- Email: [email protected]
Hyperactivity Disorder (ADHD): A Comorbidity Study Based on Medication Treatment
NEW RESEARCH POSTERS 6.29 — 6.31
response scores of WCST, the digit span scores (P < 0.05), and coding and symbol search scores (P < 0.01) of WISC-IV; their scores in SWM, total interval errors, and SWM strategy were reduced significantly (P < 0.05). In the PSQ questionnaire, the scores of behavior problems, learning problems, hyperactivity impulsivity, hyperactivity index, and anxiety (P < 0.05) were decreased significantly. Conclusions: Through the exploratory research, we found that computerbased training could improve the executive function performance on response inhibition, working memory, processing speed, cognitive flexibility, and plan-monitoring fields in children with ADHD, as well as the core symptoms of ADHD.
ADHD, COMP, NEPSYC Supported by Natural Science Foundation of China Grant 81271510 http://dx.doi.org/10.1016/j.jaac.2017.09.373
6.29 ATYPICAL FUNCTIONAL CONNECTIVITY IN ADOLESCENTS AND ADULTS WITH PERSISTENT AND REMITTED ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER (ADHD) Giorgia Michelini, MSC, King’s College London, giorgia. [email protected]; Joseph Jurgiel, BS, University of California, Los Angeles, [email protected]; Ioannis Bakolis, PhD, King’s College London, ioannis. [email protected]; Celeste H.M. Cheung, PhD, King’s College London, [email protected]; Philip Asherson, MRCPsych, King’s College London, philip. [email protected]; Sandra K. Loo, PhD, University of California, Los Angeles, [email protected]; Jonna Kuntsi, PhD, King’s College London, jonna.kuntsi@kcl. ac.uk; Iman Mohammad-Rezazadeh, PhD, University of California, Los Angeles, [email protected] Objectives: ADHD diagnosed in childhood often persists into adolescence and adulthood, but the neural mechanisms underlying ADHD persistence/ remission are poorly understood. In a follow-up study, we aimed to examine whether brain functional connectivity, measuring the interdependency of brain oscillations between brain regions, reflects enduring deficits unrelated to ADHD outcome or is a marker of ADHD remission, improving concurrently with clinical profiles. Methods: On average, six years after assessments in childhood, high-density EEG was recorded in 110 adolescents and young adults with childhood ADHD (87 persisters, 23 remitters) and 169 typically developing control subjects during an arrow-flanker task-eliciting cognitive control. Functional connectivity was quantified by applying a network-based (graph-theory) approach. Groups were compared on connectivity metrics in theta, alpha, and beta frequency bands in incongruent (high-conflict) trials before target onset (prestimulus), during target processing (poststimulus), and in the degree of change from prestimulus to poststimulus. ADHD outcome was examined with clinical diagnosis (persistent/remitted ADHD) and with ADHD severity indicated by continuous measures of symptoms and functional impairment. Results: ADHD persisters showed increased prestimulus connectivity in theta, alpha, and beta oscillations; increased poststimulus beta connectivity; and reduced prestimulus/post-stimulus change in theta connectivity compared with control subjects (all P < 0.01). In most measures showing ADHD persistercontrol differences, ADHD remitters differed from control subjects (all P < 0.05) but not from persisters. Likewise, no association emerged between connectivity measures and ADHD severity in participants with childhood ADHD. Conclusions: Adolescents and young adults with persistent and remitted ADHD shared atypical connectivity profiles (hyperconnectivity and reduced ability to modulate connectivity patterns with task demands), compared with control subjects. These results indicate that these connectivity impairments may represent enduring deficits in individuals with childhood ADHD, irrespective of current diagnostic status in adolescence/young adulthood.
ADHD, NEURODEV Supported by Action Medical Research and the Peter Sowerby Charitable Foundation Grant GN1777, UK Medical Research Council (MRC) Grant
S286
www.jaacap.org
G0300189, NIMH Grant R01MH062873, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London Grant G9817803, and the National Institute for Health Research Biomedical Research Centre for Mental Health at King’s College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley National Health Service Foundation Trust http://dx.doi.org/10.1016/j.jaac.2017.09.374
6.30 AN INVESTIGATION INTO THE UTILITY AND SENSITIVITY OF THE SNAP-IV PARENT- AND TEACHER-RATED QUESTIONNAIRE IN THE ASSESSMENT OF ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER (ADHD) Cristal J. Oxley, MA, MBBS, MRCPsych, South London and Maudsley NHS Foundation Trust, [email protected]; Jenny Phillips, King’s College London, [email protected]; Omer S. Moghraby, BSc, MBBS, MRPsych, The Maudsley Hospital, [email protected] Objectives: The purpose of this study is to establish the utility and sensitivity of the Swanson, Nolan and Pelham Teacher and Parent Rating Scale (SNAP-IV) in assessing ADHD in a clinical sample. Methods: This study consisted of a retrospective review of medical records from a clinical patient sample (N ¼ 65), aged seven to 17 years. Sensitivity of SNAP-IV scores to medication changes were assessed using a two-tailed paired t-test while Cohen’s kappa coefficient was used to assess concurrent validity between SNAP-IV and Strengths and Difficulties Questionnaire (SDQ) scores and interrater reliability (parents and teachers). Internal consistency was measured using Cronbach’s alpha coefficient. Statistical analysis was performed on the total SNAP-IV scores, both inclusive (items 1 - 26) and exclusive (items 1 - 18) of the ODD items, and across the respective subdomains of inattention, hyperactivity/impulsivity, and ODD. Results: Total SNAP-IV scores showed no significant change following a medication increase. Significant changes were observed in SNAP-IV scores in the inattentive domain in patients who had no history of medication resistance. SNAP-IV demonstrated acceptable test-retest reliability (a ¼ 0.781) and moderate correlation between parent and teacher ratings (l ¼ 0.626). Correlation between SDQ and SNAP-IV reports was fair for parents (l ¼ 0.256) and teachers (l ¼ 0.286). Conclusions: This study provides evidence that SNAP-IV can be a reliable and valid screening tool as a component in assessment of ADHD behaviors within a clinical sample. Further research with a larger sample size is required to further test the sensitivity of SNAP-IV to changes in medication dose.
ADHD, RI, TREAT http://dx.doi.org/10.1016/j.jaac.2017.09.375
6.31 ASTHMA AND ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER (ADHD): A COMORBIDITY STUDY BASED ON MEDICATION TREATMENT Murat Pakyurek, MD, University of California, Davis, [email protected]; Anca B. Luminare, MD, University of California, Davis School of Medicine, abluminare@ucdavis. edu; Ana-Maria Iosif, PhD, University of California, Davis, [email protected]; Atoosa Azarang, MD, University of California, Davis Medical Center, [email protected]; Thomas E. Nordahl, MD, PhD, University of California, Davis School of Medicine, [email protected] Objectives: Previous cross-sectional studies have suggested an association between asthma and ADHD. Our study aimed at evaluating the comorbidity of asthma and ADHD based on how frequently drugs used to treat those disorders are prescribed to the same patients. This study is stimulated by the work of Ole Bernt Fasmer in Bergen, Norway.
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
NEW RESEARCH POSTERS 6.32 — 6.34
Methods: A cohort study of 1,890,990 patients were segregated based on the medication prescribed (anti-asthma medication, 125,006 patients, 6.61% of the total patients in the system; anti–ADHD medication, 12,442 patients, 0.66% of the total patients in the system; both anti-asthma and anti–ADHD medication, 2,983 patients, 0.10% of the total patients). Odds ratios (OR) and 95% confidence intervals (CI) were derived from multivariate logistic regression models with having a prescription for asthma medication (yes/ no) as the outcome variable. Our initial model used categorical predictors for gender, age-group, and presence of anti–ADHD prescription (yes/no). A second model also included terms for all two-way interactions, as well as a term for the three-way interaction of gender, anti–ADHD prescription, and age-group. All tests were two-sided, with a ¼ 0.05. Analyses were implemented using PROC LOGISTIC in SAS, Version 9.4. The authors used data from the University of California Davis Medical Center, Cohort Discovery System between 2006 and 2012. Results: Patients who had been prescribed anti–ADHD drugs had an abnormally high risk (OR ¼ 4.19) of also being prescribed asthma medication. Female patients with ADHD had an overall higher probability to be prescribed anti-asthma medication than did males (OR ¼ 1.28). For both males and females, the association was stronger in the older age-groups (the OR exceeded six for men aged 35–84 years and for women aged 45– 84 years). Conclusions: These prescription patterns suggested a marked comorbidity between asthma and ADHD for both genders and across all age-groups.
ADHD, TREAT, RF http://dx.doi.org/10.1016/j.jaac.2017.09.376
6.32 DOES THE COLLABORATIVE SERVICE DELIVERY MODEL INFLUENCE PRIMARY CARE PROVIDERS’ PHARMACOLOGIC MANAGEMENT OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)? Carol M. Rockhill, MD, PhD, MPH, Seattle Children’s Hospital and University of Washington, carol.rockhill@seattlechildrens. org; L. Lee Carlisle, MD, Child Study and Treatment Center, [email protected]; Kathleen Myers, MD, DFAACAP, MPH, MS, University of Washington and Seattle Children’s Hospital, [email protected] Objectives: The goal of this presentation is to examine the effect of two psychiatric service delivery models (groups A and B) for ADHD over a period of 22 weeks on subsequent pharmacologic management by primary care physicians (PCPs). As treatment for ADHD is integrated into primary care, providers need to determine optimal models for collaboration. The current study compares the effect of two collaborative models for ADHD over 22 weeks on PCPs’ subsequent prescribing practices. Group A received short-term (six sessions) expert psychiatric treatment using telehealth technologies. Group B received telehealth consultation followed by management by PCPs. Children in group A demonstrated significantly better outcomes than children in group B. Improved outcomes were associated with psychiatrists’ more assertive pharmacologic treatment, more often achieving 50 percent symptom reduction. The current study examines whether this significantly assertive pharmacologic management was continued 10 weeks after study completion (32 weeks) by PCPs for children in group A compared with group B. Methods: We obtained PCP records for 168 of the original 214 subjects (78.5%). We extracted data from enrollment to intervention completion at 22 to 32 weeks during PCP follow-up. Variables included service utilization and pharmacologic management. Descriptive analyses compared variables across the two collaborative models. Results: Children in group A were managed more assertively at 32 weeks as proven by the following: more follow-up visits; ADHD medication; higher doses of stimulant medications; and polypharmacy, predominantly the use of an a2 agonists with stimulants. Conclusions: These findings suggest that a collaborative model with shortterm expert psychiatric care will be associated with more assertive PCP
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
management of ADHD over short-term follow-up compared with a consultation model.
PPC, ADHD, CON Supported by NIMH Grant R01MH081997 http://dx.doi.org/10.1016/j.jaac.2017.09.377
6.33 FACTORS ASSOCIATED WITH PSYCHIATRIC DISORDER IN CHILDREN WITH EPILEPSY (CWE): A SYSTEMATIC REVIEW Maria Teresa Lax Pericall, PhD, South London and Maudsley NHS Foundation Trust, [email protected]; Eric Taylor, PhD, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, [email protected] Objectives: The goals of this presentation are to review the literature in a systematic way using previously published guidelines and identify factors associated with psychiatric disorders and psychopathology in children with epilepsy (CWE). Factors included the following: 1) child variables— gender, age, and IQ; 2) epilepsy—seizure frequency (sz freq), epilepsy syndrome, and age of onset of epilepsy; and 3) environmental—socioeconomic status (SES). Methods: Database searches were conducted from 2004 to July 2015 in Ovid Medline, PsycINFO, EMBASE, Cinahl, and child and adolescent development research databases. Terms and inclusion and exclusion criteria were specified. Results: The search elicited 5,302 references. After the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA), 83 papers were selected for the review. The quality assessment of the papers (National Institute of Health for observational study tool) ranked 36 papers as good, 29 as fair, and 18 as poor. 1) ADHD was associated with benign epilepsy with centro-temporal spikes (BECTS) and frontal lobe epilepsy; there is unclear association with gender and sz freq, and there is no significant association with SES. It is noteworthy that some papers show that ADHD was diagnosable in children before the onset of epilepsy. 2) ASD was associated with low IQ, West and Dravet syndromes, and age of onset of epilepsy before age three years; there is an unclear association with gender and no significant association with SES. 3) Internalizing disorders were associated with age of child (adolescent); there was unclear association with gender, age of onset of epilepsy, and sz freq and no significant association with SES. 4) Psychosis was associated with learning disability and autism spectrum disorder (ASD) (one paper) and older age (one paper). 5) Psychopathology (outcome measured with scales) was associated with low IQ and low SES in industrial countries; there was unclear association with gender and sz freq. Conclusions: Psychiatric diagnosis was not clearly associated with seizure frequency. Age of onset of epilepsy may not be associated with psychiatric disorder if it is analyzed as a continuous variable, but if it is analyzed as a dichotomous variable (before three years), it is associated with ASD. Clinicians should be aware that BECTS is associated with ADHD. Girls with epilepsy are at a much higher risk for ASD and ADHD compared with girls in the general population. The reasons for this deserve further study.
EP, PSP, RF http://dx.doi.org/10.1016/j.jaac.2017.09.152
6.34 NEUROPSYCHOLOGICAL PROFILES OF LOW BIRTHWEIGHT/PRETERM ADOLESCENTS WITH PERSISTING AND REMITTING INATTENTION SYMPTOMS Marisa N. Spann, PhD, Columbia University, College of Physicians and Surgeons, [email protected]; Judith Feldman, PhD, Columbia University, College of Physicians and Surgeons, [email protected]; Anna Silberman, MS, Columbia University, College of Physicians and Surgeons, [email protected]; J. Blake Turner, PhD, Columbia University, College of Physicians
www.jaacap.org
S287
response scores of WCST, the digit span scores (P < 0.05), and coding and symbol search scores (P < 0.01) of WISC-IV; their scores in SWM, total interval errors, and SWM strategy were reduced significantly (P < 0.05). In the PSQ questionnaire, the scores of behavior problems, learning problems, hyperactivity impulsivity, hyperactivity index, and anxiety (P < 0.05) were decreased significantly. Conclusions: Through the exploratory research, we found that computerbased training could improve the executive function performance on response inhibition, working memory, processing speed, cognitive flexibility, and plan-monitoring fields in children with ADHD, as well as the core symptoms of ADHD.
ADHD, COMP, NEPSYC Supported by Natural Science Foundation of China Grant 81271510 http://dx.doi.org/10.1016/j.jaac.2017.09.373
6.29 ATYPICAL FUNCTIONAL CONNECTIVITY IN ADOLESCENTS AND ADULTS WITH PERSISTENT AND REMITTED ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER (ADHD) Giorgia Michelini, MSC, King’s College London, giorgia. [email protected]; Joseph Jurgiel, BS, University of California, Los Angeles, [email protected]; Ioannis Bakolis, PhD, King’s College London, ioannis. [email protected]; Celeste H.M. Cheung, PhD, King’s College London, [email protected]; Philip Asherson, MRCPsych, King’s College London, philip. [email protected]; Sandra K. Loo, PhD, University of California, Los Angeles, [email protected]; Jonna Kuntsi, PhD, King’s College London, jonna.kuntsi@kcl. ac.uk; Iman Mohammad-Rezazadeh, PhD, University of California, Los Angeles, [email protected] Objectives: ADHD diagnosed in childhood often persists into adolescence and adulthood, but the neural mechanisms underlying ADHD persistence/ remission are poorly understood. In a follow-up study, we aimed to examine whether brain functional connectivity, measuring the interdependency of brain oscillations between brain regions, reflects enduring deficits unrelated to ADHD outcome or is a marker of ADHD remission, improving concurrently with clinical profiles. Methods: On average, six years after assessments in childhood, high-density EEG was recorded in 110 adolescents and young adults with childhood ADHD (87 persisters, 23 remitters) and 169 typically developing control subjects during an arrow-flanker task-eliciting cognitive control. Functional connectivity was quantified by applying a network-based (graph-theory) approach. Groups were compared on connectivity metrics in theta, alpha, and beta frequency bands in incongruent (high-conflict) trials before target onset (prestimulus), during target processing (poststimulus), and in the degree of change from prestimulus to poststimulus. ADHD outcome was examined with clinical diagnosis (persistent/remitted ADHD) and with ADHD severity indicated by continuous measures of symptoms and functional impairment. Results: ADHD persisters showed increased prestimulus connectivity in theta, alpha, and beta oscillations; increased poststimulus beta connectivity; and reduced prestimulus/post-stimulus change in theta connectivity compared with control subjects (all P < 0.01). In most measures showing ADHD persistercontrol differences, ADHD remitters differed from control subjects (all P < 0.05) but not from persisters. Likewise, no association emerged between connectivity measures and ADHD severity in participants with childhood ADHD. Conclusions: Adolescents and young adults with persistent and remitted ADHD shared atypical connectivity profiles (hyperconnectivity and reduced ability to modulate connectivity patterns with task demands), compared with control subjects. These results indicate that these connectivity impairments may represent enduring deficits in individuals with childhood ADHD, irrespective of current diagnostic status in adolescence/young adulthood.
ADHD, NEURODEV Supported by Action Medical Research and the Peter Sowerby Charitable Foundation Grant GN1777, UK Medical Research Council (MRC) Grant
S286
www.jaacap.org
G0300189, NIMH Grant R01MH062873, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London Grant G9817803, and the National Institute for Health Research Biomedical Research Centre for Mental Health at King’s College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley National Health Service Foundation Trust http://dx.doi.org/10.1016/j.jaac.2017.09.374
6.30 AN INVESTIGATION INTO THE UTILITY AND SENSITIVITY OF THE SNAP-IV PARENT- AND TEACHER-RATED QUESTIONNAIRE IN THE ASSESSMENT OF ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER (ADHD) Cristal J. Oxley, MA, MBBS, MRCPsych, South London and Maudsley NHS Foundation Trust, [email protected]; Jenny Phillips, King’s College London, [email protected]; Omer S. Moghraby, BSc, MBBS, MRPsych, The Maudsley Hospital, [email protected] Objectives: The purpose of this study is to establish the utility and sensitivity of the Swanson, Nolan and Pelham Teacher and Parent Rating Scale (SNAP-IV) in assessing ADHD in a clinical sample. Methods: This study consisted of a retrospective review of medical records from a clinical patient sample (N ¼ 65), aged seven to 17 years. Sensitivity of SNAP-IV scores to medication changes were assessed using a two-tailed paired t-test while Cohen’s kappa coefficient was used to assess concurrent validity between SNAP-IV and Strengths and Difficulties Questionnaire (SDQ) scores and interrater reliability (parents and teachers). Internal consistency was measured using Cronbach’s alpha coefficient. Statistical analysis was performed on the total SNAP-IV scores, both inclusive (items 1 - 26) and exclusive (items 1 - 18) of the ODD items, and across the respective subdomains of inattention, hyperactivity/impulsivity, and ODD. Results: Total SNAP-IV scores showed no significant change following a medication increase. Significant changes were observed in SNAP-IV scores in the inattentive domain in patients who had no history of medication resistance. SNAP-IV demonstrated acceptable test-retest reliability (a ¼ 0.781) and moderate correlation between parent and teacher ratings (l ¼ 0.626). Correlation between SDQ and SNAP-IV reports was fair for parents (l ¼ 0.256) and teachers (l ¼ 0.286). Conclusions: This study provides evidence that SNAP-IV can be a reliable and valid screening tool as a component in assessment of ADHD behaviors within a clinical sample. Further research with a larger sample size is required to further test the sensitivity of SNAP-IV to changes in medication dose.
ADHD, RI, TREAT http://dx.doi.org/10.1016/j.jaac.2017.09.375
6.31 ASTHMA AND ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER (ADHD): A COMORBIDITY STUDY BASED ON MEDICATION TREATMENT Murat Pakyurek, MD, University of California, Davis, [email protected]; Anca B. Luminare, MD, University of California, Davis School of Medicine, abluminare@ucdavis. edu; Ana-Maria Iosif, PhD, University of California, Davis, [email protected]; Atoosa Azarang, MD, University of California, Davis Medical Center, [email protected]; Thomas E. Nordahl, MD, PhD, University of California, Davis School of Medicine, [email protected] Objectives: Previous cross-sectional studies have suggested an association between asthma and ADHD. Our study aimed at evaluating the comorbidity of asthma and ADHD based on how frequently drugs used to treat those disorders are prescribed to the same patients. This study is stimulated by the work of Ole Bernt Fasmer in Bergen, Norway.
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
NEW RESEARCH POSTERS 6.32 — 6.34
Methods: A cohort study of 1,890,990 patients were segregated based on the medication prescribed (anti-asthma medication, 125,006 patients, 6.61% of the total patients in the system; anti–ADHD medication, 12,442 patients, 0.66% of the total patients in the system; both anti-asthma and anti–ADHD medication, 2,983 patients, 0.10% of the total patients). Odds ratios (OR) and 95% confidence intervals (CI) were derived from multivariate logistic regression models with having a prescription for asthma medication (yes/ no) as the outcome variable. Our initial model used categorical predictors for gender, age-group, and presence of anti–ADHD prescription (yes/no). A second model also included terms for all two-way interactions, as well as a term for the three-way interaction of gender, anti–ADHD prescription, and age-group. All tests were two-sided, with a ¼ 0.05. Analyses were implemented using PROC LOGISTIC in SAS, Version 9.4. The authors used data from the University of California Davis Medical Center, Cohort Discovery System between 2006 and 2012. Results: Patients who had been prescribed anti–ADHD drugs had an abnormally high risk (OR ¼ 4.19) of also being prescribed asthma medication. Female patients with ADHD had an overall higher probability to be prescribed anti-asthma medication than did males (OR ¼ 1.28). For both males and females, the association was stronger in the older age-groups (the OR exceeded six for men aged 35–84 years and for women aged 45– 84 years). Conclusions: These prescription patterns suggested a marked comorbidity between asthma and ADHD for both genders and across all age-groups.
ADHD, TREAT, RF http://dx.doi.org/10.1016/j.jaac.2017.09.376
6.32 DOES THE COLLABORATIVE SERVICE DELIVERY MODEL INFLUENCE PRIMARY CARE PROVIDERS’ PHARMACOLOGIC MANAGEMENT OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)? Carol M. Rockhill, MD, PhD, MPH, Seattle Children’s Hospital and University of Washington, carol.rockhill@seattlechildrens. org; L. Lee Carlisle, MD, Child Study and Treatment Center, [email protected]; Kathleen Myers, MD, DFAACAP, MPH, MS, University of Washington and Seattle Children’s Hospital, [email protected] Objectives: The goal of this presentation is to examine the effect of two psychiatric service delivery models (groups A and B) for ADHD over a period of 22 weeks on subsequent pharmacologic management by primary care physicians (PCPs). As treatment for ADHD is integrated into primary care, providers need to determine optimal models for collaboration. The current study compares the effect of two collaborative models for ADHD over 22 weeks on PCPs’ subsequent prescribing practices. Group A received short-term (six sessions) expert psychiatric treatment using telehealth technologies. Group B received telehealth consultation followed by management by PCPs. Children in group A demonstrated significantly better outcomes than children in group B. Improved outcomes were associated with psychiatrists’ more assertive pharmacologic treatment, more often achieving 50 percent symptom reduction. The current study examines whether this significantly assertive pharmacologic management was continued 10 weeks after study completion (32 weeks) by PCPs for children in group A compared with group B. Methods: We obtained PCP records for 168 of the original 214 subjects (78.5%). We extracted data from enrollment to intervention completion at 22 to 32 weeks during PCP follow-up. Variables included service utilization and pharmacologic management. Descriptive analyses compared variables across the two collaborative models. Results: Children in group A were managed more assertively at 32 weeks as proven by the following: more follow-up visits; ADHD medication; higher doses of stimulant medications; and polypharmacy, predominantly the use of an a2 agonists with stimulants. Conclusions: These findings suggest that a collaborative model with shortterm expert psychiatric care will be associated with more assertive PCP
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
management of ADHD over short-term follow-up compared with a consultation model.
PPC, ADHD, CON Supported by NIMH Grant R01MH081997 http://dx.doi.org/10.1016/j.jaac.2017.09.377
6.33 FACTORS ASSOCIATED WITH PSYCHIATRIC DISORDER IN CHILDREN WITH EPILEPSY (CWE): A SYSTEMATIC REVIEW Maria Teresa Lax Pericall, PhD, South London and Maudsley NHS Foundation Trust, [email protected]; Eric Taylor, PhD, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, [email protected] Objectives: The goals of this presentation are to review the literature in a systematic way using previously published guidelines and identify factors associated with psychiatric disorders and psychopathology in children with epilepsy (CWE). Factors included the following: 1) child variables— gender, age, and IQ; 2) epilepsy—seizure frequency (sz freq), epilepsy syndrome, and age of onset of epilepsy; and 3) environmental—socioeconomic status (SES). Methods: Database searches were conducted from 2004 to July 2015 in Ovid Medline, PsycINFO, EMBASE, Cinahl, and child and adolescent development research databases. Terms and inclusion and exclusion criteria were specified. Results: The search elicited 5,302 references. After the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA), 83 papers were selected for the review. The quality assessment of the papers (National Institute of Health for observational study tool) ranked 36 papers as good, 29 as fair, and 18 as poor. 1) ADHD was associated with benign epilepsy with centro-temporal spikes (BECTS) and frontal lobe epilepsy; there is unclear association with gender and sz freq, and there is no significant association with SES. It is noteworthy that some papers show that ADHD was diagnosable in children before the onset of epilepsy. 2) ASD was associated with low IQ, West and Dravet syndromes, and age of onset of epilepsy before age three years; there is an unclear association with gender and no significant association with SES. 3) Internalizing disorders were associated with age of child (adolescent); there was unclear association with gender, age of onset of epilepsy, and sz freq and no significant association with SES. 4) Psychosis was associated with learning disability and autism spectrum disorder (ASD) (one paper) and older age (one paper). 5) Psychopathology (outcome measured with scales) was associated with low IQ and low SES in industrial countries; there was unclear association with gender and sz freq. Conclusions: Psychiatric diagnosis was not clearly associated with seizure frequency. Age of onset of epilepsy may not be associated with psychiatric disorder if it is analyzed as a continuous variable, but if it is analyzed as a dichotomous variable (before three years), it is associated with ASD. Clinicians should be aware that BECTS is associated with ADHD. Girls with epilepsy are at a much higher risk for ASD and ADHD compared with girls in the general population. The reasons for this deserve further study.
EP, PSP, RF http://dx.doi.org/10.1016/j.jaac.2017.09.152
6.34 NEUROPSYCHOLOGICAL PROFILES OF LOW BIRTHWEIGHT/PRETERM ADOLESCENTS WITH PERSISTING AND REMITTING INATTENTION SYMPTOMS Marisa N. Spann, PhD, Columbia University, College of Physicians and Surgeons, [email protected]; Judith Feldman, PhD, Columbia University, College of Physicians and Surgeons, [email protected]; Anna Silberman, MS, Columbia University, College of Physicians and Surgeons, [email protected]; J. Blake Turner, PhD, Columbia University, College of Physicians
www.jaacap.org
S287