Adelaide Robb | The George Washington University (original) (raw)

Papers by Adelaide Robb

Research paper thumbnail of Aggression, Translationally Considered

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2018

Research paper thumbnail of 4.62 a Six-Month Open-Label Extension Study of Vortioxetine in Pediatric Patients

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2016

Research paper thumbnail of CoLT and TEAM: What Do the Results Tell Clinicians about Rational Treatment for Pediatric Bipolar Disorder?

Child and Adolescent Psychopharmacology News, Aug 1, 2012

After Kraepelin described prepubertal mania in the late 19th century (Trede et al., 2005), mania ... more After Kraepelin described prepubertal mania in the late 19th century (Trede et al., 2005), mania was rarely diagnosed in the pediatric age group until the last decade. While the fi eld has abundant research on the pharmacotherapy of adult BP, pharmacotherapy for children and adolescents with the disorder is still in its early stages. Determining the most effi cacious, safe, and tolerable treatment for bipolar disorder is the goal of treatment research. Recent NIH medication trials in pediatric bipolar I disorder (BP-I) are presented, studying the use of lithium, risperidone, and divalproex sodium. These trials provide vital data that will inevitably inform the treatment recommendations for early-onset BP-I. BP Overview The diagnosis of early-onset BP has increased over the past 15 years (McClellan et al., 2007; Carlson et al., 2005). Lifetime prevalence of BP in youth is reported to be at least 1% (Lewinsohn et al., 2000). In addition, the heritability rate of Educational Objectives Upon completion of this activity, participants should be able to: • Describe pediatric bipolar disorder • Enumerate and evaluate new and available research for treatment Target Audience This CME activity is intended for child and adult psychiatrists, pediatricians and other healthcare professionals with an interest in the psychopharmacology and treatment practices for child and adolescent psychiatric disorders. Physician Accreditation This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medical Education Resources and Guilford Publications. Medical Education Resources is accredited by the ACCME to provide continuing medical education for physicians. Credit Designation Medical Education Resources designates this enduring material for a maximum of 1 AMA PRA Category 1 credit TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. Release Date: 9/12 Expiration Date: 9/13 Estimated time to complete this activity: 1 hour Disclaimer The content and views presented in this educational activity are those of the authors and do not necessarily refl ect those of Medical Education Resources or Guilford Publications. The authors have disclosed if any discussion of published and/or investigational uses of agents that are not indicated by the FDA in their presentations. The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of MER or Guilford Publications. Before prescribing any medicine, primary references and full prescribing information should be consulted. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities. The information presented in this activity is not meant to serve as a guideline for patient management. Disclosure of Confl icts of Interest Medical Education Resources (MER) ensures balance, independence, objectivity and scientifi c rigor in all our educational programs. In accordance with this policy, MER identifi es confl icts of interest with its instructors, planners, managers and other individuals who are in a position to control the content of an activity. Confl icts are resolved by MER to ensure that all scientifi c research referred to, reported or used in a CME activity conforms to the generally accepted standards of experimental design, data collection and analysis. MER is committed to providing its learners with high quality CME activities that promote improvements or quality in healthcare and not the business interest of a commercial interest. The faculty reported the following fi nancial relationships with commercial interests:

Research paper thumbnail of Dr. Wagner and Colleagues Reply

American Journal of Psychiatry, Apr 1, 2005

Research paper thumbnail of Psicoterapia de grupo

Research paper thumbnail of 2.4 Use of Psychopharmacology and Neurotherapeutics in Treatment-Resistant Adolescent Depression

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2022

Research paper thumbnail of Eating disorders

Child and Adolescent Psychiatric Clinics of North America, Apr 1, 2002

Research paper thumbnail of An Update in Psychopharmacology Relevant to Clinical Practice: Focus on Psychopathology Overlap with Mood Dysregulation

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2020

Research paper thumbnail of Advanced Psychopharmacology

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2019

Research paper thumbnail of Underrecognized Metabolic and Hormonal Side Effects of Psychotropics

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2021

Research paper thumbnail of Managing Adverse Effects of Psychotropics in Children

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2018

Research paper thumbnail of 12.4 The Evidence Behind Lithium Treatment for Bipolar Depression in Youth

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2017

with brief psychoeducation in alleviating depressive symptoms. A third twoyear trial of FFT in ad... more with brief psychoeducation in alleviating depressive symptoms. A third twoyear trial of FFT in adolescents with BD I/II did not replicate this main result but did find differential benefits of FFT on various dimensions of quality of life. Other approaches to bipolar adolescents, such as dialectical behavior therapy, may improve depressive symptoms in bipolar spectrum disorders and reduce suicidal behavior. A brief review of emerging approaches is offered. Conclusions: The results are limited by the small number of trials, but existing studies suggest that focusing on family relationships may be a critical component of care for children or adolescents with bipolar depression. Suggestions for clinical techniques to use in practice will be offered.

Research paper thumbnail of 12.0 When Depression Strikes in Pediatric Bipolar Disorder: From Recognition to Treatment

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2017

Conclusions: The economic burden of anxiety disorders over time remains high. Early exposure to e... more Conclusions: The economic burden of anxiety disorders over time remains high. Early exposure to evidence-based treatment and remission following short-term treatment seems to do little to offset this burden. Future research aimed at understanding barriers to care is needed.

Research paper thumbnail of Practical Pediatric Psychopharmacology for the Primary Care Practitioner and Early Career Psychiatrist

63rd Annual Meeting, Oct 29, 2016

The presentation will open with the information on the prevalence of ASD in nonreferred and in ps... more The presentation will open with the information on the prevalence of ASD in nonreferred and in psychiatrically referred populations. The first part of the talk will underscore the burden of psychopathology associated with ASD followed by description of the clinical presentation and recognition of co-occurring ADHD. The second part of the talk will discuss special considerations in the psychopharmacological management of youth with ASD and provide a comprehensive overview of the available evidence on the psychopharmacology of ADHD in ASD. Presentation will emphasize best evidence practice pathways for practical, multimodal treatment of ADHD in the outpatient setting. The concluding portion of the talk will discuss the promising role of glutamate-modulating agents for the treatment of social deficits as well as frequently associated psychopathology, including ADHD, in ASD. Conclusions: Emerging literature highlights high levels of psychopathology and dysfunction in youth with ASD. Proper recognition of psychopathology in ASD offers opportunity for appropriate medication intervention. An up-todate knowledge of evidence-based pharmacotherapy for ADHD in youth with ASD will help optimize therapeutic interventions.

Research paper thumbnail of 4.3 Effect of Lurasidone on Body Weight and Laboratory Parameters in Adolescent Patients with Schizophrenia: Results from a 6-WEEK, Double-Blind, Placebo-Controlled Study

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2016

The objective of this study was to investigate the medical and psychiatric comorbidities of Korea... more The objective of this study was to investigate the medical and psychiatric comorbidities of Korean children and adolescents with ADHD. Methods: This study used the Korean National Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) data in 2011. We used information on 2,140 children and adolescents (age 10.9 AE 3.1 years, 1,710 boys) who had ADHD (ICD-10: F90) and 219,410 children and adolescents who did not have ADHD (age 12.4 AE 3.7 years, 113,704 boys). We compared demographic information with medical and psychiatric comorbidities of the two groups. We weighted logistic regression for calculating odds ratio between two groups. Results: Most medical comorbidities were frequent in subjects with ADHD. Disease of nervous systems (OR ¼ 2.59, 95% CI 2.52-2.66) was almost three times more frequent than in non-ADHD subjects, followed by endocrine, nutritional, and metabolic diseases (OR ¼ 2.09, 95% CI 2.04-2.15); congenital malformations, deformations, and chromosomal abnormalities (OR ¼ 2.00, 95% CI 1.90-2.11); disease of circulatory systems (OR ¼ 1.79, 95% CI 1.71-1.87); and disease of the blood and blood-forming organ and certain disorders involving the immune mechanism (OR ¼ 1.78, 95% CI 1.70-1.86).

Research paper thumbnail of 8.4 Rational Use of Antipsychotic Drugs and Mood Stabilizers in Youth With Aggression in Autism and Bipolar Disorder

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2016

Objectives: With the increasing number of presentations of children and adults with ADHD, practit... more Objectives: With the increasing number of presentations of children and adults with ADHD, practitioners are requiring strategies for those individuals with the disorder, as well as those who do not respond or are unable to tolerate traditional treatment. Methods: A systematic review of the literature was undertaken to elucidate data on stimulant and nonstimulant pharmacological treatments for ADHD simplex and for treatment refractory or comorbid ADHD. Studies using controlled, open, retrospective, and case series will be highlighted and "weighted" according to the study design. Longer-term outcomes of existing agents and recently published data are favored. Results: The literature combined with practice parameters and the clinical experience indicates that both stimulants and nonstimulants remain among first-line pharmacotherapy for ADHD in preschoolers, latency/school-aged youth, and adolescents. Alterations in the use of traditional stimulants, the use of nonstimulants, and combinations of medications can enhance a patient's ADHD response. A discussion of predictable (e.g., weight loss) and idiosyncratic adverse effects will be undertaken with recent longer-term data on these treatments presented. Conclusions: In this session, pharmacological strategies for treating ADHD children and adolescents will be presented, incorporating new research findings and US FDA approvals punctuated by systematic clinical observation.

Research paper thumbnail of Master of disguise: Eating disorders in the emergency department

Clinical Pediatric Emergency Medicine, Sep 1, 2004

Children with eating disorders rarely present to the emergency department with a chief complaint ... more Children with eating disorders rarely present to the emergency department with a chief complaint of eating disorder symptoms. Much more frequently, children present with the co-morbid psychiatric illness or the medical sequelae of their eating disorder. This article will review the common eating disorders across three different age ranges. It will review the common co-morbid psychiatric presentations and the medical sequelae of starvation and medical symptoms specific to each eating disorder. Emergency department clinicians must include eating disorders in their differential for a variety of medical and psychiatric presentations to avoid missing an important and treatable illness of childhood.

Research paper thumbnail of 8.4 Treatment of Bipolar Disorder and Irritability in Autism

Journal of the American Academy of Child & Adolescent Psychiatry, 2017

The objective of this presentation is to teach early career clinicians the key elements about the... more The objective of this presentation is to teach early career clinicians the key elements about the diagnosis, treatment, and short-and longterm management of children with bipolar disorder (BD) and aggression in autism. As more children with these disorders are being treated in the community, it is important for pediatricians and psychiatrists to recognize these disorders and manage them with psychotropic medications. Methods: For each disorder, we describe the DSM-5 diagnostic criteria, common presenting symptoms, and pharmacological treatments, including mood stabilizers and second-generation antipsychotic drugs, strategies for initiating treatment, monitoring regimens, and recommendations for length of treatment and discontinuation strategies. The talk covers important side effects, studies in children supporting the use of these medications for BD and aggression in autism, and FDA concerns. Results: This talk teaches pediatricians and early career psychiatrists the basics about diagnosis, treatment, and management of BD and aggression in autism in their pediatric outpatients. Conclusions: Knowing how to manage these serious childhood mental illnesses allows pediatricians to work closely in collaboration with psychiatric colleagues in the care and management of these children.

Research paper thumbnail of Improving Youth Suicide Risk Screening and Assessment in a Pediatric Hospital Setting by Using The Joint Commission Guidelines

Hospital Pediatrics, 2020

OBJECTIVES: Hospitals accredited by The Joint Commission (TJC) are now required to use a validate... more OBJECTIVES: Hospitals accredited by The Joint Commission (TJC) are now required to use a validated screening tool and a standardized method for assessment of suicide risk in all behavioral health patients. Our aims for this study were (1) to implement a TJC-compliant process of suicide risk screening and assessment in the pediatric emergency department (ED) and outpatient behavioral health clinic in a large tertiary care children’s hospital, (2) to describe characteristics of this population related to suicide risk, and (3) to report the impact of this new process on ED length of stay (LOS). METHODS: A workflow using the Columbia Suicide Severity Rating Scale was developed and implemented. Monthly reviews of compliance with screening and assessment were conducted. Descriptive statistics were used to define the study population, and multivariable regression was used to model factors associated with high suicide risk and discharge from the ED. ED LOS of behavioral health patients was ...

Research paper thumbnail of Development of a Symptom-Focused Model to Guide the Prescribing of Antipsychotics in Children and Adolescents: Results of the First Phase of the Safer Use of Antipsychotics in Youth (SUAY) Clinical Trial

Journal of the American Academy of Child & Adolescent Psychiatry, 2021

OBJECTIVE To develop a new approach to prescribing guidelines as part of a pragmatic trial, Targe... more OBJECTIVE To develop a new approach to prescribing guidelines as part of a pragmatic trial, Targeted and Safer Use of Antipsychotics in Youth (SUAY; ClinicalTrials.gov Identifier: NCT03448575), which supports prescribers in delivering high-quality mental health care to youths. METHOD A nominal group technique was used to identify first- to nth-line treatments for target symptoms and potential diagnoses. The panel included US pediatricians, child and adolescent psychiatrists, and psychopharmacology experts. Meeting materials included information about Medicaid review programs, systematic reviews, prescribing guidelines, and a description of the pragmatic trial. Afterward, a series of 4 webinar discussions were held to achieve consensus on recommendations. RESULTS The panel unanimously agreed that the guideline should focus on target symptoms rather than diagnoses. Guidance included recommendations for first- to nth-line treatment of target mental health symptoms, environmental factors to be addressed, possible underlying diagnoses that should first be considered and ruled out, and general considerations for pharmacological and therapeutic treatments. CONCLUSION Prescribing guidelines are often ignored because they do not incorporate the real-world availability of first-line psychosocial treatments, comorbid conditions, and clinical complexity. Our approach addresses some of these concerns. If the approach proves successful in our ongoing pragmatic trial, Targeted and Safer Use of Antipsychotics in Youth (SUAY), it may serve as a model to state Medicaid programs and health systems to support clinicians in delivering high-quality mental health care to youths. CLINICAL TRIAL REGISTRATION INFORMATION Targeted and Safer Use of Antipsychotics in Youth; http://clinicaltrials.gov/; NCT03448575.

Research paper thumbnail of Aggression, Translationally Considered

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2018

Research paper thumbnail of 4.62 a Six-Month Open-Label Extension Study of Vortioxetine in Pediatric Patients

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2016

Research paper thumbnail of CoLT and TEAM: What Do the Results Tell Clinicians about Rational Treatment for Pediatric Bipolar Disorder?

Child and Adolescent Psychopharmacology News, Aug 1, 2012

After Kraepelin described prepubertal mania in the late 19th century (Trede et al., 2005), mania ... more After Kraepelin described prepubertal mania in the late 19th century (Trede et al., 2005), mania was rarely diagnosed in the pediatric age group until the last decade. While the fi eld has abundant research on the pharmacotherapy of adult BP, pharmacotherapy for children and adolescents with the disorder is still in its early stages. Determining the most effi cacious, safe, and tolerable treatment for bipolar disorder is the goal of treatment research. Recent NIH medication trials in pediatric bipolar I disorder (BP-I) are presented, studying the use of lithium, risperidone, and divalproex sodium. These trials provide vital data that will inevitably inform the treatment recommendations for early-onset BP-I. BP Overview The diagnosis of early-onset BP has increased over the past 15 years (McClellan et al., 2007; Carlson et al., 2005). Lifetime prevalence of BP in youth is reported to be at least 1% (Lewinsohn et al., 2000). In addition, the heritability rate of Educational Objectives Upon completion of this activity, participants should be able to: • Describe pediatric bipolar disorder • Enumerate and evaluate new and available research for treatment Target Audience This CME activity is intended for child and adult psychiatrists, pediatricians and other healthcare professionals with an interest in the psychopharmacology and treatment practices for child and adolescent psychiatric disorders. Physician Accreditation This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medical Education Resources and Guilford Publications. Medical Education Resources is accredited by the ACCME to provide continuing medical education for physicians. Credit Designation Medical Education Resources designates this enduring material for a maximum of 1 AMA PRA Category 1 credit TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. Release Date: 9/12 Expiration Date: 9/13 Estimated time to complete this activity: 1 hour Disclaimer The content and views presented in this educational activity are those of the authors and do not necessarily refl ect those of Medical Education Resources or Guilford Publications. The authors have disclosed if any discussion of published and/or investigational uses of agents that are not indicated by the FDA in their presentations. The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of MER or Guilford Publications. Before prescribing any medicine, primary references and full prescribing information should be consulted. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications on dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities. The information presented in this activity is not meant to serve as a guideline for patient management. Disclosure of Confl icts of Interest Medical Education Resources (MER) ensures balance, independence, objectivity and scientifi c rigor in all our educational programs. In accordance with this policy, MER identifi es confl icts of interest with its instructors, planners, managers and other individuals who are in a position to control the content of an activity. Confl icts are resolved by MER to ensure that all scientifi c research referred to, reported or used in a CME activity conforms to the generally accepted standards of experimental design, data collection and analysis. MER is committed to providing its learners with high quality CME activities that promote improvements or quality in healthcare and not the business interest of a commercial interest. The faculty reported the following fi nancial relationships with commercial interests:

Research paper thumbnail of Dr. Wagner and Colleagues Reply

American Journal of Psychiatry, Apr 1, 2005

Research paper thumbnail of Psicoterapia de grupo

Research paper thumbnail of 2.4 Use of Psychopharmacology and Neurotherapeutics in Treatment-Resistant Adolescent Depression

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2022

Research paper thumbnail of Eating disorders

Child and Adolescent Psychiatric Clinics of North America, Apr 1, 2002

Research paper thumbnail of An Update in Psychopharmacology Relevant to Clinical Practice: Focus on Psychopathology Overlap with Mood Dysregulation

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2020

Research paper thumbnail of Advanced Psychopharmacology

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2019

Research paper thumbnail of Underrecognized Metabolic and Hormonal Side Effects of Psychotropics

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2021

Research paper thumbnail of Managing Adverse Effects of Psychotropics in Children

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2018

Research paper thumbnail of 12.4 The Evidence Behind Lithium Treatment for Bipolar Depression in Youth

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2017

with brief psychoeducation in alleviating depressive symptoms. A third twoyear trial of FFT in ad... more with brief psychoeducation in alleviating depressive symptoms. A third twoyear trial of FFT in adolescents with BD I/II did not replicate this main result but did find differential benefits of FFT on various dimensions of quality of life. Other approaches to bipolar adolescents, such as dialectical behavior therapy, may improve depressive symptoms in bipolar spectrum disorders and reduce suicidal behavior. A brief review of emerging approaches is offered. Conclusions: The results are limited by the small number of trials, but existing studies suggest that focusing on family relationships may be a critical component of care for children or adolescents with bipolar depression. Suggestions for clinical techniques to use in practice will be offered.

Research paper thumbnail of 12.0 When Depression Strikes in Pediatric Bipolar Disorder: From Recognition to Treatment

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2017

Conclusions: The economic burden of anxiety disorders over time remains high. Early exposure to e... more Conclusions: The economic burden of anxiety disorders over time remains high. Early exposure to evidence-based treatment and remission following short-term treatment seems to do little to offset this burden. Future research aimed at understanding barriers to care is needed.

Research paper thumbnail of Practical Pediatric Psychopharmacology for the Primary Care Practitioner and Early Career Psychiatrist

63rd Annual Meeting, Oct 29, 2016

The presentation will open with the information on the prevalence of ASD in nonreferred and in ps... more The presentation will open with the information on the prevalence of ASD in nonreferred and in psychiatrically referred populations. The first part of the talk will underscore the burden of psychopathology associated with ASD followed by description of the clinical presentation and recognition of co-occurring ADHD. The second part of the talk will discuss special considerations in the psychopharmacological management of youth with ASD and provide a comprehensive overview of the available evidence on the psychopharmacology of ADHD in ASD. Presentation will emphasize best evidence practice pathways for practical, multimodal treatment of ADHD in the outpatient setting. The concluding portion of the talk will discuss the promising role of glutamate-modulating agents for the treatment of social deficits as well as frequently associated psychopathology, including ADHD, in ASD. Conclusions: Emerging literature highlights high levels of psychopathology and dysfunction in youth with ASD. Proper recognition of psychopathology in ASD offers opportunity for appropriate medication intervention. An up-todate knowledge of evidence-based pharmacotherapy for ADHD in youth with ASD will help optimize therapeutic interventions.

Research paper thumbnail of 4.3 Effect of Lurasidone on Body Weight and Laboratory Parameters in Adolescent Patients with Schizophrenia: Results from a 6-WEEK, Double-Blind, Placebo-Controlled Study

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2016

The objective of this study was to investigate the medical and psychiatric comorbidities of Korea... more The objective of this study was to investigate the medical and psychiatric comorbidities of Korean children and adolescents with ADHD. Methods: This study used the Korean National Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) data in 2011. We used information on 2,140 children and adolescents (age 10.9 AE 3.1 years, 1,710 boys) who had ADHD (ICD-10: F90) and 219,410 children and adolescents who did not have ADHD (age 12.4 AE 3.7 years, 113,704 boys). We compared demographic information with medical and psychiatric comorbidities of the two groups. We weighted logistic regression for calculating odds ratio between two groups. Results: Most medical comorbidities were frequent in subjects with ADHD. Disease of nervous systems (OR ¼ 2.59, 95% CI 2.52-2.66) was almost three times more frequent than in non-ADHD subjects, followed by endocrine, nutritional, and metabolic diseases (OR ¼ 2.09, 95% CI 2.04-2.15); congenital malformations, deformations, and chromosomal abnormalities (OR ¼ 2.00, 95% CI 1.90-2.11); disease of circulatory systems (OR ¼ 1.79, 95% CI 1.71-1.87); and disease of the blood and blood-forming organ and certain disorders involving the immune mechanism (OR ¼ 1.78, 95% CI 1.70-1.86).

Research paper thumbnail of 8.4 Rational Use of Antipsychotic Drugs and Mood Stabilizers in Youth With Aggression in Autism and Bipolar Disorder

Journal of the American Academy of Child and Adolescent Psychiatry, Oct 1, 2016

Objectives: With the increasing number of presentations of children and adults with ADHD, practit... more Objectives: With the increasing number of presentations of children and adults with ADHD, practitioners are requiring strategies for those individuals with the disorder, as well as those who do not respond or are unable to tolerate traditional treatment. Methods: A systematic review of the literature was undertaken to elucidate data on stimulant and nonstimulant pharmacological treatments for ADHD simplex and for treatment refractory or comorbid ADHD. Studies using controlled, open, retrospective, and case series will be highlighted and "weighted" according to the study design. Longer-term outcomes of existing agents and recently published data are favored. Results: The literature combined with practice parameters and the clinical experience indicates that both stimulants and nonstimulants remain among first-line pharmacotherapy for ADHD in preschoolers, latency/school-aged youth, and adolescents. Alterations in the use of traditional stimulants, the use of nonstimulants, and combinations of medications can enhance a patient's ADHD response. A discussion of predictable (e.g., weight loss) and idiosyncratic adverse effects will be undertaken with recent longer-term data on these treatments presented. Conclusions: In this session, pharmacological strategies for treating ADHD children and adolescents will be presented, incorporating new research findings and US FDA approvals punctuated by systematic clinical observation.

Research paper thumbnail of Master of disguise: Eating disorders in the emergency department

Clinical Pediatric Emergency Medicine, Sep 1, 2004

Children with eating disorders rarely present to the emergency department with a chief complaint ... more Children with eating disorders rarely present to the emergency department with a chief complaint of eating disorder symptoms. Much more frequently, children present with the co-morbid psychiatric illness or the medical sequelae of their eating disorder. This article will review the common eating disorders across three different age ranges. It will review the common co-morbid psychiatric presentations and the medical sequelae of starvation and medical symptoms specific to each eating disorder. Emergency department clinicians must include eating disorders in their differential for a variety of medical and psychiatric presentations to avoid missing an important and treatable illness of childhood.

Research paper thumbnail of 8.4 Treatment of Bipolar Disorder and Irritability in Autism

Journal of the American Academy of Child & Adolescent Psychiatry, 2017

The objective of this presentation is to teach early career clinicians the key elements about the... more The objective of this presentation is to teach early career clinicians the key elements about the diagnosis, treatment, and short-and longterm management of children with bipolar disorder (BD) and aggression in autism. As more children with these disorders are being treated in the community, it is important for pediatricians and psychiatrists to recognize these disorders and manage them with psychotropic medications. Methods: For each disorder, we describe the DSM-5 diagnostic criteria, common presenting symptoms, and pharmacological treatments, including mood stabilizers and second-generation antipsychotic drugs, strategies for initiating treatment, monitoring regimens, and recommendations for length of treatment and discontinuation strategies. The talk covers important side effects, studies in children supporting the use of these medications for BD and aggression in autism, and FDA concerns. Results: This talk teaches pediatricians and early career psychiatrists the basics about diagnosis, treatment, and management of BD and aggression in autism in their pediatric outpatients. Conclusions: Knowing how to manage these serious childhood mental illnesses allows pediatricians to work closely in collaboration with psychiatric colleagues in the care and management of these children.

Research paper thumbnail of Improving Youth Suicide Risk Screening and Assessment in a Pediatric Hospital Setting by Using The Joint Commission Guidelines

Hospital Pediatrics, 2020

OBJECTIVES: Hospitals accredited by The Joint Commission (TJC) are now required to use a validate... more OBJECTIVES: Hospitals accredited by The Joint Commission (TJC) are now required to use a validated screening tool and a standardized method for assessment of suicide risk in all behavioral health patients. Our aims for this study were (1) to implement a TJC-compliant process of suicide risk screening and assessment in the pediatric emergency department (ED) and outpatient behavioral health clinic in a large tertiary care children’s hospital, (2) to describe characteristics of this population related to suicide risk, and (3) to report the impact of this new process on ED length of stay (LOS). METHODS: A workflow using the Columbia Suicide Severity Rating Scale was developed and implemented. Monthly reviews of compliance with screening and assessment were conducted. Descriptive statistics were used to define the study population, and multivariable regression was used to model factors associated with high suicide risk and discharge from the ED. ED LOS of behavioral health patients was ...

Research paper thumbnail of Development of a Symptom-Focused Model to Guide the Prescribing of Antipsychotics in Children and Adolescents: Results of the First Phase of the Safer Use of Antipsychotics in Youth (SUAY) Clinical Trial

Journal of the American Academy of Child & Adolescent Psychiatry, 2021

OBJECTIVE To develop a new approach to prescribing guidelines as part of a pragmatic trial, Targe... more OBJECTIVE To develop a new approach to prescribing guidelines as part of a pragmatic trial, Targeted and Safer Use of Antipsychotics in Youth (SUAY; ClinicalTrials.gov Identifier: NCT03448575), which supports prescribers in delivering high-quality mental health care to youths. METHOD A nominal group technique was used to identify first- to nth-line treatments for target symptoms and potential diagnoses. The panel included US pediatricians, child and adolescent psychiatrists, and psychopharmacology experts. Meeting materials included information about Medicaid review programs, systematic reviews, prescribing guidelines, and a description of the pragmatic trial. Afterward, a series of 4 webinar discussions were held to achieve consensus on recommendations. RESULTS The panel unanimously agreed that the guideline should focus on target symptoms rather than diagnoses. Guidance included recommendations for first- to nth-line treatment of target mental health symptoms, environmental factors to be addressed, possible underlying diagnoses that should first be considered and ruled out, and general considerations for pharmacological and therapeutic treatments. CONCLUSION Prescribing guidelines are often ignored because they do not incorporate the real-world availability of first-line psychosocial treatments, comorbid conditions, and clinical complexity. Our approach addresses some of these concerns. If the approach proves successful in our ongoing pragmatic trial, Targeted and Safer Use of Antipsychotics in Youth (SUAY), it may serve as a model to state Medicaid programs and health systems to support clinicians in delivering high-quality mental health care to youths. CLINICAL TRIAL REGISTRATION INFORMATION Targeted and Safer Use of Antipsychotics in Youth; http://clinicaltrials.gov/; NCT03448575.