Temper Loss and Persistent Irritability in Preschoolers: Implications for Diagnosing Disruptive Mood Dysregulation Disorder in Early Childhood.

Disruptive Mood Dysregulation Disorder (DMDD) is a new and controversial child psychiatric disorder characterized by persistent irritability and frequent temper loss. Among the controversies surrounding DMDD is whether the age of onset criterion-that DMDD may not be diagnosed before age 6 years-is justified. This study examined DMDD symptoms and associated patterns of psychiatric comorbidity, behavioral, and family functioning in a sample of 139 preschoolers (ages 4-0 to 5-11 years) admitted to an early childhood psychiatric day treatment program. DMDD symptoms were common in this acute clinical sample, with 63 children (45.3 %) presenting with frequent temper outbursts and chronic irritability. As compared to children who did not present with DMDD symptoms, these children demonstrated more aggression and emotional reactivity and lower receptive language skills, with high rates of comorbidity with the disruptive behavior disorders. Findings contribute to an emerging literature on preschool DMDD, with implications for early childhood psychiatric assessment and clinical interventions.

Comparison of the Lunar Prodigy and iDXA Dual-Energy X-ray Absorptiometers for Assessing Total and Regional Body Composition.

The objective of the study was to assess the agreement of the Lunar Prodigy with the newer Lunar iDXA dual-energy X-ray absorptiometer for determining total body and regional (arms, legs, trunk) bone mineral density (BMD), bone mineral content (BMC), fat mass (FM), lean tissue mass (LTM), total body mass, and percent fat. Ninety-two healthy adult males (n = 36) and females (n = 56) were scanned consecutively on the iDXA and the Prodigy dual-energy X-ray absorptiometers. For iDXA, relative to Prodigy, paired t tests indicated significantly lower estimates for total body and regional BMD and BMC (p < 0.001). Measures of total body and trunk FM, LTM, and percent fat did not differ between the instruments. In regional analyses, estimates of FM and percent fat were greater, and that of LTM was lower, in the arms (p < 0.001). In contrast, iDXA estimates of LTM were higher in the legs (p < 0.001). All body composition measures were significantly correlated (p < 0.001). Bland-Altman analyses indicated that significant bias existed between iDXA and Prodigy for total body and regional BMD estimates (p < 0.001) such that iDXA underestimated BMD to a greater extent in persons with higher values. In addition, iDXA overestimation bias existed for FM in total body, arms, and legs, and the overestimation was primarily observed in participants with greater body fat (p < 0.001). When combining or comparing data from iDXA with those from Prodigy, investigators should be aware that certain total body and regional estimates are significantly different. The greatest percent differences were observed for arm BMD, FM, and percent fat.

Adverse Events in Very Young Children Prescribed Psychotropic Medications: Preliminary Findings from an Acute Clinical Sample.

OBJECTIVE: The present study used the Pediatric Adverse Events Rating Scale (PAERS) to provide a systematic assessment of adverse events (AEs) related to psychotropic medication use in a clinical sample of young children attending a specialized, early childhood partial hospital program. Study goals were as follows: 1) To describe the frequency and types of specific psychotropic medication-related AEs experienced by very young children (ages 3-7 years) in an acute clinical sample, and 2) to identify the psychotropic medication(s) and/or class(es) associated with the highest frequency of AEs. METHODS: Participants were 158 children (118 males; ages 36-95 months, mean=66 months, SD=14.6 months) who presented to a hospital-based day treatment program for young children with severe emotional and behavioral problems, and were prescribed a psychotropic medication at any point during the hospitalization. Data on AEs related to psychotropic medication were collected using the PAERS from 2011 to 2014. RESULTS: The percentages of children who experienced one or more AEs attributed to a psychiatric medication ranged from 0 (sertraline, melatonin) to 41.2% (fluoxetine), with wide variability in the types AEs reported. The overall frequencies of events caused by a stimulant were similar across the two medications examined (21.4% and 27.7% for mixed amphetamine salts and methylphenidate, respectively), with mood-related difficulties and decreased appetite being the most common AEs reported. The frequencies of AEs caused by an α agonist were also similar across the two medications examined (9.8% and 17.2% for guanfacine and clonidine, respectively), with fatigue as the most commonly reported AE. With respect to the selective serotonin reuptake inhibitor (SSRI) class, there was a trend for fluoxetine to be associated with more AEs (41.2%) than sertraline (for which no AEs were reported). The most common AEs reported for fluoxetine were impulsivity and poor concentration. CONCLUSIONS: The data presented here support existing literature reporting differences in AEs between age groups. More rigorous studies are warranted to further examine the types and frequencies of AEs related to psychotropic medications in very young children.

Sleep Onset and Night Waking Insomnias in Preschoolers with Psychiatric Disorders.

This study examined the nature and prevalence of diagnostically defined sleep disorders, including Sleep Onset Insomnia (SOI) and Night Waking Insomnia (NWI), in a sample of 183 young children admitted to an early childhood psychiatric day treatment program. A semi-structured diagnostic interview, the Diagnostic Infant and Preschool Assessment, was used to assess for sleep and other psychiatric disorders. Daily sleep diaries and the Child Behavior Checklist were also examined. 41 % of children met criteria for a sleep disorder; 23 % met diagnostic criteria for SOI and 4 % met criteria for NWI, with an additional 14 % meeting criteria for both (SOI + NWI). Sleep-disordered children demonstrated longer latency to sleep onset, longer and more frequent night awakenings, less total sleep, and lower sleep efficiency than non-sleep disordered participants. Diagnosable sleep disorders, particularly SOI, were quite common in this acute clinical sample, exceeding previous estimates obtained in community and pediatric practice samples.

Reliability and Validity of the Dyadic Observed Communication Scale (DOCS).

We evaluated the reliability and validity of the Dyadic Observed Communication Scale (DOCS) coding scheme, which was developed to capture a range of communication components between parents and adolescents. Adolescents and their caregivers were recruited from mental health facilities for participation in a large, multi-site family-based HIV prevention intervention study. Seventy-one dyads were randomly selected from the larger study sample and coded using the DOCS at baseline. Preliminary validity and reliability of the DOCS was examined using various methods, such as comparing results to self-report measures and examining interrater reliability. Results suggest that the DOCS is a reliable and valid measure of observed communication among parent-adolescent dyads that captures both verbal and nonverbal communication behaviors that are typical intervention targets. The DOCS is a viable coding scheme for use by researchers and clinicians examining parent-adolescent communication. Coders can be trained to reliably capture individual and dyadic components of communication for parents and adolescents and this complex information can be obtained relatively quickly.

Parental illness encouragement behavior among children with functional gastrointestinal disorders: a factor analysis with implications for research and clinical practice.

The objective of the current study was to assess the factor structure of the Illness Behavior Encouragement Scale (IBES) by Walker and Zeman (1992) among children with functional gastrointestinal disorders (FGIDs). Two hundred seventy nine children (63 % female), and 135 primary caregivers (90.8 % mothers), recruited from a large Midwestern children's hospital completed the IBES, a 12-item measure of parental behavior in response to abdominal pain episodes. Findings suggested the IBES possesses two conceptually distinct scales that are invariant across parent self- and child-report, and are consistent with previous factor analysis in a Dutch sample of children with headaches. Different types of parental behaviors exist that naturally cluster and diverge in reliable ways. Future research is warranted to determine if these different types of parental behavior may differentially influence illness outcomes among children with FGIDs.

The development of a diversity mentoring program for faculty and trainees: A program at the Brown Clinical Psychology Training Consortium.

There is a critical need for increasing the diversity representation among clinicians and researchers in academic medicine, including departments of psychiatry and psychology. Mentorship of under-represented groups has been identified as an important way to remediate diversity-related barriers in the field. This paper outlines the early development and pilot implementation of a diversity mentorship program at Brown University. In an effort to inform and guide future diversity programs, we discuss the challenges faced in creating the program, the successes experienced during the first year, and the future directions undertaken as a means for improving the program.

Monitoring challenges: a closer look at parental monitoring, maternal psychopathology, and adolescent sexual risk.

The present study sought to examine associations between maternal psychopathology, parental monitoring, and adolescent sexual activity among adolescents in mental health treatment. Seven hundred ninety mother-adolescent dyads recruited from adolescent mental health treatment settings completed audio computer-assisted structured interview assessments examining parent psychiatric symptoms, parental monitoring, and adolescent sexual risk behavior. Path analysis was used to examine the associations between variables of interest. Maternal caregivers who reported more mental health symptoms were more likely to have adolescents who reported recent sex and this relationship was mediated by less parental monitoring. These findings suggest that maternal caregivers with mental health symptoms may need specific interventions that provide assistance and support in monitoring their teens in order to reduce sexual risk taking among adolescents in mental health treatment.

Conceptualization and treatment of chronic abdominal pain in pediatric gastroenterology practice.

OBJECTIVES: The aim of this study was to examine how children with abdominal pain presently are viewed, assessed, and treated by pediatric gastroenterologists across North America, as well as how perspectives have changed since initial release of the Rome criteria for functional gastrointestinal disorders approximately 15 years ago. PATIENTS AND METHODS: One hundred seventy-four full members of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition completed a pediatric gastroenterology practice survey designed by the authors in 2006. The responses were examined for practice patterns and specific knowledge/use of the Rome criteria. The responses were also compared with historical data from 151 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition members who completed a similar survey in 1992. RESULTS: There were few changes in the evaluation, treatment, or outcomes for children with abdominal pain for the past 15 years. Knowledge of the Rome criteria was common, but use in practice was not; several specific problems with the criteria were identified. A mismatch also appeared between belief in the importance of psychological factors in the creation/maintenance of pediatric abdominal pain and integration of these factors as part of standard evaluation and treatment. Finally, controversy emerged regarding both the term "functional" and the importance of histologic inflammation in the pathophysiology of pediatric abdominal pain. CONCLUSIONS: The evolution and dissemination of the Rome criteria for the past 15 years have not substantially changed evaluation or treatment practices for children with abdominal pain. Many areas of inconsistency and controversy remain. More focused research is needed to better understand this common pain condition and to establish an effective treatment program that can be disseminated across practitioners.

Interparental conflict and adolescent dating relationships: the role of perceived threat and self-blame appraisals.

In line with the cognitive-contextual framework proposed by Grych and Fincham (1990), evidence suggests that children exposed to interparental conflict (IPC) are at risk for experiencing conflict within their own intimate relationships. The mediating role of adolescent appraisal in the relation between IPC and adolescent dating behavior was examined in the current study. Specifically, it was hypothesized that self-blame and threat appraisals would mediate the relation between IPC and adolescent maladaptive dating behaviors. To examine the potential mediating role of appraisal, 169 high school students completed the Children's Perception of Interparental Conflict (Grych, Seid, & Fincham, 1992) and Child and Adolescent Dating Relationships Inventory (Wolfe, Scott, Reitzel-Jaffe, Wekerle, Grasley, & Straatman, 2004). Findings suggest that self-blame appraisal partially mediated the relation between IPC and adolescent sexual aggression, and between IPC and adolescent threatening behavior. In addition, perceived threat appraisal partially mediated the relation between IPC and adolescent sexual aggression. Implications for the current findings are discussed.

Associations between the repressive adaptive style and self-reported hope in Mexican American and Euro-American children.

A large literature has examined the associations between Weinberger, Schwartz, and Davidson's (1979) repressive adaptive style (RAS) construct and various self-report measures of distress or unpleasant emotional states in adults and children. Fewer investigations have examined the role of RAS in self-reported positive psychology constructs. In this investigation, we used Weinberger et al.'s (1979) categorical typology to examine the associations between adaptive style and hope in Euro-American (n = 60) and Mexican American (n = 49) children (M age = 11.4 years) who were students at 1 of 3 parochial schools in a large Midwestern city. Partially supporting the hypotheses, a univariate 2 (ethnic group) x 2 (repressor group) analysis of variance indicated a significant main effect for adaptive style group but no significant main effect for ethnic group and no significant interaction effect. Results extend the literature on the associations between adaptive style and self-report instruments and indicate that (similar to self-reported measures of distress) self-reported hope may be subject to social desirability bias.

Screening practices for adolescent dating violence.

This study sought to determine the screening practices of child and adolescent psychiatrists regarding adolescent dating violence (DV). A questionnaire regarding screening practices for DV and other risk behaviors was administered to 817 child and adolescent psychiatrists via the Internet and mail. Twenty-one percent of clinicians screened for DV "more than 90% of the time," and 65% had identified it in the past year. Multiple logistic regression analyses found that screening for DV was associated with consistent screening for either substance use or interparental violence (OR=3.0 and 6.3, respectively). Despite the prevalence of DV, only a minority of psychiatrists screen their adolescent patients for this type of risk. These data suggest that screening for DV is associated with consistent screening practices for other risk behaviors. Screening rates may be improved with training and adherence to specific protocols.

Body composition in a seasonal model of obesity: longitudinal measures and validation of DXA.

OBJECTIVE: Collared lemmings, Dicrostonyx groenlandicus, show rapid changes in body mass on a seasonal basis. The objective of this study was to measure longitudinal changes in body composition in animals undergoing photoperiod-induced weight gain and loss using DXA. RESEARCH METHODS AND PROCEDURES: Adult, female collared lemmings exposed to either long (LD; 22 hours light/2 hours dark) or short (SD; 8 hours light/16 hours dark) photoperiods were anesthetized, and DXA was used to determine fat mass, lean tissue mass (LTM), total-body bone mineral content, and total-bone mineral density. After a baseline scan, one-half of the animals were transferred to the alternate photoperiod (SD-LD, weight loss; LD-SD, weight gain) and one-half remained on the same photoperiod (controls; SD-SD, LD-LD). Body composition was determined by DXA after 4 and 8 weeks. Animals were killed, and body composition was determined by carcass analysis. DXA-derived data were validated by comparing with carcass analysis. RESULTS: Body composition by DXA was highly related to body composition measured by chemical analysis, thereby justifying the use of DXA. Lemmings in the SD-LD group lost weight, and this was reflected in measurable losses of fat and LTM. Lemmings in the LD-SD group gained weight, which was shown by measurable increases in fat, LTM and total-body bone mineral content. DISCUSSION: Comparison of body composition determined by DXA to that by chemical extraction revealed that DXA is useful for measuring body composition. The longitudinal analysis revealed that collared lemmings undergo rapid changes in body composition when exposed to changes in photoperiod.

Effects of energy expenditure and Ucp1 on photoperiod-induced weight gain in collard lemmings.

OBJECTIVE: To determine the role of total energy expenditure (TEE) and its components in the ability of collared lemmings to increase weight in response to a decrease in photoperiod. RESEARCH METHODS AND PROCEDURES: Energy expenditure was measured by 24-hour indirect calorimetry concurrent with food-intake studies. TEE and resting and nonresting energy expenditure (REE and NREE, respectively) were adjusted for body weight by analysis of covariance (ANCOVA). Uncoupling protein 1 (Ucp1) mRNA levels from interscapular brown adipose tissue were determined by Northern blot. RESULTS: TEE and REE of lemmings exposed to a short photoperiod for 10 days were significantly lower than that of lemmings exposed to a long photoperiod (p < 0.05), whereas NREE was not significantly different (p = 0.44). Ucp1 mRNA levels in interscapular brown adipose tissue were 50% lower in short- vs. long-photoperiod lemmings (p < 0.01). Ucp1 mRNA levels were positively related to REE (r2 = 0.79, p < 0.01). After adjustment of REE for differences in Ucp1 mRNA levels, there was no longer a significant difference attributable to photoperiod treatment (p = 0.54). DISCUSSION: The results of this study indicate that the increase in body mass that occurs when collared lemmings are exposed to a short photoperiod may be primarily fueled by a decrease in REE and is correlated with a decrease in Ucp1 mRNA levels.