Publications by authors named "Jennifer M Park"

25 Publications

  • Page 1 of 1

The Burden of Caring for a Child or Adolescent With Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): An Observational Longitudinal Study.

J Clin Psychiatry 2018 12 11;80(1). Epub 2018 Dec 11.

Pediatric Divisions of Child & Adolescent Psychiatry, Stanford University School of Medicine, Palo Alto, California, USA.

Objective: To describe the longitudinal association between disease severity, time established in clinical treatment, and caregiver burden in a community-based patient population diagnosed with pediatric acute-onset neuropsychiatric syndrome (PANS).

Methods: The study included an observational longitudinal cohort design, with Caregiver Burden Inventories (CBIs) collected between April 2013 and November 2016 at the Stanford PANS multidisciplinary clinic. Inclusion criteria for this study were as follows: pediatric patients meeting strict PANS/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) diagnostic criteria (n = 187), having a caregiver fill out at least 1 complete CBI during a disease flare (n = 114); and having family who lives locally (n = 97). For longitudinal analyses, only patients whose caregiver had filled out 2 or more CBIs (n = 94 with 892 CBIs) were included. In the study sample, most primary caregivers were mothers (69 [71.1%] of 97), the majority of PANS patients were male (58 [59.8%] of 97), and mean age at PANS onset was 8.8 years.

Results: In a patient's first flare tracked by the clinic, 50% of caregivers exceeded the caregiver burden score threshold used to determine respite need in care receiver adult populations. Longitudinally, flares, compared with quiescence, predicted increases in mean CBI score (6.6 points; 95% CI, 5.1 to 8.0). Each year established in clinic predicted decreased CBI score (-3.5 points per year; 95% CI, -2.3 to -4.6). Also, shorter time between PANS onset and entry into the multidisciplinary clinic predicted greater improvement in mean CBI score over time (0.7 points per year squared; 95% CI, 0.1 to 1.3). Time between PANS onset and treatment with antibiotics or immunomodulation did not moderate the relationship between CBI score and time in clinic.

Conclusions: PANS caregivers suffer high caregiver burden. Neuropsychiatric disease severity predicts increased caregiver burden. Caregiver burden tends to decrease over time in a group of patients undergoing clinical treatment at a specialty PANS clinic. This decrease could be independent of clinical treatment.
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http://dx.doi.org/10.4088/JCP.17m12091DOI Listing
December 2018

ADHD and executive functioning deficits in OCD youths who hoard.

J Psychiatr Res 2016 11 30;82:141-8. Epub 2016 Jul 30.

Massachusetts General Hospital and Harvard Medical School, Department of Psychiatry, 55 Fruit Street, Boston, MA, 02114, USA.

Hoarding is common among youth with obsessive compulsive disorder (OCD), with up to 26% of OCD youth exhibiting hoarding symptoms. Recent evidence from adult hoarding and OCD cohorts suggests that hoarding symptoms are associated with executive functioning deficits similar to those observed in subjects with attention deficit hyperactivity disorder (ADHD). However, while hoarding behavior often onsets during childhood, there is little information about executive function deficits and ADHD in affected children and adolescents. The study sample included 431 youths (ages 6-17 years) diagnosed with OCD who participated in the OCD Collaborative Genetics Study and the OCD Collaborative Genetics Association Study and completed a series of clinician-administered and parent report assessments, including diagnostic interviews and measures of executive functioning (Behavior Rating Inventory of Executive Functioning; BRIEF) and hoarding severity (Hoarding Rating Scale-Interview; HRS-I). 113 youths (26%) had clinically significant levels of hoarding compulsions. Youths with and without hoarding differed significantly on most executive functioning subdomains and composite indices as measured by the parent-rated BRIEF. Groups did not differ in the frequency of full DSM-IV ADHD diagnoses; however, the hoarding group had significantly greater number of inattention and hyperactivity symptoms compared to the non-hoarding group. In multivariate models, we found that overall BRIEF scores were related to hoarding severity, adjusting for age, gender and ADHD symptoms. These findings suggest an association between hoarding and executive functioning deficits in youths with OCD, and assessing executive functioning may be important for investigating the etiology and treatment of children and adolescents with hoarding and OCD.
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http://dx.doi.org/10.1016/j.jpsychires.2016.07.024DOI Listing
November 2016

Can Transabdominal Cervical Length Measurement Exclude Short Cervix?

Am J Perinatol 2016 Apr 2;33(5):473-9. Epub 2015 Nov 2.

Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.

Objective: This study aims to determine if transabdominal (TA) cervical length may be used to rule out a short cervix on transvaginal (TV) ultrasound.

Study Design: We conducted a prospective cohort study of women undergoing routine anatomic survey at 17 to 23 weeks gestation. TA and TV cervical length measurements were obtained in each patient. A short cervix was defined as TV cervical length < 30 mm. Predictive characteristics were calculated for different cutoff values of TA cervical length.

Results: There were 404 patients enrolled, a TA cervical length could not be obtained in 83 women (20.6%) and 318 women had both TA and TV measurements. Of those, 14 (4.4%) had a TV cervical length < 30 mm. TA cervical length measurement ≥ 35 mm excluded the possibility of TV cervical length < 30 mm (negative predictive value, 99.5%; 95% confidence interval [CI], 97.4; 100%). In our cohort, 67.6% (95% CI, 62.2; 72.7%) of TV ultrasounds could have been avoided using a TA cervical length cutoff of ≥ 5 mm.

Conclusion: ATA cervical length of at least 35 mm excludes a short cervix of < 30 mm. While TA cervical length screening may not be feasible in 1 in 5 women, it may be used to decrease the burden of universal TV cervical length screening.
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http://dx.doi.org/10.1055/s-0035-1566308DOI Listing
April 2016

Obsessive-Compulsive Personality Traits in Youth with Obsessive-Compulsive Disorder.

Child Psychiatry Hum Dev 2016 Apr;47(2):281-90

Departments of Psychology, Pediatrics and Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.

While interest in the relationship between obsessive-compulsive disorder (OCD) and obsessive compulsive personality disorder has increased, there are currently no studies that have examined the presence of obsessive compulsive personality traits (OCPTs) in youth. The current study sought to determine the latent factors and psychometric properties of a modified version of the Childhood Retrospective Perfectionism Questionnaire (CHIRP) and examine the correlates of specific OCPTs (e.g., rigidity, perfectionism) in youth with OCD. Participants included 96 treatment-seeking youth diagnosed with primary OCD (and a parent). Parents and youth completed measures of OCPTs, OCD severity, depression, and disability. A confirmatory factor analysis of the modified CHIRP resulted in a two-factor model: perfectionism and preoccupation with details. The CHIRP and its subscales demonstrated acceptable internal consistency and preliminary evidence for convergent and divergent validity. Obsessive compulsive traits in youth were also found to be associated with the checking, symmetry and contamination symptom dimensions.
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http://dx.doi.org/10.1007/s10578-015-0565-8DOI Listing
April 2016

Living with tics: reduced impairment and improved quality of life for youth with chronic tic disorders.

Psychiatry Res 2015 Feb 4;225(3):571-9. Epub 2014 Dec 4.

Department of Psychology, University of South Florida, Tampa, FL, USA; Department of Pediatrics, University of South Florida, Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA; Roger׳s Behavioral Health - Tampa Bay, Tampa, FL, USA; All Children׳s Hospital - Johns Hopkins Medicine, St. Petersburg, FL, USA.

Pharmacological and behavioral interventions have focused on reducing tic severity to alleviate tic-related impairment for youth with chronic tic disorders (CTDs), with no existing intervention focused on the adverse psychosocial consequences of tics. This study examined the preliminary efficacy of a modularized cognitive behavioral intervention ("Living with Tics", LWT) in reducing tic-related impairment and improving quality of life relative to a waitlist control of equal duration. Twenty-four youth (ages 7-17 years) with Tourette Disorder or Chronic Motor Tic Disorder and psychosocial impairment participated. A treatment-blind evaluator conducted all pre- and post-treatment clinician-rated measures. Youth were randomly assigned to receive the LWT intervention (n=12) or a 10-week waitlist (n=12). The LWT intervention consisted of up to 10 weekly sessions targeted at reducing tic-related impairment and developing skills to manage psychosocial consequences of tics. Youth in the LWT condition experienced significantly reduced clinician-rated tic-impairment, and improved child-rated quality of life. Ten youth (83%) in the LWT group were classified as treatment responders compared to four youth in the waitlist condition (33%). Treatment gains were maintained at one-month follow-up. Findings provide preliminary data that the LWT intervention reduces tic-related impairment and improves quality of life for youth with CTDs.
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http://dx.doi.org/10.1016/j.psychres.2014.11.045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314444PMC
February 2015

Adult offspring perspectives on parental hoarding behaviors.

Psychiatry Res 2014 Dec 2;220(1-2):328-34. Epub 2014 Aug 2.

Departments of Psychology and Pediatrics, University of South Florida, United States; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, United States.

Hoarding disorder (HD) is characterized by difficulty discarding unneeded items and the accumulation of items within living spaces and is associated with significant functional impairment and distress. Along with the negative impact of hoarding on the individual, HD is substantially impairing for family members, and linked to disruptions in family functioning. The present study utilized a path model analysis to examine the associations between an array of hoarding variables hypothesized to impact family functioning and parent-offspring relationships in 150 adult-aged children of hoarders who responded to online requests to participate in a research study. It was hypothesized that increased hoarding severity, decreased insight, and increased family accommodation (i.e., act of family members facilitating or assisting in hoarding behaviors) would be associated with decreased family functioning, decreased quality of parent-offspring relationships, and increased offspring impairment. Results from the path model revealed that family functioning mediated the relationship between hoarding severity and parent-offspring relationship. Diminished insight in the hoarding parent (as reported by the offspring) was associated with increased familial conflict and family functioning partially mediated the relationship between insight and quality of parent-offspring relationship. Increased family accommodation was significantly associated with increased impairment (work, social, and family domains) in offspring of hoarders.
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http://dx.doi.org/10.1016/j.psychres.2014.07.061DOI Listing
December 2014

Does d-Cycloserine Augmentation of CBT Improve Therapeutic Homework Compliance for Pediatric Obsessive-Compulsive Disorder?

J Child Fam Stud 2014 Jul;23(5):863-871

Departments of Pediatrics and Psychiatry, University of South Florida, St Petersburg, FL, USA.

Clinical studies in adults and children with obsessive-compulsive disorder (OCD) have shown that d-cycloserine (DCS) can improve treatment response by enhancing fear extinction learning during exposure-based psychotherapy. Some have hypothesized that improved treatment response is a function of increased compliance and engagement in therapeutic homework tasks, a core component of behavioral treatment. The present study examined the relationship between DCS augmented cognitive-behavioral therapy (CBT) and homework compliance in a double-blind, placebo controlled trial with 30 youth with OCD. All children received 10 CBT sessions, the last seven of which included exposure and response prevention paired with DCS or placebo dosed 1 h before the session started. Results suggested that DCS augmented CBT did not predict improved homework compliance over the course of treatment, relative to the placebo augmented CBT group. However, when groups were collapsed, homework compliance was directly associated with treatment outcome. These findings suggest that while DCS may not increase homework compliance over time, more generally, homework compliance is an integral part of pediatric OCD treatment outcome.
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http://dx.doi.org/10.1007/s10826-013-9742-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078886PMC
July 2014

Novel approaches in treatment of pediatric anxiety.

F1000Prime Rep 2014 6;6:30. Epub 2014 May 6.

OCD and Related Disorders Program, Massachusetts General Hospital 185 Cambridge St., Suite 2200, Boston, MA 02114 USA ; Department of Psychiatry, Harvard Medical School Boston, MA USA.

Pediatric anxiety disorders have high prevalence rates and morbidity and are associated with considerable functional impairment and distress. They may be predictors for the development of other psychiatric disorders and, without intervention, are more likely to persist into adulthood. While evidence-based pharmacological and behavioral interventions are currently available, there remains a sizable subset of youth who remain only partially treatment-responsive and therefore symptomatic following treatment. Novel methods of treatment, pharmacologic and non-pharmacologic, including acceptance and commitment therapy (ACT), attention bias modification (ABM), d-cycloserine (DCS) augmentation of cognitive behavioral treatment (CBT), and glutamatergic agents such as riluzole, are briefly introduced and discussed.
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http://dx.doi.org/10.12703/P6-30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017908PMC
June 2014

Family-based exposure and response prevention therapy for preschool-aged children with obsessive-compulsive disorder: a pilot randomized controlled trial.

Behav Res Ther 2014 May 2;56:30-8. Epub 2014 Mar 2.

Department of Pediatrics, University of South Florida, USA; Department of Psychology, University of South Florida, USA; Department of Psychiatry & Behavioral Neurosciences, University of South Florida, USA.

Aims: To examine the feasibility, acceptability and preliminary efficacy of family-based exposure/response prevention therapy (E/RP) versus treatment as usual (TAU) in a cohort of very young children with early onset obsessive-compulsive disorder (OCD).

Methods: Thirty-one children ages 3-8 years (M = 5.8 years) with a primary diagnosis of OCD were randomized to E/RP or TAU. The E/RP condition received 12 sessions of family-based E/RP twice weekly over 6 weeks. Families were assessed at baseline, post-treatment, 1-month and 3-month follow up. The Children's Yale Brown Obsessive Compulsive Scale and Clinical Global Impression served as primary outcome measures.

Results: A large group effect emerged in favor of the E/RP group (d = 1.69). Sixty-five percent of the E/RP group was considered treatment responders as compared to 7% in the TAU group. Symptom remission was achieved in 35.2% of the E/RP group and 0% of the TAU group. There was no attrition and satisfaction was high; gains were maintained at 3 months.

Conclusions: Even amongst children as young as 3 years, developmentally tailored E/RP is efficacious and well-tolerated in reducing OCD symptoms. Key adaptations for younger children include extensive parent involvement, targeting family accommodation, and frequent meetings while delivering a full course of E/RP.

Clinicaltrialsgov Identifier: NCT01447966 http://clinicaltrials.gov/ct2/show/NCT01447966?term=ocd+and+st+petersburg&rank=1.
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http://dx.doi.org/10.1016/j.brat.2014.02.001DOI Listing
May 2014

Neuropsychological performance across symptom dimensions in pediatric obsessive compulsive disorder.

Depress Anxiety 2014 Dec 12;31(12):988-96. Epub 2014 Feb 12.

Department of Psychology, University of South Florida, Tampa, Florida; Department of Pediatrics, University of South Florida, Saint Petersburg, Florida.

Background: Few studies have examined neuropsychological functioning among youth with obsessive compulsive disorder (OCD), with inconclusive results. Although methodological differences may contribute to inconsistent findings, clinical factors may also account for differential performance. Symptom dimensions are associated with specific patterns of genetic transmission, comorbidity, and treatment outcome, and may also be uniquely associated with neuropsychological performance. This study examined differences in cognitive sequelae and neurocognitive impairment across symptom dimensions among youth with OCD.

Method: Participants included 93 treatment-seeking youth diagnosed with OCD. A trained clinician administered the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) to parents and children together. Afterward, youth completed a battery of neuropsychological tests that assessed nonverbal memory and fluency, verbal memory, verbal fluency, verbal learning, processing speed, and inhibition/switching.

Results: Across five symptom dimensions, youth exhibiting Hoarding symptoms (χ(2) = 5.21, P = .02) and Symmetry/Ordering symptoms had a greater occurrence of cognitive sequelae (χ(2) = 4.86, P = .03). Additionally, youth with Symmetry/Ordering symptoms had a greater magnitude of cognitive impairment (Mann-Whitney U = 442.50, Z = -2.49, P < .02), with specific deficits identified on nonverbal fluency (P < .01), processing speed (P < .01), and inhibition and switching (P < .02).

Conclusions: Neuropsychological deficits identified in youth with Hoarding and Symmetry/Ordering symptoms may suggest that these symptoms have characteristics specific to neurocognitive impairment. Alternatively, symptoms associated with these dimensions may impede youth's performance during testing. Findings advise neuropsychological testing for youth with symptoms on either of these dimensions when concerns about neuropsychological and/or academic impairment are present.
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http://dx.doi.org/10.1002/da.22241DOI Listing
December 2014

Neuropsychological functioning in youth with obsessive compulsive disorder: an examination of executive function and memory impairment.

Psychiatry Res 2014 Apr 18;216(1):108-15. Epub 2014 Jan 18.

Departments of Pediatrics and Psychiatry & Behavioral Neurosciences, University of South Florida, Rothman Center for Neuropsychiatry, Child Development and Rehabilitation Center, 880 6th Street South, Suite 460 Box 7523, Saint Petersburg, FL 33701, USA.

Preliminary research suggests neuropsychological deficits in youth with obsessive-compulsive disorder (OCD) similar to those in adults; however, small samples and methodological confounds limit interpretation. We aimed to examine the rates and clinical correlates of cognitive sequelae in youth with OCD, focusing on executive functioning and memory abilities. Youth ages 7-17 years with OCD (N=96) completed a hypothesis-driven neuropsychological battery (including the Rey-Osterreith Complex Figure, California Verbal Learning Test, and subtests of the Delis-Kaplan Executive Function System and Wide Range Assessment of Memory and Learning) that primarily assessed executive functioning, memory and processing speed. Cognitive sequelae were identified in 65% of youth (37% using a more stringent definition of impairment). Magnitude of cognitive sequelae was not associated with OCD severity or age; however, greater neuropsychological impairments were found amongst youth prescribed atypical neuroleptics and those diagnosed with comorbid tic disorders. Comorbidity burden was associated with presence of neuropsychological impairment, but was not specific to any single test. Findings suggest that the presence of cognitive sequelae is prevalent amongst treatment-seeking youth with OCD. Deficits were found in executive functioning and non-verbal memory performance but these impairments were not associated with OCD severity.
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http://dx.doi.org/10.1016/j.psychres.2014.01.014DOI Listing
April 2014

Application of second-stage passive descent in morbidly obese women.

Obstet Gynecol 2012 Dec;120(6):1338-44

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA.

Objective: To estimate whether passive descent in the second stage of labor in morbidly obese parturients is associated with reduced active pushing times and improved labor outcomes compared with immediate pushing.

Methods: This was a retrospective cohort study of all consecutive women with a body mass index (BMI) of 40 or greater admitted for term labor that reached the second stage of labor from 2004 to 2008 at a single institution. Detailed information was collected for maternal demographics, labor progress, and neonatal outcomes. Length of active pushing, length of total second stage, and maternal and neonatal outcomes were compared between women selected to passive descent for at least 30 minutes and those who pushed immediately.

Results: A total of 558 women with a BMI of 40 or greater were identified; of these, 97 underwent passive descent and 461 pushed immediately. Morbidly obese women selected for passive descent were just as likely to actively push for at least 60 minutes compared with those who pushed immediately (16.5% compared with 7.2%, adjusted odds ratio [OR] 1.51, 95% confidence interval [CI] 0.74-3.12). They were also significantly more likely to push for more than 30 minutes (37.1% compared with 13.9%, adjusted OR 2.03, 95% CI 1.17-3.54). Their overall time (minutes) spent pushing was significantly longer (median 19, interquartile range 7-39 compared with median 7, interquartile range 3-17, P<.001) as was their overall length of second stage (median 81, interquartile range 57-127 compared with median 15, interquartile range 8-27, P<.001). They had similar rates of operative delivery and maternal febrile morbidity.

Conclusion: Passive descent of morbidly obese parturients was associated with a greater amount of time actively pushing with similar rates of operative delivery and maternal febrile morbidity.
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http://dx.doi.org/10.1097/aog.0b013e318270ea73DOI Listing
December 2012

Hoarding in Children With ADHD.

J Atten Disord 2016 07 24;20(7):617-26. Epub 2012 Aug 24.

University of South Florida, Tampa, FL, USA

Objective: Although evidence suggests that hoarding may be associated with symptoms of ADHD, no study has examined this relationship in children.

Method: Participants included 99 youth diagnosed with ADHD (and a parent) seen in a general outpatient psychiatry clinic. Children completed the Obsessive-Compulsive Inventory-Child Version, the Revised Child Anxiety and Depression Scale, and the Rosenberg Self-Esteem Scale. Parents completed the Children's Saving Inventory and Vanderbilt ADHD Diagnostic Rating Scale-Parent Version.

Results: Inattentive and hyperactive/impulsive symptoms were the only indicator that differentiated those with and without clinically significant hoarding. Symptoms of ADHD, but not nonhoarding obsessive-compulsive symptoms, significantly predicted hoarding. Inattention and hyperactivity/impulsivity were uniquely associated with individual hoarding features. Hoarding symptoms mediated the relationship between ADHD and oppositionality.

Conclusion: These findings contribute to the growing literature about the association between hoarding and ADHD.
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http://dx.doi.org/10.1177/1087054712455845DOI Listing
July 2016

Evidence-based assessment of compulsive skin picking, chronic tic disorders and trichotillomania in children.

Child Psychiatry Hum Dev 2012 Dec;43(6):855-83

Department of Psychology, University of South Florida, Tampa, FL, USA.

Body-focused repetitive behavior (BFRB) is an umbrella term for debilitating, repetitive behaviors that target one or more body regions. Despite regularly occurring in youth, there has been limited investigation of BFRBs in pediatric populations. One reason for this may be that there are few reliable and valid assessments available to evaluate the presence, severity and impairment of BFRBs in youth. Given the shift toward evidence-based assessment in mental health, the development and utilization of evidence-based measures of BFRBs warrants increasing attention. This paper examines the available evidence-base for assessments in youth across three BFRB-related disorders: compulsive skin picking, chronic tic disorders and trichotillomania. Based upon present empirical support in samples of youth, recommendations are made for an evidence-based assessment of each condition.
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http://dx.doi.org/10.1007/s10578-012-0300-7DOI Listing
December 2012

Cervical cerclage: one stitch or two?

Am J Perinatol 2012 Jun 7;29(6):477-81. Epub 2012 Mar 7.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, USA.

Objective: We sought to determine whether routine placement of a second stitch at the time of cervical cerclage improves its efficacy.

Study Design: This is a retrospective cohort study of patients who had cervical cerclage placement at a single institution. Operative reports, ultrasound images, and delivery records were reviewed. Pregnancy outcomes of patients receiving a two-stitch cerclage were compared with those who received a one-stitch cerclage, with a primary outcome of spontaneous preterm delivery at <35 weeks' gestation. Univariable, multivariable, and Kaplan-Meier survival analyses were performed.

Results: Of 146 patients, 63 had two stitches and 83 had one. Baseline characteristics and indications for cerclage were similar except for differences in history of prior cerclage and multiple gestations. The two-stitch approach was associated with a greater median cerclage height (20 mm versus 17 mm, p = 0.008), but there was no difference in spontaneous preterm delivery at <35 weeks' gestation (47.6% versus 41.0%, adjusted odds ratio 1.22, p = 0.630).

Conclusion: A two-stitch approach to cervical cerclage increases cerclage height, but may not improve efficacy.
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http://dx.doi.org/10.1055/s-0032-1304831DOI Listing
June 2012

Convergent and discriminant validity and reliability of the pediatric anxiety rating scale in youth with autism spectrum disorders.

J Autism Dev Disord 2012 Nov;42(11):2374-82

Department of Pediatrics, University of South Florida, 880 6th Street South, St. Petersburg, FL 33701, USA.

The psychometric properties of the Pediatric Anxiety Rating Scale (PARS), a clinician-administered measure for assessing severity of anxiety symptoms, were examined in 72 children and adolescents diagnosed with an autism spectrum disorder (ASD). The internal consistency of the PARS was 0.59, suggesting that the items were related but not repetitive. The PARS showed high 26-day test-retest (ICC = 0.83) and inter-rater reliability (ICC = 0.86). The PARS was strongly correlated with clinician-ratings of overall anxiety severity and parent-report anxiety measures, supporting convergent validity. Results for divergent validity were mixed. Although the PARS was not associated with the sum of the Social and Communication items on the Autism Diagnostic Observation System, it was moderately correlated with parent-reported inattention, aggression and externalizing behavior. Overall, these results suggest that the psychometric properties of the PARS are adequate for assessing anxiety symptoms in youth with ASD, although additional clarification of divergent validity is needed.
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http://dx.doi.org/10.1007/s10803-012-1489-9DOI Listing
November 2012

Early childhood trichotillomania: Initial considerations on phenomenology, treatment, and future directions.

Infant Ment Health J 2012 Mar 23;33(2):163-172. Epub 2012 Feb 23.

University of South Florida.

Historically, trichotillomania (TTM) in young children (0-3 years old) generally has been considered to be a benign habit that is clinically distinct from the TTM seen in older children and adults. However, early childhood TTM can be an impairing pathological disorder that merits formal intervention. The present article reviews the extant literature on TTM in young children, highlighting the limited available phenomenological data. We discuss a behavioral approach to conceptualization and treatment, highlighting core intervention strategies in three early childhood TTM cases seen in our clinic. We conclude by discussing areas in need of further empirical attention.
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http://dx.doi.org/10.1002/imhj.21317DOI Listing
March 2012

Compulsive hoarding in children.

J Clin Psychol 2011 May 4;67(5):507-16. Epub 2011 Mar 4.

Department of Pediatrics, University of South Florida, 800 6th Street, South, Box 7523, St. Petersburg, FL 33701, USA.

This article discusses the nature and treatment of compulsive hoarding among children. We summarize the phenomenology of compulsive hoarding, including its clinical presentation, comorbidity with varied mental disorders, and associated impairment. The limited data on treatment outcome are presented along with a behavioral framework that we utilized to treat youth who hoard. Our approach is highlighted in the context of a case illustration of an 11-year-old girl suffering from compulsive hoarding and several comorbid mental health disorders. We conclude with recommendations for clinical work with this challenging and neglected population.
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http://dx.doi.org/10.1002/jclp.20794DOI Listing
May 2011

The Leyton Obsessional Inventory-Child Version Survey Form does not demonstrate adequate psychometric properties in American youth with pediatric obsessive-compulsive disorder.

J Anxiety Disord 2011 May 2;25(4):574-8. Epub 2011 Feb 2.

Department of Pediatrics, University of South Florida College of Medicine, USA.

The psychometric properties of the Leyton Obsessional Inventory-Child Version Survey Form (LOI-CV Survey Form) and the Short Leyton Obsessional Inventory-Child Version Survey Form (Short LOI-CV Survey Form) were examined in a clinical sample of 50 children and adolescents with obsessive-compulsive disorder (OCD). The internal consistency of the LOI-CV and Short LOI-CV Survey Forms were acceptable and poor, respectively (α=.79 and .65). The LOI-CV Survey Form was significantly and moderately correlated with child-rated OCD-related impairment, but was not significantly correlated with any other measures of OCD symptom frequency or severity, OCD-related impairment, global symptom severity, child reports of anxiety and depressive symptoms, and parent reports of children's obsessive-compulsive, internalizing, and externalizing symptoms. Modest support for the cognitive-behavioral treatment sensitivity of the LOI-CV Survey Form (Cohen's d=0.98) but not the Short LOI-CV Survey Form (Cohen's d=0.09) was demonstrated. Diagnostic sensitivity was poor for the LOI-CV Survey Form at both pre- (0.14) and post-treatment (0.06). Overall, these results suggest that the psychometric properties of the LOI-CV and Short LOI-CV Survey Forms are not adequate for use as a screening instrument or in assessing symptom severity in pediatric OCD.
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http://dx.doi.org/10.1016/j.janxdis.2011.01.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808992PMC
May 2011

The Leyton Obsessional Inventory-Child Version Survey Form does not demonstrate adequate psychometric properties in American youth with pediatric obsessive-compulsive disorder.

J Anxiety Disord 2011 May 2;25(4):574-8. Epub 2011 Feb 2.

Department of Pediatrics, University of South Florida College of Medicine, USA.

The psychometric properties of the Leyton Obsessional Inventory-Child Version Survey Form (LOI-CV Survey Form) and the Short Leyton Obsessional Inventory-Child Version Survey Form (Short LOI-CV Survey Form) were examined in a clinical sample of 50 children and adolescents with obsessive-compulsive disorder (OCD). The internal consistency of the LOI-CV and Short LOI-CV Survey Forms were acceptable and poor, respectively (α=.79 and .65). The LOI-CV Survey Form was significantly and moderately correlated with child-rated OCD-related impairment, but was not significantly correlated with any other measures of OCD symptom frequency or severity, OCD-related impairment, global symptom severity, child reports of anxiety and depressive symptoms, and parent reports of children's obsessive-compulsive, internalizing, and externalizing symptoms. Modest support for the cognitive-behavioral treatment sensitivity of the LOI-CV Survey Form (Cohen's d=0.98) but not the Short LOI-CV Survey Form (Cohen's d=0.09) was demonstrated. Diagnostic sensitivity was poor for the LOI-CV Survey Form at both pre- (0.14) and post-treatment (0.06). Overall, these results suggest that the psychometric properties of the LOI-CV and Short LOI-CV Survey Forms are not adequate for use as a screening instrument or in assessing symptom severity in pediatric OCD.
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http://dx.doi.org/10.1016/j.janxdis.2011.01.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808992PMC
May 2011

The Leyton Obsessional Inventory-Child Version Survey Form does not demonstrate adequate psychometric properties in American youth with pediatric obsessive-compulsive disorder.

J Anxiety Disord 2011 May 2;25(4):574-8. Epub 2011 Feb 2.

Department of Pediatrics, University of South Florida College of Medicine, USA.

The psychometric properties of the Leyton Obsessional Inventory-Child Version Survey Form (LOI-CV Survey Form) and the Short Leyton Obsessional Inventory-Child Version Survey Form (Short LOI-CV Survey Form) were examined in a clinical sample of 50 children and adolescents with obsessive-compulsive disorder (OCD). The internal consistency of the LOI-CV and Short LOI-CV Survey Forms were acceptable and poor, respectively (α=.79 and .65). The LOI-CV Survey Form was significantly and moderately correlated with child-rated OCD-related impairment, but was not significantly correlated with any other measures of OCD symptom frequency or severity, OCD-related impairment, global symptom severity, child reports of anxiety and depressive symptoms, and parent reports of children's obsessive-compulsive, internalizing, and externalizing symptoms. Modest support for the cognitive-behavioral treatment sensitivity of the LOI-CV Survey Form (Cohen's d=0.98) but not the Short LOI-CV Survey Form (Cohen's d=0.09) was demonstrated. Diagnostic sensitivity was poor for the LOI-CV Survey Form at both pre- (0.14) and post-treatment (0.06). Overall, these results suggest that the psychometric properties of the LOI-CV and Short LOI-CV Survey Forms are not adequate for use as a screening instrument or in assessing symptom severity in pediatric OCD.
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http://dx.doi.org/10.1016/j.janxdis.2011.01.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808992PMC
May 2011

Factors associated with extended length of stay for patients presenting to an urban psychiatric emergency service: a case-control study.

J Behav Health Serv Res 2009 Jul 17;36(3):300-8. Epub 2008 Dec 17.

Massachusetts General Hospital, Freedom Trail Clinic, Boston, MA, USA.

This study assessed factors associated with extended length of stay (ELOS) for patients presenting to a psychiatric emergency service (PES). Two hundred six subjects with a length of stay of 24 h or longer were compared with time-matched controls (patients that presented directly after the ELOS patient). Binary logistic regression was used to identify risk factors for ELOS. ELOS was associated with suicidal ideation, disposition to an inpatient unit, homicidal ideation, lack of insurance, homelessness, male gender, past history of psychiatric hospitalization, diagnosis of substance abuse, significant psychiatric co-morbidity (represented by three or more Axis I diagnoses), and diagnosis of a psychotic disorder. Lack of insurance, suicidal ideation, disposition to inpatient unit, and homicidal ideation all made nonredundant contributions to predicting stays of 24 h or longer.
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http://dx.doi.org/10.1007/s11414-008-9160-0DOI Listing
July 2009

Access to health care for persons with disabilities in Rhode Island: results from the Primary Care Practitioner Survey.

Med Health R I 2004 May;87(5):139-41

Disability & Health Program/HEALTH, Rhode Island Department of Health, USA.

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May 2004

Child disability and mothers' tubal sterilization.

Perspect Sex Reprod Health 2003 May-Jun;35(3):138-43

Department of Sociology, Brown University, Providence, USA.

Context: The needs of children with disability can be substantial, leading some parents to consider contraceptive sterilization to prevent additional births.

Methods: Matched records from the 1993 National Health Interview Survey and the 1995 National Survey of Family Growth were used to investigate the relationship between child disability and mothers' sterilization. Data included the birth records of 8,711 children, information on older children in the household, and the mothers' background and reproductive characteristics. Logistic and Cox regression models were used to estimate the effect of the birth of a child with a disability on the risk of mothers' sterilization.

Results: The birth of a child with disability has no effect on the likelihood that a mother will undergo sterilization within the next month; however, women who have an older child with severe disability are more likely than those whose older children are nondisabled to undergo sterilization within a month after the birth of another child (odds ratio, 2.6). Severe disability in a newborn significantly increases the risk of sterilization 1-36 months after birth (risk ratio, 1.7); severe disability among older children also appears to increase the risk of sterilization 1-36 months after birth (1.5), although this result was only marginally significant.

Conclusions: Women often respond to the birth of children with disabilities by changing their fertility plans, although usually not immediately unless they have older children with severe disability. These findings are consistent with parents'desire to have a nondisabled child and with their need to care for an exceptional child by forgoing additional births.
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http://dx.doi.org/10.1363/3513803DOI Listing
October 2003