PLEASE NOTE: Children of Bellevue is a nonprofit auxiliary to NYC Health+Hospitals/Bellevue.
We do not provide patient care. If your child needs medical attention, please call 212-562-4141.

Research

1. Identification of Trauma Exposure and PTSD in Adolescent Psychiatric Inpatients: An Exploratory Study
Jennifer F. Havens,1,2 Omar G. Gudi˜no,1,2 Emily A. Biggs,1,2 Ursula N. Diamond,1,2 J. Rebecca Weis,1,2 and Marylene Cloitre2,3

1Department of Child & Adolescent Psychiatry, Bellevue Hospital Center, New York, New York, USA,

2Department of Child & Adolescent Psychiatry, New York University School of Medicine, New York, New York, USA

3National Center for PTSD, Palo Alto, California, USA

ABSTRACT:

Trauma exposure and posttraumatic stress disorder (PTSD), though prevalent among adolescent psychiatric inpatients, are underidentified in standard clinical practice. In a retrospective chart review of 140 adolescents admitted to a psychiatric inpatient unit, we examined associations between probable PTSD identified through the Child PTSD Symptom Scale and adolescents’ service use and clinical characteristics. Results suggest a large discrepancy between rates of probable PTSD identified through standardized assessment and during the emergency room psychiatric evaluation (28.6% vs. 2.2%). Adolescents with probable PTSD had greater clinical severity and service utilization, an increased likelihood of being diagnosed with bipolar disorder (27.5% vs. 9.2%) and being prescribed antipsychotic medications (47.5% vs. 27.6%), and were prescribed more psychotropic medications. Upon discharge, those with probable PTSD were more than those without to be assigned a diagnosis of PTSD (45% vs. 7.1%), a comorbid diagnosis of major depressive disorder (30% vs. 14.3%), to be prescribed an antidepressant medication (52.5% vs. 33.7%), and to be prescribed more medications. The underidentification of trauma exposure and PTSD has important implications for the care of adolescents given that accurate diagnosis is a prerequisite for providing effective care. Improved methods for identifying trauma-related problems in standard clinical practice are needed.

 

2. Randomized Controlled Trial of Primary Care Pediatric Parenting Programs
Alan L. Mendelsohn, MD; Benard P. Dreyer, MD; Carolyn A. Brockmeyer, PhD; Samantha B. Berkule-Silberman, PhD; Harris S. Huberman, MD, MPH; Suzy Tomopoulos, MD

Arch Pediatr Adolesc Med. 2011 Jan;165(1):42-8. doi: 10.1001/archpediatrics.2010.266.

ABSTRACT:

OBJECTIVES:To determine whether pediatric primary care-based programs to enhance parenting and early child development reduce media exposure and whether enhanced parenting mediates the effects.

DESIGN:Randomized controlled trial.

SETTING:Urban public hospital pediatric primary care clinic.

PARTICIPANTS: A total of 410 mother-newborn dyads enrolled after childbirth.

INTERVENTIONS: Patients were randomly assigned to 1 of 2 interventions, the Video Interaction Project (VIP) and Building Blocks (BB) interventions, or to control group. The VIP intervention comprised 1-on-1 sessions with a child development specialist who facilitated interactions in play and shared reading through review of videotapes made of the parent and child on primary care visit days; learning materials and parenting pamphlets were also provided. The BB intervention mailed parenting materials, including age-specific newsletters suggesting activities to facilitate interactions, learning materials, and parent-completed developmental questionnaires (Ages and Stages questionnaires).

OUTCOME MEASURES: Electronic media exposure in the home using a 24-hour recall diary.

RESULTS: The mean (SD) exposure at 6 months was 146.5 (125.0) min/d. Exposure to VIP was associated with reduced total duration of media exposure compared with the BB and control groups (mean [SD] min/d for VIP, 131.6 [118.7]; BB, 151.2 [116.7]; control, 155.4 [138.7]; P = .009). Enhanced parent-child interactions were found to partially mediate relations between VIP and media exposure for families with a ninth grade or higher literacy level (Sobel statistic = 2.49; P = .01).

CONCLUSION: Pediatric primary care may represent an important venue for addressing the public health problem of media exposure in young children at a population level.