Jennie Smith

Children with a history of atopic disease (AD) are at a significantly higher risk for an anemia diagnosis than are children without AD, according to an analysis of two large U.S. population-based studies.

In addition, the risk of anemia increased with the number of caregiver-reported atopic disorders, reported the investigators, Dr. Jonathan I. Silverberg and his associates in the department of dermatology, Northwestern University, Chicago. A current diagnosis of eczema or asthma was associated with a significantly increased risk of anemia, particularly microcytic anemia, in the study, published online on Nov. 30 in JAMA Pediatrics (doi: 10.1001/jamapediatrics.2015.3065).

The authors evaluated data from the U.S. National Health Interview Survey (NHIS) on about 207,000 children and adolescents collected between 1997 and 2013, and from the National Health and Nutrition Examination Survey (NHANES) on nearly 31,000 children and adolescents between 1999 and 2012.

Data from the NHIS cohort found a significantly elevated anemia risk among children with a caregiver-reported history of hay fever, eczema, asthma, and food allergy (P less than .001 for all 4 disorders). After adjustments for age, sex, ethnicity and socioeconomic factors, the anemia risk for a child with any single atopic disorder was modestly elevated (adjusted odds ratio, 1.84; 95% confidence interval, 1.60-2.11; P less than .001). The adjusted risk among those with all four disorders was markedly elevated (adjusted OR, 7.87; 95% CI, 5.17-12.00; P less than .001).

In the NHANES cohort, the investigators found a current asthma or eczema diagnosis associated with anemia, as defined by laboratory assessment (adjusted OR, 1.33; 95% CI, 1.04-1.70; P = .02 for asthma; and an adjusted OR 1.93; 95% CI, 1.04-3.59; P = .04 for eczema).

©roobcio/thinkstockphotos.com

In the NHANES cohort, asthma was associated with an increased risk for microcytic anemia (adjusted OR, 1.61; 95% CI 1.09-2.38 P = .02). In the 2005-2006 NHANES cohort, a history of eczema was associated with an increased risk of microcytic anemia (adjusted OR, 2.03; 95% CI, 1.20-3.46; P = .009). But no significant associations for hay fever and any type of anemia were noted.

While the reasons for the observed association between atopic disease and anemia remain unknown and are probably multifactorial, physicians “should be aware that fatigue may be related to unrecognized anemia and not merely sleep loss owing to atopic dermatitis or airway disease,” the investigators wrote. Moreover, they noted, restricted diets to treat atopic disorders could play a role. “This finding underscores the importance of properly evaluating and ruling out suspected food allergy in children rather than placing them on empirical avoidance diets that might contribute to anemia,” they said.

The study was funded by the Agency for Healthcare Research and Quality and the Dermatology Foundation. Dr. Silverberg and his coauthors, Kerry E. Drury and Matt Schaeffer, declared no conflicts of interest.

Children with a history of atopic disease (AD) are at a significantly higher risk for an anemia diagnosis than are children without AD, according to an analysis of two large U.S. population-based studies.

In addition, the risk of anemia increased with the number of caregiver-reported atopic disorders, reported the investigators, Dr. Jonathan I. Silverberg and his associates in the department of dermatology, Northwestern University, Chicago. A current diagnosis of eczema or asthma was associated with a significantly increased risk of anemia, particularly microcytic anemia, in the study, published online on Nov. 30 in JAMA Pediatrics (doi: 10.1001/jamapediatrics.2015.3065).

The authors evaluated data from the U.S. National Health Interview Survey (NHIS) on about 207,000 children and adolescents collected between 1997 and 2013, and from the National Health and Nutrition Examination Survey (NHANES) on nearly 31,000 children and adolescents between 1999 and 2012.

Data from the NHIS cohort found a significantly elevated anemia risk among children with a caregiver-reported history of hay fever, eczema, asthma, and food allergy (P less than .001 for all 4 disorders). After adjustments for age, sex, ethnicity and socioeconomic factors, the anemia risk for a child with any single atopic disorder was modestly elevated (adjusted odds ratio, 1.84; 95% confidence interval, 1.60-2.11; P less than .001). The adjusted risk among those with all four disorders was markedly elevated (adjusted OR, 7.87; 95% CI, 5.17-12.00; P less than .001).

In the NHANES cohort, the investigators found a current asthma or eczema diagnosis associated with anemia, as defined by laboratory assessment (adjusted OR, 1.33; 95% CI, 1.04-1.70; P = .02 for asthma; and an adjusted OR 1.93; 95% CI, 1.04-3.59; P = .04 for eczema).

©roobcio/thinkstockphotos.com

In the NHANES cohort, asthma was associated with an increased risk for microcytic anemia (adjusted OR, 1.61; 95% CI 1.09-2.38 P = .02). In the 2005-2006 NHANES cohort, a history of eczema was associated with an increased risk of microcytic anemia (adjusted OR, 2.03; 95% CI, 1.20-3.46; P = .009). But no significant associations for hay fever and any type of anemia were noted.

While the reasons for the observed association between atopic disease and anemia remain unknown and are probably multifactorial, physicians “should be aware that fatigue may be related to unrecognized anemia and not merely sleep loss owing to atopic dermatitis or airway disease,” the investigators wrote. Moreover, they noted, restricted diets to treat atopic disorders could play a role. “This finding underscores the importance of properly evaluating and ruling out suspected food allergy in children rather than placing them on empirical avoidance diets that might contribute to anemia,” they said.

The study was funded by the Agency for Healthcare Research and Quality and the Dermatology Foundation. Dr. Silverberg and his coauthors, Kerry E. Drury and Matt Schaeffer, declared no conflicts of interest.

Children with a history of atopic disease (AD) are at a significantly higher risk for an anemia diagnosis than are children without AD, according to an analysis of two large U.S. population-based studies.

In addition, the risk of anemia increased with the number of caregiver-reported atopic disorders, reported the investigators, Dr. Jonathan I. Silverberg and his associates in the department of dermatology, Northwestern University, Chicago. A current diagnosis of eczema or asthma was associated with a significantly increased risk of anemia, particularly microcytic anemia, in the study, published online on Nov. 30 in JAMA Pediatrics (doi: 10.1001/jamapediatrics.2015.3065).

The authors evaluated data from the U.S. National Health Interview Survey (NHIS) on about 207,000 children and adolescents collected between 1997 and 2013, and from the National Health and Nutrition Examination Survey (NHANES) on nearly 31,000 children and adolescents between 1999 and 2012.

Data from the NHIS cohort found a significantly elevated anemia risk among children with a caregiver-reported history of hay fever, eczema, asthma, and food allergy (P less than .001 for all 4 disorders). After adjustments for age, sex, ethnicity and socioeconomic factors, the anemia risk for a child with any single atopic disorder was modestly elevated (adjusted odds ratio, 1.84; 95% confidence interval, 1.60-2.11; P less than .001). The adjusted risk among those with all four disorders was markedly elevated (adjusted OR, 7.87; 95% CI, 5.17-12.00; P less than .001).

In the NHANES cohort, the investigators found a current asthma or eczema diagnosis associated with anemia, as defined by laboratory assessment (adjusted OR, 1.33; 95% CI, 1.04-1.70; P = .02 for asthma; and an adjusted OR 1.93; 95% CI, 1.04-3.59; P = .04 for eczema).

©roobcio/thinkstockphotos.com

In the NHANES cohort, asthma was associated with an increased risk for microcytic anemia (adjusted OR, 1.61; 95% CI 1.09-2.38 P = .02). In the 2005-2006 NHANES cohort, a history of eczema was associated with an increased risk of microcytic anemia (adjusted OR, 2.03; 95% CI, 1.20-3.46; P = .009). But no significant associations for hay fever and any type of anemia were noted.

While the reasons for the observed association between atopic disease and anemia remain unknown and are probably multifactorial, physicians “should be aware that fatigue may be related to unrecognized anemia and not merely sleep loss owing to atopic dermatitis or airway disease,” the investigators wrote. Moreover, they noted, restricted diets to treat atopic disorders could play a role. “This finding underscores the importance of properly evaluating and ruling out suspected food allergy in children rather than placing them on empirical avoidance diets that might contribute to anemia,” they said.

The study was funded by the Agency for Healthcare Research and Quality and the Dermatology Foundation. Dr. Silverberg and his coauthors, Kerry E. Drury and Matt Schaeffer, declared no conflicts of interest.

Chemotherapy and neoadjuvant chemotherapy are given more often to non-Hispanic black, Hispanic, and Asian women than to non-Hispanic white women with breast cancer, while black women saw a lower rate of pathological complete response (pCR), according to the results of a new study.

Dr. Brigid Killelea of Yale University, New Haven, Conn., and her colleagues looked at records from nearly 280,000 patients in the National Cancer Data Base who received treatment for stage I-III disease in 2010 and 2011.

Dr. Cecil Fox/National Cancer Institute

In the cohort as a whole, 46% of women received chemotherapy, and, among the majority of patients for whom information on the timing of chemotherapy was available, 23% received neoadjuvant therapy, with non-white women receiving chemotherapy and neoadjuvant chemotherapy more frequently (P less than .001). This could mainly be explained by the advanced age, higher-grade tumors and a larger share of triple-negative and human epidermal growth factor receptor–positive tumors in the non-white women, the investigators said (J Clin Oncol. 2015 Nov. 23. doi: 10.1200/JCO.2015.63.7801).

Of about 18,000 patients in the cohort with known outcomes, 33% had a pathological complete response, Dr. Killelea and her colleagues found. Black women in the study had a lower rate of pCR, compared with white women for estrogen receptor/progesterone receptor–negative, human epidermal growth factor receptor2–positive tumors (43% vs. 54%, P = .001) and for triple-negative tumors (37% vs. 43%, P less than .001) despite adjustment for a large number of clinical and socioeconomic factors. Racial disparities in breast cancer incidence, treatment, and survival have been long reported, and racial disparities in neoadjuvant chemotherapy are important to measure, the investigators wrote, as neoadjuvant chemotherapy allows for initiation of systemic therapy before surgery in patients with locally advanced and/or node-positive disease, among other potential advantages. Meanwhile, pCR has been shown in recent years to be a key prognostic indicator for certain breast cancer subtypes and therefore is also important to measure with regard to race. Dr. Killelea and colleagues concluded that the reasons for the lower pCR rates seen among black women in the study could not be determined, and may involve differences in treatment, chemosensitivity, or socioeconomic factors that they could not control for, but that warranted investigation in future studies. “One hypothesis is that the lower pCR rate reflects undertreatment,” the investigators wrote in their analysis. “Women who were unable to complete chemotherapy or had dose reduction, treatment delays, or less-aggressive chemotherapy regimens would be less likely to have a pCR.”

Chemotherapy and neoadjuvant chemotherapy are given more often to non-Hispanic black, Hispanic, and Asian women than to non-Hispanic white women with breast cancer, while black women saw a lower rate of pathological complete response (pCR), according to the results of a new study.

Dr. Brigid Killelea of Yale University, New Haven, Conn., and her colleagues looked at records from nearly 280,000 patients in the National Cancer Data Base who received treatment for stage I-III disease in 2010 and 2011.

Dr. Cecil Fox/National Cancer Institute

In the cohort as a whole, 46% of women received chemotherapy, and, among the majority of patients for whom information on the timing of chemotherapy was available, 23% received neoadjuvant therapy, with non-white women receiving chemotherapy and neoadjuvant chemotherapy more frequently (P less than .001). This could mainly be explained by the advanced age, higher-grade tumors and a larger share of triple-negative and human epidermal growth factor receptor–positive tumors in the non-white women, the investigators said (J Clin Oncol. 2015 Nov. 23. doi: 10.1200/JCO.2015.63.7801).

Of about 18,000 patients in the cohort with known outcomes, 33% had a pathological complete response, Dr. Killelea and her colleagues found. Black women in the study had a lower rate of pCR, compared with white women for estrogen receptor/progesterone receptor–negative, human epidermal growth factor receptor2–positive tumors (43% vs. 54%, P = .001) and for triple-negative tumors (37% vs. 43%, P less than .001) despite adjustment for a large number of clinical and socioeconomic factors. Racial disparities in breast cancer incidence, treatment, and survival have been long reported, and racial disparities in neoadjuvant chemotherapy are important to measure, the investigators wrote, as neoadjuvant chemotherapy allows for initiation of systemic therapy before surgery in patients with locally advanced and/or node-positive disease, among other potential advantages. Meanwhile, pCR has been shown in recent years to be a key prognostic indicator for certain breast cancer subtypes and therefore is also important to measure with regard to race. Dr. Killelea and colleagues concluded that the reasons for the lower pCR rates seen among black women in the study could not be determined, and may involve differences in treatment, chemosensitivity, or socioeconomic factors that they could not control for, but that warranted investigation in future studies. “One hypothesis is that the lower pCR rate reflects undertreatment,” the investigators wrote in their analysis. “Women who were unable to complete chemotherapy or had dose reduction, treatment delays, or less-aggressive chemotherapy regimens would be less likely to have a pCR.”

Chemotherapy and neoadjuvant chemotherapy are given more often to non-Hispanic black, Hispanic, and Asian women than to non-Hispanic white women with breast cancer, while black women saw a lower rate of pathological complete response (pCR), according to the results of a new study.

Dr. Brigid Killelea of Yale University, New Haven, Conn., and her colleagues looked at records from nearly 280,000 patients in the National Cancer Data Base who received treatment for stage I-III disease in 2010 and 2011.

Dr. Cecil Fox/National Cancer Institute

In the cohort as a whole, 46% of women received chemotherapy, and, among the majority of patients for whom information on the timing of chemotherapy was available, 23% received neoadjuvant therapy, with non-white women receiving chemotherapy and neoadjuvant chemotherapy more frequently (P less than .001). This could mainly be explained by the advanced age, higher-grade tumors and a larger share of triple-negative and human epidermal growth factor receptor–positive tumors in the non-white women, the investigators said (J Clin Oncol. 2015 Nov. 23. doi: 10.1200/JCO.2015.63.7801).

Of about 18,000 patients in the cohort with known outcomes, 33% had a pathological complete response, Dr. Killelea and her colleagues found. Black women in the study had a lower rate of pCR, compared with white women for estrogen receptor/progesterone receptor–negative, human epidermal growth factor receptor2–positive tumors (43% vs. 54%, P = .001) and for triple-negative tumors (37% vs. 43%, P less than .001) despite adjustment for a large number of clinical and socioeconomic factors. Racial disparities in breast cancer incidence, treatment, and survival have been long reported, and racial disparities in neoadjuvant chemotherapy are important to measure, the investigators wrote, as neoadjuvant chemotherapy allows for initiation of systemic therapy before surgery in patients with locally advanced and/or node-positive disease, among other potential advantages. Meanwhile, pCR has been shown in recent years to be a key prognostic indicator for certain breast cancer subtypes and therefore is also important to measure with regard to race. Dr. Killelea and colleagues concluded that the reasons for the lower pCR rates seen among black women in the study could not be determined, and may involve differences in treatment, chemosensitivity, or socioeconomic factors that they could not control for, but that warranted investigation in future studies. “One hypothesis is that the lower pCR rate reflects undertreatment,” the investigators wrote in their analysis. “Women who were unable to complete chemotherapy or had dose reduction, treatment delays, or less-aggressive chemotherapy regimens would be less likely to have a pCR.”

Black women with node-positive breast cancer were less likely to receive tumor gene profiling for treatment decision making compared with women of other ethnicities, according to a new study. However, black women who were node negative were just as likely to receive the test as were other women, suggesting that testing protocols for black women are kept closer to guidelines than for other groups.

The genetic test, known as Oncotype DX (ODX), came into wide use a decade ago as a chemotherapy decision-making tool for patients with estrogen receptor–positive, human epidermal growth factor receptor-2–negative breast cancer, stage I or II, with tumors of 0.5 cm or larger. Current guidelines used by public and private insurers, including Medicare, incorporate ODX testing for these patients who are node negative. Still, there is some evidence suggesting a role for ODX for women with up to three positive nodes, and one major clinical trial is underway to determine whether ODX testing is helpful in these patients.

©benjaminalbiach/ThinkStock

Megan C. Roberts, Ph.D., of the University of North Carolina at Chapel Hill, and her colleagues, looked at data for 1,468 women (609 black) from the population-based, phase III Carolina Breast Cancer Study.

Overall in the cohort, 42% of women received ODX testing, and no racial disparities were seen in the likelihood of ODX testing in node-negative women. For patients with node-positive disease, black women were 46% less likely to receive ODX testing than were nonblack women (adjusted risk ratio 0.54, 95% CI 0.35 to 0.84; P = .006).

“Current medical guidelines do not recommend ODX testing in patients with node-positive, early-stage, ER+ breast cancer,” Dr. Roberts and colleagues wrote in their analysis (J Clin Oncol. 2015 Nov 23. doi: 10.1200/JCO.2015.63.2489).

“Therefore, lower rates of ODX testing among black women in our sample reflect their receipt of more guideline-concordant care than nonblack women with node-positive breast cancer. Thus, differential receipt of ODX testing does not necessarily reflect a racial disparity in the quality of care. This paradox illustrates challenges that will accompany the measurement of disparities in the early adoption of new genetic technologies into clinical practice,” the researchers wrote.

They noted as a study limitations the fact that patient preferences regarding ODX could not be accounted for, and that previous studies have suggested these could differ by race.

Black women with node-positive breast cancer were less likely to receive tumor gene profiling for treatment decision making compared with women of other ethnicities, according to a new study. However, black women who were node negative were just as likely to receive the test as were other women, suggesting that testing protocols for black women are kept closer to guidelines than for other groups.

The genetic test, known as Oncotype DX (ODX), came into wide use a decade ago as a chemotherapy decision-making tool for patients with estrogen receptor–positive, human epidermal growth factor receptor-2–negative breast cancer, stage I or II, with tumors of 0.5 cm or larger. Current guidelines used by public and private insurers, including Medicare, incorporate ODX testing for these patients who are node negative. Still, there is some evidence suggesting a role for ODX for women with up to three positive nodes, and one major clinical trial is underway to determine whether ODX testing is helpful in these patients.

©benjaminalbiach/ThinkStock

Megan C. Roberts, Ph.D., of the University of North Carolina at Chapel Hill, and her colleagues, looked at data for 1,468 women (609 black) from the population-based, phase III Carolina Breast Cancer Study.

Overall in the cohort, 42% of women received ODX testing, and no racial disparities were seen in the likelihood of ODX testing in node-negative women. For patients with node-positive disease, black women were 46% less likely to receive ODX testing than were nonblack women (adjusted risk ratio 0.54, 95% CI 0.35 to 0.84; P = .006).

“Current medical guidelines do not recommend ODX testing in patients with node-positive, early-stage, ER+ breast cancer,” Dr. Roberts and colleagues wrote in their analysis (J Clin Oncol. 2015 Nov 23. doi: 10.1200/JCO.2015.63.2489).

“Therefore, lower rates of ODX testing among black women in our sample reflect their receipt of more guideline-concordant care than nonblack women with node-positive breast cancer. Thus, differential receipt of ODX testing does not necessarily reflect a racial disparity in the quality of care. This paradox illustrates challenges that will accompany the measurement of disparities in the early adoption of new genetic technologies into clinical practice,” the researchers wrote.

They noted as a study limitations the fact that patient preferences regarding ODX could not be accounted for, and that previous studies have suggested these could differ by race.

Black women with node-positive breast cancer were less likely to receive tumor gene profiling for treatment decision making compared with women of other ethnicities, according to a new study. However, black women who were node negative were just as likely to receive the test as were other women, suggesting that testing protocols for black women are kept closer to guidelines than for other groups.

The genetic test, known as Oncotype DX (ODX), came into wide use a decade ago as a chemotherapy decision-making tool for patients with estrogen receptor–positive, human epidermal growth factor receptor-2–negative breast cancer, stage I or II, with tumors of 0.5 cm or larger. Current guidelines used by public and private insurers, including Medicare, incorporate ODX testing for these patients who are node negative. Still, there is some evidence suggesting a role for ODX for women with up to three positive nodes, and one major clinical trial is underway to determine whether ODX testing is helpful in these patients.

©benjaminalbiach/ThinkStock

Megan C. Roberts, Ph.D., of the University of North Carolina at Chapel Hill, and her colleagues, looked at data for 1,468 women (609 black) from the population-based, phase III Carolina Breast Cancer Study.

Overall in the cohort, 42% of women received ODX testing, and no racial disparities were seen in the likelihood of ODX testing in node-negative women. For patients with node-positive disease, black women were 46% less likely to receive ODX testing than were nonblack women (adjusted risk ratio 0.54, 95% CI 0.35 to 0.84; P = .006).

“Current medical guidelines do not recommend ODX testing in patients with node-positive, early-stage, ER+ breast cancer,” Dr. Roberts and colleagues wrote in their analysis (J Clin Oncol. 2015 Nov 23. doi: 10.1200/JCO.2015.63.2489).

“Therefore, lower rates of ODX testing among black women in our sample reflect their receipt of more guideline-concordant care than nonblack women with node-positive breast cancer. Thus, differential receipt of ODX testing does not necessarily reflect a racial disparity in the quality of care. This paradox illustrates challenges that will accompany the measurement of disparities in the early adoption of new genetic technologies into clinical practice,” the researchers wrote.

They noted as a study limitations the fact that patient preferences regarding ODX could not be accounted for, and that previous studies have suggested these could differ by race.

SAN ANTONIO– Results from a pilot randomized double-blind trial suggest that repetitive transcranial stimulation, or rTMS, a technology currently approved to treat depression that is being investigated in a range of psychiatric disorders, might be a viable treatment strategy to improve executive function in young people with autism spectrum disorder (ASD).

The findings were presented by Dr. Stephanie Ameis of the Campbell Family Mental Health Research Institute in Toronto at the annual meeting American Academy of Child and Adolescent Psychiatry.

Impairments in executive function are common among higher functioning people with ASD. Previous studies have found executive function impairments to have common neurobiologic underpinnings. No studies to date have investigated rTMS on executive function in autism, but previous research by Dr. Ameis’s colleague and coauthor on the study, Dr. Z. Jeff Daskalakis, found that a course of rTMS significantly improved executive function among people with schizophrenia (Biol Psychiatry. 2013;73[6]:510-7).

Dr. Ameis and her colleagues hypothesized that a similar treatment approach might be feasible in people with ASD with known executive function impairment.

The researchers randomized 18 patients aged 16-35 years to 4 weeks of rTMS (20Hz) to the dorsolateral prefrontal cortex or sham treatment. All subjects were clinically stable, with an IQ greater than 70 (mean 95) and a qualifying measure of disability on the BRIEF (Behavior Rating Inventory of Executive Functions) assessment tool used to measure real-world impairment.

MRI and cognitive assessment were performed at baseline and 1 month after the treatment period ended. Baseline analysis of diffusion MRI indicated a trend toward a significant positive association between working memory scores on the BRIEF and white matter structures along the anterior thalamic radiation. Though white matter integrity in this part of the brain has been linked to executive function in other disorders, Dr. Ameis cautioned that the MRI findings in her study were preliminary and that it was too early to draw conclusions from them.

Mean age in the study was 23 years. Dr. Ameis said she hopes to continue to recruit a younger cohort, but that recruitment challenges led the group to expand an initial targeted age range of 16-25 years up to 35 years.

“We want to focus our intervention on the transition period to adulthood, as this is a time where effective interventions can really make an impact on individuals’ successful transition to work and school as young adults.”

The goal, Dr. Ameis said, “is to see if rTMS is feasible for this particular indication or treatment target, and so it’s the first study that’s really used a rigorous sham study design for this indication. We’re seeing whether people are interested and able to tolerate the 4-week protocol, as well as the other aspects of our study and secondarily, whether we are changing things with regard to [executive function].”

The protocol was well tolerated, the researchers found, with the time commitment – about 30 minutes a day, 5 days a week – being the biggest demand on subjects. rTMS was associated with no adverse effects except headaches around treatment times.

The pilot study established tolerability and feasibility in this patient group, Dr. Ameis said. Now the investigators will measure differences in executive function after a second year of recruitment to double the current sample size.

Dr. Ameis reported no conflicts of interest related to the findings. A coauthor on the study, Dr. Paul E. Croarkin, reported funding from Pfizer, and study supplies and genotyping from Assurex. Dr. Daskalakis acknowledged funding from Neuronetics.

SAN ANTONIO– Results from a pilot randomized double-blind trial suggest that repetitive transcranial stimulation, or rTMS, a technology currently approved to treat depression that is being investigated in a range of psychiatric disorders, might be a viable treatment strategy to improve executive function in young people with autism spectrum disorder (ASD).

The findings were presented by Dr. Stephanie Ameis of the Campbell Family Mental Health Research Institute in Toronto at the annual meeting American Academy of Child and Adolescent Psychiatry.

Impairments in executive function are common among higher functioning people with ASD. Previous studies have found executive function impairments to have common neurobiologic underpinnings. No studies to date have investigated rTMS on executive function in autism, but previous research by Dr. Ameis’s colleague and coauthor on the study, Dr. Z. Jeff Daskalakis, found that a course of rTMS significantly improved executive function among people with schizophrenia (Biol Psychiatry. 2013;73[6]:510-7).

Dr. Ameis and her colleagues hypothesized that a similar treatment approach might be feasible in people with ASD with known executive function impairment.

The researchers randomized 18 patients aged 16-35 years to 4 weeks of rTMS (20Hz) to the dorsolateral prefrontal cortex or sham treatment. All subjects were clinically stable, with an IQ greater than 70 (mean 95) and a qualifying measure of disability on the BRIEF (Behavior Rating Inventory of Executive Functions) assessment tool used to measure real-world impairment.

MRI and cognitive assessment were performed at baseline and 1 month after the treatment period ended. Baseline analysis of diffusion MRI indicated a trend toward a significant positive association between working memory scores on the BRIEF and white matter structures along the anterior thalamic radiation. Though white matter integrity in this part of the brain has been linked to executive function in other disorders, Dr. Ameis cautioned that the MRI findings in her study were preliminary and that it was too early to draw conclusions from them.

Mean age in the study was 23 years. Dr. Ameis said she hopes to continue to recruit a younger cohort, but that recruitment challenges led the group to expand an initial targeted age range of 16-25 years up to 35 years.

“We want to focus our intervention on the transition period to adulthood, as this is a time where effective interventions can really make an impact on individuals’ successful transition to work and school as young adults.”

The goal, Dr. Ameis said, “is to see if rTMS is feasible for this particular indication or treatment target, and so it’s the first study that’s really used a rigorous sham study design for this indication. We’re seeing whether people are interested and able to tolerate the 4-week protocol, as well as the other aspects of our study and secondarily, whether we are changing things with regard to [executive function].”

The protocol was well tolerated, the researchers found, with the time commitment – about 30 minutes a day, 5 days a week – being the biggest demand on subjects. rTMS was associated with no adverse effects except headaches around treatment times.

The pilot study established tolerability and feasibility in this patient group, Dr. Ameis said. Now the investigators will measure differences in executive function after a second year of recruitment to double the current sample size.

Dr. Ameis reported no conflicts of interest related to the findings. A coauthor on the study, Dr. Paul E. Croarkin, reported funding from Pfizer, and study supplies and genotyping from Assurex. Dr. Daskalakis acknowledged funding from Neuronetics.

SAN ANTONIO– Results from a pilot randomized double-blind trial suggest that repetitive transcranial stimulation, or rTMS, a technology currently approved to treat depression that is being investigated in a range of psychiatric disorders, might be a viable treatment strategy to improve executive function in young people with autism spectrum disorder (ASD).

The findings were presented by Dr. Stephanie Ameis of the Campbell Family Mental Health Research Institute in Toronto at the annual meeting American Academy of Child and Adolescent Psychiatry.

Impairments in executive function are common among higher functioning people with ASD. Previous studies have found executive function impairments to have common neurobiologic underpinnings. No studies to date have investigated rTMS on executive function in autism, but previous research by Dr. Ameis’s colleague and coauthor on the study, Dr. Z. Jeff Daskalakis, found that a course of rTMS significantly improved executive function among people with schizophrenia (Biol Psychiatry. 2013;73[6]:510-7).

Dr. Ameis and her colleagues hypothesized that a similar treatment approach might be feasible in people with ASD with known executive function impairment.

The researchers randomized 18 patients aged 16-35 years to 4 weeks of rTMS (20Hz) to the dorsolateral prefrontal cortex or sham treatment. All subjects were clinically stable, with an IQ greater than 70 (mean 95) and a qualifying measure of disability on the BRIEF (Behavior Rating Inventory of Executive Functions) assessment tool used to measure real-world impairment.

MRI and cognitive assessment were performed at baseline and 1 month after the treatment period ended. Baseline analysis of diffusion MRI indicated a trend toward a significant positive association between working memory scores on the BRIEF and white matter structures along the anterior thalamic radiation. Though white matter integrity in this part of the brain has been linked to executive function in other disorders, Dr. Ameis cautioned that the MRI findings in her study were preliminary and that it was too early to draw conclusions from them.

Mean age in the study was 23 years. Dr. Ameis said she hopes to continue to recruit a younger cohort, but that recruitment challenges led the group to expand an initial targeted age range of 16-25 years up to 35 years.

“We want to focus our intervention on the transition period to adulthood, as this is a time where effective interventions can really make an impact on individuals’ successful transition to work and school as young adults.”

The goal, Dr. Ameis said, “is to see if rTMS is feasible for this particular indication or treatment target, and so it’s the first study that’s really used a rigorous sham study design for this indication. We’re seeing whether people are interested and able to tolerate the 4-week protocol, as well as the other aspects of our study and secondarily, whether we are changing things with regard to [executive function].”

The protocol was well tolerated, the researchers found, with the time commitment – about 30 minutes a day, 5 days a week – being the biggest demand on subjects. rTMS was associated with no adverse effects except headaches around treatment times.

The pilot study established tolerability and feasibility in this patient group, Dr. Ameis said. Now the investigators will measure differences in executive function after a second year of recruitment to double the current sample size.

Dr. Ameis reported no conflicts of interest related to the findings. A coauthor on the study, Dr. Paul E. Croarkin, reported funding from Pfizer, and study supplies and genotyping from Assurex. Dr. Daskalakis acknowledged funding from Neuronetics.

SAN ANTONIO– Results from a pilot randomized double-blind trial suggest that repetitive transcranial stimulation, or rTMS, a technology currently approved to treat depression that is being investigated in a range of psychiatric disorders, might be a viable treatment strategy to improve executive function in young people with autism spectrum disorder (ASD).

The findings were presented by Dr. Stephanie Ameis of the Campbell Family Mental Health Research Institute in Toronto at the annual meeting American Academy of Child and Adolescent Psychiatry.

Impairments in executive function are common among higher functioning people with ASD. Previous studies have found executive function impairments to have common neurobiologic underpinnings. No studies to date have investigated rTMS on executive function in autism, but previous research by Dr. Ameis’s colleague and coauthor on the study, Dr. Z. Jeff Daskalakis, found that a course of rTMS significantly improved executive function among people with schizophrenia (Biol Psychiatry. 2013;73[6]:510-7).

Dr. Ameis and her colleagues hypothesized that a similar treatment approach might be feasible in people with ASD with known executive function impairment.

The researchers randomized 18 patients aged 16-35 years to 4 weeks of rTMS (20Hz) to the dorsolateral prefrontal cortex or sham treatment. All subjects were clinically stable, with an IQ greater than 70 (mean 95) and a qualifying measure of disability on the BRIEF (Behavior Rating Inventory of Executive Functions) assessment tool used to measure real-world impairment.

MRI and cognitive assessment were performed at baseline and 1 month after the treatment period ended. Baseline analysis of diffusion MRI indicated a trend toward a significant positive association between working memory scores on the BRIEF and white matter structures along the anterior thalamic radiation. Though white matter integrity in this part of the brain has been linked to executive function in other disorders, Dr. Ameis cautioned that the MRI findings in her study were preliminary and that it was too early to draw conclusions from them.

Mean age in the study was 23 years. Dr. Ameis said she hopes to continue to recruit a younger cohort, but that recruitment challenges led the group to expand an initial targeted age range of 16-25 years up to 35 years.

“We want to focus our intervention on the transition period to adulthood, as this is a time where effective interventions can really make an impact on individuals’ successful transition to work and school as young adults.”

The goal, Dr. Ameis said, “is to see if rTMS is feasible for this particular indication or treatment target, and so it’s the first study that’s really used a rigorous sham study design for this indication. We’re seeing whether people are interested and able to tolerate the 4-week protocol, as well as the other aspects of our study and secondarily, whether we are changing things with regard to [executive function].”

The protocol was well tolerated, the researchers found, with the time commitment – about 30 minutes a day, 5 days a week – being the biggest demand on subjects. rTMS was associated with no adverse effects except headaches around treatment times.

The pilot study established tolerability and feasibility in this patient group, Dr. Ameis said. Now the investigators will measure differences in executive function after a second year of recruitment to double the current sample size.

Dr. Ameis reported no conflicts of interest related to the findings. A coauthor on the study, Dr. Paul E. Croarkin, reported funding from Pfizer, and study supplies and genotyping from Assurex. Dr. Daskalakis acknowledged funding from Neuronetics.

SAN ANTONIO– Results from a pilot randomized double-blind trial suggest that repetitive transcranial stimulation, or rTMS, a technology currently approved to treat depression that is being investigated in a range of psychiatric disorders, might be a viable treatment strategy to improve executive function in young people with autism spectrum disorder (ASD).

The findings were presented by Dr. Stephanie Ameis of the Campbell Family Mental Health Research Institute in Toronto at the annual meeting American Academy of Child and Adolescent Psychiatry.

Impairments in executive function are common among higher functioning people with ASD. Previous studies have found executive function impairments to have common neurobiologic underpinnings. No studies to date have investigated rTMS on executive function in autism, but previous research by Dr. Ameis’s colleague and coauthor on the study, Dr. Z. Jeff Daskalakis, found that a course of rTMS significantly improved executive function among people with schizophrenia (Biol Psychiatry. 2013;73[6]:510-7).

Dr. Ameis and her colleagues hypothesized that a similar treatment approach might be feasible in people with ASD with known executive function impairment.

The researchers randomized 18 patients aged 16-35 years to 4 weeks of rTMS (20Hz) to the dorsolateral prefrontal cortex or sham treatment. All subjects were clinically stable, with an IQ greater than 70 (mean 95) and a qualifying measure of disability on the BRIEF (Behavior Rating Inventory of Executive Functions) assessment tool used to measure real-world impairment.

MRI and cognitive assessment were performed at baseline and 1 month after the treatment period ended. Baseline analysis of diffusion MRI indicated a trend toward a significant positive association between working memory scores on the BRIEF and white matter structures along the anterior thalamic radiation. Though white matter integrity in this part of the brain has been linked to executive function in other disorders, Dr. Ameis cautioned that the MRI findings in her study were preliminary and that it was too early to draw conclusions from them.

Mean age in the study was 23 years. Dr. Ameis said she hopes to continue to recruit a younger cohort, but that recruitment challenges led the group to expand an initial targeted age range of 16-25 years up to 35 years.

“We want to focus our intervention on the transition period to adulthood, as this is a time where effective interventions can really make an impact on individuals’ successful transition to work and school as young adults.”

The goal, Dr. Ameis said, “is to see if rTMS is feasible for this particular indication or treatment target, and so it’s the first study that’s really used a rigorous sham study design for this indication. We’re seeing whether people are interested and able to tolerate the 4-week protocol, as well as the other aspects of our study and secondarily, whether we are changing things with regard to [executive function].”

The protocol was well tolerated, the researchers found, with the time commitment – about 30 minutes a day, 5 days a week – being the biggest demand on subjects. rTMS was associated with no adverse effects except headaches around treatment times.

The pilot study established tolerability and feasibility in this patient group, Dr. Ameis said. Now the investigators will measure differences in executive function after a second year of recruitment to double the current sample size.

Dr. Ameis reported no conflicts of interest related to the findings. A coauthor on the study, Dr. Paul E. Croarkin, reported funding from Pfizer, and study supplies and genotyping from Assurex. Dr. Daskalakis acknowledged funding from Neuronetics.

SAN ANTONIO– Results from a pilot randomized double-blind trial suggest that repetitive transcranial stimulation, or rTMS, a technology currently approved to treat depression that is being investigated in a range of psychiatric disorders, might be a viable treatment strategy to improve executive function in young people with autism spectrum disorder (ASD).

The findings were presented by Dr. Stephanie Ameis of the Campbell Family Mental Health Research Institute in Toronto at the annual meeting American Academy of Child and Adolescent Psychiatry.

Impairments in executive function are common among higher functioning people with ASD. Previous studies have found executive function impairments to have common neurobiologic underpinnings. No studies to date have investigated rTMS on executive function in autism, but previous research by Dr. Ameis’s colleague and coauthor on the study, Dr. Z. Jeff Daskalakis, found that a course of rTMS significantly improved executive function among people with schizophrenia (Biol Psychiatry. 2013;73[6]:510-7).

Dr. Ameis and her colleagues hypothesized that a similar treatment approach might be feasible in people with ASD with known executive function impairment.

The researchers randomized 18 patients aged 16-35 years to 4 weeks of rTMS (20Hz) to the dorsolateral prefrontal cortex or sham treatment. All subjects were clinically stable, with an IQ greater than 70 (mean 95) and a qualifying measure of disability on the BRIEF (Behavior Rating Inventory of Executive Functions) assessment tool used to measure real-world impairment.

MRI and cognitive assessment were performed at baseline and 1 month after the treatment period ended. Baseline analysis of diffusion MRI indicated a trend toward a significant positive association between working memory scores on the BRIEF and white matter structures along the anterior thalamic radiation. Though white matter integrity in this part of the brain has been linked to executive function in other disorders, Dr. Ameis cautioned that the MRI findings in her study were preliminary and that it was too early to draw conclusions from them.

Mean age in the study was 23 years. Dr. Ameis said she hopes to continue to recruit a younger cohort, but that recruitment challenges led the group to expand an initial targeted age range of 16-25 years up to 35 years.

“We want to focus our intervention on the transition period to adulthood, as this is a time where effective interventions can really make an impact on individuals’ successful transition to work and school as young adults.”

The goal, Dr. Ameis said, “is to see if rTMS is feasible for this particular indication or treatment target, and so it’s the first study that’s really used a rigorous sham study design for this indication. We’re seeing whether people are interested and able to tolerate the 4-week protocol, as well as the other aspects of our study and secondarily, whether we are changing things with regard to [executive function].”

The protocol was well tolerated, the researchers found, with the time commitment – about 30 minutes a day, 5 days a week – being the biggest demand on subjects. rTMS was associated with no adverse effects except headaches around treatment times.

The pilot study established tolerability and feasibility in this patient group, Dr. Ameis said. Now the investigators will measure differences in executive function after a second year of recruitment to double the current sample size.

Dr. Ameis reported no conflicts of interest related to the findings. A coauthor on the study, Dr. Paul E. Croarkin, reported funding from Pfizer, and study supplies and genotyping from Assurex. Dr. Daskalakis acknowledged funding from Neuronetics.

SAN ANTONIO – New models of autism research and treatment are increasingly looking to study specific genetic causes, including Phelan-McDermid syndrome.

Phelan-McDermid Syndrome, or PMS, is caused by deletion or mutation of the SHANK3 gene and is characterized by intellectual disability, delayed or absent speech, hypotonia, and autism spectrum disorder (ASD). Children with PMS also often have an uneven gait and other motor difficulties.

SHANK3 deletions and mutations are thought responsible for up to 2% of ASD cases; however, aberrant behavior, such as irritability, lethargy, stereotypy, hyperactivity, and inappropriate speech have not been thoroughly investigated in PMS.

Erin Li, a 4th-year medical student, presented findings at the annual meeting of the American Academy of Child and Adolescent Psychiatry from a study in children with PMS that sought to discern whether a caregiver checklist for aberrant behavior used in diagnosing ASD and intellectual disabilities could pinpoint differences in aberrant behaviors between PMS and idiopathic ASD.

The study looked at two cohorts of children, 24 with ASD caused by PMS (mean age, 7.2 years; 14 males) and 23 with idiopathic ASD (mean age, 6.4 years;15 males) using the Aberrant Behavior Checklist (ABC) developed by Michael G. Aman, Ph.D., and his colleagues. Children in both cohorts had intellectual disability, reported Ms. Li, of the Icahn School of Medicine at Mount Sinai, New York.

The ABC is a 58-item parent-reported checklist, and Ms. Li and her colleagues did not find significant differences in the severity of aberrant behavior between groups. The results suggest that, similar to idiopathic ASD, aberrant behavior in PMS can be measured using the ABC.

However, only genetic screening can detect PMS, Ms. Li noted in an interview. The best tool is the chromosomal microarray (CMA) test.

Ms. Li’s research was conducted at the Seaver Autism Center at Mount Sinai, a clinical research group headed by Dr. Alexander Kolevzon. The team also is investigating several treatments for children with PMS, including with insulinlike growth factor–1 (IGF-1), which was seen in a small pilot study (n = 9) to be associated with significant improvement in social impairment and restrictive behaviors (Mol Autism. 2014 Dec 12;5[1]:54).

A larger study with IGF-1 is currently underway, and the group is beginning to investigate treatment of PMS with oxytocin, after results from an animal study suggested that it could improve social deficits in mice with SHANK3 deletions.

Ms. Li and her coauthors disclosed no conflicts of interest related to their findings. The director of the Seaver Autism Center, Joseph Buxbaum, Ph.D., and Mount Sinai hold a shared patent for the use of IGF-1 in PMS.

SAN ANTONIO – New models of autism research and treatment are increasingly looking to study specific genetic causes, including Phelan-McDermid syndrome.

Phelan-McDermid Syndrome, or PMS, is caused by deletion or mutation of the SHANK3 gene and is characterized by intellectual disability, delayed or absent speech, hypotonia, and autism spectrum disorder (ASD). Children with PMS also often have an uneven gait and other motor difficulties.

SHANK3 deletions and mutations are thought responsible for up to 2% of ASD cases; however, aberrant behavior, such as irritability, lethargy, stereotypy, hyperactivity, and inappropriate speech have not been thoroughly investigated in PMS.

Erin Li, a 4th-year medical student, presented findings at the annual meeting of the American Academy of Child and Adolescent Psychiatry from a study in children with PMS that sought to discern whether a caregiver checklist for aberrant behavior used in diagnosing ASD and intellectual disabilities could pinpoint differences in aberrant behaviors between PMS and idiopathic ASD.

The study looked at two cohorts of children, 24 with ASD caused by PMS (mean age, 7.2 years; 14 males) and 23 with idiopathic ASD (mean age, 6.4 years;15 males) using the Aberrant Behavior Checklist (ABC) developed by Michael G. Aman, Ph.D., and his colleagues. Children in both cohorts had intellectual disability, reported Ms. Li, of the Icahn School of Medicine at Mount Sinai, New York.

The ABC is a 58-item parent-reported checklist, and Ms. Li and her colleagues did not find significant differences in the severity of aberrant behavior between groups. The results suggest that, similar to idiopathic ASD, aberrant behavior in PMS can be measured using the ABC.

However, only genetic screening can detect PMS, Ms. Li noted in an interview. The best tool is the chromosomal microarray (CMA) test.

Ms. Li’s research was conducted at the Seaver Autism Center at Mount Sinai, a clinical research group headed by Dr. Alexander Kolevzon. The team also is investigating several treatments for children with PMS, including with insulinlike growth factor–1 (IGF-1), which was seen in a small pilot study (n = 9) to be associated with significant improvement in social impairment and restrictive behaviors (Mol Autism. 2014 Dec 12;5[1]:54).

A larger study with IGF-1 is currently underway, and the group is beginning to investigate treatment of PMS with oxytocin, after results from an animal study suggested that it could improve social deficits in mice with SHANK3 deletions.

Ms. Li and her coauthors disclosed no conflicts of interest related to their findings. The director of the Seaver Autism Center, Joseph Buxbaum, Ph.D., and Mount Sinai hold a shared patent for the use of IGF-1 in PMS.

SAN ANTONIO – New models of autism research and treatment are increasingly looking to study specific genetic causes, including Phelan-McDermid syndrome.

Phelan-McDermid Syndrome, or PMS, is caused by deletion or mutation of the SHANK3 gene and is characterized by intellectual disability, delayed or absent speech, hypotonia, and autism spectrum disorder (ASD). Children with PMS also often have an uneven gait and other motor difficulties.

SHANK3 deletions and mutations are thought responsible for up to 2% of ASD cases; however, aberrant behavior, such as irritability, lethargy, stereotypy, hyperactivity, and inappropriate speech have not been thoroughly investigated in PMS.

Erin Li, a 4th-year medical student, presented findings at the annual meeting of the American Academy of Child and Adolescent Psychiatry from a study in children with PMS that sought to discern whether a caregiver checklist for aberrant behavior used in diagnosing ASD and intellectual disabilities could pinpoint differences in aberrant behaviors between PMS and idiopathic ASD.

The study looked at two cohorts of children, 24 with ASD caused by PMS (mean age, 7.2 years; 14 males) and 23 with idiopathic ASD (mean age, 6.4 years;15 males) using the Aberrant Behavior Checklist (ABC) developed by Michael G. Aman, Ph.D., and his colleagues. Children in both cohorts had intellectual disability, reported Ms. Li, of the Icahn School of Medicine at Mount Sinai, New York.

The ABC is a 58-item parent-reported checklist, and Ms. Li and her colleagues did not find significant differences in the severity of aberrant behavior between groups. The results suggest that, similar to idiopathic ASD, aberrant behavior in PMS can be measured using the ABC.

However, only genetic screening can detect PMS, Ms. Li noted in an interview. The best tool is the chromosomal microarray (CMA) test.

Ms. Li’s research was conducted at the Seaver Autism Center at Mount Sinai, a clinical research group headed by Dr. Alexander Kolevzon. The team also is investigating several treatments for children with PMS, including with insulinlike growth factor–1 (IGF-1), which was seen in a small pilot study (n = 9) to be associated with significant improvement in social impairment and restrictive behaviors (Mol Autism. 2014 Dec 12;5[1]:54).

A larger study with IGF-1 is currently underway, and the group is beginning to investigate treatment of PMS with oxytocin, after results from an animal study suggested that it could improve social deficits in mice with SHANK3 deletions.

Ms. Li and her coauthors disclosed no conflicts of interest related to their findings. The director of the Seaver Autism Center, Joseph Buxbaum, Ph.D., and Mount Sinai hold a shared patent for the use of IGF-1 in PMS.

SAN ANTONIO – Disadvantaged Hispanic mothers in New York enrolled in a medication clinical trial remitted from depression at a faster rate when compared with a more advantaged cohort of non-Hispanic white mothers in Canada.

The Hispanic children also appeared to benefit from their mothers’ remission, seeing levels of psychopathology and impairment significantly improved over the course of the 36-week treatment trial.

These surprising findings, presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry, came from the Parental Remission from Depression and Child Psychopathology Study, a randomized, double-blind clinical trial examining the effects of maternal depression treatment on children in two sites: New York and Ottawa (Am J Psychiatry. 2015 May 1;172[5]:450-9).

A previous study of similar design found single mothers to be more likely to drop out of depression treatment and less likely to remit if they remained in treatment. Among those single mothers who remained in treatment, the children were less likely to improve their levels of psychopathology even if their mothers remitted (Soc Psychiatry Psychiatr Epidemiol. 2007;42[12]: 962-71).

For this study, Marivel Davila, Ph.D., of Columbia University in New York and her colleagues, compared results from 33 Hispanic mothers in New York and their children, aged 7-17, with 36 non-Hispanic white mothers in Ottawa and their children, also aged 7-17. All participating mothers were diagnosed with major depressive disorder without psychosis.

Hispanic mothers in New York were more likely to be disadvantaged, compared with their non-Hispanic white counterparts in Ottawa. Seventy percent of Hispanics reported being single mothers, and 44% of the Canadian mothers were. About 71% of the New York group had household incomes under $15,000 a year, compared with 22% of the Canadian women. And nearly two-thirds of the Hispanic mothers reported receiving public assistance, compared with about 8% of the Canadian cohort.

Based on previous findings regarding depression treatment outcomes among single mothers, the study authors hypothesized that Hispanic mothers and their children in New York would not perform as well as their more socially advantaged counterparts in Ottawa.

“When you look at Latinas in the literature, their high rates of disadvantage make them a difficult group to treat,” Dr. Davila said in an interview. “Previous studies have shown that if you are single or disadvantaged, you are more likely to drop out of treatment, you don’t do as well, and your children also don’t do as well, compared to women who are more socially advantaged.”

However, the Hispanic mothers and their children performed well in this trial. After 12 weeks of treatment on escitalopram, bupropion, or a combination of the two, 81.8% of the Hispanic mothers remitted from depression (P less than .05), compared with 55.6% in the Canadian group; at 36 weeks, 90.9% of Hispanic mothers vs. 72% of non-Hispanic mothers had remitted (P less than .05). Hispanic mothers in New York were significantly less likely to drop out of the study over the course of 36 weeks, compared with non-Hispanic Canadian mothers (9.1% vs. 13.9%, respectively, P less than .05).

Among children, while both sites saw improvements in social anxiety and separation/panic disorders, Hispanic children in New York improved their levels of overall anxiety and anxiety with physical symptoms at a faster rate, compared with the children in Canada. They also saw significant improvements in their levels of depressive symptoms and functioning over the course of the 36-week study.

Dr. Davila said the fact that so few of the Hispanic women dropped out of the study points to the therapeutic alliance between the women and those providing their treatment. “Many of the people treating these women at Columbia were Hispanic physicians who spoke Spanish, as many of these women were Spanish dominant. Anyone who receives attentive care has a chance of doing well,” she said, “and in this case the benefits extended to the children.”

Dr. Davila’s study was funded by the National Institute of Mental Health, and its authors declared no conflicts of interest. One coauthor on the study, Myrna Weissman, Ph.D., was the principal investigator on the original study.

SAN ANTONIO – Disadvantaged Hispanic mothers in New York enrolled in a medication clinical trial remitted from depression at a faster rate when compared with a more advantaged cohort of non-Hispanic white mothers in Canada.

The Hispanic children also appeared to benefit from their mothers’ remission, seeing levels of psychopathology and impairment significantly improved over the course of the 36-week treatment trial.

These surprising findings, presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry, came from the Parental Remission from Depression and Child Psychopathology Study, a randomized, double-blind clinical trial examining the effects of maternal depression treatment on children in two sites: New York and Ottawa (Am J Psychiatry. 2015 May 1;172[5]:450-9).

A previous study of similar design found single mothers to be more likely to drop out of depression treatment and less likely to remit if they remained in treatment. Among those single mothers who remained in treatment, the children were less likely to improve their levels of psychopathology even if their mothers remitted (Soc Psychiatry Psychiatr Epidemiol. 2007;42[12]: 962-71).

For this study, Marivel Davila, Ph.D., of Columbia University in New York and her colleagues, compared results from 33 Hispanic mothers in New York and their children, aged 7-17, with 36 non-Hispanic white mothers in Ottawa and their children, also aged 7-17. All participating mothers were diagnosed with major depressive disorder without psychosis.

Hispanic mothers in New York were more likely to be disadvantaged, compared with their non-Hispanic white counterparts in Ottawa. Seventy percent of Hispanics reported being single mothers, and 44% of the Canadian mothers were. About 71% of the New York group had household incomes under $15,000 a year, compared with 22% of the Canadian women. And nearly two-thirds of the Hispanic mothers reported receiving public assistance, compared with about 8% of the Canadian cohort.

Based on previous findings regarding depression treatment outcomes among single mothers, the study authors hypothesized that Hispanic mothers and their children in New York would not perform as well as their more socially advantaged counterparts in Ottawa.

“When you look at Latinas in the literature, their high rates of disadvantage make them a difficult group to treat,” Dr. Davila said in an interview. “Previous studies have shown that if you are single or disadvantaged, you are more likely to drop out of treatment, you don’t do as well, and your children also don’t do as well, compared to women who are more socially advantaged.”

However, the Hispanic mothers and their children performed well in this trial. After 12 weeks of treatment on escitalopram, bupropion, or a combination of the two, 81.8% of the Hispanic mothers remitted from depression (P less than .05), compared with 55.6% in the Canadian group; at 36 weeks, 90.9% of Hispanic mothers vs. 72% of non-Hispanic mothers had remitted (P less than .05). Hispanic mothers in New York were significantly less likely to drop out of the study over the course of 36 weeks, compared with non-Hispanic Canadian mothers (9.1% vs. 13.9%, respectively, P less than .05).

Among children, while both sites saw improvements in social anxiety and separation/panic disorders, Hispanic children in New York improved their levels of overall anxiety and anxiety with physical symptoms at a faster rate, compared with the children in Canada. They also saw significant improvements in their levels of depressive symptoms and functioning over the course of the 36-week study.

Dr. Davila said the fact that so few of the Hispanic women dropped out of the study points to the therapeutic alliance between the women and those providing their treatment. “Many of the people treating these women at Columbia were Hispanic physicians who spoke Spanish, as many of these women were Spanish dominant. Anyone who receives attentive care has a chance of doing well,” she said, “and in this case the benefits extended to the children.”

Dr. Davila’s study was funded by the National Institute of Mental Health, and its authors declared no conflicts of interest. One coauthor on the study, Myrna Weissman, Ph.D., was the principal investigator on the original study.

SAN ANTONIO – Disadvantaged Hispanic mothers in New York enrolled in a medication clinical trial remitted from depression at a faster rate when compared with a more advantaged cohort of non-Hispanic white mothers in Canada.

The Hispanic children also appeared to benefit from their mothers’ remission, seeing levels of psychopathology and impairment significantly improved over the course of the 36-week treatment trial.

These surprising findings, presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry, came from the Parental Remission from Depression and Child Psychopathology Study, a randomized, double-blind clinical trial examining the effects of maternal depression treatment on children in two sites: New York and Ottawa (Am J Psychiatry. 2015 May 1;172[5]:450-9).

A previous study of similar design found single mothers to be more likely to drop out of depression treatment and less likely to remit if they remained in treatment. Among those single mothers who remained in treatment, the children were less likely to improve their levels of psychopathology even if their mothers remitted (Soc Psychiatry Psychiatr Epidemiol. 2007;42[12]: 962-71).

For this study, Marivel Davila, Ph.D., of Columbia University in New York and her colleagues, compared results from 33 Hispanic mothers in New York and their children, aged 7-17, with 36 non-Hispanic white mothers in Ottawa and their children, also aged 7-17. All participating mothers were diagnosed with major depressive disorder without psychosis.

Hispanic mothers in New York were more likely to be disadvantaged, compared with their non-Hispanic white counterparts in Ottawa. Seventy percent of Hispanics reported being single mothers, and 44% of the Canadian mothers were. About 71% of the New York group had household incomes under $15,000 a year, compared with 22% of the Canadian women. And nearly two-thirds of the Hispanic mothers reported receiving public assistance, compared with about 8% of the Canadian cohort.

Based on previous findings regarding depression treatment outcomes among single mothers, the study authors hypothesized that Hispanic mothers and their children in New York would not perform as well as their more socially advantaged counterparts in Ottawa.

“When you look at Latinas in the literature, their high rates of disadvantage make them a difficult group to treat,” Dr. Davila said in an interview. “Previous studies have shown that if you are single or disadvantaged, you are more likely to drop out of treatment, you don’t do as well, and your children also don’t do as well, compared to women who are more socially advantaged.”

However, the Hispanic mothers and their children performed well in this trial. After 12 weeks of treatment on escitalopram, bupropion, or a combination of the two, 81.8% of the Hispanic mothers remitted from depression (P less than .05), compared with 55.6% in the Canadian group; at 36 weeks, 90.9% of Hispanic mothers vs. 72% of non-Hispanic mothers had remitted (P less than .05). Hispanic mothers in New York were significantly less likely to drop out of the study over the course of 36 weeks, compared with non-Hispanic Canadian mothers (9.1% vs. 13.9%, respectively, P less than .05).

Among children, while both sites saw improvements in social anxiety and separation/panic disorders, Hispanic children in New York improved their levels of overall anxiety and anxiety with physical symptoms at a faster rate, compared with the children in Canada. They also saw significant improvements in their levels of depressive symptoms and functioning over the course of the 36-week study.

Dr. Davila said the fact that so few of the Hispanic women dropped out of the study points to the therapeutic alliance between the women and those providing their treatment. “Many of the people treating these women at Columbia were Hispanic physicians who spoke Spanish, as many of these women were Spanish dominant. Anyone who receives attentive care has a chance of doing well,” she said, “and in this case the benefits extended to the children.”

Dr. Davila’s study was funded by the National Institute of Mental Health, and its authors declared no conflicts of interest. One coauthor on the study, Myrna Weissman, Ph.D., was the principal investigator on the original study.

SAN ANTONIO – Simultaneous prescription of psychotropic drugs likely to cause problematic interactions increased in children over a 10-year period, according to findings from a review of Medicaid data presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Another study presented at AACAP, also using Medicaid data, found that children in areas underserved by child psychiatrists are likelier to be prescribed atypical antipsychotic drugs for nonpsychotic conditions than in areas where more child psychiatrists practice.

The polypharmacy study, presented by Dr. Regina Bussing of the University of Florida in Gainesville, looked at Medicaid records from 29 states to identify 45-day overlaps in concurrently prescribed psychiatric medications in children. The researchers used three commercially available interaction checkers to identify combinations classed as contraindicated.

Dr. Bussing and her colleagues found that the prevalence of scripts of two or more medications in different drug classes rose from 1999 through 2007 and plateaued afterward, meaning that anywhere from 18.3% to 27.7% children were prescribed at least one psychotropic drug. About 1.5% of children treated with two or more drugs received two atypical antipsychotics, and 0.6% were prescribed two stimulant classes.

The researchers looked at prescription data for cohorts of between 485,874 and 966,613 patients for each 2-year bracket studied. Throughout the study period, the overall prevalence of psychotropic drug combinations rated as “contraindicated” or having “major” interaction risks was 0.21% for children 5 years and under, 1.12% for children 6-9 years, 2.06% for ages 10-14 years, and 2.83% for children 15-17.

In Florida, the prevalence of potentially risky prescriptions was considerably higher, at 0.46% of the youngest children and 3.92% of the oldest. The state of Florida “is No. 49 in funding for mental health; that might be one of the factors” promoting the polypharmacy trend, Dr. Bussing commented.

More common patterns classified as potentially risky that were seen in the study included combining a selective serotonin reuptake inhibitor with trazodone. This likely represents efforts by clinicians to target mood and insomnia symptoms simultaneously, suggested Dr. Bussing. However, adding trazodone can increase the risk of serotonin syndrome or cardiac conduction problems. As for other drug combinations seen in the study, “I don’t understand it at all. I’d love to know what people are trying to do,” she noted.

Dr. Bussing said further research was needed to better understand the clinical, rather than just theoretical, interaction risks of polypharmacy in this patient group. Electronic health records are increasingly programmed to alert to potential interactions, but clinicians routinely override them, she said, likely feeling the true risk to be lower than conveyed by interaction-checking databases.

Findings from a separate study showed that the use of atypical antipsychotic drugs varied widely by county in Maryland, and that children aged 4-17 years who lived in counties with more practicing child psychiatrists were less likely to be prescribed an atypical antipsychotic drug for a nonpsychotic condition, according to Dinci Pennap of the University of Maryland School of Pharmacy in Baltimore.

Ms. Pennap and colleagues reviewed Medicaid data for 133,247 children aged 4-17 years. Of these, 48,087 (36%) had one or more nonpsychotic diagnoses, and 9.6% of these received at least one prescription for an atypical antipsychotic drug between 2010 and 2012.

The investigators also determined from registries how many child psychiatrists practiced in the counties where subjects resided. Adequate coverage was calculated at one child psychiatrist per approximately 7,000 youth. Of the 24 counties in Maryland, 7 had no child psychiatrists, 10 had too few, and 7 had sufficient numbers.

Non-Hispanic black children in counties without any child psychiatrists were significantly more likely to receive an atypical antipsychotic drug, compared with other racial and ethnic groups (12.1% vs. 6.6%; P less than .0001). County variations accounted for 2.7% of atypical antipsychotic drug use in this population. The use of atypical antipsychotic drugs was also higher in children with multiple diagnoses.

“A major limitation here was that we couldn’t account for who was prescribing what because we are using county level data,” Ms. Pennap said. “However, the underlying statement is that someone besides child psychiatrists has to be doing [the prescribing]”; in some counties there were none practicing at all, Ms. Pennap said.

Moreover, “there is no indication in the Maryland Medicaid data that children on [atypical antipsychotic drugs] are being followed for metabolic or cardiovascular disorders” that might result from treatment, Ms. Pennap said.

Dr. Bussing’s study was funded by the University of Florida. She disclosed prior research support from Pfizer and Otsuka. Ms. Pennap’s study had no outside funding. She disclosed no conflicts of interest.

SAN ANTONIO – Simultaneous prescription of psychotropic drugs likely to cause problematic interactions increased in children over a 10-year period, according to findings from a review of Medicaid data presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Another study presented at AACAP, also using Medicaid data, found that children in areas underserved by child psychiatrists are likelier to be prescribed atypical antipsychotic drugs for nonpsychotic conditions than in areas where more child psychiatrists practice.

The polypharmacy study, presented by Dr. Regina Bussing of the University of Florida in Gainesville, looked at Medicaid records from 29 states to identify 45-day overlaps in concurrently prescribed psychiatric medications in children. The researchers used three commercially available interaction checkers to identify combinations classed as contraindicated.

Dr. Bussing and her colleagues found that the prevalence of scripts of two or more medications in different drug classes rose from 1999 through 2007 and plateaued afterward, meaning that anywhere from 18.3% to 27.7% children were prescribed at least one psychotropic drug. About 1.5% of children treated with two or more drugs received two atypical antipsychotics, and 0.6% were prescribed two stimulant classes.

The researchers looked at prescription data for cohorts of between 485,874 and 966,613 patients for each 2-year bracket studied. Throughout the study period, the overall prevalence of psychotropic drug combinations rated as “contraindicated” or having “major” interaction risks was 0.21% for children 5 years and under, 1.12% for children 6-9 years, 2.06% for ages 10-14 years, and 2.83% for children 15-17.

In Florida, the prevalence of potentially risky prescriptions was considerably higher, at 0.46% of the youngest children and 3.92% of the oldest. The state of Florida “is No. 49 in funding for mental health; that might be one of the factors” promoting the polypharmacy trend, Dr. Bussing commented.

More common patterns classified as potentially risky that were seen in the study included combining a selective serotonin reuptake inhibitor with trazodone. This likely represents efforts by clinicians to target mood and insomnia symptoms simultaneously, suggested Dr. Bussing. However, adding trazodone can increase the risk of serotonin syndrome or cardiac conduction problems. As for other drug combinations seen in the study, “I don’t understand it at all. I’d love to know what people are trying to do,” she noted.

Dr. Bussing said further research was needed to better understand the clinical, rather than just theoretical, interaction risks of polypharmacy in this patient group. Electronic health records are increasingly programmed to alert to potential interactions, but clinicians routinely override them, she said, likely feeling the true risk to be lower than conveyed by interaction-checking databases.

Findings from a separate study showed that the use of atypical antipsychotic drugs varied widely by county in Maryland, and that children aged 4-17 years who lived in counties with more practicing child psychiatrists were less likely to be prescribed an atypical antipsychotic drug for a nonpsychotic condition, according to Dinci Pennap of the University of Maryland School of Pharmacy in Baltimore.

Ms. Pennap and colleagues reviewed Medicaid data for 133,247 children aged 4-17 years. Of these, 48,087 (36%) had one or more nonpsychotic diagnoses, and 9.6% of these received at least one prescription for an atypical antipsychotic drug between 2010 and 2012.

The investigators also determined from registries how many child psychiatrists practiced in the counties where subjects resided. Adequate coverage was calculated at one child psychiatrist per approximately 7,000 youth. Of the 24 counties in Maryland, 7 had no child psychiatrists, 10 had too few, and 7 had sufficient numbers.

Non-Hispanic black children in counties without any child psychiatrists were significantly more likely to receive an atypical antipsychotic drug, compared with other racial and ethnic groups (12.1% vs. 6.6%; P less than .0001). County variations accounted for 2.7% of atypical antipsychotic drug use in this population. The use of atypical antipsychotic drugs was also higher in children with multiple diagnoses.

“A major limitation here was that we couldn’t account for who was prescribing what because we are using county level data,” Ms. Pennap said. “However, the underlying statement is that someone besides child psychiatrists has to be doing [the prescribing]”; in some counties there were none practicing at all, Ms. Pennap said.

Moreover, “there is no indication in the Maryland Medicaid data that children on [atypical antipsychotic drugs] are being followed for metabolic or cardiovascular disorders” that might result from treatment, Ms. Pennap said.

Dr. Bussing’s study was funded by the University of Florida. She disclosed prior research support from Pfizer and Otsuka. Ms. Pennap’s study had no outside funding. She disclosed no conflicts of interest.

SAN ANTONIO – Simultaneous prescription of psychotropic drugs likely to cause problematic interactions increased in children over a 10-year period, according to findings from a review of Medicaid data presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

Another study presented at AACAP, also using Medicaid data, found that children in areas underserved by child psychiatrists are likelier to be prescribed atypical antipsychotic drugs for nonpsychotic conditions than in areas where more child psychiatrists practice.

The polypharmacy study, presented by Dr. Regina Bussing of the University of Florida in Gainesville, looked at Medicaid records from 29 states to identify 45-day overlaps in concurrently prescribed psychiatric medications in children. The researchers used three commercially available interaction checkers to identify combinations classed as contraindicated.

Dr. Bussing and her colleagues found that the prevalence of scripts of two or more medications in different drug classes rose from 1999 through 2007 and plateaued afterward, meaning that anywhere from 18.3% to 27.7% children were prescribed at least one psychotropic drug. About 1.5% of children treated with two or more drugs received two atypical antipsychotics, and 0.6% were prescribed two stimulant classes.

The researchers looked at prescription data for cohorts of between 485,874 and 966,613 patients for each 2-year bracket studied. Throughout the study period, the overall prevalence of psychotropic drug combinations rated as “contraindicated” or having “major” interaction risks was 0.21% for children 5 years and under, 1.12% for children 6-9 years, 2.06% for ages 10-14 years, and 2.83% for children 15-17.

In Florida, the prevalence of potentially risky prescriptions was considerably higher, at 0.46% of the youngest children and 3.92% of the oldest. The state of Florida “is No. 49 in funding for mental health; that might be one of the factors” promoting the polypharmacy trend, Dr. Bussing commented.

More common patterns classified as potentially risky that were seen in the study included combining a selective serotonin reuptake inhibitor with trazodone. This likely represents efforts by clinicians to target mood and insomnia symptoms simultaneously, suggested Dr. Bussing. However, adding trazodone can increase the risk of serotonin syndrome or cardiac conduction problems. As for other drug combinations seen in the study, “I don’t understand it at all. I’d love to know what people are trying to do,” she noted.

Dr. Bussing said further research was needed to better understand the clinical, rather than just theoretical, interaction risks of polypharmacy in this patient group. Electronic health records are increasingly programmed to alert to potential interactions, but clinicians routinely override them, she said, likely feeling the true risk to be lower than conveyed by interaction-checking databases.

Findings from a separate study showed that the use of atypical antipsychotic drugs varied widely by county in Maryland, and that children aged 4-17 years who lived in counties with more practicing child psychiatrists were less likely to be prescribed an atypical antipsychotic drug for a nonpsychotic condition, according to Dinci Pennap of the University of Maryland School of Pharmacy in Baltimore.

Ms. Pennap and colleagues reviewed Medicaid data for 133,247 children aged 4-17 years. Of these, 48,087 (36%) had one or more nonpsychotic diagnoses, and 9.6% of these received at least one prescription for an atypical antipsychotic drug between 2010 and 2012.

The investigators also determined from registries how many child psychiatrists practiced in the counties where subjects resided. Adequate coverage was calculated at one child psychiatrist per approximately 7,000 youth. Of the 24 counties in Maryland, 7 had no child psychiatrists, 10 had too few, and 7 had sufficient numbers.

Non-Hispanic black children in counties without any child psychiatrists were significantly more likely to receive an atypical antipsychotic drug, compared with other racial and ethnic groups (12.1% vs. 6.6%; P less than .0001). County variations accounted for 2.7% of atypical antipsychotic drug use in this population. The use of atypical antipsychotic drugs was also higher in children with multiple diagnoses.

“A major limitation here was that we couldn’t account for who was prescribing what because we are using county level data,” Ms. Pennap said. “However, the underlying statement is that someone besides child psychiatrists has to be doing [the prescribing]”; in some counties there were none practicing at all, Ms. Pennap said.

Moreover, “there is no indication in the Maryland Medicaid data that children on [atypical antipsychotic drugs] are being followed for metabolic or cardiovascular disorders” that might result from treatment, Ms. Pennap said.

Dr. Bussing’s study was funded by the University of Florida. She disclosed prior research support from Pfizer and Otsuka. Ms. Pennap’s study had no outside funding. She disclosed no conflicts of interest.