Background Failure to detect respiratory compromise can lead to emergency healthcare use and fatal asthma attacks. The purpose of this study was to examine the effect of predicting peak expiratory flow (PEF) and receiving feedback on perception of pulmonary function and adherence to inhaled corticosteroids (ICS). Methods The sample consisted of 192 ethnic minority, inner-city children (100 Puerto Rican, 54 AfricanAmerican, 38 Afro-Caribbean) with asthma and their primary caregivers recruited from outpatient clinics in Bronx, New York. Children's PEF predictions were entered into an electronic spirometer and compared with actual PEF across 6 weeks. Children in one study were blinded to PEF (n=88; no feedback) and children in a separate study were able to see PEF (n=104; feedback) after predictions were locked in. Dosers were attached to asthma medications to monitor use. Results Children in the feedback condition displayed greater accuracy ( p<0.001), less under-perception (p<0.001) and greater over-perception (p<0.001) of respiratory compromise than children in the no feedback condition. This between-group difference was evident soon after baseline training and maintained across 6 weeks. The feedback condition displayed greater adherence to ICS ( p<0.01) and greater quick-relief medication use ( p<0.01) than the no feedback condition. Conclusions Feedback on PEF predictions for ethnic minority, inner-city children may decrease underperception of respiratory compromise and increase adherence to controller medications. Children and their families may shift their attention to asthma perception and management as a result of this intervention.

Background: There remains a need for interventions addressing psychopathology in individuals with cognitive and intellectual disability (ID). This case examines the application of Dialectical Behavior Therapy (DBT) in an adolescent with Neurofibromatosis 1 (NF1) and multiple psychiatric diagnoses. Treatment targeted suicidal ideation (SI), non-suicidal self-injury (NSSI) and impulsivity, while addressing cognitive limitations. Case background:The patient met criteria for Major Depressive Disorder, Borderline Personality Disorder, and Attention-Deficit Hyperactivity Disorder. She had a two-year history of NSSI behavior and two prior psychiatric inpatient hospitalizations. At baseline, she presented with deficits in interpersonal relationships, emotional reactivity and maternal conflict. Course of treatment:The treatment plan followed the DBT-A protocol, with modifications made to address the patient's cognitive limitations. Adaptions included greater reliance on behavioral and visual learning strategies, increased maternal involvement, regular collaboration with the multidisciplinary care team, and shortened sessions to fit the patient's attentional capability. Treatment outcomes:The patient showed a reduction in NSSI, SI, and did not require further psychiatric hospitalization. Patient and mother evidenced increased skill use. Additional outcomes are discussed.Conclusions: These adaptations offer a preliminary account of DBT-A for an adolescent with cognitive impairments. Important factors for successful modification included a multidisciplinary treatment approach, adapted and targeted teaching methods, and significant reliance on behavioral principles. This case study suggests that DBT is a promising treatment for individuals with ID and cognitive impairments and should be further tested within this population.