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24- and 36-Week Outcomes for the Child/Adolescent Anxiety Multimodal Study (CAMS)
09 Dec 2013 10:17 am
Publication date: Available online 28 November 2013
Source:Journal of the American Academy of Child & Adolescent Psychiatry
Author(s): John Piacentini , Shannon Bennett , Scott Compton , Phillip Kendall , Boris Birmaher , Anne
Marie Albano , John March , Joel Sherrill , Dara Sakolsky , Golda Ginsburg , Moira Rynn , R. Lindsey
Bergman , Elizabeth Gosch , Bruce Waslick , Satish Iyengar , James McCracken , John Walkup
Objective We report active treatment group differences on response and remission rates and changes in
anxiety severity at weeks 24 and 36 for the Child/Adolescent Anxiety Multimodal Study (CAMS). Method
CAMS youth (N=488; 74%≤12 years) with DSM-IV separation, generalized, or social anxiety disorder were
randomized to 12 weeks of cognitive behavior therapy (CBT), sertraline (SRT), CBT+SRT (COMB), or
medication management/pill placebo (PBO). Responders attended 6 monthly booster sessions in their
assigned treatment arm; youth in COMB and SRT continued on their medication throughout this period.
Efficacy of COMB, SRT, and CBT (N=412) was assessed at 24 and 36 weeks postrandomization. Youth
randomized to PBO (n=76) were offered active CAMS treatment if nonresponsive at week 12 or over followup and were not included here. Independent evaluators blind to study condition assessed anxiety severity,
functioning, and treatment response. Concomitant treatments were allowed but monitored over follow-up.
Results Most (>80%) acute responders maintained positive response at both weeks 24 and 36.
Consistent with acute outcomes, COMB maintained advantage over CBT and SRT, which did not differ, on
dimensional outcomes; the 3 treatments did not differ on most categorical outcomes over follow-up.
Compared to COMB and CBT, youth in SRT obtained more concomitant psychosocial treatments, while
those in SRT and CBT obtained more concomitant combined (medication plus psychosocial) treatment.
Discussion COMB maintained advantage over CBT and SRT on some measures over follow-up, while the 2
monotherapies remained indistinguishable. The observed convergence of COMB and monotherapy may be
related to greater use of concomitant treatment during follow-up among youth receiving the monotherapies,
although other explanations are possible. While outcomes were variable, most CAMS-treated youth enjoyed
sustained treatment benefit. Clinical trial registration information— Child and Adolescent Anxiety Disorders
(CAMS); http://clinicaltrials.gov ; NCT00052078 .
A 60-Year Climb on the Mountain of Nosology
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child & Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Daniel S. Pine
A Follow-Up Study of Maternal Expressed Emotion Toward Children With AttentionDeficit/Hyperactivity Disorder (ADHD): Relation With Severity and Persistence of ADHD and
Comorbidity
09 Dec 2013 10:17 am
Publication date: Available online 3 December 2013
Source:Journal of the American Academy of Child & Adolescent Psychiatry
Author(s): Jennifer S. Richards , Alejandro Arias Vásquez , Nanda N.J. Rommelse , Jaap Oosterlaan ,
Pieter J. Hoekstra , Barbara Franke , Catharina A. Hartman , Jan K. Buitelaar
Objective Attention-deficit/hyperactivity disorder (ADHD) is associated with conflicted parent–child
relationships. The underlying mechanisms of this association are not yet fully understood. We investigated
the cross-sectional and longitudinal relationships between externalizing psychopathology in children with
ADHD, and expressed emotion (EE; warmth and criticism) and psychopathology in mothers. Method In this
6-year follow-up study 385 children with an ADHD combined subtype were included at baseline (mean=11.5
years, 82.7% male), of which 285 children (74%) were available at follow-up (mean=17.5 years, 83.6%
male). At both time points, measures of child psychopathology (i.e., ADHD severity, oppositional, and
conduct problems), maternal EE, and maternal psychopathology (i.e., ADHD and affective problems) were
obtained. Results EE was not significantly correlated over time. At baseline, we found a nominally negative
association ( p ≤.05) between maternal warmth and child ADHD severity. At follow-up, maternal criticism
was significantly associated with child oppositional problems, and nominally with child conduct problems.
Maternal warmth was nominally associated with child oppositional and conduct problems. These
associations were independent of maternal psychopathology. No longitudinal associations were found
between EE at baseline and child psychopathology at follow-up, or child psychopathology at baseline and
EE at follow-up. Conclusions The results support previous findings of cross-sectional associations between
parental EE and child psychopathology. This, together with the finding that EE was not stable over six
years, suggests that EE is a momentary state measure varying with contextual and developmental factors.
EE does not appear to be a risk factor for later externalizing behavior in children with ADHD.
A Longitudinal Investigation of Maternal Influences on the Development of Child Hostile
Attributions and Aggression
18 Nov 2013 06:58 pm
Journal of Clinical Child & Adolescent Psychology, Volume 0, Issue 0, Page 1-13, Ahead of Print.
A Potential Electroencephalography and Cognitive Biosignature for the Child Behavior
Checklist–Dysregulation Profile
09 Dec 2013 10:17 am
Publication date: November 2013
Source:Journal of the American Academy of Child & Adolescent Psychiatry, Volume 52, Issue 11
Author(s): James J. McGough , James T. McCracken , Alexander L. Cho , Edward Castelo , Alexandra
Sturm , Jennifer Cowen , John Piacentini , Sandra K. Loo
Objective The Child Behavior Checklist–Dysregulation Profile (CBCL/DP) identifies youth at increased risk
for significant psychopathology. Although the genetic architecture and several biological correlates of the
CBCL/DP have been described, little work has elucidated its underlying neurobiology. We examined the
potential utility of electroencephalography (EEG), along with behavioral and cognitive assessments, in
differentiating individuals based on the CBCL/DP. Method Participants aged 7 to 14 years of age were
categorized into 3 age- and sex-matched groups based on clinical assessment and CBCL/DP: typically
developing controls without attention-deficit/hyperactivity disorder (ADHD) (n = 38), individuals with ADHD
without the CBCL/DP (ADHD/DP−) (n = 38), and individuals with the CBCL/DP (CBCL/DP+) (n = 38).
Groups were compared with EEG and measures of clinical phenomenology and cognition. Results
ADHD/DP− and CBCL/DP+ groups had increased inattention, but the CBCL/DP+ group had increased
hyperactive/impulsive symptoms, disruptive behavior, mood, and anxiety comorbidities compared with the
group with ADHD alone. Cognitive profiles suggested that ADHD/DP–participants had fast impulsive
responses, whereas CBCL/DP+ participants were slow and inattentive. On EEG, CBCL/DP+ had a distinct
profile of attenuated δ-band and elevated α-band spectral power in the central and parietal regions
compared to ADHD/DP− and controls. The low-δ/high-α profile was correlated with measures of emotion
and behavior problems and not with inattentive symptomatology or cognitive measures. There were no EEG
differences between the ADHD/DP− and control groups. Conclusions An EEG/cognitive profile suggests a
distinct pattern of underlying neural dysfunction with the CBCL/DP that might ultimately serve as a
biosignature. Further work is required to identify potential relationships with clinically defined psychiatric
disorders, particularly those of dysregulated mood.
A prospective study of heart rate and externalising behaviours in young children
28 Nov 2013 07:53 am
Background Low heart rate predicts externalising and delinquent behaviour in adults, adolescents and
school-age children. In younger children the evidence is less clear. Moreover, the specificity of the relation
between the autonomic nervous system and different forms of externalising behaviour is uncertain. We
investigated the longitudinal relation between resting mean heart rate and different externalising
behaviours. Methods In 412 children of the Generation R Study, we measured resting mean heart rate at
14 months. At 3 years, child problem behaviour was assessed by the mother with the Child Behavior
Checklist. In a gift delay task, we observed whether children were compliant and whether they lied about
their noncompliance. The association of heart rate with behaviour was contrasted with the effect of harsh
parenting. Results In our main analysis, we examined the association between heart rate and reported and
observed child behaviour. For comparison, the association of heart rate with behaviour was contrasted with
the effect of harsh parenting. Mean heart rate was positively associated with Anxious/Depressed scale
scores (β = .1, 95% CI = 0.01; 0.2, p = .04), but not with Aggressive Behaviour (β = .02; 95% CI = −0.1; 0.1,
p = .8) nor Attention Problem scale scores (β = .08, 95% CI = −0.3; 0.5, p = .8). We could not demonstrate
an association between mean heart rate and noncompliance during the gift delay task (OR = 1.14, 95%
CI = 0.9; 1.1, p = .2), but lower heart rate predicted higher odds of the child lying (OR = 0.56, 95% CI = 0.3;
0.9, p = .03). In contrast, harsh parenting was associated with mother-reported Aggressive Behaviour
(β = .7, 95% CI = 0.4; 0.9, p < .001) and Attention Problems (β = .2, 95% CI = 0.1; 0.3, p < .001), but not
with observed lying (OR = 1.03, 95% CI = 0.8; 1.4, p = .8). Conclusions Lower resting mean heart rate at
age 14 months predicts low anxiety symptoms and higher odds of lying at age 3 years. Low resting mean
heart rate may be less an indicator of early childhood aggression than of fearless behaviour.
Acknowledgements
13 Nov 2013 04:47 pm
Journal of Clinical Child & Adolescent Psychology, Volume 42, Issue 6, Page 874-876, NovemberDecember 2013.
Advancing a Multidimensional, Developmental Spectrum Approach to Preschool Disruptive
Behavior
09 Dec 2013 10:17 am
Publication date: Available online 7 November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry
Author(s): Lauren S. Wakschlag , Margaret J. Briggs-Gowan , Seung W. Choi , Sara R. Nichols , Jacqueline
Kestler , James L. Burns , Alice S. Carter , David Henry
Objective Dimensional approaches are gaining scientific traction. However, their potential for elucidating
developmental aspects of psychopathology has not been fully realized. The goal of this paper is to apply a
multidimensional, developmental framework to model the normal-abnormal spectrum of preschool
disruptive behavior. The Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), a novel
measure, was used to model dimensional severity across developmental parameters theorized to
distinguish the normative misbehavior of early childhood from clinically salient disruptive behavior. The 4
MAP-DB dimensions are: Temper Loss, Noncompliance, Aggression, and Low Concern for Others. Method
Parents of a diverse sample of 1,488 preschoolers completed the MAP-DB. Multidimensional item response
theory (IRT) was employed for dimensional modeling. Results The 4-dimension, developmentally informed
model demonstrated excellent fit. Its factor loadings did not differ across demographic subgroups. All
dimensions provided good coverage of the abnormal end of the severity continuum, but only Temper Loss
and Noncompliance provided good coverage of milder, normatively occurring behaviors. The developmental
expectability and quality of behaviors distinguished normative from atypical behaviors. The point at which
frequency of behaviors was atypical varied based on dimensional location for Temper Loss,
Noncompliance, and Aggression. Conclusion The MAP-DB provides an innovative method for
operationalizing developmentally specified, dimensional phenotypes in early childhood. Establishing the
validity of these dimensional phenotypes in relation to clinical outcomes, neurocognitive substrates and
etiologic pathways will be a crucial test of their clinical utility.
Alpha-2 Agonists for Attention-Deficit/Hyperactivity Disorder in Youth: A Systematic Review
and Meta-Analysis of Monotherapy and Add-on Trials to Stimulant Therapy
09 Dec 2013 10:17 am
Publication date: Available online 6 December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry
Author(s): Tomoya Hirota , Simon Schwartz , Christoph U. Correll
Objective To meta-analyze the efficacy and safety of alpha-2-agonists in pediatric attentiondeficit/hyperactivity disorder (ADHD). Method We searched MEDLINE, EMBASE, Cochrane Library,
CINAHL, and PsycINFO until 05/2013 for randomized trials comparing alpha-2-agonists with placebo in
ADHD youth. Primary outcome was reduction in overall ADHD symptoms. Secondary outcomes included
hyperactivity/impulsivity, inattentiveness, oppositional defiant disorder symptoms (ODD symptoms), allcause discontinuation, specific-cause discontinuation and adverse effects. Standardized mean differences
(SMD), risk ratio (RR), and number-needed-to-treat/harm (NNT/NNH) were calculated. Data were analyzed
separately in monotherapy and as add-on to psychostimulants. Results Altogether, 12 studies (N=2,276)
were included. Across 9 studies (n=1,550), alpha-2-agonist monotherapy significantly reduced overall
ADHD symptoms (SMD=−0.59, p &lt;0.00001), hyperactivity/impulsivity (SMD=−0.56, p &lt;0.00001),
inattention (SMD=−0.57, p &lt;0.00001) and ODD symptoms (SMD=−0.44, p =0.0004). Similarly, alpha-2agonist add-on treatment (3 studies, n=726) significantly reduced overall ADHD symptoms (SMD=−0.36, p
&lt;0.0001), hyperactivity/impulsivity (SMD=−0.33, p &lt;0.0001), and inattention (SMD=−0.34, p &lt;0.0001),
but effect sizes were lower than in monotherapy trials ( p =0.03–0.04). As monotherapy, alpha-2-agonists
had lower all-cause (RR=0.70, p =0.01, NNT=10) and inefficacy-related (RR=0.39, p &lt;0.0001)
discontinuations than placebo; whereas intolerability-related discontinuation was similar, despite
significantly more common fatigue (NNH=10), sedation (NNH=17), and somnolence (NNH=4) and
significantly greater hypotensive (clonidine-IR), bradycardic (clonidine-IR) and QTc prolonging (guanfacineXR) effects. Added to stimulants, alpha-2-agonists had comparable all-cause and specific-cause
discontinuations like placebo, but somnolence (NNH=10) was more common, and hypotensive and
bradycardic effects (clonidine-XR and guanfacine-XR) were greater than with placebo. Conclusions Alpha2-agonist monotherapy and, possibly, and possibly, to a lesser extent, cotreatment, are significantly
superior to placebo for overall, hyperactivity and inattentive ADHD symptoms. Efficacy advantages need to
be balanced against fatigue, somnolence/sedation, hypotension, bradycardia and, possibly, QTc
prolongation.
Annual Research Review: Towards a developmental neuroscience of atypical social
cognition
28 Nov 2013 07:56 am
Abstract As a starting point for our review we use a developmental timeline, starting from birth and divided
into major developmental epochs defined by key milestones of social cognition in typical development. For
each epoch, we highlight those developmental disorders that diverge from the normal developmental
pattern, what is known about these key milestones in the major disorders affecting social cognition, and any
available research on the neural basis of these differences. We relate behavioural observations to four
major networks of the social brain, that is, Amygdala, Mentalizing, Emotion and Mirror networks. We focus
on those developmental disorders that are characterized primarily by social atypicality, such as autism
spectrum disorder, social anxiety and a variety of genetically defined syndromes. The processes and
aspects of social cognition we highlight are sketched in a putative network diagram, and include: agent
identification, emotion processing and empathy, mental state attribution, self-processing and social
hierarchy mapping involving social ‘policing’ and in-group/out-group categorization. Developmental
disorders reveal some dissociable deficits in different components of this map of social cognition. This
broad review across disorders, ages and aspects of social cognition leads us to some key questions: How
can we best distinguish primary from secondary social disorders? Is social cognition especially vulnerable
to developmental disorder, or surprisingly robust? Are cascading notions of social development, in which
early functions are essential stepping stones or building bricks for later abilities, necessarily correct?
Annual Research Review: the neurobehavioral development of multiple memory systems –
implications for childhood and adolescent psychiatric disorders
29 Nov 2013 12:29 am
Extensive evidence indicates that mammalian memory is organized into multiple brains systems, including a
‘cognitive’ memory system that depends on the hippocampus and a stimulus-response ‘habit’ memory
system that depends on the dorsolateral striatum. Dorsal striatal-dependent habit memory may in part
influence the development and expression of some human psychopathologies, particularly those
characterized by strong habit-like behavioral features. The present review considers this hypothesis as it
pertains to psychopathologies that typically emerge during childhood and adolescence. These disorders
include Tourette syndrome, attention-deficit/hyperactivity disorder, obsessive–compulsive disorder, eating
disorders, and autism spectrum disorders. Human and nonhuman animal research shows that the typical
development of memory systems comprises the early maturation of striatal-dependent habit memory and
the relatively late maturation of hippocampal-dependent cognitive memory. We speculate that the differing
rates of development of these memory systems may in part contribute to the early emergence of habit-like
symptoms in childhood and adolescence. In addition, abnormalities in hippocampal and striatal brain
regions have been observed consistently in youth with these disorders, suggesting that the aberrant
development of memory systems may also contribute to the emergence of habit-like symptoms as core
pathological features of these illnesses. Considering these disorders within the context of multiple memory
systems may help elucidate the pathogenesis of habit-like symptoms in childhood and adolescence, and
lead to novel treatments that lessen the habit-like behavioral features of these disorders.
Appreciating “Normal” Development: How Did We Get Here?
09 Dec 2013 10:17 am
Publication date: November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 11
Author(s): Laura M. Prager
Approaches to Enhancing the Early Detection of Autism Spectrum Disorders: A Systematic
Review of the Literature
09 Dec 2013 10:17 am
Publication date: Available online 19 November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry
Author(s): Amy M. Daniels , Alycia K. Halladay , Andy Shih , Lauren M. Elder , Geraldine Dawson
Objective A reliable diagnosis of autism can be made as early as 24 months, yet many children are
diagnosed much later. A delay in diagnosis translates into a missed opportunity to provide early intervention
services and improve outcomes. The aim of the current study was to review the literature on early detection
approaches in primary care and other community settings in the United States. Methods A search was
conducted of the peer-reviewed and gray literature to identify studies published from January 1990 through
January 2013 testing approaches to enhance the early detection of autism in community settings in the
United States. Results The search identified 40 studies describing 35 approaches, which were grouped into
the following categories: awareness (n=4), routine screening (n=21), and practice improvement to enhance
screening (n=10). Awareness approaches were associated with positive changes in knowledge of autismrelated topics. Routine screening yielded high or increased rates of screening and referrals; however, few
studies assessed the effect of screening on age at diagnosis or services enrollment. Practice improvement
approaches resulted in increased screening and referral rates and highlighted the importance of adopting a
multipronged approach to enhance early detection. Conclusions While studies that tested screening
approaches in community settings found positive results, the effectiveness of such efforts on reducing time
to diagnosis and services enrollment remains largely untested. The fact that few studies reported outcomes
beyond rates of referral indicates the need for enhanced methodological rigor particularly with respect to
length of follow-up and quality of measures used.
Attention Network Hypoconnectivity With Default and Affective Network Hyperconnectivity
in Adults Diagnosed With Attention-Deficit/Hyperactivity Disorder in Childhood
01 Dec 2013 12:00 am
Importance
The neurobiological underpinnings of attention-deficit/hyperactivity disorder (ADHD) and particularly those
associated with the persistence of ADHD into adulthood are not yet well understood. The correlation
patterns in spontaneous neural fluctuations at rest are known as resting-state functional connectivity
(RSFC) and could characterize ADHD-specific connectivity changes.
Objective
To determine the specific location of possible ADHD-related differences in RSFC between adults diagnosed
as having ADHD in childhood and control subjects.
Design
Using resting-state functional magnetic resonance imaging, we calculated and compared functional
connectivity from attention, affective, default, and cognitive control networks involved in the
psychopathology of ADHD between the ADHD and control groups.
Setting
University psychiatric service and magnetic resonance imaging research center.
Participants
Sixteen drug-free adults (5 women and 11 men; mean age, 24.5 years) diagnosed with combined-type
ADHD in childhood and 16 healthy controls matched for age (mean age, 24.4 years), sex, handedness, and
educational level recruited from the community.
Intervention
Functional magnetic resonance imaging.
Main Outcomes and Measures
Connectivity data from ventral and dorsal attention, affective, default, and cognitive control networks and
ADHD symptoms derived from ADHD-specific rating instruments.
Results
Adults with ADHD showed significantly decreased RSFC within the attention networks and increased RSFC
within the affective and default mode and the right lateralized cognitive control networks compared with
healthy controls (P < .01, familywise error for whole-brain cluster correction). Lower RSFC in the ventral and
dorsal attention network was significantly correlated with higher levels of ADHD symptoms (P < .001).
Conclusions and Relevance
These RSFC findings might underpin a biological basis for adult ADHD and are functionally related to
persistent inattention, disturbance in cognitive control, and emotional dysregulation in adults with ADHD.
These findings need to be understood in the context of all aspects of brain function in ADHD.
Beyond Rising Rates: Personalized Medicine and Public Health Approaches to the
Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder
09 Dec 2013 10:17 am
Publication date: Available online 22 November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry
Author(s): John T. Walkup , Lauren Stossel , Rebecca Rendleman
Callous-Unemotional Traits, Proactive Aggression, and Treatment Outcomes of Aggressive
Children With Attention-Deficit/Hyperactivity Disorder
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Joseph C. Blader , Steven R. Pliszka , Vivian Kafantaris , Carmel A. Foley , Judith A. Crowell ,
Gabrielle A. Carlson , Colin L. Sauder , David M. Margulies , Christa Sinha , Jeffrey Sverd , Thomas L.
Matthews , Brigitte Y. Bailey , W. Burleson Daviss
Objective Stimulant treatment improves impulse control among children with attention-deficit/hyperactivity
disorder (ADHD). Decreased aggression often accompanies stimulant pharmacotherapy, suggesting that
impulsiveness is integral to aggressive behavior in these children. However, children with high callousunemotional (CU) traits and proactive aggression may benefit less from ADHD pharmacotherapy, because
their aggressive behavior seems more purposeful and deliberate. This study’s objective was to determine
whether pretreatment CU traits and proactive aggression affect treatment outcomes among aggressive
children with ADHD receiving stimulant monotherapy. Method We implemented a stimulant optimization
protocol with 160 children 6 to 13 years of age (mean [SD] age of 9.31 [2.02] years; 78.75% male) with
ADHD, oppositional defiant or conduct disorder, and significant aggressive behavior. Family-focused
behavioral intervention was provided concurrently. The primary outcome was the Retrospective Modified
Overt Aggression Scale. The Antisocial Process Screening Device and the Aggression Scale, also
completed by parents, measured CU traits and proactive aggression, respectively. Analyses examined
moderating effects of CU traits and proactive aggression on outcomes. Results In all, 82 children (51%)
experienced remission of aggressive behavior. Neither CU traits nor proactive aggression predicted
remission (CU traits: odds ratio [OR] = 0.94, 95% CI = 0.80–1.11; proactive aggression, OR = 1.05, 95%
CI = 0.86–1.29). Children whose overall aggression remitted showed decreases in CU traits (effect
size = −0.379, 95% CI = −0.60 to −0.16) and proactive aggression (effect size = −0.463, 95% CI = −0.69 to
−0.23). Conclusions Findings suggest that pretreatment CU traits and proactive aggression do not forecast
worse outcomes for aggressive children with ADHD receiving optimized stimulant pharmacotherapy. With
such treatment, CU traits and proactive aggression may decline alongside other behavioral improvements.
Clinical trial registration information—Medication Strategies for Treating Aggressive Behavior in Youth With
Attention Deficit Hyperactivity Disorder; http://clinicaltrials.gov/ ; NCT00228046 ; and Effectiveness of
Combined Medication Treatment for Aggression in Children With Attention Deficit With Hyperactivity
Disorder (The SPICY Study); http://clinicaltrials.gov/ ; NCT00794625 .
Can Children With Callous and Unemotional Traits Be Treated Successfully?
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Jeffrey H. Newcorn
Candidate Genetic Pathways for Attention-Deficit/Hyperactivity Disorder (ADHD) Show
Association to Hyperactive/Impulsive Symptoms in Children With ADHD
09 Dec 2013 10:17 am
Publication date: November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 11
Author(s): Janita Bralten , Barbara Franke , Irwin Waldman , Nanda Rommelse , Catharina Hartman , Philip
Asherson , Tobias Banaschewski , Richard P. Ebstein , Michael Gill , Ana Miranda , Robert D. Oades ,
Herbert Roeyers , Aribert Rothenberger , Joseph A. Sergeant , Jaap Oosterlaan , Edmund Sonuga-Barke ,
Hans-Christoph Steinhausen , Stephen V. Faraone , Jan K. Buitelaar , Alejandro Arias-Vásquez
Objective Because multiple genes with small effect sizes are assumed to play a role in attentiondeficit/hyperactivity disorder (ADHD) etiology, considering multiple variants within the same analysis likely
increases the total explained phenotypic variance, thereby boosting the power of genetic studies. This study
investigated whether pathway-based analysis could bring scientists closer to unraveling the biology of
ADHD. Method The pathway was described as a predefined gene selection based on a well-established
database or literature data. Common genetic variants in pathways involved in dopamine/norepinephrine and
serotonin neurotransmission and genes involved in neuritic outgrowth were investigated in cases from the
International Multicentre ADHD Genetics (IMAGE) study. Multivariable analysis was performed to combine
the effects of single genetic variants within the pathway genes. Phenotypes were DSM-IV symptom counts
for inattention and hyperactivity/impulsivity (n = 871) and symptom severity measured with the Conners
Parent (n = 930) and Teacher (n = 916) Rating Scales. Results Summing genetic effects of common
genetic variants within the pathways showed a significant association with hyperactive/impulsive symptoms
( p empirical = .007) but not with inattentive symptoms ( p empirical = .73). Analysis of parent-rated
Conners hyperactive/impulsive symptom scores validated this result ( p empirical = .0018). Teacher-rated
Conners scores were not associated. Post hoc analyses showed a significant contribution of all pathways to
the hyperactive/impulsive symptom domain (dopamine/norepinephrine, p empirical = .0004; serotonin, p
empirical = .0149; neuritic outgrowth, p empirical = .0452). Conclusion The present analysis shows an
association between common variants in 3 genetic pathways and the hyperactive/impulsive component of
ADHD. This study demonstrates that pathway-based association analyses, using quantitative
measurements of ADHD symptom domains, can increase the power of genetic analyses to identify
biological risk factors involved in this disorder.
Caregiver-child mental health: a prospective study in conflict and refugee settings
29 Nov 2013 12:29 am
Background In humanitarian settings, family-level drivers of mental health are insufficiently documented; we
examined the strength of caregiver-child associations with two-wave, family-level Afghan data. Methods We
recruited a gender-balanced sample of 681 caregiver-child dyads (n = 1,362 respondents) using stratified
random-sampling in government schools in Kabul (364 dyads) and refugee schools in Peshawar (317
dyads). One year after baseline, we re-interviewed 64% of Kabul and 31% of Peshawar cohorts (n = 331
dyads, 662 respondents), retaining fewer Peshawar families due to refugee repatriation. In multivariable
analyses adjusted for baseline, we assessed the extent to which caregiver mental health (Self-Report
Questionnaire, SRQ-20) was associated with child symptom scores of post-traumatic stress (Child Revised
Impact of Events Scale, CRIES), depression (Depression Self-Rating Scale, DSRS), psychiatric difficulties,
impact, and prosocial strength (Strength and Difficulties Questionnaire, SDQ). Results Caregiver mental
health was prospectively associated with all eight measures of child mental health at follow-up, adjusted for
baseline. For post-traumatic stress, caregiver mental health had a predictive impact comparable to the child
experiencing one or two lifetime trauma events. For depression, caregiver mental health approached the
predictive impact of female gender. Thus a one SD change in caregiver SRQ-20 was associated with a 1.04
point change on CRIES and a 0.65 point change in DSRS. For multi-informant SDQ data, caregiver-child
associations were strongest for caregiver ratings. For child-rated outcomes, associations were moderated
by maternal literacy, a marker of family-level dynamics. Both adults and children identified domestic
violence and quality of home life as independent risk and protective factors. Conclusions In the context of
violence and displacement, efforts to improve child mental health require a thoughtful consideration of the
mental health cascade across generations and the cluster of adversities that impact family wellbeing. We
identify culturally meaningful leverage points for building family-level resilience, relevant to the prevention
and intervention agenda in global mental health.
Children's Parasympathetic Reactivity to Specific Emotions Moderates Response to
Intervention for Early-Onset Aggression
05 Dec 2013 06:19 pm
Journal of Clinical Child & Adolescent Psychology, Volume 0, Issue 0, Page 1-14, Ahead of Print.
Clinical Usefulness of Observational Assessment in the Diagnosis of DBD and ADHD in
Preschoolers
13 Nov 2013 04:46 pm
Journal of Clinical Child & Adolescent Psychology, Volume 42, Issue 6, Page 749-761, NovemberDecember 2013.
Cogmed Working Memory Training for Youth with ADHD: A Closer Examination of Efficacy
Utilizing Evidence-Based Criteria
13 Nov 2013 04:46 pm
Journal of Clinical Child & Adolescent Psychology, Volume 42, Issue 6, Page 769-783, NovemberDecember 2013.
Correction note
16 Nov 2013 04:39 am
Council Page
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Daniel W.ShwalbBarbara J.ShwalbMichael E.LambFathers in Cultural
Context2013RoutledgeNew York
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Shannon Wagner Simmons
Developmental Mismatch Why Some Immigrants Seem Protected From Affective,
Personality, and Substance Use Disorders
01 Dec 2013 12:00 am
To the Editor In a recently published article about risks of mental disorders associated with various types of
foreign migration, Cantor-Graae and Pedersen reported higher risks for schizophrenia-related disorders in
all types of migrants, except in children born to expatriates. In addition, which I found particularly interesting,
they found lower risks for affective, personality, and substance use disorders in first- and second-generation
migrants with 2 foreign-born parents but higher risks in foreign-born adoptees, second-generation
immigrants with 1 foreign-born parent, and native Danes who resided abroad. The question is, what is the
difference between these 2 types of migrants compared with the other types?
Distinctions Between Sluggish Cognitive Tempo, ADHD-IN, and Depression Symptom
Dimensions in Spanish First-Grade Children
13 Nov 2013 04:45 pm
Journal of Clinical Child & Adolescent Psychology, Volume 42, Issue 6, Page 796-808, NovemberDecember 2013.
Editorial Board
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Editorial Perspective: School exclusion is a mental health issue
16 Nov 2013 04:39 am
Editorial: Counting the cost: estimating the burden of child mental health
16 Nov 2013 04:39 am
The publication of the first report from the Global Burden of Disease (GBD) Study (Murray & Lopez, 1996)
radically changed evaluations of the public health significance of mental disorders. Before that time,
diseases were typically ranked in terms of their impact on premature mortality. The GBD Study added
estimates of impact on disability, and in so doing highlighted the huge public health burden attendant on
poor mental health.
Effects of the KiVa Antibullying Program on Cyberbullying and Cybervictimization
Frequency Among Finnish Youth
13 Nov 2013 04:46 pm
Journal of Clinical Child & Adolescent Psychology, Volume 42, Issue 6, Page 820-833, NovemberDecember 2013.
Efficacy and Safety of Atomoxetine in Children and Adolescents With AttentionDeficit/Hyperactivity Disorder: Results from a Comprehensive Meta-Analysis and
Metaregression
09 Dec 2013 10:17 am
Publication date: Available online 25 November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry
Author(s): Simon Schwartz , Christoph U. Correll
Objective To comprehensively evaluate atomoxetine’s (ATX’s) efficacy and safety in pediatric attentiondeficit/hyperactivity disorder (ADHD). Method Meta-analysis of all double-blind randomized controlled trials
(DBRCTs) evaluating ATX’s efficacy and tolerability for ADHD. Pooled, random-effects analyses were
conducted, calculating standardized mean difference (SMD), yielding effect sizes (ES), relative risk (RR),
and number-needed-to-treat/harm (NNT/NNH).Moderator/mediator analyses were also conducted, including
metaregression. Results Across 25 DBRCTs (56 treatment arms, N=3,928), ATX outperformed placebo
regarding overall ADHD symptoms (ES=−0.64, 95% CI=−0.56, −0.71, p &lt;0.0001), hyperactivity/impulsivity
(ES=−0.67, CI=−0.53, −0.81, p &lt;0.0001) and inattention (ES=−0.59, CI=−0.51, −0.67, p &lt;0.0001).
Altogether, 44.4% vs. 21.4% of patients improved by &gt; 40% (NNT=4), while 39.9% vs. 65.9% improved
by &lt; 25% (NNT=4). Oppositional defiant disorder symptoms (ES=−0.33) and quality of life-related
outcomes (ES=−0.48 to −0.25) improved somewhat less. Higher percent treatment-naïve patients
moderated ATX’s efficacy for overall ADHD symptoms ( p =0.017). All-cause discontinuation with ATX was
similar to placebo ( p =1.00), with lower discontinuation due to inefficacy (RR=0.51, CI=0.36–0.74, p
&lt;0.0001, NNT=34), but higher discontinuation due to adverse effects (AEs) (RR=1.89, CI=1.08–3.31, p
=0.03, NNH=50) with ATX. At least one adverse effect (AE) (70.4% vs. 56.1%, p &lt;0.01, NNH=6) and &gt;
1 psychiatric AE (21.5% vs. 7.4%, NNH=7, p &lt;0.01) were more frequent with ATX, while serious AEs
(1.5% vs. 1.0%), aggression (7.5% vs. 6.0%) and suicidal ideation (1.3% vs. 0.9%) were not different from
placebo. Conclusions Short-term ATX treatment is safe and superior to placebo for overall ADHD
symptoms and key secondary outcomes, with a medium ES. However, a relevant patient subgroup (40%)
continues to have significant symptomatology, requiring additional clinical attention.
Emotional Face Processing in Pediatric Bipolar Disorder: Evidence for Functional
Impairments in the Fusiform Gyrus
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Susan B. Perlman , Jay C. Fournier , Genna Bebko , Michele A. Bertocci , Amanda K. Hinze ,
Lisa Bonar , Jorge R.C. Almeida , Amelia Versace , Claudiu Schirda , Michael Travis , Mary Kay Gill ,
Christine Demeter , Vaibhav A. Diwadkar , Jeffrey L. Sunshine , Scott K. Holland , Robert A. Kowatch ,
Boris Birmaher , David Axelson , Sarah M. Horwitz , L. Eugene Arnold , Mary A. Fristad , Eric A.
Youngstrom , Robert L. Findling , Mary L. Phillips
Objective Pediatric bipolar disorder involves poor social functioning, but the neural mechanisms underlying
these deficits are not well understood. Previous neuroimaging studies have found deficits in emotional face
processing localized to emotional brain regions. However, few studies have examined dysfunction in other
regions of the face processing circuit. This study assessed hypoactivation in key face processing regions of
the brain in pediatric bipolar disorder. Method Youth with a bipolar spectrum diagnosis (n = 20) were
matched to a nonbipolar clinical group (n = 20), with similar demographics and comorbid diagnoses, and a
healthy control group (n = 20). Youth participated in a functional magnetic resonance imaging (fMRI)
scanning which employed a task-irrelevant emotion processing design in which processing of facial
emotions was not germane to task performance. Results Hypoactivation, isolated to the fusiform gyrus, was
found when viewing animated, emerging facial expressions of happiness, sadness, fearfulness, and
especially anger in pediatric bipolar participants relative to matched clinical and healthy control groups.
Conclusions The results of the study imply that differences exist in visual regions of the brain’s face
processing system and are not solely isolated to emotional brain regions such as the amygdala. Findings
are discussed in relation to facial emotion recognition and fusiform gyrus deficits previously reported in the
autism literature. Behavioral interventions targeting attention to facial stimuli might be explored as possible
treatments for bipolar disorder in youth.
Engendering Identity
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Peter T. Daniolos , Cynthia J. Telingator
Equivalence of the Short Form of the Reynolds Adolescent Depression Scale across
Groups
18 Nov 2013 07:55 pm
Journal of Clinical Child & Adolescent Psychology, Volume 0, Issue 0, Page 1-9, Ahead of Print.
Evidence Base Updates: The Evolution of the Evaluation of Psychological Treatments for
Children and Adolescents
02 Dec 2013 08:42 pm
Journal of Clinical Child & Adolescent Psychology, Volume 0, Issue 0, Page 1-6, Ahead of Print.
Evidence-Based Psychosocial Treatments for Children and Adolescents with AttentionDeficit/Hyperactivity Disorder
18 Nov 2013 06:54 pm
Journal of Clinical Child & Adolescent Psychology, Volume 0, Issue 0, Page 1-25, Ahead of Print.
Father Almighty
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Schuyler W. Henderson
Future Directions in the Developmental Science of Addictions
13 Nov 2013 04:45 pm
Journal of Clinical Child & Adolescent Psychology, Volume 42, Issue 6, Page 863-873, NovemberDecember 2013.
Gender Differences in the Relationship Between Social Communication and Emotion
Recognition
09 Dec 2013 10:17 am
Publication date: November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 11
Author(s): Radha Kothari , David Skuse , Justin Wakefield , Nadia Micali
Objective To investigate the association between autistic traits and emotion recognition in a large
community sample of children using facial and social motion cues, additionally stratifying by gender. Method
A general population sample of 3,666 children from the Avon Longitudinal Study of Parents and Children
(ALSPAC) were assessed on their ability to correctly recognize emotions using the faces subtest of the
Diagnostic Analysis of Non-Verbal Accuracy, and the Emotional Triangles Task, a novel test assessing
recognition of emotion from social motion cues. Children with autistic-like social communication difficulties,
as assessed by the Social Communication Disorders Checklist, were compared with children without such
difficulties. Results Autistic-like social communication difficulties were associated with poorer recognition of
emotion from social motion cues in both genders, but were associated with poorer facial emotion
recognition in boys only (odds ratio = 1.9, 95% CI = 1.4, 2.6, p = .0001). This finding must be considered in
light of lower power to detect differences in girls. Conclusions In this community sample of children, greater
deficits in social communication skills are associated with poorer discrimination of emotions, implying there
may be an underlying continuum of liability to the association between these characteristics. As a similar
degree of association was observed in both genders on a novel test of social motion cues, the relatively
good performance of girls on the more familiar task of facial emotion discrimination may be due to
compensatory mechanisms. Our study might indicate the existence of a cognitive process by which girls
with underlying autistic traits can compensate for their covert deficits in emotion recognition, although this
would require further investigation.
Genetic Associations Between the Symptoms of Attention-Deficit/Hyperactivity Disorder and
Emotional Lability in Child and Adolescent Twins
09 Dec 2013 10:17 am
Publication date: Available online 25 November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry
Author(s): Andrew Merwood , Wai Chen , Fruhling Rijsdijk , Caroline Skirrow , Henrik Larsson , Anita
Thapar , Jonna Kuntsi , Philip Asherson
Objective Emotional lability is recognised as an associated feature of attention-deficit/hyperactivity disorder
(ADHD). However, the degree of phenotypic and etiologic overlap between emotional lability and the ADHD
dimensions of hyperactivity-impulsivity and inattention remains unclear. The present study examines these
associations in a large, community twin sample. Method Structural equation models were fit to data from
1,920 child and adolescent twin pairs (age range 5–18 years). Symptoms of hyperactivity-impulsivity (HI)
and inattention (IA) were assessed using a modified version of the DuPaul rating scale, completed by
parents. Symptoms of emotional lability (EL) were assessed using the parent-rated Conners 10-item scale.
Results There were moderate to strong phenotypic correlations between HI, IA, and EL. Multivariate twin
modeling revealed that a common pathway model best accounted for the covariance between these
dimensions, represented by a highly heritable latent factor. Ad-hoc analyses confirmed that all additive
genetic influences on HI, IA, and EL were shared and identified a significantly stronger association of EL
with the latent ADHD factor in older than younger individuals. Conclusions Emotional lability was
phenotypically and genetically associated with hyperactivity-impulsivity and inattention in children and
adolescents. The finding that a single, heritable, latent factor accounted for covariation among these
phenotypes indicates that their co-occurrence is primarily the result of overlapping genetic effects. These
data support the hypothesis that emotional lability is etiologically-relevant to the core ADHD phenotype and
that it should be targeted in assessment and treatment in clinical practice.
Genetic and environmental influences on adolescent attachment
21 Nov 2013 06:22 am
Background Twin studies consistently point to limited genetic influence on attachment security in the infancy
period, but no study has examined whether this remains the case in later development. This study presents
the findings from a twin study examining the relative importance of genetic and environmental influences on
attachment in adolescence. Methods The sample included 551 twin pairs aged 15 years recruited from the
larger Twins Early Development Study (TEDS). Attachment was assessed using a semistructured interview,
the Child Attachment Interview. Results We found robust associations between MZ twins' scores for
Coherence and their overall security of attachment (r = .42, p < .001; kappa = .26, p < .001), but
substantially lower associations for DZ twins (r = .20, p = .001; kappa = .09, p = .20), suggesting genetic
influence on adolescent attachment (and substantial nonshared environment). Model-fitting analyses
confirmed this impression, indicating approximately 40% heritability of attachment and negligible influence
of the shared environment. Conclusions The results suggest that genes may play an important role in
adolescent attachment and point to the potentially distinct aetiological mechanisms involved in individual
differences in attachment beyond early childhood.
Hats Off: Journal Awards 2013
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Andrés Martin , Martin J. Drell , Larry K. Brown , David A. Axelson , Paula D. Riggs
Here and There/Global Burden of Disease
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Christian Kieling
Here/In This Issue and There/Abstract Thinking: Are We There Yet?
Electroencephalography as a Diagnostic Tool for Attention-Deficit/Hyperactivity Disorder
09 Dec 2013 10:17 am
Publication date: November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 11
Author(s): Natalie Weder
How Should We Interpret and Value the Pursuit of Blood-Based Biomarkers for Autism
Spectrum Disorders?
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Stephen J. Glatt
Internet-Delivered, Family-Based Treatment for Early-Onset OCD: A Preliminary Case
Series
02 Dec 2013 08:42 pm
Journal of Clinical Child & Adolescent Psychology, Volume 0, Issue 0, Page 1-14, Ahead of Print.
Invisible Allies: Thanking Our Reviewers
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Journal of Clinical Child and Adolescent Psychology
13 Nov 2013 04:47 pm
Journal of Clinical Child & Adolescent Psychology, Volume 42, Issue 6, Page 877-887, NovemberDecember 2013.
Life-time prevalence and psychosocial correlates of adolescent direct self-injurious
behavior: A comparative study of findings in 11 European countries
12 Nov 2013 02:20 am
Objectives To investigate the prevalence and associated psychosocial factors of occasional and repetitive
direct self-injurious behavior (D-SIB), such as self-cutting, -burning, -biting, -hitting, and skin damage by
other methods, in representative adolescent samples from 11 European countries. Methods Cross-sectional
assessment of adolescents was performed within the European Union funded project, Saving and
Empowering Young Lives in Europe (SEYLE), which was conducted in 11 European countries. The
representative sample comprised 12,068 adolescents (F/M: 6,717/5,351; mean age: 14.9 ± 0.89) recruited
from randomly selected schools. Frequency of D-SIB was assessed by a modified 6-item questionnaire
based on previously used versions of the Deliberate Self-Harm Inventory (DSHI). In addition, a broad range
of demographic, social, and psychological factors was assessed. Results Overall lifetime prevalence of DSIB was 27.6%; 19.7% reported occasional D-SIB and 7.8% repetitive D-SIB. Lifetime prevalence ranged
from 17.1% to 38.6% across countries. Estonia, France, Germany, and Israel had the highest lifetime rates
of D-SIB, while students from Hungary, Ireland, and Italy reported low rates. Suicidality as well as anxiety
and depressive symptoms had the highest odds ratios for both occasional and repetitive D-SIB. There was
a strong association of D-SIB with both psychopathology and risk-behaviors, including family related neglect
and peer-related rejection/victimization. Associations between psychosocial variables and D-SIB were
strongly influenced by both gender and country. Only a minor proportion of the adolescents who reported DSIB ever received medical treatment. Conclusion These results suggest high lifetime prevalence of D-SIB in
European adolescents. Prevalence as well as psychosocial correlates seems to be significantly influenced
by both gender and country. These results support the need for a multidimensional approach to better
understand the development of SIB and facilitate culturally adapted prevention/intervention.
MAP as a Model for Practice-Based Learning and Improvement in Child Psychiatry Training
18 Nov 2013 06:57 pm
Journal of Clinical Child & Adolescent Psychology, Volume 0, Issue 0, Page 1-11, Ahead of Print.
Maternal Depression During Pregnancy and the Postnatal Period Risks and Possible
Mechanisms for Offspring Depression at Age 18 Years
01 Dec 2013 12:00 am
Importance
Some small studies suggest that maternal postnatal depression is a risk factor for offspring adolescent
depression. However, to our knowledge, no large cohort studies have addressed this issue. Furthermore,
only 1 small study has examined the association between antenatal depression and later offspring
depression. Understanding these associations is important to inform prevention.
Objective
To investigate the hypothesis that there are independent associations between antenatal and postnatal
depression with offspring depression and that the risk pathways are different, such that the risk is
moderated by disadvantage (low maternal education) with postnatal depression but not with antenatal
depression.
Design, Setting, and Participants
Prospective investigation of associations between symptoms of antenatal and postnatal parental depression
with offspring depression at age 18 years in a UK community-based birth cohort (Avon Longitudinal Study
of Parents and Children) with data from more than 4500 parents and their adolescent offspring.
Main Outcomes and Measures
Diagnosis of offspring aged 18 years with major depression using the International Classification of
Diseases, 10th Revision.
Results
Antenatal depression was an independent risk factor. Offspring were 1.28 times (95% CI, 1.081.51; P = .003) more likely to have depression at age 18 years for each standard deviation increase in
maternal depression score antenatally, independent of later maternal depression. Postnatal depression was
also a risk factor for mothers with low education, with offspring 1.26 times (95% CI, 1.06-1.50; P = .01) more
likely to have depression for each standard deviation increase in postnatal depression score. However, for
more educated mothers, there was little association (odds ratio, 1.09; 95% CI, 0.88-1.36; P = .42). Analyses
found that maternal education moderated the effects of postnatal but not antenatal depression. Paternal
depression antenatally was not associated with offspring depression, while postnatally, paternal depression
showed a similar pattern to maternal depression.
Conclusions and Relevance
The findings suggest that treating maternal depression antenatally could prevent offspring depression
during adulthood and that prioritizing less advantaged mothers postnatally may be most effective.
Medical and Nonmedical Use of Prescription Stimulants: Results From a National
Multicohort Study
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Sean Esteban McCabe , Brady T. West
Objective To examine the lifetime prevalence of medical and nonmedical use of prescription stimulants
(e.g., Adderall, Concerta, Ritalin, Dexedrine) among high school seniors in the United States, and to assess
substance use behaviors (i.e., cigarette smoking, binge drinking, marijuana, and other drug use) based on
lifetime histories of medical and nonmedical use of prescription stimulants. Method Nationally
representative samples of high school seniors from the Monitoring the Future study were surveyed via selfadministered questionnaires. The sample consisted of 4,572 individuals (modal age 18 years) from 2
independent cohorts (2010 and 2011) and represented a population that was 50% female, 57% white, 12%
African-American, 13% Hispanic, and 18% other. Results The lifetime prevalence of medical use of
prescription stimulants was 9.5%, and the lifetime nonmedical use of prescription stimulants was also 9.5%.
Among those who were ever prescribed stimulants, approximately 59.3% reported medical use only, 22.9%
reported medical use before nonmedical use, and 17.8% reported nonmedical use before medical use. The
odds of substance use behaviors generally did not differ between medical users only and non-users. In
contrast, the odds of substance use behaviors were greater among nonmedical users only and medical
users who reported any history of nonmedical use relative to nonusers. Conclusions About 1 in every 6 high
school seniors in the United States has ever had some exposure to prescription stimulants, either medically
or nonmedically. Health care professionals should carefully screen and monitor adolescents, because the
risk for substance abuse is directly associated with a history of nonmedical use of prescription stimulants.
Microvascular Abnormality in Schizophrenia as Shown by Retinal Imaging
01 Dec 2013 12:00 am
Objective
Retinal and cerebral microvessels are structurally and functionally homologous, but unlike cerebral
microvessels, retinal microvessels can be noninvasively measured in vivo by retinal imaging. The authors
tested the hypothesis that individuals with schizophrenia exhibit microvascular abnormality and evaluated
the utility of retinal imaging as a tool for schizophrenia research.
Method
Participants were members of the Dunedin Study, a population-representative cohort followed from birth
with 95% retention. Study members underwent retinal imaging at age 38. The authors assessed retinal
arteriolar and venular caliber for all members of the cohort, including individuals who developed
schizophrenia.
Results
Study members who developed schizophrenia were distinguished by wider retinal venules, suggesting
microvascular abnormality reflective of insufficient brain oxygen supply. Analyses that controlled for
confounding health conditions suggested that wider retinal venules are not simply an artifact of co-occurring
health problems in schizophrenia patients. Wider venules were also associated with a dimensional measure
of adult psychosis symptoms and with psychosis symptoms reported in childhood.
Conclusions
The findings provide initial support for the hypothesis that individuals with schizophrenia show
microvascular abnormality. Moreover, the results suggest that the same vascular mechanisms underlie
subthreshold symptoms and clinical disorder and that these associations may begin early in life. These
findings highlight the promise of retinal imaging as a tool for understanding the pathogenesis of
schizophrenia.
Natasha J.CabreraCatherine S.Tamis-LeMondaHandbook of Father Involvement:
Multidisciplinary Perspectives, Second Edition2013RoutledgeNew York
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Shannon G. Caspersen
Negative Peer Status and Relational Victimization in Children and Adolescents: The Role of
Stress Physiology
18 Nov 2013 07:52 pm
Journal of Clinical Child & Adolescent Psychology, Volume 0, Issue 0, Page 1-12, Ahead of Print.
Negative Social Preference in Relation to Internalizing Symptoms Among Children with
ADHD Predominantly Inattentive Type: Girls Fare Worse Than Boys
13 Nov 2013 04:47 pm
Journal of Clinical Child & Adolescent Psychology, Volume 42, Issue 6, Page 784-795, NovemberDecember 2013.
Overreactive Brain Responses to Sensory Stimuli in Youth With Autism Spectrum Disorders
09 Dec 2013 10:17 am
Publication date: November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 11
Author(s): Shulamite A. Green , Jeffrey D. Rudie , Natalie L. Colich , Jeffrey J. Wood , David Shirinyan ,
Leanna Hernandez , Nim Tottenham , Mirella Dapretto , Susan Y. Bookheimer
Objectives Sensory over-responsivity (SOR), defined as a negative response to or avoidance of sensory
stimuli, is both highly prevalent and extremely impairing in youth with autism spectrum disorders (ASD), yet
little is known about the neurological bases of SOR. This study aimed to examine the functional neural
correlates of SOR by comparing brain responses to sensory stimuli in youth with and without ASD. Method
A total of 25 high-functioning youth with ASD and 25 age- and IQ-equivalent typically developing (TD) youth
were presented with mildly aversive auditory and visual stimuli during a functional magnetic resonance
imaging (fMRI) scan. Parents provided ratings of children's SOR and anxiety symptom severity. Results
Compared to TD participants, ASD participants displayed greater activation in primary sensory cortical
areas as well as amygdala, hippocampus, and orbital-frontal cortex. In both groups, the level of activity
in these areas was positively correlated with level of SOR severity as rated by parents, over and above
behavioral ratings of anxiety. Conclusions This study demonstrates that youth with ASD show neural hyperresponsivity to sensory stimuli, and that behavioral symptoms of SOR may be related to both heightened
responsivity in primary sensory regions as well as areas related to emotion processing and regulation.
Pathways to Violent Behavior During First-Episode Psychosis A Report From the UK
National EDEN Study
01 Dec 2013 12:00 am
Importance
Although many studies have explored the correlates of violence during first-episode psychosis (FEP), most
have simply compared violent psychotic individuals with nonviolent psychotic individuals. Accumulating
evidence suggests there may be subgroups within psychosis, differing in terms of developmental processes
and proximal factors associated with violent behavior.
Objective
To determine whether there are subgroups of psychotic individuals characterized by different
developmental trajectories to violent behavior.
Design, Setting, and Participants
The National EDEN (Evaluating the Development and Impact of Early Intervention Services in the West
Midlands) Study longitudinal cohort assessed premorbid delinquency (premorbid adjustment adaptation
subscale across childhood and adolescence), age at illness onset, duration of untreated psychosis, past
drug use, positive symptoms, and violent behavior. Group trajectories of premorbid delinquency were
estimated using latent class growth analysis, and associations with violent behavior were quantified. This
study included 6 early intervention services in 5 geographical locations across England, with violent
behavior information available for 670 first-episode psychosis cases.
Main Outcomes and Measures
Violent behavior at 6 or 12 months following early intervention services entry.
Results
Four groups of premorbid delinquency were identified: stable low, adolescent-onset high to moderate,
stable moderate, and stable high. Logistic regression analysis, with stable low delinquency as the reference
group, demonstrated that moderate (odds ratio, 1.97; 95% CI, 1.12-3.46) and high (odds ratio, 3.53; 95%
CI, 1.85-6.73) premorbid delinquency trajectories increased the risk for violent behavior during FEP. After
controlling for confounders, path analysis demonstrated that the increased risk for violence in the moderate
delinquency group was indirect (ie, partially mediated by positive symptoms) (probit coefficient
[β] = 0.12; P = .002); while stable high delinquency directly increased the risk for violence (β = 0.38; P = .05).
Conclusions and Relevance
There appear to be diverse pathways to violent behavior during FEP. Stable high premorbid delinquency
from childhood onwards appears to directly increase the risk for violent behavior, independent of psychosisrelated risk factors. In addition to tackling illness-related risks, treatments should directly address antisocial
traits as a potent risk for violence during FEP.
Perinatal Problems and Psychiatric Comorbidity Among Children With ADHD
13 Nov 2013 04:45 pm
Journal of Clinical Child & Adolescent Psychology, Volume 42, Issue 6, Page 762-768, NovemberDecember 2013.
Practice Parameter for the Assessment and Treatment of Children and Adolescents With
Tic Disorders
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Tanya K. Murphy , Adam B. Lewin , Eric A. Storch , Saundra Stock
Tic disorders, including Tourette’s disorder, present with a wide range of symptom severity and associated
comorbidity. This Practice Parameter reviews the evidence from research and clinical experience in the
evaluation and treatment of pediatric tic disorders. Recommendations are provided for a comprehensive
evaluation to include common comorbid disorders and for a hierarchical approach to multimodal
interventions.
Practitioner Review: Dysphoria and its regulation in child and adolescent depression
21 Nov 2013 06:22 am
Background By emphasizing the importance of emotions, the ‘affect revolution’ in how human behavior is
conceptualized has inspired a new generation of studies on dysphoric experience and its regulation in
clinical depression, and novel efforts to characterize the precursors of affective disorders in juveniles at
familial risk for depression. Method We review clinical, behavioral, and functional neuroimaging studies of
dysphoric experience and its regulation in depressed children and adolescents, and in juvenile offspring of
parents with histories of clinical depression. We discuss the implication of the literature in the context of
maternal depression. Results Findings confirm the high rate of clinically significant dysphoria in depressed
children and adolescents and reveal notable affective lability in daily life as a function of context and activity.
Findings also show that depressed youngsters have problems in attenuating dysphoria. Similarly, neverdepressed offspring at familial risk for depression display problems in mood repair and impaired mood
repair mechanisms. Brain neuroimaging findings indicate that, overall, depressed, and high-risk youngsters
differ from never depressed controls in neural functioning (activation, connectivity) both at rest and in
response to emotion triggers. Conclusion The evaluation of depressed youngsters should include questions
about reactivity of dysphoric mood to the changing contexts of daily life and about how they manage
(respond to) their own sadness and distress. The resultant information may help the clinician to restructure
a young patient's day for the better and identify helpful mood repair responses. Evidence of impaired mood
repair mechanisms in youngsters at high-risk for depression suggests the need for early intervention. But
interventions must consider that many depressed and high-risk children have depressed mothers, who may
be constrained in their ability to help offspring's emotion regulation efforts. To optimize treatment response
of offspring, mothers of depressed children should therefore be routinely screened for depression and
treated, as warranted.
Predicting young adult outcome among more and less cognitively able individuals with
autism spectrum disorders
09 Dec 2013 12:45 am
Background The range of outcomes for young adults with Autism Spectrum Disorders (ASD) and the early
childhood factors associated with this diversity have implications for clinicians and scientists. Methods This
prospective study provided a unique opportunity to predict outcome 17 years later for a relatively large
sample of children diagnosed with ASD at 2 years old. Diagnostic and psychometric instruments were
administered between 2 and 19 with data from 2, 3, and 19 included in this study. Clinicians administered
tests without knowledge of previous assessments whenever possible. Caregivers provided additional
information through questionnaires. Results Significant intellectual disabilities at 19 were predicted by age 2
about 85% of the time from VIQ and NVIQ scores together, though prediction of young adult outcome for
youths with average or higher intelligence was more complex. By 19, 9% of participants had largely
overcome core difficulties associated with ASD and no longer retained a diagnosis. These youths with Very
Positive Outcomes were more likely to have participated in treatment and had a greater reduction in
repetitive behaviors between age 2 and 3 compared to other Cognitively Able youths (VIQ ≥70) with ASD.
Very Positive Outcome youths did not differ phenotypically from Cognitively Able ASD individuals at 2 but
both groups differed from Cognitively Less Able individuals (VIQ <70). Conclusion Those most at risk for
intellectual disabilities and ASD can be reliably identified at an early age to receive comprehensive
treatment. Findings also suggest that some cognitively able children with ASD who participate in early
intervention have very positive outcomes, although replication with randomized, larger samples is needed.
In order to improve understanding of very positive outcomes in ASD, future research will need to identify
how variations in child characteristics and environmental factors contribute to the nature and timing of
growth across individuals and areas of development.
Preference-for-Solitude and Adjustment Difficulties in Early and Late Adolescence
13 Nov 2013 04:46 pm
Journal of Clinical Child & Adolescent Psychology, Volume 42, Issue 6, Page 834-842, NovemberDecember 2013.
Preschool Anxiety Disorders in Pediatric Primary Care: Prevalence and Comorbidity
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Lauren Franz , Adrian Angold , William Copeland , E. Jane Costello , Nissa Towe-Goodman ,
Helen Egger
Objective We sought to establish prevalence rates and detail patterns of comorbidity for generalized anxiety
disorder, separation anxiety disorder, and social phobia in preschool-aged children. Method The Duke
Preschool Anxiety Study, a screen-stratified, cross-sectional study, drew from pediatric primary care and
oversampled for children at risk for anxiety. A total of 917 parents of preschool children (aged 2–5 years)
completed the Preschool Age Psychiatric Assessment. Results Generalized anxiety disorder, separation
anxiety disorder, and social phobia are common in preschool-aged children attending pediatric primary
care. Three-fourths of preschoolers with an anxiety disorder only had a single anxiety disorder. Generalized
anxiety disorder displayed the greatest degree of comorbidity: with separation anxiety disorder (odds ratio
[OR] = 4.1, 95% CI = 2.0–8.5), social phobia (OR = 6.4, 95% CI = 3.1–13.4), disruptive behavior disorders
(OR = 5.1, 95% CI = 1.6–15.8), and depression (OR = 3.7, 95% CI = 1.1–12.4). Conclusions The weakness
of association between generalized anxiety disorder and depression stands in contrast to substantial
associations between these 2 disorders reported in older individuals. Attenuated associations in preschoolaged children could translate into clinical opportunities for targeted early interventions, aimed at modifying
the developmental trajectory of anxiety disorders.
Preschool Irritability: Longitudinal Associations With Psychiatric Disorders at Age 6 and
Parental Psychopathology
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Lea R. Dougherty , Victoria C. Smith , Sara J. Bufferd , Argyris Stringaris , Ellen Leibenluft ,
Gabrielle A. Carlson , Daniel N. Klein
Objective There is increasing scientific and clinical attention to chronic irritability in youth. However, little is
known about the predictive validity and clinical significance of chronic irritability during early childhood. This
prospective, longitudinal study examined associations of chronic irritability with psychiatric disorders and
parental psychopathology in a large community sample of preschoolers. Method Four hundred sixty-two
preschool-age children were assessed at 3 and 6 years of age. Child psychopathology was assessed at
baseline (3 years) and follow-up (6 years) using a diagnostic interview, the Preschool Age Psychiatric
Assessment, with parents. Items from the Preschool Age Psychiatric Assessment were used to create a
dimensional measurement of chronic irritability. Parental psychopathology was assessed with a diagnostic
interview at baseline. Results Chronic irritability was concurrently associated with a wide range of
psychiatric disorders and functional impairment at 3 and 6 years of age. Irritability at 3 years predicted
depression, oppositional defiant disorder, and functional impairment at 6 years after controlling for baseline
disorders. Irritability also was associated with parental depression and anxiety. Conclusions Findings
underscore the central role of irritability in early-emerging mental health problems. They are consistent with
longitudinal studies in older youth indicating that chronic irritability predicts later depression and anxiety and
support the importance of early detection and interventions targeting preschool irritability.
Prosociality and Negative Emotionality Mediate the Association of Serotonin Transporter
Genotype With Childhood ADHD and ODD
13 Nov 2013 04:46 pm
Journal of Clinical Child & Adolescent Psychology, Volume 42, Issue 6, Page 809-819, NovemberDecember 2013.
Protecting Adolescents From Self-Harm: A Critical Review of Intervention Studies
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): David A. Brent , Dana L. McMakin , Betsy D. Kennard , Tina R. Goldstein , Taryn L. Mayes ,
Antoine B. Douaihy
Objective To review the studies that test treatments targeting adolescent suicidal ideation, suicide attempts,
or self-harm, and to make recommendations for future intervention development. Method The extant
randomized clinical trials that aim to reduce the intensity of suicidal ideation or the recurrence of suicide
attempts or self-harm were reviewed with respect to treatment components, comparison treatments, sample
composition, and outcomes. Results The majority of studies that showed any effect on suicidal ideation,
attempts, or self-harm had some focus on family interactions or nonfamilial sources of support. Two of the
most efficacious interventions also provided the greatest number of sessions. Some other treatment
elements associated with positive effects include addressing motivation for treatment and having explicit
plans for integrating the experimental treatment with treatment as usual. In many studies, suicidal events
tend to occur very early in the course of treatment prior to when an effective “dose” of treatment could be
delivered. Important factors that might mitigate suicidal risk, such as sobriety, healthy sleep, and promotion
of positive affect, were not addressed in most studies. Conclusion Interventions that can front-load
treatment shortly after the suicidal crisis, for example, while adolescent suicide attempters are hospitalized,
may avert early suicidal events. Treatments that focus on the augmentation of protective factors, such as
parent support and positive affect, as well as the promotion of sobriety and healthy sleep, may be beneficial
with regard to the prevention of recurrent suicidal ideation, attempts, or self-harm in adolescents.
Randomized controlled effectiveness trial of executive function intervention for children on
the autism spectrum
21 Nov 2013 06:22 am
Background Unstuck and On Target (UOT) is an executive function (EF) intervention for children with
autism spectrum disorders (ASD) targeting insistence on sameness, flexibility, goal-setting, and planning
through a cognitive-behavioral program of self-regulatory scripts, guided/faded practice, and visual/verbal
cueing. UOT is contextually-based because it is implemented in school and at home, the contexts in which
a child uses EF skills. Methods To evaluate the effectiveness of UOT compared with a social skills
intervention (SS), 3rd–5th graders with ASD (mean IQ = 108; UOT n = 47; SS n = 20) received
interventions delivered by school staff in small group sessions. Students were matched for gender, age,
race, IQ, ASD symptomotolgy, medication status, and parents' education. Interventions were matched for
‘dose’ of intervention and training. Measures of pre–post change included classroom observations,
parent/teacher report, and direct child measures of problem-solving, EF, and social skills. Schools were
randomized and evaluators, but not parents or teachers, were blinded to intervention type. Results
Interventions were administered with high fidelity. Children in both groups improved with intervention, but
mean change scores from pre- to postintervention indicated significantly greater improvements for UOT
than SS groups in: problem-solving, flexibility, and planning/organizing. Also, classroom observations
revealed that participants in UOT made greater improvements than SS participants in their ability to follow
rules, make transitions, and be flexible. Children in both groups made equivalent improvements in social
skills. Conclusions These data support the effectiveness of the first contextually-based EF intervention for
children with ASD. UOT improved classroom behavior, flexibility, and problem-solving in children with ASD.
Individuals with variable background/training in ASD successfully implemented UOT in mainstream
educational settings.
Reduced Error-Related Activation of Dorsolateral Prefrontal Cortex Across Pediatric Anxiety
Disorders
09 Dec 2013 10:17 am
Publication date: November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 11
Author(s): Kate D. Fitzgerald , Yanni Liu , Emily R. Stern , Robert C. Welsh , Gregory L. Hanna ,
Christopher S. Monk , K. Luan Phan , Stephan F. Taylor
Objective Abnormalities of cognitive control functions, such as conflict and error monitoring, have been
theorized to underlie obsessive-compulsive symptoms but only recently have been considered a potentially
relevant psychological construct for understanding other forms of anxiety. The authors sought to determine
whether these cognitive control processes elicit the same abnormalities of brain function in patients with
pediatric obsessive-compulsive disorder (OCD) as in those with non-OCD anxiety disorders. Method
Functional magnetic resonance imaging of the Multisource Interference Task was used to measure conflictand error-related activations in youth (8–18 years) with OCD (n = 21) and non-OCD anxiety disorders
(generalized anxiety disorder, social phobia, separation anxiety disorder; n = 23) compared with agematched healthy controls (n = 25). Results There were no differences in performance (accuracy, response
times) among groups. However, a significant effect of group was observed in the dorsolateral prefrontal
cortex (dlPFC) during error processing, driven by decreased activation in patients with OCD and those with
non-OCD anxiety compared with healthy youth. Between patient groups, there was no difference in errorrelated dlPFC activation. Conclusions Hypoactive dlPFC response to errors occurs in pediatric patients with
OCD and those with non-OCD anxiety. These findings suggest that insufficient error-related engagement of
the dlPFC associates with anxiety across traditional diagnostic boundaries and appears during the early
stages of illness.
Regulatory variant of the TPH2 gene and early life stress are associated with heightened
attention to social signals of fear in infants
05 Dec 2013 03:01 am
Background Cross-species evidence suggests that genetic and experiential factors act early in development
to establish individual emotional traits, but little is known about the mechanisms that emerge during this
period to mediate long-term outcomes. Here, we tested the hypothesis that known genetic and
environmental risk conditions may heighten infants' natural tendency to attend to threat-alerting stimuli,
resulting in a cognitive bias that may contribute to emotional vulnerability. Methods Data from two samples
of 5–7-month-old infants (N = 139) were used to examine whether established candidate variations in the
serotonin-system genes, i.e., TPH2 SNP rs4570625 (-703 G/T) and HTR1A SNP rs6295 (-1019 G/C), and
early rearing condition (maternal stress and depressive symptoms) are associated with alterations in infants'
attention to facial expressions. Infants were tested with a paradigm that assesses the ability to disengage
attention from a centrally presented stimulus (a nonface control stimulus or a neutral, happy, or fearful facial
expression) toward the location of a new stimulus in the visual periphery (a geometric shape). Results
TPH2 -703 T-carrier genotype (i.e., TT homozygotes and heterozygotes), presence of maternal stress and
depressive symptoms, and a combination of the T-carrier genotype and maternal depressive symptoms
were associated with a relatively greater difficulty disengaging attention from fearful facial expressions. No
associations were found with infants' temperamental traits. Conclusions Alterations in infants' natural
attentional bias toward fearful facial expressions may emerge prior to the manifestation of emotional and
social behaviors and provide a sensitive marker of early emotional development.
Rejuvenation: Editor’s Annual Report—Volume 52, 2013
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Andrés Martin
Relational Aggression in Middle Childhood Predicting Adolescent Social-Psychological
Adjustment: The Role of Friendship Quality
13 Nov 2013 04:47 pm
Journal of Clinical Child & Adolescent Psychology, Volume 42, Issue 6, Page 855-862, NovemberDecember 2013.
Replication and External Validation of a Bi-Factor Parameterization of Attention
Deficit/Hyperactivity Symptomatology
20 Nov 2013 04:19 pm
Journal of Clinical Child & Adolescent Psychology, Volume 0, Issue 0, Page 1-12, Ahead of Print.
Research Review: The shared environment as a key source of variability in child and
adolescent psychopathology
22 Nov 2013 04:31 am
Background Behavioral genetic research has historically concluded that the more important environmental
influences were nonshared or result in differences between siblings, whereas environmental influences that
create similarities between siblings (referred to as shared environmental influences) were indistinguishable
from zero. Recent theoretical and meta-analytic work {Burt. Psychological Bulletin [135 (2009) 608]} has
challenged this conclusion as it relates to child and adolescent psychopathology, however, arguing that the
shared environment is a moderate, persistent, and identifiable source of individual differences in such
outcomes prior to adulthood. Methods The current review seeks to bolster research on the shared
environment by highlighting both the logistic advantages inherent in studies of the shared environment, as
well as the use of nontraditional but still genetically informed research designs to study shared
environmental influences. Results Although often moderate in magnitude prior to adulthood and free of
unsystematic measurement error, shared environmental influences are nevertheless likely to have been
underestimated in prior research. Moreover, the shared environment is likely to include proximal effects of
the family, as well as the effects of more distal environmental contexts such as neighborhood and school.
These risk and protective factors could influence the child either as main effects or as moderators of genetic
influence (i.e. gene-environment interactions). Finally, because the absence of genetic relatedness in an
otherwise nonindependent dataset also qualifies as ‘genetically informed’, studies of the shared
environment are amenable to the use of novel and non-traditional designs (with appropriate controls for
selection). Conclusions The shared environment makes important contributions to most forms of child and
adolescent psychopathology. Empirical examinations of the shared environment would thus be of real and
critical value for understanding the development and persistence of common mental health issues prior to
adulthood.
Resting State Functional Connectivity of the Ventral Attention Network in Children With a
History of Depression or Anxiety
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Chad M. Sylvester , Deanna M. Barch , Maurizio Corbetta , Jonathan D. Power , Bradley L.
Schlaggar , Joan L. Luby
Objective We examined whether depression and anxiety disorders in early childhood were associated with
changes in resting state functional connectivity (RSFC) of the ventral attention network (VAN), and whether
RSFC in the VAN was associated with alterations in attention specific to these disorders. Important clinical
features of these illnesses, including changes in attention toward novel stimuli and changes in attention to
stimuli of negative valence (threat/sad bias), indirectly implicate the VAN. Method We collected resting state
functional magnetic resonance imaging data in children aged 8 to 12 years. Data were volume censored to
reduce artifact from submillimeter movement, resulting in analyzable data from 30 children with a history of
depression and/or anxiety and 42 children with no psychiatric history. We compared pairwise RSFC among
the following VAN regions: right ventro-lateral prefrontal cortex (VLPFC), right posterior superior temporal
gyrus (pSTG), and right ventral supramarginal gyrus (vSMG). We also collected measures of threat bias
and current clinical symptoms. Results Children with a history of depression and/or anxiety had reduced
RSFC among the regions of the VAN compared to children with no psychiatric history. The magnitude of
VAN RSFC was correlated with measures of attention bias toward threat but not with current depressive,
internalizing, or externalizing symptoms. No RSFC changes were detected between groups among
homotopic left hemisphere regions. Conclusions Disruption in the VAN may be an early feature of
depression and anxiety disorders. VAN changes were associated with attention bias and clinical history but
not with current symptoms of depression and anxiety.
Risk Factors and the Evolution of Psychosis in 22q11.2 Deletion Syndrome: A Longitudinal
2-Site Study
09 Dec 2013 10:17 am
Publication date: November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 11
Author(s): Doron Gothelf , Maude Schneider , Tamar Green , Martin Debbané , Amos Frisch , Bronwyn
Glaser , Hadas Zilkha , Marie Schaer , Abraham Weizman , Stephan Eliez
Objective 22q11.2 Deletion syndrome (22q11.2DS) is associated with high rates of schizophrenia, other
neuropsychiatric disorders, and cognitive deficits. The objectives of this 2-center study were to longitudinally
assess the trajectories of psychiatric disorders in 22q11.2DS from childhood to adulthood, and to identify
risk factors for their emergence. Method A total of 125 children and adults with 22q11.2DS were evaluated
at 2 time points, baseline and follow-up (4 years apart), using standardized psychiatric and cognitive
measures. Results The rate of mood disorders tended to decrease during childhood and increase during
late adolescence. Statistically significant predictors for the presence of a psychotic disorder as well as the
severity of positive symptoms at follow-up were identical, and consisted of an anxiety disorder at baseline,
lower baseline Full Scale IQ, and a greater decrease in verbal IQ scores between time points. Nine of 10
individuals with an emerging psychotic disorder had an anxiety disorder at baseline. The age of onset for a
psychotic disorder was between 14 and 22 years in 82.6% of cases. Conclusions It is important to evaluate
the presence of anxiety disorders in children and adolescents with 22q11.2DS, as they are major risk
factors for the emergence of psychotic disorders, which usually occur during late adolescence in this at-risk
population.
Schizophrenia: an integrated sociodevelopmental-cognitive model
08 Dec 2013 01:45 pm
Publication date: Available online 6 December 2013
Source:The Lancet
Author(s): Oliver D Howes , Robin M Murray
Schizophrenia remains a major burden on patients and society. The dopamine hypothesis attempts to
explain the pathogenic mechanisms of the disorder, and the neurodevelopmental hypothesis the origins. In
the past 10 years an alternative, the cognitive model, has gained popularity. However, the first two theories
have not been satisfactorily integrated, and the most influential iteration of the cognitive model makes no
mention of dopamine, neurodevelopment, or indeed the brain. In this Review we show that developmental
alterations secondary to variant genes, early hazards to the brain, and childhood adversity sensitise the
dopamine system, and result in excessive presynaptic dopamine synthesis and release. Social adversity
biases the cognitive schema that the individual uses to interpret experiences towards paranoid
interpretations. Subsequent stress results in dysregulated dopamine release, causing the misattribution of
salience to stimuli, which are then misinterpreted by the biased cognitive processes. The resulting paranoia
and hallucinations in turn cause further stress, and eventually repeated dopamine dysregulation hardwires
the psychotic beliefs. Finally, we consider the implications of this model for understanding and treatment of
schizophrenia.
Stimulant Misuse: Is the Pursuit of Happiness by Youth Overrated?
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Author(s): Yifrah Kaminer
Strong Genetic Influences on the Stability of Autistic Traits in Childhood
09 Dec 2013 10:17 am
Publication date: Available online 22 November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry
Author(s): Karla Holmboe , Fruhling V. Rijsdijk , Victoria Hallett , Francesca Happé , Robert Plomin ,
Angelica Ronald
Objective Disorders on the autism spectrum, as well as autistic traits in the general population, have been
found to be both highly stable across age and highly heritable at individual ages. However, little is known
about the overlap in genetic and environmental influences on autistic traits across age and the contribution
of such influences to trait stability itself. The present study investigated these questions in a general
population sample of twins. Method More than 6,000 twin pairs were rated on an established scale of
autistic traits by their parents at 8, 9, and 12 years of age and by their teachers at 9 and 12 years of age.
Data were analyzed using structural equation modeling. Results The results indicated that, consistently
across raters, not only were autistic traits stable, and moderately to highly heritable at individual ages, there
was also a high degree of overlap in genetic influences across age. Furthermore, autistic trait stability could
largely be accounted for by genetic factors, with the environment unique to each twin playing a minor role.
The environment shared by twins had virtually no effect on the longitudinal stability in autistic traits.
Conclusions Autistic traits are highly stable across middle childhood and this stability is caused primarily by
genetic factors.
Table of Contents
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
The Delivery of Mental Health Care: Where Are We and Where Are We Going?
09 Dec 2013 10:17 am
Publication date: November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 11
Author(s): J. Michael Houston , D. Richard Martini
The Hotel Study: Multimorbidity in a Community Sample Living in Marginal Housing
01 Dec 2013 12:00 am
Objective
The health of people living in marginal housing is not well characterized, particularly from the perspective of
multimorbid illness. The authors investigated this population in a community sample.
Method
A prospective community sample (N=293) of adults living in single-room occupancy hotels was followed for
a median of 23.7 months. Assessment included psychiatric and neurological evaluation, multimodal MRI,
and viral testing.
Results
Previous homelessness was described in 66.6% of participants. Fifteen deaths occurred during 552 personyears of follow-up. The standardized mortality ratio was 4.83 (95% CI=2.91–8.01). Substance dependence
was ubiquitous (95.2%), with 61.7% injection drug use. Psychosis was the most common mental illness
(47.4%). A neurological disorder was present in 45.8% of participants, with definite MRI findings in 28.0%.
HIV serology was positive in 18.4% of participants, and hepatitis C virus serology in 70.3%. The median
number of multimorbid illnesses (from a list of 12) was three. Burden of multimorbidity was significantly
correlated with lower role functioning score. Comorbid addiction or physical illness significantly decreased
the likelihood of treatment for psychosis but not the likelihood of treatment for opioid dependence or HIV
disease. Participants who died during follow-up appeared to have profiles of multimorbidity similar to those
of the overall sample.
Conclusions
This marginally housed cohort had greater than expected mortality and high levels of multimorbidity with
adverse associations with role function and likelihood of treatment for psychosis. These findings may guide
the development of effective health care delivery in the setting of marginal housing.
The Relationship Between Alliance and Client Involvement in CBT for Child Anxiety
Disorders
18 Nov 2013 07:52 pm
Journal of Clinical Child & Adolescent Psychology, Volume 0, Issue 0, Page 1-7, Ahead of Print.
The association of attention deficit hyperactivity disorder with socioeconomic disadvantage:
alternative explanations and evidence
26 Nov 2013 06:21 am
Background Studies throughout Northern Europe, the United States and Australia have found an
association between childhood attention deficit hyperactivity disorder (ADHD) and family socioeconomic
disadvantage. We report further evidence for the association and review potential causal pathways that
might explain the link. Method Secondary analysis of a UK birth cohort (the Millennium Cohort Study,
N = 19,519) was used to model the association of ADHD with socioeconomic disadvantage and assess
evidence for several potential explanatory pathways. The case definition of ADHD was a parent-report of
whether ADHD had been identified by a medical doctor or health professional when children were 7 years
old. Results ADHD was associated with a range of indicators of social and economic disadvantage
including poverty, housing tenure, maternal education, income, lone parenthood and younger motherhood.
There was no evidence to suggest childhood ADHD was a causal factor of socioeconomic disadvantage:
income did not decrease for parents of children with ADHD compared to controls over the 7-year study
period. No clinical bias towards labelling ADHD in low SES groups was detected. There was evidence to
suggest that parent attachment/family conflict mediated the relationship between ADHD and SES.
Conclusion Although genetic and neurological determinants may be the primary predictors of difficulties with
activity level and attention, aetiology appears to be influenced by socioeconomic situation.
The developmental progression of age 14 behavioral disinhibition, early age of sexual
initiation, and subsequent sexual risk-taking behavior
20 Nov 2013 06:22 am
Background Research has demonstrated a consistent relationship between early sexual experience and
subsequent sexual risk-taking behaviors. We hypothesized that this relationship is due to a general
predisposition toward behavioral disinhibition (BD), and that relationships among BD, early sex, and
subsequent risky sexual behavior may be influenced by common genetic influences for males and common
environmental influences for females. Methods A prospective sample of 1,512 same-sex adolescent twins
(50.2% female) was used. Adolescent BD was measured by clinical symptom counts of conduct disorder,
oppositional defiant disorder, and self-reported delinquent behavior (age 14). Age of sexual initiation was
defined as first age of consensual oral or penetrative sex (mean age ~17). Adult risky sexual behavior was
defined by sexual behaviors under the influence of drugs and alcohol and number of casual sexual partners
in the past year (age 24). Results Multivariate analyses showed evidence for substantial common genetic
variance among age 14 BD, age at sexual initiation, and adult risky sexual behavior for males, but not
females. There was no significant difference in the degree of common environmental influence on these
variables for females compared to males. Notably, age of sexual initiation was not significantly correlated
with age 24 risky sexual behavior for females. Conclusion The relationship between early sex and later risky
sex can be better understood through a general liability toward BD, which is influenced primarily by genetic
factors for males. The association between age 14 BD and age of sexual initiation was influenced through a
combination of genetic and environmental factors for females; however, age of sexual initiation does not
appear to be a salient predictor of adult women's sexual risk-taking behavior. Findings suggest that
prevention programs aimed at reducing sexual risk behavior might target youth exhibiting BD by age 14,
particularly males. More research is needed on what predicts adult sexual risk-taking behavior for females.
The effects of sleep extension and sleep hygiene advice on sleep and depressive
symptoms in adolescents: a randomized controlled trial
20 Nov 2013 06:22 am
Objective Sleep problems are common and persistent during adolescence and can have negative effects on
adolescents' mood. To date, studies that investigate the effects of sleep extension on adolescents' sleep
and depressive symptoms are still lacking. This study aims to investigate the effects of gradual sleep
extension combined with sleep hygiene advice in adolescents with chronic sleep reduction on objectively
measured sleep, self-reported sleep problems and depressive symptoms. Methods Fifty-five adolescents
with chronic sleep reduction (mean age: 15.44 years; 85.5% females) were included in the study.
Participants were randomly assigned to either a sleep extension group (gradual sleep extension by
advancing bedtimes in the evening and receiving sleep hygiene advice) or to a control group (no
instruction). Sleep was measured with actigraphy during three weeks, the first week was the baseline week,
and the last two weeks were the experimental weeks during which sleep was extended. Other outcome
variables were self-reported sleep problems (daytime sleepiness, symptoms of insomnia and circadian
rhythm sleep disorder) and depressive symptoms, which were assessed before and after the experimental
manipulation. Results During the third week of the experiment, adolescents in the sleep extension group
had earlier bedtimes, earlier sleep onsets, spent more time in bed and slept longer than adolescents in the
control group. Their chronic sleep reduction, insomnia symptoms and depressive symptoms diminished
significantly. In addition, there was a trend of improved circadian rhythm sleep disorder symptoms and
sleep quality. Conclusion Gradual sleep extension combined with sleep hygiene advice seems to have
beneficial effects on sleep, self-reported sleep problems and depressive symptoms of adolescents with
chronic sleep reduction. Although we cannot distinguish between the effects of sleep extension and sleep
hygiene advice, the results suggest that advancing bedtimes can extend sleep and improve depressive
symptoms.
The persistence of cognitive deficits in remitted and unremitted ADHD: a case for the stateindependence of response inhibition
22 Nov 2013 04:18 am
Background Response inhibition, working memory, and response variability are possible endophenotypes
of ADHD based on their association with the disorder and evidence of heritability. One of the critical
although rarely studied criteria for a valid endophenotype is that it persists despite waxing and waning of the
overt manifestations of the disorder, a criterion known as state-independence. This study examined whether
these aspects of cognition exhibit state-independence in ADHD. Methods One hundred and seventy-nine
children diagnosed with ADHD in a rigorous baseline assessment were contacted for follow-up assessment
in adolescence. Of this sample, 130 (73%) were reascertained. At follow-up, children previously diagnosed
with ADHD were identified as remittent (n = 24), persistent (n = 64), or in partial remission (n = 42) based on
symptoms and impairment of the disorder. Response inhibition, working memory, and response variability
were assessed both in childhood (baseline) and adolescence (follow-up) and were compared with agematched controls (40 children and 28 adolescents) seen at either time point. Results Relative to controls,
ADHD children showed baseline deficits in response inhibition, working memory, and response variability.
Only the group difference in response inhibition remained significant in adolescence. In general, cognitive
performance among ADHD participants improved with age and did so regardless of changes in ADHD
symptoms and impairment. Within the ADHD group, however, cognitive performance in childhood and in
adolescence did not differ amongst those with persistent, remittent, and partially remittent forms of the
disorder. Conclusions Results demonstrate that response inhibition not only distinguishes ADHD children
from their unaffected peers but is also state-independent, such that deficits remain present irrespective of
changes in the disease phenotype. In other words, inhibitory deficits measured in childhood persist into
adolescence even when the ADHD phenotype remits. These findings provide further evidence that the
ability to stop prepotent actions is an endophenotype of ADHD.
Translating the Common Elements Approach: Social Work's Experiences in Education,
Practice, and Research
18 Nov 2013 07:29 pm
Journal of Clinical Child & Adolescent Psychology, Volume 0, Issue 0, Page 1-11, Ahead of Print.
Transparency: Disclosure of Financial Interests
09 Dec 2013 10:17 am
Publication date: December 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 12
Trends in the Parent-Report of Health Care Provider-Diagnosed and Medicated AttentionDeficit/Hyperactivity Disorder: United States, 2003–2011
09 Dec 2013 10:17 am
Publication date: Available online 21 November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry
Author(s): Susanna N. Visser , Melissa L. Danielson , Rebecca H. Bitsko , Joseph R. Holbrook , Michael D.
Kogan , Reem M. Ghandour , Ruth Perou , Stephen J. Blumberg
Objective Data from the 2003 and 2007 National Survey of Children’s Health (NSCH) reflect the increasing
prevalence of parent-reported attention-deficit/hyperactivity disorder (ADHD) diagnosis and treatment by
health care providers. This report updates these prevalence estimates for 2011 and describes temporal
trends. Method Weighted analyses were conducted with 2011 NSCH data to estimate prevalence of parentreported ADHD diagnosis, current ADHD, current medication treatment, ADHD severity, and mean age of
diagnosis for U.S. children/adolescents aged 4 to 17 years and among demographic subgroups. A history of
ADHD diagnosis (2003–2011), as well as current ADHD and medication treatment prevalence (2007–2011),
were compared using prevalence ratios and 95% confidence intervals. Results In 2011, 11% of
children/adolescents aged 4 to 17 years had ever received an ADHD diagnosis (6.4 million children).
Among those with a history of ADHD diagnosis, 83% were reported as currently having ADHD (8.8%); 69%
of children with current ADHD were taking medication for ADHD (6.1%, 3.5 million children). A parentreported history of ADHD increased by 42% from 2003 to 2011. Prevalence of a history of ADHD, current
ADHD, medicated ADHD, and moderate/severe ADHD increased significantly from 2007 estimates.
Prevalence of medicated ADHD increased by 28% from 2007 to 2011. Conclusions Approximately 2 million
more U.S. children/adolescents aged 4 to 17 years had been diagnosed with ADHD in 2011, compared to
2003. More than two-thirds of those with current ADHD were taking medication for treatment in 2011. This
suggests an increasing burden of ADHD on the U.S. health care system. Efforts to further understand
ADHD diagnostic and treatment patterns are warranted.
Understanding Adolescent Response to a Technology-Based Depression Prevention
Program
18 Nov 2013 07:13 pm
Journal of Clinical Child & Adolescent Psychology, Volume 0, Issue 0, Page 1-13, Ahead of Print.
Universal Mental Health Screening in Pediatric Primary Care: A Systematic Review
09 Dec 2013 10:17 am
Publication date: November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 11
Author(s): Lawrence S. Wissow , Jonathan Brown , Kate E. Fothergill , Anne Gadomski , Karen Hacker ,
Peter Salmon , Rachel Zelkowitz
Objective Universal mental health screening in pediatric primary care is recommended, but studies report
slow uptake and low rates of patient follow-through after referral to specialized services. This review
examined possible explanations related to the process of screening, focusing on how parents and youth are
engaged, and how providers evaluate and use screening results. Method A narrative synthesis was
developed after a systematic review of 3 databases (plus follow-up of citations, expert recommendations,
and checks for multiple publications about the same study). Searching identified 1,188 titles, and of these,
186 full-text articles were reviewed. Two authors extracted data from 45 articles meeting inclusion criteria.
Results Published studies report few details about how mental health screens were administered, including
how clinicians explain their purpose or confidentiality, or whether help was provided for language, literacy,
or disability problems. Although they were not addressed directly in the studies reviewed, uptake and
detection rates appeared to vary with means of administration. Screening framed as universal, confidential,
and intended to optimize attention to patient concerns increased acceptability. Studies said little about how
providers were taught to explore screen results. Screening increased referrals, but many still followed
negative screens, in some cases because of parent concerns apparently not reflected by screen results but
possibly stemming from screen-prompted discussions. Conclusions Little research has addressed the
process of engaging patients in mental health screening in pediatric primary care or how clinicians can best
use screening results. The literature does offer suggestions for better clinical practice and research that
may lead to improvements in uptake and outcome.
Universal Mental Health Screening in Pediatrics: Toward Better Knowing, Treating, or
Referring
09 Dec 2013 10:17 am
Publication date: November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 11
Author(s): Michael S. Jellinek
Use of Latent Profile Analysis to Assess the Validity of a Peer-Rejected Group of Children
13 Nov 2013 04:47 pm
Journal of Clinical Child & Adolescent Psychology, Volume 42, Issue 6, Page 843-854, NovemberDecember 2013.
What Does Risperidone Add to Stimulant and Parent Training for Severe Aggression in
Child Attention-Deficit/Hyperactivity Disorder?
09 Dec 2013 10:17 am
Publication date: Available online 18 November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry
Author(s): Michael G. Aman , Oscar G. Bukstein , Kenneth D. Gadow , L. Eugene Arnold , Brooke S.G.
Molina , Nora K. McNamara , E. Victoria Rundberg-Rivera , Xiaobai Li , Heidi Kipp , Jayne Schneider , Eric
M. Butter , Jennifer Baker , Joyce Sprafkin , Robert R. Rice Jr. , Srihari S. Bangalore , Cristan A. Farmer ,
Adrienne B. Austin , Kristin A. Buchan-Page , Nicole V. Arradaza , Elizabeth A. Hurt , Sabrina N. Grondhuis
, Robert L. Findling
Objective Although combination pharmacotherapy is common in child/adolescent psychiatry, there has
been little research evaluating it. We tested the value of adding risperidone to concurrent psychostimulant
and parent training (PT) in behavior management for children with severe aggression. Method We
randomized 168 children age 6–12 years (mean 8.89 + 2.01) with severe physical aggression to a 9-week
trial of PT, stimulant, and placebo ( Basic treatment; n=84) or PT, stimulant, and risperidone ( Augmented
treatment; n=84). All had diagnoses of attention-deficit/hyperactivity disorder (ADHD) and either
oppositional defiant (n= 124) or conduct disorder (n= 44). Children received psychostimulant (usually OROS
methylphenidate) for 3 weeks, titrated for optimal effect, while parents received PT. If there was room for
improvement at the end of Week 3, either placebo or risperidone was added. Assessments included parent
ratings on the Nisonger Child Behavior Rating Form (NCBRF; Disruptive-Total subscale = Primary
outcome) and Antisocial Behavior Scale (ABS); blinded clinicians rated change on the Clinical Global
Impressions (CGI) scale. Results Compared to Basic treatment (PT+stimulant[STIM][44.8 + 14.6
mg/day]+placebo [1.88 + 0.72]), Augmented treatment (PT+STIM[46.1 + 16.8 mg/day]+risperidone[1.65 +
0.75]) showed statistically significant improvement on the NCBRF Disruptive–Total subscale (treatment-bytime interaction p= 0.0016 ), the NCBRF Social Competence subscale ( p= 0.0049), and ABS Reactive
Aggression ( p= 0.01). CGI scores were substantially improved for both groups but did not discriminate
between treatments (CGI-I &lt; 2, 70% for Basic treatment vs. 79% for Augmented treatment). Prolactin
elevations and gastrointestinal upset occurred more with Augmented; other adverse events differed
modestly from Basic treatment; weight gain within the Augmented treatment group was minor. Conclusions
Risperidone provided moderate but variable improvement in aggressive and other seriously disruptive child
behavior when added to PT and optimized stimulant treatment. Clinical trial registration information—
Treatment of Severe Childhood Aggression (The TOSCA Study); http://clinicaltrials.gov/ ; NCT00796302 .
Wraparound, System of Care, and Child Psychiatrists
09 Dec 2013 10:17 am
Publication date: November 2013
Source:Journal of the American Academy of Child &amp; Adolescent Psychiatry, Volume 52, Issue 11
Author(s): Kaye McGinty , Robert Klaehn , Peter Metz , Gordon Hodas , Justine Larson , Mark Chenven
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