Utilization of Integrated and Colocated Behavioral Health Models in Pediatric Primary Care.

Integrating behavioral health services within pediatric primary care may help address barriers to these services for youth, especially the underserved. Models of primary care behavioral health include coordinated, colocated, integrated, and collaborative care. This study began exploring the comparative utility of these models by investigating differences in the demographics and diagnoses of patients seen for a behavioral health warm handoff (integrated model) and a scheduled behavioral health visit (colocated model) across 3 pediatric primary care sites. The 3 sites differed in their rates of warm handoff usage, and there were differences in certain diagnoses given at warm handoffs versus scheduled visits. Depression diagnoses were more likely to be given in warm handoffs, and disruptive behavior, trauma/adjustment, and attention-deficit/hyperactivity disorder-related diagnoses were more likely to be given in scheduled visits. These results have implications for the influence of office structure and standardized procedures on behavioral health models used in pediatric primary care.

Oligonucleotide-Polymer Conjugates: From Molecular Basics to Practical Application.

DNA exhibits many attractive properties, such as programmability, precise self-assembly, sequence-coded biomedical functions, and good biocompatibility; therefore, DNA has been used extensively as a building block to construct novel nanomaterials. Recently, studies on oligonucleotide-polymer conjugates (OPCs) have attracted increasing attention. As hybrid molecules, OPCs exhibit novel properties, e.g., sophisticated self-assembly behaviors, which are distinct from the simple combination of the functions of DNA and polymer, making OPCs interesting and useful. The synthesis and applications of OPCs are highly dependent on the choice of the polymer block, but a systematic summary of OPCs based on their molecular structures is still lacking. In order to design OPCs for further applications, it is necessary to thoroughly understand the structure-function relationship of OPCs. In this review, we carefully categorize recently developed OPCs by the structures of the polymer blocks, and discuss the synthesis, purification, and applications for each category. Finally, we will comment on future prospects for OPCs.

Dumbbell-Like Silica Coated Gold Nanorods and Their Plasmonic Properties.

Silica coated gold nanorods (GNRs@SiO2) with dumbbell-like morphology allowing dual functionalization in an individual nanostructure have attracted great attention for applications such as sensing and biological imaging. We report a detailed study on the feasibility of controlling the morphology of silica coating on GNRs. The morphology of the silica shell can be either cylindrical or dumbbell shaped. With constant GNR concentration, the ratio of hexadecyltrimethylammonium bromide (CTAB) and tetraethylorthosilicate (TEOS) concentrations is the key to determine the amount of available TEOS for silica deposition on the GNR since the TEOS will diffuse toward the surface of GNRs. The effect of morphologies on surface-enhanced Raman scattering (SERS) performance was also investigated, and we found that the dumbbell morphology of silica coated gold nanorods has the most significant SERS enhancement. Our study is significant in terms of the capability to control the dumbbell morphology of silica coated gold nanorods, which can eventually broaden the application of these plasmonic nanomaterials.

Developmental Differences in Functioning in Youth With Social Phobia.

Social phobia (SoP) in youth may manifest differently across development as parent involvement in their social lives changes and social and academic expectations increase. This cross-sectional study investigated whether self-reported and parent-reported functioning in youth with SoP changes with age in social, academic, and home/family domains. Baseline anxiety impairment data from 488 treatment-seeking anxiety-disordered youth (ages 7-17, N = 400 with a SoP diagnosis) and their parents were gathered using the Child Anxiety Impact Scale and were analyzed using generalized estimating equations. According to youth with SoP and their parents, overall difficulties, social difficulties, and academic difficulties increased with age, even when controlling for SoP severity. These effects significantly differed for youth with anxiety disorders other than SoP. Adolescents may avoid social situations as parental involvement in their social lives decreases, and their withdrawn behavior may result in increasing difficulty in the social domain. Their avoidance of class participation and oral presentations may increasingly impact their academic performance as school becomes more demanding. Implications are discussed for the early detection and intervention of SoP to prevent increased impairment over the course of development.

The Treatment of Anxiety in Autism Spectrum Disorder (TAASD) Study: Rationale, Design and Methods.

This paper describes the rationale, design, and methods of the Treatment for Anxiety in Autism Spectrum Disorders study, a three-site randomized controlled trial investigating the relative efficacy of a modular CBT protocol for anxiety in ASD (Behavioral Interventions for Anxiety in Children with Autism) versus standard CBT for pediatric anxiety (the Coping Cat program) and a treatment-as-usual control. The trial is distinct in its scope, its direct comparison of active treatments for anxiety in ASD, and its comprehensive approach to assessing anxiety difficulties in youth with ASD. The trial will evaluate the relative benefits of CBT for children with ASD and investigate potential moderators (ASD severity, anxiety presentation, comorbidity) and mediators of treatment response, essential steps for future dissemination and implementation.

Assessing anxiety in youth with the multidimensional anxiety scale for children.

The present study examined the psychometric properties, including discriminant validity and clinical utility, of the youth self-report and parent-report forms of the Multidimensional Anxiety Scale for Children (MASC) among youth with anxiety disorders. The sample included parents and youth (N = 488, 49.6% male) ages 7 to 17 who participated in the Child/Adolescent Anxiety Multimodal Study. Although the typical low agreement between parent and youth self-reports was found, the MASC evidenced good internal reliability across MASC subscales and informants. The main MASC subscales (i.e., Physical Symptoms, Harm Avoidance, Social Anxiety, and Separation/Panic) were examined. The Social Anxiety and Separation/Panic subscales were found to be significantly predictive of the presence and severity of social phobia and separation anxiety disorder, respectively. Using multiple informants improved the accuracy of prediction. The MASC subscales demonstrated good psychometric properties and clinical utilities in identifying youth with anxiety disorders.

Characteristics of exposure sessions as predictors of treatment response in anxious youth.

Guidelines for conducting effective exposure treatment with anxious youth emphasize preparation for and processing of the exposure task as important elements, but limited research has examined these guidelines. Using multiple regression, this study evaluated the extent to which independent observers' ratings of preparation and processing of in-session exposure tasks were associated with treatment outcome in a sample of 61 anxiety-disordered youth. Results indicated that preparation for exposure was not related to outcome, but postevent processing of the exposure task was significantly associated with clinician-rated diagnostic improvements. Exploratory analyses suggest that treatment responders were more likely to be assigned between-session exposure tasks as "homework" and were more likely to be rewarded for their efforts in session. Although time is spent preparing youth for exposure tasks, the activities that occur after the task is conducted are influential in reducing youth anxiety over the course of treatment. Additional implications and future directions are discussed.