Bright Light Therapy for Major Depressive Disorder in Adolescent Outpatients: A Preliminary Study.

BACKGROUND: Bright light therapy (BLT) has not been well-studied in adolescents with major depressive disorder, particularly in outpatient settings. METHODS: We conducted an 8-week clinical trial of BLT in adolescents recruited from a primary care practice with moderate to severe major depression. Acceptability and feasibility were defined by daily use of the light box and integration into daily routines. To assess treatment effects, we utilized the Short Mood and Feelings Questionnaire (SMFQ) and actigraphic sleep variables. RESULTS: Of the nine enrolled adolescents, the rate of daily use of the light therapy box was 100% at week 2, 78% at week 4 (n = 7), and 67% at weeks 6 and 8 (n = 6). Participants were better able to integrate midday BLT compared to morning BLT into their day-to-day routines. Mean depression scores improved during the 2-week placebo lead-in (dim red light-DRL) and continued to show significant improvement through 6 weeks of BLT. Sleep efficiency increased significantly (p = 0.046), and sleep onset latency showed a trend toward a significant decrease (p = 0.075) in the BLT phase compared to the DRL phase. CONCLUSION: Bright light treatment that was self-administered at home was feasible, acceptable, and effective for adolescent outpatients with depression. Findings support the development of larger, well-powered, controlled clinical trials of BLT in coordination with primary care.

Pediatric collaborative care outcomes in a regional model.

Background: Despite the movement toward hospital-based medical centers acquiring pediatric primary care offices, many primary care pediatricians still work in small, independent practices. To expand mental healthcare access, service delivery models must consider primary care practice needs and regionally available resources. Objective: This report describes the implementation and evaluation of the Mood, Anxiety, ADHD Collaborative Care (MAACC) program over a 4 years period. MAACC. MAACC engaged 97 pediatric primary care clinicians across 39 practices in mental health training and supported the treatment of referred patients through a collaborative care model. To support psychosocial treatment needs, we built a child community therapy referral network of 213 licensed psychotherapy providers. Methods: Data were collected on service delivery patterns (e.g., referrals, treatment use, and attrition) and patient outcomes. Measures included parent and children and adolescents PROMIS anxiety and depression short forms and the Parent NICHQ Vanderbilt. Results: Six hundred ninety-six children and adolescents aged 6-18 were evaluated and provided treatment recommendations. Anxiety disorders were the most common diagnosis (45.4%), followed by ADHD (30.7%) and mood disorder (17%). For children and adolescents with an anxiety or mood disorder, significant improvement was observed from baseline to any initial follow-up and from baseline to 6, 12-, and 18 weeks on children and adolescents and parent measures of anxiety and depression. For children and adolescents with ADHD, significant improvement was observed from baseline to any initial follow-up measure and at 6 and 18 weeks on parent-reported inattentive symptoms. Significant differences in treatment outcomes were identified for children and adolescents with anxiety receiving psychotherapy alone and medication management and psychotherapy. Conclusion: MAACC utilization and patient outcomes suggest that real-world collaborative care can effectively provide high-quality care while cultivating increased primary care treatment capacity and building on existing community resources.

Suicide Risk Assessment and Safety Planning in Pediatric Primary Care.

Suicidal thoughts and behavior are an increasing concern for youth. Pediatricians can prevent youth suicide through a stepwise process of screening, risk assessment, and safety planning incorporated into their practice. This article describes practical steps for pediatric clinicians to effectively detect and assess risks associated with suicidal thoughts and behaviors in youth while concurrently providing effective intervention. [Pediatr Ann. 2023;52(11):e422-e425.].

State of the Evidence for Use of Psychotropic Medications in School-Age Youth.

Psychotropic medications are commonly prescribed to school-aged youth for the management of mental health concerns. This paper describes the current state of evidence for psychotropic medications in school-aged youth. More specifically, the following sections summarize relevant medication research trials and practice parameters pertaining to psychotropic medication prescribing as well as the specific medications indicated for a range of commonly presenting disorders and symptom clusters in school-aged youth. For each of these disorders and symptom clusters, key findings pertaining to the current state of science and practice are highlighted for the purpose of offering patients, clinicians, researchers, and policymakers with nuanced considerations for the role of psychopharmacology within the context of a larger "whole-child" approach to care that relies on the collaboration of providers and services across systems of care to promote optimal child and family health and wellness. The paper concludes with a discussion about supporting the use of medication treatments in schools, including considerations for ensuring effective family-school-health system collaboration to best meet youth mental health needs.

Light Therapy for Adolescent Depression: A Scoping Review.

PURPOSE: Depressive disorders in adolescents are a major health concern associated with developmental, social, and educational impairment. Bright Light Therapy (BLT) is a feasible and effective treatment for depressive disorders in adults, but few controlled trials have been conducted with children or adolescents. This scoping review focuses on the current state of knowledge for BLT in the treatment of adolescent depression. We reviewed the literature for novel data and methodologic approaches using BLT and pediatric and young adult populations. RECENT FINDINGS: BLT is a tolerable treatment with few side effects. However, there is a marked lack of well-powered studies to support BLT as a treatment for depressive disorders in adolescent populations. Given evidence of tolerability and positive treatment effect on depression in the adult literature, research is needed to establish the efficacy, feasibility, and acceptability of BLT in adolescents.

Comparative analysis of pediatric anxiety measures in clinical sample: evaluation of the PROMIS pediatric anxiety short forms.

OBJECTIVE: Examine the psychometric properties, validity in relation to a legacy measure, and diagnostic accuracy of the PROMIS Anxiety Short Form 2.0 (PROMIS A-SF) Caregiver and Youth Reports in a clinical sample. METHODS: Participants were 301 youth and caregivers referred to a behavioral health clinic by their pediatrician. Participants and their caregivers completed PROMIS A-SF (youth and caregiver proxy), SCARED (youth and caregiver proxy), and a semi-structured interview. Descriptive, correlational, test-retest reliability, and receiver operating characteristic (ROC) analyses were conducted for both measures. RESULTS: PROMIS A-SF measures were highly correlated with SCARED total scores and the panic subscale. PROMIS A-SF measures had AUCs ranging from .49-.79 for the detection of any of three primary subtypes of anxiety: Generalized Anxiety, Separation Anxiety, and Social Anxiety. IMPLICATIONS: Dimensional anxiety subtypes, such as Social Anxiety may not be well detected on the PROMIS youth measure. Use of the PROMIS A-SF as a part of Evidence Based Assessment process is discussed.

Improving diagnostic accuracy: Comparison of nomograms and classification tree analyses for predicting the diagnosis of oppositional defiant disorder.

Unstructured clinical interviews are inaccurate tools for diagnostic decision-making. While structured diagnostic evaluations improve reliability, they are infrequently used in clinical practice. Empirical approaches are a hallmark of evidenced-based assessment and may reduce burdens of structured interviews. We explore two approaches to empirical prediction of diagnosis, the naïve nomogram, and classification tree analysis (CTA). To illustrate the clinical utility of each approach, we compared their use in a sample of 6-year-olds (N = 619) to predict structured-interview diagnoses of oppositional defiant disorder (ODD). Findings indicate the accuracy of both approaches in predicting the absence of a disorder and improved detection of ODD using CTA for subgroups of children. Both empirical prediction techniques have applicability to diagnostic decision-making in psychiatry and pediatrics. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Screening for Mental Health Problems in Pediatric Primary Care.

Systematic mental health screening is a recommended but controversial process in the pediatricians' behavioral health tool kit. Although the American Academy of Pediatrics and other organizations promote routine behavioral health screening, implementing an effective and sustainable screening program can be challenging. We discuss the rationale for and barriers to screening in pediatric settings, identify accessible validated tools that can be easily incorporated into practice, and suggest a practical strategy for implementing a more accurate screening system for common mental health concerns in pediatric primary care. [Pediatr Ann. 2020;49(10):e421-e425.].

Editorial: Promoting Quality Psychotherapy: It Is Not the Process but the Outcome That Matters!

The article published in this issue of the Journal by Bear et al.1 is the first to use meta-analytic procedures to try to understand the value of psychotherapy for pediatric anxiety and depression as usually delivered in the community. The authors scoured the literature for psychotherapy clinical trials that used treatment as usual as a control group or observational studies of treatment in mental health settings, then applied meta-analytic approaches to get a better idea of what treatment as usual outcomes were and by extension what to expect from psychotherapy as usually delivered. The study findings suggest that psychotherapy as practiced in the community even in high-quality settings does not provide consistently good outcomes. In this editorial, we will review the results of this study and discuss trends in psychotherapy research and practice that could improve the outcomes for patients and families.

Evidence-based assessment in clinical settings: Reducing assessment burden for a structured measure of child and adolescent anxiety.

Clinically useful and evidence-based mental health assessment requires the identification of strategies that maximize diagnostic accuracy, inform treatment planning, and make efficient use of clinician and patient time and resources. This study uses classification tree analyses to determine whether parent- and child-report instruments, alone or in combination, can accurately predict diagnoses as measured by the Anxiety Disorders Interview Schedule (ADIS). The ADIS, which is the gold-standard semistructured interview for anxiety disorders in children and adolescents, requires formal training and lengthy administration. Data were collected as part of the standard diagnostic assessment process for 201 patients (ages 5 to 17 years) in an urban outpatient psychiatry specialty clinic. Analyses examined 2 models to determine which predictors reached an acceptable level of diagnostic accuracy for generalized anxiety, social anxiety, and separation anxiety disorders. The first model used scores on a parent- and child-report anxiety measure combined with demographic factors, and the second model incorporated a broad-band measure of child psychopathology and a depression measure into the analysis. Although demographic factors did not emerge as accurate predictors in either model, particular measures, either alone or in combination, were able to predict specific ADIS diagnoses in some cases, allowing for the potential streamlining of ADIS administration. These results suggest that a classification-tree analysis lends itself to the construction of simple algorithms that have high clinical utility and may advance the feasibility and utility of evidence-based assessment strategies in real-world practice settings by balancing cost effectiveness, administration demands, and accuracy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

An investigation of the partial-assignment completion effect on students' assignment choice behavior.

This study was designed to investigate the partial assignment completion effect. Seventh-grade students were given a math assignment. After working for 5 min, they were interrupted and their partially completed assignments were collected. About 20 min later, students were given their partially completed assignment and a new, control assignment that contained the same number of equivalent problems that were incomplete on their partially completed assignment. Students were told that they would have to complete an assignment but could choose which assignment they completed. Significantly more students chose their partially completed assignment. Theoretical and applied implications and directions for future research are discussed.