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Non-suicidal self-injury (NSSI) in childhood is not well documented, especially among youth with pediatric bipolar disorder (PBD). The current study evaluated prevalence and correlates of NSSI, and its impact on intervention response, in a randomized trial of Child- and Family-Focused Cognitive-Behavioral Therapy (CFF-CBT) versus Treatment As Usual (TAU), adjunctive to pharmacotherapy. This study included 72 children ages 7–13 (58% male) with PBD. NSSI and correlates were assessed at baseline; mood and psychiatric severity were measured longitudinally. NSSI was common: 31% endorsed NSSI behaviors; 10% reported thoughts of NSSI, in the absence of behaviors. Children engaging in NSSI reported higher depression, psychosis, suicidality, and hopelessness; lower self-esteem; and reduced family help-seeking in univariate analyses. In a multivariate logistic regression, high child depression and psychosis, and low family help-seeking, remained significantly associated with baseline NSSI. In mixed-effects regression models, presence of NSSI at baseline did not influence the response of depressive symptoms to treatment. Children who endorsed NSSI experienced steeper response trajectories for psychiatric severity, regardless of treatment group. Youth who denied NSSI showed poorer response to TAU for manic symptoms; mania trajectories in CFF-CBT were similar across youth. Thus, NSSI in PBD is common and associated with impairment. As children might engage in NSSI for different reasons, the function of NSSI should be considered in treatment. Since children without NSSI fared worse in TAU, it may be important to ensure that youth with PBD receive structured, intensive interventions. CFF-CBT was efficacious regardless of NSSI, and thus shows promise for high-risk children with PBD.

Objectives: Understanding the pathways linking caregiver- and family-level psychosocial factors and child oral health behaviors is critical for addressing oral health disparities. The current study examined the associations between caregiver psychosocial functioning and family chaos and child toothbrushing behaviors in children at high risk for poor oral health outcomes. Methods: Data were drawn from the baseline wave of the CO-OP Chicago Cohort Study (U01DE030067), a longitudinal study on child/caregiver dyads exploring oral health behaviors and caries development in young children (N = 296 dyads; child mean age = 5.36, SD = 1.03; caregiver mean age = 33.8 years, SD = 6.70; caregiver race = 43% Black; caregiver ethnicity = 55% Latinx). The oral health behavioral outcomes included child toothbrushing frequency, child plaque levels, and caregiver assistance with child toothbrushing. The data included demographics; caregiver depression, anxiety, post-traumatic stress disorder (PTSD) symptoms, social functioning, social support, and resilience; and family-level household chaos. Results: Multiple regression models indicated that greater household chaos was significantly related to lower caregiver assistance with child toothbrushing (p = 0.0075). Additionally, caregiver anxiety and PTSD symptoms as well as number of children in the home significantly predicted higher levels of household chaos (p < 0.01). Notably, 18% of caregivers reported clinically significant PTSD. The relationships between caregiver-level psychosocial factors and child oral health behaviors were not significant. Conclusions: The results suggest household chaos may play an important role in child oral health behaviors and highlight the importance of investigating family-level factors for understanding and addressing child oral health risk.

Family-based psychosocial treatments have been developed to address the significant impairments in psychosocial functioning among youth with pediatric bipolar disorder (PBD), yet factors impacting engagement in these treatments have yet to be extensively studied. Early termination from treatment may lead to negative outcomes among youth with PBD. Thus, the primary aim of this exploratory study was to identify predictors and moderators of treatment dropout in PBD. Drawing from the child attrition literature, this study examined characteristics likely to be associated with dropout in families affected by PBD, including potential targets of treatment. Using Cox proportional hazards regressions, we explored the impact of modifiable parent, child, and family characteristics (i.e., parent stress, family coping, child symptoms) and stable demographic characteristics (i.e., family income, ethnic minority status) on dropout among 59 youth aged 7 to 13 who participated in a randomized clinical trial comparing a manualized psychotherapy for PBD (child- and family-focused cognitive behavioral therapy; CFF-CBT) versus treatment as usual (TAU). Specifically, we explored whether dropout was related to baseline levels and changes in these characteristics over the course of treatment in CFF-CBT versus TAU. Findings provide preliminary support for high parental stress as a predictor of dropout across treatments and low baseline parent coping as a predictor of retention in CFF-CBT specifically. Worsening of child depression symptoms over treatment predicted greater likelihood of dropout in CFF-CBT. Finally, improvement in children’s global functioning was associated with reduced dropout across treatments. Results have important implications for tailoring interventions for PBD.

Pediatric bipolar disorder (PBD) affects approximately 2% of the population and disrupts mood regulation, psychosocial functioning and quality of life among affected youths and families. Given the significant psychosocial impairment and poor long-term prognosis associated with PBD, psychosocial intervention is considered to be an essential component of a multimodal treatment approach. This relatively young field of research has witnessed significant growth in the evidence base for psychosocial treatments targeting youths in the past decade, particularly family-based interventions grounded in a biopsychosocial framework. This article reviews existing empirically supported interventions for children and adolescents with PBD. Common elements of successful interventions are identified, and future research directions to address current limitations in the field and advance understanding of treatment for PBD are discussed.

Objective: Co-morbid diagnoses, such as disruptive behavior disorders (DBDs) and high levels of aggression, are extremely common among youth with pediatric bipolar disorder (PBD) and may interfere with treatment response; however, they have rarely been examined as predictors of response to pharmacotherapy. The current study examines co-morbid DBD and aggression prospectively as predictors of pharmacotherapy outcome, as well as potential moderators of response to a specific medication (risperidone vs. divalproex), among children with PBD. Methods: Data are from a prospective 6-week double-blind, placebo-controlled, randomized outpatient medication treatment trial of risperidone versus divalproex for manic episodes in 65 children 8–18 with PBD. Outcome measures were administered at pretest, post-test, and weekly during the 6 weeks of treatment. Mixed-effects regression models were used to examine pharmacotherapy response. Results: Results indicated that youth with co-morbid DBD experienced greater improvement in manic symptoms in response to risperidone versus divalproex, whereas youth with non-co-morbid DBD experienced similar trajectories of symptom improvement in both medication groups. In addition, the non-DBD group experienced greater improvement in global functioning over time as compared with youth with co-morbid-DBD, and this gap increased over the course of treatment. Results also indicated that high-aggression youth experienced worse global functioning by end treatment versus low-aggression youth. Conclusions: In conclusion, a co-morbid diagnosis of DBD and/or high levels of aggressive symptoms in youth with PBD may be important clinical predictors of variation in treatment response to pharmacotherapy. These findings may help researchers and clinicians develop tailored treatment approaches that optimize symptom and functional outcomes.

Pediatric bipolar disorder (PBD) is a chronic and severe disorder that is associated with significant impairments in psychosocial functioning. Psychosocial intervention is an important component of comprehensive treatment for PBD. Child- and family-focused cognitive-behavioral therapy (CFF-CBT), also called RAINBOW therapy, is a manual-based, 12 session psychosocial intervention developed for youth 7-13 with PBD and their families. It combines cognitive-behavioral therapy with psychoeducation and other therapeutic interventions from interpersonal psychotherapy, mindfulness, and positive psychology in an intensive family-based treatment model. Specifically, CFF-CBT therapy aims to improve functioning in seven core areas: routines, affect regulation, self-efficacy, negative thoughts and behaviors, social skills, interpersonal and family problem-solving, and social support. Preliminary open trial results, detailed in this manuscript, have demonstrated promise for CFFCBT's efficacy in reducing symptoms and improving psychosocial functioning and it is now being tested in a randomized clinical trial.

Objectives. To compare asthma control for children receiving either community health worker (CHW) or certified asthma educator (AE-C) services. Methods. The Asthma Action at Erie Trial is a comparative effectiveness trial that ran from 2016 to 2019 in Cook County, Illinois. Participants (aged 5-16 years with uncontrolled asthma) were randomized to 10 home visits from clinically integrated asthma CHWs or 2 in-clinic sessions from an AE-C. Results. Participants (n = 223) were mainly Hispanic (85%) and low-income. Both intervention groups showed significant improvement in asthma control scores over time. Asthma control was maintained after interventions ended. The CHW group experienced a greater improvement in asthma control scores. One year after intervention cessation, the CHW group had a 42% reduction in days of activity limitation relative to the AE-C group (b = 0.58; 95% confidence interval = 0.35, 0.96). Conclusions. Both interventions were associated with meaningful improvements in asthma control. Improvements continued for 1 year after intervention cessation and were stronger with the CHW intervention.

Objectives. To compare asthma control for children receiving either community health worker (CHW) or certified asthma educator (AE-C) services. Methods. The Asthma Action at Erie Trial is a comparative effectiveness trial that ran from 2016 to 2019 in Cook County, Illinois. Participants (aged 5‒16 years with uncontrolled asthma) were randomized to 10 home visits from clinically integrated asthma CHWs or 2 in-clinic sessions from an AE-C. Results. Participants (n = 223) were mainly Hispanic (85%) and low-income. Both intervention groups showed significant improvement in asthma control scores over time. Asthma control was maintained after interventions ended. The CHW group experienced a greater improvement in asthma control scores. One year after intervention cessation, the CHW group had a 42% reduction in days of activity limitation relative to the AE-C group (b = 0.58; 95% confidence interval = 0.35, 0.96). Conclusions. Both interventions were associated with meaningful improvements in asthma control. Improvements continued for 1 year after intervention cessation and were stronger with the CHW intervention. Public Health Implications. Clinically integrated asthma CHW and AE-C services that do not provide home environmental remediation equipment may improve and sustain asthma control.

Dramatic shifts in state-level cannabis laws (CLs) and federal hemp regulations have resulted in increased availability and use of cannabis and cannabidiol (CBD) products throughout the US, with unknown implications for the youth. Youth with mood disorders represent a vulnerable population that is more likely to use cannabis and CBD and is at elevated risk for experiencing cannabis-related adverse health outcomes. This multisite study characterized attitudes, health perceptions, and behaviors related to cannabis and CBD use among US youth receiving mood disorder treatment and their parents, and assessed whether attitudinal differences varied as a function of respondent group and state-level CL status. Anonymous surveys were completed by 84 youths and 66 parents recruited from six child mood clinics providing care to patients living in eleven US states with variable CLs. Covariate-adjusted regressions were run using respondent group and state-level CL status as between-subject factors. Most youths (76% and 74%) and parents (65% and 68%) endorsed believing that cannabis and CBD, respectively, are safe and effective treatments for mental health conditions, and that regular use of these products reduces depression, anxiety, and suicidal behaviors. Intergenerational differences in cannabis-related attitudes and health perceptions were observed, with some associations varying as a function of state-level CL. Among the youth, male sex and positive cannabis expectancies and attitudes were associated with higher cannabis use intentions. Findings can inform prevention and public health messaging efforts.

Understanding the predictors and processes influencing escalation in adolescent smoking remains one of the most important challenges in the literature. Guided by self-medication models of substance use (e.g., Khantzian, 1997), the current study focused on affect variability as a risk factor for smoking escalation among a sample of 461 9th and 10 th grade adolescents. Using real-time assessments of mood via Ecological Momentary Assessments (EMA) as well as paper/pencil questionnaire measures from a longitudinal study of youth smoking, the present study prospectively examined the roles of mood variability, overall mood, depressive symptoms, and affect-related smoking motives in a model of youth smoking behavior. It was hypothesized that mood variability would prospectively predict the progression from experimentation at baseline to frequent cigarette use at the follow-up 15 month wave, and that escalation in cigarette use would lead to subsequent improvements in mood variability over time. Moreover, it was hypothesized that mood variability would mediate the relations between depressive symptoms and future cigarette use. Mood variability was examined via the intraindividual standard deviations of mood ratings across the measurement week at the baseline and 15-month waves. Results highlight the role of negative affect in the progression to daily cigarette use, but different affective dimensions conferred risk for boys' versus girls' smoking. Logistic regression analyses revealed that negative mood variability predicted smoking progression for girls, whereas overall negative mood was significantly associated with escalation among boys possessing higher affect regulation smoking motives. Contrary to expectations, depressive symptoms were largely unrelated to smoking behavior and thus the mediational hypothesis was not supported. Additionally, mixed-effects regression models revealed that adolescents who escalated in their smoking experienced a reduction in mood variability and overall negative mood as smoking increased; in contrast, girls' with sustained frequent smoking across baseline to follow-up experienced a worsening of mood variability. Results thus support a complex, dynamic model of mood-smoking relationships that vary across the developmental trajectory of smoking, involving elements of both self-medication and dependence. Findings raise important implications for the design of prevention and intervention efforts aimed at youth smoking.