Reducing Risk in the Treatment of Attention-Deficit/Hyperactivity Disorder Among Adults With Comorbidities.

Recent widely publicized shortages in the U.S. supply of first-line medications for treatment of attention-deficit/hyperactivity disorder (ADHD) are thought to reflect increases in public awareness, help seeking, and treatment. ADHD is one of the most common neurodevelopmental disorders and is typically identified in childhood. In adulthood, ADHD symptoms are less likely to include hyperactivity, but inattention, impulsivity, and emotional dysregulation are common. Clinical evaluation of symptomatic adults who were not diagnosed as children requires corroboration of ADHD diagnostic symptoms in childhood and careful differentiation of ADHD from frequently co-occurring psychiatric and substance use disorders. Treatment of adult ADHD can result in improved functioning across multiple dimensions and comorbid disorders. Existing guidelines and consensus statements recommend an integrated approach to treating ADHD and all existing comorbid disorders, prioritizing the disorder that is creating the most difficulty for the individual. [Journal of Psychosocial Nursing and Mental Health Services, 62(1), 8-11.].

Brain, Gut, and Immune Interconnections in Psychiatric Disorders: Implications for Treatment.

Recent studies have linked the gut microbiota to psychiatric symptoms and disorders through complex bidirectional networks. The purpose of the current article is to describe the associations between the gut microbiota and brain in psychiatric disorders. Although there are no approved treatments, there are global efforts underway to find more accurate measures to guide treatment and research. In this brief review, we describe current conceptualizations regarding the complex interconnections between psychiatric disorders and the gut microbiota. [Journal of Psychosocial Nursing and Mental Health Services, 61(3), 7-11.].

Evidence-Based Use of Atypical Antipsychotics in the Care of Children and Adolescents.

Atypical antipsychotics are increasingly used to treat children and adolescents with a variety of mental and behavioral symptoms, despite restrictive U.S. Food and Drug Administration indications. A recent taskforce advocates for a symptom-based approach to atypical antipsychotic use, rather than by diagnosis alone. Cautious prescribing of atypical antipsychotics should only take place after careful diagnostic assessment, review of prior treatments, and trials of other evidence-based medications. When used, monitoring metabolic indicators is crucial for the health and safety of patients. Risperidone and aripiprazole are highlighted as two different types of atypical antipsychotics commonly used to treat youth. [Journal of Psychosocial Nursing and Mental Health Services, 61(1), 8-11.].

Treatment in Children and Adolescents With Obsessive-Compulsive Disorder: Review for Practitioners.

Obsessive-compulsive disorder (OCD) is one of the most debilitating mental health conditions, interrupting functioning at school and social well-being in children and adolescents. Youth tend to delay interventions and when sought, response to treatment might not be optimal. The current article discusses treatment guidelines for youth with OCD and pediatric autoimmune neuropsychiatric symptoms. [Journal of Psychosocial Nursing and Mental Health Services, 61(8), 11-15.].

Children's moral emotions, narratives, and aggression: relations with maternal discipline and support.

Children who attribute more positive emotions to hypothetical moral victimizers are typically more aggressive and have more behavior problems. Little is known, however, about when individual differences in these moral emotion attributions first emerge or about maternal correlates of these differences. In this study, 63 4-6-year-olds judged how they would feel after victimizing peers for gain and enacted event conclusions using narrative methods adapted from the MacArthur Story Stem Battery. In addition, children's mothers completed assessments of their disciplinary styles and social support, and children's aggressive tendencies were assessed based on ratings from mothers and a second familiar adult. Results revealed that most preschoolers expected to feel happy after their victimizing acts, but variations in happy victimization were unrelated to children's aggression. Several of children's narrative themes, including making amends (e.g., apologizing, reparations), aggressive acts, and mentions of death/killing, however, were related to children's aggression. Moreover, two maternal disciplinary dimensions, higher warmth and reasoning, as well as greater social support were also related to lower child aggression. Children's emotion attributions and moral narratives, however, were unrelated to maternal disciplinary practices or social support.

The role of adolescent attachment in moderating and mediating the links between parent and adolescent psychological symptoms.

The present study examined whether adolescent attachment security and attachment-related representations moderate and mediate, respectively, the link between parent symptoms (depressive and anxiety) and adolescent depressive symptoms. Participants were 189 (118 girls) eleventh graders and their parents in a community sample. Results showed that adolescent attachment moderated the connection between parent and adolescent symptoms; in most cases attachment security was more protective if both parents were high on anxiety symptoms or if one parent was high on anxiety but the other parent was low on depressive symptoms. Mediational analyses indicated that representations of their mothers as a secure base mediated the link between maternal and adolescent depressive symptoms. Perceptions of fathers as a secure base did not play a mediating role, although paternal depressive symptoms were associated with lower perceptions of the father as a secure base. Neither parent's anxiety symptoms were related to perceptions of the parent as a secure base or to adolescent depressive symptoms.

The generalization of attachment representations to new social situations: predicting behavior during initial interactions with strangers.

The idea that attachment representations are generalized to new social situations and guide behavior with unfamiliar others is central to attachment theory. However, research regarding this important theoretical postulate has been lacking in adolescence and adulthood, as most research has focused on establishing the influence of attachment representations on close relationship dynamics. Thus, the goal of this investigation was to examine the extent to which attachment representations are predictive of adolescents' initial behavior when meeting and interacting with new peers. High school adolescents (N=135) participated with unfamiliar peers from another school in 2 social support interactions that were videotaped and coded by independent observers. Results indicated that attachment representations (assessed through interview and self-report measures) were predictive of behaviors exhibited during the discussions. Theoretical implications of the results and contributions to the existing literature are discussed.

Advanced practice registered nurses attitudes toward suicide in the 15- to 24-year-old population.

PURPOSE: The purpose of this study is to assess advanced practice registered nurses (APRNs) attitudes toward suicide in the 15- to 24-year-old population. DESIGN AND METHODS: A convenience sample of national psychiatric and pediatric APRNs was obtained from postings on professional websites and sending invitations to members utilizing anonymous Qualtricsⓒ survey that included demographic questions and the Suicide Opinion Questionnaire (SOQ). FINDINGS: The pediatric APRNs demonstrated more positive attitudes toward suicide as measured by the SOQ when individual items were analyzed. PRACTICE IMPLICATIONS: One of the outcomes of this study is to raise awareness and foster prevention related to suicide for advanced practice registered nurses and the 15- to 24-year-old population.

The development of negative reactivity in irritable newborns as a function of attachment.

This longitudinal study builds on existing research exploring the developmental course of infants' negative reactivity to frustration in a sample of 84 irritable infants. We investigated whether infants' negative reactivity to frustration differed during the first year as a function of infant attachment classification. Various elements of the designs of previous studies investigating negative reactivity and attachment preclude the strong conclusion that negative reactivity develops differently as a function of attachment. Thus, we utilized the same observational assessment of infant negative reactivity, conducted without parental involvement, at 5 and 12 months. One proposition, based in attachment theory (Bowlby, 1969/1982; Cassidy, 1994), is that relative to secure infants, insecure-avoidant infants come to minimize their negative emotional reactions, whereas insecure-ambivalent infants come to maximize their negative emotional reactions. As expected, we found that at 5 months, attachment groups did not differ in reactivity, but at 12 months, insecure-avoidant infants were the least reactive, followed by secure infants, and insecure-ambivalent infants were the most reactive. Results are discussed in terms of conceptualizing the development of emotion regulation and their implications for future research.

Stability of maternal depressive symptoms among urban, low-income, African American adolescent mothers.

BACKGROUND: Maternal depressive symptomatology is an important public health issue with negative consequences for both mothers and infants. METHODS: This study examined prevalence and patterns of depressive symptoms among 181 urban, low-income, first-time, African American adolescent mothers recruited from urban hospitals following delivery. Follow-up evaluations were conducted at 6 (N=148; 82%) and 24 (N=147; 81%) month home visits. Depressive symptoms were measured with Beck Depression Inventory (BDI). RESULTS: Half of mothers (49%) had BDI scores >9 at baseline, with significant correlations between BDI scores across all visits (r=0.28-0.50). Depressive symptom trajectories analyzed using group-based trajectory modeling revealed three trajectories of depressive symptoms: Low (41%), Medium (45%), and High (14%). The high depressive symptom group reported lower self-esteem, more negative life events, and lower parenting satisfaction than the low and moderate depressive symptoms groups. LIMITATIONS: Depressive symptoms were self-reported and not verified with a clinical interview. Findings are limited to urban, low-income, African American adolescent mothers and may not be generalizable to other populations. CONCLUSIONS: The high prevalence and relative stability of depressive symptoms through 2years of parenting suggest the need for early identification and treatment of maternal depressive symptoms. Brief screening for maternal depressive symptoms conducted during pediatric well-child visits is a feasible and effective method for identifying mothers with depressive symptoms, however, screening measures can not differentiate between high and low levels of depressive symptoms. Brief intervention may be an effective treatment for mothers with mild symptoms of depression; mothers with moderate to severe symptoms may require more intensive intervention.

Parent--child emotion communication, attachment, and affective narratives.

Forty-four pre-schoolers (ages 4.3 to 5.8 years) and their primary caregivers participated in a study on the connections between parent-child emotion communication and a narrative assessment of pre-schoolers' attachment. Children completed the Separation Anxiety Test (SAT), a narrative assessment of children's responses to attachment-related separations (including self-reliance, avoidance, attachment and coherence scores). Several aspects of parent-child discussions of emotion-eliciting events were also assessed in the Emotion Communication Task. Results indicated that SAT coherence was positively related to SAT attachment and negatively related to SAT avoidance. Furthermore, SAT coherence was positively related to parental scaffolding and negatively related to parental and child negativity during the Emotion Communication Task. Parental scaffolding and child reciprocity were positively related to each other and, in general, were negatively related to parental and child negativity. Discussion focused on the potential contributions of children's interactions with caregivers to the development of children's attachment narratives and emotion-related understanding.