- Email: [email protected]
44.1 THE RELEVANCE OF THE ADVERSE CHILDHOOD EXPERIENCES STUDY FOR CHILD AND ADOLESCENT PSYCHIATRISTS
CLINICAL PERSPECTIVES 43.4 – 44.2
methodological considerations in translating results from the human laboratory to randomized clinical trials in the clinical setting. Methods: A literature search was conducted to identify randomized, placebo-controlled trials in adult outpatients seeking treatment for cannabis use disorder, as well as work conducted with pharmacological agents tested in the laboratory setting. Results: Methodological and feasibility issues that arise when translating laboratory research conducted in nontreatment-related heavy cannabis users into clinical settings will be discussed. Targeting withdrawal or relapse prevention may require different laboratory and clinical designs, as well as pharmacological interventions. Examples of current work that has bridged the laboratory and outpatient setting will be highlighted. Conclusions: Although there are limited data to guide the use of pharmacological interventions for cannabis use disorder, this is a burgeoning area of interest. Attention to methodological issues and clinical outcome choices might increase the likelihood of finding promising pharmacological interventions.
NIDA PPC SUD Supported by NIDA Grants U54DA037842 and K24DA029647 http://dx.doi.org/10.1016/j.jaac.2016.07.697
43.4 ADOLESCENT CONSIDERATIONS IN CANNABIS USE DISORDER PHARMACOTHERAPY Kevin M. Gray, MD, Medical University of South Carolina, Medical University of South Carolina, 125 Doughty Street, Suite 190, Charleston, SC 29425-0001 Objectives: Amid a period of critical biological, psychological, and social development, adolescents are more likely than adults to initiate cannabis use, develop cannabis use disorder (CUD), and experience potentially lasting cannabis-associated adverse consequences. There is a pressing need for adolescent-focused treatments, but translation of findings between adult and adolescent populations may be challenging. The objective of this presentation is to provide developmental perspective in CUD pharmacotherapy research, contrasting findings between adult and adolescent medication trials. Methods: The large majority of CUD pharmacotherapy research has focused on adult populations, and little research to date has provided clear guidance for medication treatment to complement psychosocial interventions for adolescent CUD. This presentation will include a review of adolescent brain development and implications for CUD, followed by presentation of findings from adolescent-relevant CUD pharmacotherapy trials. Results: Findings from recent trials of the over-the-counter glutamatemodulating antioxidant N-acetylcysteine in adolescents and adults with CUD will be presented and contrasted, providing developmental perspective for current clinical practice and future pharmacotherapy research. Conclusions: Adolescents and adults with CUD may respond differently to behavioral and medication treatments, and understanding of adolescent development may help in the development and implementation of efficacious interventions for this particularly vulnerable group.
ADOL PPC SUD Supported by NIDA Grants R01DA026777, UG1DA013727, and U01DA031779
of the 10 ACE survey items to a number of mental health and health conditions. Beyond the impact that this study has had on bringing added awareness to medical and mental health professionals, opportunities to build on the ACE phenomenon and take action in terms of additional research far exceed the well-documented dose-response nature of ACEs and increased attention and delivery of tailored treatments and interventions that specifically target the impact of ACEs and other traumatic life events on children and families. Methods: The authors describe strategies for considering ACEs in relation to other child traumas and describe new studies that focus on which ACEs are most potent in predicting negative outcomes and which have synergistic/ multiplicative interactions with each other and other traumas. A review of evidence-based treatments and resources to address the impact of ACE on children and families from a prevention and intervention perspective will be described. Results: Child psychiatrists, pediatricians, and other mental health professionals attend to ACEs and other traumatic life events in their work and face the need to not only become aware and understand this impact on the developing child, per the National Center for Child Traumatic Stress “take awareness to action,” but to intervene appropriately by screening, assessments, and referrals and providing access to appropriate evidence-based treatment and other interventions. Conclusions: Knowing where to go beyond the understanding of the ACE Study is imperative to child-serving professionals within an “awareness to action” framework.
CAN EBP PYI Sponsored by AACAP's Child Maltreatment and Violence Committee http://dx.doi.org/10.1016/j.jaac.2016.07.700
44.1 THE RELEVANCE OF THE ADVERSE CHILDHOOD EXPERIENCES STUDY FOR CHILD AND ADOLESCENT PSYCHIATRISTS Steven Berkowitz, MD, Psychiatry, University of Pennsylvania, 612 Farragut Ave, Haddonfield, NJ 08033-3834 Objectives: This presentation will review the findings from the adverse childhood experience (ACE) study as well as the current use of the ACE survey. The issues and potential applicability of the study for CAPs will be described. Methods: A critical overview of the ACE study methodology and findings will be presented. In addition, recent uses of the ACE survey will be described that both support and question the original study. Issues with the use of the ACE survey in children, as well as its optimal use in assessment, will be discussed. Results: The large sample size of the ACE study and adult epidemiological findings concerning physical and mental health and social and economic issues require that CAPs understand its implications as well as the flaws of the study. The use of the ACE survey with adult caregivers can aid in understanding the impact of intergenerational issues in children. Conclusions: The ACE study and its survey have had tremendous impact in pediatrics, education, and child welfare, as well as in other fields. It is essential that CAPs understand the pros and cons of the ACE study and its survey and how it may be best used in practice.
RCR
http://dx.doi.org/10.1016/j.jaac.2016.07.698
http://dx.doi.org/10.1016/j.jaac.2016.07.701
CLINICAL PERSPECTIVES 44
44.2 BEYOND ADVERSE CHILDHOOD EXPERIENCES: FROM AWARENESS TO ACTION
THE ADVERSE CHILDHOOD EXPERIENCES STUDY AND BEYOND
Lisa Amaya-Jackson, MD, MPH, Duke University Medical Center, National Ctr for Child Traumatic Stress, 411 West Chapel Hill St, Suite 200, Durham, NC 27701
Lisa Amaya-Jackson, MD, MPH, Duke University Medical Center, National Ctr for Child Traumatic Stress, 411 West Chapel Hill St, Suite 200, Durham, NC 27701 Objectives: The Adverse Child Experiences (ACE) Study has resulted in a number of analyses and publications illustrating the dose-response nature
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Objectives: The Adverse Child Experiences (ACE) Study has resulted in a number of analyses and publications, illustrating the dose-response nature of 10 ACE survey items to a number of mental health and health conditions. Beyond the impact that this study has had on bringing added awareness to medical and mental health professionals, there are opportunities to build
www.jaacap.org
S67
methodological considerations in translating results from the human laboratory to randomized clinical trials in the clinical setting. Methods: A literature search was conducted to identify randomized, placebo-controlled trials in adult outpatients seeking treatment for cannabis use disorder, as well as work conducted with pharmacological agents tested in the laboratory setting. Results: Methodological and feasibility issues that arise when translating laboratory research conducted in nontreatment-related heavy cannabis users into clinical settings will be discussed. Targeting withdrawal or relapse prevention may require different laboratory and clinical designs, as well as pharmacological interventions. Examples of current work that has bridged the laboratory and outpatient setting will be highlighted. Conclusions: Although there are limited data to guide the use of pharmacological interventions for cannabis use disorder, this is a burgeoning area of interest. Attention to methodological issues and clinical outcome choices might increase the likelihood of finding promising pharmacological interventions.
NIDA PPC SUD Supported by NIDA Grants U54DA037842 and K24DA029647 http://dx.doi.org/10.1016/j.jaac.2016.07.697
43.4 ADOLESCENT CONSIDERATIONS IN CANNABIS USE DISORDER PHARMACOTHERAPY Kevin M. Gray, MD, Medical University of South Carolina, Medical University of South Carolina, 125 Doughty Street, Suite 190, Charleston, SC 29425-0001 Objectives: Amid a period of critical biological, psychological, and social development, adolescents are more likely than adults to initiate cannabis use, develop cannabis use disorder (CUD), and experience potentially lasting cannabis-associated adverse consequences. There is a pressing need for adolescent-focused treatments, but translation of findings between adult and adolescent populations may be challenging. The objective of this presentation is to provide developmental perspective in CUD pharmacotherapy research, contrasting findings between adult and adolescent medication trials. Methods: The large majority of CUD pharmacotherapy research has focused on adult populations, and little research to date has provided clear guidance for medication treatment to complement psychosocial interventions for adolescent CUD. This presentation will include a review of adolescent brain development and implications for CUD, followed by presentation of findings from adolescent-relevant CUD pharmacotherapy trials. Results: Findings from recent trials of the over-the-counter glutamatemodulating antioxidant N-acetylcysteine in adolescents and adults with CUD will be presented and contrasted, providing developmental perspective for current clinical practice and future pharmacotherapy research. Conclusions: Adolescents and adults with CUD may respond differently to behavioral and medication treatments, and understanding of adolescent development may help in the development and implementation of efficacious interventions for this particularly vulnerable group.
ADOL PPC SUD Supported by NIDA Grants R01DA026777, UG1DA013727, and U01DA031779
of the 10 ACE survey items to a number of mental health and health conditions. Beyond the impact that this study has had on bringing added awareness to medical and mental health professionals, opportunities to build on the ACE phenomenon and take action in terms of additional research far exceed the well-documented dose-response nature of ACEs and increased attention and delivery of tailored treatments and interventions that specifically target the impact of ACEs and other traumatic life events on children and families. Methods: The authors describe strategies for considering ACEs in relation to other child traumas and describe new studies that focus on which ACEs are most potent in predicting negative outcomes and which have synergistic/ multiplicative interactions with each other and other traumas. A review of evidence-based treatments and resources to address the impact of ACE on children and families from a prevention and intervention perspective will be described. Results: Child psychiatrists, pediatricians, and other mental health professionals attend to ACEs and other traumatic life events in their work and face the need to not only become aware and understand this impact on the developing child, per the National Center for Child Traumatic Stress “take awareness to action,” but to intervene appropriately by screening, assessments, and referrals and providing access to appropriate evidence-based treatment and other interventions. Conclusions: Knowing where to go beyond the understanding of the ACE Study is imperative to child-serving professionals within an “awareness to action” framework.
CAN EBP PYI Sponsored by AACAP's Child Maltreatment and Violence Committee http://dx.doi.org/10.1016/j.jaac.2016.07.700
44.1 THE RELEVANCE OF THE ADVERSE CHILDHOOD EXPERIENCES STUDY FOR CHILD AND ADOLESCENT PSYCHIATRISTS Steven Berkowitz, MD, Psychiatry, University of Pennsylvania, 612 Farragut Ave, Haddonfield, NJ 08033-3834 Objectives: This presentation will review the findings from the adverse childhood experience (ACE) study as well as the current use of the ACE survey. The issues and potential applicability of the study for CAPs will be described. Methods: A critical overview of the ACE study methodology and findings will be presented. In addition, recent uses of the ACE survey will be described that both support and question the original study. Issues with the use of the ACE survey in children, as well as its optimal use in assessment, will be discussed. Results: The large sample size of the ACE study and adult epidemiological findings concerning physical and mental health and social and economic issues require that CAPs understand its implications as well as the flaws of the study. The use of the ACE survey with adult caregivers can aid in understanding the impact of intergenerational issues in children. Conclusions: The ACE study and its survey have had tremendous impact in pediatrics, education, and child welfare, as well as in other fields. It is essential that CAPs understand the pros and cons of the ACE study and its survey and how it may be best used in practice.
RCR
http://dx.doi.org/10.1016/j.jaac.2016.07.698
http://dx.doi.org/10.1016/j.jaac.2016.07.701
CLINICAL PERSPECTIVES 44
44.2 BEYOND ADVERSE CHILDHOOD EXPERIENCES: FROM AWARENESS TO ACTION
THE ADVERSE CHILDHOOD EXPERIENCES STUDY AND BEYOND
Lisa Amaya-Jackson, MD, MPH, Duke University Medical Center, National Ctr for Child Traumatic Stress, 411 West Chapel Hill St, Suite 200, Durham, NC 27701
Lisa Amaya-Jackson, MD, MPH, Duke University Medical Center, National Ctr for Child Traumatic Stress, 411 West Chapel Hill St, Suite 200, Durham, NC 27701 Objectives: The Adverse Child Experiences (ACE) Study has resulted in a number of analyses and publications illustrating the dose-response nature
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Objectives: The Adverse Child Experiences (ACE) Study has resulted in a number of analyses and publications, illustrating the dose-response nature of 10 ACE survey items to a number of mental health and health conditions. Beyond the impact that this study has had on bringing added awareness to medical and mental health professionals, there are opportunities to build
www.jaacap.org
S67