Diana Mahoney

Montreal — In children diagnosed with an autism spectrum disorder, those with Asperger's syndrome, minority children, and those whose families do not follow one of the major autism treatment approaches fall behind others when it comes to early intervention services, service intensity, and family involvement in providing treatment services, an analysis shows.

The findings highlight the need to develop family-level interventions for disseminating information, enhancing decision making, and supporting parents to enssure adequate access to effective service elements for all children with an autism spectrum disorder (ASD), Kathleen Thomas, Ph.D., said at the 5th International Meeting for Autism Research.

As part of a 4-year study aimed at assessing family and child use of effective autism program elements funded by the National Institute of Mental Health, Dr. Thomas and her colleagues at the University of North Carolina at Chapel Hill recruited a sample of 383 families with a child aged 11 years or younger with an ASD diagnosis to participate in a combined telephone/in-person survey.

Sixty percent of the sample was obtained through the university's Neurodevelopmental Disorders Research Center Subject Registry; 40% was obtained through direct recruitment from schools and developmental services agencies within the state.

The survey assessed demographics, access to services, use of services, payment for services, and overall satisfaction with services. The response rate among recruited families was 91%. The mean age of the children represented in the survey was 7 years; 71% of the children were white, and 87% were male.

Most families (58%) reported having private insurance, 21% received Medicaid alone, and 8% had both. About 70% of the children had a diagnosis of typical autism, 21% were diagnosed with Asperger's syndrome, and the rest had other diagnoses along the autism spectrum. The average age at diagnosis was 4 years.

Of the families participating in the survey, 95% reported involvement with a major autism treatment approach. “Because the participants were from North Carolina, most of the families use TEACCH [Treatment and Education of Autistic and Related Communication Handicapped Children, which was developed at the University of North Carolina and was the first statewide program for treatment and services for people with autism], although a fair number also reported using programs built on the 'applied behavior analysis' model, as well as some others,” Dr. Thomas said. “Five percent of the families said they were not really following any formal approach.”

On average, the children were receiving four service sessions a week in school and eight service sessions a week out of school, four of which the family was providing.

An 18-item measure was used to evaluate family well-being and use of and satisfaction with service elements, including social therapies, specialist care providers, medication therapies, and child care.

“Our goal was to look at associations between child/family characteristics and different service elements,” Dr. Thomas said. “We saw that children from minority families were getting diagnosed at a later age, they were receiving fewer services, and the proportion of family involvement in services was lower than the average.”

In the families that didn't follow one of the major treatment approaches, “there was no association with age at diagnosis, but they also received fewer services overall and had less family involvement,” she said. Children with Asperger's syndrome were diagnosed later than were those with typical autism; those with a diagnosis of mental retardation were identified earlier.

Nearly 15% of the respondents reported not being satisfied with the services they were receiving, even though they were receiving a higher proportion of services and had more family involvement.

Among the enabling characteristics, neither family stress nor ability to pay for services was associated with any differences in the receipt of or family involvement with services, Dr. Thomas said. However, “children who were diagnosed at a younger age were receiving more service sessions in school than those diagnosed later.”

In addition, screening efforts should cast a wider net to include those children who may not fall within the typical autism diagnosis but who could benefit from early identification and intervention, she said.

Montreal — In children diagnosed with an autism spectrum disorder, those with Asperger's syndrome, minority children, and those whose families do not follow one of the major autism treatment approaches fall behind others when it comes to early intervention services, service intensity, and family involvement in providing treatment services, an analysis shows.

The findings highlight the need to develop family-level interventions for disseminating information, enhancing decision making, and supporting parents to enssure adequate access to effective service elements for all children with an autism spectrum disorder (ASD), Kathleen Thomas, Ph.D., said at the 5th International Meeting for Autism Research.

As part of a 4-year study aimed at assessing family and child use of effective autism program elements funded by the National Institute of Mental Health, Dr. Thomas and her colleagues at the University of North Carolina at Chapel Hill recruited a sample of 383 families with a child aged 11 years or younger with an ASD diagnosis to participate in a combined telephone/in-person survey.

Sixty percent of the sample was obtained through the university's Neurodevelopmental Disorders Research Center Subject Registry; 40% was obtained through direct recruitment from schools and developmental services agencies within the state.

The survey assessed demographics, access to services, use of services, payment for services, and overall satisfaction with services. The response rate among recruited families was 91%. The mean age of the children represented in the survey was 7 years; 71% of the children were white, and 87% were male.

Most families (58%) reported having private insurance, 21% received Medicaid alone, and 8% had both. About 70% of the children had a diagnosis of typical autism, 21% were diagnosed with Asperger's syndrome, and the rest had other diagnoses along the autism spectrum. The average age at diagnosis was 4 years.

Of the families participating in the survey, 95% reported involvement with a major autism treatment approach. “Because the participants were from North Carolina, most of the families use TEACCH [Treatment and Education of Autistic and Related Communication Handicapped Children, which was developed at the University of North Carolina and was the first statewide program for treatment and services for people with autism], although a fair number also reported using programs built on the 'applied behavior analysis' model, as well as some others,” Dr. Thomas said. “Five percent of the families said they were not really following any formal approach.”

On average, the children were receiving four service sessions a week in school and eight service sessions a week out of school, four of which the family was providing.

An 18-item measure was used to evaluate family well-being and use of and satisfaction with service elements, including social therapies, specialist care providers, medication therapies, and child care.

“Our goal was to look at associations between child/family characteristics and different service elements,” Dr. Thomas said. “We saw that children from minority families were getting diagnosed at a later age, they were receiving fewer services, and the proportion of family involvement in services was lower than the average.”

In the families that didn't follow one of the major treatment approaches, “there was no association with age at diagnosis, but they also received fewer services overall and had less family involvement,” she said. Children with Asperger's syndrome were diagnosed later than were those with typical autism; those with a diagnosis of mental retardation were identified earlier.

Nearly 15% of the respondents reported not being satisfied with the services they were receiving, even though they were receiving a higher proportion of services and had more family involvement.

Among the enabling characteristics, neither family stress nor ability to pay for services was associated with any differences in the receipt of or family involvement with services, Dr. Thomas said. However, “children who were diagnosed at a younger age were receiving more service sessions in school than those diagnosed later.”

In addition, screening efforts should cast a wider net to include those children who may not fall within the typical autism diagnosis but who could benefit from early identification and intervention, she said.

Montreal — In children diagnosed with an autism spectrum disorder, those with Asperger's syndrome, minority children, and those whose families do not follow one of the major autism treatment approaches fall behind others when it comes to early intervention services, service intensity, and family involvement in providing treatment services, an analysis shows.

The findings highlight the need to develop family-level interventions for disseminating information, enhancing decision making, and supporting parents to enssure adequate access to effective service elements for all children with an autism spectrum disorder (ASD), Kathleen Thomas, Ph.D., said at the 5th International Meeting for Autism Research.

As part of a 4-year study aimed at assessing family and child use of effective autism program elements funded by the National Institute of Mental Health, Dr. Thomas and her colleagues at the University of North Carolina at Chapel Hill recruited a sample of 383 families with a child aged 11 years or younger with an ASD diagnosis to participate in a combined telephone/in-person survey.

Sixty percent of the sample was obtained through the university's Neurodevelopmental Disorders Research Center Subject Registry; 40% was obtained through direct recruitment from schools and developmental services agencies within the state.

The survey assessed demographics, access to services, use of services, payment for services, and overall satisfaction with services. The response rate among recruited families was 91%. The mean age of the children represented in the survey was 7 years; 71% of the children were white, and 87% were male.

Most families (58%) reported having private insurance, 21% received Medicaid alone, and 8% had both. About 70% of the children had a diagnosis of typical autism, 21% were diagnosed with Asperger's syndrome, and the rest had other diagnoses along the autism spectrum. The average age at diagnosis was 4 years.

Of the families participating in the survey, 95% reported involvement with a major autism treatment approach. “Because the participants were from North Carolina, most of the families use TEACCH [Treatment and Education of Autistic and Related Communication Handicapped Children, which was developed at the University of North Carolina and was the first statewide program for treatment and services for people with autism], although a fair number also reported using programs built on the 'applied behavior analysis' model, as well as some others,” Dr. Thomas said. “Five percent of the families said they were not really following any formal approach.”

On average, the children were receiving four service sessions a week in school and eight service sessions a week out of school, four of which the family was providing.

An 18-item measure was used to evaluate family well-being and use of and satisfaction with service elements, including social therapies, specialist care providers, medication therapies, and child care.

“Our goal was to look at associations between child/family characteristics and different service elements,” Dr. Thomas said. “We saw that children from minority families were getting diagnosed at a later age, they were receiving fewer services, and the proportion of family involvement in services was lower than the average.”

In the families that didn't follow one of the major treatment approaches, “there was no association with age at diagnosis, but they also received fewer services overall and had less family involvement,” she said. Children with Asperger's syndrome were diagnosed later than were those with typical autism; those with a diagnosis of mental retardation were identified earlier.

Nearly 15% of the respondents reported not being satisfied with the services they were receiving, even though they were receiving a higher proportion of services and had more family involvement.

Among the enabling characteristics, neither family stress nor ability to pay for services was associated with any differences in the receipt of or family involvement with services, Dr. Thomas said. However, “children who were diagnosed at a younger age were receiving more service sessions in school than those diagnosed later.”

In addition, screening efforts should cast a wider net to include those children who may not fall within the typical autism diagnosis but who could benefit from early identification and intervention, she said.

MONTREAL — Home-based intensive skills therapy for autism appears to be a more effective early intervention than integration into mainstream preschool classrooms, according to preliminary findings of a small pilot study reported at the 5th International Meeting for Autism Research.

In an effort to evaluate the success of community-based early intervention services for preschool children with autism, Amanda Morgan, a PhD candidate in the department of psychology at the University of New Brunswick in Fredericton, Canada, and her colleagues compared the 12-month outcomes of two groups of children diagnosed with an autism spectrum disorder. The mean age of the children at the start of the study was 33 months, ranging from 24 to 43 months.

One group, consisting of six children, received a minimum of 20 hours per week of one-on-one home-based interventions based on the applied behavior analysis (ABA) therapy model, whereas the second group of four children attended integrated preschool classrooms with teacher's assistants.

ABA is a highly structured, skills-based therapy that teaches by breaking an objective down into multiple small steps, encouraging the mastery of one step at a time, and rewarding correct responses. Integrating autistic children into regular classrooms is, by comparison, a less structured approach.

“The [thinking is] that by integrating children with autism into typical classrooms, they will benefit by learning to model 'typical' social behaviors, although studies are showing that this is not necessarily the case,” commented Ms. Morgan in a poster presentation.

All of the children in the study underwent standardized testing at baseline and at 12 months thereafter. Such evaluation included the Child Development Index (CDI), the Childhood Autism Rating Scale, the Vineland Adaptive Behavior Scales: Survey Form, and the Psychoeducational Profile-Revised (PEP-R). At baseline, the mean scores on all the tests were similar in both groups. After 12 months, “mean improvement scores across the PEP-R, CDI, and Vineland measures were 15.9 months for the ABA group, compared with 5.5 months for the preschool groups,” Ms. Morgan reported.

Although the statistically significant findings add substance to the growing body of literature demonstrating the efficacy of intensive skills-based therapies over classroom integration, “the results cannot be generalized to all school-based efforts, because some may incorporate elements of [ABA or other skills-based] approaches that would close the gap,” said Ms. Morgan. “We need more information before making definitive statements.”

In particular, a larger study population and a more controlled comparison of the important features of both types of interventions would be useful, she said.

Ms. Morgan reported no conflict of interest with respect to her presentation.

MONTREAL — Home-based intensive skills therapy for autism appears to be a more effective early intervention than integration into mainstream preschool classrooms, according to preliminary findings of a small pilot study reported at the 5th International Meeting for Autism Research.

In an effort to evaluate the success of community-based early intervention services for preschool children with autism, Amanda Morgan, a PhD candidate in the department of psychology at the University of New Brunswick in Fredericton, Canada, and her colleagues compared the 12-month outcomes of two groups of children diagnosed with an autism spectrum disorder. The mean age of the children at the start of the study was 33 months, ranging from 24 to 43 months.

One group, consisting of six children, received a minimum of 20 hours per week of one-on-one home-based interventions based on the applied behavior analysis (ABA) therapy model, whereas the second group of four children attended integrated preschool classrooms with teacher's assistants.

ABA is a highly structured, skills-based therapy that teaches by breaking an objective down into multiple small steps, encouraging the mastery of one step at a time, and rewarding correct responses. Integrating autistic children into regular classrooms is, by comparison, a less structured approach.

“The [thinking is] that by integrating children with autism into typical classrooms, they will benefit by learning to model 'typical' social behaviors, although studies are showing that this is not necessarily the case,” commented Ms. Morgan in a poster presentation.

All of the children in the study underwent standardized testing at baseline and at 12 months thereafter. Such evaluation included the Child Development Index (CDI), the Childhood Autism Rating Scale, the Vineland Adaptive Behavior Scales: Survey Form, and the Psychoeducational Profile-Revised (PEP-R). At baseline, the mean scores on all the tests were similar in both groups. After 12 months, “mean improvement scores across the PEP-R, CDI, and Vineland measures were 15.9 months for the ABA group, compared with 5.5 months for the preschool groups,” Ms. Morgan reported.

Although the statistically significant findings add substance to the growing body of literature demonstrating the efficacy of intensive skills-based therapies over classroom integration, “the results cannot be generalized to all school-based efforts, because some may incorporate elements of [ABA or other skills-based] approaches that would close the gap,” said Ms. Morgan. “We need more information before making definitive statements.”

In particular, a larger study population and a more controlled comparison of the important features of both types of interventions would be useful, she said.

Ms. Morgan reported no conflict of interest with respect to her presentation.

MONTREAL — Home-based intensive skills therapy for autism appears to be a more effective early intervention than integration into mainstream preschool classrooms, according to preliminary findings of a small pilot study reported at the 5th International Meeting for Autism Research.

In an effort to evaluate the success of community-based early intervention services for preschool children with autism, Amanda Morgan, a PhD candidate in the department of psychology at the University of New Brunswick in Fredericton, Canada, and her colleagues compared the 12-month outcomes of two groups of children diagnosed with an autism spectrum disorder. The mean age of the children at the start of the study was 33 months, ranging from 24 to 43 months.

One group, consisting of six children, received a minimum of 20 hours per week of one-on-one home-based interventions based on the applied behavior analysis (ABA) therapy model, whereas the second group of four children attended integrated preschool classrooms with teacher's assistants.

ABA is a highly structured, skills-based therapy that teaches by breaking an objective down into multiple small steps, encouraging the mastery of one step at a time, and rewarding correct responses. Integrating autistic children into regular classrooms is, by comparison, a less structured approach.

“The [thinking is] that by integrating children with autism into typical classrooms, they will benefit by learning to model 'typical' social behaviors, although studies are showing that this is not necessarily the case,” commented Ms. Morgan in a poster presentation.

All of the children in the study underwent standardized testing at baseline and at 12 months thereafter. Such evaluation included the Child Development Index (CDI), the Childhood Autism Rating Scale, the Vineland Adaptive Behavior Scales: Survey Form, and the Psychoeducational Profile-Revised (PEP-R). At baseline, the mean scores on all the tests were similar in both groups. After 12 months, “mean improvement scores across the PEP-R, CDI, and Vineland measures were 15.9 months for the ABA group, compared with 5.5 months for the preschool groups,” Ms. Morgan reported.

Although the statistically significant findings add substance to the growing body of literature demonstrating the efficacy of intensive skills-based therapies over classroom integration, “the results cannot be generalized to all school-based efforts, because some may incorporate elements of [ABA or other skills-based] approaches that would close the gap,” said Ms. Morgan. “We need more information before making definitive statements.”

In particular, a larger study population and a more controlled comparison of the important features of both types of interventions would be useful, she said.

Ms. Morgan reported no conflict of interest with respect to her presentation.

BOSTON — Normal-weight African American women were twice as likely to have insulin resistance as were similarly lean white and Hispanic women, based on the findings of an epidemiologic study.

In addition, unlike their white and Hispanic counterparts, African American women's increasing body mass index levels only minimally influenced their prevalence rate of insulin resistance, Dr. Jennifer Wolfgang said at the annual meeting of the Endocrine Society.

Race “may be an important independent risk factor for insulin resistance and potentially type 2 diabetes and heart disease,” said Dr. Wolfgang of Wake Forest University, Winston-Salem, N.C. Weight-based screening standards may need to be adjusted so that even lean African American women are evaluated for insulin resistance, diabetes, and cardiovascular disease.

Dr. Wolfgang and her colleagues reviewed the data for participants in the multicenter Insulin Resistance Atherosclerosis Study, which was designed to evaluate the relationships between the degree of insulin sensitivity and variables associated with cardiovascular disease.

The approximately 1,600 men and women—all of whom were in general good health and without diabetes or impaired glucose tolerance—were divided by sex and placed into quartiles according to body mass index (BMI): less than 25, 25–30, 30–35, and greater than 35 kg/m

After correction for age and recruitment sites, the difference in prevalence rates for African Americans, compared with whites and Hispanics, remained statistically significant, Dr. Wolfgang said. For the other three quartiles, the women had similar risk for insulin resistance across all three ethnic groups.

A similar trend was observed for African American men, but the differences were not statistically significant.

Dr. Wolfgang speculated that the ethnic disparities might be a consequence of between-race differences in the percentage or distribution of intraabdominal fat. Some yet-to-be-identified genetic variation also could be the source of the differences, she noted.

There is no simple clinical method for routinely measuring insulin resistance, Dr. Wolfgang acknowledged, but the observation of insulin resistance at low BMI levels in African American women argues for aggressive management of the more easily measured cardiovascular risk factors, such as high blood pressure, high cholesterol levels, and high blood glucose values.

Dr. Wolfgang reported no conflict of interest with respect to her presentation.

ELSEVIER GLOBAL MEDICAL NEWS

BOSTON — Normal-weight African American women were twice as likely to have insulin resistance as were similarly lean white and Hispanic women, based on the findings of an epidemiologic study.

In addition, unlike their white and Hispanic counterparts, African American women's increasing body mass index levels only minimally influenced their prevalence rate of insulin resistance, Dr. Jennifer Wolfgang said at the annual meeting of the Endocrine Society.

Race “may be an important independent risk factor for insulin resistance and potentially type 2 diabetes and heart disease,” said Dr. Wolfgang of Wake Forest University, Winston-Salem, N.C. Weight-based screening standards may need to be adjusted so that even lean African American women are evaluated for insulin resistance, diabetes, and cardiovascular disease.

Dr. Wolfgang and her colleagues reviewed the data for participants in the multicenter Insulin Resistance Atherosclerosis Study, which was designed to evaluate the relationships between the degree of insulin sensitivity and variables associated with cardiovascular disease.

The approximately 1,600 men and women—all of whom were in general good health and without diabetes or impaired glucose tolerance—were divided by sex and placed into quartiles according to body mass index (BMI): less than 25, 25–30, 30–35, and greater than 35 kg/m

After correction for age and recruitment sites, the difference in prevalence rates for African Americans, compared with whites and Hispanics, remained statistically significant, Dr. Wolfgang said. For the other three quartiles, the women had similar risk for insulin resistance across all three ethnic groups.

A similar trend was observed for African American men, but the differences were not statistically significant.

Dr. Wolfgang speculated that the ethnic disparities might be a consequence of between-race differences in the percentage or distribution of intraabdominal fat. Some yet-to-be-identified genetic variation also could be the source of the differences, she noted.

There is no simple clinical method for routinely measuring insulin resistance, Dr. Wolfgang acknowledged, but the observation of insulin resistance at low BMI levels in African American women argues for aggressive management of the more easily measured cardiovascular risk factors, such as high blood pressure, high cholesterol levels, and high blood glucose values.

Dr. Wolfgang reported no conflict of interest with respect to her presentation.

ELSEVIER GLOBAL MEDICAL NEWS

BOSTON — Normal-weight African American women were twice as likely to have insulin resistance as were similarly lean white and Hispanic women, based on the findings of an epidemiologic study.

In addition, unlike their white and Hispanic counterparts, African American women's increasing body mass index levels only minimally influenced their prevalence rate of insulin resistance, Dr. Jennifer Wolfgang said at the annual meeting of the Endocrine Society.

Race “may be an important independent risk factor for insulin resistance and potentially type 2 diabetes and heart disease,” said Dr. Wolfgang of Wake Forest University, Winston-Salem, N.C. Weight-based screening standards may need to be adjusted so that even lean African American women are evaluated for insulin resistance, diabetes, and cardiovascular disease.

Dr. Wolfgang and her colleagues reviewed the data for participants in the multicenter Insulin Resistance Atherosclerosis Study, which was designed to evaluate the relationships between the degree of insulin sensitivity and variables associated with cardiovascular disease.

The approximately 1,600 men and women—all of whom were in general good health and without diabetes or impaired glucose tolerance—were divided by sex and placed into quartiles according to body mass index (BMI): less than 25, 25–30, 30–35, and greater than 35 kg/m

After correction for age and recruitment sites, the difference in prevalence rates for African Americans, compared with whites and Hispanics, remained statistically significant, Dr. Wolfgang said. For the other three quartiles, the women had similar risk for insulin resistance across all three ethnic groups.

A similar trend was observed for African American men, but the differences were not statistically significant.

Dr. Wolfgang speculated that the ethnic disparities might be a consequence of between-race differences in the percentage or distribution of intraabdominal fat. Some yet-to-be-identified genetic variation also could be the source of the differences, she noted.

There is no simple clinical method for routinely measuring insulin resistance, Dr. Wolfgang acknowledged, but the observation of insulin resistance at low BMI levels in African American women argues for aggressive management of the more easily measured cardiovascular risk factors, such as high blood pressure, high cholesterol levels, and high blood glucose values.

Dr. Wolfgang reported no conflict of interest with respect to her presentation.

ELSEVIER GLOBAL MEDICAL NEWS

BOSTON — Oral salsalate taken daily can reduce systemic inflammation and improve metabolic parameters in obese, nondiabetic adults, suggesting that it “may provide a novel therapeutic route for diabetes prevention,” said Dr. Amy Fleischman at the annual meeting of the Endocrine Society.

Previous studies have shown that high-dose aspirin inhibits the inhibitory kappa B kinases/nuclear factor kappa B pathway, which is known to influence inflammation, and chronic, subacute inflammation is thought to play a role in the development of insulin resistance, type 2 diabetes, and cardiovascular disease. Salicylates have also been shown to improve glucose metabolism in patients with type 2 diabetes. Although high-dose aspirin therapy is not considered a safe option for diabetes prevention in at-risk populations because of the associated bleeding risks, salsalate, a nonacetylated dimer of salicylate, “is a much weaker inhibitor of cyclooxygenase enzymes, and as such, is clinically safer,” said Dr. Fleischman of the Joslin Diabetes Center in Boston.

Dr. Fleischman and her colleagues conducted a double-blind, placebo-controlled trial of 20 nondiabetic individuals with a mean body mass index of 38 kg/m

At 1 month, the patients taking salsalate experienced a significant 8% reduction from baseline in fasting blood glucose values. Those who received placebo had a simultaneous increase in fasting blood glucose of 4% during that time. The glycemic response to glucose load, examined by oral glucose tolerance testing, improved on salsalate treatment, and worsened on placebo during the 1-month study. The glucose area under the curve improved significantly by 14% after 1 month of treatment.

Insulin levels in both study groups were unchanged, “but fasting and OGTT [oral glucose tolerance test] C-peptide levels were lower in the salsalate-treated subjects, which is consistent with what we know about salicylate's ability to inhibit insulin clearance,” she said.

Homeostasis model assessment insulin resistance calculations showed significant improvement in insulin sensitivity in patients in the salsalate group, said Dr. Fleischman, adding that “circulating inflammatory markers responded to treatment.” Specifically, mean fasting nonesterified fatty acid decreased 44%, mean C-reactive protein decreased 37%, and concentration the atheroprotective protein adiponectin increased 56%.

Salsalate treatment was generally well tolerated. Two patients in the active treatment group and one in the control group required dose reductions from 4 g to 3–3.5 g per day. At 1 month, mean salicylate levels were 17 mg/dL in the treatment group—similar to the blood salicylate levels seen with high-dose aspirin therapy. Creatinine and aspartate transaminase did not change in either group, indicating there were no toxic effects associated with salsalate therapy.

The findings also suggest that salsalate safely and effectively interferes with that inflammatory activity and by so, doing may be decrease an individual's risk of developing type 2 diabetes and cardiovascular disease, said Dr. Fleischman.

Salsalate is Food and Drug Administration approved for relief of signs and symptoms of osteoarthritis, rheumatoid arthritis, and other rheumatic diseases.

Dr. Fleischman disclosed no conflicts of interest related to her presentation.

BOSTON — Oral salsalate taken daily can reduce systemic inflammation and improve metabolic parameters in obese, nondiabetic adults, suggesting that it “may provide a novel therapeutic route for diabetes prevention,” said Dr. Amy Fleischman at the annual meeting of the Endocrine Society.

Previous studies have shown that high-dose aspirin inhibits the inhibitory kappa B kinases/nuclear factor kappa B pathway, which is known to influence inflammation, and chronic, subacute inflammation is thought to play a role in the development of insulin resistance, type 2 diabetes, and cardiovascular disease. Salicylates have also been shown to improve glucose metabolism in patients with type 2 diabetes. Although high-dose aspirin therapy is not considered a safe option for diabetes prevention in at-risk populations because of the associated bleeding risks, salsalate, a nonacetylated dimer of salicylate, “is a much weaker inhibitor of cyclooxygenase enzymes, and as such, is clinically safer,” said Dr. Fleischman of the Joslin Diabetes Center in Boston.

Dr. Fleischman and her colleagues conducted a double-blind, placebo-controlled trial of 20 nondiabetic individuals with a mean body mass index of 38 kg/m

At 1 month, the patients taking salsalate experienced a significant 8% reduction from baseline in fasting blood glucose values. Those who received placebo had a simultaneous increase in fasting blood glucose of 4% during that time. The glycemic response to glucose load, examined by oral glucose tolerance testing, improved on salsalate treatment, and worsened on placebo during the 1-month study. The glucose area under the curve improved significantly by 14% after 1 month of treatment.

Insulin levels in both study groups were unchanged, “but fasting and OGTT [oral glucose tolerance test] C-peptide levels were lower in the salsalate-treated subjects, which is consistent with what we know about salicylate's ability to inhibit insulin clearance,” she said.

Homeostasis model assessment insulin resistance calculations showed significant improvement in insulin sensitivity in patients in the salsalate group, said Dr. Fleischman, adding that “circulating inflammatory markers responded to treatment.” Specifically, mean fasting nonesterified fatty acid decreased 44%, mean C-reactive protein decreased 37%, and concentration the atheroprotective protein adiponectin increased 56%.

Salsalate treatment was generally well tolerated. Two patients in the active treatment group and one in the control group required dose reductions from 4 g to 3–3.5 g per day. At 1 month, mean salicylate levels were 17 mg/dL in the treatment group—similar to the blood salicylate levels seen with high-dose aspirin therapy. Creatinine and aspartate transaminase did not change in either group, indicating there were no toxic effects associated with salsalate therapy.

The findings also suggest that salsalate safely and effectively interferes with that inflammatory activity and by so, doing may be decrease an individual's risk of developing type 2 diabetes and cardiovascular disease, said Dr. Fleischman.

Salsalate is Food and Drug Administration approved for relief of signs and symptoms of osteoarthritis, rheumatoid arthritis, and other rheumatic diseases.

Dr. Fleischman disclosed no conflicts of interest related to her presentation.

BOSTON — Oral salsalate taken daily can reduce systemic inflammation and improve metabolic parameters in obese, nondiabetic adults, suggesting that it “may provide a novel therapeutic route for diabetes prevention,” said Dr. Amy Fleischman at the annual meeting of the Endocrine Society.

Previous studies have shown that high-dose aspirin inhibits the inhibitory kappa B kinases/nuclear factor kappa B pathway, which is known to influence inflammation, and chronic, subacute inflammation is thought to play a role in the development of insulin resistance, type 2 diabetes, and cardiovascular disease. Salicylates have also been shown to improve glucose metabolism in patients with type 2 diabetes. Although high-dose aspirin therapy is not considered a safe option for diabetes prevention in at-risk populations because of the associated bleeding risks, salsalate, a nonacetylated dimer of salicylate, “is a much weaker inhibitor of cyclooxygenase enzymes, and as such, is clinically safer,” said Dr. Fleischman of the Joslin Diabetes Center in Boston.

Dr. Fleischman and her colleagues conducted a double-blind, placebo-controlled trial of 20 nondiabetic individuals with a mean body mass index of 38 kg/m

At 1 month, the patients taking salsalate experienced a significant 8% reduction from baseline in fasting blood glucose values. Those who received placebo had a simultaneous increase in fasting blood glucose of 4% during that time. The glycemic response to glucose load, examined by oral glucose tolerance testing, improved on salsalate treatment, and worsened on placebo during the 1-month study. The glucose area under the curve improved significantly by 14% after 1 month of treatment.

Insulin levels in both study groups were unchanged, “but fasting and OGTT [oral glucose tolerance test] C-peptide levels were lower in the salsalate-treated subjects, which is consistent with what we know about salicylate's ability to inhibit insulin clearance,” she said.

Homeostasis model assessment insulin resistance calculations showed significant improvement in insulin sensitivity in patients in the salsalate group, said Dr. Fleischman, adding that “circulating inflammatory markers responded to treatment.” Specifically, mean fasting nonesterified fatty acid decreased 44%, mean C-reactive protein decreased 37%, and concentration the atheroprotective protein adiponectin increased 56%.

Salsalate treatment was generally well tolerated. Two patients in the active treatment group and one in the control group required dose reductions from 4 g to 3–3.5 g per day. At 1 month, mean salicylate levels were 17 mg/dL in the treatment group—similar to the blood salicylate levels seen with high-dose aspirin therapy. Creatinine and aspartate transaminase did not change in either group, indicating there were no toxic effects associated with salsalate therapy.

The findings also suggest that salsalate safely and effectively interferes with that inflammatory activity and by so, doing may be decrease an individual's risk of developing type 2 diabetes and cardiovascular disease, said Dr. Fleischman.

Salsalate is Food and Drug Administration approved for relief of signs and symptoms of osteoarthritis, rheumatoid arthritis, and other rheumatic diseases.

Dr. Fleischman disclosed no conflicts of interest related to her presentation.

BOSTON — Metformin was associated with weight loss that persisted at 12 months in obese adolescents at risk for diabetes, Dr. Dorit Koren said at the annual meeting of the Endocrine Society.

On the basis of the results of this small retrospective study, metformin should be submitted to further testing as a tool in the prevention of diabetes in high-risk, obese teens, she said. In previous studies of similar patients, metformin has been associated with short-term weight loss, as well as improvements in glucose levels, lipid abnormalities, and hyperandrogenism.

To determine whether the weight losses persisted at 12 months, Dr. Koren and colleagues at St. Christopher's Hospital for Children, Philadelphia, reviewed the charts of 26 nondiabetic adolescents seen in that institution's endocrine clinic. Their mean age was 14 years, and their body mass indexes were above the 95th percentile.

Metformin, 1,000 mg/day, was given to 14 of the teens because they had abnormal cholesterol values (HDL less than 40 mg/dL, triglycerides greater than 110 mg/dL) or fasting insulin levels greater than 20 μU/mL, or because of menstrual irregularities associated with polycystic ovary syndrome. At baseline and at 6 and 12 months, all of the patients underwent height and weight evaluations to calculate BMI and blood tests to measure cholesterol, blood sugar, and insulin levels.

The BMI scores of the treated group declined from 2.50 times above the average measures for age and sex to 2.35 times above average, Dr. Koren said in a poster presentation. BMI did not significantly change in the untreated group. For the treated versus the untreated groups, changes in BMI baseline score were significantly different at 6 months and still within the range of significance at 12 months. Cholesterol measures were initially better in the metformin group, but the differences between the two groups were no longer statistically significant at 12 months.

Metformin might be viewed as a complement to dietary and exercise changes in obese adolescents, she said. Its long-term safety and efficacy in nondiabetic adolescents has yet to be confirmed. Dr. Koren reported no conflicts of interest.

BOSTON — Metformin was associated with weight loss that persisted at 12 months in obese adolescents at risk for diabetes, Dr. Dorit Koren said at the annual meeting of the Endocrine Society.

On the basis of the results of this small retrospective study, metformin should be submitted to further testing as a tool in the prevention of diabetes in high-risk, obese teens, she said. In previous studies of similar patients, metformin has been associated with short-term weight loss, as well as improvements in glucose levels, lipid abnormalities, and hyperandrogenism.

To determine whether the weight losses persisted at 12 months, Dr. Koren and colleagues at St. Christopher's Hospital for Children, Philadelphia, reviewed the charts of 26 nondiabetic adolescents seen in that institution's endocrine clinic. Their mean age was 14 years, and their body mass indexes were above the 95th percentile.

Metformin, 1,000 mg/day, was given to 14 of the teens because they had abnormal cholesterol values (HDL less than 40 mg/dL, triglycerides greater than 110 mg/dL) or fasting insulin levels greater than 20 μU/mL, or because of menstrual irregularities associated with polycystic ovary syndrome. At baseline and at 6 and 12 months, all of the patients underwent height and weight evaluations to calculate BMI and blood tests to measure cholesterol, blood sugar, and insulin levels.

The BMI scores of the treated group declined from 2.50 times above the average measures for age and sex to 2.35 times above average, Dr. Koren said in a poster presentation. BMI did not significantly change in the untreated group. For the treated versus the untreated groups, changes in BMI baseline score were significantly different at 6 months and still within the range of significance at 12 months. Cholesterol measures were initially better in the metformin group, but the differences between the two groups were no longer statistically significant at 12 months.

Metformin might be viewed as a complement to dietary and exercise changes in obese adolescents, she said. Its long-term safety and efficacy in nondiabetic adolescents has yet to be confirmed. Dr. Koren reported no conflicts of interest.

BOSTON — Metformin was associated with weight loss that persisted at 12 months in obese adolescents at risk for diabetes, Dr. Dorit Koren said at the annual meeting of the Endocrine Society.

On the basis of the results of this small retrospective study, metformin should be submitted to further testing as a tool in the prevention of diabetes in high-risk, obese teens, she said. In previous studies of similar patients, metformin has been associated with short-term weight loss, as well as improvements in glucose levels, lipid abnormalities, and hyperandrogenism.

To determine whether the weight losses persisted at 12 months, Dr. Koren and colleagues at St. Christopher's Hospital for Children, Philadelphia, reviewed the charts of 26 nondiabetic adolescents seen in that institution's endocrine clinic. Their mean age was 14 years, and their body mass indexes were above the 95th percentile.

Metformin, 1,000 mg/day, was given to 14 of the teens because they had abnormal cholesterol values (HDL less than 40 mg/dL, triglycerides greater than 110 mg/dL) or fasting insulin levels greater than 20 μU/mL, or because of menstrual irregularities associated with polycystic ovary syndrome. At baseline and at 6 and 12 months, all of the patients underwent height and weight evaluations to calculate BMI and blood tests to measure cholesterol, blood sugar, and insulin levels.

The BMI scores of the treated group declined from 2.50 times above the average measures for age and sex to 2.35 times above average, Dr. Koren said in a poster presentation. BMI did not significantly change in the untreated group. For the treated versus the untreated groups, changes in BMI baseline score were significantly different at 6 months and still within the range of significance at 12 months. Cholesterol measures were initially better in the metformin group, but the differences between the two groups were no longer statistically significant at 12 months.

Metformin might be viewed as a complement to dietary and exercise changes in obese adolescents, she said. Its long-term safety and efficacy in nondiabetic adolescents has yet to be confirmed. Dr. Koren reported no conflicts of interest.

TORONTO — A single-session intervention can reduce prenatal alcohol use among at-risk pregnant women, especially those with higher reported alcohol consumption at baseline, Dr. Grace Chang reported at the annual meeting of the American Psychiatric Association.

Also, partner participation significantly enhances the intervention's positive effects.

The findings suggest that “screening and assessment with a validated instrument embedded into a patient information form can provide clinicians with important information about a woman's risk status and need for some type of intervention,” said Dr. Chang of Brigham and Women's Hospital in Boston. And providing at-risk women and their partners with alcohol education and behavior management tools early in pregnancy can significantly affect subsequent risk behaviors, she said.

To assess the impact of a brief psychoeducational intervention on women identified as being at risk for alcohol consumption during pregnancy, Dr. Chang and her colleagues randomized 304 pregnant women who met predefined alcohol risk criteria and their partners to receive a diagnostic interview and the single-session intervention or the diagnostic interview alone. Potential study participants were gleaned from Boston-area obstetrical practices based on their responses to a prenatal health and habits survey, which included questions about diet, smoking, exercise, stress, and drinking.

The predefined risk criteria for study enrollment included a total score of two or more on the four-item T-ACE alcohol screening instrument and any alcohol use in the 3 months before study enrollment (while pregnant), consumption of at least one drink per day in the 6 months before study enrollment, or drinking during a previous pregnancy. The T-ACE instrument asks four questions: How many drinks does it take to make you feel high (Tolerance)? Have people ever annoyed you by criticizing your drinking (Annoyed)? Have you ever felt you ought to cut down on your drinking (Cut down)? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)? The need for more than two drinks as a response to the tolerance question is worth two points, while positive answers to the remaining questions are each worth one point.

All of the study participants were at less than 28 weeks' gestation at the time of the diagnostic interview and intended to carry their pregnancy to term, and all were required to select a partner to participate in the study with them. Potential participants were excluded if they were under current treatment for alcohol or drug abuse or substance abuse-related medical illness, if they had current physical dependence on alcohol requiring medically supervised detoxification, if they were unable to complete the study questionnaires, or if they intended to terminate their pregnancy before gestation.

Study participants were, on average, at 11.5 weeks' gestation at the time of the study, and nearly half expected their first child. About 79% of the subjects were white, and 80% were married. Their median age was 31.4 years, and the median education level was a 4-year college degree.

At baseline, all of the pregnant participants underwent a diagnostic interview to measure daily drinking before the study, temptation to drink in certain social situations, and awareness of prenatal health behaviors. The partners underwent a separate interview to gauge their own drinking habits, their perception of their pregnant partners' drinking, and their knowledge of prenatal health behaviors.

Those partner pairs randomized to the intervention met with one of two trained nurse-practitioners or Dr. Chang for a single 25-minute session with four components: knowledge assessment with feedback, contracting and goal setting, behavior modification, and summary. The knowledge assessment and feedback component included a discussion of both partners' thoughts and misperceptions about prenatal health behaviors relative to alcohol use.

“We did not discuss the women's actual alcohol consumption in the presence of her partner unless they disclosed it voluntarily, for reasons of privacy and safety,” Dr. Chang said. “But the knowledge assessment was the springboard for the discussion of alcohol use during pregnancy.”

In the goal-setting and contracting component, the discussion focused on prenatal drinking goals. “It was not uncommon to hear women say their goal was to have 'just one drink' per week—and the women in the study were generally older and well educated. This would lead to a discussion of the surgeon general's advisory that no amount of alcohol is safe during pregnancy,” Dr. Chang said.

In the behavior-modification segment, the pregnant subjects were encouraged to think about circumstances, such as social events, that might invite the temptation to drink during pregnancy and to develop a list of alternative behaviors, such as having something to eat or a fake drink, Dr. Chang said. “We also asked the partner to list plans for personal behavior changes that could support the pregnant woman, such as drinking less or socializing differently.” Finally, the intervention was summarized on paper and provided to the partners.

Both the intervention and control subjects had a postpartum follow-up interview to review the frequency and quantity of alcohol consumed during pregnancy as well as changes in alcohol-related health habits since enrollment. “We had a 95% follow-up rate overall, and only 3% of partners were ultimately unable to participate in one part of the study or another,” Dr. Chang noted.

The investigators used univariate and multivariate analyses to compare the intervention and control groups before and after study enrollment, and least squares regression models were used to evaluate the effect of the intervention on three dependent variables: alcohol consumption quantity, frequency, and both.

When the two groups were compared, “there were no statistically significant differences in the amount or frequency of prepregnancy alcohol consumption, and most of the women in both conditions demonstrated overall reduced alcohol consumption once enrolled,” Dr. Chang said. “Many of the women spontaneously decreased the frequency of their alcohol consumption to a mean of 5% drinking days, although fewer than 20% were abstinent.”

The results of an intention-to-treat analysis showed a significant interaction between the intervention and prenatal alcohol consumption, Dr. Chang reported. “The brief intervention was most effective in reducing the frequency of consumption among women who drank more at the time of the study enrollment,” she said. Additionally, “the intervention was more effective for heavier drinking subjects when the partner was involved.”

The analyses identified additional variables that increased the risk of prenatal alcohol consumption: prenatal alcohol use before the study, level of education, temptation to drink in social situations, and number of years of regular alcohol use.

TORONTO — A single-session intervention can reduce prenatal alcohol use among at-risk pregnant women, especially those with higher reported alcohol consumption at baseline, Dr. Grace Chang reported at the annual meeting of the American Psychiatric Association.

Also, partner participation significantly enhances the intervention's positive effects.

The findings suggest that “screening and assessment with a validated instrument embedded into a patient information form can provide clinicians with important information about a woman's risk status and need for some type of intervention,” said Dr. Chang of Brigham and Women's Hospital in Boston. And providing at-risk women and their partners with alcohol education and behavior management tools early in pregnancy can significantly affect subsequent risk behaviors, she said.

To assess the impact of a brief psychoeducational intervention on women identified as being at risk for alcohol consumption during pregnancy, Dr. Chang and her colleagues randomized 304 pregnant women who met predefined alcohol risk criteria and their partners to receive a diagnostic interview and the single-session intervention or the diagnostic interview alone. Potential study participants were gleaned from Boston-area obstetrical practices based on their responses to a prenatal health and habits survey, which included questions about diet, smoking, exercise, stress, and drinking.

The predefined risk criteria for study enrollment included a total score of two or more on the four-item T-ACE alcohol screening instrument and any alcohol use in the 3 months before study enrollment (while pregnant), consumption of at least one drink per day in the 6 months before study enrollment, or drinking during a previous pregnancy. The T-ACE instrument asks four questions: How many drinks does it take to make you feel high (Tolerance)? Have people ever annoyed you by criticizing your drinking (Annoyed)? Have you ever felt you ought to cut down on your drinking (Cut down)? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)? The need for more than two drinks as a response to the tolerance question is worth two points, while positive answers to the remaining questions are each worth one point.

All of the study participants were at less than 28 weeks' gestation at the time of the diagnostic interview and intended to carry their pregnancy to term, and all were required to select a partner to participate in the study with them. Potential participants were excluded if they were under current treatment for alcohol or drug abuse or substance abuse-related medical illness, if they had current physical dependence on alcohol requiring medically supervised detoxification, if they were unable to complete the study questionnaires, or if they intended to terminate their pregnancy before gestation.

Study participants were, on average, at 11.5 weeks' gestation at the time of the study, and nearly half expected their first child. About 79% of the subjects were white, and 80% were married. Their median age was 31.4 years, and the median education level was a 4-year college degree.

At baseline, all of the pregnant participants underwent a diagnostic interview to measure daily drinking before the study, temptation to drink in certain social situations, and awareness of prenatal health behaviors. The partners underwent a separate interview to gauge their own drinking habits, their perception of their pregnant partners' drinking, and their knowledge of prenatal health behaviors.

Those partner pairs randomized to the intervention met with one of two trained nurse-practitioners or Dr. Chang for a single 25-minute session with four components: knowledge assessment with feedback, contracting and goal setting, behavior modification, and summary. The knowledge assessment and feedback component included a discussion of both partners' thoughts and misperceptions about prenatal health behaviors relative to alcohol use.

“We did not discuss the women's actual alcohol consumption in the presence of her partner unless they disclosed it voluntarily, for reasons of privacy and safety,” Dr. Chang said. “But the knowledge assessment was the springboard for the discussion of alcohol use during pregnancy.”

In the goal-setting and contracting component, the discussion focused on prenatal drinking goals. “It was not uncommon to hear women say their goal was to have 'just one drink' per week—and the women in the study were generally older and well educated. This would lead to a discussion of the surgeon general's advisory that no amount of alcohol is safe during pregnancy,” Dr. Chang said.

In the behavior-modification segment, the pregnant subjects were encouraged to think about circumstances, such as social events, that might invite the temptation to drink during pregnancy and to develop a list of alternative behaviors, such as having something to eat or a fake drink, Dr. Chang said. “We also asked the partner to list plans for personal behavior changes that could support the pregnant woman, such as drinking less or socializing differently.” Finally, the intervention was summarized on paper and provided to the partners.

Both the intervention and control subjects had a postpartum follow-up interview to review the frequency and quantity of alcohol consumed during pregnancy as well as changes in alcohol-related health habits since enrollment. “We had a 95% follow-up rate overall, and only 3% of partners were ultimately unable to participate in one part of the study or another,” Dr. Chang noted.

The investigators used univariate and multivariate analyses to compare the intervention and control groups before and after study enrollment, and least squares regression models were used to evaluate the effect of the intervention on three dependent variables: alcohol consumption quantity, frequency, and both.

When the two groups were compared, “there were no statistically significant differences in the amount or frequency of prepregnancy alcohol consumption, and most of the women in both conditions demonstrated overall reduced alcohol consumption once enrolled,” Dr. Chang said. “Many of the women spontaneously decreased the frequency of their alcohol consumption to a mean of 5% drinking days, although fewer than 20% were abstinent.”

The results of an intention-to-treat analysis showed a significant interaction between the intervention and prenatal alcohol consumption, Dr. Chang reported. “The brief intervention was most effective in reducing the frequency of consumption among women who drank more at the time of the study enrollment,” she said. Additionally, “the intervention was more effective for heavier drinking subjects when the partner was involved.”

The analyses identified additional variables that increased the risk of prenatal alcohol consumption: prenatal alcohol use before the study, level of education, temptation to drink in social situations, and number of years of regular alcohol use.

TORONTO — A single-session intervention can reduce prenatal alcohol use among at-risk pregnant women, especially those with higher reported alcohol consumption at baseline, Dr. Grace Chang reported at the annual meeting of the American Psychiatric Association.

Also, partner participation significantly enhances the intervention's positive effects.

The findings suggest that “screening and assessment with a validated instrument embedded into a patient information form can provide clinicians with important information about a woman's risk status and need for some type of intervention,” said Dr. Chang of Brigham and Women's Hospital in Boston. And providing at-risk women and their partners with alcohol education and behavior management tools early in pregnancy can significantly affect subsequent risk behaviors, she said.

To assess the impact of a brief psychoeducational intervention on women identified as being at risk for alcohol consumption during pregnancy, Dr. Chang and her colleagues randomized 304 pregnant women who met predefined alcohol risk criteria and their partners to receive a diagnostic interview and the single-session intervention or the diagnostic interview alone. Potential study participants were gleaned from Boston-area obstetrical practices based on their responses to a prenatal health and habits survey, which included questions about diet, smoking, exercise, stress, and drinking.

The predefined risk criteria for study enrollment included a total score of two or more on the four-item T-ACE alcohol screening instrument and any alcohol use in the 3 months before study enrollment (while pregnant), consumption of at least one drink per day in the 6 months before study enrollment, or drinking during a previous pregnancy. The T-ACE instrument asks four questions: How many drinks does it take to make you feel high (Tolerance)? Have people ever annoyed you by criticizing your drinking (Annoyed)? Have you ever felt you ought to cut down on your drinking (Cut down)? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)? The need for more than two drinks as a response to the tolerance question is worth two points, while positive answers to the remaining questions are each worth one point.

All of the study participants were at less than 28 weeks' gestation at the time of the diagnostic interview and intended to carry their pregnancy to term, and all were required to select a partner to participate in the study with them. Potential participants were excluded if they were under current treatment for alcohol or drug abuse or substance abuse-related medical illness, if they had current physical dependence on alcohol requiring medically supervised detoxification, if they were unable to complete the study questionnaires, or if they intended to terminate their pregnancy before gestation.

Study participants were, on average, at 11.5 weeks' gestation at the time of the study, and nearly half expected their first child. About 79% of the subjects were white, and 80% were married. Their median age was 31.4 years, and the median education level was a 4-year college degree.

At baseline, all of the pregnant participants underwent a diagnostic interview to measure daily drinking before the study, temptation to drink in certain social situations, and awareness of prenatal health behaviors. The partners underwent a separate interview to gauge their own drinking habits, their perception of their pregnant partners' drinking, and their knowledge of prenatal health behaviors.

Those partner pairs randomized to the intervention met with one of two trained nurse-practitioners or Dr. Chang for a single 25-minute session with four components: knowledge assessment with feedback, contracting and goal setting, behavior modification, and summary. The knowledge assessment and feedback component included a discussion of both partners' thoughts and misperceptions about prenatal health behaviors relative to alcohol use.

“We did not discuss the women's actual alcohol consumption in the presence of her partner unless they disclosed it voluntarily, for reasons of privacy and safety,” Dr. Chang said. “But the knowledge assessment was the springboard for the discussion of alcohol use during pregnancy.”

In the goal-setting and contracting component, the discussion focused on prenatal drinking goals. “It was not uncommon to hear women say their goal was to have 'just one drink' per week—and the women in the study were generally older and well educated. This would lead to a discussion of the surgeon general's advisory that no amount of alcohol is safe during pregnancy,” Dr. Chang said.

In the behavior-modification segment, the pregnant subjects were encouraged to think about circumstances, such as social events, that might invite the temptation to drink during pregnancy and to develop a list of alternative behaviors, such as having something to eat or a fake drink, Dr. Chang said. “We also asked the partner to list plans for personal behavior changes that could support the pregnant woman, such as drinking less or socializing differently.” Finally, the intervention was summarized on paper and provided to the partners.

Both the intervention and control subjects had a postpartum follow-up interview to review the frequency and quantity of alcohol consumed during pregnancy as well as changes in alcohol-related health habits since enrollment. “We had a 95% follow-up rate overall, and only 3% of partners were ultimately unable to participate in one part of the study or another,” Dr. Chang noted.

The investigators used univariate and multivariate analyses to compare the intervention and control groups before and after study enrollment, and least squares regression models were used to evaluate the effect of the intervention on three dependent variables: alcohol consumption quantity, frequency, and both.

When the two groups were compared, “there were no statistically significant differences in the amount or frequency of prepregnancy alcohol consumption, and most of the women in both conditions demonstrated overall reduced alcohol consumption once enrolled,” Dr. Chang said. “Many of the women spontaneously decreased the frequency of their alcohol consumption to a mean of 5% drinking days, although fewer than 20% were abstinent.”

The results of an intention-to-treat analysis showed a significant interaction between the intervention and prenatal alcohol consumption, Dr. Chang reported. “The brief intervention was most effective in reducing the frequency of consumption among women who drank more at the time of the study enrollment,” she said. Additionally, “the intervention was more effective for heavier drinking subjects when the partner was involved.”

The analyses identified additional variables that increased the risk of prenatal alcohol consumption: prenatal alcohol use before the study, level of education, temptation to drink in social situations, and number of years of regular alcohol use.

BOSTON — Overweight and obese adolescents are not being sufficiently screened for weight-related comorbid conditions, and the failure to do so can have enduring health implications, Dr. Margaret Stager said at the annual meeting of the Society for Adolescent Medicine.

Despite the implementation of a screening protocol in the pediatric department of an urban medical center, approximately one-third of patients seen during a 2.5-year period who were identified as being overweight (body mass index between the 85th and 94th percentile) or obese (95th percentile or higher) did not have the recommended laboratory screening tests ordered, reported Dr. Stager of the MetroHealth Medical Center in Cleveland. The recommended laboratory studies for this population according to the protocol include a full lipid profile, liver function tests, and insulin and glucose levels.

A chart review of 362 overweight and obese adolescent patients seen in the adolescent medicine division of the medical center between October 2002 and May 2005 showed that 113 patients did not have the recommended screening tests ordered, Dr. Stager reported in a poster presentation. Eighty-one of the patients had tests ordered but not completed, and 168 patients completed the lab testing.

The study population—69% of whom were female—was 46% African American, 36% white, and 18% Hispanic. The mean body mass index was 33 kg/m

There were no significant differences in either racial background or age with respect to overweight or obese status, but males were more likely to be obese than overweight, Dr. Stager pointed out.

Among the patients who underwent the recommended fasting laboratory tests, abnormal test results were found in both the overweight and obese groups, but no significant differences between the two groups were seen in mean values for total cholesterol, low-density lipoprotein, alanine aminotransferase, aspartate aminotransferase, glucose, and insulin levels.

“There were significantly more abnormal test results in the obese vs. the overweight group for high-density lipoproteins and triglycerides,” Dr. Stager said. The mean HDL levels were 49 mg/dL for the overweight group and 42 mg/dL for the obese group, and the respective mean triglyceride levels were 71 mg/dL and 97 mg/dL. Additionally, in each group, “there were two patients with impaired glucose tolerance,” she noted.

The findings suggest “a missed opportunity” for identifying patients at risk for comorbid conditions related to being overweight or obese such as cardiovascular disease or diabetes and providing supportive interventions to help minimize the health damage, said Dr. Stager.

BOSTON — Overweight and obese adolescents are not being sufficiently screened for weight-related comorbid conditions, and the failure to do so can have enduring health implications, Dr. Margaret Stager said at the annual meeting of the Society for Adolescent Medicine.

Despite the implementation of a screening protocol in the pediatric department of an urban medical center, approximately one-third of patients seen during a 2.5-year period who were identified as being overweight (body mass index between the 85th and 94th percentile) or obese (95th percentile or higher) did not have the recommended laboratory screening tests ordered, reported Dr. Stager of the MetroHealth Medical Center in Cleveland. The recommended laboratory studies for this population according to the protocol include a full lipid profile, liver function tests, and insulin and glucose levels.

A chart review of 362 overweight and obese adolescent patients seen in the adolescent medicine division of the medical center between October 2002 and May 2005 showed that 113 patients did not have the recommended screening tests ordered, Dr. Stager reported in a poster presentation. Eighty-one of the patients had tests ordered but not completed, and 168 patients completed the lab testing.

The study population—69% of whom were female—was 46% African American, 36% white, and 18% Hispanic. The mean body mass index was 33 kg/m

There were no significant differences in either racial background or age with respect to overweight or obese status, but males were more likely to be obese than overweight, Dr. Stager pointed out.

Among the patients who underwent the recommended fasting laboratory tests, abnormal test results were found in both the overweight and obese groups, but no significant differences between the two groups were seen in mean values for total cholesterol, low-density lipoprotein, alanine aminotransferase, aspartate aminotransferase, glucose, and insulin levels.

“There were significantly more abnormal test results in the obese vs. the overweight group for high-density lipoproteins and triglycerides,” Dr. Stager said. The mean HDL levels were 49 mg/dL for the overweight group and 42 mg/dL for the obese group, and the respective mean triglyceride levels were 71 mg/dL and 97 mg/dL. Additionally, in each group, “there were two patients with impaired glucose tolerance,” she noted.

The findings suggest “a missed opportunity” for identifying patients at risk for comorbid conditions related to being overweight or obese such as cardiovascular disease or diabetes and providing supportive interventions to help minimize the health damage, said Dr. Stager.

BOSTON — Overweight and obese adolescents are not being sufficiently screened for weight-related comorbid conditions, and the failure to do so can have enduring health implications, Dr. Margaret Stager said at the annual meeting of the Society for Adolescent Medicine.

Despite the implementation of a screening protocol in the pediatric department of an urban medical center, approximately one-third of patients seen during a 2.5-year period who were identified as being overweight (body mass index between the 85th and 94th percentile) or obese (95th percentile or higher) did not have the recommended laboratory screening tests ordered, reported Dr. Stager of the MetroHealth Medical Center in Cleveland. The recommended laboratory studies for this population according to the protocol include a full lipid profile, liver function tests, and insulin and glucose levels.

A chart review of 362 overweight and obese adolescent patients seen in the adolescent medicine division of the medical center between October 2002 and May 2005 showed that 113 patients did not have the recommended screening tests ordered, Dr. Stager reported in a poster presentation. Eighty-one of the patients had tests ordered but not completed, and 168 patients completed the lab testing.

The study population—69% of whom were female—was 46% African American, 36% white, and 18% Hispanic. The mean body mass index was 33 kg/m

There were no significant differences in either racial background or age with respect to overweight or obese status, but males were more likely to be obese than overweight, Dr. Stager pointed out.

Among the patients who underwent the recommended fasting laboratory tests, abnormal test results were found in both the overweight and obese groups, but no significant differences between the two groups were seen in mean values for total cholesterol, low-density lipoprotein, alanine aminotransferase, aspartate aminotransferase, glucose, and insulin levels.

“There were significantly more abnormal test results in the obese vs. the overweight group for high-density lipoproteins and triglycerides,” Dr. Stager said. The mean HDL levels were 49 mg/dL for the overweight group and 42 mg/dL for the obese group, and the respective mean triglyceride levels were 71 mg/dL and 97 mg/dL. Additionally, in each group, “there were two patients with impaired glucose tolerance,” she noted.

The findings suggest “a missed opportunity” for identifying patients at risk for comorbid conditions related to being overweight or obese such as cardiovascular disease or diabetes and providing supportive interventions to help minimize the health damage, said Dr. Stager.

TORONTO – Comorbid obsessive and compulsive behaviors persist in women with bulimia nervosa, even after the abnormal eating patterns associated with the condition have been successfully treated, Dr. Jessica C. Morgan said at the annual meeting of the American Psychiatric Association.

This finding suggests that elevated obsessive and compulsive ratings may reflect a persistent trait characteristic in individuals who develop the eating disorder–a discovery that “could lead to new treatment strategies for managing anxiety symptoms in at-risk individuals, particularly those in the recovery stages of bulimia,” said Dr. Morgan of the department of psychiatry at Dartmouth Medical School in Hanover, N.H.

Because previous studies have linked obsessive and compulsive behaviors to the primary symptoms of bulimia, Dr. Morgan and her colleagues sought to determine whether remission from bulimia had an impact on co-occurring obsessive-compulsive symptoms.

Using subject self-ratings on the Maudsley Obsessive-Compulsive Inventory (MOCI), the investigators compared the obsessive-compulsive characteristics of 25 women with active bulimia, 21 of whom were in recovery from bulimia, and 28 healthy controls–all of whom were medication free at the time of the assessment. The investigators also looked at participants' mean scores on the Eating Attitudes Test (EAT), which assesses disordered eating attitudes, and the Spielberger Trait Anxiety Inventory (STAI), which tests for anxiety disorders.

“As we had expected, the MOCI scores for the bulimia group were significantly elevated, compared to those of the controls,” said Dr. Morgan, noting that the respective scores were 5.4 vs. 2.5 on the 30-item true-false questionnaire designed to assess overt rituals and their related obsessions. “The recovery group had similarly elevated MOCI scores [5.5],” she said, which suggests that those aspects of the disease associated with obsessive-compulsive behaviors were not affected by treatment.

In contrast, the EAT and STAI scores for the women in recovery were significantly reduced, compared with those of the women with active bulimia, “although they were still significantly higher than what we observed in the control group,” Dr. Morgan said.

The persistence of obsessive-compulsive symptoms after recovery from bulimia not only suggests that such behaviors may be trait related in affected individuals, but also raises the possibility that the behaviors contribute somehow to the pathogenesis of the eating disorder, she noted.

Although more research is needed to clarify the relationship between the cooccurring conditions, the demonstrated link between the two may help clinicians more readily identify bulimia patients at risk for lingering obsessive-compulsive symptoms, Dr. Morgan said.

TORONTO – Comorbid obsessive and compulsive behaviors persist in women with bulimia nervosa, even after the abnormal eating patterns associated with the condition have been successfully treated, Dr. Jessica C. Morgan said at the annual meeting of the American Psychiatric Association.

This finding suggests that elevated obsessive and compulsive ratings may reflect a persistent trait characteristic in individuals who develop the eating disorder–a discovery that “could lead to new treatment strategies for managing anxiety symptoms in at-risk individuals, particularly those in the recovery stages of bulimia,” said Dr. Morgan of the department of psychiatry at Dartmouth Medical School in Hanover, N.H.

Because previous studies have linked obsessive and compulsive behaviors to the primary symptoms of bulimia, Dr. Morgan and her colleagues sought to determine whether remission from bulimia had an impact on co-occurring obsessive-compulsive symptoms.

Using subject self-ratings on the Maudsley Obsessive-Compulsive Inventory (MOCI), the investigators compared the obsessive-compulsive characteristics of 25 women with active bulimia, 21 of whom were in recovery from bulimia, and 28 healthy controls–all of whom were medication free at the time of the assessment. The investigators also looked at participants' mean scores on the Eating Attitudes Test (EAT), which assesses disordered eating attitudes, and the Spielberger Trait Anxiety Inventory (STAI), which tests for anxiety disorders.

“As we had expected, the MOCI scores for the bulimia group were significantly elevated, compared to those of the controls,” said Dr. Morgan, noting that the respective scores were 5.4 vs. 2.5 on the 30-item true-false questionnaire designed to assess overt rituals and their related obsessions. “The recovery group had similarly elevated MOCI scores [5.5],” she said, which suggests that those aspects of the disease associated with obsessive-compulsive behaviors were not affected by treatment.

In contrast, the EAT and STAI scores for the women in recovery were significantly reduced, compared with those of the women with active bulimia, “although they were still significantly higher than what we observed in the control group,” Dr. Morgan said.

The persistence of obsessive-compulsive symptoms after recovery from bulimia not only suggests that such behaviors may be trait related in affected individuals, but also raises the possibility that the behaviors contribute somehow to the pathogenesis of the eating disorder, she noted.

Although more research is needed to clarify the relationship between the cooccurring conditions, the demonstrated link between the two may help clinicians more readily identify bulimia patients at risk for lingering obsessive-compulsive symptoms, Dr. Morgan said.

TORONTO – Comorbid obsessive and compulsive behaviors persist in women with bulimia nervosa, even after the abnormal eating patterns associated with the condition have been successfully treated, Dr. Jessica C. Morgan said at the annual meeting of the American Psychiatric Association.

This finding suggests that elevated obsessive and compulsive ratings may reflect a persistent trait characteristic in individuals who develop the eating disorder–a discovery that “could lead to new treatment strategies for managing anxiety symptoms in at-risk individuals, particularly those in the recovery stages of bulimia,” said Dr. Morgan of the department of psychiatry at Dartmouth Medical School in Hanover, N.H.

Because previous studies have linked obsessive and compulsive behaviors to the primary symptoms of bulimia, Dr. Morgan and her colleagues sought to determine whether remission from bulimia had an impact on co-occurring obsessive-compulsive symptoms.

Using subject self-ratings on the Maudsley Obsessive-Compulsive Inventory (MOCI), the investigators compared the obsessive-compulsive characteristics of 25 women with active bulimia, 21 of whom were in recovery from bulimia, and 28 healthy controls–all of whom were medication free at the time of the assessment. The investigators also looked at participants' mean scores on the Eating Attitudes Test (EAT), which assesses disordered eating attitudes, and the Spielberger Trait Anxiety Inventory (STAI), which tests for anxiety disorders.

“As we had expected, the MOCI scores for the bulimia group were significantly elevated, compared to those of the controls,” said Dr. Morgan, noting that the respective scores were 5.4 vs. 2.5 on the 30-item true-false questionnaire designed to assess overt rituals and their related obsessions. “The recovery group had similarly elevated MOCI scores [5.5],” she said, which suggests that those aspects of the disease associated with obsessive-compulsive behaviors were not affected by treatment.

In contrast, the EAT and STAI scores for the women in recovery were significantly reduced, compared with those of the women with active bulimia, “although they were still significantly higher than what we observed in the control group,” Dr. Morgan said.

The persistence of obsessive-compulsive symptoms after recovery from bulimia not only suggests that such behaviors may be trait related in affected individuals, but also raises the possibility that the behaviors contribute somehow to the pathogenesis of the eating disorder, she noted.

Although more research is needed to clarify the relationship between the cooccurring conditions, the demonstrated link between the two may help clinicians more readily identify bulimia patients at risk for lingering obsessive-compulsive symptoms, Dr. Morgan said.

TORONTO – A single-session intervention can reduce prenatal alcohol use among at-risk pregnant women, especially those with higher reported alcohol consumption at baseline, Dr. Grace Chang reported at the annual meeting of the American Psychiatric Association.

Additionally, partner participation significantly enhances the positive effects of the intervention.

The findings suggest that “screening and assessment with a validated instrument embedded into a patient information form can provide clinicians with important information about a woman's risk status and need for some type of intervention,” according to Dr. Chang of Brigham and Women's Hospital in Boston. Also, providing at-risk women and their partners with alcohol education and behavior management tools early in pregnancy can significantly affect subsequent risk behaviors, she said.

To assess the impact of a brief psychoeducational intervention on women identified as being at risk for alcohol consumption during pregnancy, Dr. Chang and her colleagues randomized 304 pregnant women who met predefined alcohol risk criteria and their partners to receive a diagnostic interview and the single-session intervention or the diagnostic interview alone. Potential study participants were gleaned from Boston-area obstetrical practices based on their responses to a prenatal health and habits survey, which included questions about diet, smoking, exercise, stress, and drinking.

The predefined risk criteria for study enrollment included a total score of two or more on the four-item T-ACE alcohol screening instrument and any alcohol use in the 3 months before study enrollment (while pregnant), consumption of at least one drink per day in the 6 months before study enrollment, or drinking during a previous pregnancy. The T-ACE instrument asks four questions: How many drinks does it take to make you feel high (Tolerance)? Have people ever annoyed you by criticizing your drinking (Annoyed)? Have you ever felt you ought to cut down on your drinking (Cut down)? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)? The need for more than two drinks as a response to the tolerance question is worth two points, while positive answers to the remaining questions are each worth one point.

All of the study participants were at less than 28 weeks' gestation at the time of the diagnostic interview and intended to carry their pregnancy to term, and all were required to select a partner to participate in the study with them. Potential participants were excluded if they were under current treatment for alcohol or drug abuse or substance abuse-related medical illness, if they had current physical dependence on alcohol requiring medically supervised detoxification, if they were unable to complete the study questionnaires, or if they intended to terminate their pregnancy before gestation.

Study participants were, on average, at 11.5 weeks' gestation at the time of the study, and nearly half expected their first child. About 79% of the subjects were white, and 80% were married. Their median age was 31.4 years, and the median education level was a four-year college degree or the equivalent.

At baseline, all of the pregnant participants underwent a diagnostic interview to measure daily drinking before the study, temptation to drink in certain social situations, and awareness of prenatal health behaviors. The partners underwent a separate interview to gauge their own drinking habits, their perception of their pregnant partners' drinking, and their knowledge of prenatal health behaviors.

Those partner pairs randomized to the intervention met with one of two trained nurse-practitioners or Dr. Chang for a single 25-minute session consisting of four components: knowledge assessment with feedback, contracting and goal setting, behavior modification, and summary. The knowledge assessment and feedback component included a discussion of both partners' thoughts and misperceptions about prenatal health behaviors.

“We did not discuss the women's actual alcohol consumption in the presence of her partner unless they disclosed it voluntarily, for reasons of privacy and safety,” Dr. Chang said. “But the knowledge assessment was the springboard for the discussion of alcohol use during pregnancy.”

In the goal-setting and contracting component, the discussion focused on prenatal drinking goals. “It was not uncommon to hear women say their goal was to have 'just one drink' per week–and the women in the study were generally older and well educated. This would lead to a discussion of the surgeon general's advisory that no amount of alcohol is safe during pregnancy,” Dr. Chang said.

In the behavior-modification segment, the pregnant subjects were encouraged to think about circumstances, such as social events, that might invite the temptation to drink during pregnancy and to develop a list of alternative behaviors, “such as having something to eat or having a fake drink,” Dr. Chang said. “We also asked the partner to list plans for personal behavior changes that could support the pregnant woman, such as drinking less or socializing differently.” Finally, the intervention was summarized on paper and provided to the partners.

Both the intervention and control subjects underwent a postpartum follow-up interview to review the frequency and quantity of alcohol consumed during pregnancy as well as changes in alcohol-related health habits since the time of enrollment. “We had a 95% follow-up rate overall, and only 3% of partners were ultimately unable to participate in one part of the study or another,” Dr. Chang noted.

The investigators used univariate and multivariate analyses to compare the intervention and control groups before and after study enrollment, and least squares regression models were used to evaluate the effect of the intervention on three dependent variables: alcohol consumption quantity, frequency, and both.

When the two groups were compared, “there were no statistically significant differences in the amount or frequency of prepregnancy alcohol consumption, and most of the women in both conditions demonstrated overall reduced alcohol consumption once enrolled,” Dr. Chang said. “Many of the women spontaneously decreased the frequency of their alcohol consumption to a mean of 5% drinking days, although fewer than 20% were abstinent.”

The results of an intention-to-treat analysis showed a significant interaction between the intervention and prenatal alcohol consumption, Dr. Chang reported. “The brief intervention was most effective in reducing the frequency of consumption among women who drank more at the time of the study enrollment,” she said. Additionally, “the intervention was more effective for heavier drinking subjects when the partner was involved. It was really quite exciting to see that, as most of the previous research regarding partner influence has focused on two areas: prenatal cigarette smoking, where the partner's smoking habits are strong predictors of the woman's; and breast-feeding, where partner support is an important factor.”

The analyses also identified several additional variables that increased the risk of prenatal alcohol consumption: the amount of prenatal alcohol use before study enrollment, level of education, temptation to drink in social situations, and number of years of regular alcohol use. “We found that the strongest predictor was alcohol use at the previous time–lifetime use predicted prepregnancy use, prepregnancy use predicted early pregnancy use, and so on,” Dr. Chang said. “Partners' drinking was not a predictor, which was a surprise; nor was knowledge of risks a predictor, which is often the case in psychiatry–knowing the right thing to do doesn't mean someone will do it.”

TORONTO – A single-session intervention can reduce prenatal alcohol use among at-risk pregnant women, especially those with higher reported alcohol consumption at baseline, Dr. Grace Chang reported at the annual meeting of the American Psychiatric Association.

Additionally, partner participation significantly enhances the positive effects of the intervention.

The findings suggest that “screening and assessment with a validated instrument embedded into a patient information form can provide clinicians with important information about a woman's risk status and need for some type of intervention,” according to Dr. Chang of Brigham and Women's Hospital in Boston. Also, providing at-risk women and their partners with alcohol education and behavior management tools early in pregnancy can significantly affect subsequent risk behaviors, she said.

To assess the impact of a brief psychoeducational intervention on women identified as being at risk for alcohol consumption during pregnancy, Dr. Chang and her colleagues randomized 304 pregnant women who met predefined alcohol risk criteria and their partners to receive a diagnostic interview and the single-session intervention or the diagnostic interview alone. Potential study participants were gleaned from Boston-area obstetrical practices based on their responses to a prenatal health and habits survey, which included questions about diet, smoking, exercise, stress, and drinking.

The predefined risk criteria for study enrollment included a total score of two or more on the four-item T-ACE alcohol screening instrument and any alcohol use in the 3 months before study enrollment (while pregnant), consumption of at least one drink per day in the 6 months before study enrollment, or drinking during a previous pregnancy. The T-ACE instrument asks four questions: How many drinks does it take to make you feel high (Tolerance)? Have people ever annoyed you by criticizing your drinking (Annoyed)? Have you ever felt you ought to cut down on your drinking (Cut down)? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)? The need for more than two drinks as a response to the tolerance question is worth two points, while positive answers to the remaining questions are each worth one point.

All of the study participants were at less than 28 weeks' gestation at the time of the diagnostic interview and intended to carry their pregnancy to term, and all were required to select a partner to participate in the study with them. Potential participants were excluded if they were under current treatment for alcohol or drug abuse or substance abuse-related medical illness, if they had current physical dependence on alcohol requiring medically supervised detoxification, if they were unable to complete the study questionnaires, or if they intended to terminate their pregnancy before gestation.

Study participants were, on average, at 11.5 weeks' gestation at the time of the study, and nearly half expected their first child. About 79% of the subjects were white, and 80% were married. Their median age was 31.4 years, and the median education level was a four-year college degree or the equivalent.

At baseline, all of the pregnant participants underwent a diagnostic interview to measure daily drinking before the study, temptation to drink in certain social situations, and awareness of prenatal health behaviors. The partners underwent a separate interview to gauge their own drinking habits, their perception of their pregnant partners' drinking, and their knowledge of prenatal health behaviors.

Those partner pairs randomized to the intervention met with one of two trained nurse-practitioners or Dr. Chang for a single 25-minute session consisting of four components: knowledge assessment with feedback, contracting and goal setting, behavior modification, and summary. The knowledge assessment and feedback component included a discussion of both partners' thoughts and misperceptions about prenatal health behaviors.

“We did not discuss the women's actual alcohol consumption in the presence of her partner unless they disclosed it voluntarily, for reasons of privacy and safety,” Dr. Chang said. “But the knowledge assessment was the springboard for the discussion of alcohol use during pregnancy.”

In the goal-setting and contracting component, the discussion focused on prenatal drinking goals. “It was not uncommon to hear women say their goal was to have 'just one drink' per week–and the women in the study were generally older and well educated. This would lead to a discussion of the surgeon general's advisory that no amount of alcohol is safe during pregnancy,” Dr. Chang said.

In the behavior-modification segment, the pregnant subjects were encouraged to think about circumstances, such as social events, that might invite the temptation to drink during pregnancy and to develop a list of alternative behaviors, “such as having something to eat or having a fake drink,” Dr. Chang said. “We also asked the partner to list plans for personal behavior changes that could support the pregnant woman, such as drinking less or socializing differently.” Finally, the intervention was summarized on paper and provided to the partners.

Both the intervention and control subjects underwent a postpartum follow-up interview to review the frequency and quantity of alcohol consumed during pregnancy as well as changes in alcohol-related health habits since the time of enrollment. “We had a 95% follow-up rate overall, and only 3% of partners were ultimately unable to participate in one part of the study or another,” Dr. Chang noted.

The investigators used univariate and multivariate analyses to compare the intervention and control groups before and after study enrollment, and least squares regression models were used to evaluate the effect of the intervention on three dependent variables: alcohol consumption quantity, frequency, and both.

When the two groups were compared, “there were no statistically significant differences in the amount or frequency of prepregnancy alcohol consumption, and most of the women in both conditions demonstrated overall reduced alcohol consumption once enrolled,” Dr. Chang said. “Many of the women spontaneously decreased the frequency of their alcohol consumption to a mean of 5% drinking days, although fewer than 20% were abstinent.”

The results of an intention-to-treat analysis showed a significant interaction between the intervention and prenatal alcohol consumption, Dr. Chang reported. “The brief intervention was most effective in reducing the frequency of consumption among women who drank more at the time of the study enrollment,” she said. Additionally, “the intervention was more effective for heavier drinking subjects when the partner was involved. It was really quite exciting to see that, as most of the previous research regarding partner influence has focused on two areas: prenatal cigarette smoking, where the partner's smoking habits are strong predictors of the woman's; and breast-feeding, where partner support is an important factor.”

The analyses also identified several additional variables that increased the risk of prenatal alcohol consumption: the amount of prenatal alcohol use before study enrollment, level of education, temptation to drink in social situations, and number of years of regular alcohol use. “We found that the strongest predictor was alcohol use at the previous time–lifetime use predicted prepregnancy use, prepregnancy use predicted early pregnancy use, and so on,” Dr. Chang said. “Partners' drinking was not a predictor, which was a surprise; nor was knowledge of risks a predictor, which is often the case in psychiatry–knowing the right thing to do doesn't mean someone will do it.”

TORONTO – A single-session intervention can reduce prenatal alcohol use among at-risk pregnant women, especially those with higher reported alcohol consumption at baseline, Dr. Grace Chang reported at the annual meeting of the American Psychiatric Association.

Additionally, partner participation significantly enhances the positive effects of the intervention.

The findings suggest that “screening and assessment with a validated instrument embedded into a patient information form can provide clinicians with important information about a woman's risk status and need for some type of intervention,” according to Dr. Chang of Brigham and Women's Hospital in Boston. Also, providing at-risk women and their partners with alcohol education and behavior management tools early in pregnancy can significantly affect subsequent risk behaviors, she said.

To assess the impact of a brief psychoeducational intervention on women identified as being at risk for alcohol consumption during pregnancy, Dr. Chang and her colleagues randomized 304 pregnant women who met predefined alcohol risk criteria and their partners to receive a diagnostic interview and the single-session intervention or the diagnostic interview alone. Potential study participants were gleaned from Boston-area obstetrical practices based on their responses to a prenatal health and habits survey, which included questions about diet, smoking, exercise, stress, and drinking.

The predefined risk criteria for study enrollment included a total score of two or more on the four-item T-ACE alcohol screening instrument and any alcohol use in the 3 months before study enrollment (while pregnant), consumption of at least one drink per day in the 6 months before study enrollment, or drinking during a previous pregnancy. The T-ACE instrument asks four questions: How many drinks does it take to make you feel high (Tolerance)? Have people ever annoyed you by criticizing your drinking (Annoyed)? Have you ever felt you ought to cut down on your drinking (Cut down)? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)? The need for more than two drinks as a response to the tolerance question is worth two points, while positive answers to the remaining questions are each worth one point.

All of the study participants were at less than 28 weeks' gestation at the time of the diagnostic interview and intended to carry their pregnancy to term, and all were required to select a partner to participate in the study with them. Potential participants were excluded if they were under current treatment for alcohol or drug abuse or substance abuse-related medical illness, if they had current physical dependence on alcohol requiring medically supervised detoxification, if they were unable to complete the study questionnaires, or if they intended to terminate their pregnancy before gestation.

Study participants were, on average, at 11.5 weeks' gestation at the time of the study, and nearly half expected their first child. About 79% of the subjects were white, and 80% were married. Their median age was 31.4 years, and the median education level was a four-year college degree or the equivalent.

At baseline, all of the pregnant participants underwent a diagnostic interview to measure daily drinking before the study, temptation to drink in certain social situations, and awareness of prenatal health behaviors. The partners underwent a separate interview to gauge their own drinking habits, their perception of their pregnant partners' drinking, and their knowledge of prenatal health behaviors.

Those partner pairs randomized to the intervention met with one of two trained nurse-practitioners or Dr. Chang for a single 25-minute session consisting of four components: knowledge assessment with feedback, contracting and goal setting, behavior modification, and summary. The knowledge assessment and feedback component included a discussion of both partners' thoughts and misperceptions about prenatal health behaviors.

“We did not discuss the women's actual alcohol consumption in the presence of her partner unless they disclosed it voluntarily, for reasons of privacy and safety,” Dr. Chang said. “But the knowledge assessment was the springboard for the discussion of alcohol use during pregnancy.”

In the goal-setting and contracting component, the discussion focused on prenatal drinking goals. “It was not uncommon to hear women say their goal was to have 'just one drink' per week–and the women in the study were generally older and well educated. This would lead to a discussion of the surgeon general's advisory that no amount of alcohol is safe during pregnancy,” Dr. Chang said.

In the behavior-modification segment, the pregnant subjects were encouraged to think about circumstances, such as social events, that might invite the temptation to drink during pregnancy and to develop a list of alternative behaviors, “such as having something to eat or having a fake drink,” Dr. Chang said. “We also asked the partner to list plans for personal behavior changes that could support the pregnant woman, such as drinking less or socializing differently.” Finally, the intervention was summarized on paper and provided to the partners.

Both the intervention and control subjects underwent a postpartum follow-up interview to review the frequency and quantity of alcohol consumed during pregnancy as well as changes in alcohol-related health habits since the time of enrollment. “We had a 95% follow-up rate overall, and only 3% of partners were ultimately unable to participate in one part of the study or another,” Dr. Chang noted.

The investigators used univariate and multivariate analyses to compare the intervention and control groups before and after study enrollment, and least squares regression models were used to evaluate the effect of the intervention on three dependent variables: alcohol consumption quantity, frequency, and both.

When the two groups were compared, “there were no statistically significant differences in the amount or frequency of prepregnancy alcohol consumption, and most of the women in both conditions demonstrated overall reduced alcohol consumption once enrolled,” Dr. Chang said. “Many of the women spontaneously decreased the frequency of their alcohol consumption to a mean of 5% drinking days, although fewer than 20% were abstinent.”

The results of an intention-to-treat analysis showed a significant interaction between the intervention and prenatal alcohol consumption, Dr. Chang reported. “The brief intervention was most effective in reducing the frequency of consumption among women who drank more at the time of the study enrollment,” she said. Additionally, “the intervention was more effective for heavier drinking subjects when the partner was involved. It was really quite exciting to see that, as most of the previous research regarding partner influence has focused on two areas: prenatal cigarette smoking, where the partner's smoking habits are strong predictors of the woman's; and breast-feeding, where partner support is an important factor.”

The analyses also identified several additional variables that increased the risk of prenatal alcohol consumption: the amount of prenatal alcohol use before study enrollment, level of education, temptation to drink in social situations, and number of years of regular alcohol use. “We found that the strongest predictor was alcohol use at the previous time–lifetime use predicted prepregnancy use, prepregnancy use predicted early pregnancy use, and so on,” Dr. Chang said. “Partners' drinking was not a predictor, which was a surprise; nor was knowledge of risks a predictor, which is often the case in psychiatry–knowing the right thing to do doesn't mean someone will do it.”

MONTREAL – Comorbid mood and behavior problems that are present at an early age in children diagnosed with an autism spectrum disorder are associated with the frequency and severity of restrictive, repetitive, and stereotyped behaviors, a study has shown.

But those comorbid behaviors–including anxiety, hyperactivity, oversensitivity, and conduct problems–are not related to social or communication diagnostic criteria, Robin L. Gabriels, Psy.D., said at the 5th International Meeting for Autism Research.

Previous studies have demonstrated that people who have autism spectrum disorders (ASD) are at risk for various comorbid behavioral and psychiatric disturbances.

But at this point, it remains unclear whether such problems occur independently or result from pathologic processes that lead to autism, Dr. Gabriels said in a poster presentation.

And while it has been hypothesized that these comorbid problems somehow relate to the range of restrictive and repetitive behaviors and interests that characterize autism–including inflexible adherence to specific, nonfunctional routines or rituals, stereotyped and repetitive motor mannerisms, and self-injurious acts–data are lacking on how the specific behaviors relate, she said.

In an effort to gain insight into this association, Dr. Gabriels of the University of Colorado Health Sciences Center, Denver, and her colleagues compared the presence of frequent/severe repetitive behaviors and mood/behavioral problems in preschool children diagnosed with an ASD with those of a chronologic-age matched, typically developing control group.

The investigation relied on survey-based ratings by parents or other caregivers of 61 children (mean age 50.5 months) with an ASD who were recruited through the autism research registry at the University of North Carolina at Chapel Hill and 65 children (mean age 46.5 months) with typical development recruited through local preschools and day care centers.

The assessment measures included the Social Communication Questionnaire (SCQ), which screens for the presence of ASDs; the Repetitive Behavior Rating Scale-Revised (RBS-R), which measures stereotypy, self-injurious behavior, compulsions, rituals/sameness, and restricted interests; and the Nisonger Child Behavior Rating Form (NCBRF), which assesses behavior and emotional problems in children.

The investigators used unpaired t-tests for between-group comparisons of NCBRF scores for conduct, anxiety, hyperactivity, and overly sensitive behaviors, and Spearman's correlations to determine the relationship within the autism group between mood/behavior problems, autism symptoms, and repetitive behavior subtypes. Multiple regression analysis determined which NCBRF factor best predicted the total repetitive behavior score.

The data showed that the ASD group had significantly more mood and behavior problems than did the control group. Additionally, within the ASD group, “the RBS-R total score was significantly correlated with all four NCBRF subscales,” Dr. Gabriels said.

In contrast, none of the NCBRF subscales correlated significantly with the SCQ social or communication measures.

The multiple regression analysis of the individual NCBRF subscales relative to the RBS-R total score showed that anxiety was the best predictor of the presence of repetitive behaviors in the ASD group.

“Anxiety symptoms increased significantly with repetitive behaviors in the autistic group, but not in the typically developing group,” according to Dr. Gabriels.

This finding suggests that the presence of frequent and severe repetitive behaviors could signal increased anxiety in a child with an ASD, Dr. Gabriels said.

Furthermore, she said, such insight into these associations could help in the clinical assessment and management of patients by improving the accuracy of comorbid psychological diagnoses and ensuring appropriate treatment.

With respect to the anxiety finding, the male:female ratio in the ASD group was 9:1, “so it is possible that the strong relationship between more frequent/severe repetitive behaviors and symptoms of anxiety may reflect the tendency of males to have higher levels of externalizing behaviors than females,” Dr. Gabriels pointed out.

Further study is needed to gain more insight into the nature of the association, she said.

MONTREAL – Comorbid mood and behavior problems that are present at an early age in children diagnosed with an autism spectrum disorder are associated with the frequency and severity of restrictive, repetitive, and stereotyped behaviors, a study has shown.

But those comorbid behaviors–including anxiety, hyperactivity, oversensitivity, and conduct problems–are not related to social or communication diagnostic criteria, Robin L. Gabriels, Psy.D., said at the 5th International Meeting for Autism Research.

Previous studies have demonstrated that people who have autism spectrum disorders (ASD) are at risk for various comorbid behavioral and psychiatric disturbances.

But at this point, it remains unclear whether such problems occur independently or result from pathologic processes that lead to autism, Dr. Gabriels said in a poster presentation.

And while it has been hypothesized that these comorbid problems somehow relate to the range of restrictive and repetitive behaviors and interests that characterize autism–including inflexible adherence to specific, nonfunctional routines or rituals, stereotyped and repetitive motor mannerisms, and self-injurious acts–data are lacking on how the specific behaviors relate, she said.

In an effort to gain insight into this association, Dr. Gabriels of the University of Colorado Health Sciences Center, Denver, and her colleagues compared the presence of frequent/severe repetitive behaviors and mood/behavioral problems in preschool children diagnosed with an ASD with those of a chronologic-age matched, typically developing control group.

The investigation relied on survey-based ratings by parents or other caregivers of 61 children (mean age 50.5 months) with an ASD who were recruited through the autism research registry at the University of North Carolina at Chapel Hill and 65 children (mean age 46.5 months) with typical development recruited through local preschools and day care centers.

The assessment measures included the Social Communication Questionnaire (SCQ), which screens for the presence of ASDs; the Repetitive Behavior Rating Scale-Revised (RBS-R), which measures stereotypy, self-injurious behavior, compulsions, rituals/sameness, and restricted interests; and the Nisonger Child Behavior Rating Form (NCBRF), which assesses behavior and emotional problems in children.

The investigators used unpaired t-tests for between-group comparisons of NCBRF scores for conduct, anxiety, hyperactivity, and overly sensitive behaviors, and Spearman's correlations to determine the relationship within the autism group between mood/behavior problems, autism symptoms, and repetitive behavior subtypes. Multiple regression analysis determined which NCBRF factor best predicted the total repetitive behavior score.

The data showed that the ASD group had significantly more mood and behavior problems than did the control group. Additionally, within the ASD group, “the RBS-R total score was significantly correlated with all four NCBRF subscales,” Dr. Gabriels said.

In contrast, none of the NCBRF subscales correlated significantly with the SCQ social or communication measures.

The multiple regression analysis of the individual NCBRF subscales relative to the RBS-R total score showed that anxiety was the best predictor of the presence of repetitive behaviors in the ASD group.

“Anxiety symptoms increased significantly with repetitive behaviors in the autistic group, but not in the typically developing group,” according to Dr. Gabriels.

This finding suggests that the presence of frequent and severe repetitive behaviors could signal increased anxiety in a child with an ASD, Dr. Gabriels said.

Furthermore, she said, such insight into these associations could help in the clinical assessment and management of patients by improving the accuracy of comorbid psychological diagnoses and ensuring appropriate treatment.

With respect to the anxiety finding, the male:female ratio in the ASD group was 9:1, “so it is possible that the strong relationship between more frequent/severe repetitive behaviors and symptoms of anxiety may reflect the tendency of males to have higher levels of externalizing behaviors than females,” Dr. Gabriels pointed out.

Further study is needed to gain more insight into the nature of the association, she said.

MONTREAL – Comorbid mood and behavior problems that are present at an early age in children diagnosed with an autism spectrum disorder are associated with the frequency and severity of restrictive, repetitive, and stereotyped behaviors, a study has shown.

But those comorbid behaviors–including anxiety, hyperactivity, oversensitivity, and conduct problems–are not related to social or communication diagnostic criteria, Robin L. Gabriels, Psy.D., said at the 5th International Meeting for Autism Research.

Previous studies have demonstrated that people who have autism spectrum disorders (ASD) are at risk for various comorbid behavioral and psychiatric disturbances.

But at this point, it remains unclear whether such problems occur independently or result from pathologic processes that lead to autism, Dr. Gabriels said in a poster presentation.

And while it has been hypothesized that these comorbid problems somehow relate to the range of restrictive and repetitive behaviors and interests that characterize autism–including inflexible adherence to specific, nonfunctional routines or rituals, stereotyped and repetitive motor mannerisms, and self-injurious acts–data are lacking on how the specific behaviors relate, she said.

In an effort to gain insight into this association, Dr. Gabriels of the University of Colorado Health Sciences Center, Denver, and her colleagues compared the presence of frequent/severe repetitive behaviors and mood/behavioral problems in preschool children diagnosed with an ASD with those of a chronologic-age matched, typically developing control group.

The investigation relied on survey-based ratings by parents or other caregivers of 61 children (mean age 50.5 months) with an ASD who were recruited through the autism research registry at the University of North Carolina at Chapel Hill and 65 children (mean age 46.5 months) with typical development recruited through local preschools and day care centers.

The assessment measures included the Social Communication Questionnaire (SCQ), which screens for the presence of ASDs; the Repetitive Behavior Rating Scale-Revised (RBS-R), which measures stereotypy, self-injurious behavior, compulsions, rituals/sameness, and restricted interests; and the Nisonger Child Behavior Rating Form (NCBRF), which assesses behavior and emotional problems in children.

The investigators used unpaired t-tests for between-group comparisons of NCBRF scores for conduct, anxiety, hyperactivity, and overly sensitive behaviors, and Spearman's correlations to determine the relationship within the autism group between mood/behavior problems, autism symptoms, and repetitive behavior subtypes. Multiple regression analysis determined which NCBRF factor best predicted the total repetitive behavior score.

The data showed that the ASD group had significantly more mood and behavior problems than did the control group. Additionally, within the ASD group, “the RBS-R total score was significantly correlated with all four NCBRF subscales,” Dr. Gabriels said.

In contrast, none of the NCBRF subscales correlated significantly with the SCQ social or communication measures.

The multiple regression analysis of the individual NCBRF subscales relative to the RBS-R total score showed that anxiety was the best predictor of the presence of repetitive behaviors in the ASD group.

“Anxiety symptoms increased significantly with repetitive behaviors in the autistic group, but not in the typically developing group,” according to Dr. Gabriels.

This finding suggests that the presence of frequent and severe repetitive behaviors could signal increased anxiety in a child with an ASD, Dr. Gabriels said.

Furthermore, she said, such insight into these associations could help in the clinical assessment and management of patients by improving the accuracy of comorbid psychological diagnoses and ensuring appropriate treatment.

With respect to the anxiety finding, the male:female ratio in the ASD group was 9:1, “so it is possible that the strong relationship between more frequent/severe repetitive behaviors and symptoms of anxiety may reflect the tendency of males to have higher levels of externalizing behaviors than females,” Dr. Gabriels pointed out.

Further study is needed to gain more insight into the nature of the association, she said.