Examining Mother and Father (Dis)agreement of Youth Mental Health Among Ethnically Diverse Families

Many children and adolescents in the United States experience externalizing behavior problems identified as attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder. These behavior problems cause disruptions in the youth’s socioemotional functioning and academic success. The assignment of a diagnosis from the DSM-5 is often the first step in treatment planning, because many clinics and third-party payers require a diagnosis for authorization of treatment payment. However, research has repeatedly revealed that informants differ in the information they provide regarding youth mental health. While studies have separately examined the association of youth characteristics, parent characteristics, and family characteristics and informant agreement, there is a dearth of research examining the association between these variables in mother-father agreement of ethnically diverse youth. The current study addresses this gap in a sample of 88 mother-father dyads in a clinic sample of youth evaluated for the presence of externalizing behavior problems. Pearson correlations and paired t-tests were run to examine associations and discrepancies, respectively, between mother and father reports of youth inattention, hyperactivity/impulsivity, defiance/aggression, and learning problems. Regression analyses were run to examine the impact of child age, gender, symptom severity, ethnicity, family income, and parent mental health (i.e., depressive symptoms, parenting stress) on mother-father reporting discrepancies. Overall associations between mother and father reports of youth behavior problems were positively correlated, and moderate to large in magnitude. Mother’s depression scores, mother and father parenting stress scores, and child’s symptom severity were significant predictors in some regression analyses. Child age, child ethnicity, father’s depression scores, and family income were not significant predictors in the regression analyses. Results of this research contribute to the small literature base of discrepancies in parent reports in ethnically diverse youth. It further expands upon the minimal research regarding paternal caregivers. Further, it highlights the need for mental health screening of youth’s parents during child psychological assessment to identify situations in which both parent reports may be necessary for appropriate assessment of youth mental health

Interim guidelines for the assessment and treatment of pain in children with multiple sclerosis

IntroductionPain in multiple sclerosis (MS) is common, but literature on pain in children with MS remains scarce. Pain has physical, psychological, and social implications in MS, and both comprehensive assessment and interdisciplinary management approaches are needed. We sought to develop an interdisciplinary interim guideline for the assessment and management of pain in children with MS.Methods and materialsWe convened a modified Delphi panel composed of 13 experts in pediatric and adult MS neurology, physiotherapy, pain, patient lived-experience, advanced practice nursing, psychology, physiatry, and MS research. A survey was sent to panelists for anonymous completion. The panel discussed survey themes extracted by the panel chair. The process was repeated twice.ResultsThirteen assessment and treatment recommendations were produced regarding pain in children with MS.DiscussionFuture studies will assess implementation of these pain assessment and treatment guidelines in the clinical setting

Do Mothers And Fathers Agree? Examining Interparental Ratings of Youth Externalizing Behaviors among Ethnically Diverse Families

OBJECTIVE: This study examined the association between youth, parent, and family characteristics in mother-father agreement of youth externalizing behaviors among ethnically diverse families. METHOD: Eighty-eight mother-father dyads of youth (44% Latino, 38% European-American, 17% African American) 6-16 years participated. RESULTS: Overall associations between parent\u27s reports of youth behavior problems were positively correlated. Significant predictors of parent difference scores in regression analyses included mother\u27s depression scores (negatively), mother and father parenting stress scores (positively and negatively, respectively), and child\u27s symptom severity (positively in the Inattention and Learning Problems models; negatively in the Defiance/Aggression model). CONCLUSIONS: Results highlight the need for psychosocial screening of youth\u27s parents during child psychological assessment to identify situations in which both parent reports are needed for youth assessment. Further, it contributes to the small literature base of discrepancies in parent reports in minority youth and expands upon the minimal research involving paternal caregivers

Using token economies and response cost

Publication in press

Token Economies

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Pediatric Diabetes Patients Infrequently Access Outpatient Psychology Services Following Screening and Referral: Implications for Practice

Youth with diabetes are at risk for suboptimal psychological functioning. This study evaluated the prevalence of concerns and proportion of outpatient referrals provided and completed at follow-up. Participants included 100 adolescents and young adults seen at a multidisciplinary diabetes clinic. Referrals were made to 61.2% of participants for internalizing (51.6%), externalizing (8%), diabetes-related (50%), comprehensive evaluation (17%), interpersonal (10%), and other needs (3%). At follow-up, 23.7% of those referred were enrolled in outpatient services. Pediatric psychologists offer effective mental health screening and referral. Barriers to follow-up outpatient care included transportation, organization, and stigma. Implications for improving access are discussed

Few Pediatric Diabetes Patients Access Outpatient Psychotherapy following Screening and Referral

Introduction: Adolescents and young adults (AYAs) with diabetes are at risk for suboptimal psychological functioning. This study aims to describe the prevalence of elevated depression scores, outpatient psychotherapy referrals, and individuals receiving follow-up care in a clinic with an integrated psychologist. Further, we examine whether having an integrated psychologist leads to better access to mental health services for AYA. Methods: Participants were seen in a multidisciplinary diabetes clinic from September 2016 to 2017. Assessment included a semi-structured interview and depression screener (PHQ). Families with concerns related to diabetes management were offered on-site outpatient psychotherapy, others given community referrals. Follow-up with referrals was assessed at next diabetes visit. Results: Participants included 100 ethnically diverse AYAs, 11-21 years (M=16.06±2.42; 56% female), diagnosed with type 1 (79%), type 2 (19%), or MODY (2%), with a range of glycemic control (HbA1c 5.5 to \u3e14%). PHQ scores were: no/minimal (58%), mild (26%), moderate (11%), moderately severe (3%), and severe (2%). 59% of patients were referred for outpatient psychotherapy. Referral reasons included depression, anxiety, behavioral difficulties, family conflict, and diabetes management challenges. At follow-up, only 9% were receiving services. Barriers included transportation, organization (e.g., losing referral), and stigma. Conclusions: Pediatric psychologists within integrated diabetes teams offer effective mental health screening and referrals. Almost half (42%) of AYA in our cohort had ≥5 depressive symptoms, and while 59% were referred for outpatient therapy, only 9% received these services. Despite patient access to a pediatric psychologist in clinic, a large discrepancy between referral and follow-up rates remains. This disparity highlights the importance of identifying and reducing barriers to follow-up care for AYAs with diabetes

Treatment patterns and achievement of the treat-to-target goals in a real-life rheumatoid arthritis patient cohort: data from 1317 patients

Background: Data regarding the real-life predictors of low disease activity (LDA) in rheumatoid arthritis (RA) patients are limited. Our aim was to evaluate the rate and predictors of LDA and treatment patterns in RA. Methods: This was a multicenter, prospective, RA cohort study where patients were evaluated in two different time points approximately 12 months apart. Statistical analysis was performed in order to identify predictors of LDA while patterns of disease-modifying anti-rheumatic drug [DMARDs; conventional synthetic (csDMARD) or biologic (bDMARD)] and glucocorticoid (GC) use were also recorded. Results: The total number of patients included was 1317 (79% females, mean age: 62.9 years, mean disease duration: 10.3 years). After 1 year, 57% had achieved LDA (DAS28ESR3.2), 21% initiated (among csDMARDs users) and 22% switched (among bDMARDs users) their bDMARDs. Conclusion: In a real-life RA cohort, during 1 year of follow-up, 43% of patients do not reach treatment targets while only ~20% of those with active RA started or switched their bDMARDs. Male sex, younger age, lower HAQ, body mass index and co-morbidity index were independent factors associated with LDA while use of GCs or ⩾2 bDMARDs were negative predictors. © The Author(s), 2020

Treatment patterns and achievement of the treat-to-target goals in a real-life rheumatoid arthritis patient cohort: data from 1317 patients

Background: Data regarding the real-life predictors of low disease activity (LDA) in rheumatoid arthritis (RA) patients are limited. Our aim was to evaluate the rate and predictors of LDA and treatment patterns in RA. Methods: This was a multicenter, prospective, RA cohort study where patients were evaluated in two different time points approximately 12 months apart. Statistical analysis was performed in order to identify predictors of LDA while patterns of disease-modifying anti-rheumatic drug [DMARDs; conventional synthetic (csDMARD) or biologic (bDMARD)] and glucocorticoid (GC) use were also recorded. Results: The total number of patients included was 1317 (79% females, mean age: 62.9 years, mean disease duration: 10.3 years). After 1 year, 57% had achieved LDA (DAS28ESR<3.2) while 43% did not (34%: moderate disease activity: DAS28ESR ⩾3.2 to <5.1, 9%: high disease activity, DAS28ESR ⩾5.1). By multivariate analysis, male sex was positively associated with LDA [odds ratio (OR) = 2.29 p < 0.001] whereas advanced age (OR = 0.98, p = 0.005), high Health Assessment Questionnaire (HAQ) score (OR = 0.57, p < 0.001), use of GCs (OR = 0.75, p = 0.037) or ⩾2 bDMARDs (OR = 0.61, p = 0.002), high co-morbidity index (OR = 0.86, p = 0.011) and obesity (OR = 0.62, p = 0.002) were negative predictors of LDA. During follow-up, among active patients (DAS28ESR >3.2), 21% initiated (among csDMARDs users) and 22% switched (among bDMARDs users) their bDMARDs. Conclusion: In a real-life RA cohort, during 1 year of follow-up, 43% of patients do not reach treatment targets while only ~20% of those with active RA started or switched their bDMARDs. Male sex, younger age, lower HAQ, body mass index and co-morbidity index were independent factors associated with LDA while use of GCs or ⩾2 bDMARDs were negative predictors. © The Author(s), 2020