Healthy physical coactivity in parent-child dyads of children with overweight.

Parent and child physical activity levels are correlated, but are they interdependent? A dyadic version of the theory of planned behavior (TPB) was developed to investigate interdependence in the motivation and intention of parents and their children with overweight to engage in healthy physical coactivity (HPCA). Baseline measures of the TPB constructs (subjective norms, attitude, perceived behavior control, and intention) for both dyad members were used to predict parent-reports of their actual HPCA at 12 weeks using the actor-partner interdependence model. The sample included 65 mother-child dyads and 48 father-child dyads from 66 predominantly Caucasian families. In mother-child dyads, a positive attitude toward HPCA predicted each person's own intention to engage in HPCA (both actor effects). In addition, mother's perceived behavior control over HPCA predicted the child's intention to engage in HPCA (a partner effect). Mother's attitude toward HPCA also predicted mother-reported HPCA. In father-child dyads, perceived behavior control predicted each person's own intention to engage in HPCA (both actor effects). The child's intention was also predicted by the child's subjective norms (an actor effect) and the father's perceived behavior control (a partner effect). Only the child's perceived behavior control predicted father-reported HPCA. There is interdependence in the motivation to engage in HPCA because both parents' perceived behavior control predicted their child's intention. However, interventions targeting mother's attitude toward HPCA with her child and the child's perceived behavior control in relation to the father would be most likely to increase HPCA in the parent-child dyads of children with overweight. (PsycINFO Database Record

Games for Health for Children-Current Status and Needed Research.

Videogames for health (G4H) offer exciting, innovative, potentially highly effective methods for increasing knowledge, delivering persuasive messages, changing behaviors, and influencing health outcomes. Although early outcome results are promising, additional research is needed to determine the game design and behavior change procedures that best promote G4H effectiveness and to identify and minimize possible adverse effects. Guidelines for ideal use of different types of G4H by children and adolescents should be elucidated to enhance effectiveness and minimize adverse effects. G4H stakeholders include organizational implementers, policy makers, players and their families, researchers, designers, retailers, and publishers. All stakeholders should be involved in G4H development and have a voice in setting goals to capitalize on their insights to enhance effectiveness and use of the game. In the future, multiple targeted G4H should be available to meet a population's diverse health needs in developmentally appropriate ways. Substantial, consistent, and sophisticated research with appropriate levels of funding is needed to realize the benefits of G4H.

Fun, Flow, and Fitness: Opinions for Making More Effective Active Videogames.

Despite active videogames' popularity and ability to increase a player's energy expenditure, research indicates their use sharply declines over time, which limits their utility in promoting physical activity. A frequent criticism is that a player's interest is quickly exhausted. At the preconference of the International Society of Behavioral Nutrition and Physical Activity 2014, a group of investigators and videogame developers gathered to share lessons learned from using serious videogames in health behavior change and offer insight to guide future efforts.

Empirical evidence for psychopharmacologic treatment in early-onset psychosis and schizophrenia.

Psychotic symptoms presenting in youth can be clinically complex and require that a child and adolescent psychiatrist use significant skill in making a diagnosis and initiating treatment. There are a number of illnesses to rule out before making a diagnosis of early-onset schizophrenia in particular. Psychosis in youth has significant associated morbidity and places high demands not only on families but also on the medical and educational systems. More effective pharmacologic and nonpharmacologic treatments for psychosis are needed. Nonpharmacologic therapies targeting relatively treatment-resistant domains of dysfunction such as neurocognition are also necessary as adjunctive treatments to our extant pharmacologic agents.

Trabecular bone loss after administration of the second-generation antipsychotic risperidone is independent of weight gain.

Second generation antipsychotics (SGAs) have been linked to metabolic and bone disorders in clinical studies, but the mechanisms of these side effects remain unclear. Additionally, no studies have examined whether SGAs cause bone loss in mice. Using in vivo and in vitro modeling we examined the effects of risperidone, the most commonly prescribed SGA, on bone in C57BL6/J (B6) mice. Mice were treated with risperidone orally by food supplementation at a dose of 1.25 mg/kg daily for 5 and 8 weeks, starting at 3.5 weeks of age. Risperidone reduced trabecular BV/TV, trabecular number and percent cortical area. Trabecular histomorphometry demonstrated increased resorption parameters, with no change in osteoblast number or function. Risperidone also altered adipose tissue distribution such that white adipose tissue mass was reduced and liver had significantly higher lipid infiltration. Next, in order to tightly control risperidone exposure, we administered risperidone by chronic subcutaneous infusion with osmotic minipumps (0.5 mg/kg daily for 4 weeks) in 7 week old female B6 mice. Similar trabecular and cortical bone differences were observed compared to the orally treated groups (reduced trabecular BV/TV, and connectivity density, and reduced percent cortical area) with no change in body mass, percent body fat, glucose tolerance or insulin sensitivity. Unlike in orally treated mice, risperidone infusion reduced bone formation parameters (serum P1NP, MAR and BFR/BV). Resorption parameters were elevated, but this increase did not reach statistical significance. To determine if risperidone could directly affect bone cells, primary bone marrow cells were cultured with osteoclast or osteoblast differentiation media. Risperidone was added to culture medium in clinically relevant doses of 0, 2.5 or 25 ng/ml. The number of osteoclasts was significantly increased by addition in vitro of risperidone while osteoblast differentiation was not altered. These studies indicate that risperidone treatment can have negative skeletal consequences by direct activation of osteoclast activity and by indirect non-cell autonomous mechanisms. Our findings further support the tenet that the negative side effects of SGAs on bone mass should be considered when weighing potential risks and benefits, especially in children and adolescents who have not yet reached peak bone mass.

Can Dance Exergames Boost Physical Activity as a School-Based Intervention?

BACKGROUND: Children need opportunities to have physical activity (PA). Using exergames could be a feasible and acceptable way to boost PA in middle schools. Our goal was to increase PA by 40 minutes per week and to determine how much time, if any, was spent in moderate-to-vigorous PA (MVPA). SUBJECTS AND METHODS: Eighty-four middle school youth were in a pilot study for 20 weeks: half in the Generation Fit (GenFit) intervention group and half in the control group. The GenFit group played the exergame for the first 10 weeks (Session 1), and the control group joined from 10 to 20 weeks (Session 2). The main outcome was exergaming time per student per week. RESULTS: Fifty-eight students completed the pilot after 26 youth at School C were excluded for administrative reasons. Of those remaining, 40 students at School A and 18 students at School B, the average age of the sample was 13.7 years (SD=0.6), and average body mass index percentile was close to 70. During Session 1, the average dance time per child was 49 minutes per week, versus 54 minutes per week in Session 2. Mean body mass index percentile decreased by 5.6 for children who participated in GenFit, compared with 0.2 for children in the control group. At end point, accelerometers showed over half of the dance time was spent in MVPA. Qualitative data showed that most children found the exergame acceptable. CONCLUSIONS: A dance exergame in middle schools offered opportunities for PA. About half of the exergame time was spent in MVPA. Exergames may be feasible and acceptable in middle schools to boost PA, and access could provide a way for schools to support the health of students.

Comparative Effectiveness of a 12-Week Physical Activity Intervention for Overweight and Obese Youth: Exergaming with "Dance Dance Revolution".

OBJECTIVE: Experts recommend that children engage in 60 minutes of daily moderate to vigorous PA (PA), but few meet these goals. Exergames like "Dance Dance Revolution" (DDR) (Konami of America, Redwood City, CA) have the potential to provide PA. We sought to determine if DDR would boost PA among overweight or obese children. SUBJECTS AND METHODS: Children over the 85th percentile for body mass index (BMI) and between 9 and 17 years old were randomly assigned to receive DDR+pedometers (treatment group) or pedometers only (comparison group). PA levels were tracked for 12 weeks by self-report, pedometer, and accelerometer data. RESULTS: Sixty-five families completed the study. The average BMI percentile of the participant was over 96 percent. Despite randomization, participants in the treatment (DDR) group were more often male, older, and heavier than participants in the comparison group. Self-reported frequency of moderate to vigorous PA increased significantly from baseline to 12 weeks for the treatment group and declined for the comparison group. Accelerometer results indicated a significant decline in moderate activity over time for the comparison group. However, there were no significant between-group differences based on the accelerometer or pedometer data. CONCLUSION: Based on self-report measures, DDR may have increased PA levels in obese and overweight children. However, we are led to question the validity of these results because analyses based on objective measures do not confirm them. Accelerometer results indicate that although DDR did not boost PA, it may have helped to slow the decline in moderate to vigorous PA over time.

Pilot Study of an Active Screen Time Game Correlates with Improved Physical Fitness in Minority Elementary School Youth.

OBJECTIVE: The aim of our feasibility study was to examine the acceptability and utility of "Dance Dance Revolution" (DDR) (Konami of America, Redwood City, CA)) to increase physical fitness in 8-11-year-old black and Hispanic youth. SUBJECTS AND METHODS: Twenty-eight 4(th) and 5(th) grade children attending an afterschool program participated. Outcomes included physical activity, physical fitness, use of home DDR, survey of safety and acceptability, anthropometrics, and fasting metabolic profile measured at baseline, 12 weeks, and 30 weeks. RESULTS: At 12 weeks, physical fitness (maximum O2 uptake [VO2max]) increased by 4.9±9.9 percent and was sustained through 30 weeks, when the VO2max was 105.0±9.9 percent (range, 93.0-133.9 percent) of baseline values. Absolute VO2max increased by 2.97±4.99 mL/kg/minute (95% confidence interval 0.75-5.19, P=0.013). Participants maintained an average of 1.12 hours/day of increased movement to music. Trends suggested increased total moderate-vigorous physical activity, decreased light activity, and a modest increase in sedentary screen time. There were no significant changes in body mass index, fasting lipids, or glucose. Participants and parents approved of the activity. CONCLUSION: DDR appears feasible and acceptable to minority youth. DDR may increase moderate-vigorous physical activity and improve physical fitness in at-risk populations.

"Dance Dance Revolution" Used by 7- and 8-Year-Olds to Boost Physical Activity: Is Coaching Necessary for Adherence to an Exercise Prescription?

OBJECTIVE: To increase opportunities for physical activity (PA) for children in children's homes, we used a "Dance Dance Revolution" (DDR) (Konami of America, Redwood City, CA) coaching protocol for 7- and 8-year-olds. SUBJECTS AND METHODS: We randomly assigned youth to either an Enhanced (coaching) or Basic (no coaching) group. A DDR prescription of 120 minutes/week was provided to 40 children. Motor learning principles guided the coaching protocol, provided by adult graduate students, which took place weekly during weeks 1-5. PA was measured with accelerometry, DDR logs, and Sony (New York, NY) Playstation(®)2 memory cards at baseline and at week 10. RESULTS: Total accelerometer-measured PA was not significantly different between the groups at baseline or week 10; however, vigorous PA increased significantly in both groups at week 10. DDR logs showed a large range from 0 to 660 minutes/week of dance time. Respective playing time for each week (1 and 10) averaged 149 and 64 minutes for the Basic group and 184 and 47 minutes for the Enhanced group. Coaching significantly increased DDR use patterns in this population of youngsters during weeks 1 through 5 (P<0.001). CONCLUSION: Adult coaching deserves further study to determine how to maintain high levels of participation in exergames for youth who live in an obesogenic environment.

Pediatric obesity: a review for the child psychiatrist.

Child and adolescent psychiatrists frequently encounter children who are obese in their practices and may be asked to work alongside primary care physicians and other specialists who treat youngsters with obesity. To offer expert consultation, they must understand all aspects of the pediatric obesity epidemic. By summarizing the relevant endocrinology, cardiology, nutrition, exercise science, and public health literature, this review of pediatric obesity assesses the epidemic's background, delineates the challenges of clinical care, and appraises the therapeutic recommendations for this population of patients and their families.

Olanzapine approved for the acute treatment of schizophrenia or manic/mixed episodes associated with bipolar I disorder in adolescent patients.

BACKGROUND: Severe and persistent mental illnesses in children and adolescents, such as early- onset schizophrenia spectrum (EOSS) disorders and pediatric bipolar disorder (pedBP), are increasingly recognized. Few treatments have demonstrated efficacy in rigorous clinical trials. Enduring response to current medications appears limited. Recently, olanzapine was approved for the treatment of adolescents with schizophrenia or acute manic/mixed episodes in pedBP. METHODS: PubMed searches were conducted for olanzapine combined with pharmacology, schizophrenia, or bipolar disorder. Searches related to schizophrenia and bipolar disorder were limited to children and adolescents. The bibliographies of the retrieved articles were hand-checked for additional relevant studies. The epidemiology, phenomenology, and treatment of EOSS and pedBP, and olanzapine's pharmacology are reviewed. Studies of olanzapine treatment in youth with EOSS and pedBP are examined. RESULTS: Olanzapine is efficacious for EOSS and pedBP. However, olanzapine is not more efficacious than risperidone, molindone, or haloperidol in EOSS and is less efficacious than clozapine in treatment-resistant EOSS. No comparative trials have been done in pedBP. Olanzapine is associated with weight gain, dyslipidemia, and transaminase elevations in youth. Extrapyramidal symptoms, neuroleptic malignant syndrome, and blood dyscrasias have also been reported but appear rare. CONCLUSIONS: The authors conclude that olanzapine should be considered a second-line agent in EOSS and pedBP due to its risks for significant weight gain and lipid dysregulation. Awareness of the consistent weight and metabolic changes observed in olanzapine-treated youth focused attention on the potential long-term risks of atypical antipsychotics in youth.

Double-blind maintenance safety and effectiveness findings from the Treatment of Early-Onset Schizophrenia Spectrum (TEOSS) study.

OBJECTIVE: To examine the long-term safety and efficacy of three antipsychotics in early-onset schizophrenia spectrum disorders. METHOD: Patients (8 to 19 years old) who had improved during an 8-week, randomized, double-blind acute trial of olanzapine, risperidone, or molindone (plus benztropine) were eligible to continue on the same medication for up to 44 additional weeks under double-blind conditions. Adjunctive medications were allowed according to defined algorithms. Standardized symptom, safety, and functional assessments were conducted every 4 weeks. RESULTS: Of the 116 youths randomized in the acute trial, 54 entered maintenance treatment (molindone, n = 20; olanzapine, n = 13; risperidone, n = 21). Fourteen (26%) completed 44 weeks of treatment. Adverse effects (n = 15), inadequate efficacy (n = 14), or study nonadherence (n = 8) were the most common reasons for discontinuation. The three treatment arms did not significantly differ in symptom decrease or time to discontinuation. Akathisia was more common with molindone and elevated prolactin concentrations more common with risperidone. Although weight gain and metabolic adverse events had occurred more often with olanzapine and risperidone during the acute trial, no significant between-drug differences emerged in most of these parameters during maintenance treatment. CONCLUSIONS: Only 12% of youths with early-onset schizophrenia spectrum disorders continued on their originally randomized treatment at 52 weeks. No agent demonstrated superior efficacy, and all were associated with side effects, including weight gain. Improved treatments are needed for early-onset schizophrenia spectrum disorders. Clinical trial registry information-Treatment of Schizophrenia and Related Disorders in Children and Adolescents; URL: http://www.clinicaltrials.gov, unique identifier: NCT00053703.

Pediatric obesity: a review for the child psychiatrist.

Child and adolescent psychiatrists frequently encounter children who are obese in their practices and may be asked to work alongside primary care physicians and other specialists who treat youngsters with obesity. To offer expert consultation, they must understand all aspects of the pediatric obesity epidemic. By summarizing the relevant endocrinology, cardiology, nutrition, exercise science, and public health literature, this review of pediatric obesity assesses the epidemic's background, delineates the challenges of clinical care, and appraises the therapeutic recommendations for this population of patients and their families.

Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizo-affective disorder: findings from the treatment of early-onset schizophrenia spectrum disorders (TEOSS) study.

OBJECTIVE: Atypical (second-generation) antipsychotics are considered standard treatment for children and adolescents with early-onset schizophrenia and schizoaffective disorder. However, the superiority of second-generation antipsychotics over first-generation antipsychotics has not been demonstrated. This study compared the efficacy and safety of two second-generation antipsychotics (olanzapine and risperidone) with a first-generation antipsychotic (molindone) in the treatment of early-onset schizophrenia and schizoaffective disorder. METHOD: This double-blind multisite trial randomly assigned pediatric patients with early-onset schizophrenia and schizoaffective disorder to treatment with either olanzapine (2.5-20 mg/day), risperidone (0.5-6 mg/day), or molindone (10-140 mg/day, plus 1 mg/day of benztropine) for 8 weeks. The primary outcome was response to treatment, defined as a Clinical Global Impression (CGI) improvement score of 1 or 2 and >or=20% reduction in Positive and Negative Syndrome Scale (PANSS) total score after 8 weeks of treatment. RESULTS: In total, 119 youth were randomly assigned to treatment. Of these subjects, 116 received at least one dose of treatment and thus were available for analysis. No significant differences were found among treatment groups in response rates (molindone: 50%; olanzapine: 34%; risperidone: 46%) or magnitude of symptom reduction. Olanzapine and risperidone were associated with significantly greater weight gain. Olanzapine showed the greatest risk of weight gain and significant increases in fasting cholesterol, low density lipoprotein, insulin, and liver transaminase levels. Molindone led to more self-reports of akathisia. CONCLUSIONS: Risperidone and olanzapine did not demonstrate superior efficacy over molindone for treating early-onset schizophrenia and schizoaffective disorder. Adverse effects were frequent but differed among medications. The results question the nearly exclusive use of second-generation antipsychotics to treat early-onset schizophrenia and schizoaffective disorder. The safety findings related to weight gain and metabolic problems raise important public health concerns, given the widespread use of second-generation antipsychotics in youth for nonpsychotic disorders.

A pilot of a video game (DDR) to promote physical activity and decrease sedentary screen time.

OBJECTIVE: We examined the feasibility of Dance Dance Revolution (DDR), a dance video game, in participants' homes, to increase physical activity (PA) and to decrease sedentary screen time (SST). METHODS AND PROCEDURES: Sixty children (7.5 +/- 0.5 years) were randomized in a 2:1 ratio to DDR or to wait-list control (10-week delay). DDR use was logged, PA was measured objectively by accelerometry. SST was self-reported at weeks 0 and 10. At week 28, after both groups had access to DDR, accelerometry and SST were repeated. RESULTS: Mean use of DDR was 89 +/- 82 (range 0-660 min) min per week (mpw). The DDR group showed increased vigorous PA and a reduction in light PA; the control group showed no increase in moderate and/or vigorous PA (MVPA) although they also had a reduction in light PA. Differences between the groups were not observed. The DDR group also reported a decrease in SST of -1.2 +/- 3.7 h per week (hpw) (P < 0.05), whereas the controls reported an increase of +3.0 +/- 7.7 hpw (nonsignificant). The difference in SST between the groups was significant, with less SST in the DDR group. Between weeks 10 and 28, numeric reductions in SST were reported in both groups. In the DDR group, SST at week 28 (8.8 +/- 6.0 hpw) was lower than baseline (10.5 +/- 5.5 hpw; P < 0.03). DISCUSSION: This pilot study suggests that DDR reduces SST and may facilitate slight increases in vigorous PA. Further study is needed to better characterize children and contexts in which DDR may promote a healthy lifestyle.

Treatment of early-onset schizophrenia spectrum disorders (TEOSS): rationale, design, and methods.

OBJECTIVE: The Treatment of Early Onset Schizophrenia Spectrum Disorders Study is a publicly funded clinical trial designed to compare the therapeutic benefits, safety, and tolerability of risperidone, olanzapine, and molindone in youths with early-onset schizophrenia spectrum disorders. The rationale, design, and methods of the Treatment of Early Onset Schizophrenia Spectrum Disorders Study are described. METHOD: Using a randomized, double-blind, parallel-group design at four sites, youths with EOSS (ages 8-19 years) were assigned to an 8-week acute trial of risperidone (0.5-6.0 mg/day), olanzapine (2.5-20 mg/day), or molindone (10-140 mg/day). Responders continued double-blind treatment for 44 weeks. The primary outcome measure was responder status at 8 weeks, defined by a 20% reduction in baseline Positive and Negative Symptom Scale scores plus ratings of significant improvement on the Clinical Global Impressions. Secondary outcome measures included assessments of psychopathology, functional impairment, quality of life, and medication safety. An intent-to-treat analytic plan was used. RESULTS: From February 2002 to May 2006, 476 youths were screened, 173 were further evaluated, and 119 were randomized. Several significant study modifications were required to address safety, the use of adjunctive medications, and the termination of the olanzapine treatment arm due to weight gain. CONCLUSIONS: The Treatment of Early Onset Schizophrenia Spectrum Disorders Study will inform clinical practice regarding the use of antipsychotic medications for youths with early-onset schizophrenia spectrum disorders. Important safety concerns emerged during the study, including higher than anticipated rates of suicidality and problems tapering thymoleptic agents before randomization.

Treatment of early-onset schizophrenia spectrum disorders (TEOSS): demographic and clinical characteristics.

OBJECTIVE: We examined baseline demographic and clinical profiles of youths enrolled from 2001 to 2006 in the publicly funded multicenter, randomized controlled trial Treatment of Early-Onset Schizophrenia Spectrum Disorders. METHOD: Youths (8-19 years) with schizophrenia (SZ) and schizoaffective disorder were recruited at four academic sites. Diagnosis was made via structured and clinical interviews. Assessments of psychiatric symptoms and social and global functioning were included. RESULTS: A total of 119 youths were enrolled. The mean age at illness onset was 11.1 +/- 3.5 years. Patients with SZ and schizoaffective disorder had similar ratings on the Positive and Negative Symptom Scale, Brief Psychiatric Rating Scale for Children, and Clinical Global Impression-Severity Scale. The overall level of functioning was similar in the two groups. A comparison to published reports of adults with SZ indicates that these youths may have more severe symptoms based on results of the Positive and Negative Symptom Scale. CONCLUSIONS: This is one of the largest samples of youths with SZ spectrum disorders studied to date and the largest assessment of youths with schizoaffective disorder. High rates of symptoms and general psychopathology were noted. There was a substantial degree of social and functional impairment. The symptom profiles are consistent with, but more severe than, those reported in the adult literature.