ABSTRACT
Background: Cystic fibrosis (CF) is a life-limiting disease with chronic, debilitating pulmonary, endocrine, gastrointestinal, and other symptoms. Patients with CF have higher rates of anxiety and depression than the general population (Quittner 2014). Elexacaftor-tezacaftor-ivacaftor (ETI) has resulted in significant improvement of physical CF symptoms by targeting defects in in the CF transmembrane regulator proteins transcribed by the deltaF508 mutation (Middleton 2019). This data is part of a 5 year study monitoring medical and psychiatric symptoms, especially anxiety and depression, in patients taking ETI. Method(s): This is a single center, Nationwide Children's Hospital IRB approved, longitudinal observational study evaluating the effects of ETI treatment on mood and anxiety. Eligible participants were recruited during routine CF clinic visits. Subjects are administered standardized validated measures for anxiety and depression at baseline, 1, 3, 6, 9, 12, 18, 24, 36, 48, and 60 months. Measures include the PHQ-9, GAD-7, adult and pediatric PROMIS Depression and Anxiety Scales. Result(s): 184 subjects (93 males, 91 females), completed all anxiety and depression measures at the 6 month mark. Thirty-two of 184 received pediatric measures. Linear mixed-effects model was used to evaluate changes of primary outcomes, PHQ-9, GAD-7, and PROMIS over the study visits. All statistical analyses are performed in R version 4.0 (R Core Team, Vienna, Austria). Normal range score rates at baseline then 6 months were: PHQ-9, 67%/78%;GAD-7, 71%/79%;adult PROMIS Depression, 87%/91%;pediatric PROMIS Depression, 91%/85%;adult PROMIS Anxiety, 83%/87%;pediatric PROMIS Anxiety, 91%/95%. Overall trends were toward stability to slight improvement on all measures, with only 5 respondents reporting shifts from "normal" to "severe" symptoms. No study participants required emergency or inpatient psychiatric care during this 6 month period. Discussion(s): A significant majority of 184 patients with CF demonstrated normal scores on measures of depression and anxiety during their first 6 months on ETI. These results indicate trends toward improvement in mental health upon initiation of ETI in this sample. While this does not reflect each individual case, it indicates that patients with CF collectively may have decreased anxiety and depression during this time period. While improvements in anxiety and depression as CF symptoms improve with ETI treatment make intuitive sense, the first 6 months of this study occurred during the COVID-19 pandemic. Hence, anxiety and depression may also have been affected by social isolation, changes in routine, and fear of contracting COVID-19. Conclusion/Implications: Continued follow-up is required to evaluate the relationships of CF medical symptoms, depression, anxiety, and ETI treatment over time. References: Middleton PG, et al. (2019). Elexacaftor-Tezacaftor-Ivacaftor for cystic fibrosis with a single Phe508del allele. NEJM, 381(19):1809-19. Quittner AL, et al. (2014). Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers. Thorax, 69:1090-97. Copyright © 2022
ABSTRACT
Education has faced unprecedented disruption during the COVID pandemic. Understanding how students have adapted as we have entered a different phase of the pandemic and some communities have returned to more typical schooling will inform a suite of policy interventions and subsequent research. We use data from an oral reading fluency (ORF) assessment—a rapid assessment taking only a few minutes that measures a fundamental reading skill—to examine COVID’s effects on children’s reading ability during the pandemic. We find that students in the first 200 days of the 2020–2021 school year tended to experience slower growth in ORF relative to prepandemic years. We also observe slower growth in districts with a high percentage of English language learners and/or students eligible for free and reduced-price lunch. These findings offer valuable insight into the effects of COVID on one of the most fundamental skills taught to children. © The Author(s) 2022.
ABSTRACT
Objectives: This session aims to equip attendees with selected psychotherapeutic tools for the mental health assessment and treatment of medically ill children and adolescents situated in a developmental framework. Methods: Participants will have an opportunity to discuss the effects of medical illness on development from early childhood through adolescent and young adult (AYA) age groups. They will learn about therapeutic interventions with young medically ill children aged 0-6 years and their families. Presenters will share experiences on establishing remote services on the pediatric unit and emergency service with medically ill children during the pandemic and discuss bedside psychotherapy strategies. Participants will also have an opportunity to learn about psychotherapeutic strategies regarding chronic illness themes in the AYA age group, leading up to and including end-of-life care. Results: Participants will gain a new understanding of the effects of medical illness on development from early childhood through AYA age groups. Methods of psychotherapeutic engagement are evolving, whether due to forced adaptations during the COVID-19 pandemic or through recently developed psychotherapeutic tools from parent-child interaction, dignity, and meaning-centered psychotherapies for patients and families. Effective psychotherapeutic applications across the pediatric continuum of care are essential for optimal implementation and outcomes. Conclusions: Children and adolescents remain subject to chronic and terminal medical illnesses with comorbid mental health conditions and considerations. Even as medical advances have extended life expectancies, the need for relevant, practical, and effective delivery of psychotherapeutic interventions—both in person and virtual—has also increased. Child and adolescent psychiatrists are advised to be current with helpful treatment modalities in their roles as psychotherapists and multidisciplinary treatment team leaders working in settings with medically ill youth. MDM, PYI, P