These findings suggest that college students with ADHD may be at elevated risk for problematic patterns of substance use.

WHAT'S KNOWN ON THIS SUBJECT:Youths in foster care have higher rates of psychotropic use, singly and concomitantly, than do youths who are eligible for Medicaid through income or disability qualifications. However, concomitant antipsychotic use among youth in foster care has not been assessed. WHAT THIS STUDY ADDS:Compared with youths who qualify for Medicaid because of a disability or low income, youths in foster care are more likely to receive antipsychotics concomitantly and for longer periods of time despite the lack of evidence to support such regimens. abstract OBJECTIVE: Despite national concerns over high rates of antipsychotic medication use among youth in foster care, concomitant antipsychotic use has not been examined. In this study, concomitant antipsychotic use among Medicaid-enrolled youth in foster care was compared with disabled or low-income Medicaid-enrolled youth. PATIENTS AND METHODS:The sample included 16 969 youths younger than 20 years who were continuously enrolled in a Mid-Atlantic state Medicaid program and had Ն1 claim with a psychiatric diagnosis and Ն1 antipsychotic claim in 2003. Antipsychotic treatment was characterized by days of any use and concomitant use with Ն2 overlapping antipsychotics for Ͼ30 days. Medicaid program categories were foster care, disabled (Supplemental Security Income), and Temporary Assistance for Needy Families (TANF). Multicategory involvement for youths in foster care was classified as foster care/Supplemental Security Income, foster care/TANF, and foster care/adoption. We used multivariate analyses, adjusting for demographics, psychiatric comorbidities, and other psychotropic use, to assess associations between Medicaid program category and concomitant antipsychotic use. RESULTS:Average antipsychotic use ranged from 222 Ϯ 110 days in foster care to only 135 Ϯ 101 days in TANF (P Ͻ .001). Concomitant use for Ն180 days was 19% in foster care only and 24% in foster care/ adoption compared with Ͻ15% in the other categories. Conduct disorder and antidepressant or mood-stabilizer use was associated with a higher likelihood of concomitant antipsychotic use (P Ͻ .0001). CONCLUSIONS:Additional study is needed to assess the clinical rationale, safety, and outcomes of concomitant antipsychotic use and to inform statewide policies for monitoring and oversight of antipsychotic use among youths in the foster care system. Pediatrics 2011;128: e1459-e1466

Background There has been a recent growth in empirical research on assent with pediatric populations, due in part, to the demand for increased participation of this population in biomedical research. Despite methodological limitations, studies of adolescent capacities to assent have advanced and identified a number of salient psychological and social variables that are key to understanding assent. Methods The authors review a subsection of the empirical literature on adolescent assent focusing primarily on asthma and cancer therapeutic research; adolescent competencies to assent to these studies; perceptions of protocol risk and benefit; the affects of various social context variables on adolescent research participation decision making; and the inter-relatedness of these psychological and social factors. Results Contemporary studies of assent, using multivariate methods and updated approaches to statistical modeling, have revealed the importance of studying the intercorrelation between adolescents’ psychological capacities and their ability to employ these capacities in family and medical decision-making contexts. Understanding these dynamic relationships will enable researchers and ethicists to develop assent procedures that respect the authority of parents, while at the same time accord adolescents appropriate decision-making autonomy. Conclusions Reviews of empirical literature on the assent process reveal that adolescents possess varying capacities for biomedical research participation decision making depending on their maturity and the social context in which the decision is made. The relationship between adolescents and physician-investigators can be used to attenuate concerns about research protocols and clarify risk and benefit information so adolescents, in concert with their families, can make the most informed and ethical decisions. Future assent researchers will be better able to navigate the complicated interplay of contextual and developmental factors and develop the empirical bases for research enrollment protocols that will support increased involvement of adolescents in biomedical research.

This study examined the extent to which family dinnertime rituals serve a protective role for families experiencing high levels of stress. Using data from a longitudinal study of working‐class couples, the role of dinnertime rituals as a moderator of mothers' and fathers' parenting stress and child psychosocial outcomes was investigated. Greater dinnertime rituals reported by fathers moderated the effect of parenting stress on internalizing problems for girls, but not for boys. Fathers' reports of dinnertime rituals were related to fewer behavioral symptoms, internalizing problems and externalizing problems, and greater adaptive skills for girls. No significant interaction effects for mothers' parenting stress or rituals were found, but there were significant main effects of mothers' parenting stress and dinnertime rituals on child outcomes. These findings suggest that dinnertime rituals can potentially moderate the effects of parenting stress on child outcomes and fathers and daughters showed the greatest benefits of these family practices.