Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data

Perceptual alterations in the relationship between sensory reactivity, intolerance of uncertainty, and anxiety in autistic children with and without ADHD

Sensory differences and anxiety disorders are highly prevalent in autistic individuals with and without ADHD. Studies have shown that sensory differences and anxiety are associated and that intolerance of uncertainty (IU) plays an important role in this relationship. However, it is unclear as to how different levels of the sensory processing pathway (i.e., perceptual, affective, or behavioral) contribute. Here, we used psychophysics to assess how alterations in tactile perception contribute to questionnaire measures of sensory reactivity, IU, and anxiety. Thirty-eight autistic children (aged 8-12 years; 27 with co-occurring ADHD) were included. Consistent with previous findings, mediation analyses showed that child-reported IU fully mediated an association between parent-reported sensory reactivity and parent-reported anxiety and that anxiety partially mediated an association between sensory reactivity and IU. Of the vibrotactile thresholds, only simultaneous frequency discrimination (SFD) thresholds correlated with sensory reactivity. Interestingly, we found that sensory reactivity fully mediated an association between SFD threshold and anxiety, and between SFD threshold and IU. Taken together, those findings suggest a mechanistic pathway whereby tactile perceptual alterations contribute to sensory reactivity at the affective level, leading in turn to increased IU and anxiety. This stepwise association can inform potential interventions for IU and anxiety in autism.

The link between adolescent girls' interpersonal emotion regulation with parents and peers and depressive symptoms: A real-time investigation

Adolescents often experience heightened socioemotional sensitivity warranting their use of regulatory strategies. Yet, little is known about how key socializing agents help regulate teens' negative emotions in daily life and implications for long-term adjustment. We examined adolescent girls' interpersonal emotion regulation (IER) with parents and peers in response to negative social interactions, defined as parent and peer involvement in the teen's enactment of emotion regulation strategies. We also tested associations between rates of daily parental and peer IER and depressive symptoms, concurrently and one year later. Adolescent girls (N = 112; Mage = 12.39) at temperamental risk for depressive disorders completed a 16-day ecological momentary assessment protocol measuring reactivity to negative social interactions, parental and peer IER, and current negative affect. Results indicated that adolescents used more adaptive strategies with peers and more maladaptive strategies with parents in daily life. Both parental and peer IER down-regulated negative affect, reflected by girls' decreased likelihood of experiencing continued negative affect. Higher proportions of parental adaptive IER predicted reduced depressive symptoms one year later. Findings suggest that both parents and peers effectively help adolescent girls down-regulate everyday negative emotions; however, parents may offer more enduring benefits for long-term adjustment.

Investigating cross-sectional and longitudinal relationships between brain structure and distinct dimensions of externalizing psychopathology in the ABCD sample

Externalizing psychopathology in childhood is a predictor of poor outcomes across the lifespan. Children exhibiting elevated externalizing symptoms also commonly show emotion dysregulation and callous-unemotional (CU) traits. Examining cross-sectional and longitudinal neural correlates across dimensions linked to externalizing psychopathology during childhood may clarify shared or distinct neurobiological vulnerability for psychopathological impairment later in life. We used tabulated brain structure and behavioural data from baseline, year 1, and year 2 timepoints of the Adolescent Brain Cognitive Development Study (ABCD; baseline n = 10,534). We fit separate linear mixed effect models to examine whether baseline brain structures in frontolimbic and striatal regions (cortical thickness or subcortical volume) were associated with externalizing symptoms, emotion dysregulation, and/or CU traits at baseline and over a two-year period. The most robust relationships found at the cross-sectional level was between cortical thickness in the right rostral middle frontal gyrus and bilateral pars orbitalis was positively associated with CU traits (β = |0.027-0.033|, pcorrected = 0.009-0.03). Over the two-year follow-up period, higher baseline cortical thickness in the left pars triangularis and rostral middle frontal gyrus predicted greater decreases in externalizing symptoms ((F = 6.33-6.94, pcorrected = 0.014). The results of the current study suggest that unique regions within frontolimbic and striatal networks may be more strongly associated with different dimensions of externalizing psychopathology. The longitudinal findings indicate that brain structure in early childhood may provide insight into structural features that influence behaviour over time.

Cerebral blood flow differences in cognitive disengagement syndrome and attention deficit hyperactivity disorder: Doppler ultrasonography findings

OBJECTIVE

The present study aims to investigate potential differences in cerebral blood flow between children with Cognitive Disengagement Syndrome (CDS) and those with Attention Deficit Hyperactivity Disorder (ADHD) using Doppler ultrasound.

METHODS

In this single-center prospective study, we included 24 cases in the ADHD group with CDS symptoms, 29 cases in the ADHD group without CDS symptoms and, 26 children in the healthy controls. The children ranged in age from 6 to 15. Participants were evaluated by diagnostic interviews and standardized measures. Doppler ultrasound was performed to measure peak systolic velocity and blood flow volume (BFV) in the internal carotid (ICA) and vertebral arteries for each participant.

RESULTS

The right ICA and total ICA BFVs were significantly lower in the CDS group compared to the ADHD and control groups (p = 0.007 and p = 0.003, respectively). In addition, there was a weak negative correlation between right ICA BFV and CDS scores, suggesting a possible link between reduced cerebral blood flow and CDS symptom severity.

CONCLUSION

This study provides a noteworthy starting point for research on the neurovascular basis of CDS. Our findings indicated significant differences in cerebral blood flow between CDS and ADHD, supporting the idea that CDS is a unique attentional disorder with distinct neurobiological characteristics from ADHD.

Mental health problems and risk factors of refugee children exposed to the 2023 earthquakes in Turkey

BACKGROUND

Thousands of refugee children who survived the 2023 earthquakes in Turkey are at risk of developing psychiatric disorders.

AIM

Therefore, the aim of this study was to identify the mental health problems of refugee survivors in an early period after the 2023 earthquake in Turkey and to examine the risk factors they face.

RESULTS

A total of 72 Syrian refugee survivors (2-17 years old, 10.50 ± 3.96 years, 41.7 % female) participated in this study. Fifty-six (77.8 %) patients were diagnosed with at least one psychiatric disorder, while 16 (22.2 %) children did not meet the diagnostic criteria for any psychiatric disorder. Twenty-five (44.6 %) patients were diagnosed with post-traumatic stress disorder, 14 (25 %) patients with acute stress disorder, 17 (30.3 %) patients with adjustment disorder. Risk factors were grouped by the researchers as pre-quake, peri-quake and post-quake. Mental complaints and psychiatric diagnoses were significantly higher in girls (χ2 = 4.445, p = 0.032). A positive significant correlation was found between pre-earthquake risk factors and psychiatric diagnoses (r = 0.242, p = 0.041). The total number of pre-earthquake risk factors predicted the number of psychiatric complaints by linear regression analysis (β = 0.407, t = 2484, adjusted R2 = 0.164; p = 0.016). With increasing age, pre-earthquake risk factors increased (r = 0.448, p = 0.001). As resettlement time increased, the disease severity score also increased (r = 0.377, p = 0.005).

CONCLUSIONS

Efforts are needed to support earthquake-affected refugee children, especially those with pre-existing risk factors.

Do specific myelin autoantibodies and increased cerebral dopamine neurotrophic factor in the context of inflammation predict the diagnosis of attention deficit hyperactivity disorder in medication-free children?

BACKGROUND

The aim of this study was to investigate the serum levels of anti-myelin basic protein (anti-MBP), anti-myelin oligodentrocyte glycoprotein (anti-MOG), myelin-associated glycoprotein (MAG), high-sensitivity C-reactive protein (hs-CRP), cerebral dopamine neurotrophic factor (CDNF), cerebellin-1, and reelin and their relationships with clinical severity and irritability behaviours in children with attention deficit (AD) hyperactivity disorder (ADHD) and typically developing (TD) healthy controls.

METHODS

In this study, 141 children with ADHD between the ages of 8 and 14 years who were medication-free and 135 TD healthy controls were included. The serum levels of anti-MBP, anti-MOG, MAG, CDNF, hs-CRP, cerebellin, and reelin were measured using enzyme-linked immunosorbent assay kits. The Turgay Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)-based Screening and Evaluation Scale for Attention Deficit and Disruptive Behavior Disorders-Parent Form (TDSM-IV-O) and the affective reactivity index (ARI) scale were used to assess clinical severity and irritability behaviours in the children.

RESULTS

The MAG, CDNF, hs-CRP, reelin, and cerebellin levels were significantly higher in the ADHD group than in the control group, but no significant differences in anti-MBP and anti-MOG levels were found between the groups. Compared with the controls, the patients with ADHD showed significantly higher scores on the ARI self- and parent-report scales. The reelin, hs-CRP, and MAG levels were significantly associated with the TDSM-IV-O AD scores, AD and oppositional defiant (OD) disorder scores and hyperactivity, and OD and conduct disorder scores, respectively. Hs-CRP was significantly associated with anti-MBP and cerebellin levels. In an analysis of covariance, the results were unchanged even after controlling for potential confounders such as age, body mass index, and sex.

CONCLUSION

This study demonstrates that MAG, CDNF, hs-CRP, reelin, and cerebellin levels may play a potential role in the pathogenesis of ADHD.

Exploration of cognitive flexibility and emotion recognition in adolescents with eating disorders

OBJECTIVES

This study compared cognitive flexibility (CF) and emotion recognition (ER) in adolescents with eating disorders (ED) to a healthy group.

METHODS

Forty healthy individuals aged 12-18 years with no psychiatric diagnosis and 46 patients diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) according to DSM-5 criteria participated. CF was assessed using the Cognitive Flexibility Scale (CFS), Stroop Test, and Berg Card Sorting Test (BCST), while ER was evaluated using the test of perception of affect via nonverbal cues.

RESULTS

CFS scores were lower in the ED group compared to the control group. Neuropsychological test results indicated similar BCST perseverative error percentages among ED patients and controls. However, while the BED group demonstrated greater difficulties with inhibitory control, as shown in the Stroop Test, the BN and AN groups performed similarly to the control group. ER performance was similar across groups, although the AN subgroup exhibited heightened recognition of negative emotions, particularly disgust and fear.

CONCLUSIONS

This study highlights unique and shared neurocognitive patterns related to CF and ER profiles of ED patients. Despite self-reports of greater cognitive rigidity among ED patients, objective tests did not consistently confirm it. Notably, BED patients exhibited inhibitory control challenges, aligning with impulsive tendencies. ER abilities were similar to controls; however, the AN subgroup showed heightened sensitivity to certain negative emotions, such as disgust. These findings underscore the need for further research with larger, more balanced samples to explore how CF and ER vary across developmental stages and subtypes.

Associations of Child Amygdala Development With Borderline Personality Symptoms During Adolescence

BACKGROUND

The current understanding of the neural correlates of borderline personality disorder (BPD) is limited, but some evidence suggests that alterations in limbic structures play a role in adult BPD. The developmental course of structural neural differences in BPD is unknown. Whether there is specificity for structural alterations in BPD compared to other psychiatric presentations, such as major depressive disorder (MDD), remains unexplored. In the current study, we examined childhood trajectories of 2 limbic regions that have been implicated in BPD, hippocampal and amygdala volume, as they relate to adolescent BPD symptoms compared to MDD symptoms.

METHODS

Participants (n = 175; 85 [48.6%] female) were from a 17-year longitudinal study of preschool depression. Participants completed up to 5 magnetic resonance imaging scans from late childhood through adolescence. General linear models were used to examine the relationship between gray matter volume intercepts/slopes and BPD symptoms to understand the influence of the developmental trajectory of brain regions on BPD. Separate models were used to examine the relationship between MDD symptoms and volume intercepts to assess diagnostic specificity.

RESULTS

Lower childhood amygdala volume (intercept; age 13 centered) across scans was associated with higher adolescent BPD symptoms (β = -0.25, adjusted p = .015). There was no relationship between the slope of amygdala volume and BPD symptoms. There was no relationship between hippocampal volume and BPD or any relationship between amygdala or hippocampal volume and MDD symptoms during adolescence.

CONCLUSIONS

Our findings add evidence that supports the role of alterations in amygdala structure in BPD development. Decreased amygdala volume as early as age 13 may be an early indicator of the development of BPD during adolescence.

Evaluating Computerised Assessment of Motor Imitation (CAMI) for identifying autism-specific difficulties not observed for attention-deficit hyperactivity disorder or neurotypical development

BACKGROUND

Reliable and specific biomarkers that can distinguish autism spectrum disorders (ASDs) from commonly co-occurring attention-deficit/hyperactivity disorder (ADHD) are lacking, causing misses and delays in diagnosis, and reducing access to interventions and quality of life.

AIMS

To examine whether an innovative, brief (1-min), videogame method called Computerised Assessment of Motor Imitation (CAMI), can identify ASD-specific imitation differences compared with neurotypical children and children with ADHD.

METHOD

This cross-sectional study used CAMI alongside standardised parent-report (Social Responsiveness Scale, Second Edition) and observational measures of autism (Autism Diagnostic Observation Schedule-Second Edition; ADOS-2), ADHD (Conners) and motor ability (Physical and Neurological Examination for Soft Signs). The sample comprised 183 children aged 7-13 years, with ADHD (without ASD), with ASD (with and without ADHD) and who were neurotypical.

RESULTS

Regardless of co-occurring ADHD, children with ASD showed poorer CAMI performance than neurotypical children (P < 0.0001; adjusted R2 = 0.28), whereas children with ADHD and neurotypical children showed similar CAMI performance. Receiver operating curve and support vector machine analyses showed that CAMI distinguishes ASD from both neurotypical children (80% true positive rate) and children with ADHD (70% true positive rate), with a high success rate significantly above chance. Among children with ASD, poor CAMI performance was associated with increased autism traits, particularly ADOS-2 measures of social affect and restricted and repetitive behaviours (adjusted R2 = 0.23), but not with ADHD traits or motor ability.

CONCLUSIONS

Four levels of analyses confirm that poor imitation measured by the low-cost and scalable CAMI method specifically distinguishes ASD not only from neurotypical development, but also from commonly co-occurring ADHD.

Feasibility of an At-Home Experimental Circadian Misalignment Induction for Adolescents

Despite extensive research on the effects of sleep restriction on adolescent health, the field lacks experimental methods to study the health effects of mistimed sleep, which is also common among adolescents. This paper describes a novel 3-week experimental protocol that was designed to compare sleep restriction, like what many adolescents experience on school nights, against sleep that meets the recommended duration but is timed to be relatively aligned or misaligned with their circadian phase. Healthy 14-18-year-olds, classified as early ("Lark") and late ("Owl") chronotypes, entered a six-night chronotype-aligned stabilization condition, followed by five nights of sleep restriction, a return to the stabilization schedule, and five nights of healthy sleep duration (HS). During HS, participants were randomly assigned to early-to-bed versus late-to-rise arms, intended to align with or misalign with their circadian phase. Actigraphy monitored sleep, and weekly dim-light melatonin onset (DLMO) assessed circadian phase. Analyses confirmed that the protocol met five key validation metrics related to differential attrition, sleep timing, circadian phase, and experimental induction of HS that is timed to be relatively aligned vs. misaligned with circadian phase. This protocol appears useful for future research into how misaligned sleep patterns, which occur regularly for many adolescents, may impact health.

Circulating Growth Factors and Cytokines Correlate with Temperament and Character Dimensions in Adolescents with Mood Disorders

Background/Objectives: The incidence of mood disorders in adolescents is increasing. Bipolar disorder is often misdiagnosed in the early stages of the disease due to the prevalence of depressive symptoms, while manic episodes occur later. Identifying predictors of diagnosis conversion could facilitate timely and appropriate treatment. Our study aimed to find correlations of selected peripheral protein levels with temperament and character traits in adolescents diagnosed with major depressive disorder and bipolar disorder. Methods: A group of adolescents and young adults diagnosed with major depressive disorder (MDD, n = 50) or bipolar disorder (BD, n = 24) was enrolled in the study during the exacerbation of symptoms and followed up over two years. Diagnosis conversion from MDD to BD was monitored. The Temperament and Character Inventory was applied, and BDNF, proBDNF, EGF, MIF, SCF, S100B, TNF-alpha, and IL-8 serum levels were measured. Spearman's rank correlation analysis was conducted. Results: We found different patterns of correlations in MDD (TNF-alpha, IL-8, EGF, S100B with reward-dependence, self-directedness, and empathy) and BD (BDNF and EGF with persistence novelty-seeking and self-transcendence). Significant correlations were found in a group with diagnosis conversion. Conclusions: The findings of our study have the potential to significantly impact our understanding and treatment of mood disorders. Correlations obtained in the subgroup with diagnosis conversion may contribute to the development of prognostic markers in the future. Evaluating temperament and character traits alongside established biomarkers may offer a valuable method for predicting the conversion of mood disorders in adolescents, facilitating early and effective pharmacotherapy.

Association Between Early Childhood P300 Deficits and Risk for Preadolescence Depressive Disorder Mediated by Responsiveness to PCIT-ED Treatment

Preschool-onset major depressive disorder (PO-MDD) is an impairing pediatric mental health disorder that impacts children as young as three years old. There is limited work dedicated to uncovering neural measures of this early childhood disorder which could be leveraged to further understand both treatment responsiveness and future depression risk. Event-related potentials (ERPs) such as the P300 have been employed extensively in adult populations to examine depression-related deficits in cognitive and motivational systems. Few studies examine the prospective relationships between depression and P300, especially in young children. Moreover, limited research examines the relationship between P300 with psychotherapy treatment responsiveness in youths. The current study sought to examine the prospective relationships between pre-intervention P300 (i.e., choice-locked) elicited from the doors task in depressed preschool children (i.e., PO-MDD; ages 3-to-6) with reductions in depressive symptoms after completing an 18-week long dyadic psychotherapy intervention (n = 59). We also explored relations to risk for depression assessed at a follow-up visit during preadolescence (ages 8-to-12; n = 82). Those with PO-MDD exhibiting reduced choice (doors)-locked P300 demonstrated worse treatment response to psychotherapy and were more likely to meet criteria for depression during preadolescence. Moreover, the relationship between pre-intervention P300 and later preadolescence depression was significantly mediated by response to treatment. These findings suggest that deficits in brain systems linked to the choice-locked P300 component (i.e., cognitive and motivational) might be indicative of non-responsiveness to early dyadic psychotherapeutic intervention efforts for depression which impacts risk for recurrent patterns of depression in youths.

Understanding social behaviours across neurodiverse young people: roles of social cognition and self-regulation

BACKGROUND

Differences in social behaviours are common in young people with neurodevelopmental conditions (NDCs). Recent research challenges the long-standing hypothesis that difficulties in social cognition explain social behaviour differences.

AIMS

We examined how difficulties regulating one's behaviour, emotions and thoughts to adapt to environmental demands (i.e. dysregulation), alongside social cognition, explain social behaviours across neurodiverse young people.

METHOD

We analysed cross-sectional behavioural and cognitive data of 646 6- to 18-year-old typically developing young people and those with NDCs from the Province of Ontario Neurodevelopmental Network. Social behaviours and dysregulation were measured by the caregiver-reported Adaptive Behavior Assessment System Social domain and Child Behavior Checklist Dysregulation Profile, respectively. Social cognition was assessed by the Neuropsychological Assessment Affect-Recognition and Theory-of-Mind, Reading the Mind in the Eyes Test, and Sandbox continuous false-belief task scores. We split the sample into training (n = 324) and test (n = 322) sets. We investigated how social cognition and dysregulation explained social behaviours through principal component regression and hierarchical regression in the training set. We tested social cognition-by-dysregulation interactions, and whether dysregulation mediated the social cognition-social behaviours association. We assessed model fits in the test set.

RESULTS

Two social cognition components adequately explained social behaviours (13.88%). Lower dysregulation further explained better social behaviours (β = -0.163, 95% CI -0.191 to -0.134). Social cognition-by-dysregulation interaction was non-significant (β = -0.001, 95% CI -0.023 to 0.021). Dysregulation partially mediated the social cognition-social behaviours association (total effect: 0.544, 95% CI 0.370-0.695). Findings were replicated in the test set.

CONCLUSIONS

Self-regulation, beyond social cognition, substantially explains social behaviours across neurodiverse young people.

Functional and structural connectivity of the subregions of the amygdala in ADHD children with or without ODD

OBJECTIVES

The current study aimed to investigate the structural and functional connectivity of the subregions of the amygdala in children with Attention Deficit/Hyperactivity Disorder (ADHD) only or comorbid with Oppositional Defiant Disorder (ODD).

METHODS

A total of 354 children with ADHD-only, 161 children with ADHD and ODD (ADHD + ODD), and 100 healthy controls were enrolled. The Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF) were filled out by caregivers. Analysis of covariance (ANCOVA) was performed to test group-wise differences in these behavioral measures. A subsample comprising 209 participants underwent a resting-state functional MRI scan and a diffusion-weighted imaging (DWI) scan. Functional connectivity and structural connectivity were calculated using bilateral subregions of the Amygdala as seeds. Between-group voxel-wise comparisons were conducted.

RESULTS

The ADHD + ODD group had more anxious/depressed moods, more delinquent and aggressive behaviors, more emotional control problems, and more inhibition deficits than the ADHD-only group (all PBonferroni-corrected < 0.05). Compared with the control and ADHD + ODD groups, the ADHD-only group displayed increased FC strength between the amygdala subregions and the left caudate, left putamen, and frontal cortex. Regarding structural connectivity (SC), the ADHD-only group demonstrated higher streamline density in the left internal capsule, corpus callosum, and the right superior corona radiata. The altered SC was associated with emotional problems in children with ADHD, while the altered FC was associated with other ADHD-related clinical features.

CONCLUSIONS

Altered structural and functional connectivity of the subregions of the amygdala in children with ADHD compared with their healthy counterparts were respectively associated with ADHD-related behavioral and emotional problems.

CLINICAL TRIAL NUMBER

not applicable.

Sexual Minority Stress: Preliminary Evidence of Accelerated Pubertal Development in Early Adolescence

INTRODUCTION

Societal stressors place a tremendous burden on individuals who identify with a sexual minority identity. While minority stress experienced by racial/ethnic minority groups has been linked to accelerated aging, this link has yet to be examined among sexual minority youth. This study explores whether sexual minority youth who indicate experiencing stress at home or school (Minority Stress) due to their identity show evidence of accelerated aging (pubertal status or tempo) compared to those who do not report such experiences (No Minority Stress).

METHODS

Data are from the Adolescent Brain Cognitive Development (ABCD) Study. Participants were approximately 9-10 years old at baseline, 10-11 years old at Time 1, and 11-12 years old at Time 2. Measures included child-reports of sexual minority identity and stressors, and parent-reports of adolescent pubertal development.

RESULTS

Among 432 included participants who identified with a sexual minority identity, 83.6% were assigned female at birth and 24.8% were in the Minority Stress group. There were consistent results showing that sexual minority youth in the Minority Stress group showed accelerated pubertal status over time compared to those in the No Minority Stress group. Pubertal tempo (i.e., slope) was only accelerated for those who first identified as sexual minority at Time 2.

CONCLUSION

Our findings underscore that minority stress experienced by sexual minority youth may be linked to differences in pubertal development among these youth. The developmental and clinical implications of these patterns present critical lines for future research concerned with the wellbeing of sexual minority youth.

Long-Term Outcomes of Intentional Head Trauma in Infants: A Comprehensive Follow-Up of Medical, Developmental, Psychological, and Legal Perspectives

Background and Objectives: This study aimed to determine the initial clinical characteristics of children diagnosed with intentional head trauma (IHT) to obtain information about the long-term developmental, psychological, and psychosocial status of these children, to detect delayed sequelae, and to find out information about their judicial processes. Materials and Methods: Fourteen children who were followed up with the diagnosis of IHT in the Ankara Child Protection Unit between 2010 and 2021 were included in the study. These cases were evaluated in terms of physical, developmental, psychological, and visual findings. A complete physical examination was performed on the patients and their anthropometric measurements were taken. Anterior and posterior segment evaluations and visual field examinations were conducted in the visual assessment. The Expanded Guide for Monitoring Child Development and Vineland Adaptive Behavior Scale Third Edition was used in the developmental assessment. A psychiatric evaluation was performed using the Ankara Developmental Screening Inventory, Crowell observation, Affective Disorders and Schizophrenia Form, and Wechsler Intelligence Scale for Children. Results: Of the patients diagnosed with IHT, 71.4% were male and the mean age was 8.39 ± 5.86 (1.27-22.30; IQR: 3.55-11.96) months. In the long-term follow-up, cerebral palsy was detected in three of the children, epilepsy in one, optic atrophy and deviation due to this in one, and deviation due to brain trauma in one. Motor delay was detected in 50.0% of the patients, language delay in 37.5%, cognitive delay in 37.5%, and attention deficit and hyperactivity disorder in 25%. It was observed that the people who caused the injuries of two patients were punished. Conclusions: Children diagnosed with IHT should be monitored with transdisciplinary methods in terms of physical and mental health throughout childhood, starting from the first intervention. Awareness of IHT diagnosis should be increased with training in social service approaches and judicial authorities providing services for child neglect and abuse.

Disentangling the neural underpinnings of response inhibition in disruptive behavior and co-occurring ADHD

While impaired response inhibition has been reported in attention-deficit/hyperactivity disorder (ADHD), findings in disruptive behavior disorders (DBDs) have been inconsistent, probably due to unaccounted effects of co-occurring ADHD in DBD. This study investigated the associations of behavioral and neural correlates of response inhibition with DBD and ADHD symptom severity, covarying for each other in a dimensional approach. Functional magnetic resonance imaging data were available for 35 children and adolescents with DBDs (8-18 years old, 19 males), and 31 age-matched unaffected controls (18 males) while performing a performance-adjusted stop-signal task. No significant association was found between behavioral performance and symptom severities. However, contrasting successful inhibition with failed inhibition revealed that DBD and ADHD symptom severity was associated with greater activation in the right inferior frontal regions and reduced activation in the bilateral striatal regions, respectively. During successful inhibition versus go-trials, ADHD symptom severity was associated with the left lateral occipital cortex activation. The contrast of failed inhibition versus go-trials revealed reduced activation in the right frontal and left parietal regions associated with DBD symptom severity while ADHD symptom severity was associated with bilateral precunei, dorsolateral prefrontal and left posterior parietal regions. Except for the right inferior frontal regions during successful versus failed inhibition, all clusters were also found to be inversely associated with the other dimension of interest (i.e., DBD or ADHD symptoms). Opposite direction of the associations between DBD and ADHD symptom severity, and fronto-parietal and fronto-striatal activation suggest unique contributions of DBD and ADHD to the neural correlates of response inhibition.

Emotion regulation strategy and its relationship with emotional dysregulation in children with attention-deficit/hyperactivity disorder: behavioral and brain findings

Important associations between emotional dysregulation (ED) and ADHD have been identified in adults, with a key manifestation of this being differential use of emotion regulation strategies: reduced use of cognitive reappraisal (CR), but elevated expressive suppression (ES). These associations have been observed at both behavioral and neuroimaging levels. The present study aims to explore the use of CR and ES in children with ADHD, and their relationship to ED. 148 children with ADHD and 265 healthy controls (age 9-16 years) were recruited and evaluated and correlated their ED, CR, and ES. Resting-state fMRI functional connectivity, with 6 amygdala subregions as regions-of-interest, were analyzed in a subsample to identify potential neural correlates. Children with ADHD showed significant higher ED, and lower use of both CR and ES. A significant negative correlation was found between CR and ED. Mediation analysis indicated that CR has an indirect influence on the relationship between ADHD diagnosis and ED. In the neuroimaging analyses, the functional connectivity between the right superficial amygdala and left middle occipital gyrus showed a significant group-by-ES interaction, highlighting potential neural correlates for elevated ED in children with ADHD. Children with ADHD expressed elevated levels of ED, and used less CR and ES compared to healthy controls. The lower use of ES may relate to abnormal amygdala connectivity in children with ADHD. This finding suggested that brain immaturity in children may preclude effective deployment of ES in emotion regulation processes.

Neurocognitive correlates of polygenic risk for bipolar disorder among youth with and without bipolar disorder

INTRODUCTION

There is well-established evidence of reduced neurocognitive performance in adults and youth with bipolar disorder (BD). However, little is known about the polygenic underpinnings of neurocognition in individuals with BD, particularly in youth. The current study aimed to examine the association between polygenic risk score for BD (BD-PRS) and neurocognition among youth with BD and healthy controls (HC).

METHODS

129 youth of European ancestry (72 BD, 57 HC), ages 13-20 years, were included. Six neurocognitive tasks within the Cambridge Neuropsychological Test Automated Battery were assessed. General linear models were used to examine the association between BD-PRS and neurocognitive composite scores, controlling for age, sex, IQ, and two genetic principal components.

RESULTS

In the overall sample, higher BD-PRS was associated with significantly poorer affective processing (β = -0.25, p = 0.01), decision-making (β = -0.23, p = 0.02), and sustained attention (β = -0.28, p = 0.002). Secondary analyses revealed that higher BD-PRS was associated with significantly poorer sustained attention within the BD group (β = -0.27, p = 0.04), and with significantly poorer affective processing within the HC group (β = -0.29, p = 0.04).

LIMITATIONS

Cross-sectional design. Modest sample size may have reduced power to detect smaller effect sizes.

CONCLUSION

The current study found that higher BD-PRS generated based on adult GWAS was associated with poorer neurocognitive performance in youth with BD and HC. Future longitudinal studies incorporating repeated neurocognitive assessments would further inform whether the associations of BD-PRS with neurocognition vary from youth to adulthood, and whether BD-PRS is associated with differential neurodevelopmental trajectories in individuals with and without BD.

Dimensions of experienced gender and prospective self-injurious thoughts and behaviors in preadolescent children: A national study

OBJECTIVES

Gender diverse youth face higher risk of engaging in self-injurious thoughts and behaviors (SITBs) compared to cisgender youth. Limitations in past research include a focus on older adolescents, an emphasis on specific gender identity labels that may not be inclusive of the range of youth gender experiences, and reliance on cross-sectional data. Thus, the current study prospectively evaluated dimensions of experienced gender in relation to first-onset SITBs among preadolescents.

METHODS

Data were drawn from the Adolescent Brain Cognitive Development Study, a longitudinal study of youth across the United States. Youth (n = 7909) were aged 10-11 during initial assessment, and follow-up was conducted one year later. Two dimensions of experienced gender, felt-gender incongruence (not feeling aligned with the gender associated with one's sex assigned at birth) and gender non-contentedness (feeling dissatisfaction with the gender associated with one's sex assigned at birth), were assessed. Primary outcomes included non-suicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts (SA).

RESULTS

Logistic regressions were conducted stratified by sex assigned at birth. For youth assigned female at birth, felt-gender incongruence was prospectively associated with first-onset NSSI and SI and gender non-contentedness was prospectively associated with first-onset of NSSI. For youth assigned male at birth, gender non-contentedness was prospectively associated with first-onset SI. Diverse experienced gender did not prospectively predict SA.

CONCLUSIONS

Dimensions of experienced gender may be associated with subsequent first-onset SITBs among preadolescents. These findings support the need for future research on risk and protective factors that may mediate or moderate this relationship.

Longitudinal Stability of Mood-Related Resting-State Networks in Youth with Symptomatic Bipolar-I/II Disorder

Bipolar disorder (BD) is characterized by temporal instability of mood and energy, but the neural correlates of this instability are poorly understood. In previous cross-sectional studies, mood state in BD has been associated with differential functional connectivity (FC) amongst several subcortical regions and ventromedial prefrontal cortex. Here, we assess whether BD is associated with longitudinal instability within this mood-related network of interest (NOI). Young people with BD-I/II were scanned 4-6 times and healthy controls (HC) were scanned 4 times over 9 months. Following preprocessing of 20-minute resting-state scans, we assessed across-scan correlation of FC, focusing on FC between regions previously associated with BD mood state. Utilizing Bayesian models, we assessed the relationship between diagnostic group and within-person, across-scan correlation, adjusting for motion, time-of-day, and inter-scan interval; prediction intervals (PI) are reported. In a sample of 16 youth (11 BD, 5 HC; 16.3-23.3 years old) with 70 scans (50 BD, 20 HC), across-scan NOI stability was higher within-than between-person (0.70 vs. 0.54; p<.0001). BD (vs. HC) within-person scan-pairs showed lower NOI stability (mean -0.109; 95% PI -0.181, -0.038), distinguishing BD vs. HC with excellent accuracy (AUC=0.95). NOI instability was more pronounced with manic symptoms (mean -0.012; 95% PI -0.023, -0.0002) and in BD-II (vs. BD-I; mean -0.071; 90% PI -0.136, -0.007). Results persisted after accounting for medications, comorbidity, and sleep/arousal measures. Within this pilot sample, BD is characterized by less within-person stability of a mood-related NOI. While preliminary, these results highlight a possible role for precision imaging approaches to elucidate neural mechanisms underlying BD.

Altered Neural Responses to Punishment Learning in Conduct Disorder

BACKGROUND

Conduct disorder (CD) is associated with deficits in the use of punishment for reinforcement learning (RL) and subsequent decision making, contributing to reckless, antisocial, and aggressive behaviors. Here, we used functional magnetic resonance imaging (fMRI) to examine whether differences in behavioral learning rates derived from computational modeling, particularly for punishment, are reflected in aberrant neural responses in youths with CD compared with typically developing control participants (TDCs).

METHODS

A total of 75 youths with CD and 99 TDCs (9-18 years, 47% girls) performed a probabilistic RL task with punishment, reward, and neutral contingencies. Using fMRI data in conjunction with computational modeling indices (learning rate α), we investigated group differences for the 3 learning conditions in whole-brain and region of interest (ROI) analyses, including the ventral striatum and insula.

RESULTS

Whole-brain analysis revealed typical neural responses for RL in both groups. However, linear regression models for the ROI analyses revealed that only the response pattern of the (anterior) insula during punishment learning was different in participants with CD compared with TDCs.

CONCLUSIONS

Youths with CD have atypical neural responses to learning from punishment (but not from reward), specifically in the insula. This suggests a selective dysfunction of RL mechanisms in CD that contributes to punishment insensitivity/hyposensitivity as a hallmark of the disorder. Because the (anterior) insula is involved in avoidance behaviors related to negative affect or arousal, insula dysfunction in CD may contribute to inappropriate behavioral decision making, which increases the risk for reckless, antisocial, and aggressive behaviors in affected youth.

Development and Validation of a Brief Age-Normed Screening Tool for Subthreshold Psychosis Symptoms in Youth

BACKGROUND AND HYPOTHESIS

Improvements in screening tools for early subthreshold psychosis symptoms are needed to facilitate early identification and intervention efforts, especially given the challenges of rapidly differentiating age-appropriate experiences from potential early signs of emerging psychosis. Tools can be lengthy and time-consuming, impacting their utility and accessibility across clinical settings, and age-normed data are limited. To address this gap, we sought to develop and validate a brief, empirically derived, age-normed, subthreshold psychosis screening tool, for public use.

STUDY DESIGN

Computerized adaptive test simulation was used to derive a 5-item short form with age norm equivalencies from a 12-item PRIME-Screen-Revised (PRIME-12) administered to 7053 youth (Mage = 15.8, SD = 2.7; 54% female; 33% Black). Concurrent validity was assessed (n = 758) using contemporaneous administration of the PRIME-5 and the Structured Interview for Prodromal Syndromes. Comparability of criterion-related validity of the PRIME-5, PRIME-12, and Scale of Prodromal Symptoms (SOPS) was assessed by relating scores to psychosis-risk-relevant criteria. Finally, self-report versus assessor-administered PRIME total scores were compared (n = 131) to assess their concurrent validity.

STUDY RESULTS

Correlations among PRIME-5, PRIME-12, and SOPS were comparable and moderate, supporting their convergent validity. The PRIME-5 also showed comparable criterion-related validity, demonstrating similar relationships with psychosis-risk indicators as the other tools. Self-reported and assessor-administered PRIME-5 were moderately correlated.

CONCLUSIONS

Public availability of a brief, age-normed, and validated screening tool-which can be assessor or self-administered-will expedite and improve early identification of youth (age 11 and older) at risk for psychosis.

Association between auditory mismatch negativity and visual working memory in school-age children with attention deficit/hyperactivity disorder

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) patients exhibit characteristics of impaired working memory (WM) and diminished sensory processing function. This study aimed to identify the neurophysiologic basis underlying the association between visual WM and auditory processing function in children with ADHD.

METHODS

The participants included 86 children with ADHD (aged 6-15 years, mean age 9.66 years, 70 boys, and 16 girls) and 90 typically developing (TD) children (aged 7-16 years, mean age 10.30 years, 66 boys, and 24 girls). Electroencephalograms were recorded from all participants while they performed an auditory discrimination task (oddball task). The visual WM capacity and ADHD symptom severity were measured for all participants.

RESULTS

Compared with TD children, children with ADHD presented a poorer visual WM capacity and a smaller mismatch negativity (MMN) amplitude. Notably, the smaller MMN amplitude in children with ADHD predicted a less impaired WM capacity and milder inattention symptom severity. In contrast, the larger MMN amplitude in TD children predicted a better visual WM capacity.

CONCLUSIONS

Our results suggest an intimate relationship and potential shared mechanism between visual WM and auditory processing function. We liken this shared mechanism to a total cognitive resource limit that varies between groups of children, which could drive correlated individual differences in auditory processing function and visual WM. Our findings provide a neurophysiological correlate for reports of WM deficits in ADHD patients and indicate potential effective markers for clinical intervention.

Proinflammatory gene expression is associated with prospective risk for adolescent suicidal thoughts and behaviors over twelve months

OBJECTIVE

Recent theories have implicated inflammatory biology in the development of psychopathology and maladaptive behaviors in adolescence, including suicidal thoughts and behaviors (STB). Examining specific biological markers related to inflammation is thus warranted to better understand risk for STB in adolescents, for whom suicide is a leading cause of death.

METHOD

Participants were 211 adolescent females (ages 9-14 years; Mage = 11.8 years, SD = 1.8 years) at increased risk for STB. This study examined the prospective association between basal levels of inflammatory gene expression (average of 15 proinflammatory mRNA transcripts) and subsequent risk for suicidal ideation and suicidal behavior over a 12-month follow-up period.

RESULTS

Controlling for past levels of STB, greater proinflammatory gene expression was associated with prospective risk for STB in these youth. Similar effects were observed for CD14 mRNA level, a marker of monocyte abundance within the blood sample. Sensitivity analyses controlling for other relevant covariates, including history of trauma, depressive symptoms, and STB prior to data collection, yielded similar patterns of results.

CONCLUSIONS

Upregulated inflammatory signaling in the immune system is prospectively associated with STB among at-risk adolescent females, even after controlling for history of trauma, depressive symptoms, and STB prior to data collection. Additional research is needed to identify the sources of inflammatory up-regulation in adolescents (e.g., stress psychobiology, physiological development, microbial exposures) and strategies for mitigating such effects to reduce STB.

Sleep disturbance and social reward processing as characteristics linking minority victimization and suicidal ideation in youth

Adolescence is characterized by heightened sleep disturbances (e.g., poor sleep quality and irregular/insufficient sleep) and sensitivity to social feedback that may exacerbate suicidal ideation (SI). Victimization experiences (e.g., bullying, humiliation) can contribute to sleep disturbances and SI, particularly among minoritized youth (e.g., sexual/gender, racial/ethnic minorities). However, sensitivity to social reward, despite social challenges, may buffer against the effects of victimization on sleep and SI. In a diverse sample of youth at varying suicide risk, we examined sleep disturbance as a mediator of victimization and SI, and if neural response to social reward moderated the link between victimization and sleep disturbance. Ninety eight youth (14-22 years old; 50% sexual and/or racial/ethnic minority) with varying SI severity provided self-report data on past-six-month identity-related victimization, past-week sleep disturbance, and past-month SI. Seventy four youth completed an fMRI task involving receipt of social feedback. Region-of-interest analyses examined ventral striatum (VS) activity during positive feedback. Mediation and moderation effects were examined using linear regressions. Sleep disturbance mediated the association between identity-related victimization and SI: higher victimization was associated with worse sleep disturbance, predicting more severe SI. Moderation analyses revealed a positive association between victimization and sleep disturbance at lower but not higher levels of VS response to social reward. Sleep disturbance occurring in the context of social stress heightens vulnerability for SI, particularly among minoritized youth. Greater neural sensitivity to social reward buffers against the effects of victimization on sleep, with implications for mitigating SI. Findings suggest potential mechanisms and individual difference factors underlying minority health disparities.

Applied pharmacogenetics to predict response to treatment of first psychotic episode: study protocol

The application of personalized medicine in patients with first-episode psychosis (FEP) requires tools for classifying patients according to their response to treatment, considering both treatment efficacy and toxicity. However, several limitations have hindered its translation into clinical practice. Here, we describe the rationale, aims and methodology of Applied Pharmacogenetics to Predict Response to Treatment of First Psychotic Episode (the FarmaPRED-PEP project), which aims to develop and validate predictive algorithms to classify FEP patients according to their response to antipsychotics, thereby allowing the most appropriate treatment strategy to be selected. These predictors will integrate, through machine learning techniques, pharmacogenetic (measured as polygenic risk scores) and epigenetic data together with clinical, sociodemographic, environmental, and neuroanatomical data. To do this, the FarmaPRED-PEP project will use data from two already recruited cohorts: the PEPS cohort from the "Genotype-Phenotype Interaction and Environment. Application to a Predictive Model in First Psychotic Episodes" study (the PEPs study from the Spanish abbreviation) (N=335) and the PAFIP cohort from "Clinical Program on Early Phases of Psychosis" (PAFIP from the Spanish abbreviation) (N = 350). These cohorts will be used to create the predictor, which will then be validated in a new cohort, the FarmaPRED cohort (N = 300). The FarmaPRED-PEP project has been designed to overcome several of the limitations identified in pharmacogenetic studies in psychiatry: (1) the sample size; (2) the phenotype heterogeneity and its definition; (3) the complexity of the phenotype and (4) the gender perspective. The global reach of the FarmaPRED-PEP project is to facilitate the effective deployment of precision medicine in national health systems.

Differential gray matter correlates and machine learning prediction of abuse and internalizing psychopathology in adolescent females

Childhood abuse represents one of the most potent risk factors for the development of psychopathology during childhood, accounting for 30-60% of the risk for onset. While previous studies have separately associated reductions in gray matter volume (GMV) with childhood abuse and internalizing psychopathology (IP), it is unclear whether abuse and IP differ in their structural abnormalities, and which GMV features are related to abuse and IP at the individual level. In a pooled multisite, multi-investigator sample, 246 child and adolescent females between the ages of 8-18 were recruited into studies of interpersonal violence (IPV) and/or IP (i.e. posttraumatic stress disorder (PTSD), depression, and/or anxiety). Youth completed assessments for IP, childhood abuse history, and underwent high resolution T1 structural MRI. First, we characterized how differences in GMV associated with childhood abuse exposure depend on the presence or absence of IP using voxel-based morphometry (VBM). Next, we trained convolutional neural networks to predict individual psychopathology and abuse experience and estimated the strength and direction of importance of each structural feature in making individual-level predictions using Shapley values. Shapley values were aggregated across the entire cohort, and the top 1% of feature clusters with the highest importance are reported. At a group-level, VBM analyses identified widespread decreases in GMV across the prefrontal cortex, insula, and hippocampus in youth with IP, while abuse experience was specifically associated with increased GMV in the cingulate cortex and supramarginal gyrus. Further, interactions between IP and severity of abuse were identified in the ventral and dorsal prefrontal cortex, anterior cingulate cortex, and thalamus. After extensive training, model tuning, and model evaluation, the neural networks performed above chance when predicting IP (63% accuracy) and abuse experiences (71% accuracy) at the level of the individual. Interestingly, structural regions with the highest importance in making individual IP predictions had a high degree of overlap with group-level patterns. We have identified unique structural correlates of childhood abuse and IP on both the group and individual level with a high degree of overlap, providing evidence that IP and trauma exposure may uniquely and jointly impact child and adolescent structural neurodevelopment. Feature learning may offer power and novelty above and beyond traditional group-level approaches to the identification of biomarkers and a movement towards individualized diagnosis and treatment.

Progression of brain injuries associated with methotrexate chemotherapy in childhood acute lymphoblastic leukemia

BACKGROUND

Brain bases and progression of methotrexate-associated neurotoxicity and cognitive disturbances remain unknown. We tested whether brain abnormalities worsen in proportion to intrathecal methotrexate(IT-MTX) doses.

METHODS

In this prospective, longitudinal study, we recruited 19 patients with newly diagnosed acute lymphoblastic leukemia 4-to-20 years of age and 20 matched controls. We collected MRI and neuropsychological assessments at a pre-methotrexate baseline and at week 9, week 22, and year 1 during treatment.

RESULTS

Patients had baseline abnormalities in cortical and subcortical gray matter(GM), white matter(WM) volumes and microstructure, regional cerebral blood flow, and neuronal density. Abnormalities of GM, blood flow, and metabolites worsened in direct proportions to IT-MTX doses. WM abnormalities persisted until week 22 but normalized by year 1. Brain injuries were localized to dorsal and ventral attentional and frontoparietal cognitive networks. Patients had cognitive deficits at baseline that persisted at 1-year follow-up.

CONCLUSIONS

Baseline abnormalities are likely a consequence of neuroinflammation and oxidative stress. Baseline abnormalities in WM microstructure and volumes, and blood flow persisted until week 22 but normalized by year 1, likely due to treatment and its effects on reducing inflammation. The cytotoxic effects of IT-MTX, however, likely contributed to continued, progressive cortical thinning and reductions in neuronal density, thereby contributing to enduring cognitive deficits.

IMPACT

Brain abnormalities at a pre-methotrexate baseline likely are due to acute illness. The cytotoxic effects of intrathecal MTX contribute to progressive cortical thinning, reductions in neuronal density, and enduring cognitive deficits. Baseline white matter abnormalities may have normalized via methotrexate treatment and decreasing neuroinflammation. Corticosteroid and leucovorin conferred neuroprotective effects. Our findings suggest that the administration of neuroprotective and anti-inflammatory agents should be considered even earlier than they are currently administered. The neuroprotective effects of leucovorin suggest that strategies may be developed that extend the duration of this intervention or adapt it for use in standard risk patients.

The impact of sleep problems during late childhood on internalizing problems in early-mid adolescence

OBJECTIVES

Sleep and internalizing problems escalate during adolescence and can negatively impact long-term health. However, the directionality of this risk-relationship remains poorly understood within a developmental context. The current study aimed to determine the directionality of this relationship in adolescents with no history of psychiatric disorder and whether sex at birth played a role in this relationship.

METHODS

We used data from the Adolescent Brain Cognitive Development, an ongoing multisite longitudinal US study, that covered four waves (W1:9-11 years; W2:10-12 years; W3:11-13 years; W4:12-14 years). Analyses included 3,128 youth (50.99%girls) with no past or current psychiatric disorders at W1. The Sleep Disturbance Scale for Children and the Child Behavior Checklist were used to measure sleep and internalizing problems. Cross-lagged panel models were used to evaluate the cross-lagged relationships across waves.

RESULTS

The sleep-internalizing cross-lagged relationship was unidirectional, with medium-large effect sizes: greater total sleep problems were associated with more severe internalizing problems at later waves (W2➔W3, coefficient = 0.052, p = .021; W3➔W4, coefficient = 0.091, p < .001), with problems in initiating and maintaining sleep predicting internalizing problems early on. Girls showed greater sleep-internalizing risk than boys.

CONCLUSIONS

Sleep-internalizing relationships change across adolescence, becoming significant and more specific from early to mid-adolescence. Sleep interventions delivered in early adolescence, to girls in particular, may have a positive short and long-term impact on internalizing outcomes.

Evidence-Base Update of Psychosocial and Combination Treatments for Child and Adolescent Depression

OBJECTIVE

This evidence-based update (EBU) builds on three previous reviews (1998, 2008, 2017) sponsored by the Society of Clinical Child and Adolescent Psychology with the aim of evaluating the empirical support for psychosocial interventions for depression in youth.

METHOD

In the current review period (2014-2022), 25 randomized controlled trials (RCT) were identified: four in children and 21 in adolescents. Descriptive effect sizes and number-needed-to-treat (NNT) ratios were calculated for primary outcomes. Results were integrated with prior reviews, and cumulative evidence used to classify treatments as well-established, probably efficacious, possibly efficacious, or experimental. Published secondary analyses of predictors, moderators, and mediators were examined.

RESULTS

For adolescents, cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT-A), CBT in combination with antidepressant medication, and collaborative care programs were all classified as well-established. The evidence was considerably weaker for children, with no treatments achieving well-established or probably efficacious status. New developments include greater exploration of parent- and family-mediated treatment models and increasing evidence on technology-assisted interventions. Data on predictors, moderators, and mediators continued to be focused on adolescent depression samples and drawn from a limited number of RCT datasets.

CONCLUSION

Since the prior EBU, there has been incremental progress in youth depression treatment research. There is an urgent need to: (a) develop innovative approaches to substantially improve on the modest effects seen in most RCTs, (b) expand the evidence base for children and other underserved groups, (c) craft evidence-based guidelines for choosing between interventions when multiple efficacious treatments do exist, and (d) address issues of treatment effectiveness and scalability to ameliorate the wide prevalence and high impact of depression in youth.

The Balance N1 Is Larger in Children With Anxiety and Associated With the Error-Related Negativity

Background

The error-related negativity (ERN) is a brain response evoked by mistakes in cognitive tasks that is enhanced with anxiety and can predict the subsequent onset or exacerbation of anxiety in children and adolescents. A physical disturbance to standing balance evokes a brain response called the balance N1 that resembles the ERN in scalp topography and in response to a variety of moderating factors. We recently found that the balance N1 and ERN correlate in amplitude across small samples of adults.

Methods

In the current study, we tested the effect of anxiety on the balance N1 in children (ages 9-12 years) with and without diagnosed anxiety disorders (38 children with generalized anxiety, social anxiety, and/or obsessive-compulsive disorder and 50 children without these disorders). We measured the balance N1 in response to sudden release of support from a forward leaning posture, the ERN in response to mistakes on a Go/NoGo task, and anxiety symptoms using child- and parent-report forms of the Screen for Child Anxiety and Related Emotional Disorders.

Results

Both the balance N1 and the ERN were larger in the anxious group. The balance N1 was also associated with both the ERN and parent report of child anxiety symptom severity across individuals.

Conclusions

The higher measurement reliability of the balance N1 than the ERN and greater experimental control over errors suggest that balance paradigms may provide a more powerful method for investigating individual differences in error-related brain activity related to anxiety.

Hypothalamic-pituitary-adrenal axis function in the offspring of parents with bipolar disorder and the impact of the family environment: A pilot study of the Reducing Unwanted Stress in the Home (RUSH) prevention program

BACKGROUND

The home environment of offspring of parents with bipolar disorder (OBD) has been characterized by high levels of stress and disorganization, which may impact development of the hypothalamic-pituitary-adrenal (HPA) axis and their subsequent risk for affective disorders. The present study examined the effects of a family-based preventative intervention on the OBD's HPA axis functioning and whether intervention-related changes in the home environment might have driven change in the HPA axis.

METHODS

Fifty-five children (6-11 years) were recruited from families having a parent with bipolar disorder (n=26) or families having two parents with no current mental disorders (n=29). Only those families with a parent having bipolar disorder participated in the preventative intervention. Both groups completed assessments at baseline, post-prevention, 3-, and 6-months post-prevention. At each assessment, family organization, control, cohesion, conflict, and expressiveness, in addition to childhood internalizing problems, were measured, and offspring saliva samples were collected across two consecutive days.

RESULTS

Hierarchical Linear Modelling found no significant differences in HPA axis functioning between groups at baseline or across time. Improvements in family organization, however, were associated with elevations in participants' cortisol awakening response (CAR; p =.004) and total daily output (p =.023), and a steepening of their diurnal slope (p =.003) across time. Similar findings were obtained for family cohesion with respect to CAR (p <.001) and, to a lesser degree, diurnal slope (p =.064).

DISCUSSION

HPA axis functioning did not differ between the OBD and healthy controls at baseline or in response to the preventative intervention. However, intervention-related improvements in family organization and, to a lesser degree, cohesion, were associated with adaptive changes in HPA functioning over time.

Anxiety disorders in children with non-cardiac chest pain: Is routine screening needed in pediatric clinics?

BACKGROUND

The present study aimed to determine anxiety disorders and other psychopathologies in children and adolescents with non-cardiac chest pain.

METHODS

A total of 115 patients (between 8 and 16 years of age), including 61 cases of non-cardiac chest pain referred from the Pediatric Cardiology Outpatient Clinic and 54 healthy volunteers, were included in the study.

RESULTS

The majority of patients with chest pain were girls (82%, p = 0.001). The pain was predominantly localized to the left chest (73.8%), occurred both on exertion and at rest (59%), was not radiating (80.3%), lasted 1-5 min (37.7%), and had been present for more than a year. Psychiatric disorders were found in 39.3% of the chest pain group (p < 0.001). Generalized anxiety disorder (GAD) was the most common diagnosis (19.7%), followed by Attention-deficit/hyperactivity disorder (ADHD) (8.2%). Social anxiety disorder (SAD) (5.6%) and GAD (3.7%) were more common in the control group. The prevalence of GAD was significantly different between groups (p = 0.009). Screen for child anxiety-related disorders (SCARED) (p < 0.001) and Children's Somatization Inventory-24 (CSI-24) (p < 0.001) scores were significantly higher in the chest pain group. The SCARED total score was higher in girls (p = 0.011), and the subscale scores were higher for GAD in adolescents (p = 0.019) and separation anxiety in children (p = 0.043).

CONCLUSION

We believe that it would be beneficial to perform screenings using scales in outpatient clinics with a high number of patients presenting with chest pain and to refer them for psychiatric evaluation to prevent unnecessary medical diagnostic procedures in children who describe unexplained chest pain and to prevent the potential for mental disorder diagnoses in children.

Black Mothers of Children With and Without ADHD: Relationships Among Maternal Psychopathology, Parenting Stress, and Parenting Cognitions

INTRODUCTION

Parents of children with attention-deficit/hyperactivity disorder (ADHD) endorse increased parenting stress and lower levels of parenting efficacy and satisfaction as compared to parents of children without ADHD. Additionally, maternal ADHD and depression differentiate children with and without ADHD, with children with ADHD being more likely to have a mother with psychopathology.

METHOD

With a focus on an understudied population, we investigated the extent to which maternal self-reported ADHD and depression were associated with self-reported parenting stress and parenting cognitions in 70 Black mothers of children with (maternal Mage = 35.52, SD = 6.49) and without ADHD (maternal Mage = 35.39, SD = 6.53) recruited from a metropolitan area in the southeastern United States.

RESULTS

Analyses indicated that Black mothers of children with ADHD reported higher levels of parenting stress, lower levels of parenting efficacy, and lower levels of parenting satisfaction. However, there were no significant differences between groups on measures of maternal ADHD or depression. Maternal depression significantly accounted for variability in both parenting satisfaction and parenting stress beyond child ADHD and maternal education. With maternal depression in the models, the association between maternal ADHD and parenting stress and parenting satisfaction lost significance.

DISCUSSION

Given the racial disparities in the treatment of ADHD, future research should focus on investigating the linkages between maternal depression, parenting stress, parenting satisfaction, and parenting behaviors in Black mothers in order to delineate whether there are cultural adaptations that may improve treatment utilization rates for child ADHD within this population.

Examining Patterns and Predictors of ADHD Teens' Skill-Learning Trajectories During Enhanced FOrward Concentration and Attention Learning (FOCAL+) Training

OBJECTIVE

Examine patterns and predictors of skill learning during multisession Enhanced FOrward Concentration and Attention Learning (FOCAL+) training.

BACKGROUND

FOCAL+ teaches teens to reduce the duration of off-road glances using real-time error learning. In a randomized controlled trial, teens with ADHD received five sessions of FOCAL+ training and demonstrated significant reductions in extended glances (>2-s) away from the roadway (i.e., long-glances) and a 40% reduced risk of a crash/near-crash event. Teens' improvement in limiting long-glances as assessed after each FOCAL+ training session has not been examined.

METHOD

Licensed teen (ages 16-19) drivers with ADHD (n = 152) were randomly assigned to five sessions of either FOCAL+ or modified standard driver training. Teens completed driving simulation assessments at baseline, after each training session, and 1 month and 6 months posttraining. Naturalistic driving was monitored for one year.

RESULTS

FOCAL+ training produced a 53% maximal reduction in long-glances during postsession simulated driving. The number of sessions needed to achieve maximum performance varied across participants. However, after five FOCAL+ training sessions, number of long-glances was comparable irrespective of when teens achieved their maximum performance. The magnitude of reduction in long-glances predicted levels of long-glances during simulated driving at 1 month and 6 months posttraining but not naturalistic driving outcomes. FOCAL+ training provided the most benefit during training to teens who were younger and had less driving experience.

CONCLUSION

FOCAL+ training significantly reduces long-glances beginning at the 1st training session.

APPLICATION

Providing five FOCAL+ training sessions early on during teen driving may maximize benefit.

The relationship between sphingomyelin and ceramide levels and soft neurological signs in ADHD

Attention deficit hyperactivity disorder (ADHD), characterized by attention deficit, hyperactivity, and impulsivity, has recently been associated with lipid metabolism. In particular, the roles of sphingomyelin, ceramide, andgalactosylceramidase in the pathophysiology of ADHD are being investigated. This study aims to explore the relationship between sphingolipid metabolism markers and soft neurological signs (SNS) in children diagnosed with ADHD who are not undergoing medication treatment. A cross-sectional analysis was conducted on 41 children and adolescents aged 7-12 years diagnosed with ADHD and 39 neurotypically developing controls. Plasma levels of ceramide, sphingomyelin, and galactosylceramidase were measuredusing Enzyme-Linked Immunosorbent Assay (ELISA). SNS were assessed using the Physical and Neurological Examination for Soft Signs (PANESS). Statistical analyses included Student's t-tests, Mann-Whitney U tests, and Multivariate Analysis ofCovariance (MANCOVA), along with logistic regression analysis. Plasma levels of ceramide and sphingomyelin in children with ADHD showed significant differences compared to the neurotypically developing control group; however, there were no significant differences in galactosylceramidase levels between the two groups. Positive correlations were found between plasma levels of ceramide and sphingomyelin and the PANESS subscales F1 (Total Gait and Station) and F3 (Total Dysrhythmia). Additionally, logistic regression analysis indicated that high ceramide levels were positively associated with ADHD. This study underscores a significant association between alterations in sphingolipid metabolism (specifically increased levels of ceramide and sphingomyelin) and the presence of SNS in children with ADHD. These findings elucidate the potential role of sphingolipid metabolism in the pathophysiology of ADHD and provide suggestions for future therapeutic research targeting sphingolipid metabolism in the treatment of ADHD.

Person-level contributions of bipolar polygenic risk score to the prediction of new-onset bipolar disorder in at-risk offspring

BACKGROUND

Previous work indicates that polygenic risk scores (PRS) for bipolar disorder (BD) are elevated in adults and youth with BD, but whether BD-PRS can inform person-level diagnostic prediction is unknown. Here, we test whether BD-PRS improves performance of a previously published risk calculator (RC) for BD.

METHODS

156 parents with BD-I/II and their offspring ages 6-18 were recruited and evaluated with standardized diagnostic assessments every two years for >12 years. DNA was extracted from saliva samples, genotyping performed, and BD-PRS calculated based on a 2021 meta-analysis. Using a bootstrapped and cross-validated penalized Cox regression, we assessed whether BD-PRS (alone and interacting with clinical variables) improved RC performance.

RESULTS

Of 227 offspring, 38 developed BD during follow-up. The penalized regression selected BD-PRS and interactions between BD-PRS and parental age at mood disorder onset (AAO), depression, and anxiety. The resulting RC discriminated offspring who developed BD (vs. those that did not) with good accuracy (AUC = 0.81); removing BD-PRS and its interaction terms was associated with a significant decrement to the AUC (decrement = 0.07, p = 0.039). Further exploration of selected interaction terms indicated that all were significant (p-values<0.02), indicating that BD-PRS has a larger effect on the outcome in offspring with depression and anxiety, whose affected parent had a younger AAO.

CONCLUSIONS

The addition of BD-PRS to clinical/demographic predictors in the RC significantly improved its accuracy. BD-PRS predicted BD on the person-level, particularly in offspring of parents with earlier AAO who already had symptoms of anxiety and depression at intake.

Metacognition in Children and Adolescents With Obsessive-Compulsive Disorder Treated With Cognitive Behavioral Therapy

According to the metacognitive theory, maladaptive metacognition is associated with the development and maintenance of emotional disorders. This study is the first to explore maladaptive metacognition in a sample of children and adolescents (7-17 years) with obsessive-compulsive disorder (OCD) in the context of cognitive behavioral therapy (CBT). A total of 114 children and adolescents were included in the study. Of these 56 were OCD patients who were assessed on metacognition (Metacognitions Questionnaire-Child Version) and OCD symptom severity (Children's Yale-Brown Obsessive Compulsive Scale) before and after 14 sessions of individual CBT. Fifty-eight children and adolescents without any psychiatric diagnoses constituted a control group and were assessed on metacognition temporally corresponding to the OCD group. Results showed that the OCD group had significantly elevated maladaptive metacognition relative to the control group, with the exception of positive beliefs about worry. The maladaptive metacognition in the OCD group was significantly reduced from pre- to posttreatment. Additionally, the reduction in the total level of maladaptive metacognition was significantly larger than that reported by the control group. However, it remained significantly elevated relative to controls at posttreatment. Furthermore, lower posttreatment OCD severity was associated with larger reductions in negative beliefs about worry, beliefs about the need to control thoughts, and cognitive self-consciousness, as well as with a higher pretreatment level of positive beliefs about worry. Overall, age group (children vs adolescents) did not moderate these results. Collectively, the results suggest that amending maladaptive metacognition in children and adolescents with OCD might be important considering the associations between reductions in maladaptive metacognition and favorable treatment outcome.

Co-production of a state-funded centralized psychosis and psychosis risk screening, assessment, and referral service

Learning Health Systems (LHSs) strive to continuously integrate innovations and evidence-based practices in healthcare settings, thereby enhancing programmatic and patient outcomes. Duration of untreated psychosis (DUP) is a variable worthy of empirical attention, as the construct has been identified as a leading predictor of psychotic spectrum disorder prognosis and, despite the proliferation of early intervention for psychosis (EIP) teams across the U.S., remains longer than the recommended maximum established by the World Health Organization. Pathways to care are causally implicated as a DUP reduction rate-limiting factor. This paper illustrates a balanced care model, wherein resource-intensive community and clinical services are centralized to support a more efficient, standardized, and direct pathway to EIP care; identification of psychosis and psychotic risk states is made by highly-trained diagnosticians; and measurement-based care across the Learning Health System (LHS) is supported by a central assessment team. The Central Assessment of Psychosis Service (CAPS) streamlines core front-end EIP functions across the LHS, thereby alleviating the burden on EIP teams while enhancing access, equity, efficiency, and quality of the initial psychodiagnostic assessment. CAPS represents an innovative application of the balanced care model that preserves the core functions of the EIP team while task sharing or task shifting resource-intensive activities to an academic medical center partner. We review the five core functions of a centralized referral, screening, and assessment service. Given the potential for centralization to reduce DUP and enhance equity and access across the LHS, this paper will include concrete recommendations for policymakers considering centralizing core functions.

Targeted Sleep Enhancement Reduces Residual Anxiety Symptoms in Peri-Adolescents Previously Treated for Anxiety Disorders

Sleep-related problems (SRPs) are a common precursor to anxiety disorders, especially during peri-adolescence, and may be a predictor of treatment response. However, evidence-based anxiety treatments do not alleviate SRPs to a clinically significant degree. The current study examines whether improving sleep in a sample of young adolescents previously treated for anxiety disorders can further reduce anxiety severity. Participants include 46 adolescents (65% female, ages 9-14 years) previously treated for anxiety disorders who self-selected to participate in a 6-week open trial of targeted sleep enhancement (TIGERS). Measures of parent- and child report on SRPs, and clinician-rated anxiety severity, were collected at several time points of the study: pre-, and postanxiety treatment, pre- and post-TIGERS, and at four yearly follow-ups. Two hierarchical mediation models were run using either parent- or child report on sleep. On the between-subjects level, participants with higher overall average SRPs also had higher overall anxiety severity over all time points. On the within-subjects level, participation in TIGERS was not directly associated with change in anxiety severity-however, participation in TIGERS was associated with a drop in SRPs, which was associated with a drop in anxiety severity. Improving sleep in anxious peri-adolescents further improves anxiety above and beyond anxiety treatment. Further research is needed to confirm the effects of improving sleep on clinical anxiety in a randomized controlled trial.

Autistic Characteristics in a Nationally Representative Clinical Sample of Adolescents Seeking Medical Gender-Affirming Treatment in Norway

PURPOSE

Several studies have reported on the intersection of autism and gender incongruence (GI) in clinical populations. This study aims to investigate autistic characteristics and registered autism spectrum diagnoses (ASD) in a clinical cohort of 83 adolescents referred to the National Gender Team for Children and Adolescents in Norway during 2020.

METHODS

Parents completed the Social Responsiveness Scale (SRS). Background information and registered psychiatric diagnoses were extracted from patient files.

RESULTS

The results showed that 25% of the participants scored within the clinical range on the SRS: 27.4% of adolescents who were assigned female at birth (AFAB) and 19.0% of adolescents who were assigned male at birth (AMAB). AFAB had significantly higher scores on SRS Total Scale and the Social Motivation and Autistic Mannerisms subscales compared to the female norm group. AMAB had higher scores on the Social Motivation subscale and lower scores on the Social Awareness subscale, compared to the male norm population. Information from patient files revealed that 67.5% had one or more registered psychiatric diagnosis. 9.6% had received an ASD diagnosis, all AFAB. 18.1% had received an attention deficit hyperactivity disorder (ADHD) diagnosis. The most common psychiatric diagnoses were depression (25.3%) and anxiety disorders (18.1%). Further, 44.6% had a history of self-harm, and 15.7% had a history of a suicide attempt.

CONCLUSION

The results showed an overrepresentation of ASD diagnoses and autistic characteristics measured by SRS for AFAB. There was an overrepresentation of psychiatric diagnoses for both the AFAB and the AMAB group in this study sample. Implications for treatment and future research are discussed.

Effects of Methylphenidate and Atomoxetine Treatment on Improvement of Motor Coordination in Children With Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

To investigate the effects of methylphenidate and atomoxetine treatment on motor coordination in children with attention-deficit/hyperactivity disorder (ADHD).

METHODS

In this single-site, open-label, naturalistic follow-up study, 157 children (7.6±1.4 years; 139 males) with ADHD were recruited between March 2015 and May 2020 from the Department of Psychiatry, Asan Medical Center, and treated for 12 weeks with methylphenidate (n=48) or atomoxetine (n=109). Children completed the Advanced Test of Attention (ATA), and caregivers completed the ADHD Rating Scale (ARS) questionnaire and Developmental Coordination Disorder Questionnaire (DCDQ) at baseline and at 12 weeks. Paired t-tests, a mixed-effects model, and linear regression were used to compare treatment groups and assess factors influencing motor coordination changes.

RESULTS

Methylphenidate and atomoxetine resulted in significant improvement in DCDQ fine motor/handwriting, general coordination, and total scores over 12 weeks. Fine motor/handwriting had a significant main effect for time (F1=16.64, p<0.001, η2=0.097); however, the interaction effect between group and time was not significant (F1=0.24, p=0.625, η2=0.002). Changes in parent-reported ARS inattention scores (β=-0.174, p=0.029) and auditory commission errors of ATA (β=0.191, p=0.022) were significantly associated with changes in fine motor/handwriting. Additionally, changes in parent-reported ARS inattention scores (β=-0.177, p=0.034) and rater-reported ARS inattention scores (β=-0.198, p=0.017) were significant predictors of improvements in general coordination in separate models.

CONCLUSION

Methylphenidate and atomoxetine had a positive effect on motor coordination in children with ADHD. Improvement in motor coordination was associated with ADHD symptom improvement.

Losing Control: Prefrontal Emotion Regulation Is Related to Symptom Severity and Predicts Treatment-Related Symptom Change in Adolescent Girls With Conduct Disorder

BACKGROUND

Emotion regulation skills are linked to corticolimbic brain activity (e.g., dorsolateral prefrontal cortex [dlPFC] and limbic regions) and enable an individual to control their emotional experiences, thus allowing healthy social functioning. Disruptions in emotion regulation skills are reported in neuropsychiatric disorders, including conduct disorder or oppositional defiant disorder (CD/ODD). Clinically recognized means to ameliorate emotion regulation deficits observed in CD/ODD include cognitive or dialectical behavioral skills therapy as implemented in the START NOW program. However, the role of emotion regulation and its neural substrates in symptom severity and prognosis following treatment of adolescent CD/ODD has not been investigated.

METHODS

Cross-sectional data including functional magnetic resonance imaging responses during emotion regulation (N = 114; average age = 15 years), repeated-measures assessments of symptom severity (pretreatment, posttreatment, long-term follow-up), and functional magnetic resonance imaging data collected prior to and following the START NOW randomized controlled trial (n = 44) for female adolescents with CD/ODD were analyzed using group comparisons and multiple regression.

RESULTS

First, behavioral and neural correlates of emotion regulation were disrupted in female adolescents with CD/ODD. Second, ODD symptom severity was negatively associated with dlPFC/precentral gyrus activity during regulation. Third, treatment-related symptom changes were predicted by pretreatment ODD symptom severity and regulatory dlPFC/precentral activity. Additionally, pretreatment dlPFC/precentral activity and ODD symptom severity predicted long-term reductions in symptom severity following treatment for participants who received the START NOW treatment.

CONCLUSIONS

Our findings demonstrate the important role that emotion regulation skills play in the characteristics of CD/ODD and show that regulatory dlPFC/precentral activity is positively associated with treatment response in female adolescents with CD/ODD.

The diagnosis of ADHD in children and adolescents with epilepsy: a scoping review

Attention-deficit hyperactivity disorder (ADHD) is often diagnosed in children and adolescents with epilepsy, but clear clinical guidelines on how to make this diagnosis are still lacking. Without these guidelines, there is no consensus between specialists on how to proceed when assessing children with epilepsy for ADHD, which can negatively impact the quality of care being offered to this population. As a first step toward gaining more specific clinical guidelines, this scoping review was aimed at documenting the tools and procedures used to diagnose ADHD in children and adolescents with epilepsy over time and at determining whether the diagnoses were made in accordance with clinical guidelines and recommendations. The literature search was conducted using PsycINFO, PubMed, and CINAHL. Studies were included if conducted with children and adolescents aged between 4 and 18 years with epilepsy being evaluated for ADHD. Studies were clustered according to their publication date and the reported diagnostic procedures were identified. Forty-nine out of 3854 records were included. Results highlight discrepancies between how ADHD was diagnosed in reviewed studies and clinical guidelines or recommendations. Indeed, most studies did not use a multi-method and multi-informant approach when diagnosing ADHD in children with epilepsy, with no improvement over time. Future studies aimed at diagnosing ADHD in children and adolescents should ensure that they are following clinical guidelines and recommendations, in addition to adapting their diagnostic procedures to the presence of any neurological comorbidities, such as epilepsy.

Adolescents with Elevated Psychopathic Traits are Associated with an Increased Risk for Premature Mortality

The mortality rate among adolescents has been steadily increasing in recent years. Researchers have previously identified forms of externalizing psychopathology measured during adolescence associated with an increased risk for premature mortality, including attention-deficit/hyperactivity disorder (ADHD), substance use disorders (SUDs), oppositional defiant disorder (ODD), and conduct disorder (CD). The current study investigated whether additional personality traits (i.e., adolescent psychopathic traits, assessed via the Hare Psychopathy Checklist: Youth Version [PCL:YV]) were also associated with premature mortality risk among maximum-security incarcerated adolescents (N = 332). During a follow-up period ranging from 10 to 14 years, premature mortality was observed in n = 33 participants (9.94%), a mortality rate nearly ten times higher than population norms. We observed that adolescents scoring the highest on PCL:YV total scores exhibited significantly higher rates of premature mortality compared to adolescents scoring lower on PCL:YV total scores via Fisher's exact tests. Additionally, through univariate Cox proportional hazard regression analyses, PCL:YV total, Factor 2 (measuring lifestyle/behavioral and antisocial/developmental psychopathic traits), Facet 1 (measuring interpersonal psychopathic traits), and Facet 3 (measuring lifestyle/behavioral psychopathic traits) scores were associated with faster time to premature mortality. In supplemental analyses performed, we observed that adolescents meeting criteria for externalizing psychopathology (i.e., ADHD, SUDs, ODD, and CD) did not exhibit higher rates of premature mortality compared to control participants. The current study therefore identifies additional maladaptive personality traits to consider in relation to premature mortality risk (i.e., psychopathic traits) among a high-risk sample of incarcerated adolescents.

The Relationship Between Social Skills and Sensory Profile, Emotion Regulation, and Empathizing/Systemizing in Adolescents on the Autism Spectrum

This study aims to evaluate the relationship between social skills and sensory features, emotion regulation, and empathy in adolescents on the autism spectrum. One hundred and twenty-three adolescents were included in the study (50 autistic, 73 typically developing-TD adolescents). The participants filled out the Adolescent/Adult Sensory Profile (AASP) and Emotion Regulation Questionnaire. Parents of the participants completed the Child Empathy and Systemizing Quotient (EQ-C/SQ-C) and Autism-Social Skills Profile (ASSP) scales. Social reciprocity, social participation/avoidance, ASSP total scores, empathy and systemizing scores were lower, and detrimental social behaviors, low registration sensory profile scores were higher in the autism spectrum group. While a difference between genders was observed in sensory sensitivity, sensation avoiding, low registration quadrants and empathy scores, no gender and group interaction was found in any domain. Social skill total scores were correlated to sensation seeking and low registration sensory features, empathy, systemizing, and reappraisal emotion regulation scores. A hierarchical multiple linear regression analysis was conducted controlling for group and gender, sensation seeking (p = .032, β = 0.138), low registration (p = .012, β = - 0.215) of the AASP, and empathy (p < .001, β = 0.555) and systemizing (p = .033, β = 0.138) scores of the EQ/SQ-C was found to significantly predict social skill total scores. Although emotional regulation strategies may play a role, sensory processing features and empathy and systemizing skills seem to be the more significant contributors to social skills during adolescence. Interventions targeting sensory processing and especially improving empathy and systematization skills may positively affect social skills in adolescents on the autism spectrum.

Brain functional effects of cognitive behavioral therapy for depression: A systematic review of task-based fMRI studies

BACKGROUND

Depressive disorders are associated with alterations in brain function, affecting processes such as affective and reward processing and emotion regulation. However, the influence of Cognitive Behavioral Therapy (CBT) on the neuronal patterns remains inadequately understood. Therefore, this review systematically summarizes longitudinal fMRI brain activity changes in depressive patients treated with CBT and their association with symptom remission.

METHODS

This systematic review was conducted according to the PRISMA statement. Out of 2149 results of the literature search, N = 14 studies met the inclusion criteria (e.g., diagnosis of a current depressive disorder, assessment of longitudinal task-based fMRI, and the analysis of functional changes before and after CBT).

RESULTS

The findings reveal (1) diminished limbic reactivity following CBT across various tasks, (2) increased striatal activity during reward processing, but decreased activity during affective processing and future thinking, and (3) alterations in cingulate and prefrontal cortex activity across tasks. Partially, these results are associated with symptom remission, especially in the subgenual anterior cingulate cortex.

LIMITATIONS

There are heterogenous results especially in cortical areas that might partially be due to methodological issues like differences across the studies in terms of task content, statistical evaluation, and interventions. Thus, future research should focus on the standardization of methodologies.

CONCLUSIONS

The results indicate that CBT partially normalizes the neural patterns of depressive patients, particularly within regions involved in affective and reward processing and the development of negative cognitive biases. Overall, potential neural mechanisms underlying CBT were identified, underscoring its effectiveness on an objective neurobiological basis.

Carer-reported sleep disturbance and carer- and teacher-rated executive functioning in children with prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder

Children with prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorder (FASD) have high rates of sleep disturbance and marked difficulties with executive functioning (EF). Sleep disturbance has been associated with poorer EF across development in typically developing children. The contribution of insomnia symptoms and nightmares to EF difficulties in children with PAE and FASD is unclear. The current study examined whether caregiver-reported insomnia symptoms and nightmares predicted difficulties with EF in children with PAE who were assessed at FASD diagnostic clinics. Archival data on 116 children with PAE assessed at FASD diagnostic clinics were extracted from databases. Children were assigned to a preschool-age group (3.1 to 5.9 years, n = 40) and a school-age group (5.9 to 10.9 years, n = 76). Insomnia symptoms and nightmares were measured using items extracted from the Child Behavior Checklist (CBCL) while EF was measured using the caregiver and teacher Behavior Rating Inventory of Executive Function (BRIEF) rating forms. Bootstrapped regression models were used examine the effects of insomnia symptoms and nightmares on domains of EF in each group while adjusting for potential confounds. For preschool children, insomnia symptoms were associated with greater daytime tiredness while nightmares were associated with greater difficulties with Emergent Metacognition according to their teachers. For school-age children, insomnia symptoms predicted greater EF difficulties across most domains according to their caregivers but not teachers. Sleep disturbance may compound EF impairments in children with PAE and should be screened for as part of FASD diagnostic assessment.

A validity and reliability study of the Work and Social Adjustment Scale (WSAS) Youth and Parent Forms in the Turkish population

This study assessed the validity and reliability of the Youth and Parent Forms of the Work and Social Adjustment Scale (WSAS) in the Turkish population. The patient group comprised 298 young patients aged 8 to 18 with any anxiety disorder, while 107 healthy young people formed the control group. Participants completed assessments, including the Screen for Child Anxiety-Related Disorders and the Pediatric Quality of Life Inventory (PedsQL), alongside the WSAS, while parents also completed the PedsQL and the WSAS. After 2 weeks, 100 individuals from the patient group were reevaluated for test-retest reliability. Results showed satisfactory validity and reliability, supported by statistical analyses, including Rasch analysis and Cronbach's alpha coefficient. The WSAS demonstrated validity across all evaluations and reliable internal consistency (Cronbach's alpha: parent form = .755, youth form = .750), test-retest reliability (correlation coefficients: parent form = 0.934, youth form = 0.937). Overall, the WSAS proved valid and reliable in the Turkish language.