Predicting Intervention Use in Youth with Rare Variants in Autism-Associated Genes.

Specialized multidisciplinary supports are important for long-term outcomes for autistic youth. Although family and child factors predict service utilization in autism, little is known with respect to youth with rare, autism-associated genetic variants, who frequently have increased psychiatric, developmental, and behavioral needs. We investigate the impact of family factors on service utilization to determine whether caregiver (autistic features, education, income) and child (autistic features, sex, age, IQ, co-occurring conditions) factors predicted service type (e.g., speech, occupational, behavioral) and intensity (hours/year) among children with autism-associated variants (N = 125), some of whom also had a confirmed ASD diagnosis. Analyses revealed variability in the types of services used across a range of child demographic, behavioral, and mental health characteristics. Speech therapy was the most received service (87.2%). Importantly, behavior therapy was the least received service and post-hoc analyses revealed that use of this therapy was uniquely predicted by ASD diagnosis. However, once children received a particular service, there was largely comparable intensity of services, independent of caregiver and child factors. Findings suggest that demographic and clinical factors impact families' ability to obtain services, with less impact on the intensity of services received. The low receipt of therapies that specifically address core support needs in autism (i.e., behavior therapy) indicates more research is needed on the availability of these services for youth with autism-associated variants, particularly for those who do not meet criteria for an ASD diagnosis but do demonstrate elevated and impactful child autistic features as compared to the general population.

Shared and divergent mental health characteristics of ADNP-, CHD8- and DYRK1A-related neurodevelopmental conditions.

BACKGROUND: Neurodevelopmental conditions such as intellectual disability (ID) and autism spectrum disorder (ASD) can stem from a broad array of inherited and de novo genetic differences, with marked physiological and behavioral impacts. We currently know little about the psychiatric phenotypes of rare genetic variants associated with ASD, despite heightened risk of psychiatric concerns in ASD more broadly. Understanding behavioral features of these variants can identify shared versus specific phenotypes across gene groups, facilitate mechanistic models, and provide prognostic insights to inform clinical practice. In this paper, we evaluate behavioral features within three gene groups associated with ID and ASD - ADNP, CHD8, and DYRK1A - with two aims: (1) characterize phenotypes across behavioral domains of anxiety, depression, ADHD, and challenging behavior; and (2) understand whether age and early developmental milestones are associated with later mental health outcomes. METHODS: Phenotypic data were obtained for youth with disruptive variants in ADNP, CHD8, or DYRK1A (N = 65, mean age = 8.7 years, 40% female) within a long-running, genetics-first study. Standardized caregiver-report measures of mental health features (anxiety, depression, attention-deficit/hyperactivity, oppositional behavior) and developmental history were extracted and analyzed for effects of gene group, age, and early developmental milestones on mental health features. RESULTS: Patterns of mental health features varied by group, with anxiety most prominent for CHD8, oppositional features overrepresented among ADNP, and attentional and depressive features most prominent for DYRK1A. For the full sample, age was positively associated with anxiety features, such that elevations in anxiety relative to same-age and same-sex peers may worsen with increasing age. Predictive utility of early developmental milestones was limited, with evidence of early language delays predicting greater difficulties across behavioral domains only for the CHD8 group. CONCLUSIONS: Despite shared associations with autism and intellectual disability, disruptive variants in ADNP, CHD8, and DYRK1A may yield variable psychiatric phenotypes among children and adolescents. With replication in larger samples over time, efforts such as these may contribute to improved clinical care for affected children and adolescents, allow for earlier identification of emerging mental health difficulties, and promote early intervention to alleviate concerns and improve quality of life.

Predictors of Engagement Barriers for Adolescent ADHD Treatment.

OBJECTIVE: The purpose of this study was to understand patient characteristics that predict engagement barriers during behavior therapy for ADHD. METHOD: Participants were 121 adolescents with ADHD and parents who received evidence-based behavior therapy for ADHD. Multiple regression examined relationships between six independent variables and frequency of barriers. RESULTS: ODD comorbidity and parental ADHD predicted higher frequency of overall barriers. With respect to barriers subtypes, these variables also predicted higher frequencies of cognitive, teen, early-treatment and mid-treatment barriers. Late-treatment, ODD predicted higher frequency of barriers, while minority status predicted lower barriers. CONCLUSIONS: Adolescents diagnosed with ADHD and comorbid ODD, or who have parents that are also diagnosed with ADHD, are at greatest risk for engagement barriers during behavior therapy. During all phases of treatment, this patient subgroup would benefit from enhancements to standard behavior therapy that focus on therapeutic engagement-particularly targeting teen beliefs about treatment.

Are There Long-Term Effects of Behavior Therapy for Adolescent ADHD? A Qualitative Study.

We utilized qualitative methodology to characterize potential long-term effects (therapeutic and iatrogenic) of behavior therapy for adolescents with ADHD. Forty-two in-depth interviews were conducted with adolescents with ADHD and parents, 4 years post-treatment. Grounded theory methods identified and reported prevalence of themes. All reported long-term effects were classified as benefits; no iatrogenic effects were noted. Long-term impact themes reported for a majority of participants included: development of organization skills (81.0%), enhanced motivation (57.1%), improved self-awareness (57.1%), improved parental knowledge of ADHD (76.2%), increased parent autonomy granting (61.9%), enhanced parental engagement with the youth (52.4%), and improved parent-teen relationships (52.4%). Fourteen themes were present for smaller subsamples, including reduced need for medication (3 of 9 medicated participants). Experimental studies of behavior therapy for adolescent ADHD should measure themes detected herein and directly test the possibility of long-term treatment effects.

Building a Theoretical Model for Supporting Teens' Autonomy Daily (STAND): A Network Analysis of Family-Perceived Changes.

Little is known about processes through which behavior therapy (BT) for adolescent ADHD improves outcomes. The purpose of this study was to build a theoretical model for the processes through which a BT for adolescent ADHD (Supporting Teens' Autonomy Daily; STAND) impacts functioning. Seventy-eight audio recordings from a standard therapeutic task in the final STAND session were analyzed as parents and adolescents (ages 11-16) reflected upon what changed during STAND and why. Qualitative coding sorted parent and teen statements into orthogonal categories of perceived changes. Network analysis examined inter-relations between categories. Results indicated twenty-one categories of perceived change areas. Parent use of behavioral strategies, adolescent motivation, and adolescent organization skills were central nodes in the network of perceived changes, with strong relations to academic and parent-teen relationship outcomes. A model is proposed in which skills training in STAND increases parent behavioral strategy use and teen organization skills, while Motivational Interviewing (MI) in STAND increase parent behavioral strategy use and initial adolescent motivation. In turn, parent behavioral strategy use is proposed to further reinforce teen motivation through contingency management, thereby increasing teen application of organization skills to daily life. As a result of improved teen motivation and organization skills, the model proposes that ADHD symptoms, academic problems, and parent-teen conflict abate. We discuss secondary mechanisms and outcomes in this model, the possibility of person-specific processes, implications for community-based adaptation of STAND, and plans to validate this conceptual model using sophisticated mediational models.

Parenting practices among Dominican and Puerto Rican mothers.

This study presents descriptive qualitative data about Latino parenting practices in an urban context. Focus groups were conducted with Dominican and Puerto Rican mother-adolescent pairs in the Bronx borough of NewYork City. When parenting style typologies are integrated with the Latino cultural components familismo, respeto, personalismo, and simpatía, Latino parenting practices and their underlying styles are better understood. Content analysis of parents' focus groups revealed five essential Latino parenting practices: (1) ensuring close monitoring of adolescents; (2) maintaining warm and supportive relationships characterized by high levels of parent-adolescent interaction and sharing; (3) explaining parental decisions and actions; (4) making an effort to build and improve relationships; and (5) differential parenting practices based on adolescents' gender. Mothers reported concerns related to the risks associated with living in an urban area, exposure to different cultural values, and opportunities for engaging in risky behaviors. Adolescents' recommendations for effective parenting strategies were similar to the practices reported by their mothers. The study has important applied implications for culturally competent social work practice with Latino adolescents and their families.

Multiple regression analyses in clinical child and adolescent psychology.

A major form of data analysis in clinical child and adolescent psychology is multiple regression. This article reviews issues in the application of such methods in light of the research designs typical of this field. Issues addressed include controlling covariates, evaluation of predictor relevance, comparing predictors, analysis of moderation, analysis of mediation, assumption violations, outliers, limited dependent variables, and directed regression and its relation to structural equation modeling. Analytic guidelines are provided within each domain.

Maternal perceptions of alcohol use by adolescents who drink alcohol.

OBJECTIVE: This research examines correlates of mothers' misperceptions of their adolescent children's regular alcohol consumption. Theories of adolescent autonomy, attribution processes, and stereotypes were used to make predictions about the biasing effects on attribution accuracy of maternal age, relationship satisfaction, and supervision of one's adolescent, as well as the adolescent's age, gender, physical development level, and peers. METHOD: The present research used a nationally representative sample of approximately 20,000 parent-adolescent dyads from the National Longitudinal Study of Adolescent Health (Add Health). Add Health is a school-based sample of 20,745 adolescents in Grades 7-12. Mothers indicated their perceptions of their adolescent children's alcohol use, and adolescents reported their actual use of alcohol. RESULTS: There was a tendency for mothers to underestimate alcohol use, sometimes substantially so. Maternal attributions followed a correlational pattern consistent with the scientific literature. There was evidence, however, that mothers may overgeneralize the applicability of these correlates, resulting in misattributions. CONCLUSIONS: Our analyses have important practical implications for parent-based intervention programs aimed at preventing adolescent alcohol use. First, programs should alert parents to the cues that signify adolescent alcohol consumption. Second, intervention programs should appropriately sensitize parents to identifying adolescent alcohol use in cases in which the child may not fit the stereotype of an adolescent drinker. Third, intervention messages should emphasize firm and consistent parental actions that minimize alcohol use independent of the particular cues that an adolescent is projecting.

Parental and school correlates of binge drinking among middle school students.

OBJECTIVES: We examined the prevalence and dynamics of binge drinking among middle school students. METHODS: We analyzed data from the National Longitudinal Study of Adolescent Health. The sample was composed of approximately 5300 seventh-and eighth-grade students who were interviewed at 2 points in time. RESULTS: Approximately 8% of seventh graders and 17% of eighth graders reported engaging in binge drinking during the past 12 months. These rates varied as a function of school characteristics. Low scores on the parenting variables-communication quality, use of reasoning, and control and supervision-and binge drinking during middle school also were predictive of binge drinking during high school. CONCLUSIONS: Binge drinking among middle school students is an important phenomenon that for many students forecasts future binge drinking during high school.

Binge drinking among Latino youth: role of acculturation-related variables.

This research examined the relationship between acculturation-related variables and binge drinking behavior among nationally representative samples of Mexican American, Cuban American, and Puerto Rican youth. It explored the relationship between length of residence in the United States, type of language spoken in the home (Spanish vs. English) and binge drinking in each of these subgroups. Results suggest that Latino youths with no prior history of alcohol consumption remain largely unaffected by these acculturation-related variables. Youth with a previous history of alcohol consumption experience greater likelihood of binge drinking as a function of the acculturation-related variables, but the relationships are complex.