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With more than 30 available stimulant medications, choosing among therapeutic options for attention-deficit/hyperactivity disorder (ADHD) has become increasingly complex and patient specific. All ADHD stimulants owe their action to variants of either amphetamine or methylphenidate, yet formulation and delivery system differences create unique pharmacokinetic and clinical profiles for each medication. A benefit of the diversity within ADHD pharmacotherapy is that it facilitates tailoring treatment to meet patient needs. Historically, there has been a constant among long-acting stimulant options, regardless of formulation, which was morning dosing. The introduction of delayed-release and extended-release methylphenidate (DR/ER-MPH) is the first long-acting stimulant that patients take in the evening, with the clinical effect delayed until awakening in the morning. This paradigm shift has generated questions among clinicians and continued interest in real-world experience and data. This review used available clinical data, real-world evidence, emerging analyses, and clinical experience to evaluate the characteristics of DR/ER-MPH and its clinical utility within the greater context of ADHD medications and to provide clinicians with practical guidance on the use of DR/ER-MPH in children, adolescents, and adults with ADHD. [ABSTRACT FROM AUTHOR]

Objective: To develop a reliable and valid parent-report screening instrument for mania, based on DSM-IV symptoms. Method: A 21-item Child Mania Rating Scale-Parent version (CMRS-P) was completed by parents of 150 children (42.3% female) ages 10.3 plus or minus 2.9 years (healthy controls = 50; bipolar disorder = 50; attention-deficit/hyperactivity disorder [ADHD] = 50). The Washington University Schedule for Affective Disorders and Schizophrenia was used to determine DSM-IV diagnosis. The Young Mania Rating Scale, Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, Child Behavior Checklist, and Child Depression Inventory were completed to estimate the construct validity of the measure. Results: Exploratory and confirmatory factor analysis of the CMRS-P indicated that the scale was unidimensional. The internal consistency and retest reliability were both 0.96. Convergence of the CMRS-P with the Washington University Schedule for Affective Disorders and Schizophrenia mania module, the Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, and the Young Mania Rating Scale was excellent (0.78-0.83). The scale did not correlate as strongly with the Conners parent-rated ADHD scale, the Child Behavior Checklist-Attention Problems and Aggressive Behavior subscales, or the child self-report Child Depression Inventory (0.29-0.51). Criterion validity was demonstrated in analysis of receiver operating characteristics curves, which showed excellent sensitivity and specificity in differentiating children with mania from either healthy controls or children with ADHD (areas under the curve of 0.91 to 0.96). Conclusion: The CMRS-P is a promising parent-report scale that can be used in screening for pediatric mania. (Contains 2 figures and 4 tables.)

Objective: To assess the feasibility and effectiveness of an evidence-based pharmacotherapy algorithm in the treatment of pediatric bipolar disorder. Method: The study reports the results of a study of 64 bipolar type I subjects who were treated according to an algorithm developed in our specialty clinic. All subjects had been diagnosed using the Washington University in St. Louis Schedule for Affective Disorders and Schizophrenia. Subjects scored an average of 28 ([+ or -] 4) on the baseline Young Mania Rating Scale. All subjects were assessed over an 18-month period. In addition, we were able to match 17 of the 64 subjects in the algorithm sample for gender, age, ethnicity, socioeconomic status, and diagnosis with an equal number of subjects in a psychopharmacology clinic who received treatment as usual. Results: Prescribing clinicians were able to implement primary and secondary strategies, including detailed tactics of medication choices in the algorithm group. Growth curve analysis of the total algorithm group showed strong and significant improvement in symptoms. Analyses of the matched groups also showed strong effects for the treatment algorithm over treatment as usual. Treatment adherence and family satisfaction were higher in the algorithm group. Conclusion: An evidence-based, problem-solving pharmacotherapy algorithm is feasible and may be associated with better outcomes in the treatment of pediatric bipolar disorder. Randomized trials will be necessary to gather additional support for the algorithm's effectiveness.

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder characterized by persistent inattention, hyperactivity, and impulsivity that impairs functioning of the child/adolescent. Although ADHD is the most commonly seen psychiatric disorder in childhood and adolescence, diagnosis of ADHD in children and adolescents in the United States has grown over the past 20 years, with prevalence rates increasing from 6.1% to 10.2% from 1997 to 2016. The current article describes the epidemiology of ADHD, factors that contribute to successful treatment, and recommendations to improve nursing practice. [ABSTRACT FROM AUTHOR]

This pilot randomized control trial was designed to examine whether Rumination-Focused Cognitive Behavior Therapy (RFCBT) reduces rumination and residual depressive symptoms among adolescents with a history of Major Depressive Disorder (MDD) who are at risk for relapse. We also examined whether these changes in symptoms were associated with changes in functional connectivity of the posterior cingulate cortex (PCC), a key node in the default mode network (DMN). Thirty-three adolescents (ages 12–18) were randomized to eight weeks of RFCBT or an assessment only (AO) control. Twenty two adolescents successfully completed fMRI scans pre- and post-intervention. Adolescents were recruited from the clinic and community and met criteria for at least one previous episode of MDD and were currently in full or partial remission. An Independent Evaluator interviewed parent and child before and after the eight-week intervention. The left PCC (-5, -50, 36) seed was used to probe resting state functional connectivity of the DMN. Adolescents who received RFCBT demonstrated reduced rumination (F = -2.76, df = 112, p < .01, 95% CI [-4.72,-0.80]) and self-report depression across eight weeks (F = -2.58, df = 113, p < .01, 95% CI [-4.21, -0.94]). Youth who received RFCBT also demonstrated significant decreases in connectivity between the left PCC and the right inferior frontal gyrus (IFG) and bilateral inferior temporal gyri (ITG). Degree of change in connectivity was correlated with changes in self-report depression and rumination. These data suggest that rumination can be reduced over eight weeks and that this reduction is associated with parallel decreases in residual depressive symptoms and decreased functional connectivity of the left PCC with cognitive control nodes. These changes may enhance the ability of vulnerable youth to stay well during the transition to adulthood. Trial Registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

This article explores the recent increase in adolescent psychiatric inpatient admissions. Factors fueling the tendency to hospitalize are discussed, and the concept of medicalization of adolescent behavior problems is related to this trend. Reflecting the medicalization concept, several questions and hypotheses regarding parental decision-making as it is related to adolescent hospitalization are presented. Through further investigation, a better understanding of the factors influencing or determining need for adolescent psychiatric hospitalization can be gained. [ABSTRACT FROM AUTHOR]

PURPOSE: There has been an increase in the number of children and adolescents requiring behavioral health care services since 2012. Many of these children and adolescents experience symptoms for several years before parents seek services. Psychiatric mental health nurse practitioner (PMHNP) graduate programs often offer students a minimum of child adolescent content, leaving PMHNP graduates less prepared to provide services for these complex patients. SUMMARY OF EVIDENCE: In 2015, 3 million children and adolescents had a depressive episode in the previous year. A total of 6.5 million adolescents have had a diagnosis of anxiety disorder. Many children and adolescents with symptoms do not seek services for behavioral health. Often PMHNPs lack clinical experience and expertise in the diagnosis and treatment of complex childhood disorders. DESCRIPTION: Increasing numbers of pediatric patients are seeking care for anxiety disorder, depression, and disruptive mood dysregulation disorder. Fewer skilled providers exist to address this demand. This presentation will be a "how to" diagnose and treat increasing complex presentation in children and adolescents patients using a holistic lens. VALIDATION OF EVIDENCE: National Institute of Mental Health/ American Academy of Child and Adolescent Psychiatry reports that since 2012, increased numbers of children and adolescent are presenting with behavior health issues. The numbers of Food and Drug Administration-approved medications are limited, and fewer research protocols address treatment modalities in this population. RELEVANCE/OUTCOMES: PMHNPs are uniquely positioned to diagnosis and provide evidence-based care for these children and adolescents but often lack knowledge and experience. IMPLICATIONS: Improved PMHNP knowledge of evidence-based treatment for children and adolescents will increase the health outcomes for this specialized population. [ABSTRACT FROM AUTHOR]

Introduction: This study is a preliminary report of a group adaptation of child- and family-focused cognitive behavior therapy (CFF-CBT) for pediatric bipolar disorder (PBD). Methods: CFF-CBT group treatment was provided to twenty six families who had children with a diagnosis of PBD ranging between six- and twelve-years-old. Results: Results indicated that CFF-CBT was feasible and acceptable to families. CFF-CBT resulted in significant improvement in manic, but not depressive, symptoms and in children's psychosocial functioning post-treatment. In addition, although not statistically significant, parents reported an increased ability to cope with their child's illness. Results of this study suggest that group psychosocial treatment provided alongside pharmacotherapy may help attain remission of symptoms, as well as increase overall psychosocial coping and wellbeing in both children and parents. Conclusion: Future work must include a more rigorous test of CFF-CBT in a randomized controlled trial. [ABSTRACT FROM AUTHOR]