Are Family Factors Differentially Associated with Externalizing Symptoms Among Youth with Perinatally Acquired HIV?

Youth with perinatally-acquired HIV (PHIV) face unique psychosocial stressors. They are at risk for externalizing problems, including symptoms of oppositional defiant disorder, conduct disorder (CD), and attention-deficit/hyperactivity disorder (ADHD), as well as risk-taking behaviors, such as substance use (SU). Although family factors have been differentially associated with externalizing and SU behaviors based on youth sex in prior research, there is a dearth of literature considering these processes among youth with PHIV. Participants included 314 youth with PHIV (M = 12.88 years, SD = 3.08 years; 50.80% male; 85.30% Black or Latinx). Boys exhibited higher levels of ADHD symptoms than girls. Among boys, lower levels of consistency in discipline were associated with higher CD symptoms. Lower levels of family cohesion were associated with higher levels of SU among girls, and higher levels of CD symptoms across youth sex. Findings support the need for family-focused behavioral interventions among youth with PHIV.

Physical and sexual victimization of persons with severe mental illness seeking care in central and southwestern Uganda.

Purpose: This study established the prevalence of physical and sexual victimization, associated factors and psychosocial consequences of victimization among 1,201 out-patients with severe mental illness at Butabika and Masaka hospitals in Uganda. Methods: Participants completed structured, standardized and locally translated instruments. Physical and sexual victimization was assessed using the modified adverse life events module of the European Para-suicide Interview Schedule. We used logistic regression to determine the association between victimization, the associated factors and psychosocial consequences. Results: The prevalence of physical abuse was 34.1% and that of sexual victimization was 21.9%. The age group of > = 50 years (aOR 1.02;95% CI 0.62-1.66; p = 0.048) was more likely to have suffered physical victimization, while living in a rural area was protective against physical (aOR 0.59; 95% CI 0.46-0.76; p = <0.001) and sexual (aOR 0.48, 95% CI 0.35-0.65; p < 0.001) victimization. High socioeconomic status (SES) (aOR 0.56; 95% CI 0.34-0.92; p = <0.001) was protective against physical victimization. Females were more likely to have been sexually victimized (aOR 3.38; 95% CI 2.47-4.64; p = <0.001), while being a Muslim (aOR 0.60; 95% CI 0.39-0.90; p = 0.045) was protective against sexual victimization. Risky sexual behavior was a negative outcome associated with physical (aOR 2.19; 95% CI 1.66-2.90; p = <0.001) and sexual (aOR 3.09; 95% CI 2.25-4.23; p < 0.001) victimization. Mental health stigma was a negative outcome associated with physical (aOR 1.03; 95% CI 1.01-1.05; p < 0.001) and sexual (aOR 1.03; 95% CI 1.01-1.05; p = 0.002) victimization. Poor adherence to oral anti-psychotic medications was a negative outcome associated with physical (aOR 1.51; 95% CI 1.13-2.00; p = 0.006) and sexual (aOR 1.39; 95% CI 0.99-1.94; p = 0.044) victimization. Conclusion: There is a high burden of physical and sexual victimization among people with SMI in central Uganda. There is need to put in place and evaluate complex interventions for improving detection and response to abusive experiences within mental health services. Public health practitioners, policymakers, and legislators should act to protect the health and rights of people with SMI in resource poor settings.

Diagnostic accuracy of the Child and Adolescent Symptom Inventory (CASI-4R) substance use subscale in detecting substance use disorders in youth.

Identifying substance use disorders (SUDs) early and accurately improves case formulation and treatment. Previous studies have investigated validity and reliability of the Child and Adolescent Symptom Inventory (CASI) for anxiety, mood, and behavior problems. The present study's aim was to test if the embedded CASI Substance Use (SU) subscale can discriminate adolescents and young adults (AYA) with and without a SUD diagnosis accurately enough to justify clinical application within an evidence-based assessment framework. N = 479 outpatient AYA (age 14-21) and their caregivers completed K-SADS-PLW semistructured diagnostic interviews; caregivers completed the CASI and adolescents completed a parallel version, the Youth (self-report) Inventory (YI). K-SADS-PLW indicated that 33 youth met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for SUDs. Receiver Operating Characteristic (ROC) analyses found that both CASI and YI Substance Use subscale scores significantly identified K-SADS-diagnosed SUDs in AYA: Caregiver area under curve (AUC) = .91, p < .0005; YI(AUC) = .90, p < .0005. There was no significant difference in diagnostic accuracy between informants. Both subscales showed diagnostic and clinical utility in identifying AYA SUDs in outpatient mental health settings. Findings suggest that the CASI-4R subscale could be a helpful screening instrument for AYA SUDs. A case vignette illustrates the clinical application of study findings. Future research should examine rapport as a moderator of reporting accuracy, and replicate use of these measures under varying clinical scenarios. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Importance of Parent-Teacher Informant Discrepancy in Characterizing Autistic Youth: A Replication Latent Profile Analysis.

OBJECTIVE: Research about autism spectrum disorder (ASD) supports variation in symptom presentations across settings, and there is a growing literature that explicates how this variability may improve characterization of the autism phenotype. Capitalizing on a well-established literature on informant discrepancy as an index of contextual variability, research suggests that differing parent and teacher perceptions may impact treatment or education-related outcomes. A prior investigation by Lerner and colleagues suggests that parent-teacher discrepancies in ASD symptom ratings define discrete and clinically meaningful subgroups. However, replication in a larger sample is important to support the validity and utility of the subgroups for use in research and practice. METHOD: The present paper used latent profile analysis (LPA) to (1) replicate the previous study by Lerner and colleagues in a larger sample of 514 clinic-referred autistic youth (aged 6-18, 83.2% male, 90.4% White, IQ 19-140) and (2) determine if parent-teacher informant discrepancies relate to clinical and functional correlates. We hypothesized that parent-teacher discrepancies in ASD symptom severity ratings would validly characterize ASD subgroups and predict clinical and functional correlates. RESULTS: The results of the LPA supported a 4-profile solution made up of two parent-teacher agreement groups (high parent-teacher, 21.2%, and low parent-teacher, 34.2%) and two parent-teacher discrepancy groups (high parent-low teacher, 18.1%, and moderate parent-high teacher, 26.5%), replicating findings from Lerner and colleagues. Latent profile membership differentially predicted IQ, age, and educational outcomes of participants. CONCLUSIONS: Unique, clinically useful information about the taxonomy and impact of ASD is obtained by considering informant discrepancies in symptom severity ratings, which underscores the importance of considering contextual variability assessed through multiple informants.

Physical and psychiatric comorbidities among patients with severe mental illness as seen in Uganda.

While psychiatric and physical comorbidities in severe mental illness (SMI) have been associated with increased mortality and poor clinical outcomes, problem has received little attention in low- and middle-income countries (LMICs). This study established the prevalence of psychiatric (schizophrenia, bipolar affective disorder, and recurrent major depressive disorder) and physical (HIV/AIDS, syphilis, hypertension and obesity) comorbidities and associated factors among 1201 out-patients with SMI (schizophrenia, depression and bipolar affective disorder) attending care at two hospitals in Uganda. Participants completed an assessment battery including structured, standardised and locally translated instruments. SMIs were established using the MINI International Neuropsychiatric Interview version 7.2. We used logistic regression to determine the association between physical and psychiatric comorbidities and potential risk factors. Bipolar affective disorder was the most prevalent (66.4%) psychiatric diagnoses followed by schizophrenia (26.6%) and recurrent major depressive disorder (7.0%). Prevalence of psychiatric comorbidity was 9.1%, while physical disorder comorbidity was 42.6%. Specific comorbid physical disorders were hypertension (27.1%), obesity (13.8%), HIV/AIDS (8.2%) and syphilis (4.8%). Potentially modifiable factors independently significantly associated with psychiatric and physical comorbidities were: use of alcohol for both syphilis and hypertension comorbidities; and use of a mood stabilisers and khat in comorbidity with obesity. Only psychiatric comorbidity was positively associated with the negative outcomes of suicidality and risky sexual behaviour. The healthcare models for psychiatric care in LMICs such as Uganda should be optimised to address the high burden of psychiatric and physical comorbidities.

Prevalence, Risk Factors, and Negative Outcomes of Anxiety and Depressive Disorders among HIV-Infected Children and Adolescents in Uganda: CHAKA Study 2014-2017.

Background: Children and adolescents infected with HIV/AIDS (CA-HIV) experience a considerable burden of depressive and anxiety disorders that have a tendency to persist into adulthood. The aim of this study was to determine the prevalence of anxiety, depression, and their clinical correlates among children and adolescents with HIV/AIDS (CA-HIV) in Uganda. Methods: A random sample of 1339 CA-HIV (ages 5-18 years) and their caregivers completed a standardized DSM-5-referenced psychiatric rating scale, the Child and Adolescent Symptom Inventory-5 (CASI-5). The prevalence of "anxiety and depression" was estimated at 95% confidence intervals. Logistic and ordinal regression models were fitted for the clinical correlates and clinical outcomes. Results: The overall prevalence of "any anxiety and depressive disorders" was 13.7% at 95% CI (based upon the symptom count criteria); 4.0% (95% CI) met the clinical psychiatric disorder criteria (both symptom count and functional impairment criteria). Anxiety disorder was more prevalent (9%, 95% CI) than depression (6.4%, 95% CI). Correlates of "anxiety and depressive disorders" included age of the child, caregiver' psychological distress, caregivers' age, child-caregiver relationship, and child's current CD4 count (aOR1.00, 95% CI 1.02-1.05; p = 0.021). Anxiety disorders (aOR 2.58, 95% CI 1.16-5.42; p = 0.02) and depressive disorders (aOR 2.47, 95% CI 1.93-6.52; p = 0.041) were also associated with hospital admissions. Limitations. Analyses were cross-sectional; we cannot comment on the causal directions. The results are entirely based upon caregiver' reports. Conclusions: There is an urgent need to integrate mental health services into routine HIV care for CA-HIV in sub-Saharan Africa.

Family Contextual Factors are Differentially Associated with Depressive Symptoms among Boys and Girls with Perinatally Acquired HIV.

Youth with perinatally acquired HIV (PHIV) are at risk for depressive symptoms, which are associated with a range of adverse outcomes. Although family contextual factors associated with depressive symptoms differ among boys and girls without PHIV, it is unclear whether this is also the case among youth with PHIV. Participants included 314 youth with PHIV (M = 12.88, SD = 3.08 years old; 51% male; 85% Black/Latinx) and their caregivers. Higher levels of caregivers' own depressive symptoms, caregiver-child detachment, and family conflict were associated with higher levels of caregiver-reported youth depressive symptoms. Less consistent discipline was associated with higher levels of youth-reported depressive symptoms. Higher youth-reported depressive symptoms were associated with greater family cohesion among boys and greater caregiver detachment among girls. Consideration of contextual variables is essential for interventions for depressive symptoms among youth with PHIV, but attention to sex differences with family contextual factors is also important.

Prevalence and risk factors for youth suicidality among perinatally infected youths living with HIV/AIDS in Uganda: the CHAKA study.

BACKGROUND: Research from high income countries indicates that suicide is a major mental health care concern and a leading cause of preventable deaths among children and adolescents. Proper assessment and management of youth suicidality is crucial in suicide prevention, but little is known about its prevalence and associated risk factors in Sub-Saharan Africa. In low income countries there is an increased risk of suicide among persons with HIV/AIDS even in the presence of the highly active antiretroviral therapy. OBJECTIVE: To determine the prevalence of and risk factors for youth suicidality among perinatally infected youth living with HIV/AIDS in Uganda. METHODS: We studied 392 HIV positive children (5-11 years) and adolescents (12-17 years) and their caregivers in Kampala and Masaka districts. Caregivers were administered the suicide assessment section of the MINI International Psychiatric Interview. Socio-demographic characteristics, psychiatric diagnoses, and psychosocial and clinical factors were assessed and suicidality (suicidal ideation and or suicidal attempt) was the outcome variable. Logistic regression was used to calculate odds ratios adjusting for study site and sex at 95% confidence intervals. RESULTS: Caregivers reported a suicidality rate of 10.7% (CI 8-14.1) in the past one month with higher rates among urban female (12.4%, CI 8.6-17.7) than male (8.7%, CI 5.4-13.8) youth. Lifetime prevalence of attempted suicide was 2.3% (n = 9, CI 1.2-4.4) with the highest rates among urban female youth. Among children, caregivers reported a lifetime prevalence of attempted suicide of 1.5%. The self-reported rate of attempted suicide in the past month was 1.8% (n = 7, CI 0.8-3.7) with lifetime prevalence of 2.8% (n = 11, CI 1.6-5.0). The most common methods used during suicide attempts were cutting, taking overdose of HIV medications, use of organophosphates, hanging, stabbing and self-starvation. Clinical correlates of suicidality were low socioeconomic status (OR = 2.27, CI 1.06-4.87, p = 0.04), HIV felt stigma (OR = 2.10, CI 1.04-3.00, p = 0.02), and major depressive disorder (OR = 1.80, CI 0.48-2.10, p = 0.04). Attention-deficit/hyperactivity disorder was protective against suicidality (OR = 0.41, CI 0.18-0.92, p = 0.04). CONCLUSION: The one-month prevalence of suicidality among CA-HIV was 10.7%.

Atypical communication characteristics among clinic-referred youth with and without autism spectrum disorder: Stability and associations with clinical correlates.

Atypical communication characteristics (ACCs), such as speech delay, odd pitch, and pragmatic difficulties, are common features of autism spectrum disorder (ASD) as are the symptoms of a wide range of psychiatric disorders. Using a simple retrospective method, this study aimed to better understand the relation and stability of ACCs with a broad range of psychiatric symptoms among large, well-characterized samples of clinic-referred children and adolescents with and without ASD. Youth with ASD had higher rates and a more variable pattern of developmental change in ACCs than the non-ASD diagnostic group. Latent class analysis yielded three ACC stability subgroups within ASD: Stable ACCs, Mostly Current-Only ACCs, and Little Professors. Subgroups exhibited differences in severity of ASD symptomatology, co-occurring psychiatric symptoms, and other correlates. Our findings provide support for the clinical utility of characterizing caregiver-perceived changes in ACCs in identifying children at risk for co-occurring psychopathology and other clinically relevant variables.

Clinical correlates and adverse outcomes of ADHD, disruptive behavior disorder and their co-occurrence among children and adolescents with HIV in Uganda.

Attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are important mental health concerns among children and adolescents living with HIV (CA-HIV). This study examines clinical correlates and adverse outcomes associated with ADHD, ODD/CD and ADHD + ODD/CD among (N = 1,336) CA-HIV living in Uganda. Being male, higher socio-economic status, emotional disorder, greater caregiver distress and youth-caregiver conflict were associated with a greater risk of behavioral disorders, particularly ADHD + ODD/CD. This group was also five-times more likely to have engaged in sex than their peers and report greater disciplinary problems at school than those without a behavioral disorder. These findings highlight the distinct clinical presentation and adverse outcomes associated with ADHD + ODD/CD among CA-HIV. As more CA-HIV are surviving into adulthood, screening and treatment of mental disorders is needed to ensure they are given the chance to thrive. In addition to youth, interventions should target caregivers due to their impact on youth outcomes.

Major Depressive Disorder Among HIV Infected Youth in Uganda: Incidence, Persistence and Their Predictors.

Incidence and persistence of major depressive disorder (MDD) in children and adolescents with HIV (CA-HIV) in Uganda is described. 1339 CA-HIV attending care were enrolled and followed up for 12 months. MDD was assessed using the DSM-5 referenced Child and Adolescent Symptom Inventory-5 (CASI-5), with a prevalence for MDD at baseline of 5% (95% CI 3.3-7.3). Kaplan-Meir method was used to estimate incidence of MDD and Cox models were fitted to investigate predictors of incident MDD. Cumulative incidence of MDD over 12 months was 7.6 per 100 person-years 95% CI (6.2-9.4) and a rate of persistent MDD of 10/105 (9.5% CI 3.9-15.1). Significant independent predictors of incident MDD were: highest educational level of CA-HIV (protective), increasing depressive scores and decreasing CD4 Nadir. These finding have implications for what should constitute components of a mental health integration model in HIV youth services and for the future development of individualised mental health care.

Development of a Composite Primary Outcome Score for Children with Attention-Deficit/Hyperactivity Disorder and Emotional Dysregulation.

Objective: Study goals were to (1) provide a rationale for developing a composite primary outcome score that includes symptom severity for attention-deficit/hyperactivity disorder (ADHD) and emotional dysregulation, plus symptom-induced impairment; (2) demonstrate weighting methods to calculate the composite score using a sample of children diagnosed with ADHD and aggression; and (3) identify the optimal weighting method most sensitive to change, as measured by effect sizes. Methods: We conducted secondary data analyses from the previously conducted Treatment of Severe Childhood Aggression (TOSCA) study. Children aged 6-12 years were recruited through academic medical centers or community referrals. The composite primary outcome comprised the ADHD, oppositional defiant disorder, disruptive mood dysregulation disorder, and peer conflict subscales from the Child and Adolescent Symptom Inventory (CASI), a DSM (Diagnostic and Statistical Manual)-referenced rating scale of symptom severity and symptom-induced impairment. Five weighting methods were tested based on input from senior statisticians. Results: The composite score demonstrated a larger (Cohen's d) effect size than the individual CASI subscales, irrespective of the weighting method (10%-55% larger). Across all weighting methods, effect sizes were similar and substantial: approximately a two-standard deviation symptom reduction (range: -1.97 to -2.04), highest for equal item and equal subscale weighting, was demonstrated, from baseline to week 9, among all TOSCA participants. The composite score showed a medium positive correlation with the Clinical Global Impressions-Severity scores, 0.46-0.47 for all weighting methods. Conclusions: A composite score that included severity and impairment ratings of ADHD and emotional dysregulation demonstrated a more robust pre-post change than individual subscales. This composite may be a more useful indicator of clinically relevant improvement in heterogeneous samples with ADHD than single subscales, avoiding some of the statistical limitations associated with multiple comparisons. Among the five similar weighting methods, the two best appear to be the equal item and equal subscale weighting methods.

Social Anhedonia in Children and Adolescents with Autism Spectrum Disorder and Psychiatry Referrals.

Social anhedonia (SA) is a widely accepted symptom phenotype in autism spectrum disorder (ASD), depression, and schizophrenia spectrum disorder; nevertheless, its clinical implications are relatively unstudied in populations of clinic-referred youth with and without ASD. Youth with ASD (n = 268) and nonASD psychiatry referrals (n = 641) between 6 and 18 years of age were evaluated for SA, ASD severity, co-occurring psychiatric symptom severity, and a wide range of common clinical correlates. Participants were parsed into youth with and without parent-defined SA, and the latter were further subdivided into youth with (SA+ alone) and without (SA/-alone) a preference for being alone. Two thirds of the ASD group met criteria for SA compared with one fourth of psychiatry referrals. SA was associated with higher rates of ASD social skill deficits, social anxiety, depression, and schizophrenia symptoms in both clinic samples. SA+ alone had the highest rates of social anxiety. Among the ASD sample, severity of social anxiety and ASD social skills deficits were relatively small predictors of SA. There was little evidence of divergence between youth with and without SA for a wide range of commonly studied biopsychosocial clinical correlates, for example, youth, family, medical, and treatment characteristics. Although factors associated with the ASD diathesis contribute to an increased risk of SA, they do not in and of themselves explain our results. Lack of syndrome specificity supports the notion that SA is a useful transdiagnostic symptom phenotype in referred youth and challenges traditional conceptualizations of ASD as a categorical clinical phenotype.

Atypical Communication Characteristics, Differential Diagnosis, and the Autism Spectrum Disorder Phenotype in Youth.

This study compared atypical communication characteristics (ACCs) in clinic-referred youth with and without autism spectrum disorder (ASD), identified subgroups based on different patterns of ACCs in youth with ASD, and determined if ACC subgroups result in meaningful clinical phenotypes in their relation to psychopathology and functional outcomes. Youth 6-18 years of age (N= 947; M age = 11.41; 72% male; 84% Caucasian) with and without ASD were assessed using Child and Adolescent Symptom Inventory-4R and the Parent Questionnaire, which included a checklist of ACCs. Prevalence of ACCs was examined and receiver operational characteristic analyses were used to estimate the diagnostic accuracy of number of ACCs for ASD. Latent class analysis was conducted to see if patterns of ACCs yielded clinically useful subgroups in youth with ASD. Youth with ASD exhibited higher rates of ACC than non-ASD psychiatry referrals, and a summary score of ACCs easily differentiated the two clinic-referred samples. Among youth with ASD, ACC subgroups exhibited differences in severity of psychiatric symptoms, ASD symptomatology, and functional outcomes. Our results suggest that ACCs are an important characteristic of the ASD clinical phenotype and may be a useful consideration for defining more precise ASD symptomatology, functional outcomes, and treatment targets.

Symptom Profiles of CD and ODD Among Youth With Perinatally Acquired HIV.

OBJECTIVE: Youth with perinatally acquired human immunodeficiency virus (PHIV) face increased risk for conduct disorder (CD) and oppositional defiant disorder (ODD) symptoms, and heterogeneous findings indicate that there may be subgroups of youth with PHIV differing in the quality and/or frequency of symptoms. The present study examined symptom profiles of CD and ODD among youth with PHIV and whether profiles differed in terms of parent-child and family correlates. METHODS: Participants included 314 youth with PHIV, aged 6-17 years (M = 12.88 years, SD = 3.08; 51% male; 85% Black or Latinx), and their caregivers who were recruited from 29 clinics in the US involved in the International Maternal Pediatrics Adolescent AIDS Clinical Trials (IMPAACT) Group's P1055 study. Caregivers reported on youth CD and ODD symptoms, parent-child interactions, and family environment. RESULTS: Latent class analysis indicated that a four-class model (i.e., moderate CD/high ODD, high ODD, moderate ODD, low CD/ODD) best fit the data. Ancillary analyses to validate these classes revealed differences for family cohesion and conflict; and child-centeredness, detachment, guilt-induced control, and consistency in parent-child interactions. The low CD/ODD class generally differed from other classes with additional differentiation between some higher risk profiles. CONCLUSIONS: Findings suggest that homogeneous classes of CD/ODD symptoms can be identified among youth with PHIV, and these profiles differ in terms of family processes, consistent with previous work among chronically ill youth.

A transdiagnostic model of psychiatric symptom co-occurrence and autism spectrum disorder.

Understanding whether the co-occurrence of psychiatric symptoms within autism spectrum disorder (ASD) are specific to the ASD diagnosis or reflect similar higher-order patterns observed in both ASD and non-ASD samples, or a confluence of the two, is of critical importance. If similar, it would suggest that comorbid psychiatric conditions among individuals with ASD are not symptoms of specific, non-ASD psychiatric disorders per se, but reflect a general liability to psychopathology associated with ASD. To this end, the current study examined whether the higher-order structure of co-occurring psychiatric symptoms was the same within ASD and non-ASD youth. Parents of clinic-referred youth with (n = 280) and without (n = 943) ASD completed a DSM-IV-referenced psychiatric symptom rating scale. A confirmatory factor analytic framework was used to examine four levels of measurement invariance across groups to determine the extent to which transdiagnostic factors were comparable. Transdiagnostic factors were characterized by symptoms of the same disorders (configural invariance) and the same factor loadings across groups (metric invariance). Furthermore, both groups evidenced equivalent numbers of symptoms of most psychiatric conditions with the notable exceptions of attention deficit hyperactivity disorder (ADHD) and social anxiety (partial strong invariance), which were higher in the ASD sample. It was concluded that disparities in the co-occurrence of psychiatric symptoms between youth with and without ASD may be largely reflective of transdiagnostic factor level differences associated with ASD and not indicative of the ASD diagnosis per se. However, for ADHD and social anxiety, there appears to be some specific associations with the ASD diagnosis. Autism Res 2020, 13: 579-590. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Few transdiagnostic dimensions relate common mental disorder diagnoses with one another. These dimensions explain psychiatric comorbidity (i.e., the finding that many persons possess several disorder diagnoses simultaneously). However, it is unclear if these dimensions differ among children with autism spectrum disorder (ASD), compared with their non-ASD counterparts. The results of this study demonstrate that underlying transdiagnostic dimensions are similar in both ASD and non-ASD children. However, there appear to be ASD-specific differences when it comes to social anxiety and attention deficit hyperactivity disorder.

Standardized Observation Analogue Procedure in the Treatment of Severe Childhood Aggression Study.

Objective: To explore blinded observational outcomes in the Treatment of Severe Childhood Aggression (TOSCA) study. Methods: During a 9-week acute trial, children with severe physical aggression and attention-deficit/hyperactivity disorder received parent training + titrated psychostimulant for 3 weeks, and those who failed to show an optimal response during Week 4 through Week 6 received in addition either randomly assigned placebo (Basic treatment) or titrated risperidone (Augmented treatment). Child and parent behaviors were videotaped in a Standardized Observation Analogue Procedure (SOAP) designed to elicit problems and strengths in child and parent interactions. SOAPs were collected at baseline and Week 9 and 52 follow-up. Results: During the acute 9-week trial, augmented treatment was associated with better outcomes than basic treatment for 3 of 13 measures: increased Child Compliance (p = 0.004; significant after correction for multiple tests), greater use of positive Parent Reinforcement (p = 0.03), and more Shared Enjoyment (p = 0.04). At follow-up, when medication was no longer by randomized assignment, parents used more Alpha Commands and displayed fewer Parent Negative Behaviors, and the dyads showed more Shared Enjoyment regardless of original randomization. Thus, there were better parent-child interactions with Augmented treatment, and interactions improved overall at follow-up regardless of original treatment assignment. Conclusions: The SOAP demonstrated sensitivity to behavior changes between short-term treatments for a few (but not most) measures. The acute treatment differences for Child Compliance and Child Negative Behavior are generally consistent with the moderate superiority of Augmented over Basic treatment previously reported for the primary study outcome.

Mr. Kim et al. Reply.

We write to respond to an erudite letter to the editor by Zachary J. Williams.1 that extended analyses presented in our recent publication2 investigating the latent structure of autism phenotypic symptoms. The letter by Williams reported results of a bifactor analysis using the standardized loadings and interfactor correlations derived from a Schmid-Leiman orthogonalization of the optimal correlated factor model that we identified. Williams examined the relative contributions of the general and three specific autism symptom factors (ie, social interaction [SI], communication [COM], and restrictive and repetitive behavior [RRB]) to the autism symptom indicators. Those analyses indicated that the majority of autism spectrum disorder (ASD) symptom covariation could be explained by a single general autism factor, whereas the three specific autism symptom factors accounted for minimal covariation among indicators. To pursue the intriguing points raised in the letter, we performed additional analyses using the original raw data.

Agreement and Discrepancy on Emotional and Behavioral Problems Between Caregivers and HIV-Infected Children and Adolescents From Uganda.

Background: HIV-infected children and adolescents (CA-HIV) face significant mental health challenges related to a broad range of biological and psychosocial factors. Data are scarce on the agreement and discrepancy between caregivers and CA-HIV regarding emotional and behavioral problems (EBPs) in CA-HIV. Objectives: We determined agreement between self- versus caregiver- reported EBPs and describe factors associated with informant discrepancy among caregiver-youth dyads who participated in the "Mental health among HIV-infected CHildren and Adolescents in KAmpala and Masaka, Uganda" (CHAKA) study. Methods: In a cross-sectional sample, caregiver-reported EBPs were assessed with the Child and Adolescent Symptom Inventory-5 (CASI-5), and self-reported problems were evaluated with the Youth Inventory-4 (YI-4) in 469 adolescents aged 12-17 years and the Child Inventory-4 (CI-4) in 493 children aged 8-11 years. Adolescents were questioned about experiences of HIV stigma. Caregiver psychological distress was assessed with the Self-Reporting Questionnaire (SRQ-20). Linear regression models were applied to identify variables associated with discrepancy scores. Results: Self-reported emotional problems (EPs) were present in 28.8% of adolescents and 36.9% of children, and 14.5% of adolescents self-reported behavioral problems (BPs). There was only a modest correlation (r ≤ 0.29) between caregiver- and CA-HIV-reported EBPs, with caregivers reporting more EPs whereas adolescents reported more BPs. Informant discrepancy between adolescents and caregivers for BPs was associated with adolescent age and caregiver's employment and HIV status. Among adolescents, EP discrepancy scores were associated with adolescent's WHO HIV clinical stage, caregiver level of education, and caregivers caring for other children. Among children, EP discrepancy scores were associated with child and caregiver age, caregiver level of education, and caregiver self-rated health status. HIV stigma and caregiver psychological distress were also associated with discrepancy, such that adolescents who experienced HIV stigma rated their EPs as more severe than their caregivers did and caregivers with increased psychological distress rated EBPs as more severe than CA-HIV self-rated. Conclusions: EBPs are frequently endorsed by CA-HIV, and agreement between informants is modest. Informant discrepancy is related to unique psychosocial and HIV-related factors. Multi-informant reports enhance the evaluation of CA-HIV and informant discrepancies can provide additional insights into the mental health of CA-HIV.