Co-Occurring Psychopathology Moderates Social Skills Improvement in a Randomized Controlled Trial of a Collaborative School-Home Intervention for Children with ADHD.

OBJECTIVE: Children with ADHD often exhibit marked impairment in their social skills, but evidence-based psychosocial interventions for ADHD have shown limited efficacy in remediating these deficits. Co-occurring psychopathology exacerbates social deficits in children with ADHD and is a plausible moderator of treatment response. To identify factors contributing to variable social skills treatment response, we examined co-occurring externalizing, depression, and anxiety symptoms as moderators of social skills outcomes in a randomized controlled trial of the Collaborative Life Skills (CLS) program, an evidence-based collaborative school-home ADHD intervention. METHOD: Participants were 159 children with ADHD (M age = 8.35 years, 28.3% female) at 27 schools in an urban public school district. Twenty-three schools were randomly assigned to CLS or usual services, with an additional four schools assigned to Spanish-adapted CLS or usual services. Multi-informant measures of co-occurring psychopathology and social skills were collected at baseline and post-treatment. RESULTS: Parent-rated externalizing and depression symptoms moderated treatment effects on social skills, whereby higher symptomatology in each domain was unrelated to social skills improvement in the CLS group but predicted worsening social skills in response to usual services. In contrast, teacher-rated anxiety moderated treatment effects on social skills, whereby higher anxiety predicted greater social skills improvement in response to CLS but was unrelated to social skills outcomes following usual services. CONCLUSIONS: Findings reflect novel evidence that child psychopathology domains exhibit unique moderating effects on social skills treatment response in children with ADHD. We discuss implications for optimizing evidence-based interventions to target social impairment in this population.

Agitation Management in Pediatric Males with Anti-N-Methyl-D-Aspartate Receptor Encephalitis.

OBJECTIVES: Severe agitation is a common symptom in pediatric cases of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis-an autoimmune encephalitis with prominent neuropsychiatric symptoms. Agitation is a major barrier to treatment of the underlying disease process and increases patients' risk of harming themselves and others. Furthermore, male patients often have undetectable tumors and are especially at risk for extended hospitalization, but have been infrequently studied. This report presents a case series of four pediatric male patients with anti-NMDAR encephalitis complicated by agitation, the strategies used to address treatment challenges, and a review of the current literature. METHODS: A chart review of four agitated pediatric male patients with anti-NMDAR encephalitis and a PubMed search of the current literature were conducted. RESULTS: A number of first-generation and second-generation antipsychotics (SGAs) have been reported for use in child and adult patients; however, treatment with these antipsychotics often has been complicated by movement disorders and autonomic instability caused by the underlying encephalitis that appears similar to and can be exacerbated by adverse effects of antipsychotics, including neuroleptic malignant syndrome (NMS), extrapyramidal symptoms (EPS), and tardive dyskinesia. The literature shows SGAs to be less likely to cause NMS and quetiapine to be one of the least likely SGAs to cause EPS. However, quetiapine has rarely been reported for use in patients with anti-NMDAR encephalitis. In the four pediatric male patients, quetiapine was generally effective, well tolerated, and not associated with NMS or significant EPS. CONCLUSION: These cases and review of the literature suggest that quetiapine may be particularly beneficial for treating agitation secondary to anti-NMDAR encephalitis in pediatric patients and have fewer adverse effects.