Behavioral Medicine Commons^™

Effects Of A Preventive Mental Health Curriculum Embedded Into A Scholarly Gaming Course On Adolescent Self-Esteem: Prospective Matched Pairs Experiment., Christopher Jenson, Sharon Fitzgerald Wolff, Libby Milkovich

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Positive self-esteem predicts happiness and well-being and serves as a protective factor for favorable mental health. Scholarly gaming within the school setting may serve as a channel to deliver a mental health curriculum designed to improve self-esteem.

OBJECTIVE: This study aims to evaluate the impact of a scholarly gaming curriculum with and without an embedded preventive mental health curriculum, Mental Health Moments (MHM), on adolescents' self-esteem.

METHODS: The scholarly gaming curriculum and MHM were developed by 3 educators and a school-based health intervention expert. The scholarly gaming curriculum aligned with academic guidelines from the International Society for Technology Education, …

Hold Off That Olanzapine! The Development Of Neuroleptic Malignant Syndrome In A Dehydrated Pediatric Patient., Maryam Tariq, Danielle N. Wentzel, Joshua B. Beggs

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Barriers To The Diagnosis, Care, And Management Of Pediatric Patients With Ehlers-Danlos Syndrome In The United States: A Qualitative Analysis., William R. Black, Lora L. Black, Jordan T. Jones

Manuscripts, Articles, Book Chapters and Other Papers

Objectives: Ehlers-Danlos Syndromes (EDS) are a family of heritable connective tissue diseases. Primary practitioners are capable of diagnosing and managing EDS; however, few are knowledgeable and comfortable enough to see patients with EDS, resulting in delays in diagnosis and care. This study explores the barriers physicians experience with diagnosing, managing, and caring for patients with EDS, and potential resolutions to those barriers. Methods: As part of a larger online study, providers (n = 107) in the United States were asked to specify "What information would improve (their) comfort" in diagnosing, caring for, and managing EDS via open-ended questions. Results …

Pharmacogenetic Testing In Patients With Autism Spectrum Disorder Evaluated In A Precision Medicine Clinic., Rachel Goodson, Jennifer Wagner, Tracy L. Sandritter, Vincent S. Staggs, Sarah E. Soden, Cy Nadler

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: This study investigated outcomes of pharmacogenetic testing of youth with autism spectrum disorder (ASD) referred to a precision medicine clinic and explored associations between patient characteristics and pharmacogenomic testing results.

METHODS: Records for patients diagnosed with ASD and subsequently referred to a pediatric hospital's precision medicine clinic between July 1, 2010, and June 30, 2020, were reviewed. Pharmacogenetic testing results were abstracted focusing on CYP2D6 and CYP2C19. In addition, we compiled counts of patients' co-occurring diagnoses, histories of adverse drug reactions (ADRs), previously trialed ineffective medications, and previous psychiatric medication changes. Logistic regression models were fit to examine CYP2C19 …

The Effects Of Prenatal Buprenorphine Exposure On The Neurobehavioral Development Of The Child, Zaineb Zubair, Maryam Zubair, Juan Alonso, Abdullah Zubair

Rowan-Virtua Research Day

Background: Current guidelines for pregnant women with substance use disorder advise prenatal maintenance of opioid agonist therapy with either buprenorphine or methadone. Despite this rise in prenatal opioid agonist therapy, little is known about the effect of prenatal buprenorphine on the neurobehavioral development of the child. This poses the question: does buprenorphine have a long-lasting effect on the central and peripheral nervous system development and behavior of children who were exposed prenatally?

Methods: A comprehensive literature review identified articles relating to prenatal buprenorphine and neurobehavioral outcomes. Article searches were conducted on PubMed and Dynamed. Publications from 2002 through November 2021 …

Residential Racial Segregation And Neighborhood Adversity: Associations With Hemoglobin A1c In Adolescents With Type 1 Diabetes, Zechariah Jean, April Carcone, Deborah Ellis

Medical Student Research Symposium

Black adolescents with Type 1 Diabetes (T1D) are at increased risk for disparities in health outcomes. More research is necessary on the effects of neighborhood characteristics such as residential racial segregation (RRS) and neighborhood adversity on health.

149 Black youth with T1D were recruited from seven pediatric diabetes clinics in Detroit and Chicago to participate in a clinical trial to improve diabetes management. RRS was calculated at the census block group level based on US census data using Location Quotients. LQs represented the ratio of patients to total population in the block group compared to the same ratio in the …

Risk And Resilient Functioning Of Families Of Children With Cancer During The Covid-19 Pandemic., Renee Gilbert, Carolyn R Bates, Devanshi Khetawat, Meredith Dreyer Gillette, Rachel Moore

Manuscripts, Articles, Book Chapters and Other Papers

Previous literature highlights the impact of COVID-19 on family functioning. Less is known about the impact of the pandemic on families of pediatric cancer patients. In order to determine universal and unique risk and resilience factors of these families during the pandemic, a qualitative analysis was conducted on families currently receiving cancer treatment at a Midwestern hospital. Results of the data analysis depict ways in which these families have been impacted by and have adapted to COVID-19. These findings suggest that families of pediatric cancer patients have unique experiences in the context of COVID-19, in addition to universal experiences outlined …

Gender Dysphoria In Adolescents With Ehlers-Danlos Syndrome., Jordan T. Jones, William R. Black, Christine Moser, Eric T. Rush, Lindsey Malloy-Walton

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: Ehlers-Danlos Syndrome represents a family of heritable connective tissue disorders that include joint hypermobility, tissue fragility, and skin hyperextensibility. Ehlers-Danlos Syndrome presents with clinical sequela across multiple body systems that require multidisciplinary care. Little is known about adolescents with Ehlers-Danlos Syndrome who are transgender and gender diverse. To date, there have been no reports of transgender and gender diverse youth in pediatric patients with Ehlers-Danlos Syndrome. The objective of this study was to characterize transgender and gender diverse adolescents with Ehlers-Danlos Syndrome seen in a pediatric multidisciplinary specialty clinic.

METHODS: A retrospective chart review was performed and it was …

Psychosocial Considerations For The Child With Rare Disease: A Review With Recommendations And Calls To Action., Leslee Belzer, Margaret Wright, Emily J. Goodwin, Mehar N. Singh, Brian S. Carter

Manuscripts, Articles, Book Chapters and Other Papers

Rare diseases (RD) affect children, adolescents, and their families infrequently, but with a significant impact. The diagnostic odyssey undertaken as part of having a child with RD is immense and carries with it practical, emotional, relational, and contextual issues that are not well understood. Children with RD often have chronic and complex medical conditions requiring a complicated milieu of care by numerous clinical caregivers. They may feel isolated and may feel stigmas in settings of education, employment, and the workplace, or a lack a social support or understanding. Some parents report facing similar loneliness amidst a veritable medicalization of their …

Barriers And Facilitators To Precision Medicine For Black Children With Autism Spectrum Disorder, Rachel Goodson

Research Days

Background: The field of pharmacogenomics (identification of biomarkers regarding drug metabolism and activity to inform precision prescribing) is rapidly advancing for individuals on the autism spectrum, but these advancements are not equitably benefiting all communities. Specifically, utilization data suggests that Black families may be less likely to have access to clinical precision medicine supports. Moreover, historic underrepresentation of African-descended populations in genetic reference samples means that emerging research on precision medicine will retain these biases and perpetuate disparities in downstream clinical benefit. These issues are especially relevant to the autism community, who are more likely to receive psychotropic medications that …

Behavioral Parent Training For Adhd And Sleep: A Dream Pair, Whitney Rolling

Research Days

Background: Estimates for children with attention-deficit/hyperactivity disorder (ADHD) and comorbid sleep disorders range from 25-75% (4,5,10). Among childhood sleep disorders, behavioral insomnia is one of the most common, with the treatment of choice being behavioral parent training (BPT) (4). BPT therefore is a common treatment element for both sleep disturbance and ADHD and presents a unique opportunity for more holistic pediatric care.

Objectives/Goal: Our objective was to implement and evaluate a behavioral sleep intervention in an ADHD behavioral parent training (BPT) program. Goals of the intervention were to decrease behavioral sleep symptoms, increase sleep duration, and decrease ADHD impairment.

Methods/Design: …

Understanding Both Sides Of The Blood Draw: The Experience Of The Pediatric Patient And The Phlebotomist, Julie R. Piazza, Sandra Merkel, Brooke Rothberg, Joan Gargaro, Kristin Kullgren

Patient Experience Journal

A phlebotomist’s words and actions play a crucial role in success of a blood draw and in providing a supportive patient experience. This study examined use of comfort measures during a pediatric blood draw. The phlebotomist’s use of soft words, positioning, distraction, coaching/support were observed with sixty children between 3-14 years of age during a blood draw. The level of fear /anxiety before and during the blood draw was recorded by an RA. The child’s level of fear/anxiety was observed and reported by the parent/caregiver after the procedure. Comfort measures provided by phlebotomists, the parent/caregiver’s report of their child’s usual …

Sleep Patterns & Sleep Problems Vary By Age In Children With Autism, Charles F Reynolds, Matthew Siegel, Briana Taylor

Costas T. Lambrew Research Retreat 2022

Adolescence is a time of increased vulnerability for youth with autism spectrum disorder (ASD).1 • In non-ASD youth, sleep and circadian rhythms demonstrate marked changes during adolescence that delay the biological propensity for sleep.2 • In combination with early school start times, these agerelated changes in sleep and circadian rhythms result in insufficient sleep duration, circadian misalignment, daytime sleepiness, and numerous behavioral and psychiatric problems.3 • Age-related changes in sleep and circadian rhythms, and their relevance for behavioral and psychiatric health have not been examined in youth with ASD.

Self-Reported Sexual Behavior In A Pediatric Gender Clinic Sample, Mirae J. Fornander, Anna Egan, Christine Moser

Posters

Introduction Previous studies of transgender/gender diverse (TGD) youth indicate differences in rates of sexual behaviors between TGD youth and their cisgender peers. However, few studies have reported the sexual behavior and preferences of TGD youth in a large clinic sample, and no studies, to our knowledge, have utilized questionnaires that do not assume the sex or gender of one’s sexual partner. The current study aims to explore the self-reported sexual behavior of TGD youth presenting for gender-affirming medical care. Methods Retrospective chart review of 589 patients (ages 12-22, M= 15.92, SD= 1.54; 72.9% assigned female sex at birth (SAB)) presenting …

Screening For Adverse Childhood Experiences In Primary Care, Michelle Mckay, Logan Shetlar

View All Washington/Montana GME

Presented at the 2022 Virtual Northwest Medical Research Symposium

Eating Disorders In Adolescents: Facts And Recommendations For The Oral Health Care Team, Catherine A. Miller Md, James R. Boynton Dds, Ms, Terrill Bravender Md, Mph

The Journal of the Michigan Dental Association

Eating disorders typically begin during the adolescent years. These disorders are a spectrum of thoughts and behaviors related to food, weight and exercise that lead to significant psychological and physical morbidity. Medical complications of eating disorders are common and can be life-threatening. Dental providers can play an important role in care by recognizing oral signs and symptoms associated with eating disorders, giving advice on mitigating these issues, and helping patients and families connect with appropriate care. In this article, we provide key information about eating disorders, the complications including oral health issues, and advice for dental providers regarding care and …

A Pathway For Inclusive Innovation In Pediatric Mental Health: Prevention And Intervention Using Technology, Kate Corinne Bennett

DSW Capstone Projects

It is no secret that access to quality healthcare is difficult for citizens to achieve in the United States. Racism, discrimination, and oppression further exist at the root of compounding social problems, including limits in minority access to mental health services. The COVID-19 pandemic has also exacerbated mental health problems for young children, especially those who are already underserved and at risk. For these reasons, it is imperative that the social work profession emphasizes innovative approaches to equitable treatment access, including a focus on early intervention and the use of technology. Product one of this capstone engages a systematic review …

Conditions That Mimic Attention Deficit Hyperactivity Disorder In A Pediatric Population: A Diagnostic Guide For Primary Care Providers, Elena Schatell

Capstone Showcase

This article outlines common neurobiological, developmental, psychological, and other medical diagnoses and conditions that symptomatically mimic attention deficit hyperactivity disorder (ADHD) in the pediatric population. Many of these disorders are comorbid with ADHD, but they may also be misdiagnosed as ADHD. Due to the similarity in presentation, these conditions must be included when formulating a differential diagnosis. Accurately diagnosing a child with ADHD requires a thorough evaluation and work up to rule out diagnoses on the differential.

The Similarities And Differences Between Glomerular Vs. Non-Glomerular Diagnoses On Intelligence And Executive Functions In Pediatric Chronic Kidney Disease: A Brief Report., Stephen R. Hooper, Rebecca J. Johnson, Marc Lande, Matthew Matheson, Shlomo Shinnar, Amy J. Kogon, Lyndsay Harshman, Joann Spinale, Arlene C. Gerson, Bradley A. Warady, Susan L. Furth

Manuscripts, Articles, Book Chapters and Other Papers

Pediatric chronic kidney disease (CKD) appears to be a heterogeneous group of conditions, but this heterogeneity has not been explored with respect to its impact on neurocognitive functioning. This study investigated the neurocognitive functioning of those with glomerular (G) vs. non-glomerular (NG) diagnoses. Data from the North American CKiD Study were employed and the current study included 1,003 children and adolescents with mild to moderate CKD. The G Group included 260 participants (median age = 14.7 years) and the NG Group included 743 individuals (median age = 9.0 years). Neurocognitive measures assessed IQ, inhibitory control, attention regulation, problem solving, working …

The Ecology Of Mental Health And The Impact Of Barriers On Mental Health Service Utilization, Alisha Aggarwal

Theses & Dissertations

Mental health has emerged as a major public health concern in recent times with several disparities and barriers related to adequate health service utilization. Different age groups experience diverse symptoms and face distinct barriers in accessing and utilizing healthcare. Policies like Mental Health Parity and Addiction Equity Act and the Patient Protection and Affordable Care Act were launched to improve insurance coverage and delivery of mental health services. However, a large gap of unmet needs exists for adequate mental health service utilization in the country. This dissertation aims to describe the financial and non-financial barriers to mental health service utilization …

Conference Proceedings: Select Abstracts Presented At 2021 Advocate Aurora Health Scientific Day

Journal of Patient-Centered Research and Reviews

Abstracts published within this supplement were presented at the 47th annual Advocate Aurora Health Scientific Day, held virtually on May 26, 2021. This research symposium provides a forum for disseminating results from studies conducted by faculty, fellows, residents, and other allied health professionals associated with Midwest-based health system Advocate Aurora Health, which publishes the Journal of Patient-Centered Research and Reviews.

Pharmacogenetic Testing In Patients With Autism Spectrum Disorder Evaluated In A Pediatric Precision Medicine Clinic, Rachel Goodson, Cy Nadler, Jennifer A. Wagner, Sarah Soden, Sarah Nyp, Tracy L. Sandritter

Posters

Pharmacogenetic Testing In Patients with Autism Spectrum Disorder Evaluated in a Pediatric Precision Medicine Clinic Purpose The purpose of this study is to investigate the demographic and presentation profiles of children with autism spectrum disorder (ASD) who present for evaluation in a pediatric precision medicine clinic. Methods: This retrospective, observational cohort study utilized data extracted from a pediatric precision medicine clinic database between 2010 and 2021 with recorded ICD9/10 codes of Autism Spectrum Disorder, Autistic Disorder, Pervasive Developmental Disorder, or Asperger’s Syndrome. Extracted variables included demographic data, presenting medication regimens and concerns to be addressed by precision medicine. Results: A …

Identifying The Content And Context Of Pain Within Paediatric Rheumatology Healthcare Professional Curricula In The Uk: A Summative Content Analysis., Rebecca Rachael Lee, Janet E. Mcdonagh, Mark Connelly, Sarah Peters, Lis Cordingley

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The curriculum for professionals working in paediatric rheumatology should include pain but it is unclear to what extent this currently occurs. The aim of this study was to identify pain-related curriculum content and the context in which pain is presented in educational and training documentation for healthcare professionals in this clinical speciality.

METHODS: Core curricula documents from UK based professional organisations were identified in partnership with healthcare professionals. Documents were analysed using a summative content analysis approach. Key pain terms were quantified and weighted frequencies were used to explore narrative pain themes. Latent content was interpreted qualitatively to explore …

Pharmacogenetic Testing In Patients With Autism Spectrum Disorder Evaluated In The Children’S Mercy Hospital Goldiloks© Clinic, Rachel Goodson

Research Days

Background: Autism Spectrum Disorder (ASD) affects 1 in 54 children in the United States. Children with ASD are more likely to be diagnosed with co-occurring mental health disorders. There is currently little research guiding medication choice and dosing in patients with ASD. Children with ASD are at increased risk for reduced clinical response and adverse reaction (including due to polypharmacy). Pharmacogenomics is an approach for medication decision making that leverages an individual’s genetic information and clinical presentation to make informed choices, but no studies have specifically investigated the outcomes of PGX for patients with ASD. Understanding the clinical and genetic …

Impact Of Early Tracheostomy On Neurodevelopmental Outcome Of Infants With Severe Bronchopulmonary Dysplasia Exposed To Postnatal Steroids, Amjad Taha, Gangaram Akangire, Janelle R. Noel-Macdonnell Phd, Tiffany Willis, Winston M. Manimtim

Posters

Background: BPD is associated with neurodevelopmental impairment. Tracheostomy is performed in 5-12% of severe BPD for prolonged ventilation. There is evidence that chronic ventilation with tracheostomy in severe BPD may facilitate neurodevelopment and lead to improved outcome. However, there is no consensus on the optimal timing of tracheostomy. A large multicenter study of infants with tracheostomy performed at <120 days of life had better neurodevelopmental outcomes at 18-22 months of age. Use of steroids postnatally to ameliorate the severity of BPD had been controversial due to its negative effect on neurodevelopment. To date, no data has specifically evaluated the impact of early tracheostomy on neurodevelopmental outcome of infants with severe BPD who are exposed to postnatal steroids.


Objective: To compare cognitive, language and motor scores among 3 groups of severe BPD infants who received early vs late vs no tracheostomy. Secondly, evaluate if postnatal steroids had an additive negative effect on neurodevelopmental outcomes.


Design/Methods: IRB approved retrospective cohort of …

Rates Of Positive Suicide Screens Among The Emergency, Inpatient And Outpatient Clinics At A Tertiary Care Children’S Hospital, Fajar Raza, Hung-Wen Yeh, John Lantos, Mark Connelly, Shayla Sullivant

Posters

Background: Prior research has suggested that rates and acuity of suicidality are elevated among patients seen in EDs and in certain clinics. However, the occurrence and severity of suicide risk has been rarely studied in the pediatric clinic populations due in part to unsystematic screening. We examined suicidality across different pediatric clinical care settings based on data from our newly implemented hospital-wide suicide risk screening program.


Objective: To determine a) which patient populations presented with the highest rates of suicidality; and b) the percentage of patients who had current thoughts of suicide and were thus deemed “acute.”


Design/Methods: We conducted …

Registration Of Newly Diagnosed Children With Autism Spectrum Disorder And Developmental Disabilities At State Regional Offices, Whitney Rolling, Rachel Goodson

Posters

• In fiscal year 2020, 39,220 Missouri residents utilized developmental disability services through the Missouri Department of Mental Health.1 • Developmental disability services account for 53% of Missouri’s state mental health funding (about 1.3 billion dollars annually).

• Physicians and psychologists are required for making eligible diagnoses, but registration for state support is patient dependent and can be perceived as an extensive paperwork process.

• Project Goal: Measure and increase the percentage of eligible patients registered for their state mental health resource offices.

Gender Dysphoria, General Well-Being, Bmi, And Weight-Related Behaviors Among Adolescent Transgender Males, Timothy A. Roberts, Anna Egan, Mirae J. Fornander, Christine Moser, Michaela Voss

Posters

Background: Gender dysphoria is associated body-dissatisfaction, abnormal weight and weight-related behaviors.


Objective: Describe the association of gender dysphoria severity and general well-being with Body Mass Index (BMI) and weight related behaviors among transgender males.


Design/Methods: Retrospective review of 118 transgender male patients presenting to initiate gender-affirming medical care in 2017-2020. Gender dysphoria confirmed by an experienced mental health provider. We measured parent and patient reports of patient general well-being [Pediatric Quality of Life Inventory (PedsQL) 4.0 General Well-Being Scale], severity of gender dysphoria [Transgender Congruence Scale (TCS) [n=47 for TCS] and Gender Identity/Gender Dysphoria Questionnaire (GIDYQ-AA)], weight related intentions, and …

Bmi And Associated Variables In A Pediatric Gender Clinic Sample, Mirae J. Fornander, Christine Moser, Anna Egan, Timothy A. Roberts

Presentations

Background: Studies of transgender/gender diverse (TGD) youth indicate a high prevalence of overweight/obesity and concern for unhealthy weight control behavior.

Objective: Describe BMI and the association of medication use, well-being, and recreational activities in treatment-naïve pediatric TGD patients.

Design/Methods: Chart review of 302 patients (age 3-19, 73.5% sex assigned at birth (SAB) female; 85.8% white) from 2017-2020. BMI was calculated by age and SAB using CDC growth charts. Parents reported medication use; parent and self-reported Pediatric Quality of Life (PEDS-QL) Well-Being and activities were surveyed electronically.

Results: By BMI category, 3.3% were underweight (BMI<5%); 49.4% were >85% and 29.5% fell >95%. Overweight …

The Effect Of Covid-19 On The Detection And Prevalence Of Suicidality In Adolescents, John Lantos, Hung-Wen Yeh, Fajar Raza, Mark Connelly, Shayla Sullivant

Presentations

Background: The COVID-19 pandemic saw changes to the delivery of health services and concerns about psychological morbidity not directly related to COVID infection. We analyzed the effects of the pandemic on our hospital’s program to screen adolescents for suicidality.

Objective: To determine the effect of the COVID-19 pandemic on 1) a hospital-wide screening program for suicidality in teens; and 2) the prevalence of positive screens for suicidality.

Design/Methods: Our study population was all patients > 12yo seen as inpatients or in the ED or clinics at a children’s hospital in Apr-June in 2019 (T1) and 2020 (T2). Eligible pts were screened …