Abstracts of Posters, Platform Sessions, and Poster Symposiums Accepted for Presentation at the 2019 Annual Meeting of the Society for Developmental and Behavioral Pediatrics

Abstract

s of Posters, Platform Sessions, and Poster Symposiums Accepted for Presentation at the 2019 Annual Meeting of the Society for Developmental and Behavioral Pediatrics Poster Session I Abstracts Abstract 2: Predictors of Clinically-Significant Anxiety Symptoms in Typically Developing Siblings of Children with Autism Spectrum Disorders Jack Dempsey, PhD; Lindsey DeVries, PhD, University of Colorado School of Medicine, Aurora, CO2: Predictors of Clinically-Significant Anxiety Symptoms in Typically Developing Siblings of Children with Autism Spectrum Disorders Jack Dempsey, PhD; Lindsey DeVries, PhD, University of Colorado School of Medicine, Aurora, CO Purpose: The purpose of this study is to identify predictors of clinically significant anxiety symptoms in typically developing siblings of children with ASD. Methods: Data from the Simons Simplex Collection (SSC) was used to identify 53 typically-developing children with clinically significant anxiety scores on the CBCL that had a sibling with ASD. A comparison sample of typically developing children who also had a sibling with ASD but did not display clinically significant anxiety (CBCL T score < 59) was created based on matching of age (±1 year), sibling FSIQ (+10 points), household income, race, ethnicity, and sex. Univariate logistic regression was used to test the significance between these groups of potential predictor variables from the mother and sibling with ASD. Variables with likelihood p values <5% were then included in a mutually-adjusted stepwise logistic regression analysis was used to determine the most parsimonious model. Results: Some aspects of repetitive and externalizing behaviors in the sibling with ASD had a weak influence on anxiety status; however, the presence of a maternal anxiety disorder was by far the strongest predictor (OR 17.9, p < .001; 95% CI, 3.07-88.50). The large CI results from quasi-complete separation as maternal anxiety almost perfectly predicted child anxiety. The strength of maternal anxiety relative to other variables was then confirmed using an alternative algorithm (decision tree analysis). Follow-up analyses showed teachers rated the clinically anxious children (M = 58.7, SD = 4.6) as significantly more anxious than their unaffected peers (M = 52.5, SD = 9.5; t(56) = 3.11, p = .003) indicating maternal report on CBCL was not unduly influenced by the presence of parental anxiety. Conclusions: Results indicate that maternal anxiety is a strong predictor of clinical anxiety symptoms in typically developing siblings of children with ASD. While some aspects of repetitive and externalizing behaviors in the child with ASD were somewhat contributory to sibling anxiety symptoms, overall child characteristics in those with ASD did not predict clinically significant anxiety symptoms in siblings without ASD. In addition to providing further evidence to the resiliency of typically developing siblings of children with ASD, the results also suggest that the presence of an anxiety disorder in mothers of children with ASD potentially has far-reaching implications for the entire family. Abstract 3: Long Term Safety of Extended-Release Methylphenidate Hydrochloride for Treatment of ADHD in Preschool Age Children3: Long Term Safety of Extended-Release Methylphenidate Hydrochloride for Treatment of ADHD in Preschool Age Children Ann Childress, MD, Center for Psychiatry and Behavioral Medicine, Inc., Las Vegas, NV; Henry Foehl, PhD, Foehl Statistics & Analytics LLC, Glenmoore, PA; Jeffery Newcorn, MD, Icahn School of Medicine at Mount Sinai, New York, NY; Benjamin Levinson, MD; Akwete Adjei, PhD, Rhodes Pharmaceuticals L.P., Coventry, RI Purpose: ADHD in children often begins during preschool years; pharmacologic treatment may be initiated following, or in addition to, behavior modification training. Prior to this study, no long-term safety data were extant for extended-release stimulant use in children under 6. This FDA-mandated study examined the long-term safety of extended-release methylphenidate hydrochloride (MPH-MLR; Aptensio XR®) treatment in preschool children. Methods: Eligible subjects were children 4 to less than 6 years of age enrolled from a prior pharmacokinetic study (9 subjects) or efficacy study (81 subjects, treated with MPH-MLR following unsuccessful behavior training). Subjects received an optimized dose of MPH-MLR (open label) for up to 52 weeks and were monitored for safety, tolerance, and sustained efficacy (ADHD Rating Scale, Version IV [ADHD-RS-IV] total score) at 4-week intervals. Abstracts of Posters, Platform Sessions, and Poster Symposiums Accepted for Presentation at the 2019 Annual Meeting of the Society for Developmental and Behavioral Pediatricss of Posters, Platform Sessions, and Poster Symposiums Accepted for Presentation at the 2019 Annual Meeting of the Society for Developmental and Behavioral Pediatrics Results: Of 90 enrolled subjects, 89 received at least one dose of study drug (range: 10-60 mg/day; mode: 40 mg); 44 subjects completed all 52 weeks of treatment. A total 287 treatment emergent adverse events (TEAEs) were reported in 65 (73.0%) subjects. The majority of TEAEs were mild to moderate in severity. The most common TEAEs (n[%] subjects) probably or possibly related to study treatment were decreased weight (15 [16.8%]), decreased appetite (13 [14.6%] ), insomnia (6 [6.7%]), hypertension (6 [6.7%]), irritability (5 [5.6%]), affect lability (4 [4.5%]) and abdominal upper gastrointestinal pain (3 [3.4%]). For 81 subjects enrolled from the prior efficacy study, the mean (SD) ADHD-RS-IV total score at the visit prior to initial treatment with MPH-MLR was 45.0 (6.92) and the mean (SD) total score at the last on-study visit of the safety study was 25.5 (13.35), demonstrating clinical improvement. The mean ADHD-RS-IV total score for all subjects at each week across the 52 weeks was approximately 20, indicating sustained efficacy. Conclusions: Aptensio XR® is safe and well-tolerated when administered once daily for treatment of ADHD in preschool age children; the safety profile does not differ from that observed in school age children. Significant reduction in ADHD symptoms is maintained with tolerable side effects, but patients should be closely monitored for decreased weight, insomnia, and hypertension. Abstract 4: Current State of Developmental Screening Practices Using the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) within Primary Care Pediatric (PCP) Practices in the United States (U.S.) Nabila Chowdhury, M.D.; Andrew Adesman, M.D., Cohen Children s Medical Center, Lake Success, NY; Veronica Villareal , M.D. , Baylor College of Medicine/Texas Children s Hospital, Houston , TX; Anna Krevskaya , M.D., Cohen Children s Medical Center, New Hyde Park, NY4: Current State of Developmental Screening Practices Using the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) within Primary Care Pediatric (PCP) Practices in the United States (U.S.) Nabila Chowdhury, M.D.; Andrew Adesman, M.D., Cohen Children s Medical Center, Lake Success, NY; Veronica Villareal , M.D. , Baylor College of Medicine/Texas Children s Hospital, Houston , TX; Anna Krevskaya , M.D., Cohen Children s Medical Center, New Hyde Park, NY Purpose: The purpose of this study was to 1) Assess the rate of utilization of the M-CHAT-R/F, specifically the FollowUp Interview, at 18 and 24-month well-child visits at PCP practices across the U.S. 2) Examine the barriers and facilitators in screening with the M-CHAT-R/F. Methods: A novel survey was sent via Research Electronic Data Capture to 2,500 U.S. pediatricians (50 per state), who were randomly selected from the American Academy of Pediatrics’ (AAP) member directory using a geographically stratified sampling approach. To target primary care pediatricians, those in AAP Committees, Sections, or Councils were excluded. The survey assessed 1) frequency of use of the M-CHAT-R/F within PCP practices; 2) provider’s level of comfort with interpreting and following up on results of the M-CHAT-R/F; and 3) perceived barriers and facilitators to using the M-CHAT-R/F. Results: 190 PCP providers from 49 states (PA unrepresented) responded to the survey. 96% of respondents use a version of the M-CHAT. Of these, 20% use the M-CHAT, 68% the M-CHAT-R/F and 12% were unsure which version they use. 71% of those who use the M-CHAT-R/F conduct a follow-up interview for medium-risk results and 42% for high-risk results. Of those who conduct the interview, 46% rarely or never use the validated follow-up items designed by the authors of the M-CHAT-R/F, while 15% and 39% use these items sometimes and most of the time, respectively. 95% of providers reported feeling comfortable with interpreting and following up on the results of the M-CHAT-R/F, including conducting the follow-up interview. Although 74% received prior training in the use of the MCHAT or M-CHAT-R/F, 88% reported that they would benefit from more training, with 61% preferring online courses. Time constraint (50%) and insufficient reimbursement (41%) were the most common reported barriers to using the M-CHAT-R/F. Conclusions: The M-CHAT and M-CHAT-R/F are widely used in PCP offices. Although the follow-up interview is routinely conducted for medium-risk results, the validated follow-up interview items are utilized infrequently, which may affect the reliability of these follow-up procedures. Many providers unnecessarily conduct the follow-up interview for high-risk results, and could save time by using it as indicated by the authors of the M-CHAT-R/F. Further Abstracts of Posters, Platform Sessions, and Poster Symposiums Accepted for Presentation at the 2019 Annual Meeting of the Society for Developmental and Behavioral Pediatricss of Posters, Platform Sessions, and Poster Symposiums Accepted for Presentation at the 2019 Annual Meeting of the Society for Developmental and Behavioral Pediatrics t