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J Am Acad Child Adolesc Psychiatry [journal]
- Not painless. [Letter]
- J Am Acad Child Adolesc Psychiatry 2014 Apr; 53(4):478.
- Child and Adolescent Psychiatrists Are Experts in Transitional Aged Youth, Aren't We? [Letter]
- J Am Acad Child Adolesc Psychiatry 2014 Apr; 53(4):476-7.
- Increased structural connectivity in corpus callosum in adolescent males with conduct disorder. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 Apr; 53(4):466-475.e1.
Adolescents with conduct disorder (CD) are at high risk for developing adult antisocial personality disorder. However, the underlying neuropathophysiology of CD remains poorly understood. We hypothesized that the microstructure of white matter (WM) of males with CD may differ from that of healthy control subjects (HCs).Tract-based spatial statistics (TBSS) and quantitative tractography were used to assess WM microstructural differences between 36 teenaged boys with CD and 33 demographically matched HCs.The CD group behavioral scale scores were significantly higher than those of the HCs on the Barratt Impulsivity Scale, the Strength and Difficulties Questionnaire, and the Antisocial Process Screening Device total scales. TBSS revealed that, relative to HCs, the CD group had higher fractional anisotropy (FA) in the corpus callosum (CC) region, bilaterally, including the genu and body of the CC, as well as in some projection fibers in the region of the left anterior coronal radiate and right superior coronal radiate. Tractography confirmed higher FA of fibers passing through the regions with significant differences in the TBSS results. Exploratory analysis revealed that impulsivity associated positively with the FA of these fibers in the CD group.Maturation of WM microstructure in CD subjects differed from that in HCs, mainly in the CC. The abnormal maturation of WM structures may play an important role in the impulsivity and aggression of teenagers with CD.
- Cortical and subcortical abnormalities in youths with conduct disorder and elevated callous-unemotional traits. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 Apr; 53(4):456-465.e1.
Although there is growing evidence of brain abnormalities among individuals with conduct disorder (CD), the structural neuroimaging literature is mixed and frequently aggregates cortical volume rather than differentiating cortical thickness from surface area. The current study assesses CD-related differences in cortical thickness, surface area, and gyrification as well as volume differences in subcortical structures critical to neurodevelopmental models of CD (amygdala; striatum) in a carefully characterized sample. We also examined whether group structural differences were related to severity of callous-unemotional (CU) traits in the CD sample.Participants were 49 community adolescents aged 10 to 18 years, 22 with CD and 27 healthy comparison youth. Structural MRI was collected and the FreeSurfer image analysis suite was used to provide measures of cortical thickness, surface area, and local gyrification as well as subcortical (amygdala and striatum) volumes.Youths with CD showed reduced cortical thickness in the superior temporal cortex. There were also indications of reduced gyrification in the ventromedial frontal cortex, particularly for youths with CD without comorbid attention-deficit/hyperactivity disorder. There were no group differences in cortical surface area. However, youths with CD also showed reduced amygdala and striatum (putamen and pallidum) volumes. Right temporal cortical thickness was significantly inversely related to severity of CU traits.Youths with CD show reduced cortical thickness within superior temporal regions, some indication of reduced gyrification within ventromedial frontal cortex and reduced amygdala and striatum (putamen and pallidum) volumes. These results are discussed with reference to neurobiological models of CD.
- Early behavioral inhibition and increased error monitoring predict later social phobia symptoms in childhood. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 Apr; 53(4):447-55.
Behavioral inhibition (BI) is an early childhood temperament characterized by fearful responses to novelty and avoidance of social interactions. During adolescence, a subset of children with stable childhood BI develop social anxiety disorder and concurrently exhibit increased error monitoring. The current study examines whether increased error monitoring in 7-year-old, behaviorally inhibited children prospectively predicts risk for symptoms of social phobia at age 9 years.A total of 291 children were characterized on BI at 24 and 36 months of age. Children were seen again at 7 years of age, when they performed a Flanker task, and event-related potential (ERP) indices of response monitoring were generated. At age 9, self- and maternal-report of social phobia symptoms were obtained.Children high in BI, compared to those low in BI, displayed increased error monitoring at age 7, as indexed by larger (i.e., more negative) error-related negativity (ERN) amplitudes. In addition, early BI was related to later childhood social phobia symptoms at age 9 among children with a large difference in amplitude between ERN and correct-response negativity (CRN) at age 7.Heightened error monitoring predicts risk for later social phobia symptoms in children with high BI. Research assessing response monitoring in children with BI may refine our understanding of the mechanisms underlying risk for later anxiety disorders and inform prevention efforts.
- Perceived family impact of preschool anxiety disorders. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 Apr; 53(4):437-46.
We examined the perceived impact of child anxiety disorders on family functioning, because such impact is a key predictor of mental health service receipt. In addition, we examined the relative impact of preschool anxiety compared to that of other early childhood disorders, and whether this impact persisted after accounting for the effects of comorbidity, or varied by child age and sex.Drawing from a pediatric primary-care clinic and oversampling for children at risk for anxiety, 917 parents of preschoolers (aged 2-5 years) completed a diagnostic interview and reported on child psychiatric symptom impact on family finances, relationships, activities, and well-being.After accounting for comorbid disorders, families of children with anxiety were 3.5 times more likely to report a negative impact of their child's behavior on the family relative to nondisordered children. Generalized and separation anxiety had an impact on family functioning similar to that of attention-deficit/hyperactivity disorder and disruptive disorders. There was a significant family impact for girls with social phobia, whereas there was no impact for boys.Preschool anxiety has a significant, unique impact on family functioning, particularly parental adjustment, highlighting the family impairment linked with early anxiety, and the need for further research on barriers to care for these disorders.
- Childhood attention-deficit/hyperactivity disorder symptoms are risk factors for obesity and physical inactivity in adolescence. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 Apr; 53(4):425-36.
To prospectively investigate the association and directionality between attention-deficit/hyperactivity disorder (ADHD) symptoms and obesity from childhood to adolescence in the general population. We examined whether obesogenic behaviors, namely, physical inactivity and binge eating, underlie the potential ADHD symptom-obesity association. We explored whether childhood conduct disorder (CD) symptoms are related to adolescent obesity/physical inactivity.At 7 to 8 years (n = 8,106), teachers reported ADHD and CD symptoms, and parents reported body mass index (BMI) and physically active play. At 16 years (n = 6,934), parents reported ADHD symptoms; adolescents reported physical activity (transformed to metabolic equivalent of task [MET] hours per week) and binge eating; BMI and waist-hip ratio (WHR) were measured via clinical examination. Obesity was defined using the International Obesity Task Force (IOTF) cut-offs for BMI and the 95th percentile cut-off for WHR.Childhood ADHD symptoms significantly predicted adolescent obesity, rather than the opposite. Inattention-hyperactivity symptoms at 8 years were associated with indices of obesity at 16 years (obese BMI: odds ratio [OR] = 1.91, 95% confidence interval [CI] = 1.10-3.33; 95th percentile WHR: OR = 1.71, 95% CI = 1.05-2.78), adjusted for gender, baseline BMI, physical activity, family structure change, and maternal education. Child CD symptoms associated with indices of adolescent obesity. Reduced physically active play in childhood predicted adolescent inattention (OR = 1.61, 95% CI = 1.16-2.24). Childhood ADHD and CD symptoms were linked with physical inactivity in adolescence (inattention-hyperactivity; OR = 1.60, 95% CI = 1.20-2.13), but not binge eating. Physical inactivity mediated the associations.Children with ADHD or CD symptoms are at increased risk for becoming obese and physically inactive adolescents. Physical activity may be beneficial for both behavior problems and obesity.
- Child abuse, depression, and methylation in genes involved with stress, neural plasticity, and brain circuitry. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 Apr; 53(4):417-424.e5.
To determine whether epigenetic markers predict dimensional ratings of depression in maltreated children.A genome-wide methylation study was completed using the Illumina 450K BeadChip array in 94 maltreated and 96 healthy nontraumatized children with saliva-derived DNA. The 450K BeadChip does not include any methylation sites in the exact location as sites in candidate genes previously examined in the literature, so a test for replication of prior research findings was not feasible.Methylation in 3 genes emerged as genome-wide-significant predictors of depression: DNA-Binding Protein Inhibitor ID-3 (ID3); Glutamate Receptor, Ionotropic N-methyl-D-aspartate (NMDA) 1 (GRIN1); and Tubulin Polymerization Promoting Protein (TPPP) (p < 5.0 × 10(-7), all analyses). These genes are all biologically relevant with ID3 involved in the stress response, GRIN1 involved in neural plasticity, and TPPP involved in neural circuitry development. Methylation in CpG sites in candidate genes were not predictors of depression at significance levels corrected for whole genome testing, but maltreated and control children did have significantly different β values after Bonferroni correction at multiple methylation sites in these candidate genes (e.g., BDNF, NR3C1, FKBP5).This study suggests that epigenetic changes in ID3, GRIN1, and TPPP genes, in combination with experiences of maltreatment, may confer risk for depression in children. The study adds to a growing body of literature supporting a role for epigenetic mechanisms in the pathophysiology of stress-related psychiatric disorders. Although epigenetic changes are frequently long lasting, they are not necessarily permanent. Consequently, interventions to reverse the negative biological and behavioral sequelae associated with child maltreatment are briefly discussed.
- Disruptive mood dysregulation disorder and chronic irritability in youth at familial risk for bipolar disorder. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 Apr; 53(4):408-16.
Disruptive mood dysregulation disorder (DMDD) is a new diagnosis in the DSM-5. Youth with a family history of bipolar disorder (BD) are at increased risk for BD and non-bipolar psychopathology. No studies to date have examined rates of DMDD among offspring of parents with BD. This study examines the risk for DMDD in offspring of parents with BD compared to community controls and considers rates of chronic irritability (independent of a DMDD diagnosis) across diagnoses in youth with parents with BD.Modified DMDD criteria were applied post hoc to 375 offspring of parents with BD and 241 offspring, aged 6 to 17 years, of community control parents. We calculated odds ratios using generalized linear mixed models. In addition, we explored associations with a severe chronic irritability phenotype and various diagnoses in the high-risk cohort.Offspring of parents with BD were more likely to meet criteria for DMDD than were the offspring of community control parents (Odds ratio [OR] = 8.3, 6.7% vs. 0.8%), even when controlling for demographic variables and comorbid parental diagnoses (OR = 5.4). They also had higher rates of chronic irritability compared to community controls (12.5% vs. 2.5%, χ(2) = 18.8, p < .005). Within the offspring of parents with BD, the chronic irritability phenotype was frequently present in offspring with diagnoses of BD, depression, attention-deficit/hyperactivity disorder, and disruptive behavior disorders.Like other non-BD diagnoses, family history of BD increases the risk for DMDD. Severe chronic irritability and temper tantrums are the core features of DMDD, and are associated with mood and behavioral disorders in youth at risk for BD.
- The broader autism phenotype in infancy: when does it emerge? [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2014 Apr; 53(4):398-407.e2.
This study had 3 goals, which were to examine the following: the frequency of atypical development, consistent with the broader autism phenotype, in high-risk infant siblings of children with autism spectrum disorder (ASD); the age at which atypical development is first evident; and which developmental domains are affected.A prospective longitudinal design was used to compare 294 high-risk infants and 116 low-risk infants. Participants were tested at 6, 12, 18, 24, and 36 months of age. At the final visit, outcome was classified as ASD, Typical Development (TD), or Non-TD (defined as elevated Autism Diagnostic Observation Schedule [ADOS] score, low Mullen Scale scores, or both).Of the high-risk group, 28% were classified as Non-TD at 36 months of age. Growth curve models demonstrated that the Non-TD group could not be distinguished from the other groups at 6 months of age, but differed significantly from the Low-Risk TD group by 12 months on multiple measures. The Non-TD group demonstrated atypical development in cognitive, motor, language, and social domains, with differences particularly prominent in the social-communication domain.These results demonstrate that features of atypical development, consistent with the broader autism phenotype, are detectable by the first birthday and affect development in multiple domains. This highlights the necessity for close developmental surveillance of infant siblings of children with ASD, along with implementation of appropriate interventions as needed.