Early Pubertal Timing and Testosterone Associated With Higher Levels of Adolescent Depression in Girls J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-02-14 William E. Copeland, Carol Worthman, Lilly Shanahan, E. Jane Costello, Adrian Angold
Objective The prevalence of depression increases dramatically during puberty in girls. Earlier work in this sample reported that the sex steroids estradiol and testosterone were associated with increased depression in girls. Using three additional data waves (983 new Observations), we retest the relative contributions of pubertal timing, pubertal status and sex hormones on the increases in female depression. Method Eight waves of data from the prospective, representative Great Smoky Mountains Study were used covering female participants in the community age 9-16 years old (3005 assessments of 630 girls; 1993 to 2000). Structured interviews assessed depressive disorders. Youth rated their pubertal status using Tanner stage drawings, and sex steroids were assayed from dried blood spots. Results Risk for depression during puberty was associated with both age and Tanner stage in univariate models. In adjusted model accounting for pubertal timing and sex steroids, the apparent effects of age and Tanner stage were attenuated both in terms of statistical significance and effect size. The only significant predictors of change in depression status during puberty were early pubertal timing (OR=5.8, 95% CI 1.9-17.9, p =0.002 after age 12) and higher testosterone levels (OR=2.0, 95% CI 1.1-3.8, p =0.03 for quartile-split variable). Conclusion The added Observations have modified the original conclusions, implicating: 1) testosterone only, but not estradiol, and 2) early pubertal timing, but not age or pubertal status per se. These findings argue for multiple pubertal determinants of depression risk including factors that are socially- and biologically mediated.
Association Between Age and Familial Risk for Alcoholism on Functional Connectivity in Adolescence J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-02-14 Jatin G. Vaidya, Alexis L. Elmore, Alexander Wallace, Douglas R. Langbehn, John R. Kramer, Samuel Kuperman, Daniel S. O’Leary
Objective Youth with a family history of alcohol use disorder (family history positive; FHP) are at increased risk for developing maladaptive substance use relative to family history negative (FHN) peers. Building on earlier studies demonstrating morphological differences and distinct patterns of neural activation in FHP, the purpose of the present study was to investigate differential intrinsic functional connectivity among brain networks indexing premorbid risk of developing alcohol use disorder (AUD). Method The current study examined intrinsic functional connectivity using resting state functional magnetic resonance imaging (fMRI) in 191 adolescents 13 to 18 years with and without family history of alcohol use disorder (AUD) via independent component analysis (ICA), a method enabling data-driven investigation of internetwork and intranetwork connectivity among brain regions at rest. Results Analyses revealed significantly lower intranetwork connectivity in FHP compared to FHN participants between dorsal premotor cortex and other sensorimotor network regions. Reduced intranetwork connectivity in this region was further correlated with the number of biological family members with AUD and mood disorders. Robust differences were also evident in internetwork connectivity as a function of age. However, there was no evidence for family history by age interactions. Conclusion Intra- but not inter-network connectivity appears to differentiate FHP and FHN adolescents whereas age differences within adolescence are marked by differences in internetwork connectivity.
Treatment Gains Are Sustainable in Pediatric Obsessive-Compulsive Disorder: Three-Year Follow-Up From the NordLOTS J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-02-14 Karin Melin, Gudmundur Skarphedinson, Per Hove Thomsen, Bernhard Weidle, Nor Christian Torp, Robert Valderhaug, Davíð R.M.A. Højgaard, Katja. A. Hybel, Judith Becker Nissen, Sanne Jensen, Kitty Dahl, Ingela Skärsäter, Bente Storm Haugland, Tord Ivarsson
Objective This study evaluates the long-term outcomes of a stepped care treatment for pediatric obsessive-compulsive disorder (OCD) and investigates whether response to first-step cognitive-behavioral therapy (CBT) is an important indicator of three-year outcomes. Method This study is a part of the Nordic Long-term OCD Treatment study (NordLOTS), in which 269 children and adolescents were treated with CBT. Non-responders to CBT were randomized to an extended treatment with continued CBT or pharmacotherapy with sertraline. Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) scores of ≤15 and ≤10 were defined as treatment response and remission, respectively. Participants were assessed two and three years after first-step CBT. Linear mixed-effects (LME) models were used to analyze the outcomes. Results Intent-to-treat analyses showed a significant reduction in the CY-BOCS total score from baseline (24.6) to the three-year follow-up (5.0) (p=.001), with a mean reduction of 5.9 from posttreatment to the three-year follow-up. Three years after treatment, 90% (n=242) of the participants were rated as responders and 73% were in clinical remission. The duration of treatment did not influence the symptom level at the three-year follow-up (p=.998) and no significant difference was found (p=.169) between the extended treatment conditions. Conclusion The results suggest that evidence-based treatment for pediatric OCD has long-term positive effects, whether a first step of manualized CBT or extended treatment with CBT or sertraline. The improvements were maintained, and the symptoms decreased further during follow-up and were, after three years, similarly independent of the treatment duration and form of extended treatment.
Families Who Benefit and Families Who Do Not: Integrating Person- and Variable-Centered Analyses of Parenting Intervention Responses J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-02-11 Jolien van Aar, Patty Leijten, Bram Orobio de Castro, Joyce Weeland, Walter Matthys, Rabia Chhangur, Geertjan Overbeek
ObjectiveFamilies with disruptive child behavior are typically referred to services based on children’s behavior alone, rather than on underlying mechanisms of disruptive behavior. Yet, the presence of the precise mechanisms targeted by services might be essential for intervention success. We integrated person- and variable-centered approaches to test whether families with combined disruptive child behavior and harsh/inconsistent parenting indeed benefit most from a behavioral parenting intervention in indicated prevention context, compared to families with disruptive child behavior but less harsh/inconsistent parenting, and families with less severe disruptive behavior.MethodFamilies (N=387) of children aged 4-8 years (disruptive behavior >75th percentile) participated in a randomized trial of the Incredible Years parenting intervention (Trial NTR3594, www.trialregister.nl). We identified different response trajectories and tested whether families with combined child and parenting difficulties had a higher probability of responding well, compared to families with only child difficulties or less severe difficulties.ResultsMost intervention group families (82%) showed a non-response trajectory. A minority (18%) showed a response trajectory with strong reductions in disruptive behavior (Cohen’s d=1.45). As expected, families with both child and parenting difficulties were most likely to respond: 20% more than families with only child difficulties and 40% more than families with less severe difficulties.ConclusionAs indicated prevention, Incredible Years benefits mainly families in which the mechanisms targeted by the intervention (i.e., harsh/inconsistent parenting) is actually present, rather than all families. Careful matching of children to services based on assessments of both child and parenting behavior seems critical for intervention success.
Attention-Deficit/Hyperactivity Disorder in Childhood and Adolescence and the Risk of Crime in Young Adulthood in a Danish Nationwide Study J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-02-11 Christina Mohr-Jensen, Charlotte Müller Bisgaard, Søren Kjærsgaard Boldsen, Hans-Christoph Steinhausen
ObjectiveTo determine the risk of long-term conviction and incarceration associated with childhood attention-deficit/hyperactivity disorder (ADHD), and to identify risk and protective factors including associations with active treatment with ADHD medication.MethodAll participants with ADHD aged 4-15 during 1995 - 2005 were matched by year of birth and sex to a random sample of participants without ADHD from the Danish population using nationwide registers. Using Cox proportional hazard models we estimated the risk of conviction and incarceration associated with ADHD in childhood and estimated associations with active treatment on outcome.ResultsThe ADHD cohort were followed up at a mean of 22.0 (SD=5.8) years. Out of n=4,231 individuals with ADHD, n=1,355 (32.0%) had received at least one conviction compared to n=3,059 (15.6%) of the n=19,595 participants without ADHD (p<0.001). ADHD was significantly associated with conviction (HR=2.4, 95% CI=2.3-2.6) and incarceration (HR=3.0, 95% CI=2.8-3.3). Subsequent to adjustment for various risk factors, ADHD exposure was still significantly related to conviction (HR=1.6, 95% CI=1.5-1.8) and incarceration (HR=1.7, 95% CI=1.5-1.9). Comorbidity with substance use disorder, oppositional defiant disorder/conduct disorder, low family socio-economic status, parental incarceration, and parental relationship status all significantly increased the risk of conviction and incarceration. The crime rates increased with the number of associated risks but were reduced during periods of taking ADHD medication.ConclusionIn addition to ADHD, a broad range of individual, familial and social factors increases the risk of antisocial development. The findings imply that ADHD medication may contribute to crime prevention.
Association Between Repeated Episodes of Gastroenteritis and Mental Health Problems in Childhood and Adolescence J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-02-08 Carine Parent, Irina Pokhvisneva, Hélène Gaudreau, Michael J. Meaney, Patricia P. Silveira
ObjectiveThe Avon Longitudinal Study of Parents and Children (ALSPAC) and Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) cohorts were used to determine if repeated exposure to gastroenteritis in early life could predict risk for psychiatric problems in childhood and in ALSPAC adolescents. We determined if inflammatory biomarkers moderate the association between repeated gastroenteritis and mental health in adolescents from ALSPAC.MethodEpisodes of gastroenteritis from birth to 30 and 36 months were reported by mothers. Psychological problems were assessed using the total difficulties and subscale scores on the Rutter revised at 42 months and Strengths and Difficulties Questionnaire (SDQ) at 81 months in ALSPAC. Presence of psychiatric disorders at 15.5 years was assessed using the Development and Well-Being Assessment (DAWBA) in ALSPAC. In the MAVAN replication cohort, total difficulties were assessed on the SDQ at 60 and 72 months. Serum Interleukin-6 (IL-6) and C Reactive Protein (CRP) at 9.5 years and CRP at 15.5 years were measured in ALSPAC participants.ResultsRepeated gastroenteritis associated with the total difficulties score in ALSPAC and MAVAN children. Beta values were small indicating the clinical relevance of these findings requires further investigation. Repeated gastroenteritis was significantly associated with an increased prevalence of externalizing disorders at 15.5 years but odds ratios were small. CRP or IL-6 at 9.5 years or CRP at 15.5 years did not significantly moderate the association between repeated gastroenteritis and prevalence of psychiatric disorders.ConclusionIdentifying factors associated with vulnerability to psychopathology is key to early identification of individuals at risk.
Paternal Psychological Distress and Child Problem Behavior from Early Childhood to Middle Adolescence J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-02-02 Eirini Flouri, Zahra Sarmadi, Marta Francesconi
Objective To explore if paternal psychological distress is related to the longitudinal course of child Problem behaviour after accounting for maternal psychological distress. Method We used data from the Millennium Cohort Study (MCS), a large general-population birth cohort in the UK. Maternal and paternal psychological distress was measured with the Kessler 6-item psychological distress scale (K-6) at child ages 3, 5, 7, 11 and 14 years. Problem behaviour was measured with the Strengths and Difficulties Questionnaire at these ages. Data were analyzed using growth curve modelling, before and after adjustment for confounders (N = 13,442). Results The effect of paternal psychological distress was weaker than that of maternal psychological distress. However, even after adjustment for maternal psychological distress and confounding, paternal psychological distress predicted all four domains of child Problem behaviour we examined (hyperactivity, conduct, emotional and peer problems). Child problem scores were generally lower in biological father families, but the effect of paternal psychological distress was the same for children in biological and non-biological father families, and did not depend on the level of maternal psychological distress. High levels of paternal psychological distress predicted some problems (emotional symptoms and hyperactivity) more strongly in boys than girls. Conclusion There was evidence for a robust association between psychological distress in fathers and Problem behaviour in their offspring. Our findings suggest that the mental health of both fathers and mothers is important for the behaviour of their children.
Attention-Deficit/Hyperactivity Disorder, School Performance, and Effect of Medication J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-02-02 Andreas Jangmo, Amanda Stålhandske, Zheng Chang, Qi Chen, Catarina Almqvist, Inna Feldman, Cynthia M. Bulik, Paul Lichtenstein, Brian D’Onofrio, Ralf Kuja-Halkola, Henrik Larsson
Objective Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) are at increased risk of poor school performance and pharmacological treatment of ADHD may have beneficial effects on school performance. Conclusions from previous research have been limited by small sample sizes, outcome measures, and treatment follow-up. The current study analyzed school performance in students with ADHD compared to students without ADHD, and the association between pharmacological treatment of ADHD and school performance. Method A linkage of Swedish national registers covering 657,720 students graduating from year 9 of compulsory school provided measures of school performance, electronically recorded dispensations of ADHD medication, and potentially confounding background factors such as parental socioeconomic status. Primary measures of school performance included student eligibility to upper secondary school and grade point sum. Results ADHD was associated with substantially lower school performance independent of socioeconomic background factors. Treatment with ADHD medication for 3 months was positively associated with all primary outcomes, including a decreased risk of no eligibility to upper secondary school, odds ratio of 0.80, 95% confidence interval (CI) 0.76-0.84, and a higher grade point sum (range 0.0-320.0) of 9.35 points, 95% CI=7.88-10.82; standardized coefficient of 0.20. Conclusion ADHD has a substantial negative impact on school performance while pharmacological treatment for ADHD is associated with higher levels in several measures of school performance. Our findings emphasize the importance of detection and treatment of ADHD at an early stage to reduce the negative impact on school performance.
Double-Blind, Sham-Controlled, Pilot Study of Trigeminal Nerve Stimulation for ADHD J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-01-28 James J. McGough, Alexandra Sturm, Jennifer Cowen, Kelly Tung, Giulia C. Salgari, Andrew F. Leuchter, Ian A. Cook, Catherine A. Sugar, Sandra K. Loo
Objective Trigeminal nerve stimulation (TNS), a minimal risk, non-invasive neuromodulation method, has showed potential benefits for attention-deficit/hyperactivity disorder (ADHD) in an unblinded open study. This blinded sham-controlled trial was conducted to assess efficacy and safety of TNS for ADHD, as well as potential changes in brain spectral power using resting-state quantitative electroencephalography (qEEG). Method 62 children aged 8-12 years, with full-scale IQ ≥ 85 and KSADS-diagnosed ADHD, were randomized to four weeks nightly treatment with active or sham TNS, followed by one-week without intervention. Assessments included weekly clinician-administered ADHD-Rating Scales (ADHD-RS) and Clinical Global Impression (CGI) scales, and qEEG at baseline and week 4. Results ADHD-RS totals showed significant group-by-time interactions (F = 8.12, df = 1/228, p = .005); week 4 Cohen’s d = .5. CGI-Improvement also favored active treatment (Chisq = 8.75, df = 1/168, p = .003); number-needed-to-treat (NNT) = 3. Resting-state qEEG showed increased spectral power in right frontal and frontal midline frequency bands with active TNS. Neither group had clinically meaningful adverse events. Conclusion This study demonstrates TNS efficacy for ADHD in a blinded sham-controlled trial, with estimated treatment effect size similar to non-stimulants. TNS is well-tolerated and minimal risk. Additional research should examine treatment response durability and potential impact on brain development with sustained use.
A Multisite Randomized Controlled Two-Phase Trial of the Early Start Denver Model Compared to Treatment as Usual J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-01-24 Sally J. Rogers, Annette Estes, Catherine Lord, Jeff Munson, Marie Rocha, Jamie Winter, Jessica Greenson, Costanza Colombi, Geraldine Dawson, Laurie A. Vismara, Catherine A. Sugar, Gerhard Hellemann, Fiona Whelan, Meagan Talbott
Objective This single-blind, randomized, multi-site, intent-to-treat study was designed to replicate and extend Dawson et al.’s (2010) randomized controlled trial (RCT) testing effects of the Early Start Denver Model (ESDM), an intensive play-and routines-based intervention delivered in natural settings. Method An RCT was conducted at three universities. 118 children with autism spectrum disorder (ASD), 14-24 months of age, were enrolled and randomly assigned to ESDM or community interventions for 27 months. 81 children completed the full treatment course and all assessments; data from all 118 children were used in analyses. Children assigned to ESDM intervention received three months of weekly parent coaching followed by 24 months of 15 hour -per -week (on average) 1:1 treatment weekly on average in homes or daycare settings from supervised therapy assistants while parents received coaching four hours monthly from a certified ESDM therapist. Results Primary: There were both time by group and time by group by site interactions for language outcomes. In the significant three-way interaction involving site, two sites showed a significant ESDM advantage and the third site showed no significant group differences. In the planned two-way analysis that pooled the data across all three sites, there was a significant advantage found for the ESDM group. Secondary There were no significant differences between ESDM and Community groups in secondary analyses involving DQ, autism severity, or adaptive behavior. The treatment effect of group on language outcomes was not moderated by baseline DQ, autism severity, or language. Conclusion Results of the primary analysis provide a partial replication of Dawson et al.’s 2010 language findings.
Characteristics and Precipitating Circumstances of Suicide Among Incarcerated Youth J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-01-23 Donna A. Ruch, Arielle H. Sheftall, Paige Schlagbaum, Cynthia A. Fontanella, John V. Campo, Jeffrey A. Bridge
Objective Studies show incarcerated youth are at an increased risk for suicidal behavior, yet little is known about factors associated with suicide for this population. Using a nationally representative sample, this study examines characteristics and precipitating circumstances of suicide among incarcerated youth decedents relative to youth suicide decedents in the general population. Method Data were analyzed for suicide decedents aged 10-24 years (N=10,126) in the United States between 2003 and 2012 from the National Violent Death Reporting System (NVDRS). Logistic regression compared precipitating circumstances of suicide for incarcerated youth decedents and those not in custody. Details on suicide deaths in detained youth were captured from coroner/medical examiner and law enforcement reports associated with each incident. Results The majority of youth suicide decedents were older, white, and male regardless of incarceration status. Incarcerated youth suicide decedents were more likely to die by hanging/strangulation/suffocation, and less likely to disclose suicide intent, leave a suicide note, or exhibit depressive symptoms compared to those not in custody. Additional risk factors for suicide were not significantly different between youth decedents in custody and those not in custody, suggesting that unique aspects of the incarceration environment may be associated with an elevated risk of suicide. Conclusion Study findings highlight the need for early suicide risk detection and developmentally relevant interventions tailored for youth in correctional settings. Future efforts should include evaluation studies to support suicide prevention programs designed for incarcerated youth and research that examines distinctive factors associated with suicidal behavior among youth in custody.
Structural Brain Alterations in Youth With Psychosis and Bipolar Spectrum Symptoms J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-01-18 Maria Jalbrzikowski, David Freedman, Catherine E. Hegarty, Eva Mennigen, Katherine H. Karlsgodt, Loes M. Olde Loohuis, Roel A. Ophoff, Raquel E. Gur, Carrie E. Bearden
Objective Adults with established diagnoses of serious mental illness (bipolar disorder and schizophrenia) exhibit structural brain abnormalities, yet less is known about how such abnormalities manifest earlier in development. Method We analyzed the cross-sectional data publicly available from the Philadelphia Neurodevelopmental Cohort (PNC). Structural magnetic resonance neuroimaging data (sMRI) were collected on a subset of the PNC (N=989, ages 9-22 years old). We calculated measures of cortical thickness (CT) and surface area (SA), along with subcortical volumes. Study participants were assessed for psychiatric symptomatology via structured interview and the following groups were created: typically developing (TD, n=376), psychosis spectrum (PS, n=113), bipolar spectrum (BP, n=117), and BP + PS (n=109). We examined group and developmental differences in sMRI measures. We also examined to what extent any structural aberration was related to neurocognition, global functioning, and clinical symptomatology. Results In comparison to all other groups, PS youth exhibited significantly reduced SA in orbitofrontal, cingulate, precentral, and postcentral regions. PS youth also exhibited reduced thalamic volume in comparison to all other groups. Strongest effects for precentral and posterior cingulate SA reductions were seen during early adolescence (ages 13-15) in PS youth. Strongest effects for reductions in thalamic volume and orbitofrontal and postcentral SA were observed in mid-adolescence (16-18 years) in PS youth. Across groups, better overall functioning was associated with increased lateral orbitofrontal SA. Increased postcentral SA was associated with better executive cognition and less severe negative symptoms in the entire sample. Conclusion In a community-based sample, we found that reduced cortical SA and thalamic volume are present early in adolescent development in youth with psychosis spectrum symptoms, but not in youth with bipolar spectrum symptoms, or with both bipolar and psychosis spectrum symptoms. These findings point to potential biological distinctions between psychosis and bipolar spectrum conditions, which may suggest additional biomarkers relevant to early identification.
A Longitudinal Follow-Up Study Examining Adolescent Depressive Symptoms as a Function of Prior Anxiety Treatment J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-01-17 Jennifer S. Silk, Rebecca B. Price, Dana Rosen, Neal D. Ryan, Erika E. Forbes, Greg J. Siegle, Ronald E. Dahl, Dana L. McMakin, Philip C. Kendall, Cecile D. Ladouceur
Objective Children who are fearful and anxious are at heightened risk for developing depression in adolescence. Treating anxiety disorders in pre/early adolescence may be one mechanism through which depressive symptoms later in adolescence can be prevented. We hypothesized that anxious youth who responded positively to cognitive behavioral therapy (CBT) for anxiety would show reduced onset of depressive symptoms 2 years later compared to treatment non-responders, and that this effect would be specific to youth treated with CBT compared to an active supportive comparison treatment. Method Participants were 80 adolescents ages 11-17 who previously completed a randomized trial comparing predictors of treatment response to CBT and Child Centered Therapy (CCT). Youth met DSM-IV criteria for generalized, separation, and/or social anxiety disorder at the time of treatment. The present study was a prospective naturalistic two-year follow-up examining trajectories toward depression, in which participants were reassessed for depressive symptoms two years following anxiety treatment. Treatment response was defined as a 35% reduction in independent evaluator-rated anxiety severity on the Pediatric Anxiety Rating Scale following treatment. Results As hypothesized, lower levels of depressive symptoms were observed in anxious youth who responded to CBT for anxiety (β=-.807, p=.004) but not CCT (β=.254, p=.505). Sensitivity analyses showed that the effects were driven by girls. Conclusion Findings suggest that CBT for anxiety is a promising approach to preventing adolescent depressive symptomatology, especially among girls. The results highlight the need for better early screening for anxiety and better dissemination of CBT programs targeting anxiety in youth.
Changes in General and Specific Psychopathology Factors Over a Psychosocial Intervention J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-01-14 Matthew P. Constantinou, Ian M. Goodyer, Ivan Eisler, Stephen Butler, Abdullah Kraam, Stephen Scott, Stephen Pilling, Elizabeth Simes, Rachel Ellison, Elizabeth Allison, Peter Fonagy
Objective Recent research suggests that comorbidity among child and adolescent psychiatric symptoms can be explained by a single general psychopathology (‘p’) factor, as well as more specific factors summarizing clusters of symptoms. We investigated within- and between-person changes in the general and specific psychopathology factors over a psychosocial intervention. Method We ran a secondary analysis of the Systemic Therapy for At-Risk Teens study, a pragmatic randomized controlled trial that compared the effects of multisystemic therapy to management-as-usual for reducing antisocial behavior in 684 adolescents (82% male; 11-18 at baseline) over an 18-month period. The general p factor, as well as specific antisocial, attention, anxiety, and mood factors, were estimated from a symptom-level analysis of a set of narrow-band symptom scales measured repeatedly over the study. General and specific psychopathology factors were assessed for reliability, validity, and within- and between-person change using a parallel process multilevel growth model. Results A revised bifactor model that included a general p factor and specific anxiety, mood, antisocial, and attention factors with cross-loadings fit the data best. While the factor structure was multidimensional, p accounted for most of the variance in total scores. The p, anxiety, and antisocial factors predicted within-person variation in external outcomes. p and antisocial factors showed within-person reductions, while anxiety showed within-person increases over time. Despite individual variation in baseline factor scores, adolescents showed similar rates of change. Conclusion The bifactor model is useful for teasing apart general and specific therapeutic changes which are conflated in standard analyses of symptom scores. Clinical trial registration information: START (Systemic Therapy for At Risk Teens): A National Randomised Controlled Trial to Evaluate Multisystemic Therapy in the UK Context. http://www.isrctn.com; ISRCTN77132214
Sex Differences in Comorbidity Patterns of Attention-Deficit/Hyperactivity Disorder J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-01-08 Cæcilie Ottosen, Janne Tidselbak Larsen, Stephen V. Faraone, Qi Chen, Catharina Hartman, Henrik Larsson, Liselotte Petersen, Søren Dalsgaard
Objective To investigate sex differences in associations between attention-deficit/hyperactivity disorder (ADHD) and a spectrum of comorbid disorders. Method The study population included all children born in Denmark between 1981 and 2013 (N=1,665,729). We merged data from Danish registers and obtained information on birth characteristics, socioeconomic status, familial psychiatric history, and diagnoses of ADHD (n=32,308) and comorbid disorders. In order to estimate absolute and relative risks of comorbid disorders, incidence rates (IRs) and adjusted hazard ratios (HRs) with 95% CIs were calculated for females and males. We also examined interactions between ADHD and sex in association with comorbid disorders - estimated as ratios of the hazard ratios (HRRs) in females and males (95% CIs). Results Individuals diagnosed with ADHD had significantly increased absolute and relative risks of all 12 comorbid psychiatric disorders investigated. For some comorbid disorders, we found ADHD-sex interactions. Compared to males, ADHD in females showed a stronger association with autism spectrum disorder (HRR=1.86; 95%CI 1.62-2.14), oppositional defiant/conduct disorder (HRR=1.97; 95%CI 1.68-2.30), intellectual disability (HRR=1.79; 95%CI 1.54-2.09), personality disorders (HRR=1.23; 95%CI 1.06-1.43), schizophrenia (HRR=1.21; 95%CI 1.02-1.43), substance use disorders (HRR=1.21; 95%CI 1.07-1.38), and suicidal behavior (1.28; 95%CI 1.12-1.47). The remaining disorders showed no significant sex differences in association with ADHD. Conclusion This study indicates that the association between ADHD and several comorbid disorders is stronger in females than in males. These important findings add to the literature on sex differences in ADHD and suggest that females diagnosed with ADHD are a more vulnerable group of patients.
Changing Conceptions of Death as a Function of Depression Status, Suicidal Ideation, and Media Exposure in Early Childhood J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-01-08 Laura Hennefield, Diana J. Whalen, Grace Wood, Mary C. Chavarria, Joan L. Luby
Objective This study characterized 3- to 6-year-old children’s understanding of death as a function of depression status, suicidal ideation (SI), and media consumption. Method Participants were 79 children with depression (aged 3.0–6.11), who completed a comprehensive psychiatric assessment and experimenter-led death interview, and a comparison group of 60 healthy children (aged 4.0–7.12). The interview assessed children’s understanding of five concepts of death: universality, applicability, irreversibility, cessation, and causality. Children’s mastery of each concept, and overall death understanding, was examined as a function of depression and SI-status: depressed with SI (N=22), depressed without SI (N=57), and healthy (N=60). Children’s observed emotional reactions to hearing about natural death, accidental death, and suicide were assessed via death-themed stories. Parent-reports of children’s television and videogames/internet consumption assessed links between media exposure and death understanding. Results Children with depression and with SI scored higher on overall death understanding than depressed without SI and healthy children. They also exhibited more sad and anxious affect listening to death-themed stories and were more likely to describe death as caused by violence. Across our sample, older children were also more likely to depict death as violent. More television use was associated with less understanding of death, including the concept of irreversibility. Conclusion Children with depression and with SI have a more advanced understanding of death than their peers dispelling the myth that these ideations arise in the context of poor death understanding. The increase in violence attributions across early childhood may indicate increasing normalization of violence in children’s perceptions of death.
Trajectories of Symptom Change in the Treatment for Adolescents With Depression Study J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-01-08 Kelli Scott, Cara C. Lewis, C. Nathan Marti
Objective Depression is the most prominent mental health disorder among youth with profound impacts with respect to morbidity and mortality if not addressed. The Treatment for Adolescent Depression Study (TADS) is one of the largest randomized controlled trials that compared the effectiveness of four treatments: Cognitive Behavioral Therapy (CBT), fluoxetine (FLX), combined Cognitive Behavioral and fluoxetine treatment (COMB), and placebo (PBO). However, meaningful heterogeneous treatment courses are masked by these group mean comparisons of treatment impact. The present study sought to characterize the acute phase symptom trajectories of the depressed teens enrolled in TADS and to explore predictors of these trajectories, including TADS treatment condition. Method The TADS sample of 439 adolescent participants diagnosed with major depressive disorder was subjected to growth mixture modeling (GMM) to evaluate subgroups of adolescents with unique trajectories of depression symptom change. Results Growth mixture modeling revealed three unique classes of adolescents: (a) a high severity class with early significant improvement; (b) a high severity class with limited symptom change; and (c) moderate severity class with late significant improvement. Baseline predictors of class membership included treatment condition, gender, age, stage of change, depression severity, number of comorbid disorders, hopelessness, melancholia, suicidality, and cognitive distortions. Conclusion Results of this study may have implications for the selection of what treatment to use for which depressed adolescent.
Common Polygenic Variations for Psychiatric Disorders and Cognition in Relation to Brain Morphology in the General Pediatric Population J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-01-09 Silvia Alemany, Philip R. Jansen, Ryan L. Muetzel, Natália Marques, Hanan El Marroun, Vincent W.V. Jaddoe, Tinca J.C. Polderman, Henning Tiemeier, Danielle Posthuma, Tonya White
Objective To examine the relationship between polygenic scores (PGS) for five major psychiatric disorders and two cognitive traits with brain MRI morphological measurements in a large population-based sample of children. Additionally, we tested whether differences in brain morphology mediated associations between PGS for psychiatric disorders and related behavioral phenotypes. Method The participants included 1,139 children from the Generation R Study assessed at 10 years-of-age with genotype and neuroimaging data available. PGS were calculated for schizophrenia, bipolar disorder, major depression disorder, attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intelligence and educational attainment (EA) using results from the latest genome-wide association studies. Image processing was performed using FreeSurfer to extract cortical and subcortical brain volumes. Results Higher genetic susceptibility for ADHD was associated with smaller caudate volume (strongest prior=0.01: β =-0.07, P= 0.006). Within boys, mediation analyses estimates suggested found that 11% of the association between the polygenic score for ADHD and attention problems was mediated by differences in caudate volume (n=535), while mediation was not significant in girls or the entire sample. PGS for EA and intelligence showed positive associations with total brain volume (TBV) (strongest prior=0.5: β =0.14, P=7.12x10-8; and β =0.12, P=6.87x10-7, respectively). Conclusion Our findings indicate that the neurobiological manifestation of polygenic susceptibility for ADHD, EA, and intelligence involve early morphological differences in caudate and total brain volumes in childhood. Furthermore, the genetic risk for ADHD may influence attention problems via the caudate nucleus in boys.
Consequences of Not Planning Ahead: Reduced Proactive Control Moderates Longitudinal Relations Between Behavioral Inhibition and Anxiety J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-01-09 Sonya V. Troller-Renfree, George A. Buzzell, Daniel S. Pine, Heather A. Henderson, Nathan A. Fox
Objective Children with the temperament of Behavioral Inhibition (BI) face increased risk for developing an anxiety disorder later in life. However, not all children with BI manifest anxiety symptoms, and cognitive-control-strategy use may moderate the pathway between BI and anxiety. Individuals vary widely in the strategy used to instantiate control; the present study examined whether a more planful style of cognitive control (i.e. proactive control) or a more impulsive strategy of control (i.e. reactive control) moderates the association between early BI and later anxiety symptoms. Method Participants were part of a longitudinal study examining the relations between BI (measured at 2-3 years) and later anxiety symptoms (measured at 13 years). Cognitive control strategy use was assessed at age 13 using the AX variant of the Continuous Performance Task (AX-CPT). Results BI in toddlerhood significantly predicted increased use of a more reactive cognitive control style in adolescence. Additionally, cognitive control strategy moderated the relation between BI and anxious symptoms, such that reliance on a more reactive strategy predicted higher levels of anxiety for children high in BI. Conclusion The present study is the first to identify the specific control strategy that increases risk for anxiety. Thus, is it not cognitive control per se, but the specific control strategy children adopt that may increase risk for anxiety later in life. These findings have important implications for future evidence-based interventions given that they suggest an emphasis reducing reactive cognitive control and increasing proactive cognitive control may reduce anxious cognition.
Ethnic Differences in Referral Routes to Youth Mental Health Services J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-01-04 Julian Edbrooke-Childs, Praveetha Patalay
Objective To examine whether there are ethnic differences in referral route to youth mental health services. Method This was an analysis of national routinely collected data from N = 14,588 young people (mean [SD] age = 12.28(3.75) years, 54% female; 64% White British) accessing mental health services in the UK. Ethnicity was self-reported by young people and carers and referral route was recorded by services. Results After accounting for service-level variation and controlling for age, gender, problem type, and contextual factors, ethnicity was significantly associated with referral route. Compared to White British young people, Black young people (OR = 2.90, 95% CI = 2.07-4.06) and mixed-race young people (OR = 2.66, 95% CI = 1.91-3.72) were more than twice as likely to be referred through social care/youth justice than primary care. Compared to White British young people, Asian young people (OR=1.85, 95% CI = 1.34-2.54) were almost twice as likely to be referred through social care/youth justice than primary care. We conducted a sensitivity analysis to examine whether ethnic differences in referral route were attenuated when also accounting for service area deprivation, and the above effects were only partially attenuated. Conclusion There are ethnic differences in referral route to youth mental health services in the UK, and young people from minority ethnic backgrounds are more likely to be referred through routes that are less likely to be voluntary. Understanding the reasons for these differences is critical for reducing inequalities and improving pathways to mental health care access.
Maternal Depression and Stress in the NICU: Associations With Mother-Child Interactions at Age 5 Years J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2019-01-04 Emily D. Gerstein, Wanjiku F.M. Njoroge, Rachel A. Paul, Christopher D. Smyser, Cynthia E. Rogers
Objective Previous studies suggest that maternal postpartum mental health issues may impact parenting and child development in preterm infants, but have often not measured symptomatology in the Neonatal Intensive Care Unit (NICU) nor followed families through early childhood. This study examines how maternal depressive symptoms and stress in the NICU are related to parenting behaviors at age 5 years, in mothers of children born very preterm (≤30 weeks gestation). Method This longitudinal study followed a diverse sample of 74 very preterm children and their mothers. Maternal depression and stress were assessed in the NICU. At age 5, mother-child dyads were observed and coded for maternal intrusiveness, negativity, sensitivity, and positivity. Other covariates, including maternal and child intelligence, maternal education, income-to-needs ratio, maternal depression at age 5 years, and child sex were included in multivariate analyses. Results The interaction between maternal NICU stress and NICU depression for intrusiveness and negativity indicates that greater NICU depression was associated with more intrusiveness under medium or high levels of NICU stress, and more negativity under high levels of NICU stress. Furthermore, greater NICU depression was associated with less sensitivity, over and above other covariates. Conclusion Findings suggest that early maternal peripartum depression and stress in the NICU can have lasting impacts on multiple parenting behaviors, highlighting the need for screening and targeted interventions in the NICU.
Early Sexual Trauma Exposure and Neural Response Inhibition in Adolescence and Young Adults: Trajectories of Frontal Theta Oscillations during a Go/NoGo Task J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-12-20 Jacquelyn Meyers, Vivia V. McCutcheon, Ashwini K. Pandey, Chella Kamarajan, Stacey Subbie, David Chorlian, Jessica Salvatore, Gayathri Pandey, Laura Almasy, Andrey Anokhin, Lance Bauer, Annah Bender, Danielle M. Dick, Howard J. Edenberg, Victor Hesselbrock, John Kramer, Samuel Kuperman, Arpana Agrawal, Bernice Porjesz
Objective Trauma, particularly when experienced early in life, may alter neurophysiological and behavioral development, thereby increasing risk for substance use disorders and related psychopathology. However, few studies have empirically examined this using well characterized developmental samples that are followed longitudinally. Method We examined the association of assaultive, non-assaultive, and sexual-assaultive experiences prior to age 10 with developmental trajectories of brain function during response inhibition, by measuring electrophysiological theta and delta oscillations during No-Go and Go conditions in an equal probability Go/No-Go task. Data were drawn from the Collaborative Study of the Genetics of Alcoholism (COGA) prospective cohort, comprising offspring from high-risk and comparison families who were aged 12-22 at enrollment, with follow ups at two-year intervals since 2004. Additionally, we investigated other important predictors of neurophysiological functioning (eg, substance use, impulsivity, parental alcohol use disorders). Finally, we examined associations of neurophysiological functioning with alcohol and cannabis use disorder symptom counts (AUDsx, CUDsx), and externalizing (EXT) and internalizing (INT) psychopathology. Results Individuals exposed to sexual assaultive trauma prior to age 10 had slower rates of change in developmental trajectories of No-go frontal theta during response inhibition. Importantly, effects remained significant after accounting for exposure to other traumatic exposures, parental history of AUD and participants’ substance use, but not measures of impulsivity. Further, slower rates of changes in No-go frontal theta adolescent and young adult development were associated with increased risk for AUDsx and INT, but not CUDsx or EXT. Conclusion Childhood sexual assault is associated with atypical frontal neurophysiological development during response inhibition. This may reflect alterations in frontal lobe development, synaptic pruning and/or cortical maturation involving neural circuits for inhibitory control. These same areas may be associated with increased risk for young adult AUDsx and INT. These findings support the hypothesis that changes in neurocognitive development related to early sexual trauma exposure may increase risk for mental health and substance use problems in young adulthood.
A Longitudinal Study of Family Functioning in Offspring of Bipolar Parents J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-12-19 Amit Shalev, John Merranko, Tina Goldstein, David J. Miklowitz, David Axelson, Benjamin I. Goldstein, David Brent, Kelly Monk, Mary Beth Hickey, Danella M. Hafeman, Dara Sakolsky, Rasim Diler, Boris Birmaher
Objective To compare the longitudinal course of family functioning in offspring of parents with bipolar disorder (BD), offspring of parents with non-BD psychopathology, and offspring of healthy control parents (HC). Method Offspring of BD parents (256 parents and 481 offspring), non-BD parents (82 parents and 162 offspring) and HC parents (88 parents and 175 offspring) ages 7-18 at intake, from the Bipolar Offspring Study (BIOS), were followed for an average of 4.3 years. Family functioning was evaluated using the child- and parent-reported Family Adaptability and Cohesion Scale-II (FACES II) and the Conflict Behavior Questionnaire (CBQ). The data was analyzed using multivariate multilevel regression, generalized linear estimating equation models, and path analysis. Results Families of BD parents and parents with non-BD psychopathology showed lower cohesion and adaptability and higher conflict as compared with HC families. There were no significant differences in cohesion and adaptability between the families of parents with psychopathology. The effect of parental psychopathology on family functioning was mediated by parental psychosocial functioning, and to a lesser extent, offspring disorders. In all three groups, parent-reported family conflict was significantly higher than child-reported conflict. Across groups, family cohesion decreased over follow-up, whereas conflict increased. Conclusion Any parental psychopathology predicted family impairment. These results were influenced by the offspring’s age and were mediated by parental psychosocial functioning, and to a lesser degree, by offspring psychopathology. These findings emphasize the need to routinely assess family functioning in addition to psychopathology and provide appropriate interventions to both parents and offspring.
Developmental Premorbid Body Mass Index Trajectories of Adolescents With Eating Disorders in a Longitudinal Population Cohort J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-12-13 Zeynep Yilmaz, Nisha C. Gottfredson, Stephanie C. Zerwas, Cynthia M. Bulik, Nadia Micali
Objective To examine whether childhood body mass index (BMI) trajectories are prospectively associated with later eating disorder (ED) diagnoses. Method Using a subsample from the Avon Longitudinal Study of Parents and Children (study N=1,502), we used random-coefficient growth models to compare premorbid BMI trajectories of individuals who later developed anorexia nervosa (AN; n=243), bulimia nervosa (BN; n=69), binge-eating disorder (BED; n=114), and purging disorder (PD; n=133) and a control group without EDs or ED symptoms (n=966). We tracked BMI longitudinally from birth to age 12.5 years and assessed EDs at ages 14, 16, and 18. Results Distinct developmental trajectories emerged for EDs at an early age. The average growth trajectory for individuals with later AN veered significantly below the control group prior to age 4 for female and age 2 for male participants. BMI trajectories were higher than the control trajectory for all other ED groups. Specifically, the mean BN trajectory veered significantly above controls at age 2 for female participants, but male participants with later BN did not exhibit higher BMIs. The mean BED and PD trajectories significantly diverged from control trajectory at age 6 or younger for both sexes. Conclusion Premorbid metabolic factors and weight may be relevant to the etiology of ED. In AN, premorbid low weight may represent a key biological risk factor or early manifestation of an emerging disease process. Observing children whose BMI trajectories persistently and significantly deviate from age norms for signs and symptoms of ED could assist identification of high risk individuals.
Adolescent Victimization and Self-Injurious Thoughts and Behaviors: A Genetically Sensitive Cohort Study J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-12-12 Jessie R. Baldwin, Louise Arseneault, Avshalom Caspi, Terrie E. Moffitt, Helen L. Fisher, Candice L. Odgers, Antony Ambler, Renate M. Houts, Timothy Matthews, Dennis Ougrin, Leah S. Richmond-Rakerd, Ryu Takizawa, Andrea Danese
Objective Victimized adolescents have elevated risk of self-injurious thoughts and behaviors. However, poor understanding of causal and non-causal mechanisms underlying this observed risk limits the development of interventions to prevent premature death among adolescents. We tested whether pre-existing family-wide and individual vulnerabilities account for victimized adolescents’ elevated risk of self-injurious thoughts and behaviors. Method Participants were 2,232 British children followed from birth to age 18 as part of the Environmental Risk (E-Risk) Longitudinal Twin Study. Adolescent victimization (maltreatment, neglect, sexual victimization, family violence, peer/sibling victimization, cyber-victimization, and crime victimization) was assessed through interviews with participants and co-informant questionnaires at the age 18 assessment. Suicidal ideation, self-harm, and suicide attempt in adolescence were assessed through interviews with participants at age 18. Results Victimized adolescents had an increased risk of suicidal ideation (Odds Ratio [OR]= 2.40, 95% CI=2.11-2.74), self-harm (OR=2.38, 95% CI=2.10-2.69), and suicide attempt (OR=3.14, 95% CI=2.54-3.88). Co-twin control and propensity-score matching analyses showed that these associations were largely accounted for pre-existing familial and individual vulnerabilities, respectively. Over and above their prior vulnerabilities, victimized adolescents still showed a modest elevation in risk for suicidal ideation (OR=1.36, 95%CI=1.06-1.76) and self-harm (OR=1.50, 95% CI=1.18-1.91), but not suicide attempt (OR=1.28, 95% CI=0.83-1.98). Conclusion Risk for self-injurious thoughts and behaviors in victimized adolescents is only partly explained by the experience of victimization. Pre-existing vulnerabilities account for a large proportion of the risk. Therefore, effective interventions to prevent premature death in victimized adolescents should not only target the experience of victimization but also address pre-existing vulnerabilities.
Reading Acquisition in Children: Developmental Processes and Dyslexia Specific Effects J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-12-07 Katarzyna Chyl, Agnieszka Dębska, Magdalena Łuniewska, Artur Marchewka, Bartosz Kossowski, Kenneth R. Pugh, Katarzyna Jednoróg
Objective Reduced activation to print in the left ventral, dorsal and anterior pathways has been implicated in readers with dyslexia (DR) but is also characteristic for typical beginning readers. As the majority of studies compared DR to their age-matched peers, the observed results could either represent a dyslexia phenotype or a developmental delay. We aimed to disentangle reading and dyslexia effects by employing two control groups: age and skill matched, and a longitudinal design. Method We compared brain response for print in DR with typical readers (TR) who at the beginning of schooling (TP1, 6-7 years) read on average 3 words per minute, such as DR at TP1, but improved reading to an average level; and advanced readers (AR) who at TP1 read as well as DR two years later (TP3, 8-9 years). The TR and DR groups were tracked longitudinally to observe neurodevelopmental changes. Results At TP1, DR did not differ from TR. Along with time, only TR developed neural circuit for reading in the left inferior frontal and fusiform gyri. At TP3, DR hypoactivated these areas compared to both age- (TR TP3) and reading-matched (AR TP1) controls. At TP3, TR hypoactivated left frontal and bilateral ventral occipital regions when compared to AR, but these effects were non-overlapping with DR hypoactivations and are partly explained by IQ. Conclusion Decreased activation of the left fusiform and inferior frontal gyri to print in DR results from an atypical developmental trajectory of reading and cannot be explained solely by lower reading skills.
Reward-Related Attentional Bias at Age 16 Predicts Onset of Depression During Nine Years of Follow-Up J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-07-19 Charlotte Vrijen, Catharina A. Hartman, Albertine J. Oldehinkel
Objective This study investigated whether low reward responsiveness marks vulnerability for developing depression in a large cohort of never-depressed 16-year-old adolescents who completed a reward task and were subsequently followed for 9 years, during which onset of depression was assessed. Method Data were collected as part of the TRacking Adolescents’ Individual Lives Survey (TRAILS), an ongoing prospective cohort study. Reward responsiveness was assessed by the spatial orienting task at 16 years and depression was assessed at 19 years by the World Health Organization Composite International Diagnostic Interview and at 25 years by the Lifetime Depression Assessment Self-Report. Participants who completed the reward task at 16 years, had no previous onset of depression, and were assessed on depression onset at 19 and/or 25 years were included in the present study (N = 531; 81 became depressed during follow-up). Results Difficulties in shifting attention from expected non-reward to expected reward and from expected punishment to expected non-punishment at 16 years predicted depression during follow-up. This was found only at an automatic level of information processing. Conclusion The findings suggest that decreased reward responsiveness at 16 years marks vulnerability for depression. Prevention programs may aim at increasing at-risk adolescents’ responsiveness to cues for potential rewards, particularly in situations in which they are focused on negative experiences.
What to Teach Parents to Reduce Disruptive Child Behavior: Two Meta-Analyses of Parenting Program Components J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-11-26 Patty Leijten, Frances Gardner, G.J. Melendez-Torres, Jolien van Aar, Judy Hutchings, Susanne Schulz, Wendy Knerr, Geertjan Overbeek
Objective Parenting programs are the recommended strategy for the prevention and treatment of disruptive child behavior. Similar to most psychosocial interventions, it is unknown which components of parenting programs (i.e., parenting techniques taught) actually contribute to program effects. Identifying what parents need to be taught to reduce disruptive child behavior can optimize intervention strategies, and refine theories on how parenting shapes disruptive child behavior. Method In two meta-analyses, we updated the evidence-base for effectiveness of parenting programs delivered at various levels of prevention and treatment of disruptive behavior. We searched six databases (e.g., PsycINFO, MEDLINE) for randomized trials and coded the parenting techniques taught in each program. We identified the techniques associated with program effects in general, and for prevention versus treatment, and immediate versus longer-term effects, specifically. Results Parenting program effects on disruptive behavior gradually increased per level of prevention (universal d=−0.21, selective d=−0.27, indicated d=−0.55) and treatment (d=−0.69) (Meta-Analysis 1: 154 trials, 398 effect sizes). Three out of 26 parenting techniques were associated with stronger program effects: positive reinforcement, praise in particular, and natural/logical consequences. Several additional techniques (e.g., relationship building and parental self-management) were associated with stronger effects in treatment, but weaker effects in prevention. No techniques were associated with stronger longer-term effects (Meta-Analysis 2: 42 trials, 157 effect sizes). Conclusion Positive reinforcement and nonviolent disciplining techniques (e.g., natural/logical consequences) seem key parenting program techniques to reduce disruptive child behavior. Additional techniques (e.g., parental self-management skills) might improve program effects in treatment, but not in prevention.
Lithium for the Maintenance Treatment of Bipolar I Disorder: A Double-Blind, Placebo-Controlled Discontinuation Study J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-11-26 Robert L. Findling, Nora K. McNamara, Mani Pavuluri, Jean A. Frazier, Moira Rynn, Russell Scheffer, Vivian Kafantaris, Adelaide Robb, Melissa DelBello, Robert A. Kowatch, Brieana M. Rowles, Jacqui Lingler, Jian Zhao, Traci Clemons, Karen Martz, Ravinder Anand, Perdita Taylor-Zapata
Objective This study examined the role of lithium in the maintenance treatment of pediatric patients with bipolar I disorder (BP-I). Method Participants, aged 7 to 17 years presenting with a manic or mixed episode, received 24 weeks of lithium treatment in one of two multiphase studies, the Collaborative Lithium Trials (CoLT 1 and CoLT 2). Responders were randomized to continue lithium or to be cross titrated to placebo for up to 28 weeks. The primary outcome measure was relative risk of study discontinuation for any reason. Results A Cox regression analysis found that those who continued treatment with lithium (n=17) had a lower hazard ratio compared to those who received placebo [n=14 (p=0.015)]. The vast majority of discontinuations were due to mood symptom exacerbations, with most of these occurring in the placebo-treated group. Discontinuation for other reasons occurred at similarly low rates across both group. Most adverse events were mild to moderate in severity, and only one study participant was discontinued from the trial owing to a serious adverse event (aggression). There was no statistically significant difference with respect to weight gain in participants receiving lithium compared to those receiving placebo. Conclusion This randomized, double-blind, placebo-controlled discontinuation trial builds support for the role of lithium as a maintenance treatment in pediatric patients with bipolar disorder and for the safety and tolerability of 28 weeks of maintenance lithium treatment.
Hypothalamic Networks in Adolescents With Excess Weight: Stress-Related Connectivity and Associations With Emotional Eating J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-11-26 Cristina Martín-Pérez, Oren Contreras-Rodríguez, Raquel Vilar-López, Antonio Verdejo-García
Objective Adolescents with excess weight are particularly sensitive to stress, which may contribute to the presence of emotional eating behaviors. It is proposed that this may be due to alterations in the connectivity between hypothalamic networks and regions of the “emotional nervous system”, involved in the regulate on of energy balance and stress processing. However, this remains to be clarified in adolescents with excess weight. Method We investigated whole-brain differences in the functional connectivity of the medial and lateral hypothalamus (MH and LH) between adolescents with excess (EW, N=53; mean age: 14.64, SD=1.78) and normal weight (NW, N=51; mean age=15.29, SD=1.75) using seed-based resting-state analyses. Then, in a subset of 22 adolescents with EW (mean age=15.75, SD=1.70) and 32 with NW (mean age=15.27, SD=2.03), we explored for group interactions between the MH/LH networks and stress response in the Trier Social Stress Task (TSST), and emotional eating, assessed with the Dutch Eating Behavior Questionnaire (DEB-Q). Results Compared to NW, EW showed higher functional connectivity in the LH-orbitofrontal cortex, ventral striatum, anterior insula, and in the MH-middle temporal cortex networks. EW also showed lower connectivity in the LH-cerebellum, and in the MH-middle prefrontal, pre and postcentral gyri networks. In EW, higher connectivity of the LH-nucleus accumbens and LH-midbrain networks were associated with stress response. Higher connectivity in the LH-midbrain was also associated with a greater presence of emotional eating behaviors within EW. Conclusion Adolescents with EW showed functional connectivity alterations within both MH/LH networks. Alterations in the LH network were linked with higher levels of stress response and emotional-driven eating patterns.
Brain Structure and Function in School-Age Children With Sluggish Cognitive Tempo Symptoms J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-11-26 Jesús Pujol, Ester Camprodon-Rosanas, Gerard Martínez-Vilavella, Laura Blanco-Hinojo, Santiago Medrano-Martorell, Santiago Batlle, Joan Forns, Núria Ribas, Montserrat Dolz, Jordi Sunyer
Objective Sluggish cognitive tempo (SCT) is a cluster of symptoms associated with poor function in various domains of major life activities that may comprise a novel attention disorder distinct from attention deficit/hyperactivity disorder (ADHD). Nevertheless, very little is known about the neural substrate of SCT in children. The present study aimed to examine associations between SCT symptoms and brain structure and function in school-age children. Method We performed a cross-sectional MRI study in 178 8- to 12-year-old children from primary schools in Barcelona, Spain. Data were collected between January 2012 and March 2013. Parents completed the Sluggish Cognitive Tempo–Child Behavior Checklist (SCT-CBCL). Participants underwent MRI to assess regional brain volume, white matter integrity using diffusion tensor imaging, and functional connectivity in major neural networks. Results SCT symptoms were associated with altered anatomy of the frontal lobe in the form of increased regional volume. The anomalously large cortical regions were less mature in terms of functional connectivity. Importantly, all the anatomical and functional anomalies identified remained significant after adjusting the analyses for ADHD symptom scores. Conclusion Our results suggest that SCT symptoms are associated with distinct features of brain structure and function that differ from the classical neural substrates described in ADHD.
Saving Holden Caulfield: A Review of Suicide Prevention in Children and Adolescents J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-11-22 David A. Brent
Objective The rate of adolescent suicide and suicidal behavior has risen dramatically in the past decade. The title of the paper comes from the classic coming of age novel by J.D. Salinger, A Catcher in the Rye. Its protagonist, Holden Caulfield, is a precocious adolescent who, in the face of his inability to cope with his own self-destructives urges, imagines himself saving “little kids playing some game in this big field of rye.” He is standing on the edge of cliff trying to catch “thousands of little kids” before they fall to their demise. This vignette from Catcher in the Rye provides a useful metaphor for the relationship between mental health professionals and youth at risk for suicide, and suggests more efficient and effective alternative interventions to prevent youth suicide compared to standing by the cliff. Method These four alternative approaches are described, namely: (1) leading youth away from the cliff (ie, prevention); (2) going to where youth are (ie, improving access to care); (3) working with others to change the rule in the field (ie, changing the way care is delivered); and (4) putting a fence around the cliff (ie, restriction of access to lethal agents). The evidence to support the utility and cost-effectiveness of each of these approaches is reviewed. Conclusion: There are extant, empirically supported, cost-effective approaches to the prevention and management of adolescent suicidal behavior that, if implemented widely, are likely to significantly reverse the decade-long rise in adolescent suicide.
Amygdala Functional Connectivity During Self-Face Processing in Depressed Adolescents With Recent Suicide Attempt J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-11-23 Gabriela Alarcón, Mitchell Sauder, Jia Yuan Teoh, Erika E. Forbes, Karina Quevedo
Objective Suicide is the second leading cause of death among adolescents; however, objective biomarkers of suicide risk are lacking. Aberrant self-face amygdala activity is associated with suicide ideation and its connectivity with neural regions that enable self-processing (e.g. medial prefrontal cortex) may be a suicide risk factor. Method Adolescents (11-17 years; N=120) were sorted into four groups: healthy controls (HC), depressed low suicide ideation (LS), depressed high suicide ideation (HS) and depressed suicide attempters (SA). Youth completed an emotional (Happy, Sad, Neutral) self-face recognition task in the scanner. Bilateral amygdala task-dependent functional connectivity was determined with psychophysiological interaction analysis. Connectivity was compared across groups and within Self versus Other faces across emotions and hemispheres. Voxel-wise results were thresholded (p<0.005, uncorrected) and corrected for multiple comparisons (p<0.05, family-wise error). Results HS and SA displayed greater amygdala connectivity with dorsolateral prefrontal cortex, dorsomedial prefrontal cortex and precuneus, compared to LS, who, in turn, showed greater connectivity than HC. Greater left amygdala-rostral anterior cingulate cortex (rACC) connectivity was observed in SA compared to all other groups, whereas right amygdala-rACC connectivity was greater in HS versus LS and HC. Conclusion Greater connectivity between amygdala and other regions implicated in self-face processing differentiated suicide ideation and suicide attempt groups. A dose-dependent response showed that greater rACC-left amygdala connectivity during self-face processing was associated with a recent suicide attempt, but a greater rACC-right amygdala connectivity was associated to suicide ideation. Suicide affects individuals of all age groups; however, growing rates in recent years have placed suicide as the second leading cause of death in adolescents and young adults. 1 Youth diagnosed with depressive disorders are particularly at risk for displaying suicidal behaviors, such that among adolescents with suicide ideation (SI), a diagnosis of major depressive disorder (MDD) predicts the development of a suicide plan and subsequent transition to suicide attempt.2 Therefore, isolating the neural correlates of suicide attempt behavior in this population may assist future studies identifying predictors of suicide attempt, which is of paramount importance. Current assessments of suicide risk rely on self-reports, which are limited due to unreliable reporting of suicide behaviors and because they yield unspecific markers common to many young individuals who would never attempt suicide. 3 Objectivebiomarkers of suicide risk are needed to effectively prevent suicide in this vulnerable population.
A Twin Study on the Association Between Psychotic Experiences and Tobacco Use During Adolescence J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-11-23 Wikus Barkhuizen, Mark J. Taylor, Daniel Freeman, Angelica Ronald
Objective Psychotic experiences (PE) are dimensional phenomena in the general population that resemble psychotic symptoms, such as paranoia and hallucinations. This is the first twin study to explore the degree to which tobacco use and PE share genetic or environmental influences. Previous studies on the association between adolescent tobacco use and PE have not considered PE dimensionally, included negative symptoms, or accounted for confounding by sleep disturbance and stressful life events. Method An unselected adolescent twin sample (N=3787 pairs; M age=16.16 years) reported on PE (paranoia, hallucinations, cognitive disorganization, grandiosity and anhedonia) and regularity of tobacco use. Parents rated the twins’ negative symptoms. Regression analyses were conducted while adjusted for sociodemographic characteristics, prenatal maternal smoking, cannabis use, sleep disturbance, and stressful life events. Bivariate twin modelling was employed to estimate the degree of genetic and common and unique environmental influences shared between tobacco use and PE. Results Regular smokers were significantly more likely to experience paranoia, hallucinations, cognitive disorganization and negative symptoms (β=.17-.34), but not grandiosity or anhedonia, than non-smokers, after adjustment for confounders. Paranoia, hallucinations and cognitive disorganization correlated ≥.15 with tobacco use (r = .15-.21, all p<.001). Significant genetic correlations (rA=.37-.45) were found. Genetic influences accounted for most of the association between tobacco use and paranoia (84%) and cognitive disorganization (81%). Familial influences accounted for 80% of the association between tobacco use and hallucinations. Conclusion Tobacco use and PE during adolescence were associated after adjustment for confounders. They appear to co-occur largely due to shared genetic influences.
Obsessive Compulsive Symptomatology in Community Youth: Typical Development or a Red Flag for Psychopathology? J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-11-24 Ran Barzilay, Ariana Patrick, Monica E. Calkins, Tyler M. Moore, Daniel H. Wolf, Tami D. Benton, James F. Leckman, Ruben C. Gur, Raquel E. Gur
Objective Obsessive compulsive symptoms (OCS) are common throughout development and often considered developmentally appropriate. We evaluated the prevalence and phenotypic heterogeneity of self-reported OCS in a large community youth sample not ascertained for seeking mental-health help. We aimed to identify patterns in OCS that are associated with serious psychopathology and may thus represent a “red flag” that merits psychiatric evaluation. Method Data were analyzed from youth from the Philadelphia Neurodevelopmental Cohort (N=7054, ages 11-21, 54% females). Participants underwent structured psychiatric interviews, including screening for OCS (8 obsessions, 8 compulsions, and hoarding) and other major psychopathology domains. Factor analysis was conducted to identify clustering of OCS presentation. Regression models were used to investigate association of OCS with threshold lifetime diagnoses of obsessive compulsive disorder (OCD), depressive episode, psychosis and suicide ideation. Results OCS were common in non-mental health-seeking individuals (38.2%), although only 3% met threshold OCD criteria. OCS were more common in females and post puberty. Factor analyses resulted in four factors: F1 – Bad Thoughts; F2 - Repeating/Checking; F3 – Symmetry; F4 – Cleaning/Contamination; and Hoarding as a separate item. All OCS were associated with higher rates of OCD, depression, psychosis and suicide ideation. However, endorsement of F1 symptoms, prevalent in more than 20% of the sample, showed the most substantial associations with major psychiatric conditions. Conclusion OCS are common in community youth. While for most youths OCS symptoms may be benign, some patterns of OCS are associated with major psychiatric conditions. These findings may help identify youth at risk for serious psychopathology.
Reducing Preschool Behavior Problems in an Urban Mental Health Clinic: A Pragmatic, Non-Inferiority Trial J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-11-12 Deborah Gross, Harolyn M.E. Belcher, Chakra Budhathoki, Mirian E. Ofonedu, Daryl Dutrow, Melissa Kurtz Uveges, Eric Slade
Objective This pragmatic, randomized, non-inferiority trial compared the effectiveness and cost of group-based parent management training (PMT) versus mastery-based individual coaching PMT in a low-income, predominantly African American sample. Method Parents seeking treatment for their 2-5 year old children’s behavior problems in an urban fee-for-service child mental health clinic were randomized to the Chicago Parent Program (CPP; n=81) or Parent-Child Interaction Therapy (PCIT; n=80). Consent followed clinic intake and diagnostic assessment and PMT was delivered by clinicians employed at the clinic. Primary outcome measures were externalizing child behavior problems, assessed at baseline and post-intervention follow-up, using the Child Behavior Checklist (CBCL) and average per participant treatment cost. Results Data from 158 parents were analyzed. Most were mothers (75.9%), African American (70.3%), and economically disadvantaged (98.7% Medicaid insured). Among the children, 58.2% were boys, mean age (SD) was 3.6 years (1.03). Based on CBCL scores, behavior problems improved in both conditions (Cohen’s d=0.57 for CPP and 0.50 for PCIT). CPP was not inferior to PCIT (90% CI -1.58, 4.22) at follow-up, even after controlling for differences in treatment length (90% CI -1.63, 4.87). Average per participant treatment cost was higher for PCIT (M=$2,151) than CPP (M=$1,413) (95% CI $-1,304, $-170). Conclusions Among parents of young children living in urban poverty, CPP is not inferior to PCIT for reducing child behavior problems. CPP requires less time to complete and costs a third less than PCIT.
Shortened Sleep Duration Causes Sleepiness, Inattention, and Oppositionality in Adolescents With ADHD: Findings From a Crossover Sleep Restriction/Extension Study J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-11-02 Stephen P. Becker, Jeffery N. Epstein, Leanne Tamm, Alina A. Tilford, Clair M. Tischner, Paul A. Isaacson, John O. Simon, Dean W. Beebe
Objective Although poor sleep is often reported in adolescents with attention-deficit/hyperactivity disorder (ADHD), prior studies have been correlational. This study investigated whether sleep duration is causally linked to sleepiness, inattention, and behavioral functioning in adolescents with ADHD. Method Seventy-two adolescents (ages 14-17 years) entered a three-week sleep protocol using an experimental crossover design. The protocol included a phase stabilization week, followed in randomized counterbalanced order by 1 week of sleep restriction (6.5 hours) and 1 week of sleep extension (9.5 hours). Sleep was monitored with actigraphy and daily sleep diaries, with laboratory visits at the end of each week. Analyses included 48 adolescents who had complete actigraphy data and successfully completed the sleep protocol (defined a priori as obtaining ≥1 hour actigraphy-measured sleep duration during extension compared to restriction). Parent and adolescent ratings of daytime sleepiness, ADHD symptoms, sluggish cognitive tempo (SCT), and oppositional behaviors were the primary measures. The A-X Continuous Performance Test (CPT) was a secondary measure. Results Compared to the extended sleep week, parents reported more inattentive and oppositional symptoms during the restricted sleep week. Both parents and adolescents reported more SCT symptoms and greater daytime sleepiness during restriction compared to extension. Adolescents reported less hyperactivity-impulsivity during sleep restriction than extension. No effects were found for parent-reported hyperactivity-impulsivity, adolescent-reported ADHD inattention, or CPT performance. Conclusion This study provides the first evidence that sleep duration is a causal contributor to daytime behaviors in adolescents with ADHD. Sleep may be an important target for intervention in adolescents with ADHD.
Psychotic-Like Experiences in Offspring of Parents With Bipolar Disorder and Community Controls: A Longitudinal Study J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-11-03 Iria Mendez, David Axelson, Josefina Castro-Fornieles, Danella Hafeman, Tina R. Goldstein, Benjamin I. Goldstein, Rasim Diler, Roger Borras, John Merranko, Kelly Monk, Mary Beth Hickey, Boris Birmaher
Objective To compare the prevalence and risk factors associated with Psychotic-Like-Experiences (PLE) in offspring of parents with bipolar disorder (BP) and offspring of community control parents. Method Delusional and hallucinatory subclinical psychotic experiences were evaluated at intake and longitudinally in a cohort study of 390 offspring of BP parents and 247 offspring of control parents aged 6-18 years old. The sample was followed up every 2.5 years on average for 8.3 years. 91.7% of the sample completed at least one follow up. Risk factors at intake and at each assessment until the onset of PLE were analyzed using survival models. Results 95 (14.9%) offspring reported PLE at some point of the study, 16.9% of BP parents and 11.7% of controls, without statistically significant differences. Psychotic disorders were less frequent, 16 (2.5%) in both groups. During follow-up, three variables remained as the most significant associated with PLE in the multivariate models: 1) presence of any psychiatric disorder (HR = 3.1; p = .01); 2) low psychosocial functioning (HR = 2.94; p < .0001); and 3) current or past history of physical or sexual abuse (HR = 1.85; p = .04). There were no effects of any subtype of BP, IQ, history of medical illnesses, exposure to medications, or perinatal complications. Conclusion In line with previous studies, PLE in our sample were relatively common, and were associated with higher morbidity during the follow-up. Contrary to the literature, neither family risk for bipolar nor early neurodevelopmental insults were associated with PLE.
Anxiety and Depressive Disorders in Offspring of Parents with Anxiety Disorders: A Meta-Analysis J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-11-01 Peter J. Lawrence, Kou Murayama, Cathy Creswell
Objective We conducted meta-analyses to assess risk of anxiety disorders among offspring of parents with anxiety disorders and to establish whether there is evidence of specificity of risk for anxiety disorders as opposed to depression in offspring, and whether particular parent anxiety disorders confer risks for particular child anxiety disorders. We also examined whether risk was moderated by offspring age, gender, temperament and the presence of depressive disorders in parents. Method We searched PsycINFO, PubMed and Web of Science in June, 2016 and July, 2017 (PROSPERO CRD42016048814). Study inclusion criteria: published in peer-reviewed journals; contained at least one group of parents with anxiety disorders and at least one comparison group of parents who did not have anxiety disorders; reported rates of anxiety disorders in offspring, and used validated diagnostic tools to ascertain diagnoses. We used random and mixed-effects models and evaluated study quality. Results We included 25 studies (7285 offspring). Where parents had an anxiety disorder, offspring were significantly more likely to have anxiety (RR: 1.76, 95% CI = 1.58-1.96) and depressive disorders (RR: 1.31, 95% CI = 1.13-1.52) than offspring of parents without anxiety disorders. Parent Panic Disorder and Generalized Anxiety Disorder appeared to confer particular risk. Risk was greater for offspring anxiety than depressive disorders (RR: 2.50, 95% CI = 1.50-4.16), and specifically for offspring Generalized Anxiety Disorder, Separation Anxiety Disorder and Specific Phobia, but there was no evidence that children of parents with particular anxiety disorders were at increased risk for the same particular anxiety disorders. Moderation analyses were possible only for offspring age, gender and parental depressive disorder; none were significant. Conclusion Parent anxiety disorders pose specific risks of anxiety disorders to offspring. However, there is limited support for transmission of the same particular anxiety disorder. These results support the potential for targeted prevention of anxiety disorders.
Prevalence and Correlates of Hypersomnolence Symptoms in US Teens J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-30 Bhanu Prakash Kolla, Jian-Ping He, Meghna P. Mansukhani, Suresh Kotagal, Mark A. Frye, Kathleen R. Merikangas
Objective Recent attention to pervasive sleep deficits in U.S. adolescents has focused on sleep patterns and insomnia, but there are limited data on the prevalence and correlates of hypersomnolence symptoms. Method The sample included 6,483 adolescents ages 13-18 years who were interviewed directly and had parent reports in the National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a nationally representative sample of US youth. Information on sleep patterns/symptoms that were collected in the interview was used to determine the population prevalence of DSM-5 criterion-A defined hypersomnolence and component symptoms. Logistic regression analyses were used to examine associations between sleepiness and sub-symptoms of hypersomnolence with weekday/weekend bedtime, sleep duration, mental disorders and psychotropic medication use. Results 41.5% of US adolescents reported feeling sleepy during the daytime and 11.7% met criteria for hypersomnolence. The prevalence of hypersomnolence varied depending on age (p<0.001) and was more common in adolescent girls (OR=1.40; 95% CI=1.09-1.78). Excessive sleepiness and hypersomnolence symptoms were associated with reduced sleep duration and delayed bedtimes on weekdays and weekends Hypersomnolence was significantly associated with insomnia (OR=2.45; 95% CI=1.87-3.21) and mental disorders (OR=1.99; 95% CI=1.42-2.77). After accounting for insomnia, hypersomnolence was no longer associated with use of psychotropic medication (OR=1.61; CI=0.97-2.66). Conclusion Among adolescents with adequate sleep duration, we found that 11.7% still report symptoms of hypersomnolence. The strong association between hypersomnolence with insomnia suggests that sleep disorders in adolescents may fluctuate between over- and under-sleeping. Potential mechanisms underpinning the strong associations between sleep disturbances and mental disorders should be further pursued and may provide insight into prevention efforts.
Prescription Drug Misuse Sources of Controlled Medications in Adolescents J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-30 Ty S. Schepis, Timothy E. Wilens, Sean Esteban McCabe
Objective Adolescent controlled prescription drug misuse (PDM) co-occurs with significant consequences, including lower educational achievement, substance use disorder (SUD) symptoms, and psychopathology. Nonetheless, adolescent PDM sources and the prevalence of other substance use, SUD and mental health outcomes associated with sources remain poorly understood. Method Data were from the 2009-2014 National Survey on Drug Use and Health, including 103,920 adolescents (12-17 years). Six mutually exclusive sources were used: physician source only, theft/fake prescription only, friend/relative for free only, purchases only, other source only, or multiple sources. Analyses occurred separately for prescription opioids, stimulants and tranquilizer/sedatives. PDM source prevalence across adolescents and by sex and school enrollment/engagement were estimated. Adjusted odds of past-year DSM-IV substance-specific SUD, marijuana use, any SUD, major depression (MDD), anxiety diagnosis and mental health treatment and past-month binge drinking were estimated by source. Results Friends/relatives for free was the most common source (29.0%-33.2%), followed by physician sources for opioids (23.9%) and purchases for stimulants (23.5%) and tranquilizer/sedatives (22.7%). Few school enrollment/engagement differences existed, but females were more likely to use multiple sources. Over 70% of adolescents using multiple sources had a past-year SUD. Multiple sources, purchases, and theft/fake prescription were more strongly associated with other substance use than physician source use, and multiple source use was linked with MDD. Conclusion Adolescents using multiple sources, purchases and theft/fake prescriptions have elevated rates of other substance use, SUD and MDD and particularly warrant intervention. Also, adolescents with other SUD and MDD should be screened for PDM and misuse sources.
Sertraline Effects on Striatal Resting-State Functional Connectivity in Youth With OCD: A Pilot Study J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-30 Gail A. Bernstein, Kathryn R. Cullen, Elizabeth C. Harris, Christine A. Conelea, Alexandra D. Zagoloff, Patricia A. Carstedt, Susanne S. Lee, Bryon A. Mueller
Objective Foundational knowledge on neural circuitry underlying pediatric obsessive-compulsive disorder (OCD) and how it changes during standard treatment is needed to provide the basis for conceptualization and development of novel, targeted treatments. This study explored the effects of sertraline, a selective serotonin reuptake inhibitor, on resting-state functional connectivity (RSFC) in cortico-striatal-thalamic-cortical circuits in pediatric OCD. Method Medication-free youths with OCD (n=14) and healthy controls (n=14) were examined at baseline and 12 weeks with resting-state fMRI. Between scan sessions, participants with OCD received 12 weeks of sertraline. For each scan, we conducted seed-based whole-brain RSFC analyses with 6 striatal seeds. Analysis of variance (ANOVA) examined the interaction between group and time on striatal connectivity, including cluster-based thresholding to correct for multiple tests. Connectivity changes within circuits identified in group analyses were correlated with clinical change. Results Two significant group x time effects in the OCD group showed increased striatal connectivity from baseline to 12 weeks compared with controls. Circuits demonstrating this pattern included right putamen with left frontal cortex/insula and left putamen with left frontal cortex and pre- and post-central cortices. Increase in connectivity in left putamen circuit was significantly correlated with clinical improvement on Children’s Yale-Brown Obsessive-Compulsive Scale (r = -0.58, p = .03). Conclusion Sertraline appears to affect specific striatal-based circuits in pediatric OCD, and in part, these changes may account for clinical improvement. Future work is needed to confirm these preliminary findings, which would facilitate identification of circuit-based targets for novel treatment development.
Alcohol Use and Disordered Eating in a US Sample of Heterosexual and Sexual Minority Adolescents J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-30 Jerel P. Calzo, Blair C. Turner, Rachel Marro, Gregory L. Phillips
Objective To expand knowledge of co-occurring alcohol use and disordered eating behaviors (DEB) among sexual minority (ie, nonheterosexual) youth. Method Using pooled 2009-2015 US Youth Risk Behavior Surveys (322,687 students; 7.3% lesbian, gay, bisexual), multivariable logistic regression models examined: (1) associations of age of onset of drinking and past month binge drinking with past year DEB (fasting, diet pill use, purging, steroid use); and (2) effect modification by sexual orientation. Results Alcohol use and sexual minority identity were independently associated with elevated odds for diet pill use and purging among females, and fasting and steroid use among males. Odds of fasting increased with greater frequency of monthly binge drinking among heterosexual adolescent females, and odds of diet pill use increased with greater frequency of monthly binge drinking among heterosexual adolescent males. DEB prevalence was particularly pronounced among adolescents who binge drank and who were not sure of their sexual orientation identity. Among males not sure of their sexual orientation identity, those who binge drank more than one day in the past month had 8.63-23.62 times the odds of using diet pills relative to those who did not binge drink, and 13.37-26.42 times the odds of purging relative to those who did not binge drink. Conclusion More research is needed on psychosocial factors underlying alcohol use and DEB in youth of all sexual orientations.
Underlying Psychophysiology of Dysregulation: Resting Heart Rate and Heart Rate Reactivity in Relation to Childhood Dysregulation J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-31 Marike H.F. Deutz, Steven Woltering, Helen Vossen, Maja Deković, Anneloes L. van Baar, Peter Prinzie
Objective High co-occurrence of externalizing and internalizing problems may underlie inconsistent findings regarding the relation between heart rate and psychopathology. In this study, heart rate measures are examined in relation to a general dysregulation profile, studied from both a variable- and person-centered approach. Method The sample (N = 182) consisted of 8-12-year-old children referred for externalizing behaviors and typically-developing children (Mage = 9.70, SD = 1.26, 75.8% boys). Resting heart rate (HRrest) was assessed during a 3-minute resting period. Heart rate reactivity (HRreactivity) was assessed during an emotionally evoking Go/No-Go task. Results From a variable-centered approach, a bifactor model was fitted with a general factor of dysregulation underlying symptoms of anxiety/depression, aggression and attention problems. HRrest was positively associated with dysregulation and specific aggression. From a person-centered approach, a latent profile analysis was used to identify different psychopathology classes: normative (n = 92), predominantly-aggressive (n = 69) and dysregulated (n = 14). The latter was characterized by co-occurring elevated levels of anxiety/depression, aggression and attention problems. HRrest was elevated in the predominantly-aggressive class and HRreactivity was elevated in the dysregulated class. Conclusions High HRrest, or (trait-like) overarousal seems to be associated with dysregulation rather than uniquely with low externalizing or high internalizing symptomatology. Additionally, HRrest predicted higher aggression and HRrest was elevated in the predominantly-aggressive class. High HRreactivity, or enhanced emotional reactivity, might be characteristic for a clinically relevant dysregulated subgroup. Assessment of heart rate could provide additional knowledge on individual differences that can help refine diagnostics and intervention efforts.
Deficient Functioning of Fronto-Striatal Circuits During the Resolution of Cognitive Conflict in Cannabis-Using Youth J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-31 Marilyn Cyr, Gregory Z. Tau, Martine Fontaine, Frances R. Levin, Rachel Marsh
Objective Disturbances in self-regulatory control are involved in the initiation and maintenance of addiction, including cannabis use disorder (CUD). In adults, chronic cannabis use is associated with disturbances in fronto-striatal circuits during tasks that require the engagement of self-regulatory control, including the resolution of cognitive conflict. Understudied are the behavioral and neural correlates of these processes earlier in the course of cannabis use, disentangled from effects of long-term use. The present study investigates the functioning of fronto-striatal circuits during the resolution of cognitive conflict in cannabis-using youth. Method Functional magnetic resonance imaging data was acquired from 28 cannabis-using (CU) youth and 32 age-matched healthy participants (HC) during the performance of a Simon task. General linear modeling was used to compare patterns of brain activation during correct responses to conflict stimuli across groups. Psychophysiological interaction analyses were used to examine conflict-related fronto-striatal connectivity across groups. Associations of fronto-striatal activation and connectivity with cannabis use measures were explored. Results Reduced conflict-related activity was detected in CU relative to HC youth in fronto-striatal regions, including ventromedial prefrontal cortex (vmPFC), striatum, pallidum and thalamus. Fronto-striatal connectivity did not differ across groups, but negative connectivity between vmPFC and striatum was detected in both groups. Conclusion These findings are consistent with previous reports of cannabis-associated disturbances in fronto-striatal circuits in adults and point to the specific influence of cannabis on neurodevelopmental changes in youth. Future studies should examine whether fronto-striatal functioning is a reliable marker of CUD severity and potential target for circuit-based interventions.
Adolescent Depression and Long-Term Psychosocial Outcomes: A Systematic Review and Meta-Analysis J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-29 Zahra M. Clayborne, Melanie Varin, Ian Colman
Objective Experiencing depression in adolescence can disrupt important developmental processes, which can have long-standing impacts on socioeconomic status and relationships. The objective of this paper was to systematically review the evidence examining associations between adolescent depression and adult psychosocial outcomes. Method Five databases (MEDLINE, Embase, PsycINFO, CINAHL, and ERIC) were searched for articles published between 1980 and March 2017. Eligible articles were peer-reviewed, published in English, had prospective cohort study designs, and contrasted adult psychosocial outcomes between those with and without adolescent depression. Outcomes with sufficient data were pooled using random effects meta-analyses, with summary measures reported as odds ratios. A protocol for this review was registered on PROSPERO (CRD42017059662). Results Of the 4,988 references screened for inclusion, 31 articles comprising 136 analyses were included for review. 24 cohorts were represented. 77 analyses across ten outcomes were meta-analyzed, with remaining analyses summarized narratively. Meta-analyses suggested that adolescent depression was associated with outcomes including, but not limited to, failure to complete secondary school (odds ratio [OR] = 1.76, 95% CIs 1.29- 2.39); unemployment (OR=1.66, 1.29-2.14); and pregnancy/parenthood (OR=1.38, 1.06-1.81). Conclusion This review demonstrates that adolescent depression is associated with a myriad of adult psychosocial outcomes. Many are linked and can lead to the propagation of difficulties across the lifespan. These findings can have important implications for encouraging the provision of targeted mental health care early in development to improve life chances.
What Outcomes Count? A Review of Outcomes Measured for Adolescent Depression Between 2007 and 2017 J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-29 Karolin Rose Krause, Holly Alice Bear, Julian Edbrooke-Childs, Miranda Wolpert
Objective Measurement of treatment outcomes in childhood depression has traditionally focused on assessing symptoms from the clinician’s perspective, without exploring other outcome domains or considering young people’s perspectives. This systematic review explored the extent to which multidimensional and multi-informant outcome measurement have been used in clinical research for adolescent depression in the past decade, and how patterns evolved over time. Method We searched Embase, MEDLINE and PsycINFO, and included studies published between 2007 and 2017 that assessed the effectiveness of treatments or service provision for adolescent depression. Of 7483 studies screened, 95 met inclusion criteria and were included for data extraction and analysis. Results We identified ten outcomes domains, of which studies assessed two on average, using four outcome measures. Most studies (94%) measured symptoms, followed by functioning (52%). Other domains such as personal growth, relationships, quality of life, or service satisfaction were each considered by less than one in ten studies. Youth self-report was considered by 54% but tended to focus on secondary outcomes. Multidimensional and multi-informant measurement has been more frequent in studies published since 2015. Conclusion Recent clinical research continues to prioritize symptoms measurement based on clinician report and has not yet fully embraced multi-dimensional and multi-informant approaches. In the context of significant policy shifts towards patient-centered and evidence-based care, measuring what matters most to patients has become a priority, but this is not yet widely reflected in clinical research.
Quantifying the Optimal Structure of the Autism Phenotype: A Comprehensive Comparison of Dimensional, Categorical, and Hybrid Models J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-29 Hyunsik Kim, Cara Keifer, Craig Rodriguez-Seijas, Nicholas Eaton, Matthew Lerner, Kenneth Gadow
Objective The two primary – seemingly contradictory – strategies for classifying child psychiatric syndromes are categorical and dimensional; conceptual ambiguities appear to be greatest for polythetic syndromes such as autism spectrum disorder (ASD). Recently, a compelling alternative has emerged that integrates both categorical and dimensional approaches (ie, hybrid model) thanks to the increasing sophistication of analytic procedures. This study aimed to quantify the optimal phenotypic structure of ASD by comprehensively comparing categorical, dimensional, and hybrid models. Method The sample comprised 3,825 youth, who were consecutive referrals to a university developmental disabilities or child psychiatric outpatient clinic. Caregivers completed the Child and Adolescent Symptom Inventory-4R (CASI-4R), which includes an ASD symptom rating scale. A series of latent class analyses, exploratory and confirmatory factor analyses, and factor mixture analyses was conducted. Replication analyses were conducted in an independent sample (N=2,503) of children referred for outpatient evaluation. Results Based on comparison of 44 different models, results indicated that the ASD symptom phenotype is best conceptualized as multi-dimensional versus a categorical or categorical-dimensional hybrid construct. ASD symptoms were best characterized as falling along three dimensions (ie, social interaction, communication, and repetitive behavior) on the CASI-4R. Conclusion Findings reveal an optimal structure with which to characterize the ASD phenotype using a single, parent-report measure, supporting presence of multiple correlated symptom dimensions that traverse formal diagnostic boundaries and quantify the heterogeneity of ASD. These findings inform understanding of how neurodevelopmental disorders can extend beyond discrete categories of development and represent continuously-distributed traits across the range of human behaviors.
Increased Functional Connectivity Between Ventral Attention and Default Mode Networks in Adolescents with Bulimia Nervosa J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-29 Mirjana J. Domakonda, Xiaofu He, Secondo Lee, Marilyn Cyr, Rachel Marsh
Objective Bulimia nervosa (BN) is characterized by excessive attention to self and, specifically, body shape and weight, but the ventral attention (VAN) and default mode networks (DMN) that support attentional and self-referential processes are understudied in BN. We assessed whether altered functional connectivity within and between these networks contributes to such excessive concerns in adolescents with BN, early the course of the disorder. Method Resting-state functional magnetic resonance imaging scans were acquired from 33 BN and 37 healthy comparison (HC) adolescents (aged 12 to 21 years), group-matched by age and body mass index. Region-of-interest analyses were performed to examine group differences in functional connectivity within and between the VAN and DMN. We further explored associations of VAN-DMN connectivity with BN symptoms, body shape/weight concerns, and sustained attention on the Continuous Performance Test (CPT). Results Compared to HC adolescents, those with BN showed significantly increased positive connectivity between right ventral supramarginal gyrus and all DMN regions, as well as between right ventrolateral prefrontal cortex and left lateral parietal cortex. Within-network connectivity did not differ between groups. VAN-DMN connectivity was associated with BN severity and body shape/weight concerns in the BN group. No significant group-by-CPT interactions on VAN-DMN connectivity were detected. Conclusion Increased positive VAN-DMN connectivity in adolescents with BN may reflect abnormal engagement of VAN-mediated attentional processes at rest, perhaps related to their excessive attention to self-referential thoughts about body shape/weight. Future studies should further investigate these circuits as targets for the development of early interventions aimed at decreasing excessive body shape/weight concerns.
Attachment-Based Family and Non-Directive Supportive Treatments for Suicidal Youth: A Comparative Efficacy Trial J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-30 Guy S. Diamond, R. Rogers Kobak, E. Stephanie Krauthamer Ewing, Suzanne A. Levy, Joanna L. Herres, Jody M. Russon, Robert J. Gallop
Objective To evaluate the efficacy of Attachment-based Family Therapy (ABFT) compared to a Family Enhanced Non-Directive Supportive Therapy (FE-NST) for reducing adolescents’ suicide ideation and depressive symptoms. Method A randomized controlled trial of 129 suicidal adolescents, between the ages of 12 to 18 (49% were African-American) were randomized to ABFT (n = 66) or FE-NST (n = 63) for 16 weeks of treatment. Assessments occurred at baseline, 4, 8, 12, and 16 weeks. Trajectory of change and clinical recovery were calculated for suicidal ideation and depressive symptoms. Results: There was no significant between group difference in the rate of change in self-reported ideation Suicidal Ideation Questionnaire-Jr (SIQ-JR) (F(1,127) = 181, p=0.18). Similar results were found for depressive symptoms. However, adolescents receiving ABFT showed significant reduction in suicide ideation (t (127) = 12.61, p < .0001; effect size: d = 2.24). Adolescents receiving FE-NST experienced a similar significant reduction (t (127) = 10.88, p < .0001; effect size: d = 1.93). Response rates (i.e. 50% or more reduction in suicide ideation symptoms from baseline) at post-treatment were 69.1% for ABFT versus 62.3% for FE-NST. Conclusion Contrary to expectations, ABFT did not perform better than FE-NST. Both treatments produced substantial reductions in suicidal ideation and depressive symptoms that were comparable to or better than those reported in other more intensive, multicomponent treatments. The equivalent outcomes may be attributed to common treatment elements, different active mechanisms, or regression to the mean. Future studies will explore long-term follow up, secondary outcomes, and potential moderators and mediators.
Pathways of Association Between Childhood Irritability and Adolescent Suicidality J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-30 Massimiliano Orri, Cedric Galera, Gustavo Turecki, Michel Boivin, Richard E. Tremblay, Marie-Claude Geoffroy, Sylvana M. Côté
Objective Childhood irritability predicts suicidal ideation/attempt (suicidality), but it is unclear whether irritability is an independent and direct risk factor for suicidality, or a marker of intermediate mental health symptoms associated with suicidality. We aimed to (1) identify developmental patterns of childhood irritability; (2) test whether childhood irritability is directly associated with suicidality, or whether it is indirectly associated via intermediate mental health symptoms. Method N=1,393 participants from the Quebec Longitudinal Study of Child Development (QLSCD) were followed from birth to 17 years. Teachers assessed irritability yearly (6 to 12 years) and children self-reported intermediate mental health symptoms (depression, anxiety, disruptiveness, hyperactivity-impulsivity; 13 years), and suicidality (15 and 17 years). Results We identified 4 irritability trajectories: low (74.7%), rising (13.0%), declining (7.4%), persistent (5.0%). Children following a rising irritability trajectory (versus low trajectory) were at higher suicidality risk. A large proportion of this association was direct (OR=2.11, 95%CI=1.30-3.43) and a small proportion was indirect, via depressive symptoms (accounting for 23% of the association; OR=1.17, 95%CI=1.03-1.34). Children on a persistent irritability trajectory (versus low trajectory) were at higher risk of suicidality and this association was uniquely indirect, via depressive symptoms (accounting for 73% of the association; OR=1.51, 95%CI=1.16-1.97). The declining trajectory was not related to suicidality; no association via anxiety, disruptiveness and hyperactivity-impulsivity was found. Conclusion Rising irritability across childhood represents a direct risk for suicidality. Persistent irritability appears to be a distal marker of suicidality, acting via more proximal depressive symptoms.
Critical Decision Points for Augmenting Interpersonal Psychotherapy for Depressed Adolescents: A Pilot SMART J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-27 Meredith Gunlicks-Stoessel, Laura Mufson, Gail Bernstein, Ana Westervelt, Kristina Reigstad, Bonnie Klimes-Dougan, Kathryn Cullen, Aimee Murray, David Vock
Objective Practice parameters recommend systematic assessment of depression symptoms over the course of treatment to inform treatment planning; however, there are currently no guidelines regarding how to use symptom monitoring to guide treatment decisions for psychotherapy. The current study compared two time points (week 4 and 8) for assessing symptoms during interpersonal psychotherapy for depressed adolescents (IPT-A) and explored four algorithms that use the symptom assessments to select the subsequent treatment. Method Forty adolescents (age 12-17) with a depression diagnosis began IPT-A with an initial treatment plan of 12 sessions delivered over 16 weeks. Adolescents were randomized to a week 4 or 8 decision point for considering a change in treatment. Insufficient responders at either time point were randomized a second time to increased frequency of IPT-A (twice per week) or addition of fluoxetine. Measures were administered at baseline and weeks 4, 8, 12, and 16. Results The week 4 decision point for assessing response and implementing treatment augmentation for insufficient responders was more efficacious for reducing depression symptoms than the week 8 decision point. There were significant differences between algorithms in depression and psychosocial functioning outcomes. Conclusion Therapists implementing IPT-A should routinely monitor depression symptoms and consider augmenting treatment for insufficient responders as early as week 4 of treatment.
Disciplinary Parenting Practice and Child Mental Health: Evidence From the UK Millennium Cohort Study J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-25 Priya Rajyaguru, Paul Moran, Miguel Cordero, Rebecca Pearson
Objective To investigate whether a longitudinal association exists between differential disciplinary parenting practices at age 3 and later child psychopathology at age 11. Method Data were obtained from the Millennium Cohort Study (MCS), a UK wide cohort. Discipline style was assessed using a validated maternal reported questionnaire at age 3, for which later outcome data were available. We distinguished between ‘active’ (including smacking, shouting and telling off) and ‘withdrawal’ approaches (including ignoring, removal of privileges and sending to bedroom). Child emotional and behavioral problems were assessed at age 3 and 11 using the maternally completed Strengths and Difficulties Questionnaire (SDQ). The independence of associations between early discipline and later child mental health were investigated using mutually adjusted regression analyses and potential reverse causality was considered by looking at changes between SDQ subscale scores from age 3 to 11. Results Differential associations with change in child psychopathology according to discipline type was observed. Both active and withdrawal discipline were associated with a reduction in conduct problems from ages 3 to 11 (active beta cf -0.28, 95% CI -0.34 to -0.21, p<0.001 and withdrawal beta cf -0.19 95% CI -0.24 to -014, p<0.001). However, active approaches were also associated with an increase in emotional problems (beta cf 0.07 95% CI 0.00 to 0.14, p=0.03); not observed for withdrawal approaches. Conclusion Different approaches to discipline appear to have differential associations with later child mental health. Further research accounting for a greater number of parent and child characteristics is needed to assess whether such associations are causal.
Development and Psychometric Evaluation of the Children’s Yale-Brown Obsessive-Compulsive Scale Second Edition J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-25 Eric A. Storch, Joseph F. McGuire, Monica S. Wu, Rebecca Hamblin, Elizabeth McIngvale, Sandra L. Cepeda, Sophie C. Schneider, Katrina A. Rufino, Steven A. Rasmussen, Lawrence H. Price, Wayne K. Goodman
Objective To develop and examine the psychometric properties of the Children’s Yale-Brown Obsessive-Compulsive Scale Second Edition (CY-BOCS-II) in children and adolescents with obsessive-compulsive disorder (OCD). Method Youth with OCD (N=102; range 7-17 years), who were seeking treatment from one of two specialty OCD treatment centers, participated in the study. The CY-BOCS-II was administered at an initial assessment, and measures of OCD symptom severity, anxiety and depressive symptoms, behavioral and emotional problems, and global functioning were also administered. Inter-rater and test-retest reliability were assessed on a subsample of participants (n= 50 and n= 31, respectively) approximately one week after intial assessment. Results The CY-BOCS-II demonstrated moderate-to-strong internal consistency (α = .75-.88) and excellent inter-rater (ICC = .86-.92) and test-retest reliability (ICC = .95-.98) across all scales. Construct validity was supported by strong correlations with clinician-rated measures of OCD symptom severity and moderate correlations with measures of anxiety symptoms. Exploratory factor analysis revealed a two-factor structure, which was generally inconsistent with its adult counterpart, the Yale-Brown Obsessive-Compulsive Scale Second Edition (Y-BOCS-II). Conclusion Initial findings support the CY-BOCS-II as a reliable and valid measure of obsessive-compulsive symptoms in youth.
Trends, Safety, and Recommendations For Caffeine Use in Children and Adolescents J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-22 Jennifer L. Temple
Objective Caffeine use is common in children and adolescents, but the recommendations for safe consumption are based on decades-old data collected exclusively in adults. Increased availability of caffeine-containing products and a concerted marketing effort aimed at children and adolescents, has increased interest in understanding the physiological, behavioral, and psychological effects of caffeine within this population. This manuscript provides a review of the literature concerning trends and safety of ingested caffeine in children and adolescents. Method A search of the National Library of Medicine database was conducted using the terms: caffeine, children, adolescents, and safety in addition to tailored searches on specific topics using combinations of search terms such as energy drinks, cardiovascular, mood, cognitive, mental health, sleep and regulations. Results The majority of the literature reviewed here suggests that typical, moderate caffeine consumption in children and adolescents is relatively safe, but higher doses of caffeine consumption (> 400 mg) can cause physiological, psychological, and behavioral harm, in particular in subgroups of children, such as those with psychiatric or cardiac conditions. More attention is being paid to the potential adverse effects of both acute and chronic caffeine use and additional regulations surrounding the sale and marketing of highly caffeinated beverages are now being considered. Conclusion More research is needed to fill in gaps in our knowledge, including understanding the relationship between caffeine use and initiation of other substances, such as cigarettes, alcohol, or marijuana, identifying individuals at risk for caffeine toxicity, and developing harm-reduction strategies.
Clinical and Psychosocial Characteristics of Young Children with Suicidal Ideation, Behaviors and Non-Suicidal Self-Injurious Behaviors J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-22 Joan Luby, Diana Whalen, Rebecca Tillman, Deanna Barch
Objective Based on previous findings that suicidal ideation (SI) and behavior (SB) arose in depressed preschoolers and showed stability into school age, we sought to investigate whether unique clinical and psychosocial correlates of SI/SB and non-suicidal self-injurious behaviors (NSSI) could be identified in young children recuited into a depression treatment study and healthy controls. Method Data from n=288 3.0-6.11 year-old children recruited for participation in a psychotherapy treatment study of depression and n=26 healthy control subjects (total N=314) were used. At baseline, subjects received a comprehensive assessment of psychopathology and suicidal ideation/suicidal behavior. Multinominal logistic regressions were conducted comparing those with no SI/SB/NSSI to those with SI/SB or NSSI. Those with SI/SB who also had NSSI were placed in the SI/SB group. Results In this sample of young children, the rates of NSSI, SI, and SB were 21.3%, 19.1% and 3.5% respectively. Children with SI/SB or NSSI experienced a greater frequency of violent life events than children with no SI/SB/NSSI. Children with SI/SB had significantly more preoccupation with death compared to subjects with NSSI and subjects with no SI/SB/NSSI. Children with SI/SB had more vegetative signs of depression and greater depression severity and those with NSSI were more irritable with higher depression severity than those with no SI/SB/NSSI. Conclusion Distinct characteristics of SI/SB and NSSI in early childhood were identified, informing high risk sub-groups. Findings suggest that clinicians should be aware of the potential for SI/SB and/or NSSI in young children and should directly address these symptoms in clinical interviews.
Racial and Ethnic Differences in Adequate Depression Care Among Medicaid-Enrolled Youth J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-17 Janet R. Cummings, Xu Ji, Cathy Lally, Benjamin G. Druss
Objective We examined racial/ethnic disparities in the receipt of minimally adequate depression treatment among Medicaid-enrolled youth. Method We used 2008-2011 Medicaid claims data to derive a cohort of youth (age 5 to 17) that was diagnosed with a new episode of major depression (N=45,816) across nine states. Dichotomous outcomes measured the receipt of: (1) minimally adequate psychotherapy (≥ four psychotherapy visits within 12 weeks of initiation); (2) minimally adequate medication (filled antidepressants for 84 of 144 days); (3) any minimally adequate treatment (psychotherapy or medication); and (4) no psychotherapy or medication. Racial/ethnic disparities were estimated using multivariate logistic regressions that controlled for predisposing, enabling, and need-related factors. Results Less than four-tenths (38.3%) of the cohort received minimally adequate psychotherapy, 19.2% received minimally adequate pharmacotherapy, and 49.9% received any minimally adequate treatment; conversely, 16.4% received no treatment. The adjusted percentages of Black (42.3%, p<0.001) and Hispanic (48.2%, p<0.001) youth that received minimally adequate treatment were significantly lower than among non-Hispanic whites (54.7%), due to lower likelihoods of receiving minimally adequate psychotherapy and/or minimally adequate pharmacotherapy. Additionally, the adjusted percentages of Black (20.2%, p<0.001) and Hispanic (15.0%, p<0.01) youth that received no treatment were significantly greater than among non-Hispanic white youth (12.9%). Conclusion The percentage of Medicaid-enrolled youth that receive minimally adequate treatment for depression is low overall, and even lower among racial/ethnic minorities than among whites. Future research is needed to identify strategies that improve the overall quality of depression treatment among Medicaid-enrolled youth, as well as reduce disparities in care.
Network Meta-Analyses in Child and Adolescent Psychiatry: A Meta-Review J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-16 Samuele Cortese, Anneka Tomlinson, Andrea Cipriani
Objectives Network meta-analyses (NMAs) are gaining traction as the preferred method for evidence synthesis of intervention studies. We aimed to 1) summarize the basics of NMAs; 2) conduct a meta-review of available NMAs on the treatment of child/adolescent psychiatric disorders, appraising their quality. Method We systematically searched Pubmed (Medline), PsycInfo, Embase, Ovid Medline, and Web of Knowledge (last update: 9 January 2018). We appraised the quality of each included NMA using the AMSTAR-2 tool and the PRISMA-NMA checklist, which include specific items for NMAs. Results We retrieved 18 NMAs (ADHD: 6; psychotic disorders: 4; depression: 2; anxiety disorders: 2; OCD: 1; disruptive behavior disorder: 1, bipolar disorder: 1, plus one NMA on antipsychotics across disorders). Results from the AMSTAR-2 assessment showed that only 27% of the appraised NMAs were rated as moderate; the majority were rated as either low (33%) or critically low quality (40%). Only three of the appraised NMAs reported all of the PRISMA-NMA items specific for NMAs; the network structure was graphically presented in the majority of NMAs (80%), and inconsistency was only described in 47%. Conclusion Given the paucity of head-to-head trials in child and adolescent psychiatry, NMAs have the potential to contribute to the field, as they provide evidence-based hierarchies for treatment decision-making, even in the absence of trials directly comparing two or more treatments. However, due to important limitations in the included NMAs, additional methodologically-sound NMAs are needed to inform future guidelines and clinical practice in child and adolescent psychiatry.
Beyond a Binary Classification of Sex: An Examination of Brain Sex Differentiation, Psychopathology, and Genotype J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-09 Owen R. Phillips, Alexander K. Onopa, Vivian Hsu, Hanna Maria Ollila, Ryan Patrick Hillary, Joachim Hallmayer, Ian H. Gotlib, Jonathan Taylor, Lester Mackey, Manpreet K. Singh
Objective Sex differences in the brain are traditionally treated as binary. We present new evidence that a continuous measure of sex differentiation of the brain can explain sex differences in psychopathology. The degree of sex differentiated brain features (ie, features that are more common in one sex) may predispose individuals toward sex-biased psychopathology and may also be influenced by the genome. We hypothesized that individuals with a female-biased differentiation score would have greater female-biased psychopathology (internalizing symptoms, such as anxiety and depression), whereas individuals with a male-biased differentiation score would have greater male-biased psychopathology (externalizing symptoms, such as disruptive behaviors). Method Using the Philadelphia Neurodevelopmental Cohort database acquired from database of Genotypes and Phenotypes, we calculated the sex differentiation measure, a continuous data-driven calculation of each individual’s degree of sex differentiating features extracted from multimodal brain imaging data (Magnetic resonance imaging (MRI) /Diffusion MRI) from the imaged participants (n=866, 407F/459M). Results In males, higher differentiation scores were correlated with higher levels of externalizing symptoms (r=0.119, p=0.016). The differentiation measure reached genome-wide association study significance (p<5*10-8) in males with single nucleotide polymorphisms Chromsome5:rs111161632:RASGEF1C and Chromosome19:rs75918199:GEMIN7, and in females with Chromosome2:rs78372132:PARD3B and Chromosome15:rs73442006:HCN4. Conclusion The sex differentiation measure provides an initial topography of quantifying male and female brain features. This demonstration that the sex of the human brain can be conceptualized on a continuum has implications for both the presentation of psychopathology and the relation of the brain with genetic variants that may be associated with brain differentiation.
Parenting is an Environmental Predictor of Callous-Unemotional Traits and Aggression: A Monozygotic Twin Differences Study J. Am. Acad. Child Adolesc. Psychiatry (IF 6.25) Pub Date : 2018-10-09 Rebecca Waller, Luke W. Hyde, Kelly L. Klump, S. Alexandra Burt
Objective Callous-unemotional (CU) traits increase risk for children developing severe childhood aggression and Conduct Disorder. CU traits are typically described as highly heritable and debate continues about whether the parenting environment matters in their etiology. Strong genetically-informed designs are needed to test for the presence of environmental links between parenting practices and CU traits. Our objective was to determine whether parental harshness and parental warmth were related to children’s aggression or CU traits when accounting for genetically-mediated effects. Method We examined 227 monozygotic twin pairs (454 children) drawn from population-based and at-risk samples of twin families, leading to oversampling of twins living in poverty. We computed multi-informant difference scores combining mother and father reports of their harshness and warmth towards each twin, and differences in mother reports of each twin’s aggression and CU traits. Results Twin differences in parental harshness were related to differences in both aggression and CU traits, such that the twin who received harsher parenting had higher aggression and more CU traits. Differences in parental warmth were uniquely related to differences in CU traits, such that the twin receiving warmer parenting evidenced lower CU traits. These effects were not moderated by child sex, age, or family income, with the exception that the relationship between differential parental harshness and differential child aggression was stronger among low-income families. Conclusion Parenting is related to child CU traits and aggression, over and above genetically-mediated effects, with low parental warmth being a unique environmental correlate of CU traits.
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- J. Acad. Nutr. Diet.
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- J. Alloys Compd.
- J. Am. Ceram. Soc.
- J. Am. Chem. Soc.
- J. Am. Soc. Mass Spectrom.
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- J. Eur. Ceram. Soc.
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- J. Porphyr. Phthalocyanines
- J. Power Sources
- J. Solid State Chem.
- J. Taiwan Inst. Chem. E.
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- New J. Chem.
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- npj 2D Mater. Appl.
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- PLOS ONE
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- Polym. Rev.
- Powder Technol.
- Proc. Combust. Inst.
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- Prog. Solid State Chem.