Cognitive and emotional components of frontal lobe functioning in childhood and adolescence

Development of the selection and manipulation of self-generated thoughts in adolescence

The ability to select and manipulate self-generated (stimulus-independent, SI), as opposed to stimulus-oriented (SO), information, in a controlled and flexible way has previously only been studied in adults. This ability is thought to rely in part on the rostrolateral prefrontal cortex (RLPFC), which continues to mature anatomically during adolescence. We investigated (1) the development of this ability behaviorally, (2) the associated functional brain development, and (3) the link between functional and structural maturation. Participants classified according to their shape letters either presented visually (SO phases) or that they generated in their head by continuing the alphabet sequence (SI phases). SI phases were performed in the presence or absence of distracting letters. A total of 179 participants (7-27 years old) took part in a behavioral study. Resistance to visual distractors exhibited small improvements with age. SI thoughts manipulation and switching between SI and SO thoughts showed steeper performance improvements extending into late adolescence. Thirty-seven participants (11-30 years old) took part in a functional MRI (fMRI) study. SI thought manipulation and switching between SO and SI thought were each associated with brain regions consistently recruited across age. A single frontal brain region in each contrast exhibited decreased activity with age: left inferior frontal gyrus/anterior insula for SI thought manipulation, and right superior RLPFC for switching between SO and SI thoughts. By integrating structural and functional data, we demonstrated that the observed functional changes with age were not purely consequences of structural maturation and thus may reflect the maturation of neurocognitive strategies.

Invited commentary: understanding brain mechanisms of pain processing in adolescents' non-suicidal self-injury

Whereas non-suicidal self injury (NSSI) is reported in 13-23% of adolescents and is an increasingly studied topic, there has been little investigation into the pathophysiology behind self-injury. This commentary examines recent research into pain and emotional distress to discuss implications for the manner we should understand, research, and treat NSSI in the future. Research indicates that adolescents may be particularly vulnerable to NSSI behaviors due to neurodevelopmental changes in the processing of distress and pain. Additionally, emotional distress and physical pain neural pathways may have been altered in these individuals, leading to the development of NSSI behaviors during adolescence when changes in ongoing brain development may lead to further emotional dysregulation and poor impulse control. Further studies that directly characterize the relationship between emotional distress and physical pain in adolescence, as well as the neural differences between self-injurers and non-self-injurers, are needed.

Classification of eating disturbance in children and adolescents: proposed changes for the DSM-V

Childhood and adolescence are critical periods of neural development and physical growth. The malnutrition and related medical complications resulting from eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified may have more severe and potentially more protracted consequences during youth than during other age periods. The consensus opinion of an international workgroup of experts on the diagnosis and treatment of child and adolescent eating disorders is that (a) lower and more developmentally sensitive thresholds of symptom severity (e.g. lower frequency of purging behaviours, significant deviations from growth curves as indicators of clinical severity) be used as diagnostic boundaries for children and adolescents, (b) behavioural indicators of psychological features of eating disorders be considered even in the absence of direct self-report of such symptoms and (c) multiple informants (e.g. parents) be used to ascertain symptom profiles. Collectively, these recommendations will permit earlier identification and intervention to prevent the exacerbation of eating disorder symptoms.

Diagnostic classification of eating disorders in children and adolescents: how does DSM-IV-TR compare to empirically-derived categories?

OBJECTIVE

The purpose of this study was to empirically derive eating disorder phenotypes in a clinical sample of children and adolescents using latent profile analysis (LPA), and to compare these latent profile (LP) groups to the DSM-IV-TR eating disorder categories.

METHOD

Eating disorder symptom data collected from 401 youth (aged 7 through 19 years; mean 15.14 +/- 2.35 years) seeking eating disorder treatment were included in LPA; general linear models were used to compare LP groups to DSM-IV-TR eating disorder categories on pretreatment and outcome indices.

RESULTS

Three LP groups were identified: LP1 (n = 144), characterized by binge eating and purging ("Binge/purge"); LP2 (n = 126), characterized by excessive exercise and extreme eating disorder cognitions ("Exercise-extreme cognitions"); and LP3 (n = 131), characterized by minimal eating disorder behaviors and cognitions ("Minimal behaviors/cognitions"). Identified LPs imperfectly resembled DSM-IV-TR eating disorders. LP1 resembled bulimia nervosa; LP2 and LP3 broadly resembled anorexia nervosa with a relaxed weight criterion, differentiated by excessive exercise and severity of eating disorder cognitions. The LP groups were more differentiated than the DSM-IV-TR categories across pretreatment eating disorder and general psychopathology indices, as well as weight change at follow-up. Neither LP nor DSM-IV-TR categories predicted change in binge/purge behaviors. Validation analyses suggest these empirically derived groups improve upon the current DSM-IV-TR categories.

CONCLUSIONS

In children and adolescents, revisions for DSM-V should consider recognition of patients with minimal cognitive eating disorder symptoms.

Clarifying criteria for cognitive signs and symptoms for eating disorders in DSM-V

OBJECTIVE

This article reviews literature relevant to challenges in clinical ascertainment of cognitively-based diagnostic criteria of anorexia nervosa (AN) and bulimia nervosa (BN) to examine whether revision might enhance their clinical utility.

METHOD

We performed a systematic literature search to identify publications relevant to clinical evaluation of cognitive symptoms of AN and BN.

RESULTS

The literature supports several reasons that individuals with an eating disorder may not endorse cognitive symptoms, despite their presence. These include limited insight, minimization, or denial, as well as intentional concealment related to perceived stigma, social desirability, or investment in maintaining behavioral symptoms. We also identified reasons that the word "refusal" in AN criterion A may render its application problematic.

DISCUSSION

We conclude that specific guidance for ascertainment of cognitive signs for AN and BN in the absence of patient disclosure or endorsement, longitudinal evaluation, and/or collateral data may improve clinical utility of these diagnostic criteria.

Emotional development and adaptive abilities in adults with intellectual disability. A correlation study between the Scheme of Appraisal of Emotional Development (SAED) and Vineland Adaptive Behavior Scale (VABS)

The importance of emotional aspects in developing cognitive and social abilities has already been underlined by many authors even if there is no unanimous agreement on the factors constituting adaptive abilities, nor is there any on the way to measure them or on the relation between adaptive ability and cognitive level. The purposes of this study was to test the psychometric characteristics of a specific tool for the assessment of the emotional development and correlating such test with the Vineland Adaptive Behavior Scale, one of the most widely used tools to assess adaptive abilities in order to verify possible correlations between emotional development and adaptive abilities. Thirty-three adults living in residential centres for people with Intellectual Disability without psychiatric/behavioral disorders of clinical significance, were evaluated by administering the Scheme of Appraisal of Emotional Development (SAED) and the Vineland Adaptive Behavior Scale (VABS) and a statistical analysis was been conducted to verify possible correlations. The SAED proved to be a reliable psychometric tool and a strong positive correlation has indeed emerged between VABS' and SAED's general scores, therefore as the emotional development age increases so does at the same time adaptive age. The need to complete the assessment of adaptive abilities with that of emotional development seems therefore confirmed. Such tools provide the opportunity to gather extremely important information on the emotional needs of particular person regardless of the presence or absence of Intellectual Disability.

Invited commentary: understanding brain mechanisms of pain processing in adolescents' non-suicidal self-injury

Whereas non-suicidal self injury (NSSI) is reported in 13-23% of adolescents and is an increasingly studied topic, there has been little investigation into the pathophysiology behind self-injury. This commentary examines recent research into pain and emotional distress to discuss implications for the manner we should understand, research, and treat NSSI in the future. Research indicates that adolescents may be particularly vulnerable to NSSI behaviors due to neurodevelopmental changes in the processing of distress and pain. Additionally, emotional distress and physical pain neural pathways may have been altered in these individuals, leading to the development of NSSI behaviors during adolescence when changes in ongoing brain development may lead to further emotional dysregulation and poor impulse control. Further studies that directly characterize the relationship between emotional distress and physical pain in adolescence, as well as the neural differences between self-injurers and non-self-injurers, are needed.

The neural basis of response inhibition and attention allocation as mediated by gestational age

Children and adolescents born before 33 weeks of gestation, that is very preterm, may experience problems with the inhibitory control of behaviour and the allocation of attention. Previous functional magnetic resonance imaging (fMRI) studies have found preterm-born adolescents to display altered brain activation in tasks measuring inhibitory control. However, adolescence is a period during which dynamic changes are occurring in the brain, and it is not yet known whether these functional alterations will persist into adulthood, or instead reflect developmental delay. This study used an event-related fMRI Go/No-Go motor response inhibition paradigm, which included an oddball task measuring attention allocation to infrequent stimuli, to compare blood-oxygen-level-dependent (BOLD) signal between 26 preterm-born adults and 21 controls. Group differences in brain activation were observed in inhibition and attention networks during both conditions. During motor response inhibition, preterm-born participants compared to controls showed increased BOLD signal in medial and right lateral posterior brain regions, including middle temporal/occipital gyrus, posterior cingulate gyrus and precuneus. During oddball trials, preterm-born young adults displayed attenuated brain activation in a fronto-parietal-cerebellar network which is involved in mediating attention allocation. This pattern of reduced brain activation in task-relevant regions of attention allocation, and increased activation in posterior brain regions during inhibitory control, suggests adult alteration of inhibition and attention processing following very preterm birth, which may reflect a developmental delay.

Cognitive development in macaques: Attentional set-shifting in juvenile and adult rhesus monkeys

In humans and nonhuman primates, the structure and function of frontal cortical regions of the brain are not completely developed until early adulthood. How this cortical development affects cognitive function continues to be elucidated. To that end, this experiment tested the ability of juvenile and adult rhesus monkeys to perform a cognitive task that is dependent upon intact frontal cortical function for optimal performance. Twenty-four juvenile (mean age 2.3 years) and 16 adult (mean age 10.3 years) rhesus monkeys were tested on the Cambridge Neuropsychological Test Automated Battery intradimensional/extradimensional set-shifting (ID/ED) task. Performance on the ID/ED task has been shown to be dependent upon frontal cortical function in both humans and nonhuman primates. Compared with adults, juveniles were impaired on the reversal of simple discrimination, intradimensional shift, reversal of intradimensional shift, and the extradimensional shift stages of the task. These results indicate juveniles committed more perseverative errors and more errors on the set-formation and set-shifting components of the ID/ED task. The developmental stage of the juvenile monkeys corresponds to roughly 5 to 6-year-old children, and these results are consistent with performance of human children and adults on similar ID/ED tests and on several other tests of attentional set-shifting or attentional flexibility. Furthermore, these results are consistent with the ongoing development of frontal cortical structures relating to ongoing cognitive development in nonhuman primates.

Passenger distractions among adolescent drivers

PROBLEM

Adolescents who drive with peers are known to have a higher risk of crashes. While passengers may distract drivers, little is known about the circumstances of these distractions among teen drivers.

METHOD

This study used survey data on driving among 2,144 California high school seniors to examine distractions caused by passengers.

RESULTS

Overall, 38.4% of youths who drove reported having been distracted by a passenger. Distractions were more commonly reported among girls and students attending moderate- to high-income schools. Talking or yelling was the most commonly reported type of distraction. About 7.5% of distractions reported were deliberate, such as hitting or tickling the driver or attempting to use the vehicle's controls. Driving after alcohol use and having had a crash as a driver were both significant predictors of reporting passenger-related distraction.

CONCLUSION

Adolescents often experience distractions related to passengers, and in some cases these distractions are intentional.

IMPACT ON INDUSTRY

These results provide information about teenage drivers who are distracted by passenger behaviors. In some cases, passengers attempted to use vehicle controls; however, it seems unlikely that this behavior is common enough to warrant redesign of controls to make them less accessible to passengers.

Disorders of childhood and adolescence: gender and psychopathology

Early-onset disorders (e.g., conduct problems, autism) show a marked male preponderance, whereas adolescent-onset disorders (e.g., depression, anxiety) show a marked female preponderance. A developmental psychopathology framework provides a means to investigate complex gender-related etiologies of these different disorders. This review focuses on biological and environmental factors implicated in the development of conduct problems and depression in boys and girls. Boys and girls showed certain differences in types, rates, comorbidities, antecedents, correlates, and trajectories of these problems. Origins of male and female preponderant problems are likely to be rooted, in part, in biological, physical, cognitive, and social-emotional differences in boys and girls that can precede the expression of clinical problems. These male-like and female-like characteristics are considered regarding conduct problems and depression to explore how they inform biological and environmental theories about gender and psychopathology. At the same time, because boys and girls also show many similarities, it is important to avoid sex-stereotyping mental health problems.

Classification of child and adolescent eating disturbances. Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA)

OBJECTIVE

: The purpose of this article is to summarize major conceptual and clinical variables related to age-appropriate and developmentally appropriate classification of eating problems and disorders in children and adolescents.

METHOD

A review of current classifications and related literature in child development is provided. Problems with current classification schemes are identified and discussed.

RESULTS

Current classifications are inadequate to address the clinical and research needs of children and adolescents with eating disturbances and disorders.

CONCLUSION

A range of possible changes in classification strategies for eating disorders in children and adolescents are described.

Emotional and cognitive changes during adolescence

Adolescence is a critical period for maturation of neurobiological processes that underlie higher cognitive functions and social and emotional behavior. Recent studies have applied new advances in magnetic resonance imaging to increase understanding of the neurobiological changes that occur during the transition from childhood to early adulthood. Structural imaging data indicate progressive and regressive changes in the relative volumes of specific brain regions, although total brain volume is not significantly altered. The prefrontal cortex matures later than other regions and its development is paralleled by increased abilities in abstract reasoning, attentional shifting, response inhibition and processing speed. Changes in emotional capacity, including improvements in affective modulation and discrimination of emotional cues, are also seen during adolescence. Functional imaging studies using cognitive and affective challenges have shown that frontal cortical networks undergo developmental changes in processing. In summary, brain regions that underlie attention, reward evaluation, affective discrimination, response inhibition and goal-directed behavior undergo structural and functional re-organization throughout late childhood and early adulthood. Evidence from recent imaging studies supports a model by which the frontal cortex adopts an increasingly regulatory role. These neurobiological changes are believed to contribute, in part, to the range in cognitive and affective behavior seen during adolescence.