Literature Collection

This study investigated the therapeutic effectiveness of the Berard Auditory Integration Training (AIT) protocol, a neurosensory intervention believed to address underlying auditory processing deficits that often contribute to the high comorbidity of learning disabilities (LD) and attention-deficit/hyperactivity disorder (ADHD), for treating children diagnosed with both conditions. A prospective, single-arm interventional study was conducted using a standardized 10-day AIT program with the Earducator device on ten pediatric participants with dual diagnoses. Measurements were taken at baseline, mid-intervention, post-intervention, and a 15-day follow-up using a validated behavioral observation checklist and an academic skills assessment. Quantitative analysis demonstrated marked improvements across all domains, with hyperactivity and attention-deficit scores significantly decreasing from severe to mild-moderate levels, and academic skills such as letter recognition and language showing consistent improvement. Furthermore, qualitative parental reports corroborated these findings, noting improvements in social interaction, reduced auditory sensitivity, and better adaptive behaviors. The findings provide preliminary evidence that AIT serves as an effective adjunctive therapy for reducing core ADHD symptoms and fostering academic and behavioral gains in children with LD, thus justifying the need for larger, randomized controlled trials.

OBJECTIVE: To determine the accuracy of the Parent's Observation of Social Interactions (POSI) when deployed for universal autism screening within a large healthcare network. STUDY DESIGN: Retrospective analysis of electronic health record data from children screened for autism spectrum disorder (ASD) using POSI at the 18- and 24- month pediatric well-child care (WCC) visits across Southern California Permanente Medical Group facilities throughout the 2022 calendar year. Data on ASD diagnoses placed in the electronic health record problem list were analyzed 1 year later (until the end of 2023) to calculate sensitivity, specificity, and positive/negative likelihood ratio (LR+ and LR-) values. RESULTS: At the 18-month WCC, 8014 of 30 375 children (26.4%) had elevated POSI scores of ≥3 (positive screen), and the sensitivity and specificity were 77.9% and 76.1%, respectively. At the 24-month WCC, 5988 children of 27 975 (21.4%) had positive POSI screens, and the sensitivity and specificity were 76.5% and 81.4%, respectively. The LR+ was 3.3 at 18 months and 4.2 at 24 months. The LR- was 0.29 at both the 18- and 24-month time points. CONCLUSIONS: The POSI screen for ASD had adequate sensitivity and specificity (both >76%) when systematically deployed in a primary care setting at 18- and 24-month WCC visits. Children diagnosed with ASD were 3.3 and 4.2 times more likely to have screened positive at 18 and 24 months, compared with children who were not diagnosed with ASD. Conversely, children not diagnosed with ASD were 3.4 times more likely to have screened negative than children with ASD at 18 and 24 months.

Despite high mortality rates due to opioid overdose and excessive alcohol consumption, medications for the treatment of alcohol and opioid use disorder have not been widely used in the USA. This paper provides an overview of the literature on the availability of alcohol and opioid used disorder medications in the specialty substance use disorder treatment system, other treatment settings and systems, and among providers with a federal waiver to prescribe buprenorphine. We also present the most current data on the availability of alcohol and opioid use disorder medications in the USA. These estimates show steady growth in availability of opioid use disorder medications over the past decade and a decline in availability of alcohol use disorder medications. However, overall use of medications in the USA remains low. In 2017, only 16.3% of specialty treatment programs offered any single medication for alcohol use disorder treatment and 35.5% offered any single medication for opioid use disorder treatment. Availability of buprenorphine-waivered providers has increased significantly since 2002. However, geographic disparities in access to buprenorphine remain. Some of the most promising strategies to increase availability of alcohol and opioid use disorder medications include the following: incorporating substance use disorder training in healthcare education programs, educating the substance use disorder workforce about the benefits of medication treatment, reducing stigma surrounding the use of medications, implementing medications in primary care settings, implementing integrated care models, revising regulations on methadone and buprenorphine, improving health insurance coverage of medications, and developing novel medications for the treatment of substance use disorder.

IMPORTANCE: Thousands of pregnant people with opioid use disorder (OUD) enter US jails annually, yet their access to medications for OUD (MOUD) that meet the standard of care (methadone and/or buprenorphine) is unknown. OBJECTIVE: To assess the availability of MOUD for the treatment of pregnant individuals with OUD in US jails. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, electronic and paper surveys were sent to all 2885 identifiable US jails verified in the National Jails Compendium between August 19 and November 7, 2019. Respondents were medical and custody leaders within the jails. MAIN OUTCOMES AND MEASURES: The primary outcome was the availability of MOUD (methadone and/or buprenorphine) for the treatment of pregnant people with OUD in US jails. Availability of MOUD was assessed based on (1) continuation of MOUD for pregnant incarcerated individuals (if the individual was receiving MOUD before incarceration), with or without initiation of MOUD; (2) both initiation and continuation of MOUD for pregnant individuals; (3) only continuation of MOUD for pregnant individuals; and (4) management of opioid withdrawal for pregnant individuals. Secondary outcomes included MOUD availability during the postpartum period and logistical factors associated with the provision of MOUD. Multivariate logistic regression analysis was used to assess factors associated with MOUD availability during pregnancy. RESULTS: Among 2885 total surveys sent, 1139 (39.5%) were returned; of those, 836 surveys (73.4%; 29.0% of all surveys sent) could be analyzed, with similar proportions from metropolitan (399 jails [47.7%]) and rural (381 jails [45.6%]) settings. Overall, 504 jails (60.3%) reported that MOUD was available for medication continuation, with or without medication initiation, during pregnancy. Of those, 267 jails (53.0%; 31.9% of surveys included in the analysis) both initiated and continued MOUD, and 237 jails (47.0%; 28.3% of surveys included in the analysis) only continued MOUD; 190 of 577 jails (32.9%; 22.7% of surveys included in the analysis) reported opioid withdrawal as the only management for pregnant people with OUD. Among the 504 medication-providing jails, only 120 (23.8%) continued to provide MOUD during the postpartum period. Methadone was more commonly available at jails that only continued MOUD (84 of 123 jails [68.3%]), whereas buprenorphine was more commonly available at jails that both initiated and continued MOUD (73 of 119 jails [61.3%]). In an adjusted model, jails with higher odds of MOUD availability were located in the Northeast (odds ratio [OR], 10.72; 95% CI, 2.43-47.36) or metropolitan areas (OR, 1.92; 95% CI, 1.31-2.83), had private health care contracts (OR, 1.49; 95% CI, 1.03-2.14) and a higher number of women (≥70) reported in the female census (OR, 1.69; 95% CI, 1.02-2.80), and provided pregnancy testing within 2 weeks of arrival at the jail (OR, 2.66; 95% CI, 1.69-4.17). CONCLUSIONS AND RELEVANCE: In this cross-sectional study, a substantial proportion of US jails did not provide access to MOUD to pregnant people with OUD. Although most jails reported continuing to provide MOUD to individuals who were receiving medication before incarceration, few jails initiated MOUD, and most medication-providing jails discontinued MOUD during the postpartum period. These results suggest that many pregnant and postpartum people with OUD in US jails do not receive medication that is the standard of care and are required to endure opioid withdrawal, signaling an opportunity for intervention to improve care for pregnant people who are incarcerated.