- Email: [email protected]
6.26 PREDICTION OF IMPAIRMENT IN SCHOOL FUNCTION OVER ONE SCHOOL YEAR IN SPECIAL EDUCATION STUDENTS WITH PSYCHIATRIC DISORDERS
NEW RESEARCH POSTERS 6.25 – 6.27
Methods: Charts were reviewed of patients seen by a psychiatric consult service in a major children’s hospital over 3.5 years. Seventeen patients received dexmedetomidine for severe anxiety, agitation/aggression, and delirium. Demographic information, presenting problems and reasons for consultation, medical and psychiatric diagnoses, psychotropic medications before, during, and after consultations, complications, and duration of treatment with demedetomidine were considered. Results: Seventeen patients, age range 6.1 to 33.75 years (average 17.76 years), 13 females and 4 males, received dexmedetomidine for non-procedural, psychiatric reasons. Nine were treated for agitated delirium who had medical contraindications to antipsychotics (QT prolongation, drug interactions). Of these, five had combined profound neurodevelopmental disorders and deliria due to sepsis, two were post cardiac surgery, one had anti-NMDA receptor encephalitis, and one had E. coli sepsis. Of seven patients with cystic fibrosis, all were treated while on ventilators, including four with severe anxiety before they expired, and three who survived but had difficulty weaning from the ventilator due to severe anxiety. A 21-year-old severely agitated, aggressive autistic male on numerous psychotropic medications and requiring medical care received dexmedetomidine to permit weaning of unnecessary polypharmacy and to keep self and others safe while medical issues were addressed. Finally, a 15-year-old male with aggression secondary to a drug induced intoxication delirium and dangerous autonomic instability due to “spice” and “kratom” also was treated with dexmedetomidine with a good outcome. Conclusions: Dexmedetomidine is a useful agent for use in medical and critical care settings for time-limited treatment of severe anxiety, agitation, or delirium associated with multiple conditions for which usual psychotropic medications are ineffective or contraindicated.
ANX CON PYI Supported by Nationwide Children's Hospital Division of Pulmonary Medicine http://dx.doi.org/10.1016/j.jaac.2016.09.344
6.25 PREVALENCE RATES AND DETERMINANTS OF ELEMENTARY SCHOOL-BASED SERVICES FOR EXTERNALIZING BEHAVIOR PROBLEMS OVER A THREE-YEAR PERIOD IN GIRLS Pierrette Verlaan, PhD, Psychoeducation, University of Sherbrooke, 2500 Boulevard Universite, Sherbrooke, QC J1K 2R1, Canada; Michele Dery, PhD; Jean Toupin, PhD; Jean-Pascal Lemelin, PhD Objectives: Externalizing Behavior Problems (EBP) are frequent causes of referrals to school-based psychological services. Studies suggest that girls with EBP may have more unmet needs, present more severe impairment, and receive less prolonged treatment than boys. In addition to these concerns, little is known about referral determinants for school-based services for girls. The aims of this study were to examine gender differences in: 1) the severity of EBP and in prevalence rates of service reception, and 2) child, family and school-related determinants associated with maintaining (>12 months) school-based services. Methods: The data are part of an ongoing longitudinal study on gender differences in trajectories and service use for children with EBP in Canada. Eligible children (372;149 girls) were those receiving school-based services for emotional and behavior problems aged less than 10 years at recruitment. Guided by an ecological approach, determinants for EBP in child, family and school contexts were collected from parent and teachers initially and at each follow-up points (12, 24 and 36 months). Multilevel Generalized Estimating Equations (GEE) models were used to identify the determinants most likely to account for girls and boys maintaining services over time. Results: Prevalence rates indicated that more girls than boys were experiencing clinical levels of EBP and fewer remained in services at each follow-up points. Inversely, more boys than girls presented subthreshold levels of EBP at each follow-up points and were more likely to maintain services. GEE models indicated that along severity of EBP, dysfunctional relationships with parents, teachers and peers increased significantly the likelihood of girls maintaining school-based services (R2 ¼ 0.253, p < 0.001). A larger set of determinants emerged as important for boys, they included comorbid
S212
www.jaacap.org
internalizing problems and ADHD, family instability and pathology, as well as dysfunctional teacher-child and peer relationships (R2 ¼ 0.338, p < 0.001) Conclusions: The higher rates of service reception, the lower threshold of EBP and the larger set of determinants found for boys, suggest a greater sensitivity of adults to boys’ difficulties than for girls. To be noticed, girls may have to present severe disruptive behaviors and conflicting interpersonal relationships with adults and peers.
CD EDUC RF Supported by the Canadian Social Sciences and Humanities Research Council (SSHRC-37890/SSHRC-326706) and the Canadian Institutes of Health Research (CIHR-82694) http://dx.doi.org/10.1016/j.jaac.2016.09.345
6.26 PREDICTION OF IMPAIRMENT IN SCHOOL FUNCTION OVER ONE SCHOOL YEAR IN SPECIAL EDUCATION STUDENTS WITH PSYCHIATRIC DISORDERS Richard E. Mattison, MD, Pennsylvania State University, Department of Psychiatry, H073, Hershey Medical Center, Hershey, PA 17033 Objectives: Functional impairment in school is routinely measured by grade point average (GPA), absenteeism, and suspensions. The purpose of this study was to determine for students with psychiatric disorders those variables that could predict the worst dysfunction on these measures over a school year, thus identifying the most at-risk students to school staff, and suggesting more specific targets for interventions. Methods: A cohort of 196 students in a self-contained public school for secondary special education students with psychiatric disorders was followed over one school year. By the end of the first marking period the following information was available: demographics, IQ, reading and math achievement, and teacher ratings of psychopathology. Logistic regression analyses were then used to identify predictors for the worst final dysfunction in GPA, absenteeism, suspensions, and psychiatric inpatient/partial hospitalization during the school year. Results: The most dysfunctional groups were established for each area: GPA of <70 (29.6 percent), absenteeism of >24 days (33.2 percent), any suspension (36.2 percent), and any psychiatric inpatient/partial hospitalization (28.6 percent). The resultant significant predictors for each most impaired group were: GPA (non-Caucasian, low Verbal IQ, and high ADHD-Inattentive scale; concordance ¼ 76.7 percent); absenteeism (older and high Social Anxiety scale; 71.3 percent), suspension (high Conduct Disorder scale; 75.7 percent), and hospitalization (younger and high Depression scale; 67.5 percent). Conclusions: Information that child psychiatrists can easily obtain for their special education students with psychiatric disorders can produce practical results that can benefit both their patients and school staffs to whom they consult. For example, academically, non-Caucasian students with decreased language skills and attention appeared to be most at-risk for poor GPA. Consequently, clinicians and school staffs could ensure optimal treatment for such students in any ADHD, language disorders, and accompanying learning disorders in reading and/or writing. The results further model how practical research can be conducted in schools, as well as increase the limited evidence base that school consultants can use to assist their patients and special education colleagues.
CON EDUC LD http://dx.doi.org/10.1016/j.jaac.2016.09.346
6.27 EXPLORING BENEFITS OF SCHOOL-BASED CRISIS INTERVENTION PROGRAMS: A PRELIMINARY STUDY Ji min Cha, MD, Child and Adolescent Psychiatry, Kyungpook National University, 45, Deulan-ro 78-gil, Suseong-gu, Daegu, 42010, The Democratic People’s Republic of Korea Objectives: In Korea the most common cause of death for teenagers is suicide and this occupies a major part of school crisis. The adolescents who
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Methods: Charts were reviewed of patients seen by a psychiatric consult service in a major children’s hospital over 3.5 years. Seventeen patients received dexmedetomidine for severe anxiety, agitation/aggression, and delirium. Demographic information, presenting problems and reasons for consultation, medical and psychiatric diagnoses, psychotropic medications before, during, and after consultations, complications, and duration of treatment with demedetomidine were considered. Results: Seventeen patients, age range 6.1 to 33.75 years (average 17.76 years), 13 females and 4 males, received dexmedetomidine for non-procedural, psychiatric reasons. Nine were treated for agitated delirium who had medical contraindications to antipsychotics (QT prolongation, drug interactions). Of these, five had combined profound neurodevelopmental disorders and deliria due to sepsis, two were post cardiac surgery, one had anti-NMDA receptor encephalitis, and one had E. coli sepsis. Of seven patients with cystic fibrosis, all were treated while on ventilators, including four with severe anxiety before they expired, and three who survived but had difficulty weaning from the ventilator due to severe anxiety. A 21-year-old severely agitated, aggressive autistic male on numerous psychotropic medications and requiring medical care received dexmedetomidine to permit weaning of unnecessary polypharmacy and to keep self and others safe while medical issues were addressed. Finally, a 15-year-old male with aggression secondary to a drug induced intoxication delirium and dangerous autonomic instability due to “spice” and “kratom” also was treated with dexmedetomidine with a good outcome. Conclusions: Dexmedetomidine is a useful agent for use in medical and critical care settings for time-limited treatment of severe anxiety, agitation, or delirium associated with multiple conditions for which usual psychotropic medications are ineffective or contraindicated.
ANX CON PYI Supported by Nationwide Children's Hospital Division of Pulmonary Medicine http://dx.doi.org/10.1016/j.jaac.2016.09.344
6.25 PREVALENCE RATES AND DETERMINANTS OF ELEMENTARY SCHOOL-BASED SERVICES FOR EXTERNALIZING BEHAVIOR PROBLEMS OVER A THREE-YEAR PERIOD IN GIRLS Pierrette Verlaan, PhD, Psychoeducation, University of Sherbrooke, 2500 Boulevard Universite, Sherbrooke, QC J1K 2R1, Canada; Michele Dery, PhD; Jean Toupin, PhD; Jean-Pascal Lemelin, PhD Objectives: Externalizing Behavior Problems (EBP) are frequent causes of referrals to school-based psychological services. Studies suggest that girls with EBP may have more unmet needs, present more severe impairment, and receive less prolonged treatment than boys. In addition to these concerns, little is known about referral determinants for school-based services for girls. The aims of this study were to examine gender differences in: 1) the severity of EBP and in prevalence rates of service reception, and 2) child, family and school-related determinants associated with maintaining (>12 months) school-based services. Methods: The data are part of an ongoing longitudinal study on gender differences in trajectories and service use for children with EBP in Canada. Eligible children (372;149 girls) were those receiving school-based services for emotional and behavior problems aged less than 10 years at recruitment. Guided by an ecological approach, determinants for EBP in child, family and school contexts were collected from parent and teachers initially and at each follow-up points (12, 24 and 36 months). Multilevel Generalized Estimating Equations (GEE) models were used to identify the determinants most likely to account for girls and boys maintaining services over time. Results: Prevalence rates indicated that more girls than boys were experiencing clinical levels of EBP and fewer remained in services at each follow-up points. Inversely, more boys than girls presented subthreshold levels of EBP at each follow-up points and were more likely to maintain services. GEE models indicated that along severity of EBP, dysfunctional relationships with parents, teachers and peers increased significantly the likelihood of girls maintaining school-based services (R2 ¼ 0.253, p < 0.001). A larger set of determinants emerged as important for boys, they included comorbid
S212
www.jaacap.org
internalizing problems and ADHD, family instability and pathology, as well as dysfunctional teacher-child and peer relationships (R2 ¼ 0.338, p < 0.001) Conclusions: The higher rates of service reception, the lower threshold of EBP and the larger set of determinants found for boys, suggest a greater sensitivity of adults to boys’ difficulties than for girls. To be noticed, girls may have to present severe disruptive behaviors and conflicting interpersonal relationships with adults and peers.
CD EDUC RF Supported by the Canadian Social Sciences and Humanities Research Council (SSHRC-37890/SSHRC-326706) and the Canadian Institutes of Health Research (CIHR-82694) http://dx.doi.org/10.1016/j.jaac.2016.09.345
6.26 PREDICTION OF IMPAIRMENT IN SCHOOL FUNCTION OVER ONE SCHOOL YEAR IN SPECIAL EDUCATION STUDENTS WITH PSYCHIATRIC DISORDERS Richard E. Mattison, MD, Pennsylvania State University, Department of Psychiatry, H073, Hershey Medical Center, Hershey, PA 17033 Objectives: Functional impairment in school is routinely measured by grade point average (GPA), absenteeism, and suspensions. The purpose of this study was to determine for students with psychiatric disorders those variables that could predict the worst dysfunction on these measures over a school year, thus identifying the most at-risk students to school staff, and suggesting more specific targets for interventions. Methods: A cohort of 196 students in a self-contained public school for secondary special education students with psychiatric disorders was followed over one school year. By the end of the first marking period the following information was available: demographics, IQ, reading and math achievement, and teacher ratings of psychopathology. Logistic regression analyses were then used to identify predictors for the worst final dysfunction in GPA, absenteeism, suspensions, and psychiatric inpatient/partial hospitalization during the school year. Results: The most dysfunctional groups were established for each area: GPA of <70 (29.6 percent), absenteeism of >24 days (33.2 percent), any suspension (36.2 percent), and any psychiatric inpatient/partial hospitalization (28.6 percent). The resultant significant predictors for each most impaired group were: GPA (non-Caucasian, low Verbal IQ, and high ADHD-Inattentive scale; concordance ¼ 76.7 percent); absenteeism (older and high Social Anxiety scale; 71.3 percent), suspension (high Conduct Disorder scale; 75.7 percent), and hospitalization (younger and high Depression scale; 67.5 percent). Conclusions: Information that child psychiatrists can easily obtain for their special education students with psychiatric disorders can produce practical results that can benefit both their patients and school staffs to whom they consult. For example, academically, non-Caucasian students with decreased language skills and attention appeared to be most at-risk for poor GPA. Consequently, clinicians and school staffs could ensure optimal treatment for such students in any ADHD, language disorders, and accompanying learning disorders in reading and/or writing. The results further model how practical research can be conducted in schools, as well as increase the limited evidence base that school consultants can use to assist their patients and special education colleagues.
CON EDUC LD http://dx.doi.org/10.1016/j.jaac.2016.09.346
6.27 EXPLORING BENEFITS OF SCHOOL-BASED CRISIS INTERVENTION PROGRAMS: A PRELIMINARY STUDY Ji min Cha, MD, Child and Adolescent Psychiatry, Kyungpook National University, 45, Deulan-ro 78-gil, Suseong-gu, Daegu, 42010, The Democratic People’s Republic of Korea Objectives: In Korea the most common cause of death for teenagers is suicide and this occupies a major part of school crisis. The adolescents who
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016