Dr. Robert Findling and the Longitudinal Assessment of Manic Symptoms (LAMS) Study

On February 14, the Schubert Center hosted Dr. Robert Findling of the Case Western Reserve University’s School of Medicine as part of the monthly Schubert Center Conversations on Children in Research, Policy, and Practice seminar series. Dr. Findling spoke about the Longitudinal Assessment of Manic Symptoms (LAMS) Study, which has been conducted since December 2005 in Ohio and western Pennsylvania and is funded by the National Institute of Mental Health (NIMH). The study tested a cohort of 707 children every six months for elevated symptoms of mania (ESM), a hallmark feature of bipolar disorder.

Although ESM are a key feature of bipolar disorder, there are no reliable means of predicting whether children who have ESM may eventually develop bipolar disorder. An estimated 1 million youth in the United States currently suffer from bipolar disorder, which is characterized by aggression, attention problems, anxiety, depression and delinquency in youth. Dr. Findling and his colleagues followed cohort of 707 children, 621 with ESM and 86 controls without ESM, who had presented for care at out-patient mental health clinics. The children were screened for ESM using the Parent General Behavior Inventory 10-Item Mania Scale (PGBI-10M) every six months for up to five years.

Over time, the researchers found that children who had persistently high or increasing scores on the PGBI-10M, were three times as likely to be diagnosed with bipolar disorder than children whose ESM had subsided or who did not have ESM. Additionally, persistent ESM did not increase the odds of being diagnosed with other mental health and behavioral disorders. The researchers also found that white and/or privately insured children were more likely to be treated with a medication-therapy combination, the most effective treatment, than ethnic minorities and children covered by Medicaid.

In his talk, Dr. Findling additionally suggested that insurance-claims-based data, which are often used to determine prevalence of mental health conditions including those related to Elevated Symptoms of Mania (ESM), may not be completely representative of actual ESM diagnosis and treatment. For example, clinicians may submit insurance claims based on insurance coverage for a particular medication or disorder, which may differ from the actual diagnosis. Parents also may have differing beliefs and perceptions of their child’s symptoms or may have difficulty accessing and paying for prescribed treatments.

In 2010 the LAMS study was awarded a $7.8 million renewal grant to continue the study for an additional five years. The extension of this study also allows the incorporation of two neuroscience-based technologies, neurocognitive testing and neuroimaging, to better understand how ESM and bipolar disorder are related to brain functioning and to develop better diagnostic tools.

Dr. Findling’s study highlights the importance of coordination between sectors of care for children, particularly school and outpatient settings, as most participants with ESM began using mental health services at 6 to 7 years old. After his talk, Dr. Findling was joined by Dr. Michael Manos, the head of the Center for Pediatric Behavioral Health at the Cleveland Clinic, and Jennifer Blumhagen, Director of Community Services at Bellefaire JCB, who spoke about their experiences working with children’s mental health, access to mental health services, and accountable care organizations.

Several other Schubert Center Faculty Associates are involved in children’s mental health research. Eileen Anderson-Fye conducts research on adolescent mental health cross-culturally. Faye Gary studies prevention of mental health disorders. Jeffrey Kretschmar researches mental health and substance abuse. Gerald Mahoney studies early childhood mental health. Mark Singer researches adolescent behavior and co-existing drug and mental disorders. James Spilsbury studies child mental health and its relationship to family violence. Christopher Stormann researches adolescents diagnosed with severe emotional disturbances. Elizabeth Tracy studies co-occuring substance abuse and mental disorders.

Download a policy brief on Dr. Findling’s work.

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