Integrated care models for ADHD in children and adolescents: A systematic review.

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) in children and adolescents is commonly managed in primary care. Changes in United States health care have led to the integration of behavioral health services within a patient's "medical home" to improve access to, engagement in, and continuity of quality health care. Despite proliferation of these integrated care models, no studies have specifically examined models for managing ADHD in children and adolescents within primary care. METHOD: We searched PsycINFO, MEDLINE, and Google Scholar databases, and found 8 studies describing 6 integrated care models (i.e., combined psychosocial and medication treatments with coordination of care between primary care clinicians and behavioral health clinicians). We reviewed characteristics (i.e., settings, target populations, providers, levels of integration, evaluation and treatment approaches, and methods of interprofessional collaboration) and outcomes (i.e., access, outcomes, and acceptability) of these models. RESULTS: The 6 integrated care models demonstrate the potential to improve access to and acceptability of ADHD care for children and adolescents. The models also demonstrate that behavioral health clinicians can integrate at various levels within primary care to achieve superior clinical outcomes compared with nonintegrated models. DISCUSSION: We identified 6 effective integrated care models for addressing ADHD in children and adolescents that may be adaptable to local needs and internal capacities. We discuss results of these models with regard to their implications for clinical practice and research. (PsycINFO Database Record

Assessing treatment barriers in young adults with type 1 diabetes.

AIMS: The current study was designed to identify barriers that prevent young adults with DM1 from achieving glycemic control. METHODS: Eighty-three young adult patients with DM1 [age 22.2 ± 2.8 years (mean ± SD), duration diabetes 11.3 ± 5.6 years, HbA1c 8.8 ± 2.1%] completed a battery of surveys assessing potential barriers to achieving glycemic control. Results of questionnaires were correlated with the patient's most recent HbA1c, and a multiple regression analysis was conducted to determine what barriers were significantly associated with HbA1c levels. RESULTS: Questionnaires that significantly correlated with HbA1c levels included the Conflict Subscale of the Diabetes Responsibility and Conflict Scale (r = .55, p < .01), the Modified Barriers to Adherence Questionnaire (r = .42, p < .01), and the Hospital Anxiety and Depression Scale (r = .31, p < .05). An item analysis of the Modified Barriers to Adherence Scale suggested that patient confidence with carbohydrate counting was most statistically associated with HbA1c [F(3, 80) = 12.95, p < .01, R²=.35]. CONCLUSIONS: Results suggest that despite attempts to educate patients; barriers such as family conflict, psychological issues, and carbohydrate counting remain obstacles impeding glycemic control in young adults with DM1.

Parental report of medication acceptance among youth: implications for everyday practice.

OBJECTIVE: Evidence-based interventions for pill swallowing training exist but are primarily implemented in pediatric specialty hospitals. Given increasing interest in the translation of brief and effective interventions to the wider population, there is a need to examine medication acceptance in a normative sample. METHODS: Participants (N = 304) completed the Medication Acceptance Survey, which assessed child/adolescent liquid and pill medication history and acceptance as well as parental interest in pill swallowing training. RESULTS: Results showed that 30-40% of youth had rejected/refused a pill or liquid formulation. Over half were unable to swallow a standard size pill or small capsule. Despite these difficulties, most parents did not express interest in an empirically supported pill swallowing training intervention. CONCLUSIONS: The results provide directions for future research as well as the translation of pill swallowing interventions to primary care.

Assessment and treatment of autism.

Physicians are often the first health care professionals to encounter children that display symptoms associated with developmental disorders such as autism. Unfortunately, there is lack of information regarding what strategies physicians should adopt in treating these symptoms and where they should look to refer individuals who present with severe symptoms of autism. This paper provides some preliminary information regarding the current behavioral assessment and treatment strategies in order to help physicians identify and make appropriate recommendations for successful treatment when working with autistic children. The essential components of successful treatment for autism are outlined; some preliminary treatment methodologies that physicians can recommend parents or caregivers attempt are also highlighted. In addition, the current behavioral treatment strategies used for acquisition of social skills and language are covered as well as methodologies for the reduction of maladaptive behavior in children with autism.

Functional analysis and treatment of the bizarre speech of dually diagnosed adults.

Nine behavior-analytic studies, each reporting data for a single participant, have shown that bizarre speech can be maintained by social reinforcement. In the current study, we controlled for a possible referral bias in this literature by including nonreferred participants with dual diagnoses. Functional analyses identified attention functions for 2 participants and nonsocial functions for the others. Noncontingent reinforcement decreased the bizarre speech of both participants who displayed attention-maintained bizarre speech.

Using video modeling and reinforcement to teach perspective-taking skills to children with autism.

We evaluated video modeling and reinforcement for teaching perspective-taking skills to 3 children with autism using a multiple baseline design. Video modeling and reinforcement were effective; however, only 2 children were able to pass an untrained task, indicating limited generalization. The findings suggest that video modeling may be an effective technology for teaching perspective taking if researchers can continue to develop strategies for enhancing the generalization of these new skills.

An evaluation of simultaneous and sequential presentation of preferred and nonpreferred food to treat food selectivity.

In the current investigation, we compared two methods of food presentation (simultaneous vs. sequential) to increase consumption of nonpreferred food for 3 children with food selectivity. In the simultaneous condition, preferred foods were presented at the same time as nonpreferred food (e.g., a piece of broccoli was presented on a chip). In the sequential condition, acceptance of the nonpreferred food resulted in presentation of the preferred food. Increases in consumption occurred immediately during the simultaneous condition for 2 of the 3 participants. For 1 participant, increases in consumption occurred in the simultaneous condition relative to the sequential condition, but only after physical guidance and re-presentation were added to treatment. Finally, consumption increased for 1 participant in the sequential condition, but only after several sessions. These results are discussed in terms of possible mechanisms that may alter preferences for food (i.e., establishing operations, flavor-flavor conditioning).