The role of melatonin in the effective attainment of electroencephalograms in children in a Sub-Saharan setting

Rationale: The paucity of access to electroencephalograms (EEGs) in sub-Saharan Africa results in a high patient load attending the few centres with neurophysiology units. Sleep state for EEGs performed on children improves yield and reduces artefact. Melatonin induces “natural sleep” without the risk of airway compromise. This study evaluated the effectiveness of oral melatonin in attainment of useful electroencephalograms in South African children. Methods: Consecutive children booked for routine EEG who were either unable to cooperate or were referred for sleep EEG received oral melatonin (3mg 15kg) (September 2013-March 2014). Comparison was made to a retrospective control group who received the previous sleep protocol agent, chloral hydrate. Outcome measures were the proportion of children who achieved sleep, useful EEG study data, sleep latency and duration, presence and level of artifacts and presence of recorded EEG study abnormalities. Results: 173 children were recruited, 88 (51%) male, median age 4 years 9 months (interquartile range of 2 years 2 months – 7 years 6 months). 87% of the children achieved stage 2 sleep and were deemed to have successfully entered sleep state. The median sleep latency was 44.5 minutes and the duration of sleep was 25 minutes (range 18.5 – 29 minutes). Children showed no signs of post-sedation irritability or persistent drowsiness. They were awoken and were immediately able to go home. In the melatonin group there were no adverse events, and no child needed their study deferred due to inter-current illnesses. All children administered melatonin cooperated and permitted a successful EEG recording with useful records even if sleep was not achieved. Sedation with melatonin was less successful (74% compared to 88%) in children with developmental and behavioural problems (χ 2 = 6.18, P= 0.046), they also had higher rate of artifacts (χ 2 = 5.83, P=0.05). 33.5% of the study group children (n=58) had abnormal EEG studies. These outcomes were comparable to a historical cohort of age equivalent children who were sedated with chloral hydrate (45.5%) (χ 2 = 1.22, P= 1.27). 79% that received melatonin compared with 86% of those that were sedated with chloral hydrate had artifacts (χ 2 = 0.63, P= 0.42) Conclusion: Melatonin is effective and safe in inducing sleep for EEG recording in our setting

Exploring risk factors for suicidality in adolescents with autism spectrum disorders

Background: Suicidality, suicidal ideation and suicidal behaviour, is a significant health concern for adolescents with Autism Spectrum Disorders (ASD). Depression and Irritability have been identified as risk factors for suicidality in autistic adolescents. Autistic youth may have higher vulnerability to these factors than typically developing adolescents. No study has compared the relationship between suicidality and different depressive phenotypes, nor used a UK clinical sample. This study aimed depression, irritability, and specific depressive phenotypes as risk factors for suicidality in adolescents with ASD within a UK clinical population. Method: This clinical cohort study used archival data extracted from an electronic mental health records database. The sample consisted of 1314 adolescents (13+ years) who received an ICD-10 ASD diagnosis between 2008 and 2013. Outcome measure was suicidality, with exposure variables of depression, irritability, and phenotypes (depression with comorbid irritability (DWI), depression without comorbid irritability (DNI), irritability without comorbid depression (IND)). Results: Cross-sectional analysis found depression to be associated with higher likelihood of suicidality. Irritability was found to be associated with higher likelihood of suicidality, even after controlling for depression. DWI was a more significant predictor of suicidality than IND, but no different from DNI. Psychosis, being female, antidepressant use, and caregiver mental health difficulties were also positively associated with suicidality, but significantly less likely in individuals diagnosed with ID. Conclusions: Results indicate multiple characteristics of adolescents with ASD at high-risk of suicidality. Early identification of high-risk individuals could help deliver timely intervention, potentially reducing both incidence and progression of suicidality

Doctor of Philosophy

dissertationThe current study evaluated the efficacy of a parent training treatment package using errorless compliance training to increase compliance in preschoolers with autism spectrum disorders (ASD). The study included three parent-child dyads that received a single parent training session using video modeling and direct instruction. A nonconcurrent multiple baseline design was used to evaluate what effects the treatment package had on increasing compliance rates in preschool-aged participants. The compliance rates of participants were coded during parent-led compliance sessions once per week to determine treatment efficacy. Parents also completed social-behavioral checklists pre- and post treatment to determine changes in parenting stress and externalizing behaviors in children. Parent fidelity with the treatment components was evaluated via telehealth during each phase of the study and at the end of the program. Effect size was calculated along with the use of visual analysis to examine the efficacy of the parent training treatment package

Physical Activity and Mood in Bipolar Disorder

Systematic review Background: Bipolar disorder is associated with a higher rate of physical health problems and lower levels of physical activity than other clinical and general populations. Despite the potential benefits of physical activity to people with bipolar disorder, little research has been published around this and no recent review of this topic is available. Due to the clinical utility of summarising the available research evidence on this topic, this review aimed to answer the question “Is physical activity associated with manic and depressive symptoms in people with bipolar disorder?”. Methods: Seven electronic databases were searched using a range of search terms to reflect physical activity and bipolar disorder variables. Results: Ten studies were identified that reported associations between physical activity and mood symptoms of bipolar disorder. There were inconsistent findings on the relationship between physical activity and mood, in particular with relation to manic symptoms, with reports of physical activity being both helpful and harmful to manic symptoms. Findings were more consistent with regards to the association between physical activity and depressive symptoms, with most showing that higher levels of physical activity are associated with lower depressive symptoms. Limitations: Many studies had small sample sizes and very few manipulated physical activity and included a control group. Measures and diagnosis method were heterogeneous. Four studies lacked a direct measure of manic symptoms. Conclusions: Results showed inconsistent findings with regards to the relationship between physical activity and mood symptoms and further research is needed to inform any guidelines developed for this client group. Empirical paper: Background: Despite the published evidence for the benefits of physical activity on mood in the general population and in people with mental illness, there is a lack of research into the associations between physical activity and mood in people with bipolar disorder. The current study therefore aimed to investigate the relationship between symptoms of mania and depression and different intensities, regularity, and total duration of physical activity per day and across the week. Methods: People with a diagnosis of bipolar disorder (N = 29) completed daily diaries on physical activity and manic and depressive symptoms over 14 days. Analysis included multilevel modelling, t-tests and correlation analysis. Results: No association was found between manic symptoms and physical activity, either at the within- or the between-person level. An association was found at the within-person level between higher duration of physical activity and lower depression symptoms, however no association was found at the between-person level. Limitations: The small sample size was adequate only to detect large-sized effects for between-person hypotheses. Participants were highly active and may not be representative of the wider BD population. Physical activity levels were assessed via self-report. Conclusions: The relationship between physical activity and manic symptoms in BD remains inconclusive, but a significant within-person association indicates that physical activity may reduce depressive symptoms in the short term. Given previous research on physical activity and manic symptoms, people with BD and professionals working with them may need to remain cautious, modifying any PA engagement depending on mood state

IT’S ALL THE RAGE: AN ANIMATED APPROACH TO SCREENING FOR POSTPARTUM DEPRESSION

Postpartum depression presents a complication for mothers which can, in some cases, be severe and even life-threatening. Instruments commonly used to screen for this psychological condition have been challenged by an extensive body of literature, with many mothers being unidentified and even untreated for their symptoms. The presented research introduces a newly developed screening instrument for detecting probable postpartum depression using text-free scenario-based animations, based on the lived experience of the condition as qualified by empirical research and the existing body of literature. Developed items were controlled for quality via Think Aloud Protocol and alignment studies with subject matter experts (mothers and clinicians). A consequently revised version of a scale was piloted within the United States (N=433) using an online survey platform and was tested for psychometric quality. Overall, the presented studies show promise for this newly developed tool and provide ample reason to believe that using animated scenario-based items to measure the construct of postpartum depression in a screening context is a viable option for practice and a method that deserves additional research. Additional research related to the practicality of this method of assessment and its potential to increase access and fairness in receiving care for mental health conditions is needed. The development of this assessment has the potential to innovate psychological screening practices and clinical assessment for patients at large. This approach to assessment, being patient-informed and technology-based, provides promise for lowering the rate of maternal suicide, creating a common language between patients and providers, and potentially expanding the field of psychological assessment by forming ways of reaching those who have been missed by limited screening tools (i.e., historically marginalized groups). By freeing instrument development from typical protocol and grounding the entire process in the lived experience, using animation introduces an innovative method of assessing which is not only feasible, but also favored by the users themselves

2016-2017

Contains information on courses and class descriptions as well as campus resources at Collin College.https://digitalcommons.collin.edu/catalogs/1028/thumbnail.jp

2015-2016

Contains information on courses and class descriptions as well as campus resources at Collin College.https://digitalcommons.collin.edu/catalogs/1027/thumbnail.jp

Emotional self-regulation of individuals with autism spectrum disorders: smartwatches for monitoring and interaction

In this paper, we analyze the needs of individuals with Autism Spectrum Disorders (ASD) to have a pervasive, feasible and non-stigmatizing form of assistance in their emotional self-regulation, in order to ease certain behavioral issues that undermine their mental health throughout their life. We argue the potential of recent widespread wearables, and more specifically smartwatches, to achieve this goal. Then, a smartwatch system that implements a wide range of self-regulation strategies and infers outburst patterns from physiological signals and movement is presented, along with an authoring tool for smartphones that is to be used by caregivers or family members to create and edit these strategies, in an adaptive way. We conducted an intensive experiment with two individuals with ASD who showed varied, representative behavioral responses to their emotional dysregulation. Both users were able to employ effective, customized emotional self-regulation strategies by means of the system, recovering from the majority of mild stress episodes and temper tantrums experienced in the nine days of experiment in their classroomThis work has been partially funded by the projects “e-Training y e-Coaching para la integración socio—laboral” (TIN2013-44586-R) and “eMadrid-CM: Investigación y Desarrollo de Tecnologías Educativas en la Comunidad de Madrid” (S2013/ICE-2715). It has been also funded by Fundación Orange during the early stages of the project “Tic-Tac-TEA: Sistema de asistencia para la autorregulación emocional en momentos de crisis para personas con TEA mediante smartwatches