Mental health professionals' awareness of the parental functioning of persons with severe mental disorders: a retrospective chart study.

BACKGROUND: The proportion of persons with severe mental illness (SMI) who are parents has increased in recent decades. Children of parents with SMI are at increased risk for medical, behavioral, emotional, developmental, academic, and social problems. They also have an increased risk for injuries, accidents, and mortality, addictions, and various psychiatric disorders compared to children of parents with no such diagnoses. We aimed to examine the extent to which mental health professionals (MHPs) who treat adult patients with SMI in ambulatory settings are aware of these individuals' functioning in three parenting domains: parental functioning, familial support system and children's conditions. We also compared psychiatrists' awareness with that of psychologists and social workers. METHODS: In this retrospective practice-oriented study, we reviewed 80 clinical files of individuals diagnosed with schizophrenia, affective disorder or personality disorder treated in a mental health outpatient clinic, using the Awareness of Family's Mental Health Checklist (AFMHC) developed for this study. Thus, awareness was determined on the basis of what was recorded in the patient file. RESULTS: Almost half of the MHPs were unaware to their patients' parental functioning as only 44% of files contained records relating to this issue. Awareness to other domains was even lower: 24% of files contained information on patient's support system and 12% had information about their children's mental and/or physical health. No statistically significant differences between psychiatrists and other MHPs were found with regards to awareness to the various domains. Positive correlations were found among MHP's for awareness in the three domains. CONCLUSION: Lack of awareness among MHPs to their patients' parental functioning is not specific to a certain profession and may be attributed to patients (e.g., reluctance to disclose relevant information) or to MHPs (e.g., lack of training). Awareness of family and parental functioning by MHPs working with persons with SMI should be part of a standard procedure, integrated into policy and training.

Stimulant Treatment Effect on Anxiety Domains in Children with Attention-Deficit/Hyperactivity Disorder With and Without Anxiety Disorders: A 12-Week Open-Label Prospective Study.

Objectives: The effect of stimulants on anxiety domains has not been systematically studied. We assessed prospectively the impact of stimulant treatment in children with attention-deficit/hyperactivity disorder (ADHD) on the severity of anxiety domains and on ADHD with comorbid anxiety disorders. Methods: Children with ADHD (n = 57, aged 6-15 years) started a stimulant or were switched from one stimulant to another. Assessments were conducted at four time points (baseline and weeks 2, 6, and 12) and consisted of parental questionnaires (ADHD rating scale, screen for child anxiety related disorders [SCARED]), and side effect questionnaire completed by a child psychiatrist. Results: A significant improvement in total SCARED scores was obtained after 12 weeks stimulant treatment in children both with and without anxiety disorders. Significant reductions were detected in generalized anxiety, separation anxiety, and school avoidance SCARED subscales, but not in panic and social anxiety subscales. ADHD symptoms significantly improved both in children with and without anxiety comorbidities. Conclusion: We found specific effects of stimulants on anxiety domains. Stimulant treatment, even for ADHD children diagnosed with comorbid anxiety disorders, is relatively safe regarding the risk of anxiety exacerbation. Moreover, the presence of anxiety symptoms or disorders does not interfere with the beneficial effect of the stimulants on the ADHD core symptoms. Clinical trial regestration number: IRB SMC-6893-20.

Feeding, Eating, and Emotional Disturbances in Children with Avoidant/Restrictive Food Intake Disorder (ARFID).

Avoidant/restrictive food intake disorder (ARFID) is a relatively new diagnostic category. We sought to determine whether the Stanford Feeding Questionnaire (SFQ), an instrument for assessing picky eating, can differentiate children with ARFID from control children, and whether children with ARFID would show more nonfeeding/eating emotional problems than controls. Fifty children with ARFID were compared to 98 controls. Parents completed the SFQ, Screen for Child Anxiety Related Emotional Disorders (SCARED), Strength and Difficulties Questionnaire (SDQ), and Sensory Responsiveness Questionnaire (SRQ). On the SFQ, 12 items represented child ARFID behaviors (SFQ-ARFID Scale), and another 15 items represented parental feeding problems (SFQ-PFP Scale). We found that the SFQ-ARFID and SFQ-PFP Scale scores were significantly higher in children with ARFID vs. controls. Children with ARFID demonstrated higher SDQ-Total-Difficulties, higher SDQ-Internalizing-Difficulties and lower SRQ-Hedonic scores compared with controls. Of all parameters, the SFQ-ARFID Scale best differentiated children with ARFID from control children (area under receiver operating characteristics curve = 0.939, 95% CI, 0.895-0.983, p < 0.001). These findings suggest that parental reports show more eating problems and emotional disturbances in children with ARFID vs. controls, and more parental feeding problems. Further research is required to determine whether the SFQ-ARFID Scale may serve as an effective screening tool for the identification of ARFID.

Testing the Efficacy of a Smartphone Application in Improving Medication Adherence, Among Children with ADHD.

BACKGROUND: Adherence to medication is a key factor for successful treatment of children with ADHD. However, most children do not adhere to their pharmacotherapy regimen, and have no contact with their physician during the first month of pharmacotherapy. A mobile health (mHealth) approach may bridge the gap between physicians and patients, allowing for more frequent communications as well as better monitoring of adherence to the prescribed treatment. METHOD: The study sample included 39 children with ADHD (27 boys), aged 9.56±2.41 years. Participants were randomly assigned to one of the following two groups: (1) a study group in which participants and their parents were prompted to use a mobile application (i.e., mobile app or app); or to (2) a control group in which participants were treated as usual, without the app. Pill counts, which is a common strategy for confirming medication adherence, was recorded at week 4 and week 8. Clinical assessment conducted at baseline, week 4, and week 8. RESULTS: Participants who were prescribed with the app demonstrated higher overall pill counts over 8-weeks period, F=4.33, p<.05. In addition, a significant improvement in total CRS score was found among the study group compared to controls in week 4 and week 8, F=4.74, p<.05. CONCLUSIONS: The current study provides initial support for the feasibility of a new mobile app in promoting adherence to stimulants among youth with ADHD.

The link between parent and child sleep disturbances in children with attention deficit/hyperactivity disorder.

OBJECTIVE: Although sleep problems are widely known to be a prominent feature of childhood attention deficit/hyperactivity disorder (ADHD), little is known about the link between these difficulties and parental sleep disturbances. METHODS: The design was cross-sectional assessing a clinical sample of 62 children, aged 7-17 years (mean age = 10.0 years) diagnosed with ADHD and their parents. All participants completed measures of ADHD symptoms, sleep, anxiety, and executive functioning. RESULTS: Regression analysis revealed that child's pre-sleep arousal significantly predicted parental sleep, and that medication status and children's anxiety significantly predicted children's sleep. Children with a clinical sleep score were more impaired in behavioral, emotional, and cognitive domains. CONCLUSION: Parents of children with ADHD exhibit sleep disturbances that might be affected by their child's arousal prior to bedtime. The nature of the interaction between children with ADHD and their parents' sleep abnormalities is yet to be elucidated.