- Email: [email protected]
Anxiety in Individuals With Autism Spectrum Disorder: Clinical Assessment, Biology, and Treatments
SYMPOSIA 41.3 – 42.0
education, income, and self-ratings of impairment) suggest that childhood ADHD has pernicious, long-term effects.
ADHD LONG RF http://dx.doi.org/10.1016/j.jaac.2016.07.361
41.3 LONG-TERM OUTCOMES OF CHILDHOOD ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: THE NEW YORK STUDY Rachel G. Klein, PhD, Psychiatry, New York University School of Medicine, 1016 5th Ave Apt 14D, New York, NY 10028-0132; F. Xavier Castellanos, MD; Maria Ramos-Olazagasti, PhD Objectives: The goals of this study are to describe long-term clinical and functional outcomes in the New York Study of hyperactive children who were followed prospectively for 33 years and identify possible predictors that influence these outcomes. Methods: White hyperactive boys (N ¼ 207 probands) were recruited in childhood and followed in adolescence (mean age 18 years), early adulthood (mean age 25 years), and mid-adulthood (mean age 41 years). In late adolescence, 178 comparison participants were recruited. At the final followup in mid-adulthood, a total of 135 probands and 136 comparison participants (65.2 and 76.4 percent of original cohort, respectively) were assessed. Outcome measures included occupational, economic, and educational attainment and marital history, occupational and social functioning, ongoing and lifetime psychiatric disorders, hospitalizations, obesity, risk-taking behaviors, and criminal behaviors. Results: Compared with peers without ADHD, probands showed greater persistence of ADHD, along with greater prevalence of CD/antisocial personality disorder (APD) and SUD in late adolescence. These dysfunctions continued into early adulthood, even when ADHD remitted for the majority of the sample group, and were associated with deficits in educational and occupational attainment, leading to a relative economic disadvantage. Furthermore, the disproportionally high rate of CD/APD and SUD in probands versus comparison participants translated to significantly higher rates of criminality, risk-taking behavior, and risk-related medical outcomes in adulthood. Probands also showed elevated obesity rates in relation to comparison participants but no differences in mood or anxiety disorders. Conclusions: There is heterogeneity in the clinical and functional outcomes of children with ADHD. This study’s findings show that childhood ADHD does not preclude adequate functioning in various life domains. However, it does predispose to maladjustment in adolescence and adulthood in a subset of these children, particularly those who develop CD/APD, an important predictor of long-term outcome.
ADHD LONG OTH http://dx.doi.org/10.1016/j.jaac.2016.07.362
41.4 PERSISTENCE OF BEHAVIORAL AND AFFECTIVE UNDER-CONTROL IN ATTENTIONDEFICIT/HYPERACTIVITY DISORDER RISK OF SUBSTANCE ABUSE: SUCCESS AND FAILURE IN THE QUEST FOR PREDICTORS Brooke S.G. Molina, PhD, Psychiatry & Psychology, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213; Sarah L. Pedersen, PhD; Christine A.P. Walther, PhD; Seth C. Harty, PhD; Margaret H. Sibley, PhD; Elizabeth M. Gnagy; William E. Pelham Jr., PhD Objectives: The purpose of this session is to describe recent findings from The Pittsburgh ADHD Longitudinal Study with regard to predictors of longterm outcome, with an emphasis on alcohol and substance abuse. Methods: Children diagnosed with ADHD (n ¼ 364) and demographically similar individuals without ADHD (n ¼ 240) are being followed longitudinally through early adulthood. Probands were diagnosed in childhood between
S324
www.jaacap.org
1987 and 1996 using comprehensive research diagnostic criteria (semistructured clinical interview and standardized parent and teacher rating scales) upon presentation of attention-deficit disorder to the Western Psychiatric Institute and Clinic for assessment and treatment. They completed their first follow-up assessment of individuals between the ages of 11 and 28 years; the non–ADHD group was recruited at this time from greater Pittsburgh, Pennsylvania, USA. Assessments occurred annually thereafter until 2008 when they were switched to age-targeted visits (annually to age 23 years followed by ages 25, 27, 30, 35 years and so on). Most (89 percent) are boys and Caucasian (81 percent), and parental education is variable. Results: We report the contribution of symptom persistence, as well as “urgency”—impulsivity when experiencing strong mood—to the risk of alcoholism as indexed by frequency of alcohol use in adolescence and the number of problems associated with alcohol by age 29 years. We report the contributions of impulsive anger and coping skills with alcohol-related problems and posit a model of alcoholism vulnerability that includes poorly managed emotion within ADHD as contributory to maladaptive outcome. Finally, we report the absence of traditional expectancy effects (beliefs about the positive and negative effects of various substances) for explaining alcohol and marijuana use in this sample group. Conclusions: Taken together, our findings implicate a complicated vulnerability triad of persisting behavioral and affective disorders under control with a cognition-behavior disconnect that conflicts with traditional models of substance abuse vulnerability. We discuss the implications of these findings for treatment development and future research.
ALC ADHD SUD http://dx.doi.org/10.1016/j.jaac.2016.07.363
SYMPOSIUM 42 ANXIETY IN INDIVIDUALS WITH AUTISM SPECTRUM DISORDER: CLINICAL ASSESSMENT, BIOLOGY, AND TREATMENTS Antonio Hardan, MD, Stanford University, 401 Quarry Road, Stanford, CA 94305; Lawrence K. Fung, MD, PhD, Stanford University, 401 Quarry Rd., Stanford, CA 94301; Bryan H. King, MD Objectives: Current strategies for the assessments and treatments of anxiety in ASD are unclear and nonspecific. In this symposium, we will 1) describe findings of a new and more specific instrument for assessing anxiety in youth with ASD; 2) systematically analyze the evidence for assessment of the hypothalamus-pituitary-adrenal axis in individuals with ASD; 3) discuss the principles and evidence base of CBT for anxiety in children with ASD; and 4) present preliminary findings from pilot studies examining the effectiveness of arginine-vasopressin and N-acetylcysteine in the treatment of anxiety and repetitive behaviors in children with ASD. Methods: This symposium brings together four presenters and a discussant to review recent research focusing on the clinical assessment, biology, cognitive behavioral treatment, and pharmacologic treatment of anxiety in individuals with ASD. Results: Presentations will include the following: 1) better measurement of anxiety in youth with ASD; 2) cortisol in individuals with ASD: meta-analysis and systematic review; 3) cognitive and behavioral interventions for anxiety in children with autism; 4) psychopharmacological treatment of anxiety symptoms in ASD; and 5) synthesis of all of the presentations that will discuss implications in clinical practice and future research directions. Conclusions: In light of the frequency of anxiety in ASD, a comprehensive approach is needed to understand the underlying pathophysiology and, more importantly, the development of systematic assessments and effective treatment strategies. This scientific symposium will aim at discussing ongoing studies that are focusing on the clinical assessment and treatments of anxiety in ASD.
ANX ASD OCD http://dx.doi.org/10.1016/j.jaac.2016.07.365
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
education, income, and self-ratings of impairment) suggest that childhood ADHD has pernicious, long-term effects.
ADHD LONG RF http://dx.doi.org/10.1016/j.jaac.2016.07.361
41.3 LONG-TERM OUTCOMES OF CHILDHOOD ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: THE NEW YORK STUDY Rachel G. Klein, PhD, Psychiatry, New York University School of Medicine, 1016 5th Ave Apt 14D, New York, NY 10028-0132; F. Xavier Castellanos, MD; Maria Ramos-Olazagasti, PhD Objectives: The goals of this study are to describe long-term clinical and functional outcomes in the New York Study of hyperactive children who were followed prospectively for 33 years and identify possible predictors that influence these outcomes. Methods: White hyperactive boys (N ¼ 207 probands) were recruited in childhood and followed in adolescence (mean age 18 years), early adulthood (mean age 25 years), and mid-adulthood (mean age 41 years). In late adolescence, 178 comparison participants were recruited. At the final followup in mid-adulthood, a total of 135 probands and 136 comparison participants (65.2 and 76.4 percent of original cohort, respectively) were assessed. Outcome measures included occupational, economic, and educational attainment and marital history, occupational and social functioning, ongoing and lifetime psychiatric disorders, hospitalizations, obesity, risk-taking behaviors, and criminal behaviors. Results: Compared with peers without ADHD, probands showed greater persistence of ADHD, along with greater prevalence of CD/antisocial personality disorder (APD) and SUD in late adolescence. These dysfunctions continued into early adulthood, even when ADHD remitted for the majority of the sample group, and were associated with deficits in educational and occupational attainment, leading to a relative economic disadvantage. Furthermore, the disproportionally high rate of CD/APD and SUD in probands versus comparison participants translated to significantly higher rates of criminality, risk-taking behavior, and risk-related medical outcomes in adulthood. Probands also showed elevated obesity rates in relation to comparison participants but no differences in mood or anxiety disorders. Conclusions: There is heterogeneity in the clinical and functional outcomes of children with ADHD. This study’s findings show that childhood ADHD does not preclude adequate functioning in various life domains. However, it does predispose to maladjustment in adolescence and adulthood in a subset of these children, particularly those who develop CD/APD, an important predictor of long-term outcome.
ADHD LONG OTH http://dx.doi.org/10.1016/j.jaac.2016.07.362
41.4 PERSISTENCE OF BEHAVIORAL AND AFFECTIVE UNDER-CONTROL IN ATTENTIONDEFICIT/HYPERACTIVITY DISORDER RISK OF SUBSTANCE ABUSE: SUCCESS AND FAILURE IN THE QUEST FOR PREDICTORS Brooke S.G. Molina, PhD, Psychiatry & Psychology, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213; Sarah L. Pedersen, PhD; Christine A.P. Walther, PhD; Seth C. Harty, PhD; Margaret H. Sibley, PhD; Elizabeth M. Gnagy; William E. Pelham Jr., PhD Objectives: The purpose of this session is to describe recent findings from The Pittsburgh ADHD Longitudinal Study with regard to predictors of longterm outcome, with an emphasis on alcohol and substance abuse. Methods: Children diagnosed with ADHD (n ¼ 364) and demographically similar individuals without ADHD (n ¼ 240) are being followed longitudinally through early adulthood. Probands were diagnosed in childhood between
S324
www.jaacap.org
1987 and 1996 using comprehensive research diagnostic criteria (semistructured clinical interview and standardized parent and teacher rating scales) upon presentation of attention-deficit disorder to the Western Psychiatric Institute and Clinic for assessment and treatment. They completed their first follow-up assessment of individuals between the ages of 11 and 28 years; the non–ADHD group was recruited at this time from greater Pittsburgh, Pennsylvania, USA. Assessments occurred annually thereafter until 2008 when they were switched to age-targeted visits (annually to age 23 years followed by ages 25, 27, 30, 35 years and so on). Most (89 percent) are boys and Caucasian (81 percent), and parental education is variable. Results: We report the contribution of symptom persistence, as well as “urgency”—impulsivity when experiencing strong mood—to the risk of alcoholism as indexed by frequency of alcohol use in adolescence and the number of problems associated with alcohol by age 29 years. We report the contributions of impulsive anger and coping skills with alcohol-related problems and posit a model of alcoholism vulnerability that includes poorly managed emotion within ADHD as contributory to maladaptive outcome. Finally, we report the absence of traditional expectancy effects (beliefs about the positive and negative effects of various substances) for explaining alcohol and marijuana use in this sample group. Conclusions: Taken together, our findings implicate a complicated vulnerability triad of persisting behavioral and affective disorders under control with a cognition-behavior disconnect that conflicts with traditional models of substance abuse vulnerability. We discuss the implications of these findings for treatment development and future research.
ALC ADHD SUD http://dx.doi.org/10.1016/j.jaac.2016.07.363
SYMPOSIUM 42 ANXIETY IN INDIVIDUALS WITH AUTISM SPECTRUM DISORDER: CLINICAL ASSESSMENT, BIOLOGY, AND TREATMENTS Antonio Hardan, MD, Stanford University, 401 Quarry Road, Stanford, CA 94305; Lawrence K. Fung, MD, PhD, Stanford University, 401 Quarry Rd., Stanford, CA 94301; Bryan H. King, MD Objectives: Current strategies for the assessments and treatments of anxiety in ASD are unclear and nonspecific. In this symposium, we will 1) describe findings of a new and more specific instrument for assessing anxiety in youth with ASD; 2) systematically analyze the evidence for assessment of the hypothalamus-pituitary-adrenal axis in individuals with ASD; 3) discuss the principles and evidence base of CBT for anxiety in children with ASD; and 4) present preliminary findings from pilot studies examining the effectiveness of arginine-vasopressin and N-acetylcysteine in the treatment of anxiety and repetitive behaviors in children with ASD. Methods: This symposium brings together four presenters and a discussant to review recent research focusing on the clinical assessment, biology, cognitive behavioral treatment, and pharmacologic treatment of anxiety in individuals with ASD. Results: Presentations will include the following: 1) better measurement of anxiety in youth with ASD; 2) cortisol in individuals with ASD: meta-analysis and systematic review; 3) cognitive and behavioral interventions for anxiety in children with autism; 4) psychopharmacological treatment of anxiety symptoms in ASD; and 5) synthesis of all of the presentations that will discuss implications in clinical practice and future research directions. Conclusions: In light of the frequency of anxiety in ASD, a comprehensive approach is needed to understand the underlying pathophysiology and, more importantly, the development of systematic assessments and effective treatment strategies. This scientific symposium will aim at discussing ongoing studies that are focusing on the clinical assessment and treatments of anxiety in ASD.
ANX ASD OCD http://dx.doi.org/10.1016/j.jaac.2016.07.365
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016