼ 4.3, p < .001) and significant decreases in number of behavior problems, as indicated by changes on the ECBI problem scale (mother ratings t(44) ¼ 6.9, p < .001; father ratings t(17) ¼ 5.5, p < .001). Conclusions: Results suggest modifying a behavioral parent training intervention by incorporating principles from attachment theory and techniques from interventions based on attachment theory did not reduce effectiveness and improved retention of families in treatment. Future research on IoWAPCIT using a randomized controlled trial is needed to establish efficacy. Research assessing security of attachment pre- and post-IoWA-PCIT is needed to determine impact of this intervention on attachment.
ATTACH OPDD P http://dx.doi.org/10.1016/j.jaac.2016.09.396
6.78 CHILDREN WITH OPPOSITIONAL DEFIANT DISORDER IN THE DANISH NATIONAL BIRTH COHORT Rune V. Kristensen, MD; Argyris Stringaris, PhD; Rikke Wesselhoeft, PhD, Research Unit of Child and Adolescent Mental Health & Research Unit of E-Mental Health, University of Southern Denmark, Sdr. Boulevard 29, Odense, 5000, Denmark Objectives: The diagnosis of childhood ODD reflects both behavioral and affective symptomatology that may be divided into three dimensions: irritable, headstrong, and hurtful. It is well known that children with ODD have a marked risk for concurrent and later psychopathology. However, it seems that the type of psychopathology (internalizing vs. externalizing) is dependent on the ODD symptom distribution between dimensions. The aims of the study were: 1) To estimate the prevalence of ODD in a Danish National Birth Cohort (DNBC); 2) To examine how the ODD symptom presentation divided into the three dimensions is associated with comorbid psychopathology; and 3) To examine to what extent children with ODD are exposed to life stressors. Methods: The study had a two-phase nested case-control design in the DNBC. Mothers of 3,421 DNBC children (age 8-10 years) completed the online Development and Well-Being Assessment (DAWBA). Results: The DNBC ODD total point prevalence was 1.0 percent. The irritable dimension was associated with co-occurring emotional disorders (OR 3.4; p<0.001). Children with ODD were more often exposed to school-related stressors than non-ODD children (OR 16.8; CI 10.1-26.5). Conclusions: ODD is not a common disorder in DNBC. The irritable dimension, and not the headstrong or hurtful dimension, is associated with concurrent emotional disorder. Environmental stressors previously found to be associated with ODD are confirmed.
CM OPDD SAC Supported by the Danish National Research Foundation, the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, the Augustinus Foundation, the Health Foundation, the Lundbeck Foundation (195/04) the Danish Medical Research Council (SSVF 0646) the Psychiatric Research Fund of the Region of Southern Denmark, the Lundbeck Foundation, and the University of Southern Denmark http://dx.doi.org/10.1016/j.jaac.2016.09.397
www.jaacap.org
S229
6.73 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER AND CIGARETTE SMOKING: UNDERSTANDING THE FACTORS THAT INCREASE RISK OF SMOKING AMONG INDIVIDUALS WITH A HISTORY OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER Jessica D. Rhodes, PhD; Elizabeth M. Gnagy; William E. Pelham Jr., PhD; Brooke S.G. Molina, PhD, Psychiatry & Psychology, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213 Objectives: Children with ADHD are more likely to become regular cigarette smokers and to demonstrate more severe smoking behaviors. Specific smoking factors are prognostic of future abstinence and are considered risk factors for those with ADHD. It is likely the culmination of a number of factors that result in the risk of smoking among individuals with a history of ADHD. The present study hypothesized that 1) individuals with ADHD would be more likely to be daily smokers and smoke more in adulthood, as well as report more severe risk profiles, and 2) the risk profile would partially mediate the ADHD-smoking relationship. Methods: Data were used from the Pittsburgh ADHD Longitudinal Study (PALS). Participants included ADHD (n¼364; 89 percent male, 79 percent Caucasian) and nonADHD (n¼240; 89% male, 85% Caucasian) groups. ADHD probands were diagnosed in childhood using comprehensive procedures between 1987 and 1996. Annual and age-specific interviews were completed with all participants. A risk profile was created based on self-reported age of initiation, quantity of use, and withdrawal and craving severity during ages 1825. Smoking outcomes were at age 29/30 follow-up. Results: Childhood ADHD significantly predicted both adult daily smoking (Wald ¼ 9.9, p ¼ .002) and higher quantities (Wald ¼ 15.3, p<.001). A more severe risk profile significantly predicted adult daily smoking (Wald¼50.5, p<.001) and quantity (Wald¼35.8, p<.001). The risk profile partially mediated the relationship between ADHD history and daily smoking (Wald¼5.6, p¼.02, k2 ¼ 0.05), but did not mediate ADHD history and quantity (Wald¼14.4, p<.001, k2 ¼ 0.02). Conclusions: This is the first study, to our knowledge, to demonstrate that a more severe risk profile partially mediates the relationship between ADHD symptoms in childhood and daily smoking in adulthood. Contrary to hypotheses, the risk profile did not mediate the relationship between ADHD symptoms in childhood and quantity of cigarette consumption in adulthood. Processes such as social influences and nicotine sensitivity may contribute to the differential outcomes. The present study demonstrates that there are a number of factors that place individuals with a childhood history of ADHD at risk of smoking, and as such ought to be targeted in prevention and treatment efforts.
ADHD NIC SUD Supported by NIH grants AA011873 and DA12414 http://dx.doi.org/10.1016/j.jaac.2016.09.392
6.74 SUBSTANCE USE ESCALATION INTO EARLY ADULTHOOD AMONG THE CHILDREN IN THE MTA Brooke S.G. Molina, PhD, Psychiatry & Psychology, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213; Andrea L. Howard, PhD; James M. Swanson, PhD; Annamarie Stehli, MPH; John T. Mitchell, PhD Objectives: Children with ADHD report more substance use disorders by adulthood, but there is heterogeneity in the findings and little understanding in the progression. This study makes use of the longitudinal follow-up of the children in the multimodal treatment of ADHD (MTA) study to examine substance-specific escalation into early adulthood. We also tested the hypothesis that atypical teenage substance use may portend a particularly worsened prognosis for children with ADHD. Methods: A total of 579 children were diagnosed with DSM-IV-classified ADHD, combined subtype, and 258 children of Local Normative Comparison
S228
www.jaacap.org
Group (LNCG) without ADHD were followed to a mean age (Mage) of 25 years. Substance use was self-reported up to eight times using the Substance Use Questionnaire. SUD data were taken from 411 to 434 children with ADHD and from 219 to 229 children from LNCG (12, 14, and 16 years after ADHD baseline into adulthood). Results: ADHD group predicted more weekly marijuana use at Mage ¼ 25 (32.4 vs. 21.1 percent, P ¼ 0.0028) and daily smoking at all adult waves (e.g., 35.4 vs. 16.4 percent LNCG, P < 0.0001 at Mage ¼ 25) but not binge alcohol (35 percent at least monthly in both groups) or illicit drug use. Non-marijuana illicit and prescription drug misuse rates were low (e.g., 4.1 percent for stimulant misuse at age 25, both groups). Piece-wise latent growth curve models for categorical variables tested group differences in rate of change and frequency of use in adolescence (piece 1) and early adulthood (piece 2). Both groups demonstrated expected increases in substance use through adolescence but stable frequencies in early adulthood. Early and/or heavy adolescent substance use [52.5 percent ADHD, 39.5 percent LNCG, X2(1) ¼ 12.02, P ¼ 0.0005] predicted more frequent substance use at age 25 but not differently for the ADHD compared with LNCG groups. Conclusions: Support for our hypotheses was mixed, but the finding of increased regular marijuana use for children with ADHD was particularly important, given the heterogeneity across prior studies. Given the prognostic value of early/heavy teenage substance use for adult substance use and the chronicity of ADHD, our findings suggest that prevention and continued monitoring may be necessary to forestall the development of substancerelated problems in early adulthood.
ALC ADHD SUD Supported by NIDA DA039881 http://dx.doi.org/10.1016/j.jaac.2016.09.393
6.75 THE ASSOCIATIONS BETWEEN ADOLESCENTS’ SUBSTANCE USE, DEVIANT BEHAVIORS, SELF-REPORTED HEALTH, AND CYBERDATING ABUSE PERPETRATION Joris Van Ouytsel, MSc, Department of Communication Studies, University of Antwerp, Sint- Jacobstraat 2-4, Antwerp, 2000, Belgium; Elizabeth Torres, MPH; Koen Ponnet, PhD; Michel Walrave, PhD; Hye Jeong Choi, PhD; Jeff R. Temple, PhD Objectives: Little is known about how adolescent risk behaviors are related to Cyber Dating Abuse (CDA) perpetration. The present study focuses on the associations between sexual risk behaviors, substance use, self-reported health, deviant behaviors, and CDA perpetration. Methods: We report on a survey that was conducted among 705 respondents (n¼408; 57.9 percent Results: Adolescents with a self-reported history of sexual intercourse were more likely to engage in CDA perpetration than those who did reported that they did not have sexual intercourse (aOR:2.15;CI:1.18–3.93). Similarly, students who used substances (alcohol or drugs) prior to having sexual intercourse were more likely to have perpetrated CDA (aOR:1.32;CI: 1.03–1.70). Youth who reported use of alcohol (aOR:1.67;CI:1.03–2.72) and cigarettes (aOR:1.77; CI:1.13–2.78), and the misuse of over-the-counter (aOR:2.28; CI:1.13–4.63) and prescription (aOR:2.44;CI:1.41–4.24) medications were more likely to have engaged in CDA perpetration than their non-substance using counterparts. Youth who evaluated their physical health as worse than most teens their age were more likely to have engaged in CDA perpetration (aOR:5.79;CI: 2.89–11.60). Adolescents who reported bullying victimization (aOR:1.53;CI: 1.16–2.03) or perpetration (aOR:1.75;CI:1.28–2.38) were more likely to have engaged in CDA perpetration. Conclusions: Our results suggest that prevention efforts targeting dating violence and CDA could also discuss adolescents’ substance use, and that youth who use these substances might be a target group of prevention campaigns. Given the links with sexual behaviors comprehensive sexual education interventions may benefit from discussing CDA prevention and vice versa. CDA was also linked with engagement in cyber bullying. Coercive relationships with peers might be continued by these adolescents within their romantic relationships, and bullying and dating abuse might share similar
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
NEW RESEARCH POSTERS 6.76 – 6.78
underlying factors. The results have important implications for future research, prevention and intervention.
AGG ALC MED Supported by the National Institute of Child Health and Human Development (NICHD) grant K23HD059916 and the National Institute of Justice grant 2012-WG-BX-0005, and the Research Foundation - Flanders fellowship (FWO-Aspirant) http://dx.doi.org/10.1016/j.jaac.2016.09.394
6.76 SOCIODEMOGRAPHIC PROFILE AND MANAGEMENT IDENTIFICATION OF AGGRESSIVE PATIENTS AGED 6 TO 17 IN THE EMERGENCY ROOM AT UNIVERSITY OF PUERTO RICO HOSPITAL Joalex L. Antongiorgi, MD; Gustavo Fors, MD; JeanMarie Acevedo, PhD; Gloria Gonzalez Tejera, MD; Gloria M. Suau Sanchidrian, MD, Psychiatry, University of Puerto Rico, PO Box 365067, San Juan, PR 00936-5067 Objectives: For the last few decades, studies have determined that exposure to violence and traumatic events are common in children and adolescents. Childhood violence or trauma that goes unattended can affect the individual’s development and may lead to future psychological or psychiatric disorder. This study reports on the sociodemographic profile of this population and evaluates risk factors. Methods: From 2012- 2014, information data was gathered from 103 patients aged 6- 17 who were evaluated in an emergency room setting due to complaints of aggressiveness or related keywords. A protocol sheet was designed to gather information regarding risk factors that were documented by physicians. Results: The demographic data consists, mainly, of males from the metropolitan area with previous psychiatric diagnosis. When evaluating previous episodes of aggressive behavior, only 60 percent of the examined records documented this risk factor, and from this data we found 87 percent of those patients had a positive history of aggressive behavior. Screening for family history of violence was documented in 34 percent of the cases, and those reflected 53 percent as present. Only 45 percent of the examined records reported if the patient had been victims of violence, however the majority (73 percent) of those documented were victims of violence. We also found that only 47 percent of the patients had adequate substance abuse screening. From those that were documented, 68 percent of those presented with a history of substance abuse. Conclusions: From all the cases studied, only 46 percent were correctly documented with all of the pertinent risk factors. The results available support the literature that, in patients with aggressive behavior, being victims of violence, substance abusers and presenting with a history of violence are strong risk factors. Further study will be required after implementation of physician education and the use of Protocol Sheet created that was inspired by these findings.
AGG CON RF http://dx.doi.org/10.1016/j.jaac.2016.09.395
6.77 INTEGRATING BEHAVIORISM AND ATTACHMENT THEORY IN ADDRESSING DISRUPTIVE BEHAVIOR Beth Renee Troutman, PhD, Carver College of Medicine, Psychiatry Research, 1-182 Medical Education Building, Iowa City, IA 52242-1057 Objectives: This poster presents the results of a small open trial of a parent coaching approach integrating behaviorism and attachment theory in the treatment of children referred for disruptive behavior. Integration of Working Models of Attachment into Parent-Child Interaction Therapy (IoWA-PCIT) (Troutman, 2015; Troutman, 2016a; Troutman, 2016b) is a modification of an
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
evidence-based behavioral parent training intervention (Eyberg & Funderburk, 2011). Methods: This clinical trial is based on fifty children and their caregivers (biological, foster, and adoptive parents) referred for treatment to a clinic specializing in young children with disruptive behavior. The clinic is located in an academic department of Child and Adolescent Psychiatry. At the initial evaluation, caregiver(s) completed ratings of their child’s disruptive behavior on the Eyberg Child Behavior Inventory (ECBI). The ECBI was also completed at each subsequent session of IoWA-PCIT. Results: Forty-five of the 50 children referred for treatment (90%) participated in at least 3 sessions of IoWA-PCIT with their caregiver(s) and were included in analyses (mean number of sessions including evaluation session ¼ 13.8). Results indicate children participating in IoWA-PCIT with their caregivers exhibit significant decreases in overall level of disruptive behavior, as indicated by changes on the ECBI intensity scale (mother ratings t(44) ¼ 9.1, p < .001; father ratings t(17) ¼ 4.3, p < .001) and significant decreases in number of behavior problems, as indicated by changes on the ECBI problem scale (mother ratings t(44) ¼ 6.9, p < .001; father ratings t(17) ¼ 5.5, p < .001). Conclusions: Results suggest modifying a behavioral parent training intervention by incorporating principles from attachment theory and techniques from interventions based on attachment theory did not reduce effectiveness and improved retention of families in treatment. Future research on IoWAPCIT using a randomized controlled trial is needed to establish efficacy. Research assessing security of attachment pre- and post-IoWA-PCIT is needed to determine impact of this intervention on attachment.
ATTACH OPDD P http://dx.doi.org/10.1016/j.jaac.2016.09.396
6.78 CHILDREN WITH OPPOSITIONAL DEFIANT DISORDER IN THE DANISH NATIONAL BIRTH COHORT Rune V. Kristensen, MD; Argyris Stringaris, PhD; Rikke Wesselhoeft, PhD, Research Unit of Child and Adolescent Mental Health & Research Unit of E-Mental Health, University of Southern Denmark, Sdr. Boulevard 29, Odense, 5000, Denmark Objectives: The diagnosis of childhood ODD reflects both behavioral and affective symptomatology that may be divided into three dimensions: irritable, headstrong, and hurtful. It is well known that children with ODD have a marked risk for concurrent and later psychopathology. However, it seems that the type of psychopathology (internalizing vs. externalizing) is dependent on the ODD symptom distribution between dimensions. The aims of the study were: 1) To estimate the prevalence of ODD in a Danish National Birth Cohort (DNBC); 2) To examine how the ODD symptom presentation divided into the three dimensions is associated with comorbid psychopathology; and 3) To examine to what extent children with ODD are exposed to life stressors. Methods: The study had a two-phase nested case-control design in the DNBC. Mothers of 3,421 DNBC children (age 8-10 years) completed the online Development and Well-Being Assessment (DAWBA). Results: The DNBC ODD total point prevalence was 1.0 percent. The irritable dimension was associated with co-occurring emotional disorders (OR 3.4; p<0.001). Children with ODD were more often exposed to school-related stressors than non-ODD children (OR 16.8; CI 10.1-26.5). Conclusions: ODD is not a common disorder in DNBC. The irritable dimension, and not the headstrong or hurtful dimension, is associated with concurrent emotional disorder. Environmental stressors previously found to be associated with ODD are confirmed.
CM OPDD SAC Supported by the Danish National Research Foundation, the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, the Augustinus Foundation, the Health Foundation, the Lundbeck Foundation (195/04) the Danish Medical Research Council (SSVF 0646) the Psychiatric Research Fund of the Region of Southern Denmark, the Lundbeck Foundation, and the University of Southern Denmark http://dx.doi.org/10.1016/j.jaac.2016.09.397
www.jaacap.org
S229