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J Am Acad Child Adolesc Psychiatry [journal]
- True grit. [Letter]
- J Am Acad Child Adolesc Psychiatry 2014 May; 53(5):589.
- Disrupted expected value signaling in youth with disruptive behavior disorders to environmental reinforcers. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 May; 53(5):579-588.e9.
Youth with disruptive behavior disorders (DBD), including conduct disorder (CD) and oppositional defiant disorder (ODD), have difficulties in reinforcement-based decision making, the neural basis of which is poorly understood. Studies examining decision making in youth with DBD have revealed reduced reward responses within the ventromedial prefrontal cortex/orbitofrontal cortex (vmPFC/OFC), increased responses to unexpected punishment within the vmPFC and striatum, and reduced use of expected value information in the anterior insula cortex and dorsal anterior cingulate cortex during the avoidance of suboptimal choices. Previous work has used only monetary reinforcement. The current study examined whether dysfunction in youth with DBD during decision making extended to environmental reinforcers.A total of 30 youth (15 healthy youth and 15 youth with DBD) completed a novel reinforcement-learning paradigm using environmental reinforcers (physical threat images, e.g., striking snake image; contamination threat images, e.g., rotting food; appetitive images, e.g., puppies) while undergoing functional magnetic resonance imaging (fMRI).Behaviorally, healthy youth were significantly more likely to avoid physical threat, but not contamination threat, stimuli than youth with DBD. Imaging results revealed that youth with DBD showed significantly reduced use of expected value information in the bilateral caudate, thalamus, and posterior cingulate cortex during the avoidance of suboptimal responses.The current data suggest that youth with DBD show deficits to environmental reinforcers similar to the deficits seen to monetary reinforcers. Importantly, this deficit was unrelated to callous-unemotional (CU) traits, suggesting that caudate impairment may be a common deficit across youth with DBD.
- Predictive neurofunctional markers of attention-deficit/hyperactivity disorder based on pattern classification of temporal processing. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 May; 53(5):569-578.e1.
Attention-deficit/hyperactivity disorder (ADHD) is currently diagnosed on the basis of subjective measures, despite evidence for multi-systemic structural and neurofunctional deficits. A consistently observed neurofunctional deficit is in fine-temporal discrimination (TD). The aim of this proof-of-concept study was to examine the feasibility of distinguishing patients with ADHD from controls using multivariate pattern recognition analyses of functional magnetic resonance imaging (fMRI) data of TD.A total of 20 medication-naive adolescent male patients with ADHD and 20 age-matched healthy controls underwent fMRI while performing a TD task. The fMRI data were analyzed with Gaussian process classifiers to predict individual ADHD diagnosis based on brain activation patterns.The pattern of brain activation correctly classified up to 80% of patients and 70% of controls, achieving an overall classification accuracy of 75%. The distributed activation networks with the highest delineation between patients and controls corresponded to a distributed network of brain regions involved in TD and typically compromised in ADHD, including inferior and dorsolateral prefrontal, insula, and parietal cortices, and the basal ganglia, anterior cingulate, and cerebellum. These regions overlapped with areas of reduced activation in patients with ADHD relative to controls in a univariate analysis, suggesting that these are dysfunctional regions.We show evidence that pattern recognition analyses combined with fMRI using a disorder-sensitive task such as timing have potential in providing objective diagnostic neuroimaging biomarkers of ADHD.
- Amygdala-function perturbations in healthy mid-adolescents with familial liability for depression. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 May; 53(5):559-568.e6.
Functional magnetic resonance imaging (fMRI) studies have identified increased amygdala responses to negative stimuli as a risk marker of depression in adults, and as a state marker of depression in adults and adolescents. Hyperreactivity of the amygdala has been linked to negatively biased emotional processing in depression. However, no study has elucidated whether similar amygdala perturbations can be found in healthy mid-adolescents with familial liability for depression. We hypothesized that healthy 14-year-olds with relatives with depression would demonstrate increased amygdala responses to negative stimuli, as compared with their peers with no family history of mental disorders.We investigated a community-based sample of 164 typically developing 14-year-olds without record of past or current mental disorders. Of these individuals, 28 fulfilled criteria for family history of depression, and 136 served as controls. Groups did not differ with regard to cognitive ability, depressive symptomatology, and anxiety. During fMRI they performed a perceptual discrimination task in which visual target and distractor stimuli varied systematically with regard to emotional valence.Both a hypothesis-driven region-of-interest analysis and a whole-brain analysis of variance revealed that negative distractors elicited greater amygdala activation in adolescents with a family history of depression compared to controls. Amygdala responses also differed during the processing of negative target stimuli, but effects were reversed.Our study demonstrates that familial liability for depression is associated with correlates of negatively biased emotional processing in healthy adolescents. Amygdala perturbations during the processing of negative stimuli might reflect an early and subtle risk marker for depression.
- Sleep problems predict and are predicted by generalized anxiety/depression and oppositional defiant disorder. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 May; 53(5):550-8.
We tested whether sleep problems co-occur with, precede, and/or follow common psychiatric disorders during childhood and adolescence. We also clarified the role of comorbidity and tested for specificity of associations among sleep problems and psychiatric disorders.Data came from the Great Smoky Mountains Study, a representative population sample of 1,420 children, assessed 4 to 7 times per person between ages 9 and 16 years for major Diagnostic and Statistical Manual-Fourth Edition (DSM-IV) disorders and sleep problems. Sleep-related symptoms were removed from diagnostic criteria when applicable.Sleep problems during childhood and adolescence were common, with restless sleep and difficulty falling asleep being the most common symptoms. Cross-sectional analyses showed that sleep problems co-occurred with many psychiatric disorders. Longitudinal analyses revealed that sleep problems predicted increases in the prevalence of later generalized anxiety disorder (GAD) and high GAD/depression symptoms, and oppositional defiant disorder (ODD). In turn, GAD and/or depression and ODD predicted increases in sleep problems over time.Sleep problems both predict and are predicted by a diagnostic cluster that includes ODD, GAD, and depression. Screening children for sleep problems could offer promising opportunities for reducing the burden of mental illness during the early life course.
- An empirically derived classification of adolescent personality disorders. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 May; 53(5):528-49.
This study describes an empirically derived approach to diagnosing adolescent personality pathology that is clinically relevant and empirically grounded.A random national sample of psychiatrists and clinical psychologists (N = 950) described a randomly selected adolescent patient (aged 13-18 years, stratified by age and gender) in their care using the Shedler-Westen Assessment Procedure-II-A for Adolescents (SWAP-II-A) and several additional questionnaires.We applied a form of factor analysis to identify naturally occurring personality groupings within the patient sample. The analysis yielded 10 clinically coherent adolescent personality descriptions organized into 3 higher-order clusters (internalizing, externalizing, and borderline-dysregulated). We also obtained a higher-order personality strengths factor. These factors and clusters strongly resembled but were not identical to factors similarly identified in adult patients. In a second, independent sample from an intensive day treatment facility, 2 clinicians (the patients' treating clinician and the medical director) independently completed the SWAP-II-A, the Child Behavior Checklist (CBCL), and a measure of adaptive functioning. Two additional clinicians, blinded to the data from the first 2 clinicians, independently rated patients' ward behavior using a validated measure of interpersonal behavior. Clinicians diagnosed the personality syndromes with high agreement and minimal comorbidity among diagnoses, and SWAP-II-A descriptions strongly correlated in expected ways with the CBCL, adaptive functioning, and ward ratings.The results support the importance of personality diagnosis in adolescents and provide an approach to diagnosing adolescent personality that is empirically based and clinically useful.
- School Mobility and Prospective Pathways to Psychotic-like Symptoms in Early Adolescence: A Prospective Birth Cohort Study. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 May; 53(5):518-527.e1.
Social adversity and urban upbringing increase the risk of psychosis. We tested the hypothesis that these risks may be partly attributable to school mobility and examined the potential pathways linking school mobility to psychotic-like symptoms.A community sample of 6,448 mothers and their children born between 1991 and 1992 were assessed for psychosocial adversities (i.e., ethnicity, urbanicity, family adversity) from birth to 2 years, school and residential mobility up to 9 years, and peer difficulties (i.e., bullying involvement and friendship difficulties) at 10 years. Psychotic-like symptoms were assessed at age 12 years using the Psychosis-like Symptoms Interview (PLIKSi).In regression analyses, school mobility was significantly associated with definite psychotic-like symptoms (odds ratio [OR] =1.60; 95% CI =1.07-2.38) after controlling for all confounders. Within path analyses, school mobility (probit coefficient [β] = 0.108; p = .039), involvement in bullying (β = 0.241; p < .001), urbanicity (β = 0.342; p = .016), and family adversity (β = 0.034; p < .001) were all independently associated with definite psychotic-like symptoms. School mobility was indirectly associated with definite psychotic-like symptoms via involvement in bullying (β = 0.018; p = .034).School mobility is associated with increased risk of psychotic-like symptoms, both directly and indirectly. The findings highlight the potential benefit of strategies to help mobile students to establish themselves within new school environments to reduce peer difficulties and to diminish the risk of psychotic-like symptoms. Awareness of mobile students as a possible high-risk population, and routine inquiry regarding school changes and bullying experiences, may be advisable in mental health care settings.
- Parental Suicide Attempt and Offspring Self-Harm and Suicidal Thoughts: Results From the Avon Longitudinal Study of Parents and Children (ALSPAC) Birth Cohort. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 May; 53(5):509-517.e2.
Parental suicidal behavior is associated with offspring's risk of suicidal behavior. However, much of the available evidence is from population registers or clinical samples. We investigated the associations of self-reported parental suicide attempt (SA) with offspring self-harm and suicidal thoughts in the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective birth cohort.Parental SA was self-reported on 10 occasions from pregnancy until their child was 11 years of age. Offspring self-reported lifetime self-harm, with and without suicidal intent, suicidal thoughts, and suicide plans, at age 16 to 17 years. Multivariable regression models quantified the association between parental SA and offspring outcomes controlling for confounders.Data were available for 4,396 mother-child and 2,541 father-child pairs. Adjusting for confounders including parental depression, maternal SA was associated with a 3-fold increased risk of self-harm with suicidal intent in their children (adjusted odds ratio [aOR] = 2.94, 95% confidence interval [CI] = 1.43-6.07) but not with self-harm without suicidal intent (aOR = 0.83, 95% CI = 0.35-1.99). Children whose mother attempted suicide were more likely to report suicidal thoughts and plans (aOR = 5.04, 95% CI = 2.24-11.36; aOR = 2.17, 95% CI = 1.07-4.38, respectively). Findings in relation to paternal SA were somewhat weaker and not significant.Maternal SA increased their offspring's risk of self-harm with suicidal intent and of suicidal thoughts, but was unrelated to self-harm without intent; findings for paternal suicide attempt were weaker and not significant. Maternal SA, which may not come to the attention of health care professionals, represents a major risk for psychiatric morbidity in their offspring.
- A Comparison of DSM-IV Pervasive Developmental Disorder and DSM-5 Autism Spectrum Disorder Prevalence in an Epidemiologic Sample. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 May; 53(5):500-8.
Changes in autism diagnostic criteria found in DSM-5 may affect autism spectrum disorder (ASD) prevalence, research findings, diagnostic processes, and eligibility for clinical and other services. Using our published, total-population Korean prevalence data, we compute DSM-5 ASD and social communication disorder (SCD) prevalence and compare them with DSM-IV pervasive developmental disorder (PDD) prevalence estimates. We also describe individuals previously diagnosed with DSM-IV PDD when diagnoses change with DSM-5 criteria.The target population was all children from 7 to 12 years of age in a South Korean community (N = 55,266), those in regular and special education schools, and a disability registry. We used the Autism Spectrum Screening Questionnaire for systematic, multi-informant screening. Parents of screen-positive children were offered comprehensive assessments using standardized diagnostic procedures, including the Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule. Best-estimate clinical diagnoses were made using DSM-IV PDD and DSM-5 ASD and SCD criteria.DSM-5 ASD estimated prevalence was 2.20% (95% confidence interval = 1.77-3.64). Combined DSM-5 ASD and SCD prevalence was virtually the same as DSM-IV PDD prevalence (2.64%). Most children with autistic disorder (99%), Asperger disorder (92%), and PDD-NOS (63%) met DSM-5 ASD criteria, whereas 1%, 8%, and 32%, respectively, met SCD criteria. All remaining children (2%) had other psychopathology, principally attention-deficit/hyperactivity disorder and anxiety disorder.Our findings suggest that most individuals with a prior DSM-IV PDD meet DSM-5 diagnostic criteria for ASD and SCD. PDD, ASD or SCD; extant diagnostic criteria identify a large, clinically meaningful group of individuals and families who require evidence-based services.
- Risk for mood pathology: neural and psychological markers of abnormal negative information processing. [Editorial]
- J Am Acad Child Adolesc Psychiatry 2014 May; 53(5):497-9.