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Article ; Online: Altered Lateral Prefrontal Cortex Functioning During Emotional Interference Resistance Is Associated With Affect Lability in Adults With Persisting Symptoms of Attention-Deficit/Hyperactivity Disorder From Childhood.

Ojha, Amar / Jones, Neil P / Henry, Teague / Versace, Amelia / Gnagy, Elizabeth M / Joseph, Heather M / Molina, Brooke S G / Ladouceur, Cecile D

Biological psychiatry. Cognitive neuroscience and neuroimaging

2024

Abstract: Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention and/or impulsivity/hyperactivity. ADHD, especially when persisting into adulthood, often includes emotional dysregulation, ... ...

Abstract	Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention and/or impulsivity/hyperactivity. ADHD, especially when persisting into adulthood, often includes emotional dysregulation, such as affect lability; however, the neural correlates of emotionality in adults with heterogeneous ADHD symptom persistence remain unclear. Methods: The present study sought to determine shared and distinct functional neuroanatomical profiles of neural circuitry during emotional interference resistance using the emotional face n-back task in adult participants with persisting (n = 47), desisting (n = 93), or no (n = 42) childhood ADHD symptoms while undergoing functional magnetic resonance imaging. Results: Participants without any lifetime ADHD diagnosis performed significantly better (faster and more accurately) than participants with ADHD diagnoses on trials with high cognitive loads (2-back) that included task-irrelevant emotional distractors, tapping into executive functioning and emotion regulatory processes. In participants with persisting ADHD symptoms, more severe emotional symptoms were related to worse task performance. Heightened dorsolateral and ventrolateral prefrontal cortex activation was associated with more accurate and faster performance on 2-back emotional faces trials, respectively. Reduced activation was associated with greater affect lability in adults with persisting ADHD, and dorsolateral prefrontal cortex activation mediated the relationship between affect lability and task accuracy. Conclusions: These findings suggest that alterations in dorsolateral prefrontal cortex function associated with greater interference in cognitive processes from emotion could represent a marker of risk for problems with emotional dysregulation in individuals with persisting ADHD and thus represent a potential therapeutic target for those with greater emotional symptoms of ADHD.
Language	English
Publishing date	2024-02-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2879089-3
ISSN	2451-9030 ; 2451-9022
ISSN (online)	2451-9030
ISSN	2451-9022
DOI	10.1016/j.bpsc.2024.02.003
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Article ; Online: The interaction between infant negative emotionality and cognition predicts ADHD-related behaviors in toddlerhood.

Joseph, Heather M / Lorenzo, Nicole E / Wang, Frances L / Wilson, Michelle A / Molina, Brooke S G

Infant behavior & development

2022 Volume 68, Page(s) 101742

Abstract: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent disorder commonly identified in childhood. Affective and cognitive characteristics that are identifiable as early as infancy could be signals of risk for developing ADHD. Specifically, ...

Abstract	Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent disorder commonly identified in childhood. Affective and cognitive characteristics that are identifiable as early as infancy could be signals of risk for developing ADHD. Specifically, the interplay between emotionality and cognition may be important in predicting early symptoms of ADHD. This study examined the independent and interactive effects of infant negative emotionality and cognition on the development of inattention and hyperactivity/impulsivity in toddlerhood among infants at high and low familial likelihood for ADHD. Participants were 64 infants (M = 8.7, SD = 1.8) at high (n = 32) and low (n = 32) familial likelihood for ADHD, defined as at least one parent with ADHD or two parents without ADHD, respectively. Negative emotionality and cognition in infancy were assessed using the Infant Behavior Questionnaire and the Bayley's Scales of Infant and Toddler Development, and ADHD symptoms were assessed at toddler follow-up (M= 20.0, SD= 3.2) using the Child Behavior Checklist. Accounting for the quality of parent-child interaction, infants' negative emotionality (β = .033, p = .938) and cognition (β = .006, p = .884) did not independently predict toddlers' ADHD-related behaviors, but their interaction did (β = .110, p = .019). For infants with higher levels of cognition (>95th percentile), higher negative emotionality predicted more ADHD-related behaviorss. For infants with lower levels of cognition (<11th percentile), higher negative emotionality predicted fewer ADHD-related behaviors. There may be two affective-cognitive pathways to inattention and hyperactivity/impulsivity in toddlerhood. The combination of higher levels of negative emotionality and cognition may result in greater frustration when goals are blocked, resulting in the expression of dysregulated behaviors (i.e., ADHD symptoms). Alternatively, low levels of negative emotionality and cognition combined may lead to dysregulation that is primarily cognitive in nature (such as the inattention symptoms of ADHD). Investigating affective and cognitive processes simultaneously may be important for increasing understanding of the early signals of ADHD risk.
MeSH term(s)	Attention Deficit Disorder with Hyperactivity/diagnosis ; Attention Deficit Disorder with Hyperactivity/psychology ; Cognition ; Emotions ; Humans ; Infant ; Infant Behavior ; Parents
Language	English
Publishing date	2022-06-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	224510-3
ISSN	1934-8800 ; 1879-0453 ; 0163-6383
ISSN (online)	1934-8800 ; 1879-0453
ISSN	0163-6383
DOI	10.1016/j.infbeh.2022.101742
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Article ; Online: Mother-child neural synchronization is time linked to mother-child positive affective state matching.

Morgan, Judith K / Santosa, Hendrik / Conner, Kaetlyn K / Fridley, Rachel M / Forbes, Erika E / Iyengar, Satish / Joseph, Heather M / Huppert, Theodore J

Social cognitive and affective neuroscience

2023 Volume 18, Issue 1

Abstract: In the first years of life, in which self-regulation occurs via external means, mother-child synchronization of positive affect (PA) facilitates regulation of child homeostatic systems. Mother-child affective synchrony may contribute to mother-child ... ...

Abstract	In the first years of life, in which self-regulation occurs via external means, mother-child synchronization of positive affect (PA) facilitates regulation of child homeostatic systems. Mother-child affective synchrony may contribute to mother-child synchronization of neural systems, but limited research has explored this possibility. Participants were 41 healthy mother-child dyads (56% girls; Mage = 24.76 months; s.d. = 8.77 months, Range = 10-42 months). Mothers' and children's brain activities were assessed simultaneously using near-infrared spectroscopy while engaging in dyadic play. Mother and child PA during play were coded separately to characterize periods in which mothers and children (i) matched on high PA, (ii) matched on low/no PA or (iii) showed a mismatch in PA. Models evaluated moment-to-moment correlations between affective matching and neural synchrony in mother-child dyads. Greater positive affective synchrony, in which mother and child showed similarly high levels of PA but not similarly low levels of PA, was related to greater synchrony in medial and lateral frontal and temporoparietal regions. Age moderated associations between mother and child neural activities but only during moments of high PA state matching. Positive, synchronous mother-child interactions may foster greater neural responding in affective and social regions important for self-regulation and interpersonal bonds.
MeSH term(s)	Female ; Humans ; Male ; Mothers/psychology ; Emotions ; Mother-Child Relations/psychology
Language	English
Publishing date	2023-01-23
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2236933-8
ISSN	1749-5024 ; 1749-5016
ISSN (online)	1749-5024
ISSN	1749-5016
DOI	10.1093/scan/nsad001
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Article ; Online: Research Review: A systematic review and meta-analysis of infant and toddler temperament as predictors of childhood attention-deficit/hyperactivity disorder.

Joseph, Heather M / Lorenzo, Nicole E / Fisher, Nadiyah / Novick, Danielle R / Gibson, Cassandra / Rothenberger, Scott D / Foust, Jill E / Chronis-Tuscano, Andrea

Journal of child psychology and psychiatry, and allied disciplines

2023 Volume 64, Issue 5, Page(s) 715–735

Abstract: Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset as early as preschool and impairment across the lifespan. Temperament factors, specifically those that theoretically map onto ADHD symptoms, ... ...

Abstract	Background: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset as early as preschool and impairment across the lifespan. Temperament factors, specifically those that theoretically map onto ADHD symptoms, may be early markers of risk for developing later childhood ADHD that could be identifiable in infancy or toddlerhood. This meta-analysis examined the associations between these early temperamental factors and later symptoms and diagnosis of ADHD and mapped early temperament constructs onto the three ADHD symptom dimensions. Methods: A systemic review of the literature was conducted to identify prospective longitudinal studies that included theoretically relevant temperament constructs (sustained attention, activity level, inhibition, and negative emotionality) examined from birth to 36 months old and ADHD (symptoms or diagnosis) in preschool or childhood. The association between each temperament construct and ADHD outcomes was examined using pooled standardized estimates in meta-analyses. Results: Forty-eight articles (n = 112,716 infants/toddlers) prospectively examined temperament and the relation to childhood ADHD symptoms or diagnosis. Activity level (k = 18) in infancy and toddlerhood was moderately associated with childhood ADHD (r = .39, CI = 0.27, 0.51, p < .001). Moderate effect sizes were also observed for sustained attention (k = 9; r = -.28, CI = -0.42, -0.12, p < .001) and negative emotionality (k = 33; r = .25, CI = 0.16, 0.34, p < .001) with ADHD. The specificity of each temperament construct for later ADHD symptom dimensions was such that activity level and negative emotionality were predictive of all three symptom dimensions (i.e., inattention, hyperactivity/impulsivity, and combined), whereas sustained attention was only associated with combined symptoms. Conclusions: Infant and toddler temperament is an early risk factor for the development of childhood ADHD that could be utilized for early intervention identification. Yet, this systematic review found that relatively few prospective longitudinal studies have examined sustained attention (k = 9) and inhibition (k = 15) in infancy and toddlerhood in relation to later ADHD highlighting the need for further research.
MeSH term(s)	Humans ; Infant ; Child, Preschool ; Attention Deficit Disorder with Hyperactivity/epidemiology ; Attention Deficit Disorder with Hyperactivity/diagnosis ; Temperament/physiology ; Prospective Studies ; Risk Factors
Language	English
Publishing date	2023-01-04
Publishing country	England
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review ; Research Support, N.I.H., Extramural
ZDB-ID	218136-8
ISSN	1469-7610 ; 0021-9630 ; 0373-8086
ISSN (online)	1469-7610
ISSN	0021-9630 ; 0373-8086
DOI	10.1111/jcpp.13753
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Article ; Online: Maternal Parenting and Toddler Temperament: Predictors of Early School Age Attention-Deficit/Hyperactivity Disorder-Related Behaviors.

Joseph, Heather M / McKone, Kirsten M P / Molina, Brooke S G / Shaw, Daniel S

Research on child and adolescent psychopathology

2021 Volume 49, Issue 6, Page(s) 763–773

Abstract: Detection of early risk for developing childhood attention-deficit/hyperactive disorder (ADHD) symptoms, inattention and hyperactivity, may be critical for prevention and early intervention. Temperament and parenting are two promising areas of risk, ... ...

Abstract	Detection of early risk for developing childhood attention-deficit/hyperactive disorder (ADHD) symptoms, inattention and hyperactivity, may be critical for prevention and early intervention. Temperament and parenting are two promising areas of risk, representing potential targets for preventive intervention; however, studies have rarely tested these factors longitudinally using multiple methods and reporters. In a longitudinal sample of 312 low-income boys, this study tested the hypothesis that negative emotionality (NE) and effortful control (EC) in toddlerhood (1.5-3.5 years old) would predict mother- and teacher-reported ADHD-related behaviors at school age (5-7 years old). Direct effects of observed warm, supportive and harsh maternal parenting were tested in relation to ADHD-related behaviors and as moderators of associations between NE and EC and ADHD-related behaviors. Several predictions were supported: 1) Greater maternal-reported toddler NE positively predicted mother-reported ADHD behaviors; 2) Greater observed EC was associated with fewer mother- and teacher-reported ADHD-related behaviors; 3) Warm, supportive parenting predicted fewer teacher-reported ADHD-related behaviors, and harsh parenting predicted more ADHD-related behaviors as reported by parents and teachers; 4) Harsh parenting moderated the association between observed EC and mother-reported ADHD-related behaviors. Together, the findings suggest that lower child EC, lower warm/supportive parenting, and greater harsh parenting in toddlerhood independently signal increased risk for later ADHD-related behaviors; further, the association between low EC and ADHD-related behaviors was amplified in the context of high levels of harsh parenting.
MeSH term(s)	Attention Deficit Disorder with Hyperactivity/diagnosis ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Maternal Behavior ; Parenting ; Schools ; Temperament
Language	English
Publishing date	2021-02-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	3041907-4
ISSN	2730-7174 ; 2730-7166
ISSN (online)	2730-7174
ISSN	2730-7166
DOI	10.1007/s10802-021-00778-0
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Article ; Online: Parent ADHD Is Associated With Greater Parenting Distress in the First Year Postpartum.

Joseph, Heather M / Khetarpal, Susheel K / Wilson, Michelle A / Molina, Brooke S G

Journal of attention disorders

2021 Volume 26, Issue 9, Page(s) 1257–1268

Abstract: Objective: Little is known about the experience of parenting infants when a mother or father has ADHD. This study examined cross-sectional predictors of parenting distress experienced by parents with and without ADHD who also have infants.: Methods: ... ...

Abstract	Objective: Little is known about the experience of parenting infants when a mother or father has ADHD. This study examined cross-sectional predictors of parenting distress experienced by parents with and without ADHD who also have infants. Methods: Participants were 73 mother-father pairs ( Results: Parent or partner ADHD, lower parent sleep quality, fewer social supports, and less infant surgency and effortful control were associated with greater parental distress. Infant negative affect and sleep were not associated. Conclusions: Parents with ADHD and their partners experience greater parenting distress in the first year of their child's life than parents without ADHD. Addressing parent ADHD symptoms and co-occurring difficulties, including sleep disturbances, are potential targets for early interventions to maximize both parent and infant mental health outcomes.
MeSH term(s)	Attention Deficit Disorder with Hyperactivity/psychology ; Child ; Cross-Sectional Studies ; Female ; Humans ; Infant ; Parenting/psychology ; Parents/psychology ; Postpartum Period
Language	English
Publishing date	2021-12-23
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2004350-8
ISSN	1557-1246 ; 1087-0547
ISSN (online)	1557-1246
ISSN	1087-0547
DOI	10.1177/10870547211066488
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Article ; Online: Sleep patterns among preschool offspring of parents with and without psychopathology: Association with the development of psychopathology in childhood.

Levenson, Jessica C / Joseph, Heather M / Merranko, John / Hafeman, Danella M / Monk, Kelly / Goldstein, Benjamin I / Axelson, David / Sakolsky, Dara / Diler, Rasim S / Goldstein, Tina / Birmaher, Boris

Bipolar disorders

2023 Volume 26, Issue 2, Page(s) 176–185

Abstract: Background: Disturbed sleep during early childhood predicts social-emotional problems. However, it is not known how various early childhood sleep phenotypes are associated with the development of childhood psychopathology, nor whether these ... ...

Abstract	Background: Disturbed sleep during early childhood predicts social-emotional problems. However, it is not known how various early childhood sleep phenotypes are associated with the development of childhood psychopathology, nor whether these relationships vary as a function of parental psychopathology. We identified sleep phenotypes among preschool youth; examined whether these phenotypes were associated with child and parent factors; and determined if early sleep phenotypes predicted later childhood psychopathology. Methods: Using data from the Pittsburgh Bipolar Offspring study, parents with bipolar disorder (BD), non-BD psychopathology, and healthy controls reported about themselves and their offspring (n = 218) when their children were ages 2-5. Offspring and parents were interviewed directly approximately every 2 years from ages 6-18. Latent class analysis (LCA) identified latent sleep classes; we compared these classes on offspring demographics, parental sleep variables, and parental diagnoses. Kaplan-Meier survival models estimated hazard of developing any new-onset Axis-I disorders, as well as BD specifically, for each class. Results: The optimal LCA solution featured four sleep classes, which we characterized as (1) good sleep, (2) wake after sleep onset problems, (3) bedtime problems (e.g., trouble falling asleep, resists going to bed), and (4) poor sleep generally. Good sleepers tended to have significantly less parental psychopathology than the other three classes. Risk of developing new-onset Axis-I disorders was highest among the poor sleep class and lowest among the good sleep class. Conclusions: Preschool sleep phenotypes are an important predictor of the development of psychopathology. Future work is needed to understand the biopsychosocial processes underlying these trajectories.
MeSH term(s)	Child ; Adolescent ; Humans ; Child, Preschool ; Bipolar Disorder/psychology ; Child of Impaired Parents/psychology ; Parents/psychology ; Sleep ; Psychopathology
Language	English
Publishing date	2023-08-09
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	1472242-2
ISSN	1399-5618 ; 1398-5647
ISSN (online)	1399-5618
ISSN	1398-5647
DOI	10.1111/bdi.13376
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Article ; Online: Delineating early developmental pathways to ADHD: Setting an international research agenda.

Miller, Meghan / Arnett, Anne B / Shephard, Elizabeth / Charman, Tony / Gustafsson, Hanna C / Joseph, Heather M / Karalunas, Sarah / Nigg, Joel T / Polanczyk, Guilherme V / Sullivan, Elinor L / Jones, Emily J H

JCPP advances

2023 Volume 3, Issue 2, Page(s) e12144

Abstract: Background: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent, impairing, and highly heritable condition typically diagnosed in middle childhood. However, it is now recognized that symptoms emerge much earlier in development. Research ... ...

Abstract	Background: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent, impairing, and highly heritable condition typically diagnosed in middle childhood. However, it is now recognized that symptoms emerge much earlier in development. Research focused on understanding-using multiple units of analysis-the cascade of early-life (i.e., prenatal-infant-toddler) developmental changes that will later emerge as ADHD has the potential to transform early identification, prevention, and intervention. To this end, we introduce the recently established Early ADHD Consortium, an international network of investigators engaged in prospective, longitudinal studies of risk for ADHD beginning early in life, conducted within a developmental framework, and which incorporate multimethod approaches. This network seeks to harmonize measures and methodological approaches to increase the potential for data sharing and subsequent impact. Methods: This perspective paper highlights the importance of investigating pre-diagnostic markers of ADHD, and potential models and mechanisms of ADHD risk and development, with the long-term objective of facilitating development of preemptive interventions that will minimize the impact of ADHD symptoms on everyday functioning and maximize health and developmental outcomes. Results: We selectively describe key challenges and questions for this field related to theoretical models and developmental mechanisms in ADHD and recommend next steps for the science, including methodological, measurement, and study design considerations. We then describe potential implications for preemptive intervention development. We conclude by considering other issues including ethical concerns and the critical value of incorporating stakeholder input. Conclusions: It is hoped that this perspective puts forth a research agenda that will enhance collaborative efforts and accelerate progress in understanding developmental mechanisms and the early ADHD phenotype, with implications for early intervention enhancement of healthy development for infants, young children, and their families.
Language	English
Publishing date	2023-02-13
Publishing country	United States
Document type	Journal Article
ISSN	2692-9384
ISSN (online)	2692-9384
DOI	10.1002/jcv2.12144
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Article ; Online: The Influence of Smoking on Breast feeding Among Women Who Quit Smoking During Pregnancy.

Joseph, Heather M / Emery, Rebecca L / Bogen, Debra L / Levine, Michele D

Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco

2017 Volume 19, Issue 5, Page(s) 652–655

Abstract: 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!# ...

Abstract	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 women's 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.
MeSH term(s)	Adult ; Black or African American/statistics & numerical data ; Breast Feeding/statistics & numerical data ; Decision Making ; Educational Status ; Female ; Humans ; Intention ; Postpartum Period ; Pregnancy ; Recurrence ; Smoking/epidemiology ; Smoking Cessation/statistics & numerical data ; United States/epidemiology ; White People/statistics & numerical data ; Young Adult
Language	English
Publishing date	2017-03-31
Publishing country	England
Document type	Journal Article
ZDB-ID	1452315-2
ISSN	1469-994X ; 1462-2203
ISSN (online)	1469-994X
ISSN	1462-2203
DOI	10.1093/ntr/ntw254
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Article ; Online: Effects of Training on Use of Stimulant Diversion Prevention Strategies by Pediatric Primary Care Providers: Results from a Cluster-Randomized Trial.

McGuier, Elizabeth A / Kolko, David J / Pedersen, Sarah L / Kipp, Heidi L / Joseph, Heather M / Lindstrom, Rachel A / Bauer, Daniel J / Subramaniam, Geetha A / Molina, Brooke S G

Prevention science : the official journal of the Society for Prevention Research

2022 Volume 23, Issue 7, Page(s) 1299–1307

Abstract: Pediatric primary care is a promising setting for reducing diversion of stimulant medications for ADHD. We tested if training pediatric primary care providers (PCPs) increased use of diversion prevention strategies with adolescents with ADHD. The study ... ...

Abstract	Pediatric primary care is a promising setting for reducing diversion of stimulant medications for ADHD. We tested if training pediatric primary care providers (PCPs) increased use of diversion prevention strategies with adolescents with ADHD. The study was a cluster-randomized trial in 7 pediatric primary care practices. Participants were pediatric PCPs (N = 76) at participating practices. Practices were randomized to a 1-h training in stimulant diversion prevention or treatment-as-usual. At baseline, 6 months, 12 months, and 18 months, PCPs rated how often they used four categories of strategies: patient/family education, medication management/monitoring, assessment of mental health symptoms/functioning, and assessment of risky behaviors. They completed measures of attitudes, implementation climate, knowledge/skill, and resource constraints. Generalized Estimating Equations estimated differences in outcomes by condition. Mediation analyses tested if changes in knowledge/skill mediated training effects on strategy use. PCPs in the intervention condition reported significantly greater use of patient/family education strategies at all follow-up time points. There were no differences between conditions in medication management, assessment of mental health symptoms/functioning, or assessment of risky behaviors. At 6 months, PCPs in the intervention condition reported more positive attitudes toward diversion prevention, stronger implementation climate, greater knowledge/skill, and less resource constraints. Differences in knowledge/skill persisted at 12 months and 18 months. Brief training in stimulant diversion had substantial and enduring effects on PCPs' self-reported knowledge/skill and use of patient/family education strategies to prevent diversion. Training had modest effects on attitudes, implementation climate, and resource constraints and did not change use of strategies related to medication management and assessment of mental health symptoms/functioning and risky behaviors. Changes in knowledge/skill accounted for 49% of the total effect of training on use of patient/family education strategies. Trial registration This trial is registered on ClinicalTrials.gov (NCT03080259). Posted March 15, 2017.
MeSH term(s)	Adolescent ; Child ; Humans ; Mental Disorders ; Mental Health ; Primary Health Care
Language	English
Publishing date	2022-08-11
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2251270-6
ISSN	1573-6695 ; 1389-4986
ISSN (online)	1573-6695
ISSN	1389-4986
DOI	10.1007/s11121-022-01411-2
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