PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-25 (62)
 

Clipboard (0)
None

Select a Filter Below

Year of Publication
more »
1.  Heroin overdose resuscitation with naloxone: patient uses own prescribed supply to save the life of a peer 
BMJ Case Reports  2015;2015:bcr2015210391.
Opiate overdose is the primary cause of death among injection-drug users, representing a major public health concern worldwide. Opiate overdose can be reversed through timely administration of naloxone, and users have expressed willingness to carry the antidote for emergency use (take-home naloxone). In November 2014, new WHO guidelines identified that naloxone should be made available to anyone at risk of witnessing an overdose. We present the case of a 46-year-old man in opioid-maintenance treatment who used take-home naloxone to rescue an overdose victim. This is the first- ever account of a patient using dose titration of naloxone to restore respiratory function while minimising the risk of adverse effects. To improve the safety of take-home naloxone, the authors call for clinicians involved in the treatment of opiate users to: prescribe take-home naloxone to all patients; forewarn patients of potential side effects; and instruct patients in naloxone dose titration.
doi:10.1136/bcr-2015-210391
PMCID: PMC4577613  PMID: 26370638
2.  Proceedings of the 14th annual conference of INEBRIA 
Holloway, Aisha S. | Ferguson, Jennifer | Landale, Sarah | Cariola, Laura | Newbury-Birch, Dorothy | Flynn, Amy | Knight, John R. | Sherritt, Lon | Harris, Sion K. | O’Donnell, Amy J. | Kaner, Eileen | Hanratty, Barbara | Loree, Amy M. | Yonkers, Kimberly A. | Ondersma, Steven J. | Gilstead-Hayden, Kate | Martino, Steve | Adam, Angeline | Schwartz, Robert P. | Wu, Li-Tzy | Subramaniam, Geetha | Sharma, Gaurav | McNeely, Jennifer | Berman, Anne H. | Kolaas, Karoline | Petersén, Elisabeth | Bendtsen, Preben | Hedman, Erik | Linderoth, Catharina | Müssener, Ulrika | Sinadinovic, Kristina | Spak, Fredrik | Gremyr, Ida | Thurang, Anna | Mitchell, Ann M. | Finnell, Deborah | Savage, Christine L. | Mahmoud, Khadejah F. | Riordan, Benjamin C. | Conner, Tamlin S. | Flett, Jayde A. M. | Scarf, Damian | McRee, Bonnie | Vendetti, Janice | Gallucci, Karen Steinberg | Robaina, Kate | Clark, Brendan J. | Jones, Jacqueline | Reed, Kathryne D. | Hodapp, Rachel M. | Douglas, Ivor | Burnham, Ellen L. | Aagaard, Laura | Cook, Paul F. | Harris, Brett R. | Yu, Jiang | Wolff, Margaret | Rogers, Meighan | Barbosa, Carolina | Wedehase, Brendan J. | Dunlap, Laura J. | Mitchell, Shannon G. | Dusek, Kristi A. | Gryczynski, Jan | Kirk, Arethusa S. | Oros, Marla T. | Hosler, Colleen | O’Grady, Kevin E. | Brown, Barry S. | Angus, Colin | Sherborne, Sidney | Gillespie, Duncan | Meier, Petra | Brennan, Alan | de Vargas, Divane | Soares, Janaina | Castelblanco, Donna | Doran, Kelly M. | Wittman, Ian | Shelley, Donna | Rotrosen, John | Gelberg, Lillian | Edelman, E. Jennifer | Maisto, Stephen A. | Hansen, Nathan B. | Cutter, Christopher J. | Deng, Yanhong | Dziura, James | Fiellin, Lynn E. | O’Connor, Patrick G. | Bedimo, Roger | Gibert, Cynthia | Marconi, Vincent C. | Rimland, David | Rodriguez-Barradas, Maria C. | Simberkoff, Michael S. | Justice, Amy C. | Bryant, Kendall J. | Fiellin, David A. | Giles, Emma L. | Coulton, Simon | Deluca, Paolo | Drummond, Colin | Howel, Denise | McColl, Elaine | McGovern, Ruth | Scott, Stephanie | Stamp, Elaine | Sumnall, Harry | Vale, Luke | Alabani, Viviana | Atkinson, Amanda | Boniface, Sadie | Frankham, Jo | Gilvarry, Eilish | Hendrie, Nadine | Howe, Nicola | McGeechan, Grant J. | Ramsey, Amy | Stanley, Grant | Clephane, Justine | Gardiner, David | Holmes, John | Martin, Neil | Shevills, Colin | Soutar, Melanie | Chi, Felicia W. | Weisner, Constance | Ross, Thekla B. | Mertens, Jennifer | Sterling, Stacy A. | Shorter, Gillian W. | Heather, Nick | Bray, Jeremy | Cohen, Hildie A. | McPherson, Tracy L. | Adam, Cyrille | López-Pelayo, Hugo | Gual, Antoni | Segura-Garcia, Lidia | Colom, Joan | Ornelas, India J. | Doyle, Suzanne | Donovan, Dennis | Duran, Bonnie | Torres, Vanessa | Gaume, Jacques | Grazioli, Véronique | Fortini, Cristiana | Paroz, Sophie | Bertholet, Nicolas | Daeppen, Jean-Bernard | Satterfield, Jason M. | Gregorich, Steven | Alvarado, Nicholas J. | Muñoz, Ricardo | Kulieva, Gozel | Vijayaraghavan, Maya | Adam, Angéline | Cunningham, John A. | Díaz, Estela | Palacio-Vieira, Jorge | Godinho, Alexandra | Kushir, Vladyslav | O’Brien, Kimberly H. M. | Aguinaldo, Laika D. | Sellers, Christina M. | Spirito, Anthony | Chang, Grace | Blake-Lamb, Tiffany | LaFave, Lea R. Ayers | Thies, Kathleen M. | Pepin, Amy L. | Sprangers, Kara E. | Bradley, Martha | Jorgensen, Shasta | Catano, Nico A. | Murray, Adelaide R. | Schachter, Deborah | Andersen, Ronald M. | Rey, Guillermina Natera | Vahidi, Mani | Rico, Melvin W. | Baumeister, Sebastian E. | Johansson, Magnus | Sinadinovic, Christina | Hermansson, Ulric | Andreasson, Sven | O’Grady, Megan A. | Kapoor, Sandeep | Akkari, Cherine | Bernal, Camila | Pappacena, Kristen | Morley, Jeanne | Auerbach, Mark | Neighbors, Charles J. | Kwon, Nancy | Conigliaro, Joseph | Morgenstern, Jon | Magill, Molly | Apodaca, Timothy R. | Borsari, Brian | Hoadley, Ariel | Scott Tonigan, J. | Moyers, Theresa | Fitzgerald, Niamh M. | Schölin, Lisa | Barticevic, Nicolas | Zuzulich, Soledad | Poblete, Fernando | Norambuena, Pablo | Sacco, Paul | Ting, Laura | Beaulieu, Michele | Wallace, Paul George | Andrews, Matthew | Daley, Kate | Shenker, Don | Gallagher, Louise | Watson, Rod | Weaver, Tim | Bruguera, Pol | Oliveras, Clara | Gavotti, Carolina | Barrio, Pablo | Braddick, Fleur | Miquel, Laia | Suárez, Montse | Bruguera, Carla | Brown, Richard L. | Capell, Julie Whelan | Paul Moberg, D. | Maslowsky, Julie | Saunders, Laura A. | McCormack, Ryan P. | Scheidell, Joy | Gonzalez, Mirelis | Bauroth, Sabrina | Liu, Weiwei | Lindsay, Dawn L. | Lincoln, Piper | Hagle, Holly | Wallhed Finn, Sara | Hammarberg, Anders | Andréasson, Sven | King, Sarah E. | Vargo, Rachael | Kameg, Brayden N. | Acquavita, Shauna P. | Van Loon, Ruth Anne | Smith, Rachel | Brehm, Bonnie J. | Diers, Tiffiny | Kim, Karissa | Barker, Andrea | Jones, Ashley L. | Skinner, Asheley C. | Hinman, Agatha | Svikis, Dace S. | Thacker, Casey L. | Resnicow, Ken | Beatty, Jessica R. | Janisse, James | Puder, Karoline | Bakshi, Ann-Sofie | Milward, Joanna M. | Kimergard, Andreas | Garnett, Claire V. | Crane, David | Brown, Jamie | West, Robert | Michie, Susan | Rosendahl, Ingvar | Andersson, Claes | Gajecki, Mikael | Blankers, Matthijs | Donoghue, Kim | Lynch, Ellen | Maconochie, Ian | Phillips, Ceri | Pockett, Rhys | Phillips, Tom | Patton, R. | Russell, Ian | Strang, John | Stewart, Maureen T. | Quinn, Amity E. | Brolin, Mary | Evans, Brooke | Horgan, Constance M. | Liu, Junqing | McCree, Fern | Kanovsky, Doug | Oberlander, Tyler | Zhang, Huan | Hamlin, Ben | Saunders, Robert | Barton, Mary B. | Scholle, Sarah H. | Santora, Patricia | Bhatt, Chirag | Ahmed, Kazi | Hodgkin, Dominic | Gao, Wenwu | Merrick, Elizabeth L. | Drebing, Charles E. | Larson, Mary Jo | Sharma, Monica | Petry, Nancy M. | Saitz, Richard | Weisner, Constance M. | Young-Wolff, Kelly C. | Lu, Wendy Y. | Blosnich, John R. | Lehavot, Keren | Glass, Joseph E. | Williams, Emily C. | Bensley, Kara M. | Chan, Gary | Dombrowski, Julie | Fortney, John | Rubinsky, Anna D. | Lapham, Gwen T. | Forray, Ariadna | Olmstead, Todd A. | Gilstad-Hayden, Kathryn | Kershaw, Trace | Dillon, Pamela | Weaver, Michael F. | Grekin, Emily R. | Ellis, Jennifer D. | McGoron, Lucy | McGoron, Lucy
doi:10.1186/s13722-017-0087-8
PMCID: PMC5606215
3.  Randomized controlled pilot trial of naloxone-on-release to prevent post-prison opioid overdose deaths 
Addiction (Abingdon, England)  2016;112(3):502-515.
Background and aims
Naloxone is an opioid antagonist used for emergency resuscitation following opioid overdose. Prisoners with a history of heroin injection have a high risk of drug-related death soon after release from prison. The N-ALIVE pilot trial (ISRCTN34044390) tested feasibility measures for randomized provision of naloxone-on-release (NOR) to eligible prisoners in England.
Design
Parallel group randomized controlled pilot trial in 16 prisons.
Setting
English prisons.
Participants
A total of 1685 adult heroin injectors, incarcerated for at least 7 days pre-randomization, release due within 3 months and more than 6 months since previous N-ALIVE release.
Intervention
Using 1:1 minimization, prisoners were randomized to receive on-release a pack containing either a single ‘rescue’ injection of naloxone or a control pack with no syringe.
Measurements
Key feasibility outcomes were tested against prior expectations: on participation (14 English prisons; 2800 prisoners), consent (75% for randomization), returned prisoner self-questionnaires (RPSQs: 207), NOR-carriage (75% in first 4-weeks) and overdose-presence (80%).
Findings
Prisons (16) and prisoners (1685) were willing to participate (consent-rate, 95% CI: 70% to 74%); 218 RPSQs were received; NOR-carriage (95% CI: 63% to 79%) and overdose-presence (95% CI: 75% to 84%) were as expected. We randomized 842 to NOR, 843 to control during 30 months but stopped early because only one third of NOR administrations was to the ex-prisoner. Nine deaths within 12 weeks of release were registered for 1557 randomized participants released before 9 December 2014.
Conclusions
Large randomized trials are feasible with prison populations. Provision of take-home emergency naloxone prior to prison release may be a life-saving interim measure to prevent heroin overdose deaths among ex-prisoners and the wider population.
doi:10.1111/add.13668
PMCID: PMC5324705  PMID: 27776382
4.  Contingency Management interventions for non-prescribed drug use during treatment for opiate addiction: A systematic review and meta-analysis 
Drug and Alcohol Dependence  2017;178:318-339.
Highlights
•Contingency management (CM) reduces other drug use in opiate addiction treatment.•Meta-analyses did not find evidence of effectiveness for non-prescribed opiate use.•CM is effective for cocaine, tobacco, opiates + cocaine, tobacco, polysubstance use.•Evidence is lacking for long-term effects.
Background and aims
Use of non-prescribed drugs during treatment for opiate addiction reduces treatment success, creating a need for effective interventions. This review aimed to assess the efficacy of contingency management, a behavioural treatment that uses rewards to encourage desired behaviours, for treating non-prescribed drug use during opiate addiction treatment.
Methods
A systematic search of the databases Embase, PsychInfo, PsychArticles and Medline from inception to March 2015 was performed. Random effects meta-analysis tested the use of contingency management to treat the use of drugs during opiate addiction treatment, using either longest duration of abstinence (LDA) or percentage of negative samples (PNS). Random effects moderator analyses were performed for six potential moderators: drug targeted for intervention, decade in which the study was carried out, study quality, intervention duration, type of reinforcer, and form of opiate treatment.
Results
The search returned 3860 papers; 22 studies met inclusion criteria and were meta-analysed. Follow-up data was only available for three studies, so all analyses used end of treatment data. Contingency management performed significantly better than control in reducing drug use measured using LDA (d = 0.57, 95% CI: 0.42–0.72) or PNS (d = 0.41) (95% CI: 0.28–0.54). This was true for all drugs other than opiates. The only significant moderator was drug targeted (LDA: Q = 10.75, p = 0.03).
Conclusion
Contingency management appears to be efficacious for treating most drug use during treatment for opiate addiction. Further research is required to ascertain the full effects of moderating variables, and longer term effects.
doi:10.1016/j.drugalcdep.2017.05.028
PMCID: PMC5558146  PMID: 28688295
Meta-analysis; Contingency management; Opiates; Cocaine; Tobacco; Polysubstance; Reinforcement
5.  Contingency management for tobacco smoking during opioid addiction treatment: a randomised pilot study 
BMJ Open  2017;7(9):e017467.
Introduction
Smoking rates among individuals in treatment for opioid addiction are close to five times that of the general public. Moreover, drug-addicted smokers have a premature mortality rate four times greater than drug-addicted non-smokers. The aim of this pilot study was to investigate whether contingency management (CM) can be successfully added to evidence-based stop smoking treatment in individuals undergoing treatment for opioid addiction and assess preliminary evidence for its impact.
Participants
Forty tobacco smokers currently undergoing treatment for opioid addiction.
Intervention
Escalating with reset CM as an adjunct to standard smoking cessation treatment. Financial incentives will be administered over a 5-week period for either biochemically verified abstinence from smoking or attendance at the clinic. Participants will be randomised to conditions stratified on current levels of smoking (high or low).
Objectives and analyses
To assess whether a CM intervention can be successfully added to standard stop smoking services treatment, in patients undergoing outpatient treatment for opioid addiction. This will be measured as the number of people completing the 5 weeks of the intervention.
Ethics and dissemination
Ethics approval for the study was granted on the 16 June 2016 by the London—city and east (reference 16/LO/0990) ethics committee. The pilot study was retrospectively registered on clincaltrials.gov in January 2017 (ID: NCT03015597). A SPIRIT checklist and figure are available for this protocol. It is planned that the results of this study will be published in an academic journal.
doi:10.1136/bmjopen-2017-017467
PMCID: PMC5589007  PMID: 28864706
addicton; tobacco; smoking; opiates; contingency management
6.  External data required timely response by the Trial Steering-Data Monitoring Committee for the NALoxone InVEstigation (N-ALIVE) pilot trial 
The prison-based N-ALIVE pilot trial had undertaken to notify the Research Ethics Committee and participants if we had reason to believe that the N-ALIVE pilot trial would not proceed to the main trial. In this paper, we describe how external data for the third year of before/after evaluation from Scotland’s National Naloxone Programme, a related public health policy, were anticipated by eliciting prior opinion about the Scottish results in the month prior to their release as official statistics. We summarise how deliberations by the N-ALIVE Trial Steering-Data Monitoring Committee (TS-DMC) on N-ALIVE’s own interim data, together with those on naloxone-on-release (NOR) from Scotland, led to the decision to cease randomization in the N-ALIVE pilot trial and recommend to local Principal Investigators that NOR be offered to already-randomized prisoners who had not yet been released.
doi:10.1016/j.conctc.2017.01.006
PMCID: PMC5389338  PMID: 28424796
Data Monitoring Committee; randomized pilot trial; external evidence; elicitation; causality; cessation
7.  The acceptability and feasibility of a brief psychosocial intervention to reduce blood-borne virus risk behaviours among people who inject drugs: a randomised control feasibility trial of a psychosocial intervention (the PROTECT study) versus treatment as usual 
Background
While opiate substitution therapy and injecting equipment provision (IEP) have reduced blood-borne viruses (BBV) among people who inject drugs (PWID), some PWID continue to share injecting equipment and acquire BBV. Psychosocial interventions that address risk behaviours could reduce BBV transmission among PWID.
Methods
A pragmatic, two-armed randomised controlled, open feasibility study of PWID attending drug treatment or IEP in four UK regions. Ninety-nine PWID were randomly allocated to receive a three-session manualised psychosocial group intervention and BBV transmission information booklet plus treatment as usual (TAU) (n = 52) or information booklet plus TAU (n = 47). The intervention was developed from evidence-based literature, qualitative interviews with PWID, key stakeholder consultations, and expert opinion. Recruitment rates, retention in treatment, follow-up completion rates and health economic data completion measured feasibility.
Results
Fifty-six percent (99/176) of eligible PWID were recruited. More participants attended at least one intervention session in London (10/16; 63%) and North Wales (7/13; 54%) than in Glasgow (3/12; 25%) and York (0/11). Participants who attended no sessions (n = 32) compared to those attending at least one (n = 20) session were more likely to be homeless (56 vs 25%, p = 0.044), injected drugs for a greater number of days (median 25 vs 6.5, p = 0.019) and used a greater number of needles from an IEP in the last month (median 31 vs 20, p = 0.056). No adverse events were reported. 45.5% (45/99) were followed up 1 month post-intervention. Feedback forms confirmed that the intervention was acceptable to both intervention facilitators and participants who attended it. Follow-up attendance was associated with fewer days of injecting in the last month (median 14 vs 27, p = 0.030) and fewer injections of cocaine (13 vs 30%, p = 0.063). Analysis of the questionnaires identified several service use questionnaire categories that could be excluded from the assessment battery in a full-randomised controlled trial.
Conclusions
Findings should be interpreted with caution due to small sample sizes. A future definitive RCT of the psychosocial intervention is not feasible. The complex needs of some PWID may have limited their engagement in the intervention. More flexible delivery methods may have greater reach.
Trial registration
ISRCTN66453696
Electronic supplementary material
The online version of this article (doi:10.1186/s12954-017-0142-5) contains supplementary material, which is available to authorized users.
doi:10.1186/s12954-017-0142-5
PMCID: PMC5359828  PMID: 28320406
Blood-borne virus transmission; People who inject drugs; Feasibility randomised controlled trial; Psychosocial interventions; Focus group research
8.  An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence 
Addiction (Abingdon, England)  2016;111(9):1616-1627.
Abstract
Aims
To determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost‐effective use of health‐care resources.
Design
A probabilistic cost‐effectiveness analysis was conducted, using a decision‐tree to estimate the short‐term clinical and health‐care cost impact of the vaccination strategies, followed by a Markov process to evaluate the long‐term clinical consequences and costs associated with hepatitis B infection.
Settings and participants
Data on attendance to vaccination from a UK cluster randomized trial.
Intervention
Two contingency management options were examined in the trial: fixed versus escalating schedule financial incentives.
Measurement
Life‐time health‐care costs and quality‐adjusted life years discounted at 3.5% annually; incremental cost‐effectiveness ratios.
Findings
The resulting estimate for the incremental life‐time health‐care cost of the contingency management strategy versus usual care was £21.86 [95% confidence interval (CI) = –£12.20 to 39.86] per person offered the incentive. For 1000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI = 8–30). The probabilistic incremental cost per quality adjusted life‐year gained of the contingency management programme was estimated to be £6738 (95% CI = £6297–7172), with an 89% probability of being considered cost‐effective at a threshold of £20 000 per quality‐adjusted life years gained (97.60% at £30 000).
Conclusions
Using financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost‐effective use of health‐care resources in the UK as long as the incidence remains above 1.2%.
doi:10.1111/add.13385
PMCID: PMC5347913  PMID: 26990598
Contingency management; economic; incentives; injecting; methadone maintenance program; opiates; vaccination; viral hepatitis
9.  Onset Of Opportunity To Use Cannabis And Progression From Opportunity To Dependence: Are Influences Consistent Across Transitions? 
Drug and alcohol dependence  2016;160:57-64.
Background
There is a developing body of research looking at cannabis use opportunity, but little research examining timing of opportunity to use cannabis.
Aims
Identify factors associated with 1) earlier opportunity to use cannabis and 2) faster progression from opportunity to cannabis dependence.
Method
Cross-sectional study of 3824 Australian twins and siblings, measuring age of onset of cannabis use opportunity and DSM-IV cannabis dependence. Survival analysis identified factors associated with faster progression to opportunity or dependence.
Results
Factors associated with both speed of progression to opportunity and dependence were conduct disorder (opportunity HR 5.57, 95%CI 1.52–20.47; dependence HR 2.49, 95%CI 1.91–3.25), parental drug problems (opportunity HR 7.29, 95%CI 1.74–30.62; dependence HR 3.30, 95%CI 1.63–6.69), weekly tobacco use (opportunity HR 8.57, 95%CI 3.93–18.68; dependence HR 2.76, 95% CI 2.10–3.64), and female gender (opportunity HR 0.69, 95%CI 0.64–0.75; dependence HR 0.44, 95%CI 0.34–0.55). Frequent childhood religious attendance (HR 0.74, 95%CI 0.68–0.80), parental conflict (HR 1.09, 95%CI 1.00–1.18), parental alcohol problems (HR 1.19, 95%CI 1.08–1.30) and childhood sexual abuse (HR 1.17, 95%CI 1.01–1.34) were uniquely associated with transition to opportunity. Depressive episode (HR 1.44, 95%CI 1.12–1.85), tobacco dependence (HR 1.36, 95%CI 1.04 – 1.78), alcohol dependence (HR 2.64, 95%CI 1.53–4.58), other drug use (HR 2.10, 95%CI 1.64–2.69) and other drug dependence (HR 2.75, 95%CI 1.70–4.43) were uniquely associated with progression to dependence.
Conclusion
The profile of factors associated with opportunity to use cannabis and dependence only partially overlaps, suggesting targeting of interventions may benefit from being tailored to the stages of drug use.
doi:10.1016/j.drugalcdep.2015.12.032
PMCID: PMC4946162  PMID: 26811121
Cannabis; Opportunity; Dependence; Transitions; Substance Use; Survival Analysis; Risk Factors; Etiology
10.  External data required timely response by the Trial Steering-Data Monitoring Committee for the NALoxone InVEstigation (N-ALIVE) pilot trial 
The prison-based N-ALIVE pilot trial had undertaken to notify the Research Ethics Committee and participants if we had reason to believe that the N-ALIVE pilot trial would not proceed to the main trial. In this paper, we describe how external data for the third year of before/after evaluation from Scotland's National Naloxone Programme, a related public health policy, were anticipated by eliciting prior opinion about the Scottish results in the month prior to their release as official statistics. We summarise how deliberations by the N-ALIVE Trial Steering-Data Monitoring Committee (TS-DMC) on N-ALIVE's own interim data, together with those on naloxone-on-release (NOR) from Scotland, led to the decision to cease randomization in the N-ALIVE pilot trial and recommend to local Principal Investigators that NOR be offered to already-randomized prisoners who had not yet been released.
doi:10.1016/j.conctc.2017.01.006
PMCID: PMC5389338
Data Monitoring Committee; Randomized pilot trial; External evidence; Elicitation; Causality; Cessation
11.  Randomized controlled pilot trial of naloxone‐on‐release to prevent post‐prison opioid overdose deaths 
Addiction (Abingdon, England)  2016;112(3):502-515.
Abstract
Background and Aims
Naloxone is an opioid antagonist used for emergency resuscitation following opioid overdose. Prisoners with a history of heroin injection have a high risk of drug‐related death soon after release from prison. The NALoxone InVEstigation (N‐ALIVE) pilot trial (ISRCTN34044390) tested feasibility measures for randomized provision of naloxone‐on‐release (NOR) to eligible prisoners in England.
Design.
Parallel‐group randomized controlled pilot trial.
Setting
English prisons.
Participants
A total of 1685 adult heroin injectors, incarcerated for at least 7 days pre‐randomization, release due within 3 months and more than 6 months since previous N‐ALIVE release.
Intervention
Using 1 : 1 minimization, prisoners were randomized to receive on release a pack containing either a single ‘rescue’ injection of naloxone or a control pack with no syringe.
Measurements
Key feasibility outcomes were tested against prior expectations: on participation (14 English prisons; 2800 prisoners), consent (75% for randomization), returned prisoner self‐questionnaires (RPSQs: 207), NOR‐carriage (75% in first 4 weeks) and overdose presence (80%).
Findings
Prisons (16) and prisoners (1685) were willing to participate [consent rate, 95% confidence interval (CI) = 70–74%]; 218 RPSQs were received; NOR‐carriage (95% CI = 63–79%) and overdose presence (95% CI = 75–84%) were as expected. We randomized 842 to NOR and 843 to control during 30 months but stopped early, because only one‐third of NOR administrations were to the ex‐prisoner. Nine deaths within 12 weeks of release were registered for 1557 randomized participants released before 9 December 2014.
Conclusions
Large randomized trials are feasible with prison populations. Provision of take‐home emergency naloxone prior to prison release may be a life‐saving interim measure to prevent heroin overdose deaths among ex‐prisoners and the wider population.
doi:10.1111/add.13668
PMCID: PMC5324705  PMID: 27776382
Fatality; naloxone; opioid‐overdose; post‐release; prevention; prisoners; randomization; trial
12.  Longitudinal Examination of Adaptive Behavior in Autism Spectrum Disorders: Influence of Executive Function 
This study characterizes longitudinal change in adaptive behavior in 64 children and adolescents with autism spectrum disorder (ASD) without intellectual disability (ID) evaluated on multiple occasions, and examines whether prior estimate of executive function (EF) problems predicts future adaptive behavior scores. Compared to standardized estimates for their developmental stage, adaptive behavior in most participants was impaired and did not improve over time. Prior EF predicted later adaptive behavior in daily living skills and socialization domains after controlling for age and IQ. Self-monitoring behaviors robustly predicted later adaptive behavior in all domains (d = 0.60-0.94). Results support targeting treatment of adaptive skills in ASD, as well as the importance of assessing for EF problems that may contribute to adaptive behavior difficulties.
doi:10.1007/s10803-015-2584-5
PMCID: PMC4726475  PMID: 26349921
autism spectrum disorder; adaptive behavior; executive function; cognitive ability; longitudinal
13.  A randomised controlled trial of the clinical and cost-effectiveness of a contingency management intervention compared to treatment as usual for reduction of cannabis use and of relapse in early psychosis (CIRCLE): a study protocol for a randomised controlled trial 
Trials  2016;17:515.
Background
Around 35–45 % of people in contact with services for a first episode of psychosis are using cannabis. Cannabis use is associated with delays in remission, poorer clinical outcomes, significant increases in the risk of relapse, and lower engagement in work or education. While there is a clear need for effective interventions, so far only very limited benefits have been achieved from psychological interventions. Contingency management (CM) is a behavioural intervention in which specified desired behavioural change is reinforced through financial rewards. CM is now recognised to have a substantial evidence base in some contexts and its adoption in the UK is advocated by the National Institute for Health and Care Excellence (NICE) guidance as a treatment for substance or alcohol misuse. However, there is currently little published data testing its effectiveness for reducing cannabis use in early psychosis.
Methods
CIRCLE is a two-arm, rater-blinded randomised controlled trial (RCT) investigating the clinical and cost-effectiveness of a CM intervention for reducing cannabis use among young people receiving treatment from UK Early Intervention in Psychosis (EIP) services. EIP service users (n = 544) with a recent history of cannabis use will be recruited. The experimental group will receive 12 once-weekly CM sessions, and a voucher reward if urinalysis shows that they have not used cannabis in the previous week. Both the experimental and the control groups will be offered an Optimised Treatment as Usual (OTAU) psychoeducational package targeting cannabis use. Assessment interviews will be performed at consent, at 3 months, and at 18 months. The primary outcome is time to relapse, defined as admission to an acute mental health service. Secondary outcomes include proportion of cannabis-free urine samples during the intervention period, severity of positive psychotic symptoms, quality-adjusted life years, and engagement in work or education.
Discussion
CIRCLE is a RCT of CM for cannabis use in young people with a recent history of psychosis (EIP service users) and recent cannabis use. It is designed to investigate whether the intervention is a clinically and cost-effective treatment for cannabis use. It is intended to inform future treatment delivery, particularly in EIP settings.
Trial registration
ISRCTN33576045: doi 10.1186/ISRCTN33576045, registered on 28 November 2011.
doi:10.1186/s13063-016-1620-x
PMCID: PMC5075422  PMID: 27770820
Financial incentives; Contingency management; Cannabis; Psychosis; Early intervention; Substance misuse
14.  Are take‐home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria 
Addiction (Abingdon, England)  2016;111(7):1177-1187.
Abstract
Background and Aims
Fatal outcome of opioid overdose, once detected, is preventable through timely administration of the antidote naloxone. Take‐home naloxone provision directly to opioid users for emergency use has been implemented recently in more than 15 countries worldwide, albeit mainly as pilot schemes and without formal evaluation. This systematic review assesses the effectiveness of take‐home naloxone, with two specific aims: (1) to study the impact of take‐home naloxone distribution on overdose‐related mortality; and (2) to assess the safety of take‐home naloxone in terms of adverse events.
Methods
PubMed, MEDLINE and PsychINFO were searched for English‐language peer‐reviewed publications (randomized or observational trials) using the Boolean search query: (opioid OR opiate) AND overdose AND prevention. Evidence was evaluated using the nine Bradford Hill criteria for causation, devised to assess a potential causal relationship between public health interventions and clinical outcomes when only observational data are available.
Results
A total of 1397 records (1164 after removal of duplicates) were retrieved, with 22 observational studies meeting eligibility criteria. Due to variability in size and quality of the included studies, meta‐analysis was dismissed in favour of narrative synthesis. From eligible studies, we found take‐home naloxone met all nine Bradford Hill criteria. The additional five World Health Organization criteria were all either met partially (two) or fully (three). Even with take‐home naloxone administration, fatal outcome was reported in one in 123 overdose cases (0.8%; 95% confidence interval = 0.4, 1.2).
Conclusions
Take‐home naloxone programmes are found to reduce overdose mortality among programme participants and in the community and have a low rate of adverse events.
doi:10.1111/add.13326
PMCID: PMC5071734  PMID: 27028542
Bradford Hill; death; heroin; naloxone; opiate; opioid; overdose; prevention
15.  Neural correlates of set-shifting in children with autism 
Autism spectrum disorder (ASD) is often associated with high levels of inflexible thinking and rigid behavior. The neural correlates of these behaviors have been investigated in adults and older adolescents, but not children. Prior studies utilized set-shifting tasks that engaged multiple levels of shifting, and depended on learning abstract rules and establishing a strong prepotent bias. These additional demands complicate simple interpretations of the results. We used functional magnetic resonance imaging (fMRI) to investigate the neural correlates of set-shifting in 20 children (ages 7-14) with ASD and 19 typically developing, matched, control children. Participants completed a set-shifting task that minimized non-shifting task demands through the use of concrete instructions that provide spatial mapping of stimuli-responses. The shift/stay sets were given an equal number of trials to limit the prepotent bias. Both groups showed an equivalent ‘switch cost’, responding less accurately and slower to Switch stimuli than Stay stimuli, although the ASD group was less accurate overall. Both groups showed activation in prefrontal, striatal, parietal, and cerebellum regions known to govern effective set-shifts. Compared to controls, children with ASD demonstrated decreased activation of the right middle temporal gyrus across all trials, but increased activation in the mid-dorsal cingulate cortex/superior frontal gyrus, left middle frontal and right inferior frontal gyri during the Switch vs. Stay contrast. The successful behavioral switching performance of children with ASD comes at the cost of requiring greater engagement of frontal regions, suggesting less efficiency at this lowest level of shifting.
doi:10.1002/aur.1454
PMCID: PMC4508240  PMID: 25599972
autism; cognitive control; set-shifting; fMRI; cingulate; prefrontal cortex
16.  The association between speed of transition from initiation to subsequent use of cannabis and later problematic cannabis use, abuse and dependence 
Addiction (Abingdon, England)  2015;110(8):1311-1320.
Aims
To test whether speed of transition from first use to subsequent use of cannabis is associated with likelihood of later cannabis dependence and other outcomes, and whether transition speed is attributable to genetic or environmental factors.
Design
Cross-sectional interview study
Setting
Australia
Participants
2239 twins and siblings who reported using cannabis at least twice (mean age at time of survey = 32.0, 95% CI 31.9–32.1, range 22–45).
Measurements
Time between first and subsequent cannabis use (within 1 week; within 3 months; between 3 months–12 months; more than 1 year later), later use of cannabis and symptoms of DSM-IV cannabis abuse/dependence. Multinomial regression analyses (comparison group: more than 1 year later) adjusted the association between speed of transition and the outcomes of cannabis daily use, abuse/dependence, and treatment-seeking after controlling for socio-demographic, childhood, mental health, peer and licit drug factors. Twin modelling estimated the proportion of variance in transition speed attributable to genetic (A), common environment (C) and unique environmental (E) factors.
Findings
Subsequent use of cannabis within one week of first use was associated with daily use (OR 2.64, 95% CI 1.75–3.99), abuse and/or dependence (OR 3.25, 95%CI 2.31–4.56) and treatment-seeking for cannabis problems (OR 1.89, 95%CI 1.03–3.46). Subsequent use within 3 months was associated with abuse and/or dependence (OR 1.61, 95%CI 1.18–2.19). The majority of the variation of the speed of transition was accounted for by unique environment factors (0.75).
Conclusions
Rapid transition from initiation to subsequent use of cannabis is associated with increased likelihood of subsequent daily cannabis use and abuse/dependence.
doi:10.1111/add.12963
PMCID: PMC4509683  PMID: 25917230
17.  DEVELOPMENT AND VALIDATION OF ‘SURE’: A PATIENT REPORTED OUTCOME MEASURE (PROM) FOR RECOVERY FROM DRUG AND ALCOHOL DEPENDENCE 
Drug and Alcohol Dependence  2016;165:159-167.
Highlights
•‘SURE’ is a new patient reported outcome measure of recovery from drug and alcohol dependence.•‘SURE’ has been developed with significant input from people in recovery.•‘SURE’ has good face and content validity, acceptability and usability for people in recovery.•SURE’ comprises 21 items (5 factors) and is psychometrically valid, quick and easy-to-complete.•‘SURE’ can be used by individuals in private or in a therapeutic context
BACKGROUND
Patient Reported Outcome Measures (PROMs) assess health status and health-related quality of life from the patient/service user perspective. Our study aimed to: i. develop a PROM for recovery from drug and alcohol dependence that has good face and content validity, acceptability and usability for people in recovery; ii. evaluate the psychometric properties and factorial structure of the new PROM (‘SURE’).
METHODS
Item development included Delphi groups, focus groups, and service user feedback on draft versions of the new measure. A 30-item beta version was completed by 575 service users (461 in person [IP] and 114 online [OL]). Analyses comprised rating scale evaluation, assessment of psychometric properties, factorial structure, and differential item functioning.
RESULTS
The beta measure had good face and content validity. Nine items were removed due to low stability, low factor loading, low construct validity or high complexity. The remaining 21 items were re-scaled (Rasch model analyses). Exploratory and confirmatory factor analyses revealed 5 factors: substance use, material resources, outlook on life, self-care, and relationships. The MIMIC model indicated 95% metric invariance across the IP and OL samples, and 100% metric invariance for gender. Internal consistency and test-retest reliability were granted. The 5 factors correlated positively with the corresponding WHOQOL-BREF and ARC subscales and score differences between participant sub-groups confirmed discriminative validity.
CONCLUSION
‘SURE’ is a psychometrically valid, quick and easy-to-complete outcome measure, developed with unprecedented input from people in recovery. It can be used alongside, or instead of, existing outcome tools.
doi:10.1016/j.drugalcdep.2016.06.006
PMCID: PMC4946826  PMID: 27344196
Patient Reported Outcome Measure (PROM); addiction recovery; addiction service users; qualitative methods; psychometrics
18.  Identifying mortality risks in patients with opioid use disorder using brief screening assessment: Secondary mental health clinical records analysis 
Drug and Alcohol Dependence  2016;164:82-88.
Highlights
•Prompt identification of those at risk is key.•We examine clinical appraisal of patient risks and mortality in 4488 opioid dependent patients.•Addiction-specific risk assessment is useful in predicting mortality.•Non-admission of patients where suicidality is evident increases mortality.
Background
Risk assessments are widely used, but their ability to predict outcomes in opioid use disorder (OUD) treatment remains unclear. Therefore, the aim was to investigate if addiction-specific brief risk screening is effective in identifying high mortality risk groups and if subsequent clinical actions following risk assessment impacts on mortality levels.
Methods
Opioid use disorder (OUD) patients were identified in the South London and Maudsley Case Register. Deaths were identified through database linkage to the national mortality dataset. Cox and competing-risk regression were used to model associations between brief risk assessment domains and all-cause and overdose mortality in 4488 OUD patients, with up-to 6-year follow-up time where 227 deaths were registered. Data were stratified by admission to general mental health services.
Results
All-cause mortality was significantly associated with unsafe injecting (HR 1.53, 95% CI 1.10–2.11) and clinically appraised likelihood of accidental overdose (HR 1.48, 95% CI 1.00–2.19). Overdose-mortality was significantly associated with unsafe injecting (SHR 2.52, 95% CI 1.11–5.70) and clinically appraised suicidality (SHR 2.89, 95% CI 1.38–6.03). Suicidality was associated with a twofold increase in mortality risk among OUD patients who were not admitted to mental health services within 2 months of their risk assessment (HR 2.03, 95% CI 1.67–3.24).
Conclusions
Diagnosis-specific brief risk screening can identify OUD patient subgroups at increased risk of all-cause and overdose mortality. OUD patients, where suicidality is evident, who are not admitted into services are particularly vulnerable.
doi:10.1016/j.drugalcdep.2016.04.036
PMCID: PMC4907127  PMID: 27179824
Opioids; Heroin; Treatment; Mortality; Risk assessment; Suicide; Overdose; Injecting
19.  Increasing Adaptive Behavior Skill Deficits From Childhood to Adolescence in Autism Spectrum Disorder: Role of Executive Function 
Almost half of all children with autism spectrum disorder have average cognitive abilities, yet outcome remains poor. Because outcome in HFASD is more related to adaptive behavior skills than cognitive level it is important to identify predictors of adaptive behavior. This study examines cognitive and demographic factors related to adaptive behavior, with specific attention to the role of executive function (EF) in youth with HFASD aged 4–23. There was a negative relationship between age and adaptive behavior and the discrepancy between IQ and adaptive behavior increased with age. EF problems contributed to lower adaptive behavior scores across domains. As such, it is important to target adaptive skills, and the EF problems that may contribute to them, in youth with HFASD.
doi:10.1007/s10803-014-2309-1
PMCID: PMC4433442  PMID: 25398602
autism spectrum disorder; adaptive behavior; executive function; cognitive ability
20.  Understanding Heroin Overdose: A Study of the Acute Respiratory Depressant Effects of Injected Pharmaceutical Heroin 
PLoS ONE  2015;10(10):e0140995.
Opioids are respiratory depressants and heroin/opioid overdose is a major contributor to the excess mortality of heroin addicts. The individual and situational variability of respiratory depression caused by intravenous heroin is poorly understood. This study used advanced respiratory monitoring to follow the time course and severity of acute opioid-induced respiratory depression. 10 patients (9/10 with chronic airflow obstruction) undergoing supervised injectable opioid treatment for heroin addiction received their usual prescribed dose of injectable opioid (diamorphine or methadone) (IOT), and their usual prescribed dose of oral opioid (methadone or sustained release oral morphine) after 30 minutes. The main outcome measures were pulse oximetry (SpO2%), end-tidal CO2% (ETCO2%) and neural respiratory drive (NRD) (quantified using parasternal intercostal muscle electromyography). Significant respiratory depression was defined as absence of inspiratory airflow >10s, SpO2% < 90% for >10s and ETCO2% per breath >6.5%. Increases in ETCO2% indicated significant respiratory depression following IOT in 8/10 patients at 30 minutes. In contrast, SpO2% indicated significant respiratory depression in only 4/10 patients, with small absolute changes in SpO2% at 30 minutes. A decline in NRD from baseline to 30 minutes post IOT was also observed, but was not statistically significant. Baseline NRD and opioid-induced drop in SpO2% were inversely related. We conclude that significant acute respiratory depression is commonly induced by opioid drugs prescribed to treat opioid addiction. Hypoventilation is reliably detected by capnography, but not by SpO2% alone. Chronic suppression of NRD in the presence of underlying lung disease may be a risk factor for acute opioid-induced respiratory depression.
doi:10.1371/journal.pone.0140995
PMCID: PMC4619694  PMID: 26495843
21.  Default mode network segregation and social deficits in autism spectrum disorder: Evidence from non-medicated children 
NeuroImage : Clinical  2015;9:223-232.
Functional pathology of the default mode network is posited to be central to social-cognitive impairment in autism spectrum disorders (ASD). Altered functional connectivity of the default mode network's midline core may be a potential endophenotype for social deficits in ASD. Generalizability from prior studies is limited by inclusion of medicated participants and by methods favoring restricted examination of network function. This study measured resting-state functional connectivity in 22 8–13 year-old non-medicated children with ASD and 22 typically developing controls using seed-based and network segregation functional connectivity methods. Relative to controls the ASD group showed both under- and over-functional connectivity within default mode and non-default mode regions, respectively. ASD symptoms correlated negatively with the connection strength of the default mode midline core—medial prefrontal cortex–posterior cingulate cortex. Network segregation analysis with the participation coefficient showed a higher area under the curve for the ASD group. Our findings demonstrate that the default mode network in ASD shows a pattern of poor segregation with both functional connectivity metrics. This study confirms the potential for the functional connection of the midline core as an endophenotype for social deficits. Poor segregation of the default mode network is consistent with an excitation/inhibition imbalance model of ASD.
Highlights
•The DMN is a potential endophenotype for social deficits in ASD.•This study used resting state functional MRI to probe the default mode network.•MPFC–PCC connection was reduced in strength in ASD and correlated with ASD severity.•Graph theory analysis showed that DMN had greater cross-network connectivity in ASD.•Findings support DMN as an ASD endophenotype and align with a GABA theory of ASD.
doi:10.1016/j.nicl.2015.07.018
PMCID: PMC4573091  PMID: 26484047
Default mode network; Autism spectrum disorders; Functional connectivity; Resting state
22.  Randomized Controlled Effectiveness Trial of Executive Function Invention for Children on the Autism Spectrum 
Background
Unstuck and On Target (UOT) is an executive function (EF) intervention for children with autism spectrum disorders (ASD) targeting insistence on sameness, flexibility, goal-setting and planning through a cognitive-behavioral program of self-regulatory scripts, guided/faded practice, and visual/verbal cueing. UOT is contextually-based because it is implemented in school and at home, the contexts in which a child uses EF skills.
Methods
To evaluate the effectiveness of UOT as compared to a social skills intervention (SS), 3rd-5th graders with ASD (mean IQ=108; UOT n=47; SS n=20) received interventions delivered by school staff in small group sessions. Students were matched for sex, age, race, intelligence, ASD symptomotolgy, medication status, and parent education. Interventions were matched for “dose” of intervention and training. Measures of pre-post change included classroom observations, parent/teacher report and direct child measures of problem-solving, EF, and social skills. Schools were randomized and evaluators, but not parents or teachers, were blind to intervention type.
Results
Interventions were administered with high fidelity. Children in both groups improved with intervention, but mean change scores from pre- to post-intervention indicated significantly greater improvements for UOT than SS groups in: problem-solving, flexibility, and planning/organizing. Also, classroom observations revealed that participants in UOT made greater improvements than SS participants in their ability to follow rules, make transitions, and be flexible. Children in both groups made equivalent improvements in social skills.
Conclusions
These data support the effectiveness of the first contextually-based EF intervention for children with ASD. UOT improved classroom behavior, flexibility and problem-solving in children with ASD. Individuals with variable background/training in ASD successfully implemented UOT in mainstream educational settings.
doi:10.1111/jcpp.12161
PMCID: PMC4532389  PMID: 24256459
autism; executive function; flexibility; intervention; CBT
23.  Take-home naloxone to prevent fatalities from opiate-overdose: Protocol for Scotland's public health policy evaluation, and a new measure to assess impact 
Drugs (Abingdon, England)  2014;22(1):66-76.
Aims: Scotland was the first country to adopt take-home naloxone (THN) as a funded public health policy. We summarise the background and rigorous set-up for before/after monitoring to assess the impact on high-risk opiate-fatalities. Methods: Evidence-synthesis of prospectively monitored small-scale THN schemes led to a performance indicator for distribution of THN-kits relative to opiate-related deaths. Next, we explain the primary outcome and statistical power for Scotland's before/after monitoring. Results: Fatality-rate at opiate overdoses witnessed by THN-trainees was 6% (9/153, 95% CI: 2–11%). National THN-schemes should aim to issue 20 times as many THN-kits as there are opiate-related deaths per annum; and at least nine times as many. Primary outcome for evaluating Scotland's THN policy is reduction in the percentage of all opiate-related deaths with prison-release as a 4-week antecedent. Scotland's baseline period is 2006–10, giving a denominator of 1970 opiate-related deaths. A priori plausible effectiveness was 20–30% reduction, relative to baseline, in the proportion of opiate-related deaths that had prison-release as a 4-week antecedent. A secondary outcome was also defined. Conclusion: If Scotland's THN evaluation shifts the policy ground seismically, our new performance measure may prove useful on how many THN-kits nations should provide annually.
doi:10.3109/09687637.2014.981509
PMCID: PMC4438351  PMID: 26045638
Effectiveness; overdose deaths; performance measure; prevention; public policy; Scotland; take-home naloxone
24.  Linked randomised controlled trials of face-to-face and electronic brief intervention methods to prevent alcohol related harm in young people aged 14–17 years presenting to Emergency Departments (SIPS junior) 
BMC Public Health  2015;15:345.
Background
Alcohol is a major global threat to public health. Although the main burden of chronic alcohol-related disease is in adults, its foundations often lie in adolescence. Alcohol consumption and related harm increase steeply from the age of 12 until 20 years. Several trials focusing upon young people have reported significant positive effects of brief interventions on a range of alcohol consumption outcomes. A recent review of reviews also suggests that electronic brief interventions (eBIs) using internet and smartphone technologies may markedly reduce alcohol consumption compared with minimal or no intervention controls.
Interventions that target non-drinking youth are known to delay the onset of drinking behaviours. Web based alcohol interventions for adolescents also demonstrate significantly greater reductions in consumption and harm among ‘high-risk’ drinkers; however changes in risk status at follow-up for non-drinkers or low-risk drinkers have not been assessed in controlled trials of brief alcohol interventions.
Design and methods
The study design comprises two linked randomised controlled trials to evaluate the effectiveness and cost-effectiveness of two intervention strategies compared with screening alone. One trial will focus on high-risk adolescent drinkers attending Emergency Departments (Eds) and the other will focus on those identified as low-risk drinkers or abstinent from alcohol but attending the same ED.
Our primary (null) hypothesis is similar for both trials: Personalised Feedback and Brief Advice (PFBA) and Personalised Feedback plus electronic Brief Intervention (eBI) are no more effective than screening alone in alcohol consumed at 12 months after randomisation as measured by the Time-Line Follow-Back 28-day version. Our secondary (null) hypothesis relating to economics states that PFBA and eBI are no more cost-effective than screening alone.
In total 1,500 participants will be recruited into the trials, 750 high-risk drinkers and 750 low-risk drinkers or abstainers. Participants will be randomised with equal probability, stratified by centre, to either a screening only control group or one of the two interventions: single session of PFBA or eBI. All participants will be eligible to receive treatment as usual in addition to any trial intervention. Individual participants will be followed up at 6 and 12 months after randomisation.
Discussion
The protocol represents an ambitious innovative programme of work addressing alcohol use in the adolescent population.
Trial registration
ISRCTN45300218. Registered 5th July 2014.
doi:10.1186/s12889-015-1679-4
PMCID: PMC4394590  PMID: 25886178
Adolescents; SBI; eBI; Emergency Department
25.  Separate components of Emotional Go/No-Go performance relate to autism versus attention symptoms in children with autism 
Neuropsychology  2013;27(5):537-545.
Objective
The present investigation examined whether higher-functioning children with autism would demonstrate impaired response inhibition performance in an emotional Go/No-Go task, and whether severity of ADHD or autism symptoms correlated with performance.
Method
Forty-four children (21 meeting criteria for autism; 23 typically developing controls (TDC)) completed an emotional Go/No-Go task where an emotional facial expression (angry, fearful, happy, or sad) was the Go stimulus and a neutral facial expression was the No-Go stimulus, and vice versa.
Results
The autism group was faster than the TDC group on all emotional Go trials. Moreover, the children in the autism group who had the fastest RTs on emotional Go trials were rated as having the greatest number of symptoms (ADOS Social+Communication score); even after accounting for the association with ADHD symptoms. The autism group also made more impulsive responses (i.e., lower d′, more false alarms) than the TDC group on all No-Go trials. As d′ decreased or false alarms increased so did ADHD symptoms. Hyperactivity/Impulsivity symptoms were significantly correlated with false alarms, but Inattention symptoms were not. There was not a significant relationship between No-Go false alarms and autism symptoms, and even after partialling out associations with autism symptoms the significant correlation between ADHD symptoms and No-Go false alarms remained. Conclusions: The present findings support a comorbidity model that argues for shared and independent risk factors, because ADHD and autism symptoms related to independent aspects of emotional Go/No-Go performance.
doi:10.1037/a0033615
PMCID: PMC4374985  PMID: 23937480
Autism; Attention Deficit Hyperactivity Disorder; cognitive control; response inhibition; emotion

Results 1-25 (62)