Heather M. Joseph

The Influence of Smoking on Breast feeding Among Women Who Quit Smoking During Pregnancy

Introduction Understanding factors related to breast-feeding intention, initiation, duration, and weaning among women who quit smoking as a result of pregnancy may inform interventions to increase breast-feeding rates among women who smoke. Methods Women (N = 300) who quit smoking as a result of pregnancy and enrolled in a postpartum relapse prevention trial were interviewed about breast-feeding intention prior to delivery. Breast-feeding initiation, duration, reasons for weaning, and relapse to smoking were assessed at 12-weeks postpartum. Results The majority of pregnant former smokers intended to breastfeed (68%), and actual rates of breast feeding were higher (74%). Among women who initiated breast feeding, weaning before 2 months was common (41%). For most women (69%), smoking had no effect on breast-feeding decisions. Among the 31% of women who reported that smoking influenced their feeding decisions, 83% indicated that they did not smoke or decreased smoking frequency in order to breastfeed while 17% did not breastfeed or quit breast feeding in order to smoke. Women who decided to forgo breast feeding to smoke were significantly more likely to have a high school education or less (p < .001) and to be African American (p < .0001) than those who had other reasons not to breastfeed. Conclusions Most women who quit smoking during pregnancy initiate breast feeding, and the majority report smoking did not influence feeding decisions. Importantly, among women for whom smoking did influence feeding decisions, most reported changing smoking behavior to enable breast feeding. Interventions to increase breast-feeding initiation and duration may decrease postpartum relapse and improve maternal and infant health. Implications This study extends the literature on womens perception of the influence of smoking on breast feeding by assessing breast-feeding intent, initiation, duration, and reasons for weaning longitudinally among women who quit smoking as a result of pregnancy. The results support a need for additional research to determine the effectiveness of breast feeding supports as a component of interventions to reduce postpartum smoking relapse.

Antisocial Alcoholism in Parents of Adolescents and Young Adults With Childhood ADHD

Objective: Test the hypothesis that alcoholism, including antisocial alcoholism, is more prevalent among mothers and fathers of children with versus without ADHD. Method: Mothers (312 ADHD group, 235 non-ADHD group) and fathers (291 ADHD group, 227 non-ADHD group) in the Pittsburgh ADHD Longitudinal Study were interviewed along with their adolescent and young adult offspring. Results: Maternal and paternal alcoholism, with and without comorbid antisociality, was more prevalent in the ADHD group. Paternal alcoholism without antisociality was only marginally higher for probands after controlling for paternal ADHD. Offspring conduct disorder comorbidity was associated with parental antisociality but not parental antisocial alcoholism. Conclusion: Our findings that 44% of proband fathers and 25% of proband mothers experienced alcohol problems with or without antisociality are further evidence of increased alcoholism prevalence in families affected by ADHD. Maternal alcoholism and antisociality are prominent contributors to this family-level vulnerability. These findings indicate the need to assess long-term offspring outcomes as a function of parental alcohol and externalizing comorbidities, and perhaps other indicators of parental alcoholism phenotype, as familial vulnerability unfolds across development.

Fathers with Childhood ADHD, Parenting, and Their Young Children’s Behavior: Offspring of the Pittsburgh ADHD Longitudinal Study (PALS)

Despite high heritability, no research has followed children with ADHD to parenthood to study their offspring and parenting behaviors. Given greater prevalence of ADHD in males and lack of research involving fathers, this study evaluated offspring of fathers with and without ADHD histories for ADHD and disruptive behavior and compared fathers’ parenting behaviors. Male fathers (N = 29) from the Pittsburgh ADHD Longitudinal Study (PALS) participated with their preschool-aged offspring. Fathers completed self-reported measures, and father-child dyads completed an interaction task. ADHD offspring had elevated ADHD symptoms and behavior dysregulation. All fathers displayed positive parenting. ADHD fathers reported lower supportive responses to their child’s negative emotions than comparison fathers, yet rated their parenting as more efficacious. ADHD offspring were distinguishable as early as age 3; thus, earlier diagnosis and intervention may be feasible for this at-risk population. Future research should investigate the acceptability and efficacy of parent training for fathers with ADHD.

Development of a women’s mental health curriculum and evolution to a Women’s Mental Health Area of Concentration in a psychiatry residency program

In 2014, the U.S. Department of Health and Human Services’ Office on Women’s Health emphasized the importance of women’s health education, particularly in the realm of behavioral health. In order to support the professional interests of psychiatry trainees, a women’s mental health study group (WMHSG) was developed and implemented. The WMHSG aimed primarily to supplement the resident curriculum and promote consideration of careers in women’s mental health. After successful implementation, the curriculum was formalized into a Women’s Mental Health Area of Concentration within the Department of Psychiatry’s residency training program. Participants found the WMHSG to be interesting, to increase knowledge and improve clinical practice, and to facilitate mentorship opportunities. The creation and evolution of a WMHSG into an Area of Concentration offers an example for enhancing training in WMH topics and principles that can be extended to other medical specialties.

3.3 FAMILIAL TRANSMISSION OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: A PILOT STUDY OF FATHERS WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER AND THEIR YOUNG CHILDREN

Objectives: The goal of this session is to assess the impact of antipsychotic tapering and discontinuation on measures of metabolic functioning and psychiatric symptom severity in severely impaired youth hospitalized in a psychiatric state hospital. Methods: The study examined psychiatric and metabolic measures in 67 hospitalized children and adolescents (mean age 12.0 years; 56 with discontinued use of antipsychotic drugs, 10 with continued use of antipsychotic drugs, and one started on an antipsychotic drug). Admission and discharge BMI, Child and Adolescent Needs and Strengths (CANS) subscale scores and laboratory values were compared using paired sample t-tests within the group of youth who experienced antipsychotic discontinuation and within the group who had antipsychotic continuation. Results: Upon admission, 56 youth were weaned off of antipsychotic medications, started on other forms of pharmacotherapy (92.9 percent were started on medications used to treat ADHD), and received routine behavioral programming; they were ultimately discharged from the hospital. The mean duration of treatment was 228 days for the discontinuation group and 204 days for the continuation group. A significant decrease in BMI (t53 1⁄4 7.12, P 1⁄4 0.0001), BMI percentile (t53 1⁄4 6.73, P 1⁄4 0.0001), and systolic blood pressure (t53 1⁄4 3.53, P 1⁄4 0.001) from admission to discharge was found in the antipsychotic discontinuation group. Changes in BMI, BMI percentile, or systolic blood pressure were not found in the group who were maintained on antipsychotic drugs. Both groups experienced a significant increase in their Global Assessment of Functioning score (t52 1⁄4 19.98, P 1⁄4 0.0001 for discontinued and t8 1⁄4 5.092, P 1⁄4 0.001 for maintained). For additional psychiatric changes across hospitalization, CANS scores significantly decreased in many subscales relevant to disruptive behaviors and mood disorders for those who were removed from the medications. For those maintained on the antipsychotic drugs, there were fewer changes in CANS scores. Conclusions: Discontinuationof antipsychoticmedications in conjunctionwith tailoring treatment to presenting diagnoses resulted in metabolic and psychiatric symptom improvement among severely impaired state hospital inpatient youth. These results serve as a demonstration that it is possible to safely discontinue antipsychotic drugs without destabilizing psychiatric symptoms. ICP PPC TREAT Supported by the Indiana Division of Mental Health and AACAP’s Summer Medical Student Fellowship http://dx.doi.org/10.1016/j.jaac.2016.09.132