497 - Associations Between Parenting Behaviors and Use of Psychotropic Medications and Other Mental Health Outcomes

Publication Number: 4488.497

Kelsi Mellin, VUMC, Nashville, TN, United States; Chandler H. Sullivan, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Ellen L. McMahon, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Grant Mercer, Vanderbilt University School of Medicine, Oakland, CA, United States; Tina S. Chai, Johns Hopkins Children's Center, Baltimore, MD, United States; Margaret Benningfield, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Mary S.. Dietrich, Vanderbilt University School of Medicine, Nashville, TN, United States; Seth Scholer, Vanderbilt University School of Medicine, Nashville, TN, United States

Background: National rates of childhood mental, emotional, and behavioral (MEB) problems continue to rise; 13-20% of children have a diagnosed disorder, 19% have impairment without a diagnosis, and 8% are prescribed psychotropic medication by latest estimates. Exposure to unhealthy discipline is a modifiable environmental risk factor for poor MEB outcomes in children. Practical tools that screen for these caregiving behaviors and predict downstream risk are needed to guide crucial secondary prevention efforts.

Objective: To assess the associations between a brief parenting assessment tool and three child MEB outcomes over five years.

Design/Methods: The Quick Parenting Assessment (QPA) is a validated tool to screen caregivers for unhealthy discipline during routine well child care (WCC). Caregivers (N=1494) of children ages 6 months-10 years presenting for WCC completed QPA prospectively, and scores were categorized as low (0), medium (1-4), or high (>4) risk. Child outcomes were collected via chart review five years later. We used Chi-square and logistic regression methods to assess the associations between baseline QPA score and three dichotomous outcomes: 1) psychotropic medication prescription, 2) referral to MEB services, and 3) caregiver-completed Pediatric Symptom Checklist (PSC-17) score ≥15, the standardized cutoff to indicate significant psychosocial dysfunction.

Results: Median (IQR) child age at baseline was 2.0 (1.0, 5.0) years. Caregiver-reported child race and ethnicity was 36.9% Black/African American, 19.3% White, 33.4% Hispanic, 2.9% Asian, and 7.5% other; 50.6% were male. Baseline QPA scores were 25.2% low-, 55.1% medium-, and 19.7% High-risk. Compared to QPA of 0, QPA>4 was associated with increased likelihood of psychotropic medication use [OR 9.43 (95%-CI 4.39-20.23) p<.001], referral to MEB services [OR 4.08 (95%-CI 2.58-6.46); p<.001], and elevated PSC-17 score [OR 31.56 (95%-CI 3.91-254.51); p<.001] at five years.

Conclusion(s): A brief tool designed to identify risk factors and guide parental support during routine WCC is associated with longitudinal MEB outcomes in children. In particular, the relationship between high-risk QPA and psychotropic medication reveals a potentially critical opportunity for secondary prevention in children at risk of requiring treatment with medication. Findings have practice and policy implications for improving early identification and intervention on modifiable socioecological risk factors for poor MEB outcomes in children.