Thinking and Feeling Interact
to Influence Behavior and
Mental Health
Tony J. Simon & CABIL Team
Director, Cognitive Analysis and Brain Imaging Lab
Assoc. Director UC Davis IDDRC
MIND Institute, University of California, Davis
http://mindinstitute.ucdavis.edu/research/cabil
tjsimon@ucdavis.edu
Funding: NIH R01HD04269 (Simon), K99MH086616 (Beaton),
U54HD079125 (IDDRC), U54 HD079125 (Abbeduto), NIH
TR000002 UC Davis MCRTP, UC Davis CEDD, Dempster Family
Foundation
Monday, June 2, 14
1
Core Working Hypothesis
Cognitive impairments limit competence in numerous domains
but vary widely among children and across ages
Despite cognitive limitations some children outperform predictions
from testing while others fall very short
“copers” show lower anxiety, higher real world functioning and often
achieve in academics far beyond what cognitive testing would predict
“strugglers” show the reverse pattern - more anxiety poorer
adaptive functioning and worse academics
2
Monday, June 2, 14
2
Core Working Hypothesis
Cognitive impairments limit competence in numerous domains
but vary widely among children and across ages
Despite cognitive limitations some children outperform predictions
from testing while others fall very short
“copers” show lower anxiety, higher real world functioning and often
achieve in academics far beyond what cognitive testing would predict
“strugglers” show the reverse pattern - more anxiety poorer
adaptive functioning and worse academics
strugglers might experience more stress & higher psychiatric risk
If so, we can help target cognitive, emotional and environmental factors
for intervention to improve academics, mental health, family dynamics
2
Monday, June 2, 14
2
Stimulation
Monday, June 2, 14
3
Anxiety Not IQ Predicts Adaptive Function
22q: N=99; r=-0.04; p=0.71
TD: N=45; r=0.5; p=0.002
Unlike TD children, FSIQ is NOT related to adaptive function in children with
22q11.2DS aged 7-14 years
Monday, June 2, 14
4
Anxiety Not IQ Predicts Adaptive Function
Monday, June 2, 14
4
Anxiety Not IQ Predicts Adaptive Function
22q11.2, N=62; r=-0.34, p=0.007
Copers
Strugglers
In children with 22q11.2DS aged 7-14 years, adaptive function is strongly and
negatively related to anxiety levels
Monday, June 2, 14
4
“Hot Cognition: Attention”
New tasks manipulate emotional content with different faces to see
effect on functioning. Dot Probe Threat Bias is affective attention task
anxious children orient attention to “threat”, losing some control
5
Monday, June 2, 14
5
“Hot Cognition: Attention”
New tasks manipulate emotional content with different faces to see
effect on functioning. Dot Probe Threat Bias is affective attention task
anxious children orient attention to “threat”, losing some control
500ms
500ms
2500ms
5
Monday, June 2, 14
5
“Hot Cognition: Attention”
New tasks manipulate emotional content with different faces to see
effect on functioning. Dot Probe Threat Bias is affective attention task
anxious children orient attention to “threat”, losing some control
500ms
500ms
2500ms
5
Monday, June 2, 14
5
Results: Bias
Affect, Anxiety and Attention
Clusters based on Anxiet
more sensitive than diag
Clustering used ONLY anxiety/adaptive function scores, not 22q/TD Dx
C2=Strugglers (ALL 22q): low adaptive scores, high anxious scores
C1=Copers (Mostly TD): high adaptive scores, low anxiety scores
replicates pattern in sample published in Angkustsiri et al, 2012
Cluster
•
•
•
•
Monday, June 2, 14
Gener
Replic
anxiet
All str
Not al
6
6
anxiety and a
Affect & Copers vs. Strugglers
All shows:
strugglers
• faces
Patterns of looking (from eye tracker) to different
Angry: copers and strugglers look more overall at Angry vs. Neutral
Not
all
coper
•
Happy: only copers look more at overall Happy vs. Neutral
suggests strugglers respond differently to emotional faces
E
•
•
7
Monday, June 2, 14
7
C
e Reyes1,2, Heather Shapiro1,2, Tony J. Simon1,2
better
results
than
diagnosis
ze (EG) bias by Dx
Arousal (Pupillometry) and Adaptation •
A
ant Angry Bias, both groups
appy Bias, both groups
Results:
But, arousal patterns,
from early toPupilometry
late in experiment, are very different
es based not on DX but on
Dilation
=
increased
arousal,
Contraction
=
reduced
arousal
uggler
status dysfunction has been documented in children with
Autonomic
Angry:12Copers dilate early, contract later = reducing arousal
Coper
vs. Struggler patterns?
anxiety
•
Angry: Strugglers contract early, dilate later = avoid then high arousal?
responses
and eyeearly,
movements
be=voluntary
• Motor
Happy:
Copers neither
contractmay
later
reducing arousal again
dilations
or contractions
are dilate
involuntary
• Pupil
Differences
Happy:
Strugglers
neither early,
later = neutral then high arousal
• Objective measure of autonomic arousal13
ptive scores may be
xiety and adaptive scores
anti-correlation between
e5 in a novel sample
sample have 22q
sample are TD
s - by Cluster
Monday, June 2, 14
Angry vs. Neutral Trials:
• Copers initially dilate to angry, but
later contract, possibly showing
initial arousal and later adaptation
• Strugglers initially contract and
later dilate, possibly indicating
greater arousal with repeated
exposures
8
8
“Cold” Cognitive (Inhibitory) Control
Tests ability to withhold/inhibit in-appropriate responses
“Go” trials (75%): press a button as quickly as possible to
“whack” the mole
“No-Go” trials (25%): do NOT press button to avoid
“squashing” the vegetable
Preceded by 1, 3, or 5 “Go” trials
5
3
1
9
Monday, June 2, 14
9
Cognitive Control - Overall Results
70
80
60
50
75
40
70
30
20
65
10
600
90
TD
22q
470
460
450
440
430
3
80
75
70
420
65
410
60
400
1Overall
TD
22q
85
Accuracy (%)
85
80
ns
TD
22q
Response
RT time
(ms)(ms)
Accuracy (%)
(%)
Accuracy
90
TD N=23
22qN=32
]
90
480
390 5
Younger
1
Older
2
ns
ns
p=0.02
1
3
5
5
3
5
3
4
5
Go trials: in order following No-Go
1
5
3
3
1
1
Both groups monitor appropriately
# preceding Go trials
Despite tracking NoGo likelihood, children with 22q11.2DS, were
much less able than TD children, to withhold response in NoGo
Monday, June 2, 14
10
10
Cognitive Control - Overall Results
10
Monday, June 2, 14
10
Cognitive Control - Overall Results
Full results in Shapiro et al., 2013 Frontiers in Child & Neurodev. Psychiatry
100
90
80
70
60
50
40
30
20
10
90
Accuracy (%)
Accuracy (%)
100
80
70
60
50
40
7
8
9
10
11 12 13 14 15
TD−younger
TD−older
22q−younger
22q−older
Age
Increased performance variance in older children with 22q11.2DS suggests a
subgroup with poorer response inhibition than most younger children
10
Monday, June 2, 14
10
“Hot” Cognitive (Inhibitory) Control
Whacking moles & protecting vegetables is all very well but .....
What happens when what you want to do really COUNTS?
11
Monday, June 2, 14
11
“Hot” Cognitive (Inhibitory) Control
Whacking moles & protecting vegetables is all very well but .....
What happens when what you want to do really COUNTS?
11
Monday, June 2, 14
11
“Hot” Cognitive (Inhibitory) Control
Whacking moles & protecting vegetables is all very well but .....
What happens when what you want to do really COUNTS?
Whoa, that was stressfull! And that was for something that feels good!
What happens if you have to control yourself when things feel bad?
Monday, June 2, 14
11
11
“Hot” Cognitive (Inhibitory) Control
Do emotionally salient stimuli affect the ability to withhold responses?
Go trials (75%): press a button as quickly as possible to in
response to Happy (50%) or Angry (50%) face
No-Go trials (25%): do NOT press button in response to
Neutral face
Preceded by 1, 3, or 5 “Go” trials
5
3
1
12
Monday, June 2, 14
12
“Hot” Cognitive (Inhibitory) Control
correct
withholding
Monday, June 2, 14
No-Go Accuracy (%)
Original “Cold
22q11.2DS
Cognition” Data
TD
90
80
*
Kids see 1-5
Happy or Angry
faces. Press Go
Then Neutral
face is NoGo
signal
70
60
1
3
5
No-Go Trial Type
(# Preceding Go Trials)
13
“Hot” Cognitive (Inhibitory) Control
90
80
*
70
100
Emotive
Go / Neutral No-Go
angry Go / neutral No-Go:
Percent Accuracy on NoGo Trials: Emotive Go / Neutral No−Go
90
Percent Accuracy
(%)!
Accuracy
on NoGo trials
TD: Accuracy for Happy 65-80%
• close to “cold” cognition variant
TD: Accuracy for Angry 65-90%
• threat seems to enhance inhibition
22q: Similar but improved pattern
• threat seems to enhance inhibition
• ... for some but not for all!
“Privileged limbic-to-PFC access?”
70
60
Percent Accuracy
80
TD: angry
22q: angry
TD: happy
22q: happy
90
90
80
70
60
50
40
30
20
10
80
0
1
1
1
3
3
5
3
5
5
70
happy Go / neutral No-Go:
22q
TD
p2 = happy go / neutral no−go
60
100
50
40
50
Accuracy (%)
TD: angry
22q: angry
TD: happy
Percent Accuracy on NoGo Trials: Emotive Go / Neutral No−Go
22q: happy
22q
TD
p1 = angry go / neutral no−go
100
Accuracy (%)
1
3
5
No-Go Trial Type
(# Preceding Go Trials)
1
3
5
# preceding Go trials
1
3
# Preceding Go Trials
5
Accuracy (%)
60
100
Monday, June 2, 14
Then Neutral
face is NoGo
signal
Kids see 1-5
Happy or Angry
faces. Press Go
Accuracy (%)
correct
withholding
No-Go Accuracy (%)
Original “Cold
22q11.2DS
Cognition” Data
TD
90
80
70
60
50
40
30
40
20
1
3
# Preceding Go Trials
1
1
1
5
3
3
3
5
5
5
13
Arousal, Anxiety & Inattention
22q = 74
Michelle Y Deng, Ph.D.
Monday, June 2, 14
N
%
Neither
13
18
Anxiety
54
73
ADHD
38
51
Both
31
42
14
Arousal, Anxiety & Inattention
22q = 74
Neither
Michelle Y Deng, Ph.D.
Monday, June 2, 14
N
%
Neither
13
18
Anxiety
54
73
ADHD
38
51
Both
31
42
14
Arousal, Anxiety & Inattention
22q = 74
ADHD
Neither
Michelle Y Deng, Ph.D.
Monday, June 2, 14
N
%
Neither
13
18
Anxiety
54
73
ADHD
38
51
Both
31
42
14
Arousal, Anxiety & Inattention
22q = 74
ADHD
Anxiety
Neither
Michelle Y Deng, Ph.D.
Monday, June 2, 14
N
%
Neither
13
18
Anxiety
54
73
ADHD
38
51
Both
31
42
14
Arousal, Anxiety & Inattention
22q = 74
Anxiety
+ADHD
ADHD
Anxiety
Neither
Michelle Y Deng, Ph.D.
Monday, June 2, 14
N
%
Neither
13
18
Anxiety
54
73
ADHD
38
51
Both
31
42
14
Stress, Anxiety & Psychiatric Diagnoses
IQ of 75: In some domains, a 9-year-old in a 12-year-old’s world
50-60% of children with 22q11.2DS have significant anxiety
20-50% of children with 22q11.2DS get a diagnosis of ADHD
(mainly Inattentive or combined type) and take medications
Does “ADHD” = hyperarousal/hypervigilance from anxiety?
Mismatched cognitive and social demands & resulting anxiety
and avoidance might explain frequent “Autism” diagnoses
Monday, June 2, 14
15
Chr. 22q11.2 Deletion Consortium
16
Monday, June 2, 14
16
Chr. 22q11.2 Deletion Consortium
16
Monday, June 2, 14
16
Chr. 22q11.2 Deletion Consortium
SCHNEIDER, DEBBANÉ, BASSETT, ET AL.
FIGURE 1. Age Distribution of 1,402 Participants With 22q11.2 Deletion Syndrome Assessed for Psychiatric Disorders
100
90
80
Number of Participants
70
60
50
40
30
20
10
0
6
9
12
15
18
21
24
27
30
33
36
16
39
42
45
48
51
54
57
60
63
66
69
Age (years)
Monday, June 2, 14
16
Chr. 22q11.2 Deletion Consortium
SCHNEIDER, DEBBANÉ, BASSETT, ET AL.
FIGURE 1. Age Distribution of 1,402 Participants With 22q11.2 Deletion Syndrome Assessed for Psychiatric Disorders
100
Anxiety ~25%
Anxiety 35%
90
80
Number of Participants
70
60
50
40
30
20
10
0
6
9
12
15
18
21
24
27
30
33
36
16
39
42
45
48
51
54
57
60
63
66
69
Age (years)
Monday, June 2, 14
16
Chr. 22q11.2 Deletion Consortium
SCHNEIDER, DEBBANÉ, BASSETT, ET AL.
FIGURE 1. Age Distribution of 1,402 Participants With 22q11.2 Deletion Syndrome Assessed for Psychiatric Disorders
100
Anxiety ~25%
Anxiety 35%
90
80
Number of Participants
70
60
50
40
30
Schizophrenia 41%
20
10
0
6
9
12
15
18
21
24
27
30
33
36
16
39
42
45
48
51
54
57
60
63
66
69
Age (years)
Monday, June 2, 14
16
Chr. 22q11.2 Deletion Consortium
SCHNEIDER, DEBBANÉ, BASSETT, ET AL.
FIGURE 1. Age Distribution of 1,402 Participants With 22q11.2 Deletion Syndrome Assessed for Psychiatric Disorders
100
Anxiety ~25%
Anxiety 35%
90
80
Schizophrenia 24%
Number of Participants
70
60
50
40
30
Schizophrenia 41%
20
10
0
6
9
12
15
18
21
24
27
30
33
36
16
39
42
45
48
51
54
57
60
63
66
69
Age (years)
Monday, June 2, 14
16
GOTHELF et al.
Anxiety Appears Highly Predic4ve of 22q11.2DS Psychosis
TABLE 1
Prevalence of Psychiatric Disorders at Baseline and at Follow-up
Baseline
Age, y, m " SD
Males/females, n
Any anxiety disorder, n (%)
Separation anxiety disordera
Specific phobia
Social phobia
Panic disorder
Agoraphobiab
PTSD
OCD
GAD
Any mood disorder, n (%)
Major depressive disorder
Dysthymia
Bipolar disorder I or II
Any disruptive disorder, n (%)
ADHDc
ODDa
Conduct disorderc
Any psychotic disorder, n (%)
Schizophrenia
Schizoaffective disorder
Schizophreniform disorder
Brief psychotic disorder
Psychotic disorder NOS
Other, n (%)
Substance abuseb
Eating disorder
Follow-up
Age, m " SD
Males/females, n
Any anxiety disorder, n (%)
Separation anxiety disordera
Specific phobia
Social phobia
Panic disorder
Agoraphobiab
PTSD
OCD
GAD
Any mood disorder, n (%)
Major depressive disorder
Dysthymia
Bipolar disorder I or II
Any disruptive disorder, n (%)
ADHDc
ODDa
Conduct disorderc
Any psychotic disorder, n (%)
Schizophrenia
Schizoaffective disorder
Schizophreniform disorder
Brief psychotic disorder
Psychotic disorder NOS
Monday, June 2, 14
1196
www.jaacap.org
Children (n ¼ 49)
8.4 " 1.8
26/23
23 (46.9)
2 (4.1)
14 (28.6)
5 (10.2)
0 (0)
0 (0)
0 (0)
7 (14.3)
5 (10.2)
8 (16.3)
5 (10.2)
3 (6.1)
1 (5.6)
31 (63.3)
31 (63.3)
9 (18.4)
0 (0)
2 (4.1)
1 (2)
0 (0)
0 (0)
0 (0)
1 (2)
0 (0)
2 (4.1)
Children (n ¼ 49)
12.4 " 2.5
26/23
18 (36.7)
1 (2)
10 (20.4)
8 (16.3)
0 (0)
0 (0)
0 (0)
2 (4.1)
7 (14.3)
2 (4.1)
2 (4.1)
0 (0)
0 (0)
29 (59.2)
28 (57.1)
9 (18.4)
0 (0)
4 (8.2)
2 (4.1)
0 (0)
0 (0)
1 (2)
1 (2)
Adolescents (n ¼ 46)
14.0 " 1.9
22/24
27 (58.7)
3 (6.5)
20 (43.5)
3 (6.5)
1 (2.2)
1 (6.3)
0 (0)
8 (17.4)
4 (8.7)
5 (10.9)
1 (2.2)
5 (10.9)
0 (0)
17 (37)
14 (30.4)
10 (21.7)
0 (0)
1 (2.2)
1 (2.2)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
Adolescents (n ¼ 46)
18.3 " 2.9
22/24
18 (39.1)
0 (0)
13 (28.9)
0 (0)
3 (6.7)
0 (0)
0 (0)
3 (6.7)
6 (13.3)
11 (24.4)
6 (13.3)
6 (13.3)
0 (0)
15 (44.1)
12 (35.3)
2 (5.9)
1 (2.9)
8 (17.4)
5 (10.9)
0 (0)
1 (2.2)
1 (2.2)
1 (2.2)
J OURNAL
OF THE
Adults (n ¼ 30)
27.6 " 7.2
11/19
16 (53.3)
0 (0)
10 (35.7)
3 (10.7)
0 (0)
2 (7.1)
0 (0)
4 (14.3)
2 (7.1)
8 (28.6)
5 (17.9)
5 (17.9)
0 (0)
6 (35.3)
6 (35.3)
1 (5.9)
0 (0)
10 (33.3)
5 (16.7)
2 (6.7)
2 (6.7%)
1 (3.3)
0 (0)
Total (n ¼ 125)
15.1 " 8.4
59/66
66 (52.8)
5 (5.3)
44 (35.2)
11 (8.8)
1 (0.8)
3 (4)
0 (0)
19 (15.2)
11 (8.8)
21 (16.8)
11 (8.8)
13 (10.4)
1 (0.8)
54 (48.2)
51 (45.5)
19 (20)
0 (0)
13 (10.4)
7 (5.6)
2 (1.6)
2 (1.6)
1 (0.8)
1 (0.8)
3 (10)
0 (0)
3 (4)
2 (1.6)
Adults (n ¼ 30)
Total (n ¼ 125)
32.3 " 7.4
11/19
11 (36.7)
0 (0)
8 (26.7)
1 (3.3)
0 (0)
0 (0)
2 (6.7)
3 (10)
3 (10)
5 (16.7)
2 (6.7)
2 (6.7)
2 (6.7)
2 (11.8)
2 (11.8)
0 (0)
0 (0)
8 (26.7)
5 (16.7)
3 (10)
0 (0)
0 (0)
0 (0)
19.4 " 8.8
59/66
47 (37.6)
1 (1)
31 (25)
9 (7.3)
3 (2.4)
0 (0)
2 (1.6)
8 (6.5)
16 (12.9)
18 (14.5)
10 (8.1)
8 (6.5)
2 (2.2)
46 (46)
42 (42)
11 (11)
1 (1)
20 (16)
12 (9.6)
3 (2.4)
1 (0.8)
2 (1.6)
2 (1.6)
p
NS
NS
*
***
p
NS
*
**
NS
AMERICAN ACADEMY OF C HILD & ADOLESCENT PSYCHIATRY
VOLUME 52 NUMBER 11 NOVEMBER 2013
Gothelf et al. 2013
17
GOTHELF et al.
Anxiety Appears Highly Predic4ve of 22q11.2DS Psychosis
TABLE 1
Prevalence of Psychiatric Disorders at Baseline and at Follow-up
Baseline
Age, y, m " SD
Males/females, n
Any anxiety disorder, n (%)
Separation anxiety disordera
Specific phobia
Social phobia
Panic disorder
Agoraphobiab
PTSD
OCD
GAD
Any mood disorder, n (%)
Major depressive disorder
Dysthymia
Bipolar disorder I or II
Any disruptive disorder, n (%)
ADHDc
ODDa
Conduct disorderc
Any psychotic disorder, n (%)
Schizophrenia
Schizoaffective disorder
Schizophreniform disorder
Brief psychotic disorder
Psychotic disorder NOS
Other, n (%)
Substance abuseb
Eating disorder
Children (n ¼ 49)
8.4 " 1.8
26/23
23 (46.9)
2 (4.1)
14 (28.6)
5 (10.2)
0 (0)
0 (0)
0 (0)
7 (14.3)
5 (10.2)
8 (16.3)
5 (10.2)
3 (6.1)
1 (5.6)
31 (63.3)
31 (63.3)
9 (18.4)
0 (0)
2 (4.1)
1 (2)
0 (0)
0 (0)
0 (0)
1 (2)
Adolescents (n ¼ 46)
14.0 " 1.9
22/24
27 (58.7)
3 (6.5)
20 (43.5)
3 (6.5)
1 (2.2)
1 (6.3)
0 (0)
8 (17.4)
4 (8.7)
5 (10.9)
1 (2.2)
5 (10.9)
0 (0)
17 (37)
14 (30.4)
10 (21.7)
0 (0)
1 (2.2)
1 (2.2)
0 (0)
0 (0)
0 (0)
0 (0)
Adults (n ¼ 30)
27.6 " 7.2
11/19
16 (53.3)
0 (0)
10 (35.7)
3 (10.7)
0 (0)
2 (7.1)
0 (0)
4 (14.3)
2 (7.1)
8 (28.6)
5 (17.9)
5 (17.9)
0 (0)
6 (35.3)
6 (35.3)
1 (5.9)
0 (0)
10 (33.3)
5 (16.7)
2 (6.7)
2 (6.7%)
1 (3.3)
0 (0)
Total (n ¼ 125)
15.1 " 8.4
59/66
66 (52.8)
5 (5.3)
44 (35.2)
11 (8.8)
1 (0.8)
3 (4)
0 (0)
19 (15.2)
11 (8.8)
21 (16.8)
11 (8.8)
13 (10.4)
1 (0.8)
54 (48.2)
51 (45.5)
19 (20)
0 (0)
13 (10.4)
7 (5.6)
2 (1.6)
2 (1.6)
1 (0.8)
1 (0.8)
p
NS
NS
*
The predictive value of having an anxiety disorder at
baseline for later development of psychosis was quite
robust, as 9 of 10 patients with emerging psychotic
disorder in our sample were diagnosed with an anxiety
disorder at baseline.
Follow-up
Age, m " SD
Males/females, n
Any anxiety disorder, n (%)
Separation anxiety disordera
Specific phobia
Social phobia
Panic disorder
Agoraphobiab
PTSD
OCD
GAD
Any mood disorder, n (%)
Major depressive disorder
Dysthymia
Bipolar disorder I or II
Any disruptive disorder, n (%)
ADHDc
ODDa
Conduct disorderc
Any psychotic disorder, n (%)
Schizophrenia
Schizoaffective disorder
Schizophreniform disorder
Brief psychotic disorder
Psychotic disorder NOS
Monday, June 2, 14
1196
www.jaacap.org
0 (0)
2 (4.1)
Children (n ¼ 49)
12.4 " 2.5
26/23
18 (36.7)
1 (2)
10 (20.4)
8 (16.3)
0 (0)
0 (0)
0 (0)
2 (4.1)
7 (14.3)
2 (4.1)
2 (4.1)
0 (0)
0 (0)
29 (59.2)
28 (57.1)
9 (18.4)
0 (0)
4 (8.2)
2 (4.1)
0 (0)
0 (0)
1 (2)
1 (2)
0 (0)
0 (0)
Adolescents (n ¼ 46)
18.3 " 2.9
22/24
18 (39.1)
0 (0)
13 (28.9)
0 (0)
3 (6.7)
0 (0)
0 (0)
3 (6.7)
6 (13.3)
11 (24.4)
6 (13.3)
6 (13.3)
0 (0)
15 (44.1)
12 (35.3)
2 (5.9)
1 (2.9)
8 (17.4)
5 (10.9)
0 (0)
1 (2.2)
1 (2.2)
1 (2.2)
J OURNAL
OF THE
3 (10)
0 (0)
3 (4)
2 (1.6)
Adults (n ¼ 30)
Total (n ¼ 125)
32.3 " 7.4
11/19
11 (36.7)
0 (0)
8 (26.7)
1 (3.3)
0 (0)
0 (0)
2 (6.7)
3 (10)
3 (10)
5 (16.7)
2 (6.7)
2 (6.7)
2 (6.7)
2 (11.8)
2 (11.8)
0 (0)
0 (0)
8 (26.7)
5 (16.7)
3 (10)
0 (0)
0 (0)
0 (0)
19.4 " 8.8
59/66
47 (37.6)
1 (1)
31 (25)
9 (7.3)
3 (2.4)
0 (0)
2 (1.6)
8 (6.5)
16 (12.9)
18 (14.5)
10 (8.1)
8 (6.5)
2 (2.2)
46 (46)
42 (42)
11 (11)
1 (1)
20 (16)
12 (9.6)
3 (2.4)
1 (0.8)
2 (1.6)
2 (1.6)
***
p
NS
*
**
NS
AMERICAN ACADEMY OF C HILD & ADOLESCENT PSYCHIATRY
VOLUME 52 NUMBER 11 NOVEMBER 2013
Gothelf et al. 2013
17
p values are given for age group by demographic parameter interactions determined by ANOVA for age and estimated IQ;
Fisher’s exact test for sex and race.
Psychopathology Symptoms are Common in 22q11.2DS
Table 2. Current psychopathologies of participants with 22q11.2 deletion syndrome (22q11DS)
Age group (years)
Parameter
All ages
8–11
12–17
18–23
524
p value
Any psychopathology
Co-morbidities 52
Co-morbidities 53
89 (79)
47 (42)
18 (16)
22 (85)
8 (31)
2 (8)
37 (82)
23 (51)
7 (16)
18 (82)
11 (50)
7 (32)
12 (63)
5 (26)
2 (11)
N.S.
Mood disorders
MDD
Depression NOS
Mood NOS
Dysthymia
Bipolar I disorder
Anxiety disorders
GAD
Anxiety NOS
Separation anxiety
OCD
ADHD
Substance/alcohol abuse
Psychosis prone
APS
Psychotic
Schizophrenia
Psychosis NOS
Delusional disorder
16 (14)
10 (9)
3 (3)
1 (1)
1 (1)
1 (1)
38 (34)
17 (15)
13 (12)
7 (6)
9 (8)
35 (31)
0 (0)
53 (47)
24 (21)
12 (11)
6 (5)
4 (4)
2 (2)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
6 (23)
3 (12)
3 (12)
2 (8)
1 (4)
10 (38)
0 (0)
13 (50)
5 (19)
2 (8)
0 (0)
2 (8)
0 (0)
5 (11)
5 (11)
0 (0)
0 (0)
0 (0)
0 (0)
16 (36)
7 (16)
5 (11)
2 (4)
4 (9)
15 (33)
0 (0)
28 (62)
13 (29)
2 (4)
0 (0)
1 (2)
1 (2)
7 (32)
4 (18)
2 (9)
0 (0)
1 (5)
0 (0)
10 (45)
3 (14)
4 (18)
2 (9)
3 (14)
6 (27)
0 (0)
10 (45)
5 (23)
4 (18)
3 (14)
0 (0)
1 (5)
4
1
1
1
0
1
6
4
1
1
1
4
0
2
1
4
3
1
0
(21)
(5)
(5)
(5)
(0)
(5)
(32)
(21)
(5)
(5)
(5)
(21)
(0)
(11)
(5)
(21)
(16)
(5)
(0)
N.S.
N.S.
40.01
N.S.
N.S.
N.S.
40.001
N.S.
N.S.
40.01
MDD, Major depressive disorder; NOS, not otherwise specified; GAD, generalized anxiety disorder; OCD,
obsessive–compulsive disorder; ADHD, attention deficit hyperactivity disorder; APS, attenuated positive symptom syndrome;
N.S., not significant (p > 0.05).
Values given as n (%).
p values are given for age group by diagnosis interactions determined by Fisher’s exact test.
Tang et al. 2013
Monday, June 2, 14
18
p values are given for age group by demographic parameter interactions determined by ANOVA for age and estimated IQ;
Fisher’s exact test for sex and race.
Psychopathology Symptoms are Common in 22q11.2DS
Table 2. Current psychopathologies of participants with 22q11.2 deletion syndrome (22q11DS)
Age group (years)
Parameter
All ages
8–11
12–17
18–23
524
p value
Any psychopathology
Co-morbidities 52
Co-morbidities 53
89 (79)
47 (42)
18 (16)
22 (85)
8 (31)
2 (8)
37 (82)
23 (51)
7 (16)
18 (82)
11 (50)
7 (32)
12 (63)
5 (26)
2 (11)
N.S.
Mood disorders
MDD
Depression NOS
Mood NOS
Dysthymia
Bipolar I disorder
Anxiety disorders
GAD
Anxiety NOS
Separation anxiety
OCD
ADHD
Substance/alcohol abuse
Psychosis prone
APS
Psychotic
Schizophrenia
Psychosis NOS
Delusional disorder
16 (14)
10 (9)
3 (3)
1 (1)
1 (1)
1 (1)
38 (34)
17 (15)
13 (12)
7 (6)
9 (8)
35 (31)
0 (0)
53 (47)
24 (21)
12 (11)
6 (5)
4 (4)
2 (2)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
0 (0)
6 (23)
3 (12)
3 (12)
2 (8)
1 (4)
10 (38)
0 (0)
13 (50)
5 (19)
2 (8)
0 (0)
2 (8)
0 (0)
5 (11)
5 (11)
0 (0)
0 (0)
0 (0)
0 (0)
16 (36)
7 (16)
5 (11)
2 (4)
4 (9)
15 (33)
0 (0)
28 (62)
13 (29)
2 (4)
0 (0)
1 (2)
1 (2)
7 (32)
4 (18)
2 (9)
0 (0)
1 (5)
0 (0)
10 (45)
3 (14)
4 (18)
2 (9)
3 (14)
6 (27)
0 (0)
10 (45)
5 (23)
4 (18)
3 (14)
0 (0)
1 (5)
4
1
1
1
0
1
6
4
1
1
1
4
0
2
1
4
3
1
0
(21)
(5)
(5)
(5)
(0)
(5)
(32)
(21)
(5)
(5)
(5)
(21)
(0)
(11)
(5)
(21)
(16)
(5)
(0)
N.S.
N.S.
40.01
N.S.
N.S.
N.S.
40.001
N.S.
N.S.
40.01
MDD, Major depressive disorder; NOS, not otherwise specified; GAD, generalized anxiety disorder; OCD,
obsessive–compulsive disorder; ADHD, attention deficit hyperactivity disorder; APS, attenuated positive symptom syndrome;
N.S., not significant (p > 0.05).
Values given as n (%).
p values are given for age group by diagnosis interactions determined by Fisher’s exact test.
Tang et al. 2013
Monday, June 2, 14
18
p values are given for age group by demographic parameter interactions determined by ANOVA for age and estimated IQ;
Fisher’s exact test for sex and race.
Psychopathology Symptoms are Common in 22q11.2DS
Table 2. Current psychopathologies of participants with 22q11.2 deletion syndrome (22q11DS)
Age group (years)
Parameter
All ages
8–11
12–17
18–23
524
p value
Any psychopathology
Co-morbidities 52
Co-morbidities 53
89 (79)
47 (42)
18 (16)
22 (85)
8 (31)
2 (8)
37 (82)
23 (51)
7 (16)
18 (82)
11 (50)
7 (32)
12 (63)
5 (26)
2 (11)
N.S.
N.S.
N.S.
16 (14) with psychotic
0 (0)
5 (11)
7 (32)
4 (21) to have
40.01
We also found that those
features
were
more likely
a
10 (9)
0 (0)
5 (11)
4 (18)
1 (5)
lifetime diagnosis of 3mood
or anxiety
disorder.
(3)
0 (0)
0 (0)
2 (9)
1 (5)
Mood disorders
MDD
Depression NOS
Mood NOS
Dysthymia
Bipolar I disorder
Anxiety disorders
GAD
Anxiety NOS
Separation anxiety
OCD
ADHD
Substance/alcohol abuse
Psychosis prone
APS
Psychotic
Schizophrenia
Psychosis NOS
Delusional disorder
1 (1)
1 (1)
1 (1)
38 (34)
17 (15)
13 (12)
7 (6)
9 (8)
35 (31)
0 (0)
53 (47)
24 (21)
12 (11)
6 (5)
4 (4)
2 (2)
0 (0)
0 (0)
0 (0)
6 (23)
3 (12)
3 (12)
2 (8)
1 (4)
10 (38)
0 (0)
13 (50)
5 (19)
2 (8)
0 (0)
2 (8)
0 (0)
0 (0)
0 (0)
0 (0)
16 (36)
7 (16)
5 (11)
2 (4)
4 (9)
15 (33)
0 (0)
28 (62)
13 (29)
2 (4)
0 (0)
1 (2)
1 (2)
0 (0)
1 (5)
0 (0)
10 (45)
3 (14)
4 (18)
2 (9)
3 (14)
6 (27)
0 (0)
10 (45)
5 (23)
4 (18)
3 (14)
0 (0)
1 (5)
1
0
1
6
4
1
1
1
4
0
2
1
4
3
1
0
(5)
(0)
(5)
(32)
(21)
(5)
(5)
(5)
(21)
(0)
(11)
(5)
(21)
(16)
(5)
(0)
N.S.
Perhaps individuals with significant anxiety are at even higher risk than the
22q11DS population at large.
..
NS
N.S.
40.001
N.S.
N.S.
40.01
MDD, Major depressive disorder; NOS, not otherwise specified; GAD, generalized anxiety disorder; OCD,
obsessive–compulsive disorder; ADHD, attention deficit hyperactivity disorder; APS, attenuated positive symptom syndrome;
N.S., not significant (p > 0.05).
Values given as n (%).
p values are given for age group by diagnosis interactions determined by Fisher’s exact test.
Tang et al. 2013
Monday, June 2, 14
18
Conclusions
Cognitive impairments/Developmental Delay induce stress
Chronic stress likely induces anxiety, depression, reduces self-esteem
Avoidance of challenge slows development further, increasing challenge
Family/School/Community supports further modulate this interaction &
influence “coper/struggler” trajectory
reducing stress & anxiety might reduce psychosis risk
19
Monday, June 2, 14
19
Conclusions
Cognitive impairments/Developmental Delay induce stress
Chronic stress likely induces anxiety, depression, reduces self-esteem
Avoidance of challenge slows development further, increasing challenge
Family/School/Community supports further modulate this interaction &
influence “coper/struggler” trajectory
reducing stress & anxiety might reduce psychosis risk
Strugglers can be converted to copers with child, school, family change
not with stem cells or brain surgery but commonly available therapy
Child: cognitive behavioral/behavioral therapy, SSRI, cognitive training
School: effective IEP, careful calibration of challenge based on testing
Family: coping strategies for parents, matching parent/child expectations19
Monday, June 2, 14
19
Thanks
MOST important: Kids who participated & their families!!
Majority of the work presented here was done by:
Josh Cruz, Nina Cung, Dave Reyes, Margie Cabaral, Freddy Bassal,
Heather Shapiro Ph.D., Ling Wong Ph.D., Elliott Beaton Ph.D.,
Siddarth Srivastava Ph.D., Michelle Deng Ph.D., Joel Stoddard, M.D.,
Danielle Harvey, Ph.D., Naomi Hunsaker, Ph.D., Kathy Angkustsiri
M.D., Ingrid Leckliter Ph.D., Janice Enriquez Ph.D., Nicole Tartaglia
M.D., Khyati Brahmbatt, M.D.
UC Davis Center of Excellence in
Developmental Disabilities
Dempster Family Foundation
National Institutes of Health/NICHD
Monday, June 2, 14
20
A HUGE Thanks & Farewell!
Monday, June 2, 14
21
Do Cognitive Challenges Cause Stress?
Some quotes from an adult posting on facebook
“it seems like I really only have a few things that stress me out. One of my
big stressers is dealing with change and coins. ... I have no clue why change
makes me panic, but I am trying to learn it....They don't understand that
its difficult for me even if it shows the amount or not, I am not able to
process it in my head. That is the most frustrating thing ever. For some
reason when I am not in a rush, or when I am not feeling stressed, I can
do it just fine. Math is the other big stresser, Its always going to be hard
for me no matter how many classes I take, I just like to stay away from it
as much as posbbile”.
“I feel like this direction stuff is driving me nuts. No matter how many
times we practice driving to the new spot, I still don't get it. I am
completely lost. I am not making it up, it's frustrating cause I dont know
why it's so confusing for me. I have to practice knowing where I'm going,
and then people eventually notice, and then I get embarrassed :/((”
22
Monday, June 2, 14
22