Publications by authors named "Elizabeth Reynolds"

54 Publications

Factors Associated with Pediatric Burn Clinic Follow-up after Emergency Department Discharge.

J Burn Care Res 2021 Mar 6. Epub 2021 Mar 6.

Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry.

Attrition between emergency department discharge and outpatient follow-up is well documented across a variety of pediatric ailments. Given the importance of outpatient medical care and the lack of related research in pediatric burn populations, we examined sociodemographic factors and burn characteristics associated with outpatient follow-up adherence among pediatric burn patients. A retrospective review of medical records was conducted on patient data extracted from a burn registry database at an urban academic children's hospital over a 2-year period (January 2018-December 2019). All patients were treated in the emergency department and discharged with instructions to follow-up in an outpatient burn clinic within one week. A total of 196 patients (Mage=5.5 years; 54% male) were included in analyses. Average percent total body surface area was 1.9 (SD=1.5%). One-third of pediatric burn patients (33%) did not attend outpatient follow-up as instructed. Older patients (OR=1.00; 95% CI: [.99-1.00], p=.045), patients with superficial burns (OR=9.37; 95% CI: [2.50-35.16], p=.001), patients with smaller percent total body surface area (OR=1.37; 95% CI: [1.07-1.76], p=.014), and patients with Medicaid insurance (OR=.22; 95% CI: [.09-.57], p=.002) or uninsured/unknown insurance (OR=.07; 95% CI: [.02-.26], p=.000) were less likely to follow up, respectively. Patient gender, race, ethnicity, and distance to clinic were not associated with follow-up. Follow-up attrition in our sample suggests a need for additional research identifying factors associated with adherence to follow-up care. Identifying factors associated with follow-up adherence is an essential step in developing targeted interventions to improve health outcomes in this at-risk population.
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http://dx.doi.org/10.1093/jbcr/irab046DOI Listing
March 2021

Characteristics of Mental Health Patients Boarding for Longer Than 24 Hours in a Pediatric Emergency Department.

JAMA Pediatr 2020 Feb 17. Epub 2020 Feb 17.

Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.

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http://dx.doi.org/10.1001/jamapediatrics.2019.5991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042916PMC
February 2020

College Students' Perceptions of Concurrent/Successive Nonverbal Behaviors as Sexual Consent.

J Interpers Violence 2020 Feb 13:886260520905544. Epub 2020 Feb 13.

Clemson University, SC, USA.

In previous studies, researchers had students rate single nonverbal behaviors as signals conveying and inferring sexual consent. In real-life interactions, young people use an array of behaviors occurring concurrently or successively to interpret sexual consent. With use of a 7-point scale (0 = , 6 = ), students at a southeast public university were asked to rate their perceptions of nine nonverbal behaviors as signals of sexual consent, nine combinations of two of those behaviors, and eight combinations of three behaviors. There were significant effects for both gender and number of behaviors ( < .001). Over 43% of women answered "0" to all behaviors and combinations of behaviors, whereas only 20.3% of men answered "0" to all. The mean ratings for men were greater than those for women under all three conditions and increased with the number of behaviors. At least one third of men responded with "3" (the midpoint of the scale) or greater to seven of the eight combinations of three behaviors, whereas the percentage of women responding "3" or greater never exceeded 18% for any of the individual behaviors or combinations. It is concluded that as the number of nonverbal behaviors increases the subjective interpretation of sexual consent also increases, thus also increasing the chances of unwanted sexual advances.
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http://dx.doi.org/10.1177/0886260520905544DOI Listing
February 2020

Risk Factors for Seclusion in Children and Adolescents Inpatient Psychiatry: The Role of Demographic Characteristics, Clinical Severity, Life Experiences and Diagnoses.

Child Psychiatry Hum Dev 2020 08;51(4):648-655

School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, 21287-3335, USA.

Objective: To understand the risk factors for seclusion in a sample of children and adolescents admitted to an inpatient psychiatry unit looking at demographic, clinical severity, life experience, and diagnostic characteristics.

Methods: An unmatched case-control retrospective analysis of psychiatric records in a pediatric inpatient unit from December 2011 to December 2015 (N = 1986) RESULTS: Individual characteristics, including demographics, clinical severity, and clinical presentation as per the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) jointly predicted seclusion in adolescents, with younger age, male sex, black race, having a prior admission, and having a disruptive behavior or bipolar and related disorder diagnoses being predictive of seclusion. While demographic and clinical severity factors were predictive of seclusion in multivariate models, clinical diagnoses only added modestly to the variance explained.

Conclusions: High-risk demographic and clinical characteristics for seclusion events in children and adolescents can provide valuable information to guide interventions to prevent seclusion events during their hospitalization.
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http://dx.doi.org/10.1007/s10578-020-00963-0DOI Listing
August 2020

Assessing child quality of life impairments following pediatric burn injuries: Rasch analysis of the children's dermatology life quality index.

Qual Life Res 2020 Apr 18;29(4):1083-1091. Epub 2019 Dec 18.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.

Aims: There is a need for a brief, validated measure of quality of life (QOL) for children to monitor their adjustment to burn injuries. We aimed to apply a Rasch analysis to an existing measure of QOL from the dermatology literature to a clinical sample of pediatric burn patients.

Methods: The Children's Dermatology Life Quality Index (CDLQI) was administered to pediatric burn patients (N = 253) during a standard clinic visit. Rasch analysis was used to examine psychometric properties of this measure with a burn sample.

Results: The CDLQI showed an adequate fit to the Rasch model. Test difficulty is .61 logits greater than person ability. Results of item reliability and separation analyses were sufficiently strong and indicated a unidimensional latent trait. Person reliability (.74) and separation analyses (1.64) were moderate. Finally, the CDLQI was able to moderately separate the group of respondents into low and high levels of QOL impairments related to burn injuries.

Conclusion: The Rasch model demonstrated that the CDLQI is a reliable and valid scale that adequately measures QOL impairments in children following burn injuries.
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http://dx.doi.org/10.1007/s11136-019-02380-wDOI Listing
April 2020

Acute psychiatric care for pediatric patients.

Int Rev Psychiatry 2020 05 5;32(3):272-283. Epub 2019 Dec 5.

Department of Psychiatry and Behavioral Sciences, Division of Child & Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD, USA.

Higher level or acute psychiatric care for youth is intended to be active but short-term treatment focussing on crisis stabilisation, assessment, safety monitoring, and longer-term treatment planning. The focus of this article is on describing common challenges and the effort to address these challenges through new approaches to acute psychiatric care for children and adolescents. The review finds that (1) inpatient paediatric psychiatry beds are in high demand and often difficult to access, (2) there are a number of common challenges these units face including managing length of stays, readmissions, and adverse events, and (3) there are encouraging therapeutic approaches adapted for this setting. There is still much work to be done to advance the evidence-base for acute psychiatric care for youth particularly in defining and assessing an effective admission. Paediatric psychiatry patients are a vulnerable population and call for our best tools to be put to use to improve the quality and safety of care.
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http://dx.doi.org/10.1080/09540261.2019.1681381DOI Listing
May 2020

How Early Maternal Language Input Varies by Race and Education and Predicts Later Child Language.

Child Dev 2020 07 17;91(4):1098-1115. Epub 2019 Jul 17.

Research Triangle Institute.

The maternal language input literature suggests that mothers with more education use a greater quantity and complexity of language with their young children compared to mothers with less education although race and socioeconomic status have been confounded in most studies because of small sample sizes. The current Family Life study included a representative sample of 1,292 children, oversampling for poverty and African American, followed from birth. This study found no race differences within maternal education levels on five measures of maternal language input from 6 to 36 months. Maternal language input variables of number of different words, mean length of utterance and number of wh-questions were partial mediators of the relationship between maternal education and later child language at school age.
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http://dx.doi.org/10.1111/cdev.13281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980228PMC
July 2020

Routine Psychological Screening for Parent Depressive Symptoms in an Outpatient Pediatric Specialty Burn Clinic.

J Burn Care Res 2019 10;40(6):947-952

Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Pediatric burn injuries are stressful for parents, yet few burn clinics report screening caregivers. We evaluated psychometric properties of a two-item depression screener administered to parents of children with burns during outpatient clinic visits. We also examined associations between parent depression symptoms and child characteristics. We used a retrospective review of pediatric patients with burn injuries (n = 496, age range: 0-21 years; M = 5.0 years, SD = 4.4 years) from an outpatient specialty burn clinic. Sample was 54.8% male; ethnicity was 42.4% Black/African American and 42.2% White. Most children (94.7%) had a burn TBSA of 10% or less and partial thickness burns (87%). Depression measure was administered at two time points as part of routine care: T1 (n = 496) and T2 (n = 121). Score range was 0 to 8. The means were 1.17 (SD = 1.74) at T1 and 0.81 (SD = 1.40) at T2. The majority scored ≤3 (89.9% caregivers) at T1. The measure demonstrated satisfactory internal consistency at T1 (Cronbach α = .74) and T2 (α = .82). Scores at T1 and T2 for a subsample (n = 121) were related (r = .61, p < .001). Parents of non-White children tended to report higher depression scores at T1. At T2, being female and greater burn degree were associated with higher depression scores. This brief two-item scale used with caregivers of pediatric burn patients is a reasonable method for screening parental depression in this setting. Given the association between parental depression and child characteristics, further studies are needed, including examination of predictive validity of parental depression with pediatric outcomes.
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http://dx.doi.org/10.1093/jbcr/irz130DOI Listing
October 2019

Predictors and Correlates of Pediatric Postburn Pruritus in Preschool Children of Ages 0 to 4.

J Burn Care Res 2019 10;40(6):930-935

Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Pruritus is a common problem following burn injuries; however, the literature to date has focused on adult survivors and/or pediatric survivors of large burns. The current study examines acute postburn pruritus in children under the age of 4 years (N = 256) with smaller burns (mean TBSA = 3.99%), which represents the most common type of patient typically treated in pediatric burn centers. Parents rated their child for pruritus, irritability, and sleep disturbances; additionally, parents completed a self-report of distress. Nearly half (47.3%) were rated by parents as displayed some level of pruritus, with the greatest proportion rated as mild. Regression analysis indicated that child minority status, greater burn TBSA, and more days elapsed since burn predicted higher levels of pruritus. In turn, pruritus was positively correlated with child irritability, delayed sleep onset, sleep disturbance, and parent distress. Thus, our results indicate that parent-rated pruritus in young pediatric burn patients is important to evaluate, as itch is significantly associated with other important clinical outcomes as early as the first month of the burn for pediatric patients and their parents.
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http://dx.doi.org/10.1093/jbcr/irz125DOI Listing
October 2019

Predictors and Correlates of Pediatric Postburn Pruritus in Preschool Children of Ages 0 to 4.

J Burn Care Res 2019 10;40(6):930-935

Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Pruritus is a common problem following burn injuries; however, the literature to date has focused on adult survivors and/or pediatric survivors of large burns. The current study examines acute postburn pruritus in children under the age of 4 years (N = 256) with smaller burns (mean TBSA = 3.99%), which represents the most common type of patient typically treated in pediatric burn centers. Parents rated their child for pruritus, irritability, and sleep disturbances; additionally, parents completed a self-report of distress. Nearly half (47.3%) were rated by parents as displayed some level of pruritus, with the greatest proportion rated as mild. Regression analysis indicated that child minority status, greater burn TBSA, and more days elapsed since burn predicted higher levels of pruritus. In turn, pruritus was positively correlated with child irritability, delayed sleep onset, sleep disturbance, and parent distress. Thus, our results indicate that parent-rated pruritus in young pediatric burn patients is important to evaluate, as itch is significantly associated with other important clinical outcomes as early as the first month of the burn for pediatric patients and their parents.
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http://dx.doi.org/10.1093/jbcr/irz125DOI Listing
October 2019

Parent Distress Following Pediatric Burn Injuries.

J Burn Care Res 2019 01;40(1):79-84

Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD.

Parents commonly report elevated distress following a child's burn injury, yet limited research has identified child or injury characteristics that may explain parent distress. The main goal of the current study is to examine prevalence and predictors of parent distress following children's burn injuries by evaluating distress symptoms in a clinic sample of parents whose children present for evaluation and treatment at a regional burn center. Participants included parents of 407 children who experienced a burn injury. Of this sample, follow-up data at a second time point was obtained for 130 children and their caregivers. Parents completed a measure of distress. Clinical and demographic variables were extracted retrospectively from the medical chart. Clinical and at risk levels of distress were reported by nearly 19% of parents at Time 1. Parent distress at Time 1 was associated with child minority race, fewer days since burn injury, and greater burn size. A propensity score was used to account for potential differences between parents with data at Time 1 only versus those with data at Time 2. Parents with Time 2 data tended to have higher levels of distress at Time 1. Of parents with Time 2 data, 17% continued to report elevated distress, and Time 1 distress was the best predictor of later distress. A proportion of parents report elevated distress following their children's burn injuries. Our results suggest that best practices should include routine screening of parent distress following pediatric burn injuries to guide appropriate interventions.
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http://dx.doi.org/10.1093/jbcr/iry048DOI Listing
January 2019

Family and Maternal Characteristics of Children With Co-Occurring ADHD and Depression.

J Atten Disord 2020 05 26;24(7):963-972. Epub 2016 Aug 26.

Johns Hopkins University School of Medicine, Baltimore, MD, USA.

This study examined differences between children with ADHD and comorbid depression ( = 26), ADHD only ( = 111), and a community control group ( = 130) on measures of family and maternal characteristics. The present study utilized a large, community sample. Diagnoses required positive endorsements from multiple sources. ANOVAs and chi-square tests were conducted to determine group differences. Compared with children with ADHD alone and community controls, mothers of depressed ADHD children reported decreased family cohesion, limited participation in social/recreational activities, increased maternal depressive symptoms, difficulty coping with parenting roles, and higher rates of bipolar and anxiety disorders. Mothers of children with ADHD (with or without comorbid depression) reported increased conflict, decreased cohesion, and poor maternal coping compared with community controls. Findings are consistent with prior literature suggesting that families of children with ADHD and depression demonstrate both similar and unique characteristics. Clinical implications are discussed.
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http://dx.doi.org/10.1177/1087054716666321DOI Listing
May 2020

Combating a Global Threat to a Clonal Crop: Banana Black Sigatoka Pathogen Pseudocercospora fijiensis (Synonym Mycosphaerella fijiensis) Genomes Reveal Clues for Disease Control.

PLoS Genet 2016 08 11;12(8):e1005876. Epub 2016 Aug 11.

Plant Research International, Wageningen University and Research, Wageningen, The Netherlands.

Black Sigatoka or black leaf streak disease, caused by the Dothideomycete fungus Pseudocercospora fijiensis (previously: Mycosphaerella fijiensis), is the most significant foliar disease of banana worldwide. Due to the lack of effective host resistance, management of this disease requires frequent fungicide applications, which greatly increase the economic and environmental costs to produce banana. Weekly applications in most banana plantations lead to rapid evolution of fungicide-resistant strains within populations causing disease-control failures throughout the world. Given its extremely high economic importance, two strains of P. fijiensis were sequenced and assembled with the aid of a new genetic linkage map. The 74-Mb genome of P. fijiensis is massively expanded by LTR retrotransposons, making it the largest genome within the Dothideomycetes. Melting-curve assays suggest that the genomes of two closely related members of the Sigatoka disease complex, P. eumusae and P. musae, also are expanded. Electrophoretic karyotyping and analyses of molecular markers in P. fijiensis field populations showed chromosome-length polymorphisms and high genetic diversity. Genetic differentiation was also detected using neutral markers, suggesting strong selection with limited gene flow at the studied geographic scale. Frequencies of fungicide resistance in fungicide-treated plantations were much higher than those in untreated wild-type P. fijiensis populations. A homologue of the Cladosporium fulvum Avr4 effector, PfAvr4, was identified in the P. fijiensis genome. Infiltration of the purified PfAVR4 protein into leaves of the resistant banana variety Calcutta 4 resulted in a hypersensitive-like response. This result suggests that Calcutta 4 could carry an unknown resistance gene recognizing PfAVR4. Besides adding to our understanding of the overall Dothideomycete genome structures, the P. fijiensis genome will aid in developing fungicide treatment schedules to combat this pathogen and in improving the efficiency of banana breeding programs.
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http://dx.doi.org/10.1371/journal.pgen.1005876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981457PMC
August 2016

Use of Modified Positive Behavioral Interventions and Supports in a Psychiatric Inpatient Unit for High-Risk Youths.

Psychiatr Serv 2016 05 14;67(5):570-3. Epub 2016 Feb 14.

The authors are with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore (e-mail: ).

Objective: Despite a call for the reduction and ultimate elimination of the use of seclusion and restraint, research on reduction of these practices in behavioral programs has been limited. This study sought to examine the effectiveness of a modified version of the Positive Behavioral Interventions and Supports (M-PBIS) implemented in a youth psychiatric inpatient unit to reduce use of seclusion and restraint.

Methods: This naturalistic, prospective study covered a four-year period (1,485 admissions).

Results: The number of seclusion and restraint events, mean duration of events, and percentage of patients placed in seclusion or restraint were reduced, as was the overall seclusion rate for the unit. Furthermore, there was a significant reduction in the use of pro re nata (PRN) medications for agitation.

Conclusions: These findings suggest that M-PBIS is a promising intervention to use in youth psychiatric inpatient units to reduce seclusion and restraint and PRNs.
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http://dx.doi.org/10.1176/appi.ps.201500039DOI Listing
May 2016

Evaluation of the Environmental Supports Scale with a Community Sample of Adolescents.

Prev Sci 2016 May;17(4):493-502

Center for Addictions, Personality, and Emotion Research, University of Maryland, 2103 Cole Student Activities Building, College Park, MD, 20742-4411, USA.

Environmental sources of psychosocial support have been found to modulate or protect against the development of psychopathology and risk behavior among adolescents. Capturing sources of environmental support across multiple developmental contexts requires the availability of well-validated, concise assessments-of which there are few in the existing literature. In order to address this need, the current study explored the factor structure, concurrent and convergent validity of the Environmental Supports Scale (ESS; Genetic, Social, and General Psychology Monographs, 117; 395-417, 1991) with a community sample of adolescents. An unconstrained exploratory factor analysis revealed a separate factor for home, school, and neighborhood settings. Internal consistency and test-retest reliability were evaluated for each factor. Concurrent and predictive validity analyses revealed that the ESS was associated in the expected directions across a range of constructs relevant to adolescent development including internalizing symptoms, well-being, external influences, and engagement in risk behavior. Convergent validity for the neighborhood context was established with an assessment of neighborhood environmental adversity. A brief assessment of perceived environmental support across key developmental contexts provides an important tool for research on resilience processes during adolescence and may help illuminate key protective factors and inform intervention and prevention efforts.
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http://dx.doi.org/10.1007/s11121-016-0637-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4840044PMC
May 2016

Risk Factors for Seclusion and Restraint in a Pediatric Psychiatry Day Hospital.

Child Psychiatry Hum Dev 2016 10;47(5):771-9

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans St., 12th Floor, Baltimore, MD, 21287, USA.

The use of seclusion and restraints (SR) in acute hospital settings remains a controversial practice. Despite the focus on SR in the psychiatric services literature, data on SR use in pediatric day hospital settings is lacking. A case-control retrospective analysis for children admitted into a pediatric psychiatry day hospital in a 2-year span examined predictors of SR use. Demographic and clinical descriptors were examined in relation to SR events using univariate and multivariate regression models. Significant univariate risk factors for SR use were psychiatric morbidity, history of physical abuse, post-traumatic stress disorder, having any anxiety disorder, and younger age. Knowledge of risk factors for SR use in pediatric psychiatric day hospitals can avert use of SR and lead to improved safety in a trauma-informed care model.
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http://dx.doi.org/10.1007/s10578-015-0608-1DOI Listing
October 2016

Psychological essentialism, gender, and parenthood: Physical transformation leads to heightened essentialist conceptions.

J Pers Soc Psychol 2015 Dec;109(6):949-67

Department of Psychology and Neuroscience, University of Colorado Boulder.

Psychological essentialism is the tendency to view entities as if they have an underlying, often invisible essence that makes them what they are (Medin & Ortony, 1989), and the presence of a genetic basis for group membership contributes to such conceptions (Dar-Nimrod & Heine, 2011; Keller, 2005). We argue that undergoing visually salient physical transformations in the process of becoming a group member leads to particularly heightened essentialist conceptions. We test this idea in the context of parenthood. Public discourse suggests the category mother is imbued with special properties and is viewed as a deeper, more lasting, and real category than father. Such perceptions may contribute to unequal work outcomes for women relative to men. Collectively, the 5 studies reported show that mothers are perceived in more essentialist terms than fathers, and that physical changes women undergo in the process of becoming mothers play a substantial role in producing this difference. Moreover, viewing mothers as a particularly natural and real category predicted judgments that women struggle to successfully manage their roles as mothers and professionals, but only when motherhood was biological in nature. The role that observable physical transformations may play in the reification of categories is discussed.
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http://dx.doi.org/10.1037/pspa0000040DOI Listing
December 2015

Management and Treatment of Attention-Deficit/Hyperactivity Disorder on College Campuses.

J Psychosoc Nurs Ment Health Serv 2015 Nov;53(11):46-51

Attention-deficit/hyperactivity disorder (ADHD) on college campuses is a serious and often underdiagnosed condition. The current investigation analyzed current best practice guidelines for the management of ADHD in a mid-sized university in the Midwestern United States. Best practices were identified through a review of current evidence-based literature on ADHD management. A data collection tool was developed and used to organize data and determine adherence with best practice guidelines. Investigators revealed that policy and procedures followed best practice guidelines. Development and implementation of ADHD protocols on college campuses allows nurse practitioners to confidently provide safe, quality care to patients diagnosed with ADHD.
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http://dx.doi.org/10.3928/02793695-20151021-03DOI Listing
November 2015

Patterned changes in urge ratings with tic suppression in youth with chronic tic disorders.

J Behav Ther Exp Psychiatry 2016 Mar 13;50:162-70. Epub 2015 Jul 13.

Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center, Level 12, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21283, USA. Electronic address:

Background: Premonitory urges are central to emerging behavioral models of chronic tic disorders (CTD). Urge reduction has been proposed as a behavioral explanation for tic maintenance and exacerbation as well as the efficacy of behavioral treatments. Prior investigations have produced inconsistent findings despite common methodologies. The current study evaluated the possibility that data aggregation obscures distinct and meaningful patterns of change in urge ratings when tics are freely expressed versus suppressed.

Method: Participants (n = 12) included children with moderate-to-marked tic severity and noticeable premonitory urges. Tic frequencies and urge ratings were obtained at 15 s and 10-s intervals, respectively, across an alternating sequence of 10-min tic freely and 40-min tic suppression conditions. Patterns were established using a two step approach.

Results: Five distinct patterns of urge rating change emerged, suggesting data aggregation may obscure meaningful patterns in the urge-tic relationship when tics are completed versus suppressed.

Limitations: Eligibility criteria may have unintentionally excluded younger affected children and included older participants with more severe tic disorders than commonly seen. Additional research with less stringent eligibility criteria and a larger sample size will help validate the results.

Conclusions: The relationship between urges and tics is much more complex than previously theorized. Investigations that rely on global assessments of urge and tic severity and/or assume uniformity when aggregating participant data may obscure meaningful differences in the urge-tic relationship. Future investigations should examine the possibility that individual differences and/or developmental considerations modulate the functional urge-tic relationship.
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http://dx.doi.org/10.1016/j.jbtep.2015.07.004DOI Listing
March 2016

A Comparison of Urge Intensity and the Probability of Tic Completion During Tic Freely and Tic Suppression Conditions.

Behav Modif 2014 Mar 12;38(2):297-318. Epub 2014 Jun 12.

Johns Hopkins Hospital, Baltimore, MD, USA.

Tic-suppression-based treatments (TSBTs) represent a safe and effective treatment option for Chronic Tic Disorders (CTDs). Prior research has demonstrated that treatment naive youths with CTDs have the capacity to safely and effectively suppress tics for prolonged periods. It remains unclear how tic suppression is achieved. The current study principally examines how effective suppression is achieved and preliminary correlates of the ability to suppress tics. Twelve youths, ages 10 to 17 years, with moderate-to-marked CTDs participated in an alternating sequence of tic freely and reinforced tic suppression conditions during which urge intensity and tic frequency were frequently assessed. Probability of tics occurring was half as likely following high-intensity urges during tic suppression (31%) in contrast to low-intensity urges during tic freely conditions (60%). Age was not associated with ability to suppress. Intelligence indices were associated with or trended toward greater ability to suppress tics. Attention difficulties were not associated with ability to suppress but were associated with tic severity. In contrast to our "selective suppression" hypothesis, we found participants equally capable of suppressing their tics regardless of urge intensity during reinforced tic suppression. Tic suppression was achieved with an "across-the-board" effort to resist urges. Preliminary data suggest that ability to suppress may be associated with general cognitive variables rather than age, tic severity, urge severity, and attention. Treatment naive youths appear to possess a capacity for robust tic suppression. TSBTs may bolster these capacities and/or enable their broader implementation, resulting in symptom improvement.
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http://dx.doi.org/10.1177/0145445514537059DOI Listing
March 2014

Dealing with ethical challenges when leading student mission trips.

J Am Dent Assoc 2014 May;145(5):486-7

Dr. Reynolds practices general dentistry in Richmond, Va., and is a member of the American Dental Association Council on Ethics, Bylaws and Judicial Affairs.

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http://dx.doi.org/10.1016/s0002-8177(14)60046-5DOI Listing
May 2014

Characterizing subjective responses to alcohol among adolescent problem drinkers.

J Abnorm Psychol 2014 Feb;123(1):117-29

Center for Alcohol and Addiction Studies, Brown University.

Theoretical models of alcoholism emphasize the acute reinforcing properties of alcohol as chief determinants of drinking, and animal research suggests adolescents are uniquely sensitive to these effects. Human studies of these phenomena, however, are virtually nonexistent. We used ecological momentary assessment methods to capture adolescents' subjective responses to alcohol in real time in their natural environments. Adolescent participants were 22 problem drinkers, ages 15 to 19 years (M = 18.3, SD = 0.09; 55% female; 55% alcohol dependent). Participants consumed alcohol on 38% of days during a 1-week monitoring period, with an average of 5 drinks per occasion. Momentary data revealed that adolescents experience decreased stimulation and increased sedation and "high" across the ascending limb of the blood alcohol curve. Notably, greater craving predicted higher volumes of subsequent alcohol consumption during the episode, whereas greater "high" attenuated use. To test for developmental differences in these effects, we pooled these data with data from a similarly ascertained sample of 36 adult heavy drinkers, ages 24 to 64 years (M = 38.1, SD = 11.8; 50% female; 61% alcohol dependent). Adolescents were more sensitive to the stimulant effects of alcohol than adults. This study provides novel data on how adolescent problem drinkers experience alcohol in their natural contexts and illustrates how these effects, which appear to differ from adult problem drinkers, confer liability for future drinking.
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http://dx.doi.org/10.1037/a0035328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102316PMC
February 2014

Analogue study of peer influence on risk-taking behavior in older adolescents.

Prev Sci 2014 Dec;15(6):842-9

This experimental study aimed to examine whether adolescents act in a riskier manner in the presence of peers and whether peer presence alone influences risk behavior or if a direct influence process is necessary. Utilizing a behavioral task assessing risk-taking, 183 older adolescents (18–20 year olds) came to the laboratory alone once and then were randomized to one of three conditions as follows: alone, peers present, and peers encouraging. An interaction was found such that at baseline, there were no significant differences between the three conditions, but at the experimental session, there was a significant increase in risk task scores particularly for the encouraging condition. These findings challenge proposed models of the interaction between peer influence and risk taking by providing evidence that adolescents take more risks when being encouraged by peers, but that the presence of peers on its own does not lead to more risks than when completing the task alone.
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http://dx.doi.org/10.1007/s11121-013-0439-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984373PMC
December 2014

Developmental trajectories of anxiety symptoms in early adolescence: the influence of anxiety sensitivity.

J Abnorm Child Psychol 2014 May;42(4):589-600

Department of Psychology, Florida State University, P.O. Box 3064301, Tallahasssee, FL, 32306-4301, USA.

Children and adolescents seem to suffer from anxiety disorders at rates similar to adults. Interestingly, anxiety symptoms appear to generally decline over time within children as evidenced by lower rates in early and middle adolescence. There is some evidence that there may be heterogeneous subpopulations of adolescent children with different trajectories of anxiety symptoms, including a class of adolescents with elevated levels of anxiety that do not dissipate over time. Anxiety sensitivity has been identified as an important risk factor in the development of anxiety psychopathology. This study prospectively examined the development of anxiety symptoms in a sample of 277 adolescents (M age = 11.52; 44 % female, 56 % male) over a 3 year period including the influence of anxiety sensitivity on this development. Further, this study investigated whether there were distinct classes of adolescents based on their anxiety symptom trajectories and including anxiety sensitivity as a predictor. Consistent with other reports, findings indicated an overall decline in anxiety symptoms over time in the sample. However, three classes of adolescents were found with distinct anxiety symptom trajectories and anxiety sensitivity was an important predictor of class membership. Adolescents with elevated anxiety sensitivity scores were more likely to be classified as having high and increasing anxiety symptoms over time versus having moderate to low and decreasing anxiety symptoms over time. There are important implications for identification of adolescents and children who are at risk for the development of an anxiety disorder.
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http://dx.doi.org/10.1007/s10802-013-9806-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046901PMC
May 2014

Emotional and behavioral functioning in children with bladder exstrophy-epispadias complex: a developmental perspective.

J Pediatr Urol 2014 Feb 17;10(1):136-41. Epub 2013 Aug 17.

James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Objective: To evaluate the emotional and behavioral functioning of children with bladder exstrophy-epispadias complex (BEEC), taking into account developmental and gender considerations. This study also sought to overcome methodological limitations of previous studies evaluating psychological well-being of children with BEEC.

Methods: Eighty-six children were consecutively evaluated using the parent report version of the Behavior Assessment System for Children during visits to a multidisciplinary urology clinic.

Results: Results indicated normative emotional and behavioral functioning across the sample. However, there was a significant effect of age, such that older children consistently had worse internalizing symptoms and adaptive functioning. Males tended to have more externalizing problems as they aged, and also tended to have lower levels of adaptive functioning but this was independent of age. The level of psychological impairment was unrelated to the specific type of BEEC, and was also unrelated to whether or not the patient had undergone continence surgery.

Conclusion: Children with BEEC have a greater likelihood of experiencing a wide range of emotional and behavioral problems as they reach adolescence. These findings point to the need to prevent potential psychological distress by intervening with these children before they become clinically impaired.
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http://dx.doi.org/10.1016/j.jpurol.2013.07.013DOI Listing
February 2014

Is it ethical to raffle off prizes in exchange for referrals?

J Am Dent Assoc 2013 Jul;144(7):839-40

American Dental Association Council on Ethics, Bylaws and Judicial Affairs, Chicago, Ill. 60611, USA.

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http://dx.doi.org/10.14219/jada.archive.2013.0197DOI Listing
July 2013

Influence of social stress on risk-taking behavior in adolescents.

J Anxiety Disord 2013 Apr 20;27(3):272-7. Epub 2013 Mar 20.

Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, 1800 Orleans Street 12th Floor, Baltimore, MD 21287, United States.

Risk-taking behavior involves making choices with uncertain positive or negative outcomes. Evidence suggests that risk-taking behavior is influenced by emotional state. One such emotional experience is social anxiety, which has been related to both risk-avoidant and risk-seeking decision making. The present study examined a community sample of 34 adolescents grouped into low (Low SA Group) and high (High SA Group) social anxiety (SA). Both groups were compared on changes in performance on a risk taking task (Balloon Analogue Risk Task) between a social threat condition (modified Trier Social Stress Test, High Stress) and a control condition (Low Stress). These conditions were administered on different days, and the order was counterbalanced across subjects. A group×condition interaction revealed that the High SA Group showed greater risk-taking behavior when exposed to the High Stress Condition compared to the Low Stress Condition, while the Low SA Group evidenced no difference between the two conditions. Interpretations for the increased risk behavior under the condition of social stress for those high in social anxiety are discussed as well as implications for understanding the complex relationship between social anxiety and risk behavior.
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http://dx.doi.org/10.1016/j.janxdis.2013.02.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693744PMC
April 2013

An Examination of the Association of Distress Intolerance and Emotion Regulation with Avoidance.

Cognit Ther Res 2013 Apr 5;37(2):363-367. Epub 2012 May 5.

Department of Psychology, Boston University, Boston, MA, USA.

Distress intolerance is an important motivator of maladaptive avoidance-based coping strategies. The selection of such avoidance behaviors is also influenced by one's access to alternative emotion regulatory strategies. However, little research has examined the relative contributions of these vulnerability factors to avoidance. This study examined whether distress intolerance and access to emotion regulation strategies were uniquely (additively or interactively) associated with self-reported avoidance. Two samples-an unselected sample ( = 300) and a clinical sample ( = 100)-comprised of patients seeking treatment for unipolar mood and/or anxiety disorders were administered measures of distress intolerance, emotion regulation, and avoidance. Results of linear regression analyses indicated that distress intolerance and access to emotion regulation strategies were uniquely and additively associated with avoidance. Implications for the prevention and treatment of psychological disorders are discussed.
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http://dx.doi.org/10.1007/s10608-012-9463-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410348PMC
April 2013

Effects of naltrexone on adolescent alcohol cue reactivity and sensitivity: an initial randomized trial.

Addict Biol 2014 Sep 13;19(5):941-54. Epub 2013 Mar 13.

Brown University, Providence, RI, USA.

Adolescent alcohol use is associated with myriad adverse consequences and contributes to the leading causes of mortality among youth. Despite the magnitude of this public health problem, evidenced-based treatment initiatives for alcohol use disorders in youth remain inadequate. Identifying promising pharmacological approaches may improve treatment options. Naltrexone is an opiate receptor antagonist that is efficacious for reducing drinking in adults by attenuating craving and the rewarding effects of alcohol. Implications of these findings for adolescents are unclear; however, given that randomized trials of naltrexone with youth are non-existent. We conducted a randomized, double-blinded, placebo-controlled cross-over study, comparing naltrexone (50 mg/daily) and placebo in 22 adolescent problem drinkers aged 15-19 years (M = 18.36, standard deviation = 0.95; 12 women). The primary outcome measures were alcohol use, subjective responses to alcohol consumption, and alcohol-cue-elicited craving assessed in the natural environment using ecological momentary assessment methods, and craving and physiological reactivity assessed using standard alcohol cue reactivity procedures. Results showed that naltrexone reduced the likelihood of drinking and heavy drinking (P's ≤ 0.03), blunted craving in the laboratory and in the natural environment (P's ≤ 0.04), and altered subjective responses to alcohol consumption (P's ≤ 0.01). Naltrexone was generally well tolerated by participants. This study provides the first experimentally controlled evidence that naltrexone reduces drinking and craving, and alters subjective responses to alcohol in a sample of adolescent problem drinkers, and suggests larger clinical trials with long-term follow-ups are warranted.
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http://dx.doi.org/10.1111/adb.12050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3729253PMC
September 2014

Preliminary evidence for a gene-environment interaction in predicting alcohol use disorders in adolescents.

Alcohol Clin Exp Res 2013 Feb 8;37(2):325-31. Epub 2012 Nov 8.

Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA.

Background: Emerging research suggests that genetic influences on adolescent drinking are moderated by environmental factors. The present study builds on molecular-genetic findings by conducting the first analysis of gene-environment interactions in the association between a functional single nucleotide polymorphism (SNP) of the μ-opioid receptor (OPRM1) gene (A118G) and risk of developing an alcohol use disorder (AUD) during adolescence. Specifically, we tested whether variation in parenting practices or affiliation with deviant peers moderated the link between the OPRM1 gene and risk of an AUD.

Methods: Adolescents reporting European ancestry (N = 104), ages 12 to 19 years (M = 15.60, SD = 1.77), were interviewed to ascertain AUD diagnoses, provided a DNA sample for genetic analyses, and completed measures of parental monitoring and deviant peer affiliation. Logistic regression was used to test the effects of environmental variables and their interactions with OPRM1 genotype as predictors of AUD diagnosis while controlling for age and sex.

Results: Case-control comparisons showed that the proportion of youth with an AUD (n = 18) significantly differed by genotype such that 33.3% of G allele carriers met criteria for an AUD compared to 10.8% of youth who were homozygous for the A allele (p = 0.006). The OPRM1 × parental monitoring (odds ratio = 0.16) and OPRM1 × deviant peer affiliation (odds ratio = 7.64) interactions were significant predictors of AUD risk, such that G allele carriers with high levels of deviant peer affiliation or lower levels of parental monitoring had the greatest likelihood of developing an AUD (p-values <0.01).

Conclusions: This study provides initial evidence that the association between the A118G SNP of the OPRM1 gene and risk of AUDs is moderated by modifiable factors. These results are limited, however, by the small sample size and require replication.
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http://dx.doi.org/10.1111/j.1530-0277.2012.01897.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3700411PMC
February 2013