- Email: [email protected]
6.11 IDENTIFYING PEDIATRIC PATIENTS WITH BEHAVIORAL HEALTH DISORDERS IN A PRIMARY CARE OUTPATIENT CLINIC
NEW RESEARCH POSTERS 6.9 – 6.11
management in the pediatric population. Current literature defines agitation and aggression without guidelines on management within an inpatient pediatric setting. Recommendations on nonpharmacologic strategies do not delineate effective methods, and no guidelines exist on pharmacological management in pediatrics. We describe current clinical management through survey data collected from inpatient pediatric practitioners. Methods: A 34-question survey was emailed to the pediatric hospitalist and consult liaison psychiatry listservs, targeting one response per team at each institution. The survey consisted of multiple choice responses, rating scales, and free text responses. Two investigators independently coded free-text responses and reviewed findings for concordance. Results: Ninety-two responses were tallied from pediatric hospitalists (56 percent) and pediatric psychiatry consultants (34 percent) practicing in pediatric inpatient care settings nationwide. Most institutions were urban and academic with >100 beds (80 percent). Ninety-four percent of respondents reported caring for pediatric patients with acute agitation or aggression associated with medical illness, with 36 percent noting that it occurred two to three times per year and 27 percent endorsing it at least monthly. The majority (76 percent) rated these cases as extremely concerning to family and staff, whereas none classified them as minimally concerning. Most sites do not formally or consistently engage caregivers in addressing agitation or aggression (64.3 percent), nor do they screen for risk factors (55 percent). Less than half (46 percent) have guidelines for nonpharmacological management (primarily restraint policies), and only 30 percent have pharmacologic guidelines for clinicians. Finally, only 33 percent endorsed standardized communication between hospital staff for escalating patients. Conclusions: Many pediatric hospitals identify agitation and aggression as a concern. Outside of restraint policies, few hospitals have systematic ways of managing these issues, such as structured pharmacologic or nonpharmacologic guidelines, screening, or prevention tools. Investigating effective de-escalation strategies and impact on patient outcomes may help standardize and improve pediatric care.
AGG CON PRE http://dx.doi.org/10.1016/j.jaac.2016.09.329
6.9 EFFECT OF ADENOTONSILLECTOMY ON ATTENTION-DEFICIT/HYPERACTIVITY DISORDER SYMPTOMS, SLEEP DISTURBANCE SYMPTOMS, AND QUALITY OF LIFE OF CHILDREN WITH ADENOTONSILLAR HYPERTROPHY AND SLEEPDISORDERED BREATHING Serhat Turkoglu, MD, Department of Child and Adolescent €niversitesi týp faku €ltesi, Psychiatry, Selcuk University, selcuk u c¸ocuk ergen psikiyatrisi polikliniði, Konya 420250, Turkey; Battal Tahsin Somuk, MD; Emrah Sapmaz, MD; Goksel Goktas, MD; Ayhan Bilgi, MD Objectives: Chronic adenotonsillar hypertrophy is the most common etiologic cause for the obstruction of the upper airways in childhood and has been found to be related with a variety of psychiatric problems and poor quality of life. To date, limited data has been available regarding the impact of adenotonsillectomy (AT) on the psychosocial well-being of chronic adenotonsillar hypertrophy subjects. In the present study, we examined the impacts of AT on ADHD and sleep disturbance symptoms and quality of life of children with chronic adenotonsillar hypertrophy. Methods: Parents of children with chronic adenotonsillar hypertrophy filled in Conners Parent Rating Scale-Revised Short (CPRS-RS), Children’s Sleep Habits Questionnaire (CSHQ), and The Pediatric Quality of Life Inventory, Parent versions (PedsQL-P) before and six months after AT. Paired t-test was used to test for mean differences between these ratings. Results: A total of 64 children were included the study (mean age, 6.8 2,4, years; 50% boys). Mean ADHD Index (11.98 6.94 versus 10.35 6.44) (before AT versus after AT) and oppositional scores (6.73 3.72 versus 5.87 3.52) improved statistically significantly after AT (p < 0.05). Cognitive problems /inattention and hyperactivity scores was reduced, but were not statistically significant (p > 0.05). All of the CSHQ subdomain scores (bedtime resistance, sleep-onset delay, sleep anxiety, night waking, parasomnias, sleep
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
disordered breathing, daytime sleepiness), except sleep duration, significantly reduced after AT (p < 0.05). Regarding to quality of life, both PedsQL-P physical health (64.2019.81 versus 69.8418.63) and psychosocial health subdomain scores (67,8312.89 versus 75.5713.16), and PedsQL-P total score (66.5712.94 versus 73.5812.46) of the patients were significantly higher six months after AT (p < 0.001). Conclusions: It is necessary for child and adolescent psychiatrists to query the symptoms of chronic adenotonsillar hypertrophy to identify children with chronic adenotonsillar hypertrophy who suffer from ADHD symptoms, oppositionality, and sleep disturbance. To carry out AT seems to be beneficial for coexisting ADHD and sleep disorder symptoms and quality of life in these children.
ADHD CON SLP http://dx.doi.org/10.1016/j.jaac.2016.09.330
6.10 VALIDATING A SHORT VERSION OF THE EARLY CHILDHOOD SCREENING ASSESSMENT Elise M. Fallucco, MD, Nemours Children’s Specialty Care, 3970 Alhambra Drive West, Jacksonville, FL 32207; Tim Wysocki, PhD; Andre Williams, PhD; Chelsea Kozikowski, BA; Lauren James, MA; Mary Margaret Gleason, MD Objectives: The Early Childhood Screening Assessment (ECSA) includes 36 items designed to detect risk for emotional and behavioral problems among children ages 18-60 months in pediatric primary care. Despite high rates of implementation by pediatric providers trained in its use, some providers have reported that a shorter measure would be preferred due to visit time constraints. The objective of this study was to develop a psychometrically sound, shorter version of the ECSA. Methods: ECSA data from two studies were included in this process. First, ECSAs completed by parents of 2,229 children ages 36-60 months presenting for well-visits in North Florida were used to analyze patterns of responses using principal components factor analysis with varimax rotation. In addition, itemtotal correlations and partial-pairwise correlations were calculated for individual ECSA items in this sample. Using these results, a team of experts in preschool child psychiatry and statistics ranked items based on their ability to identify children who required further evaluation for emotional and behavioral problems. Based on consensus, items with high specificity and clinical utility were highly ranked. Using a second, distinct sample of n¼69 mothers of children 1860 months who completed both the ECSA and the Diagnostic Interview for Preschool Age (DIPA), a Receiver Operating Characteristic (ROC) analysis was performed to determine sensitivity and specificity for detecting a DIPA diagnosis. ECSA items were sequentially deleted based on their rank order, with ROC analysis applied at each step. ROC was weighted at 0.7 to prioritize sensitivity for detecting a psychiatric diagnosis in a primary care screening setting. The final measure represents the scale with the strongest sensitivity and specificity. Results: A 22-item version with a cut-off score of 9 demonstrated acceptable sensitivity (89 percent) and specificity (85 percent) for detecting early childhood psychopathology. The short version showed strong internal consistency (Cronbach a¼0.86). Conclusions: Compared with the full 36-item version, this 22-item ECSA is shorter while retaining strong psychometric properties. Future studies should examine feasibility of use, and rates of detection and referral for early childhood problems in pediatric primary care.
CON PSC RI Supported by SAMHSA and the Nemours Foundation http://dx.doi.org/10.1016/j.jaac.2016.09.331
6.11 IDENTIFYING PEDIATRIC PATIENTS WITH BEHAVIORAL HEALTH DISORDERS IN A PRIMARY CARE OUTPATIENT CLINIC Lidija Petrovic-Dovat, MD, Psychiatry, Pennsylvania State Milton S. Hershey Medical Center, 22-B North East Drive, Hershey, PA 17033; Benjamin Fogel, MD, MPH; James G. Waxmonsky, MD; Timothy Zeiger, PsyD; Daniel A. Waschbusch, PhD; Sarah Iriana, MD; Pevitr S. Bansal, MS; Cheston Milton Berlin Jr., MD
www.jaacap.org
S207
NEW RESEARCH POSTERS 6.12 – 6.15
Objectives: The majority of children and adolescents with psychiatric disorders are treated at the primary care office. To identify potential barriers to diagnosis and treatment of mental health disorders, primary outpatient family medicine and pediatric providers completed a survey that characterized their experiences with screening, diagnosis, and treatment of mental illness in their practice. Methods: An anonymous and voluntary investigator-designed online survey was hosted and distributed by the secure web application REDCap (Research Electronic Data Capture). Of the total number of contacted providers (N ¼ 83), 34 percent of providers responded, including 52 percent from the general pediatric clinic and 45 percent from the family medicine clinic. Providers (57 percent) reported that the majority (90 percent) of their patient population was composed of children. Results: Primary care providers (74 percent) reported using evidence-based screening instruments in their practice, such as the Patient Health Questionnaire (PHQ-9) to assess depression, which was the most commonly used screening tool (63 percent); the Vanderbilt Rating Scale for ADHD (19 percent); and the Screen for Child Anxiety Related Disorders (SCARED) (19 percent). A majority of providers (76 percent) reported that they do not treat or routinely screen for anxiety disorders. Providers (84 percent) reported that ADHD was the most commonly diagnosed and treated mental health disorder compared with 4 percent for anxiety disorders. Furthermore, 88 percent reported stimulants as the most commonly prescribed psychotropic medication, whereas 8 percent reported the use of SSRIs. Conclusions: Although anxiety disorders are the most common mental health diagnoses in children and adolescents, with the lifetime prevalence of 25.1 percent in those aged between 13 and 18 years, this study indicates that primary care providers treating children are not screening adequately for anxiety disorders. The most challenging aspects of pediatric mental health reported by providers included the following: difficulty with management of mental health disorders, lack of confidence in managing behavioral and emotional problems, and lack of time required to administer diagnostic screens and managing cases. Future work should focus on interventions to address this lack of screening.
ANX CON http://dx.doi.org/10.1016/j.jaac.2016.09.332
6.12 CAREGIVER BURDEN AND RELATED FACTORS IN MOTHERS OF CHILDREN AND ADOLESCENTS WITH CYSTIC FIBROSIS Omer Faruk Akca, MD, Child and Adolescent Psychiatry, € Necmettin Erbakan University, Necmettin Erbakan Universitesi €ltesi, C¸ ocuk ve Ergen Ruh Saglıgı ve Hastalıkları Meram Tıp Faku Anabilim Dalı, Meram, Konya 42100, Turkey; Necati Uzun, MD; Sevgi Pekcan, MD; Erkan Akkus, MD; Kemal Gulec, MD Objectives: Caregiver burden (CB) is a term used to describe the physical, emotional and financial burden of a home care situation. This subjective burden is one of the most important predictors for negative outcomes of the care situation – for the caregivers themselves as well as for the one who requires care. Several studies investigated the CB in various medical conditions. However, CB in caregivers of children and adolescents with Cystic Fibrosis (CF) and factors related to the burden has not been studied before. Methods: Forty patients aged 1 to 19 years (Mean: 7.8, SD: 4.8) with the diagnosis of CF and their mothers were included in the study. CB, depression, state and trait anxiety, and perceived social support levels of mothers were evaluated. Also, socio-demographical variables, and clinical indicators associated with the severity of CF were evaluated. The factors related to CB of mothers were evaluated using correlation and regression analyses. Results: Mothers reported moderate CB levels (mean: 24.1, SD: 14.7). CB levels of mothers were related to their depression (r¼0.63, p<0.001), state (r¼0.43, p¼0.006) and trait (r¼0.36, p¼0.02) anxiety levels and the total duration of the disease (the time period between the diagnosis and the evaluation) (r¼0.32, p¼0.04). However, other socio-demographical and clinical variables were not related to CB. Additionally, only depression levels of mothers (b¼0.65, p¼0.02, t¼3.4, SE¼0.38) were related to CB when state and trait anxiety, social support and the duration of the disease were controlled using regression analysis.
S208
www.jaacap.org
Conclusions: Several studies conducted in various chronic diseases report that CB may be related to psychiatric well-being of the caregiver. This is the first study investigating the CB levels of mothers of children and adolescents with CF. CB was related to depression in case of confounding factors were controlled in children and adolescents with CF, like other chronic diseases reported in the literature. Monitoring the caregivers in terms of depressive symptoms may conclude in better life quality in both patients and their caregivers.
CON PAT http://dx.doi.org/10.1016/j.jaac.2016.09.333
6.14 CORRELATES OF BEHAVIORAL DIFFICULTIES IN ADOLESCENTS WITH AUTISM SPECTRUM DISORDER ADMITTED TO INPATIENT PEDIATRIC UNITS Eric Hazen, MD, Massachusetts General Hospital, 20 Upton St., Apt 2, Boston, MA 02118-1610; Amrita Vavilikolanu; Julia O. O’Rourke; Caitlin Ravichandran; Elizabeth Madva, MD; Christopher J. McDougle, MD Objectives: There have few studies examining the behavioral difficulties that may be experienced by adolescents with ASD admitted to pediatric medical units. This study examines the frequency and clinical correlates of these events. Methods: Through a retrospective chart review, we identified every patient 12-19 years of age with an ASD diagnosis admitted to the inpatient pediatrics unit of a large, urban teaching hospital over a five-year period. We then performed a detailed review of each of these admissions gathering clinical and demographic information including reason for admission, level of pain at the time of admission, past psychiatric history, history of agitation and selfinjurious behavior, history of sensory sensitivities, and degree of intellectual disability. The frequency and severity of episodes of agitation and self-injury occurring during the hospitalization were also recorded. Results: A total of 210 admissions meeting the study criteria were identified. At least one episode of agitation or self-injury occurred in 27 (12.9 percent) of these admissions. There was a statistically significant association between agitation or self-injury during the admission and the following factors: past history of psychiatric hospitalization (Odds Ratio¼ 4.0, p<0.003), history of agitation (OR¼12.4, p<0.001), history of self-injurious behavior (OR¼8.9, p<0.001), history of sensory sensitivities (OR¼4.1, p<0.003). There was no association between agitation and intellectual disability or the presence of acute pain upon admission. Conclusions: While the majority of adolescents with ASD admitted to pediatric medical units will not have episodes of agitation or self-injury during the admission, there is a significant subset of patients who will experience these difficulties. We found that agitation and self-injury occurred more commonly in patients with a past history of these behaviors as well as in those with a history of psychiatric hospitalization and sensory sensitivities. Agitation during admission was not associated with intellectual disability or the presence of acute pain in our sample. Further research is needed to identify risk factors for patients with ASD who may have behavioral difficulties during medical hospitalization.
AGG ASD CON Supported by the Nancy Lurie Marks Family Foundation http://dx.doi.org/10.1016/j.jaac.2016.09.334
6.15 ASSESSMENT OF COGNITIVE DEVELOPMENT OF INFANTS WITH VERY LOW BIRTH WEIGHT USING THE KOREAN WECHSLER PRESCHOOL AND PRIMARY SCALE OF INTELLIGENCE Aran Min, MD, Psychiatry, Hanyang University Seoul Hospital, 222 Wang-simni-ro., Seoul, The Republic of Korea; Ahyoung Paik, MD; Dong-Hyun Ahn, PhD Objectives: The primary objective was to investigate whether premature birth affects cognitive functioning, or whether effects are limited to internal and external psychological concerns.
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
management in the pediatric population. Current literature defines agitation and aggression without guidelines on management within an inpatient pediatric setting. Recommendations on nonpharmacologic strategies do not delineate effective methods, and no guidelines exist on pharmacological management in pediatrics. We describe current clinical management through survey data collected from inpatient pediatric practitioners. Methods: A 34-question survey was emailed to the pediatric hospitalist and consult liaison psychiatry listservs, targeting one response per team at each institution. The survey consisted of multiple choice responses, rating scales, and free text responses. Two investigators independently coded free-text responses and reviewed findings for concordance. Results: Ninety-two responses were tallied from pediatric hospitalists (56 percent) and pediatric psychiatry consultants (34 percent) practicing in pediatric inpatient care settings nationwide. Most institutions were urban and academic with >100 beds (80 percent). Ninety-four percent of respondents reported caring for pediatric patients with acute agitation or aggression associated with medical illness, with 36 percent noting that it occurred two to three times per year and 27 percent endorsing it at least monthly. The majority (76 percent) rated these cases as extremely concerning to family and staff, whereas none classified them as minimally concerning. Most sites do not formally or consistently engage caregivers in addressing agitation or aggression (64.3 percent), nor do they screen for risk factors (55 percent). Less than half (46 percent) have guidelines for nonpharmacological management (primarily restraint policies), and only 30 percent have pharmacologic guidelines for clinicians. Finally, only 33 percent endorsed standardized communication between hospital staff for escalating patients. Conclusions: Many pediatric hospitals identify agitation and aggression as a concern. Outside of restraint policies, few hospitals have systematic ways of managing these issues, such as structured pharmacologic or nonpharmacologic guidelines, screening, or prevention tools. Investigating effective de-escalation strategies and impact on patient outcomes may help standardize and improve pediatric care.
AGG CON PRE http://dx.doi.org/10.1016/j.jaac.2016.09.329
6.9 EFFECT OF ADENOTONSILLECTOMY ON ATTENTION-DEFICIT/HYPERACTIVITY DISORDER SYMPTOMS, SLEEP DISTURBANCE SYMPTOMS, AND QUALITY OF LIFE OF CHILDREN WITH ADENOTONSILLAR HYPERTROPHY AND SLEEPDISORDERED BREATHING Serhat Turkoglu, MD, Department of Child and Adolescent €niversitesi týp faku €ltesi, Psychiatry, Selcuk University, selcuk u c¸ocuk ergen psikiyatrisi polikliniði, Konya 420250, Turkey; Battal Tahsin Somuk, MD; Emrah Sapmaz, MD; Goksel Goktas, MD; Ayhan Bilgi, MD Objectives: Chronic adenotonsillar hypertrophy is the most common etiologic cause for the obstruction of the upper airways in childhood and has been found to be related with a variety of psychiatric problems and poor quality of life. To date, limited data has been available regarding the impact of adenotonsillectomy (AT) on the psychosocial well-being of chronic adenotonsillar hypertrophy subjects. In the present study, we examined the impacts of AT on ADHD and sleep disturbance symptoms and quality of life of children with chronic adenotonsillar hypertrophy. Methods: Parents of children with chronic adenotonsillar hypertrophy filled in Conners Parent Rating Scale-Revised Short (CPRS-RS), Children’s Sleep Habits Questionnaire (CSHQ), and The Pediatric Quality of Life Inventory, Parent versions (PedsQL-P) before and six months after AT. Paired t-test was used to test for mean differences between these ratings. Results: A total of 64 children were included the study (mean age, 6.8 2,4, years; 50% boys). Mean ADHD Index (11.98 6.94 versus 10.35 6.44) (before AT versus after AT) and oppositional scores (6.73 3.72 versus 5.87 3.52) improved statistically significantly after AT (p < 0.05). Cognitive problems /inattention and hyperactivity scores was reduced, but were not statistically significant (p > 0.05). All of the CSHQ subdomain scores (bedtime resistance, sleep-onset delay, sleep anxiety, night waking, parasomnias, sleep
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
disordered breathing, daytime sleepiness), except sleep duration, significantly reduced after AT (p < 0.05). Regarding to quality of life, both PedsQL-P physical health (64.2019.81 versus 69.8418.63) and psychosocial health subdomain scores (67,8312.89 versus 75.5713.16), and PedsQL-P total score (66.5712.94 versus 73.5812.46) of the patients were significantly higher six months after AT (p < 0.001). Conclusions: It is necessary for child and adolescent psychiatrists to query the symptoms of chronic adenotonsillar hypertrophy to identify children with chronic adenotonsillar hypertrophy who suffer from ADHD symptoms, oppositionality, and sleep disturbance. To carry out AT seems to be beneficial for coexisting ADHD and sleep disorder symptoms and quality of life in these children.
ADHD CON SLP http://dx.doi.org/10.1016/j.jaac.2016.09.330
6.10 VALIDATING A SHORT VERSION OF THE EARLY CHILDHOOD SCREENING ASSESSMENT Elise M. Fallucco, MD, Nemours Children’s Specialty Care, 3970 Alhambra Drive West, Jacksonville, FL 32207; Tim Wysocki, PhD; Andre Williams, PhD; Chelsea Kozikowski, BA; Lauren James, MA; Mary Margaret Gleason, MD Objectives: The Early Childhood Screening Assessment (ECSA) includes 36 items designed to detect risk for emotional and behavioral problems among children ages 18-60 months in pediatric primary care. Despite high rates of implementation by pediatric providers trained in its use, some providers have reported that a shorter measure would be preferred due to visit time constraints. The objective of this study was to develop a psychometrically sound, shorter version of the ECSA. Methods: ECSA data from two studies were included in this process. First, ECSAs completed by parents of 2,229 children ages 36-60 months presenting for well-visits in North Florida were used to analyze patterns of responses using principal components factor analysis with varimax rotation. In addition, itemtotal correlations and partial-pairwise correlations were calculated for individual ECSA items in this sample. Using these results, a team of experts in preschool child psychiatry and statistics ranked items based on their ability to identify children who required further evaluation for emotional and behavioral problems. Based on consensus, items with high specificity and clinical utility were highly ranked. Using a second, distinct sample of n¼69 mothers of children 1860 months who completed both the ECSA and the Diagnostic Interview for Preschool Age (DIPA), a Receiver Operating Characteristic (ROC) analysis was performed to determine sensitivity and specificity for detecting a DIPA diagnosis. ECSA items were sequentially deleted based on their rank order, with ROC analysis applied at each step. ROC was weighted at 0.7 to prioritize sensitivity for detecting a psychiatric diagnosis in a primary care screening setting. The final measure represents the scale with the strongest sensitivity and specificity. Results: A 22-item version with a cut-off score of 9 demonstrated acceptable sensitivity (89 percent) and specificity (85 percent) for detecting early childhood psychopathology. The short version showed strong internal consistency (Cronbach a¼0.86). Conclusions: Compared with the full 36-item version, this 22-item ECSA is shorter while retaining strong psychometric properties. Future studies should examine feasibility of use, and rates of detection and referral for early childhood problems in pediatric primary care.
CON PSC RI Supported by SAMHSA and the Nemours Foundation http://dx.doi.org/10.1016/j.jaac.2016.09.331
6.11 IDENTIFYING PEDIATRIC PATIENTS WITH BEHAVIORAL HEALTH DISORDERS IN A PRIMARY CARE OUTPATIENT CLINIC Lidija Petrovic-Dovat, MD, Psychiatry, Pennsylvania State Milton S. Hershey Medical Center, 22-B North East Drive, Hershey, PA 17033; Benjamin Fogel, MD, MPH; James G. Waxmonsky, MD; Timothy Zeiger, PsyD; Daniel A. Waschbusch, PhD; Sarah Iriana, MD; Pevitr S. Bansal, MS; Cheston Milton Berlin Jr., MD
www.jaacap.org
S207
NEW RESEARCH POSTERS 6.12 – 6.15
Objectives: The majority of children and adolescents with psychiatric disorders are treated at the primary care office. To identify potential barriers to diagnosis and treatment of mental health disorders, primary outpatient family medicine and pediatric providers completed a survey that characterized their experiences with screening, diagnosis, and treatment of mental illness in their practice. Methods: An anonymous and voluntary investigator-designed online survey was hosted and distributed by the secure web application REDCap (Research Electronic Data Capture). Of the total number of contacted providers (N ¼ 83), 34 percent of providers responded, including 52 percent from the general pediatric clinic and 45 percent from the family medicine clinic. Providers (57 percent) reported that the majority (90 percent) of their patient population was composed of children. Results: Primary care providers (74 percent) reported using evidence-based screening instruments in their practice, such as the Patient Health Questionnaire (PHQ-9) to assess depression, which was the most commonly used screening tool (63 percent); the Vanderbilt Rating Scale for ADHD (19 percent); and the Screen for Child Anxiety Related Disorders (SCARED) (19 percent). A majority of providers (76 percent) reported that they do not treat or routinely screen for anxiety disorders. Providers (84 percent) reported that ADHD was the most commonly diagnosed and treated mental health disorder compared with 4 percent for anxiety disorders. Furthermore, 88 percent reported stimulants as the most commonly prescribed psychotropic medication, whereas 8 percent reported the use of SSRIs. Conclusions: Although anxiety disorders are the most common mental health diagnoses in children and adolescents, with the lifetime prevalence of 25.1 percent in those aged between 13 and 18 years, this study indicates that primary care providers treating children are not screening adequately for anxiety disorders. The most challenging aspects of pediatric mental health reported by providers included the following: difficulty with management of mental health disorders, lack of confidence in managing behavioral and emotional problems, and lack of time required to administer diagnostic screens and managing cases. Future work should focus on interventions to address this lack of screening.
ANX CON http://dx.doi.org/10.1016/j.jaac.2016.09.332
6.12 CAREGIVER BURDEN AND RELATED FACTORS IN MOTHERS OF CHILDREN AND ADOLESCENTS WITH CYSTIC FIBROSIS Omer Faruk Akca, MD, Child and Adolescent Psychiatry, € Necmettin Erbakan University, Necmettin Erbakan Universitesi €ltesi, C¸ ocuk ve Ergen Ruh Saglıgı ve Hastalıkları Meram Tıp Faku Anabilim Dalı, Meram, Konya 42100, Turkey; Necati Uzun, MD; Sevgi Pekcan, MD; Erkan Akkus, MD; Kemal Gulec, MD Objectives: Caregiver burden (CB) is a term used to describe the physical, emotional and financial burden of a home care situation. This subjective burden is one of the most important predictors for negative outcomes of the care situation – for the caregivers themselves as well as for the one who requires care. Several studies investigated the CB in various medical conditions. However, CB in caregivers of children and adolescents with Cystic Fibrosis (CF) and factors related to the burden has not been studied before. Methods: Forty patients aged 1 to 19 years (Mean: 7.8, SD: 4.8) with the diagnosis of CF and their mothers were included in the study. CB, depression, state and trait anxiety, and perceived social support levels of mothers were evaluated. Also, socio-demographical variables, and clinical indicators associated with the severity of CF were evaluated. The factors related to CB of mothers were evaluated using correlation and regression analyses. Results: Mothers reported moderate CB levels (mean: 24.1, SD: 14.7). CB levels of mothers were related to their depression (r¼0.63, p<0.001), state (r¼0.43, p¼0.006) and trait (r¼0.36, p¼0.02) anxiety levels and the total duration of the disease (the time period between the diagnosis and the evaluation) (r¼0.32, p¼0.04). However, other socio-demographical and clinical variables were not related to CB. Additionally, only depression levels of mothers (b¼0.65, p¼0.02, t¼3.4, SE¼0.38) were related to CB when state and trait anxiety, social support and the duration of the disease were controlled using regression analysis.
S208
www.jaacap.org
Conclusions: Several studies conducted in various chronic diseases report that CB may be related to psychiatric well-being of the caregiver. This is the first study investigating the CB levels of mothers of children and adolescents with CF. CB was related to depression in case of confounding factors were controlled in children and adolescents with CF, like other chronic diseases reported in the literature. Monitoring the caregivers in terms of depressive symptoms may conclude in better life quality in both patients and their caregivers.
CON PAT http://dx.doi.org/10.1016/j.jaac.2016.09.333
6.14 CORRELATES OF BEHAVIORAL DIFFICULTIES IN ADOLESCENTS WITH AUTISM SPECTRUM DISORDER ADMITTED TO INPATIENT PEDIATRIC UNITS Eric Hazen, MD, Massachusetts General Hospital, 20 Upton St., Apt 2, Boston, MA 02118-1610; Amrita Vavilikolanu; Julia O. O’Rourke; Caitlin Ravichandran; Elizabeth Madva, MD; Christopher J. McDougle, MD Objectives: There have few studies examining the behavioral difficulties that may be experienced by adolescents with ASD admitted to pediatric medical units. This study examines the frequency and clinical correlates of these events. Methods: Through a retrospective chart review, we identified every patient 12-19 years of age with an ASD diagnosis admitted to the inpatient pediatrics unit of a large, urban teaching hospital over a five-year period. We then performed a detailed review of each of these admissions gathering clinical and demographic information including reason for admission, level of pain at the time of admission, past psychiatric history, history of agitation and selfinjurious behavior, history of sensory sensitivities, and degree of intellectual disability. The frequency and severity of episodes of agitation and self-injury occurring during the hospitalization were also recorded. Results: A total of 210 admissions meeting the study criteria were identified. At least one episode of agitation or self-injury occurred in 27 (12.9 percent) of these admissions. There was a statistically significant association between agitation or self-injury during the admission and the following factors: past history of psychiatric hospitalization (Odds Ratio¼ 4.0, p<0.003), history of agitation (OR¼12.4, p<0.001), history of self-injurious behavior (OR¼8.9, p<0.001), history of sensory sensitivities (OR¼4.1, p<0.003). There was no association between agitation and intellectual disability or the presence of acute pain upon admission. Conclusions: While the majority of adolescents with ASD admitted to pediatric medical units will not have episodes of agitation or self-injury during the admission, there is a significant subset of patients who will experience these difficulties. We found that agitation and self-injury occurred more commonly in patients with a past history of these behaviors as well as in those with a history of psychiatric hospitalization and sensory sensitivities. Agitation during admission was not associated with intellectual disability or the presence of acute pain in our sample. Further research is needed to identify risk factors for patients with ASD who may have behavioral difficulties during medical hospitalization.
AGG ASD CON Supported by the Nancy Lurie Marks Family Foundation http://dx.doi.org/10.1016/j.jaac.2016.09.334
6.15 ASSESSMENT OF COGNITIVE DEVELOPMENT OF INFANTS WITH VERY LOW BIRTH WEIGHT USING THE KOREAN WECHSLER PRESCHOOL AND PRIMARY SCALE OF INTELLIGENCE Aran Min, MD, Psychiatry, Hanyang University Seoul Hospital, 222 Wang-simni-ro., Seoul, The Republic of Korea; Ahyoung Paik, MD; Dong-Hyun Ahn, PhD Objectives: The primary objective was to investigate whether premature birth affects cognitive functioning, or whether effects are limited to internal and external psychological concerns.
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016