Reliability of a computer-based neurobehavioral assessment test battery for Bangladeshi adolescent children.

In developing countries, there is a need for low-cost neurobehavioral (NB) test batteries for vulnerable populations, particularly for children exposed to environmental neurotoxicants. The objective of the current study was to assess the feasibility and test-retest reliability of the Behavioral Assessment and Research System (BARS) in children from a rural community in Bangladesh. Fifty healthy adolescents living in the Health Effects of Arsenic Longitudinal Study (HEALS) area in Araihazar, Bangladesh completed all six tests from the BARS in two test sessions scheduled two weeks apart. The BARS tests evaluated NB functions such as motor coordination, attention, memory, and information processing speed. The reliability assessment, evaluated by test-retest correlations demonstrated moderate to strong correlations (i.e., correlation coefficients ranged from 0.43 to 0.85), which were statistically significant (p < 0.05). Paired t-tests for comparing the test and retest outcomes indicated significant improvement in NB performance, highlighting learning and practice effects. NB performance improved with increasing age in most cases. Adolescent boys performed better than the girls in Finger Tapping, Digit Span, and Simple Reaction Time, whereas the girls performed better in Continuous Performance and Symbol Digit tests. The reliability scores (Pearson's correlations 0.43-0.85) were consistent with other children studies in different cultural settings. The effects of age and sex on NB tests were also consistent with findings reported in other countries. Overall, the findings of the study support the feasibility of using this computer-based test system to assess vulnerability of brain health due to environmental exposures among rural Bangladeshi children.

Associations of the Behavioral Assessment and Research System (BARS) neurobehavioral outcomes with attention problems in children living near coal ash storage sites.

Environmental exposures have been linked to childhood problems with overactivity, attention, and impulse control, and an increased risk of attention deficit hyperactivity disorder (ADHD) diagnosis. Two approaches to identify these types of exposure-related neurobehavioral problems include the use of computerized tests, such as the Behavioral Assessment and Research System (BARS), as well as the use of behavior rating scales. To assess comparability of these two types of measures, we analyzed data from 281 children aged 6 to 14 years enrolled in a 5-year research study investigating coal ash exposure and neurobehavioral health. All children lived in proximity of coal ash storage sites. We administered six computer tests from the BARS and obtained behavior measures from the parent-completed Child Behavior Checklist (CBCL) ADHD DSM oriented scale. BARS test performance was associated with age indicating that the tests could be used to evaluate neurodevelopmental changes over time or across a wide age range. Tests within the BARS including Continuous Performance (CPT) false alarm (standardized estimate 1.57, 95% confidence interval (CI) (0.67, 2.48), adjusted p = 0.006), Selective Attention (SAT) wrong count (standardized estimate 2.8, 95% CI (1.17, 4.44), adjusted p = 0.006), and SAT proportion correct (standardized estimate -2.45, 95% CI (-4.01, -0.88), adjusted p = 0.01) were associated with attention and impulse control problems on the CBCL after adjustment for multiple comparisons. Findings support that the BARS can contribute to research on environmental exposures by assessing subclinical behaviors related to ADHD such as sustained attention, impulse control, response inhibition, associative learning, and short-term memory. Future research can examine relationships of these BARS measures with biomarkers of neurotoxic exposures related to living near coal ash storage sites to better identify the potential risk for ADHD-related behaviors among children living near coal ash storage sites.

Smoke screen: The teen vaping epidemic uncovers a new concerning addiction.

The use of nicotine products among adolescents is now designated as a national epidemic by the United States Surgeon General. The largest one-year increase ever recorded for substance use in the adolescent population should sound the alarm for Nurse Practitioners (NPs) practicing in family health and pediatrics. Vaping, or the use of e-cigarettes or electronic nicotine delivery systems (ENDS), has been purported by the vaping industry as a less harmful alternative for tobacco users in their attempt to quit smoking. In adolescents, vaping represents a dangerous and highly addictive health behavior. Initiatives on both the state and federal levels have begun to address marketing and access to young users. However, the active involvement of NPs on the front line of primary care will be necessary to combat this imposing threat. The protection of our young patients from nicotine addiction and the education of patients and families about the potential dangers of e-cigarettes are imperative to prevent harm. This article addresses concerns related to e-cigarette use in the adolescent population and the important role NPs can play in promoting their health and well-being.

Medications for Maintenance Treatment of Opioid Use Disorder in Adolescents: A Narrative Review and Assessment of Clinical Benefits and Potential Risks.

OBJECTIVE: Methadone, buprenorphine, and naltrexone are evidence-based treatments for opioid use disorder (OUD). A large body of evidence supports their effectiveness in adults with OUD. However, few studies have tested their efficacy in adolescents. This study summarizes the clinical benefits and risks of three medications for the treatment of OUD in adolescents. METHOD: We review and synthesize the published evidence about the efficacy and potential risks (including safety concerns) associated with methadone, buprenorphine, or naltrexone for the treatment of OUD in adolescents and compare their benefits and risks with that of no treatment or treatment without medications. We also discuss adolescent-specific treatment needs and strategies to overcome potential challenges in prescribing medications for adolescents with OUD. RESULTS: Methadone appears to be effective in promoting treatment retention among adolescents with heroin use disorder. Data from three randomized controlled trials suggest that buprenorphine treatment improves the likelihood of opioid abstinence and treatment retention. Although these medications have a potential risk of overdose when misused or used illegally, evidence suggests this risk is much lower for buprenorphine than methadone. Emerging data also suggest that naltrexone is a safe and feasible option for adolescents. Vast evidence demonstrates that the risks of untreated OUD far outweigh the risks of any of the previously discussed medications. CONCLUSIONS: Little published evidence specifically examines the efficacy and safety of using medications for OUD in adolescents, and more research is needed. It is essential for healthcare professionals to determine whether their adolescent patients may benefit from medications for the treatment of OUD.

Dietary quality linkage to overall competence at school and emotional disturbance in representative Taiwanese young adolescents: dependence on gender, parental characteristics and personal behaviors.

BACKGROUND: Child school performance during puberty may be at increased risk through emotional disturbance. It is hypothesized that this may be mitigated by dietary quality. METHODS: In a nationally representative sample (Nutrition and Health Survey in Taiwan, NAHSIT), 1371 Taiwanese aged 11-16 years, overall competence at school, (OCS) and emotional status have been assessed by teachers with the SAED (Scale for Assessing Emotional Disturbance). Parents provided family socio-demographics and students completed a behavioral and dietary questionnaire (Youth Healthy Eating Index - Taiwan, YHEI-TW). Associations between emotional disturbance (ED), OCS and dietary quality (YHEI-TW) were assessed in multiple linear regression models with adjustments for covariates including parental characteristics, personal behaviors, body fatness and puberty. RESULTS: Boys or girls with ED had a less favorable OCS (p < 0.001), minimally dependent on YHEI-TW. On multivariable analysis there was a more positive association between OCS and YHEI-TW among boys (ß = 0.05, p < 0.01) and girls (ß = 0.07, p < 0.001). Poor dietary quality was associated with ED, especially in girls (ß = - 0.06, p < 0.001). Additionally, parental characteristics, body fatness, and personal behaviors are associated with OCS. Puberty is associated with ED and may be indirectly linked to OCS. CONCLUSIONS: Unsatisfactory food intake is associated with the link between emotional disturbance and impaired school performance, as assessed by OCS, especially among girls. For both genders, socio-economic and behavioral factors including parenteral income, reading, screen viewing and smoking are modulators of this association. Puberty was a modifying factor in girls. Dietary quality is a relevant factor for health (ED) as well as education (OCS) during early adolescence.

Assessment and Treatment of Adolescent Substance Use Disorders: Alcohol Use Disorders.

Alcohol drinking in childhood and adolescence is a serious public health concern. Adolescence is a vulnerable period for risk-taking tendencies. Understanding the influences of problematic alcohol use is important for evolving interventions. Alcohol use in early years foreshadows a lifetime risk for psychiatric and substance use disorders. Early screening and assessment can alter tragic sequelae. We discuss clinical aspects such as confidentiality, differential levels of care, and criteria for best fitting treatments. Given the prevalence of drinking and its impact on psychiatric and substance use disorders, the need for further study and prevention are emphasized.

The associations between adolescent sleep, diurnal cortisol patterns and cortisol reactivity to dexamethasone suppression test.

Information on the associations between objectively measured sleep and hypothalamic-pituitary-adrenal axis function in early adolescence is scarce. We examined associations between average sleep duration and quality (sleep efficiency and wake after sleep onset) over 8 days with actigraphs and (1) diurnal cortisol patterns and (2) cortisol reactivity to a low-dose (3 µg/kg) overnight dexamethasone suppression test (DST) in a birth cohort born in 1998 (N=265 participants, mean age 12.3 years, SD=0.5). We also explored (3) if sleep duration and quality were affected the nights after the DST exposure. Cortisol was measured during 2 days, and participants were exposed to dexamethasone in the evening of first day. In boys, short sleep duration was associated with higher cortisol upon awakening and lower cortisol awakening response (CAR; P<0.05 and P<0.01). Long sleep duration in boys associated with higher CAR (P<0.02). Lower sleep quality in boys associated with lower CAR, but fell slightly short of significance (P<0.06). In girls, no significant associations were detected. Sleep quantity and quality were not associated with responses to the DST. There were no effects of DST on sleep (P>0.15 in between-subject analyses). The average sleep patterns showed associations with diurnal cortisol patterns during early adolescence, but only in boys. Sleep was not associated with cortisol reactivity to DST and the exogenous corticosteroid exposure did not affect sleep significantly.

Use of medication prescribed for emotional or behavioral difficulties among children aged 6-17 years in the United States, 2011-2012.

Mental health problems are common chronic conditions in children (1-3). Medication is often prescribed to treat the symptoms of these conditions (4-7). Few population-based studies have examined the use of prescription medication to treat mental health problems among younger as well as older school-aged children (8-10). This report describes the sociodemographic characteristics of children aged 6-17 years prescribed medication or taking medication during the past 6 months for emotional or behavioral difficulties, and describes parental reports of the perceived benefit of this medication.

Identifying suicidal behavior among adolescents using administrative claims data.

PURPOSE: To assess the safety of psychotropic medication use in children and adolescents, it is critical to be able to identify suicidal behaviors from medical claims data and distinguish them from other injuries. The purpose of this study was to develop an algorithm using administrative claims data to identify medically treated suicidal behavior in a cohort of children and adolescents. METHODS: The cohort included 80,183 youth (6-18 years) enrolled in Tennessee's Medicaid program from 1995-2006 who were prescribed antidepressants. Potential episodes of suicidal behavior were identified using external cause-of-injury codes (E-codes) and ICD-9-CM codes corresponding to the potential mechanisms of or injuries resulting from suicidal behavior. For each identified episode, medical records were reviewed to determine if the injury was self-inflicted and if intent to die was explicitly stated or could be inferred. RESULTS: Medical records were reviewed for 2676 episodes of potential self-harm identified through claims data. Among 1162 episodes that were classified as suicidal behavior, 1117 (96%) had a claim for suicide and self-inflicted injury, poisoning by drugs, or both. The positive predictive value of code groups to predict suicidal behavior ranged from 0-88% and improved when there was a concomitant hospitalization but with the limitation of excluding some episodes of confirmed suicidal behavior. CONCLUSIONS: Nearly all episodes of confirmed suicidal behavior in this cohort of youth included an ICD-9-CM code for suicide or poisoning by drugs. An algorithm combining these ICD-9-CM codes and hospital stay greatly improved the positive predictive value for identifying medically treated suicidal behavior.

[Visits to the doctor because of illness or injury of the students of vocational schools who consume or do not consume psychoactive substances (comparative aspects)].

AIM: To elucidate what impact has the use of different narcotic drugs, alcohol and tobacco on the health of students and the risk of injuries. MATERIAL AND METHODS: We carried out a questionnaire survey of the first year students from all six vocational schools of Klaipeda (Lithuania) in 2004, 2006 and 2008. A total of 912 students (507 boys and 405 girls, mean age 17.5 years) were surveyed with an anonymous questionnaire. The findings were analysed with computer soft SPSS (SPSS 16.0 for Windows). RESULTS: The results showed that the use of any psychoactive substances is damaging to health, especially injection and club narcotic drugs. Adolescents addicted to any psychoactive substances more often than non-addicts visited doctor due to illness or injury during the last 12 months. CONCLUSION: Adolescents on illegal drugs, especially boys on injectable narcotic drugs and girls on club drugs were at twice higher risk for disease or injury (odds ratio--OR--3.39, 95% confidence interval--CI--1.25 to 9.19, p = 0.016 and OR--2.38, CI--1.35 to 4.20, p = 0.003, respectively). Tobacco and alcohol consumption did not significantly increase this risk with the exception of tobacco smoking girls. We think it happened because these two addictions are widely spread among large part of the boys from the vocational schools.

Cannabis use disorder: epidemiology and management.

This paper provides an overview of the epidemiology of cannabis use, cannabis use disorders and its treatment. Cannabis is the most commonly used illicit drug internationally. While use is decreasing in the developed world, it appears to be stable or increasing in developing countries and some indigenous communities. Early initiation and regular adolescent use have been identified as particular risk factors for later problematic cannabis (and other drug) use, impaired mental health, delinquency, lower educational achievement, risky sexual behaviour and criminal offending in a range of studies. It is estimated that approximately one in ten people who had ever used cannabis will become dependent with risk increasing markedly with frequency of use. There has been an increase in the proportion of treatment provided for cannabis use. There are as yet no evidence-based pharmacotherapies available for the management of cannabis withdrawal and craving. Relatively brief cognitive behavioural therapy and contingency management have the strongest evidence of success, and structured, family-based interventions, provide potent treatment options for adolescents. With criminally involved young people and those with severe, persistent mental illness, longer and more intensive therapies provided by interdisciplinary teams may be required.

Ayahuasca in adolescence: a preliminary psychiatric assessment.

Ayahuasca is believed to be harmless for those (including adolescents) drinking it within a religious setting. Nevertheless controlled studies on the mental/ psychiatric status of ritual hallucinogenic ayahuasca concoction consumers are still lacking. In this study, 40 adolescents from a Brazilian ayahuasca sect were compared with 40 controls matched on sex, age, and educational background for psychiatric symptomatology. Screening scales for depression, anxiety, alcohol consumption patterns (abuse), attentional problems, and body dysmorphic disorders were used. It was found that, compared to controls, considerable lower frequencies of positive scoring for anxiety, body dismorphism, and attentional problems were detected among ayahuasca-using adolescents despite overall similar psychopathological profiles displayed by both study groups. Low frequencies of psychiatric symptoms detected among adolescents consuming ayahuasca within a religious context may reflect a protective effect due to their religious affiliation. However further studies on the possible interference of other variables in the outcome are necessary.

Measuring the loss of autonomy over nicotine use in adolescents: the DANDY (Development and Assessment of Nicotine Dependence in Youths) study.

CONTEXT: There is no validated, theory-based tool for assessing the onset of nicotine dependence. However, the use of all addictive substances can result in a loss of autonomy. We propose that nicotine dependence begins when autonomy is lost, ie, when the sequelae of tobacco use, either physical or psychological, present a barrier to quitting. OBJECTIVES: To test the autonomy theory of nicotine dependence, and to evaluate the Hooked on Nicotine Checklist (HONC) as a measure of the loss of autonomy over tobacco use. DESIGN: The psychometric performance and concept validity of the HONC were evaluated in a 30-month prospective longitudinal study of the natural history of tobacco use in a cohort of 679 seventh-grade students. RESULTS: As hypothesized, endorsement of a single item on the HONC was associated with a failed attempt at smoking cessation (odds ratio [OR], 29; 95% confidence interval [CI], 13-65), continued smoking until the end of follow-up (OR, 44; 95% CI, 17-114), and daily smoking (OR, 58; 95% CI, 24-142). Scores on the HONC correlated with the maximum amount smoked (r = 0.65; P<.001) and the maximum frequency of smoking (r = 0.79; P<.001). Internal reliability was 0.94. A 1-factor solution explained 66% of the total variance. CONCLUSIONS: The data support the autonomy theory that dependence begins with the loss of autonomy. The autonomy theory represents a potentially useful alternative to current concepts of nicotine dependence for adolescents, and the HONC appears to measure lost autonomy in adolescents. Construct validity was demonstrated by its utility in predicting failed cessation and the progression of tobacco use. In addition, the psychometric properties were excellent.

Reducing the harms caused by cannabis use: the policy debate in Australia.

The debate about cannabis policy in Australia has revolved around the harms that cannabis causes to users and the community, on the one hand, and the harms that are caused by the prohibition of its use, on the other. This paper assesses evidence on: (1) the harms caused to users and the community by cannabis use (derived from the international scientific literature) and (2) the harms that arise from prohibition (as reflected in Australian research). The most probable harms caused by cannabis use include: an increased risk of motor vehicle accidents; respiratory disease; dependence; adverse effects on adolescent development; and the exacerbation of psychosis. The harms of the current prohibition on cannabis use policy are less tangible but probably include: the creation of a large blackmarket; disrespect for a widely broken law; harms to the reputation of the unlucky few cannabis users who are caught and prosecuted; lack of access to cannabis for medical uses; and an inefficient use of law enforcement resources. Cannabis policy unavoidably involves trade offs between competing values that should be made by the political process. Australian cannabis policy has converged on a solution which continues to prohibit cannabis but reduces the severity of penalties for cannabis use by either removing criminal penalties or diverting first time cannabis offenders into treatment and education.

Assessment of neurobehavioral function with computerized tests in a population of hispanic adolescents working in agriculture.

In recent years there has been heightened concern over the potential of occupational or environmental exposures to affect neurological function in children and adolescents. The current study was designed to develop computerized tests to effectively assess neurobehavioral function in Hispanic adolescents working in agriculture and to evaluate those tests in Hispanic youths working in agriculture and in a non-agricultural group. After exclusions, 96 adolescents currently working in agriculture (AG) and 51 adolescents currently non-migratory and not working in agriculture (Non-AG) were tested. Neurobehavioral tests were selected from the computerized Behavioral Assessment and Research System. AG test performance was significantly below Non-AG performance on the cognitive tests. However, educational and cultural differences between the AG and Non-AG groups may explain this difference. Repeat testing of the AG group revealed substantially improved performance, further supporting educational or cultural differences as an explanation for the group differences. Together, these results expose the limitations in case-control or cross-sectional designs for testing migrant worker populations in the United States. Longitudinal or cross-sectional designs with repeat testing offer more promise and may be essential for drawing accurate conclusions in migrant worker groups where there are no truly equivalent comparison or control groups.

Sucrose and delinquency: behavioral assessment.

In this study, a double-blind challenge design was used to evaluate the hypothesis that sucrose ingestion may compromise the behavioral performance of juvenile delinquents. Subjects were 58 white delinquents, 57 black delinquents, and 39 white nondelinquents. The behavioral assessment included tasks that are relevant to delinquency and that might be expected to be disrupted following sucrose ingestion. The results provide no evidence that sucrose ingestion impairs the performance of juvenile delinquents. In fact, the results of several analyses indicated that the sucrose breakfast was associated with improved performance. In additional analyses the effect of sucrose on particular subgroups of juvenile delinquents was evaluated. Statistical interactions indicated that the performance of delinquents rated as more behaviorally disturbed benefited from sucrose ingestion, whereas those delinquents with less pronounced behavior problems tended to show impaired performance following a sucrose-loaded breakfast. These results indicate that simple statements regarding the effects of sucrose ingestion on behavior are likely to be misleading and highlight the need to consider individual difference variables when investigating the effects of sucrose on juvenile delinquents.

Sucrose and delinquency: oral sucrose tolerance test and nutritional assessment.

Claims that juvenile delinquency may be associated with reactive hypoglycemia or nutritional deficiencies have received widespread attention but little objective evaluation. To assess the validity of these claims, nutritional and psychological indices of juvenile delinquents have been measured. Serum glucose and insulin profiles during an oral sucrose tolerance test were measured in 137 delinquent and 41 nondelinquent male adolescents aged 14 to 19. In addition, nutritional status of both populations was assessed by anthropometry (height, weight, arm circumference, triceps skin fold) and biochemical measures (hematocrit, red-blood cell thiamin, and serum copper, ferritin, and zinc). Delinquent subjects had slightly but significantly lower serum glucose values at four of six time points (fasting, 60 minutes, 120 minutes, 180 minutes) and higher serum insulin values at one time point (30 minutes) compared with nondelinquent subjects. Changes in glucose from fasting levels indicate that these subjects were regulating serum glucose adequately, but doing so at lower values; changes in insulin from fasting levels indicate that black delinquents initially secreted more insulin than either white subject group. There were no significant associations between excursions in serum glucose or insulin and any adrenergic signs or symptoms of low blood glucose levels. Nutritional status of incarcerated delinquents did not differ from that of nonincarcerated subjects on most measures. Although the significantly lower serum glucose levels and higher serum insulin levels are intriguing, no support is offered by results of this study for allegations that sucrose ingestion causes reactive hypoglycemia in juvenile delinquents or that delinquent male adolescents are at greater risk nutritionally than male adolescents of the same age who are not delinquent.(ABSTRACT TRUNCATED AT 250 WORDS)