Development and Psychometric Evaluation of the Treatment-Emergent Activation and Suicidality Assessment Profile
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Although effective in treating a range of childhood psychiatric conditions, selective serotonin reuptake inhibitors (SSRI) have been implicated in the induction of an “activation syndrome” (characterized by symptoms of irritability, restlessness, emotional labiality, etc.) that may represent an intermediary state change that fosters suicidality. SSRI-induced activation syndrome is well-accepted by many clinicians and thought to be relatively common, particularly in children and teens. However, gaps exist in empirical data on phenomenology and tools for early detection. With this in mind, we report on a recently funded National Institutes of Health grant to develop a measure of behavioral activation to be completed in a clinical setting. We discuss the development of this measure—the Treatment-Emergent Activation and Suicidality Assessment Profile (TE-ASAP)—as well as psychometric results from a sample of youth with internalizing disorders who were at varying stages of SSRI treatment. Overall, psychometric data were quite promising, with the TE-ASAP demonstrating excellent reliability (i.e., internal consistency, inter-rater, short-term test–retest stability) and strong validity properties. Through further evaluation of the TE-ASAP in the context of a controlled multimodal trial in youth with obsessive–compulsive disorder, we hope to augment understanding of activation syndrome and, in turn, mitigate risks through early detection of this potentially lifethreatening adverse effect.
KeywordsSelective serotonin reuptake inhibitors Activation syndrome Behavioral activation Obsessive–compulsive syndrome
- Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.Google Scholar
- Adler, M., & Ziglio, E. (1996). Gazing into the oracle: The Delphi method and its application to social policy and public health. London: Jessica Kingsley Publishers.Google Scholar
- Aman, M. G., & Singh, N. N. (1986). Aberrant Behavior Checklist: Manual. East Aurora, NY: Slosson Educational Publications.Google Scholar
- Bridge, J. A., Iyengar, S., Salary, C. B., Barbe, R. P., Birmaher, B., Pincus, H. A., et al. (2007). Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: A meta-analysis of randomized controlled trials. Journal of the American Medical Association, 297, 1683–1696.CrossRefPubMedGoogle Scholar
- Department of Health, United Kingdom. (2003). Committee on safety of medicines, expert group on safety of SSRIs, minutes, June 20, 2003. Retrieved November 30, 2005, from Medicines and Healthcare products Regulatory Agency Web site: http://www.mhra.gov.uk/home/groups/pl-p/documents/committeedocument/con003485.pdf.
- Hammad, T. A. (2004). Results of the analysis of suicidality in pediatric trials of newer antidepressants. Retrieved September 6, 2005, from http://www.fda.gov/ohrms/dockets/ac/04/slides/2004-4065s1.htm.
- MacGillivray, S., Arroll, B., Hatcher, S., Ogston, S., Reid, I., Sullivan, F., et al. (2003). Efficacy and tolerability of selective serotonin reuptake inhibitors compared with tricyclic antidepressants in depression treated in primary care: Systematic review and meta-analysis. British Medical Journal, 326, 1014.CrossRefPubMedGoogle Scholar
- March, J. S., Biederman, J., Wolkow, R., Safferman, A., Mardekian, J., Cook, E. H., et al. (1998). Sertraline in children and adolescents with obsessive-compulsive disorder: A multicenter randomized controlled trial. Journal of the American Medical Association, 280, 1752–1756.CrossRefPubMedGoogle Scholar
- March, J., Silva, S., Petrycki, S., Curry, J., Wells, K., Fairbank, J., et al. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for adolescents with depression study (TADS) randomized controlled trial. Journal of the American Medical Association, 292, 807–820.CrossRefPubMedGoogle Scholar
- Poznanski, E. O., & Mokros, H. B. (1996). Children’s Depression Rating Scale-Revised, Manual. Los Angeles: Western Psychological Services.Google Scholar
- Reynolds, W. (1988). SIQ professional manual. Odessa, FL: Psychological Assessment Resources, Inc.Google Scholar
- Riddle, M. A., Reeve, E. A., Yaryura-Tobias, J. A., Yang, H. M., Claghorn, J. L., Gaffney, G., et al. (2001). Fluvoxamine for children and adolescents with obsessive-compulsive disorder: A randomized, controlled, multicenter trial. Journal of American Academy of Child and Adolescent Psychiatry, 40, 222–229.CrossRefGoogle Scholar
- Swanson, J. M. (1992). School based assessment and interventions for ADD students. Irvine, CA: KC Publications.Google Scholar
- Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J., et al. (2008). Cognitive-behavioral therapy, sertraline and their combination for children and adolescents with anxiety disorders: Acute phase efficacy and safety. New England Journal of Medicine, 359, 2753–2766.CrossRefPubMedGoogle Scholar