Treatment for Anxiety Disorders in the Pediatric Primary Care Setting.

Anxiety disorders are among the most diagnosed mental health problems in children and adolescents. Without intervention, anxiety disorders in youth are chronic, debilitating, and amplify risk of negative sequelae. Youth with anxiety present to primary care frequently and often families choose to first discuss mental health concerns with their pediatricians. Both behavioral and pharmacologic interventions can be effectively implemented in primary care, and research demonstrates the effectiveness of both approaches.

A Second-Opinion Program for the Care of Youths Prescribed Five or More Psychotropics in Washington State.

This retrospective study describes a second-opinion review program for the care of children in Washington State who received Medicaid coverage and who were prescribed five or more psychotropic medications, primarily by mental health specialists. In total, 136 second-opinion reviews from 2013 and 169 from 2018 were included in this study. Attention-deficit hyperactivity disorder (ADHD), behavioral difficulties, anxiety, and trauma were prevalent among these children, and participants were commonly prescribed ADHD medications, selective serotonin reuptake inhibitors, and second-generation antipsychotics. The incidence of reviews remained stable over the two periods, but psychosocial treatment increased significantly over this time. This study sheds light on the initiation, maintenance, and identification of polypharmacy psychotropic regimens and highlights psychosocial treatment as an intervention that increases best practice care for at-risk patients.

Reliability of StepWatch Activity Monitor to Measure Locomotor Activity in Youth With Lower Limb Salvage.

PURPOSE: The study purpose was to determine the minimum number of monitoring days necessary to reliably capture walking among individuals with lower limb salvage. METHODS: Nineteen participants with lower limb salvage wore an ankle-mounted motion sensor over a 7-day period to obtain step counts. Generalizability theory was used to examine the variance components in step counts (G study) and to determine the appropriate length of activity monitoring using various combinations of days (D study). RESULTS: Mean step counts were higher on weekends than on weekdays. Fifty percent of the total variance in step counts was accounted for by interindividual variability in walking (D study). Eighty percent was reached individually with 4 weekdays, 2 weekend days, or 3 week days + weekend days. CONCLUSION: The study provides data for an appropriate monitoring method to track walking outcomes of rehabilitation for individuals with lower limb salvage.

Implementing Integrated Care in Pediatric Mental Health: Principles, Current Models, and Future Directions.

Traditional models of health care delivery are inadequate for addressing all the needs of the child and adolescent population that has mental illness. The integrated care model seeks to partner pediatric mental health specialists with primary providers to better meet these needs. The authors outline the core principles guiding integrated care for youths and describe key characteristics of the team members involved. Three models of integrated care have emerged and have proven effective. Several representative programs are described, and the advantages and disadvantages of each are reviewed. The review concludes by identifying the challenges that have prevented wider dissemination of the integrated care model and by exploring potential future directions for the field.

Identification and Treatment of Generalized Anxiety Disorder in Children in Primary Care.

Youth with anxiety often present to their pediatricians with a chief complaint of physical symptoms without any mention of anxiety or worry. Even in the absence of reported symptoms of anxiety in such presentations, screening for an anxiety disorder as the potential source of the somatic complaints should be pursued. Generalized anxiety disorder (GAD) is a common disorder characterized by excessive anxiety and worry about a number of events coupled with at least one physical symptom. GAD is commonly underdiagnosed and treated. Consequently, many youth undergo extensive medical testing in search of a cause for their somatic symptoms before anxiety is considered. It is important to screen for anxiety early in the process of evaluating somatic complaints. This review highlights the evidence base for identifying and treating GAD in children and provides an update on its epidemiology and etiology. [Pediatr Ann. 2016;45(10):e349-e355.].