Reevaluation of the effect of phenylephrine on resolution of nephrosplenic entrapment by the rolling procedure in 87 horses.

OBJECTIVE: To evaluate the outcome in horses treated with a rolling technique or surgically for nephrosplenic entrapment of the large colon (NSE) and to examine the benefit of phenylephrine (PE) HCl on the efficacy of nonsurgical (rolling) management of NSE. STUDY DESIGN: Case series. ANIMALS: Horses (n = 211) diagnosed with NSE by rectal palpation with or without ultrasonography, or at the time of exploratory celiotomy or necropsy. METHODS: Medical records (January 1, 2001-September 1, 2008) were collected from horses diagnosed with NSE at 2 referral centers. Records were used to obtain signalment, physical exam findings, laboratory results, ultrasonographic findings, the use of PE HCl, the specific treatment used, and outcome. Rectal findings indicative of NSE were: (1) palpation of large colon within the nephrosplenic space or (2) palpation of colonic bands coursing dorsally toward the nephrosplenic space in association with ultrasonographic findings suggestive of NSE. RESULTS: Rolling was successful in 50 of 87 (58%) horses, 85 horses (98%) survived to discharge. Horses (n = 155) that were treated surgically (42 of which had previously undergone the rolling procedure) had a 94% short-term survival rate. Premedication with PE resulted in no significant difference (P = .91) in resolution of NSE by rolling. CONCLUSIONS: Resolution of NSE by rolling was not significantly affected by premedication with PE in the population studied.

Development and Psychometric Evaluation of the Treatment-Emergent Activation and Suicidality Assessment Profile.

Although effective in treating a range of childhood psychiatric conditions, selective serotonin reuptake inhibitors (SSRI) have been implicated in the induction of an "activation syndrome" (characterized by symptoms of irritability, restlessness, emotional labiality, etc.) that may represent an intermediary state change that fosters suicidality. SSRI-induced activation syndrome is well-accepted by many clinicians and thought to be relatively common, particularly in children and teens. However, gaps exist in empirical data on phenomenology and tools for early detection. With this in mind, we report on a recently funded National Institutes of Health grant to develop a measure of behavioral activation to be completed in a clinical setting. We discuss the development of this measure-the Treatment-Emergent Activation and Suicidality Assessment Profile (TE-ASAP)-as well as psychometric results from a sample of youth with internalizing disorders who were at varying stages of SSRI treatment. Overall, psychometric data were quite promising, with the TE-ASAP demonstrating excellent reliability (i.e., internal consistency, inter-rater, short-term test-retest stability) and strong validity properties. Through further evaluation of the TE-ASAP in the context of a controlled multimodal trial in youth with obsessive-compulsive disorder, we hope to augment understanding of activation syndrome and, in turn, mitigate risks through early detection of this potentially lifethreatening adverse effect.

An open trial of intensive family based cognitive-behavioral therapy in youth with obsessive-compulsive disorder who are medication partial responders or nonresponders.

This study reports an open-trial of family-based cognitive-behavioral therapy (CBT) in children and adolescents with obsessive-compulsive disorder (OCD). Thirty primarily Caucasian youth with OCD (range = 7-19 years; 15 girls) who were partial responders or nonresponders to two or more medication trials that were delivered either serially or concomitantly received 14 sessions of intensive family-based CBT. Eighty percent of participants were considered improved at posttreatment and at 3-month follow-up, and symptom severity was reduced by 54% at both posttreatment and follow-up. Seventeen (56.6%) and 16 (53.3%) participants were classified as being in remission at posttreatment and follow-up, respectively. Significant reductions in OCD-related impairment, depressive symptoms, behavioral problems, and family accommodation were noted. No significant difference in youth-reported anxiety was found.

Telehealth behavior therapy for the management of type 1 diabetes in adolescents.

BACKGROUND: Poor management of type 1 diabetes mellitus (T1DM) may result in serious medical complications. Psychological intervention may improve adherence to medical regimens; however, access to trained professionals is limited, particularly in rural communities. Telehealth interventions may address this by allowing families to access services at home; however, little is known about the efficacy of such services. METHOD: This study presents results from a pilot trial of a randomized waitlist controlled trial of Telehealth Behavioral Therapy (TBT) for youths with T1DM. Primary outcome measures were adherence to the diabetes regimen, glycemic control, and level of family discord. Thirty-two youths (23 female) with T1DM (aged 9 to 17 years) and one parent or caregiver participated. Telehealth Behavioral Therapy sessions were conducted thrice weekly for 12 weeks by phone and lasted an average of 15 min each. RESULTS: Results indicated that youths in treatment decreased their hemoglobin A1c by 0.74 compared to 0.09 in the waitlist, though this was not statistically significant. Youths in treatment reported increased unsupportive and decreased caring parental behaviors. CONCLUSION: Telehealth Behavioral Therapy improves access to knowledgeable providers and results in a clinically significant improvement in glycemic control. Despite some youths experiencing an increase in unsupportive parental behaviors, TBT is a promising method of service delivery that warrants further investigation.

Cognitive behavioral therapy plus motivational interviewing improves outcome for pediatric obsessive-compulsive disorder: a preliminary study.

Lack of motivation may negatively impact cognitive behavioral therapy (CBT) response for pediatric patients with obsessive-compulsive disorder (OCD). Motivational interviewing is a method for interacting with patients in order to decrease their ambivalence and support their self-efficacy in their efforts at behavior change. The authors present a preliminary randomized trial (N = 16) to evaluate the effectiveness of adding motivational interviewing (MI) as an adjunct to CBT. Patients aged 6 to 17 years who were participating in intensive family-based CBT for OCD were randomized to receive either CBT plus MI or CBT plus extra psychoeducation (PE) sessions. After four sessions, the mean Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score for the CBT plus MI group was significantly lower than for the CBT plus psychoeducation group, t(14) = 2.51, p < .03, Cohen's d = 1.34. In addition, the degree of reduction in CY-BOCS scores was significantly greater, t(14) = 2.14, p = .05, Cohen's d = 1.02, for the CBT plus MI group (mean Delta = 16.75, SD = 9.66) than for the CBT plus psychoeducation group (mean Delta = 8.13, SD = 6.01). This effect decreased over time, and scores at posttreatment were not significantly different. However, participants in the MI group completed treatment on average three sessions earlier than those in the psychoeducation group, providing support for the utility of MI in facilitating rapid improvement and minimizing the burden of treatment for families.

Factors influencing preschool-age children's acceptance of models presented as overweight.

OBJECTIVE: To investigate whether preschool-age children's ratings of an overweight model were influenced by perceptions of responsibility for weight, type of play activity (i.e., running or cards), and information (i.e., positive or neutral). METHODS: A total of 152 children (74 boys), aged 3 to 6 years, were randomly assigned to watch two videotapes; one presented information about the model (positive or neutral) and one depicted the model engaged in an activity (running or playing cards). RESULTS: Children who blamed models for being overweight provided lower acceptance ratings than those who did not. Ratings provided by children who blamed models were influenced by information and activity condition. This was not true for children who did not blame the models. CONCLUSIONS: Results were marked by complexity, indicating that the interplay of perceptions of responsibility and contextual cues influenced ratings. In the future, researchers should consider other variables that might interact with perceptions of responsibility to influence children's perceptions of peers who are overweight.

Perceptions of type 1 diabetes among affected youth and their peers.

Management of type 1 diabetes (T1D) involves balancing several components including diet, exercise, and medication. Peer involvement in management tasks is an important, but understudied, issue in T1D. This study presents results of a preliminary examination of perceptions of disease management in youth with T1D and their peers. Data were collected using a mixed methods (qualitative and quantitative data) approach during medical education time at a camp for youth with T1D and their peers. Results suggest that both youth with T1D and their peers believe that peers need more information about medical consequences of having diabetes. Further, youth with T1D and their peers would like coaching on how peers may help the child with T1D manage their illness better. Results provide preliminary ideas for intervention (i.e., including peers, assessing social support) in the medical setting as well as ideas for future research (i.e., examining relationships among perceptions and gender, time since diagnosis).

Decreased family accommodation associated with improved therapy outcome in pediatric obsessive-compulsive disorder.

Pediatric obsessive-compulsive disorder (OCD) is a chronic, disabling condition that affects both patients and their families. Despite the identification of efficacious treatments (e.g., cognitive-behavioral therapy and selective serotonin reuptake inhibitor medications), not all patients respond fully. The purpose of the present study was to examine whether the amount of family accommodation provided to pediatric patients with OCD is associated with treatment outcome, and whether decreases in accommodation are associated with improved outcome. The sample consisted of 49 youths (6-18 years of age), who participated in 14 sessions of family-based cognitive-behavioral therapy for OCD, and their parents. Participants completed measures at pretreatment and posttreatment. Results indicate that family accommodation was prevalent among families of pediatric patients with OCD and that such accommodation was associated with symptom severity at pretreatment. In addition, decreases in family accommodation during treatment predicted treatment outcome, even when controlling for pretreatment OCD severity-impairment. Results suggest that the level of accommodation provided by the family may indicate an important obstacle to, or predictor of, treatment outcome in pediatric OCD. Directions for future research are discussed.

Successful medication withdrawal after cognitive-behavioral therapy in a treatment-resistant preadolescent male with obsessive-compulsive disorder.

There are no reports of a child taking a selective serotonin reuptake inhibitor and an atypical anti-psychotic being successfully tapered from these medications after completion of cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder. With this in mind, we report the case of an 8.5-year-old male who was taking risperidone 0.5 mg bid, sertraline 100 mg, and atomoxetine 25 mg at presentation. After a successful course of CBT, we describe how medications were systematically withdrawn. Implications of this case on practice parameters (e.g., CBT may be an effective augmenting agent for those non-responsive to initial pharmacological treatments) are highlighted.

Impact of comorbidity on cognitive-behavioral therapy response in pediatric obsessive-compulsive disorder.

OBJECTIVE: To examine the impact of psychiatric comorbidity on cognitive-behavioral therapy response in children and adolescents with obsessive-compulsive disorder. METHOD: Ninety-six youths with obsessive-compulsive disorder (range 7-19 years) received 14 sessions of weekly or intensive family-based cognitive-behavioral therapy. Assessments were conducted before and after treatment. Primary outcomes included scores on the Children's Yale-Brown Obsessive-Compulsive Scale, response rates, and remission status. RESULTS: Seventy-four percent of participants met criteria for at least one comorbid diagnosis. In general, participants with one or more comorbid diagnoses had lower treatment response and remission rates relative to those without a comorbid diagnosis. The number of comorbid conditions was negatively related to outcome. The presence of attention-deficit/hyperactivity disorder and disruptive behavior disorders was related to lower treatment response rates, and the presence of disruptive behavior disorders and major depressive disorder were related to lower remission rates. CONCLUSIONS: The presence of a comorbid disorder, particularly disruptive behavior, major depressive, and attention-deficit/hyperactivity disorders, has a negative impact on treatment response. Assessing for psychiatric disorders before treatment entry and treating these comorbid conditions before or during cognitive-behavioral therapy may improve final outcome. Comorbid anxiety or tic disorders do not seem to negatively affect response.

Cognitive-behavioral therapy for obsessive-compulsive disorder: a non-randomized comparison of intensive and weekly approaches.

This study examined the relative efficacy of intensive versus weekly cognitive-behavioral therapy (CBT) for adults with obsessive-compulsive disorder (OCD). Sixty-two adults with OCD received either 14 sessions of weekly (n=30) or intensive CBT (n=32; daily psychotherapy sessions) in a non-randomized format. Assessments were conducted at Pre-treatment, Post-treatment, and 3-month Follow-up by raters who were blind to treatment group at the Pre-treatment assessment. Intensive and weekly CBT were similar in efficacy at Post-treatment and Follow-up and associated with large treatment effect sizes. Since many people with OCD do not have access to trained CBT providers, intensive treatment may be a viable option in such cases.

Aripiprazole augmentation of incomplete treatment response in an adolescent male with obsessive-compulsive disorder.

We report the case of adolescent male with obsessive-compulsive disorder (OCD) who had an incomplete response to combined cognitive-behavioral therapy (CBT) and sertraline before successful augmentation of CBT with aripiprazole. Standardized assessments indicated significant reductions in OCD symptomatology associated with both initial treatment and aripiprazole augmentation. This case suggests that aripiprazole may have utility as an augmenting agent of CBT in adolescents with OCD and underscores the need for conducting controlled studies to test this hypothesis.

Brief report: exposure and response prevention for obsessive compulsive disorder in a 12-year-old with autism.

Obsessive Compulsive Disorder (OCD) involves exaggerated or excessive worry about threatening and non-threatening stimuli coupled with impairing rituals believed to reduce anxiety. Autism Spectrum Disorders (ASD) are characterized by impairment in social and communicative activities as well as restricted and repetitive behaviors. Approximately 2% of children with ASD are also diagnosed with OCD. Although there is extensive research demonstrating the effectiveness of behavioral interventions for pediatric OCD, little is known about how effective these treatments are for children who have a dual diagnosis of OCD and ASD. This report describes a 12-year-old male with Autism who was treated successfully with cognitive behavioral therapy with exposure and response prevention. This case study provides initial support that cognitive-behavioral therapy is effective in symptom reduction for children with comorbid autism and OCD.

Rates, types, and psychosocial correlates of legal charges in adolescents with newly diagnosed bipolar disorder.

OBJECTIVES: To examine the rates, types, and psychosocial correlates of legal charges in adolescents with newly diagnosed bipolar disorder (BD). METHODS: Adolescents (n = 80), between the ages of 12 and 21 years (mean = 15.6, standard deviation = 2.3), hospitalized for their initial manic or mixed episode of BD, were evaluated for the incidence of prior juvenile offending (i.e., legal charges). We examined potential psychosocial correlates associated with legal charges using chi-square, t-tests, and discriminant function analyses to determine if there were differences between adolescents who did and did not offend prior to their first manic episode. RESULTS: Juvenile antisocial behaviors were common (55%) for adolescents with newly diagnosed BD. Discriminant function analysis revealed that older age at first treatment (p < 0.01), sexual activity over the previous month (p < 0.05), therapeutic use of stimulants (p < 0.05), and anxiety disorders were the most significant factors to differentiate between bipolar adolescents who offended and those who did not (Wilks' lambda = 0.80, p < 0.005). CONCLUSIONS: Our findings indicate that there are identifiable psychosocial correlates associated with antisocial behaviors in adolescents with newly diagnosed BD that may improve our understanding of juvenile antisocial behaviors.

Further psychometric examination of the Tourette's Disorder Scales.

The Tourette's Disorder Scales (Shytle et al., 2003) are parent- (Tourette's Disorder Scales-Parent Rated; TODS-PR) and clinician-rated (Tourette's Disorder Scales-Clinician Rated; TODS-CR) measures that assess tics, obsessions, compulsions, inattention, hyperactivity, aggression, and emotional disturbances among children with tics. Although the TODS-PR/CR are being increasingly used in clinical trials, relatively little psychometric data have been reported. Subjects were 44 children and adolescents recruited in a university tic specialty clinic. Families were administered the TODS-CR and Yale Global Tic Severity Scale. Completion of the TODS-PR and Child Behavior Checklist were counterbalanced. Results indicated adequate to excellent internal consistency for the TODS-PR/CR scores. Excellent inter-rater agreement and convergent and divergent validity was found. These results provide further psychometric support for the TODS-PR and TODS-CR.

Adults' attitudes toward children with cancer.

More children with cancer are receiving effective treatment, which allows for increased participation in everyday settings. Yet, little information is available about people's acceptance of children with cancer. This study examined young adults' acceptance ratings for a child receiving chemotherapy for cancer, a child with cancer in remission, and a physically healthy child. Findings did not provide support for a cancer stereotype and call into question whether results of studies using total or global scores from attitude scales should be taken at face value. Adults' responses suggested that they perceived children with cancer as experiencing primarily physical limitations (e.g., less strength and agility). Exposure to information about cancer was related to higher acceptance ratings for children described as having cancer, providing support for the importance of continued efforts to improve knowledge about the effects of this disease.

Reading about over-the-counter medications.

Many adolescents and young adults purchase and use over-the-counter (OTC) medications, and some may take these medications without reading about how to use them. Most do read package inserts and labels to learn about the medication, but studies examining what influences label reading for youth are needed. This study assessed factors related to label reading for young people, including demographic variables (gender, health status) and the types of information they were seeking about the medication. Eight hundred and seventy-six high school and college students participated, and most reported reading labels or package inserts to learn about medications. Participants experiencing pain were more likely to read labels, except for those experiencing headaches who reported being less likely to read labels. When reading labels, participants were interested in information about side effects, ingredients, dosage instructions, and symptoms treated by the medication. Future research should examine whether youth take medications as directed and what factors make labels and inserts easier to read and understand.

Children with diabetes: perceptions of supports for self-management at school.

Diabetes affects many children. Researchers know little about children's perceptions of what type of support they need at school, which was a focus of this study. Group interviews and surveys examined children's perceptions of support in caring for their diabetes (type I diabetes) from school nurses, teachers, and friends. Results indicated the children felt supported at school, but improved flexibility by teachers and nurses (e.g., let me keep my meter with me always) and individualized care plans may improve their ability to manage their diabetes at school. Participating in after-school activities may be difficult for middle school youth. Children reported they needed additional help and support to cope with hypoglycemic episodes.